How to handle covid-19—the breakthrough omicron edition

If you can, take it home.
If you can, take it home.
Image: Reuters/Hannah Beier
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It never really went away, but covid-19 is once again back to disrupt the already altered normal. The omicron variant has reached the US and is spreading at a mind-boggling speed. According to data from the Centers for Disease Control and Prevention (CDC), it went from accounting for less than 13% of all cases on Dec. 11 to more than 73% on Dec. 18.

Even in areas with high vaccination rates, breakthrough cases—which occur despite vaccine protection—are on the rise. In New York state, where more than 82% of adults have completed two vaccine doses and 28% of the eligible population has received a booster shot, new cases are still appearing at a record high, more than 22,000 a day.

The situation looks eerily similar to last year’s, but there is an important difference: immunity. The risk of hospitalization and death is about a twentieth of what it would be without the vaccines, and most breakthrough cases are expected to be asymptomatic or mild—although even a mild case of covid-19 can be disruptive and result in protracted symptoms, or long covid.

For the many who, in the past few months, have focused on getting their lives back and stopped paying much attention to the various protocols for distancing, testing, masking, or what to do in case the contracted covid-19, it’s time for a refresher.

What test should you take?

There are several reasons to take a covid-19 test—and all of them should be available for free, although not from all providers. Different tests tell us different things, and with shortages and long lines, it’s helpful to know which is the best option.

If you want peace of mind, or need proof of negative covid-19 status to travel, a rapid antigen test makes the most sense. It gives reliable results in about 15 minutes, and can be performed at home, which is preferable to spending time in testing facilities with the risk of further exposure. If you can’t find at-home tests, or need certified results for travel or employment reasons, you can get the rapid test at a facility that offers it. The tests are more accurate if there are symptoms, and if you’re at home, you can start isolating right away if the result is positive.

In January, the White House will begin sending free tests to all Americans, but until then it can be difficult to find rapid at-home tests. Some states and cities are distributing them for free, and they should otherwise be available in pharmacies for up to $25 for two. You can report any price gouging for tests and other services on your state’s attorney general sites.

To get a more accurate result you can opt for a molecular test, known as polymerase chain reaction, or PCR test. This test looks for the genetic material of the virus, and detects even smaller quantities of it. If, for instance, you were in close contact with someone who tested positive and want to be sure of their status even in the absence of symptoms, a PCR test is the safest bet, but the results can take up to a few days. You must isolate as much as possible until you receive your result.

Antibody tests were once popular but can only tell you if you had covid-19 somewhat recently, and if you are vaccinated, they can’t tell you if the immunity is due to the vaccine or infection. In short, skip them.

The test won’t tell you what variant you have. At this point, it’s likely to be omicron, but that doesn’t matter much in terms of how to deal with it.

What to do if you test positive?

If an antigen test or a PCR test comes back positive, you need to isolate immediately, by staying in a room by yourself or keeping a distance of at least six feet from others. It would be ideal not to share a bathroom, either. The CDC recommends isolating for at least 10 days since testing positive but this is, of course, not always possible: If you live in small spaces that you share with others, you might not be able to have a room to yourself. In some cases, public programs can provide assistance, such as New York City’s offer of free hotel stays for those in need of isolation.

But in absence of such safety net, if you don’t have the space and means to keep six feet between yourself and others at all times, maintain good ventilation while indoors, mask up, and ensure everyone around does too. Not all masks are created equal either; an N95 mask, or comparable ones, provide the best protection, so stock up.

If you live alone, contact someone—a relative, friend, neighbor, or even a mutual aid organization—who can check in on you consistently. Share with them the information you are given by health providers, and instruct them to contact emergency care on your behalf (and advocate for your treatment) should your condition worsen significantly. Remember though: it’s unlikely that you will become severely ill if you are vaccinated—and particularly if you are boosted—so try not to worry.

If you got tested through a lab, and especially if you went to city- or state-administered facilities, you will likely be contacted directly with your positive test results and instructions on what to do next. If you took the test at home, reach out to your state health authority (here is a list). There isn’t a federal emergency number to provide treatment information, but you can contact 1-800-CDC-INFO for guidelines.

You should also get in touch with anyone you have been in close contact with recently to let them know about your status, so they can get tested. If they are fully vaccinated, the current recommendation is that they get a test within five and seven days after their exposure, but there is no need to quarantine.

In the absence of severe illness, you just have to wait, rest, drink plenty of fluids, and take paracetamol or ibuprofen if you have a low fever or discomfort. Update your local health authorities about your symptoms, and get advice from them. You may also want to monitor your blood oxygen level through a pulse oximeter, if you can get one. Call a doctor if your oxygen level drops below 95%. If your skin is dark, the device might be less accurate in absolute terms, but you can still track the trend and call a doctor if you see the number drop.

Make the most of your means of digital communication and stay in touch with your loved ones—10 days can be a long time to be alone, and it will help your mental health. Don’t go to a hospital, a doctor’s office, or an emergency room unless strictly necessary, and only after calling, since you will risk exposing others to the virus.

If you experience severe symptoms—such as difficulty breathing, high fever, loss of speech or mobility, confusion, or chest pain, pale or blue skin or nail beds—call 911 and follow their instructions. You will likely be given all the treatment options, but if you aren’t, inquire on whether you should be treated with monoclonal antibodies (which might not be indicated for omicron infection) or an antiviral.