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COVID-19 Update | February 12, 2021
Important Highlights
CDC Alert: MMWR on Masking   
 
We have heard from several SHEA members that there are renewed discussions regarding the potential benefit of double masking on source control and prevention of COVID-19 transmission, which have prompted many questions about whether changes will be made to masking policy. Eleven months of experience has demonstrated that the healthcare setting is a well-controlled environment with robust infection prevention protocols in place that help limit the transmission of COVID-19. The healthcare setting is distinctly different than a community setting without these strict controls in place, and much of our workforce is now vaccinated. Furthermore, masks used in healthcare settings are also assessed for filtration efficacy and meet regulatory standards before distribution.  Below we’ve highlighted several key points from the CDC messaging. 
 
MMWR: Maximizing Fit for Cloth and Medical Procedure Masks to Improve Performance and Reduce SARS-CoV-2 Transmission and Exposure, 2021 
  • CDC conducted experiments to assess two ways of improving the fit of medical procedure masks: fitting a cloth mask over a medical procedure mask and knotting the ear loops of a medical procedure mask and then tucking in and flattening the extra material close to the face. Each modification substantially improved source control and reduced wearer exposure. 
  • More importantly, improving the fit of the loosely fitting medical procedural mask has been shown to offer greater improvements (20% absolute increase) and efforts to improve masking should focus on simple and effective methods of securing the fit of your mask. These include 1) tying the ear loops near where the leave the mask and tucking in the side pleats; 2) attaching the ear loops to a 3-dimensional-printed “ear guard”; 3) fastening ear loops with a 23-mm claw-type hair clip placed behind the wear’s head. 
  • Do NOT combine a N95 respirator with any other mask.  
  • Consistently and correctly wearing a mask is one of the most effective tools we have to slow the spread of COVID-19.
Resource: Improve How Your Mask Protects You. Two important ways to make sure your mask works the best it can: 
  • Make sure your mask fits snugly against your face. 
  • Pick a mask with layers to keep respiratory droplets in and others’ out.
Resource: Types of Masks 
 
We have also heard reactions from our members regarding recent changes in CDC implementation of universal use of PPE in the Infection Prevention and Control Recommendations. The updated recommendation aims to expand options for source control and patient care activities in areas of moderate to substantial transmission and describe strategies for improving fit of facemasks. Specific areas generating discussion include: 
  • One of the following should be worn by HCP for source control while in the facility and for protection during patient care encounters: 
  • An N95 respirator OR 
  • A respirator approved under standards used in other countries that are similar to NIOSH-approved N95 filtering facepiece respirators OR 
  • A well-fitting facemask (e.g., selection of a facemask with a nose wire to help the facemask conform to the face; selection of a facemask with ties rather than ear loops; use of a mask fitter; tying the facemask’s ear loops and tucking in the side pleats; fastening the facemask’s ear loops behind the wearer’s head; use of a cloth mask over the facemask to help it conform to the wearer’s face) 
  • Wear an N95 respiratory or use a PAPR in the following circumstances: 
    • In the room with a patient with known or suspected COVID-19 
    • In the room where an aerosol generating procedure is being performed 
  • Consider wearing an N95 respirator in the following circumstances: 
    •  Close contact (<6 ft) for >15min if the patient is unable or unwilling to wear a mask
Update on interim clinical considerations for COVID-19 vaccinations 
 
Updates to Interim Clinical Considerations for Use of mRNA COVID-19 Vaccines Currently Authorized in the United States.  Last week during our partner calls, a common question we received was what to do when a vaccinated health care worker has a COVID-19 exposure. This question is addressed here.
 
  • New recommendations for preventing, reporting, and managing mRNA COVID-19 vaccine administration errors (Appendix A). 
  • Clarification on contraindications and precautions. Persons with a known (diagnosed) allergy to PEG, another mRNA vaccine component, or polysorbate, have a contraindication to vaccination. Persons with a reaction to a vaccine or injectable therapy that contains multiple components, one of which is PEG, another mRNA vaccine component or polysorbate, but in whom it is unknown which component elicited the immediate allergic reaction have a precaution to vaccination. 
  • Updated information on delayed, local injection-site reactions after the first mRNA vaccine dose. These reactions are neither a contraindication or precaution to the second dose. 
  • Updated quarantine recommendations for vaccinated persons. Fully vaccinated persons who meet criteria will no longer be required to quarantine following an exposure to someone with COVID-19. Additional considerations for patients and residents in healthcare settings are provided. 
  • Additional information and updated recommendations for testing for TB infection. TB testing can be done before or at the same time as mRNA COVID-19 vaccination, or otherwise delayed for ≥4 weeks after the completion of mRNA COVID-19 vaccination. 
SHEA Coronavirus News
SHEA Converse & Convene: Safely Reopening Schools During the Pandemic (Open to SHEA Members)
Friday, February 19 | 11am - 12pm ET 
REGISTER HERE 
This members-only networking event will focus on questions related to safely reopening schools during the pandemic. Please note this event is not recorded and is intended for members to have an open, candid discussion. 
Moderator: Westyn Branch-Elliman, MD, MMSc, Harvard Medical School
Technical Guidance, Standards and Resources
Vaccines 
 
MMWRs
COVID-19 Vaccination Intent, Perceptions, and Reasons for Not Vaccinating Among Groups Prioritized for Early Vaccination — United States, September and December 2020 (CDC MMWR)
 
Demographic Characteristics of Persons Vaccinated During the First Month of the COVID-19 Vaccination Program — United States, December 14, 2020–January 14, 2021 (CDC MMWR) 
 
Early COVID-19 First-Dose Vaccination Coverage Among Residents and Staff Members of Skilled Nursing Facilities Participating in the Pharmacy Partnership for Long-Term Care Program — United States, December 2020–January 2021 (CDC MMWR) 
 
Decline in COVID-19 Hospitalization Growth Rates Associated with Statewide Mask Mandates — 10 States, March–October 2020 (CDC MMWR)  
 
Observed Face Mask Use at Six Universities — United States, September–November 2020 (CDC MMWR) 
 
Racial and Ethnic Disparities in the Prevalence of Stress and Worry, Mental Health Conditions, and Increased Substance Use Among Adults During the COVID-19 Pandemic — United States, April and May 2020 (CDC MMWR) 
 
Decreases in Young Children Who Received Blood Lead Level Testing During COVID-19 — 34 Jurisdictions, January–May 2020 (CDC MMWR) 
 
Sexual Orientation Disparities in Risk Factors for Adverse COVID-19–Related Outcomes, by Race/Ethnicity — Behavioral Risk Factor Surveillance System, United States, 2017–2019 (CDC MMWR)
 
Infection Prevention and Control
 
Special Settings and Populations 
 
Clinical Care 
 
Testing and Cases
 
PPE
*UPDATE* Strategies for Optimizing the Supply of N95 Respirators (CDC)  
Added clarifications on use of facemasks as a crisis capacity strategy
 
Research
Information for Patients, Visitors, and the General Public
Use Masks to Slow the Spread of COVID-19 (CDC)  
 
Improve How Your Mask Protects You (CDC)  
Event Announcements
International Coffee Talk 
Saturday, February 13, 2021 | 6:00 p.m. ET 
REGISTER HERE  
The goal of this series, curated by SHEA's External Affairs Committee, is to allow International experts to give presentations on the various pain points, and successes they've experienced while dealing with the COVID-19 pandemic.    
Moderators: Corey Forde, MBBS, FSHEA and Xiaoyan Song, MBBS, PhD 
Speakers: Regina Berba, MD, MSc and Hiroki Saito, MD, MPH 
News Highlights
Employers can play a bigger role in making sure Americans get COVID-19 vaccines (USA Today) 
Federal Policy Updates
GAO Report: Critical Vaccine Distribution, Supply Chain, Program Integrity, and Other Challenges Require Focused Federal Attention 
A Government Accountability Office (GAO) report released January 28 includes thirteen new recommendations for the federal response to the COVID-19 pandemic. The report highlights calls for a national COVID-19 testing strategy and a national plan to coordinate vaccine distribution, and emphasized the agency’s position that “[u]ntil the country better contains the spread of the virus, the pandemic will likely remain a significant obstacle to more robust economic activity.” 
 
COVID-19 Relief: President Biden’s “American Rescue Plan” 
President Joe Biden’s $1.9 trillion American Rescue Plan, a COVID-19 relief legislative proposal, is moving swiftly through the Congressional process. This week, House and Senate committees are drafting legislation. House Speaker Nancy Pelosi (D-CA) intends to lead the passage of the legislative plan via reconciliation by the end of February. The next COVID-19 relief bill is expected to include $400 billion to support the federal government’s COVID-19 response, including $20 billion to implement a national vaccination program, $50 billion to expand testing, and $30 billion to purchase additional personal protective equipment and other supplies. Notably, due to an amendment adopted last week in the Senate, the FY21 Joint Budget Resolution allows the House and Senate Budget Committee Chairs to reallocate funding to provide additional financial support for rural hospitals through the Provider Relief Fund. 
SHEA Education and Events
New this week:
  1. Podcast: Post-Vaccination: Adverse Events, COVID Exposure & Contraction & More
  2. Town Hall Round 41 
    Sunday, February 14, 2021 | 3:00 pm ET 
    REGISTER HERE or watch live on Facebook
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