Not too long ago, I booked my first overseas flight since the beginning of the pandemic. Destination: South Africa, where I used to work as a doctor. Departure date: early December.
I take immunosuppressive medicine for an autoimmune disease. My body mounted little response to the coronavirus vaccine, so even after the shots, I was cautious. But in August, I began receiving monoclonal antibody injections, which I could access because of both my immunosuppression and my work as an ER doctor. If I were exposed to the virus—which I was, potentially, every shift at the hospital—the antibodies would fend it off. When I bought my ticket in October, donning an N95 and flying to South Africa felt not only possible, but reasonable.
Then, on Nov. 24, I awoke to a text from a friend who is an HIV doctor in Johannesburg. “Early signs of a new variant in Joburg,” he wrote. “Will know in 2–3 days, sequencing happening.”
The news did not improve from there. The more scientists learned about omicron, the larger the threat seemed—to public health and the unvaccinated, but also to me, personally. The monoclonal antibodies I’d been getting could grab onto the spike proteins of earlier variants to inactivate the virus. But in lab experiments, these antibodies haven’t recognized the highly mutated omicron variant well; researchers predict they won’t protect me much.
In recent weeks, as omicron has spread exponentially, I’ve backed out of birthday parties and baby showers. On Nov. 27, I canceled my plans to fly to South Africa. I used the time to take a road trip to the Oregon high desert with my dog. I spent Christmas with a novel, instead of with friends or family. I wear an N95 mask every time I head to the corner store. I feel a forced stasis, the purpose of my life diminished to ensuring its continuance. I feel like I’m traveling back in time, like it’s March 2020 all over again.
But it’s not. I don’t plan on living such a restricted life for very long this time around—I don’t think I’ll have to. In fact, I had penciled in a date to relax the confines of my life under the new variant: six weeks from the end of December. I didn’t plan to ditch masks altogether on that date nor to head to a nightclub. I knew the date could shift. But over a lonely holiday, it had been a beacon: Early February marked a point at which I hope to exhale, the approximate date on which I could share a meal with friends or make plans to visit my nieces.
Based on its brief duration in South Africa, the omicron surge in the U.S. may well crest by early February—but I didn’t choose that time with this as my main criterion. Even when we aren’t in a surge, the virus still poses a threat to me. Instead, I have been hoping that three pharmaceuticals—all of which have been FDA-approved for emergency use and which show promise against the variant—will be more widely available by late winter as shipments increase.
The first is Paxlovid, Pfizer’s antiviral, which could revolutionize COVID treatment. When taken for mild or moderate COVID within five days of symptoms, the pills reduced the risk of hospitalization and death by 88 percent in study participants, who were unvaccinated and faced a higher chance of serious illness because of age or comorbidities. Paxlovid acts against the viral protease, which is essentially a pair of specialized enzymatic scissors the virus uses to slice long chains of protein into the pieces it needs to make new copies of itself. This machinery is similar between variants, so omicron shouldn’t evade the drug.
The second breakthrough is access to Evusheld, AstraZeneca’s long-acting monoclonal antibody combination, which the FDA approved under Emergency Use Authorization to prevent immunocompromised people who may not have responded fully to vaccination from getting COVID. In trial data, the injection, which lasts six months, reduced symptomatic COVID by 83 percent compared with the placebo among study participants, most of whom had risk factors for severe disease. Though Evusheld’s activity is reduced against omicron compared with prior variants, several studies so far show that the drug can still neutralize the virus, though real-world data won’t exist for months.
The third development I’m awaiting is better supply of a monoclonal antibody called sotrovimab, which cut the risk of hospitalization or death by 85 percent in outpatients who developed symptomatic COVID. As we are forced to jettison the other antibodies we were using for treatment, which can’t combat omicron, sotrovimab remains powerful, since it latches onto a piece of the spike protein that is relatively similar to that which appeared in previous strains of the virus.
Even though the FDA has approved all three of these therapies, quantities remain critically limited. The government is currently disbursing just 65,000 courses of Paxlovid in a nation experiencing more than 200,000 infections a day, with 10 million more doses—arguably still far from enough—forecast to arrive by the end of summer 2022. Paxlovid also should be started within five days of symptom onset, a difficult prospect when Amazon is constantly selling out of rapid tests and COVID testing sites often book out days in advance. For Evusheld, the first shipments to hospitals contained enough drugs to treat only a tiny fraction of eligible patients, in some places as few as 1 percent. Continued shortages loom unless the government purchases more of the drug. And hospitals are already depleting their limited stocks of sotrovimab, though more should arrive in coming months.
I’d been wagering my sanity that within six weeks, I would be able to get an injection of Evusheld to help protect me against contracting COVID, or will feel somewhat confident that I would be able to receive treatment with oral Paxlovid or intravenous sotrovimab were I to fall ill. My date was informed speculation, during a pandemic in which so much has gone not according to plan. The deadline might have to be pushed into the future, I knew. The date at which it’s safe to exit self-imposed omicron restrictions will surely be later for some at-risk people than for others, based on when they can get access to the game-changing pharmaceuticals.
Before then is a period of limbo. My dad has COVID. My cousins have COVID. A colleague has COVID. I continue to go to work in the emergency room. I’m not sure whether I do that out of well-placed faith in N95 masks or because I’ve simply been inured to danger by the events of the past couple years. “For the next 6 weeks, would step away,” my friend in Joburg texted me a few days ago about my job.
Maybe he’s right. I look at the digital display of patients in the emergency room, where COVID symptoms and exposures are again starting to elbow out aching backs and twisted ankles. I look at the bottle of immunosuppressant pills on top of my microwave and consider not taking them. Perhaps I should let myself get sick so I don’t get sick. I look at the graph of cases in San Francisco, the line tilting near vertically. I make plans to pare back my work schedule temporarily, which pains me as I email colleagues to take shifts.
I start writing this essay, and in this process of completing edits, get a phone call from the health system where I’m a patient to tell me I can book an appointment for Evusheld. My time frame of six weeks shrinks in the span of a single voicemail.
When I began antibody injections this summer, I felt as though I were reentering the world after an interminable period of cradling it in my hands like a snow globe, staring in from outside. I ate kimchi pancakes indoors at a Korean joint in Oakland. I made amaretto sours at home with a friend. I cuddled my friends’ three-week-old baby for an hour.
Six weeks, I kept reassuring myself as the scope of my activities constricted again when omicron hit. I’ve told myself that my life is merely flash frozen, that I will reanimate it soon. I don’t feel sure of much during the pandemic but I do feel sure of that.
Update, Dec. 31, 2021: Due to a production error, an earlier draft of the end of this essay was originally published. The last three paragraphs have changed slightly in this version, but the facts remain the same.
