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The Executive Briefing - Friday, September 3rd

What's the deal with boosters? Plus, a labor day surge?

COVID Recap

  • The CDC has asked unvaccinated people to refrain from travel this weekend (and even vaccinated people to be cautious and avoid travel if possible).  (CNN)
  • There’s a new variant out there - “mu” - which may be evading immunity from vaccines and previous infections. It’s been found in 39 countries. (CNBC)
  • A new study in healthcare workers showed the effectiveness of both brands of mRNA vaccines to drop from about 95% initially to about 84% effective after 4 months (with the Delta variant thrown into the mix). These vaccines still prevented nearly all hospitalizations and deaths. (NEJM)
  • Moderna has submitted data to the FDA for moving forward with booster doses.  Their booster would be a half dose of vaccine which raised antibody levels up to 40x. (Bloomberg)
  • Two top vaccine officials at the FDA will retire this year, reportedly over their dissatisfaction with the White House’s booster dose announcement, which many believe jumped the gun.  (New York Times)
  • Evictions corresponded with higher COVID rates in those areas, a new study confirms.  (JAMA)
  • Alabama, Georgia, Texas, Florida, and Arkansas are all nearing full ICU capacity with less than 10% of their beds available. COVID is dire there. (CNN)
  • Meanwhile, FL created an “artificial decline” in it’s death rate by changing the way it reported deaths to the CDC. The reality is much more grim. (Miami Herald)
  • The list of companies requiring proof of vaccination and vax mandates grows daily. (Yahoo)
  • COVID long haulers appear to be at much higher risk for severe kidney disease. (CIDRAP)
  • Oregon OSHA is being flooded with complaints regarding compliance with Oregon’s new worker mask mandate. The fine for willful violation can be up to $126,000 but some employers, employees and customers are ignoring the mask requirement. (KATU)
  • About half of Manhattan employers have delayed openings, most having pushed back to January.  (NBC)

Todays’ Health News

  • Earlier international news reports about a new Ebola case on the Ivory Coast were premature as final testing didn’t confirm the presence of Ebola.  (WHO)
  • Some experts are predicting that this flu season will be particularly bad, in large part because we really didn’t have a flu season last year. (LiveScience)
  • Kids in IL will soon be allowed to take up to five mental health days. (NPR)
  • The WHO released a major warning saying that the number of people with dementia will jump by 40% by the year 2030, to 78 million people. (Reuters)
  • Congress is demanding an investigation into the controversial fast-tracked FDA approval of Aduhelm, a new Alzheimer’s drug.  (STAT)

Best Questions

What is the deal with booster doses? Are they for everyone, or just immunocompromised people?

The landscape of booster doses is confusing and politically fraught. The FDA and CDC currently only recommend it for immunocompromised people, but the White House announced that third doses would be available for everyone 12 and up in the US before the end of September. There tend to be two camps: those who believe everyone should have access to first and second doses before healthy Americans get a third, and those who want to make sure no breakthrough infections are happening at all. Most of the controversy is between those two camps. That said, most doctors we ask still say they will get their own booster dose when it's available.

Are we still listening to doctors and hospitals that exclude someone for 14 days versus 10?

Generally, yes - we always recommend listening to a medical professional, hospital, or health department when they share a specific return to work date. There are some rare instances, like when someone is immunocompromised or hospitalized with severe illness, that the CDC recommends longer than 10 days, and we’re finding that many people aren’t ready at 10 days even if they don’t fall into those categories. If a healthcare provider recommends a slightly longer isolation period, we recommend always defaulting to them, since they know the patient best.

What should we do when a rapid antigen test is positive and then a subsequent PCR test is negative?

False positives are extremely rare, so you should assume that a positive - even with a rapid antigen test - is a true positive. We recommend retesting with another PCR test in that case. In most cases, we expect that second PCR test to come back positive. Even PCRs aren’t perfect and can miss some positive cases, and statistically the chance of a false positive are very low while a false negative is much more common. So, proceed with caution, assume it’s a true positive, and get retested to be sure.

How soon after COVID can can you get the COVID vaccine? Flu vaccine?

The only restrictions around getting vaccinated after being infected with COVID are restrictions around ending self-isolation for the protection of others. You can’t go while you’re actively infectious with COVID because you’ll put the pharmacy or clinic workers at risk. But you can go on Day 11 if you meet the criteria for ending self-isolation after Day 10! Same goes for the flu vaccine - and you can get both at the same time!

I have an associate that is not vaccinated and their child tested positive for COVID. How long does my associate need to quarantine?

If the associate isn’t able to isolate because they need to care for their child, and they’re unvaccinated, they’ll need to isolate for a full 20 days from the date their child’s symptoms started (or the date the child tested positive if asymptomatic). That’s 10 days for the child’s infectious period, plus another 10 days for their quarantine after exposure. If they are able to isolate (if it's an older child, or there’s another caregiver in the household, for example), they’ll just need to isolate for 10 days from the date of their last close contact.

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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.