Wednesday, January 5, 2022

CDC Director Rochelle Walensky Defends COVID Guidelines (VIDEO)

There's no rhyme or reason to the latest guidelines. 

First it was ten days isolation after a positive test, then corporations complained, especially the airlines. Then the CDC said after five days, if you have no symptoms, you can go back to work. Now you have to have to be tested, or something? 

Who knows? And who cares at this point? People are so over it. Done. The Biden administration's handling of the pandemic has been a complete joke. 

At NYDN, "CDC chief Dr. Rochelle Walensky defends COVID return-to-work guidelines amid widespread confusion." 

And see Zeynep Tufekci, at the New York Times, "The C.D.C. Is Hoping You’ll Figure Covid Out on Your Own":

I have some good news and some bad news, and they’re both the same.

Seven independent lab studies have found that while Omicron’s mutations make it exceptionally good at causing breakthrough cases even in people who have been vaccinated or previously infected, they also render it less able to effectively infect the lower lungs, a step associated with more serious illness. Plus, in country after country where Omicron has spread, epidemiological data shows that vaccines are still helping prevent severe disease or worse.

Why isn’t that unalloyed good news? Because it’s just luck that this highly transmissible variant appears to be less dangerous than other variants to those with prior immunity. If it had been more deadly — as Delta has been — the U.S. government’s haphazard and disorganized response would have put the whole country much more at risk. Even with this more moderate threat, the highest-ranking public health officials are making statements that seem more aimed at covering up or making excuses for ongoing failures, rather than leveling with the public.

Nowhere are these issues more apparent than on the confusing and zigzag messaging around rapid antigen tests and N95 masks, both of which are important weapons in our arsenal.

With a barrage of cases threatening vital services, the Centers for Disease Control and Prevention announced on Dec. 29 that people could return to work, masked, five days after they first learned they were infected, arguing that many people are infectious for only a short period. People could return to work even while still sick, as long as their symptoms were abating.

It’s not unreasonable to shorten quarantine for some, especially if they are vaccinated. Other countries have allowed infected people to isolate for a shorter time with the added precaution that they take rapid antigen tests to show they are negative two days in a row.

Why doesn’t the C.D.C. call for that added measure of safety? Its director, Dr. Rochelle Walensky, has explained this by saying, “We know that after five days, people are much less likely to transmit the virus and that masking further reduces that risk.”

“Much less likely” isn’t zero, and the likelihood probably varies from person to person. All this means that some would continue to be infectious. So wouldn’t it be great if we could tell who was probably still infectious after five days, and took extra precautions, while allowing people who may be clearing the virus even faster than five days to stop isolating earlier?

Not according to our top officials.

“We opted not to have the rapid test for isolation because we actually don’t know how our rapid tests perform and how well they predict whether you’re transmissible during the end of disease,” Walensky said on Dec. 29. “The F.D.A. has not authorized them for that use.”

Dr. Anthony Fauci, the president’s chief medical adviser, argued the same, also on Dec. 29. Referring to antigen tests, he said, “If it’s positive, we don’t know what that means for transmissibility” and that these antigen tests aren’t as sensitive as P.C.R. tests.

Might the real reason be that rapid tests are hard to find and expensive here (while they are easily available and relatively cheap in other countries)?

Is it possible that rapid tests are a good way to see who is infectious and who can return to public life — and their lack of sensitivity to minute amounts of virus is actually a good thing? Let’s ask a brilliant scientist and public health advocate — Rochelle Walensky, circa 2020.

Walensky, who was then on the faculty of the Harvard Medical School and chief of the division of infectious diseases at Massachusetts General Hospital, was a co-author of a paper in September 2020 that declared that the “P.C.R.-based nasal swab your caregiver uses in the hospital does a great job determining if you are infected but it does a rotten job of zooming in on whether you are infectious.”

That’s right, the key question is who is infectious, who can pass on the virus, not whether someone is still harboring some small amount of virus, or even fragments of it. P.C.R. tests can detect such tiny amounts of the virus that they can “return positives for as many as 6-12 weeks,” she pointed out. That’s “long after a person has ceased to pose any real risk of transmission to others.” P.C.R. tests are a bit like being able to find a thief’s fingerprints after he’s left the house.

So what did 2020 Walensky recommend? “The antigen test is ideally suited to yield positive results precisely when the infected individual is maximally infectious,” she and her co-author concluded. The reason is that antigen tests respond to the viral load in the sample without biologically amplifying the amount and being able to detect even viral fragments, as P.C.R. tests do. So a rapid test turns positive if a sample contains high levels of virus, not nonviable bits or minute amounts — and it’s high viral loads that correlate to higher infectiousness.

What about the objection that rapid antigen tests don’t always detect infections as well as P.C.R. tests can?

The 2020 Walensky wrote that the F.D.A. shouldn’t worry about “false negatives” on rapid tests because “those are true negatives for disease transmission” — meaning that people are unlikely to spread the virus even if they have a bit of virus lingering. In other words, the fact that rapid tests are less likely to turn positive if the viral load isn’t high is a benefit, not a problem.

Rapid tests do have their own considerations. Since you can become infectious even a day or two after getting a negative result on a rapid test, the Walensky of September 2020 noted that rapid tests are most useful if they are used frequently. A paper she co-wrote in July 2020 found that if a test was used every two days it would allow for safely reopening colleges.

The brilliant explanations of Walensky in 2020 leave me at a loss to explain why President Biden said on Dec. 22 that “I wish I had thought about ordering half a billion” rapid tests two months ago. Indeed, why didn’t officials do so two months ago, or 10 months ago?

The administration needs to do more to ramp up production of what should be one crucial tool in controlling the spread of the virus and allowing people to return to normal...

I'll say. 

More, at WSJ, "Biden’s Covid Death Milestone More Americans have died of the virus in 2021 than in all of 2020."

And at Newsweek, "Fact Check: Have More Americans Died From COVID Under Joe Biden Than Donald Trump?"