Doctors brace for second COVID-19 wave

Jewish medical professionals in the Boston area and on the North Shore are urging continued vigilance to mitigate a possible second wave of COVID-19 and the additional threat of the flu with fall in full swing.

“If we do all of the things that need to be done – masks, social distancing, hand-washing – and are observant of other data and science-driven public health controls,” said Mark Poznansky, an infectious disease physician at Massachusetts General Hospital, “we will not only flatten the curve on COVID-19, we will also flatten the curve on the flu and other seasonal respiratory viruses.”

Poznansky is the director of MGH’s Vaccine and Immunotherapy Center, where he spends 75 percent of his time. As director, he guides vaccine and immunotherapy efforts for infectious diseases including COVID-19, as well as cancer and Type 1 diabetes. The other 25 percent of his time goes toward clinical service at the main hospital for patients with infectious diseases, including COVID-19.

The surge of the past spring was a challenge for hospitals like MGH, which had hundreds of patients hospitalized. Although the number has decreased since then, it has crept back up over the past month, from 300 in September to 500 currently, according to Dr. Camille Kotton, the clinical director of transplant and immunocompromised host infectious diseases at MGH.

It is important to realize that in general, Massachusetts case numbers are “slowly trickling up,” Kotton said. Addressing the longer-term situation, she said, “We anticipate an increase in disease activity over the next six months. The likely prediction for the Boston area is that we may see up to one-third of the disease activity of the spring. We’re hoping no more than that.”

On the North Shore, medical professionals are preparing for a second round of COVID-19, should it occur.

“We all know how important are social distancing, wearing masks and avoiding large gatherings in reducing the spread of the virus,” Yuriy Levin, a primary care doctor at North Shore Medical Center, said in an email. “I also think our organization is well prepared for [a] possible increase in cases and we are in much better shape than in March/April.”

Dr. Mark Messenger, the medical director of the HomeMD primary care program at Danvers-based Care Dimensions, a provider of hospice and palliative care, and the president of Congregation Shirat Hayam in Swampscott, saw his most recent COVID-19 patient just before Labor Day. Yet he continues to take precautions when visiting patients in their homes or at assisted living centers, arriving in a gown, mask and face shield.

“I anticipate COVID will come back at some point,” he said.

If and when it does, medical professionals anticipate applying lessons already learned from the first wave.

Poznansky, of MGH, cited “how we learned Dexamethasone was useful, Remdesivir could be used to help patients with severe COVID-19 infections, how important [it is] to maintain excellent protocols in ICUs, the use of ventilators and so forth.”

Messenger said that the assisted living centers he visits have been “very careful. Everybody is wearing gloves, masks. Visits are outdoors right now. … There’s some communal dining. There’s much more knowledge.”

“There’s been a lot of learning,” Poznansky concurred. “I certainly feel, as a practicing infectious diseases physician, that we’re better equipped now to deal with a second surge.”

Farther out on the horizon is the possibility of a vaccine.

“So far, it looks like it’s a reasonable prediction to hope we have a COVID-19 vaccine in the first quarter of 2021,” Kotton said.

Although Poznansky did not give an estimate for when a vaccine might be available, he indicated that a longer time frame might be in store.

“Making a safe, effective vaccine for COVID-19 is very challenging,” he said. “Targeting any infectious disease for a vaccine under a highly accelerated timeline is extremely challenging.”

However, he cautioned, “It is possible that the first-generation vaccines may not work as well as we need them to. We may have to continue developing a second generation of COVID-19 vaccines. What we are doing at the Vaccine and Immunotherapy Center covers a new design of a vaccine for COVID-19 that may help to address any weaknesses of first-generation vaccines currently in Phase 3 clinical studies.”

As for the flu vaccine, Poznansky said, “The flu vaccine has been around for a long time. Each year, it’s made on the basis of the flu virus that is predicted to be a threat during the winter. The vaccine is safe and effective. It’s strongly recommended to have the flu vaccine this year.”

It’s been an unprecedented year for medical professionals. Poznansky and Kotton have been part of Zoom webinars at their synagogue, Temple Emanuel in Newton, sharing frontline reports and lessons with two fellow temple members – Rochelle Walensky, chief of the Division of Infectious Diseases at MGH, and Darrell Kotton, a professor in the Department of Medicine and in the Department of Pathology and Laboratory Medicine at Boston Medical Center (and the husband of Camille Kotton).

“I think one of the most important tenets of Judaism is that we do whatever it takes to save a life,” Camille Kotton said, adding that “everybody should be as careful and cautious as possible, make sure we’re saving as many lives as possible and not put any of our fellow congregants, fellow Americans, others at risk for more COVID-19.”