There has been a four-fold increase in COVID-19 cases in Florida just in the past week fueled by the emergence of the more transmissible omicron variant. Fortunately, associated severe disease and deaths are rarer than with August’s delta surge. Nonetheless, omicron has exacerbated an already serious worker shortage, threatening economic recovery. Confusing advice from national health leaders and a shortage of testing have not helped the situation. Since USF Health leaders are being deluged with COVID-19 questions, I offer three simple questions and their answers for consideration by worried readers.
What is happening? The omicron variant contains more than 50 mutations compared to the original virus. And although omicron is four times more transmissible than delta, it is less virulent, and so full vaccination with mRNA vaccines (that is, three doses) appears to protect well against symptomatic infection, and especially against severe disease and death. Breakthrough infections among those previously infected with delta or who received only two doses of an mRNA vaccine, or one dose of the Johnson & Johnson vaccine, are common, but generally mild. Severe infections, as has been the case all along, cluster among unvaccinated, older, obese and medically complicated patients.
What can we expect? Experts predict the current omicron surge will peak by mid-February. Because omicron is so transmissible and there is so much extant population immunity, this surge is likely to dissipate far more quickly than earlier COVID-19 surges. Thereafter, we should expect recurrent surges of lesser and lesser severity as the virus mutates into a form consistent with coronaviruses that cause a quarter of our common colds. While this virus has repeatedly defied predictions, we can take comfort in evolutionary biology. The most “successful” viruses are easily transmissible, generate mild symptoms and do not kill their hosts. That is why there are many more common colds than deadly Ebola, MERS or SARS-CoV-1 infections.
What is to be done? Not lockdowns. They are neither effective in the long run nor any longer politically feasible. While masks confer some protection against omicron, mask mandates are also a political non-starter, at least in Florida. So what should you do?
(1) If you are not fully vaccinated, do so immediately. If you are 16 years or older, obtain all three doses of an mRNA vaccine (Moderna or Pfizer, though only the latter is authorized for adolescents aged 16 and 17). If you had the J&J vaccine, obtain an mRNA vaccine two months after your last shot. If you have children 5 to 15, the Pfizer vaccine is recommended without a third “booster” dose.
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(2) If you are fully vaccinated (or within six months of a two-dose Moderna or Pfizer vaccine or within two months of the one dose J&J vaccine) and have been exposed to COVID-19 but have no symptoms — you do not need to quarantine but should wear a mask for 10 days and get tested five days after exposure. If you are fully vaccinated, the best strategy is to “test to stay” at school or work. Only if you test positive should you isolate.
(3) If you are not fully vaccinated and are exposed, the CDC now recommends you quarantine for five days, get tested on Day 5 (if possible) and wear a mask for another five days.
(4) If you test positive for COVID, regardless of vaccination status, the CDC now recommends you isolate for five days. If you have no symptoms or your symptoms are resolving after five days, you can leave your house but continue to wear a mask around others for five additional days. If you have a fever, continue to stay home until your fever resolves for 24 hours.
(5) If you test positive, are not fully vaccinated and have worsening symptoms or have high-risk conditions (for example, obesity, elderly, immunocompromised, diabetes, hypertension, kidney, lung or heart disease) notify your physician for advice on treatment as soon as possible. Unfortunately, the Regeneron and Eli Lilly monoclonal antibody formulations are not effective against omicron and while the GlaxoSmithKline version seems effective, it is in short supply. The FDA has just given emergency use authorization to two anti-COVID pills, Pfizer’s Paxlovid and Merck’s Molnupiravir. Both are five-day treatments. The former must be given within three days of infection, reduces hospitalizations by 90 percent and uses a standard anti-viral approach (protease inhibitor). Molnupiravir should be started within five days of symptoms, reduces hospitalizations in half but uses a more controversial RNA interrupting strategy. Neither should be used by pregnant or breastfeeding women.
(6) Unfortunately, even if you are fully vaccinated but immunocompromised (for example, cancer patients, those on certain biological agents), you will still need to wear an N-95 mask in public and socially distance as far as is practicable. Some experts are now recommending a fourth booster in such patients if their last shot was more than six months ago.
The bottom line is that if you haven’t been fully vaccinated, do so immediately. If you are fully vaccinated (including the booster) and are otherwise healthy, relax but use common sense; and if you are at high risk continue to exercise precautions.
Dr. Charles Lockwood is the senior vice president of USF Health and dean of the Morsani College of Medicine.