Every few months now it seems there is a “surge” of COVID-19 cases, and everyone worries aloud about a repeat of what happened here one year ago. In the community, it’s a constant concern for people as they see case numbers go up and down and up again.
However, in the Emergency Department at CHA Everett – and at many hospitals around the area – COVID has become just another type of illness that is being woven in with treatments for other things.
With a vaccine now being deployed, a better understanding of the virus, and more adherence to precautions, the shock and awe that exists in the community doesn’t exist so much in the hospital and there is more acceptance in the hospital ranks of COVID becoming another sickness to be dealt with – along the lines of influenza.
“In the last couple of weeks what has happened is that maybe we’re starting to see signs of what is in fact the new normal we’ve all talked about,” said Dr. Melisa Lai-Becker, chief of the Emergency Department at CHA Everett. “We are in the mode of when you’re here and have COVID-19 related symptoms or we admitted you because you’re having congestive heart failure, now it’s just routine – we test you for COVID and send off the test to find out…We weave COVID-19 into all the planning we’re doing for care already.”
Over the past two or three weeks, she said the Emergency Department could have a dozen to 20 patients with COVID-19 at any one time. Most of them are on the medical floor and the treatment is not complicated and there are far-fewer patients in the ICU – and in fact on Monday there were no patients in the ICU with COVID-19 issues. That relative calm in the hospital treating cases of COVID-19 is in stark contrast to the reports of increased case numbers right now throughout Massachusetts and the East Coast – and the constant worry from so many that the horrors of April 2020 is a threat to repeat itself at any moment in 2021. Dr. Lai-Becker said they may not have all the answers, but there is so much better understanding of the sickness by those in the hospital and those in the public.
“I don’t feel we have all the answers as much as we’ve figured out what should be done,” she said. “A year ago we were wearing head-to-toe Tyvek suits, wiping down surfaces constantly and we were having trouble with PPE. Now we have wipes from our usual distributor and not homemade wipes. We seem to have enough in stock. People are wearing their usual work clothes to the hospital – meaning they’re wearing scrubs. It’s just standard now. You see it in the patients too. They come in and wear their masks. They’re very good about it.”
So, with that “new normal” of COVID treatment and reaction, it strikes a question up about what COVID is now. Though everyone must remain diligent in taking precautions to prevent it from spreading, perhaps it should no longer be viewed by the public as the killer it was when it presented itself to America one year ago.
The discussion amongst virologists and doctors and other health care workers, Dr. Lai-Becker said, is that COVID could be another type of sickness that will be with us for some time – like influenza. Are we experiencing a fourth surge, or like influenza, has COVID just mutated in the last year as influenza has mutated as well? It could be that we never get “rid” of COVID, but that we work moving ahead with prevention and understanding of what the virus is each year.
It’s a hard reality to grasp for those outside a medical setting, as everything has been pointed with great energy at eliminating the virus. However, it might instead have become more of a seasonal flu scenario.
“There is a lot of talk about a fourth surge,” she said. “You know we have the vaccine. Maybe what this is developing into over time is a flu scenario. Technically, it’s still a pandemic. But you now have variants and we’ll address each of them. People ask if they’ll have to have a new vaccine every year. Maybe. There are all these different variants. We are already used to getting the flu shot every year. Viruses are good at mutating.”
•Anti-Body Studies Revealed
Last June, about 8 percent of the hospital staff at CHA participated in a COVID-19 anti-body testing study – a study that potentially revealed who had been exposed to or infected with COVID whether they knew it or not. The body is known to develop anti-bodies for COVID-19 if a person has been exposed to or infected with the virus. So it was that within that small testing group, about 12 percent tested positive for anti-bodies. The meaning of that is still a little uncertain, but it shows that certainly more people in the hospital had COVID than was known in the early days of the virus in Greater Boston.
“When you extrapolate that backward and forward, though there were only 8 percent tested, it probably means that overall there were about 20 percent of us in June 2020 that had been exposed to or developed anti-bodies for COVID,” said Dr. Lai-Becker.
She said there are probably a lot of reasons, mostly though that testing wasn’t as prevalent and the understanding of the virus wasn’t as advanced yet.
“From a medical standpoint, it’s probably we were treating a lot of COVID patients and there was a lot of chance for exposure,” she said. “It probably also has something to do with PPE, which we hadn’t figured out that well yet. My own thought is there is no way we’ve had 20 percent of our staff with symptoms out from work. That probably also shows in all likelihood there’s been a lot of asymptomatic people walking around.”
The coming of seasonal allergies has presented a problem for patients coming to the Emergency Room and also for staff – as the symptoms cross over very closely to those of COVID-19. So it is that a lot more testing is going on for those that end up just having the usual seasonal allergies.
“We’ve have a lot of employees that need to get tested because of seasonal allergies that create symptoms,” she said.
•A Better Flu Shot?
The advent of the COVID-19 vaccine has brought on the less-heralded perfection of using mRNA based methods for vaccination. The COVID vaccines are in fact the first mRNA-based vaccinations to be used on humans in large scale, though testing on that method of vaccine treatment has been ongoing for several years.
Now, with that process perfected, Dr. Lai-Becker said many in the medical and virology communities are wondering if it can be used to better predict how to best make the flu shot.
She said right now a lot of the annual flu shot is based on predictions that don’t always come true – at times the strain of the flu infecting the public is not the one that was contained in the flu shot. That’s because so often, providers have to have their flu shots by October and that means manufacturers have to begin making them in the summer. That leaves a lot of guess-work that many are wondering could be eliminated using the new techniques that gave the world COVID vaccines.
“Technically the flu is a pandemic,” she said. “For many years it’s something we’ve had a vaccine for. We went through the Swine Flu of 2009-2010. We created a new vaccine then. That’s where we are now. But now we have mRNA vaccines and DNA vaccines. It’s brought many to wonder if we can use the mRNA technology to make the flu vaccine more accurate.”