The 5th Covid Wave and Paxlovid Rebound Cases

South Africa, the origin country of the Covid Omicron variant, along with its subsequent sub-variants, is in the midst of its 5th wave of Covid-19 infections. Almost 90% of the cases are from the newer BA-4 and 5 Omicron sub-variants. Similar to BA-2, they appear to be causing milder disease than the original strains, but they are also more evasive of immune protection from both previous Covid infection and vaccination. This is quite concerning.

What is unique about the present wave is that the infected patients who are doing the best are those who were previously infected, but also vaccinated. New infections in unvaccinated people do the worst, followed by those who had Covid before since they have some minimal immune protection and an earlier response to the foreign invader. Those who never had Covid before and were vaccinated do better, but fare a little worse than those who had Covid AND were vaccinated.

The bottom line, get vaccinated. It’s only a matter of time before BA-4 and 5 arrive in N. America. Vaccination may not prevent you from getting Covid, but it certainly lessens the amount of suffering you may experience, not to mention reducing the risks of long-covid symptoms.

In addition, don’t assume that the 2 shot regimen, or one with J&J is protective. You MUST get boosted. Rates of boosting continue to hover below 30%, surprising to me since I was reporting less than 30% boosting rate 2 months ago!.

Paxlovid rebound/failure. There have been many reported cases of Covid patients treated with the antiviral Paxlovid, developing rebound Covid symptoms after the end of their course of treatment. The exact cause is not known but is concerning. The 3 most common theories are:

1. Overlooked drug interactions causing lesser efficacy of Paxlovid.
2. Resistance of the newer strains to this drug. Most of the other antivirals are not as effective as Paxlovid.
3. Not a high enough dose and/or not for long enough. Although unlike with antibiotics where suboptimal treatment can lead to bacterial resistance, the same does not appear to be happening with Covid. It’s just that the treatment duration is just too short and not enough of the virus is killed off.

We seem to have become comfortable with this virus being in our midst. Hearing of someone who gets Covid is no longer a concern, just an inevitability. It’s a dangerous attitude. Just like delaying the Shingles vaccine just long enough to get shingles, not getting vaccinated and hoping you don’t get sick, or worse, assuming you’ll do fine if you get it because your friend did, can lead to unnecessary suffering and possibly tragic results. People are still getting really sick and some are still dying. And Lord help us if a more aggressive variant is allowed to develop.

Please continue to be careful and please get vaccinated and/or boosted.

Stay safe and be well. 

AC

I spoke with someone recently who unfortunately developed a painful bout of shingles. Quick to put the blame on the Pfizer Covid vaccine, it turns out that they had not received the Shingles vaccine!!!

Just to be clear, the Covid vaccine, any of them, has no more potential to result in a flare up of shingles than any other stressor, physical or emotional, and certainly not more than getting Covid itself!

In fact, getting Covid, especially if unvaccinated since the disease may be worse, significantly increases the risks of getting shingles.

Let’s take a step back. What is shingles? Shingles is essentially the reactivation of the varicella zoster virus (VZV), the same virus that causes chickenpox which many adults had as children. Chicken pox is less common now since there is a pediatric vaccine against it. 

After a person recovers from chickenpox, the virus stays dormant (inactive) in their body, primarily in the roots of sensory nerves. It can sit there quietly for decades. The virus can reactivate later in life, causing shingles which manifest as a rash, following the sensory distribution of the nerve the virus is living in. Shingles also can cause varying degrees of pain, since the nerves the virus lives in are sensory. The pain can be mild, but often is quite severe, and can last for the rest of the person’s life. My grandmother, for example, had shingles involving the sensory nerve which runs from the spine around to the front of her abdomen. The rash and pain stopped exactly at the middle of her chest since these nerves do not cross the middle or overlap. Unfortunately, it involved the area where her bra would rest and for the rest of her life, she could not wear a bra since the mere touching of that skin, despite it looking quite normal, would cause severe burning pain. In my practice, I see patients in whom shingles cause severe ear infections, profound, permanent hearing loss and facial paralysis (shingles mostly affects sensory nerves but not exclusively). If shingles involves the nerves which innervate the face, especially the nose, there is potential for visual loss. Shingles can also cause meningitis and can even lead to death. 

ANY physical or emotional stress can cause the VZV to reactivate. A cold, arthritis flare up, strained knee, a bad night of sleep or freaking out because someone cut you off in traffic. Any vaccination, including COVID, stimulates an immune response which is stressful on the body. But just like anything, it is all relative. The chances of getting shingles after having COVID is significantly greater than if you get the vaccination or get COVID after vaccination, since the case is usually milder. The benefits far outweigh the risks.

The good news is also that there is a vaccine against shingles and everyone over 50 should get it. The vaccine does not eliminate the virus, just allows your body to recognise the reactivated virus sooner and beat it back. The old version was a single shot and was only somewhat effective but the newer, 2 shot version is very effective and has very few side effects. I got the shots and had zero side effects. Everyone over 50 should get it.

Despite the fact that most people who develop shingles have only one episode during their lifetime, they should still get vaccination since recurrences can occur and be more severe.

Get your Covid vaccine and stop looking for excuses not to get it.

Get your 4th booster if eligible (over 50). General rule of thumb is to get it 4-6 months after your last shot or if you had Covid.

Get your shingles vaccine if you’re over 50 or immunocompromised. 

Stay safe and be well.

AC