FROM THE EPIDEMIOLOGIST EXCELLENT ARTICLE FOR EDUCATORS AND PARENTS
(J. Harris: READABLE)
CDC UPDATES CURRENT: AUGUST 11, 2022:
”...While the CDC did away with quarantine recommendations, the new guidance says people exposed to COVID-19 should wear a high-quality mask for 10 days and get tested on day five…he new COVID-19 recommendations focus on mitigating the risk of severe disease, rather than infection itself…We’re in a stronger place today as a nation, with more tools — like vaccination, boosters and treatments — to protect ourselves and our communities, from severe illness from COVID-19…This guidance acknowledges that the pandemic is not over but also helps us move to a point where COVID-19 no longer severely disrupts our daily lives.”
FIVE CDC UPDATES
1. The guidance underscores the importance of staying up to date with vaccination, “especially as new vaccines become available.” Omicron-targeted vaccines are expected to be available in the fall.2. The six-foot standard for social distancing is no longer an explicit recommendation. The guidelines place less emphasis overall on physicial distancing as a key measure to avoid exposure, instead describing it as “just one component of how to protect yourself and others.” The updated recommendations place more onus on individuals to assess the risks and take more precautions in particular settings, such as crowded indoor spaces.
3. The CDC no longer recommends routine screening of people without symptoms in most community settings, including schools4. Isolation guidance for people with COVID-19 remains the same: Isolate for at least five days at home and wear a high quality-mask when around others. Isolation may be ended after five days if a person is fever-free for 24 hours without medication and symptoms are improving, though a mask should be worn through day 10. Immunocompromised people and those who had more severe illness should isolate through day 10.
5. The FDA on Aug. 9 released a safety alert advising people to perform repeat testing to avoid false negative results when using at-home rapid antigen tests. If a symptomatic person tests negative, they should test again 48 hours later. People without symptoms who may have been exposed should take up to three tests after receiving their first negative result, each separated by a 48-hour period….Be aware that at-home COVID-19 antigen tests are less accurate than molecular tests,” the FDA said. “COVID-19 antigen tests may not detect the SARS-CoV-2 virus early in an infection, meaning testing soon after you were exposed to someone with COVID-19 could lead to a false-negative result, especially if you don’t have symptoms. This is the reason why repeat testing is important.”
1 Omicron Subvariants Gain More Ground, Including BA.4.6 in the Midwest (CIDRAP) Though the 7-day average for new daily COVID-19 cases is slowly declining, the more transmissible and immune-evasive Omicron subvariants became even more dominant last week, with an offshoot called BA.4.6 gaining traction in some Midwestern states. Health officials brace for a possible spike in activity after school starts and people begin gathering more indoors in the fall. In its weekly variant proportion updates, the U.S. CDC said the proportion of BA.5 viruses in sequenced samples last week rose from 84.5% to 87.1%, while BA.4 declined slightly, from 8.2% to 6.6%. However, the proportion of BA.4.6 viruses rose from 4.2% last week to 4.8% this week. The subvariant has also been reported in other US regions, especially in the east.
2. Community transmission in the US is primarily driven by the Omicron BA.5 sublineage. BA.5 is now projected to account for 87.1% of sequenced specimens. The BA.4 sublineage accounts for about 6.6% of cases, while the BA.4.6 sublineage accounts for 4.8% of cases. Together, BA.2.12.1 and BA.2 now account for only about 2.9% of cases. According to the estimate, Omicron variants represent all new cases in the US.
3. EDUCATORS MIGHT NOTE:
INDOOR AIR WORKSHOP The Environmental Health Matters Initiative (EHMI) of the National Academies of Sciences, Engineering, and Medicine will host its first virtual workshop in a 3-part series on Indoor Air Management of Airborne Pathogens on August 18 from 11:30 am to 3:30 pm EDT. These workshops—follow ups to the 2020 workshop on the airborne transmission of SARS-CoV-2—will explore strategies needed for airborne disease control and risk reduction in enclosed places by drawing on accumulated community and institutional knowledge, on-the-ground observations of indoor environments management during the pandemic, and novel and promising scientific discoveries. For more information and to register, visit https://www.nationalacademies.org/event/07-21-2022/indoor-air-management-of-airborne-pathogens-lessons-practices-and-innovations.
4. IMMUNE EVASION Immune escape, or immune evasion, is driving the COVID-19 pandemic’s extended life cycle. As the virus continues to infect humans, it will mutate and likely adapt to find its way around existing levels of vaccine-induced and natural immunity. The scientific community is not surprised that SARS-CoV-2 continues to evolve to evade our ever-changing immune systems, as many other viruses do the same. But because SARS-CoV-2 is a new virus to humans, attention is focused on emerging new variants and global anxiety is heightened, wondering what variant lies around the corner.
Currently, there are many questions about whether the Omicron subvariants BA.2.75 or BA.4.6 will cause the next wave of infections. BA.2.75, which has been circulating widely in India for more than a month and has been detected in at least 20 other countries, does not currently appear likely to outcompete BA.5, the global leader of SARS-CoV-2 variants. BA.4.6, which is growing in prevalence in the US and Europe, appears to be just as transmissible as BA.2.75, but it remains unclear whether either subvariant will become predominant. Scientists continue to worry that either one of these Omicron subvariants, or an as-yet undetected variant, could gain global, regional, or local dominance. This cycle of new variant-driven waves, each with increased immune evasion, describes the global experience with COVID-19 to date, and many assume the pattern will continue into the future. This is what allowed BA.4 and BA.5 to spread widely despite widespread recent infections with the Omicron BA.1 and BA.2 subvariants.
In addition to increased variant surveillance, more must be done to help further prepare for future increases in COVID-19 cases. The first priority is to address current infections by reducing transmission of circulating virus, limiting its chances to adapt and evade existing levels of immunity. However, limiting transmission is increasingly challenging, as many countries roll back mitigation measures and as funding for testing and vaccination programs dwindles. Many appear to be placing hope in the next generation of SARS-CoV-2 vaccines, which are expected to protect against a wider array of viral lineages. Several studies, including one conducted in non-human primates published this week in Science Translational Medicine, suggest that these vaccines may be a possibility, and they may be able to provide protection that extends to other coronaviruses, so-called pancoronavirus vaccines. While those vaccines remain a distant goal, manufacturers continue to work on current vaccine platforms that enable the fast production of variant-specific boosters. The CEO of Moderna recently compared the future of SARS-CoV-2 vaccines to the iPhone’s constant updates, with new generations developed as more data and technologies become available.
5. NOVAVAX VACCINE Last month, the US FDA granted emergency use authorization (EUA) for a protein-based COVID-19 vaccine made by US-based manufacturer Novavax. Many public health advocates hoped that the vaccine’s authorization would lead to an increase in vaccinations among unvaccinated populations, having faith that the more traditional protein-based vaccine technology would ease concerns surrounding vaccination with vaccines using newer mRNA platforms. However, in the month since the EUA was issued, only about 7,400 doses have been administered in the US, with only 2,300 people receiving a 2-dose primary series using Novavax. According to the US CDC, 332,000 doses of the vaccine have been distributed nationwide. Originally, the vaccine was available at only 385 locations, although that number has grown to 986 sites. Notably, more than 53,000 locations have been used to provide other vaccinations throughout the pandemic. The limited uptake of the Novavax vaccine has received criticism given the large investment the company received from Operation Warp Speed. While it is too early to decide the fate of the vaccine in the US, Novavax recently reset its sales expectations, halving its forecast to US$2 billion to US$2.3 billion from US$4 billion to US$5 billion.
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