Until recently, panic about the new COVID omicron variant has outpaced actual information.
But the avalanche of cases is quickly leading researchers to new insights about the ubiquitous variant’s behavior. Here’s what you should know:
Q: I was just exposed. Am I immediately infectious?
A: No. When the virus enters your body, there’s a period of time where the virus has to either take hold or not.
If the virus does take hold, it goes through an “incubation period” where it is settling into your cells and starting the process of multiplication. Viral levels must climb before you feel symptoms and are infectious.
Omicron’s incubation period is three days, compared to 4.3 days for the delta variant and five days for other variants.
— U.S. Centers for Disease Control and Prevention
Q: Which test is best?
A: There are three types of tests: the lab-based PCR test, the “at home” or instant PCR test, and the rapid “at home” antigen test.
The lab-based PCR is the most accurate, but it’s hard to find appointments and there is a long delay for results. It looks for genetic material of the virus and detects infection two to three days after exposure.
The “at home” molecular nucleic acid amplification test (NAAT) tests, which are used by Google and the NBA, are also accurate, but they are expensive. Like PCR, it looks for genetic material of the virus. Results are immediate. This test detects infection three to four days after exposure.
A rapid antigen test is less sensitive than the others in the early days of infection — detecting proteins in the virus, in general, 3.5 to 4.5 days after exposure. Results are immediate. But these tests are currently hard to find in stores.
Using any of the tests, you’ve got the potential to be infectious for at least a day before you test positive. But you won’t be super infectious during that first day, because viral levels haven’t risen yet.
— Dr. Michael Mina, test expert, former Harvard professor and Chief Medical Officer at eMed, “In the Bubble with Andy Slavitt”
Q: What are omicron’s symptoms?
A: In general, among unvaccinated people the symptoms are the same as other variants. But there may not be a loss of sense of taste or smell. And because omicron replicates less well in lung cells than other variants, you are less likely to experience shortness of breath or difficulty breathing.
If you’re vaccinated or previously infected, your symptoms — such as congestion, fever, and head or body aches — are created by your immune system, not the virus. They are signs that your immune system is kicking in and trying to kill the virus. And those symptoms are almost certain to be less severe than what unvaccinated people will suffer.
— American College of Emergency Physicians, Michael Mina
Q: When am I most infectious?
A: In people with immunity, symptoms tend to correlate with contagion — you’re most contagious when you feel sick. But without vaccines, people have two or three days of peak infectiousness before they even feel their symptoms — another reason it’s dangerous to be unvaccinated.
— Michael Mina
Q: When should we consider ourselves no longer contagious and which test is best at proving it?
A: Your viral levels will be highest on the third or fourth day after infection. You might stay there for a few days. But then your viral levels will start to come back down.
When your rapid antigen test reads negative, you likely don’t have enough of the virus to transmit it to others.
But your “at home” PCR test will stay positive, even if you’re no longer contagious, for another four to 10 days. The lab-based PCR will stay positive for up to four more weeks.
— Michael Mina
Q: How can I get reimbursed for the cost of my antigen test?
A: Insurers say they are reviewing the Biden Administration’s recent guidance on reimbursement for at-home COVID-19 tests, which goes into effect on Saturday, Jan. 15. Tests purchased before then are not eligible for reimbursement.
Kaiser, California’s largest insurer, said it is “working to make these tests available at no cost to our members through multiple outlets,” and will have more information soon on how to get them.
Q: While at home, how should I treat my infection?
A: Manage mild or moderate symptoms at home, similar to the way a cold or flu is treated, with over-the-counter medication as directed by your doctor.
Two antiviral drugs — Pfizer’s Paxlovid and Merck’s molnupiravir – can reduce risk of hospitalization. But they’re in short supply.
— American College of Emergency Physicians
Q: When should I go to the emergency room?
A: Call 911 or go to the emergency department for severe illness, difficulty breathing, intense chest pain, extreme weakness, or disorientation, especially for those at high risk of COVID complications, which includes anyone older or with a weakened immune system.
— American College of Emergency Physicians
Q: How likely am I to need hospitalization?
A: Compared with delta, omicron cut the risk of hospitalization in half, according to an analysis of 52,000 omicron patients identified from electronic medical records of Kaiser Permanente of Southern California. And the average hospital stay was three days shorter, a reduction of 70%.
Some of that is due to better protection through vaccines. But the variant itself seems less severe, because it infects cells in the upper airway but is less likely to affect the lungs. That means it’s also less likely to cause deadly pneumonia.
— Joseph Lewnard, School of Public Health, University of California, Berkeley
Q: If I’m hospitalized, can monoclonal antibodies help?
A: Nearly all of the monoclonal antibodies used to prevent severe disease fail to stand up to the new variant, laboratory assays show. That’s because the new variant is different than the virus they were trained to fight.
There’s one notable exception: Sotrovimab, a monoclonal antibody developed by GlaxoSmithKline in London and Vir Biotechnology in San Francisco. But it’s being rationed, with the federal government allotting it to states on the basis of numbers of infections and hospitalizations and the prevalence of omicron. Hospitals like Stanford and UCSF are saving Sotrovimab for the patients who are most severely immunocompromised.
— Journal Nature, Dec. 21, 2021
Q: When I recover from omicron, is “long COVID” a risk?
A: We don’t yet know. Most cases of “long COVID” — long-term health problems caused by the virus — are caused when the virus takes up residence in the nerves. But there hasn’t been enough time to see whether that happens with the omicron variant. Over the next couple of months, we’ll get that data.
— Dr. David Agus, professor of medicine, University of Southern California, “In the Bubble with Andy Slavitt”
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