Entering the "take your pick" guidelines phase

States diverge from CDC as health experts disagree over how the next few months will play out. Daily deaths rising, though omicron still milder and takes aim mostly at unvaccinated

Omicron is less severe, but experts say it’s time to wear better masks. The virus is super contagious and passes via people who don’t have symptoms, yet testing guidelines and availability vary wildly. The result: even more confusion than ever. Let’s try to clear a few things up:

Time to find alternate uses for those cloth masks. Many health experts have been saying this for months, and now, the CDC is poised to make it official: protection against omicron requires tight-fitting, high quality KN95 or N95 masks, according to the Washington Post.

• Many Americans can’t forget that public health leaders first said that masks weren’t needed to protect against COVID-19, and then said don’t buy the N95s because health workers needed them.

• Although there are many counterfeit (and ineffective) masks sold as KN95s (and sometimes as N95s,) the real ones are in good supply. Buy from reputable merchants (hardware and paint stores are good sources.) ProjectN95 is a good resource, too.

• N95s are great but the fit is important. If there is air getting in or out from around the edges, the protection won’t be as good as it should be.

Something to watch: Today’s Senate Health Committee hearing may have sparks flying — and not just between Kentucky Sen. Rand Paul and White House chief medical advisor Dr. Tony Fauci. It also may be when CDC Director Rochelle Walensky clarifies or updates some of the recent guidelines confusion. Acting FDA Commissioner Janet Woodcock and Assistant Secretary for Preparedness and Response Dawn O’Connell are also at the witness table. Starts at 10:00 AM EST.

• Expect questions about a range of topics, including why the CDC now says people should stay “up to date” with vaccines instead of directly saying that fully vaccinated means three doses of an mRNA vaccine or two doses of the J&J adenovirus vaccine.

Even though omicron has reached almost everywhere around the world, the United States continues to eclipse every other nation when it comes to new COVID-19 cases, hospitalizations and deaths.

Blurred lines: Late night host Stephen Colbert was one of many comics who skewered the CDC’s revised guidelines on quarantine when a person is infected with COVID-19. At this point, many Americans have simply tuned out, and some states are deviating from the CDC standards now. Differences mostly center on whether to test. For example, Florida discourages testing, while California recommends it.

But the USA still lags on testing availability: I was in Canada recently and took no comfort in the testing shortage there, but health officials seemed more unified in their messaging about who should test and when. In many parts of the United States, tests may be recommended, but at-home antigen tests or in-person locations are increasingly hard to find or overbooked, and PCR tests once again take so long that the results are irrelevant.

• Many communities are eligible for federally supported weekly testing programs but haven’t taken advantage of these and other no-cost-to-them resources.

• Insurance companies will be required to cover up to eight at-home tests per month starting January 15, the White House announced. The federal government also is in the process of setting up a website for people to request free test kits, but that is not expected to be online until later in January.

With “pandemic fatigue” in full force, there are other factors also pushing some to simply throw caution to the wind. One of the latest is New York Rep. Alexandria Ocasio-Cortez, who announced that she tested positive after a trip to Miami. Fox News and others were having a field day because other media caught her in public without a mask just days earlier.

• Some people are hearing how omicron is less severe than previous COVID-19 strains and think it’s ok to just accept that they’ll get it. The problem with this line of thought is that the virus is exceptionally good at passing through healthier people on its quest to find the vulnerable. And the more it transmits, the more likely it will evolve to evade vaccines even more.

• Although the variant may be less severe organically, a look at data in highly vaccinated communities vs. lower vaccinated communities shows plainly how much the vaccines make an impact.

  • Marin County, Calif., with over 85% of its 250,000 residents fully vaccinated, has had a new case rate of 837 per 100,000 population and 31 hospital admissions in the past week. The county has 250,000 people.

  • Kern County, Calif., with fewer than 50% of its 900,000 people fully vaccinated, has seen a lower new case rate than Marin — 521 per 100,000 people, but 225 new hospital admissions in the past week - forcing ambulance crews to encourage patients to not seek emergency department care.

• In perspective: We are not seeing a major uptick in the death rate from omicron, but the enormous increase in the number of people infected is driving U.S. deaths up sharply. The USA recorded almost 40,000 deaths from COVID-19 in the past month, many times more than any other country in the world.

• Disease modelers forecast the daily U.S. death rate to reach 2,000 deaths per day before tapering off, perhaps as soon as late February. Widespread mask use would limit the peak and accelerate the decline, according to the University of Washington forecast.