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The original item was published from 8/17/2022 10:05:00 AM to 8/25/2022 12:00:01 AM.

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Posted on: August 17, 2022

[ARCHIVED] 8/11/22 Weekly COVID-19 Dashboard

8-11-22

There is, once again, not much to report in terms of changes to the confirmed case rate in Easthampton and the surrounding area. We continue to bounce around 20 new cases per day per 100,000 population. As always, we know this is an underreport of the true number of new infections per day, but we can get a sense of how "off" this number is in the wastewater surveillance data. What we're seeing, in fact, if you zoom way in, is that the official case rate and the concentration of virus in sewage is following a similar pattern / trend. My best guess is that this means that we still have a fairly good accounting of the trend in cases in our area, even if the actual number of infections is no longer accurate. Remember, this is because confirmed and probable cases are included in the official case rate, and folks who test positive on home-based antigen tests, even if they call to tell their city health department or health care provider, are not counted. I suspect we'll continue to see a few stable weeks before the academic year starts back up again around Labor Day. Our area remains in the "low risk" category, but the zoomed out national view of risk by county clearly highlights how much of the country - more than a third! - currently has hospitals stressed with COVID-19 patients.

Updates from the past week:


- The UK has approved an omicron-specific booster for COVID-19. The US reportedly is still on track for a fall omicron-specific booster campaign. Hopefully, we'll get some good data from the UK on booster efficacy that will help us have a successful campaign here in the US.


- Speaking of back to school and the start of the academic year, it's interesting and (I think) not at all coincidental that the CDC just released their updated more relaxed guidelines and recommendations related to COVID-19. The guidelines make it clear that the CDC considers COVID-19 "here to stay" and that the goal is to return to a pre-COVID normal. In order to achieve that, the CDC's recommendations are now much looser and suggest less isolation and masking than ever before. The relatively high level of prior immunity in the US (from vaccines and/or infection) is used as justification: in the context of high prior immunity, COVID-19 is *often* a mild illness. However! As we talked about last week, COVID-19 may have the potential to be a mild illness, but is still causing significant death in the US. There have been only minor fluctuations in the daily death rate in the past few months. I've included a visual this week focused on the COVID-19 death rate in comparison to other leading causes of death in the US throughout the pandemic and projecting into the future. Essentially, if we continue on the path of acceptance that we seem to be on, we're looking at COVID-19 - a HIGHLY PREVENTABLE death - remaining a leading cause of death in the US year after year. To release loosened recommendations in the context of on-going high daily deaths.... well, I'm just not sure how to reconcile that. We're absolutely living in two different worlds of risk. For some, COVID-19 is a low risk disease. And for some, it's a high-risk disease with serious outcomes including death. And, of course, let's not forget the risk of long-COVID! 

The CDC no longer recommends quarantine after exposure, although they do recommend that someone who was exposed tests on day 5 and wears a mask for 10 days. The CDC doubled-down on the 5 day isolation recommendation, with "release" from isolation on day 6 if they are feeling better, as long as they wear a mask through day 10. The social distancing guideline has been removed. Contact tracing is no longer recommended. Surveillance testing is no longer recommended. The CDC has made clear that the goal of the recommendations is to reduce severe disease and death, not prevent infection. 

There has been a mixed reaction to these updated guidelines, even with the health care community and the public health community. On one hand, there are aspects that make sense and that allow for fewer disruptions. On the other hand, the approach is incredibly individualized. There's almost no hint of an actual public health approach in these recommendations. The focus on individual decisions and risk will absolutely highlight and widen the gap in those "two worlds" I described above. Those who are high-risk and immunocompromised will be left behind to fend for themselves - and will be at consistently higher risk - under these new recommendations. I wish that the CDC had provided specific evidence-based guidelines for high-risk folks who want to protect themselves, and specific evidence-based guidelines for what institutions / public locations could do if they wanted to reduce the risk for high-risk folks. 

A final comment on the CDC recommendations, and then I'll move on: the doubling-down on ending isolation after 5 days is stunning. At this point, we have ample evidence that people continue to be infectious past 5 days, even if they are "feeling better." About half of people are still contagious on day 5, and 10% are still contagious at day 10. I can see no scientific reason to have doubled-down on isolating only 5 days and removing the "test to release" recommendation. If you are able to isolate longer than 5 days, and, ideally, wait until you test negative to end your isolation - please do. 


- As I mentioned, we're just weeks away from the start of the school year. I suspect most districts will have few, if any, mitigation measures in place. I'd be surprised to see mask mandates, although some districts in the US will continue to require masks. By some estimates, between 3-5% of districts nationwide are reporting a mask mandate as school reopens. We know that children can and do spread COVID-19, and that transmission does occur in schools. The goal for the school year should be to keep infection low, both to reduce disease and risk of long-COVID, but also to keep disruptions minimal. We have a few basic mitigation measures that work to prevent spread of COVID-19 that we should focus on:

a) We need to increase the vaccination rates among children. Children are woefully undervaccinated, and while they are at reduced risk for severe disease, the risk is not zero - and getting COVID-19 and feeling crummy and staying home at least a week isn't all that fun anyway. Children are also at risk for long-COVID! All to say there's a whole bunch of really good reasons that children should get up-to-date on their COVID-19 vaccine, and other routine vaccines like flu (and polio!). Schools and pediatricians are the most trusted source of information about vaccines, and there are lots of creative ways to increase vaccination rates among children. This would be a great time for a strong, universal vaccine campaign! We also see vaccine coverage differences by race / ethnicity. I've included a visual depiction of vaccine coverage for Easthampton / Westhampton. The darkest blue colors represent the greatest level of protection against infection and primarily and importantly, severe disease. 

b) Schools need to focus on ventilation and air filtration. COVID-19 is airborne and the better the ventilation and air filtration is in an enclosed space, the lower the risk of spread. There are high tech approaches that schools should be working on now (and securing federal funds to improve!), but let's not forget about low-tech approaches like opening windows. I've included a visual with three different approaches to improving air quality that range from lower to higher cost and difficulty. 

c) Sick kids and teachers should stay home, period. Until you're sure it's not COVID-19, we should assume it is COVID-19, although... regardless of what infectious disease you have, it's really best practice not to bring it to others. The FDA recently updated their guidance on testing to avoid a false negative (missing an infection): If you are exposed but not symptomatic, you should test 3 times, 48 hours apart to be sure. If you are symptomatic, you should test 2 times, 48 hours apart. 

d) Anyone returning to school after 5 days should be wearing a KF94 or better mask that fits well at all times inside until they test negative (which could be past 10 days!), or at least until past day 10. At all times has to mean AT ALL TIMES, so we need to figure out another place for folks in this group to eat. Masking all day and then taking the mask off to enjoy lunch in a crowd is just not going to cut it.

e) Finally, mask wearing should continue to be normalized and KF94 or better masks should be freely provided to students and teachers. And, just like for those getting over an infection, those who would like to mask to protect themselves should have an alternate location to eat so they're not removing their mask and eating around others who may be infectious. 

That's probably enough for this week. Take good care.


Megan W. Harvey, PhD (she/her)Epidemiologist



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