New variants have driven case counts up. Now, hospitalizations are increasing, too.

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Mike Zelek, the director of the Chatham County Public Health Department, says there’s a lot of COVID out there.

And that’s not just because the number of N.C. counties with “high” COVID-19 community levels has jumped from less than a dozen a few weeks ago to more than 60 today.

Zelek is feeling it — in every sense.

“I have been in isolation this week after testing positive,” he told the News + Record last week. “This experience has given me added perspective not only on preventing COVID transmission, which is often our primary focus, but also on how to prepare for an infection should you or someone in your household test positive.”

COVID, he said, “packs a punch.”

“And I continue to feel it almost five days in,” he said.

By last winter, the Centers for Disease Control and Prevention had estimated 58% of the U.S. population had been infected by SARS-CoV-2, the virus that causes COVID. Since then, a new wave of infections driven by Omicron variants has increased case counts and, most recently, hospital admissions.

Zelek, after being surrounded by COVID for more than two years but never being infected, is recovering. His advice at this point in the pandemic, based on his diagnosis and time in isolation:

• Stock up on at-home rapid tests before you feel sick.

“These are our best testing tools right now given their ability to give results in 15 minutes and to be self-administered without leaving the house,” he said. “The public health department continues to offer them in our lobbies free of charge.”

• Make a household plan for isolating. If someone in your household tests positive, think about how to separate them from those who are not yet infected.

“From personal experience, I know this is often easier said than done, but having a supply of N-95s on hand will also help reduce risk,” Zelek said.

• Consider your options for treatment and discuss them with your doctor.

“If you test positive, reach out to your doctor to discuss treatment options early,” he said. “Medications like Paxlovid reduce the risk of more severe illness but must be started within the first few days of infection. If you don’t have a doctor, call 1-888-675-4567. Don’t delay in starting the conversation.”

• Consider the essentials. Neighbors and family members can offer tremendous support, he said, including picking up groceries and medicines so you can stay home. Think about who may be able to help you if you become ill.

And finally: “Get vaccinated and boosted.”

‘Not a choice’

“This is not a choice between getting vaccinated or getting COVID; it is whether you have protection with the vaccine when you are exposed to COVID,” Zelek said. “I am grateful I did.”

That’s a message he’s continually preached, but it’s even more relevant now, he said, because of the virus’ unpredictable variants and subvariants — which vaccinations have helped stave off.

“This recent wave is linked to the BA.5 subvariant, which is highly infectious and more likely to cause reinfection among those who already had COVID, even recently,” he said. “While the latest subvariants tend to cause on average more mild infection, this does not mean you will not feel sick and can go about your business. Fatigue, sore throat, and fever are among the common symptoms I have experienced, and I’ll say COVID has hit me harder than I expected it to.”

Dr. Andy Hannapel, the chief medical officer at Chatham Hospital, said variants will continue to mutate, which warrants everyone’s attention.

“The story of coronavirus, you know, is that at any given time, there are hundreds of thousands — if not millions — of genetic mutations that the virus goes through,” he said. “Clearly, the vast majority never survive.”

Our natural immunity systems or problems with genetic sequencing of the virus eventually put those mutations down, he said. But the ones that make it through — such as the Omicron BA.5 variant — can wreak havoc. That’s now accounting for about 70 percent of cases in hospital intensive care units, he said.

Hannapel laments that masking and social distancing — practices that have proven to work, he said — are much less common when compared to two years ago. With the growth of at-home testing (few at-home testers report results) and that so many with mild symptoms don’t get tested, it’s no wonder case counts can spike rapidly from waves caused by new variants.

The good news with BA.5, he said, is that most of those infected see symptoms similar to a common cold — lots of coughing, congestion, etc., lasting a day or a few days.

‘But it’s not nothing’

The BA.5 variant tends to impact the upper respiratory system, he said, and less frequently the lower respiratory tract — again, making it feel more like a common cold for many who are infected.

“But it’s not nothing,” he said.

Like Zelek, Hannapel knows first-hand: shortly after he and his wife embarked on a vacation in July, both were diagnosed with COVID. He struggled with some fatigue, but was back at work within a week or so.

The majority of hospital admissions continue to be primarily among the unvaccinated, and most deaths are among the elderly — particularly those who have comorbidities that make COVID more dangerous. But he also says it’s more common now to see those who are vaccinated be hospitalized and even re-diagnosed.

It’s important, he’ll tell you, to understand how and why that’s happening. Hannapel said despite a work environment at the hospital with high levels of the virus present, with masking and other safety precautions in place, “it’s really the safest place we could be.”

It’s “out in the community” where he and his fellow medical professionals are getting exposure.

Which makes the argument for vaccines and boosters even more compelling.

“The vaccines work,” Hannapel said. “They work if you’re in the high-risk population, and if you’ve been boosted once, you should be boosted again. Don’t wait until the fall … we’re in the middle of a surge right now, so the recommendation is if you are in a higher-risk population, you should be boosted. This is not something you want to take a chance with, especially when the community spread is so high. There’s a reason transmissibility is easy.”

‘People are tired’

Hannapel says there’s recognition that people have COVID-19 fatigue.

“We know people are tired,” he said. “But the pandemic is not over, unfortunately. I wish it was. It’s going to be folded into our regular onslaught of diseases that we encounter.”

The question, he says, is how it’ll look moving forward. Seasonal, like the flu? Or something with a different cadence?

“We have yet to figure that out,” Hannapel said. Among the most significant unknowns are how new variants and strains will exploit our immune systems.

He said risks of illness, transmission, long COVID and worse still remain possible — is that worth not taking precautions, he asks?

“It’s just not worth it,” he said.

Zelek agrees, and says Gov. Roy Cooper’s plan to lift N.C.’s COVID state of emergency on Aug. 15 shouldn’t be misinterpreted as a sign that the pandemic has ended.

“We have known the state of emergency would end at some point when COVID was still with us,” Zelek said. “Thankfully, we have tools in vaccines and treatment options to help us through it.”

Monkeypox

Meanwhile, North Carolina’s monkeypox case count is growing – 34 cases as of last week, rising to the 50s this week, though none yet in Chatham County.

Monkeypox is a virus transmitted primarily through close, physical contact, Zelek said; it’s most telling symptom is a rash that may look like pimples or blisters.

“Anyone can get monkeypox, but many of the cases identified in the current outbreak to date have been among men who have sex with men,” he said. “We are encouraging anyone who meets the following criteria to get vaccinated. To do so, call our clinic at 919-742-5641.”

If you’ve have had close contact with someone who has been diagnosed with monkeypox, or have unexplained bumps, sores, blisters, or pimples that look like monkeypox, get tested, Zelek said.

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