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The Executive Briefing - Tuesday, November 15th

What you can do to slow the winter surge


  • New omicron subvariants BQ.1 and BQ1.1 are now dominant in the US, while the latest BN.1 starts to rise. (CDC)
  • A cruise ship with 800 COVID+ passengers docked in Sydney last weekend. (CNN)
  • Kids are at similar risk for long COVID as adults. About 1 in 3 people have long COVID symptoms three or more months after infection. (CIDRAP)
  • Moderna says its new BA.4 and BA.5 bivalent booster offers stronger protection against those than the original vaccine did, as well as B.Q.1.1 subvariants. (NBC)
  • President Biden again cited his “once a year” promise for boosters, despite widespread skepticism from experts who think waning immunity means we’ll need shots more than once a year, at least for a while. (SF Chronicle)
  • Boosters could keep 51,000 kids out of the hospital in the coming months, but uptake for kids remains low. (CNN)
  • A new study shows that rapid home tests aren’t highly sensitive for the newest Omicron subvariants. (CIDRAP)
  • Fever appears to be a more common symptom of the BA.2 variant. (Fortune)

Public Health & MPX News:

  • The US will extend the public health emergency through at least mid-January. (NBC)
  • Thousands of experts hired to help public health departments during the pandemic are losing their jobs, leaving some local and state health departments short-staffed heading into winter. (KHN)
  • Flu activity is high in half of US states, and “very high” across the South. It’s earlier and worse than other flu seasons. (Axios)
  • California hospitals are adding overflow tents outside ERs to help cope with the surge of flu and other respiratory illnesses like RSV and COVID. (AP)
  • Five people died in an NYC nursing home due to Legionnaires’ disease. (AP)
  • RSV hospitalizations in seniors are up 10x from this time last year. (CNN)

Mental Health News:

  • The risk of developing depression after COVID can remain for up to a year. (NY Times)
  • Young people are self-diagnosing on TikTok amid a mental health provider shortage, but there are major risks. (Boston Globe)
  • Physical and mental health harms of mass shootings affect the entire community, not just those directly affected. (Pew)
  • Seasonal blues due to shorter days can really affect mood, and in some cases cause depression. Taking a proactive approach to morning routine and diet can help. (WSJ)
  • The mental health epidemic and provider shortage are causing a serious backlog at emergency rooms nationwide. (Modern Healthcare)

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 do to try to prevent this winter’s surge from being as bad as the media is saying it could be?

The rise of new Omicron subvariants, the massive surge of RSV in kids, and the early flu season are all combining to mean trouble for the upcoming holidays and travel season. Some of these, like RSV, we can’t do much about other than renew a focus on handwashing and cleaning high-traffic touchpoints like door handles and children’s toys or play areas. But for the flu and COVID, we have vaccines already available, which are our best tool to help keep the surge down. If you haven’t yet, do not wait any longer - go get your flu and COVID shots ASAP. They’re both here right now and about to get worse, and it takes a few weeks for your protection to kick in. Encourage your employees to do the same for themselves and their families. Getting flu and COVID shots is the best way to ensure that you can enjoy those holiday plans you’re making.

How does the flu spread? Is it the same as COVID?

Like COVID, flu spreads through the air, though there’s still debate as to whether that’s via aerosolized particles or larger droplets. Surface transmission of the flu - like touching a contaminated door handle or faucet - is less common but still possible, so handwashing is still important. You’re likely contagious at least a day before you develop symptoms, and many people get the virus without ever having symptoms, which contributes to the spread. Ultimately, what works to prevent COVID works for the flu, too. Masks, social distancing, good ventilation in indoor spaces, and isolating when sick are all crucial tools to prevent the spread of both viruses.  

Do at-home COVID tests still work against the latest subvariants? Should we even bother?

At-home COVID tests do still work, but not the way that most people think they do. First, they are much less reliable for asymptomatic people. A single negative test result for someone with no symptoms doesn’t mean much. They’re much more accurate for people who have symptoms, but even then, they may not be positive on the first test. The right way to use at-home COVID tests is to take two tests, at least 24 hours apart. Serial testing, as this method is called, drastically increases the accuracy of the test and the chances that it’ll correctly identify a positive case. For asymptomatic people, a third test 24 hours later brings that sensitivity up to almost certain.

Do we need to be worried about these subvariants that are cropping up?

Yes, but there’s hope that this year will be a bit different. Last year, the emergence of the Omicron variant coincided with holiday gatherings and travel. Nobody was prepared for Omicron because it escaped immunity so well. The variants that are circulating this year are different - they’re all Omicron subvariants and they’re not so good at escaping our immune responses, in part because so many of us have had Omicron by now. Couple that with updated Omicron-specific boosters, and we’re in a much better place than we were last year at this time. That said, COVID is still spreading and we’ll almost certainly see an increase over the next two months because of the holidays, so now is not the time to let up. Keep masking, go get your flu shot and booster, and stay home if you’re sick!

Best Read:

Lost Lessons of the 1918 Influenza: The 1920s Working Hypothesis, the Public Health Paradigm, and the Prevention of Deadly Pandemics | AJPH

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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.