Of course covid hasn't gone away, we are entering a period of increased activity in the US now. (Note that reported new cases showed a slight decline, but hospitalizations are up; this likely reflects poor reporting of new infections.) If no new significantly different variants emerge, I don't think we'll see anything like last winter's covid surge. Individuals can now report home test results anonymously; if used extensively it would provide better understanding of disease activity.
Unfortunately immunocompromised and other high-risk individuals will need to weather this covid winter without much help from monoclonal antibody treatment and prevention strategies. Bebtelovimab is now unavailable for treatment due to poor neutralizing activity against current variants. Tixagevimab/cilgavimab (Evusheld) still is available for preventive management in very high-risk people due to lack of any other effective pharmacologic preventive measures, but Evusheld also is likely to be ineffective for the current variants.
Increasingly now our attention should also focus on what I call collateral damage, mainly through 2 mechanisms. First, the pandemic disrupted other respiratory virus transmission during its peak, meaning a lot of young children haven't seen our common respiratory viruses in their lifetimes. Also, a number of factors combined to lower general immunization rates across the globe. So, we have a large collection of non-immune people, including young children, at risk not only for covid but also for both common and previously rare (in high resource countries) infectious diseases.
The Mother of All Flu Seasons?
Well, no, but it's been tough and may last a bit longer. I haven't seen a flu map this bad in a long time (late October 2009, our pandemic year, is in the neighborhood; you can scroll back to see it at the same weblink).
Most of the influenza cases currently are H3N2 which is well-matched by this year's vaccine. It's still wise to provide flu vaccine to unimmunized children even if they have already had a documented influenza infection because both the 2009 pandemic strain of H1N1 as well as influenza B strains also are circulating and likely will increase later in the season. Olsetamivir is helpful for treatment of high-risk children with flu.
Be on the Lookout for Previously Rare Vaccine-Preventable Diseases
Measles probably represents our biggest risks for outbreaks and deaths worldwide, because of high transmission rate and severity of disease. It won't take much to see outbreaks in the US. Also, did you know England has already seen a diphtheria outbreak this year? The US is at risk as well. Pertussis is always around and could be more severe in the coming months; also watch out for more cases of otitis media (if poor pneumococcal vaccine rates), tetanus, and, as we've already seen, polio.
You Can Limit Collateral Damage
Pandemics and other times of upheaval have always affected immunization rates. However, I am struck by the degree of anti-vaccination campaigns and general misinformation we've seen in what should be an era of enlightenment and celebration of vaccine successes in the US. Frontline healthcare providers are an important countermeasure against this collateral damage. Don't miss an opportunity to reinforce this with your patients and families.
I am working part time at an FQHC on theEastern shore of Maryland, and I cannot believe the incredible number of families who are not vaccinating their kids. At all. They say vaccines are unsafe and don’t trust the government. They think doctors are shills for vaccine manufacturers. They are living in their own (un)reality, and it feels impossible to break through. Some of them are homeschooled, but some of them say it’s a religious decision on school forms when it is clearly not. It is infuriating and sad.
Yes, that is a tough situation. Some of these families are so entrenched in conspiracy theories and the like, even preceding the pandemic, that it is unlikely any healthcare provider can break through those beliefs. The best we can do is to offer to answer questions and ensure our availability to help as well as stress that we have common ground in that both parents and providers want what is best for the children.
Also important to understand is that some of these conspiracy concerns have roots in real life. I hope every healthcare practitioner knows the Tuskegee syphilis study story. This highly unethical study persisted until 1972, well beyond its origins in a time when penicillin was unknown and medical ethics didn't exist as such. Less well known but (in my opinion) as egregious is the Willowbrook hepatitis study where children institutionalized for intellectual disabilities were intentionally infected with hepatitis A virus.
Mission statements of most pharmaceutical companies include very altruistic language, but not surprisingly this sometimes falls awqy in search of profit, leading to disasters like the opioid epidemic. I highly recommend Dr. Marcia Angell's 2004 book, The Truth About the Drug Companies: What They Do to Deceive Us and What to Do About It (ISBN 0375760946).
For those parents who do want to learn, point them to high quality sites such as the CDC's Childhood Immunization Resources and the Vaccine Education Center in Philadelphia, though the latter sometimes is a bit heavy on the sales pitch in my opinion.
Hang in there - even if you change just one mind you've made a difference!