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Past, present, future of omicron discussed at AAP town hall

January 10, 2022

Editor’s note: For the latest news on COVID-19, visit http://bit.ly/AAPNewsCOVID19.

The latest on omicron, testing for SARS-CoV-2, quarantine guidelines and keeping kids safe in school were among the topics discussed at an AAP town hall Jan. 6 that featured pediatric experts in infectious diseases and school health.

The panel included Yvonne “Bonnie” A. Maldonado, M.D., FAAP, chair of the AAP Committee on Infectious Diseases (COID); James D. Campbell, M.D., M.S., FAAP, a COID member; and Sonja C. O’Leary, M.D., FAAP, chair of the AAP Council on School Health.

Schools vs. omicron

As omicron sweeps the nation, many schools are grappling with whether to stay open.

“… I still believe that there's not that much in school transmission, that it's all coming from the community, from home, from other close contacts,” Dr. O’Leary said. “My default is always try to keep the kids in school as much as humanly possible.”

And the way to do that hasn’t changed.

“You mask whenever possible. You distance whenever possible. You, of course, wash hands and don't come to school if you're sick,” Dr. Campbell said.

Dr. Maldonado agreed that masks are an integral part of keeping kids safe in schools.

“Health care workers aren't getting infected in the hospital when you're masking properly,” she said. “So I think this really does speak to going back to masks especially indoors.”

Test-to-stay programs are another strategy to keep kids in school. Yet, tests are hard to come by, and the accuracy of antigen tests for detecting the omicron variant has been questioned by some.

Dr. Campbell said antigen tests have a high negative predictive value and are as good as or better than rapid strep and flu tests.

“The antigen tests correlate really well with the time when you still have a virus around that you can transmit to other people,” he added.

While rapid tests are not perfect, Dr. Maldonado said, it’s unlikely that someone who is infectious with omicron will have a negative result because “the viral load is pretty high early on.”

Quarantine, isolation guidelines

The Centers for Disease Control and Prevention recently updated its guidance on quarantine and isolation for students and teachers in K-12 to align with recommendations for the general public. People who never develop symptoms can end isolation after at least five days. Those who have had symptoms can end isolation after five full days if they are fever-free for 24 hours without medication and other symptoms have improved. All should continue to wear masks through day 10.

“The evidence behind that is after the fifth day, there's still some transmission, but it's very low,” Dr. Campbell said. “It's mainly in the few days before you're infected and then those five days after infection or after symptoms.”

“We can't bring the risk to zero no matter what we do, and we kind of have to decide where that line is,” Dr. Campbell added. “And I think it's a reasonable line to set at five days.”

Omicron expected to fizzle soon

While clinics, urgent care centers and emergency departments are being overwhelmed by people infected with the omicron variant, Dr. Maldonado noted two pieces of good news.

“One is it doesn't appear to be more serious than delta,” she said. “But secondly, from the data we've seen from South Africa, it does appear that it’s rapid doubling time, depletes the pool of susceptibles and then drops off pretty rapidly. So we are anticipating based on a number of different models that by February, most of omicron should be done in the U.S.”

She acknowledged that it is unknown whether another variant will take omicron’s place or whether delta will resurge. “But we are happy to see that whatever this surge is now, it should be very short-lived. I'm sure not short enough for everybody here, but it hopefully won’t last more than a few weeks.”

Dr. Campbell said he believes omicron, which has high infectivity and lower virulence, is a step toward COVID-19 becoming endemic.

“When is that going to happen? That's really hard to predict,” he said. “But you can tell it continues to move in that direction as we go down the Greek alphabet.”

Words of encouragement

AAP Chief Medical Officer Anne R. Edwards, M.D., FAAP, who moderated the town hall, asked the panelists what words of encouragement they could offer children and colleagues as the virus continues to disrupt lives. Here’s what they had to say:

Dr. O’Leary: “Remember why you went into pediatrics in the first place and get rest and stay resilient, and I would say the same thing to our kids.”

Dr. Campbell: “You made it this far. We're gonna make it through things. It may seem overwhelming right now, but we are getting closer and closer to fully tackling this.” He also urged attendees to thank those who have participated in vaccine trials. “Kudos to everybody out there who has ever enrolled in a vaccine trial.”

Dr. Maldonado: “You've done an amazing job. The American Academy of Pediatrics and pediatricians in particular just have this stellar reputation. People are so devoted to their pediatricians. You are their rock and their strength, and I know everybody's tired and burned out and it's tough. But I do think that omicron will be coming to an end sooner than delta did, and there is a light at the end of the tunnel here. … Continue to reach out to each other. Continue to reach out to the AAP.”

The next COVID-19 town hall will be held at 7 p.m. CT on Jan. 20. To register, visit http://bit.ly/covid19townhallseries.

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