Prompt investigation and contact tracing of Covid-19 cases is still one of the best tools to prevent further transmission and to track variants, according to a US Centers for Disease Control and Prevention.
“Source investigation is important to identify origins and transmissions of viral variants or variants of concern,” said Dr. Melanie Taylor, a senior adviser for the contact tracing innovation section of CDC’s Covid-19 emergency response, during the CDC’s Weekly Partner Call.
Source investigation is a method that is used for communicable diseases that investigates the potential source of infection and identify people who may have been exposed or infected within the given pathogen. The CDC encourages that all positive Covid-19 cases are contact traced within a timely six-day window.
“We also know that as vaccine coverage increases source investigation, case investigation and contact tracing can identify remaining pockets of transmission,” Taylor said.
The CDC is encouraging employers and school administrators to collaborate with contact tracers for the most effective community public health strategy and contact tracing data.
The CDC’s traditional contact tracing efforts have focused on prompt investigation of people diagnosed with Covid-19 and early identification, notification and quarantine of people who may have been recently exposed.
The CDC estimates there are approximately 60,000 contact tracers in the US, 29% speak a language other than English and 43% are under 30 years old.
Two new studies suggest that the B.1.1.7 coronavirus variant, which was first identified in the United Kingdom, is more transmissible, but the variant does not appear to affect disease severity in someone who gets Covid-19. The new findings clash with separate research that previously suggested the variant may be tied to a higher risk of dying from Covid-19.
One of the new studies, published on Monday in The Lancet Infectious Diseases, found no evidence in a sample of hospitalized patients that the B.1.1.7 variant is associated with severe Covid-19. However, the variant was associated with increased viral load, which supports the growing evidence that it is more easily transmissible.
The other study, also published on Monday in The Lancet Public Health, found no statistically significant association between the B.1.1.7 variant and the types or duration of Covid-19 symptoms people said that they experienced.
The Lancet Infectious Diseases study included data on 496 people who were admitted to hospitals in London and tested positive for coronavirus infection. Nose and throat swab samples were collected from the patients between Nov. 9 and Dec. 20.
Among those samples, 341 underwent genome sequencing. The sequence data showed that 198 of the patients, or 58%, had infections caused by the B.1.1.7 variant while the others were cased by other strains of the coronavirus. The researchers found no difference in severe disease or death between the variant and other strains.
The data showed that 36% of patients in the study with the B.1.1.7 variant infection experienced severe illness or death compared with 38% of those with non-B.1.1.7 infections. For death specifically, 16% of with the B.1.1.7 variant infection died within 28 days compared with 17% of those with non-B.1.1.7 infections, the researchers found.
But the researchers identified increased viral load among the B.1.1.7 patients.
Overall, "patients with B.1.1.7 were younger and had fewer comorbidities than those with non-B.1.1.7 infection, possibly representing the widespread and potential increased transmission of this variant in the community or differences in probability of hospital admission, which we were not able to explore in this hospital-based cohort," the researchers wrote in their study.
"Finding B.1.1.7 more commonly in younger versus older individuals gives a subtle hint of more severe disease if patients with B.1.1.7 are hospitalised more often compared with patients with other lineages, although difference in disease severity by B.1.1.7 was not found in this hospitalised cohort in the main analysis," the researchers wrote.
The Lancet Public Health study included data on 36,920 people who reported testing positive for Covid-19 and logged their symptoms into the COVID Symptom Study app between September 28 and December 27. The app — designed by designed by researchers at King's College London, Guys and St Thomas’ Hospitals and the tech company Zoe Global Limited — helps track the spread of Covid-19 and the range of symptoms experienced.
The study’s authors, based in the UK and the United States, analyzed the data reported in the app along with Covid-19 surveillance data for the UK. The analysis showed that the prevalence of the B.1.1.7 variant in certain regions and over time was not associated with changes in the Covid-19 symptoms reported in the app nor the duration of symptoms.
The researchers found that the rate of coronavirus reinfections was low — with 0.7% of app users who reported a positive Covid-19 test, testing positive again after 90 days — and there was no evidence of increased reinfection rates associated with the B.1.1.7 variant.
The researchers did not have data on risk of dying from Covid-19 and most of the app users get tested only when they have symptoms, so there were relatively few asymptomatic infections in the data. Yet the researchers found a "multiplicative increase" in the reproduction number of the B.1.1.7 variant, suggesting it can spread more easily.
As the state of Michigan continues to see a rise in Covid-19 cases, Dr. Rochelle Walensky, director of the US Centers for Disease Control and Prevention, said on Monday that it will take more than just vaccinations to get the spread of coronavirus under control.
Rather, Walensky said, the answer may be to shut down the state.
"When you have an acute situation — extraordinary number of cases like we have in Michigan — the answer is not necessarily to give vaccine. In fact, we know that the vaccine will have a delayed response. The answer to that is to really close things down," Walensky said during a virtual White House briefing on Monday.
"I think if we tried to vaccinate our way out of what is happening in Michigan, we would be disappointed that it took so long for the vaccine to work, to actually have the impact," Walensky said. "Similarly, we need that vaccine in other places. If we vaccinate today, we will have, you know, impact in six weeks and we don't know where the next place is going to be that is going to surge."
Michigan Gov. Gretchen Whitmer has urged people to limit indoor dining and last week called on schools to suspend in-person instruction and youth sports to halt practices and games for two weeks, but said “these are not orders, mandates, or requirements,” calling it instead “a team effort.”
Whitmer has urged people to get vaccinated, and appealed for more vaccine doses to be sent to the state. President Biden spoke and Whitmer spoke last week about surging federal resources to the state, but those resources would not include a surge in vaccine doses, a White House official told CNN.
The White House said on Monday that it will be sending aid to Michigan to help with administering vaccine, Covid-19 testing and therapeutics.
"In states like Michigan, where we are seeing troubling metrics, we are taking action by deploying resources for critical areas — shots in arms, personnel, testing, therapeutics," Andy Slavitt, the White House's senior adviser for Covid-19 response, said during Monday's virtual briefing.
"We have to remember the fact that in the next two to six weeks, the variants that we have seen in Michigan, those variants are also present in other states. So, our ability to vaccinate people quickly in all of or each of those states rather than taking vaccines and shifting it to playing 'Whack a Mole' isn't the strategy that public health leaders and scientists have laid out," Slavitt said.
"There are other things that we can do. We have offered to surge the amount of monoclonal antibodies, testing, there's a CDC team on the ground, we just sent 140 FEMA vaccinators," Slavitt said. "We know there are appointments available in various parts of the state, and so that means that we have excess vaccine in some parts of the state — so we're going to help work with the state, and any state quite frankly, to help the rebalancing, which occurs in a situation like this."
Though risk assessment will vary person-to-person, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said Monday he “would not hesitate” to eat outdoors or go to a baseball game in current Covid-19 conditions.
“At an outdoor restaurant right now, where we are, I would not hesitate to do that, but the fact is I just haven’t done it,” Fauci told CNN’s Wolf Blitzer, adding that his “crazy obligations and jobs” make it hard to sit down at a restaurant.
Fauci added that attending baseball games is also something he’s personally comfortable with now.
“I would not hesitate to go to an outdoor baseball game. I will wear a mask because I’m out there in the community, my risk would be extremely low,” Fauci said. “I’m someone that is a bit risk averse, but I would not hesitate to sit in an open stand and watch the Nats play.”
The United Kingdom has reached its Covid-19 vaccination target of offering a dose to all adults over 50, the clinically vulnerable and social care workers, the British government said in a statement on Monday.
“We have now passed another hugely significant milestone in our vaccine programme by offering jabs to everyone in the nine highest risk groups. That means more than 32 million people have been given the precious protection vaccines provide against Covid-19,” Prime Minister Boris Johnson said.
“We will now move forward with completing essential second doses and making progress towards our target of offering all adults a vaccine by the end of July,” he added.
The statement said the target had been reached ahead of schedule, with the government having pledged to offer a first dose to priority cohorts 1 to 9 by April 15.
Nearly 40 million vaccines have now been given in total, with adults under 50 expected to begin to be invited in the coming days, the statement added.
The Oxford-AstraZeneca Covid-19 vaccine is to be recommended only for people aged 60 years and older in Ireland, according to a revised advice from Ireland’s National Immunisation Advisory Committee (NIAC) on Monday.
The new advice reads: “Vaxzevria COVID-19 vaccine AstraZeneca is not recommended for those aged under 60 years including those with medical conditions with very high or high risk of severe COVID-19 disease.”
It also recommends not giving a second dose of the AstraZeneca vaccine “to anyone who developed unusual blood clots with low platelets after the first dose."
However, it says people aged under 60 years with a very high risk or high-risk medical condition should receive their second dose 12 weeks later as scheduled, while those aged under 60 years without a very high risk or high-risk medical condition should have the scheduled interval between doses extended to 16 weeks to “allow further assessment of the benefits and risks as more evidence becomes available.”
Commenting on the new advice, NIAC Chair Karina Butler said:
“NIAC realises the need to balance the significant benefits of a national vaccination programme with the very rare risk of these reported events. While this is an extremely rare condition, consideration must be given to the fact that it has a very high risk of death or severe outcome. As the risk/benefits of Vaxzevria COVID-19 AstraZeneca vaccine may vary by age and as alternative COVID-19 vaccines are available NIAC has revised the recommendations for use of this vaccine.”
“All the authorised COVID-19 vaccines – Pfizer, Moderna and AstraZeneca and the newly approved Janssen, are highly effective in preventing hospitalisation and severe COVID-19 disease. Vaccination with Vaxzevria COVID-19 AstraZeneca vaccine is highly effective and substantially reduces the risk of severe COVID-19 disease across all age groups,” she added.
The decision by NIAC follows the announcement by the European Medicines Agency that it had found a possible link between the vaccine and the occurrence of rare blood clots.
Effective May 1, indoor and outdoor graduation and commencement ceremonies will be allowed with limited attendee capacity, depending on the event size and the location.
"With more people getting vaccinated every day, we are so close to the light at the end of the tunnel, but we all need to continue being vigilant and I am urging everyone to celebrate smart," he added.
All public and private schools in Puerto Rico must stop all in-person learning for two weeks due to a rise in Covid-19 cases, according to a statement tweeted by Puerto Rico's Secretary of Health Carlos Mellado López.
The decision comes just a little more than a month after some schools on the island reopened for in-person learning for the first time since the pandemic hit, for K-3 students and high school seniors.
"Although we do not have outbreaks in schools, we must have precautionary measures before the incidence and positivity of the past seven days, which raised the level of risk to a critical one for three consecutive days under the protocol of the Department of Health," Mellado López said.
There will be no face-to-face instruction starting Monday until at least April 26. The decision was made by Gov. Pedro Pierluisi and Puerto Rico's Education Secretary Elba Aponte.
"We urge the public and call for prudence and to continue with the protection protocols," the statement said.
There are more than 800 schools and nearly 300,000 students in Puerto Rico's public school system, according to the National Center of Education Statistics' data from the 2019-2020 school year.
Presidents of the Brazilian Congress and Senate announced Monday that they asked United Nations Secretary-General Antonio Guterres to help accelerate the delivery of vaccines to the country.
"I spoke today, on the phone, with the Secretary-General of the United Nations Antonio Guterres to explain the serious health situation in the country. I spoke of the need to increase the flow of vaccine delivery to the country, " wrote Arthur Lira, president of the Congress.
Rodrigo Pacheco, head of the Senate, also said he spoke to Guterres and reinforced the need for doses from COVAX to arrival in Brazil.
"I reinforced the request for help from the UN so that the country becomes a priority for the international consortium Covax Facility to anticipate vaccine deliveries," wrote Pacheco.
Guterres tweeted on Saturday saying, “More countries are beginning to receive vaccine supplies, but most people in low- and middle-income nations are still waiting. Vaccine equity is a moral test of global solidarity. COVAX – the @UN-led initiative to ensure equitable access, must be funded and supported.”
The Brazilian health ministry registered at least 1,803 new deaths and 37,017 cases of the novel coronavirus on Monday. Since the beginning of the pandemic, the country registered 353,137 deaths and 13,482,023 cases of Covid-19.