A Blog by Jonathan Low


Dec 18, 2021

How To Prepare For the Growing Likelihood of a Breakthrough Covid Case

Increasingly it appears to be a matter of when, not if, everyone will catch the virus. Those who are vaccinated - and especially those who've had a booster shot - are not especially at risk for a severe case, but it may still feel like a bad cold or flu. 

There are steps everyone needs to take so that if that happens, you are prepared to ride it out. JL

Rachel Miller reports in Vox:

Make a plan for how and where you'll get tested if you show symptoms. Determine who will be your main source of medical care if you get sick. The advent of telehealth means this might be easier, since you won’t need to worry as much about the doctor being a long car or bus ride away. Have a plan for how you'll isolate if you test positive. Stock up on essentials: cold and cough medicines, pain relievers, fever reducers, cough drops, a thermometer, and tissues. Think about what you like to eat when you’re sick of don’t have much appetite (jello, popsicles, instant ramen, soup, etc.) And be ready to feel a wave of emotions.

As case numbers increase in the US and a new variant of concern circulates, it’s hard to feel optimistic about our upcoming Covid-19 season. Among people who are vaccinated and who have been fairly cautious thus far, a dark feeling of inevitability may be beginning to settle in — a sense that even if you’ve avoided the coronavirus until now, that might not hold through the winter.

While it can be anxiety-inducing to see a cluster of storm clouds gathering and know there’s a very good chance you’re in their direct path, there is still time to do a bit of weatherproofing, so to speak — or at least put on a raincoat and grab an umbrella, so that you’re not caught totally off guard when it starts to pour.

Being prepared for a Covid-19 infection in your household is just plain practical. Even if omicron turns out to be less dangerous than previous variants, the US is also still looking at its first winter with delta, which we know is highly transmissible compared to last winter’s dominant Covid-19 variant. This means people who have tested positive or are symptomatic and waiting for PCR test results need to be especially prepared to tend to their illness without leaving the house, reducing the likelihood of infecting others. Keep in mind that underserved groups are likely to bear the burden of this and future phases of the pandemic; even if you have a case that feels truly mild, it’s still crucial to do your part to mitigate exposure and keep the pandemic from worsening.

It’s also wise to get physically and mentally ready on a personal level. During uncertain times, it can be helpful to gain some small semblance of control. While we wait to learn more about omicron, doing something lightly productive — even just restocking your now-expired cold meds — can offset feelings of powerlessness or anxiety you may be experiencing.

Lastly, getting a positive diagnosis can be unmooring, even if you’re vaccinated and not afraid of a scary outcome. You might feel mostly okay physically, but it’s unlikely you’ll want to do a ton of research or make a lot of decisions in that moment. The more time you can spend resting and healing — versus, say, trying to find the most up-to-date info on testing and treatments — the better.

If you’re hoping for the best but still want to plan for the worst, here’s advice from one health expert on what you can do right now.

Get boosted (and get a flu shot)

Plain and simple. As Vox has previously reported, booster shots today could fight omicron tomorrow, and getting a flu shot will help keep hospitals from being overwhelmed (and reduce the risk of co-infection).

Make a plan for how and where you’ll get tested if you have symptoms or an exposure

“It’s really important for people to get tested, because it’s really hard to differentiate between seasonal flu, Covid, or just a regular cold,” says Syra Madad, the senior director of system-wide special pathogens for NYC Health + Hospitals. “There are a lot of overlapping signs and symptoms, and they’re nonspecific. You can have a fever, cough, or runny nose with any of those three.”

Depending on how you’ve been utilizing testing thus far, you may not have put much thought into how or where you’ll get tested if you start showing symptoms or if you need results ASAP. (According to the CDC, vaccinated people should get tested five to seven days after an exposure or as soon as symptoms develop. Be aware, however, that omicron may have a quicker onset than other variants.)

It’s wise to figure out a testing plan now, including at-home and lab tests, when you’re presumably healthy. Determine the closest testing site(s) to you and how you’ll get there if you need a lab test; ideally, you’d avoid public transportation and ride-sharing services, but if that’s not possible, think about what you might do to minimize the risk to other people. Also make note of the testing site’s hours, whether it’s open on weekends, and whether it’s walk-in only or if you can make an appointment.

Know that getting tested when you know there’s a fairly high probability that you have Covid-19 — versus getting tested as a formality or prophylactically — can be a stressful experience. In those moments, you’re likely going to want your results quickly. So you may also want to figure out where you’ll be able to get a rapid PCR test near you, if available, and add that to the “Covid dossier” (a.k.a. Google Doc) you’re building out. As Vox has previously reported, it’s also a good idea to stock up on rapid at-home antigen tests.

Finally, if you’re going to be traveling for an extended period of time over the holidays or in the new year, make sure you know where you can get tested while you’re at your destination.

Step up your mask game

It can be difficult to think of yourself as contagious, especially when you feel great or just “not that sick.” But it’s important to internalize the reality that, at any point, you could unwittingly pose a much bigger threat to others than you realize. That means taking extra precautions to protect your community, especially if you’ve gotten a little lax about this since getting vaccinated.

“No one wants to experience a breakthrough infection,” Madad says. “We know that even fully vaccinated people can transmit the virus, obviously at a lower extent, to fully vaccinated individuals. I think that’s really important for people to understand. It’s not just about you. I know here in America, it’s a lot about me, me, me, but we need to make sure we’re also looking at we, collectively.”

The best mask is one that fits, so make sure yours does, and think about replacing your cloth masks with N95, KN95, or surgical masks. If you want to stick with cloth, consider whether it’s time to replace your current supply. (Vox reported in September 2020 that a cloth mask likely needs to be replaced after 100 rounds in the washer or 50 in the dryer because the fabric will start to break down and become more porous.)

Determine who will be your main source of medical care if you get sick

A lot of people in the US simply don’t have a primary care provider they see regularly — even people who are insured. That’s a tough spot to be in when you’re sick and everything you’re reading is telling you to “talk to your doctor” about symptoms, and treatments.

“I would definitely encourage people to make sure that they have a primary care physician,” Madad says. Of course, many people don’t, and can’t, for a slew of structural and systemic reasons. Madad says she’d like to see more centralized hotlines that people can call about symptoms, for guidance on what types of treatments (like monoclonal antibodies) they might qualify for, and to know whether or not to go to the hospital. Until that happens, the best thing for you personally to do is to spend some time on your public health department’s website and the nearest public hospital’s website to find additional resources and information about free or low-cost telehealth options.

If you do have the resources to get a primary health care provider and have simply been procrastinating doing the research to find one, make that a priority in the next couple of weeks. The good news is that the advent of telehealth means this might be considerably easier, since you won’t need to worry as much about the doctor being a long car or bus ride away.

Have a plan for how you’ll isolate if you test positive

The Covid-19 vaccines are so effective at reducing hospitalization and death that it’s possible to start to feel like we’re post-pandemic or that getting Covid-19 is no big deal. It might not be a death sentence if you’re young, vaccinated, and generally healthy, but it’s still not the same as, say, getting a cold (even if it literally feels like you just have a cold). Plus, plenty of people are simply not young or generally healthy and very much want to avoid getting Covid-19 entirely. Which is all to say: It’s important to take isolation seriously.

With that in mind, take some time to familiarize yourself with the current CDC recommendations for the Covid-positive. Plan that, per current recommendations, you’ll likely need to be at home for 10 days — and not just mostly at home, but literally not leaving your home, except to get medical care, for 10 days. (Also keep in mind the current guidance could change with omicron.) Here are some other things to think about:

  • Are there any steps you could take to mitigate spread to family members or housemates? For example, can you confine yourself to one room or even one floor? If you live in an apartment, does it make sense to buy an air purifier and a couple of fans to help with ventilation? Madad also pointed to New York City’s free hotel program for people and/or families who need to isolate. Not all cities will have options like this, of course, but it’s absolutely worth knowing that ahead of time.
  • If you have young kids, what might you do in terms of child care if you have to self-isolate and can’t send your kid to day care or school?
  • How might you get food and medicine if you can’t leave the house? Do any drug stores or grocery stores near your home offer delivery? Are there any local mutual aid groups you can join now, in case you need a supply drop-off from a neighbor later?
  • What is your workplace’s sick leave or PTO policy and how will that affect you, especially if you’re employed outside the house? Even companies with generous leave policies might require you to take short-term disability if you need to use more than five days of sick leave in a row, which is not something you want to learn for the first time mere hours after a Covid-19 diagnosis.
  • If you live in an apartment and have a dog you need to take outside, who could pick up your pet and watch it while you isolate?

The answer to some of these questions might be, “Well, I guess I’m screwed!” which absolutely does not represent a moral failing on your part. But facing the bleak reality that things like sick leave and child care in the US are not built for a pandemic (or for a non-pandemic, to be frank) is a tiny bit easier and less overwhelming when you’re feeling relatively healthy.

Stock up on essentials

One thing that will make it massively easier to isolate and to focus on getting better is a well-stocked medicine chest and pantry.

To tend to your symptoms, you’ll likely want to have a variety of cold and cough medicines, pain relievers and fever reducers (like acetaminophen and ibuprofen), cough drops, a thermometer, and a few boxes of tissues. Madad says a pulse oximeter to monitor changes in your oxygen levels also isn’t a bad idea, though the reliability of this tool varies somewhat, especially for those with dark skin. Think about what you like to eat when you’re sick and/or don’t have much appetite (jello, popsicles, instant ramen, soup, etc.) and consider bulking up your grocery list for a few weeks with pantry staples and freezer meals for the benefit of Future You.

For extra credit, here are two items that unexpectedly made my own bout of Covid-19 much easier: a big water bottle with a straw (like this), which made it much easier to stay hydrated, and a small trash receptacle to put next to the bed or couch, because having a runny nose and taking lots of individually wrapped cold meds generates a ton of trash, which quickly takes over your nightstand and adds to the generally rotten vibe of having a respiratory illness.

Mentally prepare for how much rest you’ll need when you’re sick

One of the big benefits of planning ahead like this is that it’ll make it easier to do nothing after you’ve tested positive — something that is critical to the healing process.

During the mild case of Covid-19 I had last January, I immediately took time off work, but I didn’t totally understand what it means to truly rest, in the doctor-prescribed sense. I thought I could do light chores if I felt mostly up to them, for example, or read a book. I even, somewhat inexplicably, set my alarm for a normal wake-up time every morning, like it was an average weekend instead of ... time off to deal with the respiratory illness I’d spent a year avoiding. It took me a few days to accept that doing anything but lying down and watching TV was draining, and even if I felt okay in the moment, I’d pay for it by feeling awful in the hours that followed. If you’ve been healthy your whole life, it can be difficult to comprehend how physically wiped you might feel after doing your typical version of “doing nothing.”

“We want to give our bodies time to recover,” Madad says. “You’re not going to get that healing time or recovery time if you’re going to constantly be active and on your feet and doing things that we do on a daily basis. I know so many of us live active lives, and to just stay in bed is something that’s really hard for many of us. But it’s really important.” And know that if you can’t take it easy — because, say, your boss expects you to get back to work or you have to take care of your kids, or both — it might take you longer to feel like yourself again. “If you are not giving that time to your body, then it probably will take longer for you to deal with Covid,” Madad says.

Pick up the phone if/when the health department calls you

If you’re not one to answer phone calls from unknown numbers, consider making an exception in the days following your positive test — it could very well be the local health department getting in touch. Depending on where you live, they could be calling to get your help with contact tracing, or they might want to ask you some questions about your symptoms, answer any questions you have, and provide you with important info and resources. (On the other hand, Madad says a lot of states are currently overwhelmed, so you may not get a call at all.)

Madad says that people might feel hesitant to share their friends’ or coworkers’ personal information with the health department, but stresses that contact tracing is still a critical piece of preventing future outbreaks. “Oftentimes, I hear, ‘I’m not going to give out my personal information,’ or ‘I’m not going to give information of who I have been in contact with because it’s none of their business,’” she says. “But, again, I would look at it as a form of community service. If you get that call, give that information, because their goal is to end this pandemic. By giving that information, you’re contributing to helping reduce the spread of this virus, which ultimately will help end this pandemic eventually.”

Be ready to feel a wave of emotions

Even if you’ve told yourself you’ll likely get Covid-19 eventually and it’s probably not a big deal, it’s still totally reasonable to feel overwhelmed and upset by a positive test. (It’s also completely reasonable to think it is a very big deal, and to feel afraid.) “It’s okay to be concerned, it’s okay to have those types of feelings,” Madad says. “No one wants to experience illness of any kind, whether we’re talking about Covid-19 or any type of a virus — no one wants to get sick. That’s not a condition that anybody wants to experience, especially when you talk about a variant that we’re still learning more about.”

It’s also very normal to feel a sense of shame or guilt, but Madad says it’s important to not let those feelings stop you from taking necessary steps to protect others. “Regardless of how you got infected, you want to do the right thing in terms of preventing other people from getting sick and contributing to that community transmission that is happening,” she says. That means telling close contacts they need to get tested and taking isolation seriously. “I think there should be no shame, no embarrassment,” Madad says. “You’re doing community service — you’re letting people know to protect themselves, because you’re infected, and you want to make sure that you’re staying away from them.”




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