Dr. Pissed Off: Welcome to Camp Omicron. Here are the rules

Matt Wuerker/Politico

by Dr. Pissed Off

The newest version of COVID-19 is called Omicron. You will get it whether vaccinated, or not, unless you beat the odds — kind of like the lottery. It does not care if you have already had COVID. Omicron is diabolically contagious, and will find you. 

If you are vaccinated, the more the safer, meaning get boosted. Nothing more to say on this, and nothing more to say about your medical research — this is a full-time job for medical experts. 

If you get symptoms that may put you in the COVID camp, get tested. Let me say that again — get tested.  Do this at a facility (urgent care, pharmacy, emergency room, free standing facility), or get a home test from your pharmacy.  

It is  hard for doctors to advise you unless you are tested. We do not guess whenever possible. The type and timing of the test you took will need to be discussed, whether or not you test positive. 

Your physician will also need to know the dates and type of your vaccines. If you do not know, find out, or we will assume you did not do what you do not know.  Sorry, but we are speaking from experience here.  

If you test positive for COVID and are vaccinated, keep us posted. The disease is usually of short duration, but there are exceptions. If your symptoms are severe, and you need immediate attention, call your doctor. Do not leave a message. Ask to speak to the provider on call.

If you are unvaccinated, and sick you are at increased risk for a severe and possibly life-threatening illness.  

Office policy

This seems like a good time to remind you that if you are symptomatic, do not walk into a doctors office, regardless of your COVID test status. Our office policy is to deal with your needs telephonically or in your car in our parking lot. We do offer same day help and will figure out how to do it, but it is our decision not yours. We are juggling our desire to help while at the same time protecting our staff, as well as patients who are in the office. Everyone in the office has or has had COVID, despite being fully vaccinated and boosted, and taking all of the precautions. We realize this is a risk of our chosen professions, but we prefer to define our own risk profile, as opposed to having one imposed on us. We care deeply about all of you and wish to continue helping you,  so please do not test us on this.

COVID testing

There are two basic types of COVID testing: PCR and Antigen testing. The antigen test is the 15 minute home test that tells you whether you, at the moment of testing, have live, contagious viruses in your nose.  This is the test recommended to screen participants just prior to gatherings. It is possible for this test to be negative in the morning, and positive in the evening of the same day, and for both results to be correct. This is also a good test to use when coming off isolation from a COVID infection to ensure you are no longer contagious.

The PCR test takes longer to get the result.  There are home PCR tests but they are hard to come by.  It detects whole viruses like the antigen test, as well as noncontagious viral particles. It can give some insight into contagion. It is also possible for this test to remain positive for weeks, and even months after a COVID infection. If it goes from positive to negative then it says the same thing as a negative antigen test, but if it remains positive it may be misleading in suggesting you are still contagious.

COVID treatments

Monoclonal antibody infusions are less effective against Omicron. Two of the three available options have been withdrawn from therapy, and the third is in short supply, and not available to anyone who is not at high risk. The new antiviral pills you have heard about are of variable availability. Check with your pharmacy, or your insurance company, if you have insurance coverage for the medication. Most people will get by just fine with symptomatic, over the counter medications.

If you are at high risk (65 and over, obese, heart disease, including hypertension, chronic lung disease, diabetes, chronic kidney disease, HIV, immunosuppressive therapy — you know who you are) you qualify for therapy upon infection, with the goal of keeping you alive, and out of the hospital. If you are not in the high-risk category, and are ill you may have therapeutic options based on your illness severity and progression.

We do not prescribe anything prophylactically to ward off COVID beyond get vaccinated, and get a booster. Do not ask. The answer is no. Others do and they can be found easily — they typically advertise.

Isolation for COVID test positive individuals

Isolation means if you have COVID protect others. If you can, keep yourself isolated and wear a N95 or K95 mask if you must be in the presence of other non infected individuals. Currently the CDC recommends 10 days of isolation from the onset of symptoms, or the date of your positive COVID test, whichever comes last for symptomatic individuals. For asymptomatic or mildly symptomatic individuals who are covid test positive the CDC just changed its recommendation to five days of isolation, followed by five days of mask wearing when in the presence of others. 

There is a growing consensus that in fully vaccinated people where the duration of illness and contagion is shorter, five days of isolation followed by two consecutive days of negative home antigen testing, or some variation may be adequate for post infection isolation. 

If you are unvaccinated and infected, I got nothing for you, but what the CDC recommends. Oh yeah, it is too late to get vaccinated and boosted for your current infection, but not for the next one.  

Yes, you can get COVID more than once. ER

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