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Melanie: Welcome to Expert Insights with the Carle Foundation Hospital. I'm Melanie Cole. And today, we're offering a COVID update 2022 with Dr. Robert Healy. He's the Chief Medical Quality Officer at the Carle Foundation Hospital. Dr. Healy, always a pleasure to have you with us. You're so informative for us. So now, help us to understand COVID-19, what's the latest information, the latest variance. Tell us what's going on.

Dr. Robert Healy: Yeah. Well, I guess we could start with the variance. So, currently, we're still looking at most infections being caused by the BA.5, which is one of the omicron variants. And luckily, we're seeing it winding down a bit. There's a few other variants on the horizon that we don't think are going to be something to worry about at least short-term. And then, long-term, it's up in the air. We don't know what this virus will do as it evolves and tries to escape all of our protections against it.

Melanie: Well, I was going to ask you what we can expect over the next six months, but I guess you just answered that, because we really don't know what to expect. Now, tell us a little bit about this upcoming season. We've got flu season coming up and we've got COVID and kids are going back to school and college. So we know that this, you know, could be a potential twindemic brewing. What are the latest recommendations regarding vaccinations, distancing, masking? Tell us what we do know now.

Dr. Robert Healy: Yeah. So you're right. We can't really tell the future. But from past experience, we can kind of guess as to what might happen. And we know that coronaviruses in general are more active in the fall and winter season for a lot of reasons. You mentioned some of them. We're all getting together. We're all getting together inside. Schools are back together. So, probably the crystal ball right now looks like maybe another month of quiet limited activity. Although, when I say that, we have to realize there's still, you know, thousands of people getting sick daily and people dying daily from this disease, from COVID-19 disease. But a relatively quiet period, I think over the next month or so. But we probably will see a rise in cases, possibly a new variant, hopefully not. But we'll see more cases. As we've seen this summer and going into in this past spring, I think we'll see a lot of cases among people who don't wind up being hospitalized because, as we know, if you're fully vaccinated, your chances of getting sick enough to be in the hospital are really low.

So we'll see a lot of infections in the community. We'll see some of those infections will pass on to people who are at risk for serious disease, even with being fully vaccinated. And they might be hospitalized in the ICU and die. So we're still looking at this persisting, probably peaking in a month or so. And also, as you pointed out, that's about the same time influenza traditionally hits us.

So we're our third year now of influenza and COVID together. The first year surprised us with how little influenza there was. And, you know, frankly, that's because we weren't getting together. We were still locked down. There wasn't school going on. And last year, there was flu, but not a really high rate. We don't know what'll happen this year, but the odds are it's going to be a pretty active season for influenza, so that twin pandemic that we talked about.

Melanie: What about vaccinations? What's changing?

Dr. Robert Healy: So, some information on that front, of course, with the influenza vaccine, we always recommend that to everybody, so line up when that becomes available over the next month or six weeks. You want to be protected in October, November, December, January, when the flu could really hit hard. For the COVID-19 vaccine, some exciting news there as well with the recent approval of the bivalent vaccine. So what that means is both Pfizer and Moderna have a vaccine that not only has the spike protein parts from the original virus that came out back in 2020, but also the BA.5 variant. And it's thought that those two combined will give us a really good boost as we head into this fall and winter season.

Melanie: So, as we said, people are starting to be in close quarters, the dorms things like that. What's the latest information on isolation or quarantine, as we see these things raging through places like office places and the dorms and stuff like that? Dr. Healy, what are we supposed to do as far as quarantine now, if somebody does test positive, whether it's a PCR or a home kit? And I'd like you to also talk about testing. Should we still be testing if we get these symptoms?

Dr. Robert Healy: Yeah, those are great questions. I think testing if you get symptoms is still a good idea. And as you state, most of us will be testing at home because we have the kits at home. Some of us will be getting the PCR test at our places of work or, you know, drug stores, our pharmacies, that kind of thing. If you're sick, you should stay home. That's the bottom line. And if you test positive for COVID, you should really be very vigilant about wearing a really protective mask so that you protect yourself from giving the infection to others. If your symptomatic, stay home. If you test positive or you've had a high risk exposure, but you're not symptomatic, be really vigilant about wearing that mask. That's the latest recommendations.

Melanie: So testing at home, do you feel these test kits are accurate? Because I've heard some talk and I know in my own personal experience that I've wondered about this. Should we be doing the testing at places like our local pharmacy? It takes a little bit longer, a couple of days, but it seems to be a little bit more accurate. Does this matter?

Dr. Robert Healy: Yeah, that's a great question. I think that the home tests are really a good part of our toolbox. What I would recommend is if you're symptomatic, then I would test myself at home if you have that available. If it's negative, I would continue to test on a daily basis and see what happens. Sometimes it'll take to that second test to get positive, and that could be because there's not a virus yet the first time or because these tests aren't perfect. Maybe you get what's called a false negative that first time. But if you do two tests in a row, two days in a row with symptoms, you're most likely going to catch if you have the infection or not. But always, even if you're negative, if you are able to get a PCR test, fine. But even if you're not, if you're symptomatic, even though it could be a different virus, we still don't want to transmit other viruses as well, so staying away from people, staying masked if you have to be by people if you're symptomatic is really important.

Melanie: And is there anything new in the latest of ambulatory therapeutics for high risk patients? Is there anything new that we've learned about treatment?

Dr. Robert Healy: So that's evolved over time. You know, there's four treatments available for the ambulatory world. There's paxlovid, which is a combination pill. There's another combination pill that we don't use as much. There's IV therapy or injection therapy with monoclonal antibody and with remdesivir. And what we've seen locally, and I think this is pretty much throughout the country, we see that people who are at high risk will either wind up going down the path of getting the monoclonal antibody or paxlovid from the pharmacy through your provider. And the changes there that we've seen are that the certain types of the monoclonal antibody only certain types of the monoclonal antibody work with the omicron variant, so you got to be careful of which one you're getting. And we've also seen that the supply from the federal government in the states is pretty much drying up for the monoclonal antibodies. I think it's part of the bigger transition that we're seeing as funding goes down for our fight against the COVID pandemic. Congress isn't really stepping up to reinstate some of the funding that we've had.

So the monoclonal antibody, I think, will be used less just because there's going to be less supply. Also we've realized that paxlovid, which is available now and highly effective, we really wanna push that. So paxlovid, the oral medication, is a good thing to use if you're at high risk. Some recent data, recent study came out that showed, especially if you're over 65 and you are by definition high risk, then using paxlovid is a great idea within the first five days of your symptom.

Melanie: Wow. You are just such an amazing educator and so knowledgeable. So can you wrap it up for us about COVID the latest that we know? Update what you want people to know as of now.

Dr. Robert Healy: Yeah, I think it's still here. It's going to be remain with us for a long time, most likely over the years and this might happen by next year. It'll become seasonal, so a fall and winter spike, as we see with other viruses like influenza. The most important thing is to isolate yourself if you're positive or symptomatic. Wear a mask if you have symptoms. Wear a mask if you're in an area with a higher transmission rate. Even though there's no mandate for that anymore, feel free to wear a mask as you're around people, if you feel you're at higher risk yourself. Contact your provider if you are sick and in a high risk group, so if you're over 65 or have such things as diabetes or obesity, because there might be treatment that they want to give you to keep you out of the hospital and away from the ICU.

And most important is to keep yourself up to date with your vaccine. And critically with COVID-19 is to get the new bivalent vaccine that'll become available probably within the next week or two. Talk to your provider. Get that vaccine booster that'll protect against the original virus and also the omicron variant, and I think that'll help get us through this winter where we'll probably see a peak.

Melanie: Thank you so much, Dr. Healy, for joining us today and giving us that COVID update. For more information and to get connected with one of our providers, please visit carle.org. Or for a listing of Carle providers and to view Carle-sponsored educational activities, please visit our website at carleconnect.com.

That concludes this episode Expert Insights with the Carle Foundation Hospital. I'm Melanie Cole.