We’re still not done with omicron.

As the variant’s sublineages continue to spread, the risk of testing positive and potentially suffering long-term consequences continues.

Nearly 2½ years into the pandemic, unvaccinated people of all age groups remain at higher risk of testing positive, being hospitalized and dying from COVID-19 than do those who have been vaccinated.

Unvaccinated Washington residents ages 65 and older are 3.4 times more likely to be hospitalized and 4.6 times more likely to die of COVID-19 compared to their peers with two doses of a COVID-19 vaccine.

But as the virus mutates, it is becoming more evasive of vaccine protection. That doesn’t mean we should just quit precautions, public health experts say.

“I think the risk is significant in that a lot of us are going to get exposed to it and get it over time, but I don’t look at that as a reason to be complacent about it,” said Mark Springer, an epidemiologist at the Spokane Regional Health District.

Public health officials continue to recommend booster doses to offer the best protection.

About 58% of eligible Washington residents 12 and older have received a booster dose.

In Washington, 16 children and teens have died from COVID-19 since January 2021. When the omicron variant surged in the state, it led to high case counts in schools and more intense impacts on kids, even though it typically sends fewer people to the hospital overall.

Omicron can cause long COVID, and researchers are beginning to see patients with symptoms that linger far after a positive test result.

“We’ve seen it in clinical and research patients,” said Dr. Rachel Bender Ignacio, who directs the clinical research center at the Fred Hutchinson Cancer Research Center. “We see long COVID in people who’ve not been vaccinated and in previously vaccinated people – the fact that we see it in those patients should not dissuade people from getting vaccinated or boosters.”

COVID is not just an upper respiratory tract infection; it can impact several organs, from the heart to the liver, as well as a person’s brain or sense of smell and taste.

It’s also possible to test positive again after already having omicron with one of its sublineages, Bender Ignacio said, and while this is not yet common in the United States, it’s happening elsewhere. Each sublineage of omicron is related but slightly different than the initial strain.

Omicron is not only more transmissible than delta was, but it evades immunity better than previous variants.

The research continues to happen in real time when it comes to long COVID risk. Bender Ignacio said there is not enough data to show that available treatments prevent long COVID, but the hypothesis is that they might, and at the very least, treatment might enable a person to have a lower chance of developing long COVID if they can clear the infection faster.

Treatment available

All said, we’ve never had a better chance at evading significant consequences of COVID-19 with treatment and vaccines.

Paxlovid is available to some, including older people, those who are unvaccinated and anyone with certain medical conditions as determined by the Centers for Disease Control and Prevention.

If a person tests positive for COVID-19, they should ask their doctor about treatment or seek care at an urgent care or community health clinic.

Providers are hopeful that treatment options will expand to more people in the coming months.

“We need COVID treatment accessible for everybody, and not just high-risk people, because it’s not just an upper respiratory tract infection,” Bender Ignacio said.

There is more treatment available for COVID-19 in the community than even a few months ago, and Springer encouraged people who are at high-risk for complications with COVID-19 to make a plan with their health care provider in case they test positive.

“It is a game changer for people with complications, regardless of your vaccination status,” Springer said, adding that if a person tests positive for COVID-19, they should contact a health care provider to inquire about Paxlovid or other treatments. The medications work best when started early, and they are administered for people regardless of whether they have been vaccinated.

Dozens of local pharmacies and clinics have monoclonal antibodies and Paxlovid to treat COVID-19.

Assessing your risk

People who are immunocompromised, older or have underlying health conditions are still at risk with new sublineages of the omicron variant circulating.

From February 2021 to mid-April 2022, people with two doses of a vaccine made up 25% of people who have been hospitalized with COVID-19.

Among breakthrough cases recorded in Washington from January 2021 to mid-April 2022, there have been 2,119 deaths recorded, and a little more than half of those people had underlying health conditions, state data show.

While rising counts are not translating to as many hospitalizations as previous waves of the virus, the odds of testing positive increase with higher community transmission rates.

Springer recommends keeping an eye on community transmission levels, and the health district plans to change its dashboard soon to reflect the more immediate risk to community members.

It is difficult to gauge exactly how many cases are in the community now, according to Springer. With at-home and over-the-counter testing available, cases are likely undercounted.

Springer said the community transmission, or how many cases are being seen in the county per 100,000 residents, is a good measure to help weigh risk and the need for mask wearing – especially for those considered high-risk.

That rate has increased in recent weeks in Spokane County. The two-week case rate for Spokane County is 163 cases per 100,000 residents.

As the pandemic becomes one of individual risk instead of collective risk, it’s important to understand what factors can be controlled, from masking to getting boosted. For Springer, that meant another booster dose.

Natural immunity, which used to appear to last much longer, seems to be shortened with the introduction of omicron, he added. People who tested positive during the delta wave have also tested positive during the time omicron was circulating.

“Now we’re seeing more reinfections, and we won’t really know that true risk until after the fact, which is why I think it’s still important to keep in mind the benefits of vaccination,” Springer said.

Ultimately, he said he believes it’s still worth it to try to dodge the virus and take precautions when possible.

“I don’t want long COVID, and I do want to protect those people around me still, but that can also be balanced with returning to more aspects of a normal life – it’s not a binary choice for people,” he said.

The Spokane Regional Health District did not post new case counts on Friday because the district is updating its dashboard to reflect a weekly case rate, based on real-time case data instead of when cases are reported to the district. On Monday, the district will post Friday numbers.

SRHD will report a weekly case count starting next Friday.