Vice President of the United States Kamala Harris returned to work at the White House on May 3, 2022. She in fact delivered a fiery speech decrying the content of a leaked draft of an upcoming Supreme Court of the United States decision which advocates reversal of the Roe vs. Wade decision of 1973. Even though this is a draft of the decision, the final version will profoundly affect the healthcare decisions available to the women of America. In that further discussion of this issue is not within the purview of this COVID-19 update, let us revert to detailing relevant feature of the COVID-19 contracted by the fully vaccinated and doubly boosted VP Harris. She has remained asymptomatic before and after the positive rapid antigen and PCR tests on Monday, April 25.
Acknowledge that being fully vaccinated and boosted does not prevent one from testing positive or even becoming symptomatic. Nevertheless, having protected yourself in this manner is likely to ensure that you do not become severely ill, hospitalized, or die from this virus. Vice President Harris was tested because she was planning to visit with the President that day and, like everyone that visits with him, is fully vaccinated, and tested shortly before they visit. Note that the CDC recommends that we get tested if we become symptomatic or five days after we are in close contact with a person who has tested positive, regardless of symptoms in either. “Close contact” is defined as being within six feet of a person for more than a cumulative time of 15 minutes over a period of 24 hours, irrespective of masking.
After testing positive, the VP quarantined for five days, with the day of the test being day zero. This is exactly what any person should do under these circumstances. The value of testing early, whether symptomatic or not, is that certain effective treatment modalities require usage within five days of the positive test. Specifically, the oral medication Paxlovid (Pfizer) has emergency use authorization for “mild to moderate COVID-19 in individuals 12 years or older and weighing at least 40 kg (88 lbs.) … who are at high risk for progression to severe disease”. If you have a positive test and meet these other criteria, contact your healthcare provider for this prescription only five-day course of oral treatment. The drug has been shown to decrease the risk of hospitalization and death by 89%. It works by blocking the replication of the virus in the body but only when given within five days of the illness or a positive test. There is debate about administering the drug in asymptomatic individuals. This is muted by the recognition that a person who is without symptoms today may be terribly ill tomorrow. The lives of those with comorbidities such as heart, lung, and kidney disease: obesity, diabetes, cancer, organ transplants and the immunocompromised may be saved by getting this medication at an appropriate time.
Because of White House protocol, Ms. Harris was retested on day six and it was negative. She came out of isolation/quarantine and began the required five-day time period of mask wearing. The CDC protocol (Jan.4 ,2022) does not require retesting but does recommend the wearing of a well fitted mask while around others for five days after the isolation period has been completed. If you chose to retest and the test is positive, then you should remain in isolation for the full ten days from the initial test. The recommendation for masking after isolation is based on British data which shows that 31% of persons who tested positive were still infectious after the five days of isolation. Masking protects those around you, especially the high-risk and immunocompromised. It is critically important to understand that in order for the isolation period to end a person must be asymptomatic and afebrile (without the use of fever-reducing medications) for 24 hours. The nuisances (what-ifs) to the CDC isolation and quarantine recommendations are available at https://www.cdc.gov/coronavirus/2019-ncov/your-health/quarantine-isolation.html.
Each of us can become infected with COVID-19, just as the VP. Being vaccinated, boosted, taking advantage of the scientific advances, and following protocols provide us with the best chance of returning to our normalcy.
Clyde E. Henderson, MD
Cincinnati Medical Association