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** CDC tries to calm critics but adds confusion with new quarantine guidance
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A middle school principal walks the empty halls of his school as he speaks with one of his teachers to get an update on her COVID-19 symptoms, Friday, Aug. 20, 2021, in Wrightsville, Ga. On Dec. 27, 2021, U.S. health officials cut isolation restrictions for Americans who catch the coronavirus from 10 to five days, and also shortened the time that close contacts need to quarantine. (AP Photo/Stephen B. Morton, File)

Until now, the Centers for Disease Control and Prevention said ([link removed]) if you test positive for COVID-19 and then feel fine after five days of isolation, then you can come out of isolation as long as you wear a mask. Critics attacked the CDC for not telling people who test positive to take another test after five days to see if they are still positive, and if so, stay isolated. Before that guidance, the isolation period was 10 days.

Now, CDC Director Dr. Rochelle Walensky is not exactly changing its recommendation but offered a vaguely worded recommendation ([link removed]) (You can watch the comments on this YouTube video ([link removed]) . Go to 3:27.):

If you have access to a test, and if you want to do a test at day five, and if your symptoms are gone and you're feeling well, then go ahead and do that test. But here's how I would interpret that test. If it's positive, stay home for another five days. If it's negative, I would say you still really need to wear a mask. You still may have some transmissibility ahead of you. You still should probably not visit grandma. You shouldn't get on an airplane. And you should still be pretty careful when you're with other people by wearing a mask all the time.

If you test positive, isolate for five days and then come out of isolation, the CDC says you should not visit a gym or eat in a restaurant for five more days. Why? Because even if you feel fine after five days of isolation, you may still be shedding the virus and possibly infect others.

In fact, new British data shows some people remain infectious seven days after catching the virus. The U.K. requires ([link removed]) both seven days of isolation and a negative test to come out of isolation. France requires a 10-day isolation period. In Germany ([link removed]) , people who test positive are expected to self-isolate for two weeks unless they get a negative PCR test. The World Health Organization also recommends ([link removed]) a 10-day isolation for people who test positive for COVID-19.

So why did the CDC lower the isolation period to five days and not require a negative test? Walensky says the CDC’s reluctance to require a negative test to end isolation is a reflection of the CDC’s doubts about how well the instant tests detect the omicron variant of the virus.

Of course, given how difficult it is right now to get your hands on an instant test, it might be useless to require something that people cannot find.


** How to get more reliable instant COVID test results
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Even though the Food and Drug Administration has not issued this advice, some experts are saying if you use an instant COVID-19 test, you should consider taking two tests — using one sample from your nose and a second from your throat.

To understand this advice, you have to understand how the omicron variant shows up differently in the human body. The omicron variant seems to replicate in the piping of the lungs as opposed to the nasal cavity. So, since you can’t swab your lungs, some experts suggest swabbing your throat with a rapid test and your nose with another. The FDA is not recommending this, though epidemiologists are. Slate explains ([link removed]) :

Michael Mina, the epidemiologist who has been clamoring for more rapid tests since the early days of the pandemic, is another loud proponent of the throat swab. “Throat swab + nasal may improve chances a swab picks up virus,”he tweeted ([link removed]) .

The case for sweeping a swab around the back of your mouth in the age of omicron has some evidence to back it, if you’re willing to go by a couple of preprint papers. One published on the University of Hong Kong’s website by public health and pathology researchers on Dec. 15 explains ([link removed]) that omicron “multiplies 70 times faster than the Delta variant and original SARS-CoV-2 in human bronchus.” Another published on medRxiv on Dec. 24 describes ([link removed]) test results from 382 patients at a hospital in Cape Town, South Africa. Patients tested themselves with both nasal and saliva swabs (which is different than a throat swab).

The nasal swab method successfully caught all of the delta cases — but it missed 15 percent of those caused by omicron. In contrast, the saliva swab caught all of the omicron cases.

The UK’s Public Health Department even produced a video ([link removed]) showing people how to do their own nose and throat swab. It is not fun, as you might recall if you have ever had a strep throat swabbing.
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Jennifer Rohn is a cell biologist and science writer ([link removed]) . (Twitter)

Even if you swab your throat, your test may not be reliable if you swab right after eating something. Insider reports ([link removed]) :

Susan Butler-Wu, who directs clinical testing for infectious diseases at the University of Southern California, told Insider that coffee and Coca-Cola could cause false positives ([link removed]) if you're using an oral swab.

"You're going to swab your mouth after you just drank your coffee, you're gonna get a positive, potentially," she said.

Anything acidic — like coffee, soda, or fruit juices — could "mess with the chemistry" of a rapid or lateral flow test. Butler-Wu clarified that this risk is pretty theoretical. One study ([link removed]) found that false positives showed up when unexpected substances were directly applied to test kits.

But still, test sites and kits that involve oral swabs will warn you to avoid eating, drinking, and smoking for at least 30 minutes before the test.

You should also avoid brushing your teeth or using mouthwash before a throat swab, since good oral hygiene could temporarily wipe the virus out of your mouth ([link removed]) and lead to a false negative.

Check the expiration date on your antigen tests because they have a pretty short shelf-life from several months to a year. If you have been holding on to a stockpile of tests during the pandemic, they could be losing effectiveness in your medicine cabinet.One reporter for Insider ([link removed]) bought a kit at a local drugstore in December and noticed the expiration date is at the end of this month.


** No unemployment benefits if you’re off the job because of COVID-19
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CNBC points out ([link removed]) :

Americans who get Covid and miss work aren't eligible for unemployment benefits. That wasn't the case earlier in the pandemic due to the Pandemic Unemployment Assistance program.

However, the same may not be true for people exposed (but not infected with) the virus.

Individuals who test positive for Covid-19 and stay home to recover and isolate from others aren't eligible for jobless benefits, according toMichele Evermore ([link removed]) , a senior policy advisor for unemployment insurance at the U.S. Department of Labor.

You might ask why. The answer is in the definition of what unemployment benefits are supposed to cover. Unemployment benefits law “requires Americans to be ‘able and available’ for work to qualify for the assistance.”

In March 2020 ([link removed]) , the U.S. Department of Labor advised states, “(Unemployment insurance) is not intended to be used as paid sick leave.”

But if you are off the job, say, in quarantine because you were exposed to COVID-19, but have not tested positive, Evermore says you might not qualify for unemployment pay because you may be able to work while still isolating (for example, working remotely or away from others).

And you may wonder if something changed. Yup. Last summer, the section of the CARES Act relief law that gave unemployment benefits to people who were off the job because of COVID-19 expired.

Five states have passed legislation that awards unemployment benefits to people who are fired for refusing to get vaccinated.Marca reports ([link removed]) :

In Arkansas, Florida, Iowa, Kansas and Tennessee, lawmakers have created legal exceptions for those employees who decided against getting the COVID-19 vaccine after it was made mandatory to do so at their work.

They could soon be followed by more states, though, as the Washington Post reports that Missouri, Wisconsin and Wyoming are considering similar measures.


** Concerned families bring older adults home
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The pandemic has forced families to rethink how to care for older family members. Modern Healthcare notes ([link removed]) :

The American Health Care Association, an industry group, operators of nearly four in ten nursing homes said they were losing money because patients were moving out.

And with 1.3 million Americans in nursing homes before the outbreaks, advocates say it has forced a painful reckoning in many more households.

“We’ve heard from a lot of families who are just crushed by guilt, in these really tough positions, who want to take their loved ones home but they know they can’t live independently,” says Sam Brooks of the National Consumer Voice for Quality Long-Term Care, which advocates for nursing home residents.

I don‘t know about you, but this data map from AARP surprised me. It shows the percentage of nursing home residents who are fully vaccinated and boosted. I was under the impression, as you might be, that the majority of seniors in long-term care were boosted and vaxxed.
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(AARP)

And here is a display of the percentage of nursing home staff in each state who are vaccinated with a booster.
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(AARP)

Finally, let’s look at the percentage of nursing homes in states that have staffing shortages.
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(AARP)

Notice that California, Texas and West Virginia have significantly less of a nursing home staffing problem than other states. Then again, there could be something curious about the data reporting. It is rare to see that much of a state-to-state spread when a problem as common as this one is involved.


** What should be in your medicine cabinet when somebody gets infected with COVID?
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Doctor Mauro Morganti checks a patient's oxygen saturation level with a pulse oximeter during a house call, in Tartano, near Sondrio, Italy, Tuesday, Dec. 1, 2020. (AP Photo/Antonio Calanni)

You probably already have some of the things that The Washington Post suggests you have on hand in case somebody in your household gets infected with COVID-19.

A thermometer is a must-have, as is acetaminophen and a mask. But a pulse oximeter ([link removed]) ?

These are the devices that clip onto your finger and measure the oxygen in your blood. They’re easy to find online and they typically cost about $15 to $50. Along with thermometers, pulse oximeters can help you provide valuable information to your doctor if you’re sick at home. “If they can get me those kinds of numbers, I can give them much better advice on what we can do,” Sterling N. Ransone, a family physician in Deltaville, Va., and president of the American Academy of Family Physicians said. “It can be scary when you’re diagnosed. The more data that I have, the more I can either reassure them or move forward” with treatment.


** COVID caused life expectancy to drop, by a lot
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New data from the federal government says ([link removed]) COVID-19 contributed to the loss of 1.8 years from the average American’s life expectancy in 2020. That drop is the second largest since World War II.


** Flu deaths versus COVID-19 deaths
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No matter what knuckleheads say on cable TV or social media, there is no comparison between seasonal flu deaths and deaths from COVID-19 in America. Axios pulled the data ([link removed]) and charted it.
[link removed]
(Axios)

And yes, we may be on the verge of a combined flu and COVID-19 outbreak. The CDC says about 41% of Americans have gotten the flu shot. The seasonal flu outbreak has been fairly small in the U.S. so far, but it is growing. The CDC issued this alert about a strain called A(H3N2). Here’s the alert the CDC just sent to doctors about that seasonal flu:

Because influenza activity was low last season, we are anticipating a lower level of community protection that we rely on year after year to reduce the risk of a severe influenza season. Thus, CDC is anticipating an increase of influenza illness this winter, and both A(H3N2) and B-Victoria viruses are already co-circulating. Moreover, as SARS-CoV-2 continues to circulate in the United States, illnesses associated with both viruses might stress healthcare systems. A growing body of scientific studies suggest that even when vaccination does not prevent infection it can reduce the severity of influenza illness, helping to avert serious outcomes including hospitalization and death.


** Why some people will still face surprise medical bills despite new federal legislation
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Kaiser Health News explains ([link removed]) why the a federal law that went into effect on Jan. 1 won’t help everybody, and some medical groups (especially anesthesiologists) are still trying to collect.


** What TV dramas teach about the pandemic
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You might think that after two years of pandemic life that TV dramas would include more storylines that include what will, one day, become a historic touchpoint for the time in which we live. A new study just published in the Journal of the American Medical Association says most of the dramas that mention the pandemic show medical workers in crisis and emphasize a shortage of supplies and the sorrow of death.

Here is what they found ([link removed]) :
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(JAMA Network)

Wouldn’t it be more useful if dramas told the stories of outstanding researchers looking for answers and included real medical evidence about vaccines and viruses? It could be a learning moment.

We’ll be back tomorrow with a new edition of Covering COVID-19. Are you subscribed? Sign up here ([link removed]) to get it delivered right to your inbox.
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