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An infectious disease specialist answers our questions about the new CDC guidance

DAVID GURA, HOST:

2022 - a new year, yes, but with the same 2021 problem multiplied - record-breaking numbers of new daily coronavirus infections in the U.S. And if you do test positive or someone close to you does, it can be hard to assess the risk or figure out exactly what to do and whether to worry. Here with some clarity is Dr. Celine Gounder, an infectious disease specialist and doctor at Bellevue Hospital in New York, former adviser to the Biden administration. Dr. Gounder, thanks very much for joining us.

CELINE GOUNDER: It's great to be here, David.

GURA: Let me start by asking you just about the latest data on omicron. What are doctors and researchers seeing?

GOUNDER: Well, it does seem like omicron may be less virulent. So in other words, it causes less severe disease in individuals. But we don't have for certain hard data on whether omicron would be so benign in somebody who has no immunity. And we really also are still concerned about what this virus will mean for more vulnerable populations - so the elderly, immunocompromised persons and the like.

GURA: You look at this surge, this uptick in cases, and I wonder, how much of this is because of omicron and how much is because of delta?

GOUNDER: It's some of both, certainly. And I think what we are seeing with omicron that is different - it is highly infectious, even more infectious than the delta variant. And so while there's no question that delta was still contributing, is still contributing to some of the transmission in parts of the country, omicron is really becoming the dominant variant and most of the country now.

GURA: We've been hearing so much about long wait times to get rapid tests. Obviously, they've become very popular during the holidays as people have gathered together in some cases. What do you know about the accuracy of these tests when it comes to this omicron variant?

GOUNDER: There have been reports of people testing negative on a rapid test who have symptoms and who then have a positive PCR test. This is not to say that the rapid tests are not working. The key here is to use the rapid test to assess who is contagious, who might be able to infect others. And the FDA is looking at this very carefully to see, are those negative rapid tests really indicative of failure to capture people who are contagious?

GURA: So not to put too fine a point on it, but is your recommendation that if you suspect that you have COVID to follow up with another rapid test or to take a PCR test?

GOUNDER: Yeah, the way I would use the rapid test is especially if you're going to be around other people, to be using that rapid test right before you interact with other people. It could be, you know, literally at the door of a party, for example, before you go in. If that test is positive, you need to go home and isolate and stay away from other people. If that test is negative and let's say you have symptoms or you've been exposed to somebody who you know has COVID, I would not take that negative as 100% definitive. I would then go on to get a PCR test.

GURA: I think the source of some confusion has been the CDC's decision to change its guidelines or its recommendations when it comes to isolation and quarantine. It's cut that time in half for non-health care workers from 10 to five days. Can you explain the thinking behind that and maybe just try to allay some of the confusion surrounding that? Is it just for asymptomatic carriers of this variant?

GOUNDER: Well, the thinking is that people, particularly with omicron, are not infectious for as long as they might have been with earlier variants. There was a recent paper published in the New England Journal of Medicine showing that vaccinated people on average cleared their virus about 5 1/2 days after the initial onset of symptoms. And in people who are not vaccinated, it took them about 7 1/2 days. So that five-day cutoff is honestly just barely enough, and this is why the CDC is recommending that you continue to wear a mask for an additional five days after that five-day isolation period.

GURA: I know the testing wasn't part of that recommendation. Do you think that it should have been? Do you think the testing should have been part of what the CDC is calling for here?

GOUNDER: I do. I think, unfortunately, masks have been politicized over the course of the pandemic. And unfortunately, that also means that this recommendation is likely not to be abided by, not to be followed by many people in the country. I think a much more reliable way to clear somebody from isolation would be to give them a rapid test at the end of that five-day isolation period. If they're still positive, it means they need to isolate for a little bit longer.

GURA: What do you want listeners to keep in mind as we head into the third year living with this pandemic?

GOUNDER: I think there are reasons to be optimistic. We have highly effective, safe vaccines that work even against omicron. I think it really comes down to whether we use them. The other thing about vaccination, though, that I think has not really gotten through is vaccines work best at a population level, synergistically across people. It's not this individual on-off switch of immunity. And so you really should be considering yourself fully vaccinated when you're vaccinated, but also when your community is vaccinated.

GURA: That's infectious disease specialist Dr. Celine Gounder, a doctor at Bellevue Hospital in New York City. Thank you very much for talking with us.

GOUNDER: My pleasure. Transcript provided by NPR, Copyright NPR.


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