February 21st, 2021 COVID-19 UPDATE
COVID-19 REINFECTION AND SINUSITIS, LOSS OF SMELL AND ALTERED SMELL
It is now increasingly recognized that re-infections in Covid are occurring all over the World. Initially this was not very clear but now seems to be established. Data has suggested that the antibodies that fight the Covid virus, so called neutralizing antibodies, start declining at about 2 months, thus long term immunity from antibodies does not appear to be a path for herd immunity.
T cell response duration has not been measured thus far so it is not known if T cells have the ability to provide longer term immunity. Data has suggested that patients who had more severe infection tend to have a higher antibody response than those that do not. However, one big problem with lack of sustained antibody response is re-infection with Covid-19.
In my practice, I have seen a number of patients with re-infections, one even within 3 weeks of the first infection. Because the virus was not sequenced, it is not known if the second infection occurred from the UK variant or the original coronavirus or the South African variant. The second infection can be milder or more severe than the first infection.
In our most recent patient with a re-infection within 3 weeks, the patient presented with a severe sinus and ear infection as well as a sore throat which, in non-Covid times, I would have considered as a bacterial infection, possibly from Streptococcus or Staphylococcus bacteria. A CT scan may be necessary for more severe infection. Due to high level suspicion, despite a recent Covid infection, a repeat Covid PCR test and a rapid antigen test were done and both were positive.
So even if your physician suspects only a sinus or an ear infection, at times like this, Covid must be ruled out and a recommendation to see a sinus specialist such as our practice is recommended. Treatment for sinusitis includes antibiotics, nasal and oral steroids and a Covid antibody in the early stages of the Covid infection.
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An appointment with Dr. Khetarpal is to see a doctor, not a nurse.
One study combining Remdesevir and baricitinib has shown mortality benefit for more severe infections. At the time of this writing, more than 36 states in the US had the UK variant and several states had the South African variant. The problem is that the vaccines seem less effective against the UK variant and even less so against the South African variant.
Therefore, it is important that some level of immunity be obtained with vaccination to prevent the transmission of these variants from one individual to the next and spread across the country. Even if the vaccine immunity provides more than 50% protection against these two variants (which they appear to do), this level of immunity should be protective for many.
What about loss of smell or altered smell?
It is well known from the beginning of the pandemic that alteration in smell may precede a Covid infection or occur with it. About 40-70% of patients may have change in smell, not necessarily loss of smell. The change in smell may be a smell of roast meats, sewage smell or burnt wood or another. The damage is due to the virus attacking the supporting cells around the smell receptor or the olfactory cells.
While about half or less may have improvement in smell within the first month, many have persistent smell changes for which they seek treatment. It is important that you see a sinus specialist for this symptom as early treatment may benefit in improving this symptom. One must make sure that their blood zinc, magnesium, and vitamin D levels are normal.
If you come to our office for smell or sinus issues, typically a nasal endoscopy or a scope/camera exam is done of the interior of the nose and sinus openings to assess for inflammation and structural abnormalities. A course of oral steroids may be given as well.
UMANG KHETARPAL, M.D.
Dr. Umang Khetarpal finished his medical school at the young age of 22 and is trained in Otolaryngology-Head and Neck and Facial Plastic Surgery. He completed his internship and specialty residency training in Syracuse, New York. He also has extensive research experience and additional clinical experience through fellowships at Massachusetts Eye and Ear Infirmary and Brigham and Women’s Hospital, Harvard Medical School in Boston. He has co-authored book chapters and many publications in peer reviewed journals within the specialty. He has presented at major specialty society meetings and at academic institutions. Topics of his research included hearing loss and balance disorders, sinus problems and sleep apnea. His recent research efforts have been entirely focused on sinusitis, especially recurrent acute rhinosinusitis, allergies and in office balloon sinuplasty and in office sinus surgery. He has recently presented five papers at the International meeting of Rhinology in CHicago, June 2019. He discovered and was the first to describe a novel ear disease in families that resulted in balance and hearing problems. His most innovative research was in the cutting-edge field of genetics in Otolaryngology where he was involved in finding the genetic defects for several different diseases. In addition, he has taken time to observe the surgical techniques of some of the world’s most renowned surgeons in plastics surgery. He had been featured 3 times over the years in newspapers in the Rio Grande Valley for introducing latest treatments in thyroid cancer, sleep apnea and sinus surgery locally. His current interest is in molecular genetics of allergic rhinitis and chronic sinusitis with and without polyps and in finding better cures for these conditions. He now calls Houston his home and is starting his practice in the Woodlands.