January 31,2022

endings and beginnings

My last day in clinic was 4 days ago. Ironically for me, I had my first known COVID-19 exposure in clinic that day. Amazing that I could go almost 2 years and not actually be exposed. It is a testament to my organization’s commitment to keep both staff and patients safe by first screening patients for symptoms and also requiring masks in both staff and patients. It is also a testament to my local community, which has a high commitment to both vaccinations and masks wearing. I have occasionally done COVID tests on patients over the past 2 years, if they had a recent exposure with no symptoms. Those results were always negative. As co-workers, we also order tests for each other if we have symptoms or exposures. We have successfully kept COVID-19 out of the clinic.

One of my last patients on Thursday told my MA at check-in that he had lost his sense of taste and smell, but denied fever or cough. I chose to do a COVID test for his safety- he has severe lung damage from when he had tuberculosis when he was in an Iraqi refugee camp in Lebanon. I also knew that he had not gotten his booster despite my urging and that his J&J vaccine was at least 8 months old. Sure enough, his test was positive. So far, he is doing well, but I worry about him over the next critical few days since he has had symptoms for 7 days. If people are going to crash from COVID, it is between 7-10 days after symptoms begin. I hope he does OK. My colleagues will keep checking on him for me.

For myself, this is a test to see if masking with an N95 works. I am confident it will. I have already had 2 negative rapid tests and have a PCR pending *. Jamie and are being cautious and wearing masks around each other. But, wow, after 2 years of being in the clear, to get exposed now feels like the definition of irony.

The thing is we hear that Omicron is “mild”, which may be false reassurance. Yes, it can be mild in someone immunized or who had prior infection. It can also be deadly in the unvaccinated or immunocompromised. We are seeing that, as the number of daily deaths is rising, while the number of cases is falling. One of my sweet elderly patients who repeatedly declined all vaccinations for religious reasons just passed away from an Omicron infection. She declined aggressive treatment after she became very ill a week after she developed symptoms. Her story, sadly, emphasizes the protectiveness vaccines can give.

Long COVID continues to be a concern. It may not be more common in Omicron or the vaccinated, but the data is not completely clear yet. Best to avoid infection in the first place, if possible. More understanding of Long COVID is coming. Two recent studies show possible causes or associations with Long COVID, including level of viral load early in the infection; level of autoantibodies, such as those in autoimmune diseases like Lupus; level of Epstein-Barr virus, the cause of Mononucleosis; and Type 2 Diabetes. Another study found those that had been in the ICU with severe illness or have asthma were more likely to have symptoms. More is being learned, including how to treat it.

Omicron infections are dropping in most places, but we are all more likely to know someone infected now then before. Giving our friends some help will be welcomed, if they test positive. Helping with chores, shopping, or helping other family members are good options. Even just checking in daily will be welcomed.

We are coming out the other end of this latest surge. I am seeing more light in the future and hope for more gatherings, playing tunes together, and sharing food again. But don’t loose focus. Once again, we are so close.

Wash your hands, cover your nose with a good mask, keep your distance, and check in on friends.

And finally, my caveat is that this is my experience and my opinions, which are subject to change as more information is available, and not related to the organization I work for. Thanks for reading.

*My PCR is back and is negative. If my test tomorrow is negative, I will be pleased.

https://www.nytimes.com/2022/01/29/health/omicron-chronic-illness.html

https://www.seattletimes.com/seattle-news/health/omicron-amps-up-concerns-about-long-covid-and-its-causes/

https://www.medscape.com/viewarticle/967490?src=soc_tw_share

https://www.seattletimes.com/nation-world/new-research-hints-at-4-factors-that-may-increase-chances-of-long-covid/

https://www.mdlinx.com/news/a-possible-tool-for-predicting-who-will-experience-long-covid/4mef0AJbqEVrwL02xn67WJ

https://www.seattletimes.com/nation-world/if-your-friend-or-relative-is-home-sick-with-covid-heres-how-to-help/