How to Make Sense of Omicron and Changing COVID Protocols

Jan. 12, 2022 — If you are confused about steering on the Omicron coronavirus variant — which appears to alter nearly each day at this level — you aren’t alone.

The broadly reported, record-breaking leap in each day instances appears straightforward to know. Beyond that, many unanswered questions stay: Are material face masks ever OK? How can speedy antigen checks assist, assuming you could find one? What’s up with the CDC’s 5-day quarantine suggestions? What is occurring with the flu?

Jeanne Marrazzo, MD, and Joshua Barocas, MD, addressed these and different pandemic questions throughout a media briefing this week sponsored by the Infectious Diseases Society of America.

These infectious illness consultants additionally shared one factor in regards to the pandemic that provides them hope.

Fast and Furious Flow of Information

Contributing to the confusion is the rapid-fire tempo of recent scientific developments on Omicron and associated suggestions.

“New proof is coming each day,” Barocas mentioned. “We are nonetheless constructing the aircraft as we’re flying it.”

People can deal with this deluge of knowledge, together with the controversial CDC suggestions shortening quarantine time to five days, mentioned Barocas, vice chair of the Infectious Diseases Society’s Public Health Committee.

“The American folks can digest steering, even when it is coming quickly,” he mentioned. “I wish to imagine that the American folks can internalize that steering and … determine what works finest of their lives.”

Without discounting any of the official suggestions, Marrazzo mentioned it is also essential to “hold it actual.” For instance, research present that persons are unlikely to spend a complete 10 days in isolation after they take a look at constructive, particularly in the event that they don’t have any or solely delicate signs.

Given this actuality, the CDC suggestions for five days make extra sense, Barocas mentioned.

“The most probably time that you’ll be infectious is these 5 to six days. We ask that you simply masks afterwards, we ask that you simply stay diligent.”

“We must be considerably reasonable about what persons are prepared and capable of do,” mentioned Barocas, an affiliate professor of drugs on the University of Colorado School of Medicine.

Four Ways to Reduce Risk

Vaccination, masking, isolation, and testing are “the 4 pillars or 4 corners of a constructing” that every one have to be in place to carry it up throughout this pandemic, mentioned Marrazzo, director of the Division of Infectious Diseases on the University of Alabama at Birmingham.

Barocas thinks of those 4 issues as components of a suspension bridge, and also you want all 4 to maintain the bridge standing, he mentioned.

Regardless of the analogy, vaccination and the opposite measures stay important, given the relative lack of different choices for the time being. Vaccination may have an effect on quarantine necessities, Marrazzo mentioned.

“If you might be absolutely vaccinated, you get a move on among the extra draconian quarantine necessities.”

Down to One Monoclonal Antibody Treatment

Vaccination is critically essential proper now, Marrazzo mentioned, “as a result of we have nothing else to deal with ambulatory sufferers with COVID. We have restricted entry to monocular antibodies that work.”

Also, a scarcity of the one monoclonal antibody therapy nonetheless thought-about efficient in opposition to the Omicron variant — sotrovimab from GlaxoSmithKline — just isn’t making the image any rosier.

To illustrate the disparity between provide and demand, she mentioned, “We had 16 doses of sotrovimab, which is the antibody that works in opposition to Omicron final week, when our prevalence of Omicron was 99.8%, and we’re seeing growing numbers of instances.”

At the identical time, the lately approved COVID-19 therapies in tablet type from Pfizer and Merck are usually not but accessible.

“We do not have the oral medication but, and we haven’t any different choices,” Marrazzo mentioned.

N95s, KN95s, and Cloth Masks

The advantages of masking are nothing new, however what’s novel are current suggestions that folks improve their face coverings to N95 and KN95 masks in the course of the Omicron surge.

Wearing an N95 or KN95 is advisable “if you may get them and you’ll put on them they usually’re comfy sufficient for you,” Marrazzo mentioned.

But in one other nod to actuality, she mentioned “there are material masks on the market that match like a glove.”

“If that feels higher to you and it is actually impermeable and you’ve got hassle working upstairs whenever you’re sporting your very well-fitted material masks, must you throw it away and get an N95? I’m not so positive,” she mentioned.

Barocas repeated a standard chorus: {that a} material masks is healthier than no masks. But he additionally mentioned there’s a time and place the place an upgraded masks can be higher.

“If you are somebody who feels that it’s a necessity to put on a KN95 or an N95 round your immunocompromised member of the family or your vaccine-ineligible youngsters, then completely, that is one thing that you must do.

“Personally,” he mentioned, “I’d put on it in massive crowded areas the place there’s poor air flow — one thing like a live performance or a museum.”

The suggestions for sporting N95s or KN95s come at a time when they’re once more in brief provide.

“For instance, in our hospital, we do not have sufficient N95s for each single well being care supplier at this level,” Marrazzo mentioned. “So we’re nonetheless having folks put on surgical masks in some settings.”

Another actuality test is that not each upgraded masks is comfy for each individual. Using the instance of staff serving folks from behind a counter, she mentioned, “Yes, I’d love these folks to put on an N95, however the N95s have fairly a spread of consolation. Having worn them from many hours on finish, I can inform you that there are some that you simply completely need to not put on for 8 hours.”

Stop Shaming Others

Marrazzo and Barocas agreed it is time to cease criticizing the non-public selections folks make on vaccination, masks, and different protecting measures.

“We must cease, and we’ve to kind of simply come collectively,” Marrazzo mentioned. “And say, look, we’re all experiencing a difficult actuality proper now, and we have to give one another the instruments, no matter instruments folks will use to guard themselves. We want to provide them help.”

Barocas agreed it is time to cease selecting sides. “I feel that we have to have a look at this can be a pandemic of everybody,” he mentioned.

Two issues that the majority Americans agree upon, Barocas mentioned, is defending people who find themselves weak to extreme illness and keep away from getting sick themselves to allow them to stay within the workforce.

The pandemic is “now affecting each sector of our nation, of our world,” he mentioned.

Their Take on Testing

Marrazzo recommends that anybody who has signs isolate themselves if potential proper method.

“Don’t go get examined after which wait to your take a look at outcomes to return again” earlier than appearing, she mentioned. “Stay home, and ideally use a home self-test if available.

“Ideally, if you test and find out you’re negative, that’s fantastic,” she said.

If you test positive and isolate for 5 or 6 days, it is much less likely you will be infectious to others. The CDC recommends people in this situation use caution and mask up for the full 10 days.

Effective monoclonal antibody treatment and N95/KN95 masks are not the only items in short supply, as many Americans know — rapid antigen tests are also scarce.

“We hope that the supply of tests is going to increase soon,” Marrazzo said.

“When we rapid test at home with an exposure, or with symptoms, rapid tests are incredibly good at detecting infectiousness,” Barocas said. “We’re seeing numbers that are to some of us astronomical — over a million cases. … The use of rapid tests is incredibly important for infection control purposes.”

“So while it may not protect you to get tested, it protects the people around you,” he said.

Knowing your status is important and is something infectious disease experts have been recommending with other infectious diseases for decade.

Don’t Forget Your Flu Shot

While the flu is circulating, it’s nowhere near the levels of an epidemic, Marrazzo said. Still, the flu does a number on your immune system, and anything that does that “is only going to make you more susceptible to a bad case of COVID,” she mentioned. “We don’t really talk about the flu vaccine as a way to keep your respiratory system generally healthy and able to ward off things like COVID.”

Reasons for Optimism

Asked to name the thing they are most positive about at this point in the pandemic, Marrazzo chose the oral antiviral treatment Paxlovid from Pfizer. The authorized 5-day regimen “is very similar to Tamiflu,” she said, “and it could make a really big difference.”

Treating people early with this oral medication could help keep them out of the hospital and could ease staffing shortages as well, she said.

In studies, she said, Paxlovid reduced the severity of illness and hospitalization by about 90%.

Barocas was positive about how much progress has been made in under 2 years of the pandemic.

“I can’t express in words how big my toolbox actually has become, compared to March 2020,” he mentioned.

“I felt helpless” again then, he mentioned. “All I used to be doing was shuffling deck chairs and making an attempt to maintain a ship afloat on the identical time.”

Vaccines and different preventive measures, therapies, progress in public well being infrastructure, and extra entry to genomic sequencing are all vivid spots, Barocas mentioned.

“The reality is that I can go to the hospital and regardless of how overwhelmed or how exhausted all of us are, it’s vastly totally different,” he mentioned. “It’s a vastly totally different panorama than what we had in March of 2020.”