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The Executive Briefing - Friday, February 4

Reinfections, plus what “nudges” people to get boosted?

COVID Recap:

  • Medicare will offer free at-home COVID tests from pharmacies in the spring, after being left out of the order requiring private insurers to pay. (Washington Post)
  • Maine is so overrun with Omicron cases that they’ve stopped contact tracing altogether. (Portland Press Herald)
  • The future of COVID vaccines may not be a shot at all - nasal vaccines may make better boosters by going straight to the airways where the virus gathers most. (NY Times)
  • Americans have lost 13.5 millions years of life during the pandemic, from young lives cut short by COVID. (Washington Post)
  • A megastudy of “nudges” that work for vaccination found that the most effective text message reminders told people that their flu shot was “waiting for you”, and reminded them multiple times over a few days. (PNAS)
  • Germany is likely to recommend a fourth dose of COVID vaccine. (Reuters)
  • 34 healthy people who hadn’t been vaccinated or had COVID agreed to be infected with the equivalent of one nasal droplet of the virus and 18 got sick - confirming it doesn’t take  many virus cells to get sick. They also became infectious just two days after their exposure. (Live Science)
  • Racial minorities are up to 3x more likely to report vaccine hesitancy, according to a study of more than a million adults in the UK and US. In the US, vaccine uptake is particularly low with Black individuals, including those who are willing to get vaccinated but haven’t yet. (CIDRAP)
  • About half of unvaccinated, untested adults who thought they had COVID were proven wrong by antibody tests, researchers found, while 99% of those who tested  positive developed antibodies.  (MedPage Today)
  • The reagents in rapid COVID test kits are temperature sensitive and should not be stored below 35 degrees. This means all of the at-home tests being shipped through the USPS may have less accurate results.  (Yahoo News)
  • In the really good news department, a study out of Israel confirms that those who were vaccinated and have breakthrough infections are less likely to develop long COVID. (Nature)

Today’s Health News:

  • A listeria outbreak linked to Dole salads has killed two people and sickened 17 others, according to a new alert from the CDC.  A recall had been announced in December and sell by date has now passed, leading authorities to believe the highest risk is over. (NPR)
  • An experimental cancer-fighting therapy kept one patient cancer-free for 10 years, leading the scientists to declare him cured. (STAT)
  • The FDA and CDC have declared the recent Salmonella Oranienburg outbreak over. It was linked to whole onions from Mexico, with more than 1,000 people infected and 260 hospitalized. (FDA)

Best Questions:

We have an employee who tested positive in mid-December. They’re sick again now and tested positive. Do they need to be excluded from work, and for how long? Can they have COVID again so soon?

We’re seeing this more and more, especially with the rise of Omicron. It’s not fun, but the answer is that reinfections are possible and, at least anecdotally, seem to be relatively common. If someone has symptoms, you should assume they are infectious and keep them out of work. Some people can test positive for weeks after their initial COVID infection, but if someone has tested negative at some point between their initial infection and their second bout of illness, you should assume the new positive test is a new infection that can be transmitted. When in doubt, it’s always advisable to keep anyone out who is feeling sick or who has recently tested positive again more than a few weeks after their initial infection.

Can a family member read a return-to-work test in California?

You’ll need to confirm with your legal team, but most experts we’ve talked to on this have said they think this is likely a no. The CalOSHA FAQs page says that tests can’t be self-administered and self-read “unless observed by the employer or an authorized telehealth proctor.” So, most legal teams we’ve talked to interpret that as saying the proctor can’t be just anyone.

A new hire tested positive less than 90 days before we hired them. Can we use their result to avoid any local weekly testing requirements (or close contact exclusions) for the remainder of that 90 day period?

This is another question to run by your legal team, but it came up on a Fisher Phillips call we listened in on this week, and their interpretation seemed to be a yes. While many of our clients are not hiring unvaccinated employees at this point, and are seeing their overall vaccination numbers rise over time through natural attrition, if you are hiring unvaccinated employees, it’s a good idea to ask for proof of a recent COVID+ test if they’ve had one in the past 90 days. We still recommend asking your legal counsel for their interpretation of any state or local guidance around weekly testing.

If an employee tests positive on an at home test, should we advise that they get a PCR test to confirm it?

Many people doubt their at-home tests when they’re positive, but don’t doubt them when they’re negative - which they should! But rapid at-home tests are 99% accurate for positive test results. Unless there’s a specific clinical reason to do a PCR (they may need an antiviral drug or monoclonal antibodies, which might require laboratory confirmation), an at-home positive is a positive.

An employee with multiple COVID symptoms tested negative on an at-home test.  Can they return to work sooner than 5 days because they tested negative?

Unfortunately, no. At-home tests are helpful tools, but they still have a very high rate of false-negative results. Anyone who has COVID symptoms should stay out for five days, regardless of a negative rapid test result. If you have symptoms, you should assume you are infectious and stay home to isolate for five days, even if your at-home test isn’t positive. Many people test negative on at-home rapids two or even three times before they start seeing positive results.

Best Read:

STAT News:  If Omicron's sister spreads faster, why did Omicron hit first?

Best Listen:  

A bonus today if you prefer listening over reading! Listen to our friend Mike Osterholm, whose depth of knowledge and no-nonsense approach always put things in perspective.

Dr. Mike Osterholm discusses immunity, the BA2 subvariant and why boosters matter

Best Laugh:

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Disclaimer: This post is meant for general information and educational purposes only and does not constitute, and is not intended as, any form of medical, legal or regulatory advice or a recommendation or suggestion regarding the same.  No recipient of this information should act or refrain from acting on the basis of this information without first seeking legal advice from counsel in the relevant jurisdiction.