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Ask Dr. Halverson: COVID-19: Mitigation, testing, quarantine, isolation and outpatient treatment

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By Dr. Jim Halverson, Special to the Ojai Valley News

The Omicron variant has caused case numbers and hospitalizations to be at their highest levels since the start of the pandemic. Fortunately, the severity of the illness in fully vaccinated individuals does appear to be less than at this time last year, when ICU admissions and deaths were higher. Despite this, becoming infected can have a significant impact on your life and the lives of those you spend time with.

Here are recommendations to take care of yourself and others during this challenging time:

MASKS AND MITIGATION MEASURES

N-95, KN-95, KF-94 and surgical masks (blue mask covered by a well-fitting triple layer cloth mask) are your best options. Find the one that is most comfortable for you. Always wear it when you are inside with others (except in your home) and outdoors in crowded conditions. Make sure you have a snug seal over your nose and mouth and around your cheeks. If your glasses are fogging up, it needs to be adjusted. 

Avoiding activities around large groups of people is prudent. Currently, 25% of PCR tests done in our county for SARS-CoV-2 are positive, so there is a very high likelihood that someone in that group of people has the virus.

TESTING

Home tests (also known as antigen tests) will give you results in 15 minutes. They are nearly as sensitive as the PCR test (also known as molecular tests). If you are having symptoms (cold symptoms, cough, fever, significant fatigue and less frequently vomiting or diarrhea) and the initial antigen test is negative, repeat it in one to two days. The antigen tests should become more available in the next several weeks as the federal government is offering several per family at no cost beginning Wednesday, Jan. 19. Check the Centers for Disease Control website or the Ojai Valley News for further information on how to request.

PCR tests are available free of charge at many locations. Unfortunately, due to current high demand, results are taking several days, making them much less helpful. Please note, if you have a positive antigen test, you DO NOT need to confirm that with a PCR. Also, if you opt to test following quarantine or isolation, only the antigen test is recommended. The PCR test can stay positive for several weeks after you are no longer contagious.

QUARANTINE

If you have a significant exposure to a known positive person (greater than 15 minutes over 24 hours within 6 feet of a positive person) and are NOT FULLY VACCINATED (greater than six months since your last vaccine), you should quarantine at home for five days and wear a tight-fitting mask in the home. Even if you do not develop symptoms, test at least five days after you last had close contact with the person with COVID-19. If negative and asymptomatic, you may end quarantine. Continue to wear a mask for 10 days since your last exposure and do not travel. 

If you are FULLY VACCINATED and exposed, you do not need to quarantine. However, always wear a mask out of your home and isolate and test if you develop any symptoms. Consider testing on Day 5. (Day zero is defined as the first day of symptoms or the day the positive test is taken if a person is asymptomatic.) Even if that test is negative, continue to wear a mask indoors and outdoors except at home, through Day 10.

ISOLATION

If you test positive, you must isolate. Stay home with a mask on at all times except when eating (unless you live alone) for at least five days following the first day of symptoms or the day of your positive test if you are asymptomatic. If you are feeling well enough to return to work or school after Day 5, check the guidelines with your employer or school district. At a minimum, you must continue to wear a mask inside and out through Day 10. Some employers may require a negative antigen test prior to return to work and others may require 10 days of isolation.

OUTPATIENT TREATMENT

Please do not go to your local emergency room solely to get a COVID-19 test or for minor complaints if you have tested positive. Consider emergency treatment only if you have significant shortness of breath or have serious concerns about your health. If you have any questions, call your physician’s office for guidance or visit the CDC website www.cdc.gov/coronavirus/2019-ncov/your-health/quarantine-isolation.html. 

If you are positive and have risk factors for more severe disease, your physician’s office may advise you to attempt to get a monoclonal antibody infusion at a local hospital emergency department. Currently, due to high numbers of cases, the only approved antibody, Sotrovimab, is in short supply. Ventura County receives shipments weekly of Sotrovimab and distributes them to approved infusion locations. Ojai Hospital and Community Memorial in Ventura are both approved locations.

Recently, the Food and Drug Administration granted emergency use authorization for a pair of prescription oral antiviral medications, Molnupiravir and Paxlovid. Currently, supplies are very limited and reserved for patients at very high risk. Supplies are likely to improve over the next several weeks. These medications have potential significant side effects.

VACCINATIONS

Despite breakthrough and recurrent infections, vaccinations continue to be the best way to lessen your risk of serious infection, hospitalization, or death from COVID-19. Eighty percent of the current cases are in unvaccinated individuals. Much more concerning is that the hospital rate in unvaccinated people is eight times higher and the death rate 20 times higher than fully vaccinated individuals.  

As one colleague so clearly put it: “There are two ways we can look at this pandemic. Everybody is going to be exposed to the virus at some point. We can either choose to be exposed in a way that is safe and doesn’t result in massive death (i.e., vaccination), or we can do it the hard way that we have done throughout history (prior to vaccinations) and have a pandemic that continues longer and has an even more sizable death toll than what’s already happened.” 

Fortunately, in Ventura County, 80% of eligible people (age 5 and above) have gotten at least one vaccination and 73% are fully vaccinated. Nearly 5,000 county residents continue to get their first, second, or booster dose every day, so the number of vaccinated people who live in our community will continue to improve.

Please get your booster if it has been more than five months since your last Moderna or Pfizer vaccination or two months since your first Johnson and Johnson vaccine.  Being fully vaccinated and boosted gives you the best chance of preventing a severe case of COVID-19.

THE NEAR FUTURE

This surge will gradually decrease, although the peak has not yet been reached. We were at 10 cases per 100,000 Ventura County residents per day in mid-November. Currently, there are more than 200 cases per 100,000 residents per day. In my opinion, it will be two to three more months until we are back to mid-November levels.

GRATITUDE

It is helpful to be grateful, rather than resentful, during these challenging times. If you are unvaccinated, be grateful for all those who have gotten vaccinated. They have substantially reduced the severity of this pandemic. If you are vaccinated, be grateful for all who are wearing masks and social distancing. They help reduce the spread of the Omicron variant and are lessening your risk of having a significant exposure to the coronavirus and many other respiratory viruses as well.

Stay hopeful, stay well informed, get fully vaccinated, stay safe and stay well.

— Dr. Jim Halverson is a longtime Ojai physician who wrote a weekly column on COVID-19 for the Ojai Valley News from March 2020 to June 2021 and occasionally since then.

 

 

 

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