Back to Basics: Looking Ahead & Looking Back

Key Points:

• In today’s Recommendations for Industry, we discuss the updated CDC isolation guidelines (coupled with antigen testing) while reflecting on how long this new COVID wave might last. Read more below.
• COVID-19 cases in the U.S. are at the highest level recorded through the pandemic. This can be reflected and seen in this week’s risk matrix with some states’ case rates exceeding 200 or 300 cases per 100,000 persons.
• European countries are now reporting post-holiday COVID-19 surges due to the Omicron variant. In many countries, hospitalizations are rising; however, the rise in hospitalizations is not as high as the rate of COVID-19 infections.
• A large multistate cohort study of over 40,000 pregnant women continues to support COVID-19 vaccination safety in pregnant women; there are “no links between use of mRNA vaccine or immunization during the first trimester to the two birth outcomes.” [preterm birth or small-for-gestational- age births].
• Additionally, as the influenza season is underway, an additional study in Denmark has found no interaction between the flu vaccine and “COVID-19 hospitalization or influence [on] the development of SARS-CoV-2 antibodies.”

Recommendations for Industry

Back to Basics: Looking Ahead & Looking Back

The Omicron variant continues to surge throughout the U.S. In fact, as can be seen in this week’s Risk Matrix, we are seeing dramatic rises in case rates across the country (some states exceeding 200 or 300 cases/100K persons). The increase in cases may be revealed in absenteeism throughout the next month or two. Based on the rise-plateau-fall of the Omicron variant in other countries, including South Africa, we anticipate that while different regions of the U.S. are experiencing this new COVID-wave at different times, the overall span of a wave may be between 6 – 8 weeks.

Due to feedback received and further discussions, on Tuesday (January 04, 2022) evening, the CDC slightly updated its guidance for quarantining and isolation. As a quick reminder, there is a difference between quarantine and isolation.  

• Quarantine occurs when a person removes themselves from society because they may have been exposed as a close-contact of a person who had COVID-19.
• Isolation occurs when a person is sick or when they’ve been infected (either symptomatic or asymptomatic). When a person isolates themselves, they are removing themselves from society to not expose and/or infect others. 

While the overall guidelines remain the same for the shortened isolation periods, as we previously discussed, there is a potential that individuals may still be symptomatic or continue to test positive on Day 5. To accommodate this potential, the CDC added to its guidance, recommending that if a person has access to a COVID-19 antigen test, they should be tested at or around Day 5. However, a person should only be tested if they have been fever-free for at least 24 hours (without taking fever-reducing medications) and other symptoms are improved.

So what does this mean for the workforce?

Assuming testing capabilities are available, an employee can utilize a rapid antigen test on Day 5 with improved symptoms. If the employee’s antigen test comes back as negative (on Day 5), they are safe to return to work but should continue wearing a tight-fitting mask for at least another 5 days (until Day 10). However, if their test returns as positive, they must continue to isolate until Day 10.

Unfortunately, testing availability may be limited; as such, we recommend that you ask employees to stay out and test on Day 7. If that test is negative, they can then return to work with continued masking (until Day 10). Similarly, the CDC recognizes that antigen tests may not be available. As such, if an antigen test is not available, an employee could also return to the workforce after Day 5 of isolation (with improved symptoms) as long as they are wearing a well-fitting mask until Day 10. In either case, allowing a person who had COVID to return on day 5 without a test could risk transmission of the highly contagious Omicron variant in the workplace and result in additional time out for other employees. 

Risk Matrix

The Omicron variant is the dominant variant in the U.S. Between last week and this week, there has been a dramatic rise in cases throughout the country. This past week, states with a Test Positive Rate (TPR) ≥ 10% and case rate ≥ 25 cases/100K have increased dramatically. Test Positive Rates have increased to over 30% in some places (like Georgia, Mississippi, and New Jersey). Last week, 32 states + DC had TPR ≥ 10% and case rate ≥25 cases/100K; however, this week, all states have a case rate >25 cases/100K. Except for Alaska, which has a TPR of 9%; every other state (and DC) have a TPR ≥ 10%. Case rates in 19 states + DC  have risen above 100 cases/100K persons – to even 200 and 300 cases/100K. States with a case rate above 200 cases/100K persons include:  

• District of Columbia (DC) (298 cases/100K)
• New Jersey (288 cases/100K)
• New York (318 cases/100K)

In case you missed it

• In Tuesday’s Recommendations for Industry, we discussed testing symptomatic employees prior to their return to work. Read more here.
• South Africa has declared that they’ve moved through the peak of their fourth COVID-19 wave that has been driven by the Omicron variant. Additionally, it has removed its curfew.
• The U.S. has topped 2 million cases in a week; this is a first during the pandemic for the U.S. (USA Today). 
• As discussed, the WHO is finding more evidence that the Omicron variant is milder (Aljazeera).
• In Vaccine News:
  • The FDA has authorized the Pfizer booster doses in 12 – 17-year-old individuals. Additionally, the FDA is also encouraging booster shots for immunocompromised children ages 5 – 11 years old.
  • Two recent MMWRs on Pfizer’s COVID-19 vaccine, the vaccine has been shown to be safe and effective in 5 – 11-year-olds. Additionally, the studies have found that the vaccines are 92% effective against infection in 12 – 17 year olds (CIDRAP).

Influenza:

• In the U.S., the seasonal flu is back. Severe cases could further strain the healthcare system; in fact, we are seeing increased flu hospitalizations and deaths starting to become reported. Most influenza cases detected in the US are Influenza A (H3N2). Twelve jurisdictions in the US are experiencing moderate activity while 19 are experiencing high or very high activity.
• Globally, the WHO has also seen an increase of influenza activity (although globally levels are relatively low). The WHO states, “with the increasing detections of influenza during COVID-19 pandemic, countries are encouraged to enhance integrated surveillance to monitor influenza and SARS-CoV-2 at the same time, and step-up their influenza vaccination campaign to prevent severe disease and hospitalizations in high-risk groups of influenza.”