Going Back to School During the Omicron Surge

How do we get kids back in school safely during the Omicron surge?

How do we get kids back in school and prevent them from getting COVID during the Omicron surge?

“Students benefit from in-person learning, and safely returning to in-person instruction continues to be a priority.”

Guidance for COVID-19 Prevention in K-12 Schools

After all, that’s what everyone wants, right?

Is anyone surprised that Texas leads the US in childhood COVID deaths?
Is anyone surprised that Texas leads the US in childhood COVID deaths?

It’s hard to see how we can do that safely without a lot more people getting vaccinated and boosted, masking, practicing social distancing, more testing, and following through on quarantines for those who are exposed, and isolation for those who are sick.

“CDC recommends universal indoor masking by all* students (ages 2 years and older), staff, teachers, and visitors to K-12 schools, regardless of vaccination status.”

Guidance for COVID-19 Prevention in K-12 Schools

Still, in most cases, folks don’t want to go back to on-line schooling, especially for long periods of time.

So to get kids back in school during the Omicron surge, parents, students, and staff should all work together to keep their kids safe and healthy by:

  • going into home quarantine if they have been exposed to someone with COVID and they are not vaccinated (including a booster dose if they are at least 18 years old and are eligible) or have not had COVID in the past 3 months, remaining in quarantine for at least 5 days. After 5 days, if they have not developed symptoms of COVID, they can get a COVID test and if it is negative, they can return to school, wearing a well-fitting mask for an additional 5 days. And of course, they should get tested if you develop symptoms at any time during these 10 days. If they can’t get tested after 5 days, they can still leave quarantine early if they don’t have symptoms and will wear a mask for another 5 days.
  • going into home isolation if they have COVID, remaining in isolation for at least 5 days, with the ability to end isolation after 5 days if they are fever free for 24 hours, have either had no symptoms or improving symptoms, and will wear a mask for an additional 5 days whenever they are around other people.
  • keeping away from anyone who is at high risk for severe COVID disease until the full 10 days of quarantine or isolation ends.
  • maintaining adequate distance from others during times when they have to take off their mask at school and they are still within the last 5 days of your quarantine or isolation, like when they are eating lunch.

And what if they can’t or won’t wear a mask consistently and correctly and are in quarantine or isolation?

Since they aren't allowed to tell anyone to wear a mask, the Texas Education Agency is trying to implement just half of the CDC guidance to end quarantine and isolation early. Unfortunately, it really doesn't work if you don't wear a mask!
Since they aren’t allowed to tell anyone to wear a mask, the Texas Education Agency is trying to implement just half of the CDC guidance to end quarantine and isolation early. Unfortunately, these plans don’t really work safely if you don’t wear a mask!

Then they should finish out their full 10 day quarantine or isolation at home!

“Staying home when sick with COVID-19 is essential to keep COVID-19 infections out of schools and prevent spread to others.”

Guidance for COVID-19 Prevention in K-12 Schools

What else does the CDC recommend to help keep kids in school safely?

“Vaccination is the leading public health prevention strategy to end the COVID-19 pandemic. A growing body of evidence suggests that people who have completed the primary series (and a booster when eligible) are at substantially reduced risk of severe illness and death from COVID-19 compared with unvaccinated people.”

Guidance for COVID-19 Prevention in K-12 Schools

In addition to vaccination, quarantine and isolation strategies, the CDC recommends consistent and correct mask use, physical distancing, screening testing, improving ventilation, handwashing and respiratory etiquette, contact tracing, and cleaning and disinfection, etc.

“Recommend screening testing for high-risk sports and extracurricular activities at least once per week.”

Guidance for COVID-19 Prevention in K-12 Schools

For example, in areas of low to moderate COVID transmission, doing screening tests of kids in high risk sports and extracurricular activities might help prevent outbreaks. On the other hand, when transmission rates are high, schools should probably just cancel or hold high-risk sports and extracurricular activities virtually to protect in-person learning.

Will this work?

Many big city school districts aren’t convinced and are already delaying the start of the second half of the school year…

“With the above principles in mind, the AAP strongly advocates that all local, state, and federal policy considerations for school COVID-19 plans should start with a goal of keeping students safe, physically present, and emotionally supported in school.

COVID-19 Guidance for Safe Schools and Promotion of In-Person Learning

Let’s hope the COVID surge ends quickly, states and school districts do more to protect our kids, more people get vaccinated and boosted, and we can get all of our kids back in school!

More on COVID School Guidance

What to Know About Home COVID Tests

They may be hard to get, but at least 16 different home COVID tests are now authorized.

Breaking News – you can now order 4 free at-home tests from the covidtests.gov site. (see below)

Home COVID tests that you can buy over-the-counter have been available for over two years now.

The first home COVID test was authorized by the FDA in December 2020.
The first home COVID test was authorized by the FDA in December 2020.

So why is it so hard to find one when you or your kids are sick and need to get tested?

At Home COVID Tests

Even though there are now many more types of home and OTC rapid COVID tests, it can still be hard to find these tests for one simple reason – high demand during COVID surges.

“The deliveries of tests from manufacturers to the U.S. government will begin over the next week or so. Americans will start receiving free tests in the coming weeks. We will set up a free and easy system, including a new website, to get these tests out to Americans.”

White House COVID-⁠19 Response Coordinator Jeff Zients

Being able to order free tests from the US Government will hopefully help satisfy that demand!

“Every home in the U.S. is eligible to order 4 free at-⁠home COVID-⁠19 tests. The tests are completely free. Orders will usually ship in 7-12 days.”

COVIDtests.gov

That ‘new website’ is now up and running at COVIDtests.gov.

At least 16 different home COVID tests are now authorized.
At least 16 different home COVID tests are now authorized.

Until you order and get your home COVID test from that new website, try and get your hands on whichever home COVID test you can, especially if you don’t have access to testing from your health care provider, a pharmacy, or clinic. After all, they have been all been authorized by the FDA to detect SARS-CoV-2, even if they are not formally FDA approved.

You should also know that:

  • home COVID tests are rapid antigen tests, so are not as accurate/sensitive as molecular or PCR tests
  • if your home COVID test is positive, then you have COVID and you should isolate yourself for at least 10 days (although there are some new options to end isolation early).
  • if your home COVID test is negative, understand that it doesn’t necessarily mean that you don’t have COVID… It really only means that the “the virus that causes COVID-19 was not found in your specimen.” While it may also mean that you don’t have COVID, it could also be a false negative. If you were recently exposed or your symptoms just started, stay in quarantine and test yourself again in a few days. Or consider getting a molecular or PCR test.
  • while most at-home tests are done using a nasal swab, some experts think that with the Omicron variant, doing both an oral swab of the throat and a nasal swab will give more accurate results. That is not how these tests were authorized by the FDA though. Home throat swabbing is also not easy to do by most people. To get the most accurate results, follow the manufacturer’s instructions and maybe don’t test on the first day or two of your symptoms. While you remain in isolation, wait for the viral load to increase in your nose and then test yourself. Of course, seek immediate medical attention if you develop severe symptoms at any point.

Home COVID Collection Kits

In addition to at-home tests, many types of home collection kits are available, in which you collect your sample at home, but then mail it to a lab for testing.

At least 16 different home COVID tests are now authorized.
At least 16 different home COVID tests are now authorized.

In fact, the FDA has authorized at least 63 home collection kits for COVID, including some that can be done on saliva samples!

Unfortunately, these home collection kits are also in short supply…

Fake COVID Testing Kits

Not surprisingly, fake at home tests are also a thing!

Make sure that you buy an FDA authorized at home test, which includes the:

  • BD Veritor At-Home COVID-19 Test by Becton, Dickinson and Company
  • BinaxNow COVID-19 Antigen Self Test by Abbott Diagnostics
  • BinaxNOW COVID-19 Ag Card Home Test by Abbott Diagnostics
  • BinaxNOW COVID-19 Ag Card 2 Home Test by Abbott Diagnostics
  • CareStart COVID-19 Antigen Home Test by Access Bio, Inc (marketed as on/go by Intrivo…)
  • Celltrion DiaTrust COVID-19 Ag Home Test by Celltrion USA, Inc.
  • CLINITEST Rapid COVID-19 Antigen Self-Test by Siemens Healthineers
  • COVID-19 At-Home Test by SD Biosensor, Inc
  • Ellume COVID-19 Home Test by Ellume Limited
  • Flowflex COVID-19 Antigen Home Test by ACON Laboratories, Inc
  • iHealth COVID-19 At-Home Test by iHealth Labs, Inc
  • InteliSwab COVID-19 Rapid Test by OraSure Technologies, Inc.
  • QuickVue At-Home OTC COVID-19 Test by Quidel Corporation
  • QuickVue At-Home COVID-19 Test by Quidel Corporation
  • SCoV-2 Ag Detect Rapid Self-Test by InBios International Inc.

Is your at-home COVID test not on the list?

Check the FDA for the latest list of authorized home COVID tests.

The FDA has sent warning letters to a number of folks marketing fake COVID tests.

And be on the watch for fake at-home tests.

What to Know About Home COVID Tests

For now, while we wait for more at-home tests, if you need to get tested, look for a COVID test wherever you can, whether it is with your healthcare provider, a local pharmacy or community clinic, an at-home test, or a test you collect at home and then send to a lab.

Your local or state health department might also be a good source for community testing and home collection kits.

And if you can’t find a test and think you might have COVID, just stay home in isolation and assume you have COVID.

What else can you do?

Get vaccinated and protected, including a booster dose of the COVID vaccine when it is available to you!

More on COVID Tests

Oral Antiviral COVID Treatments

Paxlovid and Molnupiravir are two new oral antiviral COVID treatments that were recently authorized.

As you are likely aware, a couple of new oral antiviral COVID treatments were recently authorized.

While that’s good news, especially if you have COVID and are at high risk for complications, it is important to understand that these still aren’t a quick cure for COVID.

Oral Antiviral COVID Treatments

So what do these treatments do then?

“Paxlovid consists of nirmatrelvir, which inhibits a SARS-CoV-2 protein to stop the virus from replicating, and ritonavir, which slows down nirmatrelvir’s breakdown to help it remain in the body for a longer period at higher concentrations.”

Coronavirus (COVID-19) Update: FDA Authorizes First Oral Antiviral for Treatment of COVID-19

If you have COVID, taking these medications will hopefully keep you out of the hospital or keep you from dying!

“In this analysis, 1,039 patients had received Paxlovid, and 1,046 patients had received placebo and among these patients, 0.8% who received Paxlovid were hospitalized or died during 28 days of follow-up compared to 6% of the patients who received placebo.”

Coronavirus (COVID-19) Update: FDA Authorizes First Oral Antiviral for Treatment of COVID-19

Paxlovid can be given to adults and children who are at least 12 years old with mild to moderate COVID-19 and who are at high risk of disease progression.

Each dose of Paxlovid consists of 2 pink tablets of nirmatrelvir with 1 white tablet of ritonavir. For each dose, you take all 3 pills at the same time. Paxlovid is given twice a day for 5 days.

Now, although ritonavir is included in Paxlovid to slow down the breakdown of nirmatrelvir, it can also affect other medications you might be taking.

That means Paxlovid is contraindicated if you are already taking any medication that is dependent on CYP3A for clearance or which induces CPY3A, including, but not limited to amiodarone, colchicine, clozapine, lovastatin, sildenafil, trazolam, carbamazepine, phenobarbital, phenytoin, rifamin, and St. John’s Wort. Ask your health care professional and pharmacist if you have any drug interactions before taking Paxlovid.

What about side effects?

In addition to liver problems and drug interactions, possible side effects of Paxlovid include dysgeusia (altered or impaired sense of taste), diarrhea, increased blood pressure, and myalgia (muscle aches).

There are also concerns about extra risks in those with uncontrolled or undiagnosed HIV-1 infection who take Paxlovid.

Where can you get Paxlovid?

As it was just authorized, Paxlovid is in limited supply in most pharmacies and will likely be hard to find.

Your health care professional can prescribe Paxlovid to those who meet the requirements of the EUA. And they have been distributed to many pharmacies, although you may have to call around to get your prescription filled.

Another oral medication, Molnupiravir, was also recently authorized and can be given twice a day for 5 days. Molnupiravir is a nucleoside analogue that inhibits SARS-CoV-2 replication by viral mutagenesis, targeting SARS-CoV-2 RNA-dependent RNA polymerase (RdRp).

“FDA has issued an EUA for the emergency use of the unapproved product molnupiravir for the treatment of mild-to-moderate coronavirus disease 2019 (COVID-19) in adults who are at high risk for progressing to severe COVID-19, including hospitalization or death, and for whom alternative COVID-19 treatment options authorized by FDA are not accessible or clinically appropriate.”

Frequently Asked Questions on the Emergency Use Authorization for Molnupiravir for Treatment of COVID-19

Unlike Paxlovid, Molnupiravir should only be prescribed when all other alternative COVID-19 treatment options authorized by FDA are not accessible
or clinically appropriate.

“Possible side effects of molnupiravir include diarrhea, nausea, and dizziness. Molnupiravir is not recommended for use during pregnancy because findings from animal reproduction studies showed that molnupiravir may cause fetal harm when administered to pregnant individuals.”

Frequently Asked Questions on the Emergency Use Authorization for Molnupiravir for Treatment of COVID-19

You should not take molnupiravir if you are pregnant or breastfeeding.

“Females of childbearing potential are advised to use a reliable method of contraception correctly and consistently, as applicable, for the duration of treatment and for four days after the last dose of molnupiravir.”

Frequently Asked Questions on the Emergency Use Authorization for Molnupiravir for Treatment of COVID-19

In addition to the warnings about pregnancy, you should not get pregnant while taking Molnupiravir. In fact, although the risk is thought to be low and studies are ongoing, to avoid pregnancy, sexually active males “with partners of childbearing potential are advised to use a reliable method of contraception correctly and consistently during treatment and for at least three months after the last dose of Molnupiravir.”

Your health care provider can prescribe Molnupiravir, but it will likely also be in short supply for a while.

What To Know About Oral Antiviral COVID Treatments

While it is great that we now have even more treatments available when folks get COVID, it is important to understand that these are still unapproved drugs that are authorized for use under Emergency Use Authorization.

More on COVID Treatments

The Latest on Masks to Keep Kids From Getting COVID

Face masks work to prevent the transmission of COVID and can help keep kids, many of whom are too young to be vaccinated, from getting COVID.

That kids wearing face masks to keep them from getting COVID is controversial is amazing to many people, especially pediatricians.

Why wouldn’t you want your kids to wear a mask if it could protect them?

The Latest on Masks to Keep Kids From Getting COVID

And yes, the data does show that wearing a mask is safe and protects kids from getting COVID…

Need some proof?

Let’s take a look at what’s happening in Texas.

A few weeks ago, there were 86 active staff and 708 active student cases in GISD.
A few weeks ago, there were 86 active staff and 708 active student cases in GISD.

In one north Texas school district that opened early, on August 2, they now have 67 active staff cases and 564 active student cases.

While that’s a lot, it is important to keep in mind that as cases are continuing to rise in most other school districts, leading to more than a few temporary school closures, they are actually dropping in GISD!

Why?

Staff and students in GISD are wearing masks and their active case counts are dropping!
Staff and students in GISD are wearing masks and their active case counts are dropping! They also limit the capacity for indoor and outdoor events once positivity rates get too high.

It is almost certainly because their staff and students are wearing masks!

Masks Save Lives

Wearing a mask can protect the person wearing the mask and the people around them.

Need more proof that masks work?

Wearing a mask is especially important to protect those who are too young to get vaccinated and those who have a true medical contraindication to getting vaccinated against COVID.

“When used in conjunction with widespread testing, contact tracing, quarantining of anyone that may be infected, hand washing, and physical distancing, face masks are a valuable tool to reduce community transmission.”

An evidence review of face masks against COVID-19

Wearing a mask is also important as COVID variants surge, some of which are more infectious, even to those who are fully vaccinated.

Masks save lives.

“Without interventions in place, the vast majority of susceptible students will become infected through the semester.”

COVID-19 Projections for K12 Schools in Fall 2021: Significant Transmission without Interventions

Parents should ignore the misinformation and disinformation about facemasks and COVID-19.

“To maximize protection from the Delta variant and prevent possibly spreading it to others, fully vaccinated people should wear a mask indoors in public if you are in an area of substantial or high transmission.”

Use Masks to Slow the Spread of COVID-19

In addition to social distancing, they should wear a mask and should encourage their kids who are at least two years old to wear masks in school and when in public around a lot of other people.

More on Masks Save Lives

Treating Kids with COVID Monoclonal Antibodies

While anti-SARS-CoV-2 monoclonal antibodies have an EUA for older, high risk children with COVID, they are not routinely recommended by most experts.

While you are likely used to hearing that there are no real cures or treatments for COVID, a few treatments do have emergency use authorization, including monoclonal antibody therapy.

“Monoclonal antibodies that target the spike protein have been shown to have a clinical benefit in treating SARS-CoV-2 infection. Preliminary data suggest that monoclonal antibodies may play a role in preventing SARS-CoV-2 infection in household contacts of infected patients and during skilled nursing and assisted living facility outbreaks.”

Anti-SARS-CoV-2 Monoclonal Antibodies

And they are available for use in kids who are at least 12 years old!

Treating Kids with COVID Monoclonal Antibodies

So why doesn’t everyone with COVID get treated with these monoclonal antibodies?

“Three anti-SARS-CoV-2 monoclonal antibody products currently have Emergency Use Authorizations (EUAs) from the Food and Drug Administration (FDA) for the treatment of mild to moderate COVID-19 in nonhospitalized patients with laboratory-confirmed SARS-CoV-2 infection who are at high risk for progressing to severe disease and/or hospitalization.”

Anti-SARS-CoV-2 Monoclonal Antibodies

In general, they are mainly used in those older children (at least 12 years of age) and adults who are at high risk for severe disease.

“When using monoclonal antibodies, treatment should be started as soon as possible after the patient receives a positive result on a SARS-CoV-2 antigen or nucleic acid amplification test (NAAT) and within 10 days of symptom onset.”

Anti-SARS-CoV-2 Monoclonal Antibodies

Also, ideally, treatment with monoclonal antibodies should be started very early, but even more importantly, it involves an IV infusion. So it is not something that your pediatrician will likely be able to give your child in their office.

So where can you get these monoclonal antibodies?

“The federal government controls the distribution of monoclonal antibodies, and the regional infusion centers in Austin, El Paso, Fort Worth, San Antonio and The Woodlands have exhausted their supply of sotrovimab, the monoclonal antibody effective against the COVID-19 Omicron variant, due to the national shortage from the federal government. They will not be able to offer it until federal authorities ship additional courses of sotrovimab to Texas in January. People who had appointments scheduled this week will be contacted directly and advised. Other monoclonal antibodies have not shown to be effective against the Omicron variant, which now accounts for more than 90 percent of new cases. The infusion centers will continue to offer those antibodies as prescribed by health care providers for people diagnosed with a non-Omicron case of COVID-19.”

Statement on Monoclonal Antibody Availability

Monoclonal antibody therapeutic treatments have been distributed to hospitals and infusion centers around the country. You can hopefully find a treatment location nearby if you need to get your high risk child treated, keeping in mind that you likely want sotrovimab if you have COVID during the Omicron surge.

How do you know if your child is high risk?

People aged 12 or older may be considered at high risk for developing more serious symptoms—making them eligible for mAb treatment—depending on their health history and how long they’ve had symptoms of COVID-19.
People aged 12 or older may be considered at high risk for developing more serious symptoms—making them eligible for mAb treatment—depending on their health history and how long they’ve had symptoms of COVID-19.

Does your child who is at least 12 years old have chronic kidney disease, diabetes, heart problems, chronic lung disease, including moderate to severe asthma and cystic fibrosis, etc., sickle cell disease, a neurodevelopmental disorder, including cerebral palsy, or have a medical device (tracheostomy, gastrostomy, or positive pressure ventilation, etc.)? Are they immunosuppressed? Are they overweight, with a BMI above the 85th percentile for their age?

Talk to your pediatrician if you aren’t sure if your child is high risk and if you need help finding COVID monoclonal antibodies for your child.

“One dose of Evusheld, administered as two separate consecutive intramuscular injections (one injection per monoclonal antibody, given in immediate succession), may be effective for pre-exposure prevention for six months.”

Coronavirus (COVID-19) Update: FDA Authorizes New Long-Acting Monoclonal Antibodies for Pre-exposure Prevention of COVID-19 in Certain Individuals

Another monoclonal antibody, Evusheld (Tixagevimab Plus Cilgavimab) is available for pre-exposure prophylaxis of adults and children who are at least 12 years old with moderate to severely compromised immune systems due to a medical condition or due to taking immunosuppressive medications or treatments.

Treating Kids with COVID Monoclonal Antibodies?

You may also want to ask if getting your child treated with monoclonal antibodies is something you really should do…

“Currently, there is insufficient evidence for utility, safety, or efficacy to recommend the routine use of monoclonal antibody therapy for children and adolescents with COVID-19, even those considered to be at higher risk of hospitalization or severe disease. At this time, neither bamlanivimab nor casirivimab plus imdevimab should be considered standard of care in any pediatric population, even in patients who meet high-risk criteria. There are no data supporting safety and efficacy in children or adolescents, and the evidence supporting use in the adult population (including young adults) is modest and/or unpublished and has limited applicability to pediatrics or to many specified risk groups.”

Initial Guidance on Use of Monoclonal Antibody Therapy for Treatment of Coronavirus Disease 2019 in Children and Adolescents

And know, that while monoclonal antibody treatments do have EUA for older children, a panel of pediatric experts has recommended against their routine use.

So get your kids vaccinated and boosted now and don’t think you can rely on monoclonal antibodies if they get sick…

More on COVID Treatments

How Many People Have Really Died With COVID-19?

There were at least 322,306 more deaths in 2020 than in 2019, which is about the number of deaths attributed to COVID-19.

Why do some people still not understand just how many people have died with COVID-19?

Why do some folks continue to push the idea that people aren't really dying with COVID-19?
Why do some folks continue to push the idea that people aren’t really dying with COVID-19? It makes it easier to convince you that you don’t need to wear a mask or get a COVID-19 vaccine…

The usual suspects…

How Many People Have Really Died With COVID-19?

If you are confused or doubt just how deadly COVID-19 has been, one easy way to estimate how many people have died with COVID-19 is to compare year-to-year total deaths.

Just over 2.8 million people died in 2018 and 2019.

For example, just over 2.8 million people died in 2018 and 2019.

In 2019, a total of 2,854,838 resident deaths were registered in the United States—15,633 more deaths than in 2018.

How does that compare to 2020?

Before you say that there were 2,913,144 deaths in 2020, keep in mind that this data doesn't include January 2020...
Before you say that there were 2,913,144 deaths in 2020, keep in mind that this data doesn’t include January 2020…

Not surprisingly, there were far fewer deaths in 2018 and 2019…

We add these 264,000 deaths from January 2020 to the 2,913,144 deaths from February to December 2020 to get our total for the year.
We add these 264,000 deaths from January 2020 to the 2,913,144 deaths from February to December 2020 to get our total for the year.

Using complete year counts:

  • 2019 total deaths – 2,854,838
  • 2020 total deaths – 3,177,144

Leaving you with 322,306 more deaths in 2020 than in 2019.

Which is just about the count of COVID-19 deaths that experts have posted.

If you still aren’t convinced that these deaths have been caused by COVID-19, if not COVID-19, then what has caused all of these extra deaths?

“Excess deaths provide an estimate of the full COVID-19 burden and indicate that official tallies likely undercount deaths due to the virus.”

Estimation of Excess Deaths Associated With the COVID-19 Pandemic in the United States, March to May 2020

The count is even more startling if you understand that many experts think that we are under-counting COVID-19 deaths!

“Simon and colleagues suggest that it is critical to consider that for every death, an estimated 9 family members are affected, such as with prolonged grief or symptoms of posttraumatic stress disorder. In other words, approximately 3.5 million people could develop major mental health needs. This does not account for the thousands of health care workers in hospitals and nursing homes who have been witness to the unimaginable morbidity and mortality associated with COVID-19.”

Excess Deaths and the Great Pandemic of 2020

What else?

Many people are underestimating their risk of what could happen if they get COVID-19. Or if one of their family members get COVID-19.

Sure, COVID-19 is much more deadly if you have risk factors, but many people still underestimate their risks of getting and dying from COVID-19.

With a case-fatality rate between 1 and 3% in the United States, that means a lot of people with COVID-19 have been dying.
With a case-fatality rate between 1 and 3% in the United States, that means a lot of people with COVID-19 have been dying.

The bottom line is that COVID-19 is indeed deadly, with the possibility of serious long-term effects for many who survive.

“While most persons with COVID-19 recover and return to normal health, some patients can have symptoms that can last for weeks or even months after recovery from acute illness.”

Long-Term Effects of COVID-19

And since we now have safe and effective COVID-19 vaccines that can help end the pandemic, you know what to do.

Over 500,000 people have now died with COVID-19 in the United States.
Over 500,000 people have now died with COVID-19 in the United States.

It’s time to get vaccinated and protected.

More on COVID-19 Deaths

The Latest COVID-19 Treatment Regimens

The latest COVID-19 treatment regimens do not include zinc, vitamin C, vitamin D, CBD oil, azithromycin, or hydroxychloroquine.

As cases surge once again, let’s do an update on COVID-19 treatment regimens, after all, you have likely been hearing about cures and treatments for months now, right?

This doc also has a daily "immune booster" regimen that has you taking zinc, aspirin, vitamin B12, vitamin D3, NAC, vitamin C, probiotics, CBD oil, and Elderberry, in addition to taking hydroxychloroquine, azithromycin, budesonide, methylprednisolone, losartan, and ivermectim when you get sick with COVID-19.
This doc also has a daily “immune booster” regimen that has you taking zinc, aspirin, vitamin B12, vitamin D3, NAC, vitamin C, probiotics, CBD oil, and Elderberry, in addition to taking hydroxychloroquine, azithromycin, budesonide, methylprednisolone, losartan, and ivermectim when you get sick with COVID-19.

Unfortunately, despite the “treatments” that some folks are pushing, there still isn’t a cure and there aren’t many treatments that are very effective for COVID-19.

Sure, the FDA has granted emergency use authorization (EUA) for some treatments, including monoclonal antibodies, convalescent plasma, remdesivir, bamlanivimab, baricitinib, and casirivimab and imdevimab, but many are either for patients with severe COVID-19, who are progressing to severe COVID-19, or they are in limited supply.

The Latest COVID-19 Treatment Regimens

But why wouldn’t you take over a dozen medicines if someone on the Internet tells you they read a bunch of well designed studies, he has the support of “America’s Frontline Doctors,” and he has his own statistics proving they work?

Take home point - don't trust a health care provider who says that masks and lockdowns do nothing.
Take home point – don’t trust a health care provider who says that masks and lockdowns do nothing.

Because it all quickly falls apart if you really take a close look at what he is doing.

Consider Dr. Procter’s comparison of “death rates”…

He is trying to talk about the case fatality rate, but fails to mention any of the things that would cause his practice to have lower rates than the rest of the world, especially younger patients without many co-morbid conditions who aren’t yet hospitalized.

How many of Dr. Procter's patients are over age 65?
How many of Dr. Procter’s patients are over age 65?

And the bias in his data aside, there is evidence that shows his recommended treatments don’t work.

Some are even dangerous.

“The results of an observational study suggest that delayed viral clearance may be a concern in patients with non-severe COVID-19 who are receiving corticosteroids without antiviral drugs. Corticosteroids have also been associated with delayed viral clearance and/or worse clinical outcomes in patients with other viral respiratory infections.”

Therapeutic Management of Patients with COVID-19

So you should likely avoid these medications and unless you have a vitamin deficiency (zinc and vitamin C deficiency are very uncommon in developed countries), there is likely no good reason to take extra or high doses of vitamins to try and prevent or treat COVID-19.

The latest NIH recommendations for treating COVID-19 in non-hospitalized patients.

You should certainly make sure you are getting plenty of all of these important nutrients, especially vitamin D, but there are no treatments for COVID-19 if you aren’t hospitalized. And understand that no treatments that will keep you from requiring hospitalization.

Mostly understand that the kind of multi-drug COVID-19 treatment regimens you might see some doctors pushing are not proven, are not recommended, and likely won’t help you get better any faster.

And again, some are harmful!

So why do some people think they work?

“Garlic is a healthy food that may have some antimicrobial properties. However, there is no evidence from the current outbreak that eating garlic has protected people from the new coronavirus.”

Coronavirus disease (COVID-19) advice for the public: Mythbusters

Probably the same reason that some folks think that eating garlic works against COVID-19 – it is a highly variable disease and some people have very mild symptoms and get better quickly. If you are lucky enough to be one of these people and you tried some alternative treatment, you will likely associate your quick recovery with that treatment, even if it was just a coincidence.

“New symptoms are usually due to the virus rather than side effects of medications.”

Brian Procter, MD

And if you are really lucky when following one of these treatment regimens, you won’t suffer any side effects as you try to recover from your COVID-19 symptoms. Especially if you are being treated by a doctor who might ignore those side effects…

So what treatments can work?

  • monoclonal antibodies, but except for sotrovimab, they don’t work well against the Omicon variant
  • high-titer COVID-19 convalescent plasma, but only only for the treatment of hospitalized patients with COVID-19 early in their disease course or hospitalized patients who have impaired humoral immunity
  • paxlovid (nirmatrelvir and ritonavir) – an oral antiviral that was recently authorized and can be given twice a day for 5 days to those nonhospitalized patients who test positive for SARS-CoV-2,who are at least 12 years old with mild to moderate COVID-19 and who are at high risk of disease progression
  • remdesivir – an IV medication that can be given once a day for 3 days to those nonhospitalized patients (off-label) who test positive for SARS-CoV-2,who are at least 12 years old with mild to moderate COVID-19 and who are at high risk of disease progression
  • molnupiravir – was recently authorized and can be given twice a day for 5 days to those nonhospitalized patients who test positive for SARS-CoV-2, who are at least 18 years old with mild to moderate COVID-19 and who are at high risk of disease progression
  • dexamethasone – typically only used in hospitalized patients who require oxygen

And of course, better than getting sick and relying on these treatments, you should encourage everyone to get vaccinated and boosted!

More on COVID-19 Treatment Regimens

Where is COVID-19 Spreading Now?

Since SARS-CoV-2 is spreading wherever a lot of people are getting together, you must adapt to life with COVID-19 now, so that you will still be around when COVID-19 is finally gone.

As cases start to surge again and countries are reentering lockdown, you might be asking yourself just who is spreading COVID-19 around now?

Is it political rallies, protestors, or kids going to school?

Where is COVID-19 Spreading Now?

In addition to very large gatherings, like political rallies, some folks might be surprised to learn that COVID-19 is now spreading:

  • after religious events and holidays
  • in daycare centers and schools
  • among recreational, high school, and college sports teams
  • at very large gatherings (>50 people), including funerals and weddings, some of which turn into superspreading events
  • at large gatherings (>10 people) of family and friends

Not surprisingly, SARS-CoV-2 is spreading wherever a lot of people are getting together.

Hopefully, understanding that can help us all avoid getting sick with COVID-19!

“Regardless of the origin of superspreading, we emphasize the particular fragility of a disease in which a major part of infections are caused by the minority. If this is the case, the disease is vulnerable to mitigation by reducing the number of different people that an individual meets within an infectious period. The significance is clear; Everybody can still be socially active, but generally only with relatively few – on the order of ten persons. Importantly, our study further demonstrates that repeated contact with interconnected groups (such as at a work-place or in friend groups) is comparatively less damaging than repeated contacts to independent people.”

Superspreaders provide essential clues for mitigation of COVID-19

Remember, the pandemic isn’t over yet.

If anything, we are heading into another big wave in most parts of the world.

And although COVID-19 vaccines are on the way, they won’t be hear quick enough to stop it.

A positive COVID-19 rapid test.
A positive COVID-19 rapid test.

Only you can stop it by social distancing from others as much as possible (stay at least 6 feet away), wearing a mask (yes, masks still work despite the new study some folks are talking about), and washing your hands regularly.

Most importantly, understand that:

  • someone can be contagious for up to two days before they develop symptoms of COVID-19 or they test positive and will continue to be contagious for at least 10 more days, their isolation period
  • if exposed to someone with COVID-19, you should avoid others and go into self-quarantine for at least 14 days after your last contact, as that is the incubation period (the time from exposure to when you might develop symptoms)
  • in addition to those who are sick before they develop symptoms (pre-symptomatic), some are contagious even though they never develop symptoms (asymptomatic transmission)
  • you can’t test out of your quarantine after being exposed
  • there are no good treatments and there is definitely no cure for COVID-19

And know that COVID-19 can be life-threatening, especially for folks who are in high risk groups, including those who are elderly and anyone with chronic health problems.

What does all of this mean?

That you have to adapt to life with COVID-19 now, so that you will still be around when COVID-19 is finally gone.

More on the Spread of COVID-19

Mask Exemptions for Kids During the COVID-19 Pandemic

If your child doesn’t want to wear a face mask, your pediatric provider might be able to offer more help than just an exemption.

Some parents who don’t want their kids to wear a mask at school might think about asking their pediatrician to write a mask exemption for their kids.

You can easily spread what you don't know you have... Remember, you can be contagious a few days before you have symptoms of COVID-19, which is why mask exemptions for kids aren't a good idea unless they are medically necessary. #BeInformed
You can easily spread what you don’t know you have… Remember, you can be contagious a few days before you have symptoms of COVID-19, which is why mask exemptions for kids aren’t a good idea unless they are medically necessary. #BeInformed

Before they do, they might understand that there are very few real medical reasons for these types of exemptions for wearing a mask.

Masks Control the Spread of SARS-CoV-2

More and more, we are learning that masks can help prevent the spread of SARS-CoV-2, the virus that causes COVID-19, protecting both the person wearing the mask and the people around them.

“The prevention benefit of masking is derived from the combination of source control and personal protection for the mask wearer. The relationship between source control and personal protection is likely complementary and possibly synergistic, so that individual benefit increases with increasing community mask use.”

Scientific Brief: Community Use of Cloth Masks to Control the Spread of SARS-CoV-2

Still, that doesn’t mean that everyone has gotten used to wearing them…

Hopefully, most folks do now understand why they are important though.

Wait, why are they important, especially if you are healthy and the people around you don’t have COVID-19?

Mostly it is because people with COVID-19 can be contagious:

  • up to two days before they start to show symptoms
  • up to two days before they test positive, even if they don’t have any symptoms

So if you are waiting to put on a mask until people around you have symptoms, then you will eventually get exposed, probably without even knowing it, and you might get sick, ending up in isolation, not being able to go to school or work.

And if you wait to put on a mask until you start to show symptoms, then you will likely eventually expose other people to the SARS-CoV-2 virus.

The alternative, if you want to reduce your risk of getting sick, is to just wear a mask any time that you can’t social distance (stay at least six feet apart) from other people.

Mask Exemptions for Kids During the COVID-19 Pandemic

So what are the medical reasons that kids, like adults, can’t wear a mask all day while they are at school?

“The Department supports actions by the airline industry to have procedures in place requiring passengers to wear masks in accordance with the CDC Order, CDC guidance, and TSA SD. At the same time, the ACAA and Part 382, which are enforced by OACP, require airlines to make reasonable accommodations, based on individualized assessments, for passengers with disabilities who are unable to wear or safely wear a mask due to their disability.”

Notice of Enforcement Policy: Accommodation by Carriers of Persons With Disabilities Who Are Unable to Wear Or Safely Wear Masks While On Commercial Aircraft

In general, a child over age two years should wear a face mask unless:

  • they have a physical or intellectual condition that would keep them from being able to remove their face mask by themselves
  • they can’t tolerate wearing a face mask because they have a condition such as autism spectrum disorder, intellectual disability, or a mental health disorder
  • they have a physical or intellectual condition and wearing a cloth face mask gets in the way of their ability to communicate

But shouldn’t these kids just do virtual school if they can’t wear a mask, instead of getting an exemption?

While that might be an option for some kids, others need the extra services that they get at school, which they can’t get with at home schooling.

In addition to a face mask exemption, some things that might work in some situations when a child won’t wear a mask include:

  • a face shield
  • a transparent face mask
  • using different fabrics for the mask
  • trying a bandana or gaiter
  • try to desensitize your child to wearing a mask

What about asthma?

In general, most kids with well controlled asthma should be able to wear a face mask. If your child’s asthma is so severe that it is made worse by wearing a face mask, then they likely need an evaluation by a pulmonologist and it might be best to avoid being around others during the pandemic.

If your child can wear a face mask, but just doesn’t want to, then it might help to allow them to pick their own mask, with a comfortable fabric and fit, maybe even getting a mask with a favorite character on it.

“Model it! Make it familiar by wearing a mask too.”

Getting Your Child to Wear a Mask

And don’t expect your child to want to wear a mask at school if you don’t wear a mask when you go out or if you don’t believe that wearing a mask is necessary.

More on Mask Exemptions

How Can You End Your COVID-19 Quarantine Early?

There are now many options to end your COVID quarantine early.

Breaking News – new CDC guidelines offer even more options to end your COVID quarantine early. (see below)

No one likes the idea of spending fourteen days in quarantine after being exposed to someone with COVID…

A quick reminder that close contacts of someone with COVID-19 need to quarantine for 14 days.
The original recommendations stated that close contacts of someone with COVID-19 need to quarantine for 14 days.

But that’s better than getting sick and exposing others to COVID, right?

Can You End Your COVID-19 Quarantine Early?

Does spending less time in quarantine sound better?

What if you just get a COVID test?

Unfortunately, if you have a negative COVID-19 test early in your quarantine period, it doesn’t mean that you can’t develop symptoms or test positive later on.

“If you are tested and the test is negative, do you still have to be quarantined?
Yes. Someone exposed to a person with COVID-19 needs a 14-day quarantine regardless of test results. This is because COVID-19 can develop between two and 14 days after an exposure.”

Coronavirus Questions and Answers

Testing negative early doesn’t get you out of quarantine.

A negative test simply means that you don’t have an active infection. It doesn’t mean that the SARS-CoV-2 virus isn’t still incubating inside you. And no, we can’t test for that.

So why get tested?

“If you do not have symptoms, it is best to get tested between 5-7 days after you’ve been in a high-risk situation.  If your test is negative, get tested again around 12 days after the event. It can take 2-14 days for COVID-19 to develop, so even if you test negative once, you could still develop COVID-19 later and spread it unknowingly.”

Symptoms and Testing: COVID-19

Getting tested can be helpful because some people can test positive even if they don’t have symptoms, they can still be contagious, and this can help with contact tracing and can help you warn others that you exposed them to COVID-19.

Ideally, since you are in quarantine, you would not have exposed anyone else though…

And if you test positive?

Well, technically that does get you out of quarantine, but only to move you to a period of isolation, which is basically a stricter form of quarantine and lasts at least 10 days.

New Options to End COVID Quarantine Early

And although it is not without risk, the CDC has suggested several alternatives to the traditional 14 quarantine after being exposed to someone with COVID-19.

This includes ending quarantine after day 7 if you have tested negative within 48 hours and you have no symptoms, understanding that you will have to continue to wear a mask, monitor yourself for symptoms each day, and that this strategy has a 5-12% risk of failure (you might still develop COVID-19).

“Persons can continue to be quarantined for 14 days without testing per existing recommendations. This option maximally reduces risk of post-quarantine transmission risk and is the strategy with the greatest collective experience at present.”

Options to Reduce Quarantine for Contacts of Persons with SARS-CoV-2 Infection Using Symptom Monitoring and Diagnostic Testing

Or even ending quarantine after day 10 without testing if you have no symptoms, understanding that you will have to continue to wear a mask and monitor yourself for symptoms each day, and be aware that this strategy has a 1-10% risk of failure (you might still develop COVID-19).

The Latest Options to End COVID Quarantine Early

The CDC has now offered guidelines to end quarantine even earlier than 7 days!

How?

Most people are thought to be most contagious in the 1-2 days prior to onset of COVID symptoms and the 2-3 days after, which allows for guidelines to end COVID quarantine early.
Most people are thought to be most contagious in the 1-2 days prior to onset of COVID symptoms and the 2-3 days after, which allows for guidelines to end COVID quarantine early.

Even if you are not fully vaccinated and boosted, after 5 days, you might be able to end your quarantine, as long as you continue to wear a mask for an additional 5 days. And of course, get tested if you do develop any symptoms of COVID.

And remember that 14 days of quarantine is still the safest option. While convenient, shorting quarantine periods do come with some risk that these folks will develop COVID after they leave quarantine.

Most importantly, understand that you don’t have to quarantine after an exposure if you are fully vaccinated and boosted!

More on Testing out of Quarantine

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