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Questions And Answers

Contact Tracing

The CDC recommends: “If testing cannot be obtained, the child should be considered a presumed case of COVID-19 and should isolate according to CDC’s recommendations for discontinuation of home isolation.”

Source: CDC

If someone who is exposed (close contact) and is in quarantine develops symptoms, they should be tested. If they test positive, they become a COVID-19 case and should proceed with isolation for 10 days from symptoms onset. If testing is not available, the person should be managed as a probable COVID-19 case.

Source: CDC

“Asymptomatic contacts testing negative should self-quarantine for 14 days from their last exposure (i.e., close encounter with confirmed or probable COVID-19 case)”

Testing negative is helpful for contact tracing and informing others. However, it does not allow someone to end quarantine early because that person may still become symptomatic after being tested. Therefore, they must wait the full 14 days in quarantine.

Source: CDC

A person becomes a confirmed case when they test positive for COVID-19. Until then, they remain a “close contact” if they have been exposed.

Source: CDC

Yes. Close contacts are people who have been exposed to someone with COVID-19. Testing is recommended in order to determine if the close contact is also contagious (ie. infected). This helps complete the process of contact tracing and inform others of their exposure.

On August 24th, 2020, the CDC changed its recommendation on testing close contacts, suggesting that it is not required and close contacts could just isolate. This was a highly criticized change in protocol. Multiple specialty societies have recommended the CDC return to its previous recommendation. For our purposes, we continue to recommend testing of all close contacts as there are numerous repercussions to employees, students, and teachers.

Here is a good summary about the CDC decision controversy: USA today

“For COVID-19, a close contact is defined as any individual who was within 6 feet of an infected person for at least 15 minutes starting from 2 days before illness onset (or, for asymptomatic patients, 2 days prior to positive specimen collection) until the time the patient is isolated.”

Source: CDC

When a person tests positive for COVID-19, all close contacts are considered exposed and should quarantine for 14 days. A close contact is defined as:

Someone who was within 6 feet of an infected person for at least 15 minutes starting from 2 days before illness onset (or, for asymptomatic patients, 2 days prior to specimen collection) until the time the patient is isolated..”

Source: CDC

Contact tracing is a process of determining which people have been exposed to someone with an infectious disease. The process is not new. It was adapted to COVID-19 in order to track those exposed, inform them, and monitor their symptoms in hopes of reducing spread of the infection.

Employees

The CDC recommends the following protocol when an employee has symptoms of COVID-19 or a positive test:

  1. Close areas where the employee spent most of their time. Closure is for 24 hors or as long as feasible, to allow time for droplets to fall from the air and reduce chances of infecting others.
  2. Clean surfaces – anything that is obviously soiled should be cleaned with soap and water before disinfection.
  3. Disinfect surfaces with an EPA approved chemical. Be sure to read the label for details about how long surfaces must be wet with the chemical in order to disinfect SARS-CoV-2.
  4. Inform any other employees who may have been exposed (less than 6 feet apart for 15 minutes or more), and be sure they do not return to work until their 14 day quarantine has been completed.

Source: CDC

Yes. The U.S. Equal Employment Opportunity Commission (EEOC) enforces the workplace anti-discrimination laws, which include the Americans with Disabilities Act (ADA) and the Rehabilitation Act. The ADA allows an employer to test an employee for COVID-19 if they are symptomatic. There are a few stipulations:

  • Employees should be symptomatic.
  • Temperature checks can be conducted.
  • Employees can be asked to stay home if they are symptomatic.
  • Employers may ask for a doctor’s note to return to work.
  • Employers may administer a COVID-19 test before allowing employees into the workplace (though this is not currently recommended by the CDC).
  • Employers may not require antibody testing of employees, since the CDC does not recommend this practice.
  • Employers must store medical information (testing data, volunteered information, and temperature) in s separate secure file.

More information is available directly from the EEOC here:

The CDC discusses testing of asymptomatic employees (no symptoms and no exposure) for areas experiencing “moderate to substantial community transmission” in these circumstances:

  • Workplaces where physical distancing is difficult and workers are in close contact (within 6 feet for 15 minutes or more) with co-workers or the public
  • Workplaces in remote settings where medical evaluation or treatment may be delayed
  • Workplaces where continuity of operations is a high priority (e.g., critical infrastructure sectors)
  • Workplaces providing congregate housing for employees (e.g. fishing vessels, offshore oil platforms, farmworker housing or wildland firefighter camps)

Approaches may include initial testing of all workers before entering a workplace, periodic testing of workers at regular intervals, and/or targeted testing of new workers or those returning from a prolonged absence.”

Source: CDC

Testing is necessary for a symptomatic child or staff member if they wish to return to school in less than 10 days, the isolation period for a symptomatic person.  However, there are repercussions to fellow students and teachers in the same classroom. All of them are presumed to be “exposed” and should be quarantined for 14 days, unless a negative test result is obtained.  This is the reason that testing is highly recommended by schools and businesses whenever someone is symptomatic. Many municipalities offer free testing. More information is typically available from the local Department of Health.

No, not yet. A sick employee should be sent home. If they demonstrate symptoms of COVID-19, testing is STRONGLY recommended. If that test result is positive, then closure of the work area for cleaning and quarantine of exposed employees should begin. All CDC quarantine protocols begin with a positive viral test result.

Fever

The CDC defines a temperature >100.4 F as a fever.

New York State Health Department guidelines for COVID currently use 100.0 F or more as the definition for fever.

Anytime there is a question about the accuracy or trend of a temperature, it should be rechecked, preferably with a different thermometer.

Temperature screening is important for all settings. In addition, the ability to perform rapid, touch-less temperature measurement has become critical. There are numerous infra-red thermometers now approved by the FDA for human temperature measurement. This has raised the question: How should we be measuring temperature?

Temperature can be checked several ways: oral, rectal, axillary (arm pit), forehead, ear, and wrist.

The loner answer is that it depends on the thermometer. When manufacturers apply for FDA approval, they submit testing data for specific measurement type. This is the same information used to provide instructions to consumers when they purchase the product. Look in the package insert and read the directions carefully. They will specify:

  • Method of measurement.
  • How far away to stand, if touch-less type.
  • Ideal environmental conditions: indoor, outdoor with no wind, etc.
  • Accuracy of the device when compared to a standard measurement, typically oral.

If you are considering changing how you measure a temperature, be sure to consult the package insert to be sure that method has been approved by the FDA for the device you are using. For more on this topic, see the FDA website here.


This study suggests that primary screening with an infra-red thermometer be conducted by forehead. Then, if any temperature over 96.8f(36c) is measured, a follow tympanic (ear) infra-red temperature should be conducted with a cut-off of 100.4f (38c)

Chen HY, Chen A, Chen C. Investigation of the Impact of Infrared Sensors on Core Body Temperature Monitoring by Comparing Measurement Sites. Sensors (Basel). 2020;20(10):2885. Published 2020 May 19. doi:10.3390/s20102885


Another interesting study. This one, also from China, studied temperature measurements from the forehead and wrist using infra-red thermometers compared with tympanic. They also grouped patients into several categories: indoors, after bicycling, after walking, after driving, and after riding in a vehicle. Wrist measurement was more accurate outdoors but forehead measurements were still acceptable. They postulated this is because the wrist was covered by clothing. Outdoor temp during the study was 44f (7c). Indoors, forehead temperature measurement performed slightly better than wrist. They concluded both are adequate for screening large populations rapidly.

Validity of Wrist and Forehead Temperature in Temperature Screening in the General Population During the Outbreak of 2019 Novel Coronavirus: a prospective real-world study

Ge Chen, Jiarong Xie, Guangli Dai, Peijun Zheng, Xiaqing Hu, Hongpeng Lu, Lei Xu, Xueqin Chen, Xiaomin Chen, medRxiv 2020.03.02.20030148

HVAC

HVAC stands for Heating, Ventilation, and Air Conditioning. It is the acronym used to describe the equipment used to maintain air temperature and quality in buildings and homes.

The CDC and healthcare organizations utilize recommendations from the American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE).

HVAC filters are rated by their Minimum Efficiency Reporting Value (MERV). Filters are rated on a scale of 1-16. ASHRAE recommends a minimum of MERV 13 rated filters, but notes that 14 or higher is “preferred”. A MERV 13 filter can provides 90% efficiency at trapping particles between 3-10 um and 85% efficiency for particles 1-3 um. The SARS-CoV-2 virus is approximately 0.12 um in size. However, it travels in droplets expelled by humans. These droplets are larger, predominantly 1um in size. It is important to keep in mind that increasing the MERV rating of your HVAC filter places additional stress on your system because it provides more resistance to air flow. Consultation with your HVAC professional is recommended.

Source: ASHRAE

HEPA filters exceed MERV 16 rating and are at least 99.97% efficient at filtering 0.3 μm particles. To function properly in an HVAC system, they must be sealed in place to prevent air leaking around the filter.

Source: ASHRAE

Yes. UV light is used in several scenarios to kill SARS-CoV-2, the virus that causes COVID-19.  UV light has been shown to be effective in decontaminating masks (article).  UV light is also used in these methods:

  1. Mobile UV light units for hospital room disinfection.
  2. “Upper Air” UV light installed near the ceiling and facing away from people, in order to sterilize air in a room.
  3. Installed directly within HVAC units to sterilize the air.

Source: ASHRAE and ASHRAE 

Air Changes Per Hour (ACH) is the number of times the total air in a room is changed. This number has slowly increased in healthcare settings. An article from 2018 examined common operating room practices and confirmed that higher air change rates resulted in lower infectious particles in the air.  “Due to variations in state building codes, 15 or 20 air changes per hour (ACH) may be the minimum required. However, in practice, most hospitals operate at 20 to 25 ACH with some using up to 40 ACH. These rates are all up from 12 ACH, which was the requirement for many years. By comparison, the requirement for patient rooms is 6 ACH. “

Source: American Society for Healthcare Engineers article in Health Facilities Management

No. In fact, outdoor air is believed to be less contagious than indoor air. The fresh air circulation and UV light outdoors is thought to be healthier and less likely to result in infection with COVID-19. Physical distancing, at least 6 feet, is still recommended even when outdoors.  For more information on visiting parks, see CDC.

No. Free standing HEPA filter units can be used to augment your standard HVAC filtration. These units have are sized for specific room dimensions. Be sure to you know your room size when making these purchases.

Masks

There is a product that has obtained FDA approval for use as a simple surgical mask in a healthcare setting. They also have the mask available for use by non-medical people. It has a plastic window with a foam sponge like material at the nose and chin to create a barrier in front of the mouth. The barrier is clear and allows for people to view the mouth of the person wearing the mask. This brand is not affiliated with Admin EM, nor do we obtain any financial incentive by promoting here. It is pictured for discussion purposes. We were recently asked if we recommended it.

clear-mask-transparent-surgical-mask-fda.png
https://www.theclearmask.com/

It’s an interesting mask. It has FDA approval as a barrier (simple mask) and is approved for use in the operative setting in hospitals. Interestingly, there is no real difference between the medical and non-medical versions other than a change in process for how they are made. (According to the web site). 

  • Is it adequate as a simple mask? Yes 
  • Is it comfortable? We don’t know. We have not been able to obtain a sample for comfort testing.
  • Does it serve its purpose for people with disabilities or special instruction? Definitely 
  • Would we recommend it over a cloth mask with 2 layers of cotton? Probably not. For these reasons:
    1. It can not be reused or washed
    2. It is primarily plastic, which may me increase sweating and condensation (remember, not tested by us)
    3. A plastic disposable mask has potential to creates a lot of waste.

So yes. It has approval as a simple surgical mask and could be helpful for teachers providing instruction requiring someone to see their face, but it will have some drawbacks. However, safety does not appear to be an issue.

Cloth masks should be washed daily. Most can be laundered in a standard laundry machine. Some require hand washing with simple soap and water instead. Instructions are typically supplied with the mask.

Masks are an expected part of any COVID-19 re-opening plan, especially school re-opening. Recommendations from the CDC and American Academy of Pediatrics (AAP) are for all children 2yo and older to wear masks. There are exclusions for children who have a medical conditions that would prevent mask use. The AAP notes “Children with severe cognitive or respiratory impairments may have a hard time tolerating a cloth face covering. For these children, special precautions may be needed.” It is our recommendation that school guidelines allow parents to exclude children from mask use only if they provide a written note from their primary care physician / pediatrician, noting that the child is unable to comply. In these situations, children and parents may consider an alternative face covering, like a shield, or make arrangements for virtual learning.

The most important part of a mask is the fit. The mask should be the correct size (adult, child). It should be worn over the mouth and nose. If there is a metallic bar at the nose, this should be lightly pinched to take the shape of the bridge of the nose. Ear loops go around the ear and the bottom of the mask should extend past the chin. The mask should fit snugly. Once in place, a mask should not be touched. Hands should be sanitized (washed or use hand sanitizer) each time the mask is touched and after removing it.

Removing a mask correctly prevents you from contaminating your hands. Masks should be removed by removing the straps around the ears and avoiding the outside of the cloth covering. Once removed, hands should be decontaminated (hand sanitizer or wash hands).

A recent study from Duke University showed that simple masks can be effective at reducing droplet spread. Among the materials tested, surgical masks worked best, followed by simple two layer cotton. Fleece material seemed to disperse large droplets into smaller ones and seemed to cause more dispersion than no mask at all.

Masks that have a valve or vent are not recommended. For COVID-19, masks serve two purposes:

  1. Prevent spread of infection from the person wearing the mask to others.
  2. Prevent the wearer from becoming infected.

Masks that have ventilation valves reduce the humidity inside the mask and improve comfort. However, they bypass the filtering capability of the mask when the wearer exhales. So, air that the person is breathing out does not go through the filter, which does not achieve the first goal of mask wearing, listed above.

Masks should be changed anytime they are soiled or hard to breathe through.

Cloth masks can be laundered in a laundry machine with regular detergent and dried in a standard clothes dryer. Alternatively, they can be washed by hand:

  • Prepare a bleach solution by mixing:
    • 5 tablespoons (1/3rd cup) household bleach per gallon of room temperature water or
    • 4 teaspoons household bleach per quart of room temperature water
  • Check the label to see if your bleach is intended for disinfection. Some bleach products, such as those designed for safe use on colored clothing, may not be suitable for disinfection. Ensure the bleach product is not past its expiration date. Never mix household bleach with ammonia or any other cleanser.
  • Soak the mask in the bleach solution for 5 minutes.
  • Rinse thoroughly with cool or room temperature water.

Source: CDC

Yes. At this time, we do not know if people are capable of being infected more than once. Therefore, the CDC recommends everyone wear a mask in public, even those who have recovered from COVID-19. Source: CDC

A person does not require a mask when they are more than 6 feet apart in a well ventilated area (ideally outdoors).

There is no evidence of harm from simple cloth masks, in children or adults. That said, the CDC and American Academy of Pediatrics do make the following recommendations: Cloth face coverings should not be placed on:

  • Children younger than 2 years old.
  • Anyone who has trouble breathing or is unconscious.
  • Anyone who is incapacitated or otherwise unable to remove the cloth face covering without assistance.

CDC recommendations are for all children 2 yo and older to wear cloth masks. More details are available here. Additionally, the American Academy of Pediatrics has similar recommendations for mask use, here.

Other

The CDC publishes a list of “high touch surfaces” that includes the following:

  • Tables
  • doorknobs
  • light switches
  • countertops
  • handles
  • desks
  • phones
  • keyboards,
  • toilets
  • faucets
  • sinks

However, there are additional everyday items and areas that we touch often which have been shown to be contaminated with bacteria and viruses.

Personal / Home

  • Cellphones
  • Remote Control
  • Dish Sponge
  • Toothbrush Holder
  • Dog Toys
  • Money
  • Purse / Wallet
  • Kitchen Towel
  • Birthday Cake (blowing out candles)

Office

  • Elevator Buttons
  • Desks
  • Door Handles
  • Computer Keyboard
  • Telephone
  • Printer / Fax / etc.
  • Outside of a Water Cooler
  • Coffee Maker
  • Coffee Pot Handle
  • Coffee Cups
  • Sink Faucet Handle
  • Microwave Handle
  • Restrooms

Restaurant

  • Menus
  • Touchscreens
  • Ice Cubes
  • Lemon Wedges
  • Buffets
  • Salad Bar
  • Cafeteria Trays
  • Condiment Bottles
  • Soap Dispenser
  • Chairs

Miscellaneous

  • Gas Pump Handles
  • Mailbox Handles
  • Escalator Rails
  • ATM Buttons
  • Parking Meters
  • Crosswalk Buttons
  • Vending Machines

Sources: CDC, ABC News , Web MD

There is discussion on social media regarding the possibility of touchless thermometers causing harm to a gland that sits beneath the brain, the pineal gland. Though very scientific sounding, this rumor is incorrect. Touchless thermometers do not emit radiation. They have an infrared detector. They detect surface temperature in the direction they are pointed. No “waves” or “emission” is projected and nothing penetrates the skin.

More on these devices can be found on the FDA approval page and in this press release.

Yes. UV light is used in several scenarios to kill SARS-CoV-2, the virus that causes COVID-19.  UV light has been shown to be effective in decontaminating masks (article).  UV light is also used in these methods:

  1. Mobile UV light units for hospital room disinfection.
  2. “Upper Air” UV light installed near the ceiling and facing away from people, in order to sterilize air in a room.
  3. Installed directly within HVAC units to sterilize the air.

Source: ASHRAE and ASHRAE 

Yes, there is limited utility to plexiglass barriers. Though they have been used frequently in businesses, and schools abroad, these barriers provide only one dimension of protection. They are capable of blocking direct spray aimed at the barrier. If they are built floor-to-ceiling, they can provide more robust protection. However, they are not meant to replace requirements for masks. In some instances, schools have installed these on tables where students remove their masks to eat. Some have also use these to provide some physical barrier where distancing can not be accomplished (< 6 feet). However, plexiglass barriers can not prevent droplets and aerosols moving in the air around the barrier. So their use for COVID-19 does not replace the need for mask use.

If you work in a school classroom, gloves are generally necessary only when cleaning up body fluids. If you work at a different business, you may be asked to wear gloves more often. When you have gloves on, there are some things you should keep in mind:

  • You don’t get the same feedback with gloves on as you do with bare hands. You might not be able to tell your hands gave gotten wet so there is a greater risk of contaminating other surfaces you touch with your gloves on.
  • You must change gloves each time you change your activity.
  • You may not reuse disposable gloves.
  • If you are not cleaning up body fluids and you are using skin friendly chemicals (see container label) you don’t need gloves
  • Decontaminate your hands with hand sanitizer or soap and water after using gloves, in case they were accidentally contaminated when removing the gloves.

Quarantine

“Quarantine” refers to the 14 day period someone has to be home and away from others, after being exposed to someone with COVID-19. “Isolation” is the 10 day period someone stays home after having a positive COVID-19 test. Many sources will use these terms interchangeably. It is important to clarify if the topic being discussed is exposure or infection.

The CDC still recommends a full 14 days of quarantine at home after being exposed to someone with COVID-19.

An exposure is defined as being less than 6 feet away from someone with COVID-19 for at least 15 minutes. Important: for those working in New York State, the Dept. of Health uses a 10 minute timeframe instead.

Yes, the exposed person still has to complete a full 14 day quarantine even if they test negative for COVID-19. Tests provide a momentary snapshot of infectivity. That means the test only tells you if you are infected at the moment the test is taken. Thought most cases of COVID-19 present within 5-7 days after exposure, it can take up to 14 days. A negative test during this period does not mean symptoms and disease will not develop before the 14 days are complete.

The CDC recommends the following protocol when an employee has symptoms of COVID-19 or a positive test:

  1. Close areas where the employee spent most of their time. Closure is for 24 hors or as long as feasible, to allow time for droplets to fall from the air and reduce chances of infecting others.
  2. Clean surfaces – anything that is obviously soiled should be cleaned with soap and water before disinfection.
  3. Disinfect surfaces with an EPA approved chemical. Be sure to read the label for details about how long surfaces must be wet with the chemical in order to disinfect SARS-CoV-2.
  4. Inform any other employees who may have been exposed (less than 6 feet apart for 15 minutes or more), and be sure they do not return to work until their 14 day quarantine has been completed.

Source: CDC

Yes. There are several states that have travel restrictions in place, requiring citizens to quarantine after traveling to “hot spot” states. This information is cataloged by individual states, and also by several non-government sources. One free resource is the New York Times article here. Even if your state does not have a mandatory travel restriction, isolation after travel is a good idea and recommended by the CDC. Travel increases risks of exposure and symptoms may not appear for up to 14 days.

No, not yet. A sick employee should be sent home. If they demonstrate symptoms of COVID-19, testing is STRONGLY recommended. If that test result is positive, then closure of the work area for cleaning and quarantine of exposed employees should begin. All CDC quarantine protocols begin with a positive viral test result.

Screening

The CDC lists the following symptoms for COVID-19:

  • Fever or chills
  • Cough
  • Shortness of breath or difficulty breathing
  • Fatigue
  • Muscle or body aches
  • Headache
  • New loss of taste or smell
  • Sore throat
  • Congestion or runny nose
  • Nausea or vomiting
  • Diarrhea

A student who is sent home for a “runny nose”, is a student who is displaying symptoms of COVID-19.  When this student is sent home, they are expected to isolate for 10 days and then return IF symptoms have been gone for 72 hours without medication.  This last stipulation “If symptoms have been gone for 72 hours without medication” is meant to prevent a student from returning in 10 days while still having fever, cough, congestion, etc. Mosts people will be symptom free in 10 days, but if not, they are to stay home until symptoms are gone for 72 hours.  The stipulation is not meant to suggest that the student could return at any point once symptoms have been gone for 72 hours. They must wait at least 10 days, and the last 3 days of isolation must be symptom free.  If a parent is questioning the need to isolate someone with a “runny nose”, it is important to frame the question as a “student displaying symptoms of COVID-19”.  Additionally, it is highly encouraged that the symptomatic student be tested. If negative, that student may return to school sooner than 10 days.

See COVID-19 Algorithm

In this scenario, there are a couple of options. First, always check with your local Dept. of Health.  Let’s review the scenario:

  1. The student was not exposed.
  2. The student’s sibling is the one who was exposed.
  3. The student and sibling have no symptoms.
  4. The family physician / pediatrician is having the student’s sibling tested.

The CDC says the following:

” If you have been around someone who was identified as a close contact to a person with COVID-19, closely monitor yourself for any symptoms of COVID-19. You do not need to self-quarantine unless you develop symptoms or if the person identified as a close contact develops COVID-19.”

So our answer is that the student does not have to quarantine because the sibling was exposed. For return to school, you have a couple of options:

1)  Student may return tomorrow as long as the student and sibling remain asymptomatic.  (reasonable)

2) Since the sibling is being tested, student should stay home until the sibling’s test result is negative, since they live in the same household and are likely hard to keep apart. (most cautious)

The CDC recommends the following protocol when an employee has symptoms of COVID-19 or a positive test:

  1. Close areas where the employee spent most of their time. Closure is for 24 hors or as long as feasible, to allow time for droplets to fall from the air and reduce chances of infecting others.
  2. Clean surfaces – anything that is obviously soiled should be cleaned with soap and water before disinfection.
  3. Disinfect surfaces with an EPA approved chemical. Be sure to read the label for details about how long surfaces must be wet with the chemical in order to disinfect SARS-CoV-2.
  4. Inform any other employees who may have been exposed (less than 6 feet apart for 15 minutes or more), and be sure they do not return to work until their 14 day quarantine has been completed.

Source: CDC

This is a good question. Effectively, what we are asking here is “Does a person have to have all the symptoms of COVID-19 to be told to stay home? Some of these are minor symptoms”. It is true that some of these are more common. Things like a runny nose and cough are very common. Muscle aches and fatigue are not as common in young children. If there is no good explanation for the symptoms, a “stay at home” recommendation is warranted. Interestingly, the CDC was very selective in which symptoms they include in their symptom screening.  If a school performs symptom screening, something the CDC is recommending only after reviewing local infection trends in an area of high transmission, here are the symptoms they utilize:iconTemperature 100.4 degrees Fahrenheit or higher when taken by mouth

  • Sore throat
  • New uncontrolled cough that causes difficulty breathing (for students with chronic allergic/asthmatic cough, a change in their cough from baseline)
  • Diarrhea, vomiting, or abdominal pain
  • New onset of severe headache, especially with a fever

The reference to “New” is meant to exclude those children who have chronic symptoms due to migraines, asthma, and allergies. It is a difficult population of people to screen regularly. Parents of these children should be informed that this season will bring challenges like frequent absences and that visit with their pediatrician to discuss better symptoms control, may be helpful prior to start of school.

No, not yet. The student should be isolated in a room away form others if they develop symptoms while at school. Once that happens a parent is called to pick up the child and COVID-19 testing is STRONGLY recommended. Based on the results of testing, decisions need to made about quarantine of the other students in the classroom and the teacher. Current CDC recommendations for quarantine begin with someone who has a positive viral test result for COVID-19.

No, not yet. A sick employee should be sent home. If they demonstrate symptoms of COVID-19, testing is STRONGLY recommended. If that test result is positive, then closure of the work area for cleaning and quarantine of exposed employees should begin. All CDC quarantine protocols begin with a positive viral test result.

Testing

The CDC recommends: “If testing cannot be obtained, the child should be considered a presumed case of COVID-19 and should isolate according to CDC’s recommendations for discontinuation of home isolation.”

Source: CDC

Antibody tests detect the presence of IgM (early antibody) or IgG (late antibody). Both antibodies form against SARS-Cov-2, the virus that causes COVID-19. However, it may be up to 14 days from symptom onset before IgM is detectable, and up to 4 weeks before IgG is detectable. Therefore, a negative test can only reliably determine that a person had the infection in the past. It can not determine if someone was infected in the past two weeks.

Additionally, antibody tests suffer from false positive rates as high as 40% depending on the prevalence of the disease in the area (city, county). So careful interpretation is required.

Source: Infectious Disease Society of America (IDSA)

Current tests fall into 3 categories:

  1. Molecular tests – these detect genetic material from SARS-CoV-2, and are used to diagnose COVID-19. Usually a nasal swab though one saliva test is now available.
  2. Antigen tests- these are rapid tests that detect certain proteins associated with SARS-CoV-2. Though rapid, they are less reliable. A negative test is not as good at excluding COVID. A positive test is accurate. Usually a nasal swab.
  3. Antibody test- these detect antibodies (IgM and IgG) formed against SARS-CoV-2. They are not used to diagnose COVID, but to determine if a person might have been infected in the past.

No. Antibody tests detect the presence of two antibodies against SARS-CoV-2, IgM and IgG. IgM is the first antibody to be formed. IgG is delayed by weeks. However, not all patients who become infected with COVID-19 will develop antibodies. Therefore, a negative antibody test does not mean a patient has not been infected, AND a positive antibody test does not tell us if a person is still infectious. Though it may have a role in epidemiology studies or certain clinical situations, this test should not be used to exclude current infection.  For more information: FDA

A molecular test (typically nasal swab) is the best, most reliable test to determine if someone is currently infected with COVID-19. This test is more reliable than antigen testing. It detects the genetic material of the SARS-CoV-2 virus, in a person’s nose. Recently, a saliva test has also become available.  Further reading: CDC

Yes. The U.S. Equal Employment Opportunity Commission (EEOC) enforces the workplace anti-discrimination laws, which include the Americans with Disabilities Act (ADA) and the Rehabilitation Act. The ADA allows an employer to test an employee for COVID-19 if they are symptomatic. There are a few stipulations:

  • Employees should be symptomatic.
  • Temperature checks can be conducted.
  • Employees can be asked to stay home if they are symptomatic.
  • Employers may ask for a doctor’s note to return to work.
  • Employers may administer a COVID-19 test before allowing employees into the workplace (though this is not currently recommended by the CDC).
  • Employers may not require antibody testing of employees, since the CDC does not recommend this practice.
  • Employers must store medical information (testing data, volunteered information, and temperature) in s separate secure file.

More information is available directly from the EEOC here:

The CDC discusses testing of asymptomatic employees (no symptoms and no exposure) for areas experiencing “moderate to substantial community transmission” in these circumstances:

  • Workplaces where physical distancing is difficult and workers are in close contact (within 6 feet for 15 minutes or more) with co-workers or the public
  • Workplaces in remote settings where medical evaluation or treatment may be delayed
  • Workplaces where continuity of operations is a high priority (e.g., critical infrastructure sectors)
  • Workplaces providing congregate housing for employees (e.g. fishing vessels, offshore oil platforms, farmworker housing or wildland firefighter camps)

Approaches may include initial testing of all workers before entering a workplace, periodic testing of workers at regular intervals, and/or targeted testing of new workers or those returning from a prolonged absence.”

Source: CDC

Testing is necessary for a symptomatic child or staff member if they wish to return to school in less than 10 days, the isolation period for a symptomatic person.  However, there are repercussions to fellow students and teachers in the same classroom. All of them are presumed to be “exposed” and should be quarantined for 14 days, unless a negative test result is obtained.  This is the reason that testing is highly recommended by schools and businesses whenever someone is symptomatic. Many municipalities offer free testing. More information is typically available from the local Department of Health.

No, not yet. The student should be isolated in a room away form others if they develop symptoms while at school. Once that happens a parent is called to pick up the child and COVID-19 testing is STRONGLY recommended. Based on the results of testing, decisions need to made about quarantine of the other students in the classroom and the teacher. Current CDC recommendations for quarantine begin with someone who has a positive viral test result for COVID-19.

No, not yet. A sick employee should be sent home. If they demonstrate symptoms of COVID-19, testing is STRONGLY recommended. If that test result is positive, then closure of the work area for cleaning and quarantine of exposed employees should begin. All CDC quarantine protocols begin with a positive viral test result.

Vaccines

A clinical trial is study designed to test a drug, a device, or a new test (blood test, imaging, etc) in human beings. The purpose is to determine if the item being tested does what it is supposed to do, how well it does it, and its safety. In order to test something on human beings, manufacturers have to prove that the drug has the desired effect in the laboratory and in animal models. In the United States, the FDA approves drugs for human testing after reviewing this data.

Once approved by the FDA, the clinical trials proceed through 3 phases:

  1. The first phase is a small test in healthy volunteers. typically less than 100 people. This helps determine dosing and initial safety in order to proceed to the next phase.
  2. The second phase typically involves people with the disease process targeted by the drug, or in the case of a vaccine, people who are healthy but susceptible because of where they live, work, or other risks. This phase involves up to several hundred people and can take up to 2 years depending on the how prevalent the disease may be.
  3. The third phase once again involves those who have the condition or are susceptible, but the group is larger. Groups can be 300-3000 or more and this phase may take up to 4 years, depending on the disease prevalence. Typically half the group receives the study drug and the other half receives a placebo. This phase is intended to determine common side effects of the drug as the groups get larger. Current U.S. phase 3 trials involve groups as large as 30,000 and will track data as long as 2 years. However, a drug can be approved before the end of phase 3 once sufficient data has been gathered.
  4. The fourth phase is rarely mentioned because it begins after approval. However, it is a very important part of the approval process. It requires manufacturers to continue surveillance for side effects and safety of the drug. At this point, groups of people are in the thousands.

More information about the FDA clinical trial approval process can be found here.

Anyone who travels away from their home and community has a higher chance of coronavirus exposure. There is no way to quantify the risk by type of travel, but the CDC has gone to some lengths to try to quantify risk by destination.

The CDC is tracking cases in the U.S. here and displays them by color. Any state with a case positivity over 5% is at increased risk and is not considered to have “controlled” transmission.

In addition, the CDC no longer has a blanket recommendation against international travel, but instead has an individual risk level for each country based on available case data. That information is available here.

Regardless of where you travel, you will need to quarantine for 14 days. The CDC guidance states:

You may have been exposed to COVID-19 on your travels. You may feel well and not have any symptoms, but you can be contagious without symptoms and spread the virus to others. You and your travel companions (including children) pose a risk to your family, friends, and community for 14 days after you were exposed to the virus. Regardless of where you traveled or what you did during your trip, take these actions to protect others from getting sick after you return:

  • When around others, stay at least 6 feet (about 2 arms’ length) from other people who are not from your household. It is important to do this everywhere, both indoors and outdoors.
  • Wear a mask to keep your nose and mouth covered when you are outside of your home.
  • Wash your hands often or use hand sanitizer (with at least 60% alcohol).
  • Watch your health and look for symptoms of COVID-19. Take your temperature if you feel sick.

Follow state, territorial, tribal and local recommendations or requirements after travel.

Source: CDC

Immunizations in the U.S. proceed through several layers of research, trials, and ongoing surveillance in order to be placed on the recommended immunization schedule.

  1. A vaccine has to progress through the clinical trial phases (1-3) and be approved by the FDA for use in children.
  2. Manufacturers of the vaccine then must test all lots to make sure they are safe, pure and potent. The lots can only be released once FDA reviews their safety and quality.
  3. The FDA performs regular inspection of vaccine production facilities.

Once in production, the Advisory Council on Immunization Practices (ACIP) reviews all available data about the vaccine from clinical trials and other studies to develop recommendations for vaccine use. This council is comprised of a group of medical and public health experts. Members of the American Academy of Pediatrics (AAP) and American Academy of Family Physicians (AAFP) are among some of the groups that also bring related immunization expertise to the committee. The ACIP continues to monitor vaccine safety and effectiveness data even after the vaccine’s routine use and may change or update recommendations based on that data. The group considers:

  • How safe is the vaccine when given at specific ages?
  • How well does the vaccine work at specific ages?
  • How serious is the disease this vaccine prevents?
  • How many children would get the disease the vaccine prevents if we didn’t have the vaccine?

ACIP recommendations are not official until the CDC Director reviews and approves them and they are published. These recommendations then become part of the United States official childhood immunization schedule.


Once added to the immunization schedule, further monitoring is performed on an ongoing basis by:

  • The Vaccine Adverse Event Reporting System (VAERS) which collects and analyzes reports of adverse events that happen after vaccination. Anyone can submit a report, including parents, patients and healthcare professionals.
  • The Vaccine Safety Datalink (VSD) which analyzes healthcare information from over 24 million people. This actively monitors vaccine safety.
  • The Post-Licensure Rapid Immunization Safety Monitoring (PRISM) which analyzes healthcare information from over 190 million people. This also actively monitors vaccine safety.
  • Clinical Immunization Safety Assessment Project (CISA) is a collaboration between CDC and 7 medical research centers. This group consists of vaccine safety experts who assist U.S. healthcare providers with complex vaccine safety questions about their patients, and conducts clinical research studies to better understand vaccine safety and identify prevention strategies for adverse events following immunization.

The CDC has a good image of this process available for download here.

SARS-CoV-2 vaccines approved by the FDA must be separately tested in children. For now, the currently tested vaccines in phase 3 are using adult volunteers. Once the vaccines are approved for use in adults, further study will have to take place in children before that approval is given. So, yes, it is anticipated that vaccines will be approved for use in children, but there will need to be another round of trials specifically aimed at children before that approval is given.

Yes. Companies like Moderna , AstraZeneca and others are producing large quantities of their vaccines in hopes that phase 3 trials will go well and approval will be granted by the FDA. This is possible due to the significant investment from governments and other entities, ahead of approval. However, this does not mean that these vaccines can be distributed or used prior to approval. But it does reduce the time it takes to make a vaccine available after approval.

There are multiple different methods that manufacturers have developed for vaccination against SARS-CoV-2, the virus that causes COVID-19. Some of these methods include:

  • mRNA vaccine: This is the type currently in phase 3 testing by Moderna. It injects messenger RNA (the building blocks of the virus) into the body, but only the part of the mRNA responsible for the proteins on the surface of the virus. This allows the body to recognize the protein and begin creating antibodies and other mechanisms to eliminate it. Once recognized, the body’s response in the future should be faster, resulting in fewer symptoms. There are numerous manufacturers using this method.
  • Virus mediated: This type requires a weakened virus, like the adenovirus which causes mild colds in humans, to carry the SARS-CoV-2 mRNA into the human body. The weakened virus is only a vehicle used to introduce the mRNA and the body’s response is the same as above. This method was used by the Chinese and Russians for development of their vaccines.
  • DNA vaccine: This type introduces DNA instead of RNA, and results in human cells creating the proteins found on the surface of the SARS-CoV-2 virus. This ultimately leads to the same immune response.
  • Inactivated and live attenuated vaccine: These types use either a completely inactivated or a weakened form of the virus to cause an immune response. This method is also being used for one of the vaccines approved in China.
  • Viral proteins: This method simply injects the full viral protein into the human body to cause an immune response.

Though there are multiple methods, the ultimate goal for all of them is to cause the human body to recognize a new protein and develop an immune response to it. This results in a faster response the next time the body sees the virus, when infected with the full version, and hopefully little to no symptoms.

More on each of the vaccines in development can be found here.

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