POST 227. January 10, 2020. CORONAVIRUS. “Stay indoors. But also return in person. Wear a mask. Not that one. The expensive one, that you can’t find. Take rapid tests. Which you also can’t find. But if you find them, don’t buy them. Rapid tests don’t work. You need PCR. There are zero appointments in your area.” (F)

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POST 225. January 3, 2021. CORONAVIRUS. “Be first, be right, be credible,” are among the most important principles for health authorities to follow in a crisis, the Centers for Disease Control and Prevention shared in a pamphlet on crisis communication in 2018….”

to read POSTS 1-227 in chronological order highlight and click on

“With infection rates mounting, the Omicron variant has ushered in a new and disorienting phase of the pandemic, leaving Americans frustrated and dismayed that the basic elements they thought they understood about the coronavirus are shifting faster than ever.

There were reasons for heightened concern and reasons for consolation: Omicron is more transmissible than previous variants, yet it appears to cause milder symptoms in many people. Hospitalizations have soared to new highs in some states, but “incidental patients” — people who test positive for Covid-19 after being admitted for another reason — make up close to half of their cases in some hospitals.

Public health officials, in response to the new variant, have halved the recommended isolation period for people with positive tests to five days from 10 days, while also suggesting people upgrade their masks from cloth to medical-grade when possible.

“Omicron has turned, quickly, into something that is just different,” said Dr. Allison Arwady, Chicago’s top health official.

Amid shifting federal public health guidance and the new and distinct variant, President Biden’s own former transition team has called on the president to adopt an entirely new domestic pandemic strategy geared to the “new normal” of living with the virus indefinitely, not to wiping it out.

And Americans, confronted with these new sets of facts, warnings and advisories, have responded with a mix of confusion, vigilance and indifference. Left mainly to navigate it all on their own, they must sort through an array of uncertain risks — ride a bus? visit friends? eat inside? — hour by hour.” (O)

“The director of the Centers for Disease Control and Prevention took a calculated gamble Friday as she sought to assume greater control over confused public health messaging about the coronavirus as the pandemic enters its third year.

Rochelle Walensky held her first solo covid-19 news conference since becoming the chief of the public health agency nearly a year ago, vowing that it would be “the first of many.”

The briefing comes at a precarious moment for Walensky, a highly regarded infectious-diseases physician who has come under intense criticism for failing to communicate CDC’s often-changing guidance clearly. With coronavirus cases surging to record levels in the United States and around the world, that criticism has been particularly stinging of late, with an uncharacteristically sharp critique this week from the American Medical Association over the agency’s failure to require a negative coronavirus test result before people exit shortened isolation.

“Potentially hundreds of thousands of people could return to work and school infectious if they follow the CDC’s new guidance on ending isolation after five days without a negative test,” the group said…

Inside the administration, frustration has also been mounting. Officials acknowledge the rapidly changing virus complicates the pandemic response, but some worry Walensky’s public statements have only added to many Americans’ confusion. At times, her guidance has also been at odds with that of other senior administration officials, most notably, that of Anthony S. Fauci, President Biden’s chief medical adviser…

Experts say Walensky has nothing to lose by “putting herself out there” to improve her relationship with the public, said Jody Lanard, a physician who worked for nearly two decades as a pandemic communications adviser consulting with the World Health Organization.

“I’m not worried about the White House throwing the CDC under the bus, because the CDC is already under the bus,” Lanard said…

“The lack of recognition that there is a problem — that’s a problem,” the scientist said, noting they had had to spend time explaining it to family members. “You kind of have to be a PhD or an MPH…”” (A)

“The following statement is attributable to: Gerald E. Harmon, M.D., President, American Medical Association              

“Nearly two years into this pandemic, with Omicron cases surging across the country, the American people should be able to count on the Centers for Disease Control and Prevention (CDC) for timely, accurate, clear guidance to protect themselves, their loved ones, and their communities. Instead, the new recommendations on quarantine and isolation are not only confusing, but are risking further spread of the virus.

“Living during a pandemic is challenging, and what we learn along the way—and data we collect—will necessarily change our course of action at times. According to the CDC’s own rationale for shortened isolation periods for the general public, an estimated 31 percent of people remain infectious 5 days after a positive COVID-19 test. With hundreds of thousands of new cases daily and more than a million positive reported cases on January 3, tens of thousands—potentially hundreds of thousands of people—could return to work and school infectious if they follow the CDC’s new guidance on ending isolation after five days without a negative test. Physicians are concerned that these recommendations put our patients at risk and could further overwhelm our health care system.

“A negative test should be required for ending isolation after one tests positive for COVID-19. Reemerging without knowing one’s status unnecessarily risks further transmission of the virus.

“Test availability remains a challenge in many parts of the country, including in hospitals, and we urge the administration to pull all available levers to ramp up production and distribution of tests. But a dearth of tests at the moment does not justify omitting a testing requirement to exit a now shortened isolation.””(G)

“For every modification and revision of its guidelines, the CDC, and Walensky, have taken heat. In May 2021, when vaccination rates were increasing, Walensky recommended that immunized people could stop wearing masks indoors. The decision balanced the science at the time—cases were falling but still far from zero—against the growing backlash from the public about the lack of benefits of vaccination; if getting the shots changed nothing about what they could do safely, then why get vaccinated? Two and a half months later, the CDC went back to urging even vaccinated people to wear masks indoors as a new variant pushed case numbers up again.

The media, politicians and the public demolished the CDC for flip-flopping. “I have spent a lot of time thinking about” the shifting advice, says Walensky. “All of the science in that moment said it was safe to take off your masks if you were vaccinated. We perhaps should have said ‘for now.’ I think that if we had said, ‘Despite the science, you have to keep your masks on,’ we would have lost the trust of people with regard to actually following the science.”

Finding that balance is a task unique to the CDC: keeping up with constantly changing science and turning that data into practical public-health advice. “We have to provide what the science says not in a vacuum but with the understanding of the uncertainty and the moment,” says Walensky. And that means adapting recommendations to the influx of new data. “Translating science into practiceable guidance is what has really distinguished the value of CDC over the arc of time,” says Dr. Julie Gerberding, chief patient officer at Merck, who ran the CDC from 2002 to 2009. “We have all had scenarios where we weren’t able to provide perfect communication [and] perfect guidance. That’s part of the challenge.”” (B)

“Nowhere are these issues more apparent than on the confusing and zigzag messaging around rapid antigen tests and N95 masks, both of which are important weapons in our arsenal.

With a barrage of cases threatening vital services, the Centers for Disease Control and Prevention announced on Dec. 29 that people could return to work, masked, five days after they first learned they were infected, arguing that many people are infectious for only a short period. People could return to work even while still sick, as long as their symptoms were abating.

It’s not unreasonable to shorten quarantine for some, especially if they are vaccinated. Other countries have allowed infected people to isolate for a shorter time with the added precaution that they take rapid antigen tests to show they are negative two days in a row.

Why doesn’t the C.D.C. call for that added measure of safety? Its director, Dr. Rochelle Walensky, has explained this by saying, “We know that after five days, people are much less likely to transmit the virus and that masking further reduces that risk.”

“Much less likely” isn’t zero, and the likelihood probably varies from person to person. All this means that some would continue to be infectious. So wouldn’t it be great if we could tell who was probably still infectious after five days, and took extra precautions, while allowing people who may be clearing the virus even faster than five days to stop isolating earlier?

Not according to our top officials.

“We opted not to have the rapid test for isolation because we actually don’t know how our rapid tests perform and how well they predict whether you’re transmissible during the end of disease,” Walensky said on Dec. 29. “The F.D.A. has not authorized them for that use.”

Dr. Anthony Fauci, the president’s chief medical adviser, argued the same, also on Dec. 29. Referring to antigen tests, he said, “If it’s positive, we don’t know what that means for transmissibility” and that these antigen tests aren’t as sensitive as P.C.R. tests.

Might the real reason be that rapid tests are hard to find and expensive here (while they are easily available and relatively cheap in other countries)?…

It’s hard not to worry that officials may be denigrating rapid tests now for the same reason they denigrated the use of masks early in the pandemic — we don’t have enough of them. Fauci essentially acknowledged this about masks, saying that the public health community had feared that they “were in very short supply” — a fair concern, but that’s not what we were told. I wouldn’t be surprised if officials eventually admitted the same about rapid tests…

On Tuesday, the C.D.C. updated its guidance to say that “if an individual has access to a test and wants to test” and is positive after five days, he or she should “continue to isolate until Day 10.” So is the C.D.C. now conceding that people who test positive are indeed still infectious? And if they don’t have a test, or don’t want one, no worries?

The job these officials have is tough, given both the reckless political opposition even to vaccines and the inevitable criticism even from people who support public health measures. Still, it’s so disappointing to enter 2022 with 2020 vibes, scouring for supplies, trying to make sense of official declarations that don’t cohere, and wondering what to do.”  (C)

“In their attempts to defend the new guidelines, Dr. Rochelle Walensky, the CDC’s director, and Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, actually helped undercut whatever support there was for those changes among people who take Covid seriously. Walensky told CNN on Wednesday that the change “really had a lot to do with what we thought people would be able to tolerate.” Fauci, meanwhile, said, “If you are asymptomatic and you are infected, we want to get people back to jobs — particularly those with essential jobs to keep our society running smoothly.”…

But by incorporating societal responses and employer requirements into their arguments, Walensky and Fauci implied that the CDC’s decision wasn’t based purely in science. While the evidence shows that people are most contagious during the early days of their infection, health experts say there’s no new data that justifies changing the guidelines. Experts haves also expressed concerns that the new guidance doesn’t include a testing requirement and leaves it up to individuals to presume they’re not infectious.

That brings us to the biggest problem Walensky and her staff face trying to explain their thinking: The gig is one of inherent contradictions. People respond well to clear, concise instructions: easy-to-remember slogans, bullet-point checklists, things that would look good on a poster. But by its very nature, there is no real certainty in the middle of a pandemic. The government’s public health officials are constantly learning new things, dealing with new variants and revising previous recommendations.

This has meant any proclamation from authorities has been required to be issued with a pretty substantial set of “buts” and “ifs” and other hedges. But if there’s one thing Americans really seem to hate, it’s a caveat…

The country’s health leaders promise that they incorporated a number of factors into their decision. I believe them on that front. Did they consider how those guidelines will be abused to make people who are sick with Covid report to work because they are unable to find a rapid test to prove that they have Covid? Yeah, I have doubts.” (D)

“In laying out the scientific basis for the revisions, the agency said more than 100 studies from 17 countries indicate that most transmission happens early in an infection. The CDC acknowledged the data come from research done when delta and other pre-omicron variants were causing the most infections. But the agency also pointed to limited, early data from the U.S. and South Korea that suggests the time between exposure and the appearance of symptoms may be shorter for omicron than for earlier variants.” (E)

“Early research suggests that some rapid COVID-19 tests may be less able to detect the Omicron variant, the U.S. Food and Drug Administration said Tuesday.

In a statement, the FDA said that antigen tests “do detect the Omicron variant, but may have reduced sensitivity,” meaning it’s possible the tests could miss an infection, particularly in the early stages of the disease.

That’s not good news, as the Omicron variant fuels surging case numbers across the country and people are scrambling to find at-home rapid testing. Antigen tests can be done within minutes at home, while the more accurate PCR tests are processed in labs and have longer turnaround times.

Still, the FDA stopped short of saying that people should stop using antigen tests.

“The FDA continues to authorize the use of these tests as directed in the authorized labeling and individuals should continue to use them in accordance with the instructions included with the tests,” the agency said. “Antigen tests are generally less sensitive and less likely to pick up very early infections compared to molecular [PCR] tests.”

The FDA didn’t specify what rapid at-home tests were used in its early research.

“With every new variant, we have to make sure that the tests work, and it looks like the tests work for this. But they’re not picking up infections as early as previous versions,” Gigi Gronvall, a senior researcher at the Johns Hopkins Center for Health Security in Baltimore, told NBC News. “So if you feel any symptoms but test negative, it’s not a get-out-of-jail-free card. You may need to test again and hold off a little bit on assuming that you’re negative.”

The FDA encouraged follow-up testing for anyone who tests negative with a rapid antigen test but is experiencing symptoms.” (H)

“A small, new real-world study suggests that two widely used at-home antigen tests, the Abbott BinaxNOW and Quidel QuickVue, may fail to detect some Omicron infections even when people are carrying high levels of the coronavirus.

The study, which has not yet been peer-reviewed, focused on 30 people infected with the virus at five workplaces that experienced what were most likely outbreaks of the Omicron variant in December. The people received both saliva-based P.C.R. tests and rapid antigen tests using nasal swabs.

It took three days, on average, for people to test positive on a rapid antigen test after their first positive P.C.R. result. In four cases, people transmitted the virus to others while the rapid test showed the negative result, according to the study, which was conducted by several members of the Covid-19 Sports and Society Working Group.

It is not clear whether the infections were missed because the antigen tests are inherently less sensitive to Omicron or because saliva tests may be better at detecting the new variant.

But the results are consistent with other preliminary evidence that the at-home tests that many Americans have come to rely on — at least as currently administered, with a nasal swab — may fail to detect some Omicron cases in the first days of infection.

The researchers said they shared their results with federal officials — including at the White House, the Food and Drug Administration and the Centers for Disease Control and Prevention — in real-time, as the outbreaks were occurring last month.” (I)

“After we released our recs early last week, it became very clear people were interested in using the rapid test, though not authorized for this purpose after the end of their isolation period,” Walensky said. “We then provided guidance on how they should be used.” (J)

“The crux of the problem, several administration officials said, is a failure by the C.D.C. and the Biden administration’s messaging experts to work in concert. Who is to blame for that is a matter of debate. Dr. Walensky’s critics say she is not collaborative enough, too often springing decisions on other federal officials who then struggle to defend them in public. Her defenders say she strives to coordinate, but that it is not her job to ensure consensus across the entire administration.

Some suggest the White House has gone too far in its hands-off, let-the-scientists-rule approach, leaving a vacuum of leadership and forcing ad-hoc coordination between the various public health agencies. That has been exacerbated by a health secretary, Xavier Becerra, who receives routine briefings from scientists but does not settle interagency disputes about the pandemic response.

Dr. Fauci, the administration’s best-known spokesman on the pandemic, has further muddied the waters at times, publicly contradicting the C.D.C. as he did this week or making statements he has later walked back.

He said in late December, for instance, that a vaccination requirement for domestic airline passengers should be seriously considered, leaving the White House to field a flurry of questions on a policy it was not prepared to recommend. Later, he said a mandate was unlikely.

On Wednesday, Jen Psaki, the White House press secretary, said it was OK for the C.D.C. to modify its guidance, adding that, for one thing, “if they hadn’t changed their recommendations over the course of time, schools would probably be closed across the country.”

But even some within Dr. Walensky’s own agency agree that the C.D.C.’s public pronouncements on the pandemic have repeatedly fallen short, long after experts say the agency should have mastered clear and concise public messaging on the worst public health crisis in a century.” (K)

“On the day President Biden was inaugurated, the advisory board of health experts who counseled him during his transition officially ceased to exist. But its members have quietly continued to meet regularly over Zoom, their conversations often turning to frustration with Mr. Biden’s coronavirus response.

Now, six of these former advisers have gone public with an extraordinary, albeit polite, critique — and a plea to be heard. In three opinion articles published on Thursday in The Journal of the American Medical Association, they called for Mr. Biden to adopt an entirely new domestic pandemic strategy geared to the “new normal” of living with the virus indefinitely, not to wiping it out…

Outlining their ideas for the “new normal” strategy, Dr. Emanuel and two co-authors — Michael T. Osterholm, an epidemiologist at the University of Minnesota, and Dr. Celine Gounder, an infectious disease expert at New York University — pointedly noted that in July, Mr. Biden proclaimed that “we’ve gained the upper hand against this virus,” which in retrospect was clearly not the case.

Now, with the Omicron variant fueling an enormous new surge, they wrote, the United States must avoid becoming stuck in “a perpetual state of emergency.” The first step, they wrote, is recognizing that the coronavirus is one of several respiratory viruses circulating, and developing policies to address all of them together.

To be better prepared for inevitable outbreaks — including from new coronavirus variants — they suggested that the administration lay out goals and specific benchmarks, including what number of hospitalizations and deaths from respiratory viruses, including influenza and Covid-19, should prompt emergency mitigation and other measures.

In addition to urging the administration to adopt a longer view, the authors took pointed issue with some of Mr. Biden’s current policies and stances — especially on political lightning rod issues. They called for more aggressive use of vaccine mandates, which have drawn fierce opposition from Republicans, and said the nation needed a digital verification system for vaccination — so-called vaccine passports — which Mr. Biden has resisted in the face of Republican attacks on the concept.” (L)

“Fauci, in other words, sounded far more hesitant than the JAMA experts to declare a “new normal.” There were, he said, “too many unknowns.” We don’t know the number of people in the country with no experience of the virus—who haven’t been vaccinated or infected. We also don’t know what level of protection an Omicron infection might provide against the next variant. “Because we will undoubtedly get a next variant,” he said. He spoke for a little while about the differing severity of various kinds of respiratory infections and the challenge of predicting how further covid variants would fit in. “I mean, for people who are not responsible for policy, it’s very easy to make a prediction,” he said. “Because if you are right you’re a hero, and if you’re wrong nobody cares.”” (M)

“A researcher in Cyprus has discovered a strain of the coronavirus that combines the delta and omicron variant, Bloomberg News reported on Saturday.

Leondios Kostrikis, professor of biological sciences at the University of Cyprus, called the strain “deltacron,” because of its omicron-like genetic signatures within the delta genomes, Bloomberg said.

So far, Kostrikis and his team have found 25 cases of the virus, according to the report. It’s still too early to tell whether there are more cases of the strain or what impacts it could have.

“We will see in the future if this strain is more pathological or more contagious or if it will prevail” against the two dominant strains, delta and omicron, Kostrikis said in an interview with Sigma TV Friday. He believes omicron will also overtake deltacron, he added.” (N)