I have been dealing with covid patients in the last 3 months. Cases are now declining in my city and I am currently practicing in Tampa, Florida. Current dominant virus is BA5, which is a very transmissible omicron sub-variant. Original omicron does not attack the lungs. But BA 5 attacks lungs and is similar to one component of delta. In my hospital, most of the patients are of ethnic minority; blacks and Hispanics. Their vaccination rate is low. Most of the positive patients are totally asymptomatic. They were admitted for different reasons. However, elderly patients with multiple co-morbidities do not survive regardless of their vaccination status or early antiviral treatment (Remdesivir, Paxlovid mostly used as outpatient treatment and monoclonal antibody which is also used as outpatient treatment however use is limited because some variants escape binding by certain antibodies). We still have to be very careful with omicron subvariant. Covid mortality in US is 500 per day which is still really high. People stopped wearing masks, and only 60% of population took booster. Immunity wanes usually after 5 to 6 months of vaccination. So, we may need to get boosted at least annually.
There is no change in treatment guideline for omicron subvariant. Vaccine cannot protect infection but it can protect severe complications from covid. We give antiviral to only high risk patients with multiple co morbidities within 5 to 10 days of onset of symptoms. According to my last 3 months experience, most of my patients under the age of 65 survived. At least 50% of my elderly pts over 80 died from respiratory failure, pulmonary embolism and secondary bacterial pneumonia. We all realize that covid will never go away. Please be vigilant with wearing mask and keeping up to date with vaccination. In US, we will have bivalent vaccine that cover for new omicron subvariant soon.
Another emerging problem is monkey pox. Monkey pox is not fatal except in severe immunocompromised patients but patients who are infected with money pox will suffer the most severe pain of their lifetime. Incubation period is 5 days to 3 weeks. Most people will need to be isolated till the skin lesion heals which is approximately 30 days. Monkey pox can spread through close, personal, often skin to skin contact, including direct contact with money pox rash, scabs or body fluid from a person with monkey pox, touching objects, fabrics, clothing, bedding or towels and contact with respiratory secretions. Monkey pox lesions can vary from small pimple, rashes to variegated lesions. Most health care professionals are not aware of that patients can have different kinds of lesions. There were so many missed diagnoses in the beginning. Patient usually presents with viral prodrome plus lymphadenopathy before the skin lesions appear. Sometimes, skin lesion started before viral prodrome. As of September, there are 23,499 reported case of monkey pox in US with one death. Globally, 61,282 cases were reported with 20 deaths. FDA allows emergency use authorization of antiviral called TPOXX (tecovirimat) for monkey pox patients within 5 days of onset of symptoms. Vaccine can be used as a part of treatment if we can give vaccine within 5 days. Despite low case fatality rate, monkey pox is very painful and disabling disease.
We are current in 2 pandemic at the same time. Covid pandemic is far from over. Monkey pox is just started. Wearing mask, hand washing, vaccination and trying avoid close contact, are the only way to prevent getting infection and to prolong your longevity.
Reference
Covid-19, UpToDate www.cdc.gov/monkeypox
Author Information
Dr Thaung Han Myint MD
Hospitalist Physician
Tampa. Florida
