Boston Public Health Commission director responds to readers’ COVID-19 questions
Can we resume life as usual after fully recovering? Not quite, says Dr. Bisola Ojikutu.
No one could’ve imagined that we’d be in the coronavirus pandemic for this long or that we’d still be learning how best to stay safe and healthy against the virus.
Boston has seen a decline in positive cases in recent weeks but questions still remain about how to best protect yourself and loved ones as we navigate another pandemic winter.
Boston.com asked readers what questions they had about COVID-19 best practices and they shared their lingering concerns on proper masking, usage of rapid tests, and when to seek emergency care.
While some cities in Massachusetts are starting to lift restrictions, Mayor Michelle Wu’s administration recently said the data doesn’t support Boston doing the same just yet.
On Wednesday, Education Commissioner Jeffrey Riley announced the state will end its mask mandate for all K-12 students and faculty and for licensed child care providers on Feb. 28.
We shared the top reader questions with Dr. Bisola Ojikutu, executive director of the Boston Public Health Commission, for her response.
While there’s been important progress, Dr. Ojikutu said, “[W]e need to continue to use the mitigation strategies that we know work.”
Ahead, Dr. Ojikutu answers top reader-submitted questions about how to navigate the current phase of the pandemic.
Are precautions still necessary?
One reader asked, “If you’ve recently had and recovered from COVID (and are fully vaccinated/boosted) what are the best practices for interacting with others?”
Positive case averages are down from the record highs of December and early January, leading some to say that the worst of the omicron surge is now behind us. Given that the case rates are trending downward, can we resume life as usual after recovering from COVID? Not quite, according to Ojikutu.
While we’re “definitely trending downward,” Ojikutu said the infection risk is “still rather high.”
The more people who are boosted “the less likely there is to be onward transmission,” but there are still cases of people getting infected after getting their booster shot, Dr. Ojikutu said. There are several factors that could influence when and if you get infected with COVID again.
“I think it’s also important to note that we are still concerned about our healthcare infrastructure. Hospitalizations are still high even though they’re no longer increasing.”
James from Quincy wanted to know how to go about taking precautionary measures now that he’s triple vaccinated.
“Caught Omicron in January and fully recovered,” he said. “I’m vaccinated and boosted, but do I need to worry about wearing a mask because I have hybrid immunity for the short term? Can I relax my safety procedures a bit?”
Ojikutu said that his risk of contracting the virus is significantly lower because of his vaccination status, noting that getting a booster shot was 90% effective at preventing severe illness and hospitalizations. Still, even while vaccinated getting COVID is still a possibility so she recommended continuing to mask indoors.
Pete from Gloucestor wrote, “I am vaccinated and boosted as of November. I contracted COVID mid-December and am fully recovered. How soon could I get COVID again?”
“After contracting COVID-19, most individuals will develop natural immunity or some level of protection from a repeat infection. Data suggest that people retain evidence of immune protection for months following infection,” she said. “However, the actual duration and strength of the protection varies by individual and is also dependent upon the circulating variant. Omicron is more capable than previous variants of evading our immune defenses and causing reinfection.”
Having a combination of vaccine immunity and natural immunity “provides people with more protection than either does alone,” and further reduces the risk of reinfection.
“Although breakthrough infections still occur, vaccination with boosting provides protection against severe illness and hospitalization,” she said.
Even if you are vaccinated and have had COVID-19, you should continue to take all appropriate precautions, according to the director. This includes indoor masking and testing when needed.
“Everyone who is eligible, even those who have had COVID-19, should be vaccinated and boosted,” said Dr. Ojikutu.
How should we handle mask-wearing?
The question of masking has caused some confusion at various points of the pandemic, first as we learned how to use them and then as the changing variants called for different kinds of masks.
“Why are we still wearing cloth masks if the CDC says they don’t work?” Everett S. from Wellesley wrote.
At this stage of the pandemic, Ojikutu recommends the average person mask indoors with a multi-ply surgical mask rather than a cloth one.
“Masking indoors is very important given the high transmissibility of this variant,” she said.
KN95 masks offer the most protection against the virus, she said, and are the best option for those at higher risk of infection. Above all else, any mask you wear should fit correctly.
“We should all be wearing a well-fitted mask over our nose and mouth. That’s important too because even if you have a higher grade mask, it may not be well-fitted.”
What if we have ‘mild’ COVID or are asymptomatic?
Leigh from Boston asked, “If my family is diagnosed with COVID and we are all relatively asymptotic or symptoms are mild (runny nose, mild cough, no fever), are we in the clear to hang around with another family in the same situation?”
Given how highly transmissible omicron is, there are many households where more than one person is infected at the same time. If multiple members of a household are positive for COVD, “it is generally believed to be okay to isolate together,” said Dr. Ojikutu.
“Omicron is so prevalent right now that it is highly likely that all household members have the same strain. But if you were exposed together and only one person is sick, you shouldn’t assume that the other person is infected and isolate together. All household members should be tested to confirm infection if exposure has occurred,” she said.
Vaccinated or not, there’s still a risk of getting COVID, and while having all necessary doses of the vaccine helps decrease the risk of getting a severe case, there are still things to look out for with “mild” cases.
“If you do have an infection and you’ve been vaccinated and boosted it is more likely to be mild,” Ojikutu said. “However, there are some people who will experience worse symptoms even if they are vaccinated and even if they are boosted.”
Regardless of your vaccination status, if you have mild or moderate symptoms but know you have an underlying illness, Ojikutu said you should contact your doctor as soon as possible to get access to treatments to “prevent the progression of severe illness.”
If you experience more severe symptoms, including difficulty breathing, chest pains, or cognitive changes, emergency care is needed right away.
When should we use a rapid test?
As omicron spread, Dave from Newton said he was unclear about when he should test for the virus.
“I have a small number of rapid tests stockpiled but I’m not sure when to use them. Should I save them for when I actively have cold symptoms or when I’ve been told I’ve been exposed to someone? Or should I test more frequently, like prior to meeting up with friends for a weekend, even if I have zero symptoms?”
At the height of the omicron surge, limited access to rapid tests led to long testing lines in many cities. Because of the limited access, Ojikutu said rapid testing should be saved for when you’re experiencing COVID-19 symptoms like fever, chills, and coughing or know you’ve been in close contact with someone who has tested positive. Another reason you might test is if you know you will be in contact with someone elderly or immunocompromised.
If you plan to travel or go to an indoor gathering, taking two rapid antigen tests at least 24 hours apart, and as close as possible to the event, will give you a better sense of if you’re infected.
“I would be judicious in regards to my use of rapid antigen testing, just because it’s a resource that is limited,” she said.
PCR testing is the “gold standard diagnostic test for COVID-19,” she said, because of its accuracy level, particularly in the early stages of infection.
But if you’re experiencing symptoms and aren’t sure whether to do a rapid test or PCR, Ojikutu said to take whichever test is most readily available to you. The Boston Public Health Commission has several testing sites located around the city, with most locations doing 1,000 tests each day, and results are typically available within 24 hours of taking the test.
How can we keep unvaccinated young children safe?
Last week Pfizer asked the Food and Drug Administration for approval to administer its vaccine to children under 5, but until that approval happens, many parents of young children are unsure what precautions they should take for their children.
“I have a one-year-old daughter. With her being unmasked and unvaccinated, I worry about her safety in public places, where others may not be following protocols,” said Alison B. from Leominster. “Is it safe to bring her into a store? What rules should family and friends follow to visit our house at this point in the pandemic?”
Each parent should evaluate based on “how comfortable they are with their child’s risk of COVID-19 infection,” Ojikutu said.
“If your child has an underlying illness and is at risk for severe illness, you may not feel comfortable taking them to crowded indoor spaces. Or, if you have few options and need to take your child with you, then you might try to go the store at a time of the day when fewer people are inside and you are able to maintain physical distancing.”
Health experts don’t recommend masking children under the age of 2, and because they can’t be vaccinated themselves, she said it’s important that young children primarily be around older children and adults who are fully vaccinated to lower their risk of infection.
“If you are up to date with your vaccinations, that puts other people at less risk,” she said. “That is the primary thing that we should be doing to protect the youngest and in our communities.”
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