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COVID-19 Update: How It Affects You

By: MEDICAL DIRECTORS FALANA CARTER, MD and JERRY I. LEVINE, MD, PA

COVID-19 continues to spread in Maryland. Individuals who remain unvaccinated are at the greatest risk of contracting and spreading COVID-19 including highly contagious variants resulting in hospitalization and death. The Centers for Disease Control and Prevention’s latest guidance recommends booster vaccines for adults over 65, those with high-risk medical conditions, and individuals at risk for COVID-19 exposure and transmission due their occupation or institutional settings. The Johnson & Johnson/Janssen vaccine has been approved for a booster after two months. The Pfizer vaccine is available for children 12 and older, and soon will be approved for children 5 years and older. Here’s how the latest COVID-19 news affects you.

The Delta variant

Like many other viruses, the coronavirus (SARS-CoV-2) continually changes, producing new strains with features different from the original virus. The Delta variant is the most common form of the virus in the U.S. today and is very dangerous, causing most new COVID-19 infections. Here’s what you should know:

The Delta variant is significantly more contagious than previous variants, infecting many more people.
The Delta variant appears to cause more severe illness in unvaccinated people than previous variants, leading to more hospitalizations and deaths.
COVID-19 vaccines are very effective in preventing Delta infections, and the vast majority of new hospitalizations and deaths are in unvaccinated people.
Fully vaccinated people can get “breakthrough” Delta infections, but they are rare and are generally less severe than in unvaccinated people.
Fully vaccinated people with Delta breakthrough infections can spread the virus to others, but vaccinated people appear to be contagious for a shorter period of time.

Booster shots

COVID-19 vaccines remain highly effective against the virus months after vaccination, but their effectiveness will decrease over time. The effectiveness of the vaccine is enhanced by getting a booster shot. Based on CDC recommendations, these groups are eligible for booster vaccines:

Adults 65 or older who received two doses of the Pfizer-BioNTech or Moderna vaccine at least six months ago
Adults 18-64 with underlying high-risk medical conditions
Adults 18-64 who are at increased risk for COVID-19 exposure and transmission due to their work or institutional settings
All adults 18 or older who received the single-dose Johnson & Johnson/Janssen vaccine at least two months ago

Also, individuals with compromised immune systems are eligible for a third dose of the Pfizer-BioNTech or Moderna vaccine at least 28 days after the first two doses.

Boosters may be “mixed and matched,” heterologous dosing. While preference remains to obtain the same booster as the primary vaccine, either Moderna or Pfizer can be received as a booster for the Johnson & Johnson/Janssen vaccine. This can be discussed with your primary care provider.

MPCP administers the Moderna and Johnson & Johnson/Janssen vaccines in our offices, and many of our offices will also offer the Pfizer-BioNTech vaccine starting November 1.

Call your MPCP office to schedule an appointment to receive a booster dose. Vaccines are also available at your local pharmacy or health department clinic.

COVID vaccines for children

The CDC is recommending COVID-19 vaccination for children 12+. Here’s the latest:

Fewer children have been infected with COVID-19 than adults, but they can still get sick from the virus and spread it to others.
CDC recommends everyone 12 years and older should get a vaccination to protect them and help prevent the spread of COVID-19.
The two-dose Pfizer-BioNTech vaccine has been shown to be safe and effective for children 12+. As with adults, serious side effects from the vaccine are rare in children, and the benefits of vaccination greatly outweigh the potential risks.

If you have questions about COVID-19 or the vaccine, contact your MPCP doctor or visit Maryland’s covidLINK website.

Dr. Levine is an MPCP partner and is certified by the American Board of Internal Medicine. He serves as MPCP’s Medical Director and Vice President, and sees patients in the Columbia office.

Dr. Carter is an MPCP partner and is certified by the American Board of Family Physicians. She serves as Assistant Medical Director and sees patients in the Arundel Mills office.

Pain Management and Opioid Prescribing at MPCP

In this video, Dr. John Billon explains how to recognize when someone is abusing opioids.

By: Jerry Levine, M.D. FACP, Vice President & Medical Director

Pain management is a real problem that our MPCP providers treat on a regular basis. The CDC estimates that 11% of adults experience daily pain. There is no question that over-prescribing of legal opioids, as well as the use of illegal opioids, has caused an epidemic of opioid abuse in Maryland.

What we do to protect you

We at Maryland Primary Care Physicians practice pain management to ensure patients have access to safer, more effective treatment while reducing the risk of opioid abuse, overdose, and death.

MPCP providers strictly follow the guidelines established in Maryland for narcotic prescribing. When prescribing any controlled medication such as opioids, the prescription is cleared through the state prescription drug monitoring program (PDMP). This is an electronic database that tracks controlled substance prescriptions at the time of prescribing. This can help identify patients who may be misusing prescription opioids or other potential medication abuse.

All of our providers also follow the published CDC guidelines for prescribing opioid medication. This is not only consistent with good clinical practice, but it is also required by the State Board of Physicians and is enhanced by continued education required to maintain a medical license in Maryland.

In establishing our goals of treatment, we first consider non-pharmaceutical and nonopioid therapy. We strongly encourage integrated pain management and collaborative working relationships with other providers (physical therapists, physical medicine specialists, pharmacists, behavioral health providers, and, importantly, Pain Management Specialists). Consultation and referral is an important part of pain management. Discussion of risk and benefits of therapy with patients, goals of treatment, and duration of medication management is key for effective treatment. At Maryland Primary Care, we have peer review requirements, which not only monitor controlled medication prescribing but allow our providers to consult their peers for pain-management problems.

How you can prevent opioid abuse

Patients can take these steps to ensure safe use of prescriptions:

follow the directions as explained on their prescription label,
never change the dose without consulting their provider,
never use another person’s prescription,
never share their prescriptions with others.

Storing and disposing of medication properly when treatment is completed is also extremely important. Follow these guidelines from the U.S. Department of Health and Human Services.

Pain management is common to our practice and requires an individualized response. Treatment can be challenging for healthcare providers as well as patients. It is possible to improve the way we manage pain and the way opioids are prescribed. Our goal in treatment at Maryland Primary Care Physicians is to reduce the number of people who misuse, abuse, or overdose from opioids while making sure our patients have access to safe and effective pain management.

Dr. Levine is a MPCP partner and is certified by the American Board of Internal Medicine. He serves as MPCP’s Medical Director and Vice President, and sees patients at the Columbia office.

Is Zika coming to Maryland?

A Q & A by: Jerry Levine, M.D., FACP, MPCP Medical Director

Q: What is Zika?

A: Zika is a virus spread mainly by Aedes aegypti mosquitoes, a species found in Maryland and many other states. These mosquitoes, when they bite people infected with Zika virus, become disease carriers and spread the virus by biting other people. In some cases, Zika can also be transmitted between sexual partners.

Q: Where does Zika come from?

A: Before 2015, Zika virus outbreaks occurred in areas of Africa, Southeast Asia, and the Pacific Islands. Since then, Zika has spread to parts of South and Central America, Mexico and the Caribbean.

See which countries have reported Zika: http://1.usa.gov/1Qq5Iow

Q: Is Zika in Maryland?

A: At the time this article was written, there were dozens of confirmed cases of Zika virus in Maryland, but all of those people were infected while traveling overseas. So far, no one has gotten Zika in Maryland, but the imported cases may result in local spread of the virus.

See Zika cases in the U.S.: http://1.usa.gov/1PiUIcc

Q: Are people with Zika contagious?

A: At this time, the Zika virus is not believed to be airborne and is not primarily spread from person to person, which means there’s little to no risk of becoming infected with the virus from simply being near an infected person. However, Zika can be transmitted sexually.

Q: How dangerous is Zika?

A: Most people infected with Zika virus won’t experience any symptoms or will only have mild symptoms. Common symptoms include fever, rash, joint pain, muscle pain, headache or conjunctivitis (red eyes). The illness is usually mild with symptoms lasting for several days to a week. Hospitalization is rarely needed, and so far there have been only two deaths from Zika reported in the U.S. – an elderly man with other health issues and a baby born infected with the virus.

The main danger from Zika is that pregnant women can pass it to their unborn children. The CDC has confirmed that the virus can cause severe defects in unborn children, including microcephaly, which leaves babies with abnormally small heads and often with brains that do not develop properly. The CDC strongly advises that women who are pregnant or plan to become pregnant soon don’t travel to Zika-infected areas.

Q: If Zika comes to Maryland, what can I do?

A: There is no medicine or vaccine to prevent or treat Zika virus disease, so prevention is key. If Zika is reported in Maryland, take these steps to protect yourself and your family:

Use insect repellents containing DEET, picaridin, IR3535, para-menthane-diol, and lemon eucalyptus oil.
When weather permits, wear long-sleeved shirts and long pants.
Use air conditioning or window/door screens to keep mosquitoes outside.
Aedes mosquitoes typically lay eggs in standing water, so empty water from containers outside your home such as buckets, bowls, bird baths, flower pots, old tires and vases.

Q: What should I do if I think I have Zika?

A: The risk of getting Zika is presently very low in Maryland. However, if you travel to an area with Zika and develop a fever, rash, joint pain, or red eyes within two weeks of returning, see your doctor. Be sure to tell your doctor where you traveled. Zika can’t be cured, but your symptoms can be treated to make you more comfortable.

Dr. Levine is an MPCP partner and sees patients in the Columbia office. He received his medical degree from New York Medical College, completed his residency program in Internal Medicine at University of Maryland Medical Center, and is certified by the American Board of Internal Medicine. Dr. Levine currently serves as MPCP’s Medical Director and Vice President.

The Changing Healthcare Environment

A Q&A with Medical Director, Dr. Jerry Levine

Q: Dr. Levine, what are your impressions of the current healthcare environment, and its impact on you as a primary care physician?

A: Today’s healthcare environment requires doctors not only to provide good care, but also measure and document good outcomes using electronic record keeping. The challenge is to do this while maintaining the one on one individual patient focus that has always been fundamental to our care.

At MPCP, we are continuing to develop effective practices to deal with these changes, as we remain focused on our patients’ well- being. The role of primary care providers is now more important than ever. Family practitioners and internal medicine specialists are on the forefront in the areas of disease prevention and wellness. We want to be partners in keeping our patients healthy, and as the population ages, this partnership will be even more critical.

Q: How do you think MPCP is positioned to deal with these changes, while continuing to provide quality care?

A: We are well prepared in many ways:

Almost 10 years ago, we began with EMR (electronic medical records) to document patient care and outcomes;
We recognize and have responded to patients’ need for more convenient access to care, including early morning, evening, and Saturday hours at most practices;
We’ve adopted electronic transmission of prescriptions to pharmacies which is proven to reduce errors; and,
We have established a strong physician recruitment program to maintain an excellent team of primary care doctors in the MPCP network.

Q: What one piece of advice would you give to patients about staying as healthy as possible?

A: We all live busy lives, but the best thing we can do to stay healthy is to make priorities of sleep, eating a healthy diet, and regular exercise (150 minutes/week). These are by far the most important things we can do, in addition to regular follow-ups and preventive care with your doctor. Another preventive measure is staying current on health screenings and adult vaccinations.

Jerry I. Levine, M.D., FACP