Relative Joy

There’s good news. And there’s bad news.

Let’s start with the bad.

SARS-CoV2 isn’t done with us yet.

For the past 3 years, we’ve seen a volley of surges that occur during or after a holiday season. The last surge happened at the beginning of 2022 – the beginning of the Omicron variant. After the onslaught of this variant, the December numbers for the year dipped to less than 7% and continued to decline to 5.5% at the beginning of 2023. Omicron had continued to shift to different sub variants and while no new variant of concern had emanated after Omicron, people continued to get COVID with milder symptoms to being asymptomatic, in the majority. The most recent wave for 2023 occurred in May 14, 2023 where the PH peaked at 24% (7-day average, with more than 53,000 tests done). As Omicron continued to evolve, the JN.1 sub variant is likely responsible for the holiday wave today. As of this writing, the national 7-day positive rate is up at 21.2% (with only a little more than 10,000 tests).

Of course, the holiday spirit is at full throttle with vengeance – revenge travel, revenge shopping and dining, revenge parties, revenge concerts, and revenge reunions. Of course, this is what normal living is. And for our mental health, we cannot keep hiding under a rock because of COVID. And so what came naturally in this holiday wave is human nature.

It’s still bad news considering that the PH had one of the longest lockdowns in the world. Bad news in the sense that many people never learned about masking etiquette. I mean, seriously, we were the only country that implemented those useless face shields for years! The government even mandated that useless tool and there were scoundrels that profited from that idiotic idea. So you’d think that the simple mask was not a large ask for the general public to remember and practice self-care and personal responsibility when one has respiratory symptoms.

Then there’s the testing.

I hate saying it, but one of the best tests (or most useful tools) in diagnosing COVID-19 infection is the self-test swab kit. In a Cochrane review on “How accurate are rapid antigen tests for diagnosing COVID-19?” [https://www.cochrane.org/CD013705/INFECTN_how-accurate-are-rapid-antigen-tests-diagnosing-covid-19#:~:text=In%20people%20with%20confirmed%20COVID,cases%20had%20positive%20antigen%20tests).], three key messages of the findings were:

• Rapid antigen tests are most accurate when they are used in people who have signs or symptoms of COVID-19, especially during the first week of illness. People who test negative may still be infected.
• Rapid antigen tests are considerably less accurate when they are used in people with no signs or symptoms of infection, but do perform better in people who have been in contact with someone who has confirmed COVID-19.
• The accuracy of rapid antigen tests varies between tests that are produced by different manufacturers and there is a lack of evidence for many commercially available tests.

Over-all, the rapid antigen tests (RAT) approved for commercial use in the PH, are stringently assessed by the local Food and Drug Administration.

The Cochrane review showed that “In people with confirmed COVID-19, antigen tests correctly identified COVID-19 infection in an average of 73% of people with symptoms, compared to 55% of people without symptoms. Tests were most accurate when used in the first week after symptoms began (an average of 82% of confirmed cases had positive antigen tests). This is likely to be because people have the most virus in their system in the first days after they are infected. For people with no symptoms, tests were most accurate in people likely to have been in contact with a case of COVID-19 infection (an average of 64% of confirmed cases had positive antigen tests).

In people who did not have COVID-19, antigen tests correctly ruled out infection in 99.6% of people with symptoms and 99.7% of people without symptoms.”

The RAT is a very useful, cost-effective point of care test to use. And I strongly urge everyone to make use of this tool, especially in the light of rising cases (or waves and surges). It is a personal responsibility which we owe to the community, particularly those in the vulnerable sector.

Finally, is the availability of an updated vaccine or a good vaccine for that matter. This topic will be a separate blog, but for now, let’s call a spade a spade. We will have to find a good vaccine that will block transmission of the virus. NONE (and I emphasize that) of the vaccines out there will do that. Getting shots against SARS-CoV2, no matter how updated they are, will not prevent an infection after exposure. However, the vaccines are helpful at decreasing the severity of infection, if one does catch COVID-19.

In summary, the bad news isn’t really Omicron. It’s a multitude of factors – human at that – that continues to challenge the evolution of respiratory pathogens based on the behavior of people globally.

Let’s face it, if we don’t observe better respiratory hygiene, we will continue to be overwhelmed with waves. Based on hybrid immunity, this will be most likely an annual affair.

The good news is short.

Thank God it’s Omicron.