When Can We Reduce Masking Requirements?

Key Points:

• In today’s Recommendations for Industry, we discuss the question: When can our business reduce or rescind our masking requirements? Read more below.
• Further decline in global COVID cases as deaths stabilize. COVID-19 cases across the globe declined last week for the second week in a row, with illness levels dropping in every region except the Western Pacific, the World Health Organization (WHO) said yesterday in its weekly pandemic snapshot. Cases were down 19% last week compared to the previous week, and deaths held steady after rising steadily for 5 weeks. The Western Pacific region’s rise was led by increases in China, South Korea, Samoa, and Brunei Darussalam. A handful of countries in Asia—which are experiencing later Omicron surges—reported record cases in the past day. 
• In the US, newly reported COVID-19 deaths are starting to decline. This is driven by drops in the Northeast and Midwest offering the latest sign that the surge fueled by the highly transmissible Omicron variant is fading. In the South, the average still appears near the peak for the Omicron wave. In the West, death counts in California have recently been on the rise, while the data indicate Nevada may have recently crested.
• Study suggests maternal COVID-19 vaccination protects babies. A COVID-19 vaccination during pregnancy can also protect the infant during the high-risk first 6 months of life. The study examining hospitalization trends across 20 children’s hospitals in 17 states from July 2021 through January 2022 showed that maternal completion of a 2-dose primary mRNA COVID-19 vaccination series during pregnancy against COVID-19 hospitalization among infants aged <6 months was 61%. A separate team that looked at COVID-19 hospitalizations in children found that levels jumped dramatically during the Omicron variant surge, especially in those younger than 4, a group not eligible yet for vaccination.
• Increased infectivity, antibody escape drive SARS-CoV-2 evolution, studies say. In a study published in the Journal of Chemical Information and Modeling, researchers using an artificial intelligence (AI) model showed that Omicron is over 10 times more infectious than the original coronavirus and 2.8 times more infectious than the Delta variant. In addition, Omicron is 14 times more likely than Delta to escape current vaccines, and it is predicted to compromise the efficacy of several monoclonal antibody therapies. Many of the predictions have been verified by emerging experimental results.
• The US government plans to make high-quality face masks available for children. According to Dr. Tom Inglesby, senior adviser to the White House COVID-19 Response Team, “that process is underway.” The forthcoming plan appears to be an extension of the White House’s ongoing effort to distribute 400 million free N95 masks from the Strategic National Stockpile for the public to access at pharmacies and community health centers nationwide.
• Retail sales jumped in January as the Omicron wave started to recede and consumers absorbed high inflation. Sales were up a seasonally adjusted 3.8% from December, the strongest monthly gain since last March, when pandemic-related stimulus was being distributed to households. With COVID restrictions easing and consumer finances their strongest in recent history, Americans are emerging eager to splurge on what they have been missing, including travel, sports events, restaurants, cruises and theme parks.

Food Safety & Public Health:

• Three Human Salmonella Cases Linked to Mass. Company’s Dog Treats.Three human cases of salmonella in people who handled Dog Gone Dog Treats have been reported in Massachusetts. The cases include two adults in their 70s and one child.The dehydrated treats are not fully cooked and include “chicken chips,” beef liver and sweet potato chips in their ingredients, and several bags tested positive for salmonella at the state public health lab.The company has stopped production of the treats; stores have been ordered to remove the treats from shelves; and consumers are advised to dispose of any they have.
• Jan Fruits Inc. Recalls Enoki Mushrooms Because of Possible Health Risk. February 8, 2022, Jan Fruits Inc. of Vernon, CA is recalling all its cases of its 200g/7.05oz packages of Enoki Mushroom (Product of Taiwan) because it has the potential to be contaminated with Listeria monocytogenes.
• FDA Requests Public Comments on the Use of Antimicrobials in Companion Animals. On Wednesday, FDA released a request for public comments about antimicrobial use (AMU) in companion animals (e.g., cats, dogs, horses) and the potential impact of this use on antimicrobial resistance in both animals and people. Recognizing the need to better understand how the use of antimicrobial drugs to treat companion animals (e.g., dogs, cats, and horses) might contribute to the development of antimicrobial resistance in both animals and people, the FDA’s Center for Veterinary Medicine (CVM) intends to use the information collected to help develop strategies to further promote antimicrobial stewardship in companion animals.

Recommendations for Industry

When Can We Reduce Masking Requirements?

As COVID cases continue to decrease in much of the U.S. – as shown in both TAG’s weekly matrix (below) and the key points (above), the most common question TAG has been getting from clients is when can our business reduce or rescind our masking requirements?

As more states and cities relax masking requirements, TAG sees the trend moving in the direction of reducing or ending mask requirements. The CDC has indicated that it may update its guidance as soon as next week. On Wednesday, the CDC director said the agency is working on “relevant” guidance, wanting to “give people a break from things like mask wearing when these metrics are better and then have the ability to reach for them again” basing guidance “on the data and the science.”

In a similar way, TAG is working on a thought model for businesses, that would include a number of external (e.g., community transmission or hospitalization rates) as well as internal (e.g., ventilation, number of workers in close contact, the percent of employees experiencing COVID-like symptoms, etc.) considerations. Additionally with some areas of the Western U.S. still seeing high rates, TAG recommends a four-step approach to masking requirements:

1. Know the local or state requirement.
2. If no requirements are in place, consider CDC community transmission guidelines based on the  level of new cases and percent of positivity.
3. If you do rescind masking mandates, TAG advises that you maintain a supply of company-provided masks for those who want to wear them.  If a future surge occurs, having masks on-hand to distribute is a good practice.
4. Consider the CDC mask guidelines for those who do wear them along with specific “use-cases,”  (e.g., employees returning after day 5 of isolation and those opting out of quarantine are good candidates for short term use of an N95 or equivalent mask, as these people are more likely to represent a transmission risk to others).
5. Use online calculators to determine the safe occupancy of poorly ventilated or crowded spaces to determine if and when masks are needed.

Meanwhile, TAG will keep an eye out for and relay new CDC updates, and continue to provide our own recommendations for masking and other COVID and infectious disease protections.

Risk Matrix:

Although cases are dropping, the case rates across the U.S. are still well above 25 cases/100K persons, except for Maryland (14 cases/100K) and New Jersey (23 cases/100K).

In case you missed it:

• In Tuesday’s Recommendations for Industry, we discussed how COVID-19 has impacted other areas of public health. Read more here.
• In the U.S., new COVID-19 cases have dropped by 42%; although death rates and hospitalizations remain high (CIDRAP). However, around the world, COVID-19 still persists. In fact, in Hong Kong, daily cases have now topped 2,000 cases per day. Similarly, cases are also high in New Zealand, where, once having originally controlled the virus is now struggling with the Omicron variant (CIDRAP₂).
• Ontario, Canada will end its COVID-19 vaccine passport system on March 1^st; individuals will no longer require proof of vaccination (Detroit News).
• A recent JAMA study found that mixing and matching COVID-19 vaccine boosters (e.g., using a different booster than the original series) may lead to fewer infections (CIDRAP). The CDC’s recent data, which seems to echo “preliminary research from Israel and Britain” has found that “protection from booster doses declines within a few months,” “plung[ing] after four months.”  However, the analysis did not include a comparison to demographic data (NYT). 
• Two papers that will soon be presented “at upcoming professional society meetings suggest that some long COVID-19 symptoms may be related to the effect of SARS-CoV-2 on the vagus nerve and that the use of enhanced external counterpulsation (EECP)—which increases blood flow—can improve some of those symptoms, respectively” (CIDRAP).

Influenza:

• Around the U.S., the CDC reports that “sporadic influenza activity continues across the country”; in fact, cases are decreasing. Where there are reports, “flu deaths tend to be occurring primarily among the elderly.” The majority of U.S. influenza cases are Influenza A (H3N2).
• Around the world, “influenza activity decreased” as well.

Public Health & Food Safety:

• Due to drug cartel interference, some Mexican avocados have been banned until further notice (Food Safety News).
• H5N1 avian flu is spreading. Not only is it spreading to hit more poultry flocks in Africa (Cameroon) and Europe (Denmark and Romania) (CIDRAP), it is also expanding into poultry flocks in Kentucky and Virginia (CIDRAP₂).
• Published in Infection Control & Hospital Epidemiology, a recent population-based surveillance study “conducted at five US sites found a high incidence of infections caused by extended-spectrum beta-lactamase–producing Enterobacterales (ESBL-E) […] An incident ESBL-E case was defined as an Escherichia coli, Klebsiella pneumoniae, or Klebsiella oxytoca isolate resistant to at least one extended-spectrum cephalosporin and non-resistant to carbapenems” (CIDRAP).
• COVID-19 continues to wreak havoc on the American healthcare system; however, this time there is fear that due to dramatic disruptions in cancer screenings, it is likely that we may see a wave of cancer and other chronic, life-threatening illnesses, that may begin to arise (VOX).