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The COVID-19 Pandemic Is Not Over Yet, Folks

Please urge your friends and family to get vaccinated.

In March 2020, when I had COVID-19 before anyone knew it was circulating in Cleveland, I was just coming into the speaking season when I travel around the country presenting at national and regional meetings. It is where I usually pick up all my engagements for the year. All the sessions got cancelled, postponed, or converted into virtual. Many organizations thought fall of 2021 was a safer bet, so they rescheduled meetings that usually are held in the spring for this month.

Delta has been making me very nervous, and I keep checking back with conference organizers to see if they are really still planning to hold the conferences in person. I think they are caught between a rock and a hard place. These annual conferences probably supply the lion’s share of income for the organizations, and there are concerns about people being disenfranchised and unengaged opting to not their memberships. But are you SURE you want to hold these conferences in-person?

I hope the irony isn’t lost on you all that I almost had to cancel my OHIMA COVID-19 talk because I thought I had COVID-19 again.

On September 30, my 90-year-old father didn’t get dressed which was somewhat unusual. I asked him why, and he replied that he thought he hadn’t felt well earlier but couldn’t remember why. The next day, he again was clad in his robe, and this time he said he still didn’t feel well but it seemed as though he couldn’t identify why. I made the mistake of asking him a leading question, “Does anything hurt?” He complained that his right knee hurt. He had a wound on his right knee from a fall weeks before and tends to develop cellulitis which devolves into sepsis, so I drove over to his assisted living facility to visualize the wound and determine if a trip to the emergency department was in order.

I asked the nursing staff to grab a set of vital signs prior to my arrival to see if he was febrile. As I approached the entrance to the building, the administrator waylaid me and informed me that my father had been tested for COVID-19 because another resident had tested positive. It took a moment for it to register that he was telling me that my father’s test had returned positive, too.

My father’s second Pfizer shot was February 4. His booster had been scheduled for the week of October 22. We had a false positive scare in August 2020. I was wondering whether this one was real or not.

I donned PPE and went into his room to assess his knee. As I did so, I ascertained that he was feeling very fatigued, and then he coughed. I recognized I was hyperventilating when I got dizzy. I realized my father had breakthrough COVID.

I conferred with the staff and his PCP, and we arranged for him to be transferred by ambulance to the local hospital that administers monoclonal antibodies. I didn’t realize that the current policy allowed for a single visitor, so I didn’t get to the emergency department until 8 pm.

When I arrived, the nurse informed me that my father had COVID-19 pneumonia on chest X-ray but wasn’t deemed a candidate for the therapy because he was not steady when he went to ambulate. I glanced around for a walker and, seeing none, asked if he had been using a walker. She looked at me quizzically (at least I thought so over her mask) and said my father hadn’t told her he uses a walker. I asked if they could obtain one, and we could try again.

I was nervous because my father often feels short of breath when he walks because he does so little activity. When we got him up, he initially desaturated, but then his pulse oximeter went to 97-98  percent and stayed there. The REGEN-COV was a go.

I sat in his room for about two hours total with an N95 mask. He was transferred back to his assisted living facility the next day. I think it was more of a transportation issue than a need for observation. He has done well. But it was the first time I had been knowingly exposed to SARS-COV-2.

In fact, my whole vaccinated immediate family had been exposed. My husband who is a radiologist was told by their infection control folks that he was able to go to work as usual unless he developed symptoms. No quarantine is in order if you are vaccinated, per the CDC.

Five days later, the day before I was planning to drive to Columbus to speak to OHIMA, my throat felt scratchy, I sneezed, and had a stuffy nose. I slept fitfully and realized the prudent action would be to do a COVID-19 test. I had picked up four kits earlier in the week from the library…just in case. Had I not been exposed, I would have shrugged off the symptoms, attributing them to ragweed allergy.

I opted to perform a rapid antigen test. It was a government-supplied test, and there were strong admonitions against opening the kit until contacting the professional guide. These are the sort of kits which one performs if one needs proof of results, like for teachers or travel.

It was interesting. The guide who was in India had to observe me and the kit contents every step of the testing. This meant I needed my husband to hold my iPad at an angle to allow visualization of the test card and my nose at the same time. I have no idea how people who are not technically savvy or don’t have four arms can do this test properly for official purposes. The performance of the test wasn’t otherwise much different than a home pregnancy kit. And I never wished for a single pink line so hard in my life!

It was negative. The organizer of the conference informed me that another speaker had cancelled, so she would have been really bummed if I had had to cancel too. Of course, sharing this anecdote made me run three minutes over time, but, oh well.

It is so frustrating to know that we are in this predicament because people refuse to get vaccinated. If we all had gotten our shots en masse when we were eligible, the virus would have been stymied. It’s like trying to start a bonfire without fuel. If there is no dry wood (unvaccinated people), there is no fire (virus outbreak). My poor father with his elderly weak immune system is like a piece of wet wood. It is less likely to catch fire, but combustion is not impossible.

My husband and I spent a few days recharging in Columbus. We hiked (please don’t tell my orthopedist because I am still recuperating from foot surgery) and ate outside. On Saturday, we ended up in Loudonville, Ohio and were mortified to find ourselves in the midst of a street fair with “free admission, free entertainment, free exhibits” and, as far as I can tell, free COVID-19 exposure. It was curb-to-curb masses of unmasked revelers, and from my research, it was a five-day affair. How many cases will result from this?! People are thinking that the case rates and deaths are trending down, but in Ashland County with a vaccination rate of 37 percent, this clearly will send the incidence back up in 2-3 weeks.

I just read a disturbing article about an almost-term pregnant woman who refused vaccination and vacationed with her family on a Florida beach which was during a COVID-19 Delta variant surge. Her entire family contracted COVID-19, and she succumbed to her infection. Her newborn baby will never meet her, and her 22-month-old son now only gets to hear her voice in a teddy bear recording.

Obstetricians who rarely lose patients are noting a very unsettling trend of patients dying from COVID-19, and they are almost exclusively unvaccinated. Only 31 percent of pregnant women are vaccinated. 15-25 percent of COVID-positive pregnancies are requiring critical care, and the death rate from Delta for them is considerably higher than the original variant. The CDC and ACOG now unequivocally recommend vaccination during pregnancy.

Please get vaccinated. Please urge your friends and family to get vaccinated. The COVID-19 pandemic is not over yet.

As soon as you are eligible, get your booster shot. The vaccines work, but their efficacy diminishes with time. I expect sometime in the next few weeks that we will be told that Moderna and Janssen/Johnson and Johnson vaccines require boosters as well.

My dad will get his booster in three months according to protocol. You don’t receive vaccine within 90 days of monoclonal antibodies. As for me, I can’t wait to be eligible. Bring it!

Finally, please join me this Thursday, October 14 or on demand for a COVID-19 webinar. Go to ICDUniversity bookstore niversity to register.

Programming Note: Listen to Dr. Erica Remer when she relates her personal story during Talk Ten Tuesdays today at 10 Eastern.

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Erica E. Remer, MD, CCDS

Erica Remer, MD, FACEP, CCDS, has a unique perspective as a practicing emergency physician for 25 years, with extensive coding, CDI, and ICD-10 expertise. As physician advisor for University Hospitals Health System in Cleveland, Ohio for four years, she trained 2,700 providers in ICD-10, closed hundreds of queries, fought numerous DRG clinical determination and medical necessity denials, and educated CDI specialists and healthcare providers with engaging, case-based presentations. She transitioned to independent consulting in July 2016. Dr. Remer is a member of the ICD10monitor editorial board and is the co-host on the popular Talk Ten Tuesdays weekly, live Internet radio broadcasts.

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