- Testing – Isolation-Quarantine and Risk Reduction Precautions
This has my comments about specific issues with the CDC Guidelines and other reports relevant to our important procedure that we have been working with for nearly two years.
I welcome your comments and possibly discussing the important challenges facing us. Keeping our staff and patients and their families safe and preparing them to respond to questions about specific aspects of managing the Pandemic especially to engage in the task of working on a white board with an algorithm format app to present the safest trajectories under specific threat contexts.
Last Review of Reports. 12 30 21 There are numerous reports of Non- Scientific Considerations being taken into account to create the flow charts for managing risk. The CDC and Dr. Fauci are NOT following Evidence based -authenticated research reports driven policies. Since mid-Dec when they formulated and announced the lightened requirements for isolation and quarantining and testing and didn’t provide definitions of these terms as well what is symptomatic and asymptomatic and that are the different purposes for the utilizing the PCR test and Antigen Tests. I decide to stop after last Night when I saw the Ayman Mohedin report for Rachel Maddow. I want to be front I have followed the reports posted by Dr. Michael Mina, MD , a former Harvard epidemiologist who is now the chief science officer for eMed, a company that distributes at-home tests, advises an even tighter testing window. He suggests you take the test in your car just 15 minutes before the event if that’s practical. Please scroll to page 7.
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The CDC’s Defense of Its New COVID Guidelines Is Complete Nonsense (msn.com)
The CDC”s Defense of its New Covid Guidelines is Complete Nonsense.
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What’s baffling is that the CDC isn’t asking people to test out of isolation, particularly with home tests. As Eric Topol of the Scripps Research Institute has written, there’s enormous variation in how long individuals remain contagious with COVID, meaning that even after a five day wait, some people will still spread the disease. And while masks [what type of masks.VM] might help reduce that risk some, it’s unclear how much good they’ll do with preventing the spread of omicron, given its high level of infectiousness.
Antigen tests, however, are very good at detecting people who are still infectious to others. Ashish Jha, the Dean of Brown’s school of public health, calls them “contagiousness tests:” They won’t detect every speck of virus that their PCR counterparts are attuned to do, but they can detect the important part—if someone is producing enough of the virus that they’re likely to spread it. Plus, they do not require a drive to a testing site, and a wait of hours or days for results. “It makes no sense,” Topol told me of the CDC’s omission. “Rapid antigen tests are perfect for this.”
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Watch Rachel Maddow Highlights: Dec. 29 - YouTube 4:32 minutes into interview [to 20:22] Conducted by Mr. Ayman Mohedin confronted Dr. T. Fauci on the lightened guidance on testing and isolation and got through the disinformation and brought how he was mixing oranges and apples when he was discussing tests and there was no evidence for the lightened requirements for isolation and testing. He pressed Fauci on why Health care Workers are “ There is no specific data that HC workers need 7 days of isolation and others require only 5 days. That is from internal data at CDC.[It is NOT published Peer Reviewed data.VM] It could go back to 5 days for HC workers if THEY WANT DO. [What is this about?} The Antigen can indicate by the bars the intensity of the Viremia. This is when the person is infectious . At the left side of the curve and the right side of the curve the Antigen test may fail to detect the Virus and not predict infectiousness. But if the Antigen test is positive just before an event or a meeting or after exposure- the infected and infectious person must Isolate. The PCR test reveals if someone was infected and not if the person is infectious because the virus may have been cleared. He also confronted Dr. Fauci on the results of the PCR tests because the test can be positive for several days or weeks and not if you are infectious. He got into jargon after this. Unlike Mr Smerconish on Sunday Mr Mohedin really pressed MR Fauci. I have commented on the issues with PCR and the Antigen test. From all that have learned over 20 months this it: With the PCR: Positivity is reliable and says you have been infected but not if you are infectious especially if you are asymptomatic because it can stay positive for weeks after the Virus is cleared. The Antigen test can miss the low levels in the beginning and tail end of the curve for Viremia but when positive it states you are infectious and MUST Isolate even if asymptomatic after you had an exposure or you are planning to attend and event or examine a patient. He disputed the recommendations on persons who are symptomatic, and the PCR and Antigen Test are negative. Dr. Mina believes one should isolate- assume they are both infected and Infectious until a second Antigen test after a day or two is performed and the strength of the positive result is known which would indicate that the person is infected, to what degree and if infectious. If today 5-7 days after exposure a person is asymptomatic, and the PCR is positive then the Antigen test can help determine if the person is infected and infectious today. This result is necessary to inform the person and his employer to determine if he can return to work or not even of PCR is positive. If the Antigen Test returns a positive results the persons must isolate no matter how well this person is feeling because the results of both suggest this person is both infected with a culturable virus at high counts 100 million to 1 million copies/ml in the nose and the Antigen test confirm this person is infectious and can cause an exponential surge of infections if NOT Isolated with an R naught # of 3-5 for the Omicron variant.
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Newsroom with Alisyn 12 30 21. 2-4 PM [around 3 PM]Dr. Michael Mina interviewed by Alisyn Camarota. Please obtain transcript or watch thee Video He gave lucid explanation about tests and testing as well as his issues with the Characterizations of the Tests by Dr. Rochelle Walensky and pointed out the problems he has with specific recommendations of the CDC … If symptoms are resolving after the 5-day isolation period, positive individuals can leave their house while continuing to wear well-fitting source control. In this recommendation CDC didn’t define what test was used. If PCR test was positive it cannot say if the person is infectious or not now because the PCR can remain positive for weeks. A Rapid Antigen test can indicate if a person is infected and infectious at this point in the course of the infection.[Sadly there is severe dearth of Rapid Antigen’s test kits right NOW.] If the Rapid Test is positive and depending on the brightness of the Red stripes indicates there is culturable Virus in the nose in the range of 100 million to 1 Billion virus in the Nose. This places at least with the Omicron Virus as the predominant variants between 3 and 5 other persons and exponentially. Dr. Susan Hopkins, the chief medical adviser at the U.K. Health Security Agency, said Thursday that the Omicron’s R-value — a number that determines how many people can be infected from another person — is somewhere between three and five, The Guardian reports. This means one person, on average, would infect three to five more people with the Omicron variant.
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CDC Director Rochelle Walensky Gives Away the Game During CNN Interview (msn.com)
CDC Director Rochelle Walensky Gives the game during CNN Interview
Kyle Koster 12 29 21 10:11 AM
The US Centers for Disease Control and Prevention on Monday shortened the recommended isolation time for those who have tested positive for COVID from 10 days to five days, a dramatic shift in guidance that has been met with equal parts optimism and confusion.
"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," the CDC explained. "Therefore, people who test positive should isolate for five days and, if asymptomatic at that time, they may leave isolation if they can continue to mask for five days to minimize the risk of infecting others."
Skepticism exists from those who think the new gameplan was influenced, if not shaped by Big Business exerting pressure on the health organization in the interest of greasing the gears of capitalism with even more risk to workers. Those in that camp of belief will not be assuaged by CDC director Rochelle Walensky's appearance on CNN's New Day this morning.
Pressed by Kaitlin Collins, Walensky offered up a revealing answer: that the new decision had a lot to do with what the CDC thought the American people would tolerate.
CNN's @kaitlancollins: "It sounds like this decision had just as much to do with business as it did the science." @CDCDirector Dr. Rochelle Walensky: "It really had a lot to do with what we thought people would be able to tolerate." This supports my assertion this Policy was not based on peer reviewed Published Scientific Research. It is merely a figment of somebody’s imagination. VM
Smarter people than us can debate the merits of each and every step of this pandemic process, which is headed into its third year. Basing so-called scientific judgements on the public's willingness to go with the findings does not seem like a great process, no matter what side of the aisle you sit on.
Happy to be proven wrong. This is Director of the CDC. We are looking towards her for proof instead she is looking towards the public for proof that she is wrong.
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Strategies to Mitigate Healthcare Personnel Staffing Shortages | CDC
Strategies to Mitigate Healthcare Personnel Staffing Shortages: Updated Dec. 23, 2021 There are helpful Tables.
As of December 23, 2021
Due to concerns about increased transmissibility of the SARS-CoV-2 Omicron variant, this guidance is being updated to enhance protection for healthcare personnel (HCP), patients, and visitors and to address concerns about potential impacts on the healthcare system given a surge of SARS-CoV-2 infections. These updates will be refined as additional information becomes available to inform recommended actions.
- Ensure that SARS-CoV-2 testing is performed with a test that is capable of detecting external icon SARS-CoV-2, even with the currently circulating variants in the United States.
- Updated contingency and crisis strategies for mitigating staff shortages.
On Monday, CDC also announced that Updates to Recommended Isolation and Quarantine Period for General Population. [In additions to other shortcomings these recommendations don’t differentiate between the two types of tests since the Type of the Test is not specified. It is one thing to know who is infected [e.g., Positive result of PCR test can endure for weeks] but it is vital to know who is contagious or infectious with an Antigen Home based test. Please see Item I A. VM]
- Individuals with a positive test result, regardless of vaccination, should stay home (isolate) for 5 days and continue to wear a mask around others for an additional 5 days. If symptoms are resolving after the 5-day isolation period, positive individuals can leave their house while continuing to wear well-fitting source control. { I have concerns about the data in the tables. It doesn’t specify what needs to be done if the person develops symptoms.VM}
- For those individuals who have been “boostered” OR completed the primary series of Pfizer or Moderna vaccine within the last 6 months OR completed the primary series of J&J vaccine within the last two months and have an exposure to someone with COVID-19, CDC recommends wearing a mask around others for 10 days and testing on day 5, if possible. If at any time symptoms develop, seek out a test and stay home. {This is totally unacceptable. This MUST not be optional and left to the discretion and judgement of people in the community. No specification about -duration of isolation or what to do if the test comes back positive and symptoms persists. ?VM}
- Exposed individuals who are unvaccinated OR are eligible for a booster dose but have not received one, should stay home (quarantine) for 5 days and continue to wear a mask around others for 5 additional days. Testing on day 5 is recommended for this group. Those unable to quarantine should wear a mask for 10 days.{This is totally Unacceptable because it doesn’t say what a person must do if symptoms develop and or the test result from the antigen test is positive.-stating they are infected and presumed infectious. Also not specifying the need for both the PCR and Rapid Antigen test prior to day the individual seeks to get back to work is very fraught and harm to others that accrues from the person returning to work with symptoms and without undergoing appropriate and necessary tests. This can be construed as professional negligence and incompetence on the part of the Employer who endorses these inadequate and poorly structured recommendations with inadequate contingencies that can be safely implemented with algorithms that is clear to everyone and have a better than even chance of achieving the goal of mitigating staff shortages.VM}
II.C
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.
Isolation relates to behavior after a confirmed infection. Isolation for 5 days followed by wearing a well-fitting mask will minimize the risk of spreading the virus to others. Quarantine refers to the time following exposure to the virus or close contact with someone known to have COVID-19. 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.
Data from South Africa and the United Kingdom demonstrate that vaccine effectiveness against infection for two doses of an mRNA vaccine is approximately 35%. A COVID-19 vaccine booster dose restores vaccine effectiveness against infection to 75%. COVID-19 vaccination decreases the risk of severe disease, hospitalization, and death from COVID-19. CDC strongly encourages COVID-19 vaccination for everyone 5 and older and boosters for everyone 16 and older. Vaccination is the best way to protect yourself and reduce the impact of COVID-19 on our communities.
12 27 21 My annotated notes address my concerns above and tests. VM
III.
Covid-19 At-Home Testing and PCR, Rapid Testing Questions: What to Know - The New York Times (nytimes.com) [This provides clear definitions for Isolation, Quarantine, Type of Tests.VM]
By Tara Parker-Pope, Dani Blum and Nicole Stock
Dec. 24, 2021
Which Covid Test Should I Get? When Should I Test? What If I Can’t Find One? Answers About Testing and Omicron.
Testing is essential to stopping the spread of Omicron. But nearly two years into the pandemic, many people are still confused about the best way to get tested for Covid-19 or frustrated that they can’t find a test.
Stores have run out of home tests, and long lines at testing centers have made it difficult for people to find out quickly if they are infected. We asked public health experts for answers to some common questions about coronavirus testing during the Omicron surge. Here’s what they had to say.
Holiday Testing
Is one type of test better than the other?
Virus tests are categorized based on what they look for:
Molecular tests, which look for the virus’s genetic material, [PCR test]and
Antigen tests that look for viral proteins.
But comparing rapid antigen tests and lab tests (also known as P.C.R. tests) is sort of like comparing an X-ray to an M.R.I. scan. Both tests are dependable, serve unique purposes and can be useful at different times. The advantage of an X-ray is that it’s cheap, fast, and pretty good at spotting obvious problems. An M.R.I. takes much longer and costs a lot more but gives you a more precise look at what’s going on in the body. [ Not quite- the Rapid Antigen test when positive says the person is infected and infectious on the day of the test because it is measuring the presence of the Virus at the present time. Further if the PCR test is positive and because it can take 3-4 days to get the result the Persons may not or may be inadvertently spreading the virus. The initial viremia would have abated in the interim period before the PCR test result is available.VM} If symptomatic regardless of the test results there are specific recommendations. The timing of the tests are also very important with respect to a specific events. Both tests are needed because the Rapid Antigen Tests because it may not detect the presence of the Virus at the initial and tail ends of the Viremia in the person on a given day, so it is important to do the rapid tests for e.g., on two different days one or two day apart. Also, if the Rapid test is negative because it can’t detect the tail end of the trajectory, the person must continue to be quarantined for a total of 7 days even if asymptomatic. Further the PCR test may be negative if the Covid-19 infection is just starting, and you don’t have symptoms yet — or it could happen if you've had COVID-19 for more than a week before being tested. A negative test doesn’t mean you are safe for any length of time: You can be exposed to COVID-19 after your test, get infected and spread the SARS-Cov-2 virus to others. Thus , a Rapid Antigen Test can assist in determining the infectivity status of a person on a given day period to a specific events or after a potential exposure if the PCR test is negative after the exposure events.. A combination of the PCR and Antigen test performed at two different points in time before and after an event can provide data to determine if one is infective or not even if PCR test is positive especially if the person is asymptomatic. So, the analogy between the Xray and MRI is NOT adequate or relevant or applicable to the dynamics of the Host/Virus engagement process. VM]
The advantage of rapid antigen tests, whether they are taken at home or at a testing center, is that they are fast, relatively cheap and are highly reliable for telling you right now if you’re spreading the virus.
A PCR test is more sensitive and will identify an infection sooner, but it takes more time to get the result. Both tests are useful, but with a fast-spreading variant like Omicron, a rapid test can prompt someone to isolate a few days sooner, sparing others from your germs.
When is the best time to take a rapid home test before seeing family for the holidays?
Home tests can tell you whether you are infected with coronavirus right now. So, you should test as close as possible to the time of the gathering, preferably about an hour or two before everyone gets together, advises Dr. Ashish K. Jha, dean of the Brown University School of Public Health.
Dr. Michael Mina, a former Harvard epidemiologist who is now the chief science officer for eMed, a company that distributes at-home tests, advises an even tighter testing window. He suggests you take the test in your car just 15 minutes before the event if that’s practical.
While it’s important to test on the same day of the event, if you have extra time or extra tests, two tests over a few days are better than one. A few days before your party, try getting a lab test or take a rapid test, and then make sure you test again on the day of the event. [This is the Key Take home Fact. VM]
A negative test [either test} does not lower your risk to zero. But taking a test [on the day of the event.VM] can significantly reduce the risk that someone at your gathering will transmit the virus. [If the test result is negative.VM] “A [Rapid] test will not protect you from getting infected,” said Dr. Mina. “A test will protect you from infecting other people.”[If the Rapid test you took is negative.-This is key.VM]
If you’re flying or taking a train, you should test the day you travel to make sure you’re not infecting your fellow passengers. Once you arrive, you should test in two or three days to make sure you didn’t pick up the virus during your travels.
What if I can’t find home tests before the holidays?
The most important precaution is that everyone at the party who is eligible be fully vaccinated and have a booster shot. But since even vaccinated people can spread Omicron, rapid testing a few hours before an event adds another layer of protection and can prevent an infected person from unknowingly spreading the virus at the gathering.
But if you can’t find rapid home tests, everyone should try to get a lab test as close as possible to the event, timing it so you get the results back before you see everyone. “Any test is better than no test,” said Mara Aspinall, an expert in biomedical diagnostics at Arizona State University who is also on the board of OraSure, which makes rapid Covid tests.
Limit other activities and try to isolate as you wait for the lab results, so you don’t get infected in the interim.
If everyone at the party can’t get tested, then you’ll need to assess the risk. If all the partygoers are relatively young and healthy, and everyone has been vaccinated and boosted, the risk of gathering is relatively low.
But if a vulnerable person — someone very old or who has significant health risks — will be at the party, you may decide to scale it back or cancel if everyone can’t be tested. If you decide to gather without testing, consider asking everyone to wear masks, and focus on ventilation by opening windows or getting a HEPA air cleaner. If you’re in a warm area, try taking activities outside. This minimizes the risk of spread especially if vulnerable persons of whatever age even if they vaccinated and boosted if they are among the guest. VM]
“If you can’t get tests, you have to decide how much risk you’re willing to take,” said Dr. Robert Wachter, professor, and chairman of the department of medicine at the University of California, San Francisco. “Would I still get together if I couldn’t find a test? In a relatively low risk situation, with everyone boosted and vaccinated and everyone feels fine, I probably would. If someone is at high risk and I couldn’t get a test, I think I’d be inclined to have people wear masks and keep the windows open. I’d do the best I could to keep everyone as safe as possible.”
Timing of Tests
When is the best time to test if I was exposed to an infected person?
Omicron moves fast, and many public health experts say people with potential exposures to the virus should test sooner than advised for previous variants. The current guidance from the Centers for Disease Control and Prevention says vaccinated people don’t have to quarantine if they have had close contact with someone who has Covid-19, but that they should get tested five days later. Testing experts, however, say that’s probably not soon enough for Omicron.
A recent outbreak of Omicron Covid infections in Norway after a holiday office party in November gives us clues about the best time to test based on how quickly an Omicron exposure can “convert” to an infection, said Dr. Wachter. The party was held in a restaurant on a Friday, and everyone was vaccinated. Of 80 confirmed and suspected cases, nearly 75 percent were detected on the Sunday, Monday, and Tuesday after the party. That suggests that the best times to test are on days 2, 3 and 4 after exposure.
So, if you think you’ve been exposed to an infected person, or you’ve been traveling through airports and are worried that you picked up the virus, the best time to start testing is probably on day 2 and 3 after the event. If you can, test daily or every other day at least through day 6. And if you know you were exposed to an infected person, it’s a good idea to limit your contacts and mask up around others for about a week after the exposure.
Is it possible to test too early?
Yes. Don’t test immediately after an exposure or high-risk gathering and assume you are in the clear, since it can take a few days for the virus to reach detectable levels. “Doing it too soon is like a pregnancy test,” said Dr. Panagis Galiatsatos, a pulmonary and critical care medicine physician at Johns Hopkins Medicine. “If you test too soon, it means nothing.”[If the test is NEGATIVE. Pay attention if it is a Positive result. VM]
The advice changes if you already are experiencing Covid symptoms. In that case, you should get tested right away. Try taking a rapid test on the day symptoms start, and if that’s negative, take another test a few days later.
When should you retest if your first test is negative?
If your first test is negative after you’ve had a known exposure (or attended a high-risk gathering), you should test again two or three days later, taking precautions in the interim.
I have symptoms but tested negative on a rapid test. Am I in the clear?
No. If you start to feel Covid symptoms, especially if you live in an area with high case numbers, you should assume that you have the virus, at least until you’ve tested negative at least twice over a few days. Early symptoms in a vaccinated person may be a sign that the body is fighting the virus, and it’s possible the viral load isn’t yet high enough to turn a rapid test positive. “Take symptoms seriously,” said Dr. Mina. “Our bodies are giving us an early warning signal.”
If you have symptoms and your rapid home test is negative, it’s still a good idea to try getting a lab-based P.C.R. test, which may find the virus sooner. If that test is also negative, it’s unlikely you have Covid. But if you have any respiratory symptoms, you still should stay home. In addition to Covid, you can also ask to be tested for two other potentially serious viral illnesses — influenza (the flu) and respiratory syncytial virus (RSV) — which are also circulating.
What does an “indeterminate” result mean?
While it’s unclear how often it happens, some people who get tested for Covid at a hospital or testing center receive an “indeterminate” test result. If this happens to you, you should not assume you are negative. You should retake the test, at a different testing site if possible. [Or a PCR test should be obtained. VM]
Indeterminate results happen for a variety of reasons. Sometimes the sample itself is inadequate for testing. In some cases, a mistake in processing or a machine calibration issue can lead to an indeterminate result. And sometimes it happens because the patient’s viral load is so low, it doesn’t create a true positive result. [However, this does not preclude the person if infected can develop symptoms of Long Covid regardless of seriousness of the Covid Infection. VM]
Should I retest if I got a positive result on a home test?
If your rapid test is positive, you should assume that you have Covid. If you have reason to doubt the result, you can take a second test. False positives aren’t common, but they can happen. Most experts say they would isolate after a positive rapid test, but they would also get a confirmatory test from a lab. Getting the confirming lab test means your positive result will be documented in your medical records, which could speed things along if a patient needs additional treatments or develops Covid-related health issues in the future.
My lab test result [This is the PCR test] is different than my rapid test. Which test is right?
It’s possible to test negative on a rapid test and test positive on a P.C.R. test. Both results may be correct, even if they disagree. The reason is that the tests are looking for different things. Rapid tests look for antigens indicating you’re infectious. A negative test indicates you’re not [at the point of the test] spreading coronavirus right now. A lab based P.C.R. test is more sensitive and can tell you if you’ve been infected with coronavirus [But not if you infectious.VM]. It’s possible for a P.C.R. test to detect coronavirus when you’re not infectious.
If you test positive on a rapid antigen test, and later test negative on a P.C.R. test, you probably don’t have Covid, said Dr. Jha. In this case, the rapid test likely was a false positive. [And the PCR is more likely to be accurate. VM]
If you have respiratory symptoms and get conflicting test results, it’s worth getting a third lab test a day or two later to break the tie.
“If you’re testing in the context of symptoms, and you have a positive test on either one, then I would take them seriously and consider them positive, and not be reassured by the negative one,” said Dr. Paul Sax, an infectious disease expert at Brigham and Women’s Hospital and professor at Harvard Medical School.
If you’ve received conflicting test results and are not able to get a third test to break the tie, you should still take protective actions to prevent spreading the illness, said Tara Kirk Sell, a senior scholar at the Johns Hopkins Center for Health Security.
Types of Tests
What’s the difference between a rapid antigen test and a lab based P.C.R. test?
Virus tests all use a sample collected from the nose, throat or mouth that may be sent away to a lab or processed within minutes at home.
An antigen test hunts for pieces of coronavirus proteins. Most rapid home antigen tests work sort of like a pregnancy test — if virus antigens are detected in the sample, a line on a paper test strip turns dark. The tests are highly dependable for telling you if you’re spreading the virus on the day you take the test, but a single test won’t tell you that you definitely don’t have coronavirus. The main advantage of the test is that it’s fast and can be used to lower the risk of small indoor gatherings.
A laboratory molecular test, also known as the P.C.R., or polymerase chain reaction, test, uses a technique that looks for bits of the virus’s genetic material — similar to a detective looking for DNA at a crime scene. This test is considered the gold standard of coronavirus testing because of its ability to detect even very small amounts of viral material. A positive result from a P.C.R. test almost certainly means you’re infected with the virus. The downside is that the typical turnaround time is one to three days, and during the current Omicron surge, people seeking tests are waiting in long lines and some centers are running out of tests.
Are nasal swabs better than spit tests?
Some lab tests use a nasopharyngeal swab that is inserted deep (and uncomfortably) into the nasal cavity. Home tests typically rely on a nasal swab that collects a sample with a few easy swishes inside both nostrils. And some tests use a collection method that requires the patient to drool or spit into a test tube. For some people it might take about five minutes to generate enough spit to fill the vial, and testing sites ask you to not eat or drink anything 30 minutes before collecting a saliva sample.
Saliva tests are slightly less accurate than nasal swabs, but the difference isn’t that meaningful, said Dr. Adam Ratner, director of pediatric infectious diseases at NYU Langone Hassenfeld Children’s Hospital.
Does it matter what brand of rapid home antigen test I get?
As long as the tests are cleared by the Food and Drug Administration under an Emergency Use Authorization, it doesn’t matter which brand you get, said Dr. Ratner.
At-home tests can be purchased at most major drugstores, though Walgreens and CVS announced on Wednesday they’re limiting the number of test kits per purchase at locations nationwide amid a surge in demand.
Currently, there are several rapid home antigen tests available in the United States. The best known include Abbott’s BinaxNOW, Quidel’s QuickVue and the recently authorized test by Acon Labs, Flowflex. Newer tests on the market include the Intrivo On/Go, the iHealth Covid-19 test and the BD Veritor at-home digital test kit. The InteliSwab test has the longest wait time, at 30 to 40 minutes. Australia’s Ellume has been in the news for a high rate of false positives, but those faulty tests have been recalled. Most of the tests are typically packaged two per box, although Flowflex offers a single test pack for about $10. Read the label before you buy. Some of the tests require an app.
Are rapid home molecular tests better?
A more expensive home test, called a rapid home molecular test, uses a technology similar to what you might get at the doctor’s office. While a molecular test is more sensitive, these tests can also be hard to find and are expensive, so they aren’t a practical option for most people to use regularly. The Lucira Check It test kit costs $75 and takes about 30 minutes. A new test, detect, offers a $75 starter kit that includes a reusable “hub” that processes the test in about an hour. Additional Detect tests cost $49 each, but the tests are often sold out. Another test called Cue offers subscription plans that include a $149 test reader and a $49 monthly subscription that includes 10 tests a year and discounts on future tests.
Will my insurance plan reimburse me for home tests?
The Biden administration has said it will release rules by Jan. 15 outlining an insurance reimbursement process for rapid home tests. It is unclear if the government will limit reimbursements per person. It does not appear reimbursement for Covid tests will be allowed for tests purchased before the rules are in place but keep your receipts just in case. Some employer-sponsored health plans have been covering the costs of home tests for the last year, so check with your plan to make sure you’re not already eligible for reimbursement.
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A. COVID-19 Quarantine and Isolation | CDC
Quarantine vs. Isolation
- You quarantine when you might have been exposed to the virus and may or may not have been infected.
- You isolate when you have been infected with the virus, even if you don’t have symptoms.
B.
CDC Updates Guidance, Says People with Covid-19 only need to isolate for 5 days if Asymptomatic- Jody Serrano 12 26 21. 9:47 PM
Citing increased scientific knowledge of covid-19 and the raging omicron variant, the Centers for Disease Control and Prevention modified its isolation and quarantine guidelines for people who test positive for the virus and those who are in contact with someone confirmed to be infected.
In an announcement on Monday, the CDC shortened its recommended isolation time for people with covid-19 from 10 days to five days if they are asymptomatic at that time. Nonetheless, individuals must still wear a mask for the five days after their isolation period ends when they are around others to reduce the risk of passing the virus to 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,” the CDC said. “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.”
The health agency also made changes to its recommended quarantine period for people exposed to covid-19. Although they are often used interchangeably, “isolation” and “quarantine” have key differences. As explained by the CDC, you isolate when you have been infected with covid-19, even if you don’t have any symptoms. [Please see link above.VM]
Meanwhile, you quarantine when you have been exposed to the virus or have had close contact with someone known to have covid-19 but don’t know whether you have been infected.
For people that have been exposed to covid-19, the CDC offered a range of new guidance. It can be summarized as follows:
- Those who are unvaccinated or who have received their second mRNA vaccine (Pfizer or Moderna) more than six months ago and have not received a booster shot must quarantine for five days and wear a mask for an additional five days.
- Those who received the Johnson & Johnson vaccine more than two months ago and have not received a booster shot must quarantine for five days and wear a mask for an additional five days.
- Those who have received a booster shot don’t need to quarantine but should wear a mask for 10 days after being exposed.
The CDC said that if a five-day quarantine was not feasible, exposed individuals should wear a mask for 10 days. In addition, the health agency urged all of those exposed to get a covid-19 test five days after they had been exposed. Should they develop symptoms, the CDC recommends that they “immediately quarantine until a negative test confirms symptoms are not attributable to COVID-19.”
CDC director Dr. Rochelle Walensky in a statement acknowledged the quick spread of the omicron variant and affirmed that it has “the potential to impact all facets of our society.”
“CDC’s updated recommendations for isolation and quarantine balance what we know about the spread of the virus and the protection provided by vaccination and booster doses,” Walensky said. “These updates ensure people can safely continue their daily lives.”
Walensky added that prevention is the best response to the virus and encouraged the public to get vaccinated, get their booster shot, and wear a mask in public indoor settings if they live in areas of substantial and high community transmission. She also advised people to take a covid-19 test before getting together, something that might be difficult at the moment due to the holiday season, which has put at-home tests and tests at clinics in high demand.
If you’re like me, that’s quite a lot of guidance to always keep in mind. It’s complicated, but then again, so is the coronavirus. The key will be transmitting the new guidance in a way everyone can easily remember or understand. Until then, I will be bookmarking this article as well as the announcement.
C. Testing for COVID-19 (cdc.gov)
Testing for COVID-19 Updated Oct. 4, 2021
About Testing
Testing is critically important to help reduce the spread of COVID-19
III.
Velandy Manohar, MD.,
Distinguished Life Fellow- Am Psychiatric Association
2) Role and utility Rapid Antigen Tests. PBS News Hour.
While having dinner and listening to the News Hour I happened on this very direct back and forth conversation about the role of the Rapid Antigen Tests in the management of the contagiousness of the new Variant. Prof Kirsten Bibbins- Domingo, Ph.D., MD., MAS. at UCSF.
PBS NewsHour – December 31, 2021 – PBS NewsHour full episode – Twin Cities PBS (tpt.org)
Ms. Amna Nawaz interviewed Dr. Kirsten Bibbins-Domingo, PhD, MD, MAS.
12 31 21 Covered 3:05 to 8:00 minutes into the broadcast.
Kirsten Bibbins-Domingo, PhD, MD, MAS is Professor and Chair of the Department of Epidemiology and Biostatistics, and the Lee Goldman, MD Endowed Professor of Medicine.UCSF
She made these responses during the interview: Talking about the Rapid Antigen Tests.
- “The message should not be these tests don’t work”
- “My understanding of the evidence is in fact these tests work”
- “It is a useful Tool” “These are absolutely useful tests”
- Despite the mutations, “it can still find the Virus”
- If a line appears however faint, act like you have Covid. If test is positive, pay attention to result and isolate.
- If the test is negative, it is not certain you don’t have the virus because it may not be as sensitive to detect the Virus.
- So, this rapid test cannot tell you with 100% certainty that you don’t carry the virus and not contagious or infectious.
- It the antigen test is negative; you must make sure what this means by taking another test preferably the more accurate PCR test to confirm the person is not infected.
- To determine infectivity or contagiousness the Rapid Test is a useful tool.
3) Corona SARS 2 Virus Pandemic - The strategies to stay safe at work, to return to work or interacting in the community after Exposure and getting a positive test result.
Good afternoon,
I am so sorry that it is already 4 PM before I could get to this task. I have been thinking about the interaction that Nikhil and Marc had several days ago about in person assessment of our trusting patients who want to be seen and heard and experience what it is to be valued as person by getting our full attention on my ARC device. I began to formulate my response which was not easy unlike the facts that were extant before November middle. I noticed CDC and Dr Fauci from the White house were promoting a newly crafted set of CDC Guidelines. I found the data provided couldn’t help me to draw the algorithms based on the stark statements without definitions and time intervals etc. Some of recommendations in crucial decision point son the algorithm included statements such as “seek a test” at the point of deciding to leave isolation.
I have created a composite document with many data sources starting from most recent. I have made annotated comments [as I was studying all these reports to let you all know where I stand on these issues and why] to facilitate an internal discussion to create a safe alternative algorithm on white Board. We have one or two big ones in our North Haven Office and at least one Big One in the Wallingford HQ office of the specific circumstances a staff person could be in and trajectories with decision points especially with respect to the questions about when to isolate when to quarantine, how to utilize BOTH the PCR test and the Home based or suitable lab based Antigen Tests to ascertain the DX of Covid is accurate by validating the Rapid test with the PCR and how to use the Rapid test to decide if a person who tests positive is CONTAGIOUS or INFECTIOUS before leaving the isolation safety bubble. These rapid tests may need to be used on day 1, 3 or 5 after the exposure to make health sustaining decisions or on the day of appointment for instances for the patients and the Care Giver such a prior to scheduled detailed intimate psychiatric assessments where emotions can surge and one may need to comfort if one is in the room[I see you, I hear you, I want to understand what you are trying to tell me. {actually, I want to help them tell the stories that they need to tell me to STAY ALIVE. [We need such story telling experiences to hold fast to what we stand for] The early creators of AA understood the hidden healing power of this iterative narration strategies.] So being with someone is helpful But, we must have scientific fact based algorithms with decision points supported by specific information not conjecture or any other influence such as they made an in house decision in the CDC about why HC staff needs to isolate 7 days while regular people need to isolate only for five days regardless of the test results or if they are symptomatic or not.
These documents provide specific interactions with Journalists that reveal a serious breakdown of the decision-making processes at the CDC and the WH with respect to the factual basis of these guidelines from Dr. R. Walensky (CNN] Dr Fauci [MSN, Dr. M. Mina, Dr. A. Jha and Responses evoked by these fraught with vagueness and light on the facts decision points.
I welcome food faith efforts to review and revise the guidelines with eyes wide open on the tightness of the definitions and criteria for critical decision points which are replicable, will keep our staff, reduce the risk of burnout from exhaustion, keep our patients and their families as well as ours safe.
I welcome responses and feedback on specific assertions I have made.
Warm Regards,
Velandy Manohar, MD
PS. I am a member – Advisory and Review Board of the Whiting Forensic Hospital. Our Board members are working with decision makers in DMHAS and WFA on managing the terrible surges affecting WFH and Mx Hospital system [one of our members is from Mx Health] to protect their residents, staff, and family members.
Part of my preparation work to respond to Marc and Nikhil has been helpful in my work on the Board.
These have been very tough 3-4 weeks at the end of nearly 22 months since the Pandemic began. I am currently listening for some hours to this composition: César Franck: "Les Béatitudes" (Amsterdam, 1977) - YouTube The graphics as well as the messages are very restorative, uplifting and inspiring. I can keep tryingto live by the beatitudes. I am working on the love thy neighbor message from the Parable of the good Samaritan, the last message from that parable is simple- Go, and do thou likewise. Like everyone else has found I find every day this is easier said than done. VM
The CDC’s Defense of Its New COVID Guidelines Is Complete Nonsense (msn.com)
The CDC’ s Defense of its New Covid Guidelines is Complete Nonsense.
Jordan Weisman 8 hours ago- 12 30 21 8 PM
The Biden administration has spent much of the past two days trying to defend its widely pilloried new guidelines for how long Americans should isolate if they contract COVID-19. So far, the effort hasn’t been very convincing.
With case counts surging amid the omicron wave, the Centers for Disease Control and Prevention on Monday cut its recommended isolation and quarantine time from 10 days down to five for people who are asymptomatic or for those whose “symptoms are resolving.” After then, people can return to normal life, but should wear a mask for an additional five days, according to the agency.[CDC Policy neither specifies type of Masks, nor are symptoms specified. [This impedes research, training, educating patients and staff, and replicating results accrued from implementing these CDC recommendations to validate or rebut parts of the recommendations.VM]
The reduction makes some sense: In recent weeks, a number of public health leaders have suggested that 10 days of isolation was excessive, especially for the vaccinated, and that the wait time could perhaps be cut by half given a negative test.[The Antigen test but not PCR- the Positive result of the PCR test can remain positive for weeks. This won’t help in deciding when to stop isolating.VM] Other countries have taken a similar approach; in England, for instance, individuals only have to isolate for 7 days if they come up if they come up negative on consecutive rapid antigen tests.
The key in those arguments and policies, though, is the negative test.[the Antigen Test.VM]The CDC’s new guidance, in contrast, does not recommend a test before exiting isolation. This is a huge difference—one that could mean many, many people exit a period of careful isolation, only to walk around and spread the highly-contagious virus. [The R Naught # is between 3-5 VM]The most generous feedback could be described as “partially supportive.” Experts have mostly described the CDC’s decision as “reckless,” not based in science, and “bullshit.”
In response, administration officials have since embarked on a media tour to try and justify the new guidelines. CDC Director Rochelle Walensky told CNN that the agency chose five days because that’s typically the period when individuals are most infectious. “Those five days account for somewhere between 85 to 90 percent of all transmission that occurs,” she said. “So, we really wanted to make sure that most of those five days were spent in isolation.” What about the transmission that can happen on later days? Five days, Walensky said, was the amount of time “we thought people would be able to tolerate.” [NOT SCIENCE BASED FACT- It is an Opinion.VM] Anthony Fauci, currently the Chief Medical adviser to President Biden, was even more frank: “The reason is that with the sheer volume of new cases that we are having and that we expect to continue with omicron, one of the things we want to be careful of is that we don’t have so many people out,” he explained on CNN. That is: we need people to get out of isolation so that they can get back to work.[Policy Not based on Science but frankly, rather on Expediency and Business interests.VM]
These are fine rationales for significantly cutting the amount of time people isolate—if they test negative before they leave isolation. After all, there’s no point in making workers call in sick (and potentially forcing their employers to shut down) if they’re unlikely to be contagious. And given that spending 10 days in isolation is incredibly disruptive, it’s possible that the old, longer quarantine recommendation might have discouraged some people from even getting tested for COVID in the first place.
What’s baffling is that the CDC isn’t asking people to test out of isolation, particularly with home tests. As Eric Topol of the Scripps Research Institute has written, there’s enormous variation in how long individuals remain contagious with COVID, meaning that even after a five day wait, some people will still spread the disease. And while masks [what type of masks.VM] might help reduce that risk some, it’s unclear how much good they’ll do with preventing the spread of omicron, given its high level of infectiousness.
Antigen tests, however, are very good at detecting people who are still infectious to others. Ashish Jha, the Dean of Brown’s school of public health, calls them “contagiousness tests:” They won’t detect every speck of virus that their PCR counterparts are attuned to do, but they can detect the important part—if someone is producing enough of the virus that they’re likely to spread it. Plus, they do not require a drive to a testing site, and a wait of hours or days for results. “It makes no sense,” Topol told me of the CDC’s omission. “Rapid antigen tests are perfect for this.”
Here’s how Walensky defended the decision to not recommend rapid tests, to CNN:
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. The FDA has not authorized them for that use. We don’t know how they perform.
So, what we said was well, if you got a rapid test at five days and it was negative, we weren’t convinced that you weren’t still transmissible. We didn’t want to leave a false sense of security. We still wanted you to wear the mask. And if it was positive, we still know the maximum amount of transmission was behind you. We still wanted you to wear a mask.[Type Not specified. VM]
And given that we were not going to change our recommendations based on the result of that rapid test, we opted not to include it.[Per CDC]
This is nonsensical on a few levels. The FDA doesn’t have to greenlight every single specific use of a medicine or a test for doctors to use it. We allow Botox for migraines, and aspirin for strokes, for example. And while it’s true that we don’t know with absolute mathematical certainty how well rapid antigen tests detect contagiousness at each stage of COVID, that’s hardly a justification for tossing them aside. If a patient tests positive, it means they are still producing lots of the virus, which is a very good reason to worry that they could still be infectious to others.[if brightly positive there 100million to a billion copies of the virus/ml in the nose. Dr. Mina] Sure, perhaps someone could tests positive without being contagious–but it seems worth erring on the side of having people stay isolated, versus sending them out into the world with a mask. [Especially because the R naught # is 3-5, the spread can be exponential and double the new cases every few days.VM.] “They’re used in the UK and all the other countries that have relied on rapid tests for well over a year, just for this reason,” says Topol “They have a protocol for self-isolation until your rapid tests convert into negative. So, to question that is preposterous, because that’s been well-established and validated.”
“It’s much better than no information,” he added. “It’s exceedingly better than no information. It’s blind to do it without a test.”
The worry that some Americans might use a false negative as an excuse not to wear a mask when they leave isolation is both paternalistic, and out of touch. It’s possible, sure, that some folks would test negative, and then choose to ignore a recommendation to mask up . But the CDC could also just try giving clear, honest instructions about why people should still mask up for five days, even if they think they’re negative. Plus, does the CDC really think the guidance they have issued will help Americans happily and reliably wear masks? It seems more likely that people who have been following the letter of the law when it comes to coronavirus guidance will continue to do so, and those that are against masking will continue to be against masking.
Given how weak the CDC’s arguments are, it’s hard not to suspect that the real reason it opted not to recommend taking a rapid antigen test is that the kits simply too hard to find in the U.S. right now. Walensky has denied this:” This really had nothing to do with supply. It had everything to do with knowing what to do with the information when we got it,” she told CBS. But it makes vastly more sense than the official explanation, which is that U.S. health authorities have decided every other country is wrong and rapid testing just isn’t that useful for figuring out whether someone might still be capable of spreading the plague after five days at home.
Even if the CDC had recommended testing after five days, some Americans obviously wouldn’t have with it bothered because of the hassle (plenty aren’t bothering to isolate at all). The tests are expensive to have lying around just in case you need to isolate and can require effort to even find in stock. “The sad reality is that we’re two years into the pandemic and we still have a scarcity of tests in the U.S,” director of the World Health Organization’s Collaborating Center on National and Global Health Law told NBC. The Biden administration’s failure to make rapid testing widely available would be haunting our response no matter what.
But given that many employers rely on the CDC’s guidelines for when workers can return to their jobs after getting [?exposed], there’s a good chance these new, looser rules are going to result in more infections, which could end up disrupting people’s lives and businesses just as much as requiring infected individuals to test negative or stay home a couple extra days. The CDC’s nonsense justifications don’t make that any less of a frustrating reality.
4) VINDICATION-CDC and Fauci reconsidering the FLAWED Fast get out of Isolation guidelines
Good afternoon colleagues,
I have shared with you a series of reports including a very destabilizing set of Guidelines that met with robust fact-based rebuttals on specific weak points with respect to protecting the person who was responding to exposure or a positive test result. You have all the information form authoritative original sources. [e.g. Amna Nawaz interview with Dr. Bibbins- Domingo, MD.
From: AMA- Morning Rounds
To: Velandy Manohar, MD
Monday 01 03 21 8:52 AM
Leading the News
CDC considers testing recommendation as part of shorter COVID-19 quarantine protocol for asymptomatic infections
The Washington Post (1/2, Stein) reports NIAID Director Dr. Anthony Fauci “said Sunday that U.S. health officials are considering recommending that Americans get tested for the coronavirus before going back to work under the shortened isolation protocol they recently introduced.” During an interview, “Fauci acknowledged the backlash over the Centers for Disease Control and Prevention reducing the recommended isolation period after a positive coronavirus test from 10 days to five,” and “said officials may soon add a testing component at the end of the five-day period.”
The AP (1/2, Yen, Madhani) reports Fauci said, “There has been some concern about why we don’t ask people at that five-day period to get tested. ... Looking at it again, there may be an option in that, that testing could be a part of that, and I think we’re going to be hearing more about that in the next day or so from the CDC.”