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Covid 'first-timers' are feeding surge, but with milder symptoms and fewer hospitalizations

Buffalo News - 8/3/2022

Aug. 3—Lynne Jakubowski has spent more than two years following the ebbs, flows and public health recommendations that have shifted with the coronavirus pandemic.

She locked down in 2020, masked up while shopping and at work, and limited social gatherings to outdoors unless Covid-19 rates in the Buffalo Niagara region were extremely low.

She got vaccinated and boosted last year for added protection.

None of it stopped her from coming home with Covid-19 after a recent vacation, joining the ranks of those testing positive for the first time during the latest pandemic mini-surge.

"It came on all of a sudden," said Jakubowski, 61, an Erie Community College counselor who lives in Clarence. "I started feeling achy and got chills. I went to bed and got up the next morning and I'm like, 'Oh my gosh, I'm really sick.' "

Jakubowski's experience is a familiar one for the thousands of people who made it through the worst days of the pandemic only to have Covid-19 finally get to them more than two and a half years after it first became a global health emergency. In Western New York and across the state, data shows that five times as many people are being diagnosed with the coronavirus for the first time than people who have contracted the illness before and are getting it again.

Those numbers come with a major asterisk: Health experts agree that the availability of at-home tests makes it likely that many positive cases are not being reported to health departments.

But the trend is being seen anecdotally, as well. For example, in recent weeks, the staff at the UBMD Family Medicine Town of Tonawanda office has received five to 10 calls a week from patients who have tested positive for the first time, after going months with no more than five in any week since early this year.

Blame Omicron BA.5. It became the dominant Covid subvariant in the region by late June and so far has proven the most contagious.

Still, its punch remains far less lethal than the original version in a nation where more than 93 million Americans have tested positive for at least one iteration of the virus and 107 million have received at least some protection through vaccination.

"The most important thing to convey is that the people who are fully vaccinated and boosted are not sick enough to go to the hospital and they're certainly not dying with Covid," said Dr. Andrea Manyon, president and CEO of UBMD Family Medicine, and clinical professor and interim chair of the Department of Family Medicine in the University at Buffalo Jacobs School of Medicine and Biomedical Sciences.

Turn of fortunes

Jakubowski stayed in a rental vacation house in Charleston, S.C., from June 26 through July 3 with family from Buffalo, Rochester, Baltimore and Colorado.

A few family members had previously been infected with Covid-19, although she and her adult son and daughter were among those who had not.

The group took daily shopping and sightseeing trips and dined once as a group in the city's French Quarter. They mostly cooked and ate meals together in the vacation rental.

Jakubowski — one few who wore a mask on the planes to and from Buffalo — got a call from a nephew on July 5. He tested positive with Covid and had mild symptoms.

She came down with symptoms and tested positive the next day.

They were the only ones on the trip who did so.

"The fatigue was the worst part and I did have minor congestion," Jakubowski said. "In about a week and a half, I completely felt better."

Vaccines, monoclonal antibodies other treatments — as well prior Covid-19 infections — have generally brought down the number of hospitalizations and deaths more common during previous spikes.

Still, vaccinated or not, if you haven't yet tested positive with Covid-19, the chances you will do so remain significantly higher.

New York State tracks the number of reported infections and in recent months began breaking them down among those testing positive for the first time and those reporting a reinfection.

The most recent data, from July 22, shows Western New Yorkers tested positive for the first time at a rate of 16.6 per 100,000 population. The reinfection rate was 3.5 per 100,000, suggesting someone yet to be infected was nearly five times more likely to be in mid-July.

For the week of July 18, 340 people in Western New York were reinfected, while 1,607 tested positive for the first time.

The figures make the point that those who remain unvaccinated and have not yet tested positive are at higher risk for infection. But Dr. Thomas Russo, professor and chief of the Division of Infectious Diseases in UB's Jacobs School of Medicine and Biomedical Sciences, said "those numbers need to be taken with a grain of salt." Many who contract Covid-19 are asymptomatic, take-home test results usually go unreported and those with mild cases sometimes spurn tests, making the numbers less precise. But Russo said there is more than enough data to show the pecking order when it comes to Covid immunity.

"Fully vaccinated is two shots, which is almost useless against Omicron," he said. "No shot, never been infected, you're a sitting duck. Even if you've got four shots, it's still imperfect and it depends on when you got that fourth shot. If it was four months ago, then protection against infection is significantly waning at this point, whereas the protection against hospitalization and severe disease is extraordinarily good."

Russo called a combination of vaccination and prior infection "the best immunity in the world." He stressed that even this kind of immunity is fleeting and that many remain at higher risk, including those who are elderly, obese or have compromised immune systems, as well as those with diabetes, heart, lung and kidney disease.

Seeking help

Manyon said most of those who have called her office for advice in recent weeks range in age from 40 to 60. They mostly have dealt with upper respiratory discomfort like Jakubowski had.

She has recommended patients drink more fluids, alternate treating body aches with Tylenol and ibuprofen, and treat cough and upper respiratory symptoms with over-the-counter medications. She encourages them to call the office if symptoms worsen or visit the emergency room if breathing becomes labored.

"I also advise people to take it easy," Manyon said. "This is not the time to make sure you get your daily 10,000 steps."

The primary care doctor and her colleagues have prescribed Paxlovid for those with chronic health challenges, especially if they over 65.

Russo recommends patients with weakened and suppressed immune systems get Evursheld, a monoclonal antibody that provides preventative protection for up to six months for those with weakened or suppressed immune systems.

He is among infectious disease specialists who expects another surge in cases after Halloween, when respiratory infection season starts. An Omicron-related booster around that time should add a greater sense of security for those concerned that Covid-19 could wreak havoc with the late-year holidays.

The Biden administration looks to line up a booster by then that includes protection from the Omicron variant.

"There's almost no one on this planet anymore who hasn't either been vaccinated or infected or both," Russo said. "If you have some level of immunity, when you get infected that's going to decrease the likelihood to develop more severe disease. I think eventually this is how this pandemic is going to play out, slowly over time."

Short term at least, Jakubowski will live on the bright side.

"I made reasonable choices and I know this sounds crazy but I'm kind of glad I got it and that it was the strain that it was," she said, "because it wasn't as big a deal. Overall, it was like having a mild flu, and I feel like at least your body has more immunity to it now, so that's a good thing."


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