Apr 3, 2022

We’ve certainly moved into a new phase of the pandemic. After the surge of Omicron over the winter case counts have dropped dramatically here in Chicago and across the country. Since Omicron is so infectious and was able to infect vaccinated people—particularly those who had yet to be boosted—a high number of folks got infected. Now that more people are protected from infection, there are fewer people it could infect. So, we’re seeing a step drop in cases.

If you’ve been vaccinated and got infected in this most recent wave, it seems your protection is persisting. If case counts pop back up again, it remains to be seen how durable this immunity is. For now we have not seen or read about anyone in this category being infected.

What does this mean if you have yet to be infected? First, the vaccine and booster are still preventing people from being hospitalized and dying of Covid. It is still true that the overwhelming majority of people with serious consequences of the infection are unvaccinated.

So, the good news about low case counts is that it is safer to be out and about. For those of us who have yet to be infected and don’t want to get infected, your behavior needs to change when case counts are high in your local area: quality mask use, avoidance of crowds, al fresco-only dining, etc. When case counts are low like now, the chances become much lower that someone you encounter will have Covid. So, this could give you some freedom to be more active.

That means you need to make a personal decision about how cautious you want to be. The highest risk situations are large crowds in enclosed spaces with limited circulation and no mask wearing. The lowest risk is you taking a walk outside in a park. Everything in between is all relative. For those at highest risk (active cancer treatment, immune-suppressive drugs, etc.) the drug Evusheld can be given with an intramuscular injection. This monoclonal antibody treatment, given every six months, is designed to prevent infection after exposure. Harper Health is securing doses of this medication for its highest-risk patients.

Should we be worried about the BA.2 Variant? The BA.2 variant is a sub-variant of Omicron that is more infectious than the original Omicron, which was already more infectious than the Delta and Alpha variants before it. What this means is that it takes less time being around an infected person to get infected, yourself. BA.2 is in the Chicago area and will likely become the dominant strain in the next few weeks. While it’s more infectious, it does not seem to be more virulent or dangerous than the original Omicron.

So, what should you do if you test positive? Contact your provider and they will share with you our outpatient vitamin/supplement/medication protocol. They will also determine along with you whether you are at high risk of progression to severe illness. For those at high risk, we have a “test and treat” approach with dose packs of Paxlovid available in our clinic. Paxlovid is an antiviral medication from Pfizer that was shown to be very effective in preventing severe illness and death in a study with unvaccinated people. The success in preventing bad outcomes in this population paralleled the effectiveness of vaccination - over 90%. It’s not yet clear how effective Paxlovid would be in a vaccinated and boosted adult with Covid. We will learn more as time passes, but we will recommend it to people at high risk. Paxlovid must be used with caution, though. It can cause liver inflammation, needs to be dose-adjusted for folks with kidney disease, and there is a long list of medications that influence whether it can be used in a particular patient. It’s important to check with your provider before taking Paxlovid.

While the IV monoclonal antibody treatment, sotrovimab, may still be used in the Chicago area, it won’t be long before this option is eliminated. Sotrovimab is not effective against the BA.2 variant.

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