Roman Catholic Diocese of Brooklyn, New York v. Andrew M. Cuomo, Governor of New York

, the US Supreme Court ruled that Gov. Cuomo was wrong when he tried to set limits on the number of people who can gather to worship. The diocese and its co-plaintive in the case, the Jewish Orthodox group, Agudath Israel of America, hailed the decision as a victory for religious freedom. Kevin Kavanagh, MD, a member of 

’s Editorial Advisory Board doesn’t necessarily disagree with the court’s decision, in which the justices faulted Cuomo for not placing similar limitations on secular businesses such as liquor stores and bicycle shops. But if Kavanagh had been a testifying expert, he would have told the justices that “it’s very important that all high-risk venues are treated equally, but the remedy isn’t opening up one high-risk venue, the remedy should be closing down all high-risk venues, according to public health strategies, which have to be implemented during this severe spike in the virus.” But the court’s decision is not the only topic Kavanagh touched on in a wide-ranging discussion with 

. The coming COVID vaccine, for instance. Kavanagh thinks that “we’re looking at a mutation at some point where we’re going to have to have another vaccine made and distributed to the population.” Mostly, Kavanagh wants the public to understand the dangers posed by coronavirus disease 2019 (COVID-19). Unfortunately, says Kavanagh, judging by the amount of travel over the Thanksgiving holiday, that message hasn’t seemed to sink in yet.

Now you’re a doctor, you’re not a lawyer, and you want to see people stay healthy. That’s the bottom-line view, I think. But if you had a chance, how would you rectify these two sides? Is there a way to rectify these two sides?

Well, definitely. When I read the thought process behind the Supreme Court decision, I did not feel it was a church-versus-state decision, more than saying, “Hey, we need to do everything equally.” And that’s extremely important in infection control. You cannot have some high-risk facilities open and others closed. That’s not only not fair, but it also won’t control the pandemic. As you know, we’ve written extensively and talked extensively about control of MRSA [Methicillin-resistant 

], and how the recommendations between hospitals and nursing homes do not coincide with each other. They make no sense, nursing homes being much more lenient. And because of that, I think the Supreme Court decision may actually shine a light on us having a uniform process of making recommendations that are pathogen, not venue, specific. They need to be specific for the pathogen. I do not believe that the Supreme Court decision is a checkmark against public health, and in a way it can be used to actually bolster public health and to move it forward.

I think you’ve told me in past discussions that COVID should not be politicized. Rallies for President Trump weren’t a good idea. And neither were the protests for George Floyd a good idea. That social distancing was important in each case, correct?

Absolutely. The virus does not care. And I think you need to realize that when the Supreme Court says, “Well, we need to do things equally.” That doesn’t mean we should go and open up schools. How we can get together on this is that if one side feels a venue is unsafe, and another side says, “Well, but we can’t close down that venue during this horrible pandemic surge because this other venue is just as unsafe and it is open.” The remediation should be to close down the other unsafe venue. And I think that this has to be the take-home message. It should be noted that the Supreme Court is meeting virtually. Washington is starting to close down. Even Senator Mitch McConnell has this week stated that the Republican luncheons are no longer going to be meeting in person. These types of precautions are being taken by many people in many different venues, both on the right and the left. And what we don’t want to do is start fighting each other and having the public being pawns. When we feel that there is an inequity in restrictions, we need to go to the default position of safety especially during a severe surge which we’re currently experiencing. And that means closing down the other venue in question, not opening up all unsafe venues. I should also add that sporting events are also problematic. And we are seeing that in Kentucky where we have college sports being open. And we’ve discussed at length regarding this on this program and also in some of the writings that we’ve done. If you wear a mask that is just a layer of protection, these are cotton masks. They don’t include goggles, hazmat suits, proper donning and doffing. All it is, is a mask. And even if you put only a few people in a stadium, if they’re yelling and screaming, they’re going to aerosolize the virus and defeat the mask. So, the mask has to be viewed as a layer of protection. And that’s why just saying, “Well, as long as everybody wears a mask, these venues are OK.” That is not good public health thinking. It will cut down on viral transmission. Help to slow down the pandemic. But as far as providing you with enough personal safety, you still have to practice other public health strategies. And one of the primary ones when the virus is surging is to avoid going into or participating in high-risk activities. For example, if you wear a mask, and let’s say that provides you with a six times greater protection. But instead of just going to the grocery store, once a week, you decide to go to retail establishments 20 times a week, because you now think you have this protection. Well, you’ve actually now just placed yourself in a higher risk category than you were without wearing a mask and only maybe visiting once a week. And of course, I’m not advocating not wearing a mask. I’m just giving you this as an example. So, masks are a false sense of security if you think they’re going to protect you 100%. They’re not N95 masks. They’re not full hazmat gear. You’re not doing proper downing and doffing. So, when the pandemic is surging, the idea of congregating in schools, in churches, in retail establishments are all very problematic. People should be avoiding indoor activities with people who are not in their family unit and be purchasing online or with pickup. It is extremely important. Because if we outstrip our healthcare resources, which unfortunately is currently being done in several different regions of the United States, if we do this, you will see death rates soar not only from COVID-19, but from other illnesses where people cannot get the proper care that they need because there’s not a hospital bed, an ICU, or a timely OR suite that’s available. This is very problematic. And we’re seeing these reports right now coming out of El Paso, Utah, South Dakota, and North Dakota, along with Wisconsin. And the pandemic is still skyrocketing. And we expect another surge because of the Thanksgiving activities. So, right now it is a time for siding on caution, not for opening up and going back to the way that we were.

You’ve been pretty on point about this pandemic from the beginning. I remember you said before anybody else said that this thing is serious. I’m sure you have friends and relatives who are just so impatient with this at this point. They want to get back to the old normal. Will there ever be an old normal again? When can we start acting like we did before? And will the 

, which seems to be a reality more and more each day, could that possibly backfire in giving us a false sense of security?

Well, let’s see if I can remember all of the parts [of your question]. First of all, I don’t think we’re ever going to go back to the way that it was. Online shopping and pickup I think are here to stay. People like that. Working at home, that’s here to stay. People like that and production in many different industries is actually up. Because instead of spending long times traveling, people are actually working. And costs are down. So, we’re going to see a transformation. We’re never going to see us going back to the way things were. It will get more normal, but not the same normal. Currently, I feel this virus is going to become endemic. It’s already in animals. It’s in dogs, cats. And we’ve seen it enter the mink population in Denmark, necessitating the culling of 17 million mink. And that virus, you’ve seen mutate to a form that they were worried was resistant to the vaccines. I do think vaccines are going to come about. I’m worried that they are going to cause a significant immune response, not one that’s dangerous, but one which may discourage people from getting the vaccine. We see this with the shingles vaccine. People take the first dose. They don’t want to take the second dose, because they had a 

fever and were sick. That may be very problematic. This virus may repeatedly enter into our population because it is now residing in an animal host. And I also think that we’re looking at a mutation at some point where we’re going to have to have another vaccine made and distributed to the population. Now, the good news on that front is that with the new technology of mRNA, it looks like these vaccines may be able to be printed in a matter of weeks. So that you’ll have very rapid response. And as we get geared up with manufacturing and distribution, we won’t see the delay like we’re currently seeing. But I do think we’re going to be living differently. And we’re going to have to actually have a different type of outlook on infectious disease. I feel that masks in many venues are going to be here to stay. And that may be actually a good thing. If you’re sick, or you’re coming down with a cold, you will be able to wear a mask and go out in public where before maybe you weren’t able to do that because you were socially looked down upon. Granted, I’m not advocating that if you have a cold that you go out and do that. But you know, sometimes when you’re living alone, and you have the sniffles, you have to go out. And this will add I think, an extra layer of protection to our society. But I tell you, I don’t think we’re going to go back to the way things were. There are a lot of problems that this virus has created. There are a lot of solutions. But those solutions mean that we’re going to be doing things differently. We’ll be looking at the good old days back before 2020. And they won’t be the same as what we’ll be living in the future.

As you know, the flu of 1918 killed about 60 million people around the world. Could this have had the potential to have killed that many people around the world if the world didn’t basically bring its economy to a cold stop as it did?

Oh, I definitely think so. And you’ve seen estimates such as that…. Well out of New York City in the initial stages of the pandemic. But you need to remember, it’s not only bringing the world economy to a semi-halt. But also, we’ve had great advances in medical care: the giving of oxygen, the proning, mechanical ventilation, the ability to give life support, anti-coagulation and all of this has helped to improve survival. That wasn’t available in 1918. However, if we outstrip our medical care, in other words, if we have more cases and can be cared for, that’s when you'll see fatality soar, similar to 1918. We’re at a real turning point right now. We really do need to follow public health strategies, side on the side of caution, and really tightened down and batten down the hatches. These next couple of weeks, until this peak subsides and we get the vaccine the light is at the end of the tunnel, we just need to hang on.

There was some lessening of travel over the recent Thanksgiving holiday. But do you think it was enough?

Absolutely not. I think it’s very problematic with what I’ve seen. I’m very scared we’re going to have another surge. If you are traveling or you did travel, it is recommended that you get a test I've heard anywhere from three to five to seven days out, and that you should be quarantining yourself for at least seven days, possibly up to 14. I’m hearing different things from different authorities. I mean, there were so many people, it’s hard to quarantine half the United States. But nevertheless, the median incubation period for COVID-19 is five days. So, you certainly want to quarantine yourself longer than five days. Two weeks would be best, at least do seven to 10 days. I know it’s hard. It’s a lot task. But if we outstrip our resources and have another surge it’s going to be very problematic. And if we then repeat this during Christmas, it’s just going to be really something that I think will be a very heavy price to pay for people not following public health strategies.

Editorial Advisory Board Member Saskia v. Popescu [PhD, MPH, MA, CIC] wrote an excellent article that was just posted on 

’s website, about the CDC considering making the quarantine guidance 7 to 10 days. Saskia is worried that it’s a range and leaves too much in the hands of an individual provider. Should it be 7 days? Or should it be 10 days? And let’s not forget 8 days and 9 days, which are also in that range.

Well, there’s also 14 days and one of the problems is that people really don’t know what is needed to be done. The other is that there’s a real wrestling between what is going to be safest for the individual versus compliance and safest for society. Obviously safest for the individual is you quarantine for 14 days. But if you have nobody complying with that, then that does little good. And I think that’s why during this Thanksgiving time, they’ve lowered the time period saying, “Gee, if we can at least get the public, who is out there traveling, to quarantine for 7 to 10 days, as a society, we’ll see drops in the number of potential cases.” Is that as good as quarantining for 10 to 14 days? No, it’s not. Don’t think if you just quarantine for 7 days, it’ll provide you with as much protection or provide your loved ones with as much protection. It won’t. But maybe we’ll get people to do that. Because you need to realize, if people didn’t take the advice and went traveling, what are the chances that they’ll do voluntary quarantining? I mean, this is very problematic. The public is not following public health guidance. And if they were, we wouldn’t be in this position. We’d be similar to South Korea, where our total deaths adjusted for population would be in the thousands, rather than the hundreds of thousands. And so, we’re in a situation now where it is very hard to advise people on what to do. And of course, we far outstripped the availability of good PPE for the public. There are just too many potential infections, too many venues which are now very high risk. Community spread is rampant. And so, this is a time, as I said, for the next couple of weeks, I would shelter in place as much as possible, and order online or do pickup.

And finally, to circle back to the Supreme Court decision that we started with, if you were a testifying expert, testifying before the Supreme Court, in a nutshell, what would you tell US Supreme Court?

Well, I would tell the Supreme Court that it’s very important that all high-risk venues are treated equally, but the remedy isn’t opening up one high-risk venue, the remedy should be closing down all high-risk venues, according to public health strategies, which have to be implemented during this severe spike in the virus.

This interview has been edited for clarity and length.

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Kevin Kavanagh, MD:  “I would tell the Supreme Court that it’s very important that all high-risk venues are treated equally, but the remedy isn’t opening up one high-risk venue, the remedy should be closing down all high-risk venues.”

Q&A: ‘Arguing’ Before the Supreme Court

Infection preventionists were thrust into the spotlight this year thanks to coronavirus disease 2019 (COVID-19). They’ve been manning—and continue to man—the frontlines in hospitals against the novel coronavirus. But their expertise is being sought outside of healthcare settings. Businesses, school districts, public health agencies, sports franchises: you name it, they’re all suddenly very interested in infection prevention. That might create employment opportunities outside of healthcare. That’s a career move that Susan E. Campbell, PhD, CIC, made years ago. Campbell is an 

 to discuss what such a career move might entail. “It’s a little more difficult than you might expect. Largely because we don’t have a megaphone…. And I think one of the things you’re seeing, as this pandemic develops, is that epidemiologists are in fairly high demand and infectious disease doctors, because they get the platform…. [I]f you’re an infection preventionist, you have a lot harder time reaching your audience.” But it can be done.

What’s the market for the services that you offer through Infection Control Coach LLC?

Well, we really can work with anyone, whether it’s in the healthcare domain or out in the rest of the world. Our target market is businesses and schools, assisted living. Organizations that typically are not supported by hired infection prevention and control experts.

Do you see your type of business growing as a result of the COVID-19 pandemic?

Well, I do think there is a market there. It’s a fairly difficult one to shape. Because organizations somehow have the impression that if they just do the very minimum that public health is recommending that everything will be OK. And for a large part it will because the CDC [US Centers for Disease Control and Prevention] and the local boards of health, make recommendations and guidelines that protect most of the people most of the time. But as we know, there are people who are in special situations either because they are doing things like standing shoulder to shoulder, such as in the meat packing industry, where they can’t maintain that six feet of social distancing. Or other companies that require very dense involvement of their staff. Or just people who have a difficult time following directions, such as those who live in group homes or who are in some form of congregate living. And really cannot social distance, cannot necessarily choose their face coverings, or who might have a medical condition that makes them more vulnerable to the pandemic virus. We can take the special circumstances into account in talking with organizations, business leaders, organizations like unions or associations, and also individuals who find themselves in unique situations and would really like someone with a lot of expertise to come in and help and work with them on their specific risk reduction.

What did people ask you about most often before COVID-19? And what do people ask you about after COVID-19 about infection control and prevention?

Well, I think before COVID-19, the standard kinds of things … they want their staff to learn about hand hygiene and about chain of infection and breaking the chain of infection and what a boehmite is and how to disinfect properly, whether it’s a dietary setting or non-dietary one. But when you’re in COVID-19, we’re dealing with not only a pathogen that is airborne, but one that is transmitted both by droplets within the 3- to 6-foot radius of the individual who coughs it out or speaks it out. But also the aerosol that’s much, much finer, and can stay aloft for very long periods of time and move, you know, 30 feet or more from the individual that exhaled it or spoke it or shouted it or saying it. And this is something that’s new to the world and even some healthcare professionals are having difficulty understanding that the protections that worked for them in the past are not necessarily as complete in their coverage today.

The metaphor I read about COVID-19 that struck me as really to the point is that imagine that you’re in a closed room and somebody’s smoking a cigarette. Now you can maintain 6 feet of distance from that person. But that smoke is going to hang in the air, it’s going to come to you eventually. Is that an apt metaphor?

Yes, indeed. It’s a very good one. In days past, when we infection practitioners in healthcare centers would certify our negative pressure rooms, that they were functioning properly, we used to, sometimes with the engineer that would work with us, do a smoke test, and see which way the smoke was blowing. And of course, in a negative pressure room, it’s supposed to be pulled into the room out of the corridor and then be pulled into a vent that exits to the outside of the building. Of course, it needs to be a long distance away from any entrances or other windows that can be opened. And so that’s really instructive when you think about the problem you just posed, which is a closed room, whether that room be in a clinic, in a nursing home, or in somebody’s own home. If you have dead air, then you’re going to have cumulative aerosol build up over time, even if everybody in the house who has it is asymptomatic. And that’s something that people really don’t think about these days yet enough.

Do you think that COVID-19 is spreading the word a little bit that being an infection preventionist might be something that someone would want to choose as a career? And is there a right career path for people to take?

It’s a little more difficult than you might expect. Largely because we don’t have a megaphone. We infection preventionists don’t have a megaphone. And although APIC [Association for Professionals in Infection Control and Epidemiology], the organization that supports the infection practitioners, does have an arm that is political, and does lobbying to raise awareness among elected officials of the infection preventionist role, we don’t get a lot of airtime. And I think one of the things you’re seeing, as this pandemic develops, is that epidemiologists are in fairly high demand and infectious disease doctors, because they get the platform. They’re offered the soapbox. They’re called to come on the new shows. And if you’re an infection preventionist, you have a lot harder time reaching your audience. Now, the thing is that we do this all the time. We think practically all the time. And we can certainly in many cases, perhaps not all cases, but in many cases, infection preventionists can adapt what they know in the hospital setting and make it work in other settings. Whereas for physicians who are doing this, even infectious disease specialists or epidemiologists, their role is actually quite different than ours. They’re in a way making it up as they go. I think we do have a lot to learn in terms of how to market our services. And even if we do know how to present ourselves and explain that we have a very practical, real-world approach to solving problems and helping people reduce risk in their own settings, it’s still very hard to get that megaphone to be able to say it.

Anything else you want to add to that you think might be pertinent that I didn’t ask you?

Well, I think that each situation that presents itself, whether it’s getting together with friends and family during the holidays, or just ordinary life and figuring out whether to shop or to have your groceries delivered requires a lot of thought. There really isn’t a straightforward way to address every single problem. Now, over time, I’m sure we will develop algorithms for each and every typical circumstance. But individuals really have to consider where they are, how many people they’re coming in contact with, and how often that contact is occurring, and how long it’s occurring and how distant they are. And the simple reason for that is that most of the people who are infected do not realize it. At least half of them don’t realize it until they become symptomatic. The other half stay asymptomatic. They can be busy spreading their infection to everyone around them and look and act and feel perfectly normal. And that’s, again, something that’s very unusual for us in the infection prevention world. And I think that simple message, getting out to businesses, getting out to community organizations, can help to spread the word that we can be involved, and we can help whether we’re doing it as volunteers in our community, or whether we’re trying to stand up a business. It first requires people to recognize that there is a problem, and then that we can help them define their specific problem. And we can help them come up with solutions. For instance, in my own family, people said to me, “Well, you know, do we dare come and visit our mom for the holidays? She hasn’t seen anybody in six months. And, you know, her partner died a while back, and she’s really suffering from the loneliness.” And in this situation, if that person has discussed it with her, and she finds it more important that she get a visit, then that she continued to maintain her quarantine, then they need to talk about how they can make that visit the safest possible. And that can be things like getting a couple of tests beforehand at the right period of time, the right period of time really should be discussed with the visitor’s own physician. And they should talk about when their last possible exposure to someone else was. How intensive that exposure was likely to have been. Was it a known exposure, or just the last person they saw outside their own home and they’re away from their own housemates? Do their own housemates go out by the house, or do they also self-quarantine? If you have those conditions met, that there’s been a self-quarantine for two weeks, and the doctor says, “OK, one PCR test we’ll do. Or two antibody tests we’ll do. And stay in your own car and bring your own food along and your own water along on the trip.” Then you can probably have a pretty safe visit, especially if you will wear at least a simple barrier face covering while you’re visiting your mom. But other than that, it could be very dangerous for an elderly person to get visits from their younger family. And so those are the kinds of situations that really should be thought through. Because in the end analysis, would you want to see that parent end up in the ICU or dead? Because they were lonely, and you were lonely, and you wanted to both have a visit? So that’s the nature of the question asking that needs to happen. And it’s not an easy thing to do on your own. It’s even sometimes hard to raise the questions.

Susan E. Campbell, PhD, CIC:  “In many cases, perhaps not all cases, but in many cases, infection preventionists can adapt what they know in the hospital setting and make it work in other settings.”

How Infection Preventionists Work Outside of Healthcare

A photograph of a physician comforting an elderly COVID patient seems to have driven home the point of just how much of an emotional toll the coronavirus has taken. Hospitals are being swamped, as there were over 96,000 COVID hospitalizations yesterday, according to the COVID Tracking Project. That means there were over 96,000 stories of individuals dealing with the disease, and thousands of more stories about the healthcare providers trying to assist them.

The photo, circulated worldwide via the Internet, shows the patient at United Memorial Medical Center in Houston, being comforted by Joseph Varon, MD, the hospital’s chief of staff.

 that on Thanksgiving, he’d just happened to be passing the man’s hospital room when he saw that the patient was out of his bed, distraught, and crying. Varon tells CNN: “So, I get close to him and I tell him ‘why are you crying’ and the man says, ‘I want to be with my wife’. So, I just grab him, I hold him, I did not know that I was being photographed at that time.”

 has been reporting about the emotional toll caring for COVID-19 patients has taken on infection preventionists and other healthcare providers. And it’s not just doctors, nurses and providers who are usually on the hospital wards who have witnessed this heartbreak. In a 

 on November 13, Linda K. Groah, MSN, RN, CNOR, NEA-BC, FAAN, the CEO and executive director of the Association of periOperative Registered Nurses (AORN), spoke about how operating room nurses at times in the pandemic have had to work on hospital wards. Groah said that “at the early onset of COVID-19, operating room nurses were retrained to go out and help on the nursing units. In critical care or in med-surg units. Not necessarily as the primary caregiver but as an assistant. So, some of them did experience that kind of an issue where a patient died, and they were holding the phone for the last conversation that that patient had with their family member.”

Varon tells CNN that “we have so many patients that sometimes we cannot hold every patient or grab the hand of a patient or at least try to be a little more human. Some of them cry, some of them try to escape—we actually had somebody that tried to escape through a window the other day.”

Varon says that he doesn’t know how he keeps going and he can see the emotional strain being place on other healthcare professionals at the hospital.

“My nurses have broken down,” he tells CNN. “My nurses cry in the middle of the day because they get so sad, sometimes for situations like this. Just seeing a patient that's crying because he wants to see his family.”

 on September 30, Ernest Grant, PhD, the president of the American Nurses Association, strongly stressed the need for nurses and other healthcare providers to look out for their own physical and mental health. Grant said that unfortunately, too may healthcare providers “are not seeking the appropriate assistance that is offered to help deal with that. We are great at caring for patients, and others, but sometimes when it comes to caring for ourselves, we always put ourselves last. And in this case, the frontline workers need to recognize that it’s important that they take care of themselves first. Because you’ve got to operate at your optimum in order to take care of all the challenges that are going to come along. You’re not going to be very beneficial if you yourself are not up to par.”

Sometimes, though, COVID doesn’t let the weary rest. Varon tells CNN that he had been working 265 days nonstop. He says that the public needs to do the right things in terms of infection control and prevention—hand hygiene, social distancing, masking—and stay out of already overloaded hospitals.

Articles

The photograph captures the human anguish caused by COVID-19. The elderly man just wanted to go home and see his wife for Thanksgiving. A doctor tried to comfort him.

Photo Captures Anguish of COVID Patients … and Providers

Moderna is submitting its application to the US Food and Drug Administration (FDA) for Emergency Use Authorization (EUA) o 

The submission, anticipated for Monday, would initiate a timeline which may see the mRNA platform vaccine become available for the US public as early as December 21 if the FDA finds safety and efficacy evidence to be substantial for approval.

The FDA will now decide on 2 COVID-19 vaccine EUA applications in December, including 

Pfizer’s own mRNA vaccine candidate, BNT162b2.

mRNA-1273 was co-developed by biotechnology company Moderna and the National Institutes of Allergy and Infectious Diseases (NIAID) Vaccine Research Center—a product first completed as a clinical batch in the first week of February, and undergoing phase 1 clinical by March 16.

As a nucleoside-modified messenger RNA (mRNA) platform-hosted vaccine, it is encoded for a prefusion stabilized form of the SARS-CoV-2 Spike protein, based on the virus’ sequencing provided by Chinese investigators at the beginning of the COVID-19 outbreak. NIAID director Anthony Fauci explained to sister publication 

 in a podcast interview this September that the concept of the vaccine was borne on January 11—just 1 day after the SARS-CoV-2 sequence was made public.

“I got my team together on the 11th (of January) and said, ‘We’ve got to partner with Moderna and put this in an mRNA platform.’ By the 15th, we started doing it,” he explained. “Sixty-five days later, we were in a phase 1 trial. And 7 months later, we’re in a phase 3 trial. That process would normally take a few years, but we didn’t compromise anything.”

The vaccine is currently being assessed in the ongoing phase 3, randomized, placebo-controlled COVE trial, in which a 100 mcg dose of mRNA-1273 is being compared versus placebo across 30,000 US adults aged 18 years and older.

The primary endpoint of assessment is preventing symptomatic COVID-19 disease with the vaccine, while key secondary endpoints including preventing severe forms of the virus, and overall infection by SARS-CoV-2.

As developed under guidance from the FDA and the National Institutes of Health (NIH), the COVE study additionally includes 7000-plus participants over the age of 65 years, as well as 5000-plus participants with chronic diseases including diabetes, severe obesity, and cardiac disease—both indicators of high severe COVID-19 risk.

Currently, these high-risk groups represent 42% of all observed patients in the phase 3 trial.

The newest data reported by COVE investigators indicated that mRNA-1273 is associated with a 94.1% efficacy rate, based on the benchmark of 196 total COVID-19 cases in the trial population.

Efficacy against severe COVID-19, however, remained at 100%—based on the benchmark of 30 total severe cases, all in the placebo group.

Investigators additionally reported consistent efficacy across patient age, race and ethnicity groups, as well as gender demographics.

Currently, the safety profile of mRNA-1273—which is under continuous review—has shown no new serious safety concerns in treated participants, and common adverse reactions including injection site pain, fatigue, myalgia, arthralgia, headache, and erythema at the injection site. The frequency and severity of such anticipated reactions were raised after the second injection of the two-dose vaccine.

Moderna investigators will submit the phase 3 data for publication in a peer-reviewed journal shortly.

Stephane Bancel, chief executive officer of Moderna, said the primary analysis of COVID-19 prevention—as well as severe COVID-19 prevention—was confirmed by the newest efficacy rate reported.

“We believe that our vaccine will provide a new and powerful tool that may change the course of this pandemic and help prevent severe disease, hospitalizations and death,” Bancel said in a 

. “I want to thank the thousands of participants in our Phase 1, Phase 2 and Phase 3 studies, as well as the staff at clinical trial sites who have been on the front lines of the fight against the virus.”

Accompanied with the news of the EUA submission is the expectation the FDA will host a Vaccines and Related Biological Products Advisory (VRBPAC) meeting for mRNA-1273 on Thursday, December 17.

The intent of the meeting is for members of the FDA committee to host a discussion on the vaccine’s supporting data, before submitting their vote to either support the EUA or not—an outcome that is very historically tied to final FDA decisions.

The VRBPAC meeting is scheduled for 6 days following the planned discussion for Pfizer’s BNT162b2, which may provide clearer indication as to how Moderna’s product will be perceived and scrutinized by the panel of experts.

Following (potentially) VRBPAC support and corresponding emergency authorization, Moderna would be ready to ship approximately 20 million doses of two-dose mRNA-1273 through the US by the end of the year, with priority being recommended by the US Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP).

Moderna—which worked with the CDC, Operation Warp Speed, and federally-contracted COVID-19 vaccine distributor McKesson to be prepared for immediate manufacturing and distribution in the event of an EUA—is on track to manufacture 500 million to 1 billion doses for a global population in 2021.

Prioritization of one vaccine versus another—particularly in the case of similar platform candidates being produced by the major industry player Pfizer and expert-guided newcomer Moderna—is not something experts anticipate unless future long-term safety assessment indicates otherwise.

 that mRNA-1273’s early effect on T-cell activation and triggered antibody response in its older participant population, as well as its involvement with Fauci and NIAID, gives it a unique leg up in potential versus the Pfizer vaccine.

Efficacy against severe COVID-19 is 100%—based on the benchmark of 30 total severe cases, all in the placebo group. Consistent efficacy was seen across patient age, race and ethnicity groups, as well as gender demographics.

Moderna Submits COVID-19 Vaccine for FDA Approval

For so many of us in infection prevention and control (IPC) these are the months we often see as a busy time of year – influenza and respiratory virus season is not a traditionally quiet one in healthcare. But this year promises to be different, because everything in 2020 has been different thanks to coronavirus disease 2019 (COVID-19). The coming weeks will surely see high case counts following considerable travel, gatherings, and indoor activities due to cold weather. With COVID-19 numbers surging, the fatigue is real and the hope is that the implantation measures being put into place will help ease the burden.

There are two reports this week that are particularly insightful and relevant for IPC efforts in the face of COVID-19. The first regards 

 as outlined by the US Centers for Disease Control and Prevention (CDC). Maternal and child health is a vital part of the work we do, but in the era of a pandemic, it can become difficult to develop protocols and strategies to reduce the risk of transmission between the breastfeeding parent and newborn.

This focus was a result of noticing a nearly 18% drop in in-person lactation support and that nearly 73% of hospitals discharged mothers and their babies less than 48 hours after birth. The gaps in knowledge and experience carrying to neonates born to mothers with COVID-19 creates a complex situation during a novel pandemic. “Follow-up of mothers with COVID-19 delivering at three large New York birth hospitals found reduced breastfeeding rates both in the hospital and after returning home among mothers who had been separated from their newborns,” says the study in the CDC’s 

). “After identification of this finding, and the observed stress among mothers and newborns as a result of separation, the hospital system revised its policy and began to allow asymptomatic mothers with laboratory-confirmed COVID-19 to room-in and breastfeed.” Ultimately, 1344 surveyed hospitals painted a clear picture of a change that was desperately needed—focused efforts to ensure breastfeeding and IPC were syncing during this time to ensure adequate care for the newborn and mother.

areas where mask mandates were mandated via executive orders

. This has been a particularly hot topic, but recent months have seen more publications on the impact that mask mandates have had on COVID-19 incidence in the community. In this case, the authors focused on the state of Kansas and the executive order that required masks in public spaces which went into effect on July 3, 2020. The authors noted that following this order, incidence across the 24 counties with mask mandates decreased by 6% (new cases per 100,000 people) but in those 81 counties without mask mandates, COVID-19 incidence continued to increase.

The authors noted that “after implementation of mask mandates in 24 Kansas counties, the increasing trend in COVID-19 incidence reversed. Although rates were considerably higher in mandated counties than in nonmandated counties by the executive order, rates in mandated counties declined markedly after July 3, compared with those in nonmandated counties. Kansas counties that had mask mandates in place appear to have mitigated the transmission of COVID-19, whereas counties that did not have mask mandates continued to experience increases in cases.” Ultimately, we can glean from this that if you’re in an area with a mask mandate, it will likely help reduce cases, so adding these pivotal community pieces into the IPC plans are highly suggested.

Strategies are needed to reduce the risk of COVID transmission between the breastfeeding mother and newborn. Meanwhile, mask mandates work.

COVID-19 Hot Topics: Breastfeeding, and Mask Mandates

There are two pivotal pieces of news that will likely impact infection prevention efforts in the coming weeks. Aside from the hopeful news of vaccine candidates, the Centers for Disease Control and Prevention (CDC) also might be lessening the quarantine time for those exposed to coronavirus disease 2019 (COVID-19). Currently, the recommended quarantine time is 14 days from the last known date of exposure to a person with suspected or confirmed COVID-19. It has more recently been 

 that it’s likely this guidance will go down to 7-10 days and a negative SARS-CoV-2 test.

What does this mean for infection prevention efforts? While healthcare workers are often able to work following an exposure due to the use of PPE and self-monitoring, this will likely impact community-based quarantine efforts. The range though is concerning—is it 7 or 10 days? From 

my experience, it’s best not to leave a range, but rather provide a specific guidance that doesn’t allow for bias. Perhaps the guidance will state that a required test during quarantine can only be performed after day 7 but will not shorten the 10-day quarantine period if it’s negative. In either case, the more specific the guidance, the better it is for implementation and communication to the public. This is also be determined by local public health department efforts and if they choose to follow the CDC’s guidance or stick to the existing 14 days.

This possible guidance comes as we put the long Thanksgiving weekend in the rearview mirror but, unfortunately, we’re nowhere near putting COVID-19 behind us. As of this writing, the United States has reported over 12.7 million cases of COVID-19, resulting in more than 254,000 deaths. These numbers will only increase as time progresses and we see the fallout of the holiday that had too many people traveling, and the winter months bringing more people indoors in a time of pandemic fatigue. From the holidays to cold weather and traveling, this will be a challenging time of year for all of us.

The second piece of news was the authorization of the 

. The Food and Drug Administration (FDA) announced recently that they had given the first rapid SARS-CoV-2 at-home test approval. Katherine Wu, MD, recently wrote in the 

 that “laboratory tests that look for the coronavirus’s genetic material using a technique called polymerase chain reaction, or P.C.R., are still considered the gold standard for detecting the virus. But the new at-home test relies on similar principles by using a method called a loop mediated amplification reaction, or LAMP. Like P.C.R., LAMP repeatedly copies genetic material until it reaches detectable levels, making it possible to identify the virus even when it is present at only very low levels in the respiratory tract. While faster and less cumbersome than P.C.R., LAMP is generally thought to be less accurate.”

While this is exciting news for more accessible testing, there is still concern with how it will be used and the communication to the public that a test is a single moment in time. Moreover, what we gain in speed, we lose in accuracy. Also, how will these results be reported to the local health department? There are a variety of questions that come with these advancements and while we can all safely say that more accessible and quick testing is important, the nuances of how they are deployed is critical.

The CDC may lower the days someone needs to be quarantined because of COVID exposure from the current 14, to from 7 to 10 days. That range is troublesome: Which is it, 7 or 10?

Closely Examine the ‘Good News’ on COVID-19 Front

 (CRAB) is not much seen in the United States now, but it has begun to emerge as a deadly pathogen where it does strike, with a 55% mortality rate and an ability to resist most antibiotics thrown its way. Investigators with the Utah Department of Health (UDOH) wanted to study what should be the best response when CRAB emerged at a skilled nursing facility in that state in February 2018. Investigators argue that their findings, published in a pre-print 

, suggest that the kind of infection control and prevention methods seen in intensive care units (ICUs) should also be used at skilled nursing facilities that have a ventilator (what the authors abbreviate as vSNF). Such vSNFs can attract highly resistant pathogens.

“Containment in this resource-restrained setting requires an aggressive multi-faceted infection control approach that will address the multiple gaps that have contributed to the outbreak,” the study states. “Resources should be prioritized to enhance basic infection control practices such as: hand hygiene and PPE [personal protective equipment] use; surveillance; environmental cleaning, and communication between providers. An understanding of patient transfer patterns and increased surveillance and reporting of CRAB throughout the United States, and a regional approach focusing on inter-facility connections would improve regional containment efforts.”

A patient identified as Patient 1 was found to have CRAB posthumously. Four other patients at the facility were also afflicted with the disease. An investigation was launched by the UDOH and the US Centers for Disease Control and Prevention (CDC).

“Of the 47 patients screened, OXA-23-producing CRAB were detected in 10 patients (21%), with 7 patients (15%) having been transferred from out-of-state facilities,” the study states. “Of patients who screened positive, 60% did not exhibit any signs or symptoms of active infection by chart review. A total of 38 environmental samples were collected and CRAB was recovered from 37% of those samples. Whole genome sequencing analyses of patient and environmental isolates suggested repeated CRAB introduction into the facility and highlighted the role of shared equipment in transmission.”

Investigators note that CRAB can survive for up to six months in dry environments and that makes them very difficult to kill in healthcare settings. Furthermore, CRAB has chameleon-like tendencies because it can absorb material from other organisms, and that allows it to ward off most antibiotics. It’s a Superbug.

 can cause infections in the blood, urinary tract, and lungs (pneumonia), or in wounds in other parts of the body,” says the 

. “It can also ‘colonize’ or live in a patient without causing infections or symptoms, especially in respiratory secretions (sputum) or open wounds.”

Which is what happened at the Utah facility, which investigators found out after collecting sputum, oropharyngeal, wound and skin samples from the groin and axilla. Meanwhile, they also investigated the environment, focusing on high-touch surfaces such as nursing carts, physical therapy equipment, vital signs monitoring equipment, ventilators, bed rails, and respiratory therapy equipment.

“Immediate recommendations included: training and auditing of hand hygiene and PPE [personal protective equipment] use; limiting access to the high-acuity unit; and improved cleaning of high-risk areas and shared patient equipment,” the study states.

Investigators take into account the intrinsic differences between ICUs and vSNFs, writing that “because the patient population in the high-acuity vSNF setting is similar to those seen in ICUs, containment strategies should be modeled after infection control practices in ICU settings, while also balancing patient quality of life and available resources.”

CRAB has chameleon-like tendencies that allow it to absorb material from other organisms, and that allows it to ward off most antibiotics. It’s a Superbug.

When Carbapenem-resistant Acinetobacter baumannii Comes Calling

The debate about whether someone should be vaccinated for influenza every year will probably continue, but researchers with Kochi Medical School Hospital, Nankoku, Japan, have come up with a strong argument that people should get vaccinated against flu each year. The investigators—who published their findings in a 

—conclude that flu vaccinations do not lose their effectiveness if given each year over 5 years.

“This is a controversial point, and to the best of our knowledge, this is the first time that this issue has been addressed with objective measures of immune response to vaccination,” the study states. Investigators cite previous studies that contradict one another on this point, saying that “the impact of repeated seasonal vaccination remains to be clarified.”

They focused on antibody responses after flu vaccination to measure the ongoing effectiveness of repeated vaccination. In each of the 5 years, investigators found that hemagglutination inhibition (HI) antibody titers for influenza A/H1N1, influenza A/H3N2, and influenza B were elevated at 4 weeks after vaccination. And in each of the 5 years, the titers of all decreased to their original levels 8 months later. “PRs (the proportion of individuals with HI antibody titers ≥1:40 (or 40)) at 4 weeks after vaccination were similar among most of the 5 seasons evaluated,” the study states.

Investigators say that vaccination is necessary to have high titers during flu seasons.

“Our results suggest that annual vaccination is necessary in order to re-establish antibody responses to both influenza A and B even if vaccine strain does not change as overall antibody titiers will have dropped,” the investigators state.

The five flu seasons in which data were collected were: 2005-2006, 2006-2007, 2007-2008, 2008-2009, and 2009-2010.

As in every study, there were some limitations. For instance, there was no unvaccinated cohort involved. “While HI antibody titer is a meaningful parameter that adequately describes the immune response to vaccination, vaccine effectiveness is more clinically important,” the study states, adding that “our cohort included only those older than 61 years of age. Immune responses are different among different age groups; it is therefore not possible to generalize the results of the current study.”

Nevertheless, the findings offer support to those who argue that the flu vaccine should be gotten every year. “Taken together, our results suggest that annual vaccination is necessary to maintain humoral immunity for the elderly population,” the study states. “Furthermore, our findings revealed that annual seasonal vaccination was not associated with reduced vaccine effectiveness, and that the reformation of the vaccine resulted in amplified immune responses among those undergoing yearly vaccination in the elderly population.”

The study states that “annual vaccination is necessary to maintain humoral immunity for the elderly population. Furthermore, our findings revealed that annual seasonal vaccination was not associated with reduced vaccine effectiveness….”

Study: Yearly Flu Vaccines Don’t Lose Effectiveness

Just a small portion of advice the day before Thanksgiving. Susan E. Campbell, PhD, CIC, is an 

 to discuss many topics having to do with her area of expertise. Below is an excerpt of a much longer conversation in which Campbell—a certified infection preventionist with a doctoral degree in microbiology—discusses safe approaches to eating a Thanksgiving meal for infection preventionists and other healthcare workers who have to work tomorrow. Also, even though a good portion of the public is listening to the US Centers for Disease Control and Prevention (CDC) and keeping Thanksgiving celebrations 

 so as to slow the spread of the disease, a good many other people will travel, presenting opportunities to this opportunistic pathogen. Those people should take the party outdoors if they can. Campbell says that “if somebody has one of those backyard fire pits, this is an excellent time to fire it up and make some s'mores around the fire and wear your nice down jackets. And please avoid singing loud songs because, once again, you’re going to just be propelling the aerosol to the person 20 feet or 30 feet away from you.”

We’re starting to head into the holidays and people are in the mood to mingle and party. Any words about having fun in the midst of a pandemic?

 Certainly. I think that in a healthcare setting, staff have to eat. And it’s ideal if they can go out and eat in their car safely away from others. But I think people also need to somehow experience some relief and some camaraderie, and they look forward to those gatherings. The problem is you can’t eat with a mask on. And here we are in a situation where in some facilities, some individuals who are known COVID-positive, but asymptomatic, are being asked to work because they’re just out of healthcare staff. I think such individuals should take it upon themselves to not participate in group eating when they know they’re infected, because there’s truly no safe way that they can be close to their comrades, their coworkers, when they’re having lunches or any kind of party. But we also need to think about the airflow. And even when hospitals have done the minimum six room air exchanges per hour, when you have a number of people in one small room, that probably is not going to be enough. So best thing to do would be to be in a room with large windows that can be opened and a door that can be opened. And people wear their coats where they’re going to be eating in a communal way, so that they can maintain their social distancing, but also have some fresh air involved to reduce the aerosol that may be circulating. It would be preferable to even open those windows and doors before this gets started so that the room air can be fresher before people start entering. And I would suggest that particularly for home parties as well. And especially if somebody has one of those backyard fire pits, this is an excellent time to fire it up and make some s'mores around the fire and wear your nice down jackets. And please avoid singing loud songs because, once again, you’re going to just be propelling the aerosol to the person 20 feet or 30 feet away from you. But you know, speak loudly enough to be heard and enjoy the camaraderie but be in as much fresh air as you possibly can be. And once again, if you know that you may have been in contact with someone who could be positive, or if you yourself have gotten a positive diagnosis, until you’ve been cleared by your physician or nurse practitioner, please don’t take off your mask and enjoy a communal eating situation. You could put others in danger. And I know nobody wants to do that knowingly, but they might just not be thinking about it. So, I’m here to remind you.

Susan E. Campbell, PhD, CIC, offers advice to infection preventionists and other healthcare professionals who’ll be working Thanksgiving on how to safely eat their holiday meal together.

Infection Preventionist Offers Holiday Safety Tips

In its fashion, coronavirus disease 2019 (COVID-19) will most likely be feasting over the Thanksgiving holiday, infecting more and more people. Even though a good portion of the public is listening to the US Centers for Disease Control and Prevention (CDC) and keeping Thanksgiving celebrations limited so as to slow the spread of the disease, a good many other people will travel, presenting opportunities to this opportunistic pathogen. Thanksgiving could cause a surge on top of the surge already happening as November registers at least 20 consecutive days of 100,000 or more of 

. Infection preventionists and other healthcare professionals brace themselves, as the CDC warns that it’s possible that the number of hospitalizations due to COVID-19 are likely to rise every day for the next 4 to 10 weeks, further straining an already strained 

COVID-19 is far from running its course, according to a 

. That study says that as of September, a vast majority of people in the United States don’t have the coronavirus antibodies needed to fight the disease, meaning that a vast majority remain vulnerable.

“In this repeated, cross-sectional study of 177,919 residual clinical specimens, the estimated percentage of persons in a jurisdiction with detectable SARS-CoV-2 antibodies ranged from fewer than 1% to 23%,” the study states. “Over 4 sampling periods in 42 of 49 jurisdictions with calculated estimates, fewer than 10% of people had detectable SARS-CoV-2 antibodies.”

Complicating the problem is evidence that the prevalence of COVID-19 antibodies decreases over time. For instance, the investigators cite “declining seroprevalence in New York” where the percentage of people with antibodies decreased from 23.3% to 17%.

“Assays to detect other factors associated with the immune response, such as quantitative antibody levels and neutralizing antibodies for SARS-CoV-2, are resource intensive and not yet widely available,” the study states.

Mortality rates are plummeting, as Stephan Hahn, MD, the commissioner of the US Food and Drug Administration (FDA), pointed out yesterday in an 

 interview with Sen. Tim Scott. Hahn said that in the beginning of the pandemic, the mortality rate for those over 70 was 30%.

“Now it's around 11%, and that’s because the great doctors of this country have learned how to take care of the patients, but we have new treatments,” Hahn said. Remdesivir, steroids, convalescent plasma, and monoclonal antibodies are among the treatments Hahn cites.

He also notes the progress being made by several pharma companies in the development of a 

. However, a COVID vaccine only works if you take it and some researchers argue that a public health campaign for vaccine acceptance needs to 

Hahn also sees a lot of promise in the development of self-administered COVID-19 tests the people can perform in their homes. The Lucira COVID-19 All-In-One Test Kit, a self-test for Covid-19 that can provide results in 30 minutes or less, was recently granted 

Hahn told Scott: “This is the first step, and I see more of this coming.”

The bottom line, though, is that people need to continue doing what health experts have been exhorting them to do since the beginning of the pandemic: hand hygiene, masking, and social distancing.

Infection preventionists must brace themselves for a huge influx of COVID patients, as more data reveal just how formidable of a foe this novel coronavirus can be. 

Healthcare Experts: Don’t Invite COVID to Thanksgiving Dinner

Infection preventionists and other healthcare professionals have good reason to feel overwhelmed these days, as the number of hospitalizations due to coronavirus disease 2019 (COVID-19) keeps breaking records this month. According to the COVID Tracking Project over 83,000 people were hospitalized for COVID-19 yesterday, and the record for hospitalizations has been broken every day since November 10.

The infection rate won’t slow down any time soon, especially with Thanksgiving coming this week and people interacting indoors. The US Centers for Disease Control and Prevention (CDC) 

 that, according to four recognized COVID tracking models, the number of new hospitalizations from COVID-19 are likely to rise every day for the next 4 to 10 weeks. “For December 14, the forecasts estimate 4,600 to 21,000 new COVID-19 hospitalizations per day,” the CDC reports.

We might be about to see a “surge superimposed upon a surge,” says Anthony Fauci, MD, director of the CDC’s National Institute of Allergy and Infectious Diseases. In an interview yesterday with the 

, Fauci urged Americans to stay home for Thanksgiving. Fauci told the 

 that “we are in a very steep escalation of cases right now in the mid-fall season. If in fact, you’re in a situation when you do the things that are increasing the risk—the travel, the congregate settings, not wearing masks—the chances are you will see a surge superimposed upon a surge.”

The message might be getting through, at least to some extent, according to a 

 by the Axios/Ipsos Coronavirus Index that says that 6 in 10 Americans have decided to scale back their Thanksgiving celebrations. “This greater willingness to turn inward and exercise caution around the holidays comes amid signs of increased trust in the Centers for Disease Control and Prevention and a growing confidence there will soon be a safe and effective 

Just how much of a scaling back on Thanksgiving will occur remains to be seen. As 

 reports, AAA expects that 55 million Americans will be traveling this holiday weekend, and according to the Transportation Security Administration, more than a million people travelled by air last Friday.

People who do travel for Thanksgiving may feel they are less at risk, even if they do catch COVID. As 

, those hospitalized with COVID have a much better chance of surviving than those who’d been hospitalized in the spring and summer. Many of the patients these days are younger (and therefore have a better chance of surviving) and physicians have learned how to better treat the disease. However, while better survival rates can be cheered that does nothing to ease the pressure on infection preventionists and others on the frontlines and, in fact, probably adds to it. Many who survive still have to be treated in hospitals.

In North Dakota and Illinois those hospitals are already overburdened, and hospital officials in Utah say that they’ve been forced to ration care.

And while it appears that many Americans have indeed scaled back on their plans for Thanksgiving, heeding the CDC’s recommendation that celebrations should be limited to only household members (people who’ve lived under the same roof for at least the last 14 days), too many have not.

The US could possibly double the number of COVID cases by January 20, according to forecasters at Washington University in St. Louis. Not all of those projected 20 million COVID cases will wind up in the hospital, but many will.

The United States recorded 169,190 confirmed cases of COVID-19 yesterday, while 889 people died of the novel coronavirus, according to Johns Hopkins University. Overall, in the United States, there have been about 12.5 million confirmed cases of COVID-19 and about 258,000 people have died from the disease.

The CDC warns that it’s possible that the number of hospitalizations due to COVID-19 are likely to rise every day for the next 4 to 10 weeks, further straining an already strained healthcare system.

Next Course? COVID ‘Surge Superimposed Upon a Surge’

Time to gird for the bird. It won’t be much a Thanksgiving holiday for infection preventionists and other healthcare professionals grappling with an alarming spike in cases of coronavirus disease 2019 (COVID-19). This huge surge in COVID cases—20 straight days of reported cases of over 100,000 or more—floods hospitals in the United States even before the start of the long Thanksgiving weekend, where millions of people will be traveling and gathering and thus giving SARS-CoV-2 even more opportunities to spread.

Connie Steed, MSN, RN, CIC, FAPIC, president of the Association for Professionals in Infection Control and Epidemiology (APIC), 

 the public that now is not the time to let its guard down against COVID-19. “While news of a 

 is welcome, we must continue masking and social distancing until broad distribution of the vaccine becomes a reality,” Steed said in press release last Friday. “With cases rising, and many hospitals at or nearly at capacity, we all must do what we can to prevent the spread of COVID-19. Wear a mask when you’re outside your home, stay six feet from others, wash your hands, don’t touch your face, and stay home if you feel sick.”

The US Centers for Disease Control and Prevention (CDC) 

 people to stay home for the holiday, but the public seems to be turning a deaf ear to that warning as AAA 

 that more than 55 million travelers will hop planes, trains, and automobiles to visit their loved ones. That’s about 10% fewer travelers than last year, but still way too many, as far as the CDC is concerned.

The agency suggests that Thanksgiving celebrations be limited to household members only; people who’ve lived under the same roof for the last 14 days. “People who do not currently live in your housing unit, such as college students who are returning home from school for the holidays, should be considered part of different households,” states the CDC guidance. “In-person gatherings that bring together family members or friends from different households, including college students returning home, pose varying levels of risk. Organizers and attendees of larger events should consider the risk of virus spread based on event size (number of attendees and other factors) and take steps to reduce the possibility of infection, as outlined in the 

Considerations for Events and Gatherings.

Hospitalizations and deaths are lagging indicators, but they are surging as well. 

, about 83,870 patients were hospitalized yesterday, the 13th straight day the US COVID hospitalization record has been broken. And last week, the daily death count from COVID reached 2000, the first time that’s happened since May,

 Administration, more than a million people travelled by air last Friday.

’s Editorial Advisory Board, says that the risk just isn’t worth it. “The virus doesn’t care,” Kavanagh told 

. “People get together, it will spread. So, right now I would be more worried about getting the family together for next Thanksgiving than this Thanksgiving. And if you’re going to get your family together this Thanksgiving, you may not have all members together next Thanksgiving, and that’s what needs to be remembered.”

 released last Friday, the CDC says that 50% of COVID cases are spread by asymptomatic carriers.

Overall, in the United States, there have been over 1.2 million confirmed cases of COVID-19 as of yesterday and about 257,000 have died from the novel coronavirus. In the world, there have been over 58 million confirmed cases of COVID-19, and nearly 1.4 million people have died from COVID-19.

Kevin Kavanagh, MD: “I would be more worried about getting the family together for next Thanksgiving than this Thanksgiving. And if you’re going to get your family together this Thanksgiving, you may not have all members together next Thanksgiving, and that’s what needs to be remembered.”

Infection Preventionists Gird for Thanksgiving Fallout

The coronavirus disease 2019 (COVID-19) pandemic put infection preventionists (IPs) in the spotlight and might present expanded employment opportunities for IPs in business, government and 

Airflow matters when it comes to keeping schools safe for children, teachers, and staff. And school officials should make sure that their ventilation systems work properly to ensure the delivery of clean air and the dilution of possible contaminants in the air, according to updated 

 by the US Centers for Disease Control and Prevention (CDC). Consult with experts in heating, ventilation, and air conditioning (HVAC) when determining the safety of the school environment, the CDC recommends. School officials should also adhere to recommendations from the American Society of Heating, Refrigerating, and Air-Conditioning Engineers (ASHRAE).

Paula J. Olsiewski, PhD, an expert in safe ventilation standards for hospitals, tells 

 that she welcomes the update. “I am delighted to see that CDC has updated their COVID19 guidance for schools to include HEPA portable air cleaners and a range of other steps to improve ventilation, based on ASHRAE guidance,” says Olsiewski, a contributing scholar at the Johns Hopkins Center for Health Security. “This will keep everyone safer indoors.”

However, Olsiewski wishes that the CDC had gone a bit further. The guideline update “was limited and did not include portable air cleaners … and on Twitter I was actively pushing for portable air cleaners in schools,” she said.

 for schools and universities that deal with ventilation strategies for different types of buildings and what should be in place for occupancy. The CDC guidelines say:

“Consider running the HVAC system at maximum outside airflow for 2 hours before and after the school is occupied.

Ensure restroom exhaust fans are functional and operating at full capacity when the school is occupied.

Inspect and maintain local exhaust ventilation in areas such as restrooms, kitchens, cooking areas, etc.

Use portable high-efficiency particulate air (HEPA) fan/filtration systems to help enhance air cleaning (especially in higher risk areas such as the nurse’s office).

Generate clean-to-less-clean air movement by re-evaluating the positioning of supply and exhaust air diffusers and/or dampers (especially in higher risk areas such as the nurse’s office).

Consult with experts in heating, ventilation, and air conditioning (HVAC) when determining the safety of the school environment, the CDC recommends.