Jason Prystowsky MD, MPH: Some Omicron reflections from the last week
From your friendly, neighborhood, community ER doc (who worked 12 of the last 14 days). . .
1) Omicron is here. It is 3x more contagious than Delta variant and 6-8x more contagious than original variant. It is causing “breakthrough infections” in those vaccinated (more so in those with J&J or two doses mRNA vaccine rather than 3 doses and boosted). Thus far it appears to cause less severe illness especially in those who have already had COVID or have been vaccinated. If (or when) you get COVID, you may be asymptomatic or you may feel miserable. As of today, we are out of the monoclonal antibody infusions that have shown to be minimally to moderately effective at preventing severe disease. We also do not have the new Merck or Pfizer antivirals. If you come to the ER expecting unavailable or ineffective interventions, you will not get them so please do not make demands or threats. Ivermectin and hydroxychloroquine are NOT effective treatments. If you catch COVID please stay hydrated, rest, invest in a pulse oximeter (about $30) and check your oxygen level every few hours (should consistently above 96% in healthy lungs). Please notify everyone you had been in contact with for the 5 days before you got sick (indoors, >15 minutes, <6 feet apart, both not wearing masks). Contact your physician for a telehealth visit so that a health professional can monitor your symptoms. I have seen athletic, healthy, young people be completely bed ridden with COVID for 2 weeks, so set your expectations. If you do have COVID… do NOT go to work, go out to eat with friends, go to a house party, go to the grocery store, go to gym, go to hot yoga, get a massage, go to a wedding, watch Fox news, smoke/vape marijuana, tobacco, methamphetamines, knowingly expose other people to COVID, order unnecessary things on amazon (all are activities I have heard from COVID patients within the last week). Reasons to come to the ER or call your physician: pulse oximetry <90% consistently, dehydrated and unable to keep down fluids, severe chest pain, severe shortness of breath, confusion; or for children, persistent fever and symptoms that are worse than a mild cold (rash, diarrhea, inability to eat, short of breath, pulse oximetry <90%). Please see the CDC criteria for MIS-C.
2) Testing. There is a lot of misinformation out there about testing, so be sure you are getting your information from reliable sources. PCR (or nucleic acid amplification tests) are the most accurate, but they are also more expensive and take longer for results to come back. Rapid antigen tests are faster, can be purchased at pharmacies, and are currently being distributed by local public health agencies. These tests are usually accurate if you are symptomatic but are less accurate if you are asymptomatic, or pre-symptomatic (i.e. you have been exposed and are worried you may have it, but have not developed symptoms yet). Last I checked, CVS was sold out of rapid antigen tests and SB county public health ran out. I know that various local urgent cares are offering COVID testing including Cottage Urgent Care, MedCenter, and Sansum Urgent Care. There are some local businesses that can do same-day testing but can be expensive (such as South Coast Analytics). Teachers and students can get PCR screening at Earl Warren Showgrounds, but need to make an appointment. UCSB students have access to testing through student health. If you need to be tested for work or school, please check with your supervisor about where to go. If you come to the ER, we are always happy to evaluate you, but please do not come to the ER demanding to be tested unless you are sick or experiencing an emergency.
3) Vaccines. The Pfizer and Moderna vaccines are safe and effective. Please get the vaccine if you are eligible and have not already gotten it. Please get the booster. If you do not believe in vaccines, please shut the hell up. Spreading misinformation is dangerous and hurts people. We stopped agreeing to disagree when I started missing family time so I could spend more time treating COVID patients who don’t believe in vaccines. Those who catch COVID and have had the vaccine and booster are getting a mild form, and are rarely hospitalized. Nobody should die from a preventable illness. COVID19 deaths are preventable with a vaccine.
4) Masks while indoors. Please wear a mask while indoors. Please feel emboldened to remind other people to wear masks while indoors. Surgical paper masks are more effective than cloth masks. Multiple layer masks are more effective than single layer masks. N95s are the most effective. If you refuse to wear a mask indoors because you have a medical exemption, then stay the hell home. Your medical exemption should probably prevent you from interacting with other people during a pandemic. If you refuse to wear a mask while indoors in a public space, then you are a selfish narcissist or you are < 3 years old (and an age-appropriate selfish narcissist).
5) Quarantine. This is a moving target as the CDC recently changed guidelines from 10 days to 5 days. The change was made because Omicron has a shorter incubation period, but, more importantly, is the HR component; we are unable to staff hospitals, fire stations, grocery stores, police departments, and all essential functions if everyone quarantines for 10 days given how fast this variant spreads. Consider your workplace safety, the new CDC guidelines, and how essential it is to have people at work or school when making a calculated decision about how long to quarantine after exposure or infection.
6) Avoid misinformation. This is a dynamic situation with constant changing science. Please fact check information and get information from reliable sources. If you live locally in Santa Barbara please review the local SB public health department resources (https://sbcphd.maps.arcgis.com/apps/MapSeries/index.html…). You can also check the CDC (https://www.cdc.gov/coronavirus/2019-ncov/index.html) or California Department of Public Health (https://covid19.ca.gov). If you are a doctor, clinician, public health expert, then please continue to share public service announcements that are cited, and evidence supported. If you are not a clinician or public health expert, then please only share reputable sources that improve the quality of health in our community. If you are sharing conspiracy theories, your own fringe personal opinions, or dangerous misinformation… then stop. You are part of the problem.
7) Burnout. If you work in healthcare, EMS, public service, then you are burnt out or you are an enlightened bodhisattva and blissfully ignorant of your own fatigue. Thank you for your service. You are my people, and I love you. If you are not in healthcare or essential public service, then please be respectful of those who are. Show support or at least behave in a civilized respectful manner. I have seen more temper tantrums, entitlement, vitriol hostility, and frankly childish behavior in the last few weeks. We are exhausted and over it too. We cancelled our holiday plans and are desperately covering sick calls, and constantly looking for childcare so we can work overtime to keep our hospitals open and functioning above capacity. When you come to the ER and start making demands and threats, it impairs our ability to care for you and your family effectively. Be kind. Be patient. We will take excellent care of you in the ER, and if there are delays it is probably because there is someone more ill than you who has our attention. You reminding us that your brother is a malpractice lawyer or that you are calling the hospital CEO to complain just confirms for us that you are indeed an asshole. And be aware that our hospitals are either full or almost full. Now is the not the time to take up extreme sports, drive recklessly, or do anything that begins with “hold my beer, and watch this. . .” We may not have the staffing or resources to provide you with optimal care.
PS … if you are a troll who indulges in misinformation and has the time and lack of moral character to leave hostile adversarial comments, please make no comments. My diplomacy is struggling a bit these days, and losing your friendship maybe the small price to pay to advocate for the health of my community, my colleagues, and my own self-care.
Stay healthy Santa Barbara. We will get through this.
From your local, friendly, community, neighborhood emergency physician,
Jason Prystowsky MD, MPH