Interesting Articles: COVID-19 Edition

[S209]

Here is what they said:

Options to reduce quarantine
CDC and other scientists have explored changing the current recommendation to quarantine for 14 days after last exposure. Reducing the length of quarantine may make it easier for people to quarantine by reducing economic hardship if they cannot work during this time. In addition, a shorter quarantine period can lessen stress on the public health system, especially when new infections are rapidly rising.

Local public health authorities make the final decisions about how long quarantine should last in the communities they serve, based on local conditions and needs. Follow the recommendations of your local public health department if you need to quarantine.

CDC now recommends two additional options for how long quarantine should last. Based on local availability of viral testing, for people without symptoms quarantine can end:

On day 10 without testing
On day 7 after receiving a negative test result
After stopping quarantine, people should

Watch for symptoms until 14 days after exposure.
If they have symptoms, immediately self-isolate and contact their local public health authority or healthcare provider.
Wear a mask, stay at least 6 feet from others, wash their hands, avoid crowds, and take other steps to prevent the spread of COVID-19.
CDC continues to endorse quarantine for 14 days and recognizes that any quarantine shorter than 14 days balances reduced burden against a small possibility of spreading the virus. CDC will continue to evaluate new information and update recommendations as needed. See Options to Reduce Quarantine for Contacts of Persons with SARS-CoV-2 Infection Using Symptom Monitoring and Diagnostic Testing for guidance on options to reduce quarantine.

[Dan]

In February I had an upset stomach 6 days after I was in NYC, but didn't get a fever until 10 days after exposure.

[S209]

In February I had an upset stomach 6 days after I was in NYC, but didn't get a fever until 10 days after exposure.

You may have tested positive by day 7 though.

(Although my mother tested negative on Monday and positive on Tuesday after having symptoms for 2 days already).

[etech0]

You may have tested positive by day 7 though.

(Although my mother tested negative on Monday and positive on Tuesday after having symptoms for 2 days already).

were those rapid tests or pcr/molecular?

[ExGingi]

were those rapid tests or pcr/molecular?

Were they testing people who didn't have difficulty breathing or high fever back then? Not IME.

[Randomex]

At those ages I would be surprised if it is different in any advanced economy that's not engaged in war.

@ExGingi

In the USA, death by "unintentional injury" is between 2 and 3 times more common:
https://www.cdc.gov/injury/wisqars/pdf/leading_causes_of_death_by_age_group_2015-a.pdf
https://www.cdc.gov/injury/wisqars/pdf/leading_causes_of_death_by_age_group_2016-508.pdf 

[S209]

were those rapid tests or pcr/molecular?

Negative rapid and PCR on Monday, then positive PCR on Tuesday.

[S209]

@ExGingi

In the USA, death by "unintentional injury" is between 2 and 3 times more common:
https://www.cdc.gov/injury/wisqars/pdf/leading_causes_of_death_by_age_group_2015-a.pdf
https://www.cdc.gov/injury/wisqars/pdf/leading_causes_of_death_by_age_group_2016-508.pdf

That includes car accidents

[ExGingi]

@ExGingi

In the USA, death by "unintentional injury" is between 2 and 3 times more common:
https://www.cdc.gov/injury/wisqars/pdf/leading_causes_of_death_by_age_group_2015-a.pdf
https://www.cdc.gov/injury/wisqars/pdf/leading_causes_of_death_by_age_group_2016-508.pdf

Where's drug OD?

Also the chart might be misleading. I would assume that deaths from DM at young ages (most likely hypoglycemic shock) are very different than DM deaths (more likely complications such as heart and kidney issues) at older ages.

[biobook]

לא ראינו אינה ראיה 

I don't read everything out there, but I seem to recall seeing something about it. Maybe @biobook can chime in.

Is there any source to show otherwise? That people have gone into quarantine (Isolation) and tested negative on day 1 and day 7 (and preferably all days in between) and yet started presenting symptoms after 7 days of isolation and negative tests?

Not sure what you're asking. 
I don't think anyone is testing every day, for 7 days, because there's not an abundance of available tests.
Are you asking: Are there people who first develop symptoms more than 7 days post-exposure, even though they've had one or more negative tests?  I think the answer is yes.

Some quotes from the article you posted:
Seems like testing on day 7 does *not* eliminate the risk, but does alleviate it to a large extent. Right now we’re not at a place as a country where we are going to eliminate each path of infection but compliance is waning, so they are taking a calculated risk designed to increase compliance and reduce overall spread.

A Nafka Mina? If the shorter length is just to increase compliance, it’s quite probable that halachically one must still wait the full 14 days. This isn’t hypothetical- I am quarantined at the moment due to exposure to my wife.

Not sure that the CDC would give a halachic determination, but they probably would put it this way:

Most people (99%?) who develop symptoms do so within 14 days after exposure, so everyone should isolate for that time.

But many people began to rebel against this chumrah, and went OTD, refusing to isolate at all.

So the CDC says, Okay, We'll be makel, you can isolate for just 10 days, or 7 with a negative test. That should still block most (90%?) of transmissions.

But they add, Kol hamarbeh levoded 14 yom, harei zeh meshubach.

[biobook]

Some more quotes:
https://www.nytimes.com/2020/12/02/health/coronavirus-quarantine-period.html

Travelers returning home should keep nonessential activities to a minimum for at least seven days if they are getting tested, and for 10 days if they are not getting tested. (Many states already require travelers to self-quarantine after arrival, though the rules vary from state to state.)

Federal health officials also offered two new ways to shorten quarantine periods. Those without symptoms may end quarantine after seven days if they are tested for the virus and receive a negative result, or after 10 days without a negative test.

P.C.R. or rapid tests are both acceptable, the officials said, and should be taken within 48 hours of the end of the quarantine period. People should continue to watch for symptoms for 14 days.

(Quarantine refers to people who are well but may become ill; isolation refers to those known to be ill.)

Until now, the C.D.C. has recommended a 14-day quarantine period following potential exposure, and Dr. Walke stressed that the full two weeks is still considered ideal and the surest way to curb transmissions.

While a shortened quarantine period may be more palatable to Americans, officials acknowledged that the new guidance might lead to some infections being missed.

“We can safely reduce the length of quarantine, but accepting that there is a small residual risk that a person who is leaving quarantine early could transmit to someone else if they became infected,” said Dr. John Brooks, the chief medical officer for the Covid-19 response at the C.D.C.

Some patients may not develop symptoms until two weeks after exposure, and even longer in a very small fraction of cases. Infected individuals may pass the virus to others before they develop symptoms; recent studies show they are most infectious two days before symptoms begin, and for about five days afterward.


https://www.cdc.gov/media/releases/2020/t1202-covid-19-telebriefing.html

BUSINESS INSIDER: HI, YEAH, THANKS FOR TAKING MY CALL.  MY QUESTION.  I WANTED TO ASK MORE SPECIFICS ABOUT THE TESTING OUT OF QUARANTINE.  WHEN IS THE BEST TIME TO DO THAT?  SHOULD PEOPLE GET A TEST ON THE FIRST DAY OF QUARANTINE, ON THE FIFTH DAY OF QUARANTINE?  TALK ABOUT LIKE WHEN IS THE BEST TIME?

BROOKS: WELL, THE RECOMMENDATION FOR DISCONTINUATION OF QUARANTINE IS DAY SEVEN WITH A NEGATIVE TEST.  OUR MODELLING SHOWS — LET ME REPHRASE THAT OUR MODELLING WAS BASED ON COLLECTING THE SPECIMEN WITHIN THE 48 HOURS PRIOR TO THE TIME OF ANTICIPATED DISCHARGE.  SO IT COULD BE A TEST THAT WAS DONE THAT DAY IF YOU HAVE AN ANTIGEN TEST, BUT WE PROVIDE THE POSSIBILITY OF COLLECTING SPECIMEN UP TO 48 HOURS BEFOREHAND IF THEY HAVE A PCR TEST WHICH MAY TAKE A DAY OR TWO TO GET THE RESULT BACK.
....

BROOKS: THAT’S RIGHT.  THEY COULD BE TESTED ON DAY FIVE IF THAT — BUT THEY HAVE TO COMPLETE SEVEN DAYS OF QUARANTINE.  I WANT TO BE CLEAR ABOUT THAT.  IT CAN BE ANY TIME IN THE 48 HOURS PRIOR TO THE ANTICIPATED TIME OF DISCHARGE, BUT THEY DO HAVE TO GET ALL THE WAY TO THE END OF SEVEN DAYS REGARDLESS OF WHEN THE RESULT OF THE TEST COMES BACK.  IF THE TEST HASN’T COME BACK BY THE END OF SEVEN DAYS, THEY CAN DISCONTINUE QUARANTINING WHEN THEY GET THE NEGATIVE RESULT.  THEY NEED THE NEGATIVE RESULT TO DISCONTINUE.

[S209]

So the CDC says, Okay, We'll be makel, you can isolate for just 10 days, or 7 with a negative test. That should still block most (90%?) of transmissions.

But they add, Kol hamarbeh levoded 14 yom, harei zeh meshubach.

I understand. My question is, what is my actual Halachic hishtadlus? How rare is it for that to happen? @ExGingi seemed to be implying it *never* happens.

[biobook]

I understand. My question is, what is my actual Halachic hishtadlus? How rare is it for that to happen? @ExGingi seemed to be implying it *never* happens.

You mean how rare is it for someone to be asymptomatic yet contagious more than 7-10 days after exposure?  Or how rare is it for someone to develop symptoms more than 7-10 days after exposure?  IDK.  I think you have to consider both the probability of that and the places you'll go (to financially-necessary workplace or visiting vulnerable relatives). 

The CDC based their new guidelines in part on a recent Lancet article, but I haven't read it.
https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(20)30172-5/fulltext

Even the press release is rather long. 
https://www.eurekalert.org/pub_releases/2020-11/tl-pss111920.php

[S209]

You mean how rare is it for someone to be asymptomatic yet contagious more than 7-10 days after exposure?  Or how rare is it for someone to develop symptoms more than 7-10 days after exposure?  IDK.  I think you have to consider both the probability of that and the places you'll go (to financially-necessary workplace or visiting vulnerable relatives). 

The CDC based their new guidelines in part on a recent Lancet article, but I haven't read it.
https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(20)30172-5/fulltext

Even the press release is rather long. 
https://www.eurekalert.org/pub_releases/2020-11/tl-pss111920.php

The article does not examine people who are exposed, only people who already have a positive test. They do not suggest anything vis a vis quarantining of contacts.

Key takeaway: Most live viral shedding occurs in the first 5 days from onset of symptoms (no surprise there). More interestingly,

Of the eleven studies that attempted to isolate the live virus, all eight studies included that used respiratory samples successfully managed to culture viable virus within the first week of illness.

No study included in this systematic review managed to successfully isolate live virus beyond day nine of symptoms in any type of sample, despite persistently high viral RNA loads.

It would seem that 10 days from onset of symptoms is sufficient to end isolation, regardless of worsening/lingering symptoms.

[ExGingi]

Not sure what you're asking. 
I don't think anyone is testing every day, for 7 days, because there's not an abundance of available tests.
Are you asking: Are there people who first develop symptoms more than 7 days post-exposure, even though they've had one or more negative tests?  I think the answer is yes.
Not sure that the CDC would give a halachic determination, but they probably would put it this way:

Most people (99%?) who develop symptoms do so within 14 days after exposure, so everyone should isolate for that time.

But many people began to rebel against this chumrah, and went OTD, refusing to isolate at all.

So the CDC says, Okay, We'll be makel, you can isolate for just 10 days, or 7 with a negative test. That should still block most (90%?) of transmissions.

But they add, Kol hamarbeh levoded 14 yom, harei zeh meshubach.

Why are we conflating positive PCR tests (which is what I was talking about) and symptoms?

Has there been ANY study showing that a person who was exposed, went into isolation, and tested negative (preferably daily, but at least twice - 3 days apart), subsequently tested positive on day 6 or beyond? (PCR tests).

[aygart]

Why are we conflating positive PCR tests (which is what I was talking about) and symptoms?

Has there been ANY study showing that a person who was exposed, went into isolation, and tested negative (preferably daily, but at least twice - 3 days apart), subsequently tested positive on day 6 or beyond? (PCR tests).

Not a study, but I personally know more than one person that happened to.

[S209]

NY study showing that a person who was exposed, went into isolation, and tested negative (preferably daily, but at least twice - 3 days apart), subsequently tested positive on day 6 or beyond? (PCR tests).

Have there been any studies that indicated otherwise?

[PlatinumGuy]

WH cluster

[biobook]

Why are we conflating positive PCR tests (which is what I was talking about) and symptoms?

Because I'm slow-witted.  I'm not even sure what "we" means in the above sentence.  You and I?  Everyone here?  The Royal We?  Or what you mean when you say you're taking about positive PCR tests, when before you were talking about negative tests.

That people have gone into quarantine (Isolation) and tested negative on day 1 and day 7 (and preferably all days in between) and yet started presenting symptoms after 7 days of isolation and negative tests?

Okay, maybe the above was a rhetorical question, and this is the only one I should respond to:
 

Has there been ANY study showing that a person who was exposed, went into isolation, and tested negative (preferably daily, but at least twice - 3 days apart), subsequently tested positive on day 6 or beyond? (PCR tests).

You're asking about a very specific result, but to answer that, I have to search for the research study they would have done to get that result.  Are you thinking of a study like this:

Let's take a group of people with a known exposure to a positive case, isolate them for two weeks to prevent a second exposure, and conduct repeated PCR tests during this time to determine how long it takes for the first positive test to appear.

[ExGingi]

Because I'm slow-witted.  I'm not even sure what "we" means in the above sentence.  You and I?  Everyone here?  The Royal We?  Or what you mean when you say you're taking about positive PCR tests, when before you were talking about negative tests.

We. As in anyone participating in the discussion and bringing up symptoms (whether symptomatic or asymptomatic) when my argument is about PCR testing (whether positive or negative).

Are you thinking of a study like this:

Let's take a group of people with a known exposure to a positive case, isolate them for two weeks to prevent a second exposure, and conduct repeated PCR tests during this time to determine how long it takes for the first positive test to appear.

Exactly. Such a study would be a simple one to conduct, and there are tens of thousands (probably a lot more) of people around the globe being sent to isolation due to exposure. All that needs to happen to understand the effects better is daily testing of significant sample.

With almost a year of global turmoil over this pandemic, one would imagine that this is one of the first things people determining policy would want to know.