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2/11/21 COVID-19 Brief: COVID-19 Q&A

By far, most of the questions we field here at WorkSTEPS these days have to do with COVID-19 vaccines and vaccinations. Questions come from clients as well as friends and family members. Some questions have policy implications, while others are more personal. And while not all the answers are what we wish for right now, we need to remember that our country/our world is now on the offense against COVID-19.

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

COVID-19 Q & A

By far, most of the questions we field here at WorkSTEPS these days have to do with COVID-19 vaccines and vaccinations. Questions come from clients as well as friends and family members. Some questions have policy implications, while others are more personal.

With that, I thought I’d focus this week’s article on a bit of Q&A. But first, a few points for context:

1. For each question, I attempt to provide a simple answer, but often there are nuances to consider and more details that can be conveyed. So, for each answer I’m also providing a link or two where additional information can be found.

2. This is certainly not the only Q&A on vaccines. The US CDC, World Health Organization, the New York Times and local health department websites are all good resources to consult.

3. Since more scientific studies are published daily, the answers you get to a question today may change next week. We are constantly learning about the virus, emerging variants of concern, and the different vaccines. Go back to reputable sources often to see if answers have been updated.

4. Finally, when it comes to news stories about vaccines, don’t react; think critically and use information from reputable sources. News organizations need to get our attention, and the topic of vaccines and vaccinations is “hot.” If people are counting on you as a source of credible information, be willing to read deeper into stories, click on the research citations, and check out how other credible outlets are reporting a story.

Q & A

1. I’ve heard of people getting sick after being vaccinated. Do the vaccines work?

The simple answer here is “Yes, the vaccines work; but they’re not perfect.” None of the vaccines offer 100% protection against COVID-19, though it does appear that they offer close-to-perfect protection from serious illness and death.

When you read deeper into reports of people getting sick after they were vaccinated, you find that either: A) they were likely sick before they got their first shot but didn’t have symptoms until after the shot; or B) they got sick after just one jab, before the protective effects of the vaccine had built up and been boosted by the second shot. Remember, vaccine’s add an additional layer of protection as depicted in the Swiss Cheese Model covered in earlier briefs.  

Real world evidence is beginning to accumulate, and this early study is very promising. It comes out of Israel, where close to 90% of those over 60 have received at least one dose of Pfizer’s vaccine. Infections rates and hospitalizations among the group have dropped substantially.

2. Will the vaccines protect us from emerging variants of the virus?

This is a three-part answer: A) It appears that existing vaccines are effective against most variants of the disease; B) The possible exception is the South African variant against which the AstraZeneca/Oxford vaccine appears to be much less effective; and C) The virus will mutate, because that’s what viruses do. How mutations play out vs. vaccines is still unknown, but the overall implication is that the faster we move to vaccinate everyone (globally), the less problematic mutations are likely to be. Here is an up-to-date summary of the vaccines vs. variants issue.

3. Do I need to get two doses of vaccine, or is one dose enough?

There are some who advocate for vaccinating more with at least one dose by delaying the second dose. And, initial data out of the UK where they’ve implemented a single-dose regimen of the AstraZeneca/Oxford vaccine is promising. However, the US FDA recommends adhering to the two-dose regimen, with doses 1 and 2 administered at prescribed intervals, because no other dosing regimen has been studied and proven to work.

Might one dose prove to be sufficient? Yes. Is it prudent to recommend a single dose or to have a policy that prolongs the period between doses? No. Over time, real world evidence may give us a more satisfying – one dose is all you need! - answer; but for now, science suggests sticking with recommended dosing.

4. Once I’m vaccinated completely, do I still need to worry about distancing and wearing a mask?

Here is another unsatisfying answer. We want the answer to be No…you’re protected now. Return to normal living. But there are two problems with that scenario. First, even at 95% effective, you are still exposed to risk of infection. And even if you conclude “I can live with that risk,” there is the second issue. We don’t yet know if being vaccinated will keep people from spreading the virus to others, even if they don’t get sick themselves.

So, as the US CDC recommends, the prudent thing to do is to continue to wear a mask and keep your distance when around others indoors, and to wear a mask when within 6 feet outdoors. As overall population risks go down, we’ll be able to loosen these protections.

5. I’ve already had COVID-19; do I still need to get vaccinated?

The US CDC’s answer here is clear: “Yes. Due to the severe health risks associated with COVID-19 and the fact that reinfection with COVID-19 is possible, you should be vaccinated regardless of whether you already had COVID-19 infection. If you were treated for COVID-19 symptoms with monoclonal antibodies or convalescent plasma, you should wait 90 days before getting a COVID-19 vaccine.”

6. Which vaccines work best? Are there more vaccines coming? And how do the different vaccines work?

The website we’ve been using to keep up to date on the vaccines pipeline and information about different vaccines is the New York Times Vaccine Tracker. Information is accurate and regularly updated, and they have some terrific explainers for how different vaccines work.

As noted earlier, there are many more questions and – thank goodness – some credible resources that have sound answers. And while not all the answers are what we wish for right now, we need to remember that our country/our world is now on the offense against COVID-19. We have approved vaccines, more are on the way, and distribution/administration is getting better and better. Certainly, there are unknowns, and some COVID-19 risk is likely to be with us for a very long time. But, as discussed in this recent article, we will soon approach a time when “COVID-19 mortality falls, and the disease is de-exceptionalized in society”…and we will transition to normalcy. Can’t wait!

Let us know if your company has any questions we can answer – related to COVID-19 or other occupational health, safety, and wellbeing issues.  

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 107,510,735 2,353,744 79,430,451
United States 27,804,262 479,810 17,642,439

Global: On Monday, health officials in South Africa announced halting rollout of the Oxford Astra-Zeneca vaccine to investigate early findings that it offered little protection against mild-to-moderate disease caused by the B1351 variant. They also found that viral neutralization against the B1351 variant was substantially less when compared to the standard virus. Researchers reviewed data from 2,000 volunteers with a median age of 31. In a press release the team said efforts are underway at Oxford to produce a second-generation version of the vaccine that targets variants similar to B1351. At a WHO briefing on Monday, a member of South Africa's COVID-19 advisory committee said concerns about vaccine efficacy against the B1351 variant deepened after Novavax reported 89% efficacy in the UK, but only 49% in South Africa. The B1351 variant currently makes up 80% to 90% of cases in the nation.

National: For the first time since Nov 2, daily case counts have fallen below 100,000 in the US. The CDC head urges American to stay vigilant since daily cases are still higher that averages seen during summer 2020 peak. Texas and California, two states with the highest new case counts during this surge have also turned a corner indicating a slowing down in new infections. On Tuesday, California saw new daily cases drop to slightly over 10,000.  California Gov. Newsom reported a 25% decrease in COVID-19 ICU patients. Texas has for the first time since late December reported less than 10,000 COVID-19 hospitalizations – Texas this week reported 9,401 in inpatient settings.

COVID-19 and Dementia: On Tuesday, a new study showed that not only are adults with dementia twice as likely to have COVID-19 infections, but those who get infected also experience higher mortality rates and increased severity. Using electronic health record  (EMR) data, the researchers observed data on 810 people who had both COVID and dementia from February through August 2020. Vascular dementia had the highest COVID infection risk, followed by pre-senile dementia, Alzheimer's disease, senile dementia, and post-traumatic dementia. Because of the association between vascular dementia and COVID infection, the researchers suggest that brain pathology may be a risk for SARS-CoV-2, the virus that causes COVID-19.

Overall, the 6-month mortality risk for adults with dementia and COVID-19 (21.0%) was higher than both the mortality rates for those with COVID but no dementia (4.8%) and those with dementia but no COVID infections (7.6%).

Study: Pfizer’s mRNA vaccine neutralizes COVID-19 variants: A study published Monday showed Pfizer's mRNA vaccine, the first vaccine approved in the US for use against COVID-19, neutralized three variants of the virus, including the B117 strain first identified in the United Kingdom, and two new variants first confirmed in South Africa. The mutations tested included the N501Y from the United Kingdom and South Africa, the 69/70-deletion + N501Y + D614G from United Kingdom; and E484K + N501Y + D614G from South Africa. To conduct the study, researchers engineered three COVID-19 viruses with the spike mutations from the variants. They then measured neutralization geometric mean titers (GMTs) against the variants in 20 samples of human sera from subjects who had been vaccinated with Pfizer's two-dose vaccine 2 to 4 weeks earlier. GMTs were 0.81- to 1.46-fold of the GMTs of the original, wild type virus, against which Pfizer’s vaccine is 95% effective.

Mitigation / Suppression:

Study finds U.S on trajectory for B117 surge: A team of scientists sequenced SARS-CoV-2 genomes from 10 states to track the emergence and spread of variant B117. Among the 460 samples successfully sequenced from December 2020 through January 2021, 209 (45%) were B117. During January, the B117 growth rate among the samples doubled about every 10 days, suggesting 35% to 45% higher transmissibility than other strains. The variant is currently spreading at a rate of about 7% each day in the US. As of Wednesday, the CDC has reported 932 B117 cases in 34 states. Currently labs in the U.S. are only sequencing a small subset of SARSCoV-2 samples, as such the true sequence diversity of variants in the country is still unknown. Scientists are urging the U.S to act now to increase mitigation efforts and genomic surveillance capacity to keep track of the B117 variant, which will also help to quickly identify other variants when they emerge. They caution that the U.S. is on a similar trajectory as the UK and Portugal where B117 rapidly became the dominant SARS-CoV-2 variant.

State vaccination data: Across the nation, 10 states have vaccinated more than 10% of their population  with at least one shot. An additional 19 states are following closely behind and are close to hitting that goal. Alaska leads with 15%, followed by West Virginia (12.2%) and New Mexico (12.0%). On Tuesday, Biden administration announced it would boost weekly vaccine supply to states to 11 million for the next three weeks. On Wednesday, the CDC COVID Data tracker shows 62,898,775 COVID-19 vaccine doses have been distributed in the US, and 43,206,190 doses have been administered. At present 9.9% of the U.S population have received a first dose of the vaccine.  

Kaiser Vaccine Survey: On Tuesday, the Kaiser Family Foundation released a new survey on vaccines attitudes. 36% of adults mentioned general side effects as their main concern. About  12% stated their biggest concern was the newness of the vaccine, and development speed.  10% of respondents mentioned issues related to accessing the vaccine and general availability.

7% of the respondents reported concerns of the vaccine’s effectiveness. Lastly 5% had concerns about safety.

Corporate:

CDC report on mask fit: Yesterday, the CDC released a report on boosting mask effectiveness in light of the new COVID-19 variants. In absence of N95 and KN95 masks which have better fit.  They recommend two methods that substantially boost fit and protection from widely available masks. One is wearing a cloth mask over a disposable surgical mask. The second is improving the fit of a single surgical mask by knotting the ear loops and tucking in the sides close to the face to prevent air from leaking out around the edges and to form a closer fit. Both of those methods reduced exposure to potentially infectious aerosols by more than 95 percent in a laboratory experiment using dummies, the report said. More on the report here.

Two new mask studies show decreased transmission: On Friday, two new studies led by CDC researchers indicated that mask mandates likely yield benefits. One linked the measure to reduced hospitalizations and the other showed good compliance on college campuses.

In the hospitalization study, CDC researchers and their partners looked at states with mask mandates and compared COVID-19 growth rates before and after the mask order took effect.

They found a 5.5-percentage-point decline in weekly hospitalizations for COVID-19 in adults 18 to 64 years old after mandates were ordered, compared with the 4 weeks before the measure began. The findings support other studies that suggest distancing measures, including masks mandates, are associated with immediate declines in coronavirus case.

In the second study, CDC researchers observed mask use at six college campuses that had mask mandates from September to November, indoors and outdoors, as well as on and off campus. In indoor settings, the team found high compliance, with 91.7% wearing masks correctly. Use in off-campus indoor settings was at 90.6%. Mask use outdoors, recommended when social distancing wasn't possible, was less common, at 67.6%.

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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