Yep,
It's a COVID update.
Heading back to school, cooler temperatures today reminiscent of the fall, canning everything in my garden....it is time. We are heading indoors folks and here is what you need to know.
Most of us are no longer wearing masks. My staff took their masks off a couple of months ago and we have enjoyed that freedom. I will advise them to put the masks back on next week. We need to be prepared for an influx of upper respiratory infections caused by the flu, RSV and COVID-19. It's tough to distinguish between these three. They can all present with the same symptoms. Because we see so many of these patients in the fall and winter and in expectation of a huge surge in mild to moderately ill children and adults, the masks will go back on. I will also strongly recommend that all of my staff get vaccinated. Because I am the oldest and I am not 60 yet, we are holding out for the new Moderna vaccine which will be omicron XBB variant specific. It's been about 8 months since our last vaccine.
So, what the heck is XBB and what about this new and very different variant? XBB.1.5, XBB.1.16 and XBB.2.3 are all COVID 19 viruses that are members of the Omicron sub-variant family. XBB has been the most common COVID-19 virus circulating in the last year globally taking over the BA-4 and BA-5 Omicron sub-variants and causing most COVID-19 infections world-wide. Thankfully, the infections caused by XBB have been mostly mild to moderate upper respiratory tract infections with serious illnesses occurring mainly in the elderly, the immunocompromised and those with chronic health issues. COVID-19 still causes 40 deaths a week in Canada.
Most low risk people had their last vaccine last fall and early winter and most of us received the Pfizer bivalent vaccine which protected against BA-4 and BA- 5 viruses. Over the course of the spring, the number new cases of infection dropped steadily and dramatically and then settled into a low level of infection throughout the summer. But then XBB slowly became the main circulating virus and cases are now increasing as we head into the fall.
What does that mean for people who are considering their next vaccine? Both Moderna and now Pfizer, have created a new vaccine that is XBB specific and very effective at reducing the risk of serious illness and reducing the spread of the virus. The XBB specific Moderna vaccine should be available in Ontario by mid-October just around the same time that flu shots will become available.
The good news is that the XBB specific vaccines are also proving, in pre-clinical data, to have some efficacy against the new variant of concern that is now circulating, EG.5.1 or Eris. (Please stop reading and have a cup of tea or your favourite summer beverage on your porch if this is triggering any traumatic memories. That's where I am headed after this).
What EG.5.1 does remains to be seen. Of interest, the original COVID viruses, Delta, Beta, Alpha are now extinct. That's what mutated and more transmissible variants do. They wipe out all pre-existing viruses as they become the dominant circulating strain. Yeah, I am still a geek when it comes to this stuff.
And here we go with recommendations:
1/Most healthy people under the age of 65 whose last COVID vaccine was more than 6 months ago should wait for the XBB specific Moderna vaccine. We can wait because the majority of the population in Canada has already developed longer lasting protection against serious illness after multiple rounds of vaccine, illness or both. There will be lots of the old Pfizer bivalent vaccine in freezers out there so make sure you ask for the Moderna XBB vaccine. The recommendations will be that this low risk group consider getting a COVID vaccine annually from this point on.
2/ Anyone at higher risk of serious illness including adults older than 65, pregnant people, people who are immunocompromised or with serious underlying acute or chronic illnesses should be vaccinated every 6 months. Because we are so close to having the Moderna XBB variant specific vaccine in Canada, I am telling my patients who belong to this group to stay safe, wear a mask and avoid indoor gatherings until they receive this vaccine.
3/ It is considered safe to get your flu shot and COVID vaccine at the same time.
4/ Health Canada is actively reviewing submissions for updated vaccines for children six months of age and up. No recommendations for this group presently exist.
This post is getting a bit long but I do want to add some important information about the Rapid Antigen Test ( RAT). The RAT test was designed to detect the original COVID viruses. Some studies suggest that the RAT test is only about 20 % effective at detecting the newer variants of COVID-19 including XBB. It is important to be able to test for COVID -19 for so many reasons but especially in at-risk groups who are eligible for the anti-viral, Paxlovid. Paxlovid reduces the length and severity of COVID infection but a person needs a positive test to receive this medication from their primary prescriber or their pharmacist. The medication is taken twice daily for five days and needs to be started within 5 days of the start of symptoms in order to be effective.
So how do we test? You are not going to like this. We still use the RAT but we test at five sites for 5 seconds at each site: inside the lower gum line on both sides, the back of the throat and deep into each nostril. Yep. Hold and twist the swab for 5 seconds at each site. I don't think I can hold a swab at the back of my throat for five seconds without gagging and possibly vomiting so lets hope a new RAT is available soon.
More updates to follow and please leave your questions in the comments section. That will help me as I generate new posts.
Anne-Marie
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