 And joining us to talk about your health is Dr. Niharika Khanna, a family and community medicine physician at the University of Maryland Medical Center and a professor of family medicine at the University of Maryland School of Medicine. Doctor, thank you so much for joining us. We're almost three years into the COVID pandemic and it continues to change rapidly, which we will get into. I'm curious what's been happening in your practice over the last month or so since the holidays? Thank you for inviting me. It's a pleasure to be with you. And thank you for asking me to talk about COVID. There's a lot that's been going on with COVID, not only for the last month, but really for almost three years. That's all we've been doing is COVID and all of the fall out from COVID. So since the last fall, I'm going to say there has been a lot of progress in vaccines for children and for pregnant adults. There's been a lot of work on that. There have been some emerging new guidelines that have come up around vaccination. And it really, it's all about trying to understand this COVID virus, which has been mutating at an unbelievable speed and trying to keep up with the strains that are circulating in the environment. And what we've seen is that the XBB strain has really taken over the community at large. So we are seeing that as our dominant strain and good for us that it is susceptible to the vaccines that are available now, which includes the biavalent vaccine, which also has the old strain and the newer Omicron strains as well. It has also led to some thinking around how many vaccines we are going to give people. Are we going to just vaccinate them every time we see a new strain? Or are we going to come up with a plan that is more sustainable, which looks at a trajectory of evolution of this virus and tries to devise a strategy and not just a vaccine strategy, but that includes preventive measures like ventilation, like wearing a mask, washing your hands, and trying to protect yourself if you're immunocompromised and also utilizing the therapeutics that are available. One of the things that also happened in the last month is that a drug called evouchel, which we were using in prevention for our immunocompromised patients, which immunocompromised meaning those patients who are either on steroids for any health reason or they have cancer or perhaps a transplant. These patients had the ability to get this medication called evouchel, which would protect them. And that particular drug has been, the authorization for that has been withdrawn by the federal government because the circulating strains, more than 90% of these do not respond to the evouchel, so that's gone away. Doctor, I'm curious about the circulating strain now and how it affects, I guess that's one treatment that was knocked out. Has it affected other treatments? Do the home COVID tests still work, for example? So that's a very good point. And a lot of discussion has gone on in media and the scientific circles on these home tests. And there is some concern that some tests might be better than others. Some are not good at all, people are saying. Now, when you evaluate them more systematically, you find that the differences between the home tests is very small. So they are effective tests. So in a sense, if you've taken the specimen properly, you know, you went up your nose, you rotated it five times, tried to do it in both nostrils, and then you put it into the tube and follow the instructions. They're a little bit different, for most tests, but majority of the time you have to wait for a period of time and then look at a color coding that appears. If you do them right, they're very similar in their predictive value. You know, in a sense, in the number of tests that are positive for patients who are infected is very good. So I would say if you can get a home test and utilize some of the pre-tests that are available to you through your libraries, through your local health departments, I think you should get them and keep them in the house and test yourself as needed. The other interesting thing is to utilize a process called test to treat. That is something the government has been trying to promote, which is establishing centers around Baltimore City, for example, and all over Maryland to make available to you centers that will test you. If you walk in there and say that I had a significant exposure, and it's been four or five days, I'd like to get tested, they'll test you. They'll also tell you whether they can give you the medication to protect yourself a little bit, you know, at least somewhat protect yourself from going to the hospital. Doctor, so many people seem to have mentally moved on from COVID. If you walk through the airport, you walk through the grocery store, you see, I don't know, maybe 10% of people wearing masks at this point, no longer concerned. Maybe they've had a vaccine, maybe they've been infected and think they're protected in some way. What would you say to that group of people? Are they right? Yeah, that has been an unfortunate reality of our times. I think when I go out into the communities, which have been doing for a number of different grants that I have been working on, what you find is that there are people who just don't want to talk to you about COVID anymore. They're over it. You know, they think, okay, well, it was a bad situation in 2020, and then there's all this hype going on with various entities such as government, such as industry, who are talking to us about various drugs, which they want to sell us, and we don't want to be party to any sort of experimentation. There is also a lot of misconceptions out there, you know, that I cannot be really sick. I am not the person who's going to die. This is really prevalent in younger populations who just don't want to see any more vaccinations out there, which is very unfortunate. I would say to everybody that you don't have to look at the country. You want to look at Maryland and realize that there have been 1.3 million cases in Maryland alone. And today, there are 677 people sitting in the hospital sick. They're not all old. They're not all your grandparents and your other older relatives. A lot of them are younger, and they may have a known chronic condition, you know, such as a bad lung condition, perhaps a bad heart condition, maybe diabetes, or they might be healthy and did not know that they had a condition. And some of those people are now being diagnosed in the hospital. So I would say to people that you need to remember that this virus hasn't gone away. It's a very difficult virus. It has been running this race with us over almost three years now while we're trying to catch up with it with proper vaccine, proper medications, proper preventive measures, and we haven't quite got it 100% yet. So we all have a duty to help ourselves by trying to not be exposed to this virus. And you can do that by proper ventilation. You know, you can try and get yourself in a place where the virus has a chance to circulate out. And you can also try to wear that mask if possible, when sometimes people will come back and tell me they can't breathe in the mask, which I know is sometimes very difficult to wear endlessly. But when you're in a group setting where you don't know whether other people have been exposed or other people might be sick, it's a good idea to either not be there or to try and protect yourself in some fashion and wash your hands. Doctor, question for you about the flu this year. Maybe I've become an amateur epidemiologist through all of this. I was looking on a regular basis at the CDC's flu map. And it's spread across the country and everything was red, and I ran out and got a flu shot. And that was December, now it's January, and it seems to have receded. Does that match with what you're seeing in practice? And is that maybe a hint that COVID could do the same at some point? Well, that's an interesting thing you bring up. Now, if you're going to talk flu, we should also bring in RSV, which is a third virus. You know, there are three major viruses this fall and winter. And that is COVID, the influenza virus, and the RSV virus, which is the respiratory syncytial virus. The respiratory syncytial virus had a sort of a peak around October, November, and then it has slowly started to come down. Influenza started late this year. And influenza has been very interesting because of the masking and all of the other preventive measures that have gone on. The whole influenza map has changed. In the past, I could tell you almost exactly when a flu would arrive in Maryland, in Baltimore, and when it would start to recede. But now, because people have not been exposed for a couple years, they haven't seen the influenza virus, the whole immune system hasn't been attuned to what's going on in the communities. And we're seeing influenza appearing a little bit later. And it is still here. We're still seeing influenza in the patients that are presenting to us in our immediate care, knowledge, and care settings in our own practice. And we're still trying to keep up with them. We're still trying to tell them that when you're in a party with a family party, you know, we've just come out of a bunch of Christmas, New Year's, and then there was a large holiday where thankfully most people were outdoors at the MLK event doing service, which was somewhat protective, I think. But when you're indoors and you're sitting with multiple people, like I said, where the vaccination status is. Dr. Niharika Khan, I'm afraid we're going to have to leave it there. Thank you so much for joining us. Thank you. It was a pleasure to talk to you. Your health segments are a co-production of Maryland Public Television and the University of Maryland Medical System.