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Friday, May 13, 2022

The COVID-19 Update: Summer 2022

Episode 70

 
Speaker 1 (00:03):

Coming to you from Beaumont, this is your HouseCall.

Dr. Nick Gilpin (00:17):

The US experienced the huge COVID surge in the winter months of 2022. This was fueled mainly by the Delta variants initially, and then followed by the slightly milder, but more contagious Omicron variant. A lot of people got sick with COVID during these months. As that surge wore off in February, our reprieve in March was short lived. COVID cases began rising again in April, this time the new Omicron stealth variant BA.2, was to blame for the increase in community cases. Now, as we start looking towards warmer weather, we're continuing to see significant community transmission. Hospitalizations are on the rise and once again, we have a new variant to keep an eye on. So, where do we go from here? And what should we be doing to stay safe and slow down the spread of COVID? Keep it here, the HouseCall podcast has your answers.

Dr. Nick Gilpin (01:09):

Hello, and welcome to the Beaumont HouseCall podcast. I'm Dr. Nick Gilpin. And my goal is to help you and your family live a smarter, healthier life. Today's conversation is about this post fourth wave, slow burn that we're experiencing right now. It's not quite a surge per se, but cases are certainly on the rise and we should be paying attention. We have Dr. Justin Skrzynski, a familiar voice to talk us through this. Just to remind you, Dr. Skrzynski is a hospital internal medicine physician at the Beaumont Royal Oak campus. He's been involved in the care of hundreds of patients with COVID-19, and he has been one of our COVID stalwarts in the quest to get good information out to the public. Hi, Justin.

Dr. Justin Skrzynski (01:53):

Hi, pleasure to join.

Dr. Nick Gilpin (01:54):

Welcome back. Let's do this. So, as I like to do in these situations, I want to put a little timestamp on things, because information changes quickly. Right now it is mid-May 2022, community transmission is high throughout most of Michigan, the Midwest, and even the East Coast. Community levels and just to differentiate that, the community levels have more to do with hospitalization numbers and hospital bed utilization, we'll talk about that a little bit more, are considered to be low throughout much of the US. With a few pockets, I guess we could call them, of medium level risk in Southeast Michigan and some high risk levels in the New England states. So, just to frame it up again, transmission is high, but the community levels throughout most of the areas are considered low. So Justin, let's try to explain this because it's a bit nuanced. So, let's explain this to the listeners. What exactly does it mean when we say transmission is high, but the community risk level is low? Help us understand that, it seems very counterintuitive.

Dr. Justin Skrzynski (03:01):

Definitely. And I think that was one of the disconnects that we saw when we had our big Omicron surges, that we had these gigantic ballooning numbers and also hospitalizations as well. The mortality, fortunately, was not that high because, again, we're dealing with a different variant. Omicron just behaves a bit differently than the previous variants did. So right now, we are seeing a lot of community transmission of COVID, definitely are. And even in the hospitals, we are seeing some rise of COVID patients. I think one of the things to point out is that as the phrase goes, these are patients in the hospital with COVID not from COVID. And I think that just represents the higher community incidents. But the idea is that we're not seeing this ballooning necessarily of COVID hospitalization, so people coming in with that nasty, deadly COVID pneumonia. Fortunately, we are not seeing that. So, that is a little bit of cause for optimism. It's a very, very mixed right now in terms of what we're going to see over the next few months, much less into the fall. But that is a little bit of cause for optimism right now.

Dr. Nick Gilpin (04:01):

So, let me pick up on a couple things that you said, because this jives with that idea that this Omicron and it's many sub-variance, and we'll talk about those in just a moment. They are more transmissible. They do seem to be causing less severe disease and that lower index of disease severity is probably, it's hard to parse it out, right? It could be a feature of the virus itself, or it could be a feature of the fact that we have more collective immunity to COVID as a collective people. Most of us at this point have seen COVID in some fashion, whether by having had it before or by having been vaccinated one or two or three or four times. So, collectively we have some immune protection on board. But as the denominator goes up, which it is doing right now in the community, you are going to see that translate to hospitalizations.

Dr. Nick Gilpin (04:53):

And that's pretty much exactly what we're seeing right now is yes, those hospital numbers are starting to tick up. And even in Southeast Michigan where we live, even the number of deaths is starting to tick up. So, let's pivot now, you tell me in your day job, what are you seeing right now in the hospitals?

Dr. Justin Skrzynski (05:10):

Fortunately, it is much better than it was before, as you mentioned, as I mentioned as well, the numbers are going up and I think that's really the important point. I think chatting with different people in the community and what have you, a lot of people are saying, "Well, Omicron is not deadly. It's just the flu. It's just a cold now. I don't have to worry about it." And that's not true. It's still the same COVID that caused all those deaths only a couple months ago. So, while we fortunately do have lower numbers now, and I think what you said is exactly correct, that we have a lot of exposure to both the virus in the community, as well as the vaccine in the community. Again, the vaccine's going to provide much more reliable protection. So, that's still the way to go, the way to get protected against COVID is not to be exposed to it. It's still vaccine.

Dr. Justin Skrzynski (05:58):

But because we do have that preexisting protection, we are not seeing these big ballooning numbers, even though we know that Omicron and all of its children now, unfortunately, are just so incredibly transmissible compared to previous versions of COVID.

Dr. Nick Gilpin (06:13):

Just to put a finer point on that, COVID hospitalizations in our healthcare system, up to nearly 200 patients now across eight hospitals, which is double what it was just two weeks ago. It's more than triple what it was from about a month ago. So, that kind of gives you an idea of what the pace we're on. Another metric we track is the number of healthcare workers that are out sick with COVID. We've seen that number also go up. It's about double what that was in the last month and it's the highest that it's been since early March when we had our last surge. And as we said, just a moment ago, the community transmission numbers, the percentage of positive tests in the community also keeps going up. We're now sitting somewhere between, say 13% and 18% in our part of Southeast Michigan. Do these patients that you're seeing in the hospital with COVID or hospitalized with, versus for COVID, do they look any different to you than in prior surges or prior COVID outbreaks?

Dr. Justin Skrzynski (07:10):

They do look different. And fortunately, again, we're not seeing a lot of the sort of severe COVID pneumonias. It's a very scary disease and we can talk about that too. It's not only frightening for the people who have it, but also it's a very difficult disease to treat, seeing these patients, they're not doing well. And so, that takes its toll on the staff too, the ones taking care of them. But fortunately, we do have a bit of a reprieve from that. So, we're seeing a lot of upper respiratory symptoms. COVID can cause kind of a whole grab bag of different symptoms. So, from GI to nerve issues, to stroke, to respiratory stuff. So, COVID can almost masquerade as other things. So, sometimes it's a surprise these people are testing positive. I will say that, in terms of the mix of patients that we get, the majority of patients that we've got, who do test positive are still unvaccinated. So, still unvaccinated, otherwise it's just a broad spectrum, young, old, every kind of demographic you can imagine.

Dr. Nick Gilpin (08:13):

One thing I'm hearing is there's a bit of a misperception, I think, that a lot of my friends and even some of my coworkers have been saying, "Oh, it's just going to keep getting milder and milder and milder. This is a good thing. So, eventually it's going to just morph into something that is akin to a common cold." And I must admit, I think that sort of anchor, I feel that also. I want that to be the truth. But I think we have to step back and say, it doesn't have to be that way. This virus could very well mutate into something and I'm not saying statistically it's probable, but it is possible that it could mutate into something completely different. And we see this with seasonal influenza. Every so often a new seasonal flu strain pops up and it completely sort of catches us off guard, catches our immune systems off guard and can cause much more severe disease. So, I think we have to really snap out of that notion that this is just going to keep getting better and better until infinity.

Dr. Justin Skrzynski (09:16):

Absolutely. And I think two key points, one, Delta variant was downstream of the original COVID good point. And that was an awful disease. Delta was a terrible disease, very aggressive, high mortality and that was a mutation from the original COVID. So again, that's just chance that it happened to get more lethal. And I think the other thing too, is that, again, COVID doesn't want anything. The virus doesn't have an agenda. It doesn't have a goal. If it does want anything it's just to reproduce.

Dr. Nick Gilpin (09:46):

Make more copies.

Dr. Justin Skrzynski (09:47):

Exactly. And so, once it's already made its copies and transmitted itself to the next host, doesn't really care what happens to the first host. So, whether that person does well or not is immaterial. And so, there's no pressure for the virus to become more or less lethal necessarily, as long as it's still doing that sort of leapfrogging afterwards, jumping person to person. So, the bottom line is, it's just chance whether or not this thing will get more or less lethal down the road.

Dr. Nick Gilpin (10:14):

I agree. I think that's well said. Let's talk about that because we do have a new sort of sub variant, if you will, on the menu. And that's the Omicron sub-variant BA.2.12.1, which is the newest variant of concern, that's making the rounds in the United States. When I checked the numbers on the CDCs data tracker, it accounts for around a third. They're estimating a third of cases up to maybe as many as a half of all current COVID cases in the US. This is based on genomic surveillance data and it is becoming the dominant strain and it probably will be in the next week or two. So, to catch us up, BA.2 was the first Omicron sub-variant, that became the dominant strain in the early spring. And it has since spawned several other mutations on the spike protein compared to the original BA.1 Omicron.

Dr. Nick Gilpin (11:08):

And it was, to your point, Justin, it was more transmissible than its predecessor, because that seems to be how these things are progressing. And this new variant appears to spread more easily, again, like its predecessors. And it may have a better ability to evade immunity, but at this point we need more data and you've heard me say this before. This stuff takes time to accumulate the kind of data to know whether it is or is not causing more severe disease. It does take some time. There are some additional sub-variance that are out there, BA.4, BA.5. These have been detected in other countries, places like South Africa. They have not yet really gathered a strong foothold in the US, but hey, here we go again, right?

Dr. Justin Skrzynski (11:49):

Here we go again. And we know from, let's say the Omicron variant, from the time that Omicron became a word that people were even aware of to the time that it became the dominant strain. That was a month maybe. So, we definitely live in a global society. We know that these things will transmit very rapidly and one of the really infuriating things about COVID and I would even say one of the key things that made this a pandemic is this latent period. The fact that some can be exposed and have five days a week until they have symptoms. And part of that, they can be transmissible. So, someone can easily be exposed, get on a plane, go from Johannesburg to New York City. And now, suddenly you have one of these new COVID sub-variance that's going to be present in the US.

Dr. Justin Skrzynski (12:33):

So, I think it's a wise idea to anticipate that we will see that. And we're not asking certainly for panic or concern. I think a lot of people have these eye rolls of, "Okay, here we go again, it's another variant. It's another round of mandates and lockdowns." No, no, no. I think there's a very smart and very moderate way to go about this, which is for people to be cognizant of what's going on, people to make smart decisions. And again, vaccination really is key. The vaccine is still, especially with that booster dose, it's still holding up in terms of preventing the really serious outcomes with Omicron.

Dr. Nick Gilpin (13:08):

I agree with what you said, that it is a global disease and we certainly have to think globally, where are the spikes happening around the world. And we have to be cognizant of that because what's happening right now in South Africa or parts of Asia, will probably someday make its way over to the US. I think we also have to continue to think of this as an individual disease too. Because each of these variants strains, whatever you want to call them, they all started with a single person.

Dr. Justin Skrzynski (13:34):

Absolutely.

Dr. Nick Gilpin (13:34):

Omicron started in South Africa, probably from some patient zero that we don't really know, and we could have potentially stopped it right there in its tracks. If we'd had the foresight and the knowledge and the proper protocols to shut it down at that time.

Dr. Justin Skrzynski (13:49):

A hundred percent. And I think that this entire thing has been planted by the numbers. And I think that's one of the take home points is that yes, you can certainly assess your individual risk, but it's all percentages. I saw some people would say, "Okay, I'm young, I'm healthy. I don't need to be vaccinated. I'm low risk for COVID." That's true that you're low risk, but again, this is all playing it by the numbers. So, I've seen many, many people who are young, healthy, succumb to COVID, unfortunately very sad, but it's the same thing; whereas, you said it only takes one person to have that mutation. And similarly, like we also talked about before, it's a chance thing, whether or not this thing will get more or less lethal. So, again, you can play it by the numbers and say, "Well, we probably won't have this, probably will not have that." But we don't know that. And again, there's precautions we can take right now, which are very moderate, very reasonable.

Dr. Nick Gilpin (14:40):

To kind of start to frame this up. What, if anything, with these new variants emerging, what does this mean for us? You said it a minute ago, vaccines are still our best protection for the most part. A good best offense is a good defense, as they say. Stay home, if you're sick. I think we're getting to a place now where apathy is the enemy. Everybody's just saying, "Well, we got to learn to live with COVID, whatever that means." But I don't think that means we need to go to work if we're sick. I think we have to break that habit. And I really hope that COVID would help us push out of some of these bad practices. We need to be pushing to get tested. If we're sick, it's not hard to get a test. Is it? I mean, last time I checked, it's pretty darn easy to get a test and we're making sure that we're protecting ourselves when we're out in public.

Dr. Nick Gilpin (15:26):

Particularly, when those cases start to get up there, when those community levels start to tick up from low to medium to high, that's when we all have to be reacting, putting on our masks and being more aware of what our personal risk is and the risk of the people around us.

Dr. Justin Skrzynski (15:43):

I absolutely agree. And the people that would say that this is sort of fading to the background or that it's a cold or it's a flu. It's not, unfortunately. We're just shy of a very sad milestone, which is a million deaths in the US. Just shy of that. And unfortunately, we will hit that soon. No flu outside of the last hundred years, with the exception of the pandemic, that we had a hundred years ago, the flu doesn't kill a million people in two years. And, if you take a look at the virus that we're getting from the people now, it's the same virus that caused the deadly Omicron surge we had months ago. So, it has not gone away. And now that we're in this phase where the virus will circulate in our society, it's going to be there and I don't think it's good enough to say, "Well, we have to learn to live with it." Because that's a level of mortality and a level of loss, that's really not acceptable.

Dr. Nick Gilpin (16:34):

Completely agree. I want to pivot to talk a little bit more with specificity about masks because I've seen it. I'm sure you've seen it. I think that weather's getting warmer around here, less likelihood to see people wearing masks out in public. This very prevalent sense that the pandemic is over or very nearly over. So, the CDC, we talked earlier about community levels and we talked about what that means. And community levels are defined by not just how much COVID a community has, but the proportion of hospitals that are taken up with COVID patients and bed utilization. So, it's a pretty good way to quickly sort of quantify how bad the COVID situation is in your community. And if it's low, so if you look at the map on the CDC webpage and it's green, meaning it's low, the recommendation would be to wear a mask based on your personal risk and your personal preference.

Dr. Nick Gilpin (17:32):

So, if you are a high risk patient, if you're immune compromised from some underlying condition, or from some medication that you take, "And I'm going to go out to the grocery store, I'll probably encounter a bunch of people that I don't know. It's probably not a bad idea for me to wear a mask, if that's something I feel comfortable with." When you get up to medium, so now you've gone from green to, I think it's yellow at that point. Now, we need to be a little bit more mindful of our situation, not only our situation, but the situation of the people that we come into contact with regularly and people who are at high risk for disease, people in our household that are at high risk for disease. We should be wearing masks with more regularity in those situations. And then when we get to high, which is the highest level, now it's orange.

Dr. Nick Gilpin (18:21):

Now, really we should be wearing masks. Pretty much all of us, regardless of our individual risk status, regardless of our vaccination status, we really should be defaulting to wearing more masks. Now, fortunately, like I said, we're not seeing a lot of high community level risk in the country right now, that could change. It's mid-May right now, fast forward two weeks, I don't know what things are going to look like. So, I encourage people to be aware of what these levels are in your own community and sort of let that guide how you approach masking.

Dr. Justin Skrzynski (18:55):

And I think, again, that's a very reasonable way to do it. I know that, go back months or even a year or two ago, and when incidents was low in the community, a lot of people were kind of chaffing against the idea of wearing mask. They would say, "Why am I doing this?" So, I think the adaptability is key and that goes both ways. So, from the top down the guidance that we receive needs to be adaptable to what's going on the ground level. But at the same time, I know one of the concerns is that we say, "Well, if we take the masks off, when things are good, what are the odds that people are willing to put them back on if things get bad?" And I think that's the main concern. That's a tough issue though, because you certainly don't want to get paternalistic and say, "Well, we know best. How about we keep the masks on all the time cause we don't trust people to do the right thing."

Dr. Justin Skrzynski (19:43):

But that's the point, is that we are trusting people to do the right thing. And that's why it's really important not to obsess about it, but again, to stay vigilant, to just make smart decisions.

Dr. Nick Gilpin (19:53):

Always easy to scale things down. And people are always in a hurry to get those masks off as quickly as they can and start deescalating some of the precautions. And by the way, I think it's important to highlight here, that in our hospitals, we still require masks all day, every day, especially in our clinical areas. I just like to punctuate this for the people that are listening because we're a hospital. I mean, this is a different ballgame. We've got vulnerable patients, we've got healthcare providers. We need to keep everybody healthy. Having healthy workforce translates to making sure we have healthy patients. We certainly don't want to see any COVID transmission within our hospitals, even though I must say, unfortunately, it does happen from time to time. We do our best to mitigate those things. So yes, for the foreseeable future and who knows for how long, we will be masking in our hospitals.

Dr. Justin Skrzynski (20:46):

And I think that's a very smart idea. I mean, again, in the hospital, a lot of people are there for transmissible diseases. I think that's a very reasonable thing. And perhaps just because we're used to it. We're used to being in the hospital setting, we're used to taking care of patients. Perhaps, I'm more used to wearing the mask, but honestly for the duration of time that I go to the store or where it is that I walk inside, it's really not a huge inconvenience for the protection that it provides.

Dr. Nick Gilpin (21:14):

So, let's talk about some other advice that we want to share with the community regarding certain things. So, right now it's spring, it's prom season, we're starting to see a lot more things pop up on the calendar. We've got wedding season, live music is coming back and sports, whatever's going on. So, how should we be approaching some of these situations? Can you give us your best advice?

Dr. Justin Skrzynski (21:37):

For sure, for sure. Again, I think there's a very reasonable way to do it. And first off is, as you mentioned, look what the incidences in the area. If you have high incidents, that's when you might want to think, "Okay, this is not the right venue or not the right time to have this event." It might very well be that if you waited a month or picked a different area, that things would cool down. And also, I think one of the things to pay attention to, and just know where people are coming from, too. So, it's one thing to say, well for instance, let's say Oakland County's got very low case numbers. Well, if you go to the bar though, how many people are not from Oakland County, they're going to be sitting next to you.

Dr. Justin Skrzynski (22:13):

So again, just have a good reasonable view of how things look in the community. And again, there are very easy ways to protect yourself and vaccination is still the top one. If you look at the risk reduction of dying or being seriously hurt from COVID, it's tremendous, especially with the vaccine plus the booster. So, it still works, it's still holding up against Omicron. Not as good in terms of preventing the symptomatic infections as it did with the original COVID. But again, it's like that game of telephone, we're several links down the chain now with Omicron. But still, if you want to stay out of the hospital, if you want to stay on the right side of the ground, as it were from COVID, vaccination is still the most important thing.

Dr. Nick Gilpin (22:57):

I'm glad you said that. I would add right now is a very good time. If you're going to be doing events of any kind, think about ways to do outdoor events. We know that your risk of COVID transmission is considerably less. I don't want to say it's zero, but it's pretty darn close to zero, if we're outside and we're able to get some space and we have nice air circulating around us. So, I'm always telling people, if you have the luxury of doing your events outdoors, I think that's a lot better. We talked a little bit a minute ago about testing, but I want to just, I guess maybe put a finer point on some of that. Definitely still important to get tested if you're having symptoms or if you're in a close contact exposure type situation. If you're positive, you need to be staying home. There's a little bit of fungibility as far as how long, say five days, if you're asymptomatic or mildly symptomatic up to 10 days, maybe longer if your immune system is compromised in some fashion. Antigen tests are good. PCR tests are good.

Dr. Nick Gilpin (23:55):

I think the best answer is what's the test that you can get fairly readily. There's also at home tests, which I would argue are also very good. So, I think testing is something that, thankfully, we've not been too handcuffed with the ability to get good tests.

Dr. Justin Skrzynski (24:10):

For sure. And a lot of free options as well. And also that plays into the idea too, that you mentioned at the beginning, with the idea of transmission versus risk. Risk right now, because the fact that we're dealing with variance of different severity and also the fact that people are testing at home and we may not have access to those numbers either. So, the real barometer is going to be risk. So what do the hospitalizations look like? What does mortality look like?

Dr. Nick Gilpin (24:34):

Justin, let's bring this home with some final thoughts. So, I'll start. I think for me, one final thought that I want to get out there is, I think there's a lot of perception that when we start to see these numbers going up again, that we're going backwards. That we're moving in the wrong direction. And I think that people really bristle at this. So, I think I'd like to frame this in people's minds that we're not going backwards. We need to think about this as we need to adapt. We need to adapt and we need to move in tandem with what we're seeing in our community. So, when the numbers start to go up again, we kind of move with it. We need to adjust based on what our community levels and our individual risk is.

Dr. Nick Gilpin (25:13):

And we need to make smart choices. If we're in a community where there is medium risk and we are a high risk person, because we have underlying medical conditions and we're going to be going into a crowded environment, use common sense, put your mask on. And if you're going to be going out to, say an outdoor barbecue with your family members, you don't necessarily need to wear a mask in that situation, if you're going to be in a safe environment. So, that's the kind of messaging I want to get into people's minds and hopefully help us reframe things in a certain way.

Dr. Justin Skrzynski (25:48):

I agree, a hundred percent. And as a parting thought, first off, I'd like to say, Happy Nurses Week to all of our beloved fellow professionals. The work that I've seen people do, both in and out of the hospital has just been flooring. It's the level to which people have stepped up over the last couple years, is just unimaginable. So thank you to all of them and the invaluable work that they do. And then just to briefly piggyback on the thought that you had, too. I think that's what you said. That's what living with COVID means. Living with COVID is not just accepting that a tremendous number of people will die every year. Living with COVID means implementing reasonable, acceptable and sustainable solutions.

Dr. Nick Gilpin (26:30):

Excellent point. I think we'll leave it there. That's about all the information we have time for today. I want to thank Justin for having this important conversation. Thank you.

Dr. Justin Skrzynski (26:38):

Always my pleasure.

Dr. Nick Gilpin (26:39):

I want to remind our listeners to check out beaumont.org/covid for all things COVID. And I also want to remind you to send along any questions you might have or suggestions to our email address, which is podcast@beaumont.org. And I will leave you today with this healthy thought. We may be done with COVID, but COVID is not done with us, not yet. As the virus continues to adapt, we also need to adapt. And that means keeping an eye on what's going on in our community and paying attention to our individual risk factors. Masks, vaccines, and all the things we've discussed remain the best way to keep yourself and your family safe from COVID. Thanks for listening.

Speaker 1 (27:20):

Continue your journey to living a smarter, healthier life. Visit beaumont.org/podcast to access information and resources related to today's podcast.