COVID Update (01/2022)

It is January 2022 and many areas across the world are steeped in COVID cases caused by the Omicron variant. As we struggle to treat our patients, here are a few updates that may be relevant to your practice.

  • Hospital Capacity: Hospitals across the U.S. are reporting increasing numbers of patients. Although the Omicron variant is reported to cause less severe disease, the increased number of people infected simultaneously is believed to be responsible for the high number of hospitalizations. This month, the number of COVID related hospitalizations in the U.S. exceeded any other point in the pandemic. As of January 12th, 2022 the U.S. Department of Health & Human Services is reporting 151,261 patients currently hospitalized with COVID-19.
  • A Turning Point: The crisis is showing the possibility of improvement. Cases in the District of Columbia appear to be taking a step downward. Additionally, the rate of new cases in the New York City metro area also appears to be slowing. The Omicron surge was predicted to peak in January in many metropolitan areas and heavily populated states. This is welcome news.
  • Similarly, cases abroad in the U.K. Also appear to have peaked.
  • Vaccination Benefit Against Omicron: The New York Times data from New York City and Seattle on hospitalizations for COVID continues to show a clear benefit to vaccination. Though there have been increasing reports of breakthrough cases (vaccinated and boosted patients contracting COVID) this data from the NYT shows that a significantly smaller number of vaccinated patients contract the illness, are hospitalized, or suffer death from COVID, even during this Omicron surge. For the vaccinated, this remains welcome news.
  • Therapies Against Omicron: There have been a number of therapeutics shown to be of benefit against Omicron, that have been approved by the FDA. Though all of these are still in early production or in short supply, this is still welcome news in the battle to end this pandemic
    • Glaxo Smith Kline’s monoclonal antibody, Sotrovimab, is reported to be effective against Omicron. It was given emergency authorization by the FDA for the treatment of patients 12 years and older in May, 2021.
    • Astra Zenaida’s long acting monoclonal antibody, Evusheld, is also reported to be effective against Omicron. It was given emergency authorization by the FDA in December, 2021, for pre-exposure prophylaxis in high risk patients 12 years and older. Its use has not been authorized for treatment or post-exposure prophylaxis.
    • Pfizer’s tablet Paxlovid (nirmatrelvir and ritonavir) is also reported to be effective against Omicron. It was given emergency authorization by the FDA in December, 2021, for use in high risk patients 12 years and older who are NOT hospitalized.
    • Merck’s tablet Molnupiravir is also reported to be effective against Omicron. It was given emergency authorization by the FDA in December, 2021, for adults 18 years and older who are NOT hospitalized. There is a warning against its use in pregnant patients.
    • Both Pfizer and Moderna CEOs have publicly stated that the companies are developing COVID vaccines targeting the Omicron variant, which may be available as early as March, 2022. This commentary by Professor Deborah Fuller helps explain how the process of updating mRNA vaccines works and how long the process might take.
  • Anticoagulation: The National Institute of Health updated its guidelines on anticoagulation of COVID patients on January 5th, 2022. They now recommend full dose anticoagulation with unfractionated or low molecular weight heparin for hospitalized patients who Do Not require intensive care. The decision was reached after a handful of studies showed a benefit in this population. Counter intuitively, the same studies showed no benefit in ICU or critically ill patients receiving full dose anticoagulation. The recommendation for the critically ill is still prophylactic dosing. Oral anticoagulation with direct oral anticoagulants (DOAC) remains a question in need of more published data. The complete COVID treatment guidelines can be found here.

Be safe,

Sam

For Further Reading:

Covid-19 Omicron There are over 20 known variants of SARS-CoV-2, the virus that causes COVID-19. Many of these have been of little significance to people who are not epidemiologists…

Practical Protocols for Managing Patients With SARS-CoV-2 Infection (COVID-19) in the Emergency Department Interdisciplinary teams at Mount Sinai Health Systems in New York developed protocols for management of COVID-19 patients. This February 2021 update of the 

COVID-19: The Effects on the Practice of Pediatric Emergency Medicine Summary and review of the results of a survey of 65 pediatric emergency department leaders in the U.S. and Canada.

4 thoughts on “COVID Update (01/2022)

  1. Early Remdesivir September 18 2020 to April 8 2021 in a trial of 279 patients (Treatment) and 283 (placebo) saw a reduction in hospital admission by 87% .
    2/279 (0.7%)in Remdesivir treated group went to hospital Vs 13/283 (5.3%) placebo going to hospital .
    Gottleib Robert L et Al NEJM 22 December 2021
    What is the view on this in that Remdesivir is available ?

  2. Molnupiravir, Sotrovimab, Remdesivir have been tested on unvaccinated, naive subjects. Does anyone have news about the influence of serological status (vaccinated subject, relapse, etc.)? If you want to use monoclonal, is it useful to determine the BAUs first?

    1. Hi Wolfgang. You pose a great question. Unfortunately, there is no evidence available to answer your question. The Remdesivir outpatient trial published in NEJM specifically excluded patients with prior vaccination or infection. Similarly the Pfizer trial of Paxlovid, published by Pfizer, also excluded this population of patients. So there is no evidence available on which to base an answer. At this point, I would say it is not useful to know a patient’s antibody levels (BAU) as there is nothing available to help us determine what to do with that information.

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