Home Web information How to make sense of Omicron and change COVID protocols

How to make sense of Omicron and change COVID protocols


January 12, 2022 – If you’re unsure of advice on the Omicron coronavirus variant – which seems to change almost daily at this point – you’re not alone.

The record and widely reported jump in daily cases seems easy to understand. Beyond that, many questions remain unanswered: are sheet masks still acceptable? How can rapid antigenic testing help, assuming you can find one? What’s up with the CDC’s 5-day quarantine recommendations? What Happens With The Flu?

Jeanne Marrazzo, MD, and Joshua Barocas, MD, addressed these and other pandemic issues during a press 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.

Fast and furious information flow

The frenetic pace of new scientific developments on Omicron and the associated recommendations are contributing to the confusion.

“New evidence is coming in daily,” Barocas said. “We always build the plane while we fly it.”

People can handle this deluge of information, including the controversial CDC recommendations reducing the quarantine time to 5 days, said Barocas, vice chair of the Infectious Diseases Society public health committee.

“The American people can digest the advice, even if it comes quickly,” he said. “I like to believe that the American people can internalize this advice and… figure out what works best in their lives.”

Without neglecting any of the official recommendations, Marrazzo said it was also important to “stay real”. For example, studies show that people are unlikely to spend 10 full days in isolation after testing positive, especially if they have no symptoms or only mild symptoms.

Given this reality, the CDC’s recommendations for 5 days make more sense, Barocas said.

“The most likely time you are going to be contagious is those 5-6 days. We ask you to mask yourself afterwards, we ask you to be diligent.”

“We have to be somewhat realistic about what people are willing and able to do,” said Barocas, 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 must all be in place to hold it in place during this pandemic, said Marrazzo, director of the Division of Infectious Diseases from the University of Alabama. in Birmingham.

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

Regardless of the analogy, vaccination and other measures remain essential, given the relative lack of other options at this time. Vaccination may also affect quarantine requirements, Marrazzo said.

“If you are fully vaccinated, you get a pass for some of the more draconian quarantine requirements.”

Up to monoclonal antibody treatment

Vaccination is of critical importance right now, said Marrazzo, “because we have nothing else to treat outpatients with COVID. We have limited access to the monular antibodies that work.”

Furthermore, a shortage of the only monoclonal antibody treatment still considered effective against the Omicron variant – sotrovimab from GlaxoSmithKline – does not make the picture any rosier.

To illustrate the mismatch between supply and demand, she said, “We had 16 doses of sotrovimab, which is the antibody that works against Omicron last week, when our prevalence of Omicron was 99.8%, and we are seeing an increasing number of cases.

At the same time, the recently approved COVID-19 treatments in pill form from Pfizer and Merck are not yet available.

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

N95s, KN95s and cloth masks

The benefits of masking aren’t new, but what is new are recent recommendations that people upgrade their face covers to N95 and KN95 masks during the Omicron push.

Wearing an N95 or KN95 is recommended “if you can get them and you can wear them and they’re comfortable enough for you,” Marrazzo said.

But in another nod to reality, she said “there are cloth masks that fit like a glove.”

“If this suits you better and it’s really waterproof and you have a hard time walking up the stairs when wearing your super tight fitting fabric mask, should you throw it away and get yourself an N95? I’m not so safe, ”she said. .

Barocas repeated a common refrain: that a cloth mask is better than no mask. But he also said there is a time and a place where an improved mask would be better.

“If you feel there is a need to wear a KN95 or N95 around an immunocompromised family member or vaccine ineligible children, 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 N95s or KN95s come at a time when they are becoming scarce again.

“For example, in our hospital, we don’t have enough N95 for every healthcare provider at this point,” Marrazzo said. “So we always have people who wear surgical masks in certain contexts. “

Another reality check is that not all upgraded masks are comfortable for every person. Using the example of workers serving people behind a counter, she said, “Yes, I would like these people to wear an N95, but N95s provide some comfort. From having worn them for many hours, I can tell you that there are some that you absolutely don’t want to wear for 8 hours. “

Stop shaming 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 kind of have to come together,” Marrazzo said. “And say, listen, we’re all in a difficult situation right now, and we have to give ourselves the tools, whatever tools people use to protect themselves. We have to give them our support.”

Barocas agreed it was time to stop choosing sides. “I think we have to consider this to be everyone’s pandemic,” he said.

According to Barocas, two things most Americans agree on are protecting those vulnerable to serious illness and avoiding getting sick themselves so they can stay in the workforce.

The pandemic “is now affecting all sectors of our nation, of our world,” he said.

Their take on testing

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

“Don’t go get tested and wait for your test results to come back” before you act, she said. “Stay home and ideally use a home self-test if available.

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

If your test is positive and you self-isolate for 5 or 6 days, it is much less likely that you will be contagious to others. The CDC recommends that people in this situation exercise caution and mask themselves for the full 10 days.

Effective monoclonal antibody therapy and N95 / KN95 masks aren’t the only items in short supply, as many Americans know – rapid antigen testing is also rare.

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

“When we do rapid tests at home with exposure or symptoms, rapid tests are incredibly effective at detecting infectivity,” said Barocas. “We are seeing numbers that are for some of us astronomical – over a million cases.… The use of rapid tests is extremely important for infection control purposes.”

“So while it doesn’t protect you from getting tested, it does protect the people around you,” he said.

Knowing your status is important, and it’s something infectious disease experts have been recommending along with other infectious diseases for a decade.

Don’t forget your flu shot

As the flu circulates, it is far from the levels of an epidemic, Marrazzo said. Still, the flu does a number on your immune system, and anything that does that “will only make you more vulnerable to a bad case of COVID,” she said. “We’re not really talking about the flu shot as a way to keep your respiratory system generally healthy and able to fend off things like COVID.”

Reasons for optimism

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

Treating people early with this oral drug could help keep them off going to the hospital and could alleviate staffing shortages, she said.

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

Barocas was positive about the progress made in less than 2 years of the pandemic.

“I cannot express in words how big my toolbox has become compared to March 2020,” he said.

“I felt helpless” at the time, he said. “All I did was toss the deckchairs and try to keep a boat afloat at the same time.”

Vaccines and other preventative measures, treatments, growing public health infrastructure and better access to genomic sequencing are all positives, Barocas said.

“The point is, I can go to the hospital and no matter how overwhelmed or exhausted we are, it’s very different,” he said. “It’s a very different landscape than what we had in March 2020.”