Written by JobSiteCare
November 12, 2021
Globally, Europe has once again become the main center of COVID case increases around the world. Cases in Europe have increased to around 45 cases per 100k per day on average, although this is heavily tilted towards Eastern Europe.
Russia, notably, continues on an upward trend with a new record number of cases and deaths nearly every day. A large part of this is due to the country only having fully vaccinated less than 36% of the population, and most of those having been vaccinated with vaccines of Russian origin, which have demonstrably lower efficacy than those available in other parts of the world.
Germany is reporting around 35 cases per 100k per day, with the three populous southern states of Bavaria, Thuringia, and Saxony being the hardest hit. This is the highest rate for Germany since COVID started. The three states noted also have the lowest vaccine uptake rates in Germany, which overall does have a high fully vaccinated rate, but a very low booster rate at just over 3% of the population.
The United Kingdom now has about 3 weeks of fairly steady decreases in COVID cases, and deaths, which never increased at a rate comparable to cases, have also leveled off.
Moving to South Asia, in India and Bangladesh, cases are less than half a case per 100k per day – below negligible. Further East, Japan cases round to zero, and Korea, Singapore, Hong Kong, and Australia all appear to have the situation well in hand. Vietnam has seen a resurgence up to about 8 cases per 100k per day, but this appears to be leveling off.
South America and Africa continue to see very minimal COVID activity.
Last week, an emergency temporary standard was issued by the US Occupational Safety and Health Administration in which most employers with more than 100 employees must have COVID vaccination or testing mandate programs in place.
On Saturday, however, the US 5th Circuit Court of Appeals announced a nationwide temporary injunction against this new standard. In the order, the 3-judge panel cited both “grave statutory and constitutional concerns,” which is strong language for a temporary injunction.
The problem is that since that injunction can be lifted at any time, most companies feel that in order to be able to comply with the upcoming deadlines of December 5th for requiring masking in the workplace for anyone not vaccinated and January 4th for having in place a mandatory vaccination or testing program, they must still move forward with developing the required data on vaccination status. Unfortunately, this often entails an entirely new data structure because most companies do not store anything else that would be considered medical data, including all of the protections that now surround that type of data. As is typical for these types of government programs, the complexity is not the policy, but the compliance and reporting requirements. This is a major reason why regulations of this magnitude typically require months of public comment in order to develop a better understanding of the true costs of compliance.
At this point, while many authorities believe that the emergency temporary standard will be dismissed on both statutory and constitutional grounds, without further clarification of timelines in the event that it is upheld, most companies will have no choice but to move forward with the policy development and information gathering phases, which is where all the business costs and efforts will be. So even if the ETS is eventually thrown out, it will likely have had most of the intended effect of using employment to push vaccine mandates.
It is a very close call from a medical standpoint as to whether or not to get a vaccine for a 5- to 11-year-old. To be sure, the public health community and the American Academy of Pediatrics are strongly in favor of vaccination to increase the overall vaccination rate in society and get us closer to herd immunity. Additionally, from a practical point of view, in terms of dealing with schools and travel, especially international travel, if a child is vaccinated, they are likely to run into fewer administrative hurdles, so since it is a close call from a pure individual medical point of view when these other issues are added, many will simply decide to get their kids vaccinated.
For completeness, however, it is important to consider the equation from the purely medical side. The bottom line is that either choice – vaccinating or not vaccinating is associated with exceedingly low risk to the individual child, although we have little data on any long-term issues.
Most authorities estimate that greater than 50% of children in the US have already been infected with COVID. That equates to around 14M kids. Of that, there have been 94 deaths, with about 2/3rds of those being children with significant other medical issues, and most of the deaths occurring before the availability of the very successful medical treatments. Additionally, there have been 562 children hospitalized with COVID. Many of those have occurred in the Delta era, but the great bulk of these have also occurred in children with significant medical issues.
On the vaccination side, while the “top line” adverse event rate for the Pfizer vaccine for these younger children is just over 10%, none of these events in the study population of 2176 kids were considered serious, with most being things like sore arms or transient fevers (which did occur in 6.5%, mostly after the second dose). Importantly, we do not have any data on whether side effects were more common in children who did have evidence of prior infection, which would be very useful to know. In any event, the data does support the short-term safety of the vaccine in younger children, although 2176 kids is not a big population for detecting uncommon side effects, such as myocarditis as is seen in older children. Additionally, we have little data on long-term effects such as auto-immune problems. We do know that there are rare auto-immune issues that develop in adults, but children are different, and typically, before a major vaccine program, children in test populations are followed for a couple of years before the approval of a vaccine. That does not mean there are any significant issues expected or even postulated, but there are a significant number of medical scientists who raise questions not based on what we know but what we don’t know. The post-vaccine monitoring program for children is very robust and many parents may choose to wait for data to come in from this robust monitoring, but if travel or school and activity restrictions are having significant impacts on children, parents should be able to go ahead with vaccinating their kids knowing that any short-term side effects are either minimal or extremely rare and there is nothing specific that raises concerns of long-term effects.
Natural vs. Vaccine Immunity
Lastly this week, we will try to clear up a little confusion on the effectiveness of natural immunity versus vaccine-induced immunity. The official position of the CDC is that in regard to studies of immunity following natural infection, “There are insufficient data to extend the findings related to infection-induced immunity at this time to persons with very mild or asymptomatic infection or children.” This typically gets characterized in media as vaccine immunity is better than natural immunity, where what it is really saying is that CDC doesn’t know, especially for “minor infections” and we can’t really quantify what is minor. Consequently, the CDC is essentially saying that since vaccine-induced immunity is fairly standardized, we can make assumptions that we cannot make with natural immunity.
At the same time, however, there is an excellent study out of Israel that demonstrated that natural immunity compares very favorably to vaccine immunity and most often is better. Additionally, the combination of infection plus even one dose of vaccination was even more powerful in reducing risk. This study does not support not getting vaccinated and instead of getting infected, but it does speak to the issue of whether infection should be considered a vaccination equivalent. The issue remains what to do with “mild infections,” but that’s where clinical judgment comes into play.
How this is going to play out with various types of mandates remains to be seen, but in the absence of a specific vaccine requirement, in anyone who had a clear and non-trivial infection experience, we tend to consider infection to at least be the equivalent of a dose of a vaccine.