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Zero Hour Health + Zedic Newsletter - Tuesday, May 11th

Teen vaccines, TB treatment and can we mix vaccine brands?

ZHH Updates

Now On-Demand: Relaxing COVID Restrictions

Special thanks to Kerry Bridges from Chipotle and Michael Halen from Bloomberg Intelligence for joining Wednesday’s webinar on navigating risk as COVID restrictions continue to ease. In case you missed it, here is a link to the recording as well as the Twitter thread we created in real-time during the discussion.

Today's Recap

  • The FDA has granted Pfizer emergency use authorization for teens 12-15 years old, and the CDC advisory committee is expected to recommend it tomorrow for immediate rollout. Another panel will meet in early June to discuss what info they’ll need to allow it in even younger kids. (FDA)
  • Novavax likely won’t seek emergency use authorization for its COVID vaccine from the FDA until the summer. (Washington Post)
  • A new study shows that TB can be treated effectively in just four months vs. the much longer nine+ months previously thought. TB has always been one of the top illnesses that our clients have needed our help with. (NEJM)
  • The kerfuffle over the use of over-the-counter NSAIDs like Advil or Motrin has finally been resolved and it’s OK to take them if you have COVID.  (MedPage Today)
  • Moderna announced some positive initial booster data against COVID variants. (Moderna
  • With the launch of a new national hotline, anyone can call 1-800-232-0233 to schedule vaccination appointments in English, Spanish and many other languages for free. You can also text your zip code to GETVAX (for English) or VACUNA (for Spanish) for vaccination sites near you.  (NPR)
  • The White House has backed a temporary waiver of international patent protections for COVID vaccines at the World Trade Organization, though a number of hurdles need to be crossed before it’s turned into policy. If this happens, it’s a big factor in being able to ramp up vaccine manufacturing immediately. (The Hill)
  • A new variant of concern, B.1.617.2, first identified in India, may respond better to existing vaccines than other variants, according to a top English public health expert. (Reuters)
  • COVID restrictions are lifting across the U.S., and it appears much of the country will be open with few rules in the coming months. (New York Times)
  • The WHO is launching an international COVID trial to test whether three existing drugs might prevent death in already hospitalized patients. (Nature)
  • Some experts, like Dr. Fauci, are predicting that the federal guidance for requiring face masks indoors may be changing, and soon. It’s worth noting that the lifting of these mandates partially hinges on getting more shots in arms. (CNN)
  • This last flu season may have gone by relatively quietly, but that could spell trouble for next year. As COVID restrictions ease, scientists worry that in 2022, we could be dealing with “a whole lot of flu”. (NBC)

Best Questions

Can we mix and match vaccine brands for doses one and two? And when it comes to boosters, will we need the same vaccine as our original?

Since the current COVID vaccines received Emergency Use Authorization in the US, the general rule of thumb has been that you need two doses of the same brand (except in very rare circumstances like severe allergic reaction). Appointments have even been rescheduled when the same brand wasn’t available on the date of their second dose. 

But new research suggests that it may not matter if you mix and match between the same type (in the US, that’s only relevant for Pfizer and Moderna, both mRNA vaccines) and that there may even be an immunological benefit, though that’s still being studied.  This week, there’s been a similar conversation around upcoming booster doses. That’s all still to be determined since boosters are still in development. 

At the end of the day, you should absolutely stick to the same brand of vaccine for both doses and you shouldn’t get two different vaccinations for “more coverage” -  both are not yet studied well enough to know the risks. Plus, sticking to one brand lets you irrationally cheer for your own. Most of us here at ZHH and Zedic are #TeamPfizer because we got vaccinated earlier in the rollout, but we have #ModernaGang and those repping #JnJ proudly, too. 


When can we allow fully vaccinated back of house employees working in hot kitchens to take off their masks?

We know this is something your teams want badly and there are a few things you’ll need to consider before allowing BOH employees to remove their masks. First, everyone they come in contact with at work will need to be fully vaccinated. While the BOH team might be small and highly motivated to get the vaccine if it means they can be unmasked, the reality is that managers, servers and bussers are likely going into the back regularly throughout their shifts. If the entire restaurant team is fully vaccinated, you might be able to consider ditching masks, but we’re still a long way off from that being a reality in most places. Many of our larger clients are still seeing less than 30% of their staff fully vaccinated. 


Are you seeing a trend of allowing optional mask usage when working outdoors - like serving on patios?

The realities of removing masks outdoors and putting them back on when going indoors, plus the proper hand washing required, makes the whole process much more complicated. Plus employee and guest sentiment is varied and matters. Many guests aren’t comfortable with their servers being unmasked, even outside. And while some employees are getting the vaccine, most are not yet fully vaccinated and wearing a mask reduces their individual risk of COVID by about 65%. We still recommend wearing masks, even outside, and for now, even for fully vaccinated employees.


What kinds of rollbacks on theatrical cleaning are you seeing?

The CDC has made clear that the coronavirus is primarily spread through airborne droplets and person-to-person transmission, and the risk of getting COVID from surfaces is low. Reducing the “hygiene theater” is a delicate balance between clinical accuracy and the way it makes guests and employees feel. One client shared they went from hourly sanitizing to once every four hours and once at the end of the day. Others haven’t officially reduced their frequency of sanitizing but are aware that individual locations may be doing it less often than stated in their protocols.

And nearly all of our clients have dropped regular fogging. Save intensive deep cleaning for situations when you know a guest or employee got sick in the 24 hours after they were in the workplace, or if there’s a bump in cases in the local area. But increased attention to high-touch surfaces like doorknobs, faucets and touch screens is still a good idea, and will not only reduce the transmission of COVID but also other illnesses like noro, Hep A and the common cold. We continue to see a major uptick in noro nationally. 


If an employee was fully vaccinated more than 14 days ago but was exposed to someone COVID+ before the 14th day, do they need to be excluded and for how long?


Yes, unfortunately. The risk is lower, but it’s definitely not zero and, in fact, we’ve seen multiple cases where someone was exposed before they were fully protected and got sick with COVID just before or even just after day 14 after their final dose of vaccine. If someone was exposed to COVID at any point before they are fully protected (14 days after final dose), they should be excluded for a full 10 days from their most recent exposure, even if some of that time falls after their 14th day when they are fully protected. It’s possible to get exposed on day 10 post-vaccination and then get sick with COVID symptoms on day 14 or 15, for example.


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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.