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COVID hospitalizations up, but fewer people needing ICU, vents

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As antiviral treatments become more widely available, that could help explain why Michigan's seeing the lowest rate of hospitalizations requiring ICU or ventilator use since September 2020.

For the first time during the COVID-19 pandemic, we’re seeing hospitalizations go up without a corresponding spike in ICU and ventilator use.

Experts say the decoupling is likely because antiviral treatments like Paxlovid and Molnupiravir are more widely available and are preventing people from getting seriously ill. In fact, the state is "currently seeing the lowest percentage of hospitalizations requiring ICU or ventilator since September 2020," according to state health officials.

That’s probably thanks “in part to vaccinations and therapeutics,” like monoclonal antibodies and oral antiviral medications, the Michigan Department of Health and Human Services said in its latest weekly COVID data and modeling update. While the FDA’s emergency use authorization for Paxlovid extends only to people who are at high risk for getting seriously ill from COVID, Michigan patients can now get the drug at pharmacies like Walgreens and Meijer.

“I’ve prescribed it to a few people, and they’ve done really great with this medication,” said Dr. Dennis Cunningham, director of infection control and prevention at Henry Ford Health. “I think it’s incredibly effective, incredibly safe. I wish we did more.”

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A graph of COVID hospitalization and severe illness trends, showing that in previous surges, by the time Michigan had hit about 1,000 adults hospitalized for COVID (which is where the state stands now), a larger share of those patients were severely ill in the ICU or on ventilators.

While initially the problem with Paxlovid was limited supply, Cunningham said they’re now pushing doctors to take advantage of the increased availability. “It is getting better, but I'd like to see it used a lot more,” he said. “One thing that would make everyone's lives easier, is that we don't have a lot of the antivirals being prescribed in the state. So we are sending messages out to our providers to make sure they are aware that we have a small number of doses of the monoclonal antibodies, but the two antivirals that are out there are very effective.

“Unfortunately, the better one of the two is Paxlovid, but it has a lot of drug interactions. So clinicians may have to be creative about holding other medicines or decreasing doses, but it's worth the effort because Paxlovid will prevent hospitalizations in people at high risk for severe COVID disease by 80%, if you start it within the first five days of symptoms,” said Cunningham.

But this doesn’t mean people should let down their guard. Michigan’s increase in cases these last several weeks comes just as we’re getting a better picture about who gets long COVID, and what those health issues can look like in the weeks, months, and even years after an initial infection.

“I think people look at [rising case rates] and say, ‘Most of us are going to be fine. We're not going to wind up in the hospital,’” said Cunningham. “But that long-haul COVID is very real, where people can be impacted for quite a while. So that should really go into people's equation. It's not just the short illness you're going to get through. You don't want that fatigue, the brain fog, the other symptoms [that can last far longer.]”

On Tuesday, the CDC released a new study suggesting as many as 1 in 5 adults who survive COVID will go on to have health issues that may be related to the virus for weeks, months, and sometimes even years after initial infection. Across the board, the risks for COVID survivors, compared to people who were never infected, were highest for acute pulmonary embolism (blockage of a lung artery) and respiratory symptoms.

The picture is even bleaker for those over the age of 65, nearly half of whom experienced “incident conditions” that could be part of long COVID, according to the study. Those include neurologic problems that could last beyond the one year mark, such as “mood disorders, other mental conditions, anxiety, and substance-related disorders.”

“People's lives are really impacted,” Cunningham said. “And you know, you hear fatigue and brain fog is bad, but [you think] ‘I'll get through it.’ There's people who are going to have trouble getting out of bed, going to work, doing their activities of daily living, taking care of their kids, all the things we all have to do."

"I really do worry about the impact that long COVID is going to have. Not that people are going to die, but it's going to be pretty miserable," he said.

And while vaccination may offer some protection against long COVID, a major new study from the Department of Veterans Affairs published Wednesday found that while vaccination appeared to give greater protection from lung and blood clot problems in long COVID, it didn’t offer as much protection from other long COVID symptoms as experts had hoped.

“The vaccines are miraculous at doing what they were designed to do [in terms of preventing hospitalization and death,]” lead author Dr. Ziyad Al-Aly told NBC news. But they “offer very modest protection against long Covid,” he said.

Kate Wells is a Peabody Award-winning journalist currently covering public health and the COVID-19 pandemic.
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