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Melanie Cole (Host): Welcome to Expert Insights with the Carle Foundation Hospital. I'm Melanie Cole and today we're giving a COVID update, Omicron variant of concern. Joining me is Dr. Robert Healy. He's the Chief Medical Quality Officer at Carle Foundation Hospital. Dr. Healy, it is always a pleasure. What a great guest you are. So, let's talk about this strain Omicron. It's a variant of concern now. It's the first new one since Delta. Tell us a little bit about what we know now.

Robert Healy, MD (Guest): Yeah. Well, thank you very much for that introduction. And every time I talk to you, it's an update and it seems like it's not the best news. One of these times we're going to, I'm going to get out and tell you how this all, you know, look back on the pandemic.

Host: I would like that. Let's look forward to that for sure.

Dr. Healy: But for now we're dealing with Omicron. It really came on quickly. It was first identified really right around the end of November. So, the end sort around Thanksgiving is when it hit the press that there was this new variant of concern and the WHO moved it right to a variant of concern right away.

So, we knew that was past variant of interest. So, we knew that there was something up and then reports came in and quickly about all the different mutations this variant had and the concern that it was going to be very contagious. The unknown at the time of whether it would take over from Delta if it would be more infectious, if it would be more you know, cause more serious illness, all kinds of things were unknown.

But we did quickly learn that it took over from Delta quickly. So, we have, here in Urbana with the University of Illinois, we have access to some faster sequencing that's available that the U of I does on their samples. And so right away, within two weeks, we saw that it had become the predominant, like over 95% of the new positive cases in Urbana. And then we saw that it quickly then caught up that the data from IDPH and CDC quickly caught up and showed us that this is as infectious or more so than we thought. And now we're dealing with pretty much strictly Omicron.

Host: So, let's talk about the vaccines because there's a lot of talk about whether or not Omicron is resistant to the current vaccines, including the booster. Tell us about that and how much does what we're seeing Pfizer, J and J, Moderna. How much are they helping with Omicron?

Dr. Healy: So, what we found is you know, the initial concern was that it would escape all protection from the vaccine, but that turned out not to be true. But what did turn out to be true, is that just basic series of vaccine. So two of them of Pfizer, one of J and J, which we haven't given out a lot of so, we have most of the data on the Moderna and Pfizer locally. But anyway it turned out that the vaccines were protective, but not as great as we hoped they would be like before they were 90% effective. They were more like in the 70% range and we didn't know what that would mean for people getting sick, breakthrough infections, hospitalizations, et cetera.

Host: What about severity because we're hearing people talk about that it's less severe, more sniffles, more headache, that sort of thing. Does it have different symptoms? Are we seeing pretty much the same? Tell us a little bit about the severity of it.

Dr. Healy: What we've found is probably about I'm not sure this is the right way to put it, but probably about half as severe as Delta, as the other original COVID 19 virus. So, what happens is we see about probably 5% of people who get infected are winding up in the hospital, and that was about 10% with Delta.

The unfortunate thing is that a lot more people are getting Omicron. So, our hospitals quickly became overwhelmed. We really had record cases over the last couple of weeks of people in the hospital. We started to see a downtrend there and we're hoping that's going to sustain. I can talk later on about why that might not happen. So, it doesn't seem to make you as sick as Delta, but it's still not a fun virus to have. You're still sick more, more sore throat and upper respiratory infection type symptoms with Omicron than with Delta, it seems like, so more of a you know, you've got that scratchy throat and then a day or two you're just got the sore throat, stuffed up nose, and then you start coughing.

And that seems to be what we're seeing a lot of. What we're not seeing as much of is the loss of taste or smell. So, just a little difference there in the different variants that are affecting us. So, we see it about probably half as bad as that is of winding you up in the hospital. Some positive things we're seeing however, is that the booster really seems to be protective against having someone wind up in the hospital and especially having someone wind up in the ICU or die ,from this new variant.

Host: This is great information. And Dr. Healy, obviously with the original COVID, it was affecting our elderly in such large numbers, but now it seems we're seeing it across the age range. Is that what you've been seeing as well? So, that now it's even affecting our kiddos.

Dr. Healy: That is what we're seeing. And kiddos, especially the ones under five who can't get vaccinated, you know, when Delta was out, we talked about how that was going to be a pandemic of the unvaccinated. I think Omicron is even more so that way. We're seeing kind of three different people that come into our clinics or the emergency department, and that is people who have gotten a booster. So, they've gotten their first two mRNA vaccines, and then a booster dose. Sometimes we're not even seeing them in the ED.They come into the office. So, they call us and they're, and they just, like I said, have that regular cold that we're all used to. And they spend, you know, five to seven days on the couch and they feel miserable, but they get better.

People who have just had the vaccine, the first two doses. So, what was considered fully vaccinated at this point by CDC, they're getting sicker and they're sometimes having to be admitted. But luckily they're not getting really sick in the hospital. They sort of, they seem to turn pretty quickly to just needing oxygen and then getting off oxygen and being able to go home.

But the people that are unvaccinated are really getting kind of walloped by this. They're, they're coming into the emergency department at a greater rate. They're being admitted and having longer length of stays. And then they're the ones that are winding up with the ICU stays and even dying from this new variant of COVID-19.

Host: I've heard it called more of the virus of the unvaccinated. So, that's interesting that you say that now, as guidelines are updated and changed, it can be a little bit confusing. People have been going back to work in person. Do you have any tips to share on keeping safe if you do have to work in an office? Should we be upgrading our masks? We're hearing now we should be using either N95s or KN95s. Tell us a little bit about the change in quarantine recommendations, going back to work, tips for keeping us safe.

Dr. Healy: Yeah, it's been very confusing. Hasn't it? And I think about the quarantine issue. You know, I don't know how the CDC thinks or what their experts think, but it seems like what they saw and we saw this as well, is that Omicron seems to hit you harder, faster, meaning a couple of days after exposure, you can really have symptoms. Whereas with the other variants, it seemed like it would be five or seven days. And then what some studies showed is that it left us quicker as well. So, a high peak of virus, like a day before, and then when we're symptomatic, then it went away pretty quickly. Ideally we'd be able to test at day five, do an antigen test at home and see if we didn't have positivity anymore. And we can feel safe of going back out into our communities, masking still for at least five days and always when you're indoors with other people. But unfortunately, as you know, we don't have enough testing. Hopefully that'll be fixed in the future. We'll see if that happens.

But the five days was based on some science that the virus went away quicker. What we're worried about is if people go back to work earlier or don't feel as sick and want to work when they're sick, then they really could spread it to a lot of other people. So, I think going along with that, the masks recommendations have been changed there were the cloth masks don't seem to really work anymore, if they ever did. I think they help with large particles, but not necessarily with the real fine particles that this virus can travel in. So, really wearing a procedure mask or a surgical mask is a great idea. Even wearing something like a KN95 or 94. Those are what we don't use those in the hospital because they're not fit tested. They're not the N95s that we're used to in the hospital, but in the community, they're a great idea. You know, you can get those through online retailers and at stores. They seem to offer better protection.

Host: Dr. Healy, you mentioned getting tested. In some parts of the country, it's pretty hard to get tested. And now we're hearing about, you know, the home kits. Now I got four of them at our local Walgreens, and so I have them here. What do you think about these home test kits? And now we hear, we might even get sent some in the mail, I mean, some people are even questioning why bother? Just if you get sick, stay home. But that's for reporting purposes. Right. So, tell us a little bit about the testing situation right now.

Dr. Healy: Yeah, another really confusing thing. So, so the home tests are antigen based tests and those seem to better tell us whether we're able to infect others or not, because the gold standard, the PCR test, the one that is running in the hospital labs and send away labs really is sensitive. And it picks up any little bit of COVID 19 virus is in our system. So, even if we're not shedding the virus or not able to infect someone else, that test could still be positive. Whereas the antigen test, if that's positive, it means you're able to infect someone. And for the most part of it's negative, it means you're not able to infect someone.

And the reason I put in that for the most part is because no test is perfect. And there's some suggestions that maybe we shouldn't be doing nasal swabs with these tests, which is what they're designed for, but maybe we should be doing throat swabs with these tests. And just to clarify, I'm not suggesting that people do throat swabs or a lot of people I've seen in social media and others I've heard are saying, test your nose and then test saliva on the same test. Probably not a good idea, cause that can nullify the effects of the test or the way the antigen would spread to that line that says you're positive, if it's present. Some have recommended, you know, there's two tests in one kit, so maybe do one in your nose. And one from saliva that might be a better way to do things, but these are all unknowns. In general that the tests do work well. They do pick up the Omicron variant. There's probably just a lot more, but it's still a low amount of people who won't test positive, even if, even though they do have the infection.

Host: You're such a knowledgeable expert, Dr. Healy and such a great educator, as well. As we wrap up, do you have any thoughts on what we can expect after this surge? I know we're in, you know, twin demic season, there's RSV, there's flu, there's COVID, there's colds. I mean, there's all kinds of things floating around here. Do you have any idea what you think will happen and please offer your best advice about Omicron for other providers and the general listeners.

Dr. Healy: I think the thing to know about Omicron is it's much more contagious. I think if anyone has upper respiratory infection type symptoms right now it is Omicron or COVID-19 causing it. You're right, that there's other things. And in the proper age groups, clinicians should always think about RSV and influenza is always in the background at a low level.

And we're worried that might rear its ugly head unlike last year when it was so quiet. So, for the clinicians, I'd say, you know, keep a broad open mind, but pretty much if someone's sick with upper respiratory infection symptoms, they've got COVID and they should isolate for five days or quarantine for five days until they're feeling better and don't have a fever anymore.

And then they could just be out in the community if they're better and mask for those next five days all the time. And if you yourself are sick, I'd say, if there's a testing system available for you, go ahead and do it. So, if you've got some kits that you were able to score from Walgreens or Costco or wherever they've been at before, I would test myself and see if I was positive.

If I was sick, I wouldn't come to work. Because I don't want to infect others. And if I had a positive test, I would kind of ride it out at home for the five days until I'm feeling better and then go back out in the community. And any time, if I had, you know, problems to begin with, someone with heart disease or diabetes is not well-controlled or an immune compromising condition, I would definitely want my provider didn't know that I was positive. But otherwise quarantine, isolate, stay away from others. And we should see this Omicron peaking hopefully now, and going down over the next number of weeks. I think we're always concerned because every person that has the virus does create mutations and almost all those mutations aren't beneficial for the virus, luckily, but sometimes they are.

And that's how we get things like Delta and then Omicron. And I know the next couple of letters in the Greek alphabet are PI and RO. I hope we never have to deal with those.

Host: Well, I certainly agree with you there and, you know, listeners, if you haven't gotten your vaccines and your boosters, go ahead and do that. And as Dr. Healy said, mask up when you're out and about in the community, especially if you're indoors, that way we can protect each other and ourselves. And for more information, or to get connected with one of our providers, you can always visit carle.org or for a listing of Carle providers, and to view Carle sponsored educational activities, please visit our website at carleconnect.com. That concludes this episode of Expert Insights with the Carle Foundation Hospital. I'd like to thank Dr. Robert Healy. What a great guest. I'm Melanie Cole. Thanks so much for listening.