With many schools across the U.S. already back in session, the Harris Poll fielded August 20th to 22nd surveyed parents about how they are feeling as their students return to classrooms and campuses. 60% of parents said knowing that some students are returning to school unvaccinated and potentially without masks makes them uncomfortable. 74% of parents supported masks for college, middle, and high school students; 73% of parents supported masks for elementary schools; and 63% of parents even supported masks for children over the age of 2 in daycare or preschool.
To mitigate the risk inherent in school and campus returns, some universities are requiring vaccination. The Washington Post recently reported that 49 students registered for fall classes at the University of Virginia (UVA) had been “disenrolled after failing to meet the school’s vaccine mandate.” Students were required to provide proof of vaccination by July 1, and the university has followed up repeatedly with students who were not in compliance after that date. In other parts of the country, some schools have announced mask requirements as a mitigating measure. These mask and vaccine mandates in education contexts continue to elicit passionate, politicized debate.
In the business world, Goldman Sachs has pursued an even more stringent path than simply mandating vaccines or masks. The Wall Street institution announced a vaccination, regular testing, and mask usage mandate effective September 7th. This mandate requires that all personnel coming on site – whether employees or clients – be vaccinated. In addition, the bank will introduce a mandatory weekly testing program for vaccinated workers and will require mask-wearing in all common areas, except when seated and eating or drinking.
As more and more educational institutions and employers announce requirements around masks and vaccination, it is unsurprising that American adults are instituting their own personal policies to manage COVID risk. Respondents to the Harris Poll reported the following inclinations when asked about personally imposed mandates:
- Approximately 66% (two thirds) of respondents said they would require vaccination if they were hosting an event, while only 15% said they would expect party hosts to require vaccination
- 37% of respondents said they would require vaccination regardless of party size
- Perhaps most intriguing: some respondents reported having cut ties with friends or family because those individuals would not get the COVID vaccine, ranging from 7% of Baby Boomers to 33% of Millennials
Cutting off friends may not seem friendly, but it’s certainly a growing trend. In fact, Friends cast member Jennifer Aniston made headlines recently when she told an interviewer for InStyle magazine that contrary to the lyrics of her star-making show’s theme song, she would not “be there” for the people in her life who declined vaccination. Aniston explained, “I’ve just lost a few people in my weekly routine who have refused or did not disclose [whether or not they had been vaccinated], and it was unfortunate. I feel it’s your moral and professional obligation to inform.”
As the U.S. continues to navigate the stormy seas of personal and institutional risk mitigation policies, the need to create layered strategies remains. Those layers must unite the most up-to-date knowledge about the risks of COVID with ways to reduce transmission via people-based and environmental factors. This blog post will share the latest information about variants, vaccines, mask usage, and indoor space safety in order to underscore the importance of continuing to fight COVID with multi-faceted plans of attack.
The Latest News on COVID Variants
Over the course of this current summer 2021 COVID surge, the Delta variant of the coronavirus has proven a formidable threat to public health domestically and internationally. While other variants of the COVID virus constitute a veritable “Greek Row” of options, Delta and Lamba have exceeded the Alpha, Beta, and Gamma variants in potency and prevalence. With a few months’ worth of data now available, the Delta variant has distinguished itself by proving more contagious than its predecessors. The Wall Street Journal reported that scientists studying the variant believe it infects people with a greater viral load and is more capable of attaching itself to cells in human airways. These adaptations contribute to the variant’s greater contagion because they make the COVID Delta variant easier to exhale and transmit, even with less exposure.
With increased infectiousness comes increased risk that younger populations can catch the COVID Delta variant. Some recent studies have estimated that the risk of hospitalization after infection with the Delta variant could be 85% higher than with the Alpha variant. Furthermore, states and hospitals have indicated that the level of infection in younger patients is increasing. For example, the state of North Carolina reported that the average age of hospitalized COVID patients has dropped from 61 years of age in January to 44 years of age in August. Thanks to this summer Delta surge, 20% of ICUs in the U.S. have reached or exceeded 95% occupancy in recent weeks, placing increasing strain on the U.S. healthcare system.
While Delta continues to dominate, threats from other COVID variants may be on the horizon. Currently, the Lambda variant has been responsible for less than 2,000 cases in the U.S. but is a “variant of interest” (VOI) to the World Health Organization (WHO) – one classification below the Delta variant, which is a “variant of concern” (VOC). Experts are watching Lambda closely because it has already demonstrated high transmissibility in Latin American countries. Dr. Gregory Poland, director of the Vaccine Research Group at the Mayo Clinic, recently explained to a local news station in New York, “What makes it dangerous is that it’s highly infectious and can resist some of the vaccine-induced immunity and spread easily between people.”
This week, the WHO has also added the Mu variant to its VOI watchlist. The Guardian reported that this COVID variant was added “after it was detected in 39 countries and found to possess a cluster of mutations that may make it less susceptible to the immune protection many have acquired.” Originally identified in Colombia in January 2021, the Mu variant currently accounts for less than 0.1% of COVID infections globally. In a weekly epidemiological update released on August 31, the WHO described that the Mu variant had reached VOI status because it has “a constellation of mutations that indicate potential properties of immune escape.” Currently, the WHO classifies the Alpha, Beta, Gamma and Delta variants as “variants of concern” (VOCs), while Mu joins Eta, Iota, Kappa, and Lambda on the VOIs list.
People-Based COVID Mitigation Strategies: The Latest News on Vaccines
As researchers continue to study the differences between the COVID virus variants, including their interaction with vaccines, the CDC released a report on August 24th comparing vaccine effectiveness for the Alpha versus Delta variants. The CDC report shows that a study of frontline workers revealed a 25% reduction in vaccine effectiveness when comparing Alpha variant and Delta variant infection. The study states, “The VE [vaccine effectiveness] point estimates declined from 91% before predominance of the SARS-CoV-2 Delta variant to 66% since the SARS-CoV-2 Delta variant became predominant.” Despite this differential, experts remain firm in their recommendation that the public get vaccinated. The CDC’s lead study author, Ashley Fowlkes, told CNN, “While we did see a reduction in the protection of the Covid-19 vaccine against the Delta variant, it’s still two-thirds reduction of risk . . . It’s still a very powerful vaccine.”
The New England Journal of Medicine published its own vaccine efficacy study based on data from England and found a less dramatic difference in efficacy. The study authors concluded, “Overall, we found high levels of vaccine effectiveness against symptomatic disease with the delta variant after the receipt of two doses. These estimates were only modestly lower than the estimate of vaccine effectiveness against the alpha variant. Our finding of reduced effectiveness after the first dose would support efforts to maximize vaccine uptake with two doses among vulnerable groups in the context of circulation of the delta variant.”
An additional CDC study published in their Morbidity and Mortality Weekly Report underscores the importance of vaccination. The study notes that in July, when the Delta variant had established dominance in the U.S., “infection and hospitalization rates among unvaccinated persons were 4.9 and 29.2 times, respectively, those in fully vaccinated persons.” This means that unvaccinated people were 5 times more likely to be infected and 29 times more likely to be hospitalized than unvaccinated people. In its own review of latest vaccine efficacy studies, biotech, pharma, and the life sciences industry website Stat observed, “With vaccination rates in a number of states still far too low, the amount of SARS-2 circulating is dismayingly high at this point, more than a year-and-a-half into the pandemic in the United States. The way to make progress in the fight is to get more people vaccinated — both here and abroad — to cut transmission and the risk of new variants emerging.”
A further study of interest was published this week comparing the two-dose Pfizer and Moderna vaccines. According to a research letter published to the JAMA Network website, the Moderna vaccine generated more than double the antibodies generated by the Pfizer vaccine. The letter explains, “This study demonstrated a significantly higher humoral immunogenicity of the SARS-CoV-2 mRNA-1273 vaccine (Moderna) compared with the BNT162b2 vaccine (Pfizer-BioNTech), in infected as well as uninfected participants, and across age categories.”
All of this research helps address vaccine hesitancy and increase confidence in vaccine efficacy. A further boon to these efforts came with the August 23rd announcement that the Food and Drug Administration (FDA) had fully approved the Pfizer COVID vaccine for administration to patients 16 and older. The Harris Poll fielded August 27-29 found that 80% of Americans surveyed, including 57% of unvaccinated respondents, felt more confident in the vaccine following the FDA’s full approval of the Pfizer jab. Furthermore, 49% of currently unvaccinated respondents said they will now get vaccinated given the FDA’s full approval. The Pfizer vaccine, which will be known commercially as Comirnaty, will continue to be available under emergency use authorization (EUA) for individuals ages 12 to 15 and for boosters administered to people who are immunocompromised. Just over half of U.S vaccine recipients (~92 million of ~170 million) have received the Pfizer vaccine. According to the Johns Hopkins Coronavirus Resource Center, 52% of the U.S. population is currently fully vaccinated.
As efforts to encourage and legitimize vaccination increase, recommendations around booster shots have been causing some buzz. The general thinking behind boosters is that these additional shots can bolster (or boost) a recipient’s immune system as the protective power of the original doses naturally wane over time. While needing a vaccine booster is quite common. the frequency with which people need to receive boosters or additional doses varies by vaccine type. For example, the CDC recommends that adults receive doses of the flu vaccine every year, while a booster dose of the Tetanus, diphtheria, and pertussis (Tdap) vaccine is only needed every 10 years. In recent weeks, President Biden and his health advisers have recommended booster shots for Americans who received the Pfizer and Moderna vaccines, with suggested timing dropping from eight to six to now five months after recipients’ most recent (second) dose. For individuals who received the single-dose J&J vaccine, a second dose “booster” also seems likely. The New York Times has reported that both Pfizer and J&J submitted data to the FDA last week seeking approval to offer boosters.
People-Based COVID Mitigation Strategies: The Latest News on Masks
Masks remain a hot-button issue in the U.S., particularly when it comes to mandates and schools. Currently, The New York Times reports that 15 states have mandated masks in schools. At the other end of the mandate spectrum, seven states have banned mask mandates in schools. The remaining states and territories in the U.S. have some mandates or guidelines determined by local discretion in place. The debates about masks in schools have been so widespread that the federal government announced an investigation of states banning masks in schools this week. As detailed in The New York Times on August 30, the U.S. Education Department’s Office for Civil Rights will use the investigation to explore whether or not state bans on mask mandates in schools “may be preventing schools from meeting their legal obligations not to discriminate based on disability and from providing an equal educational opportunity to students with disabilities who are at heightened risk of severe illness from Covid-19.” The states included in the investigation are Iowa, Oklahoma, South Carolina, Tennessee, and Utah. States with mask bans that have not been included because of active legal cases around the states’ bans are Arizona, Arkansas, Florida, and Texas.
Mask policies also have a broader presence beyond just educational settings. At the total state level, six states have reinstated state-wide mask policies, while nine states have introduced bans on mask mandates state-wide. The remaining states and territories have put in place either mandates with restrictions or recommendations for mask usage. As of August 13, the CDC’s mask guidelines state, “If you are not fully vaccinated and aged 2 or older, you should wear a mask in indoor public places. . . If you are fully vaccinated, to maximize protection from the Delta variant and prevent possibly spreading it to others, wear a mask indoors in public if you are in an area of substantial or high transmission.”
Environment-Based COVID Mitigation Strategies: Barriers and Disinfection
The high variability in vaccine receipt and mask usage underscores the importance of not relying on people-based mitigation strategies alone to fight the spread of infection. When individual human behavior can be unreliable, environmental mitigation and layered strategies become all the more essential. Furthermore, choosing the right environmental strategy is critical.
A recent New York Times article revealed that one particularly widespread tactic – the use of plastic and plexiglass barriers – may actually be exacerbating rather than mitigating transmission in shared spaces. The article explains, “Intuition tells us a plastic shield would be protective against germs. But scientists who study aerosols, air flow and ventilation say that much of the time, the barriers don’t help. . . Research suggests that in some instances, a barrier protecting a clerk behind a checkout counter may redirect the germs to another worker or customer. Rows of clear plastic shields, like those you might find in a nail salon or classroom, can also impede normal air flow and ventilation.” The addition of these plastic barriers in a space modifies the air flow, disrupts ventilation, and even impedes dispersion of aerosolized viral particles, leading to potentially dangerous particle buildup in “dead zones.”
Quality of air and the overall health of an indoor environment remain crucial to promoting safety in shared spaces. In a recent webinar co-presented by R-Zero and AASA (The School Superintendents Association), Dr. Paula Fujiwara of the International Union Against TB and Lung Disease noted that environmental controls are arguably the most overlooked component in the three-part hierarchy of infection control. This hierarchy also includes administrative measures (plans, policies, and protocols) as well as people-based measures (personal protection such as vaccination and the use of masks).
When elaborating on the important role of environmental mitigation in controlling infections, Dr. Fujiwara highlighted two key tactics: UV light disinfection and ventilation. UV light technology can effectively disinfect the air and surfaces in an indoor environment without the use of chemicals, while adequate ventilation can help disperse airborne particles to reduce risk. The International Ultraviolet Association (IUVA) has emphasized the efficacy of UV light in neutralizing COVID and other microbial threats. In a fact sheet specifically detailing UV light’s germicidal properties for COVID, the IUVA explains, “UVC disinfection is often used with other technologies in a multi-barrier approach to ensure that whatever pathogen is not ‘killed’ by one method (say filtering or cleaning) is inactivated by another (UVC). In this way UVC could be installed now in clinical or other settings to augment existing processes or to shore up existing protocols where these are exhausted by excessive demands due to the pandemic.”
As the pandemic continues, organizations wishing to continue operations with any degree of shared space indoors will need to employ ever-evolving layered approaches to transmission mitigation. Recent national headlines have demonstrated that relying on people alone is too risky. Despite expert wisdom and recommendations, some individuals may choose not to engage in personal protection measures such as vaccination or mask usage or may prefer not to abide by the administrative controls of plans, policies, and procedures that might mandate these behaviors. Consequently, it is imperative that organizations as varied as schools, corporate entities, and healthcare systems, to name a few, implement efforts that will improve the indoor environments within their stewardship. By leveraging tools such as UV light disinfection and effective ventilation, these organizations can achieve better outcomes now, in these current COVID conditions, and in the future when facing other microbial threats.
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