Omicron is here but maybe this is a good thing. This virus has mutated where it’s crazy infectious (like measles), but appears that it’s less likely to attack the lungs – where the morbidity and mortality from covid pneumonia and the cytokine storm happens.
Either way, having Omicron can even provide immunity from delta but acts like a upper respiratory infection (aka the common cold). Remember there are 4 other coronavirus that causes the common cold.
PRESENTATION
Omicron has sore throat, runny nose, sneezing, muscle /body aches (lower back for whatever reason), and peaks at day 3-4 like most URIs and gets better. Less likely to cause pneumonia, but if you are asthmatic or have chronic lung disease or heart failure, this may tip you to an exacerbation.
SELF-CARE/MANAGEMENT
Since all the virus remains in the mucous membranes of nasal and oropharynx — gargles, and nasal rinses, to me, may help reduce the viral load in this – just like all cold viruses. Also, the occasional acetaminophen and ibuprofen can help you feel better. Also stay home when sick, and wear face-masks (n95 even) if you want to prevent people from getting ill from your boogers and snots.
TESTING
Well, if you have the rapid antigen – that’s pretty good if you test +. The sensitivity however is not as good so you can get false negatives. If you can’t find it, then PCR or other molecular test in the community or home kit is gold standard, but if you can’t get the results for 4 days, well, it’s kinda pointless right? CDC recommends only 5 days of isolation and 5 days of additional masking.
SEEK MEDICAL CARE IF…
Don’t come in to seek care if you are having the sniffles. This is like primary care 101. If you can get a test, maybe that’s the only thing you should do. Even then, there are difficulty to get a test so – if you stay home for 5 days, you’ll probably be fine as long as you don’t develop other symptoms.
If you are having shortness of breath – then come in. with omicron this is less likely but still Delta is around and like I said if you have asthma or COPD, or heart failure, like any URI – if can tip people into exacerbation.
MEDICATIONS – NEW AND NOTABLE!
Monoclonals – not as effective, but one of them, for the right person. Sotrovimab apparently works but is it really necessary? Maybe for the highest of risk?
Fluvoxamine : interesting data – showing reduction of hospitalizations! this is an SSRI and actually has a great RCT to demonstrate effectiveness.
Paxlovid – new pfizer drug. pretty cool – but lots of drug-drug interactions.
Other older medications really reserved for those that need hospital care, so I won’t touch on that. Remdesivir, dexamethasone, and world class ICU care – the usual standard of care for delta.
(and no, you don’t need ivermectin at this point..why would you with all the data that shows that the above works??)
PRIMORDIAL AND PRIMARY PREVENTION
Stay healthy – eat/sleep/drink well! Not too much to say here except that we can really prevent lots of chronic disease and maybe even COVID if we stay healthy. Harder done than said though.
Vaccination – vaccination appears to be helpful – but even this we’ll find out if this is even necessary if this becomes a “common cold.” Definitely helpful for Delta and Alpha but omicron? who knows.
n95 facemasks – while out? depends on your tolerance to risk, right? I can’t imagine all of society having to wear n95 or kn94 masks, but yea if you are high risk and maybe even on a plane, consider it.
PUBLIC HEALTH RESPONSE
this is such a controversy, so I don’t think I’ll go there with the exception is that- vaccines works (condition for employment in healthcare and military) but other mandates?-mask mandates?-school guidance? JAMA, January 6, published a few articles/editorials about the public health response and what the US should do. Written by former Biden administration COVID team. A good read if interested in Public Health.
I think this is the area that is going to morph the most if omicron will predominate as the endemic virus. so we’ll see!!
ARTICLES/PODCASTS TO REVIEW (for those interested)
1. Fluvoxamine: https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(21)00448-4/fulltext
2. Omicron and the endemic phase. https://zdoggmd.com/omicold/
3. State of Omicron https://peterattiamd.com/covid-19-current-state-omicron/
4. Public Health Response https://jamanetwork.com/journals/jama/fullarticle/2787945; https://jamanetwork.com/journals/jama/fullarticle/2787944
Be well folks!
Robert Oh, MD, MPH 