CMO Update January 3, 2022 |
I hope everyone and your families enjoyed a healthy and relaxing holiday season. It’s safe to say Omicron is dominating the news once more as this pandemic moves into year 3. Fortunately, we have learned a lot about the coronavirus, its variants, and strategies to prevent it as shown below. If we employ all these measures responsibly and uniformly we can limit the spread and impact to our lives. |
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Omicron News
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Much more contagious (70X)! Omicron now accounts for almost all US cases with a record surge
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Cloth masks MUCH less effective; please use surgical mask in all settings – both work and home
- Use N95 for higher risk patients, procedures or if you have high risk medical conditions
- Surgery in/near oral or nasal mucosal sites; aerosolizing procedures
- Rotate N95 masks every 3 days (place in bag) to reduce waste of PPE
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Numerous studies confirm Omicron binds primarily in upper airway (nose, mouth, throat) >> lungs and replicates very quickly
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High rate of asymptomatic carriers noted with Omicron as compared with prior variants; high viral nasal titers in many carriers adds to its rapid spread capability
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Rapid replication in nose/throat causes earlier symptoms, 3 days after exposure compared to 4 days with Delta and 5 days or longer with original Alpha strain
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Symptoms more consistent with cold, sore throat, congestion >> cough, shortness of breath
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Omicron replicates 10X less effectively in lungs than Delta; causes generally less severe infections, less pneumonia, hospitalizations and death
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Breakthrough infections generally asymptomatic or very mild if vaccinated and especially if boosted with rare hospitalization (red line)
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Moderate to severe illness for unvaccinated or immunosuppressed; unvaccinated continue to account for nearly all deaths and hospitalizations (blue line), as shown below in data from New York.
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Pfizer and Moderna report Omicron evades protection from standard 2-dose vaccination in lab studies, BUT booster dose restores significant protective immunity against Omicron
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COVID Treatments
- Pfizer reported antiviral pill Paxlovid effective in preventing severe COVID-19 in clinical trial; FDA likely to authorize use; oral drug given over 5 days; effective against Omicron and Delta
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BUT, not yet widely available for Omicron surge and production will take months
- Monoclonal antibodies by Eli Lilly and Regeneron are so ineffective they are not used at all for Omicron
- Only sotrovimab by GlaxoSmithKline is effective against Omicron, BUT remains in extremely limited supply and will not be available to most patients
- While many individual cases are mild, especially for immunized, hospitals and ICUs are being overwhelmed again at the same time that many nurses, respiratory techs and doctors are also out sick with COVID; now is a very worrisome time to be hospitalized due to staffing shortages that may prevent optimal care
- Please do everything you can now to prevent being infected or transmitting COVID and protect yourself, your family and our patients and teammates by getting vaccinated and boosted ASAP.
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COVID Work Restrictions for Health Care Personnel
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The CDC has revised the Guidelines for COVID isolation and quarantine to maintain ongoing medical care during these times of staffing shortages (See Table below). These recommendations are primarily intended for health care settings with staff shortages and that provide more urgent or emergent care than our typical dermatology offices. Therefore, QDP is recommending a modification of these Contingency Plans that allows some flexibility for return to work decisions, but also helps protect our patients and teammates.
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The CDC rationale for reducing isolation from 10 days to 5-7 days is based upon Omicron’s more rapid replication and then clearance, so that about 85-90% of patients are no longer shedding viable virus after 5 days. But, we don’t know which people comprise that 10-15% who are still contagious. We also know that vaccinated and boosted workers have lower viral loads and clear them more quickly, so the vaccination status may be factored into individual return to work decisions, under the Contingency Status.
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QDP Modified Isolation Guidelines
Therefore, for COVID positive workers who are asymptomatic or have improving mild symptoms, QDP recommends a Rapid Antigen Lateral Flow Test on Day 6 and if negative, the teammate can immediately return to work. Rapid Antigen Lateral Flow Tests are simply the standard home test kits, like for pregnancy, that use a few drops of liquid in one well and then it reads out with a line at an adjacent well after a brief period of time, usually 15 minutes. For any positive Rapid tests, the worker would then remain in isolation until two consecutive Rapid Antigen Tests taken 24 hours apart are both negative before returning to work. Day 0 is when first symptoms arise or first positive test if asymptomatic. (See Table below)
Importantly, for those returning to work early each teammate must wear a N95 mask at all times and avoid unprotected close contact with patients or other staff (break room, work station) during their abbreviated isolation (Days 6-10). QualDerm began working with Delasco during the holidays to procure a number of Rapid Antigen Tests to help support our clinical staff. Due to the high demand our first scheduled delivery of these tests is expected around the middle to end of January. Availability of Rapid Antigen Tests in different clinics and markets may create situations where local physician leaders will make individual determinations on a case-by-case basis after consultation with CMO and Joint Operating Committees.
This Omicron surge is another good opportunity to emphasize the importance of compliant PPE use at all times in our clinics because it is inevitable that an asymptomatic COVID patient will be treated in a QDP office and/or an asymptomatic teammate will later test positive. Close contact exposures (>15 min at <6 feet) do not require quarantine or any patient or staff notifications if PPE was used.
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There has been some good news from both South Africa and United Kingdom, as both countries with early outbreaks are now past their Omicron peak and they were able to manage their surges relatively well. The US is predicted to hit its Omicron peak by end of January, so we have another two months to navigate before some light at the end of the tunnel. Experts predict that Omicron is so contagious that everyone will soon have significant immunity from either infection and/or vaccination. As long as another variant does not arise that evades our immune system, we should have several effective oral treatments in good supply and a health care system that can catch its collective breath and arise from crisis mode. COVID will remain an endemic illness like influenza, but I am optimistic that vaccines and new treatments will allow us to reclaim some sense of normalcy for our lives by spring. Let’s all do our part this winter to reduce our risks and keep our practices vibrant and viable for the patients we serve.
Looking forward to a great 2022!
~ Dr. A
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