This past week brought lots of information surrounding COVID-19. There have been updates to algorithms and recommendations, increasing evidence of young children not being significant contributors to spread of disease, continuing outbreaks throughout the U.S. and more. Details are below. As always, this newsletter is free. If it was forwarded to you and you would like to receive it by email weekly, you may register here.
1) CDC changes exposure definition
The CDC changed its definition of exposure to COVID on Oct 21st. The change is subtle but significant. The previous definition of 6 feet and 15 minutes of exposure to someone with COVID-19 has been replaced by 6 feet and a total of 15 minutes over a 24 hour period. The AP News reported the change was in response to a CDC investigation of a correctional officer who became infected after multiple short encounters with prisoners with COVID-19. At multiple times before the prisoners were known to be infected with COVID, the correctional officer was exposed to the individual prisoners in small periods totaling 17 minutes. The prisoners were unmasked for some of that time. The change highlights the importance of mask use by all parties. It also reduces the focus on a specific time frame. The change requires updating of algorithms for contact tracing. The Admin-EM algorithms (login required) have been updated to reflect the change.
2) New York Cluster Updates
On Oct 21, Governor Cuomo announced updates to the cluster zones in Queens and Brooklyn. The updates ease restrictions and allow for more school and business openings. You can view the updated cluster zone maps here. The improvements in these zones are an important step in keeping the overall case positivity for the state below the 5% threshold and below the New York City 3% threshold for school closures.
3) CDC Holiday Recommendations
It is nearing the winter holidays and people are beginning to make Thanksgiving and Christmas plans. As you decide if your family should travel or host guests for these holidays, exposure risk of COVID-19 will enter into the decision making. The CDC has done a good job summarizing recommendations for holiday travel and celebrations. The list includes things like how to be safe while traveling, what to do if you are planning gatherings at your home, and how to decide if it is safe for you to attend a holiday gathering. Above all, it reinforces that there is no “zero” risk activity. The best defense remains a mask. Though it may feel odd to use masks with friends and family, remember that they protect you and your family members from illness, especially those at higher risk like grandparents. Continue your vigilance and consider some of the mitigation recommendations made by the CDC.
4) COVID vs Influenza
It is flu season and vaccinations are available. The return of influenza has caused some to begin comparing it to COVID once again. The CDC published a study on Oct 23rd comparing VA hospitalized patients with COVID-19 with those hospitalized for influenza. They examined the medical records of over 9000 patients in an attempt to determine the risk of complications. They found that patients hospitalized with COVID had a 5 fold higher risk of death over those hospitalized with influenza. They also had higher risks of a multitude of respiratory and non-respiratory complications. Hopefully this study settles any doubt about the severity of COVID-19 compared to the seasonal flu. As we have heard from multiple other studies, this study also found that the elderly, those with multiple medical problems, and people of Black, Latino, and Native American ethnicity had the worst outcomes.
5) Astra Zeneca Patient Death
The Brazilian National Health Authority reported that a participant in the Astra Zeneca vaccine trial died of COVID-19, according to multiple news sources . The health authority was unable to release any details regarding the patient’s medical history. They did note that a medical review board found no evidence that the vaccine trial lead to the patient’s death and did not recommend pausing the trial. Some have suggested that this means the patient was in the placebo arm of the trial, not receiving the actual vaccine. At this point, it is impossible to tell without more information. However, receiving the placebo instead of the study vaccine would be one reason why the trial would not be interrupted. The patient was 28 years old. His death is tragic and a reminder that COVID-19 can effect the young and healthy.
Both the Wall Street Journal and Reuters report that the FDA is allowing Asrta Zeneca to resume its vaccine trial in the U.S.. The report states the FDA has concluded its investigation into both cases of reported neurological symptoms in trial patients and is allowing the trial to continue. The initial case, occurring in June, was found to be related to multiple sclerosis and not a side effect of the vaccine. The second case was only reported as a “neurological problem” and no further details have been released. According to the reports, trial participants must be notified of the cases and asked to monitor for similar symptoms. No public announcement from the FDA is available yet.
6) Spread of COVID in the U.S.
COVID Act Now has published a 22 second video demonstrating the spread of COVID through the U.S. since the pandemic began. It is a powerful visual representing the reach of the disease. The visual allows us to follow the outbreaks in each portion of the country from March through September. It is a stark reminder that no part of the country is spared from this disease.
7) Asymptomatic COVID in the Elderly
A new study published in JAMA studied records of 5403 nursing home residents who tested positive for COVID-19. They found that 41% of the group remained asymptomatic, 19% were pre-symptomatic (developing symptoms later), and 40% were symptomatic at the time of testing. The study found higher numbers of asymptomatic patients in nursing homes than expected and concluded that universal testing in nursing homes is necessary in order to isolate infected patients and prevent disease spread in this vulnerable population. We know that asymptomatic cases in younger patients have been common. This is the first report of asymptomatic cases of this magnitude in the elderly.
8) Do Child Care Providers Have Increased COVID Risk?
A new study was pre-published in the journal Pediatrics. In a cooperative effort between Yale researchers, Child Care Aware of America, and Johns Hopkins, 57,000 child care providers were surveyed about COVID-19 diagnosis and symptoms between May and June 2020 to answer the question: Do child care providers have an increased risk of COVID? By comparing survey responses to background COVID disease transmission rates from the Johns Hopkins database, the Yale researchers concluded that “exposure to child care” did not increase the risk of contracting COVID. They found no difference in risk for those who were working in child care centers or staying home during the two month period. They did find that child care workers had the same risk of contracting COVID as the rest of the community, and that Black, Latino, and Native Americans carried a higher risk. This pre publication study is yet to be formally reviewed but provides more support for the theory that young children do not spread the disease more than adults and that exposure to young children does not increase your risk of contracting COVID-19. It is important to note that all those surveyed worked in child care centers using mitigation strategies like temperature checks, frequent hand washing, high touch surface cleaning and more. The study does not suggest that mitigation strategies are unnecessary, only that being a child care provider does not increase your risk of contracting COVID-19.
9) New York City School COVID Testing Results
The New York Times reported on early data from the city’s targeted testing program. The results show a significantly smaller number of positive cases in school children than the surrounding community. This is good news for schools, children, and families. It shows that re-opening schools with good mitigation standards is safe, and does not contribute to outbreaks. As the data continues to be studied, our understanding of the contribution children have in the spread of this disease will improve. Meanwhile, this is excellent news for New York City communities and teachers.
10) The Tri-State Area and COVID-19
Governor Cuomo announced he would not add New Jersey and Connecticut to the covid travel advisory list despite those states reaching the threshold for disease transmission. He noted that the connections between these states and NY were too numerous and that enforcing the quarantine would be difficult and impractical. Instead, he counseled residents to avoid non-essential travel. Currently, these states are the only exceptions to the mandatory 14 day quarantine of travelers arriving from states or countries with increased disease transmission. Forbes, NYTimes
11) John Snow Memorandum
Last week we discussed the Great Barrington Declaration and the White House embracing its description of an approach to herd immunity as a strategy to combat COVID-19. In response, a group of scientists published the John Snow Memorandum. Now with over 5000 scientists and healthcare professionals signing in support, the memorandum describes the multitude of problems with herd immunity and COVID-19. Originally published in the journal Lancet , the memorandum describes the herd immunity approach as a “…dangerous fallacy unsupported by scientific evidence.” The authors instead espouse the method of community control through mitigation strategies until vaccination is available. They note “the evidence is very clear: controlling community spread of COVID-19 is the best way to protect our societies and economies until safe and effective vaccines and therapeutics arrive within the coming months. We cannot afford distractions that undermine an effective response; it is essential that we act urgently based on the evidence.” Much like the Great Barrington declaration, this memorandum detailed its scientific basis for the opinions included but did not include significant details regarding how disease control could be achieved. We look forward to hearing more about their recommended approach.
12) Remdesivir Is Formally Approved
The FDA has formally approved Remdesivir as the first treatment for COVID-19. You may recall us discussing this antiviral drug, previously trialed with Ebola and SARS. It has been used since the beginning of the COVID-19 pandemic under emergency use authorization from the FDA. In May, the National Institute of Health reported that the drug showed benefit in reducing length of hospitalization. More recently, the World Health Organization led study found that the drug did not prevent COVID-19 deaths in hospitalized patients. The approval from the FDA represents a move from emergency use authorization to full FDA approval meaning the drug is felt to have shown benefit and is now no longer experimental therapy. Significantly, the approval is for patients 12 years and older who are hospitalized. Further study is under way for younger patients .