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It’s easy to point the finger.
This week, U.S. health officials reduced isolation times for Americans who test positive for COVID-19 but have no symptoms from 10 to five days, and also cut the time that close contacts need to self-quarantine.
After those five days, Americans should still wear a mask around others for another five days, the Centers for Disease Control and Prevention said Monday. People who have a fever should still isolate beyond five days until their symptoms resolve, the agency said.
The new policy comes just days after the CDC announced that health-care workers who previously contracted the coronavirus, but test negative and don’t have any symptoms, could return to work after seven days instead of 10 days.
Early studies suggest that many people who contract the omicron variant will have less severe symptoms, and many will have no symptoms at all, but the highly-contagious variant is fast becoming the dominant strain in Europe and the U.S.
“‘Day 1 is the first full day after your symptoms start, but that’s really Day 6.’”
Dr. Gregory Poland, who studies the immunogenetics of vaccine response at the Mayo Clinic, acknowledges that the new CDC recommendations are frustrating. “The guidelines are changing and getting confusing,” he told MarketWatch.
Both the guidelines and public behavior are less than perfect, he said. “Day 1 is the first full day after your symptoms start, but that’s really Day 6. They’ll dismiss that, and say, ‘I don’t want to get quarantined.’ This is going to get messy.”
And the new recommendations? “They say wear a mask, but it doesn’t say wear a proper mask properly. Of those who wear a mask, how many wear a proper mask? Even fewer. How many wear a proper mask properly? Even fewer.”
“In a crisis situation, they are very liberal because they can’t afford to have people take time off work,” he said. “It’s born of necessity. What do you do when there are no healthcare workers to work, or too few? Something is better than nothing.”
Dr. Gregory Poland: ‘What do you do when there are no healthcare workers to work, or too few? Something is better than nothing.’
Public-health authorities in the U.S. are, experts contend, trying to balance what we know of the omicron variant with the needs of the hospitals, airlines, retailers and other companies that are buckling under staff shortages.
On Dec. 21, Delta Air Lines
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chief executive officer Ed Bastian, medical advisor Carlos del Rio and chief health officer Henry Ting wrote to CDC director Rochelle Walensky, imploring her to reconsider the agency’s recommended isolation times.
“This guidance was developed in 2020 when the pandemic was in a different phase without effective vaccines and treatments. At Delta, over 90% of our workforce are fully vaccinated, and those rates are increasing daily,” they wrote.
“Similar to healthcare, police, fire, and public transportation workforces, the Omicron surge may exacerbate shortages and create significant disruptions,” they added. “All airline personnel are required to mask at airports and on airplanes.”
“‘This guidance was developed in 2020 when the pandemic was in a different phase without effective vaccines and treatments.’”
Poland shares their frustration: “It’s fundamentally driven by the inability of public-health authorities to communicate with clarity the changing nature of COVID, and the unwillingness of the population to follow public-health recommendations.”
“It’s a globe that is a petri dish, teeming with COVID,” Poland added. “Because people didn’t take precautions and because people didn’t get vaccinated, we’ve had continued recirculation of this virus.”
This is the fifth variant of concern. “Omicron primarily appears to be infecting cells in the upper airways of the lungs,” he said. “What happens if it infects the lower airways? Then you have the transmission of omicron with the severity of delta.”
The CDC’s decision to shorten isolation times received a backlash from some members of the public, with many critics taking to Twitter
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to say the letter from Delta Air Lines management influenced its decision.
Walensky is making accommodations for the public’s patience — or lack thereof — in addition to company staffing shortages, says Tina Tan, professor of pediatrics, infectious diseases, at Feinberg School of Medicine, Northwestern University.
“This is a compromise,” she said. “They are trying to deal with a real-world situation.” But Tan added a note of caution to those who exit self-isolation. “You are relying on individuals to wear a mask for an additional five days.”
Dr. Luis Ostrosky, division director and professor, infectious diseases at the Department of Internal Medicine at the University of Texas in Houston, told MarketWatch that the new guidelines leverage recent science about omicron.
The highest infectivity period is from the two days prior to symptoms to three days after symptoms, he said, and the new efficacy estimates for vaccines and boosters (75% for people with the booster shot for disease acquisition).
The guidelines, he said, “address the very real need to get people back at work and out in the community in a safe fashion.” They also take into account that vaccines and boosters provide a high level of protection against hospitalization and death.
The longer the isolation, the more cases you will pick up. “Even at 14 days, people slip through,” said Dr. Aaron Glatt, chair of the Department of Medicine at Mount Sinai South Nassau. And the shorter the isolation? The opposite is true.
“‘Even at 14 days, people slip through.’”
The isolation time depends on the patient and severity of the COVID-19 infection. “All guidelines are, by definition, guidelines. They need to be individualized,” he added. An immunocompromised person, for instance, may be contagious for longer.
Poland said the recommendations “are not optimal, they are probability based in order to maintain the economy and in order to maintain medical-care capacity, and in hopes that people will be more willing to follow less onerous guidelines.”
“In Chicago, pediatric hospitalizations for COVID-19 have tripled over the last week. Hospitals in many areas are in an all-hands-on-deck status. We have four states that have higher peaks of COVID than at any time during this pandemic.”
For those who are angry with the CDC and the government, Poland recommends people do some soul-searching. “Each society creates its own pathology. It’s really pretty simple. Wear a mask and get a free vaccine. It’s maddening.”
“There’s nothing you can say to move people,” he told MarketWatch. “They are solidly stuck in their rabbit hole until it happens to them. Then they call me and say I want everything science knows to do, but it’s too late.”
Tan agrees that people are sick of changing rules, wearing masks, staying home, or even feeling under pressure to go to work when they’re not feeling 100%: “So many people are over COVID that they don’t want to deal with it anymore.”
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