As the covid-19 omicron variant surges across the United States, top federal health officials are looking to add a negative test along with its five-day isolation restrictions for asymptomatic Americans who catch the coronavirus, the White House's top medical adviser said Sunday.
Appearing on ABC News' "This Week," Dr. Anthony Fauci, the chief medical adviser to President Joe Biden, acknowledged the backlash over the U.S. Centers for Disease Control and Prevention reducing the recommended isolation period after a positive coronavirus test from 10 days to five.
"There has been some concern about why we don't ask people at that five-day period to get tested," Fauci said. "Looking at it again, there may be an option in that, that testing could be a part of that, and I think we're going to be hearing more about that in the next day or so from the CDC."
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The possibility of further changes to the CDC's isolation guidance reflects the challenge facing U.S. public health officials, who have tried balancing competing pressures in responding to the omicron wave. The change would mark a reversal of one of the most criticized aspects of the new CDC guidelines -- one that experts said could lead to increased viral transmission.
Federal officials faced requests from airline and other industries to shorten quarantine and isolation times in response to worker shortages and flight cancellations that they reported had been driven by workers who tested positive and were isolating.
Fauci said the U.S. has been seeing almost a "vertical increase" in new cases, now averaging 400,000 cases a day, with hospitalizations also up.
"We are definitely in the middle of a very severe surge and uptick in cases," he said. "The acceleration of cases that we've seen is really unprecedented, gone well beyond anything we've seen before."
Fauci said he's concerned that the omicron variant is overwhelming the health care system and causing a "major disruption" on other essential services.
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"When I say major disruptions, you're certainly going to see stresses on the system and the system being people with any kind of jobs ... particularly with critical jobs to keep society functioning normally," Fauci said. "We already know that there are reports from fire departments, from police departments in different cities that 10, 20, 25 and sometimes 30% of the people are ill. That's something that we need to be concerned about."
CDC Director Rochelle Walensky previously said the new rules were consistent with the protections afforded by vaccinations and booster shots. The CDC also recommended that people returning to the workforce after five days wear masks for the full 10-day period.
Walensky told The Washington Post that her agency decided against requiring a negative test result after five days of isolation because the tests are often inaccurate at that point. Polymerase chain reaction tests can yield positive results even when the patient is not infectious, she said.
Several public health experts have challenged the revamped CDC rules, with some calling them too permissive.
"I absolutely don't want to sit next to someone who turned Positive 5 days ago and hasn't tested [negative]," tweeted epidemiologist Michael Mina, an assistant professor at Harvard T.H. Chan School of Public Health. Mina called the guidance "reckless."
A new testing requirement could mollify public health experts who have criticized the administration's new guidance, but it also could put additional strain on the already limited testing supply, experts say.
The Biden administration has faced criticism over long delays for securing tests in many parts of the country.
"There's a bit of a conundrum here for the administration. Many experts have recommended testing negative to end isolation after you have covid, but it's really hard to find tests right now," said Larry Levitt, a public health expert at the Kaiser Family Foundation, a nonprofit. "The need for testing combined with the lack of tests has put the administration in a tough spot."
The Food and Drug Administration last week said preliminary research indicates at-home rapid tests detect omicron but may have reduced sensitivity. The agency noted that it's still studying how the tests perform with the variant, which was first detected in late November.
Fauci said Americans "should not get the impression that those tests are not valuable."
"I think the confusion is that rapid antigen tests have never been as sensitive as the PCR test," Fauci said. "They're very good when they are given sequentially. So if you do them like maybe two or three times over a few-day period, at the end of the day, they are as good as the PCR. But as a single test, they are not as sensitive."
A PCR test usually needs to be processed in a laboratory. The test looks for the virus's genetic material and then reproduces it millions of times until it's detectable with a computer.
It is also unclear whether a single rapid antigen test would provide particularly useful guidance on whether a worker is still infectious.
Jorge Caballero, a health data scientist, said the United States should move to a system more closely resembling that in Britain, where patients are expected to test negative several times in a row before ending their isolation periods. That protocol helps account for the uneven usefulness of rapid antigen tests, he said.
Including a testing requirement after five days would be an improvement, Caballero said, but "it does not address the limitations around rapid antigen tests -- they are less sensitive and less able to pick up asymptomatic cases."
Coronavirus cases have been surging across the country, but deaths have not spiked. There is some evidence that the omicron variant is less fatal than other iterations of the coronavirus.
The nation is recording an average of about 400,000 cases per day, and hospitalizations have started to rise. But recent quick declines in cases in South Africa suggest that the virus will soon fade, health officials say, and U.S. officials are watching what is happening there and in Britain with guarded optimism.
The uncertain stage of the pandemic represents a new challenge for public health officials, who have already faced substantial criticism for repeated shifts in the official guidance.
"You have to balance the need for flexibility with the need for a credible consistent message, and that's never going to be easy with a dynamic situation," said Harold Pollack, a public health expert at the University of Chicago. "But when your recommendations change, that undermines your ability to have a stable message."
SCHOOL WORRIES
With coronavirus infections soaring, the return from schools' winter break will be different from what some had planned as administrators again tweak protocols and make real-time adjustments in response to the shifting pandemic. All are signaling a need to stay flexible.
Mask requirements are returning in some school districts that had dropped them. Some are planning to vastly ramp up virus testing among students and staff members. And a small number of school systems are switching to remote learning -- for just a short while, educators hope.
Long after the widespread closures in the pandemic's early days, school and elected leaders say they are using the lessons and tools of the past two years to navigate the latest surge without long-term shutdowns, which had woeful effects on learning and students' well-being.
Still, pressure from parents and teachers unions has added to the urgency surrounding safety measures as the omicron-fueled surge sends up caseloads and puts children in the hospital in close to record numbers.
In the New York City school system, 2 million at-home test kits provided by the state will be used to increase testing after the break, officials announced last week. Students whose classmates test positive can keep going to school as long as their at-home tests are negative and they don't have symptoms.
Michael Mulgrew, president of the United Federation of Teachers, which represents New York City educators, questioned whether the new testing initiatives will be available in every school by the time schools reopen today.
"We are moving closer to a safe reopening of school. ... But we are not there yet," he said.
In Chicago, the nation's third-largest school district, officials announced the purchase of 100,000 laptops over the holidays in case they are needed for remote learning this month, though district leaders said they hope to avoid a system-wide closure. The Chicago Teachers Union has proposed pausing in-person learning unless new safety measures are introduced, including negative covid tests for returning students.
Los Angeles health officials announced in late December tightened testing and masking rules for all employees and students when Los Angeles County public and private schools return to campuses today.
Concerned by a spike of the omicron variant, the county health department mandated that teachers wear medical-grade masks in class, and students and staffers wear masks outdoors in crowded spaces. Schools will have two weeks to comply.
Out of more than 13,000 school districts nationwide, relatively few have announced plans to start remotely after winter break. Like Newark, those districts generally plan to resume in-person instruction within a couple of weeks.
Ronald Taylor, superintendent of the South Orange-Maplewood School District in New Jersey, said a spike in cases and subsequent quarantining heading into the break had disrupted operations by forcing consolidation of classes where there wasn't enough staff. He said the district would be remote the first week back.
"Like many other school districts, we have seen a consistent trend, after each of our school breaks, both Thanksgiving and our fall break in early November, there has been a sharp increase in our student/staff population of covid cases," he said.
In Florida's Miami-Dade County, where one in four people were testing positive for the virus, the school system announced Thursday that all employees, volunteers and visitors will be required to wear face coverings at schools and facilities, and students will be strongly encouraged to wear them. A state law prevents school districts from imposing mask mandates for students.
To help keep as many students in school as possible, the CDC and U.S. Education Secretary Miguel Cardona endorsed test-to-stay in December as an alternative to the previously recommended 10-day quarantines. Hundreds of schools have adopted test-to-stay policies for students who have had contact with infected classmates.
"The goal remains to keep all schools open for in-person learning five days a week throughout the 2021-22 school year and beyond," Cardona said in a message to schools marking the halfway point of the academic year. He said 99% of schools were open in-person in December, compared with 46% last January.
Some school systems are moving toward requiring vaccinations for students, but not anytime soon. In the Los Angeles school district, which was among the first to announce mandatory covid-19 vaccinations for students, a Jan. 10 deadline for students age 12 and older was postponed until the fall of this year. Officials said the earlier date would have barred about 27,000 unvaccinated students from campuses.
The District of Columbia announced Dec. 22 that all students, whether in public, private or charter schools, must be fully vaccinated by March 1.
Information for this article was contributed by Jeff Stein of The Washington Post; and by Carolyn Thompson, Hope Yen and Aamer Madhani of The Associated Press.