Today I was busy with medical issues. Nothing bad to report on my side. But I feel somewhat sad for the people in the U.S. who's health get screwed by its 'elite' over and over again.
Seven days ago the CEO of Delta Airlines asked the Centers for Disease Control and Prevention (CDC) to cut quarantine time for Covid breakthrough cases:
Delta Air Lines Inc's chief executive asked the head of the U.S. Centers for Disease Control and Prevention on Tuesday to shrink quarantine guidelines for fully vaccinated individuals who experience breakthrough COVID-19 infections, citing the impact on the carrier's workforce.
CEO Ed Bastian, along with the company's chief health officer and a medical adviser, asked in a letter to CDC Director Rochelle Walensky seen by Reuters that the agency's recommended quarantine period for anyone who tests positive with a breakthrough COVID-19 infection be reduced to five days from the current 10.
The letter suggested that individuals could end isolation with appropriate testing.
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"With the rapid spread of the Omicron variant, the 10-day isolation for those who are fully vaccinated may significantly impact our workforce and operations," Bastian wrote. "Similar to healthcare, police, fire, and public transportation workforces, the Omicron surge may exacerbate shortages and create significant disruptions."
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Delta said that "as part of this policy change, we would be interested to partner with CDC and collect empirical data."
The CDC immediately set off to do what the business side of the U.S. told it to do. Yesterday it changed its guidelines for recommended isolation and the quarantine period:
Given what we currently know about COVID-19 and the Omicron variant, CDC is shortening the recommended time for isolation from 10 days for people with COVID-19 to 5 days, if asymptomatic, followed by 5 days of wearing a mask when around others. 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 1-2 days prior to onset of symptoms and the 2-3 days after. Therefore, people who test positive should isolate for 5 days and, if asymptomatic at that time, they may leave isolation if they can continue to mask for 5 days to minimize the risk of infecting others.
Additionally, CDC is updating the recommended quarantine period for those exposed to COVID-19. 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. Alternatively, if a 5-day quarantine is not feasible, it is imperative that an exposed person wear a well-fitting mask at all times when around others for 10 days after exposure. 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.
These recommendation are:
- way too differentiated and thereby confusing. Only the first sentence up to but excluding the word 'asymptomatic' will be followed.
- not based on science as the infectious period of Covid cases varies over a relative wide range and can be even more than ten days after symptom onset.
- misses the use of tests after the five day period.
- does not mention the varying quality of different masks and does not recommend the use of K95/FFP2 masks which are the only ones that should be used by likely infectious persons.
The recommendations give backing to businesses who tell their workers to come to work even when sick.
They go far beyond what the Delta CEO asked for. The three points set in bold in the first quote above get ignored in the CDC recommendations.
The U.S. doctors and scientist I follow on Twitter all disagree with the CDC.
Jerome Adams @JeromeAdamsMD – 13:50 UTC · Dec 28, 2021
Regardless of what CDC says, you really should try to obtain an antigen test (I know- easier said than done) and confirm it’s negative prior to leaving isolation and quarantine.
There’s not a scientist or doctor I’ve met yet who wouldn’t do this for themselves/ their family.
Ashish K. Jha, MD, MPH @ashishkjha – 13:48 UTC · Dec 28, 2021
While new CDC isolation guidelines are reasonable, here's what I would have done differently
1. Required a neg antigen test after 5 days
2. Had different guidelines for vaccinated (contagious for shorter time) versus unvaccinated
3. Specified higher quality masks
Short thread …
Eric Topol @EricTopol – 14:50 UTC · Dec 28, 2021
The data that supports the new @CDCgov 5 day isolation period without a negative test
Topol's tweet has a picture of an empty paper attached to it.
The often quoted Angie Rasmussen is livid:
Dr. Angela Rasmussen @angie_rasmussen – 15:34 UTC · Dec 28, 2021
Once again, @CDCgov outdoes itself by taking what might be a reasonable policy (test to leave isolation) and removing the part that makes it reasonable (the testing part). This is reckless and, frankly, stupid.Mandatory 10-day isolations could be reduced if a person tests negative sequentially. Example: 2 negative tests 24 hr apart beginning on day 5. But just assuming that people with no symptoms aren’t shedding shitloads of virus? CDC, where have you been this entire pandemic?
SARS-CoV-2 spreads readily from people without symptoms. That’s a key reason why the pandemic has been so hard to contain. @SaskiaPopescu and I reviewed this nearly A YEAR AGO, long before omicron befouled our holidays.
SARS-CoV-2 transmission without symptoms
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I’m very disappointed with yet another failure to actually use evidence in formulating recommendations. I’m very disappointed in @CDCDirector @RWalensky’s leadership, which has been at best erratic and at worst nonexistent.Actual public health leadership means not putting business interests first during a public health crisis with policies you just pulled out of your ass. It’s callow, it is devastating to public confidence, and it’s going to blow up when omicron cases continue their meteoric rise.
This isn’t changing policy to reflect the changing evidence. This is caving to business interests with a nakedly evidence-free one-size-fits-all solution that was probably cooked up in lieu of the will to actually increase testing availability to make test-to-release possible.
Angie gets political:
We all had such high hopes for the Biden administration’s pledge to let science lead the way out of this pandemic. Those hopes have been dashed repeatedly by the lack of follow through on any of the promises made regarding the pandemic.
A year later, we still don’t have enough tests, 40% of people are unvaccinated, there’s no national mask mandate or vaccine mandate, and the country is ablaze with omicron. It didn’t have to be this way and wouldn’t be if @POTUS kept his promises.
Well Angie, its the system that is sick and not the man at the top.
In a phone call with governors Biden yesterday rejected all responsibility:
Republicans wasted no time slamming Joe Biden after the flip-flopping president said 'there is no federal solution' to combatting COVID-19 on Monday.
The CDC changes will ease COVID-related flight cancellations as sick flight personal will be able to help spread the virus even when they don't like to do so:
"We said we wanted to hear from medical professionals on the best guidance for quarantine, not from corporate America advocating for a shortened period due to staffing shortages,” said Association of Flight Attendants-CWA International President Sara Nelson following the CDC announcement shortening the recommended quarantine duration from 10 days to five days.
“The CDC gave a medical explanation about why the agency has decided to reduce the quarantine requirements from 10 to five days, but the fact that it aligns with the number of days pushed by corporate America is less than reassuring,” Nelson said.
The CDC and the Food and Drug Administration (FDA) have had so many screw ups during the pandemic that one must doubt their usefulness.
Recently the FDA authorized and even praised Pfizer's Paxlovid anti-Covid drug. But its use is seriously in doubt:
When Paxlovid is paired with other medications that are also metabolized by the CYP3A enzyme, the chief worry is that the ritonavir component may boost the co-administered drugs to toxic levels.
Complicating matters, the drugs that pose interaction risks are widely prescribed to people at the greatest risk from Covid because of other health conditions.
The medications include, but are not limited to: blood thinners; anti-seizure medications; drugs for irregular heart rhythms, high blood pressure and high cholesterol; antidepressants and anti-anxiety medications; immunosuppressants; steroids (including inhalers); HIV treatments; and erectile dysfunction medications.
The half of the U.S. population that is most in danger due to Covid will not be able to take Paxlovid as it already uses incompatible medications.
The CDC is still unable to track the number of Omicron cases. Today it admitted that it (again) screwed up its own statistic:
The Centers for Disease Control and Prevention significantly revised its model of the breakdown of Covid-19 variants on Tuesday, estimating the Omicron strain accounted for about 58.6 percent of U.S. cases as of Dec. 25.
The public health agency’s previous estimate that the rapidly spreading variant accounted for 73.2 percent of cases nationwide on Dec. 18 is now revised down to 22.5 percent — a significant drop that falls outside the agency's earlier 95 percent prediction interval, or likely range where future analysis will fall, of 34 to 94.9 percent of all cases.
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The U.S. is now recording more than 206,000 daily Covid-19 infections — a number that is rapidly growing. Americans continue to travel at high levels through the holidays: more than 2 million people flew yesterday, according to Transportation Security Administration data.
Tomorrow the number of new Cocid cases per day in the U.S. will likely exceed the previous record.
Omicron guarantees that the next few month will be a wild ride. But no matter how high the number of cases will be the U.S. the federal government and its institutions will do nothing about it. They have been proven to be incapable for systemic reasons independent of their leadership. It does not have to be that way but I see no one who is trying to change that.
To be clear. I am not worried for myself. I am vaccinated and was boostered today. But I worry about those who for whatever reason are not vaccinated. And about those who will get sick with non-Covid issues and who will have difficulties to find an empty hospital bed while Omicron rushes through. Good luck to them.
(Like all Covid threads this one too will get policed to eliminate promotions of drugs that are not useful and arguments not based on science.)