COVID-19: HOW MUCH HAS JAVID ACTUALLY REDUCED THE ISOLATION PERIOD?

Today, 13 January 2022, Health Secretary Sajid Javid announced a reduction of the self-isolation period nominally from 7 days to 5 days.  That is subject to two consecutive negative daily Lateral Flow Tests and not having a temperature  A reduction of 2 days you might think. Really?

Part of my usual professional role is to examine the rules applicable to a situation and optimise the way an organisation can operate better within those rules.  This requires understanding the rules in detail, and then thinking of how to take advantage.  Much like Formula 1 teams leverage their regulations, but without pushing the limits quite as hard.

SO WHAT'S HAPPENED?

Here we looked at the change from the 10 Days rules to the 7 Days rule. just before Christmas The definitions changed, which effectively reduced the isolation period by 4 days rather than 3, being the combination of:

• 3 days change from nominally 10 days to 7 days
  
• Being able to exit isolation on day 7 rather than waiting until day 8.  The NHS website clearly said "on or after" Day 7)
  

The new 5 Days rules change the definition, such that you have to wait until day 6.  Only 1 day earlier than under the 7 Days rules.

OMICRON OR DELTA?

Delta symptoms are the now 'classic' ones listed on the NHS website, including a continuous cough,  loss of teste/smell, and a high temperature.

Omicron is effectively a 'cousin' of Delta, with very different symptoms and faster infection.  The symptom I noticed the day before my first positive LFT was a crackly voice, which is Omicron not Delta.  The day after the date I believe I was infected.

It takes longer to recover from Delta, and often requires the full 10 days in isolation.  The shorter isolation period is primarily relevant for Omicron.  The need for two consecutive negeative LFTs covers the possibility of Delta or another earlier variant.

SO WHAT DOES THAT MEAN OVERALL?

Here's a summary of the three sets of rules:

Note that for the 10 Days rule, which applies if cannot produce two negative LFTs, the NHS says that isolation ends at 2359 hrs on day 10.  Hence not being able to get out and about until early on day 11.

 The overall result is as follows:

• The Day5 rule is a misnomer.  It's 5 full days, so effectively release from isolation is on Day 6
  
• Which is only one day earlier than under the 7 Days rules
  

Furthermore, if you don't appreciate that Omicron has different symptoms, you will potentially stay in isolation a day longer than you need to.  That's the same under either the 5 Days or 7 Days rule sets.

Here it is argued that it is safe to bring exit from isolation 2 days earlier than under the 7 Days rules, subject to negative LFTs and low temperature.  That would apply for those infected by Omicron.  Delta will usually mean longer isolation.

Yet Javid has missed this trick, only making half the change that would have been feasible.  Another day could have been cut from the isolation period, subject to LFT and temperature checks.  Huh?  

The worry is that people get out into the community whilst still infectious.  The issue is primarily a communication one:

• So far the Government has been very unclear as to when exactly people can leave isolation.  This new rule would be better called the 6 Days rule.  Too late?
• People shouldn't think leaving isolation on Day 5 or 6 is automatic.  It's 10 days unless the specific conditions are met.
  

COVID-19: 10 DAYS, 7 DAYS, OR 5 DAYS SELF-ISOLATION. WHAT'S WISE?

We have a problem.  As forecast, the high rate of COVID infection means a high proportion of the workforce is off ill, and otherwise having to self-isolate.  That is adversely impacting many organisations, which are having to close or reduce services.  NHS and trains, and potentially food supply.  Getting people back to work is a critical objective.

Reducing the self-isolation period would help to get people back to work, if that is medically prudent.

In England, the self-isolation period has already been reduced to 7 days, provided certain conditions have been met.  Now 5 days is being considered, as is happening in other countries such as the USA.  

Is 5 days wise?  Let's investigate.

THE OMICRON DIFFERENCE

We now know that Omicron infects cells through a different mechanism to earlier variants.  That lets Omicron spread more quickly, both between people and within a person.   Plus different symptoms.  Generally more moderate disease, but potentially serious enough for some people to require hospital treatment, just like flu.

We're effectively got a different disease, that I'm calling COVID-21.  The 'cousin' of COVID-19, with family similarities such as PCR and LFT tests for earlier variants also working for Omicron.  

But differences that make dealing with it a different proposition. As Omicron has become the dominant variant, we need a self-isolation strategy that focuses on Omicron, but doesn't forget Delta and earlier variants.  And also is well prepared for sons of Delta and Omicron, and indeed any other new Variants of Concern.

 WHAT DO WE KNOW ABOUT DELTA INFECTION?

The speed with which early variants up to Delta spread within a person depends upon each individual.  But is broadly like this, where:

• It takes around 3 days after infection to be LFT positive 
• It takes around 8 days to then become LFT negative, but could be infectious longer.  Hence the original 10-day self-isolation period
  

The American CDC (Centers for Disease Control and Prevention) confirms that of being infectious "the majority of  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".

HOW IS OMICRON DIFFERENT?

My own experience, supported by experience of other people, suggests timescales are shortened with Omicron:

• LFT positive in only around 24 hours
  
• LFT negative as early as on day 4
  

SO HOW CAN WE CATER FOR BOTH DELTA AND OMICRON?

In shortening the self-isolation period from 10 days to 7 days, there are two important conditions:

• Two consecutive negative LFTs on days 6 and 7, at least 24 hours apart
• No symptoms such as a raised temperature

Otherwise self-isolation should continue.  That's appropriate for Delta, and in many cases the full 10 days would be required.

But do we really need 7 days for Omicron?  Provided those two conditions are fulfilled, with negative LFTs moved to days 4 and 5, it appears 'safe' (low risk) for people to exit self-isolation on day 5.  

With it being important for people to get back to work if they have recovered from Omicron, then a change to day 5 is an important improvement.

WHAT ARE THE MODELERS SAYING?

Professor John Edmunds, a member of Sage and an epidemiologist at the London School of Hygiene and Tropical Medicine, has just released experimental modeling results.  

As expected, this has confirmed that a 'test to release' scheme at 5 days produces no difference in the number of infectious days in the community from covid-positive cases than at 7 days.  

Provided each person has negative LFTs in the last two days.

 

 

WHAT ABOUT THE APPROACH IN USA?

The 5-day rules are somewhat different:

• "Isolate for 5 days and if [you] are asymptomatic or [your] symptoms are resolving (without fever for 24 hours)" - but otherwise continue self-isolating
  
• "Follow that by 5 days of wearing a mask when around others to minimize the risk of infecting people they encounter."

The requirement to wear a mask stops after 10 days.

The CDC has also adjusted the need for contacts to self-isolate, reflecting that masks are primarily to provide protection to other people, not so much the wearer:

• "Individuals who have received their booster shot do not need to quarantine following an exposure, but should wear a mask for 10 days after the exposure.  For all those exposed, best practice would also include a test for SARS-CoV-2 at day 5 after exposure. If symptoms occur, individuals should immediately quarantine until a negative test confirms symptoms are not attributable to COVID-19"
• "For people who are unvaccinated or are more than six months out from their second mRNA dose (or more than 2 months after the J&J vaccine) and not yet boosted, CDC now recommends quarantine for 5 days followed by strict mask use for an additional 5 days. Alternatively, if a 5-day quarantine is not feasible, it is imperative that an exposed person wear a well-fitting mask at all times when around others for 10 days after exposure."

 The UK approach is somewhat better:

• Adding the need for negative LFTs on two consecutive days
• An ongoing need to wear masks, in case get re-infected, and to reduce risk of being re-infected.  Bear in mind that Omicron can be caught by people who have immunity to Delta and earlier variants

IN CONCLUSION

We need an approach to ending self-isolation as early as possible that caters for all types of variants, especially Delta and Omicron:

• To let people get back to work, be they employed, self-employed on or zero hours contracts
• To let parents and carers get back to what they need to do
•  To reduce the strain on organisations struggling to stay open and provide a near-normal service.  That is especially relevant to the NHS and the food supply chain
  

With Omicron being the dominant variant now, with infection timescales shorter than Delta, it seems both reasonable and advantageous to reduce self-isolation to 5 days.  Provided the LFT and other conditions are met, which will cater for Delta and other variants.

The challenge is to ensure people are aware of the conditions, and not think 5 days is automatic.

Then to reduce risk of re-infection and passing it on, it's best to continue with basic precautions such as mask wearing beyond ending isolation, and indeed past ten days.

UPDATE 13 JANUARY 2022:  Sajid Javid has now announced a reduction to 5 days.  But is it?

 

COVID-19: FREEDOM? THE EXPERIMENT CONTINUES

Another negative, day 5

Having had Omicron over the Christmas period, being fully boosted, and not being clinically vulnerable, it looks like I have:

• Little chance of re-infection by Omicron (see footnote update)
  
• High immunity to Delta and earlier variants
• Little chance of serious infection should any of these variants be caught
  

The objective of this blog, as quoted in the header above, is "Applying business, scientific and IT expertise to get back to normality by defeating COVID-19 disease."

Subject to a future variant appearing which is serious and evades vaccination, this is the best immunity since the pandemic began.  Does that mean such normality has been achieved? Freedom?

FREEDOM?

For me, I'd say yes.  Freedom, at least whilst immunity lasts. The residual risk feels similar to the risk of crossing the road, or cycling, say.  That residual risk is being tested, as explained below.

How about for younger adults, who have not yet had chance to be fully-vaced and boosted?   Risks somewhat higher, but the chances of serious disease low.  Almost as much freedom.

Would I go to a crowded nightclub, as an example of a hi-risk environment?  Yes.  Done it already, multiple times, as below.  What about those not fully vaxed?  They need to assess the risk personally according to the number of jabs they have had, level of clinical vulnerability, and attitude to risk. 

Nightclubs and venues for similar events have been ensuring their premises are as safe as possible, to encourage patrons to attend.  My experience is that there's been clear thought about ventilation, and it has been improved.

EXPERIMENT UPDATE

As noted here, there was the opportunity at New Year to test my immunity:

• To get out to a major crowded event for New Year's Eve (NYE)
  
• To throw an 8-hour all-nighter in a crowded sweaty night club the night after

Two potentially super-spreader events.  Indeed I've heard of multiple infections at the NYE event.  No news yet from the other event.

I'm pleased to report another negative Lateral Flow Test, which I need before my daily voluntary work.  'Freedom' will continue.

ONGOING PRECAUTIONS

That doesn't mean ignoring sensible precautions.  Just like looking before crossing the road.

Masks, meeting outdoors, well-ventilated indoor spaces, and other basics worth continuing, even if no longer legally required.  For your own protection, and to protect others if you do perchance get infected.

Kissing?  That aunt who insists on it?  Why not?  Though the choice is yours.

 

UPDATE DAYS 6 & 7

Both day 6 and day 7 LFTs negative again, thankfully.  

The experiment continues.   Going in hard this coming weekend!

UPDATE DAYS 8, 9, 10 and 11

Day 7: First night done out clubbing, and enjoyed.  

Day 8 LFT again negative, though tomorrow's will be more telling.  

Day 9 negative.

Second night done out clubbing.  Oh yes!  Day 10 will be key.  

Day 10 negative!

Day 11 negative.  Experiment working, so far at least.  Haven't caught any COVID variant, despite attending four potentially super-spreader events in the last 2 weeks.

Day 12 negative.  We know positive results tend to occur within three days of infection, Looks virtually certain that neither Omicron nor Delta has been acquired from any of the four potentially super-spreader events attended in the last fortnight.  

Day 14 negative.

Experiment successful.  Immunity gained aginst Omicron and Delta by a combination of booster and having had Omicron.

FURTHER UPDATE

We're now into the third weekend.  Last night was the fifth potentially super-spreader event.

Day 15 negative.

Last night was the sixth such event.

Day 16 negative.

Day 17 negative 

Day 18 negative.

Day 19 negative

Another 2 hours at a potentially super-spreader event last night.  The 7th.  The experiment continues.

Day 20 negative.  

A heavy weekend planned.  Three hot sweaty super-spreader events done.  Now 10 so far this year..

Day 21 negative

Day 22 negative

Day 23 negative, even with a little blood.  But that's another story 

5 more hot sweaty potentially super-spreader events done.  Total of 15 so far in January since being back from Omicron infection on New Years Eve.

Day 24-33 negative

Days 34-36 negative, despite possibly fighting off second Omicron infection

If I die, I'll die happy.  Which reminds me.  Must get that Mini prepped for the RallyCross racing series.

UPDATE ON RE-INFECTION BY OMICRON

There is now evidence of people who have had Omicron being re-infected by it.  Does that matter?

In terms of illness, it is unlikely to be more serious than the first infection. The issue is a practical one. A positive LFT means self-isolating for at least five full days, to avoid passing it to others.  

Frankly that's a risk I'm prepared to take to get back to normal life.

COVID-19: A REACTION TO DOWNING STREET PRESS BRIEFING 4JAN22

This afternoon PM Johnson held a press conference, flanked by his most senior scientific advisors, Professor Sir Chris Whitty and Sit Patrick Vallance.

It was confirmed that Plan B would continue, and no further disease mitigations (restrictions) were anticipated.  Though this is kept under review.

The emphasis of the Government's strategy is to ask everyone to get boosted, or get their first jabs if not done already.  This is a good idea.  From a personal perspective:

• The Booster probably reduced the impact of my recent Omicron infection.  A negative LFT just 4 days after infection, unlikely to still be infectious
  
• Conversely a friend hadn't had her booster, and has just been badly ill for two weeks with Delta symptoms
  

The presentations and answers were much as anticipated.  But one matter to highlight.  Sir Patrick said that in London, for example, this has so far been an illness primarily amongst younger people. "As it moves up the age range, you'd expect to see more hospitalisations. Don't know for sure how that is going to manifest, and what degree of disease."

In other words hospitalisations and use of ICUs to date is not representative of the whole population, and would be expected to get worse.  When it will peak for the older age groups, and at what level, cannot yet be predicted any more accurately than it being in the next few weeks.

POST-PRESSER COMMENTS

Two key points emerged in BBC's coverage afterwards:

• Ione Wells spoke about the adverse impact that Omicron is having on staff shortages. That the Government officers are worrying not just about the NHS, but also the risk for the "food supply chain" amongst other essential services. Indeed 100,000 workers in England, "from food processing to transport to Border Force", will have to test every day they are working from 10 January.  

   

  The first I've heard or seen mention of food supply risks, despite highlighting them two weeks ago.  Why has nobody else in the media seen this coming?

   
• Nick Triggle pointed out that the official forecast modelling by Warwick University concluded this:
  
  In other words the levels of infection are effectively baked in.  If essential services begin to get closed down, or hospitals get overrun, it is effectively too late to do anything about it.
  

This 'too little, too late' government is again too late.  Taking risks that nobody sensible would contemplate.  'Hope for the best, prepare for the worst' is not a concept this Government understands. Let's hope it is not that bad.  But sadly, experience with Covid says outcomes are always at the worse end of expectations.

COVID-19: ALL THE POSTS SINCE TESTING POSITIVE

On Boxing Day I tested positive for COVID-19, likely infected Christmas Eve.  Here is the story to date in a thread of blogposts, including the New Year 'freedom' experiment.  Plus a bonus of why and how Omicron is different:

COVID-19: SHIT'S JUST GOT REAL
Boxing Day. So you've tested positive.  Now what?

COVID-19: THE POSITIVE PCR TEST (Updated for COVID-19 app)
The consequences.  Action now.
"As a former Computer Audit Manager for a Big4, the clowns who are responsible for developing and maintaining the app would not want to see my review!"

COVID-19: HOW TO CATCH IT (AND HOW TO AVOID IT)
Ventilate!

COVID-19: OMICRON OR DELTA? (Updated for new Omicron symptom. which was my first)
Important to know
For me "99%+ chance it's Omicron"

COVID-19: ALREADY NEGATIVE
No longer infectious?

COVID-19: OR IS IT NOW COVID-21 ?
What we know about Omicron. The uncertainties.  How should the UK Government respond?

Surely there's a flaw in this logic?  My most contentious blogpost yet...
COVID-19: SO YOU’VE HAD OMICRON, WHAT NOW? (Plus notes if you haven't had it)
Living life freely? Continuing with precautions?

COVID-19: WHY OMICRON BEHAVES DIFFERENTLY
New research.  Different disease

COVID-19: THE EXPERIMENT.  SO YOU DON'T HAVE TO.
Could I catch COVID-19 again?  The result is in.

COVID-19: THE EXPERIMENT. SO YOU DON'T HAVE TO.

We noted before New Year that for someone fully-vaxed who has had Omicron, and is not clinically vulnerable, they are theoretically more immune to any variant of COVID-19 than at any time in this pandemic:

• Unlikely to be re-infected with Omicron
  
• Well immune to Delta and earlier variants
• Unlikely to be seriously ill, if do get infected
  

As a result, being 'free' to live life as if before the pandemic, subject to taking sensible precautions.  And being mindful that immunity can wane.

But we can't just say it.  We have to test it. In the spirit of many scientists of previous generations, making myself the subject:

• Passing the day 6 and day 7 Lateral Flow tests just in time to get out to a major crowded event for New Year's Eve (NYE)
  
• Throwing an 8-hour all-nighter in a crowded sweaty night club the night after

Inevitably being exposed to Omicron and Delta, despite the venues checking for negative LFTs or vaccination.  Some people would have been brewing one of the variants, and become infectious during the event.  

I had had 4 daily negative Lateral Flow Test before going out on NYE.  Well clear of infection, so no longer infectious.

Indeed I've now heard four people I met at the NYE event have since tested positive, likely Omicron, with that event the only feasible source of infection.  Two others remained negative.

So, what about my LFT result after these events?   

Omicron grows in the nose very fast.  On Monday 3rd, it's more than 24 hours since leaving that nightclub, more than 48 hours after NYE.  If I'd been re-infected, a Lateral Flow Test should show positive by now.  It's negative.  I've passed.  

So far so good.  But I'll be taking daily tests, which will monitor the situation daily to allow me to carry out my volunteer work.  Testing probably for weeks to come.  If I can get hold of tests.  First box secured!

UPDATE 4 JANUARY

Hurrah!  Negative LFT today.  So, 3 days after end of NYE event and 2 days after end of NYD event:

• I have not been re-infected by Omicron
• I have not caught Delta or any other variant
• Freedom
  

.Daily tests will continue to make sure on an ongoing basis.