By Thomas Goldsmith
Given the near constant emergence of new permutations of COVID and the rise of the Omicron variant of the virus, a Duke clinician says he sticks to verifiable, often common-sense paths during conversations with people such as his own grandparents, who are in their 90s and living in long-term care.
As with almost every factor since the pandemic started, the best guidance and information can be – and has been – transformed as new science and variants arise. Thomas Holland, a specialist in infectious disease at Duke University Medical Center, says that means it can be difficult to settle on hard and fast rules that people might prefer.
“If you think back, about 18 months ago we were [communicating] about, ‘Is it six feet you need to be away from someone else or is it seven feet?’” Holland said over the phone.
“We all want to know exactly what we can and can’t do; and this has sort of defied our ability to do that.”
Part of the path forward will involve following recommendations that have been in place since the beginning of the pandemic, say additional experts involved with public health.
“In some ways, we’re going back in time to some of the recommendations at the beginning of the outbreak,” Jennifer Wolff, a professor of health policy and management at the Johns Hopkins University Bloomberg School of Public Health, told The 19th, an independent nonprofit newsroom.
Growing opinion on the importance of wearing well-fitting N95 or even KN95 masks also applies to older people, especially those who are likely to encounter larger groups of people.
“If the older person is wearing a tightly fitted mask like an N95, it might be fine for them to go grocery shopping,” Nina Blachman, director of the geriatrics fellowship program at NYU Langone Health, told The 19th.
‘Good idea to be masked’
In another shift of the guideline, family gatherings or outings that seemed for a short while to fall within acceptable places for older people to go are now out. For the moment, those activities should be considered for delays or cancellations given the rise of Omicron.
Even given the pandemic’s shifting landscape, Holland said, it’s possible to share usable guidelines on more specific topics with people like his mentally sharp grandparents.
“I told them that this variant is more transmissible and that I think it’s a good idea to be masked when they’re around other folks, except when they’re eating,” Holland said.
People of any age must deal with risks and benefits when making choices, and it’s not possible to deal with zero risk, he said.
“My grandparents are 96 years old and they are not going to wait it out for two more years without socializing or seeing anybody,” Holland said, referring to a potential endpoint for the pandemic. “So I don’t tell them that they need to stay confined to their rooms if they are not under sort of an outbreak situation.
“I tell them to enjoy socializing with other folks, but to be safe about it, meaning masking. I tell them to enjoy their meals as it’s a really important social time or part of the day for them. Hopefully, that’s the right balance.”
96 percent of 75-plus are vaccinated
Meanwhile, specific information about how the ultra-infectious, ultra-transmissible COVID variant Omicron is affecting older people in North Carolina is emerging amid the flood of sometimes contradictory COVID-19 info.
Even though it’s been a major factor for only about a month, the Omicron strain also seems less likely to bring death and hospitalization, according to the Centers for Disease Control and Prevention. It might not be as harmful to older people if they’ve been vaccinated and boosted.
There are exceptions in the risk to people with existing conditions like underlying respiratory diseases, such as COPD. That means clinicians must pass on to COPD patients the additional risks they face from the more easily transmissible COVID.
“When people have flare-ups of their COPD there’s often some kind of trigger, including respiratory viruses,” Holland said. “Pre-COVID, you knew that other viruses, whether it was flu or common cold viruses, might trigger COPD flare and now COVID gets you like that.”
The huge number of new cases — in the six figures daily — means that the overall triggering of COPD cases will also increase.
That means people with that and other underlying conditions, such as heart disease, diabetes, asthma and immune problems still need to be careful, perhaps more careful than they were this fall after the surge of Delta cases had subsided.
“We are seeing hundreds of thousands a day in this country and so, even if it’s a really small percentage that gets severely ill, that’s still a big number,” Holland said. “It’s a bit of a paradox because it’s simultaneously true that Omicron is associated with less severe illness and also true that our hospitals are overflowing and that we’re really swamped.”
The new waves of Omicron infections are affecting older people in North Carolina even though more than 90 percent of people over 65 have had at least one dose of vaccine. For 65-74s, it’s 89 percent and for those older than 75, it’s a whopping 96 percent.
But the nuances and variants matter here, too. That’s another bit of revised news that health care workers must tell the ranks of older vaccinated people: Omicron could still affect them.
“It certainly is the case that that Omicron variant is causing infections in people that are vaccinated,” Holland said.
In addition, there are indications that vaccines can lower the risk of the vexing long COVID syndrome as well as the chances for the potentially devastating multisystem inflammatory syndrome in adults or MIS-A.
“Getting a booster dose really helps protect against Omicron and then most importantly it really protects against bad outcomes from infections,” Holland said.
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How does diabetes impact Covid infections negatively?
Hello Norma,
(Putting on my registered nurse hat here) We talked about this peripherally in our recent story about the Omicron surge swamping hospitals.
Viruses – any virus, not just SARS CoV2 – can disrupt blood sugars and have other metabolic effects on people with diabetes, in part because of the role of inflammation in the body.
It’s also not uncommon for someone who has well-controlled Type 1 diabetes (the insulin dependent kind of diabetes) to experience diabetic ketoacidosis when they have a virus. DKA occurs when blood sugars skyrocket and people are unable to absorb nutrients as a result and this condition can cause coma. When I worked in the ED, we saw these people more often during flu season. It’s a real risk.
Finally, the data during the COVID pandemic have shown that people with diabetes are at higher risk for serious complications from the virus and at higher risk of death, particularly if the diabetes is not well-controlled.
Hope that answers your question.