COVID update: what you need to know for 2023 Part 1
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I am pleased to share this presentation I was requested to give to the Upstate Nurse Practitioner's Association of South Carolina. Thank you for the opportunity to share knowledge.
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COVID update: what you need to know for 2023 Part 1
- 1. COVID update: What you need to know for 2023 Part 1 11/14/23 Neil Kao, M.D.
- 2. COVID-19: 1 Highlights 1. Review the structure of coronavirus 2. Timeline of COVID-19 in US 3. Risk factors 4. Symptoms 5. Testing for COVID-19, flu, RSV
- 6. Question 1: What part of the coronavirus is responsible for its ability to cause COVID-19 ('CO' stands for 'corona,' 'VI' for 'virus,' and 'D' for the disease) in humans? 1. RNA 2. Envelope membrane protein 3. Spike glycoprotein 4. Nucleoprotein 5. Membrane protein
- 12. Question 2: How has the rate of hospitalizations and deaths from coronavirus-19 changed in the past year? 1. Stayed same 2. Decreased 3. Increased
- 25. Question 3: what is the greatest risk factor for death from COVID-19? 1. Race 2. Sex 3. Age 4. Coronary artery disease 5. Political party
- 30. around 27 percent of total COVID-19 deaths in the United States have been among adults 85 years and older, despite this age group only accounting for two percent of the U.S. population
- 31. Home tests for COVID-19 ● Go to https://www.covid.gov/tests to get 4 free home tests ● Are rapid antigen at-home tests, not PCR ● Can be taken at home or other locations. Give results within 30 minutes (no lab drop-off required) ● Can be used for testing whether you have COVID-19 symptoms or not ● Can be used for testing whether you are up to date on your COVID-19 vaccines or not. ● Are also referred to as self-tests or over the counter (OTC) tests
- 32. COVID-19 + Flu + RSV Test 1. Home collection $129 Labcorp, processed by Labcorp 2. Xpert® Xpress CoV-2/Flu/RSV plus, Processed by office (AFC, ADAC) cost $ IK??, Results in 35 min
- 33. Can use different cartridge, test for strep also.
- 34. Lucira™ by Pfizer COVID-19 & Flu Home Test Cost $99
- 35. Question 4: It is very important to know if the patient actually has COVID-19. What testing options do providers have to rapidly diagnose COVID-19? 1. Home tests 2. Combined COVID-19 + Flu + RSV Test 3. Lucira™ by Pfizer COVID-19 & Flu Home Test 4. Convalescent titers 5. 1-3
- 37. Summary
- 39. Hot take: Read my headlines!! After variant already growing. Mutations on spike
- 42. COVID update: what you need to know for 2023 Part 2 11/14/23
- 43. COVID-19: 2 Highlights 1. Prevention 2. Vaccines 3. If you were exposed or become sick: Unapproved treatments 4. Discontinued treatments 5. Approved treatments 6. Long haul 7. Miscellaneous 8. Future
- 54. Question 1: what it the lowest age that the COVID-19 vaccination has been recommended? 1. At birth 2. 4 months with the routine vaccinations 3. 6 months 4. 5 years old 5. 18 years old 6. 65 years old
- 64. Unproven therapies 1. lying supine, ivermectin, zinc, hydroxychloroquine, vitamin C 2. For long-haul, stem cell autologous transfusions, exosome therapies 3. List of unproven methods against COVID-19 - Wikipedia
- 65. Discontinued therapies 1. Johnson and Johnson vaccine 5/23 2. Convalescent serum 3. Monoclonal antibodies, all no longer effective because virus spike has mutated
- 66. Question 2: If a patient tests positive for COVID-19, but has no symptoms, and asks for a medication, I should give the patient: 1. A home mixture of herbs, zinc lozenges, vitamin C 2. Ivermectin 3. A prescription for convalescent plasma from the blood bank 4. A prescription for antibodies for COVID-19 from the infusion center 5. A prescription for Paxlovid
- 68. Personal plan 1. Level 1: avoid obviously sick people, surfaces, mask when in crowds (plans) 2. Level 2: possible exposure 3. Level 3: got covid 4. Level 4: urgent situation 5. Paxlovid cost 6. Survivorship lessons
- 69. Summary of COVID-19 Preventative Agents & Treatments
- 75. Question 3: For patients with mild-moderate symptoms and the right time frame, which medication is recommended first? 1. IV remdesivir (Veklury) 2. PO nirmatrelvir, ritonavir tablets (Paxlovid) 3. PO molnupiravir (Lagevrio) 4. PO dexamethasone (Decadron) 5. PO acyclovir (Zovirax)
- 79. Question 4: Which meds should be considered for a patient has COVID-19 infection + is hospitalized, is needing conventional oxygen treatment, but does not have any signs of systemic inflammation? Remdesivir Dexamethasone PO baricitinib IV tocilizumab All of the above
- 81. Long haul 1 in 7 people get long haul, but symptoms almost all fade away by 1 year
- 84. HOT NEWS FROM READING LIST
- 85. Future trends 1. Annual endemic infections, hospitalization, deaths 2. Combined vaccines: 2 companies COVID-flu combined testing now 3. Less breakthroughs, because less urgency (politics), less $ research, continued profit mode from pharmaceutical companies 4. Costs borne by private insurance and through patient copays + federal at extremes: expect more delays, confusion, misinformation 5. Harder to find reputable websites outside of the government, many shut down
- 87. Important sources of information 1. CDC 2. NIH https://files.covid19treatmentguidelines.nih.gov/guidelines/covid19treatmentg uidelines.pdf, https://files.covid19treatmentguidelines.nih.gov/guidelines/section/section_10 0.pdf 3. IDSA https://www.idsociety.org/practice-guideline/covid-19-guideline- treatment-and-management/#OverviewofCOVID- 19TreatmentGuidelinesSummaryTable 4. CIDRAP https://www.cidrap.umn.edu/covid-19 5. https://leaps.org/the-best-coronavirus-experts-to-follow-on-twitter/particle-1
- 89. Acknowledgements Thank the Upstate NP Association for the opportunity to review these facts about COVID-19. It’s been 3 years since last lecture and we’ve been through a tremendous amount of change. Slides will be available in link at lecture…. Almost every slide has a reference in the speaker notes I post my bibliography of important media articles on my website: neilkao.com
- 91. Underlying Medical Conditions Associated with Higher Risk for Severe COVID-19: Information for Healthcare Professionals https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical- care/underlyingconditions.html#anchor_1618433687270 2/9/23
Editor's Notes
- Credit: Kirkjufell mountain Aurora Borealis Iceland (istockphoto)
- Why is this even worth talking about? Fourth leading cause of death in US still and largely preventable! Look, here’s my theme. We are health care professionals, so we should all know the facts and recommendations (science), so when we see our individual patients, we can give them specific advice (art)(sometimes orders). I will basically try to hammer home the facts. There is so much misinformation, anecdote and controversy. We should be a guiding light.
- Electron micrograph credit UCLA. Anatomy. What we’ve learned is the exact genetic sequences
- https://www.dovepress.com/mutational-analysis-of-circulating-omicron-sars-cov-2-lineages-in-the--peer-reviewed-fulltext-article-JMDH
- https://www.weforum.org/agenda/2020/04/coronavirus-spread-covid19-pandemic-timeline-milestones/ 2 months!!
- https://asm.org/resource-pages/covid-19-resources. This is HISTORY Highlight RNA vaccine out during alpha
- https://www.mdpi.com/pathogens/pathogens-09-00331/article_deploy/html/images/pathogens-09-00331-g002.png
- US absolute number minimum 10,000 or multiples. Date: 10/25/23! Why to be concerned. Waves, international, US remains highest, statistically we are physically at greater risk of this and dying from COVID.
- https://ourworldindata.org/grapher/weekly-covid-deaths?tab=chart&country=~USA Note 1500-2500/week
- Antarctica
- Latest data
- Provisional Mortality Data US end 2022. COVID 4th leading cause. Was 3rd in 2020 & 2021
- https://www.statista.com/statistics/1254488/us-share-of-total-covid-deaths-by-age-group/ . around 27 percent of total COVID-19 deaths in the United States have been among adults 85 years and older, despite this age group only accounting for two percent of the U.S. population. Age is by far the greatest risk factor
- NCHS Data Brief No. 456, December 2022. Latest data: rate doubles per decade from ~15-24 y/o
- https://www.cdc.gov/vaccines/imz-managers/coverage/adultvaxview/pubs-resources/sociodemographic-factors-covid19-vaccination.html 5/10/21 and still true!!
- https://www.pewresearch.org/politics/2022/03/03/the-changing-political-geography-of-covid-19-over-the-last-two-years/ The point of this slide is NOT to politicize this lecture, but to point out that every conceivable variable to being obsessively tracked. It would be best if medical decisions were made without the input of politics, but that is not what happens in the US. I stress this when I speak with patients, make your decisions based on objective facts, not political party or religon or if you like Pepsi better than Coke. As much as we rely on science, we should look at the data and ask ourselves what is it that can explain this?
- https://aspr.hhs.gov/COVID-19-Therapeutics/USG-COVID19-Tx-Playbook/Pages/Module-1-COVID19-Outpatient-Therapeutics-Ovierview.aspx no date Prioritization strategy includes 4 factors: age, vaccination status, immune status, and clinical risk factors.
- People with Certain Medical Conditions https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html 5/11/13
- Skogafoss, Iceland
- https://www.uspharmacist.com/article/the-role-of-the-pharmacist-in-overcoming-vaccine-hesitancy
- https://thehill.com/homenews/nexstar_media_wire/3763787-covid-rsv-or-flu-how-to-tell-the-symptoms-apart/
- http://www.bccdc.ca/health-professionals/clinical-resources/covid-19-care/health-care-provider-support I love this slide from 5/1/20. We all do this reflexively in seconds of meeting any patient
- https://www.cdc.gov/mmwr/volumes/72/wr/mm7240a2.htm Here’s what happened during the last year. We are HERE Nov.11!
- https://www.ondemand.labcorp.com/at-home-test-kits/covid-19-flu-rsv-test-home-collection-kit, Cepheid Respiratory virus test (A&B both). There are NO home tests for RSV. https://time.com/6316682/at-home-tests-covid-19-rsv-flu/
- https://www.fda.gov/media/165690/download. There is currently only 1 home test licensed for home testing for influenza. It happens to test for COVID at the same time. Company declared bankruptcy, then was granted approval by FDA 3/23. Bought by Pfizer. https://www.statnews.com/2023/03/08/fda-comment-approval-covid-flu-home-test-lucira/
- https://www.health.com/condition/infectious-diseases/coronavirus/covid-19-test-types
- Listed updated date!!
- Great Coral Reef, Australia. Water, take a brief break for questions, drinks, bathroom run!
- Strokkur geysir, iceland
- https://www.forbes.com/sites/carminegallo/2020/12/10/the-virologist-who-created-a-swiss-cheese-metaphor-to-explain-the-pandemic-has-a-message-for-educators/?sh=7fecb7826335
- https://www.goodrx.com/conditions/covid-19/covid-19-boosters Comparing vaccines HV.1 > EG.5, versions of omicron. Just 3.5% total population vaccinated
- https://laist.com/news/health/cost-of-covid-care-likely-to-increase-after-federal-emergency-ends-in-may 1. Tests, 2. Treatments, 3. Vaccines (pending)
- https://www.kff.org/infographic/insurance-coverage-of-updated-covid-19-vaccines-a-cheat-sheet/
- https://www.goodrx.com/health-topic/vaccines/fall-vaccine-guide AGE
- https://yourlocalepidemiologist.substack.com/p/a-guide-to-fall-vaccine-options. Effectiveness, when?
- https://www.cdc.gov/respiratory-viruses/whats-new/immunization-overview-2023-2024.html. Slides is almost identical from CDC, more words, too many. Extra: where access and more information
- https://prevnar20adult.pfizerpro.com/acip-recommendations. Bonus
- https://healthunlocked.com/cllsupport/posts/148502693/pneumonia-vaccine-pcv-20-single-shot-now-recommended. Thus I am getting 3 vaccinations this Fall. Briefly thought I get 4!
- Masks are effective, reduce odds by ~50%, depending on variables: fit, type, duration, distance, ventilation/
- Himalayan mountains
- Monitor self, MASK, test, precautions
- Same pictorial, MASK
- ISOLATION and masking to reduce the viral load to those around you. Concept Viral load. The more you get, the more antibodies you need to generate, which takes time and a healthy immune system.
- https://aspr.hhs.gov/COVID-19/Therapeutics/Documents/side-by-side-overview.pdf https://www.covid19treatmentguidelines.nih.gov/management/clinical-management-of-adults/clinical-management-of-adults-summary/?utm_source=site&utm_medium=home&utm_campaign=highlights Subtle shift+ symptoms!
- Next step! Exposure, symptoms, testing! Protect you loved ones. Remember 6-10 days, if nothing else!
- More details to reduce spread.
- Stage illness! Essentialy for guiding treatment. Moderate to severe, know the difference! National Institutes of Health. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines. Accessed at www.covid19treatmentguidelines.nih.gov on 3 August 2023. COVID-19 | Annals of Internal Medicine (acpjournals.org) https://www.acpjournals.org/doi/10.7326/AITC202310170?utm_source=cmpnr&utm_campaign=tfa_202310_2&utm_content=2&cmp=1&utm_medium=email
- List of unproven methods against COVID-19 - Wikipedia There’s actually a massive list on Wikipedia, which actually seemed to me to be well curated and referenced.
- https://theconversation.com/covid-19-variants-faq-how-did-the-u-k-south-africa-and-brazil-variants-emerge-are-they-more-contagious-how-does-a-virus-mutate-could-there-be-a-super-variant-that-evades-vaccines-159032. This is how they worked but there are NO approved antibody products now.
- T
- Mount Kilamonjaro
- https://www.defense.gov/News/Inside-DOD/Blog/article/2128863/hpcon-understanding-health-protection-condition-levels/
- https://aspr.hhs.gov/COVID-19-Therapeutics/USG-COVID19-Tx-Playbook/Pages/Module-1-COVID19-Outpatient-Therapeutics-Ovierview.aspx
- https://www.goodrx.com/conditions/covid-19/covid-19-pill-paxlovid-molnupiravir 6/8/23
- https://www.idsociety.org/covid-19-real-time-learning-network/therapeutics-and-interventions/covid-19-outpatient-treatment-guidelines-roadmap/#/+/0/publishedDate_na_dt/desc/ https://www.idsociety.org/practice-guideline/covid-19-guideline-treatment-and-management/#OverviewofCOVID-19TreatmentGuidelinesSummaryTable Break apart and enlarge
- https://aspr.hhs.gov/COVID-19-Therapeutics/Outpatient-Therapeutics-Clinical-Decision-Aide/Pages/default.aspx Clinical Decision Aid for Ages 12+ years 9/23
- https://aspr.hhs.gov/COVID-19-Therapeutics/Outpatient-Therapeutics-Clinical-Decision-Aide/Pages/default.aspx Clinical Decision Aid for Pediatric patients 28 days of Age and Older 9/23
- https://www.acep.org/corona/covid-19-field-guide/treatment/effective-treatments 7/19/23 Therapeutic Management of Hospitalized Adults With COVID-19 Names redesivir, dexamethasone, tocilzumab (they are in ICU and in big trouble). Beyond this, no scope.
- NIH updated guidelines 10/10/23
- https://www.acep.org/corona/covid-19-field-guide/treatment/effective-treatments 7/19/23 Therapeutic Management of Nonhospitalized Adults With COVID-19
- Mount Tapui in Venezuela (table top), 9,700 feet to ground below. Up waterfall. Conan Doyle Lost World
- https://www.bmj.com/content/378/bmj-2022-072117 Long COVID
- https://www.bmj.com/content/378/bmj-2022-072117
- Pay attention slide. We must be informed on a timely basis and a source of accurate, objective advice.
- Underlying Medical Conditions Associated with Higher Risk for Severe COVID-19: Information for Healthcare Professionals