Time to think beyond the vax? Reflections from a COVID-stricken doc

Like most doctors and nurses, I’m not happy being the patient. As I write this, I am only a few days into my COVID-19 quarantine, having tested positive a few days ago. Thankfully, I’ve had only mild flu-like symptoms so far. This forced “vacation” has given me time to reflect on the nearly two years of this pandemic. Life as a doctor during this time has been so hectic, there hasn’t been much time to stop and think about where we’ve been, and where we’re going. 

Although I am fully vaccinated and wear an N-95 mask during all sick visits, I still managed to contract COVID. Now that I have it, there’s not really much to do about it. I am a healthy 46-year-old, and hopefully I will have a mild course. However, as I take the longest work hiatus of my career, I am forced to wonder if our approach to this virus needs some changes.             

To this point, our battle plan primarily has been focused on getting everyone vaccinated. Few would argue that the COVID vaccines have been an essential tool in the course of this story. The vaccines have been effective at protecting our most at-risk populations, keeping them out of the hospital and preventing countless deaths. The accomplishments of Operation Warp Speed were fairly remarkable. Delivering three vaccines in under a year gave us all hope that life would get back to normal. Actually, it did for a short while, in the spring and early summer of this year. It seemed that the vaccines had gotten us to a place that felt much closer to pre-COVID life. Cases were down, deaths were down, our spirits were up!            

Then along came the Delta variant, which rained on the parade. It took much of our hard-earned progress and quickly tore it to shreds. All of a sudden, the vaccines didn’t seem to work as well against this new variant. People who were vaccinated were getting sick. It was back to wearing masks and fearing the worst might happen; COVID wasn’t done with us yet.             

Through the fog of war, there are a few points that seem to have been lost. Maybe we’ve put too much faith in the notion that we’d be able to vaccinate our way out of this mess. While the vaccines have been — and remain — vital to protecting the elderly and at-risk populations from serious complications and death, they can fall short when it comes to preventing illness and the spread of COVID. If we’re going to get our lives back on track, we’re going to have to hit this virus from multiple angles — vaccines included.            

For too long, we have lacked any good therapeutic options to treat mild to moderate cases of COVID as outpatients. When a patient is diagnosed, our advice is to go home and ride it out. If you can’t breathe, go to the hospital. This is not satisfying for physicians, or perhaps patients. Monoclonal antibodies have helped those who have qualifying conditions, but are no help to healthy people such as me. Thankfully, there are several promising oral medications on the horizon. Similar to Tamiflu for influenza, these drugs would help stop the spread, as well as prevent some of these cases from progressing to more serious or complicated cases. 

We also need to accelerate the study of repurposing existing drugs to treat COVID. There have been some recent studies that show that certain commonly prescribed antidepressant drugs (SSRIs) may show activity against COVID. There may be other potential treatments sitting on shelves. Let’s apply some of the Warp Speed-type resources to studying those.          

There is one more approach that I’ve heard few people talk about. The one risk factor that has led to more complications and death from COVID is obesity. This has not been talked about enough. Obesity was already a pandemic in this country prior to COVID, taking an enormous toll in the form of heart attacks, strokes, diabetes and increased risks for certain cancers. As the primary risk factor for poor COVID outcome, it has gotten little attention. If we really want to save lives from COVID, let’s put America on a diet. We should launch programs to emphasize simple ways to improve lifestyle and lose weight. I’m not talking about fad diets and gimmicks; I’m talking about teaching people how to be healthy and to stay that way.            

If we tackle COVID from all sides, we stand a much better chance at getting back to the life that we all miss.

Frank Contacessa, M.D., is an internist with Northwell Health Physician Partners in Armonk, N.Y., with nearly 17 years of experience in private practice. He is board certified by the American Board of Internal Medicine, with professional memberships at the New York State Medical Society and Westchester County Medical Society. Follow him on twitter @DrFrank273.