Nebraska Medicine doctors answer questions about omicron

OMAHA, Neb. (WOWT) – Amid a surge of milder cases of COVID-19, two Nebraska Medicine doctors on Monday consistently urged vaccination against the virus, warning about the perils of relying on medications and notions of immunity.

In a Facebook Live COVID-19 Q&A session, Dr. Mark Rupp and Dr. Armando De Alba answered questions from the community about COVID-19 and the omicron variant.

Dr. Rupp said the emergent of variants is what we expected all along.

“I hope we don’t run out of Greek alphabet letters, but we could,” he said.

But omicron “has just exploded. It really is much more transmissible than other variants and that became painfully obvious. … Within just weeks, it was really worldwide,” doubling about every two days or so.

The latest variant seems to be affecting upper airways more than lower, which might explain why there seem to be more mild cases with omicron, he said.

“But I don’t want to give people the wrong idea: When we look at it on a population basis, this is very, very serious. And the sheer numbers of cases that we see coming through the community will predict for a greater number, overall, of hospitalizations… and deaths,” he said.

Dr. De Alba and Dr. Rupp both urged special attention to preventative measures right now, like wearing masks that fit properly — or wearing cloth masks over medical paper masks — anytime you’re around others, not just when you feel symptomatic because most people are contagious at the beginning of their sickness and often before they have symptoms.

And of course, N95 and KN95 masks work even better.

But when any of those masks get moist or start to tear, you want to get a new one, Dr. Rupp said.

Good hygiene and hand-washing will also help, but surface cleaning isn’t as vital as thought during the earliest days of the pandemic.

“It’s a respiratory disease,” he said.

It’s also crucial right now to use good judgment and avoid high-risk settings, especially in the next few weeks, Dr. Rupp said.

He also urged the community not to depend on treatments like monoclonal antibodies and other medications used to treat COVID-19 as they will be reserved for individuals at the highest risk levels.

“They’re in such desperate short supply that they’re, for the most part, are not going to be available to rescue them if they get ill,” Dr. Rupp said.

As an example, he said, that only about 50 doses are available for 9,000-10,000 patients would otherwise qualify for one such treatment or preventative medication.

Instead, he said, get vaccinated. “Don’t put yourself in harm’s way,” he said.

Dr. De Alba also encouraged those with children, especially, to get vaccinated so they can care for others in the family, should they fall ill. Be sure, too, to check on babies’ breathing, and note that dry diapers are a red flag.

He also urged people not to wait around for herd immunity, calling it “inhumane.”

“If we depend on herd immunity, a lot of people will die,” he said.

Both doctors highly discouraged COVID-19 “parties.”

Acknowledging that “it does have some intuitive appeal to it,” Dr. Rupp said you’re not guaranteed that you won’t have a severe case, and you really don’t know what the natural disease-induced immunity is going to be, especially with the omicron variant.”

It just depends on an individual’s immune system response, and “it can be really spotty.”

“I would plead for people not to have the ‘chicken pox’ parties… That’s a bad approach when we have such a better way of approaching this, which is get the vaccine,” Dr. Rupp said.

COVID-19 vaccines are still the best way to get a robust, predictable response to the virus, he said.

“I know people feel demoralized by this most recent variant. I guess I would try to emphasize that we are in a better spot than we were two years ago,” Dr. Rupp said.

These days, he said, we have a vaccine, we know more about COVID-19 and how it spreads. We just need to make sure to do the things we know work and not get derailed in those efforts.

Overcoming testing challenges is also key, Dr. Rupp said.

“Testing has been a sore point from the very, very early days in the pandemic,” he said

There were improvements along the way, he said, “but when the vaccine came in, we sort of dismantled that.”

Now, rapid antigen tests are less reliable than they were in the early days, and PCR tests are hard to get access to. Home tests are an option, but present a challenge for public health officials, Dr. Rupp said.

“We are not able to track those and figure out where the patterns of disease are,” he said.

Isolating is of the utmost importance.

If you know you were in contact with a positive case, Dr. De Alba said you should isolate — or contact the health department if you don’t have the ability to effectively isolate, and to get guidance.

“Communicate with the people you are planning to be around,” he said. “If someone has symptoms, they will need to be isolated until they show a negative PCR test.”

Following new CDC guidance, he said, test after five days; if you’re still positive, isolate for five more days.

Dr. Rupp said anyone who doesn’t have a diagnosis but does have symptoms or a definite exposure should assume they’re positive and isolate. If you’re symptomatic, isolate for 10 days — or five days, if you’re negative, but then definitely wear a mask, he said.

While there are a lot of hurdles today surrounding COVID-19 testing, it helps you understand what virus you’re infected with, especially as flu cases are again on the rise.

Flurona — a combination of COVID-19 and flu — does happen and is a big concern, especially as hospital capacity is high.

While flu was almost non-existent in 2020, “we’re not going to get that lucky this year,” Dr. Rupp said.

And doctors are still determining all the “viral dynamics” as H3N2 influenza circulates in the community, he said.

“Outcomes can be worse,” Dr. Rupp said, noting, too, that flu vaccine has been shown in some cases to be helpful in avoiding COVID-19.

If you do get COVID-19 and are able to treat it at home, Dr. De Alba recommended staying hydrated, eating fruits and vegetables, and getting lots of rest.

Staying isolated to prevent further spread is also key and wearing a mask in shared spaces in your home.

“I know it’s difficult to stay in four walls, but it’s one of the most effective ways to protect those around you,” he said.

Dr. Rupp suggested taking acetaminophen and ibuprofen, if that helps.

Those with other conditions that make them more susceptible to worse COVID-19 outcomes should contact their doctor, but “we don’t want you to come screaming into the ER if it isn’t an emergency.”

For those with greater concerns and available devices, monitoring symptoms and even oxygen levels at home is fine, he said, and you can “tough it out at home for a few days.”

Dr. De Alba said those with oximeters should definitely seek medical attention if their levels fall below 90.

But “the fight (against COVID-19) does not start in the hospitals,” he said. It starts in the community.

Dr. Rupp agreed, expressing regret at how politicized COVID-19 has become.

“This is a time when we need to pull together as a community with a unity of purpose. You know, it pains me so deeply to see these issues become politicized and become something that tears us apart. This is a time when we need to come together as a community to protect one another and to do the right thing,” he said. “Please, you know, knuckle down here for a few weeks. Help us get through this. The hospitals are stressed; they’re really just teetering on the edge at this point.”

Watch Monday’s Q&A

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