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Second Opinion: How and When Should I Get Tested? Are More Variants Coming? Dr. Fleischman Has Answers

As Omicron cases surge, Blue Shield of California's chief medical officer has suggestions to keep safe

How serious is this latest wave of the coronavirus (compared to March 2020 and the last big surge in January 2021) globally, nationally, and state-wide? Why is the Omicron variant even more contagious than other virus strains of COVID-19?

This wave of coronavirus is proving to be different from the experience in March 2020 as well as the large surge in January of 2021. The Omicron variant is highly transmissible compared to the original virus and the Delta variant. Currently, it is estimated that in California every infected person is infecting two others. The Omicron variant has mutations that change what the spike proteins look like and makes it very “immune evasive,” getting past our immune system and causing infection. The good news is that at least in the vaccinated it is causing less serious illness and hospitalizations. In a new study, scientists at Case Western Reserve University have preliminary evidence the risk of being admitted to the hospital or the intensive care unit during the Omicron surge in the U.S. is about half of the risk observed during the Delta surge. More people are infected, but the percentage needing hospitalization is lower. That said, the high absolute number of cases is stressing our healthcare system, emergency rooms in particular.

Dr. Susan Fleischman

Why are there so many breakthrough infections? Why isn’t the vaccine keeping people as safe?

There are probably two reasons we are seeing breakthrough infections. The Omicron variant mutations affect the structure of the spike protein. The vaccines help your body recognize the spike proteins as foreign which turns on your immune machinery to fight off the virus. Because the spike proteins on Omicron is different than the ones used to develop the vaccines, it can evade your bodies defense system. Secondly, the effectiveness of the vaccines tends to diminish over time. That is why boosters are needed.

What are the most important things Californians can do to protect themselves and their loved ones from Omicron?

  • Get vaccinated and stay up to date on your vaccine—get required boosters when due. 
  • Follow the public health guidelines regarding masking and social distancing.
  • Avoid crowded indoor spaces, for eating and drinking in particular.
  • Follow the California Department of Public Health recommendations regarding masking.
  • Choose a mask with good fit and good filtration. A well-fitted mask has no gaps between the face and mask. Good filtration blocks virus particles from getting through the mask itself.
  • N95 and KN95 masks are best.
  • Also, double masking is an effective way to improve fit and filtration. A close-fitting cloth mask can be worn on top of a surgical/disposable mask to improve fit.

What are the symptoms of the Omicron variant? How are they the same or different from symptoms of other COVID-19 variants?

The most common symptoms are runny nose, sore throat, nasal congestion, headache, and fatigue. Cough and fever are less common than with prior variants. Loss of smell and taste is less common. Also, symptoms come on more quickly—about three days after exposure, compared to an average of four days for Delta and five days for the original virus.

What is your guidance on testing? Should I test myself randomly? When should we use antigen tests versus PCRs?

The PCR test is the gold standard for detecting COVID-19. It looks for genetic material from the virus. Because it is so sensitive, it can remain positive long after the illness is over and long after you can spread the disease. PCR tests are mostly done in a laboratory and require a wait for results. Antigen (or over-the-counter home) tests look for viral proteins, which are present when you are actively infected, and are very accurate in people with symptoms. They are less accurate if you feel well. These can be done at home, typically with results in 15 minutes. The type of test to use and the frequency depends on the situation. For example some schools and workplaces are using antigen testing to screen out positives, but it’s not foolproof. Some people could be infected and not yet test positive. Some families are using testing before family gatherings, they may screen out the actively sick from participating, but can also create a false sense of security. A negative antigen test is not reason to throw caution to the wind.

If you have symptoms and have access to an antigen test, you can use that. If it’s negative, repeat the test in several days. If it’s positive isolate yourself; alert your contacts so that they can test themselves or quarantine as necessary, and seek medical care, if necessary, based on your symptoms. At this time please do NOT go to an ER or urgent care just to get tested. They are overwhelmed and need to focus on those needing care.

Who is most at risk from getting Omicron, and how can we help protect the most vulnerable?

Those who are unvaccinated or under-vaccinated (due for a booster) are most at risk to get Omicron. Also, those who live in crowded situations or have exposure in the workplace. Those most likely to need hospitalization are the same as for the other variants — the elderly, the immunocompromised, the unvaccinated.

We can all help the vulnerable by staying up to date on our own vaccine status, wearing masks and socially distancing.

Is it likely that other variants will emerge?

Other variants will likely emerge. Many people around the world remain unvaccinated, this sets the stage for variants to emerge. The more virus is out there, the higher the chance of mutations. Hopefully between the vaccines and the immunity from past infections we will be less vulnerable to future variants.

Should I change my travel or social plans?

Omicron is spiking in the state and around the world right now. Please be cautious in both travel and socializing. This is not the time for large parties, going to indoor bars or crowded restaurants. I have personally pulled back on my social life a bit, I am back to seeing my friends in outside settings. And I canceled an international trip recently out of fear of testing positive outside the U.S., dealing with another country’s quarantine rules, and not being able to return to the U.S. on time. This Omicron spike will not last forever, some activities can wait.

Dr. Susan Fleischman is chief medical officer at Blue Shield of California