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12/10/20 COVID-19 Update: Updated CDC Guidance = Opportunity to Reduce COVID-Related Absence

(Article updated on 12/11/2020 to acknowledge state-level rules that may prohibit adoption of updated CDC guidance.) Last week, the US CDC updated its guidance regarding how long people who may have been exposed to Covid-19 should quarantine in order to avoid infecting others. The change is an opportunity for companies to reduce absences associated with quarantine, but capitalizing on the opportunity will require changes to quarantine policies, practices and communications.

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

Updated CDC Guidance = Opportunity to Reduce COVID-Related Absence

Take-Aways

  • The CDC recently updated its guidance regarding how long people need to quarantine after they’ve been in close contact with someone with Covid-19.
  • Rather than a quarantine period of 14 days, the update offers the option of a 10-day quarantine without testing, and 7 days with testing.
  • The update balances the benefits of lower quarantine burden and better quarantine compliance against the small possibility that someone could still infect others up to 14 days after exposure.
  • If companies want to capitalize on the change (providing they change is not prohibited by state-level rules, such as in NY and CA), they will need to modify their quarantine policies and practices, and communicate new expectations to employees.
  • WorkSTEPS invites readers to request a summary of recent CDC guidance updates to inform their Covid-19 policies, practices and communications.

Last week, the US CDC updated its guidance regarding how long people who may have been exposed to Covid-19 should quarantine in order to avoid infecting others. The change is an opportunity for companies to reduce absences associated with quarantine, but capitalizing on the opportunity will require changes to quarantine policies, practices and communications.

In this article, I’ll explain the updated guidance – what it is, why it is, and the steps companies need to take in order to reduce quarantine-related lost workdays.

What Is the Updated Guidance?

Prior to the update, people who might have been infected with Covid-19 were advised to quarantine for 14 days. “People who might have been infected” includes those identified through contact tracing (at work or through public health contact tracers), and those living in the same household as people with diagnosed Covid-19.

With the update, people who may have been exposed and who are asymptomatic can now end their quarantine after 10 days (a 4-day reduction in lost time). And, if the person tests negative for Covid-19, they may end their quarantine in just 7 days (a 7-day reduction in lost time). Notably, state-level rules such as those in NY and CA appear to prohibit adopting the updated CDC guidance at this point.

Some important parameters around the guidance include:

  • The clock on quarantine starts on the date of last exposure. So, if an employee has a sick dependent at home, their quarantine begins the day that person is no longer considered contagious.
  • Testing may be performed on day 5 at the earliest, but even if a test performed on day 5 is negative, the quarantine may not end until day 7.
  • Antigen or PCR testing may be used.
  • People should continue to monitor themselves for symptoms of Covid-19 through 14 days and, if symptoms appear, should isolate themselves and get tested.

Why the Updated Guidance?

It is notable that the CDC continues to endorse a 14-day quarantine but has outlined 10- and 7-day options in an effort to balance benefits of lower quarantine burden and better quarantine compliance against the small possibility that someone could still infect others up to 14 days after exposure. Let’s unpack that:

  • Small Transmission Risk: Researchers have studied how long it takes for infections to develop and when people are most likely to infect others. Models suggest that an asymptomatic person has about a 1% chance of transmitting the virus after 10 days, and that a person who tests negative and ends their quarantine at day 7 has about a 5% chance of transmitting the virus.
  • Lower Burden/Better Compliance: The shortened quarantine options are in part a response to local public health agencies who have reported that people struggle to quarantine for the recommended 14-day period. Lowering the quarantine period reduces family, economic and social hardship, and the hoped-for result is better compliance. France and Germany have reduced quarantine times to improve overall compliance.

Realizing Benefits of the Updated Guidance

Capitalizing on the new guidance will require:

  • Updated Policies: Your organization’s policies regarding quarantine will need to be updated.
  • Updated Practices: Current administration of Covid-19-related contact tracing and quarantine & isolation policies will need to be modified. As our clients are deciding to change their policies, we are modifying the instructions our team members provide employees of theirs who are identified through self-report or contact tracing. The lost-time savings to those clients is immediate.
  • Updated Communications: Current expectations about what happens if employees are exposed to Covid-19 are likely based on the CDC’s 14-day guidance. Those expectations will need to be changed. Some employees will react negatively, but in my experience, most will welcome the opportunity to get out of quarantine sooner.

Additional Changes

While the change in quarantine guidance received the most press coverage, the CDC recently modified other guidance related to travel and isolation of people diagnosed with Covid-19. We have summarized and compiled the guidance changes in a single document that we’re happy to provide our readers. Just click here to request a copy.  

Keeping Up the Fight

We call it “Covid Fatigue” – a wariness that we’re all susceptible to as the pandemic wears on, and which has been made both better and worse by the hope of new vaccines. We’ve all had to make so many adjustments, the last thing we want to hear is that policies and practices we’ve worked hard to put in place need to be changed – even when the change works to our advantage.

So, we need to be selective - we can’t jump at every opportunity. We would say that this opportunity deserves at least careful consideration, and it may be worth fighting for.

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 69,579,031 1,582,295 48,242,995
United States 15,862,383 297,446 9,235,394

The director of the Centers for Disease Control and Prevention warned that the nation is facing a devastating winter, predicting that total deaths from Covid-19 could reach “close to 450,000” by February unless a large percentage of Americans take more precautions.

National: On Tuesday this week, the US recorded the most Covid-19 related deaths over a 7-day period. The 7-day average as of Tuesday was 2,249 deaths, the previous mark was 2,232 on April 17. The nation is averaging nearly 200,000 cases per day, an increase of 15 percent from the average two weeks earlier. The Midwest continues to be the hardest hit. North Dakota is the hardest hit and one in every 10 people has contracted the virus. Followed by South Dakota, Iowa, Wisconsin and Nebraska. The number of people hospitalized with Covid-19 has also hit a record. Each day since Dec. 2, more than 100,000 Covid-19 patients were in hospitals which is up from 60,000 at the peak of the pandemic earlier.

Global: The UK is the first Western country to deliver a broadly tested and independently reviewed vaccine to the public. The vaccine was developed by US drug maker Pfizer and Germany’s BioNTech. The country gave the green light for vaccinations on Dec. 2nd and the country has received 800,000 doses, enough to vaccinate 400,000 people. The first shots are going to people over 80 who are either hospitalized or already have outpatient appointments scheduled, nursing home workers and vaccination staff. UK patients with severe allergies were advised on a precautionary basis to hold off getting the Pfizer vaccine.  On Saturday, Russia began vaccinations with its Sputnik V vaccine, and China has also begun giving its own vaccine to their public. Neither countries’ vaccines have finished the late-stage trials scientists consider essential for proving a serum is safe and effective. Mexico plans to begin coronavirus vaccinations the third week of December.

Long-Haulers: Last week, the NIAD hosted its first workshop on long-term health effects of COVID-19. The event included input from public health experts, medical researchers, government officials, and patients. There is currently no definitive estimate of how many people suffer these long-term cardiac, neurological, respiratory, or other effects following recovery from SARS-CoV-2 infection—commonly referred to as “long haulers”—but it is clear that long-term COVID-19 sequelae will become a major public health problem, if even only a small fraction of individuals are affected. To address this threat, workshop attendees recommended that the syndrome be assigned an official, distinct medical term in order to increase awareness and prompt investigations necessary to more fully characterize the phenomenon.

CDC: 1 in 5 hospitalized younger adults with COVID-19 need ICU care: Younger adults with no comorbid conditions have been considered safer from severe Covid-19 outcomes. However, study published late last week showed that of those adults under 50 who were hospitalized for Covid-19, 22% were admitted to ICUs; 10% needed mechanical ventilation; and 0.6% died. The researchers looked at data from patients hospitalized with COVID-19 from March through August. During this period, 31.8% of the 44,865 patients in the COVID-NET system were adults under 50, of which 513 (3.9%, the study's cohort) had sufficient data to indicate they had no underlying diseases. Additionally, men made up 74% of cases. The researchers say the association between men's increased angiotensin-converting enzyme 2 levels and COVID-19 severity may contribute to the level of severe disease found in the study population.

SARS-CoV-2 may enter the brain through the nose: A small German autopsy study of Covid-19 victims demonstrated the presence of SARS-CoV-2 in nasal structures and the brain, suggesting that the virus crosses into the central nervous system (CNS) via nasal surfaces that contain nerve endings for smell. We know Covid-19 CNS effects include loss of smell and taste, headache, fatigue, nausea, vomiting, acute cerebrovascular disease, and impaired consciousness. Of the 33 autopsy patients, 60.6% (20 of 33) showed evidence of SARS-CoV-2 RNA in the lining of the nasal cavity suggesting that the virus may invade the CNS through olfactory nerves that control the sense of smell. Notably, 18.1% (6 of 33) of autopsies revealed the presence of the virus in the medulla oblongata, or brain stem—a structure that controls breathing and cardiac function—suggesting that SARS-CoV-2 invasion of brain structures may play a role in COVID-19 complications.  

Operation Warp Speed Leaders Say 20 Million COVID-19 Vaccines May Be Available This Month: Health and Human Services Secretary Alex M. Azar II said that key officials with Operation Warp Speed report that 20 million doses of the COVID-19 vaccine could be distributed this month. Azar was joined for a media briefing by Army Gen. Gustave F. Perna, chief operating officer of OWS, and Dr. Moncef Slaoui, chief advisor to OWS. If all goes well, the secretary said, OWS can make its first shipments of the vaccine to states this month. (DOD, 12/3/2020)

Mitigation/Suppression:

Here’s Why Vaccinated People Still Need to Wear a Mask: The new vaccines will probably prevent you from getting sick with Covid. No one knows yet whether they will keep you from spreading the virus to others — but that information is coming.

Effects of Cocooning on Coronavirus Disease Rates after Relaxing Social Distancing: CDC provides emerging evidence to protect those who are vulnerable through “Cocooning”.  As restrictions wax and wane, we need to protect those who are at highest risk: elderly, immunocompromised, etc. This is similar to the UK approach to COVID-19.  Cocooning involves incentivizing persons with high-risk underlying conditions to remain at home, helping persons experiencing homelessness to social distance, and broadly encouraging hand hygiene and wearing face masks for persons at high risk for severe illness or death and their caregivers.

Summary of Guidance for Public Health Strategies to Address High Levels of Community Transmission of SARS-CoV-2 and Related Deaths, December 2020: COVID-19 pandemic control requires a multipronged application of evidence-based strategies while improving health equity: universal face mask use, physical distancing, avoiding nonessential indoor spaces, increasing testing, prompt quarantine of exposed persons, safeguarding those at increased risk for severe illness or death, protecting essential workers, postponing travel, enhancing ventilation and hand hygiene, and achieving widespread COVID-19 vaccination coverage. These combined strategies will protect health care, essential businesses, and schools, bridging to a future with high community coverage of effective vaccines and safe return to more activities in a range of settings.

Detailed Data on AstraZeneca-Oxford Covid-19 Vaccine Show it has Moderate Efficacy: Data from four clinical trials reveal that the Covid-19 vaccine being developed by AstraZeneca and Oxford University is moderately effective in preventing symptomatic illness and could help significantly reduce hospitalizations in infected people. The new data, which pooled information from trials in different phases and included safety data from more than 20,000 participants, show that two standard doses of the vaccine were 62% effective against the onset of symptomatic Covid-19 in some trials. When efficacy data from all four trials — more than 11,600 participants — were pooled, that figure jumped up to 70%. The company is submitting data from its trials on a rolling basis to regulatory agencies, but expects that the FDA will require the U.S. arm of the trial to be complete before asking for emergency use authorization.

CDC published a new report highlighting what people and communities can do to help slow Covid-19 spread. The report outlines 10 evidence-based strategies that people & communities can take to save lives, restore community life, and speed up economic recovery. No single strategy can control the pandemic; rather, a multipronged approach using evidence-based strategies at the individual and community levels can break transmission chains and address high levels of community transmission; reduce related illnesses, long-term sequelae, and deaths; and mitigate the pandemic’s economic impact.

Source

Corporate:

Revisiting Swiss Cheese model of pandemic defense: Virologist Ian Mackay created an easy-to-grasp metaphor retooled from a similar model in aviation safety. We shared this in our brief a few weeks ago but it is worth repetition with vaccine administration on the horizon. Multiple layers of protection, depicted as cheese slices, block the spread of SARS-CoV-2, the virus responsible for Covid-19. No one layer is perfect; each has holes, and when the holes align, the risk of contracting the disease increases. Several layers of defense combined - social distancing, and masks, and handwashing, and testing and tracing, and ventilation, and government messaging - significantly reduce the overall risk. The new vaccination will add one more protective layer.

NIH-funded Tool Helps Organizations Plan COVID-19 Testing: A team led by the Consortia for Improving Medicine with Innovation and Technology (CIMIT) at Massachusetts General Hospital, Boston, and researchers at the Massachusetts Institute of Technology (MIT), Cambridge, developed the tool to model the costs and benefits of COVID-19 testing strategies for individual organizations. The team developed their mathematical model and calculator as part of NIH’s Rapid Acceleration of Diagnostics (RADx) Tech program. The calculator is simple - a user enters a few specifics about their site and the tool produces customized scenarios for surveillance testing. The tool models four different COVID-19 testing methods, including onsite and lab-based, and calculates the number of people to test each day. It shows the estimated cost of each testing option and outlines the tradeoffs in the speed and accuracy of each kind of test. (NIH, 12/7/2020)

Worker Safety: The safety of frontline and essential workers, particularly those with roles that cannot be performed remotely, remains a major area of concern for employers and policymakers. The US Occupational Safety and Health Administration (OSHA) has been criticized on multiple fronts for not taking sufficient action to protect worker safety during the COVID-19 pandemic. While OSHA has the ability to raise standards for occupational safety, a federal appeals court recently sided with OSHA’s stance that an emergency temporary standard was not necessary. Since then, many state and local governments implemented their own temporary workplace standards that include enhanced measures beyond those required by OSHA. State-imposed requirements include improved indoor ventilation, increased physical distancing between employees, and routine diagnostic testing. This state-by-state approach to worker safety has created a patchwork of regulations across the US.

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

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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