Dr. George Nassar Professor of Clinical Medicine in Houston Methodist Hospital and holds an academic affiliation with Weill Cornell Medicine
Lebanon Times: Dear Dr. Nassar, thank you once again for continuing your coverage of COVID-19 for Lebanon Times readers. Our readers are eager to get your opinion about whether the COVID-19 pandemic is over. Dr. Nassar: There are definite reasons for optimism that the worst of the Pandemic is over. There is declining incidence of COVID-19 infections, hospitalizations, and deaths locally in Houston, and Nationally. Lebanon Times: Dr. Nassar, you mention that the incidence of COVID-19 has declined in Houston. What can you tell us about COVID-19 in the Texas Medical Center (TMC)? Dr. Nassar: At the time of this interview (April 4, 2022), the Texas Medical Center is reporting much lower rates of new infections, and much less hospitalizations. As a reference, in mid-January 2022, the TMC reported 13,555 daily new infections and 350 daily new hospitalizations in the Greater Houston area, and the Houston Methodist Hospital Systems alone had 850 hospitalized COVID-19 patients. This past week, the TMC reported only 124 daily new infections and 63 daily new hospitalizations in the Greater Houston area, and the Houston Methodist Hospital Systems had only 66 hospitalized COVID-19 patients. This rapid local decline is reassuring. Lebanon Times: Are there still reasons for concern that yet another wave of COVID-19 might occur? Dr. Nassar: Some of the concerns could be as follows: (1) at the time of this interview, the US is still experiencing nearly 25,000-40,000 new cases daily, (2) there is a recent outbreak of COVID-19 in China and Hong Kong, (3) there is a recent rise in incident cases of COVID-19 in several European countries, (4) there is the potential of emergence of new coronarvirs-2 (SARS-Cov-2) variants, (5) there is persistent suboptimal rates of vaccination against COVID-19 nationally and worldwide, and (6) there is declining level of immunity from the initial vaccination over time. Lebanon Times: Dr. Nassar, since the Omicron has been a milder disease than the previous COVID-19 variants, should there be much concern about new infections with Omicron? Fortunately, Omicron-mediated COVID-19 disease has been milder than disease induced by the Delta variant. The main reason why the Omicron variant is milder than Delta is because it is less aggressive in attacking the lower airways of the lungs. So, Omicron tends to have less widespread pneumonia and less tendency to severe adult respiratory syndrome (SARS). However, the CDC is still reporting about 1,000 new daily deaths from COVID-19 in the US. For, this reason, caution needs to continue to be exercised especially among individuals who are immunosuppressed, getting chemotherapy, have chronic illness, or have not been vaccinated. Lebanon Times: Speaking of variants, Lebanon Times would like to ask you about the new variant named Omicron BA.2. What can you tell us about it? Dr. Nassar: Omicron is now predicted to be nearly 100% of all COVID-19 infections in the US. There seems to be 5 circulating Omicron variants. The predominant ones are BA.1 with about 57% and the BA.2 with about 35% of infections. These proportions would change over time as BA.2 is quickly gaining pace. The BA.2 variant, which emerged after the BA.1, is about 30% more infective than the original Omicron, but it is not more virulent. So, it would cause similar disease to the original Omicron variant. Lebanon Times: Dr. Nassar, what are your thoughts about a second booster shot? Dr. Nassar: I think a second booster with either Moderna or Pfizer vaccines it is a good idea; the benefit would far exceed the risk. Fortunately, the FDA just approved (March 29) a second booster dose of the Pfizer or Moderna Vaccines for those 50 years and older, and those who are immunocompromised. The ideal time to get a second booster is currently judged to be 4-6 months from the first booster. Several of my kidney transplant patients, who are high risk for serious COVID-19 due to low immunity, have already managed to get a second booster which was well tolerated. Lebanon Times: Should a person who qualifies for a second booster wait for the new vaccines that are being specifically designed against the Omicron variant of COVID-19? Dr. Nassar: My advice is not to wait for the development of omicron specific vaccines. There are 3 reasons why one should not wait, and these are: (1) It is not known when such a vaccine would be available, (2) it is not known if by then there would be new non-Omicron COVID-19 variants, and (3) current vaccines with boosters are still effective against omicron. Lebanon Times: Dr. Nassar, what are your thoughts about a second booster for those who already had a booster but then got infected with the Omicron variant of COVID-19? Dr. Nassar: If a person already had a booster and then had a confirmed infection with omicron (or any COVID-19 infection) by PCR testing, then in this case, there is no absolute need for a second booster for several months after the infection. Lebanon Times: Dr. Nassar, if someone recovers from the initial COVID-19 infection, could there be long term permanent damage? Dr. Nassar: Several organ systems could be affected by severe illness from COVID-19 leading to permanent injury: Prominent among these are: (1) Permanent lung damage may occur due to reactive scar tissue formation in the lungs leading to low oxygen. (2) A higher incidence of diabetes has been reported. A recent study from Germany, published in Diabetologia, showed an increased incidence of Type 2 diabetes mellitus following COVID-19. (3) Cardiac disease may occur. A recent report in the New England Journal of Medicine showed evidence of muscle and electrical conduction system injury following COVID-9. (4) Neurologic sequalae with permanent brain, spinal cord, or peripheral nerve injury may occur in severe cases of COVID-19. Lebanon Times: We hear about the term “Long COVID-19” what does that mean? Dr. Nassar: This refers to lingering fatigue, lack of energy, muscle pains, joint pains, mental stress, mental fog, decreased appetite, decrease physical ability, shortness of breath, sleep problems, and just “not being the same” after a COVID-19 infection. Symptoms may drag for several weeks to months before resolution. There is no specific treatment for such symptoms, but they tend to diminish over time. Fortunately, such long COVID-19 symptoms are less common with the omicron variant. Lebanon Times: Dr. Nassar, what is your advice regarding vaccinating children? Dr. Nassar: During the omicron wave, there were high rates of COVID-19 infections among children. I encourage vaccination of children according to CDC guidelines. Parents should check with their children’s Paediatricians. Lebanon Times: Dr. Nassar, do you have any concluding remarks? Dr. Nassar: I am cautiously optimistic about the status of the COVID-19 Pandemic currently. Even if a new wave of infections takes place in the Spring due to relaxing of public health measures, it might not be as intense as the previous waves that took place because now we have the benefit of vaccinations, boosters, and because many have had previous COVID-19 infections. Finally, I like to thank the nurses and respiratory therapists in the Texas Medical Center specifically, and throughout the world as well, who were in the front lines managing COVID-19 patients during very challenging and dangerous times.