“Shared expectations lead to predictability.”
431. Guidelines are being made to reflect the changing status of Covid safety.
Q: How is UUS:E moving to safely return to normal?
A: In front-page articles about the Omicron variant, the newspapers have been stressing ’the highly infectious rate and the expected huge surge in cases over the next few months. In other articles, headlines state that everyone should quickly get their booster shots because this will have a positive effect in reducing hospitalizations and serious disease this winter. The news can make everyone feel more cautious and at an increased risk. With the prevalence of Covid-19 (the number of cases per 100,000 population) rising dramatically in the previous ten days, the Policy Board discussed the issue at length last Thursday and voted to limit the number of people attending future Sunday services to 25 people in addition to the volunteers and staff who conduct and live-stream each service. Current plans include conducting two Sunday services starting January 2, one at 9:00 a.m. and the other at 11:00 a.m. The 11:00 service will be the one that will be live-streamed. Each of these services could have a congregation of up to 25 members present, doubling the number who can attend each Sunday. The ventilation modifications of the downstairs RE classrooms are expected to be completed by then, allowing RE sessions to resume in January as well. With the unknown variables of the new Omicron variant unfolding in the near future, the Policy Board agreed to continue to monitor and reconsider these and other procedures as needed to maintain a safe environment for those within the building until the pandemic becomes under control.
432. More is now understood about the Omicron variant
Q: Is the Omicron mutation more deadly?
A: Earlier, we discussed three variables that we needed to learn more about to identify a strategic approach to managing the new Omicron variant that is now present in nearly all the United States. These variables are its transmissibility – how infectious it is; its virulence – how serious are the resulting disease symptoms; and its ability to evade natural immunity and vaccines. The New York Times last week published an Internet article addressing the potential for a large surge in Covid-19 cases in the weeks and months ahead.
In South Africa, where Omicron was first identified, the recent rise has been steeper than during any previous surge. “When Omicron enters a community, the increase in case numbers looks like a vertical line,” Dr. Paul Sax of Brigham and Women’s Hospital in Boston said. The same phenomenon occurred in Great Britain where the Omicron variant emerged weeks before it was found here. Britain reported 78,610 new coronavirus cases on Wednesday, December 15, the highest number of infections in a single day since the start of the pandemic. There is a general recognition that the number of patients infected with the Omicron variant doubles every 3 days. If there were 100 Omicron infected people in Connecticut on December 31, this would lead to 3,200 patients having been infected by January 1, 2022 and 101,400 having been infected two weeks later. This parallels what Great Britain has experienced.
To examine the virulence of the Omicron variant, much has been reported that the cases have usually been mild. This is being further evaluated but remains the current assumption.
There is clear evidence that after 6 months of the second Pfizer and Moderna shots, the immunity against Covid-10 wanes, and especially with the Omicron variant, patients can become more easily infected. “There will be a lot of breakthrough cases,” Dr. Jennifer Lighter, an epidemiologist at N.Y.U. Langone Health, stated. Booster shots of the mRNA vaccine for those who are eligible dramatically reduce the chance of a breakout infection, and the chance of serious disease or hospitalization. This becomes a factor for UUS:E to consider. Currently, a very high percentage of the congregation, family, and friends are fully vaccinated and protected from the Delta variant. In the church on any Sunday, there are very few people present who can become infected with the Delta variant, and very few who might be able to pass that virus along. But can we assume that the vast majority of vaccinated people have obtained their booster shots more than two weeks before they enter the building? If we cannot make this assumption, then being in the church might not actually be perceived as safe for those who haven’t received their booster shots. On the other hand, if the infections that do breakthrough are as mild as seasonal influenza, then this could be the new normal we will have to live with.
433. New research has found that the coronavirus infects both fat and immune cells.
Q: Why is obesity a factor related to more serious Covid-19 disease outcomes?
A: Biospace is a publication that reviews current scientific studies. On December 9, they reported on a study by a group of researchers primarily out of Stanford’s School of Medicine. This study is pending publication in a peer review journal, but concludes that Covid-19 infects human adipose or fat tissue to multiply and elicit an inflammatory response corresponding with severe disease. The complications of obesity raise the risk of many diseases. Obese adults have higher rates of hypertension and type 2 diabetes. But scientists have suspected that obesity was its own risk factor, even without the comorbidities. Patients under 18 who are obese had over 3 times higher risk of hospitalization. The research group used fat freshly harvested from bariatric and cardiothoracic surgery patients, the group separated the composition and tested the response of each to exposure to Covid-19. Fat tissue consists of adipocytes, which are fat cells, pre-adipocytes, and immune cells. In the lab, the fat cells became infected, yet did not show much inflammation. But the immune cells also became infected and elicited a strong inflammatory response. The pre-adipocytes, which mature into fat cells, did not become infected, yet added to the inflammatory response. The team also found SARS-CoV-2 in the fat tissue surrounding various organs of patients who had died of Covid-19 infection. “This could well be contributing to severe disease,” said Catherine Blish, MD, a professor at Stanford University Medical Center and one of the report’s two senior authors
434. People will become sick with Omicron – and survive! Here is what to do.
Q: What do I do if I get sick with Covid-19 – especially with Omicron surging?
A: On December 15, Yasmin Tayag, a science writer for the Atlantic published a first-hand account of her recent breakthrough Covid-19 infection. “My breakthrough infection started with a scratchy throat just a few days before Thanksgiving. Because I’m vaccinated and had just tested negative for COVID-19 two days earlier, I initially brushed off the symptoms as merely a cold. Just to be sure, I got checked again a few days later. Positive. The result felt like a betrayal after 18 months of reporting on the pandemic. And as I left the testing center, I realized that I had no clue what to do next.” She knew she had to isolate herself in her shared apartment. But she wondered why for 10 days as she was advised? Once she got home, masks came on, windows were opened and she began her uncertain travail. “Oh yeah, people are very confused about breakthrough cases,” stated Peter Chin-Hong, an expert on infectious diseases at UC San Francisco. Now that the Omicron variant is here, Yasmin wrote, many more Americans may soon have to deal with breakthrough confusion. While the shots still seem effective at preventing hospitalization and death, early reports suggest that they are less effective against milder cases. So, if you do get a breakthrough infection right now, what should you do?
Stephen Kissler, an epidemiologist at Harvard advises. “Once you know you’re infected, hang tight, limit your encounters with other people, and just take care of yourself.” But the CDC guidance is limited and complicated. Specific recommendations Yasmin learned from her experience were outlined;
- Prepare – have an advanced supply of rapid tests on hand.
- Get tested. Be certain it is Covid-19 and not a cold or the flu you are experiencing.
- If you test positive, alert the public-health authority to initiate contact tracing.
- If you test positive, isolate avoiding contact with others for their protection.
- If others in the household are vaccinated, wear an N95 or KN95 mask indoors.
- Open windows four to six inches to help with ventilation.
- The usual treatment for respiratory infections—cold-and-flu medications, anti-fever drugs, liquids, and rest—are sufficient for most people with breakthrough Covid-19
- Seek emergency care if you have trouble breathing, or chest pain, or pressure.
Eventually, even with Omicron, breakthroughs will become a lot less stressful. Many professionals advise it is time to start normalizing breakthrough infections. We may have to learn to live with it as it becomes, like the seasonal flu, an ongoing contagion.
435. Guidance is available for a safer holiday celebration
Q: We plan to celebrate New Year’s Eve with friends at their home. Will we be safe?
A: Lora Strum and Rachel Gutman co-authored an article last week in The Atlantic that addressed the chances of transmission of Covid-19 at holiday gatherings this year. The safest holiday tables and gatherings this year will be the one where everyone present is fully vaccinated and, if eligible, boosted. If that’s the case, and no one at your gathering is at high risk of severe illness from COVID-19, everyone can remove their mask and celebrate with cautious optimism. Anyone at this hypothetical party still has a chance of contracting a breakthrough infection. How big that chance is will depend in part on whether the Omicron variant circulating in your area. If anyone is planning to attend who is not vaccinated or is eligible but has not taken their booster shot, they should be discouraged from attending, perhaps by joining part of the gathering from home via Zoom. If it is not known that everyone present is properly vaccinated, then all should wear masks and leave the windows open 4” to 6” for ventilation. Any meals consumed should be with people spread out rather than crowded around a table.
