Those of you with kids in New York have certainly heard the news by now - school masking requirements are going away this week! The exact timing and details vary by region and the relevant authorities (i.e. public schools vs. independent schools). But the rapid drop-off in COVID case numbers, hospitalizations and deaths have moved much of the US map from the sea of red we saw in January to an early Spring of green patches, many of which cover of our area.

So what should you do at this point? For a lot of the country, this question is meaningless - masking has either long been abandoned or actively resisted as a culture war wedge issue. In New York city, the Omicron surge had the opposite effect. Masks were everywhere, even outdoors where most experts say they are generally unnecessary. I know that plenty of New York City families are ready to drop school masking in a heartbeat, regardless of their political orientation. But other families are more risk-averse and hesitant to unmask.

In my own practice, I have heard from a number of parents who aren’t quite sure what to do. Keep masking? Stop masking? Mask in some situations? What’s important is that parents and kids understand that the decision to mask should never be seen as picking a “team”. It should never be seen as a permanent choice. And it CERTAINLY shouldn’t be a way of judging each other - you may never know why someone chooses to mask.

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Although I’m not out of my COVID isolation period, I’m feeling much better today. Despite the fact that I have a history of lung problems, my vaccines (including my four month old booster) have held the line. My oxygen saturation stayed good. I didn’t get hospitalized or intubated. I’m still here. The shots seem to be doing what they are supposed to do. And the baby in the picture is my first cousin (once removed) Felix - we will get to him in a bit. I've had a typical winter viral illness with a cough, a runny nose and some brief muscle aches and chills. I've had to shut down my practice. I've been sitting alone in a room. And now that I'm better, I've been keeping busy playing virtual reality mini golf and ping pong with my sons, and writing to y ou. When I think of what might have been, especially remembering the terror of my two hospitalizations in 2018, I am incredibly grateful to everyone involved in creating these medical miracles in record time. Staying alive for me is a big value-add, but it's not why I'm writing to you today. There is another good reason why vaccination is crucial. I recently read two articles on that topic that prompted me to write this - a substack by the brilliant Eric Topol and an editorial by the president of the AMA. I encourage you to read the originals, especially Topol's piece which is brief, appropriately detailed, clearly written and accessible to a non-medical audience.

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Well, I almost made it for two years, but I won the COVID lottery today (January 5th). I had tested negative yesterday morning, got some nasal congestion and muscle aches during the day, and this AM I tested positive on a rapid antigen test.

I spent today rescheduling upcoming patient appointments and surgery, and contacting the families who were in my office yesterday. Since I wear a high grade mask, and the visits are relatively short, it’s not a big exposure. But in addition to regular state reporting, it’s good to let people know even if quarantine isn't necessary (many of my patients are under 5 and unvaccinated).

I'm isolating at home, but I'm happy to take care of my practice as best as I can remotely (I still haven't figured out how to clean out earwax using my VR goggles!). I'm staying alone in the bedroom. My wife, daughter and I are all masking as long as they remain negative on testing.

Even though my booster was four months ago, I suspect that it will keep me safe from severe disease. Right now, I just feel like I have a typical winter cold. Israel has started giving a 4th shot to health care workers and people over 60. I guess this infection is my 4th dose for the time being, but I'll be first in line if they offer that here...

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I haven’t written much about the Omicron variant of COVID-19, because the news (like the virus) is moving very fast, and I may not be the best person to sort through it all for you. And even the people who are most qualified to do that are doing what they should do - waiting for data before giving specific advice and changing guidelines.

But still, if you have been watching the pandemic news over the past two weeks (or if you live in New York City), you will realize that this variant is much more contagious

than previous versions. Just about everyone that I know here knows multiple people - vaccinated and boosted - who have had breakthrough cases. So here are a few things that you might want to consider. And like most COVID stuff, these may all turn out to be wrong in a few weeks, so keep watching the data!

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So many of our conversations about COVID-19 involve absolutes. Vaccines either work or they don’t work. COVID is either a plague of biblical proportions or a media hoax. Masks are necessary everywhere or they are costumes for virtue signaling.

But the thing about COVID - and about all medical topics - is that the real, correct answers are almost never absolute. The most important sentence in medical school is “there’s a bell curve for everything”. That means that while nuance may be long gone from our political debates, it is crucial if you want to effectively manage anything from an ear infection to metastatic cancer to COVID-19. The range of symptoms, treatment options and outcomes for most diseases is very wide, and it's rare there is a simple, single answer to everything. Uncertainty is a big part of medicine, but we still have to make decisions based on the best information that we have at any given time, always looking for more and better data.

Our personal choices make us more or less likely to get COVID. More or less likely to be hospitalized. More or less likely to die or to have long term complications or to pass the virus on to people who can’t fight it very well. It’s an endless game of statistics and probability. Some things, like our choices, we can change. Some things, like our genes, we can't. Why does one person have a brief exposure to someone with COVID and end up in the ICU, while another person stays healthy even though they are unvaccinated and out in bars every night? That's the bell curve!

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