In summary

With 7 million Californians infected, how risky is it to work? When is it safe for omicron-infected workers to return?

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Look no further than your favorite restaurant, your kid’s school or your local hospital to see the effect of California’s latest bout of infections.

Cases have skyrocketed since the holidays, reaching nearly 7 million people infected since the pandemic began. That means so many workers are calling in sick that many businesses and offices are left understaffed and fellow workers are stretched thin. 

Health officials are walking a fine line between keeping essential services and the economy afloat and controlling the spread of the virus. But a labor shortage has noticeably influenced national and state COVID-19 policies — even temporarily allowing for health care employees to continue working despite a positive test as long as they feel no symptoms and wear an N95 respirator. These guidelines have prompted questions about safety and whether public health is being jeopardized.

Since the start of the pandemic, California’s top officials have been adamant that the state’s COVID-19 response is based on science. But these policies also have to be flexible, Gov. Gavin Newsom recently told reporters. 

“It’s called dealing with reality,” the governor said in defense of recent health workplace guidelines during his Jan. 10 budget briefing. “The pragmatism — not what you want, but what you need to do at a time of challenge.”

Experts note that the virus and the pandemic environment are fast-changing, and policies in response have to adjust quickly.

But labor needs and politics aside, when it comes to returning safely to work, what are experts and research telling us about omicron? When is it safe for an infected employee to return to work and how dangerous is it to shorten that period? What if you have no symptoms? And what should your employer be doing to keep you and your coworkers safe? Here’s what you need to know. 

With omicron, people are infectious quicker

A red flag with omicron is that early research suggests that the incubation period — the time between when one becomes infected and when one starts to show symptoms — is shorter with this variant — about three days, compared to the four to five days of earlier strains.

Usually the day before symptoms start and the day symptoms appear are when people are the most infectious, said Sanghyuk Shin, director of UC Irvine’s infectious disease science initiative. 

That means people can become highly infectious faster with omicron than with the previous variants. For example, if person A is infectious and A infects B, person B can then infect person C quicker with omicron than they may have with delta.  

“This creates epidemic dynamics that are really hard to get in front of,” said Andrew Noymer, epidemiologist and professor of public health at UC Irvine. “Because it’s so rapid.”

Here is how fast omicron is moving: It was first identified in late November; in the week ending on Dec. 18, the omicron variant was responsible for about 38% of the cases in the U.S., according to the CDC’s variant monitoring system. By the week ending on Jan. 15, omicron made up 99.5% of cases.

Experts suggest isolating until testing negative

In late December, the Centers for Disease Control and Prevention shortened the recommended isolation period for a person who tests positive but no longer has symptoms from 10 days to five. Those who were exposed but haven’t tested positive should also quarantine for five days, the agency said. 

The CDC said the change was motivated by growing data showing that much of the transmission was occurring earlier “generally in the one to two days prior to onset of symptoms and the two to three days after.”

But this move came with quite a bit of pushback and criticism from some in the public health and medical communities who deemed it too lax, especially because the federal rules don’t require a negative test to leave isolation. California updated its guidance to align with the CDC’s, but the state does ask that people remain isolated until they receive a negative test.

Some research has shown that people can still be contagious after five days of testing positive. A small study from Harvard, for example, took a look at infected NBA players and found that 25% of players infected with omicron were still infectious on day six after their first positive test and 13% were still contagious on day seven. The study has yet to be peer-reviewed.

Having people who might still be infectious return to work, could of course lead to more people getting infected and additional workers being forced to isolate,” Shin said. 

Will COVID sick leave return to California?

Gov. Gavin Newsom, Democratic leaders in the Legislature and labor unions are negotiating how to bring back extra paid sick leave for COVID. One big issue: Will businesses get state help to offset their costs?.

The World Health Organization says people with symptoms should isolate for a minimum of 10 days after the first day of symptoms, plus another three days after their symptoms end. Meanwhile, asymptomatic people should isolate for a minimum of 10 days after a positive test.

While recommendations about isolation and quarantine can be hard to keep up with, the bottom line is that people should test negative before returning to work and gathering with others, regardless of symptoms, Noymer said. 

Asymptomatic transmission is a big deal

Asymptomatic transmission does occur and it’s a big reason why the pandemic has been so difficult to control.

“We can tell everyone who feels sick to stay home, but not everyone feels sick,” said Shin. 

Experts say the best public health practice is for anyone who tests positive to isolate, regardless of how they feel.

Studies — albeit, many conducted pre-omicron — have shown that a large percentage of COVID-positive people show no symptoms. Research published in December reviewed 95 studies consisting of about 30 million people worldwide. Of those who tested positive, 40% had no symptoms at the time of testing. ​​”The high percentage of asymptomatic infections highlights the potential transmission risk of asymptomatic infections in communities,” the research authors concluded.

Meanwhile, separate studies show that the viral loads of asymptomatic patients were comparable to those who had symptoms.  

Your risks at work depend on many factors

Trying to calculate the odds that you’ll contract COVID at work is not really possible because there are so many factors to consider, experts say.

Research has shown that wearing masks indoors can substantially cut transmission, and with omicron, a high-quality mask is more important than ever. N95 masks are the gold standard, especially with a variant as contagious as omicron, Noymer said. Cloth masks are much less effective unless they have multiple layers and a nose wire. And it’s essential for masks to fit snugly around the mouth, nose and chin.

“A well-fitting N95 mask should do a pretty good job. But nothing is guaranteed,” he said. “Surgical masks do something, but they’re not great…and some masks are just pure theater.”

N95 masks can filter about 95% of particles in the air, according to the CDC. Experts at UC Davis say it is OK to reuse an N95 mask, but they recommend waiting one to two days between uses so that viral particles can die off. 

How crowded a room is also plays a big role. If you’re in a busy kitchen or warehouse without many windows, the risk will be greater, Shin said. 

Repeated tests are best 

A molecular PCR test is the most sensitive and most likely to capture an infection, but rapid antigen tests are effective tools too, experts say. 

Antigen tests are often used for routine screening of people who are not sick. If being used as a precaution for an in-person gathering, for example, Shin says a repeat test could help rule out a false negative — a test the day before and a test the day of an event.

However, given the shortage of rapid tests, this could seem like a luxury. People with symptoms looking to confirm whether they’re infected or not, ideally would seek a PCR test, Shin said. But with a backlog in testing, results are sometimes taking more than three days.

Because of the heightened demand for testing, some California counties have come out with new recommendations. Some have urged residents to only get tested if they have symptoms and others have asked people to first seek tests from their health care provider rather than county-ran testing sites because they are overwhelmed.

Motorists lined up at a COVID-19 testing site at the Long Beach Airport on Jan. 11, 2022. Photo by Pablo Unzueta for CalMatters

In an ideal world with no supply shortages, workers who come in contact with large numbers of people, such as those who work in customer service or in grocery stores, would be able to access testing easily and test repeatedly and routinely, experts say.

That said, routine testing of essential workers should go hand-in-hand with adequate paid sick leave, Shin said. “I’ve definitely known people who have said they don’t want to get tested because they don’t know what to do if they test positive. They can’t not go to work, they need to pay rent.”

California’s COVID sick leave expired in September and legislators and labor unions are negotiating how to reinstate it. 

Workplaces can do a lot to minimize workers’ risk

Shin said there is room for more education of workers on how the virus spreads. For example, if someone is in an office space alone, they might think it is safe to take their mask off, but if that same space is occupied by others throughout the day, then people should keep their masks on because COVID-19 is airborne and infectious respiratory particles can remain in the air for up to three hours

Improving ventilation helps, too.

“Opening windows seems like a no-brainer, but opening windows reduces risk,” Shin said.

Workplaces should also consider investing in high grade filtration systems or high efficiency particulate air (HEPA) filters, experts say. According to the Environmental Protection Agency, filters need to be able to remove small air particles in the size range of 0.1 to 1 microns to help remove viruses. 

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Ana covers health policy and the COVID-19 pandemic. She joined CalMatters in 2020 after four years at Kaiser Health News. She started her reporting career at McClatchy’s Merced Sun-Star. Her work has...