 Joining us to talk about your health is Dr. Greg Schrank, infectious disease physician and hospital epidemiologist at the University of Maryland Medical Center and assistant professor of medicine at the University of Maryland School of Medicine. Dr. Thank you for being with us at our taping time. What are we seeing in the community in terms of COVID? Yeah, thanks for having me, Jeff. I think what's been pretty clear and it's been reported widely in the news is that we've been seeing lots of transmission of COVID in the community. This is in contrast to earlier in the spring and the first half of the summer when we saw very, very little COVID. With transmission, of course, we've also seen some increase in hospitalization, albeit a modest amount, nothing compared to what we've seen during prior wintertime surges. And I think in comparison to where we were in the summer, though it's increased, we were starting at a very, very low level of hospitalization. So there's some COVID out there. It's causing some disease, but not yet a cause for high alarm. What I saw the last time I looked at the state data, yeah, it had been as low as maybe 50 COVID patients in hospitals statewide jumped up to about 250. As you say, it's been a couple of thousand at the previous peaks. Is there anything different about the disease that is hospitalizing these folks? Well, the landscape of COVID has changed dramatically since 2020. Much of that is due to our immunity, both at the individual level and at the population level. Most U.S. adults, almost all in fact, have either been vaccinated, infected or both. And that has huge implications for the impact that this disease has on us as individuals and as a health system and as a community. So while we're seeing lots of COVID in being transmitted from person to person, for the vast majority of individuals, this now appears similar to another upper respiratory infection or flu-like illness. But for those that are at high risk, it still poses a threat, and which is why we have another round of boosters, vaccinations authorized by the FDA and the CDC. Is it the case that it mutates to be able to evade people's immunity and vaccine immunity? But supposedly it, and maybe this doesn't always happen, but apparently it's been getting less severe. Is that true? Well, I think just going back to our immunity, that's what's helping us to avoid severe disease is that our bodies are prepared for infection. We have learned about COVID both scientifically and our immune systems. Our bodies have learned about COVID. What I think about, because I like to come up with either sports analogy, sometimes car analogies, but we'll stick to sports today, is that this is sort of like the off season, right? We're coming back into the next season. We need to go through some training camp to learn about our opponents. It's not that we've forgotten how to play football, right? We just need to shake off the rust a little bit and prime our immune system and be ready for COVID if we get infected. Well, who needs that boost to the immune system from another vaccine? Does every single American need to get one or is it people who are at higher risk maybe have not had it before and so forth? Well, starting with the CDC recommendations, the ACIP, which is a panel of experts that recommends to the CDC how to approach vaccination, they provide a universal support for the vaccine to be administered to anybody six months of age and older as long as they were at least two months out from a COVID-19 infection. That's important for a couple of reasons. One, is it now that we're outside the public health emergency, it ensures that immunizations will be covered by individuals' health insurance. That's to maximize uptake. We don't want people having to pay out of the pocket just to receive an important vaccine for their health. Another crucial component is that it's easy and it's equitable. Some people over a certain age are at risk simply because of their age, but we know that there are many others who are younger that have medical conditions that pose an increased risk to their health should they develop COVID-19. So the CDC wanted this to be broad, wanted people to have options and be able to discuss it with their primary care providers and other clinicians to help advise them as to whether or not they should receive the vaccine based on their risk. It's also the time of year when I usually, but not always go out and get a flu shot. And the idea of getting vaccinated for both at the same time, I haven't done that. It somehow makes me worry that I'm overloading my immune system, that's not a real thing, right? Well, it's a great question. And actually it's something that we didn't know entirely the answer to at the start of the pandemic either. And so research was done to look at receiving the two vaccines, both flu and COVID-19 simultaneously or separately. And the researchers found that receiving the two vaccines at the same time is not only safe, but it also maintains the same level of effectiveness as if you receive them separately. So for me personally, what I plan to do is just get them both at the same time. If I'm going to have some arm pain and a little bit of fatigue, maybe even a little bit of chills afterwards, I'd rather just get it all done in one swoop and know that I'm protected thereafter. One arm or both? It doesn't matter. I'll probably stick with one arm, but it's fine either way. In your practice around the hospital, who's wearing a mask these days? Is there no longer an order that anybody in the hospital visitors need to wear masks? Well, we take guidance from the Maryland Department of Health who previously, prior to the end of the public health emergency, had provided some guidance to health systems across the state as to when masking for patient care should be reinstituted and that's based on hospitalization rates. So we're not quite there yet. As I said, hospitalizations, even though they are up compared to the earlier in the summer, they're still relatively low. However, we, within the University of Maryland medical system, mask for both anybody who's at a really high risk, immunocompromised individuals that are in the hospital as well as any patient that requests it from their care team. And it's sort of a personal decision based in your age and your health status, I guess, and whether you might be in a situation where you're gonna be exposed. Yeah, that's right. For non-healthcare workers, for everybody else out in the community, this is definitely a decision that should be made based on what type of activity you're participating in, the number of people that will be around you and your own risk should you get infected with COVID-19. We know that high quality masks, things like the KN95s, multi-layered masks that are not cloth, but are made from medical grade material will be effective at preventing transmission. And so should you find yourself in the situation where you wanna go out, but you know that you're at risk and there's lots of COVID out there in the community or other respiratory viruses, RSV and flu, which we anticipate soon, that might be a good circumstance to put on a mask. Let's talk about treatment a little bit. If outside the hospital, somebody's in the community, they've developed symptoms, they've maybe they've taken a test, which we can talk a little bit about. And they have COVID. You have treatments available. How do you know whether you need to seek out medical care and an antiviral drug? Yeah, many of the same conditions that we think of as being high risk and priorities for getting vaccinated are the same for receiving treatment with antiviral medication. The most common one that we use is Paxilovid. That's the oral medication that can be prescribed. It's important that these meds are taken as early as possible after the onset of symptoms. Within five days is the general guidance for prescription of Paxilovid, five days of onset of symptoms. Anybody who's older in age over 65 and with one of those high risk medical conditions, which there's a long list of them, they can be found on the CDC website, but generally things like immunocompromised conditions, heart or lung disease, diabetes, those are the individuals that we wanna make sure if they are infected, have access to Paxilovid. How effective is it? Well, we know from studying the medication prior to widespread vaccination that it was very effective at preventing hospitalization and severe outcomes from COVID. What has been less clear because the studies just haven't been as robust in nature is how vaccination and prior infection impacts the effect that the drug will have, meaning that if you've been vaccinated multiple times, you've been infected at least once before, maybe you have all that immunity that we spoke about earlier. Does Paxilovid add anything in terms of protection from severe outcomes? The studies that have been done and they've been published in very well reputable journals, medical journals, suggest that there continues to be a benefit for those at greatest risk, especially those that are really older in age. But for others, it's a little bit less clear whether or not Paxilovid will add anything about vaccination. Does it change your odds of getting long COVID, which we could talk about a little bit. Is that, is it still a big thing and is there anything that we do that would increase or decrease our risk? Yeah, that's a great question. There have been a number of studies really at their, a bit late in the pandemic, frankly, and that they're urging of key stakeholder groups to invest in research and long COVID, really understanding why the curse and what can be done about it. And some of those studies are still ongoing, but it's thought that there may be some residual sanctuaries, so to speak, in the body of virus that are causing chronic inflammation. And vaccination actually has been demonstrated to reduce some of those symptoms, both boosting and vaccination prior to infection. So that's, I think, one primary area where people are concerned, whether that because of their own history or a history of a loved one of long COVID, boosting this fall is a great way to try to reduce that risk. Once again, this year, the Feds are covering the cost of at-home COVID tests that ended for a while. It's back as of today. Should everybody keep a couple around? I think it's helpful, especially for those that may find themselves calling up a provider to try to get a prescription for Paxilvid. That's really the way that you could try to figure out what's going on with yourself, also to avoid spreading to a loved one that's high risk as well. The public health emergency ending and the funding associated with it is probably the most tangible thing that people can experience right now that's changed compared to this time last year in terms of insurance coverage and whether or not things are costing out of pocket and tests being one of those. So taking advantage of the government providing free tests is sort of a no-brainer to me. I have a few tests at home that are either close to or past the expiration date on the box. And I know there's some discussion that maybe the test still has some value. That is somewhat dependent on the test itself. The FDA individually reviews these test kits and it varies based on the manufacturer whether or not they may have extended the expiration date based on their review of the performance of the test. Some of those may not have been extended, some have been extended repeatedly. So the best way to try to figure that out rather than buying new is to check the FDA's website and you can find by test manufacturer whether or not it's been extended. Dr. Greg Schrank, infectious diseases physician at the University of Maryland Medical Center. Dr. We appreciate your time. Thank you. Your health segments are a co-production of Maryland Public Television and the University of Maryland Medical System.