Covid-19 Infection Recommendations

  Covid-19 Infection Precautions

 

1. We cannot tell what variant of Covid-19 you have from the positive test.  It is very difficult and time intensive to test for a particular variant, so very few positive tests are sequenced for the variant in our state.  The most predominant variant right now is the Omicron variant BQ-1. This  Omicron variant is extremely contagious and appears to be the most contagious of the covid variants thus far.  Usually, symptoms develop about 3 days after exposure to someone with covid. It does not appear to cause more severe disease than the other Omicron variants.  However, if you are unvaccinated or immunocompromised,  you are at risk for severe disease and hospitalization.    Most people experience flu-like symptoms such as fever, cough, runny nose, stuffy nose, nausea, vomiting, dizziness, and really bad sore throat.  You may initially even think that you are experiencing allergy symptoms.  If you have any symptoms that resemble flu, sinus infection, or allergies, you should test yourself for covid or contact your doctor to be tested.  You cannot know that you do not have covid unless you get tested.  You can easily become infected with this variant even with 4 doses of the vaccine and even if you have had a  previous covid variant.  Even if you have had covid in the past month, you are still at risk of getting covid again with this variant.  The vaccine was made for the original Covid variant, and as the covid virus has modified itself, the vaccine has become less effective in preventing disease.  The vaccine does still protect against severe disease.  Vaccinated people are not very likely to be hospitalized after infection.  There is now a new booster dose that has the Omicron variants in it to help offer better protection against infection with covid.  

 

2. Isolation guidelines have changed for Covid-19.  You should isolate yourself for 5 days.  If you are no longer having symptoms after 5 days, you can leave isolation but must strictly wear a mask for 5 additional days when around others.  The best mask to wear is a KN95 or N95 mask.  If you still have symptoms, such as frequent coughing that would prevent you from continuously wearing a mask around others or a fever, you need to continue to isolate for up to 10 days after symptom onset.  You must be fever-free for at least 24 hours without using fever-reducing medications before you stop isolation.  If you never had symptoms but have tested positive, you need to isolate for 5 days from the date of the positive test and then wear a mask when around others for 5 additional days.  You do not have to test negative to stop isolation so long as you follow these guidelines.   

 

3. Steroids are not recommended during the first 7 days of Covid-19 symptoms.  Steroids block your body’s immune system, preventing you from fighting Covid-19.  The previous monoclonal antibody treatment (Regeneron) that we had been using does not work for the Omicron variants.  Paxlovid and Molunupiravir are oral antiviral medications that have been approved.   These work for all of the Omicron variants.  These medications are similar to Tamiflu for the flu.  The oral medications are intended for patients with a high risk of progressing to severe illness and must be taken in the first 5 days of onset of symptoms.  These medications work by reducing the amount of virus in your system.  Because of the drug interactions, you must have a visit with your physician before we will prescribe these antiviral medications.  We also sometimes see flu or strep throat in combination with covid and can test for both of these and treat them accordingly.  

 

Paxlovid, the new Pfizer oral medication, is approved for 12 years and above.  In the initial drug trials, Paxlovid reduced the risk of hospitalization by 90% in unvaccinated people.  It is given in a pack that has 3 pills to take twice daily for 5 days.  Paxlovid gives a metallic taste in your mouth for the 5 days you are taking it, but this side effect goes away when finished with the medication.  Paxlovid is more effective than Molnupiravir,  but it has many drug interactions.  You may not be able to take Paxlovid if you are taking certain medications or the dose of your medications may need to be reduced. We will discuss this with you during your visit.     Paxlovid also sometimes has a rebound effect in some people..  Paxlovid rebound occurs if you take it and your symptoms improve, and you test negative after finishing the medication. You then develop symptoms again a few days to a week later and test positive again.  If you are taking Paxlovid and this happens, we think that you are contagious again when your symptoms return.  If you experience Paxlovid rebound, return to wearing a mask until your symptoms resolve.  We do not know why some people experience rebound with Paxlovid or who is most likely to experience this.  In the initial trials, the rate of rebound was around 1-2%.  In reality, it is probably a little higher, but not much higher.  We have seen this happen in less than 10 people for which we have prescribed.   

 

Molnupiravir, the oral medication by Merck, is approved for 18 years and above.   Molnupiravir reduces the risk of hospitalization by 30% in unvaccinated people.  It is given as 4 pills twice daily.   

 

If you are not vaccinated, you really may want to consider taking one of the antiviral medications.   If you are vaccinated with 3 or 4 doses, these medications may not be necessary unless you are immunocompromised, since your risk for severe disease is reduced with the vaccine.  These medications must be started in the first 5 days of symptoms or they will not work.  Not all pharmacies carry these antiviral medications.  They are supplied by the government and usually stocked at certain WalMart, Walgreens, and CVS pharmacies.  Most local pharmacies do not have a government supply of these medications.  There is no cost to you for the medication.  

 

4. We do think some vitamins may offer protection, both for people who have been diagnosed with Covid and for people who have been exposed.

 

• Vitamin C – 1000 mg daily
• Vitamin D – 5000 IU daily
• Zinc – 50 mg daily (or 60 mg, if that’s what you have)
• Melatonin – 5 mg daily
• Low dose aspirin 81 mg to prevent blood clots

 

Note that some forms of zinc are sulfates. These would be safe even if you have a sulfonamide allergy (sulfa allergy). Sulfonamide allergies only are a problem with antibiotics that contain sulfonamide (Bactrim, Septra, dapsone).

 

5. Make sure to keep eating a balanced diet, maintain good fluid intake, and rest as much as you can. Do not lie in bed or recline on the couch. Covid is associated with an increase in blood clots and pneumonia. As much as possible, get up and move around every hour. Stay sitting upright so your lungs fully expand to minimize the pneumonia risk.

 

6. If you have access to a pulse oximeter, please use it. A pulse oximeter is a device we put on your fingertip to measure your heart rate and oxygen level. An oxygen level of 95% and higher is normal. Normally, we like to see it stay above 88% under normal circumstances. However, Covid has a tendency to rapidly deteriorate. If it’s staying below 90%, you should consider going to the emergency room.

 

7. The two most common reasons for hospital admission are dehydration and low oxygen/difficulty breathing. Please be on the lookout for these. Remember that the disease can rapidly worsen, so do not delay seeking treatment.

 

8.   Another major risk of Covid infections is blood clots. We recommend a low-dose aspirin unless you have a reason that prevents you from taking aspirin. You should also plan to move around at least five minutes per hour while you’re awake. If you develop shortness of breath or chest pain during your time of illness, you should plan to go to the emergency room for evaluation.