The Largest Covid Wave Yet? Anecdotally.

Protecting ourselves and shielding those at higher risk still matter.

It was a long day. It’s been a long couple of weeks. I’m going to share some thoughts about the under-reported Covid wave going on right now, whether people want to hear it or not.

I also think it is important to state from the outset that I understand Covid is not as terrifying as it once was, with so many people vaccinated, boosted, previously sick, and with better treatment options. But we should still care for these reasons:

• Getting sick with Covid can still be quite bad. I see it every day.

• Higher risk people need our help. That includes older people, those with serious health problems, the overweight and obese, pregnant women, and those kids and babies too young to be given a chance at vaccination.

• Long Covid is not uncommon, and has varying degrees and durations.

• Every case of Covid is a chance for a new variant to arise, and to keep this pandemic raging.

The office workload has been intensified by Covid-related phone calls, video visits, and messages at a level I have not felt since the Omicron wave back in early January. So despite what you might think, or what they aren’t telling you - we are definitely in a big wave right now. And with many people not wearing masks indoors, and trying to forge on with life as usual, I’m not so sure this wave will wash over as quickly as others. Fortunately, we are not seeing much devastating severe disease, or hospitals above capacity - but hospitalizations are sharply up in our system. And people who are vaccinated and boosted are still feeling quite ill, with the potential for a long haul.

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The great unmasking.

I think a simple graphic tells a powerful story. Here are the Covid case numbers for a local private school. All kids are vaccinated. The highest case count occurred last week, and was much higher than during the Omicron wave. These 28 + 8 = 36 cases also spilled into the community and into families. All kids were wearing masks in classrooms until a certain week, when masks became optional inside. Mostly boys took off their masks, for complicated social and developmental reasons. Mostly boys got sick. Can you guess which week masks became optional?

Omicron peak circled for comparison.

Sorry if the red circle provides a clue.

Even though most kids seem to be fine after Covid, we can’t forget that over 1,000 children in the U.S. have died of Covid.

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The great flying blind.

As I stated in a previous post, we are really flying blind. Many people are sick with only mild cases, but are still quite infectious. Many are not testing. Rapid antigen tests at home do not get reported. It has been estimated that whatever case rates you are reading about, you should multiply that number by 10 right now.

Don’t forget that the new, reassuring CDC maps and guidelines are not designed to protect individuals. The CDC has pivoted towards providing advice and warnings designed to keep hospital and health systems from collapsing. We can instead follow test positivity rates, sewage analysis reports, and listen to old fashioned, anecdotal reporting from low-tech family docs and be warned that rates are really high now. Hospitalization rates are going up nationally, too, which confirms a surge has been present for the past 3 weeks at least.

We’ve also learned that the Omicron variant was just as potentially severe as other variants, when adjusted for confounding variables like vaccination status, comorbidities, and various demographics. In other words, what made Omicron less severe overall was vaccination, prior infection, and some improved treatments.

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The great surrender.

The tribe has spoken. 70% of the American public agrees with the statement: “It’s time we accept that Covid is here to stay and we just need to get on with our lives.”

300-400 people are still dying every day of Covid. It rose to 600 yesterday. That’s not normal. Covid is the 3rd leading cause of death 2 years running. And even when people don’t die, the after effects I see in some of my patients include chronic shortness of breath, cough that lasts for months, cognitive problems, mental health problems, and a host of other weird new symptoms and diagnoses.

On some domestic flights, fewer than 10% of people are now wearing masks. When a Florida judge recently overruled CDC guidelines concerning mask wearing on public transportation, passengers ripped off their masks in-flight, and started exchanging lungfuls of air.

Are they not to be protected, the grandparents, the immunocompromised, the overweight and obese, the children too young to be vaccinated but whose parents want that chance? Ourselves? Masks indoors and on planes have been proven to help.

Several patients I’ve seen this week have tested positive for Covid with symptoms like fever, sore throat, and cough - yet kept working for a couple days, thinking they just had bad allergies. Some work in food service at restaurants, where neither they nor their patrons were wearing masks.

I understand I am in the minority. I understand that doctors’ advice has to compete with so many other influences and influencers. So I sincerely appreciate you reading my take here. Feel free to give me feedback in the comments.

I know people can’t be expected to wear masks indoors forever. But I would do that for you, and for myself, for as long as it takes. I find that I can go a couple days without shaving that way, too.

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The pretty great options we have.

Boosters, both first and second, are reducing severe disease quite well. 4th shots for those eligible are highly recommended in this present environment that I’m describing.

Early testing when symptoms arise, and antiviral treatments are definitely helping. Our Paxlovid plan is working quite well, for those patients able to take the medicine. For those on certain blood thinners and other medications, we have early Remdesivir infusions now that also reduce severe disease by 90%. Monoclonal infusions are an option, but with current variants, most experts consider these a third tier option.

Molnupiravir, which unfortunately translates to “Thor’s Hammer,” seems to have been prematurely and ambitiously named. It is running 4th in the list of treatment options we have based on efficacy and potential adverse effects.

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The great things we can still do.

Don’t forget that for millions of people this pandemic has been tragic, in addition to the universal bad. Compassion fatigues, but we can still try to muster it for our friends and family affected.

In June, the FDA will review the Novavax vaccine, updates for Moderna and Pfizer vaccines for the youngest children, and plans for Fall 2022 vaccine compositions.

Vaccination works. Boosters help. Ventilation is good. Outdoors is better. Still masking indoors is not crazy, especially if you are healthy and low risk and want to help protect others. N95s and the like are superior. Talk to your doctor about any special situation you have. When not feeling right, test. Rapid antigen tests are 100% covered by insurance. You should be able to get 8 free tests per month by giving your pharmacist your insurance card. I did. Test before being indoors with high risk family and friends. If you feel sick, stay home, no matter if Covid or not. And if you feel sick, but rapid home testing is negative, arrange a PCR test. Your doc can help with that. Early diagnosis facilitates early treatment within 5 days. Paxlovid is easy for most, and other options like Remdesivir and monoclonal antibodies are usually available, although access is getting tricky with high demand the last 2 weeks.

And finally, don’t despair - we are in a much, much better position, with more knowledge and weapons than when this whole mess started. I just hope that sharing what I’m seeing in my practice helps improve and inform your radar, too.

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And to Joel Embiid - win or lose tonight, thanks for being a masked warrior for your team.