COVID Vaccines and Prior Infection
Should I get vaccinated for COVID-19 if I’ve recently recovered from a COVID infection?
From the CDC website:
“Yes, you should be vaccinated regardless of whether you already had COVID-19. That’s because experts do not yet know how long you are protected from getting sick again after recovering from COVID-19. Even if you have already recovered from COVID-19, it is possible—although rare—that you could be infected with the virus that causes COVID-19 again.
If you were treated for COVID-19 with monoclonal antibodies or convalescent plasma, you should wait 90 days before getting a COVID-19 vaccine. Talk to your doctor if you are unsure what treatments you received or if you have more questions about getting a COVID-19 vaccine.”
https://www.cdc.gov/coronavirus/2019-ncov/vaccines/faq.html
“What if I already had COVID-19?There is not enough information available yet to say if, or for how long after infection, someone is protected from getting COVID-19 again. More studies are needed to better understand this. If you know you have had COVID-19 or you think you may have had COVID-19, you do not need to get any testing prior to vaccination. If you have COVID-19 right now, you should wait to be vaccinated until your isolation period is over.”
First Responders and Antibody Testing
We answer some of your questions about antibody testing for COVID-19.
Video Summary
- This is not an endorsement or recommendation for antibody testing. Currently it is not advisable to change behavior based on antibody results. However, if providers pursue testing, we want you to have the most up to date knowledge available.
- Antibody testing (blood test) is most useful if done at the same time as virus testing (nasal swab)
- Accuracy of antibody tests is currently variable. Lateral flow/point of care tests run on a finger prick are less accurate than lab tests. Positive antibody test may not mean you are immune or actually have antibodies.
- Do not change the use of PPE or social distancing based on your antibody test results.
- If you get antibody testing, we recommend getting it done at a hospital or clinical lab through a blood draw.
When can I stop self-isolating after recovering from presumptive or proven COVID-19?
See above. Unless told otherwise by your physician or public health, if you are fever free for more than 72 hours and your symptoms are improving, you can leave isolation and rejoin the rest of society in social distancing. Consistent with public health recommendations, you should continue to wear a mask in public spaces where social distancing is difficult (grocery stores, inside buildings).
Why am I not taking prophylactic hydroxychloroquine or another medication?
Both hydroxychloroquine and chloroquine are immune-modulating drugs. Hydroxychloroquine is used in treating rheumatological disorders (lupus, rheumatoid arthritis) and chloroquine has been used for malaria.
A good review of the literature can be found here.
There is not enough evidence to recommend the routine use of a chloroquine in those with mild symptoms due to the lack of data and the real risk of side effects (QT prolongation, cardiac dysrhythmia, seizures, vision changes).
If I give a patient a neb treatment or start CPAP am I needlessly spraying aerosolized SARS-CoV2 everywhere?
The concern about aerosol-generating procedures is based on the fact that not everyone in the entryway and hallways of the ED is wearing full PPE and the risk of contamination is not small.
Preferred protocol is to notify the hospital about CPAP, BVM, or nebulized albuterol and allow the receiving team (in full PPE) help determine access into the ED.
Per Santa Clara County EMS Administrative Order 2020-003, CPAP and nebulized albuterol should be reserved for patients with pulse oximetry less than 94% on or off oxygen.
What are we doing for patients once they get into the hospital?
As you know, not all patients with COVID-19 need admission.
For those who are hypoxic, treatment includes escalating amounts of oxygen via nasal cannula, non-rebreather mask, high-glow nasal cannula and then possible positive pressure ventilation before intubation.
Some patients presenting in distress or profound hypoxemia will be intubated early in the course of their admission.
Antibiotics can be given if a bacterial superinfection is suspected on top of the viral infection
Steroids and antivirals will likely be given to admitted patients who have an oxygen requirement.
Intubated patients seem to improve with prone ventilation. This is likely because dependent (backside) parts of the lung now get recruited to work, and you get improved ventilation/perfusion matching.
See the Society for Critical Care Medicine Guidelines here and here
Further Reading and Links
What Stanford EMS Medical Directors are reading:
Medications that may or may not work (Stanford)
LitCOVID (Do your own primary literature search)
Brigham and Women’s Treatment Guidelines (searchable!)
Internet Book of Critical Care (Vermont ICU physician and excellent compilation of all things COVID)