CMO Update January 24, 2022
I think we all are feeling a sense of COVID fatigue. But I am hopeful that we can soon move to a more endemic status where coronavirus is circulating and infecting people (like common cold and flu), but we have sufficient herd immunity from vaccinations and prior infection as well as abundant availability of rapid tests to identify and prevent infections along with new medications to mitigate severe disease and limit deaths. While I will attempt to summarize the current US situation below, I invite you all to read this very informative article by Dr. Eric Topol from Scripps Clinic who has been one of the leading experts throughout the pandemic. https://erictopol.substack.com/p/where-do-we-stand-with-omicron
  • Omicron is highly contagious, spreads quickly and evades immunity
  • Original coronavirus strain (Alpha) = 5 days until symptoms
  • Delta = 4 days
  • Omicron = 3 days
  • The duration of COVID contagiousness starts prior to symptoms and correlates with high viral load.
A Japanese study from the National Institute of Infectious Diseases suggests that the amount of viral RNA and peak transmission with Omicron is highest three to six days after diagnosis or symptom onset. This accounts for our QDP policy that requires a negative rapid test on Day 6 before an infected employee can return to work, despite CDC guidance that this rapid test is optional.
  • Omicron has milder or no symptoms in the young, healthy or immune (from vaccination or prior infection)

  • Higher affinity for the upper airway than the lungs (fortunately)

  • Runny nose, congestion, sore throat >>> cough or trouble breathing 

  • Lower hospitalization, ICU admissions and death for individuals compared to prior variants

  • BUT, low vax rate and low herd immunity in US leads to overcrowded hospitals operating in crisis mode with reduced staffing levels, cancelled surgeries, National Guard troops for additional manpower. Hospitalizations in the US set another record this week.

  • Omicron still deadly for older patients with obesity, heart or lung problems, immunosuppression or unvaccinated (CDC chart below on right)
  • Here is a nice chart summarizing COVID risks for individual QDP staff and family members
  • CDC recommends surgical masks >>cloth face coverings for reducing Omicron spread
  • QDP staff should NOT wear cloth face coverings
  • If performing direct patient care, strongly consider N95 or KN95 use, or double mask
  • Please ensure that masks fit properly and cover both mouth and nose
  • Avoid eating and drinking in close proximity to any teammates, given how highly contagious Omicron is proving

  • Biden administration poised to supply 400 million “high quality” N95 face masks at no cost to US population through community health centers and pharmacies; scheduled to begin this week

  • US government on Jan 18th launched new website COVIDtests.gov, that allows 4 at-home SARS-CoV-2 tests to be shipped to “valid residential addresses” at no cost.

  • Orders ship within 7-12 days by US Postal Service.

  • US citizens with private health insurance (like QDP United plans) are now eligible to purchase tests online or in stores and have them covered at the time of purchase or be reimbursed by submitting a claim to their insurer. Only tests bought on or after January 15 are eligible, and insurers are required to pay for up to 8 tests per covered individual per month.

So how good are rapid tests??
  • Official data leading to FDA approval of BinaxNow test shows 85% sensitivity in detecting COVID in symptomatic patients with confirmation by PCR test.

  • These people were ALL SYMPTOMATIC, so you can’t ignore symptoms (in the 15% not detected). All were infected but not yet INFECTIOUS, because viral loads not high enough yet
  • New study this month from UC San Francisco shows 95% sensitivity compared with PCR-test
  • What can happen once infected with Omicron??
  • Recent study demonstrates that vaccination is highly protective against Long Covid
  • 2 vaccine regimen reduces risk of Long Covid to no more than uninfected people = essentially zero (compare dark blue and magenta bars)
For those of you who want a deep dive into the data and scientific evidence regarding COVID vaccinations and the controversial debate over vaccine mandates, I encourage you to read this Viewpoint from Dr Peter Attia. https://peterattiamd.com/why-im-for-covid-vaccines-but-against-vaccine-mandates/

As Alan Wenk advised us last week, the federal vaccine mandate was struck down by the Supreme Court and therefore QDP will not require COVID vaccines, although we continue to highly recommend vaccination as a measure of protection for our teams and patients given our commitment to safe and high-quality care.

I wish you all a good week! Please continue to support one another, stay safe, report any symptoms, however mild, to your supervisor and be especially rigorous with your personal PPE and distancing given the highly contagious Omicron variant circulating everywhere these days.

Regards,

~ Dr. A
Questions or Comments?
Please send any questions or comments to the QDP Health Information inbox: health@qualderm.com