TAG’s Take on New CDC Guidance and What’s Coming Down the Road

• In today’s Recommendations for Industry, we discuss CDC’s new guidance for fully vaccinated people to mask indoors in high-risk areas, and mask and be tested if exposed to a person with COVID-19. We also look at TAG’s COVID-19 Risk Matrix to better understand what is happening around the country. Read more below.
• The C.D.C now says fully vaccinated people should get tested after exposure even if they don’t show symptoms. (See our Recommendations for Industry, below, for complete information on this.)
• Mental illness tied to higher risk of COVID hospital care, death | CIDRAP (umn.edu). A study led by researchers from the CEReSS-Health Service Research and Quality of Life Center in Marseille, France consisted of 16 observational studies from seven countries involving 19,086 patients with COVID-19 and mental illness from December 2019 to July 2020. Regardless of the primary medical risk factors for severe COVID-19, patients with mental illnesses were more likely to die of COVID-19 than their peers in pooled crude and adjusted analysis. Patients with schizophrenia and bipolar disorder had the highest ORs for death, with researchers stating that these patients may have impaired immune defenses to begin with and suggesting “that other factors lead to this health inequity in patients with mental health disorders, including several factors such as barriers to access to care, social determinants of health, immunological disturbances, and the effects of psychotropic drugs.” The study also suggests improving healthcare staff training on mental illnesses, broader implementation of advanced directives and do-not-resuscitate orders, and removing barriers to obtaining healthcare could improve patient care.
• Cases in Americas, Asia drive latest COVID-19 rise | CIDRAP (umn.edu). With another steady increase in cases last week, the world is now adding more than 500,000 cases a day, with the more transmissible Delta (B1617.2) SARS-CoV-2 variant now in 132 of the world’s 197 countries, according to the World Health Organization (WHO). Maria Van Kerkhove, PhD, the WHO’s technical lead for COVID-19, said there are marked regional differences and variations by and within countries, warning that deaths were up sharply, rising by 21% compared to the week before. Much of the recent rise is driven by substantial illness increases in the WHO’s Americas and Western Pacific regions, with a large portion of the spike in deaths from the Americas and South East Asia regions, the WHO said. The global total could pass 200 million cases in the next 2 weeks, it added.
• Natural Immunity After COVID-19 Found Durable and Robust — Precision Vaccinations. The study shows that most convalescent COVID-19 patients mount durable antibodies, B cells, and T cells specific for SARS-CoV-2 up to 250 days. The kinetics of these responses provide an early indication for a favorable course ahead to achieve long-lived immunity. Because the cohort will be followed for 2–3 more years, they can build on these results to define the progression to long-lived immunity against this novel human coronavirus, which can guide rational responses when future virus outbreaks occur.
• U.S. pole vault champ out of Olympics after positive COVID test (msn.com). A U.S. pole vaulting superstar has tested positive for COVID-19 — sending a slew of Australian athletes into isolation. Sam Kendricks, the reigning world champion and the American record holder, has had to pull out of the Tokyo Olympic Games.

Food Safety/Public Health

• Multistate E. coli outbreak linked to cake mix | Food Safety News. An ongoing E. coli outbreak affecting 16 people in 12 states has been linked to cake mix. Sick people range in age from 2 to 73 years old, with a median of 13. Seventy-five percent are children under the age of 18. Children are more likely to have a severe E. coli infection. Of 16 people with information available, seven have been hospitalized. One person has developed a type of kidney failure called hemolytic uremic syndrome (HUS), but no deaths have been reported.
• Scale of Campylobacter poultry link assessed in UK study | Food Safety News. Chicken has been confirmed as the source of most Campylobacter infections, according to a research report published by the Food Standards Agency (FSA) in the United Kingdom. The aim was to estimate contributions of the main sources to human infection and to identify changes over time. The work by Oxford University also looked at antimicrobial resistance.
• WHO calls for mycotoxin data in some peanuts, cereals and spices | Food Safety News. The first call for information covers aflatoxin in cereals and cereal-based products. This includes maize grain; flour, meal, semolina and flakes derived from maize; husked and polished rice and sorghum grain destined for further processing. Data is also wanted on total aflatoxins in cereal-based foods for infants and young children.
• BrightFarms expands recall of packaged salad greens linked to Salmonella outbreak | Food Safety News. Amid an ongoing outbreak, BrightFarms is expanding a recall of packaged salad greens that were produced in its Rochelle, IL greenhouse farm and sold in Illinois, Wisconsin, Iowa, Indiana, and Michigan because of potential Salmonella contamination

TAG’s Take on New CDC Guidance and What’s Coming Down the Road

On July 27, the CDC updated its guidance on masking for vaccinated persons with two major changes:

• Fully vaccinated people should mask in public indoor spaces if case rates in the area are “substantial” (50-99 total cases per 100K over a 7-day period) or “high”(100+ total cases per 100K over a 7-day period).  Looking at a 7-day average case rate, this translates to about 7 to 14 cases per 100K (substantial) and greater than 14 cases per 100K (high).
• Fully vaccinated persons who are exposed to COVID should:
  • Wear a mask in public indoor spaces after exposure.
  • Be tested for the virus 3 to 5 days after exposure – even if they have no symptoms.
    • If test is negative, they can stop wearing the mask unless #1 applies
    • If test is positive, they should isolate at home for 10 days.

The new guidance reflects the current state of COVID-19, with the surging Delta variant causing increased case rates, and continued studies identifying  -19 Breakthrough Infections of vaccinated persons. The Delta variant has changed the risk profile for even vaccinated persons.

TAG’s TAKE

Historically, the US has tracked with the UK experiences of COVID-19, trailing about a month behind. With the UK Delta surge lasting about 6 to 8 weeks, we predict that the US can expect the same. This would mean that the US could likely again hit the 200,000 cases/day mark with at least another month of rising cases and furthered vaccine and mask mandates.

So, our advice: Fasten your seatbelts! Things may get a lot worse in the next 4 to 8 weeks – not just in increased case counts, but also in government guidance changes in light of new science and as the country adjusts to the resurgence of COVID due to Delta. All of this continues to make it difficult for people and businesses to plan their return-to-work practices, when and whether to return to full masking, and whether vaccinations can or should be mandated. TAG is continuing to stay updated and assist businesses with all things COVID – give us a call if you need assistance.

Risk Matrix

As TAG’s matrix shows, case rates have increased nationally almost 150% in the past two weeks, with increases in all 50 states.  Some states like Florida, Louisiana, and Arkansas are reporting statewide case rates of greater than 40 per 100,000. Additionally, the trend of states with higher rates of fully vaccinated people experiencing lower relative case rates is continuing.

Table 1.

Figure 1.

Table 2.

Table 3.

• Global COVID deaths rise sharply, led by surging Delta. Global COVID deaths last week were up more than 20.6%, with about 69,000 people across the world having died; cases increased by 6.5%. Southeast Asia is currently the epicenter, and a handful of countries in that region reported more record daily highs for cases, including Malaysia with 15,902, Thailand with 15,335, and Vietnam with 7,968. The global total topped 194 million cases, climbing to 194,139,772, with at least 4,158,700 deaths
• No anaphylaxis after second dose of mRNA COVID vaccine, study finds. People who had a severe allergic reaction to their first dose of mRNA COVID-19 vaccine had no issues after their second dose. Allergic reactions are estimated to occur in up to 2% of people after their first mRNA COVID-19 vaccine dose, with anaphylaxis reported in as many as 2.5 per 10,000 vaccinees. The most common first dose allergic reactions were flushing or redness (28%), dizziness (26%), tingling (24%), throat tightness (22%), hives (21%), and shortness of breath or wheezing (21%). Thirty-two patients (17%) experienced anaphylaxis. Of the patients with first dose reactions, 130 (69%) were to the Moderna vaccine, and 59 (31%) were to Pfizer.
• The US could see 200,000 COVID-19 cases a day within the next six weeks, former CDC director says. The US could see about four times the current rate of COVID-19 cases in the next four to six weeks as the Delta variant spreads and the population hits a wall on vaccinations. The last time there were more than 200,000 new US cases in one day was in January, according to John Hopkins University data. In August, California will require all state employees and health care workers to provide proof of vaccination status or get regular tests, Gov. Gavin Newsom said Monday. A similar requirement will be implemented in New York City, where all of the workforce for the city’s agencies, including schools, fire and police, will be given the choice between vaccination or regular testing.
• A new model suggests that the current surge of COVID-19 activity will continue to gain momentum and peak in October, with around 60,000 cases and 850 deaths each day. Amid the dire predictions, the American Medical Association, American Nurses Association, and 55 other medical groups have written a joint statement calling for mandatory vaccination of all US healthcare personnel against the coronavirus.
• ‘We are now in crisis mode’: Mayor of Florida county home to Disney World sounds alarm on surging COVID cases. The mayor of the Florida county that’s home to Disney World and Universal Studios is sounding the alarm on a spike of COVID-19 cases in the area, saying the county is now in “crisis mode” as it grapples with its worsening infection rate. Over the past week, Florida accounted for nearly a quarter of all new cases in the United States – more than any other state.
• Thousands protest amid global anger against COVID restrictions. Tens of thousands of people across several countries, including France and Italy, have protested anti-COVID measures, with the French police using tear gas and water cannon to disperse protesters in the capital Paris. In France, an estimated 160,000 took to the streets. Thousands of people have also protested in London, against what they describe as an erosion of their civil liberties.
• WHO seeking data on heavy metals in food. The World Health Organization (WHO) has called for data on two heavy metals in a range of food types. The first covers methylmercury and total mercury in orange roughy, pink cusk-eel and all toothfish and the second is on lead in cereal-based foods and ready-to-eat meals for infants and young children; dried spices and culinary herbs; eggs; sugars and sugar-based candies. Both have a deadline of Oct. 15, 2021.
• Salmonella dominates outbreaks in Australia. More than 450 foodborne outbreaks were reported over a three-year period in Australia, according to a new study. There were 213 outbreaks attributed to a single food with 124 linked to consumption of eggs and egg-based dishes. Ten outbreaks affected more than 100 people. Six were due to Salmonella Typhimurium, three because of norovirus, and one with 125 patients was suspected to have been caused by a bacterial toxin in curried prawns. The largest Salmonella outbreak sickened 350 people due to potato salad with raw egg mayonnaise.
• Company initiates nationwide recall of cheese in Canada because of Listeria risk. Tree of Life Canada ULC is recalling Cahill’s brand “Original Irish Porter Cheese” because of possible Listeria monocytogenes contamination. The company distributed the cheese in the provinces of New Brunswick, Newfoundland and Labrador, Nova Scotia, Ontario, Prince Edward Island, and Quebec.
• The Delta variant of COVID-19 now accounts for 83% of all U.S. COVID-19 cases. This is a huge increase, up 50% since the week of July 3.
• The U.S. Government Accountability Office released a new statement providing 15 recommendations around topics such as program integrity and preparedness for future public health emergencies. As part of this, the GAO also encouraged “the CDC work with stakeholders to have a plan for dealing with surges in laboratory testing. Second, it recommends that CDC analyze its needs for manufacturing and deploying diagnostic test kits during public health emergencies, which could result in establishing pre-emptive contracts with test kit manufacturers” (CIDRAP).
• India’s death toll is likely much higher than its current reported; instead, estimates put the death toll at 10 times higher than the official count – perhaps up to 3 or 4 million dead.