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2/4/21 COVID-19 Brief: COVID-19 Prevention – Learning to Focus on the Vital Few

During the first half of the COVID-19 pandemic, it was difficult to focus on a vital few prevention measures, because we simply didn’t know enough about the virus and how it spread to understand what mattered most. Now that we know more about the virus, it’s a good time to reconsider where we’re investing limited resources to prevent and contain the virus.

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

Take-Aways

1. A year into the pandemic, we’ve learned a lot about the COVID-19 virus, how it spreads, and how to prevent transmission.

2. While vaccines give us hope, the pandemic is not over. So, it’s important to evaluate COVID-19 prevention strategies in light of what we’ve learned and to focus on the vital few things that will have the greatest protective impact.

3. Key learnings include our understanding of the prevalence of asymptomatic spread and that the aerosolized particles are the primary route of COVID-19 transmission.

4. In light of key learnings, employers should concentrate on the vital few measures that matter most – frequent testing, good ventilation, masking and contact tracing.

COVID-19 Prevention – Learning to Focus on the Vital Few

Focus is key to success in business. Business enterprises, departmental functions, leaders, and employees all perform better when they focus time, attention and resources on the things that matter most.

During the first half of the COVID-19 pandemic, it was difficult to focus on a vital few prevention measures, because we simply didn’t know enough about the virus and how it spread to understand what mattered most. Now that we know more about the virus, it’s a good time to reconsider where we’re investing limited resources to prevent and contain the virus.

An article ran in the WSJ last week titled New Playbook for COVID-19 Protection Emerges After Year of Study, Missteps. The article did a pretty good job of identifying what we’ve learned and how those lessons should inform our prevention efforts going forward. This article is my summary and interpretation of that piece.

Key Learnings

We’ve learned a lot about COVID-19 in the past year, but here are three that have the most profound implications for our prevention efforts in the coming months.

1. It’s not over. In a recent article, I noted that: “with vaccines we’re in the home stretch, but it’s going to be a long one. This is exactly the time we are most tempted to let up. It’s also exactly the time when we can least afford to do so.”

In the few short weeks since I wrote that, the threat of more easily transmitted variants of COVID-19 has been rising, increasing both the urgency and importance of maintaining strong prevention measures while we also work to achieve high levels of vaccination.

2. COVID-19 is most often spread by people who don’t know they’re sick. A recent study published in JAMA Network found that approximately 59% of all COVID-19 transmission is caused by people without symptoms.

3. The primary route of COVID-19 transmission is via aerosolization. Early on, our fears were focused on large droplets landing within six feet of an infected person’s cough or sneeze. While nobody wants to be sneezed on, it turns out the main culprit for COVID-19 transmission is tiny droplets emitted when people breathe, speak, sing, or yell. These particles float suspended in the air and can quickly build up within confined spaces.

Implications for the Vital Few Measures

Let’s begin with some measures that aren’t as important as we once thought.

1. Barriers. Certainly, plexiglass is still an important measure to protect retail clerks and others who have frequent face-to-face interactions with customers. However, in other environments, such barriers can do more harm than good when they obstruct air flow (see “ventilation” below) or give people a false sense of security such that they are less compliant with masking.

2. Temperature Checks. About 40% of people who get COVID-19 never develop symptoms, and those who do develop symptoms can spread the virus before symptoms appear (pre-symptomatic spread). Therefore, temperature checks are simply not a reliable screening tool.  And again, such checks can create a false sense of security leading to lax compliance with other, more important measures.

3. Surface Sanitation. While it still makes sense to sanitize frequently touched surfaces, the early diligence for all-surface sanitation is no longer necessary.

Now let’s zero in on the vital few things your COVID-19 prevention strategy should concentrate on.

1. Frequent Testing. As noted in this recent article, “Antigen testing has become accurate enough, fast enough, and cheap enough to be considered by many companies as another layer of protection. A well-designed testing strategy can cost-effectively screen and identify sick-but-symptom-free employees capable of spreading disease.”

Testing is a reliable way companies can keep sick employees from introducing infection particles into the air.

2. Good Ventilation. The importance of good air flow was not well-understood early in the pandemic but is now a cornerstone of a sound prevention strategy.

If there are sick employees breathing virus-infected particles into a workspace, good ventilation reduces the number of particles, reducing the chance that others will be infected.

3. Masking. You still find a lot of discussion about how to mask (e.g., the utility of double-masking is the latest topic), but experts agree that masks offer protection to the wearer and those around them.

Masks work because they filter out virus-infected particles that may be introduced into the air by someone who is sick or inhaled from the air by someone who is healthy. The better the mask, the better the filtration, the greater the protection for the wearer and those around them.

4. Contact Tracing. Contact tracing becomes extremely challenging during case surges as we’ve seen recently, but as case numbers come down, the efficiency and utility of contact tracing – especially if combined with frequent testing – makes it another important element of the “vital few.”  

As your organization becomes increasingly focused on workforce vaccination (including strategic communication), it will be critical not to lose sight of the need for an effective prevention strategy. Focusing time, energy and resources on the vital few measures will enable you to have greater overall success than if efforts are diluted by measures that matter less.

Please let us know if your company needs strategy guidance or help with frequent testing, contact tracing or other tactics. We are committed to working with our customers through the end of this long home stretch and look forward to returning to normalcy together.

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 105,249,024 2,286,840 76,902,713
United States 27,217,448 463,755 16,958,275

Global: The WHO COVID-19 Dashboard reports 102.94 million cases and 2.23 million deaths as of 11am EST on February 2. The weekly global incidence decreased for the third consecutive week, down to 3.63 million new cases. This is a decrease of nearly 15% compared to the previous week, and it is the lowest weekly total since late October. Weekly global mortality also decreased nearly 4% compared to the previous week, down to 93,803 deaths. Considering the reporting interruptions over the winter holidays, it is unclear exactly when the actual global incidence peaked; however, the decrease in mortality could be an early indication of a longer-term trend corresponding to decreases in incidence starting 2-4 weeks ago.

Portugal tops world rankings for new daily cases: The pressure is on Portugal after nearly two weeks at the top of the world rankings of daily new infections and deaths by size of population. In January, Portugal recorded more than 5,000 death — close to half of its official pandemic total so far. Over the month, hospitalizations grew by 136% and patients in intensive care units by 78%, straining the nation’s hospital and public health system.

National: January 2021 was the deadliest month of the coronavirus outbreak in the U.S. New COVID-19 cases and hospitalizations are plummeting, while vaccinations are picking up speed. The critical question remains whether the nation can stay ahead of the fast-spreading variants. The U.S. death toll has climbed past 443,000, with over 95,000 lives lost in January alone. Deaths are running at about 3,150 per day on average, down slightly, by about 200, from their peak in mid-January. As the calendar turned to February on Monday, the number of patients in the hospital with COVID-19 fell below 100,000 for the first time in two months.

WHO updates opinion on vaccinating pregnant women: Last week Wednesday, the WHO updated its opinion on the Moderna SARS-CoV-2 vaccine to include pregnant women. Previously, the WHO recommended against vaccinating pregnant women unless they were at elevated risk. CDC and WHO currently state that there is no evidence to suggest that the vaccine poses safety concerns for pregnant women.

Pregnant Women antibodies to the fetus: A study published last Friday provides evidence that pregnant women may be able to pass IgG antibodies (a longer lasting antibody)  against SARS-CoV-2 to their fetus. The study involved 1,417 women who recently gave birth. Among 83 mothers with detectable SARS-CoV-2 antibodies, 72 (86.7%) transferred IgG antibodies to their fetus—as detected in the newborns’ cord blood. IgM antibodies were not detected in any cord blood specimens, and antibodies were not detected in any infants born to mothers without detectable antibodies. The concentration of antibodies in the cord blood was significantly correlated with the concentration in the mother, but the antibodies were successfully transferred by mothers who exhibited symptomatic disease and asymptomatic infection. The researchers indicate that the results align with similar studies on transplacental transfer of vaccine-conferred antibodies for other diseases.

New Variant COVID Findings Fuel More Worries About Vaccine Resistance (CIDRAP): Scientists in the United Kingdom yesterday reported that a small number of B117 variants have developed the E484K mutation thought to help SARS-CoV-2 partly evade immunity, and today another UK group said their lab experiments suggest the mutation added to B117 may dampen the impact of vaccination after one dose.

New Diabetes Cases Linked to COVID-19 (Washington Post): Researchers don’t understand exactly how the disease might trigger Type 1 or Type 2 diabetes, or whether the cases are temporary or permanent. But 14 percent of those with severe COVID-19 developed a form of the disorder, one analysis found.

Mitigation / Suppression:

COVID vaccine is heading to pharmacies: An additional 1 million doses of COVID-19 vaccine will be shipped to about 6,500 pharmacies across the U.S. next week, adding to the 10.5 million weekly doses allotted to states by the federal government. The policy, announced by the Biden administration yesterday, enlists CVS, Walgreens, Walmart, Rite Aid, Costco, and supermarket pharmacies to administer the new vaccinations the way they’ve given flu shots and shingles vaccines in the past. The partnership with drugstores, announced by the Trump administration last November, is expected to grow to 40,000 pharmacies. Current coronavirus coordinator Jeff Zients said a priority will be getting the vaccine to communities of color suffering a disproportionately high toll of disease and deaths from the virus.

Johnson & Johnson announces results from Phase 3 trial: On Friday, Johnson & Johnson  announced efficacy and safety data from an international Phase 3  clinical trial, demonstrating that the investigational single-dose COVID-19 vaccine met all primary and key secondary endpoints. Results from the phase 3 trial of Johnson & Johnson's single-dose COVID-19 vaccine show it is overall 66% effective in preventing moderate to severe symptoms of COVID-19. The vaccine was 85% effective in preventing COVID-19-related hospitalizations and deaths. The vaccine requires only one dose, can be manufactured in billions of doses, and requires only standard refrigeration. Johnson & Johnson, which developed the vaccine is expected to file for emergency use authorization with the FDA next week. If approved, the vaccine would be available in the United States as soon as late February. As part of Operation Warp Speed, Johnson & Johnson is set to deliver 100 million doses to the US federal government by Jun 1.

Oxford-AstraZeneca Vaccine: On Tuesday, Oxford-AstraZeneca announced that their vaccine not only protects people from serious illness and death but also notably slows the transmission of SARSCoV2 by nearly 2/3rds (preprint). They also announced that a  single dose of the vaccine provided strong protection against COVID-19 in clinical trials when its second shots were delayed by at least three months. Among clinical trial participants who got two standard-strength doses at least three months apart, the vaccine was 82 percent effective, compared to 55 percent effective when the doses were given less than six weeks apart.

COVID-19: Surge Testing for the South Africa Variant Begins in England: From Monday 1 February, everyone over 16 living in eight postcode areas is being strongly encouraged to take a COVID-19 test, even if they do not have any symptoms. Mobile testing units will be deployed to offer polymerase chain reaction swab testing to people who have to leave their home for work or essential reasons, and additional home test kits will be supplied.

A Fast, At-home Coronavirus Test Will be Available to Americans This Year: The White House announced Monday it is buying 8.5 million rapid coronavirus tests that can be taken at home without a prescription and that yield immediate results. The $231.8 million contract will allow the Australian company Ellume, which manufacturers the tests, to quickly scale up its production and create a manufacturing facility in the United States. Once running, that factory will be able to produce 19 million tests per month.

How to Redesign COVID Vaccines so They Protect Against Variants (Nature): As evidence grows that new variants of the SARS-CoV-2 coronavirus can evade immunity produced by vaccines or previous infections; scientists are exploring the idea of redesigning the vaccines currently being rolled out worldwide. Researchers are still debating whether the new variants could undercut the effectiveness of these first-generation COVID-19 vaccines. But some vaccine developers are charging forward with plans to update their shots so that they could better target the emerging variants, such as those identified in South Africa and Brazil. Researchers are also considering the possibility that vaccines against the coronavirus might have to be updated periodically, as they are for influenza.

Corporate:

FDA places all alcohol-based hand Sanitizers from Mexico on import alert: Hand sanitizers from Mexico containing a toxic form of alcohol have been placed on import alert by the FDA, based on a concerning increase the agency has seen in products labeled to contain ethanol that actually have methanol as an ingredient. Methanol, or wood alcohol, can be toxic when absorbed through the skin. Methanol is not acceptable as a hand sanitizer. Methanol-contaminated hand sanitizers have been implicated in blindness, cardiac effects, effects on the central nervous system, hospitalizations, and death. Exposure can result in nausea, vomiting, headache, blurred vision, permanent blindness, seizures, coma, permanent damage to the nervous system, or death. Young children who ingest these products and adolescents and adults who drink them as an alcohol substitute are most at risk.

COVID’s Mental-health Toll: How Scientists Are Tracking a Surge in Depression (Nature): As the COVID-19 pandemic enters its second year, new fast-spreading variants have caused a surge in infections in many countries, and renewed lockdowns. The devastation of the pandemic — millions of deaths, economic strife, and unprecedented curbs on social interaction — has already had a marked effect on people’s mental health. Researchers worldwide are investigating the causes and impacts of this stress, and some fear that the deterioration in mental health could linger long after the pandemic has subsided.

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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Newsletter written by WorkSTEPS CMO Dr. Ben Hoffman and WorkSTEPS’ expert medical team.

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