Another challenging week in the fight against COVID has ended. This weeks newsletter focuses on common questions surrounding teachers, vaccines, and variants. As always, if this newsletter was forwarded to you and you would like to receive it by email weekly, you may register for free here.
Last year, the federal government recognized teachers as essential employees. Since then, states have varied in their quarantine rules with regards to teachers. For example, New York State’s most recent version of its travel advisory allows essential employees some exemptions to the mandatory quarantine. However, those exemptions do not apply to teachers.
Thankfully, New York State does recognize teachers as essential employees for the purposes of vaccination. This week, teachers in NY began receiving the covid-19 vaccine. In anticipation of some teachers being vaccinated, schools are asking excellent questions:
1. When is someone considered “vaccinated” against covid-19? After the second dose of the Pfizer or Moderna vaccine. There will be others approved but for now, those are the only choices and they both require two doses. Maximum effectiveness is believed to occur 14 days after the second dose.
2. Will vaccinated teachers still need to wear masks? Yes. It is not yet known if vaccinated people are capable of transmitting disease, as carriers of the virus without being infected. Until then, teachers and others who receive the vaccine must continue with all current mitigation strategies. Masks, hand hygiene, and distancing are still required.
3. What if a teacher is exposed to someone with covid, is quarantine still required? Current understanding is that quarantine due to exposure is not necessary for anyone who has recovered from the infection or received the vaccine. Though this is not overtly stated by the CDC, it is expected to be addressed soon. It is important to note that mandated quarantine after travel varies by state. For example: Those who have already recovered or have been vaccinated are excused from quarantine after travel in NH, but are not exempt in NY. Be sure to familiarize yourself with your state’s rules.
4. What if a vaccinated teacher develops a fever or covid symptoms? Again, this has not been specifically addressed by the CDC. However, those who are vaccinated or have already recovered from COVID, have an extremely low risk of (re)infection. Therefore, appropriate application of typical fever policies is necessary. Teachers and others should stay home until symptoms have resolved, especially fever, but there is no specific isolation period required. Documentation of the vaccine or previous infection is necessary in this instance. Repeat infection in those who have recovered or infection in those who have been vaccinated is not impossible, but it is extremely rare. For healthcare personnel, the CDC recommends investigation for other sources of infection (influenza, etc).
5. What if a vaccinated teacher tests positive for COVID ? If someone who has been vaccinated or recovered from the infection, tests positive once again, they should isolate for the standard 10-14 days and until symptoms have resolved.
6. Does the vaccine effect PCR or rapid testing? No
7. Does the vaccine effect antibody testing ? Yes. Depending on the manufacturer, the vaccine may cause a test result to return positive for antibodies.
Multiple variants have now been described across the world. The U.K. was the first to define a new variant, but recently multiple others have been detected. South Africa, Brazil, Japan, and the U.S. have each also described variants of the initial virus detected in Italy at the start of the pandemic. This is not unusual for a virus, but more significant when that virus is causing an international pandemic. Some common questions about variants include:
1. Why do we care about these variants ? Reports derived from contact tracing data show that these new variants spread more easily. That is significant because it means more people become infected by each infected individual. This results in more overall cases and more congestion and capacity problems in hospitals.
2. Can variants effect testing ? Yes. Though the FDA has issued an alert to healthcare providers, current PCR tests available in the U.S. are believed to still be effective in detecting the U.K. and South Africa variants. PCR testing is capable of detecting 3 different segments of the SARS-CoV-2 viral genes. If a test only detects 1 or 2 of the 3 gene segments, this may indicate the infection is being caused by a variant.
3. Are children more susceptible to variants? The U.K. published its contact tracing and testing data for the variant in that country. It shows that this variant is more contagious but does not effect children more than adults. The proportion (percentage) of children infected compared to adults is the same. However, since the variant is more contagious, overall more children are infected.
4. Are these variants killing more people? Yes and no. Again, they are not more lethal. But if they infect more people because they can be transmitted more easily, then more people will require hospitalization and more will die. But the percent of those infected who succumb to the disease remains the same. It is important to clarify what you mean when discussing deaths as a result of variants in order to prevent confusion.
5. Are current treatments effective against the variants ? Some. Eli Lilly announced that its antibody infusion is not effective against the South Africa variant but is believed to be effective against the UK variant. Meanwhile Gilead announced it is testing its drug Remdesivir, the infusion given to the president and currently approved for hospitalized patients, against the variants.
The Johnson and Johnson Vaccine
Johnson and Johnson released the results of the phase 1 and phase 2 trials of its vaccine. The data is promising. Significant findings included a single dose showing an effective antibody response in 90% of participants. In addition, multiple doses were studied in high and low concentrations with all regimens showing an adequate response. Unlike the m-rna vaccines, participants experienced less side effects after the second dose. Phase 3 trials are ongoing and we look forward to reviewing that data when it is published.
A Physician Death
A single OB/Gyn physician developed autoimmune thrombocytopenia (a condition of critically low platelets due to an immune reaction) 16 days after receiving the Pfizer vaccine. He died due to intracranial bleeding. Further investigation is ongoing to determine if there is any connection to the vaccine. There is no other similar case reported.
This is a term that many of us are unfamiliar with, and that is a good thing. Crisis care is a name given to the scenario where the need for medical care exceeds resources. It occurs at times of disaster like earthquakes and hurricanes, when there are mass casualties and injuries and local hospitals are overrun by patients. In those scenarios, hospitals begin to ration available resources and use them on those most likely to survive. Those who do not receive needed interventions, like ventilators or certain surgical procedures, are assigned to comfort care only. Pain medication and other comfort measures are provided and death is anticipated. These scenarios also require decision making to be removed from the individual physician and placed in the hands of committees who develop policies to select patients that will receive certain therapies. This allows physicians to continue treating patients without making them personally decide which patients are given needed care.
This week, California began preparations for crisis care in the state. Hospitals were encouraged to begin selecting personnel and form committees as resources in the state reach crisis levels. ICU beds, ventilators, medications, and concentrated oxygen (tanks) are being consumed at record levels which can not be sustained. Though it is just a preparatory phase, it marks a dark moment in our healthcare history, and an ominous sign for the state.