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COVID-19 cases surged in December. NGHS expert answers 8 questions about the pandemic

The Gainesville Times - 1/20/2023

Jan. 20—Northeast Georgia Health System's leading infectious disease expert recently spoke about the status of the COVID-19 pandemic.

Supriya Mannepalli, director of infectious diseases at NGHS, answered questions about the pandemic, including whether the "pandemic" label is still appropriate nearly three years after the emergence of COVID-19.

How concerning is the post-Christmas rise in COVID-19 cases and hospitalizations?

COVID-19 hospitalizations aren't nearly as high as they were around this time last year when NGHS hospitals reported a peak of 341 COVID-19 patients on Jan. 24 and cases didn't trend below 100 until late February.

Hospitalizations have fallen significantly in the past week.

As of Thursday, Jan. 19, NGHS reported 51 COVID-positive patients across its four hospitals in Gainesville, Braselton, Barrow and Lumpkin. That is down from a new-year high of 93 patients on Jan. 13. The average patient was 70 years old, and 31% were not fully vaccinated, which includes anyone who has not received the single dose of the Johnson & Johnson vaccine or both doses of the Moderna or Pfizer vaccine.

The omicron variant is "causing mostly mild and moderate disease," Mannepalli said, which explains the relatively low number of hospitalizations compared to the delta and alpha waves of the coronavirus. "We are seeing a decreasing trend in the numbers. We're keeping our fingers crossed that we don't see a February or March spike. ... Even the positivity rate is slowly, slowly improving."

Hall County, which has a population of over 206,000, had 401 total COVID-19 cases in the past two weeks, according to the Department of Public Health. The Centers for Disease Control lists Hall County's COVID-19 community level as low.

Since the start of the pandemic, Hall County has had more than 55,000 confirmed cases, over 4,000 hospitalizations and 860 deaths. Statewide, more than 2.3 million Georgians have been infected by the virus, and more than 34,500 have died from it.

How effective are vaccines against the omicron variant?

"When it comes to vaccinations, the most important message we have to communicate is that vaccines, in respect to all these emerging subvariants, continue to save lives and prevent severe infections, especially in those who are at high risk," Mannepalli said.

According to DPH data, 52% of Hall County residents are fully vaccinated, 44% are fully vaccinated with one booster and 57% have received at least one dose. Those levels are well below national vaccination rates.

The omicron variant is responsible for virtually all infections in the United States, according to CDC data. The XBB.1.5 subvariant, which accounts for 43% of infections, "is the most transmissible subvariant that has been detected yet," a World Health Organization official said at a press conference earlier this year.

Even though the omicron variant tends to cause milder illness, Mannepalli said it is still important for people to get vaccinated, receive their boosters and wear masks in crowded places.

According to the CDC, 16.2% of people five and older have received the bivalent booster. That is up from about 5% a few weeks ago, Mannepalli said, "but that's still a very low number."

The bivalent booster is available to everyone six months and older, she said, and she recommended that people consult with their doctor.

CDC recommends a bivalent booster for everyone 5 years and older if it has been at least two months since their last dose.

Children ages 6 months to 4 years who received both doses of the Moderna vaccine should also take the bivalent booster if it has been at least 2 months since their last dose, the CDC says. There is no booster recommendation for children ages 6 months to 4 years who received both doses of the Pfizer vaccine.

Are NGHS hospitals seeing high numbers of patients with other respiratory illnesses like the flu and respiratory syncytial virus?

"Historically, at least in the adult population, we didn't test for RSV a lot, but the PCR (polymerase chain reaction) test ... includes RSV and flu," Mannepalli said. "So we're testing a lot more for RSV now than we did before the pandemic and we're detecting more of it, and the reason behind it is still unclear to me."

She said it's possible that years of masking and mitigation efforts have lowered people's immunity to viruses like the flu and RSV.

Local pediatric offices were overwhelmed in November with an unusually high number of children who were sick with the flu and RSV.

Do you think COVID-19 pandemic is becoming more endemic, that is, more stable and manageable?

"We wait for direction from CDC, WHO, but the way the virus is behaving — as you've seen, the severity is down overall, hospitalizations are also down compared to the same time last year — so it's showing the signs of kind of being endemic."

How effective are antiviral drugs like Paxlovid and who should take them?

"While we're still waiting to learn more about the effectiveness of these against this new variant, they have helped prevent progression of the disease in high risk individuals, and they are recommended," Mannepalli said.

Those at high risk include older adults, people who are unvaccinated, people with medical conditions like lung disease, heart disease or a weakened immune system.

Paxlovid and Lagevrio must be started within five days of developing symptoms, the CDC says. Veklury must be started within seven days.

"Start them as soon as you're diagnosed without any delay, because that's the most important thing when it comes to antivirals," Mannepalli said.

Even in people with mild illness, there are studies showing that these antiviral drugs may help prevent long-term symptoms, she said.

Ask your doctor if these medications are right for you.

Are at-home antigen tests reliable?

Mannepalli said if you have symptoms that are suggestive of COVID-19 and your at-home test is positive, you should assume the test is accurate. But if you have symptoms and your test is negative, you should take a PCR test, which tests the genetic material of a virus. Sometimes, at-home tests can come up negative in the early stages of infection but come up positive later on. At NGHS, PCR tests also test for the flu and RSV.

How long do you have to quarantine after testing positive for COVID-19 or developing symptoms?

If you test positive for COVID-19, you should isolate for at least 5 days or until your symptoms subside without the use of fever-reducing medications or you test negative, according to CDC guidelines. People are usually most infectious during the first 5 days.

Day zero is the day of symptom onset or a positive test result.

People should "touch base with their primary care physician or their pediatrician to make sure they meet the needed criteria to discontinue the isolation," Mannepalli said. "If they have any immunosuppressive condition or they have a severe COVID infection, the duration is longer, and so I would encourage them to talk to the providers to get that guidance."

Should you wear a mask?

"Given the high transmission rates in the community, if you're going to be in a crowded setting, especially indoors, or if you're immunocompromised, it's recommended that you wear a mask," Mannepalli said.

You should also mask up if you're at high risk of developing severe illness, she said. You may be at high risk if you are older, have heart or lung conditions, a compromised immune system, obesity or diabetes.

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