January 12, 2022 – If you are confused by the instructions for Omicron coronavirus the variant – which seems to change almost daily at the moment – is not alone.
It seems easy to understand this record jump in everyday cases that is generally reported. In addition, many unanswered questions remain: are they fabric face masks ever ok How can quick antigen tests help, assuming you can find it? What about the CDC’s recommendations for 5-day quarantine? What happens to flu?
Jeanne Marrazzo, MD, and Joshua Barocas, MD, addressed these and other pandemic issues during this week’s media briefing sponsored by the American Society of Infectious Diseases.
These infectious disease experts also shared one thing about pandemic it gives them hope.
Fast and fierce flow of information
The rapid pace of new scientific developments at Omicron and related recommendations contributes to the confusion.
“New evidence comes in every day,” Barocas said. “We’re still building a plane while we’re flying it.”
People can cope with this flood of information, including the controversial shortening of CDC recommendations quarantine up to 5 days, said Barocas, vice chairman of the Public Health Committee of the Society for Infectious Diseases.
“The American people can digest the guidelines, even if they come quickly,” he said. “I like to believe that the American people can internalize those guidelines and … understand what works best in their lives.”
Without dismissing any of the official recommendations, Marrazzo said it was also important to “keep it real”. For example, studies show that it is unlikely that people will spend a full 10 days in isolation after being positive, especially if they have no symptoms or only mild symptoms.
Given this reality, the CDC’s recommendations in 5 days make more sense, Barocas said.
“The most likely time you will be contagious is those 5 to 6 days. Please disguise yourself after that, please stay diligent.”
“We need to be somewhat realistic about what people are willing and able to do,” said Barocas, 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 four corners of a building” that everyone must be in place to stay during this pandemic, said Marrazzo, director of the Department of Infectious Diseases at the University of Alabama at Birmingham.
Barocas thinks of these four things as parts of a suspension bridge, and all four you need to maintain the bridge, he said.
Regardless of the analogy, vaccination and other measures remain crucial, given the relative lack of other options at this time. Vaccination can also affect quarantine conditions, Marrazzo said.
“If you’re fully vaccinated, you get a pass for some of the draconian quarantine conditions.”
Up to one monoclonal antibody treatment
Vaccination is currently critical, Marrazzo said, “because we have nothing else to do to treat outpatients with COVID. We have limited access to monocular antibodies that work.”
Also, the lack of a single monoclonal antibody treatment that 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, an antibody that works against Omicron last week, when our prevalence of Omicron was 99.8% and we see an increasing number of cases.”
At the same time, recently approved treatments for COVID-19 in the form of tablets from Pfizer and Merck are not yet available.
“We don’t have oral medications yet and we don’t have other options,” Marrazzo said.
N95s, KN95s and canvas masks
The benefits of masking are nothing new, but what is new are recent recommendations from people upgrade your face masks on N95 and KN95 masks during Omicron strike.
“It is recommended to wear the N95 or KN95 if you can get them and you can wear them and they are comfortable enough for you,” Marrazzo said.
But in another twist of reality, she said, “there are canvas masks that fit like a glove.”
“If it’s better for you and if it’s really waterproof and you have trouble running upstairs when you’re wearing your very well-fitted canvas mask, should you throw it away and take the N95? I’m not sure,” she said.
Barocas repeated the usual refrain: that a cloth mask is better than without a mask. But he also said there is a time and place where an improved mask would be better.
“If you’re someone who thinks you need to carry a KN95 or N95 around your immunocompromised family member or your children who don’t qualify for the vaccine, then this is something you should do.
“Personally,” he said, “I’d wear it in big crowds where there’s little ventilation – something like a concert or a museum.”
Recommendations for wearing the N95 or KN95 come at a time when they are again lacking.
“For example, at our hospital at the moment we don’t have enough N95 for every single healthcare provider,” Marrazzo said. “So we still have people wearing surgical masks in some settings.”
Another reality check is that not every upgraded mask is comfortable for every person. Using the example of workers serving people behind the counter, she said: “Yes, I would like these people to wear the N95, but the N95 has quite a range of comfort. After wearing them for many hours in a row, I can tell you there are some you absolutely don’t want. wear 8 hours. “
Stop embarrassing others
Marrazzo and Barocas agreed it was time to stop criticizing the personal decisions people make about vaccinations, masks and other protective measures.
“We have to stop and we just have to get together,” Marrazzo said. “And say, look, we’re all experiencing a challenging reality right now, and we need to give each other tools, whatever tools people use to protect themselves. We need to give them support.”
Barocas agreed that it was time to stop choosing sides. “I think we need to see that this is everyone’s pandemic,” he said.
Two things most Americans agree with, Barocas said, are protecting people who are vulnerable to serious illness and avoiding getting sick on their own so they can stay in the workforce.
The pandemic “is now affecting every sector of our nation, our world,” he said.
Their opinion on testing
Marrazzo recommends that everyone who has symptoms be isolated if possible in the right way.
“Don’t go test yourself and wait for your results to come back to you” before you start, she said. “Stay at home, and it’s ideal to use self-testing at home if available.
“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 lacking, as many Americans know – rapid antigen tests are also rare.
“We hope the supply of tests will increase soon,” Marrazzo said.
“When we do a quick test at home with exposure or symptoms, quick tests are incredibly good at detecting contagion,” Barocas said. “We see numbers that are astronomical for some of us – over a million cases. … Using rapid tests is incredibly important for infection control purposes.”
“While it may not protect you from being tested, it protects the people around you,” he said.
Knowing your status is important and it is something that infectious disease experts have been recommending for other infectious diseases for a decade.
Don’t forget the flu shot
While the flu is circulating, it is nowhere near the level of the epidemic, Marrazzo said. Still, the flu makes a number on yours immune system, and anything it does will “only make you more sensitive to the severe case of COVID,” she said. “We are not talking about it influenza vaccine as a way to keep yours respiratory system generally healthy and able to prevent things like COVID. “
Reasons for optimism
Asked to list what is most positive for them at this time of the pandemic, Marrazzo chose the oral antiviral drug Paxlovid from Pfizer. The approved 5-day regime “is very similar Tamiflu“She said,” and that could make a big difference. “
Early treatment of people with this oral drug could keep them out of the hospital and could alleviate staff shortages, she said.
In studies, she said, Paxlovid reduced the severity of the disease and hospitalization by about 90%.
Barocas was positive about how much progress has been made in less than 2 years of 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 flip the deck chairs and at the same time try to keep the boat afloat.”
Vaccines and other preventative measures, treatments, growing public health infrastructure and greater access to genomic sequencing are bright spots, Barocas said.
“The fact is that I can go to the hospital, and no matter how overwhelmed or exhausted we are, it is significantly different,” he said. “It’s a significantly different landscape than we had in March 2020.”