April 13, 2022
Princeton Hospital’s Covid Experience
David Herman, MD, FACP
Infectious Disease Specialist
John Cotton, Introducer, and David Herman
Minutes of the 28th Meeting of the 80th Year
President Stephen Schreiber presided. John Cotton had four guests: Jeanne Johnson, Allegra D’Adamo, Judy Langille, and Laura Berlik. Ralph Widner had a guest, Costa Papastephanou. The minutes of the previous meeting were written by Larry Hans and read by John Riganati. There were 118 recorded attendees.
The speaker, introduced by John Cotton, was David Herman, M.D., who spoke on The Penn Medicine Princeton Health’s COVID experience, newer antiviral agents, and where SARS-CoV-2 may be headed in the future. He is a specialist in infectious diseases, is the hospital epidemiologist, and holds many other positions related to his expertise.
COVID started March 16, 2020, at Princeton Hospital, almost two months after the first reported case in the U.S. By April 2 there were 26 COVID patients on ventilators. That was the peak number during the pandemic at the hospital. The first death was March 24th, at which time there were 30 COVID patients in the hospital. The peak census of 89 was reached on April 13th. By summer the census reached zero for the first time.
The mortality during March and April was 28%, mostly elderly patients. From July to October the mortality was 6.6% due to improved treatment and vaccines. The hospital, like the rest of the country, experienced three waves, the latest this January, due to the Omicron variant. The wave spike was high but short, with briefer hospital stays. So far, over 2,000 COVID victims have been hospitalized at Penn Medicine Princeton.
At present there are three medications being used to treat COVID. One, PaxlovidTM, is a combination of two drugs. These must be used with particular care because of drug/drug interactions, especially so with immunocompromised patients who are on multiple drugs. Treatment with monoclonal antibodies has been used, but is not effective on the new viral variants. Newer monoclonal antibodies show promise but are not yet available.
What should we expect in the future? The current virus, SARS-CoV-2, is the fifth variant established in humans. The four others in this group cause colds. They mutate, and that’s why we keep getting colds.
When a large part of the world’s population will have bene vaccinated, the virus still will be finding ways successfully to change and continue to infect. And, as there will be many people unvaccinated, the more virus there is, the more mutations will occur, some more transmissible than others.
The variants all seem to be improving in how to attach to the spike protein. The omicron variant can infect people who have been vaccinated and those who have had an infection with the virus. Delta is more infectious than other variants and multiplies faster in the hosts’ airways. It is not advantageous to the virus to kill all of a victims’ upper respiratory cells, because then it has no cells in which to replicate. Omicron is highly transmissible. All of this is successful viral evolution.
Omicron variant BA.2 is more transmissible than BA.1 but responds to the victims’ immunity to BA.1. It is the dominant virus in the U.S. New variants could spread more quickly, could cause milder or more severe disease, might avoid detection by current tests, might be less responsive to current therapeutic agents, and might evade disease-induced or vaccine-induced immunity.
Dr. Herman discussed the question of who should get a fourth dose of vaccine. Evidence from the Israeli study showed that a second booster diminished hospitalization and deaths, but for only about four weeks. It was his opinion, based on current evidence, that otherwise healthy persons do not need a second booster.
What’s the best way to deal with the virus in the future? Vaccinating more people allows less opportunity for the virus to spread and mutate. Currently 35% of the world’s population have had no vaccination. Besides vaccinating more people, masking, distancing, and more testing can also help control the likelihood of variants and infection.
Respectfully submitted,
Herb Kaufmann
The speaker, introduced by John Cotton, was David Herman, M.D., who spoke on The Penn Medicine Princeton Health’s COVID experience, newer antiviral agents, and where SARS-CoV-2 may be headed in the future. He is a specialist in infectious diseases, is the hospital epidemiologist, and holds many other positions related to his expertise.
COVID started March 16, 2020, at Princeton Hospital, almost two months after the first reported case in the U.S. By April 2 there were 26 COVID patients on ventilators. That was the peak number during the pandemic at the hospital. The first death was March 24th, at which time there were 30 COVID patients in the hospital. The peak census of 89 was reached on April 13th. By summer the census reached zero for the first time.
The mortality during March and April was 28%, mostly elderly patients. From July to October the mortality was 6.6% due to improved treatment and vaccines. The hospital, like the rest of the country, experienced three waves, the latest this January, due to the Omicron variant. The wave spike was high but short, with briefer hospital stays. So far, over 2,000 COVID victims have been hospitalized at Penn Medicine Princeton.
At present there are three medications being used to treat COVID. One, PaxlovidTM, is a combination of two drugs. These must be used with particular care because of drug/drug interactions, especially so with immunocompromised patients who are on multiple drugs. Treatment with monoclonal antibodies has been used, but is not effective on the new viral variants. Newer monoclonal antibodies show promise but are not yet available.
What should we expect in the future? The current virus, SARS-CoV-2, is the fifth variant established in humans. The four others in this group cause colds. They mutate, and that’s why we keep getting colds.
When a large part of the world’s population will have bene vaccinated, the virus still will be finding ways successfully to change and continue to infect. And, as there will be many people unvaccinated, the more virus there is, the more mutations will occur, some more transmissible than others.
The variants all seem to be improving in how to attach to the spike protein. The omicron variant can infect people who have been vaccinated and those who have had an infection with the virus. Delta is more infectious than other variants and multiplies faster in the hosts’ airways. It is not advantageous to the virus to kill all of a victims’ upper respiratory cells, because then it has no cells in which to replicate. Omicron is highly transmissible. All of this is successful viral evolution.
Omicron variant BA.2 is more transmissible than BA.1 but responds to the victims’ immunity to BA.1. It is the dominant virus in the U.S. New variants could spread more quickly, could cause milder or more severe disease, might avoid detection by current tests, might be less responsive to current therapeutic agents, and might evade disease-induced or vaccine-induced immunity.
Dr. Herman discussed the question of who should get a fourth dose of vaccine. Evidence from the Israeli study showed that a second booster diminished hospitalization and deaths, but for only about four weeks. It was his opinion, based on current evidence, that otherwise healthy persons do not need a second booster.
What’s the best way to deal with the virus in the future? Vaccinating more people allows less opportunity for the virus to spread and mutate. Currently 35% of the world’s population have had no vaccination. Besides vaccinating more people, masking, distancing, and more testing can also help control the likelihood of variants and infection.
Respectfully submitted,
Herb Kaufmann