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We ask doctors about COVID reinfections and how well antiviral meds are working17:41
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Wastewater data in Massachusetts continues to rise, and COVID case numbers in the state are now higher than they were this time last year.

Children ages 5 to 11 soon will be able to get a booster, but kids younger than that still can't get their first shot.

State public health officials have said the goal no longer is to avoid infections, but rather to prevent severe illness and death. And recently, some experts say they see a future in which individuals come down with COVID several times a year.

To help decipher this moment of the pandemic, we speak with two infectious disease physicians at Tufts Medical Center: Dr. Helen Boucher, interim dean of Tufts University School of Medicine and Dr. Gabriela Andujar Vazquez, associate hospital epidemiologist at Tufts Medical Center.

Highlights from this interview have been lightly edited for clarity.

Interview Highlights

On how this COVID surge compares to prior ones we've endured:

Andujar Vazquez: I think that there's a couple of things that are different and in a good way this time. [Vaccines] still are effective, and they still are avoiding hospitalizations. The other key part is therapeutics. We have pills that you can take at home if you get COVID. We have other medications that we can give intravenously. And I think that has actually changed our hospitalizations. Also, the deaths are still not seeing increases, which is good. So even though we're living through another surge ... I think we are in a better position today than we were in previous surges.

On the effectiveness of oral antiviral medications such as Paxlovid, and the risk of "COVID rebound":

Boucher: So the oral antivirals that Dr. Andujar Vazquez mentioned include the drug Paxlovid, which is the most effective of the options that we have available. And these medicines are now widely available in our state with multiple ways to get them via telemedicine or in-person.

... Most of the population actually is recommended for medication. There are some contraindications, and that's why it's important to talk to your doctor. But if you get the medicine, it is designed to directly attack the virus and knock down the virus and shorten the duration of your symptoms and the severity of your symptoms. And it's been proven to be 90% effective at keeping people out of the hospital.

... The second thing is this observation of rebound. There have been some patients who have been treated with Paxlovid who have an initial response: They feel better, they are better. And then maybe a week later they start to have symptoms again. This has been reported and is nothing, I would say, to be overly concerned about. In fact, viruses do this as well. So we're still teasing out how much of this is related to the medicine versus the virus itself. But all in all, I think it's important to remember that these medicines are 90% effective at keeping you from getting sick enough to go to the hospital with COVID.

On the prevalence of COVID re-infection and whether it impacts the likelihood of developing severe illness or long COVID:

Andujar Vazquez: There's a proportion of the population that seems to be "more susceptible" to re-infection than others. ... We have a big proportion of the population that has had it, and not once, but twice or sometimes even three times, just based on the surveillance data. We're still trying to understand what the risk factors are for individuals to get COVID and long COVID.

There was a recent study published ... by a particular private insurer, so it's not representative of everyone in the U.S. But it was a big study, where they were trying to understand what are the risk factors the American citizens have to go into long COVID. It seems that it's more likely to happen in individuals that are middle-aged and more likely to happen when you have mild to moderate disease, as opposed to being hospitalized with it, which is very interesting. I think we have a lot to learn. I don't think that the more you have COVID — once, twice or three times — we're not sure if that increases your chances of getting long COVID. I think that we do have an idea that being vaccinated might help avoid that.

On the impact of home tests and other factors on official test positivity rates:

Boucher: A lot is different this year than last year. We have vaccinated people, and we have people testing at home. So there are fewer people getting PCR tests, and we know that more of them are symptomatic. So the rate of positivity reflects likely positivity among people who are symptomatic and more likely to have COVID. So certainly, we've got more COVID. The modelers are doing the work to kind of estimate how much we may be under or over.

... Wastewater gives us a snapshot of what's going on. And that's not a great number. It's still not to the levels that we saw with the omicron surge, but it's still trending in the wrong direction.

So, we are looking less at cases. This sort of disconnect is good. ... [Because] we have highly vaccinated individuals and a lot of people who've had COVID, there's a disconnect between infections and either hospitalizations or death. That means that COVID is not causing as much trouble as it has in the past, and that is very reassuring from a public health standpoint.

On the impact of COVID infection on mental health, and how to support individuals who get sick during their recovery:

Andujar Vazquez: While mental illness may be outside of my expertise, we do work closely with a lot of our mental health experts around COVID and related issues like this. The pandemic has affected us in many ways that we are yet to even quantify or even describe in terms of mental health, and that, on top of getting infected with the virus, can also take a toll on individuals, families, loved ones, friends.

We have learned to live with not only being sick with the COVID and what that might mean for our own health, but also worrying about people we may be living with. ... And then, it's like the uncertainty of having COVID: "Will I be fine? Will I have long COVID?" COVID behaves similarly to other viruses that we do see quite often in the infectious disease world, like infectious mononucleosis and in other herpetic viruses where people take some time to recover, which is interesting about viruses in general. And so trying to cope with all of that ... it's hard.

... I think that the one thing I would recommend [for] people that have had COVID and are struggling with recovery physically and mentally is to talk about it. Be open about it so we can together navigate those issues that maybe our patients are struggling with and try our best to help make people feel better mentally and physically.

On when we will get a vaccine for children under 5 years old:

Boucher: I certainly don't have a crystal ball. I know everybody's working hard to make sure that the data are reviewed and are of the quality that we need to know that vaccines are safe and effective for small children. The thing I do want to emphasize is that the data continue to show us, thankfully, that the risk to those small kids is proportionately low. Smaller kids don't overall get as sick with COVID. So obviously we want the vaccine to come, but parents should be reassured by those data as well.

On current quarantine expectations after COVID exposure or infection:

Andujar Vazquez: We are expected if we have COVID infection to be in isolation for a total of five days. And as long as we're fever-free and improving, we're allowed to get out of isolation with the assurance that we are going to wear a mask around others for the remaining five other days, for a total of 10 days. So what that means is, you're in strict isolation for five days and then day 6-10, I'm wearing a mask around others, even at home, to decrease that chance of transmission.

... And in terms of quarantine, if you know you're exposed ... the recommendation is to wear a mask around others for 10 days total and monitor for symptoms. Making sure that if you have a fever, cough, any of those respiratory symptoms, that you go ahead and get tested right away and isolate until you get your test results. ... Day zero is the day that you find out the test is positive or the day that you started having symptoms, and then we start counting day 1 the next day.

This segment aired on May 19, 2022.

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