Explained: As Omicron surges, why India and US have tweaked home isolation protocols

Revised guidelines

Under the new guidelines, a “patient under home isolation will stand discharged and end isolation after at least seven days have passed from testing positive and no fever for three successive days”. This period was earlier fixed at 10 days from the onset of symptoms.

Discharged patients shall continue to wear masks, the new guidelines say — however, “there is no need for re-testing after the home isolation period is over.”

Also, “asymptomatic contacts of infected individuals need not undergo Covid test and monitor health in home quarantine.”

For patients older than 60, those with co-morbidities such as hypertension, diabetes, or heart disease, and immunocompromised patients (HIV-positive, transplant recipients, cancer therapy) home isolation “shall only be allowed…after proper evaluation by the treating medical officer”. Home isolation is not recommended for the immunocompromised, the guidelines say.

Spread of Omicron

Nature of Omicron

As of Wednesday, there were 2.14 lakh active cases in India — an increase of more than six times over the last eight days, according to Health Ministry data. At the same time, hospitals have not seen an increase in Covid patients, and occupancy of oxygen and ICU beds remains low.

The Omicron variant of the coronavirus, which is driving the current surge of infections around the world, is highly transmissible but in the majority of cases causes milder disease than Delta, the variant that powered India’s deadly second wave in April-May last year. Studies have shown that recovery is in general faster with Omicron, with lesser shedding of viral load.

Experts said that the revised guidelines in both the US and India perhaps estimate a shorter incubation period for Omicron and quicker recovery in case of mild disease. The relaxing of the testing requirement might help to take some load off the system that is under pressure from the surge in infections, they said.

CDC’s argument

An update on the CDC’s website on Tuesday explained “Why CDC Shortened Isolation and Quarantine for the General Population”.

It pointed to the findings of research on the behaviour of the virus — but also to the imperative of maintaining a “functioning society and economy” by facilitating “individual social and well-being needs, return to work, and maintenance of critical infrastructure”.

The shorter isolation period of five days focused on the time when a person is most infectious, followed by masking for five days, the CDC said in an email to The Indian Express.

“The recommendations reflect the societal impact (e.g., critical infrastructure and staffing shortages) and the latest science on disease severity and when and for how long a person is maximally infectious,” it said on its website.

Prevention and pragmatism

Several experts in India said the need to avoid disruption in the economy needed to be balanced with adequate precaution against the spread of infections. They also pointed to the fact that as Omicron rages, vaccinations for adolescents have just begun — and the ‘precautionary’ doses for vulnerable groups are only scheduled from next week.

“While we cannot shut down and keep people at home for 14 days, there is equally a need for evidence prior to shortening isolation and quarantine periods. Studies are required to determine for how long a person remains infected,” said an expert, who also stressed the importance of following Covid-appropriate behaviour and increasing testing at home.

Dr Shashank Joshi, expert member of the Maharashtra Covid-19 task force, said: “Whatever clinical picture of Omicron we have seen suggests it is mild and self limiting. If 80 to 90 per cent of Omicron cases are asymptomatic for more than seven days or so, it is logical to get them back… The protocol seems relevant for the workspace. CDC has halved the isolation protocol without a test and recommended double masking. Our protocol is along similar lines…”

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