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11/5/20 COVID-19 Brief: Prevent the Spread of COVID-19 Among Family and Friends

Throughout this pandemic, we’ve been urged to limit our activities outside of the home in order to avoid COVID-19 infection and reduce transmission of the virus. That advice still stands, but what happens if a family member becomes sick?

A Message on COVID-19 from WorkSTEPS Chief Medical Officer Dr. Ben Hoffman

Safer at Home: Prevent the Spread of COVID-19 Among Family and Friends

Throughout this pandemic, we’ve been urged to limit our activities outside of the home in order to avoid COVID-19 infection and reduce transmission of the virus. That advice still stands, but what happens if a family member becomes sick? Further, as colder temperatures drive social interactions indoors, how can we reduce the risk of infection related to such gatherings?  

Preventing Transmission Within Households

While we’ve known for some time that COVID-19 spreads within households, a new study has added some important insights, including:

  • Household transmission more common than thought: The secondary infection rate among people living in the same household as a person infected with COVID-19 (index patient) is 53%.
  • Children transmit disease: In the study, when the index patient was under the age of 12 the secondary infection rate was 53%. The secondary infection rate was lower - just 38% - for youths age 13 to 18. I suspect this is due to the fact that most teens naturally self-isolate whether we’re in a pandemic or not.
  • Transmission happens fast: 75% of secondary infections happened within five days of the index patient’s illness onset.

To reduce transmission of COVID-19 within households, authors of the paper recommend:

  • 1. Isolate family members as soon as: A) They experience symptoms of COVID-19; B) If they’ve been in close contact with someone who is sick; or C) As soon as they receive a positive test result.
  • 2. Isolate means using a separate bedroom and bathroom if possible, avoid sharing objects like towels, TV remotes and utensils, and all members of the household should be masked when in the same room.
  • 3. Be sure to protect those at risk of serious illness.

Reducing Transmission Risk During In-Home Gatherings

Our recent article about holiday gatherings outlined potential risks of such gatherings and provided guidance to plan for safer events. I recommend you read and share the article liberally to help others find ways to celebrate more safely in the weeks ahead.

My focus in this article is on more ordinary gatherings that are being driven more and more indoors as temperatures across much of the country are cooling. Whether you want to have friends over to watch the big game or invite family for a quiet dinner, this article can help. The graphics featured in the article do a great job of explaining how the factors of mask-wearing, ventilation and time interact to increase or decrease the risk that someone infected with COVID-19 will transmit the virus to others in home, classroom and bar settings.

Based on sophisticated modeling, researchers predict significantly lower transmission risk when people gathered indoors wear masks, when the space is well ventilated, and when time spent together is reduced. These findings are not surprising, but the accompanying graphics make the information all the more compelling and worth sharing.

The Community-Home-Business Connection

COVID-19 cases are once again rising across the US and around the world. Even if climbing case rates don’t necessitate community-wide shut-down measures, businesses are impacted by changes in consumer activity and, of course, lost productive time due to personal or family illnesses. Educating employees about steps they can take to protect themselves and their families from the virus can have important health and productivity benefits for your business while helping to curb rising case rates in your community.  

What are you grappling with that you’d like to see covered in The Brief? Click here and let us know.

Ben Hoffman, MD, MPH
Chief Medical Officer, WorkSTEPS

For more from Dr. Hoffman, connect with him on LinkedIn.

Medical:  


Area Reported Cases Deaths Recovered
Global 48,138,924 1,224,657 34,504,505
United States 9,703,299 238,785 6,237,659
Source

Global: On Tuesday, the  global COVID-19 case total  passed 46 million. The current record single-day high was 505,756 new cases reported on October 30th. This week, the UK announced new restrictions; it’s the fifth European country to do so to combat the current surge in cases and deaths. Taiwan, meanwhile, reached a milestone of 200 days without recording a single locally transmitted coronavirus infection.

National: The US is averaging more daily coronavirus cases than previously in the pandemic. On Monday, more than 93,000 cases were announced nationwide. This is the second-highest total of the pandemic; the highest was on Friday last week. More than 20 states have set weekly case records, and more than 40 states are seeing a pattern of growing new cases. In the past week new daily cases rose by 17.4%; new daily reported deaths rose by 2.6%; and COVID-19 related hospitalizations rose by 13.2%. Nationally test positivity rate was 6.7%. Wisconsin, Arkansas, North and South Dakota  continue to experience the greatest surges.

COVID-19 hospitalizations surge across parts of the US

COVID-19 cases have been surging across the US, and so have hospitalizations from the infection, causing concerns about facilities reaching capacity soon and becoming overwhelmed. Seven states in the Midwest and Southwest, including Missouri and North Dakota, reported their highest hospitalization numbers this week, for instance. New Mexico's numbers saw a high for the 12th day in a row, while officials in Colorado said more people there were hospitalized now than at any other point in the pandemic since a peak in April. Hospitals in many of these states moved to limit elective surgeries and make other changes to accommodate the surge.

Wisconsin recorded 100,000 cases last month with areas in northern and eastern Wisconsin having the steepest trendlines in the nation. Deaths and hospitalizations in Wisconsin are also seeing an uptick; some patients are already being taken to a field hospital at the state fairgrounds outside Milwaukee.

Source

Regeneron: Regeneron, which has an antibody cocktail for treating COVID-19 announced that an independent monitoring board has halted enrolling hospitalized patients who have high oxygen requirements. However, the board endorsed continuing the trial in participants with low or no oxygen requirements, including in outpatient settings. Earlier this month the company submitted an application for emergency use authorization.

Vaccine Race: On Tuesday, Novavax delayed the start of a late-stage US trial of its COVID-19 vaccine to the end of November, citing delays in scaling up the manufacturing process. In August, Novavax said it will supply 100 million doses of its coronavirus vaccine to the US. The company has also signed supply agreements with the U.K., Canada and Japan. Last week, Moderna reported that it is on track to release phase 3-trial data vaccine by the end of November.

Global study on COVID death rates: On Monday, a multi-country study confirmed that the age-dependent risk of COVID-19 death is consistent for people below age 65, but the relative risk in older individuals varied considerably between nations. Researchers analyzed age-specific COVID-19 death data from 45 countries and 22 seroprevalence studies to estimate epidemic size and patterns. The estimated infection-fatality ratio (IFR, or the ratio of deaths per infection) for all countries was lowest among those 5 to 9 years of age.

Review Finds Almost 20% of COVID-19 Patients Only Show Gastrointestinal Symptoms: The findings of the review suggest abdominal radiologists need to remain vigilant during the pandemic while imaging patients. Gastrointestinal symptoms associated with COVID-19 vary widely but can include loss of appetite, nausea, vomiting, diarrhea and generalized abdominal pain. The researchers who conducted the review report that 18 percent of patients presented with such symptoms, while 16 percent of COVID-19 cases may only present with gastrointestinal symptoms.

A Rapid Virus Test Falters in People Without Symptoms, Study Finds: One strategy has involved the widespread use of rapid tests, which forgo sophisticated equipment and can return results in minutes. Purchased in bulk by the federal government and shipped nationwide, millions of these products have already found their way into clinics, nursing homes, schools, athletic teams’ facilities and more, buoying hopes that the tests might hasten a return to normalcy. But a new study casts doubt on whether rapid tests perform as promised under real-world conditions, especially when used in people without symptoms.

Spike in Prescribing Dexamethasone to COVID-19 Patients May Do More Harm Than Good (STAT): Authors raise this issue because there is no evidence that dexamethasone benefits COVID-19 patients who aren’t severely ill and because it has known side effects, such as depression, mood swings, and psychosis. Until there is evidence of effectiveness and safety, authors believe it is premature for clinicians to prescribe dexamethasone for COVID-19 patients who are not severely ill.

NIH Scientists Discover Key Pathway in Lysosomes That Coronaviruses Use to Exit Cells: Researchers at the National Institutes of Health have discovered a biological pathway that the novel coronavirus appears to use to hijack and exit cells as it spreads through the body. In cell studies, the researchers showed for the first time that the coronavirus can exit infected cells through the lysosome, an organelle known as the cells’ “trash compactor.” Normally the lysosome destroys viruses and other pathogens before they leave the cells. However, the researchers found that the coronavirus deactivates the lysosome’s disease-fighting machinery, allowing it to freely spread throughout the body. (NIH, 10/28/2020)

Mitigation / Suppression:

Europe is Locking Down a Second Time. But What is its Long-term Plan? (Science): With COVID-19 cases mounting and threatening to overwhelm health care capacity, much of Europe has taken similar measures to curb human contacts. Two months ago, as numbers began to creep up after a blissful summer lull, countries still held out hope that more limited, targeted measures could prevent a second wave. Now, that wave is here, with the force of a tsunami.  

COVID-19 rates and mortality in low income housing: A study this week showed higher mortality and morbidity rates associated with low income housing households. V.A. researchers conducted a nationwide analysis of 3,135 US counties using CDC, Census, and John Hopkins data. They identified an average of 14.2% of US households living in substandard housing.

The researchers found a 50% higher risk of COVID-19 incidence and a 42% higher risk of COVID-19 mortality for each 5% increase in percent of households with one or more substandard housing characteristics.

Kidney injury in 26% of COVID-19 patients: Late last week, a retrospective cohort study reported findings of the  relationship between COVID-19 and acute kidney injury (AKI). They reviewed data from 1,161 SARS-CoV-2–positive patients admitted to hospitals in the U.K., from Mar 5 to Mar 12. Researchers reported finding double the incidence of AKI in hospitalized COVID-19 patients and a threefold higher mortality than in COVID-19–negative patients. Men, nonwhite patients, and those with comorbidities were at increased risk of developing AKI with COVID-19. The study highlights that patients with COVID-19 who do not have AKI on admission should be monitored for increased risk of developing AKI while hospitalized.

Corporate:

United Airlines: United to offer free coronavirus rapid testing select flights between Newark & London starting next month.

Estimated COVID-19 risk in construction work: Researchers assessed the association between construction work during the COVID-19 pandemic and hospitalization rates for construction workers and the surrounding community. They found that allowing unrestricted construction work was associated with an increase of COVID-19 hospitalization rates through mid-August 2020 from 0.38 per 1000 residents to 1.5 per 1000 residents and from 0.22 per 1000 construction workers to 9.3 per 1000 construction workers. This increased risk was estimated to be offset by safety measures (such as thorough cleaning of equipment between uses, wearing of protective equipment, limits on workers at a worksite, and increased health surveillance) that were associated with a 50% decrease in transmission.

The Work From Home WorkSTEPS Medical Team:

Ben Hoffman, MD, MPH
Chief Medical Officer

Tony Nigliazzo, MD
Medical Director

Loraine Kanyare, MSN, MPH, RN
Director of Case Management

Robert L. Levitin, MD
Physician Consultant

Lynda Phillips, LVN
Nurse Case Manager

Codey Church, LVN
Nurse Case Manager

Kerry Womack, LVN
Nurse Case Manager

Chuck Reynolds
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.

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