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Covid. It’s On. Again. [1]

['This Content Is Not Subject To Review Daily Kos Staff Prior To Publication.']

Date: 2023-12-21

Perhaps you want to be less of a sitting duck for the holidays with Covid, flu, and RSV on the prowl.

I’m broadcasting a quick heads up from my small examining room in the real world of primary care. I live here. The media and news sources are right - Covid, RSV, and influenza are surging right now. This was predicted. It’s the right time of the year. Vaccine and booster uptake has been abysmal. And some scientists believe Covid may be damaging our collective immune systems to varying degrees, kids included. No one wants to hear that. But if you want a very credible deep dive into the theory that immune system dysregulation is potentially occurring with each Covid infection, please review this resource from Memorial Sloan Kettering, or this less alarming review by Your Local Epidemiologist, or the worst case scenario in this cherry-picking of the most concerning studies.

Suffice it to say that we’re all going to get Covid, it’s not great to keep getting it, and most of us have already had it at least once. Hospitalization and death rates are not confirming any levels of widespread immune system problems to panic about… but trends are worth watching, and erring on the side of precaution.

I’m going to present a quick local update. I’ll review the bigger RSV, Covid, and influenza picture. JN.1 is the variant of greatest concern. We will touch base on ways to reduce risk during family gatherings over the holidays. We can commiserate about how depressing this pattern of diseases surging around the holidays has become each year. And finally I’ll reveal how I truly feel about vaccination and antiviral treatment, for any of you who are still in doubt!

Local conditions

Here in Jersey I can report that the hospitals in my health system are all reporting being at or near capacity in terms of inpatient beds available. I sent a person to the ER from my office this morning, and called triage as I normally do. The ER triage nurse told me the hospital has no available beds. She cited Covid, influenza, and RSV as driving much of the crunch, in addition to cardiovascular events. Patients were not necessarily old, and many in the ER this morning were reportedly in their 40’s-50’s. I can’t confirm that, but my health system sent out an urgent message reinstating masks for staff, as many of us are going out with illness. Staffing becomes a predictable problem again. Patients were strongly encouraged to wear a mask, though few did today even when prompted. I have not taken my mask off in the actual examining rooms since March, 2020 by the way, so no big deal for me to comply.

Bigger picture

RSV, influenza A, and Covid are increasing rapidly. In some areas exponentially. The JN.1 variant is very contagious. The World Health Organization named it a variant of interest. Furthermore:

The WHO said JN.1 doesn't appear to cause a higher public health risk than other SARS-CoV-2 variants, but it warned that it could trigger a surge in COVID-19 alongside rises in other viral and bacterial infections, especially in countries entering their winter seasons—a combination of factors that would worsen the respiratory disease burden. The WHO said JN.1 appears to have higher immune-evasion properties than the BA.2.86 parent virus. The agency added that, despite some reduction in JN.1 neutralization, evidence so far suggests that the monovalent XBB.1.5 vaccines are likely effective, and scientists around the world are actively monitoring the impact of the vaccine.

RSV seems to be peaking, which means there is a lot of it. CDC influenza maps are getting uglier. I am also seeing people with back to back infections involving some mix of these three or another virus.

Ways to reduce risk over the holidays

Some ideas, updates, and reminders:

~

Ok, it’s time to go shopping now. I thought it was important to get this out with the general sense of alarm in my health system today in particular. Full hospitals before Christmas is not good.

We should find comfort that most people are doing fine with their Covid infections. I see and treat these on a daily basis. But some don’t do well, hundreds of Americans are still dying each day, thousands are picking up long haul syndromes, and we don’t know what Covid’s long, long game has in store for us. So at this time I prefer to reduce my risk when I can, while still being a social human being who needs a hug, and tall, stiff glasses of eggnog like everyone else.

Take good care. Join me on Substack as a New Year’s resolution to miss fewer vital and overlooked ideas in primary care. Article first published here.

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