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How to Make Sense of Omicron and Changing COVID Protocols


Jan 12, 2022 – If you’re confused about the guidelines for the Omicron coronavirus variant – which appears to change almost daily at this point – you’re not alone.

The widely reported and record-breaking jump seems easy to understand in everyday cases. Moreover, many unanswered questions remain: Are cloth face masks suitable at all? How can rapid antigen tests help, assuming you can find one? What’s up with the CDC’s 5-day quarantine recommendations? What happens with the flu?

Jane Marazzo, MD, and Joshua Barucas, MD, addressed these and other epidemiological questions during a briefing this week sponsored by the Infectious Diseases Society of America.

These infectious disease experts also shared one thing about the pandemic that gives them hope.

The fast and furious flow of information

Contributing to the confusion is the rapid pace of new scientific developments on Omicron and related recommendations.

“New evidence is coming in on a daily basis,” Barocas said. “We’re still building the plane and we’re flying it.”

People can deal with this deluge of information, including the CDC’s controversial recommendations shortening the quarantine time to 5 days, said Barocas, vice chair of the Public Health Committee of the Infectious Diseases Society.

“The American people can absorb the guidance, even if it comes quickly,” he said. “I like to believe that the American people can absorb this guidance and … discover what’s best in their lives.”

Without dismissing any of the official recommendations, Marazzo said it’s also important to “keep it real”. For example, studies show that people are less likely to spend 10 full days in isolation after they test positive, especially if they have no symptoms or only mild symptoms.

Given that reality, Barocas said, the CDC’s 5-day recommendations make more sense.

“The most likely time to get infected is those five to six days. We ask you to mask after that, we ask you to stay diligent.”

“We have to be somewhat realistic about what people want and what they can do,” said Barocas, an assistant professor of medicine at the University of Colorado School of Medicine.

Four ways to reduce risk

Vaccination, concealment, isolation and testing are the “four columns or four corners of a building” that should all be in place to stabilize them during this pandemic, said Marazzo, director of the Department of Infectious Diseases at the University of Alabama. in Birmingham.

Barocas thinks of these four things as parts of a suspension bridge, and you need all four of those things to keep the bridge standing, he said.

Regardless of the analogy, vaccination and other procedures remain necessary, given the relative lack of other options at present. Marazzo said vaccination could also affect quarantine requirements.

“If you are fully vaccinated, you will get clearance for some of the most stringent quarantine requirements.”

Down to a single treatment with monoclonal antibodies

Vaccination is very important right now, Marazzo said, “because we don’t have anything else to treat ambulance patients with COVID. We have limited access to monocular antibodies that work.”

Also, the lack of a single treatment with a monoclonal antibody still considered effective against the Omicron variant – sotrovimab from GlaxoSmithKline – does not make the picture any rosier.

To illustrate the disparity between supply and demand, she said, “We had 16 doses of sotrovimab, the antibody that works against Omicron last week, when the prevalence of Omicron was 99.8%, and we’re seeing increasing numbers of cases.”

Meanwhile, recently authorized COVID-19 treatments are not yet available in pill form from Pfizer and Merck.

“We don’t have the oral medications yet, and we don’t have any other options,” Marazzo said.

N95s, KN95s and Cloth Masks

Masking benefits aren’t new, but what’s new are recent recommendations that people upgrade their face coverings to N95 and KN95 masks while Omicron increases.

Wearing an N95 or KN95 is recommended “if you can have it and you can wear it and it’s comfortable enough for you,” Marrazzo said.

But in another nod to reality, she said, “There are cloth masks that go over the gloves.”

“If that sounds better to you and is really impermeable and you have trouble going upstairs when you’re wearing a well-fitting cloth mask, should you ditch it and get the N95? I’m not sure,” she said. .

Barocas repeated a common refrain: a cloth mask is better than no mask. But he also said there is a time and place when an enhanced mask is best.

“If you are someone who feels it is necessary to wear a KN95 or N95 around a loved one who is immunocompromised or your children who are not eligible for the vaccine, this is something you should definitely do.

He said, “Personally, I would wear it in large crowded areas where ventilation is poor – like a concert or a museum.”

Recommendations for wearing N95s or KN95s come at a time when they are in short supply again.

“For example, in our hospital, we don’t have enough N95s per healthcare provider at this point,” Marrazzo said. “So we’re still getting people to wear surgical masks in some places.”

Another reality check is that not every upgraded mask is comfortable for everyone. Using the example of workers serving people from behind the counter, she said, “Yes, I would like these people to wear the N95, but the N95s have a great range of comfort. After wearing them for hours on end, I can tell you there are some that you don’t want to wear for 8 hours.” “.

Stop exposing others

Marazzo and Barocas agreed that it was time to stop criticizing personal decisions people make about vaccinations, masks and other preventive measures.

“We have to stop, we just have to unite,” said Marazzo. “And let’s say, look, we’re all going through a challenging reality right now, and we need to give each other tools, whatever tools people are going to use to protect themselves. We need to give them support.”

Barocas agreed that it was time to stop taking sides. “I think we need to look at this as a pandemic for everyone,” he said.

Barocas said there are two things most Americans agree on, namely protecting people who are at risk of becoming seriously ill and avoiding getting sick so they can stay in the workforce.

The pandemic is now “affecting every sector of our nation and in our world,” he said.

What do they think of the test?

Marrazzo recommends that anyone showing symptoms self-isolate if possible, in the right way.

“Don’t go for the test and then wait for the test results to come back” before acting, she said. “Stay home, and it’s best to use a home self-test if available.

“Ideally, if you test and find yourself negative, that’s great,” she said.

If you test positive and you are isolated for 5 or 6 days, you are less likely to be contagious to others. The CDC recommends that people in this situation use caution and stay off the mask for the full 10 days.

Effective treatment with monoclonal antibodies and N95/KN95 masks aren’t the only items lacking in supply, as many Americans know — rapid antigen tests are scarce, too.

“We hope that the supply of tests will increase soon,” Marazzo said.

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

“So while it may not protect you from getting tested, it does protect the people around you,” he said.

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

Don’t forget the flu shot

While the flu is spreading, Marazzo said, it’s nowhere near epidemic levels. However, the flu does affect your immune system, and anything that does that “will make you more likely to get a bad case of COVID,” she said. “We’re not really talking about the flu shot as a way to keep the respiratory system generally healthy and able to ward off things like COVID.”

Reasons for optimism

When asked what was most positive about him at this point in the pandemic, Marazzo opted for the oral antiviral treatment Baxilovide from Pfizer. She said the authorized five-day regimen is “very similar to Tamiflu, and it can make a really big difference.”

She said treating people early with this oral medication could help keep them out of the hospital and could alleviate staffing shortages as well.

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

Barocas has been positive about how much progress has been made in the less than two years of the pandemic.

“I can’t put into words how big my toolbox really is, compared to March of 2020,” he said.

“I felt helpless” at the time, he said. “All I was doing was moving the deck chairs around and trying to keep the boat afloat at the same time.”

Vaccines and other preventative measures, treatments, growth in public health infrastructure, and increased access to genetic sequencing are all bright spots, Barocas said.

“The truth is, I can go to the hospital, and no matter how tired or exhausted we are all, it’s completely different,” he said. “It’s a completely different scene from what we experienced in March of 2020.”