A big fire will burn hot and more quickly. Such is the hope with the Omicron Variant. It has victimized many families through the Holidays, including our family at Four Seasons Pediatrics. The Delta Variant had 13 different mutations from the original SARS-CoV-2 virus while Omicron has had 50, of which 30 are the outer spike proteins. These proteins are like a photograph to our immune system. When the picture changes significantly, the immune system does not recognize the virus as effectively. One of the mutations also allows the virus to penetrate cells more quickly, leading to more infections in those never infected, those who have had COVID previously and in those who have been vaccinated. The first part of this newsletter is a review of Omicron and whether vaccines make a difference. In part two we will go over what to do if you have a positive home test (one of the most common calls we are getting right now).
Omicron and COVID Trends
Click here [1] to see NYS Cases over time. This gives a perspective of how many more cases of COVID are occurring right now, along with how rapid the cases are developing.
Infections in those vaccinated vs unvaccinated
If we could take the politics out of it (at times this seems an uphill battle), we wonder – was all the energy devoted to the vaccine worth it? We are all fatigued and most of us have a level of Post Traumatic Stress and skepticism about what is really happening amid the politicians chatter and blaming. Click here [2] and look at the first graph to see the rate of infection in those 18 years and up. Take a look at case rates for those vaccinated (red line) vs those not vaccinated (blue line) in NYS (since May). Notice that infection rates have peaked and started a decline. Also notice the significantly lower rate of infection in those vaccinated.
Hospitalizations in those vaccinated vs unvaccinated
Go back [2] and look at the second graph and you will see further separation of the hospitalization rates. Hospitalization rates have not peaked since there is typically a lag in hospitalizations/deaths from the number of cases. The top black bar shows vaccine effectiveness for hospitalization, which has held steady despite the big disappointment in the number of vaccinated people who had a breakthrough infection.
Mortality in those vaccinated vs unvaccinated
New York City has put together interactive graphs that show the difference in vaccinated vs unvaccinated. When you click on the following link, you should be in the Recent Trends tab, scroll to the bottom and look for the weekly rates graph. Click on deaths to view the differences in vaccinated (orange) vs unvaccinated (purple): Click here [3]
A look at Cases and Mortality over time
New York is among four states (with Texas, California, and Florida) that account for almost one third of the cases and about 30% of the deaths across the country. Whether we consider some died with COVID or due to COVID, New York City has been one of the hardest hit cities with cases and mortality. They have put together interactive graphs that allow you to select and view graphs (Click here [4]). In the first graph and get a look at the number of cases in this 4th wave. Compare the size of the peaks. Then click on Deaths and here is the best indication that we are headed for the Endemic Phase of COVID (the phase we can live with this virus with tools we can use to manage it). We hope you can see that vaccination is an important tool to embrace.
What about Children?
Children have a much lower rate of poor outcomes and many (though not all) are related to the same risk factors as adults. The exception to this is the MIS-C Syndrome (Multisystem Inflammatory Syndrome in Children). So far, we have not identified risk factors for MIS-C. Almost 6500 children have been reported to develop MIS-C as of January 3rd. Symptoms of MIS-C Symptoms [5] can occur between 2-6 weeks after having a COVID infection, so this number is predicted to go up. The link provided is a pictorial view of symptoms which include fever plus other symptoms (skin rash, pink or red eyes, vomiting, diarrhea, stomach pain, dizziness or lightheadedness. A recent study entitled COVID Vaccine Study on Prevention of MIS-C in Children [6] is a report from 24 Children’s Hospitals that showed the vaccine to be 91% effective [7] in preventing MIS-C. We have all been disappointed with the vaccine’s ability to prevent infection with the Omicron variant, but we are very happy to see its continued success for prevention of severe disease, hospitalizations and deaths, and most importantly for children – protection against MIS-C.
Part 2 – Positive Home Test
An antigen test that is positive almost always means you have the infection. In the presence of a higher infection rate, it does not need a confirmatory PCR test and we recommend that you treat this as a COVID infection. A negative 2nd test does not undo the first antigen test. Antigen tests are more likely to be false when they are negative.
With regard to infection, please remember that children (with rare exception) are low risk for serious disease with COVID. This infection is more likely to significantly affect the elderly and those with medical conditions such as Diabetes, High Blood Pressure, Obesity and Heart Disease, but can rarely affect those who are young and those without chronic medical conditions. Therefore children can, but rarely do have a poor outcome. What to look for during the infection: Monitor for shortness of breath, high fevers or a fever that returns after resolving for 24-48 hours, persistent fevers (over 100.4 for 4 or more days), looking sick or ill (despite treatment with acetaminophen). In the mean time, it is important that anyone who is positive isolate at home and isolate from other family members. This should be in a separate room and a separate bathroom if possible. You ISOLATE when you have infection. You QUARANTINE when you have been exposed to infection.
Until you receive guidance from the County Health Department – here is calculator (from the South Dakota Department of Health) to assist with isolation and quarantine dates:
South Dakota DOH Isolation Quarantine Calculator [8]
MIS-C – after COVID infection: Remember MIS-C can occur 2-6 weeks after infection. Review the information above so you are aware of signs to monitor.
Well exams and Testing Next Week
As we have previously described, we anticipate closer to full staffing by mid-week. We have received a limited supply of Rapid NAAT tests and will deploy them in a limited fashion while we await supplies to increase over the coming weeks.
We cannot express how much we appreciate your well wishes for our staff who are out due to illness. Your empathy, prayers and sincere warmth really means a lot to us.
The Staff and Providers of Four Seasons Pediatrics