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September 11th, 2020

Hello,

It is Sept. 11th, a day of remembrance. We hope that you are able to spend some time in peaceful reflection today. When you have time, there are a few updates in the COVID-19 arena provided for you below. As always, thank you for being a part of the Admin EM family of schools and businesses.

Sam Ashoo, MD


Contact Tracing FAQ

Many of our member schools and businesses are now open. As people test positive, questions will arise about exposures, testing, and quarantine. A new category titled “Contact Tracing” has been added to the FAQ (login required) on our website. We hope you will find it helpful.


Abbot Antibody Test

A recent article in the Lancet journal suggests that the Abbot antibody test is looking for the wrong antibody and that it is possible that “results constitute false-positive reactions”.  This test is widely utilized in the U.S. and one of two that the national health service in the UK relies upon. In the past, some have advocated for the use of antibody tests to determine if someone is infectious. We have discussed the reasons why this is not a good idea, including the FDA’s specific language against using antibody testing to determine current infection. These tests are useful to determine past infections only.  Recent studies have shown that those with antibodies against SARS-CoV-2 are likely to be immune but that re-infection with mutated strains is still possible. With the addition of this Lancet article, there will be continued calls for more study. Meanwhile, it is important for everyone, including those who have tested positive for antibodies,  to remain vigilant and continue their precautions: mask use, distancing, etc.


Astra Zeneca Halts Vaccine Trial

This week Astra Zeneca, a pharmaceutical company with a COVID-19 vaccine in phase 3 trial, announced it was halting enrollment of new patients after a case report of a possible adverse reaction. Though they released very little information about the case, other sources have indicated that the patient was a woman in the UK who received the vaccine and developed transverse myelitis. The same sources suggest this is the second time this trial has been paused to investigate a possible adverse condition. These pauses are expected and a normal part of an investigation. To date, no details regarding the cases have been published, but that is also common. Typically, a panel of experts is tasked with reviewing the ongoing safety of the trial and complete adverse reaction data is not available until it has been completed. Thought this announcement has caused considerable anxiety in the press, it is a positive sign that the manufacturer is taking each case seriously and proceeding through the normal process of investigation despite considerable pressures to produce a vaccine as fast as possible. We will keep you updated as more information is published. Meanwhile, it is too early to make any assumptions about the safety of this vaccine.


MIS-C

Multisystem Inflammatory Syndrome in Children (MIS-C) is a life threatening illness known to be caused by COVID-19. It affects people up to 20 years old and to date there have been 792 cases confirmed in the U.S. .  The bulk of the cases occur between the ages of 1-14 making it a special interest to our schools and parents. The CDC continues to track each of the cases. Most cases developed 2-4 weeks after a COVID-19 infection but there is newer evidence to suggest that it can occur during the first week of infection. Much is still unknown about this disease but it is important to know that cases are being tracked and that we are watching for any patterns related to school openings or increased COVID-19 infections in this age group. Of the 513,415 known cases in children in the U.S., only 792 cases of MIS-C have been reported. That gives it a prevalence of 0.15% which is thankfully very small.  Additionally, a recent study published in the British Medical Journal notes “Our data confirm less severe covid-19 in children and young people with SARS-CoV-2 infection than in adults“, a very helpful conclusion to keep in mind.

For those of you with a medical inclination, there is a free podcast interview on this topic I recorded for physicians, available here.


Singing

A recent study from Sweden was published in the Journal of Aerosol Science and Technology. Scientists examined the production of aerosols when people were: singing loudly, singing quietly, pronouncing specific consonants, singing with and without masks, and altering pitch. Overall, the findings are positive. They concluded:

Singing generated more respiratory aerosol particles and droplets than talking. Exhaled aerosol particles and droplets increased with song loudness. The data also indicated that emissions might increase at high pitch. Wearing an ordinary surgical facemask reduced the amount of measured exhaled aerosol particles and droplets to levels comparable with normal talking. However, as surgical masks have a loose fit, some particles may have exited on the sides where we did not measure. Based on these results, singing in groups is likely to be an activity at risk of transmitting infection if not appropriate control and prevention measures are applied, such as distancing, hygiene, ventilation and shielding.”

Though this study is not large enough to change current recommendations against singing in large groups, it does provide further evidence that singing can be a safe activity when correct precautions are taken. Current recommendations are for singing to take place outdoors, when distanced, with masks in place. However, these are likely to be amended as the volume of evidence showing singing is safe with masks in place, continues to grow.


Clear Mask

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 that has been on the market for a few months. 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 for general use, outside of special instruction? 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.


Mask Tips

Consumer Reports published an article with some helpful mask tips. Most of us are wearing masks all day long and experiencing some common problems. This article provides some excellent solutions for you and your parents and customers. These will be added to our mask FAQ section. Problems addressed included:

  • Glasses fogging up
  • ‘Maskacne’ appearing on your nose or chin
  • Difficulty hearing and communicating
  • Nose or ears getting irritated
  • Mask slipping down constantly

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