The Immunocompromised Must Not Let Down Their Guard Against Omicron

Doctor zhou January 7, 2023

Most people recover from Omicron within 2–4 weeks and develop antibodies. But the immunocompromised, even without obvious symptoms, do not easily self-recover or build enough antibodies.

A relative back home told me today: a family member has had Omicron for a month; a repeat test today is still PCR-positive with insufficient antibodies. From infection until now she has stayed asymptomatic, yet the PCR will not turn negative. Strictly she is not fully asymptomatic, because she always feels slightly off, though she cannot say what.

So today I advised her to take for a while the medicine I gave her—the Chai Gui Jing Fang Baidu Xiefei Wan I self-designed and mentioned in my article "My Empirical Formulas for Treating COVID-19 and Its Complications"—and then repeat the PCR.

Now and then people tell me of someone nearby who "recovered" and then dropped dead. That is lay talk; these patients never actually recovered. Omicron is cunning: it lurks in us; when we are well-rested and our immunity good, it hides quietly; when we overwork, get chilled, or immunity drops, it counterattacks. So "reinfection within five days or two weeks" is nonsense against common sense; such patients never recovered in the first place.

We say most people build IgG antibodies within two weeks, but not everyone does. Some immunocompromised people fail to build enough IgG even after a month, and the PCR stays positive; these are the people who suddenly fall ill when overworked or chilled.

I now observe quite a few elderly (and even some young) patients spiking blood pressure while ill. What was a normal under-140 pressure may soar to 160 or 180-plus; or some hypertensive patients drop反常ly to normal. These patients are stroke-prone, which is why so many Omicron deaths are strokes.

China has stopped routine PCR; most people need not test. But those in poor health with weak immunity should, after infection, test PCR a few times to see whether they have cleared. Antigen tests may be unreliable because their window is short and they miss cases.

Some asymptomatic people repeatedly test antigen negative and happily think they were chosen ones who dodged infection; actually they are just antigen-negative, and PCR would still detect them.

But for the great majority of asymptomatic people, testing is pointless—they are healthy and Omicron cannot touch them. Only those over 60 or with major illness need antigen and PCR; if not negative, they should seek treatment.

Over 99% of this wave did not go to hospital but got through at home. This was a forced measure in a medical crunch, not a recommendation against hospital care. Not treating does cause some damage; immunocompromised people who neither treat nor test do not know whether they have cleared or built IgG.

Some online guidelines say recoverees should rest for a month like postpartum confinement. For ordinary people, a month is enough; for the immunocompromised, it may not be. I suggest that after the care peak passes, people with weak immunity go to hospital for PCR and antibodies, use some right-supporting and antiviral drugs, and rest longer.

I have repeatedly stressed in articles that within a year of infection, the risk of stroke and sudden cardiac death is 63% higher than in the uninfected. I did not earlier know why; by recently watching the blood counts and vital signs of many infected people, I now understand: many have damaged vessels after infection, and their homeostasis seems disrupted—blood pressure, blood sugar and counts are abnormal. So we should monitor our own oxygen saturation, blood pressure, blood sugar and temperature.

My father is 74, with coronary heart disease and emphysema; though his oxygen saturation is now 98% (a level most young people cannot reach), I still will not let down my guard. I keep monitoring his vital signs, and at one month I will have him tested for PCR and antibodies. Accurate care avoids accidents; accidents happen through complacency.

Yet we need not panic about this virus. From people around me, I feel its lethality is limited: it may not kill even one in a thousand, and the dead are mostly the very old with severe underlying disease. Cluster deaths most likely reflect other outbreaks in the community or nearby clinics—flu or bacterial cross-infection.

Many this time caught influenza, RSV, and also Klebsiella, Staph aureus, Streptococcus, Aspergillus and others alongside COVID. With more than one pathogen, death risk rises sharply.

Many people are actually felled by bacterial or fungal infection but blame Omicron. Those clearly coughing yellow or greenish phlegm mostly have bacterial infection; some with white sticky phlegm also have it. Some elders cough thread-like phlegm—that suggests fungus. If these patients keep treating themselves as purely viral, they are treating the wrong cause.

So many people tell me they had no aversion to cold this time; they even felt hot, with peeling lips, and think this COVID is wind-heat, not wind-cold. They do not know they also have a bacterial or fungal infection, or that resistant bugs or fungi have long colonized them; now the virus has cleared the immune system and the resistant bugs and fungi run wild.

These patients cannot copy the ordinary Omicron regimen; their treatment must include antibacterial care. If your symptoms differ from those of most Omicron patients around you, take heed and best go to hospital to check for bacterial or fungal infection; if present, copying the ordinary regimen may be harmful. Most hospitals and checkup centers can now test ordinary patients, and antibiotics are not hard to buy. Scientific, proper treatment leads to quick recovery.

My sister-in-law had a bad cough after Omicron and assumed Omicron caused it. On the phone I took a careful history: she was coughing yellow phlegm with dry mouth. I knew she had a bacterial co-infection, so I did not recommend the Omicron regimen; I had her take cephalosporin for two days, and the cough stopped.

Also, many people recently went to hospital and found ground-glass shadows or lung nodules, and panicked to me. Last year, before controls lifted, I wrote four popular-science articles on lung nodules: "Lung Nodule Basics 1", "Lung Nodule Basics 2", "Lung Nodule Basics 3", and "Lung Nodule Basics 4". If you are panicked by lung nodules, read these links and learn the basics; it will ease your fear.

The great majority of lung nodules and ground-glass shadows appearing in this wave vanish on their own within three months and need no special treatment. Those that do not were not caused by Omicron but were pre-existing benign or malignant nodules. Some are high-risk nodules the doctor flags on CT—e.g. spiculated nodules may signal lung cancer. But those are a different matter from infection-related nodules, unrelated to Omicron; do not blame Omicron.

I myself have long-colonized resistant bacteria, but they are not very lethal, so I rarely worry. As a child in the village, after an improperly treated cold, resistant bacteria colonized my upper respiratory tract. Now whenever I overwork and immunity drops, I cough—but however severe, CT shows normal lungs.

I have worked out my own way to deal with it: moderate exercise plus more sleep. Usually two weeks of more exercise and extra sleep stop the cough without medication.

If I cannot sleep well, I take the patent medicine Erzhi Wan. The label says it is a gynecological drug, but for many it is a fine anti-anxiety, calming and sleep aid, and it also treats hair loss. Taking it I sleep deeply, and after a while the cough stops—this never fails. When work stress causes alopecia areata, half a month of Erzhi Wan regrows hair—also reliable.

When work stress is low, I do not need Erzhi Wan and fall asleep the moment my head hits the pillow, recovering quickly. But when the load is heavy, I rely on Erzhi Wan.

I do not like antibiotics now because as a child our village clinic gave them to us at every turn. I was allergic to penicillin and nearly died once on the way home from the clinic; the memory is seared. So note your own drug allergies: if you now have a bacterial infection and a penicillin allergy, do not take amoxicillin, or a serious accident may result.

Of course not everyone gets sleep and hair growth from Erzhi Wan, and it has side effects: some get diarrhea; women may have prolonged or even absent periods. So it is not for everyone.

The key to beating germs with your own immunity is exercise and rest, though in this period that is a luxury for me. But for patients with the means, I hope you rest well, drink a little more water, and sleep more; most mild symptoms self-recover. Those that do not must be correctly diagnosed and treated symptomatically—not at random.

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