Omicron drives higher COVID numbers, questions about testing. Here's what you need to know.

Posted 1/5/22

A week into our third year in a pandemic, record-high numbers of new COVID-19 cases and another surge in hospitalizations are dominating the conversations of health experts and observers — as is …

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Omicron drives higher COVID numbers, questions about testing. Here's what you need to know.

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Dr. Andrew Hannapel, Chatham Hospital's chief medical officer, was vaccinated for COVID-19 in December, among the first doses administered in Chatham.
Dr. Andrew Hannapel, Chatham Hospital's chief medical officer, was vaccinated for COVID-19 in December, among the first doses administered in Chatham.
Staff photo by Peyton Sickles
Posted

A week into our third year in a pandemic, record-high numbers of new COVID-19 cases and another surge in hospitalizations are dominating the conversations of health experts and observers — as is the severity of the Omicron variant and the reliability of tests for coronavirus.

North Carolina saw a second straight day of record case reporting — 19,174 new cases on Friday, beating Thursday’s reported 18,571 cases, according to the N.C. Dept. of Health and Human Services. Across the U.S., the seven-day rolling average of new cases has tripled in the last month, and those numbers are likely low, given that at-home test results aren’t reported.

In Chatham County, more than 100 cases were reported on a single day — Dec. 27 — for the first time since the start of the pandemic, more than doubling the previous high of 52 set Jan. 12, 2021. The county’s rolling 7-day case count was up nearly 55% with just under 12% of recorded COVID-19 tests coming back positive.

All told, 8,063 Chatham residents have had COVID; 99 have died from it.

In addition to the demand for tests, the Omicron-driven surge has also increased hospitalizations, despite reports that symptoms are milder than those found with those infected by the Delta variant. Still, hospitals across the state are reporting that the vast majority of those admitted with COVID are unvaccinated, with Chatham Hospital in Siler City and Raleigh’s WakeMed, among others, reporting that all COVID patients in intensive care — and all patients on respirators — are unvaccinated.

The time period since Christmas has also seen revisions in and updated guidance about isolation and more, but regarding vaccinations, the message from Chatham’s experts is the same: if you haven’t been vaccinated, you’re endangering yourself and others.

“(V)accinated people are less likely to get sick, require hospitalization, and pass away from COVID,” said Chatham Hospital’s Eric Wolak, who serves as the facility’s chief nursing officer and chief operating officer. “So there is no valid argument or data supporting not getting vaccinated.”

And it’s Chatham’s unvaccinated — currently the roughly 35% to 40% of eligible residents who haven’t received at least one dose — who are contributing to the problem, which is expected to worsen.

“The next several weeks will be unlike any other period of the pandemic,” said Mike Zelek, Chatham County’s Public Health Department director. “Given the infectiousness of Omicron, we will see many, many cases, and that will cause disruptions across all settings.”

Nationwide, new coronavirus infections reached 1,082,549 on Monday — another new record, according to Johns Hopkins University data — while hospitalizations were up 27% in the last week.

In this extended interview, Wolak and Zelek respond to questions generated by Omicron, case trends, changing guidelines and testing.

Let’s start with a reset for 2022. The Omicron variant has driven the number of COVID-19 cases to record numbers in some locations around the globe — including a “tsunami” of cases in Europe — and some areas within our region. And while hospitalizations are up, they’re not up at the same proportion. But Dr. Michael Osterholm, the director of the Center for Infectious Disease Research and Policy, recently said, “Over the next three to four weeks, we are going to see the number of cases in this country rise so dramatically that we’re gonna have a hard time keeping everyday life operating.” What do you think, and how do you assess what we’re seeing in terms of cases and the severity of cases?

ERIC WOLAK: The number of new cases in the past week have been very dramatic. While we are seeing that play out in Chatham County, currently the level of sickness has not required as much hospitalization. This could always change, though, and with the intense spread of this COVID variant, the increased chances we have in getting very sick patients. I do think things will be very hard these next few weeks. Personally, I’m limiting any social interactions and wearing my mask. I’ve been vaccinated and boosted, but I’m going to be especially careful until rates begin to decrease significantly.

MIKE ZELEK: The next several weeks will be unlike any other period of the pandemic. Given the infectiousness of Omicron, we will see many, many cases, and that will cause disruptions across all settings. That said, thankfully we have strong protection through vaccines and boosters, which is holding well against Omicron, particularly against severe illness and death. This is a very good thing and a public health success.

Observers talk about the “moving goalposts” of COVID. One example: the CDC has reduced the quarantine/isolation time for people who test positive for COVID-19 from 10 days to five days if they’re asymptomatic (but they should mask up for five days after isolation ends). Reaction to that, specifically?

WOLAK: I think the science is always changing because the virus and environment is always changing. In regards to the changes in quarantine/isolation, the primary intent is to maximize our normal life as much as possible, while still being safe and decrease the spread of the virus. It is my understanding that this new variant has a lower “virus life”, which means one will test positive for a shorter period of time than they did with the Delta variant. Regardless, I trust the CDC and know that their recommendations are based on the science.

ZELEK: I think more often than not the goalposts stay where they are, but COVID forces us to change our game plan. As our understanding grows and COVID evolves, we need to update our strategy. The isolation period changed early in the pandemic, and a shortened quarantine (10-day, versus 14-day) was adopted in the spring. The new guidance reflects where we are now, but it comes with important caveats that should not be overlooked.

First, those who have COVID should not leave isolation until they feel better and are fever free. Second, it is strongly recommended to test negative before you end isolation, i.e., at day five. And third, even if your isolation or quarantine period ends after day five, it is critical to wear a mask around others at least for days six through 10 (and everyone should be wearing a mask in indoor public spaces). Shortening the isolation and quarantine periods does incur some additional risk, but these additional layers can help to mitigate that risk.

One criticism of that move is that a negative test should be required before those infected leave isolation. What do you think?

WOLAK: I agree, but it is also my understanding that the test should be negative after five days for those who are asymptomatic.

ZELEK: We strongly recommend getting a negative test after day five before leaving isolation. The CDC’s decision to make this a recommendation and not a requirement reflects the sharp increase in demand for testing relative to supply, which can vary across the country. We have seen testing numbers surge in recent days in Chatham, though our no-cost community options have been able to meet current demand. However, it is best to preregister. Find more at www.chathamcountync.gov/coronavirustesting.

And regarding uncertainty … some among the unvaccinated are using that uncertainty as rationale for not getting “the jab.” Is that justified?

WOLAK: One thing the science has been very clear on is that vaccinated and boosted people have less likelihood of getting the virus and transmitting the virus to others if they have a breakthrough infection. Additionally, and this is the most important part of the science, vaccinated people are less likely to get sick, require hospitalization, and pass away from COVID. So there is no valid argument or data supporting not getting vaccinated.

ZELEK: The evidence to support getting vaccinated, including the booster shot, remains strong. Even for those who have been infected with COVID, the vaccine adds important protection. Vaccination continues to be our best tool to protect ourselves and those around us.

Commissioner Franklin Gomez Flores pictured at a Match vaccination clinic — spearheaded by the Chatham County Public Health Department and the Hispanic Liaison — which administered 280 first doses of the Moderna vaccine.

'To me, it (the vaccine) brings hope,' Gomez Flores, the first person to get vaccinated that day, said. 'A lot with what’s going on, with what my family’s gone through, what the community has gone through, it’s hope to actually get things going back to how they were before COVID.' / Staff photo by Kim Hawks


And speaking of tests: can you walk us through the options on testing, and specifically rapid tests?

WOLAK: There are various ways to get a test. You can schedule an antigen test or a PCR test at a drug store like CVS. Those results could take a few days. You can also go to a drug store and purchase an at-home test with results in 15 minutes. My wife and I took those before visiting family/friends on Christmas. While supplies of the at-home tests are not what we want, supplies are increasing. I was just in Walgreens the other day and they had just received a large shipment. I was limited to purchasing four kits, but was happy to get them.

ZELEK: There are many places to get tested, and I’ll highlight a couple of no-cost options through Optum Health. The Old Agriculture Building in Pittsboro has testing Monday-Saturday, 10 a.m. to 6 p.m. (Saturday testing begins Jan. 8). The Medical Office Building behind Chatham Hospital has testing Monday-Friday, 5 to 8 p.m. Both of these sites offer rapid (antigen) testing and PCR testing. In addition, StarMed has drive-up testing Mondays noon to 4 p.m. at CCCC in Siler City, Wednesdays at the Goldston Town Hall 2 to 7 p.m., and Thursdays noon to 4 p.m. at CCCC in Pittsboro. For a full list of options, visit the county's website.

At-home rapid tests are another great option. Unfortunately, the supply is limited, though these tests can be found at some pharmacies. The federal government is working on a plan to increase access to at-home tests, but this has not yet been implemented. North Carolina has a free program that will mail you a PCR sample collection kit. After you collect your sample, you mail it in the included package to the lab and they will notify you of your results. More information can be found here.

As a refresher, PCR tests are sent to a lab and usually take one to three days for results to come back. Antigen tests, also called rapid or at-home tests, give results in around 15 minutes. Because of their short turnaround time and high accuracy to detect COVID when someone is actively infectious, rapid tests are an important public health tool.

And let’s address the subject of the reliability of tests. There are concerns that rapid tests may be less reliable if someone is infected by the Omicron variant. Can you speak to that?

WOLAK: A report was just released that the at-home tests may not be as accurate with the Omicron variant. That being said, they still do detect the variant, but there is a higher rate of false negative (it says you don’t have the virus, but you really do). It’s important to note that no test is 100% and these at-home tests are an additional tool in our toolbox. They should not be used in isolation as one’s only approach to protecting themselves and others. But when used along with vaccinations, boosters, and masks, they can be a valuable tool to help one make informed decisions. I should also mention that the accuracy of the at-home tests are much higher if one is symptomatic.

ZELEK: Rapid tests are very accurate at detecting COVID when someone is actively infectious. While this may miss a short period when someone is pre-infectious, their short turnaround time, especially with Omicron, is very valuable. Compared to PCR tests, they are also less likely to come back positive when someone’s infectious period has ended, meaning lower risk of isolating someone who can no longer transmit to others. While some rapid tests are not effective at detecting Omicron, those in circulation here like Binax Now are, and these tests will be very important in the coming weeks and months.

Give the increase in breakthrough cases, is it indeed inevitable — as I read this week — that “most everyone you know will, at some point, get COVID”? Why or why not?

WOLAK: I do think this is an accurate statement, especially with how things are trending. But if we are vaccinated and boosted, not only are you more protected from the virus, you are also protected from getting sick if you were to get the virus.

ZELEK: Yes, I expect the vast majority will get COVID at some point, so the main question is whether you will have protection from the vaccine when you are exposed to the virus or not. That is completely within our control. That said, mitigation strategies like wearing masks remain important to slowing the spread of the virus, which can allow us to keep critical functions like education and healthcare operational during the Omicron surge.

News broke this week that booster shots for 12- to 15-year olds will soon be authorized. Your thoughts?

WOLAK: I think this is wonderful. I hope once approved, those in that age group get boosted ASAP.

ZELEK: This is promising news. The FDA and CDC, including ACIP, will carefully review the evidence to inform their final decision. This standard process is important to ensure a science-based decision and reassure parents and adolescents. I have heard from many parents who are eager to know when boosters will be available to this group.

The New York Times wrote last week that changing and confusing guidance and the plethora of “armchair epidemiologists” are making risk calculation for COVID tricky. What’s your advice about making sense of what we read and hear from sources about COVID?

WOLAK: This is an evolving virus that we are trying to learn more about. So that means that the science is ever-changing as well. Some key things are foundational, though — masks, vaccinations, booster, testing. If we keep those core tools available to use, then we are doing the right things. It is also important to consider the source. Information coming from the likes of CDC, IHI, NIH, etc., should be seen as the gold standard, because they are based on science and not opinion.

ZELEK: Eric is spot on. The core messages have remained the same for a long time, while the details have been updated based on emerging evidence and an evolving virus.

Johnsie Hubble, a nurse for 39 years — 37 of which she's been at Chatham Hospital. 'We are still learning and changing to meet these challenges,’ she told the News + Record in May. ‘It does not stop because we keep learning new information based on the current science!' / Staff photo by Peyton Sickles

Guidelines can be effective if folks follow the rules. So many of those who insist on not following guidelines and rule revel in the fact that they’re not getting sick — until, of course, they do. Meanwhile, Chatham’s vaccination rates have barely budged. We’ve asked you about this quite a few times over the past year. Anything new in terms of what you’d say to the unvaccinated?

WOLAK: For those who are still unvaccinated, I do not know why you aren’t. It’s not only important for your protection, but also for those around you. If not for yourself, please vaccinate so you don’t infect others.

ZELEK: Even now, the vast majority of those hospitalized and dying from COVID are the unvaccinated. That is the most telling endorsement from getting vaccinated.

Should the rules and guidelines be different for the vaccinated?

WOLAK: At this point, no. The virus has evolved too much and it is spreading too fast. But we know vaccinations help mitigate the spread and decrease sickness and death, and that is what is really important right now.

ZELEK: The quarantine rules yes, given those who are vaccinated within the past six months or boosted have a much stronger antibody response against COVID which prevents illness and spread. But isolation and mask wearing remain similar across groups.

I have several friends who, as we speak, are “as sick as they’ve ever been” with colds, coughs, congestion — and they’ve tested negative for COVID. How nervous should I be spending time around them?

WOLAK: This pandemic has really highlighted how quickly colds and flu spread. I would not spend any time with anyone who is sick with anything. Wait until they are better and then enjoy each other’s company.

ZELEK: Those who feel unwell should stay at home and away from others. This is standard flu-season guidance and has been a key message throughout the pandemic. As Omicron cases continue to rise, each indoor gathering will pose a greater risk of infection. Even if all feel well, I would limit the size and number of these gatherings, and get tested beforehand.

Anything new on boosters?

WOLAK: If you have not received your booster yet, and you are eligible, please get one ASAP.

ZELEK: We continue to see a steady demand and expect the updated CDC guidance will further encourage those who have not yet gotten their booster to move forward.

Before getting my booster, I heard a lot of stories about reactions to them — mainly fatigue, some aches. What are you experiencing as you encourage people to get them, and seeing people get them?

WOLAK: I have not seen hard data around this, but what I have witnessed is that when you get your booster, your reaction will probably be similar to your 1st and/or 2nd dose (for vaccines with two doses). If you did not feel anything with your first dose(s), then you may not feel anything with your booster. The same may be true for those who did have a reaction. At the end of the day, though, if you do have a reaction, please know that its short-lived and you’ll be back to your normal self in a day or two.

ZELEK: Reactions are generally pretty mild and can vary from one person to the next. They often do feel like the earlier doses.

And what do we know, and not know, about the effectiveness of vaccines over time?

WOLAK: I think we are still learning, so this is a big question mark. For myself, I’m preparing that the COVID vaccine will become an annual thing, just like the flu shot.

ZELEK: We have seen that they hold well over time against severe illness and death, though the booster can up that protection and likely reduce risk of milder infections as well. It is possible additional doses will be recommended, but we don’t yet know.

And finally ... what’s the story at Chatham Hospital in terms of how the staff is handling COVID-related workload these days?

WOLAK: We are continuing to review our staffing days/weeks ahead of time. We also continue to offer our core services, but are always making contingency plans based on patient volume, acuity, and available labor force. Our team has been amazing during these very trying times and I’m always impressed with their positive attitude and resiliency. That being said, with our increased Emergency Department visits, COVID-related absences from our staff, and overall vacancies, every day is a challenge. This is why I do hope the residents of Chatham County really do what’s best for the county and get vaccinated/boosted.

ZELEK: I am extremely grateful to Eric and our healthcare workforce for all they have done throughout the pandemic. They are heroes.

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