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The Executive Briefing - Tuesday, October 26th

Vaccine for kids coming any day now, plus are rapid tests in short supply?

COVID Recap:

  • The US will invest $70 million to boost the availability of and access to rapid tests. Shortages have driven up prices, and one new at-home test was just approved, bringing the total number of available at-home rapid tests to ten.  (Reuters)
  • FDA scientists say the benefits of the Pfizer vaccine “clearly outweigh the risks” for kids 5-11 years old. (STAT)
  • Meanwhile, Moderna says it’s low-dose vaccine produces a strong immune response in younger kids. (NY Times)
  • A new study showed that a small incentive (a $25 gift card) was highly effective in getting people to get vaccinated.  A gift card to the person who drove them was also effective in that person getting vaccinated, too! (MedScape)
  • Recipients of the J&J vaccine are rushing to get booster shots. All 15 million people who got the first J&J dose are eligible for a booster. (WSJ)
  • The most vaccinated place in America? It’s Puerto Rico. (CNN)
  • Unvaccinated pregnant women are more likely to develop very severe COVID symptoms, particularly as the Delta variant continues to circulate. (AJOG)
  • The December 8th deadline for federal contractors to get vaccinated has shippers panicked about delays in holiday shipments. (Politico)
  • Counterfeit and used medical gloves are making their way to the US and other countries, as bootleggers capitalize on the high demand. (CNN)
  • Unvaccinated people can expect to be reinfected with COVID again every 16-17 months, according to a new study. (MedScape)
  • FL Gov. DeSantis is offering unvaccinated out-of-state cops $5,000 to relocate from areas with vaccine mandates. (CBS)
  • The White House provided additional guidance ahead of the November 8th lifting of restrictions on international travel to the US.  Any brand of vaccine approved by the US or the WHO is acceptable and PCR, NAAT or rapid antigen tests either 3 days (if vaccinated) or 1 day (if unvaccinated) before travel will suffice. (White House)

Today’s Health News:

  • The source of the deadly outbreak of melioidosis that we’ve been reporting on has been found, in an aromatherapy room spray from Walmart. Public health investigators found the contaminated bottle when searching the home of one of the four people who died from the infection. (STAT)
  • There’s another salmonella outbreak, this time tied to Citterio brand salami sticks, sold at Trader Joe’s and elsewhere. Throw them away if you have them. (CDC)
  • Four states (CA, NY, TX and FL) accounted for nearly half of all tuberculosis in the US, according to a new report which also shows that efforts to eliminate TB slowed during the pandemic. (CDC)
  • The rise we’ve seen in human bird flu cases in China is likely due to new, more transmissible variants. (Reuters)

Best Questions:

A rapid antigen test had a faint red line and then a later PCR was negative.  How do we proceed?

Assume any positive is a true positive. Even a faint red line on an at-home rapid test is more than 99% accurate for positive results - meaning that there's a less than 1% chance that there's a false positive. PCR tests, even though they're the gold standard, still have around a 5% change of false negative, with some real-life studies showing anywhere from 5-15% change of a false negative. In short, it's more likely that the negative PCR was wrong than the positive rapid - even before we account for viral load, date of test compared to symptom onset, etc. A negative PCR later doesn’t mean that the positive rapid test was wrong. We’re learning more and more that those of us who are vaccinated have lower viral loads, particularly in our noses. Unfortunately, this doesn’t mean we aren’t also infectious - we’re still learning just how infectious, but we know that people with breakthrough infections can still spread the virus. So, stay home, assume it’s a real positive if you see a positive result on your at-home test, and call your doctor to discuss next steps.

Employees are reporting they’re not taking a rapid test even when developing symptoms or have a close contact exposure because they can’t find them.  Are they right?

At-home rapid tests are very sporadically available - one local pharmacy might have a great supply, while many are completely empty for months on end. But overall there is a shortage, especially of rapid at-home tests. That said, going out to a clinic, urgent care, or pharmacy for a COVID test - which may be rapid or done at the lab - is still much more available. The supply issue is likely to get worse when the Labor Department’s vaccination or weekly testing mandate goes into effect, when millions more people will need regular weekly testing.

A vaccinated employee has a child who tested positive and now the employee has multiple symptoms.  Do we need to exclude them even though they’re vaccinated?

Yes! This is a repeat question, but we get it so often we wanted to cover it again this week. Anyone with symptoms should stay home from work, regardless of their vaccination status. In this case, with a COVID+ child, the sick employee should likely stay out for a full 10 days, since the simplest explanation is that they probably have a breakthrough infection.

What should we do if an employee who has had close contact with someone COVID+ refuses to share their vaccination status?  

If you don’t know someone’s vaccination status, you must proceed as if they are unvaccinated and follow the appropriate close-contact 10 day exclusion from most recent contact.  

We’re not lawyers, and can’t speak to the legal questions around asking employee’s vaccination status, but here’s a good article from SHRM that addresses it: Consider These Steps When Asking Employees About Vaccination Status.  

We’re seeing a lot of NAAT tests.  What are they?

NAAT stands for Nucleic Acid Amplification Test. It’s a viral diagnostic test for the virus that causes COVID, and it works by detecting the genetic material (RNA, specifically) that’s unique to the virus. PCR tests, which you’ve probably heard of by now, are one type of NAAT test. NAAT tests are generally more sensitive than antigen tests, though they can vary quite a bit.  

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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.