Here we go, again!
Coronaviruses are single-strained RNA viruses with large genomes, of which there were two. In late 2019, in Wuhan, China, a third “novel” (new) coronavirus emerged, identified as SARS-CoV2, which started this COVID-19 pandemic. It started with the Alpha strain, and subsequently mutated to Delta, Omicron – BA.1 (with subvariant Stealth Omicron – BA.2). As new mutations evolved, they replace the older variants and become the dominant strains. With the Omicron Stealth subvariant (BA.2), it is our 6th wave in this pandemic.
Starting early this year, on March 29, 2022, BA.5 was discovered in South Africa. The following day BA.4 showed up. Which country they actually originated from is yet unknown.
So, here we go – again, starting from scratch! So far, we know these two subvariants are more highly transmissible, result in milder symptoms, and respond somewhat to the booster vaccines. This was what we knew earlier about Omicron. Later, we found out Omicron was a vicious killer too, even worse in some areas than Delta. So, we have to watch these BA.4 and BA.5 closely, with masks on, social distancing, and avoiding crowds again.
Do vaccines work against these new viruses?
It is believed that those who are fully vaccinated (with 2 booster shots) are protected to some degree (still being studied). They have less severe symptoms when infected, compared to those who are not fully vaccinated. The unvaccinated are at the gravest risk. A new universal Omicron vaccine is under development.
Do we need Booster #3?
Since these are two new viruses, like when the Alpha, Delta, and Omicron first emerged, we did not know anything about them. So, we have to observe how these new BA.4 and BA.5 behave clinically. In the meantime, as I said, here we go again…personal hygiene, masking, distancing, and avoiding crowds. And very importantly, those unprotected should get vaccinated. Even those who had COVID-19 infection before still need to be vaccinated fully, because NO ONE is immune from the new and future strains of this virus.
How accurate are the COVID home test kits?
The Ontario Science Table reported the sensitivity of the Rapid Antigen Test (RAT) for the Omicron was less than it was for the Delta, 37 percent versus 81 percent sensitivity for Delta. So, out of 100 infected persons tested using RAT kits, only 37 of them will test positive and 63 of them will get a false negative. However, the value of the Rapid Antigen Test is when the result says “positive,” it is practically 100 percent accurate, besides providing a rapid (within minutes) result at home.
If negative, and the person is having symptoms, isolation, and a PCR (Polymerase Chain Reaction) test are needed, because PCR is a lot more accurate than the Rapid Antigen Test. However, the latter provides rapid results, while the PCR may take 2-3 days before the report is available. PCR test is not perfect either; it has a 20-percent false-negative yield and a repeat PCR test might be required by the physician, especially if the patient is symptomatic. (Note: Do not clean the nose of mucus before the test. The viruses are in the mucus. Wiping the mucus off, like throwing away evidence, will lead to a false-negative result).
Why is the timing important?
If the patient tests positive with the rapid home test, or negative but confirmed positive by PCR, monoclonal antibody (mAb) treatment must start within 7 days of onset of the symptoms in order to be maximally effective, hence it is best to have the test results the earliest possible. If the patient developed symptoms on a Monday and became more severe on Wednesday and got tested that day, and the result was positive, there would be only 3 days left to start monoclonal antibody therapy. If the patient had hesitated to get the test sooner, that window of opportunity for mAb therapy would have been lost.
What is Monoclonal Antibody Therapy?
Monoclonal Antibodies (mAb) are not chemical compounds. They are proteins (not chemical compounds as drugs are) created in the lab, mass-produced, and act exactly like natural protective antibodies to protect the body, in this case, effectively against COVID-19 viruses. Otherwise called the “designer antibodies, tailor-made,” they are given by intravenous infusion with the person sitting up, an outpatient procedure, and the antibodies infused immediately go to work to “immunize” the patient, unlike the vaccines which will confer protection after a couple or more weeks, depending on the integrity of the person’s immune system. Eli Lilly’s Bebtelomivab is a Monoclonal Antibody that has been designed to protect against the Omicron variant too.
Is one symptom enough?
Yes, one single symptom (any one of the following: cough, fever, extreme tiredness, malaise, or diarrhea) following a history of exposure to an “unmasked” crowd or someone infected, is enough to warrant an immediate Rapid Antigen Test. If negative, even twice, it should be confirmed with a PCR test, if that single symptom persists (like cough or fever) or more symptoms develop. During this pandemic, a high index of suspicion (medical vigilance, which I called protective paranoia in my previous columns) is necessary to prevent infection and death, especially among the “vulnerable.” As I said before, we need wisdom, discipline, humility, patience, and compassion towards others to defeat this killer virus soonest, and not arrogance, indifference, carelessness, or bravado, which are dangerous attitudes and behavior. Let’s be smarter than the virus!
People with Obstructive Sleep Apnea (OSA), who hold their breaths for prolonged periods of time while asleep and develop dangerous hypoxemia (low blood oxygen saturation being circulated to all vital organs) need an oximeter to determine how serious the condition is. All our vital organs need normal (optimal) blood oxygen levels to remain healthy. Other conditions like COPD among smokers and those with gastric reflux disease, those with pulmonary illnesses, heart ailment, or other medical issues, who are advised to monitor their oxygen saturation level (SpO2), could also benefit from an oximeter.
One such device I have personally tested myself with great satisfaction is the EMAY Sleep02 PRO Wrist Pulse Oximeter (with a rechargeable battery) I ordered on amazon.com. It has a 1 ½ inch-LCD display screen and is worn around the wrist like a watch, with a connected SpO2 “sensor” probe where a finger is inserted to continuously measure in real-time the oxygen saturation and pulse rate, and the data are saved in its built-in 20-hour recorder for analysis by the physician. A most valuable health tool with prompt customer support.