Are coronavirus sufferers being 'over-confined'?

The rapid advance of the omicron variant of the coronavirus, with contagion rates never seen before, is pushing public health officials to adapt to the situation, given the possibility of running out of essential workers, confined to their home. In the UK, the government announced Tuesday that infected people will be able to reduce their isolation time from ten days to seven if they test negative for antigens on the sixth and seventh days of confinement. The measure is intended to limit the social and economic impact of the new variant, which is already creating difficulties to keep some businesses and public services running, including healthcare. According to the latest official figures, the number of infections in the United Kingdom has exceeded 90.000 a day in four of the last five days and remains close to the record since the start of the pandemic (93,045 cases, reported on Friday). And the country is already suffering from problems, such as cancellations in rail services.

Richard Tedder, from the British organization Clinical Virology Network, assures that, estimating the probabilities, the British decision is "probably correct". Despite asking for caution regarding the reliability of the self-diagnostic tests, he considers that demanding two negatives in a row may be an adequate solution, he explains, consulted by the Science Media Center. In addition, it calls for attention to the way in which changes in the virus can affect the reliability of the tests, to adapt them so that they do not lose their ability to detect infection.

Shortening the time of isolation is something that countries like France already did more than a year ago and that some studies justify. In January 2021, a team led by researcher Muge Cevik, from the University of Saint Andrews, in Scotland, carried out an analysis that delimited a period of five days from the onset of symptoms as the most infectious. Taking into account the level of non-compliance with self-isolation in the UK, Cevik then believed that reducing it to five days could lead to fewer people skipping it and improving overall results.

Cevik's analysis, however, found that there were viruses with the ability to infect up to nine days of illness, something that reminds that reducing the isolation time would imply some risks. In the UK, it is recommended that those who leave solitary confinement on the seventh day limit their contacts with vulnerable people or work from home.

In the US there are also voices that advocate a reduction of the isolation time, in part to avoid the collapse that the advance of omicron can cause, but also thinking about a future in which the covid will have to be lived together, limiting its social impact and economic. Last week, Robert Wachter, chairman of the Department of Medicine at the University of California, San Francisco, suggested that the optimal period of isolation to limit infections and keep the economy functioning could be five days. As in the British case, he considers necessary two negative antigen tests on consecutive days before returning to the streets.

Anish K. Jha, dean of the School of Public Health at Brown University (Rhode Island), also said on Twitter that he considers the ten-day period of isolation excessive.

If you have a negative test at five days and there are no symptoms, "it is reasonable to assume that you are not contagious," he wrote.

Although he pointed out that, if you want 100% security, it is always better to maintain the ten days of isolation.

Without specifying how much should be reduced, Anthony Fauci, the president's top medical adviser, has also said that the 10-day isolation may not be necessary, particularly given the shortage of doctors in that country.

Without symptoms and with adequate protection, "they can return to work before the full quarantine period," he said.

In Spain, sources from the Ministry of Health comment that reducing the days of isolation has not been considered. Luisa María Villar, Head of Immunology at the Ramón y Cajal University Hospital in Madrid, also does not consider that for the moment the situation requires this type of measures and believes that it is preferable to bet on safety. "For now we have to worry about protecting as much as possible the people we work with in hospitals, such as the immunosuppressed, who are especially vulnerable and those who may have problems with this variant, which for those vaccinated almost always produces a mild disease", Villar points out.

In any case, the application of measures such as those of the United Kingdom would demand a capacity to make evidence available to citizens in a massive way so that they could know if the isolation is in a position to end, something that in Spain does not seem possible to At the moment, given the scarcity of antigen tests in pharmacies and the collapse of primary care centers.

In addition, the omicron still hides unknowns.

Some studies indicate that it develops more quickly, showing symptoms earlier than other variants did, but it could also disappear from the body earlier, particularly in vaccinated people.

The answer to these types of questions, which science will take weeks to solve, is also essential to adjust the isolation time that a variant as contagious as omicron can turn into a social and economic problem.

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