Covering COVID-19 is a daily Poynter briefing of story ideas about the coronavirus and other timely topics for journalists, written by senior faculty Al Tompkins. Sign up here to have it delivered to your inbox every weekday morning.

Let’s start with the newest numbers. The notion that omicron is not so bad finds no home in these figures. In the map below, orange is the worst, then darker blue, then lighter colors.

(Kaiser Family Foundation)

Notice the regional clusters of the highest hospitalizations and the lower rates. And notice how states with the worst rates nearly always touch worst-rate states or the next step down, but I see only two instances of worst-rate states touching lowest-rate states (Nebraska and Arizona). Though notice that Vermont is surrounded by other high hospitalization rate states. I will take a look at why that number is so low, but I noticed the state’s COVID-19 dashboard was not updated in the last week of December through New Year’s.

2022 begins with COVID-19 school disruptions

Burbio, which uses 80,000 K-12 school calendars from all 50 states plus, just updated its graphics to show how we are starting the new year.

(Burbio)

Some places, like Seattle, are delaying reopening to test students.

Atlanta schools will go virtual for at least a week, as will schools in Newark. Lansing, Michigan, and Ann Arbor, Michigan, joined the list of schools that decided Saturday night that they would move to virtual teaching this week. Cleveland, Ohio, schools will be virtual and hope to return to in-person teaching Jan. 10.

New York City, the nation’s largest school district, is starting its “Stay Safe and Stay Open” policy today, which means schools will no longer require every student in a class to quarantine if one student gets infected. The plan in NYC is to send take-home rapid tests for students when a classmate tests positive. If the student tests negative, they may return to school the next day with another at-home test five days later. The whole plan relies on parents reporting the results of at-home tests.

A number of states — Illinois, Kansas, Pennsylvania, California and Massachusetts — have “test to stay” plans, a notion endorsed by the Centers for Disease Control and Prevention in late December.

European schools are delaying reopening, partly in anticipation of staff shortages.

More people are searching for testing info than for vaccine info

A quick check of Google Trends can sometimes give you a glimpse of what audiences want from journalists. In the last few days, for the first time, the words “COVID testing” outperformed “COVID vaccines” or “COVID booster.”

(Google Trends)

Let’s drill down on the data. These states saw a big spike in Google searches for COVID-19 tests in the last week:

(Google Trends)

It is interesting that in virtually every metro area, you will find people hungry for testing information:

(Google Trends)

Finally, I think journalists should be looking at Google Trends to find out what people want to know. Some of the most common questions they are asking of Google:

• Can you get a vaccine while you are COVID-19 positive?
• What are COVID symptoms?
• What happens if you get COVID-19 while pregnant?

FDA to authorize COVID boosters for teenagers, perhaps today

We will start the week with the Food and Drug Administration — and then, very likely, the CDC — approving third COVID-19 vaccine doses for 12-to-15-year-olds. About 40% of all teens have not been vaccinated.

An opinion piece in the New England Journal of Medicine argues that states could raise the teen vaccination rate by allowing teenagers to make their own decision to get vaccinated without parental consent. Most states require parental permission for vaccinations. The column notes:

Whether an adolescent legally has medical decision-making capacity depends on the state — and in some cases, the local jurisdiction.

All but a few states consider 18 years to be the age of majority (at which people are granted full personal legal responsibility).

• Nine states and the District of Columbia, however, allow younger adolescents who are capable of giving informed consent to make general medical decisions on their own behalf.
• Four states and the District of Columbia have age thresholds that are lower than 18 years, whereas the other half don’t specify a minimum age for independent medical decision making.
• Complicating matters further, some local jurisdictions have established their own regulations — San Francisco, for example, allows children as young as 12 to consent to receiving Covid-19 vaccines.
• Current exceptions to parental-consent requirements include allowing adolescents to seek contraceptive and abortion services and treatment for substance use disorders, mental health disorders, and sexually transmitted infections (STIs) without parental permission. In a few states, adolescents can also receive diagnostic services and treatment for reportable and other communicable diseases (other than STIs) without a parent’s permission. In even fewer states, they can receive preventive services for these conditions; these states can actively encourage adolescents to consent to Covid-19 vaccination.

Why epidemiologists are frustrated by the CDC’s newest COVID-19 guidance

The CDC, as you know, recently issued new guidance on how long an asymptomatic person infected with COVID-19 should stay in quarantine. The new guidance changed the quarantine period from 10 days to five days after exposure. The CDC also recommended wearing a mask for five days after isolation and quarantine.

We know that about 85-90% of viral #COVID19 transmission occurs in the first 5 days. During that period, we want people to stay home & isolate, then mask for 5 additional days to capture the last 10-15%. Remember, in areas of substantial or high transmission, keep your mask on. https://t.co/lfy77VMEIj

— Rochelle Walensky, MD, MPH (@CDCDirector) December 30, 2021

But why didn’t the CDC recommend that an infected person get at least one, maybe two negative COVID-19 tests before coming out of quarantine? England requires people to test negative on two rapid antigen tests to come out of quarantine after seven days. Michigan announced it is so unconvinced of the CDC’s guidance that it is not going along with the shorter quarantine period.

Slate collected responses from a range of experts:

The most generous feedback could be described as “partially supportive.” Experts have mostly described the CDC’s decision as “reckless,” not based in science, and “bull****.”

Given how weak the CDC’s arguments are, it’s hard not to suspect that the real reason it opted not to recommend taking a rapid antigen test is that the kits are simply too hard to find in the U.S. right now. (CDC director Rochelle) Walensky has denied this: “This really had nothing to do with supply. It had everything to do with knowing what to do with the information when we got it,” she told CBS. But it makes vastly more sense than the official explanation, which is that U.S. health authorities have decided every other country is wrong and rapid testing just isn’t that useful for figuring out whether someone might still be capable of spreading the plague after five days at home.

The CDC provided this as the reason for the change:

“The majority of SARS-CoV-2 transmission occurs early in the course of illness, generally in the 1-2 days prior to onset of symptoms and the 2-3 days after.”

It could be, this new study says, that omicron incubates faster than, say, delta. So it may be that people who get infected may be passing the virus to others faster. That would mean that, as the CDC says, the quarantine period can be shorter because the whole process of onset to viral load clearance is shorter.

Epidemiologists are frustrated that the CDC did not provide whatever new scientific data it relied on for this new guidance, but a range of studies said the length of time that infected people remain contagious runs from three to nine days generally at peak viral load from two days before you feel any symptoms to about four or five days after you feel sick. So those studies make the CDC’s recommendations to ease quarantine mystifying to people who study such things.

Dr. Katelyn Jetelina says the CDC should have said outright that unvaccinated people could stay infectious longer than people who have been vaccinated:

On average, viral clearance is about 5.5 days among vaccinated compared to 7.5 days for unvaccinated people (see figure below).

(New England Journal of Med 2021; 385:2489-2491)

So, the majority of vaccinated people are well on their way to clearing the virus at 5 days. This is especially true among asymptomatic people. Some vaccinated may still have the virus, but if they wear a mask they won’t contribute to an overabundance of spread. The CDC policy makes sense for vaccinated people, at least before Omicron.

Unvaccinated people clear the virus in 7.5 days, which is obviously higher than the 5-day clock with this guidance. Even more worrisome is the broad range of infectious periods for unvaccinated, which ranged from 2 to 14 days (see panel G below). This new guidance may not be a problem if the unvaccinated actually wear a mask 5 days after isolation like this guidance suggests. But I doubt this will happen. The CDC stretched the science for unvaccinated people too far.

In short, unvaccinated people who get infected can shed the virus for significantly more than five days — maybe, as this study showed, up to nine days after infection.

(Medrxiv)

The times in which we live: Some tweets by doctors and people on the front lines of COVID

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