COVID -- facts, fiction and fear

Dr. James Hodges is an extraordinary 67-year-old internist in central Texas. His most famous patient is former President George W. Bush. 

Hodges was double vaccinated against COVID with Moderna last February but was seeing a high volume of patients in hospitals, his practice, and in nursing homes, and he came down with COVID in August. His only risk factor for complications was obesity, and despite the vaccine, the delta variant afflicted him with extreme fatigue, body aches, loss of smell and taste, severe headache and cough. 

Fortunately, his pulse oximeter always read over 92% oxygen saturation, he avoided the hospital, and he went back to work after three weeks. He says he couldn’t work more than half a day until the fifth week. It took three months for his cough to go away. The loss of smell and taste has persisted intermittently since.  

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In November, Hodges was boosted with Moderna, and now in late January, he has tested PCR positive for COVID again, the omicron variant, but he has no further symptoms. He is isolating himself this week but feels completely fine.

People everywhere are confused by cases like Hodges and use them to show that the vaccine is failing. But they are wrong. 

The original vaccine protected him against severe disease, but he still got a moderate case because of his obesity. The booster plus recovery from COVID (natural immunity) protected him almost completely from omicron, which evades immunity just enough for someone like Hodges to test positive.

Emerging research backs this up. Studies from Israel, the U.K. and the Centers for Disease Control and Prevention demonstrate that fully boosted individuals (three shots) have a 90% protection against hospitalization. And studies from Qatar and elsewhere show a 50% protection against clinical infection. If you recovered from COVID on top of this, as Hodges did, the protection is that much greater, even against a highly transmissible variant like omicron. Against omicron, the more immunity you have the better, from any source.

No one who has recently recovered should be compelled to be vaccinated in order to save their job or visit a public area.  

People don’t know whether to believe that the COVID pandemic is on its way out or not. Will omicron, with millions of undocumented cases per day in the U.S. plus the close to one million that are documented, lead to enough widespread immunity to create a wall against the next variant before it emerges? We look to South Africa for the answer, and certain comparisons can be drawn. 

Dr. Waasilla Jassat, head of DATCOV hospital surveillance at the National Institute for Communicable Diseases in Johannesburg, South Africa, told me on "Doctor Radio" on SiriusXM that she thought the rapid rise and descent from omicron was due to multiple factors, including the previous delta wave, which had created some partial immunity; a strong vaccination campaign in the middle of the outbreak; rapid immunity caused by recovered omicron patients; and the fact that the population was relatively young with several preexisting conditions. 

Omicron spread widely and caused mostly milder cases. It was also summer there, when respiratory viral spread is harder to sustain.

Since then, countries with a high vaccination and booster rate, such as Portugal, Denmark, Ireland and the United Kingdom have shown a decoupling effect, with high case numbers but low hospitalizations and deaths. 

Here in the U.S., we are now averaging over 150,000 hospitalizations per day with the death rate remaining over 2,000 daily on average, still predominantly among those without prior immunity. The numbers here are dropping quickly in the Northeast, while rising in the South and the West, which predicts a several week longer exit from omicron than South Africa experienced.

In the meantime, people ask me what they should do. Should I take a booster? Should I wear a mask or shouldn’t I? Can I eat at a restaurant? When should I test myself if I am actually able to acquire home testing?

I tell people the answers are clearer than they are being led to believe by either the government or those who support it or by those who react strongly against it. Public health defies politics. 

Masks are of limited value, unless they are KN95 or better and worn correctly -- KN95s are expensive and N95s are difficult to wear. Four N95 masks being sent to your house is not useless but is more of a political gesture than a serious public health intervention. 

Rapid home testing is valuable and largely accurate when you are experiencing COVID symptoms, but the delay in getting the tests to underserved communities is significant.

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The lack of available therapeutics (the game changer pill Paxlovid) and the monoclonal antibodies that work well against omicron (Sotrovimab) are enough to forfeit confidence in the governments’ interventions, if you still had any.

I and other experts count COVID recovery as the equivalent of at least one shot. The White House or CDC’s failure to acknowledge this reality is significant. No one who has recently recovered should be compelled to be vaccinated in order to save their job or visit a public area.  

Mandates make no sense when dealing with a vaccine-evading variant or an inefficient mask. At the same time, responding to governmental rigidity or hypocrisy by refusing to be vaccinated or boosted or to use a mask in close quarters makes no sense.

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The fastest and safest way for us to exit the pandemic soon is for many more of us to be vaccinated and boosted and for all of us to voluntarily comply with at least some mitigating strategies.  

The government needs to be much less oppositional, and should immediately let up on their belittling rhetoric and restrictions and meet people where they live. Omicron immunity and vaccines will do the rest.

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