“Shared expectations lead to predictability.”
441. Guidelines are being made to reflect the changing status of Covid safety.
Q: With all the headlines about this Covid surging, how can our church remain open?
A: This is a tale of two cities (or, rather, communities), and like the famous author alleges, “It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness…” Each of us lives in multiple environments. When at home with family members, we feel safe from exposure to airborne infections like the seasonal flu or Covid-19. When we grocery shop or attend a concert or a sports event during this pandemic, we know that we should take precautions – wear masks, and keep socially distant from others. “But.” we say to ourselves, “it has been two years, and this is getting tiresome.” Foolishness, according to the CDC is to assume vaccination is not worth it, Wisdom says that for protection during this time, one must be fully vaccinated, and if your last shot was over 6 months ago, you absolutely need to get a booster shot as well.
UUS:E initially had based its decisions solely on the metrics for the state of Connecticut. With a fourth of the population unvaccinated, with many getting “pandemic fatigue” not wearing masks even in crowded situations, the government not setting any mandates for mask-wearing or vaccinations, and now the introduction of a more infectious Omicron variant, the statewide metrics have surged dramatically. “Doomsday!” the media communicate. The daily news about the foolishness of the public becomes more dramatic. But wisdom was found when our church agreed to follow the science to provide safety for the congregation. Encouraging full vaccinations and booster shots for those eligible, wearing masks at all times within the church, social distancing between family groups, modifying ventilation to exchange the air inside the building, and not allowing coffee and snacks, we take more precautions in church as a congregation than we do at home.
Some say there is still the chance for maybe a breakout infection to occur. Nothing in life is risk-free, but the science tells us that even with Omicron, a breakout infection with all the protections we hold dear would be no more serious than a seasonal flu infection had been in the years before 2020. In this “best of times,” Sunday services today give each of us the chance to personally be with each other and find what some have called sanctuary. And the wisdom of all this is that if anyone who is not convinced or who still feels uncomfortable, can always join in via Zoom and participate remotely.
442. The metric “positive test ratio” indicates if enough testing is being done.
Q: When the positive test ratio is going up, does this mean more people are infected?
A: No. In epidemiology, the positive test ratio is a way to be certain that enough testing is being done. This allows for a more reliable estimate of the actual number of infected people there are in a community. In traditional public health practice, a person who is tested positive for having an infectious disease is held in isolation for a period of time until their symptoms are resolved and they can no longer infect others. In the meantime, that person is asked who they had been in contact with previously, and each of these people is tested. Any positive test leads to a similar response with those in close contact held in quarantine. This way, the number of people who become infectious can be controlled. If random testing of a part of the population does not include a significantly high number, many infected people will be missed and carry the disease to a larger number of people. The epidemic or pandemic surges and can easily get out of control.
The calculation of an acceptable threshold percentage of the tests that were found to be positive to indicate that enough people had been tested that day is complex. The Covid Act Now group has set that threshold at 3% of the laboratory PCR tests reported. The World Health Organization has set a higher level to indicate sufficient testing is being done. Last Thursday, the Covid Act Now group reported that for Connecticut, the positive test ratio was 9.7%. Their notation associated with that number read: “Positive test rate is the percentage of COVID tests that come back positive. It measures both the severity of COVID and the limitations of testing. If a place has a high positive test rate (over 3%), it is a sign of insufficient testing in that area.” That appears to be the case for Connecticut – too many people are infecting others without being tested to learn if they are spreading the disease before they become ill themselves. This has to be a major reason why we are currently having such a dramatic surge. It also means that the actual number of identified cases (as defined by a positive PCR test) is probably lower than the actual number of people infected and spreading the disease.
443. Omicron is diagnosed as a unique variant by a separate lab evaluation.
Q: Does the PCR test for Covid-19 define if it is the Delta, Omicron or another variant.?
A. The differentiation of Omicron from other variants requires a separate laboratory analysis called genomic sequencing to identify the specific mutations to Covid-19 that are present. In Connecticut, there are two laboratories that are capable of doing this testing. The first is the Dr. Katherine A. Kelley State Public Health Laboratory located in Rocky Hill. The other is the Jackson Laboratory for Genomic Medicine, part of the University of Connecticut Health Center located in Farmington. Because of the costs and resources required, every state tests only a sample of positive PCR tests for genomic sequencing. Connecticut submits a higher percentage of positive Covid-19 tests for this added information than most other states, but this is still only 25% of the positive Covid-19 samples. Therefore, of the less-than-reliable number of Covid-19 cases in Connecticut found by testing (see discussion in previous FAQ # 443) only a quarter of these are tested further for the presence of the Omicron variant. That figure is used to estimate how much the new variant is the cause of all Covid-19 in the state. This method limits the precision of this finding, and we may never know exactly how pervasive the Omicron variant is.
444. CDC shortens Covid isolation and quarantine limits creating controversy.
Q: What’s the confusion and disagreement over the CDC’s move to shorten isolation time?
A: Last week on Monday, the CDC recommended reducing the time a person who tests positive for Covid-19 should isolate from 10 to 5 days to avoid infecting other people. At the same time, anyone who was in close contact with an infected person should be quarantined for the same reduced time to determine if they had become infected. Officials said the guidance is in keeping with growing evidence that people with the coronavirus are most infectious in the two days before and three days after symptoms develop. Early research suggests omicron may cause milder illnesses than earlier versions of the coronavirus. But the sheer number of people becoming infected – and therefore having to isolate or quarantine – threatens to crush the ability of hospitals, airlines, and other businesses to stay open, experts say.
CDC Director Rochelle Walensky said, “Not all of the Omicron cases are going to be severe. In fact, many are going to be asymptomatic,” she told The Associated Press on Monday. “We want to make sure there is a mechanism by which we can safely continue to keep society functioning while following the science.”
Last week, the agency loosened rules that previously called on health care workers to stay out of work for 10 days if they test positive. The new recommendations said workers could go back to work after seven days if they test negative and don’t have symptoms. And the agency said isolation time could be cut to five days, or even fewer, if there are severe staffing shortages. Now, the CDC is also changing the isolation and quarantine guidance for the general public to be even less stringent.
The guidance is not a mandate; it’s a recommendation to employers and state and local officials. Last week, New York state said it would expand on the CDC’s guidance for healthcare workers to include employees who have other critical jobs that are facing a severe staffing shortage. The CDC’s guidance on isolation and quarantine has seemed confusing to the public, and the new recommendations are “happening at a time when more people are testing positive for the first time and looking for guidance,” said Lindsay Wiley, an American University public health law expert.
Many public health officials have pointed out this change introduces greater risk to the public. The shortened time restrictions can lead to more people circulating who would remain infectious. Dr. Walensky has stated there is an increased risk, but because of the reduction of healthcare and other essential workers during this surge, the need is great.
It appears that this decision has stepped over the line from what science defines as ensuring maximum safety into decisions that try to anticipate what people would accept. This is the path routinely taken by politicians and economists: policies that define safety can be implemented at greater risk to meet other needs. The agency that defines safe procedures can become lost if it tries to modify the science of safety to anticipate these other needs. As one authority reflected, “The guidance continues to be complex.”
