How Are Wound Clinics Coping With Omicron?

At wound clinics, physicians and staff have dealt with a lot over the past two years while the pandemic has raged. First, they were in the trenches as COVID-19 arose and hospitals were swamped, with many patients on ventilators. Even after many were vaccinated, the Delta variant caused another surge. Now, the Omicron variant is spreading quickly, with physicians facing an even more contagious version of the disease.

“It still feels like the hits just keep on coming and we are not out of it yet,” says Caroline E. Fife, MD, FAAFP, CWS, FUHM. “Omicron is spreading so fast it’s mind blowing.”

The transmissibility of Omicron is a concern, as evidenced by what experts are seeing in data, according to Dr. Fife. As she notes, Omicron became the cause of the vast majority of new COVID-19 cases across Houston Methodist patients in less than 3 weeks. In comparison, she says the Delta variant—which wreaked havoc in the summer and fall—took 3 months to surpass 80% of total cases once initially detected in Houston. Although early findings suggest the Omicron variant causes less severe disease, Dr. Fife cautions that follow-up studies are needed to confirm this.

Dr. Fife has found vaccinated patients are largely staying out of the hospital, while unvaccinated patients are not doing as well.

Jayesh B. Shah, MD, MSc, UHM ABPM, CWSP, FAPWCA, FCCWS, FACHM FUHM, FACP, describes a “mad rush for testing” with lines at every testing center. Dr. Fife also cites challenges with testing. She notes the change in quarantine to 5 days is an improvement but many folks can’t get tested because of a lack of testing availability so they have to assume they have COVID and just stay home.

More doctors and staff are out with COVID at Dr. Fife’s facility than any other time during the pandemic. She notes they are vaccinated and none have had to be hospitalized, but they are home “and thus we are more short staffed than we have ever been,” with school closings also affecting the ability of staff. She suspects it’s the same story for the staff of many wound centers. In Dr. Fife’s area, some ERs are closed and even hospital operating rooms are closed due to lack of staff, which impacts services. To top it all off, Dr. Fife is experiencing “strange and unpredictable supply problems” she notes are still not getting better.

Dr. Shah cites similar challenges with staffing in the hospital since Omicron is so contagious, noting he cannot schedule patients when staff are out sick. In spite of staff being triple vaccinated, he notes some are still testing positive. In addition, wound care patients have serious issues so they are still coming to the clinic. He notes his facility is seeing higher cancellation rates and they are trying to do telemedicine on those patients who are not able to come.

Dr. Fife adds that it appears that the two most commonly available monoclonal antibodies, which played an important role in early treatment of COVID-19 in people who were unvaccinated or vaccinated but high risk, are much less effective against the Omicron variant. She says sotrovimab seems to be the only monoclonal antibody treatment currently still effective against the variant, but notes it’s not widely available right now—accounting for only a small portion of what was purchased and distributed by the government.

Will We Ever Get Back to ‘Normal’?

“I personally feel that we need to learn to live with COVID,” says Dr. Shah. “We cannot stop doing things just because of COVID.” The “new normal,” he says, looks like wearing a mask in crowded places all the time like people do in Japan and have done even before COVID-19.

Desmond Bell, DPM, CWS, FFPM, RCPS Glasgow, believes we will eventually return to life without the need for the restrictions we have seen over the past two years. He says time will provide more information and data to help guide decision making, whether it is regarding use of masks, vaccinations or social distancing.
 
However, the biggest concern for Dr. Bell is the psychological impact and "scars" that will remain for many people, including a younger generation of kids whose lives and childhood have been damaged to varying degrees. 

“Fear has become a daily preoccupation for many, which is extremely damaging to both the individual and society,” says Dr. Bell. “The vilification of segments of the population, the impact on people's livelihoods and the constant stress related to COVID has taken its toll.” 

As Dr. Bell muses, history shows that pandemics and viruses eventually run their course, that life goes on, and that the only "normal" thing is that nothing stays the same.

“We will never go back to how things were before. That's all in the past, just as we will never go back to life without electricity or indoor plumbing,” says Dr. Bell. “It's OK. We are always evolving, and not without being tested. We thrive when we meet challenges and look for the positives, not by spending our precious days living in fear."

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