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Will Shortened Isolation Periods Without Testing Spread the Virus?



The decision by federal health officials to shorten isolation periods for Americans infected with the coronavirus drew both tempered support and intense opposition from scientists on Tuesday, particularly over the absence of a testing requirement and fears that the omission could hasten the spread of the highly contagious Omicron variant.

The new guidance, coming amid a crush of new infections that has starved many hospitals of workers, seemed to some scientists like a necessary step to shore up work forces in essential industries. And encouraging people to leave isolation early after testing negative could spare them the hardships of prolonged periods at home.

But letting hundreds of thousands of infected people forgo those tests — even if, crucially, their symptoms were not entirely gone — risks seeding new cases and heaping even more pressure on already overburdened health systems, experts said in interviews on Tuesday.

“To me, this feels honestly more about economics than about the science,” said Yonatan Grad, an associate professor of immunology and infectious diseases at the Harvard T.H. Chan School of Public Health, who has tracked coronavirus infections in the National Basketball Association.

“I suspect what it will do is result in at least some people emerging from isolation more quickly, and so there’ll be more opportunities for transmission and that of course will accelerate the spread of Covid-19,” he added, noting that people were unlikely to adhere strictly to masking advice after leaving isolation.

Dr. Rochelle P. Walensky, the director of the Centers for Disease Control and Prevention, said in an interview on Tuesday that the new guidance had been necessitated by the volume of people about to be infected.

In a series of holiday weekend meetings, she said, agency officials pored over transmissibility data for past variants and signs that Omicron caused less severe illness. But ultimately, Dr. Walensky said, she decided that rapid tests were not effective enough at diagnosing infectiousness in people.

“You don’t necessarily do a test if you don’t know what you’re going to do with the result,” she said, adding: “The anticipated number of cases that we were seeing required us to take action at this moment.”

The C.D.C.’s recommendations cut isolation periods for infected people from 10 days to five. The agency did not recommend rapid testing before people left isolation.

But some scientists maintain that rapid tests are the most convenient indication of whether or not someone remains contagious. Regulatory delays, manufacturing problems and shortfalls in government support have left rapid tests in extremely short supply as the Omicron variant has surged, pushing caseloads to near record levels in the United States.

A scientist who has discussed isolation policy with the C.D.C. in recent months said that officials said the agency could not recommend rapid tests while supplies were so scarce. The scientist spoke on the condition of anonymity to describe confidential discussions.

President Biden has promised to make 500 million tests available free of charge, but it is not clear how quickly they will be shipped.

Dr. Walensky denied that testing availability affected the agency’s thinking, and said that masking alone addressed the risk that infected people remained contagious after isolation. The C.D.C. has asked infected people to wear a mask around others for five days after leaving isolation.

“We know that, let’s call it 85 percent, of your transmissibility time is already behind you,” Dr. Walensky said of the five-day isolation period. “A minority of it is in front of you. And if you wear a mask, you can avert it.”

Scientists said they worried that like rapid tests, the most effective masks, known as N95s, remained out of reach for many Americans.

The Food and Drug Administration said on Tuesday that rapid tests do detect Omicron cases, though they may have reduced sensitivity. (Another type of test, known as a P.C.R., is not useful for releasing people from isolation because it can return positive results after someone is no longer contagious.)

One federal official said the C.D.C. incorporated unpublished modeling on the spread of the Delta variant that found the risk of transmission was 13 percent five days after someone tested positive. The C.D.C. was working to make that data public, the official said.

Scientists, though, expressed concern about applying models of Delta’s spread at a time when Omicron was fast becoming dominant. The variant has a considerably easier time than Delta infecting vaccinated people. It is also highly contagious, potentially even more so than Delta.

The right isolation periods for Omicron depend on when people are testing, as well as an individual’s level of immunity and the properties of the variant itself, scientists said. Some people remain contagious for much longer than others, and evidence from rapid tests suggests that certain patients are still infectious for longer than five days.

“I’d be very wary of translating data from Delta to Omicron,” said Stephen Goldstein, a virologist at the University of Utah. “I think there’s the potential for this to make things even worse, or accelerate the course of the pandemic.”

Immunologists said on Tuesday that there were also signs that people infected with Omicron were developing symptoms earlier in the course of infections than they had with past variants — a shift that could have major ramifications for isolation periods.

Those symptoms, they said, were making people aware of their illnesses sooner and, in some cases, compelling them to get tested sooner. Those people may be starting the clock on their isolation periods at the very beginning of their infections — rather than at the middle or end, as was true earlier in the pandemic — and returning to work while they remained contagious.

“I don’t think reducing the time for isolation overall is a bad idea,” said Angela Rasmussen, a virologist at the Vaccine and Infectious Disease Organization at the University of Saskatchewan in Canada. “But saying, ‘Five days is probably OK, based on Delta, so let’s give it a shot and see,’ is really not what you should be doing.”

She added, “This could’ve been implemented in a much more reasonable and lower-risk way.”

The C.D.C. has long faced criticism for issuing confusing guidance during the pandemic, particularly on the use of face masks. Its isolation advice on Monday did little to allay those concerns, scientists said.

Several doctors, for example, said they were struggling to grasp what patients would fit under the C.D.C.’s advice that infected people whose symptoms were “resolving” could leave isolation after five days.

Many people’s symptoms fluctuated over the course of a single day, they said. Other patients may seem to be feeling better before experiencing a flare-up.

“The guidance is far more confusing than it could and should be,” said Dr. Megan Ranney, an emergency physician and academic dean at Brown University’s School of Public Health.

“Front and center, this should be for people who are not symptomatic. If you have symptoms, you should not be out in public.”

Dr. Marc Boom, the chief executive of Houston Methodist, said that he was grateful that the C.D.C. shortened isolation periods for health workers. In the last week, he said, roughly 3 percent of the work force had tested positive, putting more significant strain on the hospital than at any other point in the pandemic.

Still, he said that the mixed messages were confusing. “They advanced the public past the basic hospital rules,” Dr. Boom said. “That threw us for a loop. We looked at that and said, ‘That makes no sense.’”

Scientists said that they expected more data to emerge about the course of Omicron infections in the coming weeks.

Ravindra Gupta, a virologist at the University of Cambridge, said on Tuesday that he did not believe people with Omicron infections would shed virus for longer than people infected with earlier variants, given signs that it replicated less efficiently in certain human cells.

Infections with earlier variants appeared to last roughly nine days in vaccinated people and 11 days in unvaccinated people, according to studies of N.B.A. personnel, though that did not necessarily mean that people were contagious for that same period.

Denis Nash, an epidemiologist at City University of New York, said compliance with any isolation policy appeared low: A study he led indicated that only 29 percent of people with past infections had isolated, though that included some who never knew they were ill.

But he said it was not at all clear that shortening isolation periods would persuade more people to stay home.

“Not testing after five days of isolation — is that because the testing supply isn’t there?” he said. “If so, that’s no reason to make it a policy.”

Noah Weiland contributed reporting.

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Teladoc Tumbled 38% After Big First-Quarter Loss. Is It Just a Pandemic Play?



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After pandemic drop, Canada’s detention of immigrants rises again By Reuters



© Reuters. FILE PHOTO: Two closed Canadian border checkpoints are seen after it was announced that the border would close to “non-essential traffic” to combat the spread of novel coronavirus disease (COVID-19) at the U.S.-Canada border crossing at the Thousand Isla

By Anna Mehler Paperny

TORONTO (Reuters) – Canada is locking up more people in immigration detention without charge after the numbers fell during the pandemic, government data obtained by Reuters shows.

Authorities cite an overall rise in foreign travelers amid easing restrictions but lawyers say their detained clients came to Canada years ago.

Canada held 206 people in immigration detention as of March 1, 2022 – a 28% increase compared with March 1 of the previous year. Immigration detainees have not been charged with crimes in Canada and 68% of detainees as of March 1 were locked up because Canada Border Services Agency (CBSA) fears they are “unlikely to appear” at an immigration hearing, according to the data.

The rise puts Canada at odds with Amnesty International and other human rights groups that have urged Ottawa to end its use of indefinite immigration detention, noting CBSA has used factors such as a person’s mental illness as reason to detain them.

A CBSA spokesperson told Reuters that “when the number of entries (to Canada) goes up, an increase in detention is to be expected.” CBSA has said in the past it uses detention as a last resort.

A lawyer told Reuters her detained clients have been in Canada for years.

In the United Kingdom, too, immigration detention levels rose last year after dropping earlier in the pandemic, according to government statistics. Unlike Canada, the United States and Australia, European Union member states have limits on immigration detention and those limits cannot exceed six months.

The rise in detentions puts people at risk of contracting COVID-19 in harsh congregate settings, refugee lawyers say.

Julia Sande, Human Rights Law and Policy Campaigner with Amnesty, called the increase in detentions “disappointing but not surprising,” although she was reluctant to draw conclusions from limited data.

The number of immigration detainees in Canada dropped early in the pandemic, from a daily average of 301 in the fourth quarter (January through March) of 2019-20 to 126 in the first quarter (April through June) of 2020-21.


Detaining fewer people did not result in a significant increase in no-shows at immigration hearings – the most common reason for detention, according to Immigration and Refugee Board data.

The average number of no-shows as a percentage of admissibility hearings was about 5.5% in 2021, according to that data, compared to about 5.9% in 2019.

No-shows rose as high as 16% in October 2020, but a spokesperson for the Immigration and Refugee Board said this was due to people not receiving notifications when their hearings resumed after a pause in the pandemic.

Refugee lawyer Andrew Brouwer said the decline in detention earlier in the pandemic shows Canada does not need to lock up as many non-citizens.

“We didn’t see a bunch of no-shows. We didn’t see the sky fall … It for sure shows that the system can operate without throwing people in jail,” Brouwer said.

He added that detainees face harsh pandemic conditions in provincial jails – including extended lockdowns, sometimes with three people in a cell for 23 hours a day.

Refugee lawyer Swathi Sekhar said CBSA officials and the Immigration and Refugee Board members reviewing detentions took the risk of COVID-19 into account when deciding whether someone should be detained earlier in the pandemic but are doing so less now.

“Their position is that COVID is not a factor that should weigh in favor of release,” she said.

“We also see very, very perverse findings … [decision-makers] outright saying that individuals are going to be safer in jail.”

The Immigration and Refugee Board did not immediately respond to a Reuters request for comment.

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Nasdaq futures rise as market attempts comeback from April sell-off, Meta shares soar



Stock futures rose in overnight trading as the market shook off the April sell-off and investors reacted positively to earnings from Meta Platforms.

Futures on the Dow Jones Industrial Average added 70 points or 0.2%. S&P 500 futures gained 0.7% and Nasdaq 100 futures jumped 1.2%.

The moves came as shares of Meta surged more than 18% after hours following a beat on earnings but a miss on revenue, a sign that investors may see signs of relief in the beaten-up tech sector. Shares were down 48% on the year heading into the results.

Meanwhile, shares of Qualcomm gained 5.6% in extended trading on the back of strong earnings while PayPal rose 5% despite issuing weak guidance for the second quarter.

“I think a lot of people want to believe that earnings are going to pull us out of this, but earnings are not what got us into this,” SoFi’s Liz Young told CNBC’s “Closing Bell: Overtime” on Wednesday. “… But the reality is there are so many macro headwinds still in front of us in the next 60 days that the market is just hard to impress.”

The after-hour activity followed a volatile regular trading session that saw the Nasdaq Composite stoop to its lowest level in 2022, as stocks looked to bounce back from a tech-led April sell-off. The index is down more than 12% since the start of April.

In Wednesday’s regular trading, the tech-heavy Nasdaq ended at 12,488.93, after rising to 1.7% at session highs. The Dow Jones Industrial Average rose 61.75 points, or 0.2%, to 33,301.93 propped up by gains from Visa and Microsoft, while the S&P 500 added 0.2% to 4,183.96.

Investors await big tech earnings on Thursday from Apple, Amazon and Twitter, along with results from Robinhood. Jobless claims are also due out Thursday.

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