Covid update from Dr Peter

1/10/22

Omicron rolls into California – think flexibly.”

People are tired are dealing with Covid. We need to remain flexible and be aware that we have to keep working with it. This may be an intense but short surge with Omicron. Observing how this has happened around the world – the Omicron variant quickly took over since it is so transmissable. Can compare to a hurricane coming through – you can’t predict exactly how it hits, but you know it will go quickly. We don’t know what it will be like after the sharp increase comes through.

2-4 X more transmissable than the Delta variant. This is a transmission rate similar to measles, especially without precautions such as masking and social distancing. Cases pop up suddenly, all around the map, at the same time. Symptoms are upper respiratory and milder than for Delta. Loss of sense of smell is not associated with Omicron.

East coast is leading about 2 weeks ahead of the West coast.

Q: Should we be worried about getting it?

A: Probably best not to get it quickly. With a little time, we can learn more about best practices and treatments. Probably everyone will be exposed in the next few months.

Not clear how hospitalizations will be affected, or the impact on the work force. Some hospitalizations are in the “tail-end” of the Delta variant. New cases are Omicron, and these are half as likely to need emergency room treatment, and 1/3 as likely to need hospitalization. But we don’t know how many cases we will be seeing.

Peak # of cases in CA may be soon. Hospitalizations come a little later, then deaths.

Nevada County – have had 10,700 positive PCR tests of Covid 19. Most testing is not this type – people are doing rapid antigen testing, so the real number cases may be 2-3X this. Case positivity rate is up to 20.4% – the highest it’s been.

Long Term Symptoms with Omicron

We don’t know if Omicron will cause long Covid symptoms that impact quality of life. We know that about 2% of the population in the UK have symptoms of long Covid at this time. Long term Covid symptoms will be an ongoing issue around the world, but we don’t know yet about the Omicron variant and long term symptoms.

Vaccines and boosters definitely have increased protection. In CA, someone who is unvaccinated is 3.9 X more likely to get infected with Omicron, about 10.1 X more likely to get hospitalized and about 16X more likely to die.

Main long Covid symptoms include: fatigue, shortness of breath, cognitive dysfunction to the degree that it interferes with activities of daily life, beyond 2 months. Very little treatment. Diabetes is a complication in people who have had Covid.

Masks can make a big difference in transmission of Covid. Omicron is so transmissable, the highest grade mask is recommended, especially in public. Double masking is an improvement as well. Surgical mask with cloth, two surgical masks, etc.

Why does Omicron manifest differently than Delta?

It appears to affect the respiratory system differently. Instead of affecting the lower systems and alveoli (air sacs), it affects the upper respiratory system, trachea and airways. We don’t see as much Covid pneumonia. This may be why not as many people are needing oxygen.

It seems that the immunity gained after getting other Covid variants helps prevent hospitalization and death, but does not prevent you from contracting the Omicron variant.

There are many complex variables and it is difficult to compare what happens in one population to another population. For example – the Beta variant in S. Africa had an effect on immunity in that population that can’t be applied to areas without Beta.

Treatment

Ivermectin not shown to be a treatment that is very helpful, even if it may have some potential.

Regeneron – polyclonal antibodies (“passive immunity”) is effective with other variants, but not Omicron.

Remdesivir – antiviral given early works pretty well against Omicron.

Two other antivirals – Paxlovid and Molnupiravir are newer and effective

Testing

Rapid Antigen testing is the primary testing happening. One thing we have learned is that people’s tonsils are often affected and swabbing tonsils and nostrils is recommended. The home tests are a little less likely to detect Omicron and there is a higher false negative rate. If you test negative it means you are “less likely” to have Covid. If you test positive, it means “Yes – you have it”.

Once you have a single PCR test and are determining when it’s okay to come out of isolation/go to work again, a 2nd test – a negative rapid test is recommended before returning to work.

Quarantine and Isolation

With Omicron, people can be infectious up to 10 days or more, but it tends to be shorter than with other variants. When you become symptomatic (Day One) – track your isolation from symptoms, not from when test is positive. At Day Five – test again. If negative, wear mask and you don’t have to be in strict isolation. You should be testing negative AND without symptoms before coming out of isolation.

Concern is for direct exposure – if you have had direct exposure to someone who is positive/symptomatic. Being exposed to someone else who has had a direct exposure doesn’t “count” for quarantine.

California Dept of Health guidelines:

  • People who have tested positive for Covid 19 (regardless of vaccination/previous infect/symptoms) – Stay home (isolate) for 5 days. Can emerge if you have NO symptoms AND have a negative test. If you have symptoms or have a positive test – continue to isolate for 10 days. If you have a fever – isolate until fever resolves. When you leave isolation, wear a well-fitting mask around others.

  • People who have been exposed to Covid 19, who have no vaccine, or vaccine only and no booster. Quarantine for at least 5 days after being exposed – test on Day 5. Quarantine can end after 5 days if no symptoms AND negative test. If you are unable to test, stay in for full 10 days. After coming out, wear well fitting mask for 10 more days. If at any point you test positive, then isolation begins (as above).

  • People exposed to Covid 19, who are fully vaccinated with booster, or fully vaccinated and not eligible for booster yet. Do not have to quarantine – need to test on Day 5. Wear well fitting mask for at least 10 days. If tested positive anytime – then isolate (as above).

Stats:

Hospitalizations and ICU cases are high – close to the peak before we had vaccines. Even though Omicron is less deadly, it is so transmissable more people are getting it.

healthdata.org is a good site to look at for projections

Recommendations:

Be flexible, tighten up and be more careful. Use high quality masks and follow guidelines for isolation and quarantine. There is still a lot we don’t know about how this will play out.

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