What to do when you get an Omicron breakthrough infection

What to do when you get an Omicron breakthrough infection

My breakthrough infection started with a scratch on my throat just a few days before Thanksgiving. Because I was vaccinated and had just tested negative for COVID-19 two days earlier, I initially removed the symptoms as just a cold. To be sure, I was checked again a few days later. Positive. The result felt like a betrayal after 18 months of reporting the pandemic. And when I walked home from the test center, I realized I had no idea what to do next.

I had so many questions: How should I isolate myself in a shared apartment? And why for 10 days, as the doctor at the test site had recommended? Do I need to be tested again? By the doctor’s order, my partner – who had been tested negative – pulled a sleeping bag to the sofa. Masks came on, windows went up, and planes were canceled. I ate tasteless dinners on my side of the apartment. One by one, the symptoms I knew so well on paper made their debut in real life: cough, fever, fatigue, and a loss of smell so severe that I could not detect my dog’s usual fishy spirit.

It turned out that I was not the only one who felt confused about what to do. “Oh yes, people are very confused about breakthrough cases,” said Peter Chin-Hong, an infectious disease expert at UC San Francisco. Now that the Omicron variant is here, many more Americans may soon have to deal with groundbreaking confusion. There is a lot we do not know about the new variant, but it is spreading fast. Although the unvaccinated are still the most vulnerable, vaccinated America is not clear: Although the shots still seem effective in preventing hospitalization and death, early reports suggest they are less effective against milder cases. So if you’re getting a breakthrough infection right now, what should you do?

At least for now, Omicron should not change how Americans act when they get a breakthrough infection. “All the same things apply, whether it’s Delta, Omicron, or any other Greek letter or non-Greek letter with SARS-CoV-2,” said Stephen Kissler, an epidemiologist at Harvard. “When you know you’re infected, hold on tight, limit your encounters with other people, and just take care of yourself.”

If only the official guidance was so straightforward. Rebecca Wurtz, an infectious disease expert at the University of Minnesota, told me that people are confused “in part because, I think, the guidance is confusing.” CDC guidelines are limited: Isolate if you have either tested positive within the last 10 days or experience symptoms, and only end your isolation after 10 days if you have gone 24 hours without a fever (without the use of Tylenol or other) anti- fever medicine) and your other symptoms get better – not including the loss of taste and smell, which can take a few weeks to return. “They’re vague as they are stated, and they’re a little too complicated anyway,” Wurtz said. (When I contacted the CDC for comment on its breakthrough guidance, a spokesman pointed me back to the recommendations on the agency’s website.)

If you start to feel something similar to COVID symptoms or find that you have been exposed to someone who has been tested positive, some experts told me that the first thing to do is to get tested. “If you’re not sure, you need to be tested,” Chin-Hong said. This is especially true now that we are entering the winter, when all sorts of non-COVID diseases are also circulating. It may be impossible to distinguish between the early symptoms of colds, flu and COVID, and being tested is the only way to confirm a breakthrough infection. The bottom line is that it’s important to know if you’re positive, not only for yourself, but also for everyone you’ve been in contact with recently – especially those who are unvaccinated or immunocompromised.

PCR tests are still considered the gold standard, but they take much longer to generate results than quick tests that you can buy at a pharmacy and take at home. A test is just a snapshot in time, and because Omicron appears to have a shorter incubation time than previous variants, a result from a few days ago may not mean much. More than 60 fully vaccinated individuals tested positive for Omicron after an office party in Norway, and all had received negative rapid test results just a day earlier.

Wurtz said that if you are starting to feel sick but have not been in contact with anyone and do not plan to be, the best resort is to stay home, minimize exposure to other people and rest. “This may seem a little radical,” she said, “but I do not think there is a need to be tested at all in that context, period.” Again, you need to consider whether you have put anyone around you at risk for infection.

If you test positive, you should alert your local public health authority so they can start contact tracing, Chin-Hong said. Many test sites do this automatically, but home testing obviously does not. The CDC recommends that after confirming your infection, start isolating immediately, but unless you are asymptomatic, on the first day of symptoms is technically what counts as the start of your 10 days of isolation. I learned the hard way that one is not supposed to “try out” isolation when a medical assistant yelled at me because I was being tested after feeling better on day seven. She said I put others at risk, even though the CDC guide did not specifically say not to be tested. She explained to me that I would have to isolate whatever the outcome and she never told me my outcome.

It can be especially difficult to isolate yourself if, like many Americans, you do not get paid sick leave, or if you live with people who have been tested negative. It is a common situation with breakthrough infections: While a positive test in a household full of unvaccinated people may soon make everyone test positive, this is not necessarily the case in a home where everyone is vaccinated. “At the very least, you should not be in the same room,” Javaid said. “If you are going to interact with each other, you should always wear masks.” Given Omicron’s infectiousness, it is worth wearing more protective masks, such as N95s or KN95s, instead of the fabric masks common in the United States. And even though it’s cold, opening windows four to six inches, Kissler said, can help with ventilation. If people you live with start to get symptoms, the same guidelines apply: They should also isolate themselves and test whether they want to see others.

But as Atlantic OceanKatherine Wu has written, not all public health experts agree that those with breakthrough infections really need to isolate themselves for 10 days, given recent research suggesting that they remove the virus faster than the unvaccinated, for whom the 10-day window was designed. Wurtz said the 10-day isolation period is “somewhat arbitrary,” but she acknowledged that caution may be reassuring with a new, less-understood variant.

Fortunately, most breakthrough infections tend to be mild cases, and this seems to be true with Omicron as well (especially for those with booster shots). If you feel unwell, the usual treatment for respiratory infections – medications for colds and flu, medications for fever, fluids and rest – is adequate for most people with COVID breakthroughs, Wurtz said. Although monoclonal antibodies are effective in treating COVID, Chin-Hong said he only offers them to people who are elderly or immunocompromised because they are the most vulnerable, even after being vaccinated. (Soon we will have another treatment option: antiviral pills.) Breakthrough infections are unlikely to lead to hospitalization for most people, but you should seek emergency care if you develop severe symptoms such as difficulty breathing, persistent pain or pressure in the chest or confusion.

At some point, as we learn more about Omicron, the guidelines for what to do after getting a breakthrough infection may change. “I think it’s important with the new variant that we’re seeing right now to consider getting the boosters as soon as possible,” Javaid said. But other than that, the best thing vaccinated people can do is make sure they are ready for a breakthrough infection before it hits. Grab quick tests so you are not in a pinch if COVID symptoms suddenly occur. Talk to your family or roommates about where the best place to isolate yourself is in your home. Be prepared to miss out on 10 days of work if you are in person.

Fortunately, I am fully recovered from my breakthrough infection, except for the continued inability to smell my dog’s breath. For now, what makes breakthroughs like mine so confusing is that the United States is in an “awkward transition phase,” Wurtz said, between following somewhat random rules – such as isolating for 10 days – and a deeper understanding of what COVID-19 does by our bodies. I have since received a booster, and accepted that I will probably get sick with COVID again, maybe many times. COVID will one day become endemic, and having it can become more like having a cold or a bout of flu: a normal, albeit annoying, part of everyday life for most people (though not all). Eventually, even with Omicron, breakthroughs will be much less stressful. “I think it’s time to start normalizing breakthrough infections,” Wurtz added. “We must learn to live with them.”


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