Week-end update: 11,000 cases/day in the US in June, 802,000 cases last Sunday, 706,000 today

But you know what? Cases dont really matter any more: there’s huge undercounting because of the gajillion unreported at-home tests and we know Omicron is getting past our vaccines. But the vaccines are still hugely protecting us against hospitalization and deaths, and even though there’s 2000 deaths a day, the vast majority are among the unvaccinated because vaccines are keeping us from dying.

But please don’t use the word “mild” for even a nano-second to describe what’s going on now. Our hospitals — and ERs and clinics and internist and pediatrician offices — remain under the absolute worst strain they have been under since this all started.

Today let’s talk about the basics

Here is our current understanding:

1. Vaccines still protect you from getting serious disease. Most vaccinated people do not end up in the hospital. Very few die.

2. Vaccines now dont completely protect you from getting Omicron. You can do everything Practically Perfect In Every Way and still catch Covid, but it’s not your fault; please ditch the guilt and the blame. Also, it will probably be reasonably mild.

3. Boosters look like they help you not catch Omicron for a few months. They are not, however, a guarantee.

4. N95, KN94, KN95 and tri-fold masks seem to work better than cloth or loosey-goosey surgical masks

Take-home messages:

  1. Getting Covid isnt inevitable. Go get a booster shot — it does help you not catch Covid
  2. Getting really sick doesnt happen very often with vaccination. Go get vaccinated: it really helps you not get super sick!                                               (I aided and assisted several dozen friends and family over the last few weeks with their illnesses. By far the worst Covid was in a young friend who got J&J months ago and no booster. SO SICK — seven solid days in bed with no food and 24/7 misery. Everybody should get a booster shot, but if you had J&J you should RUN to get that shot.)
  3. Please dont try to deliberately catch Omicron this month:
  4. Our doctors, nurses, ERs and clinics remain way over-burdened with this avalanche of Covid cases. They are way under-staffed because so many of them caught Covid, too. It is a little better in the northeast than it was a week ago and it will be better in a few weeks but it’s still a MESS in much of the US.
    1.             Don’t go to the ER to get tested.
    1.             Don’t go because you’ve turned positive.
    1.             Only go because you are SICK or hurt.                           (In aiding and assisting my several dozen vaccinated friends and family over the last few weeks, none of them got sick enough to go to the ER — all their oxygen levels stayed in the high 90s and although they had varying levels of misery (from one day to eight), they never needed oxygen or fluids. Yay, vaccination!)
  •  We dont have any drugs to treat you. Again, things will be better in a couple of months — we will have Paxlovid (antiviral) and Sotrovimab (monoclonal antibody) — but currently these drugs SIMPLY DON’T EXIST. So right now it’s just “Take a Tylenol and maybe call me in the morning.”                                       (Countless friends have been trying to get Paxlovid for their elderly parents in Florida or Sotrovimab for their diabetic brother in Worcester, etc, etc. No luck. The federal government supplies the states and then they supply health centers and hospitals and maybe some pharmacies. The Paxlovid pills are delivered twice a week and Sotrovimab once a week and when theyre out, theyre out; you simply have to wait for the next delivery. Its like waiting for the Wells Fargo Wagon except dire. And it will be for the next couple of months.)
  •  You dont want to get long Covid. And we have no idea if long Covid is going to be worse with Omicron.
  • You dont want to give it to Great Aunt Gertrude or your friend who is immunosuppressed because of his MS drug or her cancer while you’re walking around asymptomatically contagious.                                               (Now that weve had time to test people and collect data, theres increasing science that many drugs — especially certain cancer drugs and meds for auto-immune diseases like rheumatoid arthritis, MS, ulcerative colitis, etc — are preventing people from making antibodies after theyve been vaccinated. You probably have a number of friends, family and utter strangers who may be walking around completely unvaccinated” because of this issue. Mask-up and really try not to get or spread this right now!)

What about at-home testing?

Its all about knowing whether you are contagious. A positive antigen (at-home, rapid) test mostly means you’re contagious.

If you have an exposure, lay low and wear a mask. Assume you could be contagious.

If you get symptoms (sore throat, headache, crushing fatigue, sneezes, runny nose, sinus symptoms, gi symptoms…cough, pain with deep breathing, fever), stay home and assume you ARE contagious. Make yourself wait a day or try before you self test — too early might be negative. Maybe swab your throat first, and then nose, and then test. (A wee bit gross, yes, but not as gross as the reverse!)

If you get a positive at-home test, you don’t really need to go get a PCR unless your employer requires it. Stay home. Bundle up. Turn your phone off. Hydrate. Rest. Binge. You are probably going to be absolutely fine.

If your symptoms go away or are mostly gone by Day Five, self-test again. A couple of good studies show you have about a 50% chance of being negative on Day Five. If you are negative, you are very likely not contagious but should walk around in a mask in public for the next five days. If you are positive, you should consider yourself contagious and stay home.

If you don’t have access to a Day Five test, and you don’t have symptoms, the CDC says you can go back out in the world — but definitely “mask up and mask well” until Day Ten.

At many places, including MGH, if you are positive Day Five but symptoms are better, you should test again Day Seven. Some studies have shown your chances of being positive by Day Seven are less than 20%. If you’re positive, stay home til Day Ten. If you’re negative, go back to work, etc with your mask on.

How are people doing?

Overall, I’ve come to realize that a lot of us — maybe even most of us — are having a hard time right now. These months and months of So Much Bad Stuff are taking their toll, and now it’s the dark days of winter as well (January! In Boston! What fresh hell is this?), and on top of that now pretty much everybody has somebody sick in their circle.

So at this point I’m just assuming virtually every single person I encounter is exhausted, discouraged, overworked, overwhelmed, understaffed, underpowered, uncertain, depleted, preoccupied, grasping for straws, running out of gas, and on the verge of a meltdown, usually all of these at once.

These days with virtually every transaction — at the drug store, at the school cafeteria, at the take-out window, at the four-way intersection, at the doctor’s office, at the cashier’s window, on the customer service line, at the mechanic’s shop — I brace myself for things to not go well. My goals have narrowed the last few weeks. My bar has become very, very low.

Yes, I try to maybe get some business done, but maybe it doesn’t work out. Maybe there’s eight ways to screw up my order and they’re going to screw up twelve. Maybe the person I’m working with is brand new, undertrained, terrified, too, with a sick kid at home.

All I can try to do at this point is give that poor person at the counter some grace. All I can try to do is remember that all epidemics always end. All I can do is try to not get Omicron this month.