By Rosemary Ford and Caitlin Agnew

This article has been edited for length and clarity. 

Where do things stand with COVID-19? What other viruses do we have to worry about? On this episode of The State We’re In, Melanie Plenda talks with infectious disease expert Dr. Michael Calderwood, the Chief Quality Officer at Dartmouth Hitchcock Medical Center about what we need to know about COVID-19, flu, and RSV or Respiratory Syncytial Virus.

Melanie Plenda:

So, where do things stand with COVID-19? Are we seeing the usual false spike or something different going on?

Dr. Michael Calderwood:

We have begun to see an increase in COVID 19 cases in August and going into early September. We were seeing that as we looked at numbers of hospitalizations around the country, as well as the test positivity rate. And that's the percentage of people who perform a test and it comes back saying that they have COVID 19 infection. Over the past two weeks, we actually have begun to see those hospitalization numbers go down, the test positivity rate go down and so those are encouraging trends. If we look at comparison to prior years, what you can see is that we were no higher this year than we were a year ago in September. So some of this was an expected upswing, but clearly different from the lows we had seen in June and July of this summer.

Melanie Plenda:

And is there a particular variant of concern his year?

Dr. Michael Calderwood:

So there are a large number of variants and people will read about these in the news, they all fall within the omicron lineage of SARS-CoV-2 the virus that causes COVID 19 as the illness. And what's important to recognize is that well, you can go and see that there may be 20 different variants that are circulating at this time, well over 90% are actually covered and protected by the current vaccines.

Melanie Plenda:

You mentioned hospitalizations. How do things look here in New Hampshire? And how does that compare to the rest of the country?

Dr. Michael Calderwood:

So currently, as of today, there are 30 patients in New Hampshire who are undergoing active treatment for COVID 19. This is well below where we were at our peaks in prior years. And we are seeing that that has stabilized. The other thing to recognize is that most of the people that are coming in, thankfully don't have severe illness requiring ICU level of care. So most of the COVID that we are seeing this year is out in the community, not requiring hospitalization. And for those who are hospitalized, much less severe illness than we've seen in the past.

Melanie Plenda:

So let's talk about vaccines. What can you tell us about the ones for all three viruses and how effective they are?

Dr. Michael Calderwood:

So we now have a new COVID 19 vaccine. It's formulated for the 2023/2024 respiratory virus season. And this really is becoming an annual vaccine. The idea is that we look at what is circulating in the community, we formulate a targeted vaccine that covers the majority of the viruses that are out there. You get that in the fall. And it has about six months of protection before it wanes, and the protection for severe illness and hospitalization probably lasts a little bit beyond that. But the protection against just getting sick in these winter months, is really about six months in duration. And so right now, the three vaccines that have been approved, we had two mRNA vaccines, the Pfizer and the Moderna, we just had a third of the NovaVax vaccine that was approved. And these are available and really recommended for everyone, those six months and older. So there is data for children and for adults. And it is for the most part, a single vaccination, whether you have been vaccinated before or not, we're no longer talking about this idea of a primary series new booster, but like the flu shot, you come in, get your shot, and that protects you for the respiratory virus season. It has effectiveness that is higher than we see for the flu vaccine in most years. 

So it is a very effective vaccine. It is showing a significant boost in immunity as I mentioned earlier against over 90% of the circulating variants. And we even have data that was presented to the FDA and the CDC, that is showing protection, above 10 fold higher protection for some of the variants that had raised concern that they might be resistant to novel vaccines. And so that's very encouraging. And so we recommend that folks, as soon as possible, come out and get the COVID vaccine, it will protect them through these peak months. Again, that is going to be December, January and February. You can get the flu vaccine at the same time, you can actually get a COVID vaccine in one arm and the flu vaccine in the other arm. The flu vaccine is targeted at the most common circulating forms of flu that we know from international data. They are adopted and changed annually to make sure that we are targeting what is in the community. And again, similarly an annual vaccine recommended for all gives you kind of six months of protection. About six to nine months is the thought for the flu vaccine. And that's important because there is some flu B that goes later into the spring. And we want to make sure that we're covering that as well.

Melanie Plenda:

What sorts of precautions should be taken? When is it a good idea to stay home or wear a mask for the protection of others?

Dr. Michael Calderwood:

So we've learned a lot about this over the past four years. And there really is an importance of staying home when you're sick, wearing a mask when you need to be around others that have a respiratory illness, and masks do provide a good level of protection. Now, the other thing is, we recommend testing. And there is availability to test for things like COVID and that's important. A lot of people are doing that, that home based testing. But really the most important thing is if you don't feel well, stay home, don't put others at risk. Make sure you're taking care of yourself, get rest, stay hydrated. And when you're feeling better, you can return to school, return to work, wear a mask if you need to, if you still continue to have things like a runny nose, and that's important to protect others who may be around you.

Melanie Plenda:

And you just mentioned that those are the same rules for kids. So when should parents keep them home from school?

Dr. Michael Calderwood:

So the same sorts of things. And so this idea that when children are sick, they need time to recuperate, and they are not going to be at their best In the school environment, if they are suffering from a viral illness, and in fact, they will be slower to recover from the viral illness. And so allowing children the ability to stay home and recover, before going back to school is best to reduce the transmission. But it's also best for their recovery, and the schoolwork that they need to do when they get back into the school.

Melanie Plenda:

And this week of school in Lawrence, Massachusetts went remote due to the number of COVID 19 cases there. Could that happen in New Hampshire this year, do you think?

Dr. Michael Calderwood:

So we've learned a lot through the pandemic. And this is really one thing that I think it's important for us to understand that there were some adverse impacts of decisions that we made early on. And thankfully, in New Hampshire, we had many schools that got children back into class in person, much quicker than you saw elsewhere in the country. That speaks to the fact that we didn't see some of the impacts that places like New York City saw, and they had to make different decisions. But we've learned that there were things that suffered, mental health suffered during this time, we saw a decrease in language and math scores. And we saw that social interactions changed. And so there is a lot of push and advocacy from our pediatricians, from our teachers to really not go back to a period where we shut down schools and send people to remote learning, we might see a period where people go back to wearing masks, and that might be a way to mitigate some of the risks. But again, I do not advocate shutting down schools entirely, going back to a hybrid environment or a remote environment. And it's just because we've learned about some of the adverse impacts. And the other thing is inequity. One, not everyone had the same access to technology. And so we saw those impacts differently in different groups based on ‘Did they have a computer? Did they have internet?’. And that's not true across the entirety of northern New England, we need to make sure we're meeting the needs of everyone, all the students in our communities,

Melanie Plenda:

There was some reporting recently in the national news that it looks like there was a shortage of amoxicillin headed into this sickness season. And so is that something that we're seeing here that you've seen? And do you have any sense of why that might be happening if you are?

Dr. Michael Calderwood:

So we actually, this predates the pandemic. We've had shortages of a number of medicines or antibiotics included for many years, this is actually something that we track very closely, we make sure that we are keeping an adequate supply on hand. You will see that certain local pharmacies get caught unaware when the shortages occur. A lot of this is related to things that may be generic that have a single manufacturer, and it may be that the plant has some issues with production. And so if they go offline, we no longer have access to that antibiotic. Today, we're talking about respiratory viruses and those that are not treated by antibiotics. And so that's important to mention, we do not recommend that people come to look for amoxicillin or azithromycin or some of the other common antibiotics when they have a viral illness. But if you had something like a bacterial pneumonia, and needed an antibiotic, we do continue to have plenty of antibiotics, if there was a shortage, we have alternatives that we can use.

Melanie Plenda:

Do you anticipate these shortages, such as they are, will continue? Or is there an end in sight to that?

Dr. Michael Calderwood:

So one big impact of the pandemic that we continue to grapple with is around our supply chain. And when we think about interruptions in the supply chain, these are at a global level. And so understanding how we are building the infrastructure, some of the local production of some of these critical needs in the healthcare sector, that's going to be a long term strategy that the supply chain has impacted all areas in medicine and health care. And this is something we continue to struggle with on a daily basis.

Melanie Plenda:

Infectious disease expert Dr. Michael Calderwood, the Chief Quality Officer at Dartmouth Hitchcock Medical Center, thank you so much for joining us today.

These articles are being shared by partners in The Granite State News Collaborative as part of our Race and Equity Initiative. For more information visit collaborativenh.org.