Chickenpox, fit testing and other things you need to know about COVID

Back in the ‘80s – in between wearing teal windbreakers and listening to Duran Duran – tens of millions of kids were coming down with the chickenpox. Ask anybody who ever had varicella as a kid and they’ll all say the same thing: It sucked. You broke out in a rash, got a fever. It just wasn’t fun. But for as terrible as it was to contract it as a child, it was 10 times worse to get it as an adult. So, some enterprising parents came up with the idea to try to give it to their kids on purpose, you know, to save them worse pain down the road. Affectionately referred to as “pox parties,” the solution was to have a child with chickenpox host a sleepover with those who had never had it, thus spreading the love all around.

In theory it was a solid idea. But the Centers for Disease Control and Prevention (CDC) strongly discouraged it for one obvious reason: You just never knew when it could become deadly. 

Today, we are starting to see somewhat of a similar phenomenon happening with Omicron. Or, at least, people are openly flirting with the idea of purposely getting Omicron so they can just get it over with.

“I have heard that, even from colleagues, so it’s not an uncommon sentiment,” said Danielle Scheurer, M.D., MUSC Health System chief quality officer, who oversees all things COVID for the hospital system. “But if we have learned nothing else from all these waves, it’s that we still don’t know how it will affect everybody. And I’m just not sure it’s worth taking the chance.”

With the ever-changing COVID landscape, we are periodically checking in with Scheurer to ask her the most pertinent questions that are hanging in the balance.

Q. What is MUSC Health doing for people who still have residual issues from COVID, the long-haulers as they are called?

A. We have a plan for starting up a long COVID clinic in the very near future. We’re just finalizing recruiting the providers who are going to run it. As for how it will be run, fortunately, there are plenty of blueprints out there, so we know how we want to approach it. For the most part, it will consist of symptom management and reassurance. For example, if you have a prolonged cough, we know how to ameliorate coughs, so we can treat that. Same with sleep afflictions. That said, some people may need a higher level of care – maybe they’re dealing with severe anxiety or depression – and in that case, we may need to refer them to a specialist so they can get the targeted care they need. 

Q. Why, for people who aren’t in the high-risk categories, is the idea of purposely getting Omicron a bad idea? 

A. First off, I’m not willing to take the risk that it will be mild and everything will be just fine. We still have those one-off cases where healthy young people get really sick from COVID, and we just don’t know why. Second is the risk to others. I personally live with my 78-year-old mother-in-law. I’m also more risk averse than other people because the fear of bringing it home to her is substantial. And all bets are off on long COVID. Sure, we think it’s less likely to happen with Omicron, but it’s still not zero.

Q. What percentage, roughly, of our cases are Omicron? What percentage of our admitted COVID patients are unvaccinated?

A. As of our most recent data, we were at 97%, but it’s rising fast. When it comes to the percentage of patients who are hospitalized and unvaccinated, it’s about 72%.  We’re definitely seeing more breakthrough cases with Omicron. Unfortunately, it makes some people think, “What’s the point of getting vaccinated?” But even the ones who are vaccinated and unlucky enough to get hospitalized because of COVID, they’re not as sick because of it. 

Q. How long do you think it will be before there is only Omicron? 

A. Delta will be gone very soon. I’m talking days. Honestly, because some of the data lags a little bit, we might even be there now. 

Q. How easy is it to get tested with MUSC Health, and how quickly can people expect results?

A. We’re in better shape than we were a couple of weeks ago. Our two collection sites are walk-up only, so you don’t need an appointment, and you shouldn’t have to wait long, if at all. As for speed, right now our average turnaround time for results is about 12 hours for a PCR test. 

Q. Are at-home tests helpful or reliable?

A. All of the tests you do at home are antigen tests. Meaning they don’t detect the molecular structure of COVID, so they’re not as sensitive. So on the one hand, they might miss it in the early stages, but on the other hand, a positive is very helpful. If it sees it, it’s probably there. It’s hard to get a positive if you don’t have the virus. But let’s say your at-home test is negative, and you have enduring symptoms for a day or more, it’s probably a good idea to follow up with a more sensitive test from one of our sites. 

Q. Where do we stand on disinfecting surfaces? Is that something that is still done or needs to be done?

A. There’s not really good evidence that COVID hangs out on surfaces for a long time. So these places that do deep cleans all the time, it’s probably unnecessary. But wiping down your desk after somebody who is COVID-positive was around, that’s probably a good idea. As far as routine daily or weekly deep cleans, they might make people feel better, but I’m not really sure they’re doing much risk reduction. 

Q. What kind of mask should I be wearing? Does the answer vary depending on the situation/environment?

A. The CDC just came out with some updated mask guidance. But here’s the bottom line: Any mask is better than no mask. It really boils down to what you can tolerate. If it’s just a cloth mask, wear a cloth mask but surgical masks are more effective than cloth masks and KN-95 masks are more effective than surgical masks. Of course, N-95s are still the gold standard, but that’s when they are fitted properly. For most people, KN-95 masks are a great option because they have very effective filters but also are pretty comfortable and do not require fit testing. They’re cheaper, easier to find and for the average person, do just as good a job. Where N-95s become stronger is when they are fit tested. 

Q. What exactly do you mean by “fit tested”?

A. There are a few different ways to fit test a mask. Usually we do a method where we have someone who knows what they’re doing to fit it to the team member’s face. Then we put the person in a chamber – it kind of looks like a giant bubble – and we spray a sucrose mist into the air, and if they can taste it or smell it, it’s not a good fit. It’s not completely objective, sure, but it’s a pretty solid method, all things considered. All of our front-line care team members have been fit tested for N-95s. 

Q. At what point should somebody who is positive go to the hospital?

A. Certainly, if you are experiencing significant shortness of breath. If you have the luxury of knowing your blood oxygen level, anything less than about 90%, you need to be seen. Chest pain, near fainting, passing out: all the usual “somebody needs to see me” signs apply for COVID. 

Q. How rare is MIS-C, and are there any commonalities in the kids who contract it?

A. MIS-C is a rare condition; it occurs in 316 children per 1 million infections. Of the ones who end up with it, most of them have comorbid conditions like asthma and/or obesity, and most are unvaccinated. But MIS-C is also super unsettling because we get zingers with it too. Sometimes we have a patient that doesn’t fit any of the at-risk criteria, and they get ill, and it’s so confusing. So while it’s unlikely your child will get MIS-C – no one can guarantee it’s not going to happen, even without risk factors. The best protection remains vaccination. 

Q. Can you foresee a future where we aren’t wearing masks and things are relatively normal?

A. I say this all the time, but it’s all about the variants. They will predict our future. But as for returning to “normal,” I’d say we’re nearly there now as far as learning how to co-exist with COVID. Most of us are back to work. Most schools are doing in-person learning. It doesn’t really feel like we are closed up or locked down. People are starting to travel and see their families. I feel like we are finding a decent balance. 

**Have a question you'd like answered? Email it to donovanb@musc.edu with the subject line “Vaccine Q.”