Harvard advisers on Omicron surge, shifting protocols

Cases of the Omicron variant of COVID-19 are surging to record high numbers across the country, moving toward a predicted peak in the coming weeks. The situation at Harvard is similar, with the number of cases at a higher rate than at any other time during the pandemic, requiring the University to continue to assess its procedures ahead of the return to in-person learning for the spring semester.

Leading public health and medical experts have advised Harvard throughout on policy and protocols. The Gazette spoke with University Coronavirus Advisory Group and University COVID Monitoring Committee members Sandra Bliss Nelson, assistant professor of medicine at Harvard Medical School and infectious diseases physician at Massachusetts General Hospital; Bruce Walker, founding director of the Ragon Institute of MGH, MIT, and Harvard, professor of medicine at Harvard Medical School, and co-leader of the Massachusetts Consortium on Pathogen Readiness; and Michael Klompas, professor of population medicine at Harvard Medical School and an infectious disease physician and hospital epidemiologist at Brigham and Women’s Hospital, to learn more about the latest on the variant and how it is affecting University protocols. Interviews were edited for clarity and length.

Q&A

Bruce Walker, Sandra Bliss Nelson, and Michael Klompas

GAZETTE: What’s the latest regarding our knowledge of the spread of the Omicron variant, and what could happen here in the U.S.?

WALKER: As has been widely reported, the data all convincingly point to this being a much more contagious variant. The data also show it to be more an upper-respiratory infection than a lower-respiratory infection. And we know that the existing vaccines largely protect from severe disease and death, which is what vaccines are supposed to do.

What is less certain is whether we’ll see the same kind of incredibly steep uptick and precipitous decline as was seen in South Africa on a national level here in the U.S. There are a couple of reasons why it may be different here. In South Africa, so many people were previously infected and/or immunized that the existing level of pre-Omicron immunity was very high. In the U.S. on the other hand, there is widespread variability in terms of levels of immunity, so the course of the Omicron-driven wave may be quite different and will likely vary significantly depending on geographic region.

Hopefully, we will in fact see a peak and rapid decline on a wide scale. Today, our hospitals are feeling the crush of the highest case counts we’ve seen during the entire pandemic. Important elective procedures are being canceled, and emergency rooms are past capacity, while health care workers are leaving the field due to burnout. Now is a critical time to do all we can to avoid more simultaneous infections.

GAZETTE: What should people be thinking about with regard to this variant and how it could affect them?

BLISS NELSON: There really is a difference in the way we should think about the rise of Omicron from an individual perspective versus a public health perspective, especially for the many members of the Harvard community who are young and healthy and less likely to experience some of the more severe consequences of COVID.

If you are young, vaccinated, and don’t have some of the high-risk comorbidities associated with the more severe outcomes related to COVID, even with these incredibly high levels of circulating infection, it’s not any more likely that you will have a severe outcome if infected, than from previous variants.

However, on the public health level, even if this is a milder virus, because it is so transmissible we are reaching the point where, as Bruce alluded to, hospitals may not be able to provide the same level of care not only for patients with COVID, but for patients without COVID. This, of course, can have a major impact on a very large number of people. And this is why it’s so important for all of us, especially over the next couple of months, to be mindful of how our actions can have a major impact beyond just on ourselves and our family members.

If you think about the downstream impact of a case, each person who has COVID will on average transmit it to one to two other people, and that one to two other people will transmit it to one or two other people, and so on, and so on. So, by not blocking your own infection, you can potentially lead to quite a few more infections over time, many of which are going to be unknown to you. And some of those individuals might get very sick, or even die. So again, the social responsibility piece of doing what you can to not get infected, and then following the correct protocols when you are infected, is so critically important.

KLOMPAS:  We’ve talked about flattening the curve in the past, and that’s so important right now with our health care infrastructure being so overwhelmed. If we can hold tight for a relatively short period of time while we get through the current surge, we hope that there will be a bit more flexibility a few weeks from now when the downstream social consequences of our individual actions are less dire.

GAZETTE: Yet, even as our nation seemingly sets new records daily for cases, the country remains largely open.

BLISS NELSON: We’re in a phase where we understand that this virus is going to be with us for a very long time and that we need to figure out a way to live with it. We can no longer put in place many of the restrictions we have used in the past, such as lockdowns and long periods of isolation and quarantine for those without symptoms because of the harms associated with these restrictions, in particular with regard to mental health.

GAZETTE: Harvard, of course, like the vast majority of institutions of higher education, has made the decision to continue with in-person learning. What should community members keep in mind as they return to campus?

KLOMPAS: In terms of personal guidance, I’d say first, first and foremost, make sure you get your booster shot. Harvard is requiring all students, faculty, staff, and researchers to have received a COVID-19 booster by Jan. 31, or 30 days after an individual becomes eligible for the booster.

I’d also advise community members to ask themselves: What’s my risk profile? And more than that: What’s the risk profile of the people in my community around me, such as parents, faculty, or co-workers who may be vulnerable to severe outcomes by virtue of age, medical conditions, a weak immune system, or vaccination status? If one is at increased risk for severe disease oneself or if any of those around you are at increased risk, then it’s important to be careful.

High quality, well-fitting masks are very important for reducing the spread of COVID-19. When everyone is well masked, things are quite safe; this past fall, we saw no transmission in the classroom. Indeed, the classroom is likely a safer environment than many other indoor public spaces, such as grocery stores. Mask choice matters.  Surgical-style masks are better than cloth masks, and KN95s and N95s are better than surgical masks at reducing viral exposure and viral emissions.  But none of these masks work effective if they are worn incorrectly.

And it’s critically important to remain engaged in Harvard’s comprehensive testing program. Even as rapid at-home tests become more widely available, surveillance testing like Harvard’s is important, so the University can understand the virus in its community and make changes to protocols based on that information. I’d encourage community members to review the updated testing requirements prior to returning to campus.

GAZETTE: Some of Harvard’s protocols are changing to meet the demands of the highly transmissible Omicron variant. Quarantine and isolation times for those who are infected have been adjusted to correspond with Centers for Disease Control guidance, now five days instead of 10. Isolating in place in a dorm room is also a big shift from the University’s previous approach of a separate isolation housing facility. And contact tracing policies are also changing: The Harvard University Health Services will now communicate via email with those community members who test positive for COVID-19. Can you provide some context for these changing procedures?

BLISS NELSON: The CDC’s guidance on quarantine and isolation times is based on the concept that the majority of transmissions occur in the first few days of illness, potentially even starting before the onset of symptoms. This doesn’t mean that there is no possibility of transmission after day five, but it does mean that the risk of transmission is lower at that point, provided that the individual is well. And, like with other guidance related to COVID, which are evolving as we continue to learn more about this ever-changing pandemic, there is a growing movement toward trying to provide balance and minimizing the collateral impact of social isolation. Of course, quarantine and isolation aren’t effective on their own. Mask-wearing during, and after, quarantine and isolation, minimizing social contacts, and vaccine and booster requirements all work together to create a layered approach to limiting the spread of COVID on campus.

Moreover, the reality is, with early risk of transmission, the whole premise of contact tracing becomes a little bit harder because it can be so difficult to identify positive individuals in a timeframe when you can block a chain of transmission.

GAZETTE: But should community members be concerned about this reality and the growing number of cases on campus?

BLISS NELSON: Most of us can feel some sense of security in the reality that the Harvard community is nearly entirely vaccinated, and to date the majority of infected individuals here have experienced no symptoms at all, or mild symptoms that are resolving quickly. This is unlikely to change due to the Omicron variant.

Harvard has made a decision to maintain an in-person campus in order to preserve the academic vibrancy and the emotional wellness of its community members. If a stricter isolation process remained in place, it’s very likely that that Harvard could not do so.