Giddy Up for Omicron
Welcome to January. (I’m gonna skip the exclamation point on this sentence because it feels a little too perky.)
I don’t know about you, but as we stare down the barrel of yet another COVID surge, I’m feeling a bit of deja vu. BUT! After some time away with my family and an excessive amount of mid-day coffee, I’m ready for action.
I’ll discuss Omicron: the latest data on transmissibility, severity, and immune escape plus some thoughts on schools and kids. But first, I want to discuss my recent adventures on Twitter. Because apparently I’m also ready to put my finger in the proverbial electrical socket.
Last week, one of my medical colleagues told her 50 thousand followers that she’d advised her vaccinated and boosted mother not to leave the house or to let anyone in the house because of Omicron.
What?!
I had to share my perspective (you can read my response here) on how I would advise my own parents during this crazy time—in order to illustrate a few points:
For vaccinated and boosted people, Omicron is a relatively mild illness. We’re learning that Omicron causes less severe disease across all ages because a) so many people have immunity from vaccination and/or prior infection and b) so far Omicron seems intrinsically less virulent than past variants. Note that my 20 patients diagnosed with COVID in the last 10 days are all doing fine at home. This is good news!
Once we’ve been vaccinated, we’ve taken the very best step toward preventing severe COVID. The vaccines continue to do an excellent job turning COVID-19 into a cold or flu-like illness. They’re not perfect; indeed the vaccines do not and cannot protect against every infection which is why we’ll see soaring case rates with a highly contagious variant like Omicron. But while case rates are acutely spiking, hospitalization rates aren’t; in other words the vaccines cause case rates and hospitalization rates to “decouple.” This is also good news!
Coronavirus is here to stay. In addition to recommending taking reasonable precautions post-vaccination (masking with a KN95, KF94, or N95 mask in crowded indoor spaces, for example), I’m trying to help patients manage their expectations for life with a ubiquitous virus that—again—is a manageable cold or flu-like illness for most vaccinated people. This is reality. And with a less severe version of coronavirus, this is a far better reality than what could have been.
Social isolation and living in perpetual fear is also harmful to our health. Health is about more than simply not getting COVID. For our health and wellbeing, we must understand the facts, have clarity on our medical vulnerabilities and personal goals, and then balance risk and reward with every decision we make.
Personal values and risk tolerance will vary widely among public health experts and physicians and should not be mistaken for blanket medical advice. It’s not a doctor’s job to tell other people how to live but rather to arm patients with tools to manage everyday risk around us. Just because my friend advises her mother to isolate herself doesn’t mean that you should. It also doesn’t mean that’s the wrong advice for that person.
Physicians can actually engage in civil discourse and model respectful disagreement. I know it seems antithetical to our time (and to Twitter) but it’s possible for doctors to exchange very different perspectives on the same set of medical facts. The key is not to assume that everyone has our same perspective.
The upshot? There is no one-size-fits all prescription for human behavior. Practicing medicine is about meeting people where they are and arming them with tools to face the inevitable risks we take every day.
I also recently commented on the new CDC guidelines reducing isolation from 10 to 5 days. My thoughts:
This policy makes sense because most people aren’t contagious after 5 days, particularly if vaccinated. That said, I think the policy should have included a negative rapid antigen test in order to end isolation because people can transmit the virus for up to 10 days after the onset of symptoms. Recall that rapid antigen tests are essentially “contagiousness” tests. Abbott’s BinaxNow test, for example, does a very good job of identifying contagious levels of virus in the nose. A negative rapid antigen test at day 5 (or day 6 if positive on day 5, for example) helps determine that the person being tested isn’t still contagious and could return to work or school without posing risk to other people.
PCR testing to end isolation doesn’t make sense, because PCR tests can remain positive for up to 12 weeks after an infection. In other words, PCR tests are too sensitive for the purpose of ending isolation.
A reduced isolation period is not only scientifically sound, it allows people to resume normal activities which in and of itself is healthy. For example, regular school is critical for kids’ social and emotional health, not to mention for their education.
So let’s talk a bit more about schools.
Here I am this morning on MSNBC talking with Jonathan Lamire about the importance of regular school for kids’ health and well-being. Indeed, kids need school like fish need water. Fortunately for kids and families, we have abundant evidence that kids, teachers and staff are significantly more likely to get COVID-19 in the community—not schools. (Links to a number of studies are here.) Is it possible to contract COVID within the walls of the school? Of course! But we’ve proven that people are much more likely to get COVID at a bar, restaurants, social occasion, or in their own home! So it only makes sense to keep kids in school when kids in general are at low risk for severe outcomes from COVID (especially when vaccinated but even without!), when the harms of missing school are enormous, and when vaccines are widely available.
That said, none of this is easy. Not every school has the luxury of decent ventilation and space. Access to rapid testing is severely limited. Teacher and staff shortages are a major problem. Parents and school administrators are naturally exhausted from the never ending dance with COVID-19.
(Which is why I pushed back on another high-profile physician’s Tweet that only fanned the flames of people’s anxiety around kids. My beef: Tweeting worst-case scenario hypotheticals about kids dying from COVID-19 is cruel. It doesn’t change hearts and minds and only exacerbates people’s sense of helplessness and fear. Not nice!)
Now, more than ever, we’ve got to focus on the facts, take fear out of the driver’s seat of our thoughts and behaviors, and know that there’s a lot to be hopeful about. A highly contagious but less severe variant could very well end the pandemic. From what we’ve seen in South Africa and the UK, Omicron hits hard and leaves fast. Which is why many experts predict a very challenging upcoming 6-8 weeks with lots of infections and a heavy toll on unvaccinated adults and our hospital systems—followed by high levels of population immunity (the combination of vaccine-induced and post-infection immunity) to finally contain the virus.
I realize that you all have many excellent questions about isolation, quarantine, masks, testing, therapeutics, and managing complex decisions. So please find me on Twitter and Instagram where I’ll continue to provide more frequent, real-time updates as conditions change.
In the meantime, my best advice is to limit your media exposure; prioritize exercise, sleep, and self-care; and to give yourself a little latitude as we enter the New Year. (P.S. Now is not the time—is it ever?—for stringent, unsustainable diets. There’s no need for a “cleanse” or “detox;” there is no such thing as “clean” or “dirty” foods. If you have two kidneys and a liver, you are detoxing just fine!)
My point is that the New Year is often a time to reset our behaviors and to be healthier versions of ourselves. That’s great. But it doesn’t have to happen overnight. It doesn’t have to be punitive. And people do best when they set small, achievable goals. In short, be kind to yourself. We’ve been through a lot.
I will see you next week. Until then, be well.