When is the next wave coming?
It‘s already here. It‘s Long Haul.
The first wave of Covid was horrific. Patients jammed hallways, unable to breathe, hospitals ran out of ventilators, and doctors, nurses, and first responders died with their patients. Workers placed bodies into refrigerated container trucks because morgues had no room. When Delta, the second wave, struck, we had testing, earlier diagnosis, and vastly improved clinical care. We were ready for the third wave of severe disease — but it never came.
Instead, we got Omicron, now in its third wave. It causes primarily mild infections, and home testing leads to significant underestimates of cases. It is one thousand times more infectious than Delta and mutates frequently. It has become a family of viruses — BA.1, BA.2, etc., through BA.1.12.1. It results in deaths and hospitalizations among the unvaccinated. Some variants evade vaccine and/or post-infection-induced immunity. “Breakthrough infections,” once thought rare, are common with Omicron.Omicron is one thousand times more infectious than Delta and mutates frequently. Click To Tweet
“Long Haul Covid” develops a month after a COVID infection. At the outset of the pandemic, prolonged post-infection symptoms remained below the radar; people were grateful to be alive. Now we note that a month after the Omicron sore throat and runny nose, the “long haul” hammer drops. It is three months of severe fatigue, headache, cough, shortness of breath, and foggy thinking. Voila, you are a Zombie.
The incidence is four to twenty percent of Omicron infections. There is no correlation between the severity of the COVID infection and the “long haul” that follows. Many “long haulers” had a short, mild illness, including the vaccinated. Some strains of Omicron can infect you more than once a year.Long Haul is three months of severe fatigue, headache, cough, shortness of breath, and foggy thinking. Click To Tweet
Christine Sandrock, UC Davis Health head of the post-COVID-19 Clinic, confirmed, “What’s so unusual is to see a large group of people who had less severe cases have such long-lasting symptoms. This is not something we’ve seen with any other infectious disease.” (Except Chronic Lyme Disease, Dr. Katz adds).Ninety-three percent of the dead from COVID are unvaccinated. Click To Tweet
Omicron infections can drop unvaccinated Americans like country boys plinking cans off a fence. In 2020 most deaths were among the elderly: not so anymore. “We started with the most vulnerable deaths among the elderly,” says Dr. David Zonies at Oregon Health & Science University. “As we transitioned into different variants, the age demographic shifted. We see very young people dying, around 30-year-olds and 40-year-olds. Ninety-three percent are unvaccinated.”
An Epidemic of Disability
United States rate of Covid positivity has tripled to 10% since the beginning of April. Because home tests are not reported, the true rate is 25%. COVID is rising in warmer months when it should decline in warmer months as people spend time outdoors. Estimates are tens of millions of Omicron infections. Most Americans have two shots of vaccine, limiting the threat to the healthcare system.
However, if we combine Dr. Sandrock’s observation of a high percentage of “long-haul” cases following mild infections, the denominator is millions of new cases (some people can get infected more than once). We face an epidemic of disability. The economic and social impact will be enormous. Lots of people stumbling around. Once again there will be unforeseen circumstances.
How best can you avoid it?
- There may be several Omicron variants in your area. Carry a mask. N95 preferably.
- Indoor spaces are the top opportunity for infection. If crowded with people who are not family members or coworkers (especially if there is no testing or ventilation program) either wear the mask, or consider leaving.
- This might seem excessive, but with a real positivity rate of 25%, there will be throngs of asymptomatic spreaders.
- Ventilation reduces the risk. Open windows. Well ventilated restaurants and homes are a welcome respite. Sporting arenas have very good ventilation, as do airplanes, trains, anything outdoors. Wear masks in airports; incoming travelers can bring new variants new to your immune system.
- Should you have any upper respiratory symptoms of Covid and a positive test, Paxlovid, the new oral medication can prevent infection. It must be started within the first five days. (There are reports of a rare Paxlovid rebound in symptoms. I will report on that when more data is published.)
Must Hit This Nail Again
Among the unvaccinated, it is still a game of Russian Roulette. There are one hundred million unvaccinated Americans. Any one for Russian roulette?
Get vaccinated. The life you save may be your own. And your family’s.
By: James Edward Katz, M.D.
Image credit: Night of the Living Dead production still. Wikimedia Commons.