CMO Update November 22, 2022
This is my first CMO update to our combined Pinnacle / QualDerm company and I’m hoping to meet as many of you as possible over the months and years ahead as we work together. During the pandemic, like Dr Rios, I have been sharing information regarding COVID-19 and other health concerns to help our teammates understand some of the more complicated medical issues and make informed decisions. I welcome questions and suggestions for topics. For the time being please send them to me at health@qualderm.com

RSV (respiratory syncytial virus)

My wife is a pediatrician at Wake Forest and her clinic and Children’s Hospital is overwhelmed right now. RSV cases and hospitalizations for severe infection are spiking nationwide. As a respiratory infection with easy transmission, it behooves us all to take precautions. Fortunately, RSV tends to cause mild illness in adults, but children and infants can have more severe courses, particularly with an ‘immunity gap’ from lower transmission rates during the pandemic. We have had many teammates require time off to care for sick children, so I thank everyone who has helped to cover staffing for each other during this very challenging period.
Influenza

Influenza season is in full gear and public health concerns about a severe flu season are coming to reality. Flu numbers are very high and the season has begun much earlier than normal. Most doctors will say, ‘if you feel like you’d rather be dead and can’t get out of bed, you have the flu’. While you may get mild symptoms from the vaccine (like from any vaccine), they will not be as bad as the real thing.

Of flu cases tested this year, 77% have been positive for H3N2, a strain associated with higher rates of hospitalization and death, particularly for children and seniors. Hospitalizations have not been this high and this early since 2010-11.

As you can see from this map, the Southeast and Southwest regions are experiencing particularly high levels and I’ve personally seen many patients cancel appointments and staff out of work for illness. Fortunately, this year’s flu vaccine is estimated to be a relatively good match for the circulating strains of virus, so that is more reason to get your flu shot now.
COVID-19

COVID-19 hospitalizations remain low and stable, but case counts are rising for the first time in 4 months. There is no current dominant strain as many variants are competing and none has yet demonstrated a clear advantage. Despite rising COVID case numbers, the wastewater data is showing persistent low levels, which may be a good sign.
There is likely more coronavirus circulating now than during the summer, although our ‘immunity wall’ across the US seems to be holding up. Time will tell and I encourage everyone to remain vigilant and careful while balancing the appeal of returning to normal activity. Personally, along with hand hygiene, I still wear a mask in the movies, on planes, and in crowded stores and venues where the risk remains high of some virus in the air, whether RSV, influenza or COVID. Any one of the ‘triple threat’ will make me feel miserable, miss work, and potentially infect my patients, staff, family and friends. And if you do feel sick, please stay home.

COVID-19 mortality is also decreasing with Omicron and later variants, more evidence of the effectiveness of both natural and vaccine immunity.
Vaccines are effective and have saved millions of lives globally. Young people with healthy immune systems have almost universally had COVID and/or received at least an initial vaccine, so additional boosters are less proven to further reduce death. (absence of red bar in column 1 below)

But, it’s becoming increasingly clear that adults >50 years old must be up to date to benefit fully from vaccine immunity, with many deaths occurring even in those with a primary series and 1 booster (Column 2 yellow bar), due to decreasing immune effect over time. Importantly, fewer than 30% of American adults over 50 years have their Fall booster and this potentially bodes poorly for this winter’s COVID impact. Please consider a booster if you have risk factors or like me are more ‘mature’ in age!

The beneficial booster effect is greatest in the older population, where over half of deaths occur even with 1,2 or 3 boosters (Column 3 yellow and red bars). Very few adults 65 and older remain completely unvaccinated (5%), but they comprise 22% of deaths for this age group—a very disproportional amount – given the extremely high vaccination rate. (Column 3 blue) 
Finally, this shift in who is dying toward older adults is very apparent in this graph below, showing the sharp increase in the >85 age group (red) in the last year, compared to the <65 age group (green). 
This is likely due to a few things: younger people are now vaccinated and/or possess strong natural immunity; older people have weaker immune systems; and older people are more likely to have comorbidities. Targeting communication and resources to older adults will be key to further reducing mortality, so please encourage your older family and friends to get a Fall booster in advance of the holidays.
Dr Katelyn Jetelina is a terrific epidemiologist who offers advice on how to keep your family safe and healthy this Thanksgiving week.

If you’re sick today…

There’s a good chance you’ll be contagious on Thursday, regardless the type of virus. I would seriously consider, unfortunately, staying home. The infectious windows for the “triple threat” viruses are as follows:

  • Flu: Contagious for 5-7 days after start of symptoms.

  • RSV: Contagious for 3-8 days after start of symptoms. Some infants and people with weakened immune systems can spread the virus even after they stop showing symptoms, for as long as 4 weeks.

  • COVID-19: We see strong evidence that an Omicron infection lasts, on average, 8-10 days. Some people will be infectious for less, and some will be infectious for more. You won’t know unless you test.
Considering the upcoming Thanksgiving Holiday, I want to reiterate how grateful I am for everyone in the Pinnacle / QualDerm family. I couldn’t be prouder to play a part in leading this incredible organization. Every single teammate in some meaningful way contributes to our mission to deliver the highest quality dermatologic care to serve our communities and each other, and for you all I am thankful.

Stay safe in your travels, relax with family and friends, and enjoy a healthy, happy Thanksgiving!

Dr. A
Questions or Comments?
Please send any questions or comments to the Pinnacle QDP Health Information inbox: health@qualderm.com