Do it for Felix

Although I’m not out of my COVID isolation period, I’m feeling much better today. Despite the fact that I have a history of lung problems, my vaccines (including my four month old booster) have held the line. My oxygen saturation stayed good. I didn’t get hospitalized or intubated. I’m still here. The shots seem to be doing what they are supposed to do. And the baby in the picture is my first cousin (once removed) Felix - we will get to him in a bit.

I've had a typical winter viral illness with a cough, a runny nose and some brief muscle aches and chills. I've had to shut down my practice. I've been sitting alone in a room. And now that I'm better, I've been keeping busy playing virtual reality mini golf and ping pong with my sons, and writing to y
ou. When I think of what might have been, especially remembering the terror of my two hospitalizations in 2018, I am incredibly grateful to everyone involved in creating these medical miracles in record time.

Staying alive for me is a big value-add, but it's not why I'm writing to you today. There is another good reason why vaccination is crucial. I recently read two articles on that topic that prompted me to write this - a substack by the brilliant Eric Topol and an editorial
by the president of the AMA. I encourage you to read the originals, especially Topol's piece which is brief, appropriately detailed, clearly written and accessible to a non-medical audience.
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I almost made it two years without COVID-19...

Well, I almost made it for two years, but I won the COVID lottery today (January 5th). I had tested negative yesterday morning, got some nasal congestion and muscle aches during the day, and this AM I tested positive on a rapid antigen test.

I spent today rescheduling upcoming patient appointments and surgery, and contacting the families who were in my office yesterday. Since I wear a high grade mask, and the visits are relatively short, it’s not a big exposure. But in addition to regular state reporting, it’s good to let people know even if quarantine isn't necessary (many of my patients are under 5 and unvaccinated).

I'm isolating at home, but I'm happy to take care of my practice as best as I can remotely (I still haven't figured out how to clean out earwax using my VR goggles!). I'm staying alone in the bedroom. My wife, daughter and I are all masking as long as they remain negative on testing.

Even though my booster was four months ago, I suspect that it will keep me safe from severe disease. Right now, I just feel like I have a typical winter cold. Israel has started giving a 4th shot to health care workers and people over 60. I guess this infection is my 4th dose for the time being, but I'll be first in line if they offer that here...

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Thoughts on Omicron and Isolation

I haven’t written much about the Omicron variant of COVID-19, because the news (like the virus) is moving very fast, and I may not be the best person to sort through it all for you. And even the people who are most qualified to do that are doing what they should do - waiting for data before giving specific advice and changing guidelines.

But still, if you have been watching the pandemic news over the past two weeks (or if you live in New York City), you will realize that this variant is much more contagious

than previous versions. Just about everyone that I know here knows multiple people - vaccinated and boosted - who have had breakthrough cases. So here are a few things that you might want to consider. And like most COVID stuff, these may all turn out to be wrong in a few weeks, so keep watching the data!

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A Clever Tool to Help You Stay Safer this Winter

So many of our conversations about COVID-19 involve absolutes. Vaccines either work or they don’t work. COVID is either a plague of biblical proportions or a media hoax. Masks are necessary everywhere or they are costumes for virtue signaling.

But the thing about COVID - and about all medical topics - is that the real, correct answers are almost never absolute. The most important sentence in medical school is “there’s a bell curve for everything”. That means that while nuance may be long gone from our political debates, it is crucial if you want to effectively manage anything from an ear infection to metastatic cancer to COVID-19. The range of symptoms, treatment options and outcomes for most diseases is very wide, and it's rare there is a simple, single answer to everything. Uncertainty is a big part of medicine, but we still have to make decisions based on the best information that we have at any given time, always looking for more and better data.

Our personal choices make us more or less likely to get COVID. More or less likely to be hospitalized. More or less likely to die or to have long term complications or to pass the virus on to people who can’t fight it very well. It’s an endless game of statistics and probability. Some things, like our choices, we can change. Some things, like our genes, we can't. Why does one person have a brief exposure to someone with COVID and end up in the ICU, while another person stays healthy even though they are unvaccinated and out in bars every night? That's the bell curve!

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Redefining "Fuly Vaccinated"

The meaning of the term “fully vaccinated” is changing. I’m really hoping that our federal guidelines, our local ordinances and our employer mandates keep up with that change. But until they do, you need to do something very safe, very effective and VERY important.

If you are over 18 and more than six months out from your second Pfizer or Moderna COVID vaccine (or more than 2 months out from your J&J shot), you absolutely should get a booster as soon as you can. As far as I'm concerned, that's the new definition of "fully vaccinated".

PLEASE don’t think about this in a political context. Please don’t think about this in terms of what you had read last Spring, or what some authority figure told you months ago, or what you think the world owes us after almost two years of the pandemic.

Every day we learn more about the virus and the efficacy of our response to it. Making decisions about how to deal with COVID is like making decisions about how to dress for the weather. A sunny day last June doesn’t mean that you go out in shorts during a December snowstorm. What the CDC and the FDA do - and what you should do - is watch things. Specifically, watch the risk of transmission1(3.4%)
in your community (something that can be calculated based on how much COVID there is around, how many people are vaccinated, and how many new cases there are each week). You can also watch for new developments as we track immunity after vaccination. Will the COVID vaccines be like other long established childhood immunization protocols1(3.4%), with a set plan of three shots for everyone? Or will they involve boosters at regular intervals? No one really knows the answer to that now. But we can still make good decisions with the information that we have.

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