Supply shortages, silver linings and other things you need to know about COVID

Sure, we all hated them in elementary school, but it turns out that percentages might just be our friend when it comes to gauging the severity of COVID. 

How so? Well, currently the benchmark for measuring the health of our nation comes from looking at total number of cases of virus – namely, how many people at any given time have COVID. Slowly, however, there is a shift toward focusing on hospitalization numbers since it appears that Omicron might not be as severe as previous variants. The only problem with this metric is that Omicron is so much more transmissible than Delta that the total number of infections is approaching record highs, which, in turn, is then reflected in the number of patients who are being hospitalized. 

“I think our peak number for COVID inpatients across our system was upward of 260 back in July of last year,” said Danielle Scheurer, M.D., MUSC Health System chief quality officer, who oversees all things COVID for the hospital system. “But even though we are approaching those numbers right now, it doesn’t feel as catastrophic because there are fewer of those people in the ICU. And on average, patients are a lot less sick.”

So here’s where that fourth grade math finally goes to good use: If the number of cases is going up but the severity is down, looking at the percentage of people who contract COVID – and get really sick – is as low as it’s ever been. 

“Right now, I suspect that the volume of hospitalizations will continue to be on par with some of our highest numbers, but the percentage of who is truly sick is going to be far lower,” Scheurer said.

With the ever-changing COVID landscape, we are periodically checking in with Scheurer to ask her the most pertinent questions that are hanging in the balance.

Q. What are your feelings on the new Centers for Disease Control and Prevention (CDC) guidelines that reduced quarantine time for health care providers? 

A. So far, there are pluses and minuses. Now that they’ve given us a little more flexibility around when our employees can return to work after a positive test, it’s going to be less disruptive than it used to be, but we do have to make sure our team members are not working or returning sick. And if they’re just close contact – assuming they’ve received their boosters – there is no disruption to work at all since they don’t need to quarantine or test. So what we used to think of as a major disruption is now – assuming there are no symptoms or the symptoms are mild – at most, a five-day inconvenience. It’s a very different mindset now.

Q. I’m reading about how lots of health care providers are running low on supplies – monoclonal antibodies and antiviral pills in particular. Is that true for MUSC Health, and how does that affect how we handle cases?

A. Most of the monoclonal antibody treatments that worked great for Delta don’t seem to be working for Omicron. In fact, the only one that really works is sotrovimab, and it’s in limited supply. It’s hard to get anywhere, including here. Because of that, the National Institutes of Health (NIH) has come up with tiers of who should receive it. We follow those guidelines. Right now, we are only treating the top tier of COVID patients, people who are very susceptible to progressing to serious illness, with sotrovimab. As for the oral antivirals, there are two kinds, and Paxlovid is the really effective one. Not just effective – pretty incredible. I’ve read that it reduces the likelihood of hospitalization or death by as much as 90%. The problem is it’s in very short supply. As an example, the first distribution to South Carolina was 800 courses. For the whole state. Just for perspective, at that same time, South Carolina had 50,000 new COVID diagnoses last week. 

Q. Let’s say that you’re lucky enough to have access to one of the antiviral pills. What’s the process?

A. In an ideal world, you get tested. You get results. If you’re positive, and in the high-risk category, your doctor writes you a prescription for the drug. But the problem is there are only eight Walgreens in the state that are getting the drug. So in this volume and with this limited distribution, getting your hands on it right now is a near impossibility. 

Q. Could Omicron be the catalyst that gets us to herd immunity?

A. It’s possible. That is the hope and the potential silver lining here. The only thing that could thwart that is another significant variant. That’s really what it always gets back to. The whole vaccine campaign is on a race with the variants. It’s just a matter of who’s going to win. 

Q. What do you see in our future as far as boosters go?

A. I think it’s going to end up being periodic boosters for the unforeseeable future. We just don’t know the frequency. 

Q. I know this is basic, but let’s say you feel a little off. You take an at-home test, and it’s positive. The rest of your family seems fine. What do you do? Separate? Wear masks? Just be careful? Do your kids have to stay home from school?

A. Actually, that’s a really good question. If you’re positive, you’re supposed to quarantine. But the time is shorter now. For some people, they’re going to feel normal at five days. Some are not. And yes, if you’re positive, you really should keep your kids home from school. It’s hard; I know, but it’s the safest move.

Q. If somebody still hasn’t gotten the vaccine, is there any reason to think that’s going to change at this point? 

A. I think everyone’s experience is different. People who have been directly affected, maybe a loved one got really sick, maybe they change their minds. But for most people who haven’t by now, this wave isn’t going to change their minds. 

Q. This is a sticky topic, but do you think closing schools is a good idea, or is it potentially more damaging?

A. I think it used to be more controversial. Honestly, I think we’ve gotten to the point where we all need just to learn to coexist with COVID. Now we don’t want to be reckless; we just need to be smart about it. Limit the numbers in the classrooms – stuff like that. We’ve had two years to figure out how to handle this, so we should be able to keep our schools open at this point. And this can be applied to the broader world. For instance, I’m not sure lockdowns achieve anything in the long-run. They might bring numbers down in the short term, but I feel like you’re just putting off the problem. 

Q. Do you feel like we’re finally kind of figuring out COVID?

A. For the most part, yes. But on the other hand – and I know people really don’t want to hear this – we do have cases of very severe COVID that we still can’t explain. For instance, I’m taking care of a patient who has been at MUSC Health since October. He was a perfectly healthy young guy with no underlying health conditions. He wasn’t vaccinated, but why it has hit him so hard is a total mystery. His life is devastated. He’ll never be functionally independent again. And we can’t understand why. 

**Have a question you'd like answered? Email it to donovanb@musc.edu with the subject line “Vaccine Q.”