COVID-19 Q&A with Dr. James Winslow

I want to go over some common questions I get from EMS personnel regarding COVID-19. Below I have done my best to summarize how I have answered these questions in the past. I believe that everyone should also verify information given to them, so I have included references for all data I use in my answers. Please feel free to reach out if you would like me to visit your agency to talk about COVID and the COVID vaccines. I want all EMS personnel to have the best information possible, and I want all EMS personnel to be safe. I am honored to be able to work with you. 

Please keep in mind that you should always defer to your local medical director for treatment decisions within your own practice. Also, keep in mind that if you have personal medical decisions to make, please contact your primary care physician to obtain more information and guidance. None of this information is meant to come between you and your medical director/primary care physician. 

If I get infected with COVID-19 is “natural” immunity enough to protect me from future infections?

Short Answer: No

Long Answer: People who have been infected with COVID-19 are 5.5 times more likely to be hospitalized if they get re-infected versus people who get COVID-19 after getting vaccinated. For people over age 65 the non-vaccinated group with a past history of infection was 20 times more likely to be admitted to the hospital if they were re-infected versus the vaccinated group:

https://www.cdc.gov/mmwr/volumes/70/wr/mm7044e1.htm

What’s the risk to a pregnancy if a pregnant woman gets COVID-19?

Short Answer: A pregnant woman who gets COVID has a high risk of losing the baby and dying.

Long Answer: Pregnant women who get COVID-19 have double the risk of having a still birth than a pregnant woman who does not have COVID-19. The mother is also at high risk for getting seriously ill. A pregnant woman has 22 times greater risk of dying than one not infected with COVID.

https://www.cdc.gov/mmwr/volumes/70/wr/mm7047e1.htm

https://jamanetwork.com/journals/jamapediatrics/fullarticle/2779182

How effective are steroids with COVID-19 infection and when can they be used?

Short Answer: They are effective; however, only use steroids later in the disease course after a person has developed an oxygen requirement.

Long Answer: If steroids are used during the later phase of COVID-19 infection they can improve outcomes by reducing inflammation. If steroids are given to a patient who does not have an oxygen requirement, then steroids can increase their risk of developing severe COVID-19. The reason for this is that there are two phases of COVID-19 infection. The first phase is the initial infection when the virus is starting to multiply rapidly, and the immune system is starting to fight the infection. During this first phase steroids can slow down the immune response which can prevent the body from fighting the infection. The second phase of COVID-19 is when the body’s immune system basically goes into overdrive trying to fight the infection. The immune response during the second phase often causes a large amount of excessive systemic inflammation. This inflammation can negatively affect a person. Much of this inflammation can be in the lungs and can cause an oxygen requirement to develop. The second phase is when steroids can help because they reduce the inflammation.

https://doi.org/10.1093/qjmed/hcab212

How effective are monoclonal antibodies?

Short answer: Monoclonal antibodies are very effective if used early.

Long Answer: 

Monoclonal use in previously vaccinated. One study looked at 1935 vaccinated people who go COVID-19. Of these 1935 people only 7.7 percent were hospitalized. Most of the hospitalized patients had significant medical problems. When reviewing the care given to the 1935 patients treatment with monoclonal antibodies greatly reduced the chance of hospitalization.

https://academic.oup.com/jid/advance-article/doi/10.1093/infdis/jiab570/6429422

Prophylaxis. For people who have been exposed to COVID-19, treatment with monoclonal antibodies has been shown to reduce the chance of contracting COVID-19 by 82 percent for up to six months. The study looking at the effectiveness of monoclonal antibodies also showed that no one was hospitalized with COVID-19 during that time period. Treatment with prophylactic monoclonal antibodies for people living with an infected person would likely be very protective for those exposed individuals.

https://doi.org/10.1093/infdis/jiab570

Early treatment of infection. Monoclonal antibodies are very effective early in the course of disease for those infected with COVID-19. If a person receives monoclonal antibodies less than or equal to five days after the start of symptoms, then monoclonal antibodies can reduce risk of hospitalization by 85 percent. It is important to remember that monoclonal antibodies must be given early. Also remember that monoclonal antibodies are within the scope of practice for paramedics in North Carolina.

https://www.bmj.com/content/370/bmj.m3379

If I have high COVID-19 antibody titers, am I protected?

Short answer: High antibody titers don’t mean you are immune to COVID-19.

Long answer: Unfortunately, an antibody test showing a high level of COVID-19 antibodies in your blood cannot be used to determine how much immunity you might have. Here is the exact wording from the FDA:

“Test results from currently authorized SARS-CoV-2 antibody tests should not be used to evaluate a person’s level of immunity or protection from COVID-19. If the results of the antibody test are interpreted as an indication of a specific level of immunity or protection from SARS-CoV-2 infection, there is a potential risk that people may take fewer precautions against SARS-CoV-2 exposure. Taking fewer precautions against SARS-CoV-2 exposure can increase their risk of infection and may result in increased spread of SARS-CoV-2.”

https://www.fda.gov/medical-devices/safety-communications/antibody-testing-not-currently-recommended-assess-immunity-after-covid-19-vaccination-fda-safety

If I get the vaccine, will it increase my risk of dying from some type of vaccine adverse reaction?

Short answer: People who get vaccinated for COVID-19 have a lower chance of dying from all causes than those not vaccinated.

Long answer: If you are worried you could have a vaccine adverse reaction that might cause you to die, this data shows that not getting the vaccine actually puts a person at higher risk of all causes of death. Vaccinated people have a lower non-COVID mortality risk compared to those not vaccinated. The vaccinated group had a 67 percent lower chance of dying from any cause. Put another way getting vaccinated was protective against dying. 

https://www.cdc.gov/mmwr/volumes/70/wr/mm7043e2.htm

Is there any reason not to get vaccinated?

Short answer: No

Long answer: You should not get vaccinated if you have a history of anaphylaxis to any of the vaccine components. There is nothing wrong with having questions and trying to educate yourself. As a professional you need to find reliable sources of information so that you can best inform yourself. If you are unsure about getting vaccinated contact your primary care physician or medical director. 

Dr. Winslow has worked at Baptist Hospital in Winston-Salem for the past 11 years. He was appointed as the Medical Director of the North Carolina Office of EMS in 2011. This document contains all protocol, procedures and policies for all EMS agencies in North Carolina.

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