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Highlights from Today's (08/10/21) Maine CDC/DHHS Medical Director's Call

Highlights from Today's (08/10/21) Maine CDC/DHHS Medical Director's Call
 
Comments from Dr Sears, CDC Epidemiologist:
  • Things are moving in the wrong direction for Maine and nationally. The increasing Delta variant is surging. Our Maine positivity rate is 2.4% compared to last month of .20%
  • Daily positive individuals were averaging between 10-20 daily one month ago but by comparison today we have 120 positive cases. Those who are hospitalized range in the mid to high 40s, with 59 today and 26 currently on vents. Predominantly those in hospital are unvaccinated but there are vaccinated individuals hospitalized
  • Maine vaccination rates are high which is helping our Maine populations.
  • With a highly contagious variant such as Delta the CDC has indicated that the incubation period is MUCH shorter, on average 2-3 days, with a much higher viral loads as compared to the original COVID virus.
  • ME CDC website w/ COVID data: https://www.maine.gov/dhhs/mecdc/infectious-disease/epi/airborne/coronavirus/data.shtml
 
Comments from Dr. Nirav Shah, CDC Director:
  • We are continuing to see concerning signs on the horizon with the Delta variant. Our testing volume continues to increase and the vaccination rates are increasing. In Maine we have about 80% of adults with at least the first vaccine dose.
  • The rate of breakthrough cases has not changes; however, because of the number of people vaccinated has increased so has the rate of breakthroughs. It is basic arithmetic.
  • Surveillance Testing: The theory and frequency of testing has not recently changed per the CDC. Dr. Shah does want to stress that because HETL capacity has increased
  • Sample Transport options are being discussed at the Maine CDC. Maine CDC is trying to make HETL a more accessible option for Maine homes.
 
Questions from participants:
Some heard that the chance of a vaccinated person becoming positive for covid is 1 in 100,000.  Is this accurate? It depends. The vaccine is still very effective BUT if you are around many unvaccinated individuals with higher viral loads the chances of you having a breakthrough positive COVID is higher. It is still not recommended for doing any kind of antibody treatment following vaccine 

Do we know which vaccine is most effective against the Delta variant? All the vaccines are similarly effective against COVID. 

Do you anticipate that the Governor will restrict travel to high case states - such as Florida? We are unsure. Continue to check the Governor's website as the situation develops: Gov's website to check for county status v/v masking recommendations: https://www.maine.gov/covid19/ 

Are HCW anticipated to receive a "booster" Covid vaccine?  If so, when is this recommended to occur? This is currently being discussed. There is discussion on whether this will be defined as a booster or as a third shot in the vaccine series. There is a leaning toward a third shot being focused on those immunocompromised but this has NOT been determined yet. 

Is it still spread through droplets or has that changed to aerosol? Nothing around our understanding of transmission of COVID (coughing, sneezing, speaking, singing) has changed. Proximity and duration of exposure continues to indicate the risk factors and source control should be utilized. 

Should we go back to eye protection as best practice with the high prevalence of the Delta variant? Probably not at this time. It would be better to focus on reemphasizing the use of masks and source control. Link to resource from federal CDC: https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/sars-cov-2-transmission.html#anchor_1619805150492 

Is there any thought about vaccinated people who test positive being able to retest to return to work or come out of quarantine earlier?  Generally, testing would NOT remove the need for quarantine at this time.  

Any news on when Pfizer and/or Moderna will be fully approved by the FDA? The Pfizer vaccine (perhaps later this week, this is purely speculative) may authorize 'boosters of this vaccine for immunocompromised individuals. The next thing on the horizon may be the full authorization of the Pfizer vaccine for individuals 12 and older, with a target of September. Into the fall and 2022 there will be development of a vaccine for children ages 4-12 and 2-4 with Moderna to follow about 6 weeks behind. 

I noticed the link for obtaining testing supplies has changed, how can we order supplies including Binax as well? The Maine CDC has now created a dedicated email to request PPE supplies.The email to request PPE is: PPEorC19TestingSupplies.MECDC@maine.gov. Form to request PPE/Testing supplies: https://www.maine.gov/dhhs/mecdc/public-health-systems/phep/information.shtml. This applies to both PPE and swabs/transport media. If you need Binax, Dr. Shah confirms send those requests to that email as well. Sally Weiss is also a resource for this.
 
Are there any conversations happening about perhaps not using only one employee or resident to substantiate an outbreak?  Maine CDC will NOT be changing their definition of outbreak. 

Is anyone having concerns about screening for allergy symptoms as many of them are similar to COVID19 symptoms and staff tend to either not report or state that their symptoms are not worsening?  Any recommendations to that as we would probably have to send many staff home every day. There is not one specific way to address this. There are different processes at individual facilities. What kind of risk assessment do you conduct in response to this? Have you had exposure or contact with high risk individuals. Maine licensing is looking for facilities to have a process to assess this indication. 

Is doing surveillance testing with the Binax tests following the guidance still a recommended way to look for breakout cases? PCR is still best practice and with testing capacity being high now Maine CDC would recommend PCR testing. 

With the recent outbreaks at local hospitals we have residents who were exposed and are on quarantine- and potentially their family members.   We are getting a lot of pushback from these family members to visit since the resident and family members have tested initially negative and are not symptomatic.   Based on table A this would not be allowed.  Can families choose to visit regardless? QSO 20-39 "Facilities shall not restrict visitation without a reasonable clinical or safety cause, consistent with 42 CFR § 483.10(f) (4) (v)." According to Bill Montejo, "Quarantine would be a reasonable clinical cause for restricting visitation for the short period of time. The exception would be compassionate care or end of life situations." 

Wondering if it would be possible for the CDC to publicly share with the community that there are differences in recommendations for the general public versus Long term care.  Many of our families state that "they know the CDC guidance and we are NOT following the CDC guidance."  Dr. Shah has stated they think we can do that. 

Can you advise how we can go about fit testing staff members quickly? The National Guard came to us last year but EMA has not responded to any of my submitted requests or emails. We can fit test one by one with our one kit but it is time consuming. Here, you can find the recent webinar for Respiratory protection here:  https://maineinfectionpreventionforum.org/ 

We are being told that when we have one positive case within our facility it does trigger an investigation and we are considered an outbreak is that true? This is outlined in QSO-20-39 which states: "When a new case of COVID-19 among residents or staff is identified, a facility should immediately begin outbreak testing and suspend all visitation (except that required under federal disability rights law), until at least one round of facility-wide testing is completed. Visitation can resume based on the following criteria:• If the first round of outbreak testing reveals no additional COVID-19 cases in other areas (e.g., units) of the facility, then visitation can resume for residents in areas/units with no COVID-19 cases. However, the facility should suspend visitation on the affected unit until the facility meets the criteria to discontinue outbreak testing. o For example, if the first round of outbreak testing reveals two more COVID-19 cases in the same unit as the original case, but not in other units, visitation can resume for residents in areas/units with no COVID-19 cases.

If the first round of outbreak testing reveals one or more additional COVID-19 cases in other areas/units of the facility (e.g., new cases in two or more units), then facilities should suspend visitation for all residents (vaccinated and unvaccinated), until the facility meets the criteria to discontinue outbreak testing."

Staff Contact: dwatford@mehca.org

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