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By Daniel Dunaief

For many local health care workers, the pandemic transitioned from triggering uneasiness about reports of a respiratory illness coming out of China to a significant threat to area residents.

Dr. Susan Donelan, Photo from Stony Brook Medicine/Jeanne Neville

Health care workers were in an all-out scramble to save lives even as information about the disease, its course and treatment, changed.

Five years after the start of a world-altering pandemic, infectious disease experts and emergency medicine specialists shared a range of thoughts about their initial reactions and concerns about this illness as well as insights about lessons learned and readiness to manage through future significant health threats.

Dr. Susan Donelan, Medical Director of Healthcare Epidemiology at Stony Brook Medicine, remembers raising questions about this virus towards late December of 2019. People urged her to go home and have a nice Christmas.

When Hospital CEO Carol Gomes called her on a Sunday and told Donelan she had an hour to get back to her, she recognized the approaching storm.

“I remember saying, ‘It’s a Sunday and she needs me in an hour,’” Donelan recalled. “We’re in it.”

Indeed, over the following months and, as it turned out, years, doctors dealt with numerous unknowns amid a fluid situation that threatened the population and, in particular those who were immunocompromised, had diabetes or respiratory or cardiac issues.

“People forget how bad things were,” said Dr. Gregson Pigott, Commissioner of the Suffolk County Department of Health Services. “So many people were dying” that hospitals needed to figure out where to put the deceased.

Residents also lined up to get the scarce tests for the presence of the virus and often waited days or longer for a result.

Fluid situation

Health care professionals were reacting to a fluid situation in which best practices in terms of treatment and prevention changed even as the virus was mutating.

“It seems like a blur, going back and thinking about those moments,” said Dr. Jennifer Goebel, emergency room doctor at Huntington Hospital. “It was very surreal, taking care of a disease process you knew nothing about and attempting to be the expert when we were still learning.”

Federal, state and county health officials were unsure of the best guidance for a range of safety measures, including the use of masks.

Additionally, health care experts struggled with the level of contagion based on different environments.

“I don’t think anyone really knew about the continuum that could occur depending on the ambient circumstances,” said Donelan. “I think we probably could have done a better job of letting the public know that our communications would evolve as our knowledge evolved.”

Sharing safety messages

During the worst of the pandemic, health care professionals struggled to share messages that would help people make informed decisions about protecting themselves, their families and their communities.

Dr. Sharon Nachman. Photo frm SBU

“Trust in public health was completely undermined,” said Dr. Sharon Nachman, Chief of the Division of Pediatric Infectious Diseases at Stony Brook Children’s Hospital “That hurt all of us.”

Nachman also listened to health care professionals on national TV who were discussing the health crisis. These pundits were sharing information that included far too many inaccessible words and concepts.

“Smart professionals were talking” but people weren’t understanding them, she said.

Additionally, the echo chamber of social media distorted messages, often questioning the developing science and best practices, suggesting conspiracy theories as well as treatments that were either unproven or ineffective.

Having local professionals from area hospitals made a difference on Long Island, Nachman said.

Whenever Nachman went to ShopRite, people who knew she was a part of their community saw her and asked questions.

“When it’s someone local from Northwell, Stony Brook, NYU Winthrop or others, [local communication] really works better,” she said.

Goebel added that she continues to share her medical knowledge not only with patients, but also with family members who have come to the hospital to provide support.

Hospitals, for their part, learned their lesson about stocking personal protective equipment.

“People have learned their lessons” at hospitals, said Pigott. “We need a more adequate stock of PPE.”

Health care provider PTSD

During the worst of the pandemic, one in five doctors who responded to an American Medical Association poll in 2022 said it was likely they would leave their practice within two years.

Dr. Jennifer Goebel. File photo from Northwell Health

“It was so staggering to hear some of these numbers,” said Goebel. Doctors go through over a decade of training. Seeing so many people leave was difficult.

Health care workers struggled, and continue to struggle, with memories and experiences in the midst of a crisis that killed millions around the world.

“I remember going to room nine, intubating a patient and being called to bed 12 and intubating another patient, within a matter of minutes,” said Goebel. 

As the director of wellness in the Emergency Medicine Service Line, Goebel has created new initiatives to help reduce burnout and provide support.

She developed a peer to peer pilot program that started in September in which new physicians, physician’s assistants and nurse practitioners were matched with a more experienced professional from day one.

The effort is designed to help new staff navigate the health system and address any questions or concerns.

“We’re looking to put these processes in place” throughout Northwell, Goebel said. 

Remote medicine

While remote medical choices, such as telehealth, predated the pandemic, these options have become increasingly common, particularly for residents who might struggle to get to a medical visit.

“Because people were forced to use it, with practice, they got better at it,” said Pigott.

Many organizations invested more in telehealth, which also reduces the burden on Emergency Departments.

Teleheatlh has its “risks and benefits,” said Goebel, as it can keep patients who might be vulnerable out of an environment where they might otherwise be exposed to other pathogens.

Goebel appreciates the importance of a visit with a doctor, who can differentiate between an ear ache and a potential indication of shingles.

Fortunately, for many people, Covid has become a much more manageable infection.

Pigott contracted Covid in September. He took Paxlovid, which helped knock out the symptoms within three days.

Pigott is also grateful for vaccines, which provided a dramatic reduction in mortality during the worst of the pandemic, particularly for people who are over 65.

The vaccine was “saving lives,” said Pigott. “There was real evidence that these are doing their jobs and are working out.”

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By Daniel Dunaief

In a nod to the herd immunity from a combination of illnesses and vaccinations in the population, the Centers for Disease Control and Prevention is widely expected to reduce the recommended number of days of isolation after a positive test to one day from five days.

Even as most of the population has returned to a normal life after the pandemic — toughing through colds with relatively mild symptoms at work and staying home, for the most part, when symptoms become severe — the CDC had urged Americans to remain isolated for five days.

“Covid has diminished as a real threat for the majority of people,” said Dr. Sharon Nachman, Chief of the Division of Pediatric Infectious Diseases at Stony Brook Children’s Hospital. “The responsiveness between vaccinations and multiple events [such as infections] is reasonable to prevent hospitalization and death in most people.”

In addition, Covid treatments, such as Pfizer’s Paxlovid, have become effective in reducing the severity and duration of symptoms.

The CDC likely couldn’t have provided such guidance a year ago, but, for most people, the consequence of contracting the virus that altered the course of life for people for several years, has been less problematic for their health, doctors said.

Despite ongoing illnesses and symptoms, people have become less likely to test for Covid.

“Insurance companies used to pay for eight per month, but now, people just buy one [test box] at a time,” said Michael DeAngelis, the owner of Village Chemist in Setauket.

Dr. Sunil Dhuper, chief medical officer at Port Jefferson’s St. Charles Hospital, understood the CDC’s decision, with an important warning.

“The rationale behind changing the timing of isolation guidelines is based on looking at the evolving severity of cases,” Dhuper said.

“People who are younger get more mild levels of illness and recover,” he added.

Concerns for the elderly

“The disease is beginning to behave more and more like other respiratory viruses, but we are not there yet,” Dr. Dhuper cautioned, particularly for those who are over 65.

Hospitalization for people who contract Covid is 11.2 per 100,000 for people over 65, compared with 6.9 per 100,000 in the week ending Feb. 10, according to data from the Centers for Disease Control and Prevention. 

The mortality for those over 65 from Covid is higher than for the flu, Dr. Dhuper said.

“We have to be a little cautious, sending a message to the community that you can continue to do what you want to do,” Dr. Dhuper said. “When they are around the elderly” people, particularly those who might have symptoms even if they haven’t been tested, should consider wearing masks or keeping their distance.

The incidence of Covid, among other illnesses, climbed after the December holidays and the start of 2024, as people traveled to visit with family or on vacations. Those numbers have come down, although the upcoming spring break from secondary schools and colleges raises the possibility that illnesses could climb again, doctors predicted.

Be careful of grandkids

While the public may not want to hear it, Dr. Dhuper expected that it might take another five years before Covid reaches a comparable level of potential risk to the elderly as the flu, which could also present a risk to people’s health.

Dr. Dhuper urged those who have symptoms to test themselves for Covid. Even if they don’t isolate themselves for more than 24 hours, they should be cautious around vulnerable groups.

Dr. Dhuper’s advice to grandparents is to “be careful when you’re around your grandkids, because they are like petri dishes, harboring tons of infections.”

While for many people in the community, Covid has become like white noise, it’s still causing medical problems and leading to some hospitalizations, the St. Charles doctor added.

Any change in isolation guidance from the CDC should come with an asterisk that “yes, we are changing the guidelines, but people should still exercise precautions,” Dr. Dhuper said.

Vaccination research

Amid discussions related to vaccines, Dr. Nachman added that several compelling papers have demonstrated that people who are up to date on their vaccines, including flu, are at lower risk for dementia.

The link between vaccinations and overall brain health is unclear, and it is possible that people who receive vaccines also have a lifestyle that reduces the risk of developing dementia.

“We have an aging population in New York, particularly on Long Island,” said Dr. Nachmman. “If we want to keep them healthier longer, getting appropriate medical care, including vaccines, is probably helpful.”

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By Leah S. Dunaief

Leah Dunaief

COVID got me again. This second time around makes me angry, which is probably irrational. I mean, really, I paid my dues, I succumbed like almost everyone else a couple of years ago, and I feel that should be that. Also, I did everything I was supposed to do. I was vaccinated again in the middle of October this past year and felt pretty immune, although I know the vaccine doesn’t prevent the disease, just makes it less severe if it hits. Still, I felt relatively protected and didn’t bother wearing a mask when in a group. I won’t make that mistake again.

I did take Paxlovid this time, as I had the first time, and perhaps my symptoms were less acute. This onset was a little different. Instead of the painful sore throat in the beginning, I developed a dripping nose and assumed I was getting a simple head cold. Then I got quite stuffy and began to cough and to run a low grade fever. I stayed out of the office, finally donned a mask and bought a test kit. The first test I took was negative, but the next day I tested positive, and I have been home since then.

I am sharing these details in the hope that they may be helpful for those who are experiencing COVID presently or who should be alerted now to the clear and present danger. Fortunately, I am again testing negative, but the weather is uncooperative at 17 degrees. The extreme cold and dry air is not recommended for a newly recovered respiratory system, and so I remain home for now. But I can reveal some more specifics that might be of interest.

Neurological aspects were less pronounced this second time around. The sore throat was less sore and lasted for a shorter period of time, I didn’t lose my sense of taste either time, and while the cough continues, it seems less frequent during this home stretch. But according to what I read, post COVID fatigue is worse, and I can confirm that. I haven’t slept this many hours each day since I was a teenager. Napping is also a help. I have craved hot soup, and little else, throughout these past few days. Blessings on my friends and neighbors, who have provided me with an endless supply, from homemade chicken broth to the store bought wonton variety. I am also drinking smoothies made up of fruits and especially dark green leafy vegetables, like bok choi and baby kale and arugula. This particularly helps ward off dehydration. And while I have lost a couple of pounds, this is not the preferred way to diet.

There are some studies on patients who have had COVID more than once. Experts are still unsure about how damaging that might be, if at all. New variants, like JN.1, and periodic upticks keep the virus a current threat. There are at least 1200 covid-related deaths each week, and in the last week of December, nearly 35,000 Americans were hospitalized with COVID. No one seems to know if repeated exposure to the coronavirus increases the risk of Long Covid.Those who were hospitalized with the first round of COVID were more likely to have a severe second bout. That is well established. Lingering symptoms, like fatigue, shortness of breath and brain fog may also persist, especially after a difficult first attack. But evidence is still unclear that links repeated infections with Long COVID.

So what to do next?

We should all forego our complacency, and actively try to avoid COVID-19, even though the disease appears to be less severe for most. We really don’t know the long term effects of repeated infection. That means going back to basics: washing hands often, avoiding crowds, if possible, staying home if ill, using Paxlovid, which has been highly successful in moderating the virus, and especially returning to wearing masks. No one wants to be mildly ill or to increase the health risk for others.

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Stock photo

By Leah S. Dunaief

Leah Dunaief

This message is for older people who are reading this column and may get COVID-19. The information may save your life. It may have saved mine.

Especially for older people, COVID is a deadly virus. What defines older? Let’s say, beyond 50. Now there is a medicine that dramatically reduces severity and possible death from this virus, but many Americans are not taking it. Its name is Paxlovid.

“Never really in recent history for a respiratory virus can I think of an anti-viral medication being as effective, demonstrated in scientific literature, as what Paxlovid has shown,” stated Dr. Rebecca Wang, an infectious disease specialist at Dartmouth Hitchcock Medical Center, when interviewed by The New York Times.

Both random trials and data from electronic health records have shown this medicine to be effective, particularly among older patients. The medicine works by inhibiting the virus’s replication once it invades the body. Its underuse is already associated with thousands of preventable deaths, according to Dr. Robert Wachter, chair of the medicine department at the University of California, San Francisco.

“A large chunk of deaths are preventable right now with Paxlovid alone,” Dr. Ashish Jha, the White House COVID response coordinator told David Leonhardt of The New York Times. He predicted that if every American 50 and above with COVID received a course of either Paxlovid or monoclonal antibodies, daily deaths might fall to about 50 per day, from about 400 per day.

So why aren’t people taking the medicine?

For one reason, Paxlovid, which is taken twice a day for five days, does leave a metallic taste in the mouth. So I found that by eating half a banana after each dose, I got rid of the unwelcome taste. I also got the benefit of a banana a day, which is a healthy and nutritious fruit containing fiber and some essential vitamins and minerals.

Another possible reason is the association of Paxlovid with “rebound,” a second session of the disease which can occur a week to a month after the end of the first round. Experts don’t know what causes the rebound. A rebound is possible even if the patient never used Paxlovid. And even if he or she did, perhaps a longer duration of the drug is necessary for some patients than the five days currently administered.

Research has shown that out of sample of 568,000 patients, 0.016% over 50 who used Paxlovid died. For a similar cohort of patients who did not use the drug, the death rate was four times higher or 0.070. But only 25% of patients eligible to receive the drug actually took it, even though it is available and free.

Thanks to my son, Daniel Dunaief, who has spoken with two infectious disease experts, we also have some local reaction to the drug. Dr. Andrew Handel, pediatric infectious disease physician at Stony Brook Children’s Hospital, commented, “Hesitancy to take Paxlovid seems to fall in line with the general ‘COVID fatigue.’  COVID is clearly less lethal now than during prior surges, thanks in large part to vaccinations, but it still causes some hospitalizations. Those at highest risk of severe disease, particularly those who are unvaccinated, benefit from antiviral treatment if they are infected.”

Dr. David Galinkin, infectious disease expert at St. Charles Hospital, said, “The media has overblown this rebound experience. In the literature, about 10% of cases [have a rebound.] Like any other medication, people that could really benefit from Paxlovid [should consider it.] … We are still seeing people dying from this.”

Perhaps more doctors could be better informed about this drug. Additional information and encouragement are needed from the White House, and a lot more public announcements should be placed in the media to reach people. As has been the case throughout these last two-and-one-half COVID years, instructions have been changing, adjusted as the scientific and medical professions learn more about this pathogen. Proper treatment is still a work in progress.

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An antiviral pill may be beneficial in treating COVID-19 in its early stage. Stock photo

When the pandemic first hit Suffolk County in March of 2020, health care providers tried what they could to treat COVID-19.

The treatment options may be on the verge of increasing, as Pfizer recently revealed the benefit of an antiviral pill they developed to treat the virus in its early stages.

The Pfizer pill, called paxlovid, “decreased hospitalization significantly,” said Dr. Bettina Fries, chief of the Division of Infectious Diseases at Stony Brook Medicine. “That’s exciting.”

The Pfizer pill, which would still need Food and Drug Administration authorization before medical care providers can administer it to patients, comes just a few weeks after Merck announced its antiviral pill molnupiravir was effective in treating people who contracted COVID-19.

Indeed, at the end of last week, Britain became the first country to approve the use of molnupiravir for people with underlying medical conditions, including heart disease and obesity.

“There is more information on molnupiravir as this drug was approved in the [United Kingdom] last Thursday,” Dr. Adrian Popp, chair of Infection Control at Huntington Hospital explained in an email. “It will be administered as soon as possible following a positive COVID-19 test and within five days of the onset of symptoms.”

As for Pfizer, it has not yet released data about its clinical trials to the scientific community, which means independent researchers haven’t reviewed the information.

Still, the introduction of new antiviral treatments advances the battle against the virus on another front.

“They are novel medications,” Popp added. “The speed by which they are being developed is amazing.”

Popp added that the pace at which the new Pfizer drug eliminates the virus and its symptoms is unclear because of limited data.

Fries said the Pfizer and Merck drugs were in different classes and worked differently, which means they may be most effective in combination.

In terms of side effects, Fries wouldn’t expect anything dramatic from either treatment.

Taking pills that reduce the severity of the disease also aren’t likely to reduce the body’s natural immunity to the virus.

“The immune system has already seen enough of the virus by the time you take the drug,” Fries said. Some of the patients in the trial probably had the virus for about a week, which is enough time for the immune system to recognize the invader and develop a natural resistance.

The timing of treatment with antiviral drugs determines its effectiveness. Drugs like Tamiflu, which prevents the worst symptoms of the flu, become less effective the longer the virus is in a patient.

“If you give this drug later, it will likely have less effect,” Fries said.

Additionally, Fries cautioned about overusing these drugs in future months and years, which can lead to viral resistance.

Fries believes the virus, like the flu, will continue to stick around and will return in waves.

The authorization of vaccines for children ages five to 11 will likely reduce the threat from the virus.

“A lot of parents will schlep their kids right away, especially before Thanksgiving,” Fries said. “Physicians and people who have a deeper understanding of vaccines feel comfortable” with them.

Fries recently received her third shot.

While the likelihood of children developing the worst symptoms of the disease is low, they contribute to the spread of the virus.

Additionally, the virus can mutate, which could make it “potentially a lot worse. There is [also] a low but potentially significant risk of long covid syndromes,” Fries said. “You don’t want your kid to have that. Children should be super duper healthy, not just a little bit healthy.”

Thanksgiving preparation

In terms of preparing for Thanksgiving, Fries urged everybody over 65 to get a booster, particularly if they received their initial vaccines at least six months ago.

Stony Brook Hospital is admitting patients who have been vaccinated and are over 65, in part because their initial vaccinations were over half a year ago.

“We see more and more older people presenting with the disease again,” Fries added. “Do it now so you have antibodies for Thanksgiving” particularly if a family has children returning from college.

Additionally, Fries urged residents and their families to get tested before coming together, which will reduce the risk of household transmission.

Even though Pfizer and Merck have produced drugs that may improve the treatment of COVID-19, Fries urged people to continue to get vaccinated.

“This kind of drug treatment does not make us say, ‘Okay, you don’t need to get vaccinated,’ Fries said. “Absolutely not.”

Fries noted that those people unwilling to receive an mRNA vaccine might get another option before too long.

The Novavax vaccine has “performed really well” in clinical trials, Fries said. “It is more of a traditional vaccine.” The Novavax facilities have had production problems. Once they resolve those issues, the company could apply for emergency use authorization.

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