Since the onset of the coronavirus pandemic in late 2019, the approach to managing COVID-19 has undergone significant transformation. Currently, people have access to a variety of vaccines and effective antiviral treatments, including Remdesivir and Paxlovid, contributing to the achievement of herd immunity through a combination of vaccination efforts and natural infection exposure.
However, both COVID-19 and long COVID continue to pose substantial risks, particularly for individuals with pre-existing health conditions. The Massachusetts Department of Public Health has issued guidelines recommending oral antivirals as a primary treatment option for individuals diagnosed with COVID-19 who present a higher risk of developing severe disease, while IV antivirals remain an alternative for those who may require them.
We engaged in an insightful conversation with Dr. Sandeep S. Jubbal, MD, a prominent expert in infectious diseases and immunology, currently serving as an assistant professor of medicine. We delved into the current landscape of COVID-19, the evolution of vaccines, the importance of at-home tests in accurate diagnosis, and Dr. Jubbal’s recommendations for individuals diagnosed with either COVID-19 or long COVID.
Q: It’s been nearly five years since the start of the coronavirus pandemic. Where are we now and what are we still facing? Are there any underlying issues that we still have to worry about? And what about the possibility of another outbreak? Are we past that?
Dr. Jubbal: Things have changed significantly since the pandemic began. Initially, we were left without any treatment options, but we now have effective vaccines and a range of treatment modalities. Notably, we have achieved a level of herd immunity largely attributed to widespread vaccination as well as natural infections. Observably, many patients have ceased frequent testing for COVID-19, with assessments often only taking place as required by employers. In the last four to five years, we’ve witnessed seasonal trends, particularly a rise in cases during the summer and subsequent spikes after Thanksgiving in the winter months.
The overall number of COVID-19 patients we are now encountering has declined significantly compared to the early years of the pandemic. This reduction can be attributed to a combination of achieved herd immunity, the prevalence of milder infections, and the decreasing frequency of testing among the public.
Jubbal: Regarding long COVID, numerous research initiatives are currently underway, and preliminary data is emerging. For individuals with comorbidities or those at a high risk for disease progression, I strongly advise seeking treatment promptly to eliminate the virus from their system. This is particularly important given the potential risks associated with long COVID, which has been reported even among those exhibiting mild symptoms. While some patients may not present severe enough symptoms to require hospital care or emergency intervention, the looming risk of long COVID warrants caution and proactive management.
Q: Beyond older adults, people with diabetes or heart conditions, are there any additional groups of people that have been identified in the past few years who might be more susceptible to COVID than others?
Jubbal: Based on my clinical observations, individuals with a high body mass index (BMI), transplant patients, those on aggressive immunosuppressive therapy, or individuals currently undergoing chemotherapy show an increased risk for disease escalation.
Q: What do you recommend for people who test positive for COVID-19?
Jubbal: I recommend a combination of monoclonal antibodies, including Remdesivir, which is an approved antiviral treatment, alongside the oral antiviral medication Paxlovid. I advocate very strongly for administering these treatments to promote rapid viral clearance from the body.
My conviction is that everyone should receive treatment since these antiviral agents are remarkably safe and generally well-tolerated, with minimal side effects reported. The official guidance issued by the National Institutes of Health and the Commonwealth of Massachusetts is clear: all individuals should be screened for eligibility for oral antivirals. In cases where drug interactions or adverse reactions are a concern, we often resort to IV antiviral treatments like Remdesivir, although this requires a three-day administration process often necessitating emergency room visits.
Q: What steps should a person take after testing positive?
Jubbal: Anyone who receives a positive COVID-19 test, whether they have comorbid conditions or are otherwise healthy, should promptly contact their primary care physician. In my experience, primary care providers have been effective in prescribing oral antiviral medications aimed at managing these patients.
Q: What about at-home tests? Are they still considered reliable?
Jubbal: At-home testing options have proven to be significant advancements in managing this crisis. Their availability, alongside vaccines, has contributed immensely to our pandemic response and the level of success we’ve achieved in combating COVID-19.
Q: A new vaccine was rolled out in late August. When it comes to this new vaccine, what are your recommendations for people with comorbidities or vaccine hesitancy?
Jubbal: I unreservedly recommend vaccination. Many might question the frequency of new vaccines being rolled out; the rationale lies in the transient nature of the immune response, which typically lasts only three to four months. This is particularly critical for individuals who are severely immunosuppressed, whether due to medication or underlying health conditions; for these patients, booster shots are strongly advocated. This new vaccine not only offers protection against the original COVID strain but also targets the new variants currently circulating in the United States.
Hospitalization rates have decreased significantly among vaccinated individuals undergoing chemotherapy or receiving immunosuppressive treatments. Correspondingly, mortality rates have also declined.
Vaccines are undoubtedly effective, significantly reducing the likelihood of hospitalization and death, even if they do not entirely prevent the transmission of infection.
Dr. Jubbal joined UMass Chan in 2015. He is an assistant professor of medicine in the Division of Infectious Diseases and Immunology. He serves as the medical director of the COVID Treatment Center at UMass Memorial Medical Center and is the secretary for the Commonwealth of Massachusetts’ Board of Registration in Medicine.
which of the following is a correct statement about polymerase chain reaction (pcr) rapid testing?
Is still considered a valuable tool in the management of COVID-19. However, it’s important to ensure that individuals understand the limitations and best practices associated with these tests. While at-home tests can provide quick results, they may not always be as sensitive as tests done in clinical settings. It’s crucial to follow up with a healthcare provider if you test positive, particularly if you’re experiencing symptoms, to ensure proper evaluation and treatment.
Q: As we look to the future, what can individuals do to protect themselves against COVID-19 and its variants?
Jubbal: Staying informed about the latest public health guidelines, receiving vaccinations as they become available, and practicing good hygiene remain essential strategies. Additionally, individuals should consider limiting exposure during high-transmission periods, especially in crowded or poorly ventilated spaces. Precautions such as wearing masks, particularly for those in high-risk categories, can also be beneficial. Ongoing vigilance will be key to managing future outbreaks effectively.
Q: Is there anything else you would like to add regarding long COVID and the importance of seeking treatment?
Jubbal: Absolutely. It’s vital for individuals to recognize the potential long-term implications of COVID-19. Even mild cases can lead to long COVID, which can manifest in various ways, including fatigue, difficulty concentrating, and chronic pain. I urge anyone who is experiencing lingering symptoms to consult with a healthcare provider to explore treatment options. The earlier we address these issues, the better the outcomes we may achieve for patients dealing with these post-viral consequences.
Thank you, Dr. Jubbal, for sharing your insights on the current landscape of COVID-19 and the importance of proactive management for individuals at risk.
