• In today’s Recommendations for Industry, we discuss this week’s risk matrix and how to answer your employees’ questions on the J&J vaccine. Read more below.
• The Johnson & Johnson vaccine’s use in the U.S. is currently paused as there is investigation for blood clots.
• Instead of focusing preventive measures on location, Germany’s government has “approved a measure that would give the federal government more power to impose nationwide measures to curb the country's rising cases, which would replace a patchwork system based on state laws”, Deutche Welle reports.
• Russia’s Sputnik V vaccine has been deemed safe and works similarly to Oxford-AstraZeneca’s vaccine, too! BBC breaks down how the Russian vaccine works.
• Sweden currently has the highest number of new COVID-19 cases per person in Europe at 625 new infections per 1M people.
• The NIH has begun its trial of anti-CD14 antibodies to treat COVID-19 respiratory disease. Read the news release here.
• Moderna’s stocks are rising after the company has tested two updated vaccines leading to increased antibody levels against viral mutations (in mice).
• Two new studies out of Israel have found that newborns of COVID-vaccinated moms may be protected from infection. In one, antibodies pass from mothers to infants in breast milk for 6 weeks post-vaccination and in the other, infants breast-fed by COVID-positive mothers “had evidence of infection”. CIDRAP reports this here.
• India has seen its highest day rise of COVID (on Tuesday) as millions test positive during the annual festival of Kumbh. (CNN / BBC)
• In Brazil, a rising number of younger people are becoming sick with COVID-19, with over half of ICU patients (in the last month) being less than 40 years old.
• The world is back on the move again. In the Heathrow Airport (UK), travelers had to wait up to 6 hours (BBC). With this, there is an increase in fake COVID-19 certificates of which airlines must be aware of (Washington Post)!
• We have updated the 50-State Food and Agriculture Worker Vaccination Eligibility Chart. In all states (except for Vermont and Rhode Island), food and agriculture workers can be vaccinated (be they in food/ag manufacturing, food service, or food retail). In both Vermont and Rhode Island, vaccinations for food and ag works are still age-based. In Rhode Island, individuals over 40 can be vaccinated, in Vermont, individuals over 30 years old can be vaccinated. To see the latest chart, please see here. (Please note: we have amended an error with New Jersey; New Jersey is vaccinating all food and agriculture workers as of March 29, 2021).

Answering Employee Questions on the J&J Vaccine

As has been extensively reported, CDC and FDA have paused U.S. distribution of the Johnson & Johnson COVID-19 vaccine pending their review of the data on the rare but severe type of blood clot in six young women (aged 18-48) after receiving the vaccine. In these cases, the symptoms (severe headaches, abdominal pain, leg pain or shortness of breath) occurred 6 to 13 days after vaccination. 

Following are some answers to questions your employees may be asking:

1. What is the issue?

It is the same phenomenon that was reported earlier this month in studies describing cases in Europe linked to AstraZeneca vaccine (NEJMoa2104840 and NEJMoa2104882). Called Vaccine-induced Immune Thrombotic Thrombocytopenia (VITT), it is related to an autoimmune reaction creating immune complexes with antibodies that lead to the clots. The scenario is just as FDA/CDC describe it with blood clots in vessels from the brain and the gut leading to high mortality (over 50%). So far, the rate of this appears to be around 1 per 100,000 doses. But there may be other cases we don’t know about or milder cases; additionally, the NEJM study with 5/130,000 in NEJM suggests it may be more frequent.

2. Is this occurring with the Pfizer and Moderna vaccines?  

So far, there has been nothing reported with a definitive link to this with Pfizer and Moderna, but there have been odd reports, such as one that occurred last January in Florida.

3. Should I be concerned if I received the J&J vaccine?

It appears that the likelihood of this happening in a severe way is very low, and the federal agencies are saying that the risk of COVID-19 outweighs the risk of the vaccine.  However, females under 50 are at higher risk, so should keep an eye out for symptoms, as listed by FDA as severe headache, abdominal pain, leg pain, or shortness of breath within three weeks after vaccination. Anyone who received the vaccine who exhibits these symptoms seek medical attention.

Risk Matrix

There appears to be no dramatic change in COVID cases in the U.S. from last week to this. But that stability is not really a good thing, as the levels raise concern about continued spread, whereas we would have expected rates to be decreasing by now.

• The Government Stringency Index is 39 this week. This is down from 41 last week, indicating a decrease in government stringencies.
• In Figure 1, this week, we compare the case rate/100K (Table 1) in the population to the percentage of a state’s population that has been vaccinated (with first and second doses) (Figure 1). Table 2 and 3 compare last week and this week’s percentage of states’ populations that have received their first and second vaccinations, respectively.

Table 1.

Figure 1.

Table 2.

Table 3

• Michigan is the only state with a TPR ≥ 10% and a case rate ≥ 25/100K people indicating that testing may not be adequate to fully characterize the true severity of the outbreak in the state (Table 4).
• 12 states have a TPR < 10% and a case rate≥ 25/100K people, indicating that adequate testing is likely finding most symptomatic cases of illnesses. This is up from 10 last week. These states are Pennsylvania, New Jersey, Florida, Minnesota, Colorado, Delaware, New York, Illinois, New Hampshire, Connecticut, Massachusetts, and Rhode Island (Table 4)

Table 4.

• In Monday’s Recommendations for Industry, we discuss the global status of COVID-19. Click here to read more.
• TAG has released a toolkit for “Dialing Back” that provides recommendations on phased-in reopening. Contact TAG if you are interested.
• We have updated the 50-State Food and Agriculture Worker Vaccination Eligibility Chart. In all states (except for Vermont and Rhode Island), food and agriculture workers can be vaccinated (be they in food/ag manufacturing, food service, or food retail). In both Vermont and Rhode Island, vaccinations for food and ag works is still age-based. In Rhode Island, individuals over 40 can be vaccinated, in Vermont, individuals over 30 years old can be vaccinated. To see the latest chart, please see here. *Edit: We made an error and included New Jersey; New Jersey currently allows for all individuals to be vaccinated*
• The Defense Department is trial testing new technologies to cure COVID-19 patients; in a recent test, a military spouse underwent dialysis in which COVID-19 was filter and removed from her blood. She has recovered from COVID-19.
• Michigan’s current COVID-19 crisis may portend to what the U.S. may look like in a few weeks. Currently, Michigan, Florida, Minnesota, and Massachusetts have the highest number of variant cases in the country. Additionally, the new surge of cases in Michigan (over the past few weeks) have been identified in people from their 30’s to 50’s (a much younger population than previously at the start of the pandemic) who have yet to receive a vaccine. These individuals are being sickened and hospitalized at increasing rates. The dominant variant that has been identified is the B.117 variant. CNN discusses this further.
• A few studies exploring the relationship between Oxford AstraZeneca’s vaccine and blood clots have been released. CIDRAP summarizes these studies and the findings here.
• Al Jazeera summarizes the current learnings of the B1351 COVID-19 variant first identified in South Africa. This variant contains two mutations (N501Y & E484K) that could enhance transmissibility and allow the virus to evade “parts of the immune system and antibodies”. This could portend to increasing transmissibility and would require further investigation. There are mixed studies on the efficacy of the Pfizer vaccine to be protective against this variant.
• The Chinese-developed COVID-19 vaccine efficacy is “not high”. Chinese officials are considering methods to bolster its efficacy with either additional doses, increased doses, different intervals of vaccination, and/or mixing vaccines of different technologies.
• Internationally: Germany’s COVID-19 cases surpass 3 million. Additionally, India’s COVID-19 cases has now surpassed that of Brazil’s to become the second most affected country in the world.
• In Friday’s Recommendations for Industry, we discussed the “fourth wave” of COVID in the US and CDC’s new cleaning guidance. Read more here.