Where What When: We are getting so much conflicting
information about Omicron. Do we know anything yet about how dangerous it is?
To whom? How do you know if you have Delta or Omicron? Does it matter?
Dr. Yosef
Levenbrown: As of January 1, in the
region of the United States that includes Maryland, the CDC was reporting that
the current strains of COVID were 93.8% Omicron and 6.2% Delta. The numbers in Maryland
reflected these percentages. However, in other regions, such as New York, it
was 88% Omicron and 12% Delta. In order to determine the subtype of a COVID
virus, one has to run a special test, which is not a commercial test that is
available to the public. These tests that subtype the virus to determine which variant
it is are often run in state labs or in hospitals on behalf of the state. So,
when someone is positive for COVID, there is no easy way to determine which
variant he or she has.
Recent data that has
been reported on Omicron seems to indicate that it is more contagious than
earlier variants and has resulted in more breakthrough cases in vaccinated
people as well as people who have had prior COVID infections, compared with
prior variants. In both lab studies and real world studies, the mRNA vaccines (Pfizer
and Moderna) have been shown to be effective against Omicron, not in terms of
preventing someone from getting COVID but in terms of protecting one from
severe symptoms of COVID. Getting three vaccines (the primary series plus a
booster shot) has been shown in both lab and real world studies to be more
effective than two vaccines. However, most of the people who have been getting
severe COVID symptoms, including hospitalization and death from Omicron, have
been unvaccinated.
WWW: Who should isolate? If one member of a
family is sick, can the others go out, to school, etc.?
YL: There have been major
changes in the CDC recommendations over the past two weeks regarding the need
for isolation and quarantine. As of today (1/3/2022), the isolation (for COVID
positive patients) and quarantine (for people exposed to COVID) recommendations
are as follows:
For someone who tests
positive for COVID, the CDC recommends:
·
Stay home for five days following the
onset of symptoms or the positive COVID test (whichever happened first).
- If you have no
symptoms or your symptoms are resolving after five days, you can leave
your house, however, you should continue to wear a mask around others for
five additional days.
·
If you have a fever, continue to stay home
until your fever resolves.
It is important to
point out that these relaxed guidelines, as compared with previous versions, do
not mean that one is not contagious after five days. Most people will not be
contagious after five days of symptoms, however many will, which is why the CDC
recommends wearing a mask for an additional five days when one is around
others.
Regarding quarantine
requirements for those who have been exposed to patients with COVID, it is a
little more confusing. The CDC recommends if someone has received three COVID mRNA vaccines (Pfizer or Moderna), or completed the primary series (the first two vaccines)
with the Pfizer or Moderna vaccine within the last six months, or completed the primary series of the J&J vaccine
within the last two months, they do not need to quarantine. It is recommended
that they wear a mask around others for 10 days, and test on day five,
if possible.
If
one develops symptoms, he or she should get a COVID test and stay home. If one
who was exposed to a COVID patient completed the primary series of Pfizer or
Moderna over six months ago and has not received a booster shot, or they
completed the primary series of J&J over two months ago and are not
boosted, or are unvaccinated, it is recommended that they stay home for five
days. After that, they should continue to wear a mask around others for five
additional days. If one can’t quarantine, they must wear a mask for 10 days. In
addition, one should test on day five, if possible.
WWW: Are monoclonal antibodies still being
given, or are they not effective for Omicron?
YL: Monoclonal antibodies
are still available. However, two of the monoclonal antibodies, Regen-Cov and
bamlanivimab/etesevimab are not effective against Omicron. The only one that is
effective against Omicron is sotrovimab. However, sotrovimab is in very limited
supply. Which monoclonal antibodies are being offered at any given time depends
on the percent of Omicron, and is dictated by the Maryland Department of
Health. The Hatzalah Monoclonal Antibody Infusion Center works with the
Maryland Department of Health, and follows all of their recommendations.
WWW: Has there been any progress on
therapeutics? When will Pfizer’s new drug be available?
YL: There have been a
number of new therapeutics that have been approved and released over the past
few weeks. Paxlovid is an oral medication that has been shown to decrease the
risk of COVID-related hospitalization or death by 89% if it is given within the
first three days, and by 88% if it is given within the first five days from
symptoms onset. Molnupiravir is another oral medication that has been shown to
decrease COVID-related death or hospitalization by 30%. Both Paxlovid and
molnupiravir are effective against Omicron. Both of these medications are
currently available. However, the supply is limited for now.
WWW: Why should people bother getting tested
if there is no treatment?
YL: People who have high-risk
conditions and are eligible for various therapies, such as monoclonal
antibodies or one of the oral COVID therapies, should get tested if they have
symptoms to determine if they should be treated with these therapies. Some of
the monoclonal antibodies are approved for use in people who are exposed to
patients with COVID, and others are only approved for people as treatment for
COVID.
Being that there are
other illnesses circulating in the community, such as influenza, it is
important to know if symptoms are from COVID, to determine if one should
receive any of these COVID therapies. In addition, it is important to know if
someone has COVID so as not to infect another person who may have underlying
conditions that make them susceptible to bad outcomes from COVID. As well as we
think we may know someone, we do not know everyone’s underlying medical
conditions, and as such, can unknowingly spread COVID to someone who has a
significant underlying illness.
WWW: Are home test kits reliable?
YL: It is hard to answer this question,
because there are different “home testing kits,” and some are better than
others. Most of the home tests are more accurate in patients who are
symptomatic and may be less reliable in patients who do not have symptoms or
who are early on in their disease course. In addition, some of the home COVID
tests have been shown to be less accurate in detecting Omicron. In general, a
good rule of thumb is that a positive result on a home test means you have
COVID. A negative test cannot be relied on to say that one doesn’t have COVID,
and should be confirmed with a PCR.
