Multiple Measures, Including Masks, Needed to Curb Covid-19
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
May 17, 2021
Scientific Brief
Multiple Measures, Including Masks,
Needed to Curb Covid-19
National Nurses United
Since the beginning of the spread of Covid-19, including of 12 years comprise 15 percent
pandemic, scientists have mask requirements, physical/ of the country’s population and
learned important information social distancing, avoiding currently have no access to
about how the virus that large groups, testing and con- Covid-19 vaccines.4
causes Covid-19 spreads. How tact tracing, isolation of cases
More transmissible variants
the virus spreads determines and contacts, protections for
that may be or may become
which public health measures nurses and other essential
resistant to vaccines make
will be effective. workers in their workplaces,
measures to reduce and stop
and vaccines.
» We have learned that the transmission of Covid import-
virus spreads via aerosol Vaccines are a very import- ant to maintain even as vaccine
transmission — when an ant element to reducing the roll out continues.
infected person breathes, spread of Covid-19, but we can-
On May 13, 2021 the U.S.
speaks, coughs, or sneezes not rely on vaccines alone to
Centers for Disease Control
they release aerosol stop transmission of Covid. It is
and Prevention (CDC)
particles containing infec- clear that Covid-19 vaccines are
updated its Interim Public
tious virus. These aerosol effective at preventing severe
Health Recommendations for
particles can travel long Covid-19, hospitalizations, and
Fully Vaccinated People to
distances through and stay deaths, but no vaccine is 100
recommend that vaccinated
suspended in the air. An percent effective and there are
individuals no longer needed
overwhelming amount of many unanswered questions
to wear masks, get tested, or
scientific evidence indi- about the Covid-19 vaccines,
isolate after an exposure. This
cates that aerosol transmis- including how long protection
update failed to recognize the
sion is the primary mode of will last, what protection
science on mask requirements
transmission for this virus. against mild and asymptomatic
and other measures to slow
cases looks like, and how effec-
» We have also learned that the spread of Covid and failed
tive vaccines will be against
the virus can be trans- to account for questions about
variants of concern that are
mitted by people who vaccines and variants that
or may become resistant to
are infected but have no remain unanswered.
vaccines.
symptoms — asymptomatic
This scientific brief outlines the
or pre-symptomatic trans- It is also important to note
scientific evidence for multiple
mission. Studies indicate that, as of May 16, 2021, only
measures, including masks
that approximately half of 37.1 percent of the U.S. popula-
and Covid vaccination pro-
all transmission events are tion has been fully vaccinated
grams, to curb the spread of
from cases that have no for Covid-19.3 Additionally,
Covid-19 while monitoring
symptoms.1,2 Covid-19 vaccines are currently
variants of concern.
authorized for adults and
Study after study has shown
adolescents aged 12 years and
that multiple measures are
older. Children under the age
needed to reduce and stop the
www.NationalNursesUnited.org » NationalNurses » @NationalNursesStudies Show That transmission of SARS- posted the following informa-
Multiple Measures, CoV-2.”6 As of May 16, tion about masks, in compari-
2021, New South Wales has son to respiratory protection,
Including Masks, are reported just 5,371 total in Sept 2020:12
Necessary to Mitigate cases over the course of
The purpose of wearing
Transmission of the entire pandemic, with
masks is to help reduce
Covid-19 a population of 7.95 million
the spread of COVID-19
— just 0.068 percent of the
by reducing the spread
population infected.7,8 This
Studies have shown that of the virus through
is in contrast to the United
multiple measures in a layered respiratory droplets from
States where nearly 10 per-
approach are necessary to asymptomatic individuals.
cent of the population has
stop and slow the spread of Masks are recommended
been infected, with over 32
Covid-19. Countries that have as a barrier to help pre-
million total reported cases
effectively controlled the vent large respiratory
over the course of the pan-
spread of Covid-19, such as droplets from traveling
demic, with a population of
Taiwan, South Korea, and New into the air and onto other
328 million.9,10
Zealand, have a multi-layered people when the person
approach of both individu- » A study from Taiwan wearing the mask coughs,
al-level interventions (e.g., reported: “In this compara- sneezes, talks, or raises
mask requirements) and pub- tive effectiveness research their voice. Emerging
lic health-level interventions study, the combination evidence from clinical and
(e.g., widespread testing and of case-based [contact laboratory studies shows
contact tracing programs). tracing and quarantine] that masks help reduce
Highlights from this body of and population-based the spray of droplets when
research include: interventions (with wide worn over the nose and
adherence) [social distanc- mouth. Together with
» Researchers examined
ing and facial masking] social distancing, masks
a large dataset of Covid
may explain the success of are most likely to reduce
cases from 190 countries
COVID-19 control in Taiwan the spread of COVID-19
and found that, “Distancing
in 2020. Either category of when they are widely
and the simultaneous
interventions alone would used by people in public
implementation of two
have been insufficient, settings.
or more types of NPIs
even in a country with an
[non-pharmaceutical Consistent, widespread use of
effective public health
interventions, including masks is necessary to provid-
system and comprehensive
mandatory mask, isolation ing protection from Covid-19.
contact tracing program.”11
and quarantine, and traffic A report from the Proceedings
restriction] seemed to be of the National Academy of
associated with a greater Widespread Usage Sciences of the United States
decrease in the Rt [repro- of Masks is Important found that, “The preponder-
duction number, a measure to Reducing Covid-19 ance of evidence indicates
of how quickly the virus is that mask wearing reduces
spreading] of COVID-19.”5 Spread transmissibility per contact
by reducing transmission of
» A study from New South Mask and cloth face covering infected respiratory particles
Wales, Australia found that, usage has proven to be a in both laboratory and clinical
“A multifaceted strategy critical measure in reducing contexts. Public mask wearing
that combines all three the spread of Covid-19. It is is most effective at reducing
[measures, including test- important to remember the spread of the virus when
ing, contact tracing, and science of mask-wearing. compliance is high.”13
mask usage], alongside Wearing masks provides
continued hygiene and source control, meaning The CDC’s May 13 update to
distancing protocols, is wearing a mask can reduce mask guidance for vaccinated
likely to be the most robust the respiratory droplets emit- individuals failed to recognize
means of controlling ted by the wearer. The CDC the basic science behind how
2 NNU » Scientific Brief: Multiple Measures, Including Masks, Needed to Curb Covid-19masks provide protection. infected during a two-week have failed to track infections,
Vaccinated individuals can isolation period, daily symptom hospitalizations, and deaths
still be infected and may screening detected no cases; among health care workers
transmit the virus.14,15 As of May all cases were detected by and other essential workers.
16, 2021, only 37.1 percent of weekly surveillance testing.18 The CDC’s May 13 update on
the U.S. population has been Similarly, an analysis of contact guidance for vaccinated indi-
vaccinated. 16 By exempting tracing data from Singapore viduals only increases essential
vaccinated individuals from found that a symptom-based workers’ exposure to the virus,
wearing masks, the CDC has testing strategy missed 62 while also further inhibiting
placed vulnerable people, percent of Covid diagnoses.19 their ability to get tested.
including children, babies, and
Because vaccinated individ- Additionally, it is important to
immunocompromised individ-
uals can be infected,20 it is view the CDC’s May 13 update
uals, at higher risk for Covid-19.
still important for them to in the context of decreased
The scientific evidence clearly
be tested, not just based on diagnostic testing overall and
indicates a continued need to
symptoms. The available data the lack of genomic surveil-
maintain mask requirements.
indicate that a proportion of lance in the United States. The
vaccinated individuals who past four months have seen a
Testing, Contact become infected are asymp- decline in weekly testing of 33
Tracing, and Case tomatic. For example, an inves- percent: the week of January 2
Isolation are Important tigation into an outbreak at a to 9, 2021 saw 10,049,946 tests
Kentucky skilled nursing facility conducted while the week of
Measures to Reducing where a majority of residents May 2 to 9, 2021 saw 6,705,644
Covid-19 Spread and some staff had been vacci- tests conducted.22 Genomic
nated found that 63 percent of surveillance — sequencing of
The high rate of transmission infected vaccinated individuals viruses to identify the variant
from asymptomatic and did not report symptoms.21 responsible for the infection
pre-symptomatic cases means — is lagging severely in the
that testing, contact tracing, Further, the CDC announced
United States.23 The decline
and isolation of cases and con- earlier in May 2021 that the
in testing plus inadequate
tacts are necessary measures agency would no longer track
genomic surveillance creates
to identify cases and prevent breakthrough infections in
“blindspots” which inhibit our
further transmission.17 vaccinated individuals unless
ability to respond effectively
they resulted in hospitaliza-
But the CDC’s May 13 update to the pandemic.
tion or death. Failing to track
to guidance for vaccinated asymptomatic and mild infec-
individuals, which recommends tions in vaccinated individuals
testing only for vaccinated hampers our ability to learn
individuals who develop symp- more about the efficacy of vac-
toms, ignores what we have cines to prevent asymptomatic
learned regarding the inad- and mild infections, whether
equacies of symptom-based vaccines prevent transmission,
testing programs. and undermines our ability to
Diagnostic testing based fully comprehend the impact
only on when symptoms are of variants.
present detects, at most, a It is worth noting that lack
small portion of cases, thus of testing has been an issue
bypassing an opportunity to throughout the pandemic.
prevent further transmission. Nurses and other health care
For example, a study published workers have long had diffi-
in the New England Journal culty accessing testing, even
of Medicine reported that, when exposed at work or expe-
while 1.9 percent of a cohort riencing symptoms. The CDC
of Marine recruits became and the federal government
www.NationalNursesUnited.org » NationalNurses » @NationalNurses 3Protections for nurses and health care workers. pandemic. For example, a news
Nurses and Other For a listing of studies, visit feature in the scientific journal,
NNU’s Covid-19 Bibliography Nature, reported in March
Essential Workers page. 2021:29
Remain Necessary to
There’s another problem to
Combatting Covid-19 Variants of Concern contend with as immunity
That May Be Resistant grows in a population,
Nurses and other essential
workers have been placed at to Vaccines Continue Ferrari says. Higher rates
of immunity can create
great risk of Covid exposure to Emerge and selective pressure, which
and infection during the Spread, Underlining would favour variants that
pandemic. We have seen local the Importance of are able to infect people
transmission explode after
outbreaks in workplaces. For
Maintaining Prevention who have been immunized.
Measures In Addition Vaccinating quickly and
example, a May 2020 analysis thoroughly can prevent a
found that counties with meat- to Increasing new variant from gaining
packing plants, which have Vaccination Rates a foothold. But again, the
notoriously failed to protect unevenness of vaccine roll-
their employees from Covid-19, The emergence and spread of outs creates a challenge,
had double the cases per cap- Covid-19 variants of concern Ferrari says. “You’ve got
ita compared to the average.24 that are more transmissible, a fair bit of immunity, but
The COVID Symptom Study deadlier, and are or may you still have a fair bit of
found that health care workers become resistant to vaccines disease, and you’re stuck in
in the US and the UK were 11.61 should give us all pause when the middle.” Vaccines will
times more likely to report considering relaxing pro- almost inevitably create
a positive Covid-19 test than tective measures. Especially new evolutionary pressures
the general public.25 A pre- because genomic surveillance that produce variants, which
print analysis from University — sequencing of viruses to is a good reason to build
of California San Francisco identify the variant responsible infrastructure and processes
researchers reported high for the infection — is lagging to monitor for them, he
relative excess mortality severely in the United States.27 adds.
among multiple occupational Dr. Francis Collins, the Director What we have learned about
groups including food/agricul- of the National Institutes of variants of concern circulat-
ture workers, transportation/ Health, shared his thoughts ing in the United States is
logistics workers, facilities, and on variants at the end of April concerning:
manufacturing workers.26 2021:28
» The B.1.1.7 variant, first iden-
Protections for nurses and We must continue to do tified in the U.K., has rapidly
other essential workers remain absolutely everything become the dominant
a necessary measure to com- possible, individually and variant in the United States.
bat Covid-19. It is clear that collectively, to prevent This variant is more trans-
employers have failed to pro- these new SARS-CoV-2 missible, creates higher viral
vide the necessary protections. variants from slowing or loads, and has been tied
An Emergency Temporary even canceling the progress to higher mortality risk.30,31
Standard on Covid-19 from the made over the last year. We While initial studies (pre-
U.S. Occupational Safety and need to remain vigilant for print) found “no biologically
Health Administration (OSHA) just a while longer, while significant different in
is an important part of holding encouraging our friends, neutralization activity”
employers accountable to neighbors, and loved ones between trials involving the
protecting employees from to get vaccinated. original Covid-19 strain and
Covid-19. B.1.1.7, others have reported
Others have recognized the
Additionally, extensive scien- B.1.1.7 acquiring concerning
threat that variants play to our
tific research underlines the mutations that can lead
ability to control the Covid-19
importance of protections for
4 NNU » Scientific Brief: Multiple Measures, Including Masks, Needed to Curb Covid-19to reduced neutralization » The B.1.617 variant, first A large study examined over
and reduced efficacy of identified in India, has been 73,000 individuals with Covid-
vaccines.32,33 at least partly responsible 19 who used Veterans Health
for the devastating surge Administration services and
» The B.1.351 variant, first
seen in India this spring, nearly five million controls.
identified in South Africa,
according to scientists.42 Researchers found that indi-
has concerning mutations.
This variant has mutations viduals who had Covid and
Studies have found 10-fold
tied to increase trans- were not hospitalized reported
or more decreased effi-
missibility and reduced excess negative health impacts
cacy of vaccines against
vaccine efficacy. Singapore over at least six months that
this variant.34 The CDC’s
reported a probable case affected nearly every organ
genomic surveillance data
of transmission from a case and regulatory system.46
reports that 0.9 percent of
to a spouse, who had been
sequenced samples are due A pre-print article reported
vaccinated 16 days prior to
to this variant.35 A recent on analysis of medical records
developing symptoms.43
CDC report makes clear and found that 32 percent of
that this variant has a foot- The combination of variants the Covid cases who reported
hold in the United States.36 of concern that are or may long-term symptoms at day 61
become resistant to vaccines or later were initially asymp-
» The P.1. variant, first iden-
with the unanswered questions tomatic at the time of SARS-
tified in Brazil/Japan, has
about vaccine efficacy under- CoV-2 testing.47
mutations tied to increased
lines the continued importance
transmissibility and Chronic impacts of Covid-
of the precautionary principle
decreased efficacy of vac- 19 have also been reported
— taking action to protect
cines.37,38 It is important to among children. One study
people’s health must not await
note that, despite serology looking at a cohort of pediatric
scientific certainty of harm.
evidence that more than patients with a positive Covid
67 percent of the popula- test found that two-thirds
tion of Manaus, Brazil was Preventing reported at least one persisting
infected during a prior Asymptomatic and symptom between 60 and
surge, the region has seen Mild Infections Remains 120 days after an initial Covid
a rapid and devastating diagnosis.48 The authors noted,
resurgence due to the P.1
an Important Aspect “An important and unexpected
variant.39 The CDC reports of Combatting the finding is that also children
that the P.1 variant is Covid-19 Pandemic with an asymptomatic or
responsible for 5.0 percent paucisymptomatic COVID-19
of sequenced samples in Long-term impacts of Covid developed chronic, persisting
the United States as of infections, including mild and symptoms, although fol-
the week of April 24, an asymptomatic infections, have lowed-up for a relatively short
increase from 3.6 percent been reported. Symptoms time after the diagnosis.”
of samples two weeks prior, range from severe fatigue,
indicating the variant is cognitive dysfunction, gastro- Real-World Vaccine
spreading rapidly.40 intestinal and musculoskeletal
disorders to pulmonary and
Efficacy Data Cited by
» The B.1.526 variant, first
cardiovascular diseases.44 CDC is Incomplete
identified in New York last
fall, has spread rapidly. One study of health care The CDC has posted a Science
Preliminary data indicates it workers with a documented Brief: Background Rationale
may be more infectious and Covid-19 infection found that and Evidence for Public Health
that it has the same muta- 45 percent reported persistent Recommendations for Fully
tion as the variants first symptoms and 32 percent Vaccinated People (Updated
identified in South Africa reported struggling to cope April 2, 2021). While it is clear
and Brazil that is tied to three to four months following that Covid-19 vaccines effec-
reduced vaccine efficacy.41 infection.45 tively prevent severe Covid-19
www.NationalNursesUnited.org » NationalNurses » @NationalNurses 5disease, hospitalizations, and » The CDC cites a number of
deaths, the studies cited by studies authored by individ-
the CDC in this brief provide uals who reported financial
an incomplete picture of conflicts of interest and/
vaccine efficacy. Important or relationships with Pfizer
questions remain unanswered and other companies.
about the longevity of vaccine
» It is unclear why the CDC
protection, efficacy of vaccines
has chosen to cite a press
against mild and asymptomatic
release from Covid-19 vac-
Covid, and impact of variants
cine-manufacturer Pfizer as
of concern that are more trans-
data to guide public health
missible and that are or may
recommendations and
become resistant to vaccine
clinical guidelines.
protection.
» The CDC failed to report
Table 1a is adapted from
the 95 percent confidence
the CDC’s Science Brief:
intervals for the studies
Background Rationale and
it cites. The 95 percent
Evidence for Public Health
confidence intervals are
Recommendations for Fully
indicators for how reliable
Vaccinated People. Red text
a study is and are key to
is commentary and additional
interpreting the results
information. It is important to
from a study. These are the
note the following points:
ranges within which the
» The CDC relies on a high true vaccine efficacy value
number of pre-prints. lies: “Because the true pop-
The CDC’s brief cites four ulation mean is unknown,
pre-prints, two peer- this range describes
reviewed studies, and one possible values that the
a press release from Pfizer. mean could be. If multiple
Note the disclaimer from samples were drawn from
medRxiv (a common place the same population and
to post pre-prints) about a 95 percent CI calculated
how pre-prints should not for each sample, we would
be used to guide clinical expect the population
practice or health-related mean to be found within
behaviors:49 95 percent of these CIs. CIs
are sensitive to variability in
Caution: Preprints are
the population (spread of
preliminary reports of work
values) and sample size.”50
that have not been certi-
The confidence intervals
fied by peer review. They
from studies cited by the
should not be relied on to
CDC have been added to
guide clinical practice or
the table in red font, where
health-related behavior and
reported. Note how wide
should not be reported in
some of these confidence
news media as established
intervals are, indicating lack
information.
of certainty in the findings.
6 NNU » Scientific Brief: Multiple Measures, Including Masks, Needed to Curb Covid-19Table 1a. Effectiveness against SARS-CoV-2 infection and symptomatic disease
Country Population Vaccine Outcome Vaccine Conflict of
Effectiveness interest? And
other notes
United States51 General adult Pfizer-BioNTech SARS-CoV-2 89%* (pre-print)
population- or Moderna infection (PCR
(95% CI: Financial con-
31,069 vacci- (data not positive test in
68.4 – 97.1%) flicts of interest
nated, 31,069 separated by HER, unclear
reported by
unvaccinated vaccine) criteria for
authors.
testing)
Propensity
score matching
United States52 Healthcare Pfizer-BioNTech SARS-CoV-2 90%** 1 author
workers, first or Moderna infection (self- receives funding
(95% CI:
responders, and swab weekly from Pfizer for
(data not 68 – 97%)
other essential and if symp- another project.
separated by
and frontline toms, note evi-
vaccine)
workers dence suggests
(n=3,950) that self-swab
samples are less
sensitive than
HCW swab)
United Healthcare Pfizer-BioNTech SARS-CoV-2 86%* (pre-print)
Kingdom53 workers (6% of sample infection
(95% CI: Dominant circu-
(n=23,324) received Astra- (biweekly
76 – 97%) lating variant at
Zeneca; data asymptomatic
time of study:
not separated PCR testing-
B.1.1.7
by vaccine) anterior nasal
swabs or com-
bined nose and
oropharyngeal
swabs; twice
weekly rapid
antigen testing
started Nov
2020)
United Adults aged Pfizer-BioNTech Symptomatic 89%** (pre-print)
Kingdom54 ≥ 80 years, disease
(also looked at
including those
Astra-Zeneca,
with multiple
reported results
underlying
separately)
conditions
N=62,484 who
received Pfizer
vaccine
Israel55 General adult Pfizer-BioNTech SARS-CoV-2 92%*
population infection (if test
(95% CI:
result in health
88 – 95%)
record, unclear
testing criteria)
www.NationalNursesUnited.org » NationalNurses » @NationalNurses 7Country Population Vaccine Outcome Vaccine Conflict of
Effectiveness interest? And
other notes
General adult Pfizer-BioNTech Symptomatic 94%*
population disease (if in
(95% CI:
health record)
87 – 98%)
General adult Pfizer-BioNTech Hospitalization 87%*
population
(95% CI:
55 – 100%)
General adult Pfizer-BioNTech Severe disease 92%*
population
(95% CI:
75 – 100%)
Israel56 General adult Pfizer-BioNTech Symptomatic >97%** This citation is
population disease, severe/ a press release
critical disease, from Pfizer.
death
Denmark57 Long term care Pfizer-BioNTech SARS-CoV-2 64%* (pre-print)
facility residents infection (data
(95% CI:
(n=39,040 from national
14 – 84%)
residents and testing registry,
331,039 HCW) unclear testing
criteria)
Long term care Pfizer-BioNTech SARS-CoV-2 90%*
facility residents infection (data
95% CI:
staff from national
82 – 95%)
testing registry,
unclear testing
criteria)
* >7 days after second dose
** >14 days after second dose
8 NNU » Scientific Brief: Multiple Measures, Including Masks, Needed to Curb Covid-19Additional Studies Since the CDC pub- of these studies support the
on Vaccines and lished its Science Brief: continued use of multiple
Background Rationale and prevention measures, including
Breakthrough Evidence for Public Health masking, in addition to increas-
Infections Underlines Recommendations for Fully ing vaccination rates.
the Importance of Vaccinated People (Updated
Maintaining Prevention April 2, 2021), several addi-
tional studies have been pub-
Measures, Including lished. These studies may have
Masking, in Addition also factored into the CDC’s
to Increasing May 13 update of guidance
Vaccination Rates for vaccinated individuals. It is
important to note that several
Table 1b. Additional Studies on Vaccines and Breakthrough Infections
Citation Date Published Findings Takeaways
Pilishvili, T., K.E. Fleming- May 14, 2021 This is an interim analysis This study reports high
Dutra, et al., “Interim of data from a 33-site study vaccine efficacy rates
Estimates of Vaccine of health care workers in 25 but is missing informa-
Effectiveness of Pfizer- different states. Health care tion important to under-
BioNTech and Moderna workers with the potential for standing the true impli-
COVID-19 Vaccines SARS-CoV-2 exposure through cations of the study’s
Among Health Care direct patient contact or for results. The study looked
Personnel — 33 U.S. indirect exposure (e.g., through only at symptomatic
Sites, January–March infectious materials) were Covid cases, specif-
2021,” MMWR, link. enrolled. ically requiring that
the presence of one
Cases were defined as having
symptom be reported to
a positive PCR or antigen test
be considered a Covid
and at least 1 Covid symptom.
case. But we know that
As of March 18, 2021, 623 cases
asymptomatic cases are
and 1,220 controls had been
important to consider
identified.
in terms of both pre-
The study reported a vaccine venting transmission of
efficacy rate of 94 percent the virus and in terms
(95% CI 87 to 97 percent) for of limiting long-term
two doses of an mRNA Covid impacts of long Covid.
vaccines.
Additionally, the study
It is important to note that this did not assess personal
study combined two different protective equipment
vaccines (Moderna and Pfizer) worn by cases and con-
in their analyses. trols or other infection
control measures imple-
It is also important to note mented at the 33 study
that testing programs were sites. These infection
different at each of the 33 control measures could
study sites and details were not be the reason some
provided. groups of workers saw
lower infection rates.
www.NationalNursesUnited.org » NationalNurses » @NationalNurses 9Citation Date Published Findings Takeaways
Liu, Y., J. Liu, et al., May 12, 2021 This laboratory-based study This study provides
“BNT162b2-Elicited recombined key mutations good news in terms
Neutralization against from circulating variants B.1.1.7 of the Pfizer vaccine
New SARS-CoV-2 Spike (UK), B.1.351 (South Africa), providing protection
Variants,” NEJM, link. and B.1.429 (California) to against key mutations
create lab-based models to in currently circulating
study neutralization by human variants. However, it also
serum samples collected two warns us that variants
to four weeks after the second may impact vaccine
Pfizer Covid vaccine dose. They efficacy and that we
found effective neutralization must continue to be
by vaccinated-human sera of vigilant as we learn
the key mutations in variant more about variants and
viruses. However, neutralization as we work to increase
of the L452R key mutation vaccination rates in the
from the B.1.429 (California) United States.
variant was reduced.
Damiani, V., D. Mandatori, May 10, 2021 A study from Italy analyzed Infections can occur in
et al., “SARS-CoV-2 500 nasopharyngeal swab vaccinated health care
infection in asymptom- specimens via PCR testing and workers. This study
atic vaccinated-health- whole genome sequencing. found that all infections
care workers,” Infection The swabs were collected from in fully vaccinated
Control & Hospital Epi, health care workers and hos- individuals (more than
link. pitalized patients daily at one 14 days following the
hospital. second Pfizer dose)
were asymptomatic,
Seven health care workers who
underlining the con-
were vaccinated for Covid-19
tinued importance of
(Pfizer) had been infected. One
testing.
had received only one dose
of the vaccine. Three tested
positive within eight days after
the second dose.
Three health care workers
tested positive between 23 and
36 days after the second Pfizer
dose. All were asymptomatic.
All cases were due to the B.1.1.7
(UK) variant.
Note that the total number of
health care workers who were
vaccinated at this hospital was
not reported.
10 NNU » Scientific Brief: Multiple Measures, Including Masks, Needed to Curb Covid-19Citation Date Published Findings Takeaways
Angel, Y., A. Spitzer, and May 6, 2021 This is a study from one hospi- Data on vaccine effi-
O. Henig, “Association tal in Israel where health care cacy from Israel is not
Between Vaccination workers were routinely tested directly applicable in
With BNT162b2 since May 2020. The authors the United States given
and Incidence of reported Pfizer vaccine efficacy the significantly higher
Symptomatic and for symptomatic infections at rate of vaccination in
Asymptomatic SARS- 97% and vaccine efficacy for Israel (58.9 people fully
CoV-2 Infections Among asymptomatic infections at vaccinated per 100
Health Care Workers,” 86%. people in Israel vs. 36.9
JAMA, link. per 100 people in the
It is important to note that the
United States, as of May
hospital’s screening program
16, 2021).58
changed during the study
period: from Dec 20, 2020-Jan Additionally, the
2, 2021, all health care workers differences in testing
were screened biweekly or between vaccinated and
monthly depending on risk of unvaccinated health care
exposure; Jan 3-14, 2021, hos- workers in the study
pital-wide screening occurred design call reliability of
regardless of vaccination sta- the study’s results into
tus; but then from Jan 15, 2021 question.
onward, only health care work-
ers with medium to high risk
exposure (based on job loca-
tion) and non-fully vaccinated
HCWs were screened monthly
to weekly. Of the health care
workers included in the study,
85.2% were in the low risk level
group, which means there is no
testing data for them after Jan
15, 2021 unless they developed
symptoms or elected to get
tested. This change in policy
calls into question the vaccine
efficacy results reported by the
authors.
*Note that two authors
reported receiving grants or
consulting fees from Pfizer.
www.NationalNursesUnited.org » NationalNurses » @NationalNurses 11Citation Date Published Findings Takeaways
Abu-Raddad, L.J., H. May 5, 2021 This study reports on vaccine This study provide good
Chemaitelly, et al., efficacy data from Qatar, news in terms of vaccine
“Effectiveness of the looking specifically at impacts efficacy (Qatar had vac-
BNT162b2 Covid-19 of the B.1.1.7 (UK) and B.1.351 cinated 26.6 people per
Vaccine against the B.1.1.7 (South Africa) variants. 100 people as of March
and B.1.351 Variants,” 29, 2021).59 However,
The study reports vaccine
NEJM, link. it also warns us that
efficacy of Pfizer vaccine (more
variants may impact
than 14 days after second
vaccine efficacy and
dose) of 89.5 percent (95% CI
that we must continue
85.9 to 92.3%) for B.1.1.7 variant
to be vigilant as we learn
and 75.0 percent (95% CI, 70.5
more about variants and
to 78.9%) for the B.1.351 variant.
as we work to increase
Vaccine efficacy against the vaccination rates in the
B.1.351 variant was significantly United States.
reduced compared to the clin-
ical trial and other published
studies.
One author reports funding
from Gilead Sciences.
12 NNU » Scientific Brief: Multiple Measures, Including Masks, Needed to Curb Covid-19Citation Date Published Findings Takeaways
Cavanaugh, A.M., S. April 30, 2021 This study reported on an This study underlines
Fortier, et al., “COVID-19 outbreak investigation at the fact that outbreaks
Outbreak Associated skilled nursing facility in can still occur, even
with a SARS-CoV-2 R.1 Kentucky found that, despite with moderate to high
Lineage Variant in a vaccinations, there was an vaccination levels. It also
Skilled Nursing Facility outbreak with an R.1 variant. underlines the ongoing
After Vaccination 90.4% of residents and 52.6% concerns about variants.
Program — Kentucky, of staff had received two Covid
March 2021,” MMWR, link. vaccine doses, and most were
fully vaccinated.
Once the outbreak was iden-
tified, daily rapid testing of
residents and twice-weekly
testing of workers was initi-
ated. Positive antigen results
were confirmed. It is important
to note that antigen tests are
less sensitive in detecting
asymptomatic infections, so
some infections may have been
missed.
The study reported vaccine
efficacy rates of 66.2 percent
in residents (95% CI 40.5%-
80.8%) and 75.9 percent in
health care workers (95% CI
32.5%-91.4%)
18 fully vaccinated residents
were infected (out of 26 total
infected residents), 4 fully
vaccinated health care workers
were infected (out of 20 total
health care workers infected).
Three residents died, one of
whom was vaccinated.
One health care worker had
already had Covid, was vacci-
nated, and was still infected.
www.NationalNursesUnited.org » NationalNurses » @NationalNurses 13Citation Date Published Findings Takeaways
Hacisuleyman, E., C. April 21, 2021 A cohort of 417 vaccinated uni- Researchers concluded,
Hale, et al., “Vaccine versity staff were tested weekly “…our observations
Breakthrough Infections between January 21 and March underscore the impor-
with SARS-CoV-2 17, 2021. The study reports tance of the ongoing
Variants,” NEJM, link. breakthrough infections in race between immuni-
two fully vaccinated individu- zation and the natural
als — at 19 days post-second selection of potential
Moderna dose and 36 days viral escape mutants.
post-second Pfizer dose. During this critical
period, our data support
Authors reported, “Data from
the need to maintain
Patient 1 indicate that infec-
layers of mitigation
tion with variant virus can be
strategies, including
sustained with a high viral load
serial testing of asymp-
despite high levels of neutraliz-
tomatic persons, open
ing antibodies to variants.” The
publication and analysis
variant that caused infection
of vaccination and
in patient 1 was similar to
infection databases
both B.1.1.7 (UK) and B.1.526
(such as those accruing
(NYC) but with considerable
data in New York City),
differences.
and rapid sequencing
of SARSCoV-2 RNA
obtained from a variety
of high-risk persons.”
Edelstein, S., S. March 31, 2021 This study looked at a small Data on vaccine
Tannous, et al., “BNT cohort of 14 vaccinated efficacy from Israel
13b2 Pfizer vaccine health care workers living is not directly appli-
protects against SARS- with person who was Covid- cable in the United
CoV-2 respiratory positive in Israel. Health care States given the
mucosal colonization workers were tested two to significantly higher
even after prolonged three times with PCR based rate of vaccination
exposure to positive on exposure. All tests were in Israel (58.9 people
family members,” J negative. fully vaccinated per
Hosp Infection, link. 100 people in Israel vs.
It is important to note that
36.9 per 100 people in
the study did not provide
the United States, as
information about Covid-
of May 16, 2021).60
positive individuals in
households, what exposure Additionally, missing
actually looked like (e.g., information about
did family members isolate the nature and
within the home?). amount of exposure
to vaccinated health
care workers leaves
questions about
whether vaccines
prevent transmission
unanswered.
14 NNU » Scientific Brief: Multiple Measures, Including Masks, Needed to Curb Covid-19Endnotes
1 Johansson, M.A., T.M. Quandelacy, et al., “SARS- Population-Based Interventions on COVID-19
CoV-2 Transmission From People Without Containment in Taiwan,” JAMA Internal Medicine,
COVID-19 Symptoms,” JAMA, Jan 7, 2021, https:// April 6, 2021, https://jamanetwork.com/journals/
jamanetwork.com/journals/jamanetworkopen/ jamainternalmedicine/article-abstract/2778395.
fullarticle/2774707. 12 U.S. Centers for Disease Control and Prevention,
2 Nogrady, B., “What the data say about National Institute for Occupational Safety and
asymptomatic COVID infections,” Nature, Nov Health, “Respiratory Protection vs. Source
18, 2020, https://www.nature.com/articles/ Control – What’s the difference?,” Sept 8,
d41586-020-03141-3. 2020, https://blogs.cdc.gov/niosh-science-
3 U.S. Centers for Disease Control and Prevention, blog/2020/09/08/source-control/ (Accessed
COVID Data Tracker, https://covid.cdc.gov/covid- May 16, 2021).
data-tracker/#datatracker-home (Accessed May 13 Howard, J., A. Huang, et al., “An evidence review
16, 2021). of face masks against COVID-19,” PNAS, Jan
4 Population of children aged under 12 years: 48.9 26, 2021, https://www.pnas.org/content/118/4/
million, Total population: 332.3 million e2014564118.
Forum on Child and Family Statistics, “POP1 14 Hacisuleyman, E., C. Hale, et al., “Vaccine
CHILD POPULATION: NUMBER OF CHILDREN Breakthrough Infections with SARS-CoV-2
(IN MILLIONS) AGES 0–17 IN THE UNITED Variants,” NEJM, April 21, 2021, https://www.nejm.
STATES BY AGE, 1950–2019 AND PROJECTED org/doi/full/10.1056/NEJMoa2105000.
2020–2050,” https://www.childstats.gov/ 15 Wagner, J., “What to Know About the Yankees’
americaschildren/tables/pop1.asp (Accessed May Coronavirus Outbreak,” New York Times, May
17, 2021). 13, 2021, https://www.nytimes.com/2021/05/13/
U.S. Census Bureau, “U.S. and World Population sports/baseball/gleyber-torres-yankees-covid.
Clock,” https://www.census.gov/popclock/ html.
(Accessed May 17, 2021). 16 U.S. Centers for Disease Control and Prevention,
5 Bo, Y., C. Guo, et al., “Effectiveness of non- COVID Data Tracker, https://covid.cdc.gov/covid-
pharmaceutical interventions on COVID-19 data-tracker/#vaccinations (Accessed May 16,
transmission in 190 countries from 23 January to 2021).
13 April 2020,” International Journal of Infectious 17 Johansson, M.A., T.M. Quandelacy, et al., “SARS-
Diseases, Jan 2021, 102: 247-53, https:// CoV-2 Transmission From People Without
www.sciencedirect.com/science/article/pii/ COVID-19 Symptoms,” JAMA, Jan 7, 2021, https://
S1201971220322700. jamanetwork.com/journals/jamanetworkopen/
6 Stuart, R.M., R.G. Abeysuriya, et al., “Role of fullarticle/2774707.
masks, testing and contact tracing in preventing 18 Letizia, A.G., I. Ramo, et al., “SARS-CoV-2
COVID-19 resurgences: a case study from Transmission among Marine Recruits during
New South Wales, Australia,” BMJ, April 20, Quarantine,” NEJM, Nov 11, 2020, https://www.
2021, 11:e045941, https://bmjopen.bmj.com/ nejm.org/doi/l/10.105NEJMoa2029717?query=fea
content/11/4/e045941. tured_home.
7 New South Wales Government, “NSW COVID-19 19 Ng, O.T., K. Marimuthu, et al., “SARS-CoV-2
Statistics,” https://www.nsw.gov.au/covid-19/ seroprevalence and transmission risk factors
find-the-facts-about-covid-19 (Accessed May 16, among high-risk close contacts: a retrospective
2021). cohort study,” The Lancet Infectious Diseases,
8 New South Wales Government, “Key facts about Nov 2, 2020, https://www.thelancet.com/article/
NSW,” https://www.nsw.gov.au/about-nsw/key- S1473-3099(20)30833-1/fulltext.
facts-about-nsw (Accessed May 16, 2021). 20 Hacisuleyman, E., C. Hale, et al., “Vaccine
9 CDC COVID Data Tracker, https://covid.cdc. Breakthrough Infections with SARS-CoV-2
gov/covid-data-tracker/#datatracker-home Variants,” NEJM, April 21, 2021, https://www.nejm.
(Accessed May 16, 2021). org/doi/full/10.1056/NEJMoa2105000.
10 U.S. Census Bureau, QuickFacts: United States, 21 Cavanaugh, A.M., S. Fortier, et al., “COVID-19
https://www.census.gov/quickfacts/fact/table/ Outbreak Associated with a SARS-CoV-2 R.1
US/PST045219 (Accessed May 16, 2021). Lineage Variant in a Skilled Nursing Facility After
Vaccination Program — Kentucky, March 2021,”
11 Ng, T., H. Cheng, et al., “Comparison of MMWR, April 30, 2021, https://www.cdc.gov/
Estimated Effectiveness of Case-Based and mmwr/volumes/70/wr/mm7017e2.htm.
www.NationalNursesUnited.org » NationalNurses » @NationalNurses 1522 U.S. Centers for Disease Control and Prevention, bioRxiv, Jan 19, 2021, https://www.biorxiv.org/
COVID Data Tracker, https://covid.cdc.gov/ content/10.1101/2021.01.18.426984v1.
covid-data-tracker/#trends_dailytrendscases 33 Collier, D.A., A. De Marco, et al., “Sensitivity
(Accessed May 16, 2021). of SARS-CoV-2 B.1.1.7 to mRNA vaccine-
23 Maxmen, A., “Why US coronavirus tracking elicited antibodies,” Nature, March 11, 2021,
can’t keep up with concerning variants,” Nature, 593: 136-41, https://www.nature.com/articles/
April 7, 2021, https://www.nature.com/articles/ s41586-021-03412-7.
d41586-021-00908-0. 34 Wang, P., M.S. Nair, et al., “Antibody resistance of
24 Graddy, S., S. Rundquist, B. Walker, “Investigation: SARS-CoV-2 variants B.1.351 and B.1.1.7,” Nature,
Counties With Meatpacking Plants Report March 8, 2021, https://www.nature.com/articles/
Twice the National Average Rate of COVID- s41586-021-03398-2.
19 Infections,” EWG, https://www.ewg.org/ 35 U.S. Centers for Disease Control and Prevention,
news-insights/news/investigation-counties- COVID Data Tracker, https://covid.cdc.gov/covid-
meatpacking-plants-report-twice-national- data-tracker/#variant-proportions (Accessed
average-rate (Accessed May 16, 2021). May 17, 2021).
25 Nguyen, L.H., D.A. Drew, et al., “Risk of COVID-19 36 Feder, K.A., M. Pearlowitz, et al., “Linked Clusters
among front-line health-care workers and the of SARS-CoV-2 Variant B.1.351 — Maryland,
general community: a prospective cohort study,” January–February 2021,” MMWR, April 30, 2021,
The Lancet Public Health, July 31, 2020, https:// 70(17): 627-31.
www.thelancet.com/journals/lanpub/article/
PIIS2468-2667(20)30164-X/fulltext. 37 Resende, P.C., J.F. Bezerra, et al., “Spike E484K
mutation in the first SARS-CoV-2 reinfection
26 Chen, Y., M. Glymour, et al., “Excess mortality case confirmed in Brazil, 2020,” Virological, Jan
associated with the COVID-19 pandemic 10, 2021, https://virological.org/t/spike-e484k-
among Californians 18–65 years of age, mutation-in-the-first-sars-cov-2-reinfection-case-
by occupational sector and occupation: confirmed-in-brazil-2020/584.
March through October 2020,” medRxiv,
Jan 22, 2021, https://www.medrxiv.org/ 38 Faria, N.R., T.A. Mellan, et al., “Genomics and
content/10.1101/2021.01.21.21250266v1. epidemiology of the P.1 SARS-CoV-2 lineage
in Manaus, Brazil,” Science, April 14, 2021,
27 Maxmen, A., “Why US coronavirus tracking https://science.sciencemag.org/content/
can’t keep up with concerning variants,” Nature, early/2021/04/13/science.abh2644.
April 7, 2021, https://www.nature.com/articles/
d41586-021-00908-0. 39 Faria, N.R., T.A. Mellan, et al., “Genomics and
epidemiology of the P.1 SARS-CoV-2 lineage
28 Collins, F., “Tracking the Evolution of a ‘Variant of in Manaus, Brazil,” Science, April 14, 2021,
Concern’ in Brazil,” NIH Director’s Blog, April 27, https://science.sciencemag.org/content/
2021, https://directorsblog.nih.gov/2021/04/27/ early/2021/04/13/science.abh2644.
tracking-the-evolution-of-a-variant-of-concern-
in-brazil/ (Accessed May 16, 2021). 40 U.S. Centers for Disease Control and Prevention,
COVID Data Tracker, https://covid.cdc.gov/covid-
29 Aschwanden, C., “Five reasons why COVID data-tracker/#variant-proportions (Accessed
herd immunity is probably impossible,” Nature, May 17, 2021).
March 18, 2021, https://www.nature.com/articles/
d41586-021-00728-2. 41 Annavajhala, M.K., H. Mohri, et al., “A Novel
and Expanding SARS-CoV-2 Variant, B.1.526,
30 Calistri, P., L. Amato, et al., “Infection sustained Identified in New York,” medRxiv (pre-print),
by lineage B.1.1.7 of SARS-CoV-2 is characterised April 15, 2021, https://www.medrxiv.org/
by longer persistence and higher viral RNA content/10.1101/2021.02.23.21252259v2.
loads in nasopharyngeal swabs,” International
Journal of Infectious Diseases, April 2021, 105: 42 Vaidyanathan, G., “Coronavirus variants are
753-5, https://www.ijidonline.com/article/ spreading in India — what scientists know so
S1201-9712(21)00210-1/fulltext. far,” Nature, May 11, 2021, https://www.nature.
com/articles/d41586-021-01274-7.
31 Challen, R., E. Brooks- Pollock, et al., “Risk of
mortality in patients infected with SARS-CoV-2 43 Singapore Ministry of Health, News Highlights,
variant of concern 202012/1: matched cohort Summary of New Cases, May 13, 2021, https://
study,” BMJ, 2021; 372: n579, https://www.bmj. www.moh.gov.sg/news-highlights/details/24-
com/content/372/bmj.n579.short. new-cases-of-locally-transmitted-covid-19-
infection-13-may-2021-update (Accessed May 17,
32 Muik, A., A. Wallisch, et al., “Neutralization 2021).
of SARS-CoV-2 lineage B.1.1.7 pseudovirus
by BNT162b2 vaccine-elicited human sera,”
16 NNU » Scientific Brief: Multiple Measures, Including Masks, Needed to Curb Covid-1944 Nalbandian, A., K. Sehgal, et al., “Post-acute in England. medRxiv. 2021; https://khub. COVID-19 syndrome,” Nature Medicine, March 22, net/documents/135939561/430986542/ 2021, 27:601-15, https://www.nature.com/articles/ Early+effectiveness+of+COVID+vaccines. s41591-021-01283-z. pdf/ffd7161c-b255-8e88-c2dc- 45 Gaber, T A-Z K., A. Ashish, and A. Unsworth, 88979fc2cc1b?t=1614617945615. “Persistent post-covid symptoms in healthcare 55 Dagan N, Barda N, Kepten E, Miron O, Perchik workers,” Occupational Medicine, April 8, S, Katz MA, et al. BNT162b2 mRNA Covid-19 2021, https://academic.oup.com/occmed/ Vaccine in a Nationwide Mass Vaccination advance-article/doi/10.1093/occmed/ Setting. N Engl J Med. 2021. kqab043/6217385. 56 Real-World Evidence Confirms High Effectiveness 46 Al-Aly, Z., Xie, Y. & Bowe, “High-dimensional of Pfizer-BioNTech COVID-19 Vaccine and characterization of post-acute sequalae of Covid- Profound Public Health Impact of Vaccination 19,” Nature, April 22, 2021, https://www.nature. One Year After Pandemic Declared [press com/articles/s41586-021-03553-9. release]. March 11, 2021 2021. 47 Huang, Y., M.D. Pinto, et al., “COVID Symptoms, 57 Mostsen-Helms I EH, Nielsen J, et. al. Vaccine Symptom Clusters, and Predictors for effectiveness after 1st and 2nd dose of Becoming a Long-Hauler: Looking for Clarity the BNT162b2 mRNA Covid-19 Vaccine in the Haze of the Pandemic,” medRxiv, in long-term care facility residents and March 5, 2021, https://www.medrxiv.org/ healthcare workers – a Danish cohort study content/10.1101/2021.03.03.21252086v1.full. medRxiv. 2021; https://www.medrxiv.org/ 48 Buonsenso, D., D. Munblit, et al., “Preliminary content/10.1101/2021.03.08.21252200v1.full.pdf. evidence on long Covid in children,” Acta 58 U.S. Centers for Disease Control and Prevention, Paediatrica, April 9, 2021, https://onlinelibrary. COVID Data Tracker, https://covid.cdc.gov/covid- wiley.com/doi/10.1111/apa.15870. data-tracker/#global-vaccinations (Accessed May 49 medRxiv, https://www.medrxiv.org/ (Accessed 17, 2021). May 16, 2021). 59 U.S. Centers for Disease Control and Prevention, 50 O’Brien, S.F. and Q. Long Yi, “How do I interpret COVID Data Tracker, https://covid.cdc.gov/covid- a confidence interval?,” Transfusion, 2016, data-tracker/#global-vaccinations (Accessed May 56(7): 1680-3. https://pubmed.ncbi.nlm.nih. 17, 2021). gov/27184382/. 60 U.S. Centers for Disease Control and Prevention, 51 Pawlowski C LP, Puranik A, et. al. FDA-authorized COVID Data Tracker, https://covid.cdc.gov/covid- COVID-19 vaccines are effective per real-world data-tracker/#global-vaccinations (Accessed May evidence synthesized across a multi-state health 17, 2021). system. medRxiv. 2021; https://www.medrxiv.org/ content/10.1101/2021.02.15.21251623v1.full.pdf. 52 Thompson MG BJ, Naleway AL, et al. Interim Estimates of Vaccine Effectiveness of BNT162b2 and mRNA-1273 COVID-19 Vaccines in Preventing SARS-CoV-2 Infection Among Health Care Personnel, First Responders, and Other Essential and Frontline Workers — Eight U.S. Locations, December 2020–March 2021. MMWR Morb Mortal Wkly Rep. 2021;ePub: 29 March 2021. DOI: http:// dx.doi.org/10.15585/mmwr.mm7013e3. 53 Hall A FS, Sae A, et. al. . Effectiveness of BNT162b2 mRNA Vaccine Against Infection and COVID-19 Vaccine Coverage in Healthcare Workers in England, Multicentre Prospective Cohort Study (the SIREN Study). . Lancet (preprint). 2021; https://papers.ssrn.com/sol3/ papers.cfm?abstract_id=3790399. 54 Bernal J AN, Gower C, et. al. . Early Effectiveness of COVID-19 Vaccination with BNT162b2 mRNA Vaccine and ChAdOx1 Adenovirus Vector Vaccine on Symptomatic Disease, Hospitalisations and Mortality in Older Adults www.NationalNursesUnited.org » NationalNurses » @NationalNurses 17
You can also read
