Six Steps To Being SafeR

In the good news bears category, Omicron cases — mostly caused by the BA.1 variant — continue to decline in most places around the country. We are seeing a fabulous fall in cases, hospitalizations, and need for ICU beds.

You don’t need to be a Junior Epidemiologist to see how much better things are this week — just look at any update and you’ll see beautiful downhill graphs in virtually every state.

Other good news is there’s still no other scary variants in the offing right now. That can of course change in an instant, but for the moment we’re not sensing a super scary threat from BA.2 (yet), deltacron, or anything new being found in wastewater or worldwide testing.

However, we do have to keep an eye on European countries that are often ahead of us and so serve as “canaries in the coal mine.” This week some had an uptick in numbers and we need to watch and see: is this just the normal bump up when you unmask a lot of people, or is it the start of a big jump because of BA.2? Only time will tell.

And one more piece of good news: so far, reassuringly, there’s no sign that reinfection is super common — not with omicron over delta, and not with BA.2 over BA.1. It can happen (and it’s happened to a couple of friends of mine), but it’s pretty darn rare. Plus our vaccines are still keeping both BA.2 and BA.1 from causing severe disease.

So it looks like those of us who are vaccinated and boosted might be able to have a “breather” — either a short one or a long one depending on when/if another variant pops up or if BA.2 pushes cases up. It looks like we are entering a period of time where we can walk around with less risk of running into a friend or co-worker or relative who is actively infected and infectious and gives it to us.

Right now in Massachusetts, for instance, we’re down to an average of 500 reported cases/day. (You may recall in January it was more like 30,000, yikes.)

If you do the math with certain assumptions, 500 cases a day translates into somewhere between maybe 5000 and 15,000 people who are actively infected in the whole state as of today.

So if you go to the TD Garden, there might be SOMEBODY there with Covid, but it’s extremely unlikely there’s going to be hundreds of people walking around infected. And you have pretty good odds you’re not going to be sitting or walking by any one infected person at the precise moment when they shout or sneeze. Not zero risk, but pretty low, and far far lower than a month ago.

Bottom line: because there’s so many fewer cases, it is becoming safer to be out and about in the world.

But the idea of catching it still is scary to most of us, what with Long Covid and brain fog and all the stuff we don’t know yet. Plus, I have always felt that every month we delay getting Covid is a gift as it represents another month during which our scientists can invent better treatments.

So how can we keep ourselves SafeR in a world without many precautions?

Here’s Dr Schoenthaler’s Top Six Steps to SafeR:

One) First and foremost, getting vaccinated and boosted is absolutely huge, the number one most effective thing we can possibly do. If Uncle Maskless hasn’t been boosted yet, you’ll really do him a kindness by talking to him about it again (or getting him to talk to his doctor).

(Whenever somebody tells me they’ve decided not to do the vaccine or a boost, I always ask, “Did you talk to your doctor about this decision? What did they say?” 98% of the time the answer is “No, I decided on my own”; and 100% of the time I reply, “DUDE. Do you decide on your own what blood pressure medicine you take? No! Go talk to her about this decision as well!”)

Two) Speaking of getting Uncle Maskless to talk to his doctor, do you have your own doc? Here’s another way to stay SafeR: get a PCP! I just went through several months without a PCP (my beloved PCP retired as did half my specialists; I’m hoping it wasn’t me who drove them away). I was very uncomfortable without a doc; I felt like I was swinging in the wind without a net. It is NOT okay to go through a pandemic without a PCP.

We need our PCPs more than ever:

— — to explain what’s up with Covid

— — to help us be our healthiest selves so we are at less risk if we do get Covid

— — to help get us treatment for Covid if we need it.

You NEED a friend in the medical biz right now! I finally got a new PCP and she’s fantastic and oh mercy, do I feel better and more secure and just generally SafeR knowing I’ve got somebody I can call if I get Covid.

Pro-tip if you’ve had trouble finding a PCP: call your local hospital and ask which docs are currently accepting new patients. And then call them that day! And if you hear of a new practice opening up in town, call that day! Get an appointment, no matter how far out it is, plus get put on their cancellation list. Make it a priority, a big one. And don’t let perfect be the enemy of good enough. Having an accessible PCP in your back pocket is — now that we have some great treatments — a big step to being SafeR.

Three) Have a bunch of tests in your house; they may help keep you from going to the Garden when you’re unexpectedly positive; or they may help you save Aunt Gertrude’s life by not visiting her at the wrong time. And just stay home when you’re sick in general.

Four) If you get Covid and you are at all high-risk, call your doctor and get some early treatment like the PAXLOVID tablets They are really great at keeping people out of the hospital, but you need to start them within five days of first symptoms — so jump on that phone right away.

Five) If you are immunocompromised, you may need a fourth vaccine and you should definitely go get EVUSHELD, which has been EUA approved to help increase antibody levels in people can’t make them. Sometimes people can’t make antibodies because they are taking medicines like Rituxan or chemotherapy or some MS or organ transplant meds; or because they have a disease that prevents them from making antibodies at all. Evusheld is more available than it was and it may be the best hope the immunocompromised have for a normal life. Ask your specialist!

Six) Think about masking with good masks (N95/KN95/KN94/etc) when you live in a higher risk situation (kids or immunocompromised people at home) and when you’re walking into a higher risk situation — Crowded? Lousy ventilation? Strangers? Eating? Shouting? Sobbing? Less vaccinated county? All of that can enter your risk calculus.

There really is a lot less risk right now in many areas of the US — a couple of weeks ago I would hear of 15 people in a day who had turned positive and today I only heard of two (and best wishes to you both!).

But we’re not out of the woods completely — we’re just out of the darkest parts of the woods. So we still need to use our common sense and our flashlights, and we still need to keep an eye on the path ahead.