Covid 2nd booster - to do or not to do?
Hi Everyone!
It’s been awhile since my last email newsletter. To all those who have never seen this before - I’ve been writing newsletters to patients and interested parties since the start of the pandemic. Initially it was to keep people up to date with covid19 use, but after awhile it became a regular newsletter. Apologies for the tardiness, but I just needed to get my creative juices flowing to provide useful information.
Few things to go over:
Covid19 2nd booster (4th vaccination shot) is available for certain groups of people - should you have it? See below
Antiviral medications (Paxlovid mainly) if you catch Covid19 - who get’s it and should you have it?
Cathy, our regular nurse is on leave for 6 weeks. Sue is stepping in to give us a hand.
Repeat prescriptions - please email to nurse.baysidemedical@gmail.com
Fee increases
Please see below for more information
Covid19 2nd booster (4th vaccination shot) - should you have it?
Firstly - it’s available for:
all people aged over 50 years
health, aged care and disability workers aged over 30 years
immunocompromised people who have already received 4 shots (this will be their 5th)
people aged 16 and over who have medical conditions that increase the risk of severe COVID19 or those who live with disabilities with significant or complex health needs
Given 6 months after your last covid shot, or 3 months after your covid infection.
For those aged over 50 years - it’s recommended more for
Maori and Pacific Island peoples aged 50 or more due to higher ethnic risk of severe infection
those aged over 65
Okee dokey - it' all seems like a lot of conditions right?
OK - For those of you who know me and my style - I like to start from first principles. The purpose of vaccinations is to protect those most like to get sick from getting infected in the first place or if you do get infected from getting seriously ill. The current risk of infection is high because Omicron and it’s variants is very infectious. The risk of severe illness is low because it’s less virulent. However - because a lot of people are getting sick - the sheer numbers mean a significant number of people will get seriously ill. Most of us who catch COVID19 will have a minor cold/flu like illness and get over it in 3-5 days.
There will be those who are more likely to get seriously ill - older people, or people with medical conditions that lower their immunity.
There are 2 main studies that have resulted in the recommendation for the 2nd booster, both from Israel.
The first one was on a few hundred thousand people older that 60 over 8 weeks during the Omicron outbreak period. There was a reduction in infection for up to 6 weeks after the 4th dose, but after that infection rates were about the same. There was a reduction of serious illness by 3.5x up till week 8. So there is significant reduction in serious illness, but protection against infection wanes after 6 weeks.
The second study was much smaller of about 270 health professionals who were younger. There was a slight reduction in infection rates of about 30%.
The conclusion is that there is marginal benefit in younger patients, prevention of serious illness is maintained for at least 8 weeks in older people and that protection against infection wanes after 6 weeks.
So - should you have the vaccine?
Yes - if you’re older than 60, or if you have health conditions that weaken your immune system.
Maybe if you’re in higher risk jobs like healthcare or aged care.
No if you’re young and healthy.
There is work on developing more effective variations of vaccines that might be more useful later.
What am I going to do? Well - as some of you know I got covid about 5 weeks ago from a patient. Thanks - you know who you are. I’m going to travel at the end of the year, so I’ll aim to get my booster about 2 weeks prior to my travel to try to maximize my protection against another infection. Who knows what new variant will come up by then? But I’m not too worried - covid19 for the vast majority of us will be a mild illness.
Antivirals for COVID19
If you catch covid19 - you might have access to antiviral drugs which can reduce your risk of hospitalization or death by about 30 - 89%. Not bad. Bear in mind the risk of hospitalization or death from Omicron is quite a bit lower than the original Wuhan variant and Delta as well.
Medications used currently are primarily Paxlovid (probably the best) and Molnupiravir (used if you have poor renal function) and Remdesivir (probably the lousiest).
You can access these medications if you:
have had covid19 within the last 5 days
you are mild to moderately sick (i.e. if you’re really sick you have to go to hospital anyway or be on oxygen)
are old/over 75
are significantly immunocompromised - i.e. have autoimmune conditions AND are on immunosuppression medications, Down syndrome, sickle cell disease, previous admission to ICU for COVID19
If you are UNDER 75
Maori/Pacific Islander - 4 points from the list below (because of higher risk due to ethnicity)
Otherwise other ethnicities - 5 points from the list below
See the exhaustive list below:
Patient is of Māori or Pacific ethnicity and has at least FOUR of the following factors:
Any combination of high-risk medical conditions for severe illness from COVID-19 identified by the Ministry of Health** (with each individual condition counting as one factor),
Patient is under the age of 50 and has not completed their primary course^ of vaccination (counts as one factor)
Patient is aged between 50 and 64 years (counts as one factor, or four if patient has not completed a primary course^ of vaccination)
Patient is aged between 65 and 74 years (counts as two factors, or four if patient has not completed a primary course^ of vaccination) OR
Patient is of another ethnicity and has at least FIVE of the following factors:
Any combination of high-risk medical conditions for severe illness from COVID-19 identified by the Ministry of Health** (with each individual condition counting as one factor)
Patient is under the age of 50 and has not completed their primary course^ of vaccination (counts as one factor)
Patient is aged between 50 and 64 years (counts as one factor, or two if patient has not completed a primary course^ of vaccination)
Patient is aged between 65 and 74 years (counts as two factors, or five if patient has not completed a primary course^ of vaccination) AND
Not to be used in conjunction with other COVID-19 antiviral treatments.
Should I take the antivirals if I qualify?
Yes - definitely
What are the problems/side effects that I have to look out for?
Drug interactions - OMG - so many. This is the most headachy part of the process. Check with doctor/pharmacist
Renal function - Paxlovid is cleared through the kidneys more, so if you have reduced renal function you might not be able to take it
Side effects - meh - not that many really. Usual nausea/vomiting/rash etc.
Who do I get the antivirals from? Currently you need to get a prescription from your doctor. The poor sod (likely me) will have to look through your whole medication list to work out what interacts with what, probably give up and check with the pharmacist. In the near future the pharmacist will probably be able to dispense the medication over the counter after checking interactions as well. To be honest - they are better at this than doctors and it should hopefully happen soon. I know some of my GP colleagues are apprehensive about this, but hey - we ask them about interactions anyway and they check things more often. I don’t have a problem with that. I’m under 75 and don’t have 4 or 5 points! This is unfair! Why can’t I have it to? Well - these drugs are super duper expensive now - and if your risk of hospitalization and death is super low because you are super healthy - it’s not really going to make a huge difference for you. So - given that the government is paying for the medications, they have an obligation to use it responsibly. What if you are happy to pay? No can do buddy - it’s a limited resource and the whole world wants these medications. Remember - this is about the greater good.
Fee increases We are generally increasing fees ~ $5/15 mins across the board to cover rising costs etc. Well checks will go up ~ $15 as they are over 45-60 mins generally. Thanks for your understanding. I’ve checked - our prices are about market rate.
Please share this with your friends if you find this helpful, and you think it might be helpful to them. If people are interested in finding out about our medical practice or joining us, please look us up on: https://www.baysidemedical.co.nz/