Sunday morning around 7 a.m., my spouse and I were three hours from heading to JFK airport when two pink lines materialized on my Abbott BinaxNOW rapid antigen test.

Catching the coronavirus after nearly two years of dodging exposures was extra disappointing because it meant disrupting a wedding event for the second time during the pandemic. After the lockdowns scuppered our original plans, my spouse and I took legal vows in September 2020. This week, we were due to travel across the country to hold a “second ceremony” – an outdoor Jewish wedding reception on New Year’s Day.

The guest list was mid-sized, with approximately 100 people — all of which were fully vaccinated or boosted. We were also providing rapid home testing kits to every guest and requiring that they take one the day before the reception and the morning of the main event.

Most of these plans were made before the omicron variant was detected in Botswana and South Africa in November — and before California reinstated an indoor mask mandate for all. So, we decided to move forward, feeling confident that the multiple layers of protection could keep the odds low of an infection spreading.

But no amount of precautions can guarantee staying COVID-free – a lesson I’ve learned countless times as a health news editor who has covered the pandemic from its earliest stages. My partner, coworkers and family would undoubtedly describe my adherence to protocols as above average. My exposure potentially happened while I was wearing a mask indoors – but sharing space with someone who wasn’t wearing one. My standards lapsed one time, and omicron got me.

I'm disappointed but also grateful because I have access to both testing and COVID-19 vaccines. Without the at-home tests, which we were lucky enough to order before the omicron wave exploded and drained supplies, I would have walked by hundreds of fellow travelers on Sunday, potentially exposing the people sitting next to me on the plane and imperiling my senior citizen in-laws upon arrival.

My vaccinations, meanwhile, likely kept the worst outcomes from happening, even though my symptoms rapidly intensified after I tested positive. Aside from the rudimentary runny nose and a strong cough, it initially felt like someone was occasionally stepping on my chest just below the collarbone. I began Sunday without a fever, and then my body temperature rose to 102 degrees Fahrenheit in less than three hours. My back and spine ached.

“Think about the worst cold you've ever had,” said Dr. Mark Horowitz, a physician based in the Financial District, who didn’t diagnose me but who described why most people might not have a solid sense of what “mild COVID” truly means. “And, about 10% of the time, a truck hits you on your way to Duane Reade.”

CDC

These points were echoed by a virtual doctor, who spoke with me about three hours after I put in a request for a consultation with my private health care insurer. The long wait is a sign of the epic demand for COVID health care right now, and a reminder of how people lacking access must feel lost.

Based on my virtual doctor’s description, my symptoms started mild, before the effects moved toward being moderate and then circled back to mildish. Imagine feeling teeth-chattering chills, a stifling cough and slight shortness of breath — on and off every six hours. The doctor expects me to make a full recovery, a payoff of the protection from my two vaccine doses plus a booster. But I wouldn’t have known how to track my symptoms without access to health care.

No one should be surprised that I was infected even while boosted. Based on the latest findings from the United Kingdom, the omicron variant is already starting to break through a booster shot’s barrier against infection, though protection against severe disease will be retained for most people.

Omicron’s ability to evade some of our immunity feeds into its exceptional ability to cause infections, even when people follow the rules for the most part. And despite fresh data showing omicron poses less of a hospitalization risk than its predecessor, the delta variant, the recent arrival is already causing a perilous amount of severe disease in New York City this winter.

As this surge continues, it’s valuable to understand the meaning of mild-to-moderate symptoms now that New York state and the Centers for Disease Control and Prevention have shortened isolation periods for positive cases. The new policies will call upon people to self-evaluate their conditions, allowing them to exit isolation after five days rather than 10 days if they have no symptoms or if their symptoms are improving. A similar five-day rule is also now recommended for asymptomatic people who want to exit quarantine after an exposure, regardless of vaccination status.

Under these policies, negative tests are not required to leave isolation or quarantine – and I would be eligible to return to work today or tomorrow.

Testing For My Case

Rapid antigen tests are best at catching contagious cases of COVID-19, while the more classic PCR test is more sensitive and can detect genetic signs of the virus even without symptoms. Some antigen brands offer just a single test, while other kits — like the Abbott BinaxNOW – call for taking two tests over consecutive days.

Following the instructions fulfills the maximum potential for accuracy, and my experience can speak to this maxim. I was negative on the first BinaxNOW test in my kit Saturday morning — a full 24 hours before my nasal swab showed a positive on the second try.

At this point, the New York City health department stated that I should isolate for 10 days, consult with my health care provider for treatment options and inform my close contacts. That’s anyone who spent more than 10 minutes during a 24-hour period up to two days before my symptoms started.

City health policy does not require getting a follow-up PCR test to confirm my case, but my employer does. (WNYC's building manager, who happens to be a certified contact tracer, also called to check up on me).

So my spouse and I walked about 30 minutes to the nearest PCR testing site run by Health and Hospitals, the city’s public health care system. Along the way, we passed a long line outside an urgent care, which we decided to skip. As WNYC/Gothamist published last week, these private health care providers reported longer turnaround times with test results during the pre-Christmas surge in demand.

Upon arrival at the Health and Hospitals site, we waited about 30 minutes, and our line only had about 20 people in it.

"Mild," "Moderate" and "Severe" Depends On Whom You Ask

After returning home, I contacted my private health care provider for a virtual consultation on how best to proceed. An unofficial description of my case might read thusly:

Name: Nsikan Akpan

Age: 35-44

Height: About average for an American male.

Weight: Don’t be nosy! For now, let’s remind everyone that 73% of adults in the U.S. are overweight and 42% are obese.

Vaccination status: Two shots of Pfizer last spring and a booster shot in mid-November.

Symptoms: Runny nose, fever, cough, chest congestion, some aches.

All combined, my health history and vaccination status would predict a mild or moderate case, based on federal and international guidelines. Along with the symptoms listed above, the National Institutes of Health and the World Health Organization describe a mild case as potentially having routine signs such as sore throat, headache, loss of taste and smell, nausea, vomiting and diarrhea.

Both health agencies might also classify my symptoms as moderate because I experienced some light signs of having pneumonia — slight shortness of breath and my wet, mucus-filled cough. Those symptoms possibly indicate that my lower respiratory tract — my lungs — might be struggling a bit. At the moderate stage, both standards would also call for a physical examination or a chest scan to see if the virus had harmed my lungs.

But the two agencies diverge when it comes to blood oxygen levels and the journey between a moderate to a severe state. The WHO says a severe case happens when those levels, known as oxygen saturation, drop below 90%. For the NIH, it’s 94%.

“The key is people can feel fine without realizing their oxygen levels are very low,” Dr. Abraar Karan, a Stanford University infectious disease physician, told WNYC/Gothamist.

To track my situation before it could progress to a dangerous state, my private health care provider advised that I obtain a pulse oximeter, a small device that clips to your finger to measure your blood oxygen levels. My partner is risk-averse, so we actually purchased an oximeter way back in April 2020. So far, my readings have typically been around 99% through Monday, though I did register a 96% during those early hours after testing positive.

Along with the oximeter, my remote doctor recommended fluids, fever-reducing pain relievers and a decongestant such as Mucinex. He also said that I was eligible for monoclonal antibody therapy, which prior to omicron, dramatically reduced the chances of hospitalization and death if taken within 10 days of exposure.

The U.S. Department of Health and Human Services maintains a map of potential providers, but early signs point to the new variant and its mutations bypassing some monoclonal antibodies. Due to this issue and supply shortages, New York State and the city are prioritizing the use of monoclonal antibodies to people older than 65 or those who are immunocompromised.

So for now, I could only gain access to monoclonal antibodies if my case became severe enough for an emergency room visit. My virtual doctor, who was based in California, was likely unaware of these recent rule changes.

How I caught omicron (most likely)

I was likely exposed in one or two places based on when my symptoms started: at the office of my wedding suit tailor or on the subway.

As The Atlantic reported, preliminary findings show omicron has likely shortened the time between exposure to developing symptoms down to three days. With past variants, it was four to five. I had the sniffles late Thursday going into Friday, but my symptoms started in earnest Saturday morning.

Last Wednesday, I went to my final suit fitting, and one of the employees at the tailor’s office had relaxed views on masking indoors. I had reminded them a few times to cover their nose — and even gave subtle hints by occasionally pinching the bridge of my KN95 mask.

Then there's the subway, which I rode on Wednesday. As reporters and regular New Yorkers have lamented on Twitter, mask usage still feels lax on the transit system despite the emergence of omicron. My experience has echoed these tweets in recent weeks.

Masks are most effective when everyone is wearing them indoors. Studies show that facial coverings can block up to 80% of exhaled particles, while reducing a person’s exposure to other people’s particles by 50%. A November 2020 report found that mask usage could reduce the chances of catching the coronavirus during high-exposure events by 77%. New York City health department now recommends that everyone “consider wearing two masks or a higher-grade mask, such as a KN95 or KF94. Using a cloth mask over a disposable mask improves the fit and adds layers.”

But notice none of these trends indicate absolute protection against the coronavirus because masks are just one layer of defense toward partially reducing the risk. The unmasked person at my tailor's office and I were breathing the same air for more than an hour. My mask fits well and can filter out 95% of particles, but, of course, air can still squeeze through the sides, especially when that air is coming from someone nearby.

The same applies to public transportation. Ridership is halfway back to pre-pandemic levels, making it harder to socially distance. Ventilation on subway cars is thought to help stem transmission, but some connections have been made between longer commute times and case rates.

Omicron Is A Bummer

Given omicron is estimated to account for 92% of cases in the New York and New Jersey region, the new variant is most likely what is currently attacking my respiratory tract. The assumption is also safe based on a report released late last week by the U.K. Health Security Agency.

The topline results — as many news headlines noted — showed that COVID-19 hospitalizations appear 50% to 70% less likely with omicron relative to the delta variant. But it also provided some fresh evidence on how the COVID-19 vaccine boosters are faring against omicron.

Early data shows booster shot effectiveness starts to wane against omicron infection after 5-10 weeks. BNT162b2 refers to the Pfizer-BioNTech vaccine, while mRNA-1273 is the Moderna vaccine.

U.K. Health Security Agency.

Their indications suggest that the booster shots temporarily restore effectiveness against omicron’s symptomatic infections to 70-80%. But this immunity wanes again — down to 40-50% — after a month or two.

To prevent this waning, the COVID-19 vaccines would need to be updated to address omicron's mutations, but drugmakers may not be asked to do so or could try additional booster shots in the meantime. That's because the protection against omicron's severe disease is expected to remain intact for most people. The U.K. Health Security Agency's results reiterated that the boosters prevent most symptomatic infections caused by the delta variant.

The report also carried the warning that “even at the reduced hospitalization risk observed, the combined growth advantage and immune evasion properties of omicron have the potential to lead to very high numbers of admissions to hospital.” This pattern appears to be already playing out in New York.

Despite the “omicron is milder” observation, hospital visitations and admissions for COVID-like illnesses are on record pace in New York City. Visitations are beyond last winter's peaks for all five boroughs. Admissions, meanwhile, are approaching last winter's peaks in Queens, Manhattan and Brooklyn. The two metrics offer a sense of how much demand is being placed on the health care system.

The state’s case rates are also twice as high as their previous worst peaks. Gov. Kathy Hochul’s office said about 112,000 positives were recorded Friday to Sunday. Two of every three of these Christmastime infections — about 73,300 — happened in New York City.

Myself included.