The COVID-19 landscape is constantly changing. There’s new guidance from the Centers for Disease Control and Prevention that suggests shorter isolation periods and booster shots, and there are new therapies for the most vulnerable populations. KHNS’ Mike Swasey spoke with Dr. Lisa Rabinowitz, a staff physician with public health and a member of the COVID-19 task force on Tuesday for the latest information.
Swasey – Lisa when are we most transmissible if we do contract the virus?
Rabinowitz – Yeah, so that’s a great question. And there, they’re still, you know, looking at that. With this virus, it has a shorter incubation period. So there’s a lot of thought about people potentially being infectious even before they have symptoms or test positive, as that virus amount is increasing. So we’re really, you know, recommending people to do those things, we’ve been doing this whole pandemic, wearing a mask, hand washing, ventilation, all those things, just because we don’t know if we can transmit it to others, or if people are transmitting it to us, and unknown to them, they have no symptoms.
This Omicron has really changed things a lot, the contact tracers are overwhelmed with the surge. We’ve had the, you know, record-breaking numbers over this last week. And it’s important that if you, you know, have been around people and you test positive, let them know, be really, you know, proactive on that. And moving forward, many states and, you know, even Alaska has been adjusting kind of that broad-based contact tracing that focuses on those high-risk settings. And so yeah, putting more power back into the individual to be mindful of their kind of situation.
Swasey – There’s been a lot of talk lately about a move towards saying, “Well, if you’ve got symptoms, you’re considered COVID positive.” Are you familiar with this?
Rabinowitz – Yeah, totally. And as. wearing my other hat as an emergency physician, I would say definitely. If you have symptoms of COVID, assume you have it, and take the proper precautions. And even, you know, if you have one home test at home, that’s negative, and you still have symptoms, please don’t go out. Assume that you’re positive, take care of yourself, but also taking care of your community not to continue to spread it.
So I definitely am behind that sentiment. I think we did that a lot in schools, even before Omicron. You know, if you’re sick at all stay home, and it helped in the schools and transmission. So I think we just need to think about that for our communities as well.
Swasey – Okay. How far away is herd immunity?
Rabinowitz – Haha. So, again, we don’t know. That’s the straight answer. We don’t know with this variant, like how much immunity we’ll get from infection. So those that have been infected with Omicron, we’ve not been able to watch how much immunity this gets us over time. We saw with the other variants, just like with vaccinations, that there was definitely waning immunity over time. And people are getting infected again, I’ve had patients that have, you know, now had COVID three times.
And so really, a lot of data came out last week, kind of looking at immunity. And the biggest thing they found was getting boosted, so if you’ve, you know, been infected and vaccinated or just vaccinated, definitely getting that booster brought your protective immunity up quite a bit. So, you know, I’m encouraging people stay up to date on these vaccines.
Swasey – What therapies are available?
Rabinowitz – Lots of new things have happened. So I think that the silver lining with Omicron, people generally aren’t quite as sick. We’re still seeing lots of people that do end up very sick from it. We’re having about 2000 deaths per week in the US right now, but overall, people are faring a little bit better. We’re also seeing these surges come down fairly quickly in states that have already peaked.
So all that is encouraging, especially since we now have some therapies that have come along. So we have monoclonal antibodies. Unfortunately, with Omicron, two of our three monoclonal antibodies really just don’t work for Omicron. And so we’ve had to kind of change that. And the one that does work is in fairly short supply.
We also have two oral medications, and we’re starting to get more and more supply of those. They have different nuances for kind of different sets of people, but really trying to target those high-risk individuals to keep them out of the hospital or kind of worse outcomes. And then we have Remdesivir, which we have been using in the hospital, we now have it approved for outpatient, and even the pediatric population can get that if they’re high risk. So lots of new therapy options. They’re complicated. They’re all you know, kind of different in their own way. So we’re really encouraging people to talk to their health care provider if they’re high risk or feel like they might be to make those decisions with their provider.
Swasey – Sure, and what are the two therapies that you didn’t name?
Rabinowitz – Yeah, so Paxlovid and Molnupiravir. And those are the two oral medications.
Swasey – And those are for after you’ve contracted COVID?
Rabinowitz – Yeah, that’s correct. And you have to, for those, you need to catch it within five days and have a positive test. And because they were in short supply, we’re kind of working with health care across the state, and the crisis care committee kind of worked on how we allocate to the to our higher-risk patients.
The good thing is the second one I mentioned, Molnupiravir, might not be quite as effective as Paxlovid, but we’re starting to get a lot more of it. So we’ll be able to give it to a larger group of at-risk people starting this next week. So that’s exciting for us.
Swasey – Do you have your hazmat suit still, at the ready every day when you go in? Or have things… What’s it looking like in the actual ER?
Rabinowitz – So I gotta tell you, I’ve hung up the hazmat, the PAPR hood, because it’s just too cumbersome and there’s COVID everywhere now. So I wear my N95 and I don’t take it off to drink coffee. So can you imagine a noncaffeinated ER doc? But that’s what’s happening in my world.
And I think, you know, like all of us, this has changed and the mask guidance, that’s another thing that has kind of come out. And there’s a lot of talk about these higher filtration masks, and they’re needed for certain settings, right. So, for instance, if you’re in a high-risk setting, or high exposure, like a hospital, if you’re caring for someone that has COVID if you’re high risk… But the bottom line is you really want to merit wear a mask that fits well, and you’re comfortable in so you keep it on, because that’s really the key. And so I found the mass that works for me, and I’m rocking it.
Swasey – Nice. How long does it take for your booster shot to take effect?
Rabinowitz – Yeah, so great question. And they’re all a little bit different, but that first week after you get a booster 7, 10, 14 days, that’s where you’re really getting that protection back up. And so, in that first week after your booster, you know, still assume that your protection has waned, and don’t go out there and do crazy stuff. And you know, realize that that protection is kind of increasing over that next week to two weeks.
Swasey – All right, well, Dr. Lisa Rabinowitz, thank you so much for your time.
Rabinowitz – Thank you, always a pleasure.
The new guidance recommends that if you contract the virus you isolate for five days and wear a mask for another five when around others. If you had a severe illness they do suggest a 10 day isolation period and to contact your doctor.
For those fully vaccinated and boosted people exposed to the virus, there’s no need to stay home unless you develop symptoms. That’s also true for people who have tested positive for COVID in the previous 90 days.
For those not up to date on their vaccines, which means you haven’t had a booster, or you are unvaccinated, they suggest you isolate for five days after COVID-19 exposure even if you don’t develop symptoms.
