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This is a weekly Q and A column written by Dr. Lydia S. Segal, M.D. in conjunction with Chaffee County Public Health. This column is focused on questions readers have about COVID-19 news and sciences.  As Segal points out, ‘Everything I write today is valid for today. COVID-19 news and science are rapidly evolving, assume updates will be made”

QUESTION: “What is the difference in the immunity induced by the infectious route, i.e. getting COVID, and the vaccinated route?”

Lydia S, Segal, MD, MPHANSWER: Two large studies in the last several months, one in Israel and one in the U.S., have analyzed this question with different results. The Israeli study released this summer (and still in preprint) looked at people who had COVID, people who were vaccinated, and people who were both vaccinated and previously had COVID. Their preliminary findings suggest the strongest immunity is in those that had both COVID and been vaccinated. The next highest group is those who had COVID.

The even larger study done in the USA at multiple centers in many states, including Colorado, looked at similar groups and found vaccinated people had stronger and more lasting immunity.

This question comes up for people who have had COVID but are hesitant to get vaccinated. The data shows those over 65 years of age should, at the least, get one dose of an mRNA vaccine. Keep in mind that the severity of the COVID symptoms one experiences is NOT related to the immunity they possess in the future.

The other question, how long does infectious-induced immunity last compared to vaccine induced-immunity, has not been answered as the data is still too early to be analyzed.

QUESTION:  There any medications in the pipeline that are specifically designed to be antivirals for COVID? 

ANSWER: In fact, there are several oral antiviral medications for COVID expected to be approved in the next several months. These are to be used if an individual is COVID-positive and must be used in the first few days of symptom onset, similar to how Tamiflu works when one is diagnosed with influenza. Pfizer’s drug, Paxlovid, is reported to reduce the risk of hospitalization and death by 89 percent. Merck’s drug, Molnupiravir, reduces these risks by 50 percent. We do know that these medications do NOT eliminate the need for vaccinations. Vaccines remain the front line for disease mitigation including transmission and severity of symptoms including hospitalization and death. Remember that vaccinations prevent the large majority of transmissions and infections. The antivirals are targeted to work only once you are already sick.

QUESTION:  Are there any drugs that are being repurposed for the treatment of COVID?

ANSWER: Several drugs including colchicine, ivermectin, hydroxychloroquine, an antidepressant in the SSRI category and interferon have been studied in clinical trials to see if they would be helpful in the treatment of moderate to severe COVID. These medications, while already on the market for other medical conditions, have NOT been shown to be effective in multiple studies. The endpoints in the studies looked at reduction of moderate to severe COVID resulting in hospitalization.

QUESTION: A reader asks about side effects he can be expected to have when getting his booster.  He mentions that he had a breakthrough case after being fully vaccinated with one of the mRNA vaccines.

ANSWER: While there is data that the booster, whether it be the third vaccine in the case of either mRNA, or the second in the case of the J&J, produces fewer side effects, there is currently insufficient data on what the side effects are and their severity after a fully vaccinated person gets a breakthrough case and then gets the booster. Likely within a few months, there will be data. What is known, based on Israeli data released this month, is that people with lower antibody levels tend to get breakthrough cases. How high one’s antibody levels need to be to confer immunity is still unknown.

QUESTION: What is the flu season looking like for 2021-22 and does one need a flu vaccine if there wasn’t really any flu last winter?

ANSWER: There are divergent views from medical professionals on what the forthcoming flu season looks like. It is suggested to get a flu vaccine because most of us are not carrying any immunity from last year. One of the reasons there wasn’t much flu last winter was because most people were in lockdown and not out and about like most ordinary winters.

Flu vaccines are available throughout the county at drug stores and public health and doctors’ offices. The flu vaccine can be safely given at the same time as a COVID booster.

QUESTION:  Are there home testing kits to use before the forthcoming holidays to make sure we are all safe visiting and celebrating together?

ANSWER: As described in this column two weeks ago, there are several tests available. The state is sending (for free), two double packs of home rapid test kits to anyone who requests them. The log-on is easy and takes just a few minutes if my experience is typical and most easily done on a tablet or laptop. This is the link: https://covid19.colorado.gov/covid-19-testing-at-home

An example of how to use the kits might be for guests who are coming to your home on Thursday of Thanksgiving. Anyone traveling or with high exposure to others even though fully vaccinated would use a test on Thursday morning. If positive, they stay home, if negative, one can assume they are negative or at the very least do not have enough viral particles to be able to transmit the virus to others.

For more information about COVID and the vaccines, eligibility and appointments, see the links below. Pharmacies are getting small shipments of vaccines. Information will be posted on this news platform and on the county public health and hospital web pages.

http://chaffeecounty.org/Public-Health-Coronavirus

https://www.hrrmc.com/covid-19-updates/covid-19-vaccine/

Pharmacies with vaccine clinics:

Salida:  Safeway, Walmart and Salida Pharmacy

Buena Vista: Mt Shavano (LaGree’s), City Market, BV Drug and Valley-Wide Health,

If you have questions you would like Dr. Segal to address in a future COVID Q and A column, please write to arkvalleyvoice@gmail.com

By Lydia S. Segal, M.D., MPH