Practice Management Alert

The Delta Variant is complicating the return to normalcy, plus tips for treating patients with long-term COVID-19.

At press time, the delta variant of COVID-19 accounted for 83 percent of current infections. As vaccines were rolled out, manufacturers and federal health agencies warned that breakthrough infections would occur even in people who have received a COVID-19 vaccine — the delta variant is proving that we are still very much in the midst of a pandemic.

Read up on what to do to keep yourself, your colleagues, and your patients safe from infection, as well as what you need to know about long-term COVID-19 symptoms.

Continue Using Effective Masks

When the COVID-19 vaccines were first rolled out, data showed that vaccinated people were protected against severe disease and death from COVID-19. Real-world data also showed that the vaccines were effective in preventing transmission — until the delta variant came along.

The Centers for Disease Control and Prevention (CDC), released a study evaluating an outbreak in Barnstable County, Massachusetts, over the July 4, 2021, holiday weekend, and the latest data show that the currently available vaccines are less effective in preventing infection and pretty much ineffective in preventing transmission of the delta variant. Seventy-four percent of the people infected were fully vaccinated, and although the sample size isn’t large enough or diverse enough to draw concrete conclusions, the evidence suggests that vaccines alone — without other preventive measures like masks or social distancing — may not protect people against infection from this variant.

After reviewing this data, the CDC adjusted its mask guidance, saying that fully vaccinated people should wear masks indoors if congregating with people outside their households. For more context: The CDC also says that the delta variant is much more contagious than the original strain of the virus and is as contagious as varicella, aka chickenpox.

“Real-time RT-PCR Ct [reverse transcription polymerase chain reaction cycle threshold] values in specimens from 127 fully vaccinated patients (median = 22.77) were similar to those among 84 patients who were unvaccinated, not fully vaccinated, or whose vaccination status was unknown (median = 21.54),” say the study’s lead authors Catherine M. Brown, DVM; Johanna Vostok, MPH; and Hillary Johnson, MHS.

Cycle threshold refers to the amount of viral load detected in the PCR tests. This real-world implication of this suggests that the amount of the delta variant that infected vaccinated people carry is similar to that carried by unvaccinated people.

Bottom line: If you’re in a healthcare setting and interacting with patients, protect yourself by continuing to wear masks or respirators. If you’re out in public, the vaccine may no longer be enough protection against infection in and of itself.

Beware The Incidence of Long-Term Symptoms

With the contagiousness of the delta variant, if you aren’t already seeing patients who have survived COVID-19 but are still struggling with its long-term effects, you probably will soon. Various studies show that many people who have been infected with COVID-19 have long-term symptoms. One study in Italy showed that 87 percent of patients in the sample size (all of whom were hospitalized with COVID-19) still had physician-confirmed symptoms two months later. (Read the study here https://jamanetwork.com/journals/jama/fullarticle/2768351).

Other studies note that even people who had mild cases may have long-term symptoms.

In a small study conducted in Washington, which followed people who were infected with COVID-19 but not hospitalized, some people who were not sick enough to receive hospital treatment still had trouble with their activities of daily living (ADLs).

“With 57.8 million cases worldwide, even a small incidence of long-term debility could have enormous health and economic consequences,” says corresponding author Helen Y. Chu, MD, MPH, who works in the division of allergy and infectious diseases in the Department of Medicine at University of Washington.

This study was published in January; the worldwide caseload has now surpassed 200 million, as of publication. (Read the study here https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2776560.)

Be Transparent With Patients

“Long-haul” COVID patients struggling with their personal, individual “new normal” post-COVID are going to need your reassurance, even if they’re coming to your practice for a condition or situation unrelated to their COVID-19 diagnosis or symptoms.

“Be transparent with patients. Admit that there is a lot that we don’t know about post-COVID symptoms and recovery. We are really the champions of evidence-based care,” said Alex Vosooney, MD, the chair for the subcommittee on clinical recommendations and policies for the American Academy of Family Physicians, in a June Clinician Outreach and Communication Activity (COCA) call.

If a patient is coming in to be seen for post-COVID symptoms, try to discern whether the symptoms might be attributable to another chronic condition, if they have any, Vosooney said. With fewer people seeking nonemergency care in 2020, shortness of breath may be connected to poorly managed asthma, for example, he said.

But above all, “Adhere to our oath as clinicians to do no harm for our patients. Validate what your patient is experiencing,” Vosooney said. “It’s a frustrating process for your patient to feel unwell and not like themselves, but not necessarily have a visible problem that they can show the world.”