Tuesday, December 28, 2021

The new CDC Guidelines - are they valid?

Confused by the latest CDC guidelines on when to get out of isolation? Join the crowd. Many infectious disease experts are decrying the change while others support the new rules.

What do we know? People are most likely to spread the virus in the 1-2 days before they develop symptoms and for 3-4 days after the onset of symptoms. Vaccinated individuals do not seem to shed a lot of virus after 5 days of symptoms assuming they feel better and do not have a fever. This is not true for unvaccinated individuals, who may shed virus for 10 days or more; there is a wide range – some do not shed much after 3-4 days while others can shed virus for up to 2 weeks.

The practical political aspect of this decision is that with the much more transmissible Omicron variant, we are seeing a sharp rise in cases, with many only mildly ill, and we are seeing resulting shortages of workers. The numerous flight cancellations of the past holiday weekend were in large part due to so many pilots and other crew being COVID-positive. Hospitals are running low on doctors, nurses and other staff.

I think that it is reasonable to allow vaccinated individuals to come out of isolation 5 days after testing positive but that this should only be done when they have a negative antigen (rapid) test on the day they leave. Wearing a mask gives a little extra margin of safety.

Unvaccinated individuals should probably stick to the prior 10-day isolation. They shed virus longer (and are the people who are less likely to consistently wear masks).

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Wednesday, December 1, 2021

Omicron - Is the sky falling?

Spoiler alert! Our knowledge is at an early stage, and much of what I am about to say may change as our knowledge evolves – that is inherent in any new natural phenomenon.

Viruses mutate constantly – when you are producing millions of new virus particles a day, there will be random changes in the RNA sequence. Most of these mutations are minor and have no effect on how the virus behaves but some will cause the virus to be more (or less) easily transmitted and/or more (or less) dangerous to the host (us!).

Most virus mutations are given such catchy names as B.1.1.7, but when the World Health Organization deems a virus to be more dangerous and/or more easily transmitted, it is given a Greek letter name for easier communication. We are all familiar with the Delta variant that is now the dominant strain in the United States and which has caused our case counts to shoot up.

The latest “variant of concern” is Omicron, first identified and sequenced in the Republic of South Africa. It did not necessarily emerge there, but S.A. has a much better public health system than its neighbors. We should be grateful to South Africa for promptly telling the WHO and the world about this new variant. If only China had been equally open, it might have saved precious time for a response to the initial Covid outbreak.

Given the interconnected world in which we live, it is not a surprise that Omicron has spread beyond southern Africa. As of Nov 30, at least 19 countries have reported small numbers of cases. From 1 to 20 cases have been reported from Australia, Canada, Israel, Japan, Hong Kong and 12 western European countries. While there have been no cases identified yet in the U.S., I would be shocked if there are not already a handful here. While much publicity was given to two flights from South Africa to Amsterdam carrying infected people, it is now known that the variant was present in the Netherlands at least a week earlier.

What do we know about Omicron?

1.It seems to be more easily transmitted than the original virus, though not necessarily more than Delta.

2.So far, it does not appear to cause more serious disease than existing strains.

3.Existing vaccines should give at least moderate protection against getting seriously ill, though I suspect will be less effective at preventing infection.

4.The best current therapy, monoclonal antibody infusions, will be much less effective against Omicron, because they target the spike protein and this has been greatly changed in Omicron.

5.The newly approved pills, which target a different part of the virus, should be similarly effective against Omicron, though their benefit is only moderate.

What should you do?

1.If you have not already done so, PLEASE get vaccinated and get your booster.

2.I would wear a mask whenever you are in large groups indoors (theatres, stores, etc.)

3.If you are immune compromised and/or over 75, I would avoid non-essential travel

Stay tuned! We will have more and better details in the next few weeks

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