Even as the COVID-19 pandemic wanes, health leaders are remaining vigilant regarding treatment, trends, and response to the virus. Recently, the White House COVID-19 Response Team held a Zoom meeting with more than 30 organizations to discuss updated information, and ACS Regent Kenneth W. Sharp, MD, FACS, was selected as the representative for the ACS.
The call was led by Tom Tsai, MD, MPH, FACS, a minimally invasive gastrointestinal and bariatric surgeon at Brigham and Women’s Faulkner Hospital in Boston, MA, and a senior policy advisor for the White House COVID-19 Response Team.
Dr. Sharp reports that, through August 2022, the trends in mortality have swung back to mimic the death trends in the early days of the pandemic in 2020, with 88% of deaths from COVID coming from the 65+ age groups. The new variants of COVID-19, specifically offshoots of the dominant BA.5 subvariant of Omicron called BQ1 and BQ1.1, now account for more than 33% of national infections. Effectiveness of vaccination, boosters, and the new bivalent boosters is not yet known.
Prompt treatment with Paxlovid in the groups older than 65 greatly reduces hospitalization and deaths. Those with prompt prescription had one-third the risk of hospitalization, at approximately 0.49% treated versus 1.5% untreated, and death from COVID-19, where prompt prescription reduced chance of death to 0.02 in the treatment population versus 0.10% in the untreated.
Also regarding Paxlovid, the "rebound" associated with treatment for some individuals is, more accurately, viral rebound. The incidence of recurrent symptoms after a 5-day course of Paxlovid compared to untreated patients experiencing recrudescence of symptoms is about 12% in each group.
In terms of other treatments or preventive measures, prevention of COVID-19 through Evusheld for the new variants may be unlikely. However, the small molecule drugs (Paxlovid, remdesivir, and molnupiravir) are still thought to be effective in treating COVID-19. The monoclonal antibody bebtelovimab is not expected to effectively treat COVID-19 from the new variants.
Specifically seeking any updated guidance for surgeons, Dr. Sharp asked the two questions ACS leaders are hearing most from Fellows:
- Do we still need to test all patients (or selected groups) before elective surgery?
- How long do we delay elective operations in a patient with COVID-19?
Unfortunately, there were no definitive answers from the group or the White House. The overall sentiment remains that societies should develop guidelines, which the ACS has played an important part in since the pandemic began.
