Coronavirus Pandemic (COVID-19) (SARS-CoV-2) [2020]

[Shifty Geezer]

That's where we really need the best understanding of when staff can/should return to work. If, for example, it's safe for them to return as soon as they feel well, they should. And if they don't even feel unwell, how long between a +ve test forcing them off work and not spreading the virus? What's the Omicron spread like specifically regards incubation and contagious periods? I think current 10 days (now reduced to 7 days in UK) was based on original strain but if Omicron burns hotter and faster, there could be a lot of redundant time off work.

 

[Mariner]

Problem here is that it depends on a case by case basis. Some will be well clear of the infection within a week. Others may take 2 weeks or even more. The 10 day gap was always selected as a bit of a compromise with the assumption that the great majority of those infected wouldn't still be infectious by then. The reduction to 7 days is a substantial step (and the 5 days recommended by the CDC is just crazy without even tangential evidence to back it up!).

The requirement to have negative LFTs after the 7 day period is certainly sensible, but I've seen plenty of reports (anecdotal but many from medical professionals) that there is doubt about the accuracy of them with Omicron. In particular, tests currently in circulation in the UK are nasal swabs only and many people who know they are positive are only getting positive LFT results if they manage to swab their throats as well.

There is some evidence that Omicron generation time is around 1.5 days faster than Delta but I'm not aware of any which shows that those infected remain infectious for less time. In fact, you'd think it would be the opposite given the very high levels of virus generated in those infected (something like 70-fold, I seem to think?).

I understand why the various governments are reducing the isolation period to try and keep healthcare (and the wider economy) running to some degree. We just have to realise it is a big gamble, one which can go either way.

 

[WhiningKhan]

There is some evidence that Omicron generation time is around 1.5 days faster than Delta but I'm not aware of any which shows that those infected remain infectious for less time. In fact, you'd think it would be the opposite given the very high levels of virus generated in those infected (something like 70-fold, I seem to think?).

It has been reported already for a while that average hospitalization period is shorter for omicron cases. Obviously, collecting systematic data from mild cases staying at home is much harder, but end of symptoms should still suggest end of infectiousness. There is of course no fixed number of days required, you need to stay put until the symptoms have passed.

 

[Mariner]

Hospitalisation is a separate issue to infectiousness, however. Hospitalisation for Omicron seems to be quite a bit shorter because it doesn't cause the same levels of lung disease as previous variants (though there will still be some unfortunate people who require ventilation/CPAP treatment). It doesn't tell us how long people remain infectious, especially as we know that many people only get cold-like symptoms with Omicron. Symptoms aren't a good indication of infectiousness with Covid as the many cases of outbreaks with pre-symptomatic and asymptomatic infections causing them. If you can infect somebody when you're pre-symptomatic, it only makes sense that you could infect somebody when you're only just post-symptomatic.

The LFT antigen tests should theoretically give a good indication as to whether or not a person is still infectious, but only if the sample taken is likely to return the correct result. Hence my concern about whether Omicron does show up accurately enough in nasal-only samples.

 

[Mariner]

Here's a really interesting thread from the US about Omicron hospitalisations:

https://twitter.com/x/status/1477839370019295233

Not sure I've seen a thread similarly as detailed from the UK. If this holds true over here (and into the older population here, most of which is 'boosted') then hopefully the IFR will remain very low indeed during this wave. The gamble on pretty much nothing but boosters might work out for those lucky buggers! Of course, our wave is likely to be more sustained due to the almost complete lack of mitigations in schools which reopen in about 9 hours.

 

[Shifty Geezer]

Of course, our wave is likely to be more sustained due to the almost complete lack of mitigations in schools which reopen in about 9 hours.

You mean less sustained, higher peak and more impactful? Lack of mitigations means faster spread so the wave has t be less sustained.

 

[Picao84]

Hospitalisation is a separate issue to infectiousness, however. Hospitalisation for Omicron seems to be quite a bit shorter because it doesn't cause the same levels of lung disease as previous variants (though there will still be some unfortunate people who require ventilation/CPAP treatment). It doesn't tell us how long people remain infectious, especially as we know that many people only get cold-like symptoms with Omicron. Symptoms aren't a good indication of infectiousness with Covid as the many cases of outbreaks with pre-symptomatic and asymptomatic infections causing them. If you can infect somebody when you're pre-symptomatic, it only makes sense that you could infect somebody when you're only just post-symptomatic.

The LFT antigen tests should theoretically give a good indication as to whether or not a person is still infectious, but only if the sample taken is likely to return the correct result. Hence my concern about whether Omicron does show up accurately enough in nasal-only samples.

In Northern Ireland we have instructions to swab tonsils as well for LFT tests. I know that in the Republic they don't, which is kinda weird.

 

[Shifty Geezer]

In Northern Ireland we have instructions to swab tonsils as well for LFT tests. I know that in the Republic they don't, which is kinda weird.

For some reason the tests are different in the UK, in that there are/were nose+tonsil swabs, but now the LFTs just say swap nose.

Meanwhile, given the staffing crisis in UK hospitals, seems to make more sense to have staff present who are well enough to do their job then keep them at home because they carry a disease capable of affecting a small portion of patients.

Critical incidents have been declared at six hospital trusts amid rising staff shortages due to Covid-19.

https://www.bbc.co.uk/news/uk-england-59866650

Surely it's better to have a doctor/nurse caring for you with the risk of getting C19 from them which you should be vaccinated against, than have no-one at all. Casualties from lack of staff will likely be higher than casualties from incidental C19 infections caught from staff.

 

[Mariner]

You mean less sustained, higher peak and more impactful? Lack of mitigations means faster spread so the wave has t be less sustained.

Nope. I'm thinking that infections will continue at a high rate in children throughout the next month - no under-12s vaccinated in the UK, previous infection even with Delta not offering much protection against infection and so forth. Rather puts paid to the moronic unwritten 'plan' of letting kids become infected with Delta to give them immunity which was clearly government policy following the return to schooling in September with absolutely no mitigations in place. Plenty of teens aren't 'fully' vaccinated (i.e. 2 doses) themselves yet, either. With double-vaccination prove enough for them to avoid getting Omicron? No idea. My teenage nephew gets his second dose of vaccine this weekend. This despite the fact that his father is CEV and he should have been able to get vaccinated a couple of months ago - there was absolutely no way of arranging it at the time. His GP surgery couldn't help, the vaccination sites wouldn't do it. Pretty pathetic lack of organisation and forethought there. I understand it is the same situation now that the JCVI have said kids aged 5-11 who have clinically vulnerable family members should be vaccinated. No way it can be arranged with the current system.

My view is that the continued infections in children throughout January will spread to their parents and then grandparents, many of whom are required help out with childcare. Hence my expectation that the wave will be extended as compared to what has been seen in younger age groups in London before Christmas (and South Africa, to a degree). That's just my reading of the situation. At lot of people have been very careful over Christmas and therefore avoided infection. That's not going to be possible with the kids back in schools so the peak will be extended. Hopefully the boosters will prove enough to stop too much serious illness in these grandparents. Not all will be boosted/vaccinated, of course, and neither will all the parents whose children will be exposed at schools. My son's infant school sent a helpful reminder to us yesterday as to what is expected if a member of the household tests positive. As long as he's returning negative LFT results and isn't symptomatic, he is required to continue to attend school. My wife is a secondary school teacher - same goes for her. She is supposed to continue to go to school in case of infection in the household. Quite how the children (who would absolutely undoubtedly be infected if either my wife or myself caught Covid) are supposed to be taken to school/nursery with us ill isn't really touched upon.

 

[Mariner]

In Northern Ireland we have instructions to swab tonsils as well for LFT tests. I know that in the Republic they don't, which is kinda weird.

All the recent tests I've seen (and I think all those in circulation in England) have instructions for nasal swabs only and the length of the swabs is too short to make it very easy to do the throat. If I was a conspiracy theorist, I'd say this was planned!

 

[Mariner]

Surely it's better to have a doctor/nurse caring for you with the risk of getting C19 from them which you should be vaccinated against, than have no-one at all. Casualties from lack of staff will likely be higher than casualties from incidental C19 infections caught from staff.

The problem there is that, for many patients admitted without Covid, being treated by an infected doctor/nurse would almost certainly lead to them becoming infected (especially as they still aren't being provided with proper masks!) which could rather badly affect their chances of survival.

It's going to be very difficult to keep staffing levels up over the next month or so, especially in the many areas of the country where they are working on bare minimum levels already. I don't think that anybody is really sure how it is going to pan out.

 

[WhiningKhan]

If you can infect somebody when you're pre-symptomatic, it only makes sense that you could infect somebody when you're only just post-symptomatic.

Well of course "just post-symptomatic" is not a minute-accurate expression, but guidance from pretty much from the start has been that already a day after fever lifts should be safe. Both here in Finland, as well as in US, as given here:
https://www.cdc.gov/coronavirus/2019-ncov/hcp/duration-isolation.html

The same guideline has applied to more benign common cold-type illnesses like "forever".

 

[Shifty Geezer]

Nope. I'm thinking that infections will continue at a high rate in children throughout the next month - no under-12s vaccinated in the UK, previous infection even with Delta not offering much protection against infection and so forth...My view is that the continued infections in children throughout January will spread to their parents and then grandparents, many of whom are required help out with childcare.

I don't understand. Maybe I'm reading different to what your saying, but given children going back to school with mitigations versus without, the latter should result in a shorter duration, steeper wave. You have a given number of children, let's say 5 million. And let's say it would take 6 weeks for them all to get Omicron with associated passed-on infections to family members etc. If you put in place something like mask wearing and let's say these mitigations reduce infection rate by half, all 5 million children will still get Omicron, just over 12 weeks instead of 6, and the exposure for related adults will be identical in number, just all bunched together.

She is supposed to continue to go to school in case of infection in the household. Quite how the children (who would absolutely undoubtedly be infected if either my wife or myself caught Covid) are supposed to be taken to school/nursery with us ill isn't really touched upon.

Surely that's no different to how you have to organise transport in non-covid situations like being down with the flu - if you are well enough to take them, continue to do so, and if too ill for that, arrange travel with schoolfriends and the parent network.

 

[digitalwanderer]

That chart I like so much is still going up, yesterday the USA broke our own record for most cases in a day. 1,000,000+ new cases yesterday!



Best part? People STILL aren't taking it seriously or else they're just in denial because they, "want things to go back to normal'; which is fueling this bloody spike!

I don't know how high it's gonna go, but the confirmed deaths totals are running a number of days behind the confirmed cases so it's hard to extrapolate how bad it's getting.

 

[Mariner]

My expectation is that the kids will be taken in and out of the classrooms and ultimately, the classrooms will need to shut at some point. One teacher (plus a couple of T.A.s) per class in infant school. My son is in the first year (after reception). It will take a couple of staff absences to shut down the year. Safeguarding issues, especially at that age. Classrooms opening and closing are likely to lead to an extended wave, in my opinion.

Lots of massive assumptions in your second statement. We don't have a 'parent network'. My son started school during the middle of a global pandemic. Parents haven't mixed, or at least we haven't mixed. My septuagenarian parents have helped out taking him to and picking him up from school. They shouldn't be in contact with him if we're infected. My sister lives around the corner but her husband is CEV so she shouldn't be interacting with members of a household with infections.

I don't need to remind you that isolating is a legal requirement if you've got Covid. This isn't the case with influenza because, well, Covid isn't the flu. Surprised you even made the comparison, truth be told.

 

[digitalwanderer]

My septuagenarian parents have helped out taking him to and picking him up from school.

I had to look up "septuagenarian" and in doing so discovered I'm an "quinquagenarian". :|


I'm so insanely glad my kids are out of school for this, and I don't blame them or think they're foolish for putting off college a bit right now. If you think public schools are bad you should look at the wild degree of differences/indifferences so many universities are doing.

I wish things were more normal and we could just do stuff, but it's not and we can't without putting ourselves and others at risk. We GOTTA watch out for each other to get through this, that's why I fear we won't make it.

 

[Shifty Geezer]

Lots of massive assumptions in your second statement. We don't have a 'parent network'. My son started school during the middle of a global pandemic.

One assumption. Fair enough.

I don't need to remind you that isolating is a legal requirement if you've got Covid. This isn't the case with influenza because, well, Covid isn't the flu. Surprised you even made the comparison, truth be told.

I didn't compare covid with the flu - I compared the need to still get your children to school despite being unable to yourself due to covid19 being the same as needing to still get your child to school with anything else, such as the flu. I could also have used something like, "unable to because of your cancer therapy making you too unwell," or "unable to because you had to rush to the aid of elderly parents the night before and the wife has to get to work early and can't fit the school run in with the commute." The problem of getting your child to school due to your being unable to due to covid19 doesn't add particular complications, except in the case of new school attendants like yourself which I agree does pose an additional problem. The school would expect these problems to be solved 'the ordinary way' that parents due and not considered the need to factor in special case solutions. It may be worth raising it with the school or PTA to arrange an organised car-share system where the default parent-parent relationships and support networks haven't had chance to be established.

 

[Mariner]

You're misunderstanding my viewpoint. If/when myself or my wife catch Covid, the children will inevitably do so. I'm obviously not going to send them into nursery/school if they are infected, regardless of the nonsensical government 'guidance'. The nursery actually has a more sensible policy wouldn't let my daughter attend, but that's by the bye. Two weeks off school isn't going to hurt a 6 year old (or any kid of any age, for that matter). Could potentially avoid a chain of transmission which led to a death in an older relative of one of his schoolmates, or perhaps a case of long Covid. If he had measles or chickenpox, he wouldn't be allowed into school! But a novel virus with which has killed millions around the world and has completely unknown long-term outcomes is OK? Yeah, that makes complete sense.

Do PTAs even exist in the UK, by the way? First I've ever of such a thing and I've got a teenage niece (who has left school) and nephew and a wife who is a secondary school teacher!

 

[milk]

The problem there is that, for many patients admitted without Covid, being treated by an infected doctor/nurse would almost certainly lead to them becoming infected

I agree with your concern. But is that really "almost certainly"? Legit question. Do we have solid understanding at this point of chances of infaction given exposure time/conditions. That would be extremelly interesting...

 

[Mariner]

The problem over here in the UK, milk, is that our medical staff aren't provided with proper PPE - even 2 years into the pandemic! They are given the crappy, loose-fitting surgical masks instead of proper FFP2/FFP3 masks. If you're in a room or cubicle being assessed by an infected doctor, I'd imagine there is a reasonable chance of catching the virus. The virus is also airborne, of course, so it wouldn't even take particularly close contact if enough people. From my own experiences, I know that ventilation and filtration isn't much of a consideration in our local hospital (crappy design built during the 1980s), so I think we're likely to be seeing lots of infections picked up by patients admitted for other reasons. It would be nice if these could be kept to the minimum.