COVID update: What you need to know for 2023 11/14/23

I am pleased to share this presentation I was requested to give to the Upstate Nurse Practitioner's Association of South Carolina. Thank you for the opportunity to share knowledge.

1. COVID update: What you need to know for 2023 Part 1 11/14/23 Neil Kao, M.D.

2. COVID-19: 1 Highlights Review the structure of coronavirus Timeline of COVID-19 in US Risk factors Symptoms Testing for COVID-19, flu, RSV

3. Question 1: What part of the coronavirus is responsible for its ability to cause COVID-19 ( 'CO' stands for 'corona,' 'VI' for 'virus,' and 'D' for the disease ) in humans? RNA Envelope membrane protein Spike glycoprotein Nucleoprotein Membrane protein

4. COVID-19 Pathophysiology: Structure

5. Question 2: How has the rate of hospitalizations and deaths from coronavirus-19 changed in the past year? Stayed same Decreased Increased

6. Question 3: what is the greatest risk factor for death from COVID-19? Race Sex Age Coronary artery disease Political party

7. around 27 percent of total COVID-19 deaths in the United States have been among adults 85 years and older, despite this age group only accounting for two percent of the U.S. population

8. Home tests for COVID-19 Go to https://www.covid.gov/tests to get 4 free home tests Are rapid antigen at-home tests, not PCR Can be taken at home or other locations. Give results within 30 minutes (no lab drop-off required) Can be used for testing whether you have COVID-⁠19 symptoms or not Can be used for testing whether you are up to date on your COVID-⁠19 vaccines or not. Are also referred to as self-⁠tests or over the counter (OTC) tests

9. COVID-19 + Flu + RSV Test Home collection $129 Labcorp, processed by Labcorp 2. Xpert ® Xpress CoV-2/Flu/RSV plus, Processed by office (AFC, ADAC) cost $ IK??, Results in 35 min

10. Can use different cartridge, test for strep also.

11. Lucira™ by Pfizer COVID-19 & Flu Home Test Cost $99

12. Question 4: It is very important to know if the patient actually has COVID-19. What testing options do providers have to rapidly diagnose COVID-19? Home tests Combined COVID-19 + Flu + RSV Test Lucira™ by Pfizer COVID-19 & Flu Home Test Convalescent titers 1-3

13. Summary

14. Hot take: Read my headlines!! After variant already growing. Mutations on spike

15. COVID update: what you need to know for 2023 Part 2 11/14/23

16. COVID-19: 2 Highlights Prevention Vaccines If you were exposed or become sick: Unapproved treatments Discontinued treatments Approved treatments Long haul Miscellaneous Future

17. Question 1: what it the lowest age that the COVID-19 vaccination has been recommended? At birth 4 months with the routine vaccinations 6 months 5 years old 18 years old 65 years old

18. Unproven therapies lying supine, ivermectin, zinc, hydroxychloroquine, vitamin C For long-haul, stem cell autologous transfusions, exosome therapies List of unproven methods against COVID-19 - Wikipedia

19. Discontinued therapies J ohnson and Johnson vaccine 5/23 Convalescent serum Monoclonal antibodies, all no longer effective because virus spike has mutated

20. Question 2: If a patient tests positive for COVID-19, but has no symptoms, and asks for a medication, I should give the patient: A home mixture of herbs, zinc lozenges, vitamin C Ivermectin A prescription for convalescent plasma from the blood bank A prescription for antibodies for COVID-19 from the infusion center A prescription for Paxlovid

21. Personal plan Level 1: avoid obviously sick people, surfaces, mask when in crowds (plans) Level 2: possible exposure Level 3: got covid Level 4: urgent situation Paxlovid cost Survivorship lessons

22. Summary of COVID-19 Preventative Agents & Treatments

23. Question 3: For patients with mild-moderate symptoms and the right time frame, which medication is recommended first? IV remdesivir (Veklury) PO nirmatrelvir, ritonavir tablets (Paxlovid) PO molnupiravir (Lagevrio) PO dexamethasone ( Decadron) PO acyclovir (Zovirax)

24. Question 4: Which meds should be considered for a patient has COVID-19 infection + is hospitalized, is needing conventional oxygen treatment, but does not have any signs of systemic inflammation? Remdesivir Dexamethasone PO baricitinib IV tocilizumab All of the above

25. Long haul 1 in 7 people get long haul, but symptoms almost all fade away by 1 year

26. HOT NEWS FROM READING LIST

27. Future trends Annual endemic infections, hospitalization, deaths Combined vaccines: 2 companies COVID-flu combined testing now Less breakthroughs, because less urgency (politics), less $ research, continued profit mode from pharmaceutical companies Costs borne by private insurance and through patient copays + federal at extremes: expect more delays, confusion, misinformation Harder to find reputable websites outside of the government, many shut down

28. Important sources of information CDC NIH https://files.covid19treatmentguidelines.nih.gov/guidelines/covid19treatmentguidelines.pdf , https://files.covid19treatmentguidelines.nih.gov/guidelines/section/section_100.pdf IDSA https://www.idsociety.org/practice-guideline/covid-19-guideline-treatment-and-management/#OverviewofCOVID-19TreatmentGuidelinesSummaryTable CIDRAP https://www.cidrap.umn.edu/covid-19 https://leaps.org/the-best-coronavirus-experts-to-follow-on-twitter/particle-1

29. COVID-19: 2 Summary

30. Acknowledgements T hank the Upstate NP Association for the opportunity to review these facts about COVID-19. It’s been 3 years since last lecture and we’ve been through a tremendous amount of change. Slides will be available in link at lecture…. Almost every slide has a reference in the speaker notes I post my bibliography of important media articles on my website: neilkao.com

31. Underlying Medical Conditions Associated with Higher Risk for Severe COVID-19: Information for Healthcare Professionals https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-care/underlyingconditions.html#anchor_1618433687270 2/9/23