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Hancock County and COVID

Bryan Burney MD

I received my first Pfizer mRNA COVID vaccination in December 2019. I began volunteering at our Hancock County Health Department vaccination clinic in January 2020. The clinic is staffed by a mix of a number of professionals who employees of the clinic and by many volunteers from our community who have given thousands of hours of their time to the important cause of mitigating the COVID pandemic.

The mRNA vaccine is a very important technological advance in medicine. By understanding the surface of the COVID virus, scientists at Pfizer along with their German partner, BioNTeck and also at Moderna with their NIH partners were able to produce mRNA vaccine that when injected instructs our bodies to produce antibodies (special proteins) that bind onto the surface of the COVID virus and prevent it from attaching to cells in our lungs where COVID likes to enter our bodies.

Other vaccines also became available along the way which mostly used tamed down infectious viruses as carriers of various proteins which also caused our bodies to mount an immunologic response against COVID. They are still in use but are infrequently request now as our patients get to choose which vaccine they wish to have. It also turns out that a person can mix and match vaccines without adverse effects.

Variants of COVID and Treatments

Unfortunately, a series of variants of COVID emerged. These variants are accidents of reproduction of the virus which is an RNA based organism. RNA reproduction doesn't have error catching or proofreading like DNA reproduction does. Reproductions by the COVID virus inevitably produce mistakes along the way. Most of those mistakes are trivial or insignificant. A few along the way gave the virus an advantage in one way or another and then displaced whatever variant was then dominant, essentially pushing it out by using their new advantage. Unfortunately, each variant has a different shape to the surface it presents when trying to enter our cells. This different shape makes it more difficult for the antibodies we have on board if vaccinated to bind strongly onto the virus and prevent infection. It has become apparent that our antibody response produced by the vaccines declines over time. As a result, booster shots were added to the first two shots initially recommended for both the Pfizer and the Moderna vaccines. Now it looks like the booster shots' protection begins to weaken around four months after being given.

Lilly and AstraZeneca now have antibody treatments effective against Omicron. They need to be given early in the illness before the need for hospitalization arises in order to be effective. These treatments can be obtained through your physician who should be a member of the medical staff at a hospital where the infusion will be given. It can take several hours and must be scheduled in advance.

Pfizer and Merck have also been able to produce pills for oral treatment of active, but mild COVID infections. These are five-day oral treatments, much like a ZPACK for COVID. They are is short supply with few doses available around central Indiana. They will become more available as production ramps up. They likely will be prescribed by physicians and available at local pharmacies.

Prevention and Testing

Masks remain effective for decreasing the spread of infection with many bacteria and viruses, not just COVID. Wearing a mask can be annoying. If you are going to mask up, you might as well wear the most effective mask. This mask is the N-95 mask made only by 3M and labelled as NIOSH certified on the packaging and on the mask itself. These masks have a proprietary electrostatic grid that attracts and captures very small particles as they try to go through the mask. They are effective for several weeks and then should be discarded. They shouldn't be washed, and they need to be fitted onto the face so that when you breath in resistance is felt and the mask sucks in, indicating a good seal. there are many knockoffs and counterfeits so look at the package and the labelling on the mask. Real N-95s have two head straps that don't go around the ears and a fixed conical shape, and generally do not come in child sizes (although some are starting to be made).

Covid tests are mostly either ANTIGEN tests (which give an almost immediate result) or PCR tests which rely on reproducing via chemical means any virus in the sample until it can be detected. PCR tests are considered more accurate, but it is more difficult and takes up to three days to get the results. Home tests, especially the Abbott BiNAx are readily available. Now you can even buy COVID tests at Menards.

The cost is free or minimal given the US government's involvement in distributing the test kits.

Now demand for vaccinations is declining and our Health Department Clinic isn't as busy as it was. But stay tuned for next fall and winter. Watch news media for new therapies and new vaccines. It is said Moderna will have a vaccine specific for Omicron by August. We will see. I am hoping that COVD declines from pandemic proportions and becomes just another endemic virus that is more of an annoyance that potentially fatal disease.

We take walk-ins at the clinic, (111 American Legion Place, Greenfield, Indiana) during regular business hours M-F if anyone wishes to receive their choice of vaccination against COVID. Appointments are also available online or by phone. A fifteen-minute observation period follows the shot and yes, you can receive an influenza shot the same day in your other arm.

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