COVID-19 Confusion? 11 Questions Answered

UPDATED 11/22/21

This is an exhausting and confusing time, with endless information – and misinformation – everywhere. Infectious disease expert Cindy Noyes, MD, of the University of Vermont Medical Center sat down with us to help make sense of it all. 

Should I be concerned about breakthrough infections?

Breakthrough infections happen, but infections are happening much less frequently in vaccinated people than in unvaccinated people. Breakthrough infections tend to have mild symptoms with dramatically fewer complications, such as hospitalization or death. For example, as of Sept. 7, 2021, the Vermont Department of Health reported that of the 426,323 fully vaccinated Vermonters, just 0.45% – 1,928 people – tested positive for COVID-19. Of those, an even tinier fraction of the fully vaccinated population – 0.012% or 53 people – were hospitalized. Eighteen (0.004% of fully vaccinated Vermonters) died.

Why are people taking ivermectin as a COVID treatment? 

Ivermectin is an anti-parasitic medication used worldwide in humans and animals. There have been some studies looking at possible anti-viral effects, including in COVID-19. However, there are no studies that suggest it an effective treatment for COVID-19 infection. Although generally well-tolerated, ivermectin is not meant to be administered for days on end or in high doses. Veterinary formulations have not been studied in humans; therefore any use in humans should be strongly discouraged.  

How is COVID-19 properly treated?

For inpatients, emergency use authorization (EUA) has been granted for remdesevir, which is an anti-viral drug. Anti-inflammatory medications such as dexamethasone, baricitinib and tocilizumab have also shown to be beneficial in certain circumstances. For outpatients, EUA has been granted for treatment with monoclonal antibodies. These antibodies are produced in a lab that target the spike protein of the virus to prevent it from infecting our cells. For high-risk patients, these interventions may reduce risk for severe complications, including the need for hospitalization or death.  

What is the mu variant? 

The mu variant of COVID-19 is now considered a ‘variant of concern’ by the World Health Organization and is the fifth variant to emerge. The mu variant is still in very low proportions in the US. The Centers for Disease Control and Prevention (CDC) is currently assessing to what degree we are seeing the variants, but the delta variant is currently the predominant strain. 

Why do variants keep happening?

When viruses are allowed to circulate through a community, they mutate as they replicate. This is why it’s so important to reduce the spread of COVID-19 through vaccination and prevention measures (masking, distancing, staying home when sick); the virus then has fewer opportunities to mutate into new variants. If people are vaccinated, the risk of developing and hosting COVID-19 to mutate is dramatically reduced.

Is the vaccine effective against variants?

The vaccines currently available in the U.S. (Pfizer, Moderna and Johnson & Johnson) are effective against the variants as well as the original strain of COVID-19. The vaccines may be modestly less effective against the delta variant but continue to prevent severe symptoms, hospitalization and death.  

Why do we need boosters? Does that mean the vaccine isn’t effective?

Boosters help our bodies increase the amount of antibody levels, which in turn likely increases the amount of protection to COVID-19, including to variant strains. In many vaccines, people require more than one injection to achieve protection. Most vaccines (hepatitis B, measles, tetanus and diphtheria) require a “series” of injections. These diseases are rare due to widespread vaccination programs including multiple-dose injections at the prescribed periods of time.               

The CDC and FDA have approved Pfizer and Moderna boosters if you are 18+ and received your two-dose regimen at least six months ago. Johnson & Johnson boosters are available if you are 18+ and received your first dose at least two months ago.

Now that the school year is underway, are we seeing an increase in pediatric COVID cases?

In Vermont, we are seeing more positive cases of COVID-19 in young residents, but the majority do not require hospitalization. 

Can COVID-19 become a seasonal virus like the flu?

Not unlike the H1N1 “Swine Flu” of 2009 and 2010, most of us will eventually be exposed to COVID-19 — hopefully through vaccination, but also through infection. When COVID-19 becomes “endemic” — or prevalent — in a population, the exposure to infection in that population decreases. And of a virus can’t find a susceptible host in which it can reproduce, it can’t easily be transmitted. 

That said, in typical years, 30,000 to 80,000 people become infected with the flu.  Strategies such as masking, vaccination and staying home when sick can reduce transmission.  

Are there benefits to not getting the COVID-19 vaccine? 

No. There are no benefits to not getting the COVID-19 vaccine. In fact, according to the CDC, people who are not fully vaccinated are at 10 times greater risk for hospitalization and death. Fully vaccinated people have a much greater chance of not being impacted by COVID-19.

Do we still need to practice other prevention measures if we’re vaccinated?

Yes.  At levels where transmission risk is high (Vermont and New York currently fit into this category), we should continue to mask, stay home when we’re sick, isolate and get tested with onset of symptoms.  

No one strategy by itself is fool proof, but what we’ve seen repeatedly is that our multiple layers of risk mitigation (masking in crowds or indoors, vaccination, staying home when sick) are effective.