Connecticut doctor and epidemiologist react to changing COVID guidance: 'It's a mixed bag'
Earlier this month, the nation’s top public health agency relaxed its COVID-19 guidelines.
The Centers for Disease Control and Prevention says Americans no longer have to quarantine if they come into close contact with an infected person, regardless of vaccination status.
The guidelines also say certain people who test positive for COVID can end isolation after five days, but the agency advises wearing a high-quality mask and avoiding people who are more likely to get very sick from COVID until at least Day 11.
The reworked guidance also recommends those who are immunocompromised and infected with COVID isolate through Day 10 and consult with a doctor before ending isolation.
So far, more than 1 million Americans have died from the virus. Each day, the CDC reports hundreds of new deaths. In Connecticut, hundreds of people remained hospitalized with COVID-19. Meanwhile, experts predict fall and winter could bring yet another uptick in cases, and Pfizer asked U.S. regulators Monday to authorize its combination COVID-19 vaccine that adds protection against the newest omicron relatives.
Colin McEnroe recently spoke with a Connecticut doctor and an epidemiologist who have closely followed the COVID-19 pandemic: Dr. Ulysses Wu with Hartford HealthCare and Saad Omer, a professor of medicine and director of the Yale Institute for Global Health.
This interview has been edited and condensed.
Colin McEnroe: What was your overall reaction to the [CDC’s COVID guidance] change?
Saad Omer: It's a mixed bag. There are a lot of things that warranted change, and the change has been entirely appropriate. I see the rationale behind removing the distinction between vaccinated and unvaccinated folks. But I do think, at least at this point, an ongoing distinction was warranted because of the risks associated with non vaccination. Because of the fact that we are approaching, perhaps, an increase in cases and, potentially, hospitalization starting in fall. I think there should have been a distinction that should have been maintained, at least for the next few months.
McEnroe: We're still having a little under 500 deaths a day. That's a 9/11, every single week of the year, at that rate. This doesn't feel like a disease that's so under control that all the dials on mitigation need to be turned in a downward direction.
Ulysses Wu: You're absolutely right. It's not a disease that is under control. But when you look at the social psychology of this disease, it doesn't exist as much anymore to the general public perception.
The term that we've probably heard so many times "living with COVID." Maybe this is what the CDC is trying to pivot us to. The analogy I've always said is, in the winter, we came down from Everest, and we've made it down to base camp. Well, base camp is still pretty freakin’ high.
We still got a lot of cases, and a lot of deaths, and a lot of hospitalizations.
What I'm seeing is a disconnect between what is actually reality and what is actually in the mindset of individuals.
Omer: One thing that is a bit positive in these updated [guidelines is the] CDC has articulated a little bit more clearly, the differential impact of certain factors, and certain preventive behaviors on immunocompromised individuals and their families.
They previously had recommendations for additional [vaccine] doses for immunocompromised folks. But this updated guidance actually does better in terms of identifying specific additional measures for immunocompromised individuals.
McEnroe: Which is good, but …
Omer: Which is very good.
McEnroe: It is good. Although, no person is an island. Dr. Daniel Griffin, who's on This Week in Virology, always says nobody is safe until everybody's safe.
Unless immunocompromised people stay in their house and everybody who knows them takes extreme precautions, the people who have high risk factors, not just the immunocompromised – I mean, they're just part of the population. And it seems that without designing something, and it wouldn't be hard to come up with some helpful public policy, without designing something, you are just putting them at risk.
Saad Omer: Absolutely. I am from the group that thinks that you don't have to have maximal public health interventions all the time. You can go up and down based on the recognition that the general public may not be able to comply with all of the recommendations all the time.
Having said that, specifics matter. Ending isolation without testing at five days – is something that is not evidence-based. Or, that is at least not supported by evidence.
We don't have to have two extremes: where we are doing nothing, versus doing everything and halting the society altogether.
McEnroe: There are a lot of really great doctors, terrific providers in this country. But it does look like we are also living through a mélange of over-prescribing, under-prescribing, wrongly prescribing. Even granting, this is hard. It's an unfolding situation, the playbook changes every week, it seems. There's things like prescribing dexamethasone [a steroid to treat inflammation] to patients who aren't in the secondary stage of immune overreaction, which is pointless and possibly harmful. And a waste of a resource. Or prescribing Z-Paks and other antibiotics for a virus. Or just, sort of, not knowing about Paxlovid. We're underusing Evusheld, which is a prophylactic treatment for people who are immunosuppressed.
This must be troubling to you. There's some way in which we haven't made sure that providers know what they're supposed to do.
Wu: Yeah. So, there are multiple reasons for this.
This pandemic has ushered in a golden era of how we go forward, how we get things approved, the speed of vaccinology, all of these things are incredible and wonderful.
But on the flip side, we have what I call, “Western frontier medicine,” where there's a lot of shooting from the hip. And you gave some great examples. Look back to the very beginning. The hydroxychloroquine studies [were] based off of, I think the first initial giving of it was based off of seven patients in France that, maybe, their viral load was a little lower, and all of a sudden, everybody's getting hydroxychloroquine. Ivermectin – still the same thing. We can talk about bleach, we don't really probably need to talk about bleach.
But you're right, there needs to be some sort of standard empiric evidence. But we also don't want to move at a snail's pace. And so somewhere, we have to find that Goldilocks zone that's in between this new golden era of rushing things through, but making sure that they're safe.
Paxlovid has been a wonderful addition to our armamentarium. But it's not without its own warts as well. You're absolutely right about Evusheld. That's pretty accurate that it's not out there. So these things that are being offered, we do need to get out into the collective public consciousness to make sure that they are aware of it.
McEnroe: Dr. Omer, one thing a lot of us are very interested in is a nasal vaccine. I don't know whether that strikes you as a game changer. Do you have any sort of sense how close we are to that? And does it strike you as a pretty significant game changer?
Omer: I very much think that nasal vaccines are one of the approaches we need to be exploring pretty seriously. In the future, I think we need – and we have needed for over a year – Operation Warp Speed 2.0.
We need to have public investments in the next generation of vaccines. The reason I'm specifically identifying public investments in this [is] because the front-line companies, for understandable reasons, it's in their interest to maintain the current set of vaccines because [of] the development costs, etc.
With the current vaccines, they can still deliver a pretty good product for severe disease. But it's in this taxpayers’ interest that we have these investments in the next generation of vaccines, including nasal vaccines. But also what are called pan-coronavirus vaccines that target proteins that do not change that quickly so that we can target all variants at the same time.
Listen to the full Colin McEnroe Show episode: There’s still a pandemic going on, by the way
This story contains information from the Associated Press.