COVID focus now: Protect the vulnerable, doctor says as widespread mitigation measures subside

Dr. Dale Bratzler wants the public to know that multiple options are available to prevent or treat COVID-19 — and that the therapies all work best when administered early. But some proven COVID-19 treatments are not being utilized to their full potential, he said.

It’s important for people to understand the risk factors for developing severe COVID complications, Bratzler said, so that as public health strategies relax on the backside of the latest wave, high-risk individuals can take personal precautions and know their treatment options.

“We’re in a very different place now; we have good treatments,” Bratzler said. “We just need to make sure that people — particularly those who are at risk of complications — seek out those treatments as early as they can if they get infected.”

First and foremost, vaccination remains the best prevention tool. But Bratzler said the toolbox now also contains antiviral pills, convalescent plasma, remdesivir antiviral medication, monoclonal antibodies and a specific monoclonal antibody for people who are highly immunosuppressed to protect them from infection for six months.

Bratzler, who also is interim dean of OU’s Hudson College of Public Health, recommends that people contact their primary-care physicians for information on the range of therapies. However, he expressed frustration about how underutilized some treatments are because many doctors aren’t pointing their patients in those directions.

Some COVID hospitalizations might have been prevented if the patients had received treatment early, he said.

“Frankly, I blame doctors to a certain extent,” Bratzler said. “They’re not recommending them; they’re not giving them to the patients who are at risk for the complications of the disease.”

Bratzler expressed optimism about the pandemic for the spring but offered his usual reminder that COVID-19 isn’t going away.

About 56% of Oklahoma residents are fully vaccinated — 65% of the U.S. as a whole is — and Bratzler said so many people became infected by omicron that there are many fewer people for it now to infect.

He said there is increasing evidence that natural immunity from an omicron infection might provide better protection against reinfection than prior variants did.

“If we don’t see another variant that pops up, I feel pretty good about the spring,” Bratzler said. “The cases will continue to come down, and we can get back to more pre-COVID type of activities.”

Oklahoma’s recent three-day average of COVID-19 hospitalizations was at 804 as of Friday — plateauing this week from Monday’s 807. The number is down 25% from seven days earlier, when it was 1,067, and down 64% from the record 2,243, set on Jan. 28.

Of the 804 COVID hospitalizations, 187 were of patients requiring intensive care.

“The marked reduction in hospitalizations has really freed up resources and personnel in our hospitals,” Bratzler said. “ERs are under less pressure. There’s still a lot of people in the hospital, but they’re under less pressure.”

The number of Oklahomans dying from COVID remains elevated, though that metric is coming down, too.

The seven-day average of COVID deaths in Oklahoma was at 45 per day on Friday, which is down 32% from the peak of 66 per day only 11 days earlier.

“The number of deaths that we’ve been recording in the state has actually been pretty substantial,” Bratzler said, noting that patients who develop severe COVID often stay in the hospital for weeks before succumbing to the disease.

The most dramatic drop has been in COVID case counts.

The seven-day average for new daily cases in the state was 886 on Friday, which is down 21% from 1,128 a week ago and down 93% from the record 11,908 just more than a month ago.

Bratzler said Oklahoma was down to 23 new daily cases per 100,000 residents, with the highest state — Maine — at 81. For context, he said in mid-January the highest states were at 500 during omicron’s peak.

He said doctors will have to watch “stealth omicron” — a subvariant of omicron — to see what it does. In some countries, he said, stealth omicron makes up about a third of cases.

The Centers for Disease Control and Prevention found stealth omicron to make up 3.8% of new cases in the U.S. for the week ending Feb. 19. That share of new cases was 2% the prior week, 1% the week before that and 0.3% for the week ending Jan. 22 — about a month ago.

Other omicron subvariants have been identified, Bratzler said, as happened with the delta variant. He said that isn’t uncommon, but the public just didn’t hear as much about subvariants previously.

“I think we just need to watch and see what happens,” he said.

Bratzler said he thinks the focus should shift toward solving how to protect the vulnerable as more of society re-engages in normal or near-normal activities.

“It’s just the reality of how do we protect those that are vulnerable while at the same time not having these broad-brush mitigation strategies that hold everybody accountable for things like wearing masks,” he said.

For example, Bratzler said, a vaccinated person who is young and healthy likely will experience at most a bad cold from the virus.

But that person might be around someone who is immunocompromised or elderly or has underlying conditions, such as diabetes or heart disease, who might face grave consequences if infected.

That is a challenge confronting Bratzler on OU’s Norman campus — a predominantly healthy and young population intermixed with some vulnerable individuals.

“We need to make sure that we really get the word out about what those risk factors are, and then really make sure that we teach those who are at greater risk some of the things that they can do to protect themselves,” he said. “So it might be that they’re wearing the medical-grade mask or N-95 if they’re out in public.”

Featured video: Experts say it’s too early to declare victory over COVID-19