This is post #6 in my COVID-19 series.

#1 is here on general COVID info and precautions (somewhat outdated now)
#2 is here on building a bubble/pod and navigating feelings, communication, and agreements (this info is still valid)
#3 is here on specific risk management strategies using objective tools (this info is still valid too)
#4 is here on the coronavirus variant discovered in the UK, the latest research-backed precautions, vaccines, and more
#5 is here on how risk changes once you or your friends have been vaccinated

Disclaimer: I have no medical background. I’m simply someone who’s read a lot of articles and is skilled at summarizing and simplifying complex subjects.

Reading time: 15 minutes

Quick important update from January 7, 2022:

Are you feeling like it takes too much energy to care about COVID anymore? I get it. It’s SO frustrating that all of this is still affecting our lives. It’s exhausting.

And. Long COVID is terrifying—this is a MUCH more dangerous time than you’re probably realizing given all the news coverage about how “mild” Omicron is. I just read some of the latest research that is much scarier than I’d imagined.

I want you to have this knowledge so that you can make your own informed choices; so, I’ll summarize the most striking facts I took away from each of two threads by one of the researchers:

Meta-analysis of 81 studies on Long COVID posted 3 days ago

1 in 3 individuals who were diagnosed with COVID experience Long-COVID symptoms lasting 3 months or more.
Cognitive impairment and fatigue from Long COVID do NOT seem to improve over time—the rates of both symptoms were the same before and after 6 months.
There was no difference in Long COVID symptoms between people who were hospitalized and not. In other words, even if you experienced a “mild” case and were not hospitalized, you’re just as likely to experience Long COVID symptoms.

Study on Long COVID published in top medical journal The Lancet

(from late 2020, and since Omicron is so new, the jury is still out on how it relates to Long COVID):

There was no difference on any of the following with age—they happened as often in the 18-29 year old group as the 70+ group.
Some of the most common symptoms included: cognitive dysfunction (brain fog, difficulty thinking, forgetting how to do normal routines) (85%), sensorimotor issues (tremors, tingling, skin burning) (~91%), and memory loss (73%). And, 29% of those experiencing cognitive dysfunctions reported “severe” impacts on everyday life.
Less common symptoms (but still affecting millions of people) include: sexual dysfunction in men (15%), suicidality (12%) and new allergies (9%)
Some symptoms only happened (or increased in severity) 6 months after having COVID, e.g., bone ache/burning, tinnitus, hearing loss, etc.

What if you’re vaccinated?

From the journal Nature in November: “Vaccines reduce the risk of long COVID by lowering the chances of contracting COVID-19 in the first place. But for those who do experience a breakthrough infection, studies suggest that vaccination might only halve the risk of long COVID — or have no effect on it at all.”

So, unfortunately, even vaccinated it looks like you’d still have a 1 in 3 chance, or at best a 1 in 6 chance of Long COVID symptoms if you get COVID.

So:

Please get vaccinated and boosted (even if you’ve already had COVID). Even if it might not affect Long COVID, it will at least reduce your chances of getting COVID in general (for the first time or again).
Please upgrade your mask to an N95.
Please wear masks indoors with other people.

And, I know we all have different requirements on us and varying levels of access. I know that mental health is just as important as physical health.

And, please be real with yourself: If you still haven’t been boosted and you have access to the booster, is whatever reason you haven’t gotten it yet worth risking all of the symptoms I detailed above?

Believe me: The last thing I felt like doing was writing another COVID article.

To be honest, I’ve been feeling pretty burned out on the subject, which is why I haven’t written one in nine months. But here’s the thing: The information out there on the Omicron variant has been so confusing that I felt I had to act.

There are so many bad articles out there right now (I blame the 24/7 news cycle that doesn’t allow for a “wait and learn more before reporting” approach), and I know how sick we all are of trying to make sense of all this when one headline says one thing and another contradicts it.

So, because I’m privileged enough to have time and energy to put into this kind of research, I spent a couple of days doing a deep dive into Omicron—first for my community house, to figure out if we need to update our protocols and agreements. Then, I decided I might as well share my takeaways more broadly, even if this post will be less detailed and polished than some of my previous ones.

Here we go!

Let’s start with some good news:

Multnomah County (where I live in Portland, OR) finally dropped down from red to orange on the CDC’s COVID tracker, and the case rate per 100k is below 100, which is an important milestone. I recommend regularly checking your county on that website and adjusting your protocols if it switches from one color to another.
- 12/31 update: Unfortunately, we’re now back in the deep red, with a case rate per 100k of 252. Omicron is spreading very, very quickly.
- 1/8 update: We’re now up to a case rate per 100k of 1,058. Yes, that means a 10x increase in less than 3 weeks (I had written the above about it dropping beow 100 on 12/20). 😟😟😟
The Pfizer oral anti-viral drug will be available in 4-6 weeks, which seems to be extremely effective at reducing hospitalizations and deaths.
Here’s a nice summary of our current situation from the chair of the Department of Medicine at the University of California, San Francisco (recognized as one of the top 10 hospitals in the US): “I think that the risk of getting [Omicron] is certainly at least two times that of Delta. But if you are vaccinated and, if appropriate, you are boosted and you are careful, I don’t think it’s inevitable that you’re going to get it. I can understand that point of view because it absolutely is more transmissible. But if you are taking the kind of precautions that I am now taking – you know, N95s when I’m inside with other people who I’m not 100% sure are fully vaccinated, that kind of thing – I don’t think you have to hide under the kitchen table the way you might have in March 2020. But I think if you take reasonable precautions and you’ve gotten your vaccines and boosters, think there’s a pretty good chance that you will avoid getting it. And the good news is if you get it and you have been vaccinated and boosted, the chances that you will be one of those severe cases is relatively low.”

Some of my key takeaways about Omicron:

Omicron is spreading very quickly. It’s only been 20 days since Omicron arrived in the United States, and it already represents nearly 3/4 of COVID cases here. The WHO says Omicron cases are doubling every 1.5 to 3 days.
Omicron changes things. From the NY Times on December 19: “In the United States, so-called breakthrough cases — infections among the vaccinated — were less common before Omicron, affecting just a small percentage of vaccinated people, by most counts. Now breakthrough cases among the vaccinated are fast becoming the status quo.“
The initial reports saying that Omicron is much less severe than Delta are probably inaccurate (although it’s very unlikely to be more severe). The truth is that the picture isn’t entirely clear yet—the data here has been changing very quickly and anything you read a few weeks ago is probably out of date.
Omicron is definitely more infectious (i.e., transmissible) and evades immunity more efficiently.
It’s quite possible that hospitals will be overwhelmed again shortly.
- Multnomah County (where I live) predicts that by February the hospitalizations from Omicron will be higher than they ever were with Delta. This will likely be the case everywhere.
- So, just like back at the beginning when we all tried to flatten the curve, we need to think about others again now. Yes, we’ve all faced a whole lot of mental health challenges from COVID and we all want to be back out there with friends and family. But, we also have to think about people who are older or immunocompromised and people who need all sorts of procedures from hospitals.
- When you’re deciding whether or not to do something risky, please consider: If you get COVID and need to be hospitalized, you might be taking that hospital bed away from someone else who needs it.
Your level of immunity is not just a binary anymore (i.e., vaccinated or not). There are now 5 levels (described by the Chair of the Department of Medicine at UCSF):
1. Two vaccines + booster + had COVID = super level of immunity
2. Two vaccines + booster = very immune
3. Two vaccines = moderately immune
4. One vaccine or had COVID = minimally immune
5. No vaccine and never had COVID = totally vulnerable. As the White House said in their December 17 briefing, “For the unvaccinated, you’re looking at a winter of severe illness and death for yourselves, your families, and the hospitals you may soon overwhelm.“
In other words, even if you’ve had COVID, you’re less immune than someone who was double-vaccinated, and even if you’ve been double-vaccinated, the booster makes a big difference.
So, two shots alone (without a booster) should no longer be considered “fully vaccinated.” And, in fact, it might even be dangerous to ever consider ourselves “fully vaccinated” in the sense of “I’m completely safe from now on!” The truth is that we’re most likely going to need a regular booster for a long time, at least every year if not more often. Yes, that’s annoying, but also: Wow, what a time to be alive that we have the incredible technology to create new vaccines so quickly.
For more, here are the two best articles/threads I’ve found on Omicron:
- https://twitter.com/Bob_Wachter/status/1471980512503758853
- https://unchartedterritories.tomaspueyo.com/p/the-omicron-question

Here’s some info on why the booster is so important:

The latest study from the Imperial College of London (December 16) found “vaccine effectiveness estimates against symptomatic Omicron infection of between 0% and 20% after two doses, and between 55% and 80% after a booster dose” (in other words, being boosted makes a huge difference).
This study in The Lancet (November 18) found that immunity from two vaccine shots is reduced by nearly 20% after 6 months, and this one found that immunity dropped from nearly 90% to below 50% six months after the second dose of the vaccine. But, the booster gets you back up to your original immunity level or higher.
From a preliminary Duke University study (December 15): “The antibodies that people make after they get the standard two inoculations of the Moderna mRNA vaccine are 50 times less effective against omicron than they are against the original form of the virus… An additional 17 people in the study had received a Moderna booster. And the antibodies in their blood were highly effective at blocking the omicron variant — essentially about as effective as they are at blocking the delta variant.”
According to the New England Journal of Medicine (October 7), “those in the boosted group were 11.3 times less likely to get infected with the Covid-19 coronavirus and 19.5 times less likely to have severe Covid-19 than those in the un-boosted group.”
In terms of which booster to get, mixing and matching doesn’t necessarily make a big difference, but one thing that is clear is if your original vaccine was Johnson & Johnson you should definitely get Moderna as your booster instead. Overall, Moderna seems to be the best booster in general.

My advice:

Please, please, please get a booster—any of them is great, but Moderna is probably the best one if you have a choice.
Recognize that all your feelings of frustration here are normal. It totally makes sense that you’re sick of hearing about COVID and you just want it all to stop. You don’t want to have to think about yet another variant. But we’re all in this together.
1. Please keep taking care of yourself (slow down, get off social media, make time for fun hobbies, etc.), and do whatever you can to encourage all your friends and family to get vaccinated and boosted. This is the #1 most important thing we can all do. If they don’t believe in vaccines, start by listening to their concerns rather than just telling them they’re wrong or making them feel stupid.
2. You could say something like, “That totally makes sense that you don’t trust the government. I often don’t trust them either. I’ve read a lot of great articles though by independent scientists who really helped me understand the research they’ve done, and I’m wondering if you might be open to my sharing a couple with you—not to say that they’re absolutely right, but just so you and I have the same information as a starting point. I know you’ve read some convincing articles too, and I’d love for us to come at this conversation knowing that we’re working from some common facts.”
3. Even so, some people simply won’t be willing to listen. I know it’s hard to be with that. Please take care of yourself and set your own boundaries. And, please also recognize that if we just villify anti-vaxxers and ostracize them, that will only cause them to go deeper down the rabbit hole of misinformation and spend more and more time with other anti-vaxxers to feel belonging. Instead, let’s see if we can keep welcoming them in so they feel belonging with the rest of us too, even if we disagree on some things.
4. 1/1 Update: I made this poster that you might consider sharing with skeptical friends and family.
If you or a loved one gets COVID, here’s a great article explaining the best treatment options available. By the way, if you or people you know have been curious about Ivermectin, the article explains that it “has shown mostly small effects in trials, once fabricated studies are removed.”
If you’re outside, you should be fine maskless even with people who are vaccinated but haven’t been boosted, as long as it’s not too crowded and you’re not too close to each other. Of course, as always, if there’s singing or yelling involved, the risk goes up.
1. Personally, even if we’re outside, if someone isn’t vaccinated at all, I’ll either still wear a mask or else try to keep at least 10ft away.
If you’re inside, I highly suggest wearing a high quality mask (e.g., KN95, N95, KF94) unless you know that everyone there is both double-vaccinated and boosted.
To make decisions about whether or not it’s safe to do an activity or attend an event, multiply all of the following (in other words, if one of these is lower, you’d want to make sure that all the others are higher to make up for it):
1. Personal health level (how old you are, how strong your immune system is, etc.)
2. Type of activity (whether it’s indoors, crowded, etc.)
3. Number of COVID cases in your area (check the CDC’s COVID tracker)
4. Amount of risk-reduction happening at the event (how many people are masking, what kind of masks they have, how good the ventilation is, etc.). Also, is everyone getting tested beforehand (ideally PCR tests, but at-home tests can be pretty good too)?
5. What fraction of COVID in your area is Omicron (at this point it’s probably safe to assume it’s almost all Omicron)
6. Your level of immunity (how many vaccines/boosters you’ve had, and whether or not you’ve had COVID)
7. How important the activity is to you (and, could there be a way for you to participate while also lowering your risk, like inviting fewer people, staying farther apart, using HEPA air purifiers, being outside, etc.)
8. (This is where the Microcovid calculator can be helpful too to do a lot of this for you.)

Thanks for reading, and let’s all continue trying our best to keep each other safe 🙂

P.S. My favorite mask is still the Enro (recommended in this excellent mask guide). It offers protection similar to a KN95, but it’s reusable and much more comfortable.