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The Executive Briefing - Tuesday, September 7th

Testing in Oahu, and what do antibodies really mean?


  • Fifteen staff members in the Miami-Dade School District died of COVID in just ten days. (HuffPo)
  • There continues to be a summer spike in hospitalizations in kids with COVID. (CDC)
  • A man urinated on the counter after being asked to put on a mask at a Dairy Queen in Canada. (Business Insider)
  • Businesses are scrambling to meet Oahu's fully vaccinated or weekly testing requirements that go into effect on 9/13. Rumor has it Maui will follow their lead. (OneOahu)
  • American Airlines will no longer pay COVID pay to unvaccinated employees who test positive or develop symptoms. (CNBC)
  • Opening a window in a dorm room can reduce transmission by almost 50%, according to a new study done with college students in Oregon. Ventilation is absolutely key to reducing transmission. (New York Times)
  • We still need new and better COVID vaccines - but there’s a catch: it’s not considered ethical to use a placebo as control when there are effective vaccines available. That means we’re likely stuck with what we’ve got for now until trials can get their hands on vaccines for control groups. (STAT)
  • Federal regulators advised the White House to scale back its plan for September booster shots, saying there’s only enough data to recommend Pfizer booster doses at this point. (New York Times)
  • And Dr. Fauci says Moderna’s boosters may be delayed by a few weeks as they sort that out, though Pfizer’s should be ready by September 20th. (CNBC)

Todays’ Health News

  • Over 200 top medical journalists warn that climate change is the ‘greatest threat’ to public health in the world right now. (NPR)
  • Indian health officials are racing to contain an outbreak of the deadly Nipah virus in Kerala state, which killed a young boy. Not related to COVID, it’s another bat-borne and highly infectious virus which has broken out multiple times in the past few years. (CBS)
  • RSV, another highly infectious respiratory virus commonly found in kids, is showing up in pediatrician’s offices earlier than expected this year. (KATU News)
  • Allergy season is almost here again- rising ragweed counts mean we’ll likely see an uptick in allergy complaints which are hard to separate from COVID symptoms. (US News)
  • The richest US counties are the ones seeing a huge surge in childhood hunger during the pandemic. (Kaiser Health News)
  • J&J is working on an HIV vaccine, but it still has a long way to go. (STAT)

Best Questions

An unvaccinated employee never tested COVID+, but tested positive for antibodies.  Is this person considered in the vaccinated/immune group?

Unfortunately, no - we don’t yet have a “magic number” of antibody levels that mean you’re protected. We do hope to learn more about what antibody levels provide protection in the next few months, but until we research it carefully we can't be sure. Natural immunity from a previous infection is much less reliable than immunity from vaccination. It can vary a lot from person to person, depending on their exposure, infection, immune system, and how long ago they had an infection. We just can’t be sure based on testing positive for antibodies, so you should treat this employee the same as anyone else unvaccinated, including excluding them if exposed and - as is the case for everyone - excluding them if they have symptoms.

Why shouldn’t we be requiring back to work testing?

The science is still quite clear that for the vast majority of COVID+ cases, people stop being infectious as soon as they meet the time- and symptom-based criteria for ending their self-isolation. If they’ve been isolating for 10 days, they’ve had no fever for 24 hours without fever-reducing medication, and their other symptoms are resolving, they’re extremely unlikely to be able to spread the virus. Plus, people can test positive for weeks even if they’re not actually infectious anymore. A symptom-based approach to returning to work is still the best option to get recovered folks back to work.

How are your clients handling the testing requirements in O’ahu/Honolulu?

The island of O’ahu in Hawaii has a new law requiring employees of any business to show proof of full vaccination against COVID or a negative COVID test result each week in order to operate. Customers also need to show proof of full vaccination or a negative test within 48 hours to enter businesses. The tests can be PCR or rapid, according to the Safe Access O’ahu website, but the reality of weekly testing for all unvaccinated employees is a real challenge for many businesses. Local testing is available, but can have waits up to 4 hours, so we’re helping some of our clients get large quantities of rapid test kits to their stores there to help get through the next few months. We think bulk ordering at-home rapid tests will likely save money and time given what we’re hearing about the backups at local testing sites, and the fact that employers will likely need to foot the bill for that testing time. We also recommend assigning a testing point-person at each location to help organize the logistics and keep records of testing for anyone unvaccinated.

Are your clients requiring vaccination for new hires in jurisdictions that are implementing vaccine mandates?

Yes.  The impact on staffing has not yet been determined but most of our clients have decided this is a business decision that is unavoidable.  So even in jurisdictions where there is a testing opt out (like Honolulu), they are making new hires aware of their vaccination policy and the regulations, and engaging in interactive conversations in the hiring process if someone mentions religious or medical reasons for not being able to be vaccinated. As always, this is an important legal conversation to have with your counsel, and we’re not offering legal advice.

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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.