Omicron Surge Makes Tests Scarce

Amy Gifford
Posted 1/12/22

The Centers for Disease Control (CDC) released the following statement on December 27, 2021, regarding isolation and quarantine guidelines surrounding COVID-19:“Given what we currently know …

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Omicron Surge Makes Tests Scarce

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The Centers for Disease Control (CDC) released the following statement on December 27, 2021, regarding isolation and quarantine guidelines surrounding COVID-19:
“Given what we currently know about COVID-19 and the Omicron variant, CDC is shortening the recommended time for isolation to the public. People with COVID-19 should isolate for five days and if they are asymptomatic or their symptoms are resolving (without fever for 24 hours), follow that by five days of wearing a mask when around others to minimize the risk of infecting people they encounter. The change is motivated by science demonstrating that the majority of SARS-CoV-2 transmission occurs early in the course of illness, generally in the one to two days prior to onset of symptoms and the two to three days after.
“Additionally, CDC is updating the recommended quarantine period for anyone in the general public who is exposed to COVID-19. For people who are unvaccinated or are more than six months out from their second mRNA dose (or more than two months after the j&j vaccine) and not yet boosted, CDC now recommends quarantine for five days followed by strict mask use for an additional five days. Alternatively, if a five-day quarantine is not feasible, it is imperative that an exposed person wear a well-fitting mask at all times when around others for ten days after exposure. Individuals who have received their booster shot do not need to quarantine following an exposure, but should wear a mask for ten days after the exposure. For all those exposed, best practice would also include a test for SARS-CoV-2 at five days after exposure. If symptoms occur, individuals should immediately quarantine until a negative test confirms symptoms are not attributable to COVID-19.”
This is a big change from previous quarantine guidelines from the CDC that instructed individuals to isolate for 10-14 days after testing positive or after an exposure to a positive case of the virus. The CDC also said in their statement that “both updates come as the Omicron variant continues to spread throughout the U.S. and reflects the current science on when and for how long a person is maximally infectious. These recommendations do not supersede state, local, tribal, or territorial laws, rules, and regulations, nor do they apply to healthcare workers for whom CDC has updated guidance.”
The new recommendations from the CDC for healthcare workers were updated on December 13, 2021, and are as follows:
“In general, asymptomatic health care professionals (HCP) who have had a higher-risk exposure do not require work restriction if they have received all COVID-19 vaccine doses, including booster dose, as recommended by CDC and do not develop symptoms or test positive for SARS-CoV-2. The duration of protection offered by booster doses of vaccine and their effect on emerging variants are not clear; additional updates will be provided as more information becomes available.”
The CDC goes on to clarify that “HCP are considered “boosted” if they have received all COVID-19 vaccine doses, including a booster dose, as recommended by CDC. HCP are considered “vaccinated” or “unvaccinated” if they have NOT received all COVID-19 vaccine doses, including a booster dose, as recommended by CDC.”
This clarification is important because the CDC has changed their guidelines for work restrictions for three separate scenarios: conventional, contingency, and crisis. For all HCP with active SARS-CoV-2 infections (boosted, vaccinated, or unvaccinated) in a conventional scenario are to isolate for ten days, or seven days with a negative test if asymptomatic or mildly symptomatic with improving symptoms. For all HCP with an active infection in a contingency scenario, they are to isolate for five days with or without a negative test if asymptomatic or mildly symptomatic with improving symptoms. For all HCP with an active infection in a crisis scenario, there are no work restrictions with “prioritization considerations,” such as asymptomatic or mildly symptomatic. For boosted asymptomatic HCP who have been exposed to SARS-CoV-2, there are no work restrictions with a negative test on days two and five to seven in a conventional scenario, and no work restrictions whatsoever in a contingency or crisis scenario. For vaccinated or unvaccinated HCP who have been exposed to SARS-CoV-2 (even if within 90 days of prior infection), they are to isolate for ten days, or seven days with a negative test in a conventional scenario, there are no work restrictions with negative tests on days one, two, three, and five through seven in a contingency scenario, and no work restrictions with the recommendations to test if possible in a crisis scenario. The CDC didn’t explicitly state what constituted conventional, contingency, or crisis scenarios.
On January 4, 2022, the CDC released an additional statement on their website explaining why they shortened isolation and quarantine guidelines for the general population. They acknowledged that COVID-19 cases due to the Omicron variant have increased along with seasonal increases of influenza and other respiratory viral infections and stated that the possibility of a large increase in case numbers raises “serious concerns about societal impact” due to illness.
“CDC has been monitoring the emerging science on when and for how long a person is maximally infections with Omicron, as well as the effectiveness of COVID-19 vaccines and booster doses against Omicron infection,” the statement read. “Data related to the mental health effects of the pandemic and adherence to prevention interventions have also been considered.”
The data in question included a review of 113 studies from 17 countries. The data showed that most SARS-CoV-2 transmission happens early in the course of the infection. Additionally, infectiousness has shown to peak at around one day before symptoms even begin and declines within one week of the onset of symptoms. The average period of infectiousness (and the risk of transmission) is between two to three days before and eight days after the initial onset of symptoms.
“These data are from studies of prior SARA-CoV-2 variants, including Delta,” the CDC’s statement read. “The science is evolving, particularly for the Omicron variant, and some reports suggest that compared with previous variants, Omicron has a shorter incubation period (two to four days), defined as the time between becoming infected and symptom onset.”
The CDC went on to say that statistically, hospitalization and death rates are much lower for vaccinated people for all of the SARS-CoV-2 variants. They are able to deduce this based on preliminary data from South Africa suggesting that hospitalization and death rates are actually lower for people infected with Omicron compared with other variants they’ve seen.
“Early estimates of lower vaccine effectiveness against symptomatic infection due to Omicron after the Pfizer-BioNTech primary series suggest that booster doses are important to improve protection from hospitalization and death due to infection with the Omicron variant,” the CDC said in a statement. “Spread of the Omicron variant has the potential to worsen staffing shortages and increase supply chain challenges, which jeopardizes industry, education, and other systems that are essential to maintain a functioning society and economy. The pandemic has also had a negative impact on the mental health of adults in the United States, largely due to economic and social concerns. Although many people have intentions to self-isolate, both isolation and quarantine are challenging; especially in the context that many infections are asymptomatic. Studies suggest that only a small percentage of people (25-30 percent) isolate for the full ten days.”
The CDC went on to say that the updated COVID-19 isolation and quarantine recommendations were shorter for asymptomatic and mildly ill individuals to focus on the period when a person is most infectious. They still recommend continued masking for an additional five days following the end of an isolation or quarantine.
“These updated recommendations also facilitate individual social and well-being needs, return to work, and maintenance of critical infrastructure,” read the CDC’s statement.
While the Omicron variant is reportedly more than three times as infectious as the Delta variant according to the CDC, the isolation time for the infection has been decreased under the guise that people should continue to wear well-fitting masks and take additional precautions for five days after leaving isolation or quarantine. Additionally, isolation or quarantine should only end for those who test positive for COVID-19 five days after the onset of symptoms and if the individual has been fever-free for at least 24 hours without the use of a fever-reducing medication (such as acetaminophen or ibuprofen) and other symptoms have resolved.
The only exceptions to these new guidelines are children under the age of two, people with certain disabilities, those with moderate or severe illnesses, and the immunocompromised. The CDC is still recommending that those who cannot wear a mask due to age, certain disabilities, or certain illnesses continue to isolate if infected -- and quarantine if exposed -- for ten days.
“Mask use and layered prevention strategies, such as receiving all recommended vaccination and booster doses, physical distancing, screening testing, and improved ventilation, are key to preventing COVID-19 and decreasing transmission,” the CDC stated. (source: www.cdc.gov)

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