Here’s a concise summary of where we are in the COVID pandemic, when to consider you or your children might have COVID, how to interpret tests (especially home antigen tests), and a brief intro to COVID treatments.

The current surge of Omicron variants (BA.2 and BA.2.12) started in the Northeast and is spreading across the US. Despite what is undoubtedly an undercount—as many people who test positive on home tests do not have their tests reported in official statistics—we have both high case rates and a high (and rising) test positivity. Test positivity is calculated by dividing the number of positive tests by the total number of test with reported results. Case rates are the number of cases per 100,000 population. In CA, Rates in Berkeley are now 49/ 100,000 which is as high as at any point in the pandemic other than the Omicron surge that peaked in January. Rates for Bay area counties are similarly high (see the end of this message for links to county level data).

But aren’t we in the green risk level. Yes, we are. This measures the impact on HOSPITALS, not the impact on individuals. Because Collin County has a high vaccination rate, we are not seeing a lot of hospitalizations except among those who are immunocompromised or those (including kids under age 5) who are not eligible for vaccination

You’ve likely either had COVID by now or know someone who had. And those who have had COVID in the past 4 months and who were vaccinated, likely told you it was like a bad cold or allergies that came out of the blue. This is true for people who are generally healthy and vaccinated. Unfortunately, for the unvaccinated it can still be a severe illness. Rates of COVID hospitalization among children age 0-4 (i.e. too young to be vaccinated) were 5 times (500%) higher during Omicron as during any other wave of the pandemic. https://www.cdc.gov/mmwr/volumes/71/wr/mm7111e2.htm

Further, people who are immunosuppressed, including those with cancer, those who take certain medications to treat arthritis or other rheumatologic conditions, and those who are pregnant, are still at elevated risk of severe COVID (i.e. requiring hospitalization because they cannot breathe on their own), even if they are vaccinated and boosted. I’ll get into this more below.

Finally, please don’t go out and try to get COVID. Long COVID (formally called Post-Acute Sequelae of COVID) affects at least 5% of vaccinated adults who get COVID, and approximately twice as many unvaccinated adults who get COVID. Every day in the past month, I talk to 1 or 2 previously healthy young or middle aged adults, who tell me things like “I can’t carry my laundry up and down the stairs. I get short of breath and have to stop;” or “I feel chest pain whenever I go for a walk”, or “some days I feel 100%. And other days I start out find and hit a wall of fatigue and I have to lie down. And I never know when it will happen.” There are not a lot of treatments for long COVID. Also, there are not yet data on how likely children and adolescents are to get long COVID. Here’s a graphic summary of long COVID symptoms among adults

Your best bet is still to try to avoid contracting COVID in the first place.

1. Vaccination reduces risk of getting COVID by at least 50%, and reduces risk of severe COVID by much more than this.
2. Your risk of being in a group, unmasked, is higher in a surge (i.e. right now) than when case rates are lower (as they were 6 weeks ago). So if you’re going to throw a house party, you might want to wait a few weeks.
3. Testing before getting together with people who are higher risk, such as your elderly parents or your friend who is going through chemo, is not foolproof but can help.
4. Ventilation: risk when outdoors is very very low; increase ventilation by opening windows if you’re indoors.
5. Masking: you markedly lower your risk of getting COVID (and other respiratory illnesses) as well as inadvertently passing it on, by wearing a mask when you’re indoors. I think about it this way: would I rather by inconvenienced by wearing a mask, or be inconvenienced by being sick for a week? In the school setting, please remember that there has always been a STRONG RECOMMENDATION THAT ALL PERSONS MASK IN A SCHOOL SETTING and that the decision to pull back the mandatory masking requirement at a state level was a political one, not a scientific one. From CDPH: “Masks remain one of the most simple and effective safety mitigation layers to prevent transmission of SARS-CoV-2. High quality masks, particularly those with good fit and filtration, offer protection to the wearer and optimal source control to reduce transmission to others. To best protect students and staff against COVID-19, CDPH currently strongly recommends continuing to mask indoors in school settings. ” (https://www.cdph.ca.gov/…/K-12-Guidance-2021-22-School…)

Unlike the first waves of COVID, in which people who got sick were wiped out with severe shortness of breath, chest pain, fever, and other unmistakable symptoms of illness, Omicron can often cause very mild symptoms, particularly among those who are vaccinated and generally healthy. Among adults who are vaccinated, they often start with sore throat and/or feeling like severe allergies, with runny/ stuffy nose, and only mild cough and headache. Fever is not always present. Fortunately we have home tests (rapid antigen tests). Unfortunately, they are often negative for the first 1-3 days of symptoms. Rapid antigen tests are most likely to be positive 4 days after onset of illness, and even then, they are positive 77% of the time. So if you get symptoms and your first test is negative, put on a mask and plan to retest in 2-3 days.

Schedule a PCR test here Finally, if for whatever reason you do multiple tests and ANY of them are positive, YOU HAVE COVID! When the community prevalence is high, as it is now, if you have any symptoms and at least one test is positive, you have COVID.

https://jamanetwork.com/…/jamainter…/fullarticle/2791915

OK, so you or your child tested positive. If you have mild to moderate symptoms (meaning, you are not sick enough to go to an ER), and you have risk factors for more severe disease, you may qualify for treatment with a medication called PAXLOVID. Paxlovid decreases the risk of hospitalization or death by 88% among people with risk factors—a very significant effect! It’s authorized for use in people age 12 and older.

Paxlovid must be started within 5 days after symptoms start (not 5 days after you get test results), so this is another reason to test early and then test again a few days later.

CONTACT YOUR DOCTOR IMMEDIATELY if you are within the 5 day window and have any conditions that put you at higher risk, to see if you qualify for treatment. This is prescription medication.

High risk medication conditions include (but are not limited to): overweight or obesity (BMI >30), current or former smoking, moderate or severe asthma, depression or other mental illness; as well as the ones you’re expect (age > 65, cancer, liver disease, kidney disease, immunosuppression, diabetes, heart disease, etc)

Finally, here are some resources I find useful:

https://yourlocalepidemiologist.substack.com/

Blog by Dr. Katelyn Jetelina, an epidemiologist (and mom) whose posts “’close the communication loop’ by providing a direct line from science to you. Their posts are 100% data-driven and backed by the most recent scientific evidence. Some of these are their own analyses, some of these are based on other brilliant scientists peer reviewed studies, and some are science-driven resources.”