Since the earliest days of this crisis, we’ve known that effective vaccines were the key to putting an end to the pandemic and enabling us to fully restart our businesses, schools…our very lives. But effective vaccines will only change things if enough people get vaccinated.
A Message on COVID-19 from WorkSTEPS Chief Medical Officer, Dr. Ben Hoffman
Finally, some much-needed light at the end of a very dark tunnel!
In the last ten days, we’ve seen announcements from Pfizer and Moderna that their vaccines protect about 95% of those who receive them from COVID-19, far-exceeding the 50% benchmark for approval. And, thanks to advance purchase agreements with the US government and other governments around the world, these companies have already begun production, making it possible to begin vaccinating people most in need of protection before the end of the year. And more cause for hope, according to this tracker, ten other companies are in the final stages of testing their vaccines.
Since the earliest days of this crisis, we’ve known that effective vaccines were the key to putting an end to the pandemic and enabling us to fully restart our businesses, schools…our very lives. But effective vaccines will only change things if enough people get vaccinated. According to experts “enough” people is about 60 to 70% of the population.
Vaccinating 60 to 70% of the population is a high bar, but it’s not out of reach. Key to achieving the goal will be for employers to be engaged as part of the public health effort. With vaccines available in the next few months, it’s not too soon for companies to develop and start executing their COVID-19 vaccination strategies.
Here’s a high-level road map to help you chart your course.
1. Make Vaccination a Priority. Work with company leadership to gain clarity about what’s at stake and what will be required. Broadly speaking, what’s at stake is how fast and how far our economy and society can return to full activity and stability. From supply chain disruptions to workforce availability to down-stream impacts on sales, identify and quantify specific implications of an end to the pandemic for your company.
2. Accept Your Role in Achieving Vaccination Targets. Whether and how well employers implement strategies to help drive vaccination will not only impact vaccination rates for employees, but for dependents and even the surrounding community. Doing nothing will mean that progress will be slower or that goals are never achieved. This is a time to be in the game.
3. Engage Employees in Creating Your Vision. In this step, you should share the impacts that successful vaccination will have on your business (see #1). You should also invite employees to share their thoughts about what it would mean for them if the pandemic came to an end – how it would impact their work and their lives. Done well, this step will help inspire some employees who may otherwise be reluctant to be vaccinated, because they will see their choice as contributing to the achievement of something bigger than themselves.
4. Activate Leaders Across and Down the Org Chart. Leaders will be needed to communicate key messages and, when appropriate, to model the desired behavior by getting vaccinated and sharing their stories.
5. Target Your Efforts. This recent study found that best predictor of someone’s attitude toward the COVID-19 vaccine is prior vaccine usage. So, look at your flu shot data and assume that population segments or worksites that have historically seen low flu shot participation will need extra attention to drive COVID-19 vaccination.
6. Work with Community Leaders. Community leaders may be key to influencing your employees, and you may be able to help organizations in the community achieve their goals. For instance, low vaccination rates are common among Black males. If you work with trusted leaders in the Black community (clergy, barbers, others) to help them encourage vaccination, both your company and the community will benefit.
7. Communicate, Communicate, Communicate. Develop a well-informed communication strategy that raises awareness, educates, and motivates vaccination behaviors. Your strategy should: A) Align to vaccine distribution models, making sure employees know who is eligible when so that vulnerable employees (as well as family members and friends) get vaccinated in a timely way; B) Address key concerns which, according to this recent study, include questions about side-effects, vaccine efficacy, whether vaccines have been studied long enough, and whether they’ve been “made in the USA;” and C) Cover the basics about who is eligible, where shots are available, the fact that vaccinations are free of charge, etc.
I cannot emphasize enough the importance, urgency and scale of this opportunity. Drug company scientists and researchers have done inspired work that has yielded promising results. Whether and when we capitalize on their successes depends in part on employers doing their part to achieve high rates of vaccination among their employees, families and in the communities they operate.
We’ll be taking a break for the Thanksgiving holiday and will see you again in early December. In the meantime, I want to express my gratitude for the encouragement and support we’ve received for this e-newsletter. I also ask that you join me in thanking everyone involved in the fight against this pandemic – from the frontline workers who have enabled us to carry on with our lives in this new normal state, to the health care workers struggling to care for ever-increasing numbers of seriously-ill patients, to the scientists and researchers who’ve provided light at the end of this dark tunnel. Thank you all.
National: Across the US, more than one million new cases have been identified over the last week. State officials in all 50 states report increasing caseloads. The situation is especially dire in the Midwest and Mountain West states.
However, New Hampshire, Texas, Oregon and Tennessee are among 39 states that have set weekly case records in the last few days. Deaths are also rising, with a national average of more than 1,100 a day, the most since early August, when a summer surge was peaking. On Tuesday, more than 1,580 new deaths were reported nationwide, the highest single-day total since mid-May. Five states set single-day records for new deaths.
New restrictions: In an attempt to mitigate exponential spread, more states have added mitigation restrictions this week. Ohio, New Mexico, and Puerto Rico announced a nightly curfew. Mississippi extended a mask mandate. Iowa, North Dakota, Utah issued statewide mask mandates with hospitals filled and under pressure from overwhelmed healthcare workers. Maryland will order all bars, restaurants and night clubs to close by 10 p.m. Pennsylvania will require anyone who enters the state to be tested before arrival. These actions are being enacted by Governors who warn that their hospitals are reaching capacity. Dr. Fauci, the government’s top infectious disease expert, said on Tuesday that the nation needed a coordinated united approach, instead of a state-by-state, city-by-city response.
Researchers report additional symptoms could indicate infection: Fever, coughing and shortness of breath are known symptoms of COVID-19. According to a study published recently in the American Journal of Emergency Medicine other warning signs can include weakness, poor blood sugar control and gastrointestinal complaints could also indicate coronavirus infection. Researchers analyzed nearly 12,000 visits by adult patients to emergency departments at five New York City hospitals. They found COVID-19 in 57.5 percent of patients who went to the hospital because of weakness, falls or altered mental status; 55.5 percent of those who came in because their blood sugar was out of control; and 51.4 percent of patients whose chief complaint was a gastrointestinal problem.
There is finally some light at the end of the tunnel:
Moderna: On Monday, Moderna announced that their vaccine against COVID-19 is strongly effective. This good news couldn’t have come soon enough and is building excitement about the potential of controlling the global pandemic. Moderna announced a press brief that its vaccine is showing 94.5% efficacy. This is the best news we’ve had in months. The Moderna vaccine reduced the risk of COVID-19 infection by 94.5%. There were 95 cases of infection among patients who received placebo in the company’s 30,000-patient study. There were only five infections in patients who developed COVID-19 after receiving Moderna’s vaccine, mRNA-1273
Pfizer and BioNTech: On Wednesday, Pfizer and BioNTech announced that the efficacy portion of their COVID-19 vaccine trial has been completed, and their the vaccine prevented 95% of cases of the disease. The companies stated they will submit a request for an emergency use authorization EUA in a few days. Of the 170 cases of COVID-19 that were recorded from the trial, 162 were in the placebo section of the study. The other 8 were among the vaccine group. In total, ten of the infections were severe – and nine of which were in the placebo group. This is an suggests the vaccine prevents mild cases of the disease but also prevents the severe form of infection that increases likelihood of hospitalization and fatality. What remains to be discovered over time, is how long the protection conferred by the vaccine lasts.
Immunity may be long lasting: A study published last week also found that people who have recovered from COVID-19 have powerful and protective killer immune cells (SARS-CoV-2-specific CD8+ T cells) even when antibodies are not detectable. Antibodies are just one arm of the immune system; antibodies are needed to block the virus and prevent a second infection – there are other immune cells (T cells) that recall the virus and are more often are responsible for preventing serious illness. A small number of infected people in the study did not have long-lasting immunity after recovery. Vaccines, once out, will enable overcoming the individual variability in immune response.
FDA approved new COVID test: On Tuesday, the FDA approved a rapid test that can be performed at home. This is the first rapid coronavirus test that can run from start to finish at home. This is optimistic news on the path to increasing access to testing. The test requires a prescription from a health care provider. It consists on a simple nasal swab and the test kit can return results in about half an hour. The manufacturer projected cost is $50 or less. Clinicians can also run the test on patients potentially delivering answers during a single visit bypassing lab wait times.
Vaccine Distribution: State Health departments have asked Congress for at least $8.4 billion more for ensuring a comprehensive, and equitable coronavirus vaccine distribution campaign. Negotiations for further funding are caught up in a stalemate. A new federal platform, called the Immunization Gateway (IZ), aims to connect state vaccine registries so they can share information with one another. The CDC anticipates that the IZ Gateway will play a role in a coordinated COVID-19 vaccination response by streamlining these connections and ensuring more up-to-date exchange of immunization data
Following the science: With free drive-thru testing, mask mandates, and a small army of public health workers, Cherokee Nation has managed to curtail its COVID-19 case and death rates even as those numbers surge in surrounding Oklahoma, other tribal areas, and the US as a whole. Cherokee nation has nation’s largest tribal health system, and health officials acted early, hosting twice-daily briefings and stockpiling PPE. Absent federal guidance, they proactively emulated WHO’s Ebola contact tracing strategy. The 14-county reservation is larger than Connecticut and has had 4000 cases, and 33 reported deaths.
Inhaled interferon shows immune response: Last week researchers published a clinical study showing inhaled “interferon beta-1a” helped hospitalized COVID-19 patients recover faster. Patients who received the treatment were twice as likely to improve clinically by day 15 or 16 compared to the placebo group.
Fluvoxamine possible treatment for mild-to-moderate COVID: Last week, a preliminary study conducted on 152 patients with mild-to-moderate COVID-19 infections published their preliminary data. No patient in a group of 80 people who received a 15-day course of fluvoxamine, reported clinical deterioration, as opposed to 6 (8.3%) of 72 who received a placebo. Researchers stated the drug may work by be interacting with the sigma-1 receptor to reduce the production of inflammatory molecules. Past research has demonstrated that fluvoxamine can reduce inflammation in animal models of sepsis.
Symptom-based only COVID-19 airport screening ineffective: Data published last week by the CDC shows that symptom-based airline passenger entry screening identified few laboratory-diagnosed COVID-19 cases - about 1 case for every 85,000 travelers screened. The researchers also highlighted the inadequacy of electronic airline data for contact tracing; they reported only 22% of records contain complete information to contact trace. From Jan 17 to Sep 13, a total of 766,044 travelers were screened, with 298 (0.04%) who met criteria for public health assessment, 35 (0.005%) tested for SARS-CoV-2, and 9 (0.001%) having a positive test result. Researchers concluded that using only symptom-based screening programs is ineffective because of the nonspecific clinical presentation of COVID-19 and asymptomatic cases. Researchers recommend layered travel precautions to include predeparture and post arrival testing, washing hands, social distancing, avoiding contact with high-risk people, and quarantine as recommended by local public health authorities at travelers' destinations.
60-day follow-up reveals health, financial struggles: A telephone survey of 488 Michigan residents who survived COVID-19 after hospitalization revealed that 159 (32.6%) still had symptoms, 92 (18.9%) reported new or worsening symptoms, and 58 (11.9%) said that they had more difficulty or were not able to complete daily living activities 60 days after hospital discharge. Almost half (238, 48.8%) reported emotional toll by the experience, with 28 (5.7%) seeking mental health care. Financially 36.7% reported at least mild impact. Of the 117 who were able to return to work, 30 (25.6%) said they had to have reduced or modified duties because of their health. Researchers concluded that data reinforced that the toll of COVID-19 extends well beyond hospitalization.
The Work From Home WorkSTEPS Medical Team:
Tony Nigliazzo, MD
Loraine Kanyare, MSN, MPH, RN
Director of Case Management
Robert L. Levitin, MD
Lynda Phillips, LVN
Nurse Case Manager
Codey Church, LVN
Nurse Case Manager
Kerry Womack, LVN
Nurse Case Manager
Strategic Communications Consultant
This Guidance (“Guidance”) is provided for informational and educational purposes only. It is not intended as Legal Advice or Medical Advice. Adherence to any recommendations included in this Guidance will not ensure successful diagnosis or treatment in every situation. Furthermore, the recommendations contained in this Guidance should not be interpreted as setting a standard of care or be deemed inclusive of all proper methods of care nor exclusive of other methods of care reasonably directed to obtaining the same results. The ultimate judgment regarding the propriety of any specific therapy must be made by the physician and the patient in light of all the circumstances presented by the individual patient, and the known variability and biological behavior of the medical condition. Similarly, this Guidance is based on current advice, comments, and guidance from the EEOC, CDC and the CMS made publicly available. The ultimate judgement regarding the propriety of any specific employment action must be made by the company and attorney in light of all of the circumstances presented by the company, state and federal rules existing at the time and the then current state of the National Pandemic. This Guidance and its conclusions and recommendations reflect the best available information at the time the Guidance was prepared. The results of future studies or changes in rules, regulations or laws may require revisions to the recommendations in this Guidance to reflect new data. WorkSTEPS does not warrant the accuracy or completeness of the Guidance and assumes no responsibility for any injury or damage to persons or property arising out of or related to any use of this Guidance or for any errors or omissions.