Holiday Greetings and COVID Update

COVID on the Rise

All of us at Harper Health again wish you a wonderful Holiday season. It seems a little more challenging now as we are seeing a dramatic increase in COVID cases. We are NOT, however, seeing an increase in serious illness. It's likely the Omicron variant is spreading through our comunity and there are a few reasons we're likely seeing a spike in cases:

• People are congregating more. More holiday parties means more contact with people who could be infected

• Omicron is more infectious. It's much easier to catch it from someone, so you don't need to be around an infected person for as long as Alpha or Delta in order to get infected

• Omicron is breaking through defenses. The jury is still out on much of this, but it seems the vaccines aren't as effective at preventing infection with Omicron as they were with Delta

• The incubation period for Omicron seems quicker. While it used to take 5-7 days to develop symptoms, it seems like it's just 2 to 3 days before you get sick and could spread it to others. The faster the infection sets in, the faster it's going to spread in the community

We are NOT seeing people with severe illness right now. This is likely due to the vaccination status of our patients. Almost everyone has been fully vaccinated and most have been boosted. The BEST protection for you is to get vaccinated and boosted. If you have, it's VERY UNLIKELY you will get very sick. One of Dr. Meg's friends is a intensive care unit doctor and ALL patients in the ICU at Christ Hospital are unvaccinated. All but one of the regular floor hospitalized patients is unvaccinated. While there are no guarantees, we are seeing mild illness with this wave of infection.

What should you do if you feel sick. Anyone with a cold or flu-like illness should get tested for COVID. You can't really use symptoms as a guide, here. "It's just a cold" doesn't work. There are at-home tests that you can do. In addition to those in the article, the Abbott BinaxNow test is good. If you take a rapid antigen test and it's negative, it doesn't 100% rule out infection, but makes it less likely. In order to be more sure, a PCR test is better.

If you have been exposed to someone with COVID and are vaccinated, the CDC does not currently say that you need to quarantine, as was the recommendation before vaccines. However, we strongly suggest you stay masked around others and avoid crowds while in the incubation window. The CDC recommends a test at day 5-7 after exposure to assess whether you are infected. Given the short incubation period that Omicron seems to have, we think that a test at day 2-3 after exposure and then again at day 5-7 would be best. We prefer the PCR test to be most sure, but an antigen test is also reasonable. If tests on both days are negative then infection is unlikely.

• If you develop any symptoms in the window period after infection, isolate yourself and get tested right away. If your test is positive you should isolate for 10 days to prevent the spread to others.
  What about getting together with family for the holidays? We want you to stay safe and healthy. So before you may gather with friends or family we want to remind you of the following suggestions we wrote back in November (with an added bullet point at the end):

• Vaccinate! Protect those not yet eligible for vaccination, such as young children, and reduce the potential severity of your illness by getting yourself vaccinated PLUS get the booster if it's been over six months since your Moderna or Pfizer or over two months since J&J

• Wear well-fitted masks over your nose and mouth if you are in public indoor settings.

  • Even those who are fully vaccinated should wear a mask in public indoor settings in communities with substantial to high transmission. That is definitely now.

• Avoid crowded, poorly ventilated spaces

• If you are sick or have symptoms, don’t host or attend a gathering

• If you want to be sure of absence of infection when getting together with family or friends--particularly vulnerable people--a same-day negative PCR is best with a rapid antigen acceptable if PCR is not available.

To be honest, the number of infections and esposures in our practice right now is the highest it has ever been in the pandemic. Omicron just feels different.

VACCINE UPDATE

What we've seen from this pandemic is that the SARS CoV2 virus is a rapidly mutating coronavirus. It is not atypical for a coronavirus to mutate, but this particular one is changing at a higher-than-expected rate. Omicron is dramatically different, which challenges the effectiveness of the vaccines. It is becoming clear that the two-shot series of Pfizer-BioNTech or Moderna provides inadequate protection against infection with Omicron. It seems, so far, to be protecting against severe illness and death, though. That's what we care about the most.

Early reports suggest that both boosters provide better protection against infection, with the Moderna maybe edging out Pfizer on the production of neutralizing antibodies. I have not seen any data on the effectiveness of the J&J + mRNA (Moderna or Pfizer) combo. The key going forward is going to be data we get from what happens to real people. More to come.

So, GET A BOOSTER! Get it if you're over age 18 and it's been six months or more since the end of the primary series of vaccine or over two months since your J&J.

If you had Moderna or Pfizer first, you can get the same vaccine as your booster or you can mix it up with the opposite mRNA vaccine. We do not recommend the J&J as a booster. If you got the J&J initially, the CDC recommends the regular dose of the Pfizer or the half-the-original dose of Moderna, which is the dose FDA approved for boosting. Moderna is researching using the higher dose shot as a booster for Omicron protection.

If you need the booster, all local pharmacies are providing it. You just need to call to make an appointment.