UH College of Medicine Faculty Physician Addresses Omicron Surge

Omicron is now the most dominant COVID-19 variant.
Dr. Bhavna Lall
Dr. Bhavna Lall is a clinical assistant professor of adult medicine in the Department of Clinical Sciences at the University of Houston College of Medicine.

As the world endures another crippling wave of COVID, thanks in large part to the omicron variant, confusion in the general public over what to do is rising as fast as cases and hospitalizations. Where can I get tested? How long should I isolate if I’m exposed or test positive? When and where should I wear a mask? Will this pandemic ever end? 

Those are just some of the questions being asked amid constantly changing public messaging from government and medical leaders and rampant misinformation. It can be difficult to figure out what is reliable and trustworthy. 

Dr. Bhavna Lall, clinical assistant professor of adult medicine in the Department of Clinical Sciences at the University of Houston College of Medicine, is on the front lines of helping people understand this ever-evolving pandemic. She discusses some of today’s most pressing issues in the following Q&A:

When will the Omicron surge peak? 

Based on data from other countries, Omicron is extremely contagious and will lead to a large number of cases. It may also peak at a faster rate than the other variants. However, every country is different. The U.S. has a population that is varied in their vaccination percentages and many individuals also have increased risk factors for COVID-19, including chronic disease and obesity.

In addition, due to various states’ politics into mitigation and public health strategies, mask mandates and vaccine mandates have not been enforced throughout the country which impacts a uniform mitigation strategy to help stop the spread of this virus. At the current pace of this virus, hospitalizations are increasing and if we do not increase mitigation measures such as social and physical distancing, mask wearing, improved ventilation in buildings and schools, and increase vaccination and booster rates, more people are at risk of severe disease from COVID-19.  In addition, we must help unvaccinated populations around the world get vaccinated to prevent the spread of further variants in the future.

Given the high levels of virus in the community right now, it will be with us for some time, so take precautions as much as possible and get vaccinated if you have not already done so, even if you have been previously infected with COVID-19. There is no definitive date of the peak. However, per the Institute for Health Metrics and Evaluation, the U.S. could peak in late January. The U.S. will have to see how this virus continues to spread and the measures that are taken by each state to control it. As you can see per the modeling data, cases are consistently moving upwards.

Why are the CDC’s recommendations for isolating and quarantining constantly changing?

If you have tried to purchase rapid antigen home tests, you’ve probably noticed there is a shortage. And many people have been waiting in line for hours to get PCR testing. The CDC recently changed the isolation guidelines to five days but has now amended that to add testing as an option, if you have access to it, prior to leaving isolation. If your symptoms are not resolved at day five, you could still be contagious. And if you have any doubt about leaving isolation and/or have no access to testing, you should consider isolating for 10 days especially if you are around vulnerable or high-risk populations.

If you have access to rapid antigen testing at day five and symptoms are resolved, you can test and assess if you are still positive. If still positive, continue to isolate for an additional five days for a total of 10 days. Rapid testing can also be used sequentially over the course of two days to assess if you are negative prior to leaving isolation. Regardless of if you have COVID or not right now, if you are in a public setting or outside your household, you should be wearing a good, quality mask (KN95s, N95s, KF94s) or double masking, for example a cloth mask on top of a surgical mask. Cloth masking alone has not been shown to be very effective in preventing transmission. You should also wear a mask that you are comfortable that is well fitted that you can wear continuously.

If you have no symptoms at day five and are continuing to be in a public setting and do not have access to testing, you should continue to always wear a high-quality mask until day 10, given you may still be contagious during this time. Per UK data quoted by CDC guidelines, “after the 5th day after a positive test, an estimated 31% of persons remain infectious.”

When in doubt, stay home if you feel unwell and until you have no symptoms and discuss your plan with your doctor. Here are the CDC isolation guidelines.

When it comes to testing, what does it mean when I am negative one day and positive the next?

Rapid antigen testing and PCR testing are two different methods of testing for the virus. You may test negative for the rapid antigen test and positive for PCR or vice versa. It also depends on what day of symptoms you are testing. PCR testing is more sensitive than rapid antigen testing in picking up the virus. However, rapid testing is useful to detect if you are contagious/infectious at a given moment. 

There have been instances when one test comes out negative and another one is positive in some individuals. If you have symptoms and test negative, it’s best to do an additional test for confirmation if you continue to have symptoms. If you are rapid testing at home, it’s beneficial to do sequential testing over the course of two days to test if you are positive as well. 

The Omicron COVID-19 variant is extremely contagious. Given Texas has a positivity rate of 36% right now, if you have symptoms that are consistent with COVID, assume you have the virus until you can get tested, and self-isolate until you do not have symptoms. Keep in touch with your doctor to discuss concerns regarding your symptoms.