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Six Things to Know About Testing
With coronavirus cases on the rise, at-home testing remains a useful but imperfect way to mitigate risk.
I caught up with Katherine J. Wu, a staff writer who’s been covering this pandemic, to talk about what rapid-test results can—and can’t—tell us. Below you’ll find six takeaways from our conversation.
The conversation that follows has been edited and condensed for clarity.
1. With at-home tests, you trade accuracy for convenience.
“Doctors treating patients very often reach for those really sensitive PCR laboratory tests because they want to know beyond a shadow of a doubt whether the virus is present so the person can get the right treatment. Those tests are so sensitive that people can really trust when they’re negative. With the rapid tests, a negative is a lot less of a certain answer.”
2. At-home tests are most useful when a person has symptoms.
“A lot of the rapid tests we now use at home were initially designed to be taken as diagnostics for people who are feeling sick and want answers quickly. They then got the FDA greenlight to be used as screeners. Generally, right after your symptoms first appear is when they have been shown to be most accurate.”
3. They’re less accurate when used as screeners by people who feel fine.
“Things get a little tricky when you don’t have symptoms and you don’t have a known exposure—for example, if you’re hoping for a negative so that you can clear yourself to, say, go visit a grandparent.
“Rapid tests are not as good as lab tests when it comes to picking up on the virus when it’s present at really low levels. To get around that, experts say to test repeatedly. That way, if you miss the virus on Monday, maybe you’ll catch it Tuesday.”
4. At-home tests might be your only option.
“Let’s certainly not discount the value of rapid tests. With so many cases here and abroad, laboratory-testing infrastructure is going to be crushed. It may not be practical for people to seek out PCR testing as their No. 1 choice right now. If people are able to access rapid tests, they should test themselves daily at this point because we know results can change so quickly.”
5. All tests are mere snapshots of a moment in time.
“Tests cannot predict the future. The minute that swab goes into your nose—that is what the result is going to be giving you information on. We know this virus can replicate super quickly, especially if we’re talking about something like Omicron or Delta. A person can test negative in the morning and have a blazing positive result by the evening.”
6. Omicron is making things even trickier.
“We are still figuring out how quickly this variant spreads both within individual people and between different people. But based on what we know so far, it seems to be moving super fast, and there seems to be some indication that people can go from not contagious to quite contagious very quickly. And if that’s the case, then that means that negative test results actually expire sooner.”
Pregnancy and The Covid Vaccine
Pregnancy can be a scary time for many reasons, one of which is having so many things feel off-limits for the safety of the fetus. But what about vaccines? Especially the Covid-19 vaccine? To understand the answer to this question you need data about the vaccine in pregnancy, but you also need data about lacking protection from Covid-19 in pregnancy. Fortunately, we discuss both in this episode!
Omicron could spark ‘viral blizzard’ in coming weeks, top epidemiologist says
COVID-19 cases are surging across the U.S. ahead of Christmas, sparking the cancellation of sporting events and a growing list of hospitals postponing nonessential surgeries — both a reminder of last year’s holiday surge and a sign that the next several weeks will determine the pandemic’s trajectory for the rest of the winter months.
Nationwide, the daily average for new cases was more than 133,000 on Dec. 18, a 21 percent jump over the last two weeks, according to data compiled by The New York Times.
Health officials have warned the omicron variant — which appears to cause less severe illness, though is more transmissible — could exacerbate the ongoing delta-fueled surge and overwhelm the healthcare system.
“I think we’re really just about to experience a viral blizzard,” Michael Osterholm, PhD, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, told CNN during a Dec. 17 interview. “I think in the next three to eight weeks, we’re going to see millions of Americans are going to be infected with this virus, and that will be overlaid on top of delta, and we’re not yet sure exactly how that’s going to work out.”
New York — where omicron accounts for at least 13 percent of new cases — for two consecutive days set a record for the daily number of new cases reported. Health officials reported more than 21,000 new cases on Dec.17 and 21,908 on Dec. 18. Three Midwestern states and Vermont also set COVID-19 records last week, including Ohio, which reported nearly 12,000 new cases Dec. 16.
While early data suggests omicron is tied to less severe illness than the original strain, health officials have warned against underestimating the virus. The outgoing National Institutes of Health director, Francis Collins, MD, PhD, offered a grim projection during a Dec. 19 interview with NPR.
“Even if it has somewhat lower risk of severity, we could be having a million cases a day if we’re not really attentive to all of those mitigation strategies,” Dr. Collins said.
Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, said areas with low vaccination coverage will likely be especially hard hit across the coming weeks.
“We are going to see significant stress in some regions of the country on the hospital system, particularly in those areas where you have a low level of vaccination, which is one of the reasons why we continue to stress the importance of getting those unvaccinated people vaccinated,” he told CNN Dec. 19, adding that in some regions of the U.S., omicron accounts for 50 percent of new infections, “which means it’s going to take over.”
“This virus is extraordinary. It has a doubling time of anywhere from two to three days,” Dr. Fauci said.
The daily average for U.S. COVID-19 hospitalizations was more than 69,000 as of Dec. 19, marking a 16 percent rise across the last two weeks; and while omicron may be associated with lower disease severity, a significant surge would inevitably lead to more hospitalizations and deaths, health officials say. Connecticut, Washington, D.C., and Rhode Island have seen the highest percent increase in hospitalization rates over the last two weeks.
As the holidays and planned celebrations near, Dr. Fauci emphasized the importance of booster doses in combating the surge. He urged against holiday gatherings and travel among people who have not been fully vaccinated or received their boosters. Given a rise in breakthrough cases, he also suggested people take a rapid test before attending a gathering.
“If you do these things … I do believe that you can feel quite comfortable with a family setting, the dinners and the gatherings that you have around the holiday season,” Dr. Fauci told ABC News Dec. 19. “Nothing is 100 percent risk-free, but I think if you do the things that I just mentioned, you’d actually mitigate that risk enough to feel comfortable about being able to enjoy the holiday.”
Moderna said Dec. 20 that a booster dose of its vaccine increased antibody levels against omicron 37-fold. Laboratory findings from Pfizer also indicate its booster offers significant protection against the strain.
CDC data showed 61.4 percent of the nation’s population had been fully vaccinated as of Dec. 19. Nearly 30 percent of the fully vaccinated population had received their booster dose.
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We’ll Never Be Rid of COVID, Fauci Says
On the spectrum from active outbreak to eradication, control is the most likely path forward for COVID-19 in the U.S., NIAID Director Anthony Fauci, MD, said during a National Press Club briefing today.
Fauci’s words served as a reality check for those holding out hope that COVID-19 one day might be as rare as measles or polio in America.
“We’re never going to eradicate this,” he said. “We’ve only eradicated one virus, and that’s smallpox. Elimination may be too aspirational, because we’ve only done that with infections for which we’ve had a massive vaccination campaign like polio and measles. Even though we haven’t eradicated [those viruses] from the planet, we have no cases, with few exceptions, in the U.S.”
Fauci said the country should focus on control — a level of infection “that isn’t zero, but that with the combination of the vast majority of the population vaccinated and boosted, together with those who recovered from infection and also are hopefully boosted, that we will get a level of control that will be non-interfering with our lives, our economy, and the kinds of things we would do, namely to get back to some degree of normality.”
“It’s not going to be eradication, and it’s likely not going to be elimination,” he said again later in the briefing. “It’s going to be a low, low, low level of infection that really doesn’t interfere with our way of life, our economy, our ability to move around in society, our ability to do things in closed indoor spaces.”
Fauci said the only way to achieve this will be with vaccinations, boosters, and mitigation strategies such as wearing masks in congregate settings.
“Over time, we feel confident we will get this under control,” he said. While he said he “hopes” this comes in the “next several months,” he cautioned that he “never predict[s], because you never get it right. Sure enough, someone will come back and say, ‘You said this in December and you were wrong.'”
In terms of boosters, Fauci said it’s possible that a third shot — “and maybe an additional one” — will be enough to provide durable immunity, but that “we’ll just have to wait and see. We don’t know yet.”
Kids under age 5 who have yet to be vaccinated will have to wait a few more months to get their shots, he added. While the lower, 3 μg dose of the Pfizer vaccine looked sufficient for children ages 6 months up to 2 years, that dose was not sufficient for those ages 2 to 5, he said.
“The company decided that they believe this is really a three-dose vaccine, and there’s no doubt if you give three doses you’re going to get an effective and safe vaccine,” he said. “But they haven’t proven it yet, so that’s the delay.”
“I can guarantee you it’s going to be effective,” Fauci added.
Data aren’t expected until the end of the first quarter of 2022, he said, meaning vaccines for this pediatric population likely won’t be available until “a few months into 2022.”
Health officials say omicron variant likely to cause record-high coronavirus cases, hospitalizations in U.S.
Top government health officials on Sunday warned that the United States will probably see record numbers of coronavirus cases and hospitalizations as the omicron variant spreads rapidly and forces Americans to again grapple with the dangers of a pandemic that has upended life around the globe.
“Unfortunately, I think that that is going to happen. We are going to see a significant stress in some regions of the country on the hospital system, particularly in those areas where you have a low level of vaccination,” Anthony S. Fauci, the nation’s leading infectious-disease specialist, said on CNN’s “State of the Union” when asked whether the United States could see record numbers of cases, hospitalizations and deaths.
Fauci described the variant as “extraordinary” in its transmissibility, with a doubling time of two to three days. It accounts for 50 percent of coronavirus cases in parts of the country, which meant it would almost certainly take over as the dominant variant in the United States, he added.
“It is going to be a tough few weeks, months, as we get deeper into the winter,” Fauci said.
On CBS News’s “Face the Nation,” Francis Collins, director of the National Institutes of Health, said that cases will rise steeply over the next couple of weeks and that the country could soon see 1 million new cases a day tied to the omicron variant, dramatically exceeding the record of about 250,000 new cases per day set in January.
“The big question is, are those million cases going to be sick enough to need health care and especially hospitalization?” Collins said. “We’re just holding our breath to see how severe this will be.”
Fauci and Collins painted a stark but realistic picture of the winter ahead, on the heels of a week of coronavirus-related setbacks. Coronavirus cases, hospitalizations and deaths rose across much of the country last week, with officials warning of a surge just as millions of Americans — already weary after nearly two years of the pandemic — are expected to travel for Christmas and New Year’s. On Friday, Pfizer and BioNTech announced that coronavirus vaccines for children younger than 5 would be pushed back further into 2022, as the companies modified their trials to include a third dose. On Sunday, New York, one of the country’s early epicenters in the pandemic, reported 22,478 cases.
Health officials have continued to urge the unvaccinated to get their shots and those who have received only two doses of either the Pfizer or Moderna mRNA vaccines to get booster doses. Vaccines cannot be the only layer of protection against the omicron variant, Fauci said, but defeating the pandemic would not be possible without them.
There are still safe ways for vaccinated people to get together for the holidays, including wearing a mask while traveling, testing beforehand and knowing the vaccination status of everyone present at indoor celebrations, Fauci said on “Face the Nation.”
“If you do these things, I do believe that you can feel quite comfortable with a family setting,” he said. “Nothing is 100 percent risk-free, but I think if you do the things that I just mentioned, you’d actually mitigate that risk enough to feel comfortable about being able to enjoy the holiday.”
Collins stopped short of urging people to cancel holiday plans but said travel will be risky even for vaccinated people.
“This virus is going to be all around us,” he said. “I’m not going to say you shouldn’t travel, but you should do so very carefully. … People are going, ‘I’m so sick of hearing this,’ and I am, too. But the virus is not sick of us, and it is still out there looking for us, and we’ve got to double down on these things if we’re going to get through the next few months.”
Doctors, nurses and others are warning that the nation’s health system continues to be strained by an unending stream of coronavirus cases. Confirmed U.S. coronavirus infections have surpassed more than 128,000 per day and confirmed virus deaths are near 1,300 per day, according to The Washington Post’s rolling seven-day average.
“For people trained to save lives, this moment is frustrating, exhausting and heartbreaking,” the American Hospital Association, the American Medical Association and the American Nurses Association said in a joint statement on Friday, urging more Americans to get booster shots.
Public health experts are bracing for a winter surge of cases driven by the omicron variant, which can evade some protection conferred by vaccinations and prior infections, as well as cases linked to the delta variant. Officials caution that they are still relying on preliminary data about the omicron variant’s severity compared with earlier forms of the virus.
President Biden plans to address the nation Tuesday on the status of the country’s fight against the virus, the White House said Saturday.
“We are prepared for the rising case levels,” White House press secretary Jen Psaki wrote on Twitter, adding that Biden “will detail how we will respond to this challenge. He will remind Americans that they can protect themselves from severe illness from COVID-19 by getting vaccinated and getting their booster shot when they are eligible.”
The speech, coming just before Christmas and New Year’s Day, underlines Biden’s struggle to contain the pandemic nearly a year into office. On top of the emergence of new variants and attendant challenges, the administration has at times faced criticism for what some have described as mixed signals.
Biden won high marks from the public during the first half of the year as cases declined, the country opened up from shutdowns and vaccines became widely available. But the past few months have been more difficult. After he gave a speech on July 4 saying the country was “closer than ever to declaring our independence from a deadly virus,” the situation started changing. Case rates increased as the delta variant gained a foothold and many Americans refused to get vaccinated.
And despite Biden’s promise that at-home rapid tests would become a widely available tool to fight the coronavirus, the tests remain hard to find in many parts of the country and are more expensive than in some other places across the globe.
Fauci conceded Sunday that the administration needed to do better on increasing the availability of at-home coronavirus rapid tests, though he emphasized that the country was in a much better place than it was a year ago, with 200 million to 500 million tests available per month, many of them free.
“We’re going in the right direction,” he said on CNN. “We really need to flood the system with testing. We need to have tests available for anyone who wants them, particularly when we’re in a situation right now where people are going to be gathering.”
The omicron variant also has challenged the nation’s coronavirus medicine cabinet, with evidence that mutations will wipe out or weaken the effectiveness of treatments that can reduce the virus’s severity and keep people out of hospitals. As a result, the Biden administration around Thanksgiving paused distribution of sotrovimab, the one monoclonal antibody that remains effective against the omicron variant, with senior officials such as David Kessler calculating that the drug should be maximally deployed when the variant becomes more prevalent.
By Thursday, administration officials decided to resume shipments of the drug, amid indicators that the omicron variant was spreading faster in states such as New York and Washington than data published by the Centers for Disease Control and Preventionearlier in the week indicated, said two officials with knowledge of the deliberations.
“Shipment of product will begin soon, and jurisdictions will see product arrive as early as Tuesday, December 21, 2021,” the federal health agency said in a statement on Friday, announcing that about 55,000 doses of sotrovimab would soon go out.
Doctors said they were desperate for treatments like sotrovimab as emergency rooms begin to crowd and case numbers soar.
“Too slow! We are already seeing widespread omicron,” texted one infectious-disease doctor at a large New York City hospital, who estimated that at least 50 percent of patients had contracted the variant and requested confidentiality to discuss patient care. “It’s a lot of hospitalizations that could have potentially [been] averted because of slow response.”
Fauci said Sunday that he expected it to be months before antiviral drugs can be mass-produced and available to anyone who needs them. While he did not foresee the kind of shutdowns that were put in place in the early days of the pandemic, Fauci also noted that it would be difficult to keep the virus under control when there remained “about 50 million people in the country who are eligible to be vaccinated who are not vaccinated.”
Similarly, several governors on Sunday shied away from the possibility of implementing more shutdowns to fight the spread of the new variant. Maryland Gov. Larry Hogan (R) said on “Fox News Sunday” that his state, which has seen a 150 percent increase in hospitalizations over the past two weeks, was not considering shutdowns and instead was putting more resources into testing and encouraging vaccinations and boosters. New Jersey Gov. Phil Murphy (D) said on the same show that shutdowns remained “on the table” but that he didn’t think such a move was likely because a high percentage of the state’s population was vaccinated.
Colorado Gov. Jared Polis (D) emphasized that people in his state should keep themselves safe with “individual freedom and local control.” He also said Colorado officials were looking to change the definition of “fully vaccinated” to include three shots, as health officials in the country and around the world have signaled in recent days they are also considering.
“That’s certainly where it’s headed,” Polis said on NBC News’s “Meet the Press.” “I wish they’d stop talking about [the third shot] as a booster. It really is a three-dose vaccine.”
CDC: Omicron accounted for 73% of recent COVID-19 cases
The Omicron variant accounted for more than 73% of recent COVID-19 cases in the U.S., according to Centers for Disease Control and Prevention’s updated data released on Monday.
The big picture: The data showed nearly a six-fold increase in Omicron’s share of COVID-19 infections in just one week.
- The variant was only detected in the U.S. a few weeks ago. Still, the strain has spread rapidly throughout the country and threatens to overturn the new normal.
What they’re saying: “These numbers are stark, but they’re not surprising,” said Rochelle Walensky, the CDC’s director, adding that the growing infections reflect what has been seen in other countries.
- While the Delta variant still drives up a lot of new infections, Walensky told AP she anticipates “that over time that Delta will be crowded out by Omicron.”
What’s next: President Biden on Tuesday will deliver a speech outlining new steps the administration will take to address the rapid spread of the new variant.
HENRY KOTULA 