Omicron surge: Should we shorten self-isolation time?

Omicron’s arrival has once again changed the course of the pandemic. The increased transmissibility of the COVID-19 variant means record numbers of people are being infected across the globe, and with each infection comes a period of isolation for every individual and their close contacts.

Most countries have ended their furlough schemes, so despite staff members being off with COVID-19 they have had to remain open, often short staffed. Even worse, healthcare and other front-line workers are having to take time off, potentially resulting in delays to lifesaving treatments for their patients.

The push for an uptake in boosters against the new variant has been met with less enthusiasm than in the past, with people suffering from vaccine fatigue and wondering whether there will be an end to the constant jabs. But boosters do help protect against serious illness, even if not necessarily against catching the virus.

Some argue that because Omicron seems “milder”, we should aim to relax rules around restrictions and isolation. I would argue that this is being flippant about a virus that has the potential to cause multisystem symptoms that can persist over a long period of time.

Wherever you sit on this argument, Omicron has the potential to cause huge workforce issues, something that has been recognised by the governments of the United States and United Kingdom, both of whom have slashed self-isolation times for those who test positive.

US health officials halved the recommended isolation time for people with asymptomatic COVID-19 from 10 to five days, amid a surge in cases, with the Centers for Disease Control and Prevention (CDC) updating its guidance on December 27, 2021. The CDC recommends wearing a mask when around other people for the following five days. But experts have criticised the US’s lack of testing requirements to end isolation, arguing that letting people out early when they still have the potential to be infectious will only serve to infect more people. It is particularly worrying for those working with vulnerable people who they risk infecting if their own infection hasn’t completely cleared.

The UK also changed its self-isolation rules in December, reducing the required isolation timeframe from 10 to seven days, provided people have a negative lateral flow test on days six and seven – with tests taken 24 hours apart. As cases rise in the UK and we see record staffing shortages across multiple industries, there is pressure on the government to cut isolation further or to move away from PCR testing in those who test positive on a lateral flow test but have no symptoms – both of which could prove dangerous.

While some countries are changing their advice around isolation time, the World Health Organization (WHO) has not. It says people who test positive for COVID should isolate for 14 days. Countries like Germany and Jordan are following this advice, while France and Japan have a 10-day isolation period in place.

So, who is right? And are these policy changes based on the science of protecting people against catching COVID, or are they governed by the economic impact that staff absences will have on businesses?

The answer lies in knowing how long people are infectious for after they catch COVID.

A major study published in JAMA Internal Medicine last year found people infected with the virus were most infectious two days before and three days after they develop symptoms. The CDC referred to this time period of infectiousness in its press release when they reduced the isolation time.

But this data refers to some, not all, people – and what we know about COVID is that it is unpredictable.

It makes sense that some of those who leave quarantine at five days are more likely to spread the virus, compared with those who are let out after 10 days. The decision to reduce isolation time, then, is clearly a trade-off in risk management and minimising disruption to the economy and wider society. It is a gamble, and the fact that the CDC is not recommending negative lateral flow tests before ending isolation has met strong criticism from many scientists. Although lateral flow tests are not perfect, needing a negative test result to release people from isolation early does seem prudent, especially with a new highly infectious variant like Omicron.

The UK’s approach to reducing isolation time to seven days does increase the risk of transmission by newly released individuals. However, its decision to utilise negative lateral flow tests to release those in quarantine seems more sensible than the US approach and will help mitigate the risks.

Analysis by the UK Health Security Agency (UKHSA) suggests that a seven-day isolation period together with two negative lateral flow test results has nearly the same protective effect as a 10-day isolation period without lateral flow testing for people with COVID-19. But the key word here is “nearly”, which suggests the protective effect they refer to is lower but balanced against the economic need, it is a risk worth taking.

Lateral flow tests, although imperfect, are good at picking up the most infectious individuals. A Cochrane review of 64 studies found that the tests correctly identify on average 72 percent of people who are infected with the virus and have symptoms and 78 percent within the first week of becoming ill. But in people with no symptoms, that drops to 58 percent. Clearly, this is a worry, as those who are allowed to leave isolation are those without symptoms and, according to this review, only 58 percent of those who have the virus will test positive and have to isolate further, while others will be free to roam around.

Of course, cautionary advice is given to those who are newly released: wear masks, social distance, and avoid indoor crowded spaces where possible. But not everyone will adhere to these rules.

The other fly in the ointment is the reduced vaccine efficacy and risk of re-infection with Omicron in those who have had infections from previous variants. We are letting people out early, a small proportion of whom might still be infectious with a virus that can infect the vaccinated or those who have had previous exposure – so the cycle is doomed to repeat itself.

All these decisions come down to balancing health and the economy. The irony, of course, is you cannot have a healthy economy without a healthy workforce so the two are inextricably linked. It remains to be seen what these decisions will mean for the workforce, hospitalisations and the general wellbeing of the population, but if there is one thing this pandemic has taught us is those countries that have erred on the side of caution during the pandemic have done better in terms of health and economy.

Progress report: ‘New’ COVID variant detected in France

One thing we have all know is that the SARS-CoV-2 virus that causes COVID-19 mutates. We saw it with Delta and again with Omicron. The virus has undergone many more mutations than just those two, but those, along with the original variant that emerged from Wuhan, are the main ones to have affected the course of the pandemic.

Now a new variant harbouring 46 mutations and 36 deletions in its genetic code has been detected in France. It was identified through PCR testing in the Marseille region; the first person who tested positive for the variant had recently returned from Cameroon. The variant – which has been given the name B.1.640.2 – is being closely monitored by the Mediterranee Infection University Hospital Institute (IHU), which was the team to first identify it.

The team says the variant is not completely new and is an offshoot of a previously identified variant, that was recorded in the world database last January. The original version of this French variant – called B.1.640 – was detected in several countries last year, with the highest concentrations in the Republic of Congo, when the WHO deemed it a “variant under monitoring”. The French version has not yet been detected in any other countries and has not been declared a WHO “variant of concern”.

It is too early to say what effect this variant will have, if any, on the global pandemic. Even though it has a large number of mutations, it will have to be extremely transmissible to compete with Omicron and the rate at which it is spreading in France suggests this is not the case.

The most sensible thing to do is to carefully monitor the B.1.640.2 variant as we should with all variants with this number of mutations, but not to panic. We will know more as the data emerges.

Good news: Looking after your mental health during the Omicron surge

It is hard to get away from coronavirus news, and yes, I know how ironic that sounds in the middle of a coronavirus article. But being informed and being overwhelmed are two very different things.

Taking a break from the news cycle is important for your mental health. Taking in information about how to reduce your risk of contracting COVID and what symptoms to look out for should you get it are important, but we do not want you to live in fear.

Set time periods during which you can consume unbiased, factual news about the virus – and then switch off. Be strict with yourself on this; it is easy to keep scrolling and not realise where the time has gone.

Set aside time each day to do something you enjoy. If you are busy, it helps to make a to-do list and put “me time” on it; even if it’s just for a few minutes, you are more likely to do it that way. This may mean exercising, watching a favourite TV show or reading a book – something that is just for you.

Exercise is key to good mental health, so being active at least five times a week will help boost your natural feel-good chemicals and make you feel better about yourself. Spending time outdoors in nature has a similar effect, so a brisk walk, run or cycle outdoors in a green space is a great way to spend half an hour a day, and you can even take other family members with you.

A varied, nutritious diet is not only good for your body but also good for your mind. There are trillions of beneficial micro-organisms that live in your gut and help produce most of your feel-good chemicals, but they too need to be kept happy. By eating whole foods such as legumes, nuts, seeds and vegetables you can ensure they are kept healthy and they, in turn, will keep you healthy.

Sleep is important too – we don’t prioritise it enough. Get seven to eight hours of good-quality sleep a night. Avoid caffeine in the run-up to bedtime and turn all screens off. Take a warm bath and relax before getting into bed to help aid good-quality sleep. Sleep has been proven to be beneficial to our mood and in helping reduce the risk of type 2 diabetes, heart disease and even certain cancers. That is amazing – all you have to do is lie down and let it happen.

If things are getting too much to handle and you feel your anxiety levels rising or your mood is low most of the time, speak to a healthcare professional who will advise you about the many ways we can help – and it doesn’t have to be medication if that is not what you want; there are lots of other ways to help battle low mood and anxiety.

Personal account: How does UK’s plan to ‘ride out’ COVID affect health workers?

For the first time in the pandemic, COVID-19 cases in the UK soared above the 200,000 mark on January 4, 2021. The true number is likely much higher as these are only the cases detected on PCR tests. The surge in cases, which was largely expected by healthcare professionals due to the lack of mitigations in the UK to help curb the spread, prompted Prime Minister Boris Johnson to take to his lectern in a televised address to the nation.

In his address, Johnson said he hoped England could “ride out” the current wave of COVID without further restrictions, but acknowledged the National Health Service (NHS) would “feel temporarily overwhelmed”.

I was disappointed but not surprised at the words he used.

Johnson is under huge political pressure from members of his own party to not put in further restrictive measures to curb the spread of the virus.

But we have to be clear about what “riding it out” will mean for the British public. Although it is accepted that Omicron may be less severe for many, that is not true for all, and those with underlying health conditions, the elderly and the unvaccinated could get seriously sick and may not survive.

We have already seen a number of hospitals across the UK declare major incidents as they struggle to cope with the sheer number of people attending for both COVID and non-COVID-related illnesses; this means planned treatments and surgeries for those who have already been waiting a long time will be delayed or even cancelled.

The staff within the NHS do not “feel” overwhelmed, the NHS is being overwhelmed.

And staff shortages will not only affect the NHS. Many schools are reporting teacher shortages and there is a risk that without staff at schools, lessons may have to go back to being online, something that has affected both children’s education and wellbeing. So, what can be done?

Recommending FFP2 or N95 face masks in all indoor settings, but especially clinical ones, will help reduce the spread of the virus. SARS-CoV-2 is airborne, and these masks filter out more than 95 percent of aerosol particles. By recommending these masks we could help significantly cut down person to person spread.

Installing air filtration devices in schools and high-risk indoor settings will also help bring case numbers down and keep people at workplaces. With children having returned to school after the Christmas holidays, there is a real concern we may see case numbers go up as they may get infected with the virus and bring it home to vulnerable family members. Air filters in classrooms will help mitigate this.

The UK has already had to endure more than 150,000 COVID-related deaths, and those of us in the NHS are tired. We need more to be done to protect our patients, our children and our own mental health.

Reader’s question: How can you tell the difference between COVID-19 and a cold or flu?

The short answer is that it is very difficult.

Whereas the original symptoms of COVID were very clear – a new persistent cough, a fever and a loss of sense of smell and taste – Omicron and Delta have shown us that, as the virus mutates, new symptoms become more common.

The ZOE study app, which tracks symptoms of those who test positive for COVID, has shown that the top five symptoms people have before testing positive are: runny nose, headache, fatigue, sneezing and sore throat.

Clearly, many of these symptoms overlap with the common cold or flu.

With Omicron numbers as they are, my advice is to assume your cold is guilty until proven innocent. That is, if you have symptoms that might be a cold, get a PCR test to rule out COVID.

I cannot tell you how many of my patients have insisted they have a cold or a chest infection, adamant that it is not COVID, only to test positive for the coronavirus on a PCR test. So please, if you have any symptoms no matter how mild, get tested.