‘Tis Covid Season–Again

iStockBy Mary Carpenter

ONE NEW YORKER hosted a birthday party for 28 people but wears a mask while walking her dog. A 20s-something Wall Street trader with a positive test result last week received the conflicting advice—to seek treatment but avoid medical offices, clinics or the ER at all costs. Broadway is canceling shows, and the end-of-January Sundance Film Festival is now up in the air.

For Covid holidays 2021, even the fully vaccinated and boosted are scrounging for advice, with each person making different choices depending on how their worry levels stack up against their needs, wishes and well-being—as recommendations from health experts change daily, case numbers explode and the Omicron variant spreads like wildfire.

D.C. reported 844 new cases on Saturday, December 18—compared with the 70 D.C. cases allowed by New York State for visitors from here in the summer of 2020 (related to the District’s population of about 700,000). Last week, over a three-day period, the test positivity rate in New York City tripled —not including results from thousands of unreported home tests; and the 68,000 Covid patients hospitalized nationwide represented a 21% increase from two weeks before.

“Such rapid transmission demands the United States double down on proven mitigation measures,” stated a Washington Post editorial last Friday—with masks at the top of the list.  On the facing-Op page, however, Harvard public health and “healthy buildings” expert Joseph Allen, in his “10 updates to the Covid playbook,” declared: “Where all people are vaccinated, we should do away with mask mandates and distancing requirements.”

“Anyone who fears moving away from universal masking…can continue to wear an N95 mask…live a low-risk life regardless of what others around them are doing,” Allen notes. Creating a new hierarchy of control strategies, he believes, is crucial to rescuing public health’s credibility, now “on the line;” and “relying on the 2020 playbook as we head into 2022 is as foolish as relying on the 2019 playbook as we entered 2020.”

Most experts believe that current vaccines provide protection against the worst outcomes— with additional buffers created by the boosters; and that treatments for Covid including antivirals should soon become more widely available. But because Omicron is still pretty new, the data sets are small, and hospitalizations and deaths typically lag several weeks behind infections, University of Washington Health Metrics Director Christopher Murray told the New York Times, “the most challenging question is severity.”

Last week in Denmark, three-quarters of Omicron cases occurred in people who had received two vaccine doses, the New York Times reported. And retired Harvard Medical School virologist William Haseltine warns: “doubly- and triply-vaccinated individuals, including those with prior infection, are susceptible to infection by Omicron within three months of the last boost.”

“The pool of people available to be infected with this virus is larger than it was before,” explains Chapel Hill epidemiologist Justin Lessler, due to some level of “immune escape and re-infection.” Rapid spread may be occurring now in the U.S. because Omicron causes more cases among the vaccinated than earlier variants, explains epidemiologist Jennifer Lighter at N.Y.U.. Says  Lighter, “There will be a lot of breakthrough cases.”

Omicron may spread rapidly through the air because of its explosive growth in respiratory tissues, according to a just-reported Hong Kong study: in laboratory cultures, Omicron multiplied about 70 times faster than the Delta variant, according to STATnews. Explains infectious diseases specialist Muge Cevik at the University of St. Andrews School of Medicine in Scotland, this “intrinsic enhanced infectiousness” along with its immune evasions (ability to elude antibodies from vaccines or prior infection) makes Omicron “inherently more transmissible.”

Covid testing involves its own choices—including kind and timing of the test and level of verification. Fifteen-minute antigen tests will indicate active infection, but there is no good way to be sure an infection is not incubating. According to STATnews, more than half of the 120 attendees at a recent restaurant party in Norway contracted the virus: all were vaccinated, and all had taken a rapid test the day before.

For people receiving positive Covid test results, the picture is as murky as ever, such as what to do if they are not within the five-day limit for antivirals or monoclonal antibodies. Or, if they are, should they even seek out one of these treatments. During her 10-day quarantine, the stock trader chose a combination of Dayquil and Nyquil.

“Isolation periods should be reduced from 10 days to five” following a positive test is another of Allen’s playbook updates, “because peak infectivity happens when symptoms first appear” and a day or two before “but drops rapidly after that.” He suggests allowing infected people to “test out” of isolation with two negative rapid tests; and allowing close contacts of those infected to “test to stay”—with daily testing but no quarantine until they get a positive result.

Doing “much more” to improve air quality, Allen believes, should be the focus of mitigation—to block the “air bridge” that enables Covid to spread indoors. Noting that current standards are set at a bare minimum, he suggests a goal of at least four air changes per hour —using outdoor air ventilation or HEPA (high-efficiency particulate air) filters.

The more precautions each person takes, the safer they will be—which can begin with wearing N95 protective masks. For eating in groups, many prefer venues that are uncrowded, have good ventilation or even have separate private dining areas—while others set the limit at those requiring proof of vaccination and even proof of boosters. And recent testing always adds another level of protection.

For air and train travel within the U.S., there are no pre-boarding test requirements, although the CDC recommends that anyone receiving a positive test result should isolate from others. Says College of American Pathologists President Emily Volk, “It’s the morally and ethically correct thing to do.”

In theory I believe individuals should ask for what they need to feel safe and that others should respond with kindness or at least civility. But then a close friend told me her daughter is flying home the day after developing symptoms and receiving a positive Covid test result —I am still working on how to respond.

—Mary Carpenter keeps track of continuing developments in research on Covid-19.