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The Executive Briefing - Tuesday, April 11th

Hep A cost one VA restaurant $14M + bankruptcy. Here’s what you need to know.

Health News:

  • The latest COVID variant sweeping through India seems to have a new symptom in kids: “itchy” pinkeye, sometimes called “sticky eyes.” (Fortune)
  • Ready-to-eat salads with chicken or ham may include lettuce contaminated with listeria. Brands include Revolution Farms, Fruit Ridge Farms, and Bell’s Bistro, sold in 7 states. (CNN)
  • Doctor shortages make it harder to get medical care in rural America. (KHN)
  • Strep is bad right now, and an antibiotic shortage isn’t helping.  (NPR)
  • The White House has launched a $5 billion program to speed vaccine and treatment development for coronaviruses to help with the current pandemic and future ones. (Washington Post)
  • President Biden signed a bill to end the national emergency for COVID, which is separate from the public health emergency set to end on May 11th. Healthcare providers are the primary people affected by the end of the national emergency. (Politico)
  • A Tacoma woman was arrested and held in contempt for refusing TB treatment. (CNN)
  • 4 Colorado mountain lions have died of the avian flu, but the trend appears to be slowing in the state. (Colorado Sun)
  • Wyoming has its first detection of avian flu in a pet cat. (CIDRAP)
  • Moderna hopes to offer cancer and heart disease vaccines by 2030. (CNBC)
  • Most Americans say they or a family member has experienced gun violence. (KHN)

Mental Health News:

  • Gay youths are more than 2x more likely to have sleep trouble. (NBC)
  • The record-setting amount of legislation targeting the trans community is harming trans youths’ mental health. (Axios)
  • As the mental health crisis grows in the US, more psychiatric hospitals, addiction recovery centers, and behavioral health clinics are opening to provide care. (NY Times)

If you or someone you know may be considering suicide, call 988 or message the Crisis Text Line by texting HOME to 741741.

Best Questions:

What can we learn about the Virginia restaurant Hep A outbreak?

This week’s Morbidity and Mortality Weekly Report (MMWR) from the CDC is our Best Read because it summarizes an outbreak at a restaurant chain in Virginia. In 2021, a restaurant worker who was not vaccinated for Hep A worked at three different locations of the chain for two weeks while he was infectious. Ultimately, there were 51 cases, 31 hospitalizations, and three deaths. It led to a $14 million settlement and two of the three affected locations filing for bankruptcy. This case got so bad in part because it was caught late - the employee delayed seeking medical attention and didn’t tell the health department that he worked in restaurants, both of which hampered a proper response that could have helped minimize exposure and brand damage. By the time people knew they’d been exposed, it was outside of the window when prophylactic vaccination could help prevent illness. That may have contributed to a very low vaccination uptake - only 1 in 5 eligible (unvaccinated) employees got the Hep A shot. One study showed that nearly 20% of restaurant workers had used drugs in the preceding month, which translates to 3 million restaurant employees, all of whom are at higher risk for Hep A. There are a few key takeaways for restaurants here:

  • Don’t let employees work if they have Hep A symptoms (yellow skin or eyes, dark cola-colored urine, light or gray-colored stool, diarrhea, and abdominal pain).
  • Educate your staff - especially about the risk of Hep A for anyone who takes drugs, the symptoms, and how it spreads.
  • Encourage vaccination and consider mandating Hep A vaccine for new staff, or at least collecting vaccination info upon hire so you can respond quicker in an outbreak.
  • Focus on handwashing, which is the next best way to prevent the spread besides vaccination.

Why don’t hand sanitizers work against norovirus?

We often think that hand sanitizers are just as effective as soap and water for combating viral spread, which may be true for some bugs but can be a dangerous trap with norovirus. Noro is a particularly hardy virus, which can live on surfaces for weeks and is hard to destroy. Hand sanitizers rely on alcohol to break down the cells of the virus, but noro has a hard protein shell called a capsid that protects it, and alcohol doesn’t get through it. Instead, the physical motion and friction of rubbing soap and water together in your hands physically breaks down the hard barrier protecting the norovirus particles. It’s important to wash thoroughly for 30 full seconds ("Happy Birthday" twice) and get under the nails and between fingers since even just a few microscopic particles are enough to make someone sick.

An employee is requesting a religious exemption to the Hepatitis A shot which is required by our local health department. Is that possible?

Religious exemption requests are more common after anti-vaccine sentiment rose during the COVID pandemic. Hepatitis A is one vaccine that was developed using fetal stem cell lines, so it’s a similar line of reasoning as religious objectives to the COVID vaccine (along with rubella, rabies, Hep B, and others). First, give your legal team a call - they may already have a lot of this worked out. If the religious exemption is deemed sincere by your legal team, you likely need to work with the employee and the local health department to determine whether you can offer a reasonable accommodation. That said, if the employee works in food service, it’s possible that you don’t need to accommodate that belief if it compromises workplace safety. Keep your health department and legal team looped in at each step while you work together to determine the best next steps.

Best Read:

Widespread Community Transmission of Hepatitis A Virus Following an Outbreak at a Local Restaurant in Virginia | MMWR

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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.