What a relief - another week with another substantial drop in cases and percent positivity. We're well on the other side of the omicron surge here in Easthampton. It feels great. Based on the level of vaccine-induced and post-infection immunity in our community, I anticipate several easier months ahead of us.
First, I've heard a few concerns / questions that I want to directly address:
1) There is no vaccine mandate in Easthampton.
For the first time since we've produced this dashboard, there was almost no movement in vaccination rates this week. Easthampton has great vaccine coverage in general. The rate is still lowest among 5-11 year olds and 20-29 year olds.
The vaccine provides an incredible amount of individual protection from severe outcomes, and does provide a community benefit in regards to the level of circulating virus and risk of transmission in public locations. It also benefits our health care system (and in turn, all of us by allowing for maintenance of steady high-quality health care for those with and without COVID-19). However, the decision to get vaccinated and/or boosted is entirely yours and you will receive the greatest benefit from the vaccine. I hope you feel like you have enough information at this point to decide, and if you have questions, I hope you have identified someone you trust who you can ask. You can always change your mind as you sit with the decision in the coming "easy" period. As new information becomes available on the vaccines, we'll include it here for you. The information this week is consistent with what we knew before - the vaccines are incredibly safe, reduce the risk of infection, and greatly reduce the risk of hospitalization and death.
2) There is currently a mask mandate in Easthampton.
The Board of Health meets frequently to evaluate the mandate and determine if it should continue (and if so, for how long before it's reevaluated). For folks who cannot mask, exemptions are granted. I provided some thoughts about masking decisions last week, and I hope those have been helpful in thinking through these decisions. I understand that there are strong feelings about masking, on both sides. It's not an easy decision! It's a complex balance of infection reduction, public willingness to continue masking, and social drawbacks. Public health requires us to make decisions based on evidence (science) for the greatest balance of good for the population. This is a big ask of our local leadership. I hope our community will continue to engage in respectful discussion, while respecting the policy decisions made and the science used to make the decision. I've said this for two years, and I'm saying it again now - it should never have been left up to individual communities to make these decisions. Our leaders, like our health care providers, are exhausted and overwhelmed. I know they are all taking these decisions incredibly seriously.
Finally, this week I want to cover COVID-19 treatment options. As you may recall that I've written previously, "living with" COVID-19 means relying on treatment to reduce the risk of severe outcomes after infection. We hear so much more about the vaccine and case rates than about treatment options though. We do have a few really good treatments for COVID-19, however! And although they work well, they are unknown / unasked for, underutilized, and often inaccessible. Let's see if we can change at least part of that! Please note that this content is intended to inform you of possible options and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Individuals should always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition.
There are a few different types of treatment options:
1) Antiviral treatments
2) Monoclonal antibody treatments
3) Convalescent plasma treatments
4) Other types of treatments
1) Antiviral Treatments
Antiviral treatments are medications that suppress a virus's ability to bind to healthy cells and boost the immune system. They do this by inhibiting the interaction of molecules between the virus and your healthy cells, and limiting the ability of the virus to produce new copies of itself. When they work, they minimize the symptoms of a viral infection and shorten the length of time it takes a person to clear the infection from their system.
There are currently three antiviral treatments with emergency use authorization (EUA) for COVID-19:
- Paxlovid (made by Pfizer) is for treatment of mild-to-moderate COVID-19 in people ages 12 and older who are at increased risk for severe illness. You need a prescription and need to start it within 5 days of symptom onset / testing positive.
- Molnupiravir (made by Merck and Ridgeback Biotherapeutics) is for treatment of mild-to-moderate COVID-19 in people ages 18 and older who are at increased risk for severe illness. You need a prescription and need to start it within 5 days of symptom onset / testing positive.
- Remdesivir (Gilead) is for treatment of mild-to-moderate COVID-19 in people ages 12 and older who are at increased risk for severe illness. It is delivered intravenously (by IV) over several days in an inpatient or outpatient setting.
2) Monoclonal Antibody (mAbs) Treatments
This type of treatment consists of antibodies that are ready to fight the SARS-CoV-2 virus. The antibodies are delivered by IV shortly after developing symptoms. The effect is like jumping ahead in the immune response your body is already mounting against SARS-CoV-2.
There are currently three mAbs treatments with EUA for COVID-19:
- Sotrovimab (made by GlaxoSmithKline) is for treatment of mild-to-moderate COVID-19 in people ages 12 and older and over 88 lbs who are at increased risk for severe illness. It is delivered by IV and needs to start it within 10 days of symptom onset / testing positive. Data indicates that it is effective against all known variants of the SARS-CoV-2 virus.
- Bebtelovimab (made by Eli Lilly), alone or in combination with etesevimab is for treatment of mild-to-moderate COVID-19 in people ages 12 and older and over 88 lbs who are at increased risk for severe illness. Data indicates that it is less effective against the omicron variant of the SARS-CoV-2 virus than against prior variants.
- Casirivimab plus imdevimab (made by Regeneron Pharmaceuticals) is for treatment of mild-to-moderate COVID-19 in people ages 12 and older and over 88 lbs who are at increased risk for severe illness. Data indicates that it is less effective against the omicron variant of the SARS-CoV-2 virus than against prior variants.
There is also one mAbs treatment with EUA to prevent COVID-19 among those who are immunocompromised and at risk of severe illness, or among those who cannot get vaccinated:
- Tixagevimab plus cilgavimab (made by AstraZeneca) is for prevention of COVID-19 infection in people ages 12 and older and over 88 lbs who are at increased risk for severe illness because they are immunocompromised or are unable to get the vaccine.
3) Immunomodulator Treatments
Cases of severe COVID-19 involve a hyperactive immune response. The hyperactive immune response is damaging in and of itself to the body, and increases the severity of disease. This line of treatment options for those who are severely ill is intended to suppress the hyperactive immune response and reduce symptom severity.
- Tocilizumab (made by Actemra) is for treatment of severe COVID-19 in people ages 2 and over. To qualify, the patient must be hospitalized. This monoclonal antibody treatment blocks the protein involved in inflammation in lung tissue, rather than the SARS-CoV-2 virus itself.
- Dexamethasone is a previously used steroid that reduces inflammation. It has been given EUA approval to treat COVID-19 in the case of severe illness. It can be used in combination with an antiviral like Remdesiver.
- Baricitinib (made by Eli Lilly) is a medication used to treat rheumatoid arthritis. It has been given EUA to treat COVID-19. It works by reducing inflammation and can be used for hospitalized, severely ill patients over age 2.
4) Convalescent Plasma Treatment
This type of treatment involves taking the antibodies from a patient who has recovered from COVID-19 and giving them to patients very ill (hospitalized) with COVID-19 to aid their immune response. The mechanism of action in your body is similar to mAbs treatments.
- Convalescent plasma treatment does have EUA but only in narrowly defined circumstances. It is for treatment of mild-to-moderate COVID-19 in immunocompromised people ages 12 and older. You can receive it inpatient or outpatient.
Stay well and take good care of each other.