With Critical Care Pulmonologist Joseph Seaman, MD, & Infectious Disease Specialist Manuel Gordillo, MD
** NOTE: This content was published Jan. 11, 2021. Information related to the COVID-19, vaccines and treatments is continually evolving. For the most up-to-date info, we recommend visiting the CDC’s website.
If we’ve learned anything in the last 20-plus months, it’s that COVID-19 — and what we know about it — is constantly changing. That means health experts’ related guidance on how we can safely navigate the pandemic must continually evolve in response to these changes.
In this Ask An Expert Q&A, Sarasota Memorial Infectious Disease Specialist Manuel Gordillo, MD, and Critical Care Pulmonologist Joseph Seaman, MD, discuss our area’s COVID-19 surge, the Omicron variant, available treatment options, and when to get a COVID test (or re-test).
Preventing Illness & Slowing the Spread
The best thing that you can do to protect yourself from getting severely sick or hospitalized with COVID-19 is to get vaccinated. If you are fully vaccinated, get a booster dose as soon as you become eligible.
Your Omicron Prevention Plan
Get a booster shot as soon as you're eligible.
Wash your hands frequently and properly.
Choose outdoor gatherings over indoor.
When in public and indoors, wear a quality, properly fitted face mask (KN95 preferred) and social distance.
“It's clear from all of the other communities that have reported their data, not only in the U.S. but abroad, that boosters and primary vaccinations reduce the risk of severe disease,” said Dr. Seaman.
“They reduce the risk of hospitalizations, and they've reduced the risk of ICU admissions and death. That's the primary benefit of being vaccinated and boosted. It saves you from coming to the hospital, it saves you from severe illness and it saves you from dying.”
Is it time for a COVID-19 booster shot? If it's been more than 5 months since your last COVID shot and you had the Pfizer or Moderna vaccine, it’s time to get your booster shot. If you received the Johnson & Johnson vaccine more than 2 months ago, it’s time to get your booster shot.
What if I'm vaccinated but had a breakthrough COVID infection before getting my booster shot? With protection waning from vaccines received in early 2021, this unfortunately is becoming more common. If you find yourself in this situation, ask your doctor or care provider for guidance, Dr. Gordillo advised.
People who are vaccinated but contract COVID-19 before getting their booster dose can safely delay getting the booster shot for 60 to 90 days after they tested positive (or their symptoms first appeared), according to Dr. Gordillo.
"Most medical experts are now recommending that patients wait 2 to 3 months after infection to get the booster shot," said Dr. Gordillo, "because their recent infection offers some protection, and waiting will allow the immune system to reset and mount a more robust response to the vaccine booster dose.
"However, other experts, who are the minority camp, do suggest getting the booster shot as early as 2 weeks after recovering from COVID, because there is some evidence that it may help mitigate incidence or symptoms of long COVID," he added.
COVID Testing: False Negatives & When to Re-Test
There are basically 2 types of tests for COVID-19: molecular / PCR and antigen.
Molecular / PCR tests, which are very specialized and work by detecting the virus’ RNA, are generally analyzed in hospitals and big laboratories, and they aren’t yet available generally available for self-testing at home. These are the most reliable option early on in an infection, when virus levels are low.
Antigen tests — sometimes called “rapid tests” — detect the virus’ protein rather than detecting its RNA. The technology is more accessible and can even be used at home, but they're less sensitive and more likely to give an inaccurate result.
“When there's a lot of virus in the community — like right now — our main concern is false negatives from testing,” Dr. Gordillo said.
With Omicron running rampant in our area, Dr. Gordillo explained, re-testing is not necessary for people who test positive and have COVID symptoms.
“But, if you have symptoms and test negative, it could be a false negative. So if you're negative and have symptoms, repeat the test 24 or 36 hours later,” he added. “Don't just say, ‘Oh, I don't have it.’ You could have it, but you may be at a stage where the test just could not yet detect it. And that’s why you need to re-test in a day or 2.”
Click here to learn more about COVID-19 tests, including pros/cons of PCR and antigen tests, plus when to trust a self-test.
Outpatient Monoclonal Antibody Treatments for COVID
Seeking Monoclonal Antibody Treatment?
If you’ve tested positive for COVID-19 within the last 5 days and think you may qualify for monoclonal antibody therapy, talk to your doctor or specialist. They can begin the screening process and collaborate with a treatment center to determine eligibility.
Infections in the Sarasota area are now predominantly the Omicron variant.
“And the 2 early monoclonal antibody treatments (Regeneron and Eli Lilly) are not effective against Omicron,” explained Dr. Seaman. “But there's a newer monoclonal antibody called Sotrovimab that is effective against Omicron.”
Sotrovimab is in very low supply across the U.S; the health centers that are receiving shipments of the monoclonal antibody are getting only small shipments. To make sure the Sotrovimab is distributed most effectively, these care centers and hospitals are using a specific screening process and a tiered eligibility system to determine who gets the treatment; the system is based on who has the highest risk for severe COVID-19 and who would benefit the most from Sotrovimab.
“No matter whether you’re here in Sarasota or Tampa or Miami, everyone is using the same type of tiered system to focus the drug in communities that need it most,” said Dr. Seaman.
In this triage-style approach, the top tier — the patients with the most risk who would benefit the most from Sotrovimab — are pregnant women who are un-vaccinated and nearing their due date or having complications that could trigger early labor, and people who are severely immunocompromised, such as those with cancer in active chemotherapy, transplant patients and others with conditions and treatments that suppress their immunity.
Other eligibility requirements include a physician referral and that the treatment be given within 5 days of infection, when it is most effective.
“It's a really complex decision-making process,” Dr. Seaman said, and treatment centers are relying on community physicians to help in the screening process.
“For example, if the COVID-positive patient is a pregnant woman and she’s seeking the monoclonal antibody treatment, she should ask her OB doctor to start the process,” Dr. Seaman advised. “If the patient has cancer, they should speak with their oncologist, who would then contact the hospital and start that process.
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Sarasota Memorial’s blog posts, newsletters and podcasts are published to help you make educated healthcare decisions. Always talk to your doctor about concerns related to your personal health.