• • In today’s Recommendations for Industry, we discuss the CDC’s newly published concessions for fully vaccinated people. Read more below.
  • Yesterday, the CDC announced that fully vaccinated Americans can be maskless outdoors when doing activities (biking, running) and during outdoor gatherings with friends or outdoor dining at restaurants. However, the CDC continues to recommend mask-wearing when one is in large outdoor gatherings (like concerts or sports events) because there may still be unvaccinated individuals in these circles. The CDC recommends that you continue considering current COVID-19 spread in your community, “the number of people participating in the activity, and the location of the activity”. See the charts of activities considered safe for fully vaccinated individuals both indoors and outdoors.

  

  • NPR reports on why Michigan continues to experience the highest rate of new US COVID-19 cases. Last week, Michigan had over 70 young children in hospitals. Michigan was especially hit hard by the B117 variant.
  • CIDRAP reports on a Cleveland Clinic study, published in JAMA Network Open, that found that early in the COVID-19 pandemic, early virus subgroups were associated with higher death rates. However, as the pandemic continued, “strains quickly became less diverse and the once-dominant variants were outcompeted by more transmissible variants which were tied to improved survival in hospitalized patients”. Additionally, researchers also noted that, “Early public health mitigation measures likely prevented more strains from entering the community, leading to a rapid reduction in virus strain diversity and lowering the overall death rate”. Ultimately, researchers found that “the continued evolution of SARS-CoV-2 leads to less virulence”. This study showed how different strains arrived and were outcompeted, at least in Cleveland.
  • In global news:
    • Yesterday, India’s new COVID-19 cases set another daily record, reaching over 3,000 cases for the first time.
    • Turkey’s national lockdown will last until May 17.
    • Brazil has rejected Russia’s Sputnik V vaccine “due to lack of data on safety, effectiveness, and quality”. Additionally, “Brazil's senate has launched an investigation into President Jair Bolsonaro's response to COVID-19, following months of the country's leader downplaying the threat and promoting untested treatments”.
  • Canada is sending its army and Red Cross to Ontario to support the high rates of COVID cases in the region.
  • The U.S. will send 60 million doses of unused AstraZeneca doses to other countries like India.
  • Three new “real-world” studies highlight that the Pfizer and AstraZeneca vaccines (either one or two doses) were enough to cut infections and hospitalizations.
  • A study published in NEJM of 35,000 pregnant individuals who’d received either the Pfizer or Moderna COVID-19 vaccines have found that the vaccines were not associated with increased risks of pregnancy-related or neonatal adverse events (aka: according to this study, the vaccines are safe for pregnant patients).
  • Yesterday, Portugal recorded its first day of no deaths since August 2020!
  • China has promised to meet Indian requests for COVID help.

New Concessions for Fully Vaccinated People

In its April 27 updated guidance, CDC made some significant changes to its COVID-19 protections for fully vaccinated people. Among these were two key takeaways TAG sees as of highest importance and applicability to businesses: elimination of the 90-day post-vaccine limit on quarantining and reduced indoor/outdoor protections.

Quarantining. According to the new guidance, most fully vaccinated people with no COVID-like symptoms do not need to quarantine or be tested following a close contact with an infected person. Previously CDC had allowed for the non-quarantining only within 90 days of being vaccinated, likely because of lack of evidence of vaccine immunity longevity. There are, however, some exceptions:

• They should monitor for COVID-19 symptoms for 14 days; if symptoms are experienced, they should isolate and seek medical evaluation.
• Those in higher risk situations should still be tested, including those who are:
  • Employees of high-density workplaces. CDC provides the example of poultry processing plants; TAG interprets it as workplaces where workers cannot be six feet apart and/or ventilation is not adequate)
  • Dormitory residents or similar high-density housing settings
  • Residents and employees of non-healthcare congregate settings

This is because they may face high turnover of residents, a higher risk of transmission, and challenges in maintaining recommended physical distancing.

Indoor/Outdoor. Fully vaccinated people may also begin reducing some protections in certain indoor and outdoor situations, including the following.

Those who are fully vaccinated:

• Need not wear masks outdoors except in large gatherings (e.g., sporting events, concerts, parades, etc.)
• Need not stay six feet apart indoors

In all indoor situations, and some outdoor, CDC continues to see masking as the safest option. We would expect masking to be a last aspect to be maintained, as they are one of the most protective for all.

Risk Matrix

This week’s risk matrix is continuing to show some encouraging trends, but cases are still at a risk level and vaccines not yet widely disseminated enough to reach population immunity.

• The Government Stringency Index is 36 this week. This is down from 38 last week, indicating a decrease in government stringencies. Five (5) states’ (Arizona, California, Colorado, New Mexico, and Oregon) businesses are in mixed opening stages.
• 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).
• 8 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 down from 13 last week. These states are Pennsylvania, New Jersey, Florida, Minnesota, Colorado, Delaware, Maine, and Rhode Island(Table 4)

Table 4.

• In Monday’s Recommendations for Industry, we discuss the resumption of the J&J vaccine and why vaccinations don’t eliminate the need for COVID protections. Read more here.  
• The FDA and CDC have lifted their recommended pause for the J&J COVID-19 vaccine. Ultimately, the two agencies have confidence in the safety and efficacy of the vaccine with the benefits far outweighing the potential risks. Current data shows the chance/risk of blood clots as being low and something they will continue to track. Read the News Release here.
• The European Union bloc is anticipating that fully vaccinated tourists may begin visiting Europe in the summer.
• In India, COVID-19 cases and deaths are rising as hospitals run out of oxygen and cremation sites are inundated. India has asked for global help, and countries throughout the world are stepping in with support (including sending oxygen). Day after day, India reports higher and higher daily case rates.
• The NYT reports that almost 8% of those who have received a first-dose of Pfizer or Moderna COVID-19 vaccines do not get a second dose. This is due to people choosing to not get their second shots due to symptoms experienced from the first shot, as well as vaccine providers canceling second-dose appointments due to not having the vaccine in stock or having the wrong type of vaccine.
• A recent study published in PNAS is “A guideline to limit indoor airborne transmission of COVID-19.” Its “theoretical model quantifies the extent to which transmission risk is reduced in large rooms with high air exchange rates, increased for more vigorous respiratory activities, and dramatically reduced by the use of face masks.” We discuss this article in today’s Recommendations for Industry and you can find the research article here.
• The S. State Department has issued over 115 “Do Not Travel” advisories due to the increasing rise of COVID-19 throughout the world (again).
• While we discuss global vaccine equity (and the need for it), more affluent nations (including U.S., E.U. block, U.K. Switzerland, Japan, Norway, Canada, Australia, and Brazil) are still “refusing to wave the rights on COVID vaccines” despite the increasing need for it throughout the world.
• Vaccinations have dropped for the first time since February from an average of 3.5M shots/day last week to 3M shots/day this week.