January 12, 2022 – If you are confused about the guidelines for the Omicron coronavirus variant – which seems to be changing almost daily at this time – you are not alone.
The widely reported, record-breaking jump in everyday cases seems easy to understand. Beyond that, many questions remain unanswered: Are canvas face masks OK? How can rapid antigen tests help, assuming you can find one? What about the CDC’s recommendations for a 5-day quarantine? What happens to the flu?
Jeanne Marrazzo, MD, and Joshua Barocas, MD, addressed these and other pandemic issues during a media briefing this week sponsored by the Infectious Society of America.
These infectious disease experts also shared one thing about the pandemic that gives them hope.
Fast and furious flow of information
The rapid pace of Omicron’s new scientific developments and related recommendations contributes to the confusion.
“New evidence is coming every day,” Barokas said. “We’re still building the plane while we’re flying with it.”
People can handle this flow of information, including the CDC’s conflicting recommendations to reduce quarantine time to 5 days, said Barokas, deputy chairman of the Society for Infectious Diseases’ Public Health Committee.
“The American people can learn the guidelines, even if they come quickly,” he said. “I like to believe that the American people can internalize these guidelines and … understand what works best in their lives.”
Without ignoring any of the official recommendations, Marazzo said it was also important to “keep it real”. For example, studies show that people are unlikely to spend 10 days in isolation once the test is positive, especially if they have no or only mild symptoms.
Given this reality, the CDC’s 5-day recommendations make more sense, Barokas said.
“The most likely time you will be contagious is these 5 to 6 days. Please disguise yourself afterwards, please stay diligent.”
“We need to be somewhat realistic about what people want and can do,” said Barokas, an associate professor of medicine at the University of Colorado School of Medicine.
Four ways to reduce risk
Vaccination, masking, isolation and testing are the “four pillars or the four corners of the building” that all need to be in place to keep it going during this pandemic, said Marazzo, director of the Department of Infectious Diseases at the University of Alabama at Birmingham.
Barokas thinks of these four things as parts of a suspension bridge, and you need all four to keep the bridge upright, he said.
Regardless of the analogy, vaccination and other measures remain essential, given the relative lack of other options at present. Vaccination could also affect quarantine requirements, Marazzo said.
“If you are fully vaccinated, you get a pass for some of the more draconian quarantine requirements.
Up to one treatment with monoclonal antibodies
Vaccination is extremely important at the moment, Marazzo said, “because we have nothing else to do to treat outpatients with COVID. We have limited access to working monocular antibodies.”
Also, the lack of a monoclonal antibody treatment, which is still considered effective against the Omicron variant – sotrovimab from GlaxoSmithKline – does not make the picture rosy.
To illustrate the mismatch 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 are seeing an increasing number of cases.”
At the same time, recently approved treatments for COVID-19 in pill form by Pfizer and Merck are not yet available.
“We still don’t have oral drugs and we have no other options,” Marazzo said.
N95s, KN95s and cloth masks
The benefits of masking are nothing new, but what’s new is the recent recommendation that people upgrade their facelifts to N95 and KN95 masks during the Omicron jump.
Wearing the N95 or KN95 is recommended “if you can take them and you can wear them and they are comfortable enough for you,” Marazzo said.
But in another nod to reality, she said, “there are cloth masks that fit like a glove.”
“If you feel better and it’s really waterproof and you have trouble running upstairs when you’re wearing your very well-fitting canvas mask, should you throw it away and get an N95?” “I’m not so sure,” she said.
Barokas repeated a simple refrain: that a cloth mask is better than one without a mask. But he also said there is a time and place where an upgraded mask would be better.
“If you are someone who thinks it is necessary to wear a KN95 or N95 around your immunocompromised family member or your children who do not qualify for the vaccine, then absolutely, this is something you should do.
“Personally,” he said, “I would wear it in large crowded areas where there is poor ventilation – something like a concert or a museum.”
Recommendations for wearing the N95 or KN95 come at a time when they are again in short supply.
“For example, in our hospital we currently do not have enough N95 for every health care provider,” Marazzo said. “So we still get people to wear surgical masks in certain conditions.”
Another test of reality is that not every upgraded mask is comfortable for everyone. Using the example of over-the-counter workers, she said: “Yes, I would like these people to wear the N95, but the N95 has a lot of comfort. After wearing them for many hours, I can tell you that there are some that you absolutely do not want to wear for 8 hours. “
Stop embarrassing others
Marazzo and Barokas agreed that it was time to stop criticizing the personal decisions people make about vaccinations, masks and other protective measures.
“We have to stop and just unite,” Marazzo said. “And say, look, we’re all going through a challenging reality right now, and we need to give ourselves the tools, whatever tools people use to protect themselves. We need to support them. “
Barokas agreed it was time to stop choosing countries. “I think we need to see that this is a pandemic for everyone,” he said.
Two things most Americans agree with, Barokas said, are protecting people who are vulnerable to serious illness and avoid getting sick so they can stay in the workforce.
The pandemic “now affects every sector of our nation, our world,” he said.
Their attitude to testing
Marrazzo recommends that anyone with symptoms isolate themselves if possible in the right way.
“Don’t go to the test and then wait for the test results to come back before you act,” she said. “Stay at home and ideally use a home test, if you have one.
“Ideally, if you test and find that you’re negative, that’s fantastic,” she said.
If you test positive and isolate yourself for 5 or 6 days, you are much less likely to be contagious to others. The CDC recommends that people in this situation be careful and disguise themselves for a full 10 days.
Effective treatment with monoclonal antibodies 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 will increase soon,” Marazzo said.
“When we do quick tests at home with exposure or symptoms, rapid tests are incredibly good for detecting infectivity,” Barokas said. “We see numbers that are astronomical for some of us – over a million cases. “The use of rapid tests is incredibly important for infection control purposes.”
“So while it may not prevent you from being tested, it protects the people around you,” he said.
Knowing your status is important and is something that infectious disease experts have recommended with other infectious diseases for a decade.
Don’t forget your flu vaccine
While the flu is circulating, it is not close to epidemic levels, Marazzo said. However, the flu affects your immune system, and everything it does will “only make you more susceptible to a bad case of COVID,” she said. “We’re not really talking about the flu vaccine as a way to keep your respiratory system generally healthy and able to prevent things like COVID.
Reasons for optimism
Asked to name what they were most positive about at the time of the pandemic, Marazzo chose Pfizer’s Paxlovid oral antiviral treatment. The allowed 5-day regime is “very similar to Tamiflu,” she said, “and there can be a really big difference.”
Early treatment of people with this oral medicine could help them stay out of the hospital and could also alleviate staff shortages, she said.
In studies, she said, Paxlovid reduced the severity of the disease and hospitalization by about 90%.
Baroque was positive about how much progress has been made in less than two years since the pandemic.
“I can’t put into words how big my toolbox has actually become compared to March 2020,” he said.
I felt helpless then, he said. “All I did was stir up the deckchairs and try to keep the boat afloat at the same time.
Vaccines and other preventative measures, treatments, growing public health infrastructure and more access to genomic sequencing are highlights, Barokas said.
“The fact is that I can go to the hospital and no matter how overwhelmed or exhausted we all are, it’s very different,” he said. “This is a very different landscape from the one we had in March 2020.