Don’t Beat Yourself Up if You’re Infected, Exposed and/or Confused.
Dozens of my patients have COVID-19. All have been vaccinated. Despite varying experiences, all are doing well. In fact, most of them have described their symptoms as “mild”—sore throat, cough, fatigue. Some have more significant flu-like symptoms—body aches, pounding headache, high fever. Unlike in 2020, none of my patients infected with coronavirus have required hospital care.
To be clear: there is nothing “mild” about feeling terribly sick. There is nothing “mild” about a patient requiring hospital care. There is nothing “mild” about overwhelmed ERs, ICUs, and healthcare workers. The narrative that “all COVID infections are mild” is dangerous and dismisses many people’s lived experience. But the fact is that, on an individual basis, most vaccinated people are experiencing less severe symptoms compared with people who were infected with Delta and compared with unvaccinated folks.
There’s also nothing “mild” about the three main challenges my COVID-positive patients are facing: the medical, the logistical, and the emotional.
First is the medical. Even if people know intellectually that their risk for severe illness is greatly reduced after vaccination, fear is natural and real. It’s normal to get scared when that rapid home test turns positive or when we’re notified about a positive PCR test from our doctor or local health department. So when I’m talking to a newly-diagnosed COVID patient, we go through their symptoms, various treatment options like monoclonal antibodies and oral antiviral medications for higher-risk patients, and how to monitor themselves at home. But perhaps more importantly, I help my patients frame their risk by reminding them:
how very well the vaccine continues to work against death and severe disease. Exactly how good is good? The CDC's newest data on people vaccinated with only two doses is incredibly reassuring. I highly recommend studying the table on page 3 if you’re looking to drop your shoulders a few inches and assess your own risk of severe disease based on age, sex, and underlying conditions. Let’s take a look:
Vaccinated 18-39 year-olds face a risk for severe outcomes (from needing hospital care to death) of THREE in 1.228 MILLION after two doses of vaccine.
What about for people ages 40-64? It’s 35 in 1.228 million!
For people ages 65 and over? The risk of severe illness after two shots is 151 in 1.228 million!
how well a booster shot drops that small risk of severe illness even further. (This is why we recommend boosters for most adults, particularly those who are older and at higher risk.)
the newest data showing omicron is milder than delta even in unvaccinated children under age 5 (such that the incredibly low risk for kids under age 5 has gotten even lower).
the vaccines also prevent “long-COVID” and other potential sequelae of SARS-CoV-2 infection. This robust study, published just today, showed that “Vaccination with at least two doses of COVID-19 vaccine was associated with a substantial decrease in reporting the most common post-acute COVID-19 symptoms, bringing it back to baseline.” This is HUGE!
Another big challenge for a COVID-positive person is logistical. From locating a test to isolating within a household to rejiggering our work, daycare, and school, managing the practical implications of being infected with (or exposed to) coronavirus can be overwhelming. A patient of mine called me last week: She practically apologized for even calling me (her own doctor!), acknowledging that there’s been no shortage of guidance for the last two years and confessing, “I feel sick but mostly I still feel clueless!”
Which test do I take?
How many days is isolation?
What about quarantine?
Who do I tell??
Can my kids go to school?
In other words, the guidance we’ve been absorbing for 22 months seems to go out the window when the sh*t hits the fan.
It makes sense! The CDC website is cold comfort when it’s your life, your family, and your job on the line—and when everyday decisions have to be made, STAT. These days, merely existing in the world gets a whole lot more complicated when coronavirus parks inside our nose.
The logistical shenanigans are exacerbated by the absence of nuanced public health guidance. Guidelines are changing. The news is confusing. Moreover, the CDC can’t possibly speak to our unique situations. For example, my advice to a healthy, triple vaccinated young person with COVID will differ from the guidance I give to my immunocompromised patient with COVID who needs assisted living. Both patients want to protect themselves and the people around them. Both are infected with the same virus. But their underlying health, living situations, age, and risks vary widely.
(For info on isolation and rapid versus PCR testing, see here and here.)
And last, for many of my COVID-positive patients, there’s an emotional component to getting sick. The guilt and shame associated with it can feel crushing. One patient recently told me “I’m embarrassed I’ve got COVID.” Another patient called me for advice in tears, saying “I did everything right.”
I get it. Somehow along the way we have moralized human behavior. We have associated a diagnosis of COVID-19 with recklessness, carelessness, or disdain for other people when, in reality, at this stage of the game, getting COVID-19 simply means we’re human. It means we weren’t able to sequester ourselves in a bubble for 22 months. It means we need to work, parent, and see loved ones. It means we breathe air!
Particularly with a highly transmissible variant circulating, where Omicron is in the air like oxygen itself, it’s increasingly difficult to avoid an exposure. Feeling guilty about getting sick only adds insult to injury.
At this moment of the pandemic, I call on all of us to make empathy great again. To allow ourselves some self-compassion for getting sick or exposed, for having responsibilities beyond simply not getting COVID-19, and for being human. We need to recognize how hard it is for anyone—no matter their life situation—to maintain vigilance for 22 months.
Getting COVID isn’t a moral failure; it’s part of being human.
This doesn’t mean getting COVID-19 is inevitable. But an exposure to coronavirus during our lifetime is. We cannot boost our way out of an exposure. We can try to delay our encounter with coronavirus by wearing an N95 mask if we’re particularly high-risk, but at some point we’ll all face this virus. It’s not a matter of if we’ll be exposed; it’s when.
Which is why vaccination is so important. While it cannot prevent an exposure, vaccination takes the claws and fangs away from the virus and turns it into its wimpy cousin, akin to a common cold or flu-like illness.
Omicron has rendered the vaccines weak against infection and transmission. And since coronavirus is here to stay, it’s time to realize, once again, that we cannot eliminate risk; we can only mitigate it. We can and should continue to do the best we can to minimize the potential harms of infection without losing sight of the other ubiquitous risks in our everyday life—and the importance of reaching our broad human needs for our overall health and wellbeing.
Mitigating health harms includes turning the volume up on self-compassion and turning the volume down on judgement and shame. When we accept the things we cannot control, work on the things we can, and have the wisdom to know the difference, we are healthier from the inside out.
I will see you next week. Until then, be well.