With the omicron variant of COVID-19 surging in Arkansas and beyond, we asked Dr. Amanda Novack, medical director of infection prevention at Baptist Health, to help explain what’s new this go ’round and how to stay safe.
Testing capacity at Baptist and elsewhere is stretched thin. Any advice to people seeking tests? Will capacity be able to continue to ramp up to meet demand, or should we consider the case numbers a significant undercount?
The case numbers are almost certainly an undercount because access to testing has been limited, and home tests are not accounted for in the state numbers. At this point in the surge, I think we need to prioritize testing in situations where it will make a difference in behavior. If someone in your home tested positive, and now you have symptoms, it is probably COVID. We don’t need a lab test to tell us that. Either way, the behavior would be the same: Stay at home and treat the symptoms, and call your doctor if symptoms get worse.
We keep hearing that omicron is milder than previous variants, but still poses a significant threat to the people and the health care system. Can you explain that?
The percentage of people with omicron who progress to severe disease is lower than the percentage we saw with delta. For the sake of discussion, let’s imagine that with delta, 10% of people needed to be hospitalized, and with omicron, only 1% need to be hospitalized. We would say, “Well, omicron is milder.” But if we had 5,000 people with active delta cases (so 500 hospitalizations), and now we have 70,000 with active omicron (so 700 hospitalizations), this “milder” disease can actually overwhelm the hospitals even more than the other surges. While it is relatively milder, we are still putting people with omicron on ventilators every day this week. We still have people die of omicron every day. “Milder” does not mean harmless — not by a long shot.
Rapid tests are in short supply at the moment, but more are supposed to be available soon. How and when should people use those vs. going for a PCR test?
A rapid test is usually a good start if someone has access to one. If it is positive, that is usually accurate and most of the time we can stop there without getting a PCR at all. If a rapid test is negative, there is still a decent chance someone has COVID, and the PCR is really the gold standard for picking up the virus. Once again, I think we pursue PCR when the result would affect our behavior. Are you thinking of visiting your immunocompromised sister? I would get a PCR to be sure. Are you working from home the next week either way? Then a rapid test is good enough to satisfy the basic curiosity.
Perhaps related, the new CDC guidelines that allow people to come out of quarantine after five days have been criticized by a lot of public health officials for not requiring a negative test. Should that be a part of the protocol? Does the test need to be PCR or will a rapid do?
We have known for nearly two years that a PCR stays positive long after someone stops being contagious. I have seen PCRs stay positive for weeks in people who are otherwise completely recovered and doing great. For all the advances we’ve made in science during this pandemic, we still do not have a good test for “contagiousness”. If we are going to use a test at all, it should probably be a rapid (i.e. antigen) test, because those don’t tend to stay positive as long. But in general, I only think testing is helpful in coming off isolation in very rare circumstances. Most of the time, I do not recommend a repeat test.
Everyone knows the formula for reducing your risk of COVID-19 infection — vaccination, booster, masks, social distancing — but it seems like omicron may require even more vigilance.
Omicron is definitely, hands-down, by far the most contagious version of COVID we have ever seen. There have been times when vaccines alone or masks alone were probably sufficient to protect an individual, but omicron really does require nearly 100% adherence to all the things you mentioned.
Of course many can’t do this, but if you’re able, is the best course to avoid, for a few weeks, any setting where you’ll be inside around unmasked people?
It probably is not necessary for the average person of average health to “shelter in place” right now. But I recommend behaving as though everyone you come in contact with is contagious with COVID. And I would never be inside, unmasked, around other unmasked people, if I knew they had COVID.
With previous variants, the consensus seemed to be that breezing in and out of a retail or grocery store was relatively safe. Has that changed?
There is always a spectrum of risk in these situations, with a spectrum of behaviors to mitigate that risk. Right now, personally, I wear a comfortable-but-well-fitting KN95 when I run in the grocery store. Again, if we behave as though the people around us are contagious with COVID, there are still ways to avoid infection without sheltering in place.
Also pre-omicron, gathering with people outside was seen as safe. Has that changed?
I think for the next few weeks, even gathering outside has some risks. An outdoor walk with a friend or two is probably OK, but even then I would probably wear a mask. I would not attend an outdoor wedding right now.
What about cloth masks? N95 and KN95 have always offered more protection, but are they more essential now?
For previous variants, a cloth mask (on both the infected and the uninfected person) was probably sufficient protection, most of the time. But omicron is more opportunistic than other variants, and deserves more caution. I wear a disposable “procedure” mask in situations when other people have on masks, and an N95 or KN95 when I am around unmasked people (either patients or strangers at the grocery store).