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Doctors: Clear different between vaccinated and unvaccinated in hospitals

Monoclonal antibody treatment is on hold as hospitals try to gather the right kind to treat omicron

Just get vaccinated.

That’s the message from doctors on the best way for people to treat COVID-19 as hospitals fill up and case numbers increase as the nation deals with the delta variant and even more infectious omicron variant. They say getting vaccinated will keep people out of the hospital in the first place.

“The point of the vaccine is to train the immune system to deal with the virus before it is over run,” said Dr. Irfan Hafiz, infectious disease specialist and chief medical officer for Northwestern Medicine’s McHenry County hospitals. “That has been the most reliable way. We’ve seen [that COVID-19 cases in vaccinated people] tend to be much milder, require much less oxygen, have a shorter duration of hospitalization and more likely to recover with minimal long-term effects.”

The overwhelming majority of COVID-19 patients in local hospitals are unvaccinated, Hafiz said.

“There’s a clear difference between the vaccinated and the unvaccinated,” he said. “One is going through a car crash without any breaks or air bags. The other one is going through a car crash with anti-lock breaks and seat belts.”

For people who do get COVID-19, especially those who are at high risk for severe illness, there are treatment options. People can receive an infusion of monoclonal antibodies, which target the virus’ spike proteins that allow the virus to infect cells.

“We’ve seen some reduction in complications and hospitalizations as a result of that, but it’s not perfect,” Hafiz said. “It’s also a timing issue because it’s only effective if given within the first 10 days and it’s only effective if given before hospitalization.”

Jillian Evans, RN, a nurse at Northwestern Medicine McHenry Hospital, prepares to enter the room of a patient on Dec. 13, 2021.

Monoclonal antibodies are manufactured and need to be prescribed by a doctor, according to Northwestern Medicine, which means not just anyone can receive them and supply is limited. They are usually given at hospitals.

There’s also another problem with monoclonal antibodies, which were given emergency-use authorization by the Food and Drug Administration in 2020. Not all monoclonal antibodies are effective against the omicron variant and as a result, local hospitals have stopped giving out the treatment temporarily.

“The latest data shows that currently available treatments, which have been used to prevent severe illness and hospitalization, are not effective against the now-dominant Omicron variant,” Advocate Aurora spokeswoman Katie Dahlstrom said. “One monoclonal antibody treatment, Sotrovimab, is expected to be more effective against Omicron. Demand is high, but we expect to get an allotment in the coming days.”

Before Christmas, the FDA also gave emergency-use authorization to pills manufactured by Pfizer and Merck, which health official hope will make it easier to get people treatment for COVID-19. Pfizer’s pill is 90% effective at reducing hospitalizations among high-risk people.

This image provided by Pfizer in October 2021 shows the company's COVID-19 Paxlovid pills. U.S. health regulators on Wednesday, Dec. 22, 2021 authorized the first pill against COVID-19, a Pfizer drug that Americans will be able to take at home to head off the worst effects of the virus. (Pfizer via AP)

However, accessibility issues exist for those drugs as well. Patients need a positive COVID-19 test to get a prescription, the Associated Press reported. And Paxlovid, Pfizer’s pill, has only proven effective if given within five days of symptoms appearing. With testing supplies stretched, experts worry it may be unrealistic for patients to self-diagnose, get tested, see a physician and pick up a prescription within that narrow window.

Hafiz said even with approval for the pills, vaccination is still the best thing people can do to stay out of the hospital. Other avenues, including natural immunity, are not as effective.

Raul Mendoza, a pulmonologist for Advocate Aurora, said natural immunity lasts only for up to three months, but sometimes even shorter. Omicron may also cause prior infection to be less protective, he said.

However, those who are both fully vaccinated and recently had a prior COVID-19 infection have the most immunity, Mendoza said. That’s why doctors push people to make vaccination their treatment method.

“The benefit of the vaccine always outweighs the risk in every age group,” said Rob Citronberg, executive medical director of infectious disease and prevention at Advocate Aurora.

Hospitalized patients can still receive treatment like remdesivir, Hafiz said, but the goal with vaccines is to keep people out of hospitals.

Brian Gomez, of Carpentersville, holds his daughter Eden, 5, as she gets her first dose of the Pfizer vaccine from nurse Maggie Juarez on Friday, Dec. 3, 2021, at Advocate Children's Medical Group in Crystal Lake.  Children ages 5 to 11 are now eligible for COVID-19 vaccines.

Other forms of treatment that have swirled around the internet such as ivermectin are not the best options for patients, Hafiz said. Ivermectin is an anti-parasite drug that targets worms in the body, not viruses. He said even when the drug was tried in laboratories on viruses, the drug more often targeted the host, which in this case would be a person, not the virus.

“It’s not stopping the replication,” Hafiz said. “Unfortunately, a lot of this has been taken out of context and propagated as a cure.”

About 25 times the normal amount of the drug has been used in the U.S. recently, Hafiz said, and many people are overdosing on it while attempting to treat COVID-19.

To truly slow the spread of COVID-19, getting as many people as possible vaccinated is key, Hafiz said.

While some argue the high rate of the virus’ spread, now even among the vaccinated, shows the vaccine is not working, Hafiz said it’s because herd immunity hasn’t been reached, which he estimates will occur when close to 80% of the population is vaccinated. Illinois is currently has 60% of eligible people fully vaccinated, according to the Illinois Department of Public Health.

“The goal of vaccination is always twofold. It’s not just to prevent disease in you, but to prevent you from transmitting to others,” Hafiz said.

When more variants arise, the herd immunity threshold increases, Hafiz said. People will know the population has reached herd immunity when the number of cases drops off suddenly as opposed to a linear decline that has been seen throughout the waves of the pandemic.

“It’s very important that we’re reducing the spread through vaccination. That’s more than half the purpose of getting everyone vaccinated,” he said.