Covid Update - 26 Dec 2021

Covid Christmas 2021.

One friend had their flight canceled due to the number of United pilots with active Covid infections. Another friend got home for Christmas and tested positive, and spent five days isolating at a friend's house who was out of town. More still didn't even try to go home due to a confirmed exposure within the past few days. One friend threw a party that you had to be Covid positive to attend. Needless to say, this was not the post-Covid holiday many were hoping for.

We are knee-deep in the Omicron surge. Christmas will only add fuel to the fire of spread. New Year's Eve will blow out any semblance of control over the epidemic. Officially over 1% of people in New York have tested positive in the last few days, but with rapid at-home tests not reported and holiday reporting delays, I suspect it's closer to 4-5%. Over 1,500 people are dying a day of Covid nationwide.

Test centers are nearly impossible to get access to, and I've only been able to find rapid tests available for purchase occasionally. So many critical workers are getting infected that states and companies are changing protocols to allow them to come back to work sooner. Looking at the real chance that the playoffs would have to be canceled, the NFL has essentially given up and said if you're vaccinated, then even if you test positive and are asymptomatic, you can play.

The reality is that it is past time to update the isolation protocols, especially given that a considerable portion of the country will likely be infected in the next six weeks. Rapid tests are good at telling you if you're infectious, whereas PCR will be positive for a long time past any danger to others. Yes, the rapid tests will have more false negatives [i.e., you're infectious, but it doesn't pick it up] but used correctly, they can limit spread. The FDA confirmed that Binax and QuickVue rapid tests accurately identify Omicron this week. They have not released data from other tests yet.

That's the bad news. That Omicron is as infectious as we feared and hit escape velocity right as the holidays hit.

This week did bring a lot of good news as well.

Omicron causes significantly less severe disease. We've now seen data from Denmark, the UK, and NY, confirming lower severity.  At this point in prior surges, the hospitalizations were climbing much quicker than today. We don't know if Omicron is innately less severe or if the vaccinations / prior immunity protects from severe disease. The reality is it doesn't matter why it's less severe, just that it is.

Not that getting Omicron is a walk in the park. Mild disease from a medical professional just means that you don't need to go to the hospital. Some of my friends [vaxxed + boosted] have had high fevers, and Omicron took them out for the better part of a week. This is what worries me in the coming weeks; entire hospitals or offices for critical professions could be out simultaneously.

Israel has been at the forefront of quick, science-based decisions in the entire pandemic. They were the first to detect waning immunity and the first to start to use booster shots. Last week they announced that they planned to start giving high-risk people a 4th shot but this week walked it back. After reviewing another week of data, they feel that the more mild course of the disease doesn't warrant 4th shots. This is excellent news, and I trust their scientists.

Walter Reed announced a successful Phase I trial of a pan coronavirus vaccine this week, aka the "super vaccine." This vaccine is designed to help immunize you against all types of Coronaviruses, including the common cold and SARS. The vaccines we are currently using against Covid target the spike protein, the key it uses to enter our cells. This makes the current vaccines vulnerable to mutations like Omicron, where the spike protein looks different.

The scientists at Walter Reed took a very different approach, and if it proves out, it will give us a variant-proof vaccine. It's still early; they need to go through a Phase II and Phase III trial, which will take some time. Again, our scientists and doctors are the reason we've managed to fight this virus. It's hard to convey just how incredible these advancements are and just how fast we've been able to create them.

The FDA this week authorized the Pfizer anti-viral, Paxlovid, and this is one of the most significant developments in the fight against Covid. If taken within five days of symptoms starting, it can reduce death by 90%. It's a pill and can be distributed through standard pharmacies, making it a game-changer vs. the monoclonal antibodies treatments requiring an IV. Due to supply chain issues, I suspect it won't be readily available for weeks, if not longer.

Paxlovid is a protease inhibitor. This class of drugs was developed to treat HIV / AIDS infections and only really exists due to the tireless efforts of ACT UP and other AIDS activists in the late 80's early 90's. As Covid has become endemic, Paxlovid will probably help save millions of lives in the coming years.

Over the coming weeks, many people you know will get Covid, including possibly yourself. It's a good time to plan what you will do if you get infected. Everyone gets to choose their risk tolerance, but the time to start thinking about it is not when the two lines appear.

For me, in the next two weeks, I'll be reducing my exposure, and I've counseled anyone that is a high risk to be extremely cautious. I'm certainly not going to be attending any big New Years' parties. Yes, I think we're all going to get Omicron at some point, but if you can avoid getting it in the middle of the worst surge when the hospitals will be overloaded, that's just better for you.

As always, if you have any questions or concerns, feel free to reach out.

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