COVID-19 Policy Update #405
Wednesday 12/29
I wasn't planning on doing an update during the holiday break, but there have been a few recent developments that have implications for keeping schools open and minimizing the quarantines that have been so disruptive for students this past fall. So I wanted to get out a brief update to help those of you developing plans for January. Hope you’re having a good holiday and wishing you a Happy New Year!
Top Three
New CDC Quarantine and Isolation Guidelines:
Updated guidelines from the CDC.
"People with COVID-19 should isolate for 5 days and if they are asymptomatic or their symptoms are resolving (without fever for 24 hours), follow that by 5 days of wearing a mask when around others to minimize the risk of infecting people they encounter."
"For people who are unvaccinated or are more than six months out from their second mRNA dose (or more than 2 months after the J&J vaccine) and not yet boosted, CDC now recommends quarantine for 5 days followed by strict mask use for an additional 5 days."
"Individuals who have received their booster shot do not need to quarantine following an exposure, but should wear a mask for 10 days after the exposure."
"For all those exposed, best practice would also include a test for SARS-CoV-2 at day 5 after exposure. If symptoms occur, individuals should immediately quarantine until a negative test confirms symptoms are not attributable to COVID-19."
The CDC said the revision to 5 days was based on new studies that suggest individuals are most infectious within the first five days: “The majority of SARS-CoV-2 transmission occurs early in the course of illness, generally in the 1-2 days prior to onset of symptoms and the 2-3 days after.”
But what is confusing is that the CDC guidance for healthcare workers - issued just a week earlier - said 7 days.
Katelyn Jetelina also has concerns: "Unvaccinated people clear the virus in 7.5 days, which is obviously higher than the 5-day clock with this guidance. Even more worrisome is the broad range of infectious periods for unvaccinated, which ranged from 2 to 14 days... This new guidance may not be a problem if the unvaccinated actually wear a mask 5 days after isolation like this guidance suggests. But I doubt this will happen. The CDC stretched the science for unvaccinated people too far."
But then there was this: “It really had a lot to do with what we thought people would be able to tolerate,” CDC Director Walensky said on a CNN interview. Meaning, with Omicron severity as mild, people would feel well enough to work at 5 days and wouldn't tolerate 10 day isolation.
There were mixed reactions to the guidance, including some health officials suggesting the CDC should have required a negative antigen test after 5 days.
One reason may have been that the FDA said that preliminary NIH data suggest that while antigen tests are able to detect Omicron, they may have reduced sensitivity meaning they could miss more infections than with previous variants. More via ABC News.
Some students who aren't boosted may not be able to take advantage of the new flexibilities, which could lead to further disrupted learning with longer quarantines.
Dr. Megan Ranney has a good thread including some of the research studies supporting the changes.
“They Will Be Paying for Our Generation’s Decisions the Rest of Their Lives:" Jan Crawford on CBS's Face the Nation
"It's the crushing impact that our COVID policies have had on young kids and children. By far the least serious risk for serious illness."
"But I mean, even teenagers, you know, a healthy teenager has a one in a million chance of getting, and dying from COVID, which is way lower than, you know, dying in a car wreck on a road trip. But they have suffered and sacrificed the most, especially kids and underrepresented at risk communities."
"You know, it's it's it's hurt their dreams, their future learning, loss, risk of abuse, their mental health."
"And now, with our knowledge, our vaccines. If our policies don't reflect a more measured and reasonable approach for our children, they will be paying for our generation's decisions, the rest of their lives. And that, to me, is the greatest underreported story of the past year."
COVID Risks for Small Children: Good piece by Emily Oster. I found this helpful:
"Another way to conceptualize small probabilities is with time. Let’s say there was a 100% chance your child would get COVID-19 every single month. That is: every month they get COVID again, for sure. The risk of hospitalization is 1 in 120. This means that in 120 months of this — 10 years — you’d expect to go to the hospital once."
Omicron
CDC Revises Omicron Estimates: The CDC dramatically revised its estimates of Omicron prevalence for the week ending December 18, from 73% down to 23%.
"There was a wide predictive interval posted in last week’s chart, in part because of the speed at which Omicron was increasing,” CDC spokesperson Jasmine Reed told POLITICO. “We had more data come in from that timeframe and there was a reduced proportion of Omicron.”
Omicron accounted for 58.6% of cases for the week that ended Dec. 25.
“Setting aside the question of how the initial estimate was so inaccurate, if CDC’s new estimate of Omicron prevalence is precise then it suggests that a good portion of the current hospitalizations we’re seeing from Covid may still be driven by Delta infections,” former FDA Commissioner Scott Gottlieb tweeted yesterday.
Omicron Is Not More Severe for Children, Despite Rising Hospitalizations: Via NYT
"Several states have reported increases of about 50 percent in pediatric admissions for Covid-19 in December. New York City has experienced the most dramatic rise, with 68 children hospitalized last week, a fourfold jump from two weeks earlier."
"In fact, preliminary data suggests that compared with the Delta variant, Omicron appears to be causing milder illness in children, similar to early findings for adults."
"Also complicating the picture: Alarming hospitalization figures can be misleading because they sometimes include all children who have tested positive for the coronavirus upon admission."
"I think the important story to tell here is that severity is way down and the risk for significant severe disease seems to be lower,” said Dr. David Rubin, a researcher at Children’s Hospital of Philadelphia."
Omicron Infection Enhances Neutralizing Immunity Against the Delta Variant: New study which suggesting that Omicron immunity provides protection against Delta which, per Scott Gottlieb, "will help push Delta out, as it should decrease likelihood that someone infected with Omicron will get re-infected with Delta." More via the NYT.
SARS-CoV-2 Spike T Cell Responses: New study with good news.
The FT's John Burn-Murdoch sums it up, "Although Omicron is very capable of evading antibodies and causing reinfections/breakthroughs, it barely evades T-cells at all, meaning vaxxed or recovered people are likely to retain very good protection against severe disease."
Omicron Is Pushing America Into Soft Lockdown: Via The Atlantic, "Nobody wants to mandate business closures, but so many people are getting sick that businesses are closing anyway."
Federal
White House: President Biden joins the COVID-19 Response Team’s Call with the National Governors Association.
COVID-19 Research
The Very Bad Day at the CDC: Eric Topol with a pretty scathing critique.
From Airports to Arms: New Insights and Urgent Recommendations to Accelerate Global COVID-19 Vaccinations: COVID Global Accountability Platform (COVID GAP), led by Duke University and COVID Collaborative; along with the World Health Organization, UNICEF, and Africa CDC.
The 2021 COVID Derby: Funny.
FDA’s Policy Changes for COVID-19 At-Home Diagnostics—Implications for Addressing Other Infectious Diseases and Future Pandemics: Scott Gottlieb oped in JAMA
"Perhaps one of the most enduring technological innovations will be the advent of accurate diagnostic tests that can be used at home to provide a rapid answer about a person’s clinical status."
"In the future, home diagnostic tests will be increasingly coupled with telemedicine visits to introduce rapid assessment into the home for a range of pathogens, such as group A Streptococcus, influenza virus, respiratory syncytial virus, and many more."
"The regulatory pathway outlined by the FDA for the Emergency Use Authorization of COVID-19 tests has shaped a foundational change in how these tests are developed and deployed in the US. This change creates the opportunity for a dramatic paradigm shift in the practice of medicine."
The Dangerous Push to Give Boosters to Teens: Marty Makary in the WSJ.
My Epic, Infuriating Quest For a Covid Test: Via Elisabeth Rosenthal, editor in chief of Kaiser Health News.
“The underlying problem: We’ve expected the market to resolve a public health crisis, but that’s not the market’s priority. Markets respond when they see actual demand, backed by appealing dollars. Public health, like homeland security, needs to be projecting future threats and working proactively. Serious virus variants were predictable.”
Scott Lincicome has a counter view. "So maybe additional government subsidies for stockpiles and onshore production (the focus of Biden administration rapid testing efforts) could further boost supplies and lower prices, but the miserable U.S. testing situation’s cardinal sin wasn’t a market failure; it was a regulatory one that—as past FDA rejections of at-home tests for pregnancy or HIV show—has been with us for decades."
State
California: "The Archdiocese of Los Angeles has sued Los Angeles Unified, charging it has withheld millions of dollars in federal funding from dozens of Catholic schools, denying thousands of low-income students counseling and academic services they’re entitled to."
Connecticut: Governor Lamont announces plans to distribute 3 million COVID-19 at-home rapid tests and 6 million N95 masks.
Illinois:
Chicago teachers union mulls strike to block return to classrooms.
CPS asking students to test for Covid before returning from winter break.
CPS quietly launches overhaul of schools serving its ‘forgotten students,' Chalkbeat reports.
Michigan: Gov. Whitmer signs bill that would allow Michigan public schools to use non-teaching staff as substitute teachers the rest of the academic year.
New York:
Mayor Bill de Blasio and Mayor-Elect Eric Adams announce Stay Safe and Stay Open Plan for schools which will keep schools open and double their testing program.
New plan to end classroom quarantines: when a kid tests positive, instead of everyone going remote, everyone gets an at-home rapid. If they are negative and asymptomatic, they can come back the next day, the NYT reports.
"Students will also receive rapid tests if their classmates or teachers are displaying symptoms. Those who test positive will have to quarantine for 10 days."
New York Department of Health lowered their isolation guidelines to 5 days for vaccinated essential workers, including teachers as long as they are asymptomatic or even mildly symptomatic, and no fever within 72 hrs. No testing required.
NYC's teachers’ union has come out with a stern warning for the incoming mayoral administration — fix the COVID-19 testing problems, or risk having to go back to remote learning.
Rhode Island: Gov. McKee says schools will open for in-person learning next week.
Virginia: Fairfax Co. Public Schools part of 'test to stay' pilot program.
Resources
The Students Returned, but the Fallout From a Long Disruption Remained: Good long piece from the NYT featuring Liberty High School in my hometown of Bethlehem, PA.
"Students and educators use terms like “re-entry,” “recivilizing” and “reintegrating” to describe the transition back to a more normal routine. Covid restrictions still prevent full engagement. Masks have encouraged anonymity and discouraged dialogue."
"For Nikolas Tsamoutalidis, an assistant principal, the most vivid image of the post-pandemic student body was at lunch this year, when he saw ninth graders — whose last full year in school was seventh grade — preparing to play “Duck, Duck, Goose.” “It’s like fifth or sixth graders,” he said, “but in big bodies.”
Sixth-Grader Saves Choking Classmate And Elderly Woman From House Fire In Same Day: Wow.
Nothing But Net: Third grade teacher Ms. Fitz promised her class hot chocolate if she made this shot...
Can we talk about the kid in the reindeer costume?
SportsCenter interview with Ms. Fitz.
