If you are tempted to go out into the world, I say GO. Enjoy the springtime!

COVID Update April, 2022

Dear ones –

In one sentence, my update on COVID is: For as long as it lasts, let’s enjoy this while we can!

Cases and hospitalizations around New Mexico are a tiny fraction of what we’ve seen. Our

vaccines are holding up extremely well when it comes to severe illness and hospitalization,

and as a community we are approaching numbers that suggest we may have real herd

immunity to help buffer us – come what may. If you get nervous watching trends in cases of

positive COVID infections, try to watch hospitalizations and deaths instead.

Yes, the Omicron BA2 sub-lineage is likely to take over as the dominant strain of the virus that

is circulating. It is more transmissible than the earlier Omicron subtypes, but that does not

mean it is destined to cause more severe illness and death. All of this is very good reason to

feel relief and optimism. Hospitals are no longer packed to overflowing, but our whole health

care community has been badly beat-up by everything that’s happened over the past couple

of years. This is a great time to see your dentist, get a mammogram or go see your PCP for a

checkup, but be patient – wait times for non-emergency care are going to be very long

for a good while yet.

PREVENTING COVID

You know the drill. Get vaccinated, wash your hands, and wear masks when appropriate!

MASKING

Masking continues to be one of our effective pillars of prevention. If you are in an area with

high rates of infection or have a high need for extra protection, I recommend the KF94, KN95

or N95 mask respirators– available at pharmacies and online.

However, I also believe that it is safe for fully vaccinated people to shed their masks in

most public places in New Mexico. I am currently using a benchmark of an expert

infectious diseases epidemiologist that I found helpful. His recommendation was that it

is OK to not mask in indoor public spaces as long as your community rate has a low

amount of circulating Covid – specifically, fewer than 20 cases per 100,000 population,

which you can find reported at either of the following links. (At the time of this writing,

Bernalillo County has 6 cases per 100,000 population)

CDC Prevalence Tracker: https://www.cdc.gov/coronavirus/2019-ncov/your-health/covid-by-county.html

New York Times Tracker: https://www.nytimes.com/interactive/2021/us/covid-cases.html

Outdoor and well-ventilated spaces are still safer than indoor spaces without good

circulation, and masks are still protective, especially if you have a weakened immune system

or are regularly around vulnerable people.

MORE BOOSTERS? HOW TO MAXIMIZE YOUR VACCINATION STATUS

All of you should have completed your original vaccine series (one dose of J&J or two doses of

Pfizer or Moderna) plus at least one additional booster. You should already have an account

on the NM Department of Health website - VaccineNM.ORG.

I recommend that you receive ONE additional booster with either of the mRNA vaccines

(Moderna or Pfizer), regardless of which vaccine you got originally. Side effects from the

booster doses are usually comparable to the side effects of the second dose of your original

series and can be mild or substantial enough to put you in bed for a day or two. Large,

swollen lymph nodes are a very common effect. Second booster shots (for most people, this

is the 4th shot) are a different story.

Fully vaccinated and boosted adults and children are still very well protected from

illness. Please be mindful of medically fragile people and small children in your life that may

be more vulnerable.

We are just now getting news about approval of a second booster, or a 4th shot, for

patients over 50 years old. Saying that a booster is “authorized” is not the same thing

as being “recommended,” and I am still waiting to see what kinds of guidelines follow in

coming weeks. Studies continue to come out showing that fourth doses of vaccines are

not meaningfully helpful for the large majority of the population – unless the patient has

a very abnormal immune system causing them to not respond to the first series.

The CDC will issue a guideline soon that is aimed at two important goals – keeping you

healthy as an individual, and keeping the population as healthy as possible as a

whole. When the guidelines suggest that you should consider getting an updated

booster, you’ll be able to register again through the state’s department of health

website: VaccineNM.ORG.

**** FOR PATIENTS WITH IMPAIRED OR ABNORMAL IMMUNE SYSTEMS

Your vaccination regimen is going to be different that the general public. If you have

moderate to severe immune system compromise, please be in touch with your docs to make

sure that you’re covered as fully as possible.

Moderate and severe immunocompromising conditions and treatments include but are not

limited to:

• Active treatment for solid tumor and hematologic malignancies

• Receipt of solid-organ transplant and taking immunosuppressive therapy

• Receipt of chimeric antigen receptor (CAR)-T-cell therapy or hematopoietic cell transplant

(HCT) (within 2 years of transplantation or taking immunosuppression therapy)

• Moderate or severe primary immunodeficiency (e.g., DiGeorge syndrome, Wiskott-Aldrich

syndrome)

• Advanced or untreated HIV infection (people with HIV and CD4 cell counts <200/mm3, history

of an AIDS-defining illness without immune reconstitution, or clinical manifestations of

symptomatic HIV)

• Active treatment with high-dose corticosteroids (i.e., ≥20 mg prednisone or equivalent per day

when administered for ≥2 weeks), alkylating agents, antimetabolites, transplant-related

immunosuppressive drugs, cancer chemotherapeutic agents classified as severely

immunosuppressive, tumor necrosis factor (TNF) blockers, and other biologic agents that

are immunosuppressive or immunomodulatory

IMPORTANT SCAM WARNING

The NM DOH has issued an alert that there is an active scam through which patients are

contacted by text message by agents stating that they will help schedule your 4th

vaccine shot. This text prompts recipients to enter personal information including

social security number into an online form. PLEASE BE VIGILANT. The NMDOH will

NEVER ask for your social security number by text or email.

TESTING

Thankfully the intense Omicron surge has passed, and our resources are back in good

supply. Rapid antigen tests are available over the counter. PCR tests are also widely

available again, with fast results, through the NMDOH

website: https://cv.nmhealth.org/covid-19-testing/ Being able to do a rapid antigen test at

home is going to come in very useful for almost everyone. We know that the Abbot BinaxNOW

tests and the Quidel QuickVue tests seem able to accurately detect the Omicron variant. I

would continue to stick to these two brands for now when you can. (Depending on your

circumstances, you may need to use two home tests, 2-3 days apart in order to be confident

in the results.)

IF YOU CATCH COVID

Effective medications are now widely available and should be used ASAP when an at-risk

person contracts COVID.

Please be in touch with with your physician immediately if you do catch COVID. The new

outpatient treatment options (some are pills and others are IV treatments) are incredibly

powerful and effective, but there is a very short window of time in which they need to be

prescribed. Not everyone qualifies for treatment, but A LOT of people do. Let your PCP know

so they can make sure to do everything they can to help you recover as quickly and safely as

possible.

QUARANTINE AND ISOLATION are still important for exposed or infected patients, so please

be mindful. We have learned a lot about when a COVID infection is contagious, and about the

incubation period, or when an exposure turns into an infection for those unlucky

people. Quarantine is what we do for exposed patients that are not yet infected but are being

observed. Isolation is the process for infected patients. The definitive guide that I use is

here: https://www.cdc.gov/coronavirus/2019-ncov/your-health/quarantine-isolation.html

That’s it for now! If you are tempted to go out into the world, I say GO. Enjoy the

springtime! Your mental health, physical health and preventive care are all important!

Dr. B