Category Archives: Covid-19

By now, California employers are quite familiar with the following situation: the California Department of Public Health (CDPH) makes a change to COVID-19 guidance and your workplace obligations are affected under Cal/OSHAs COVID-19 regulations. CDPH has done it again but this time in a manner that will benefit employers in the state. Heres whats changing, how it will impact your policies, and a recap of your continuing obligations.

What Changed?

Previously, CDPH and Cal/OSHA had defined a COVID-19 outbreak as three or more cases in an exposed group during a 14-day period. As discussed below, an employer in an outbreak had to follow additional requirements under the Cal/OSHA COVID-19 non-emergency regulation until there are one or fewer COVID-19 cases for a 14-day period.

On June 20, CDPH changed its definition of outbreak to mean three or more cases during a seven-day period. This change is automatically incorporated into the Cal/OSHA regulation, which the agency confirmed in an updated FAQ as follows:

Q: What is an outbreak?

A:Effective June 23, 2023, CDPH has adopted the following definition of outbreak, which now applies to the COVID-19 Prevention regulations: at least three COVID-19 cases within an exposed group during a seven-day period. The definition of outbreak will change if CDPH again changes its definition in a regulation or order.

What Does This Mean for Employers?

The bottom line for California employers is that it will now be harder to officially be considered in outbreak status (which triggers additional obligations under the Cal/OSHA regulation). Previously, an employer would be in outbreak if you had three or more cases in an exposed group within a 14-day period. Now, you are only considered in outbreak if you have three or more cases in half the amount of time (a seven-day period).

As a reminder for California employers, once you are considered in outbreak under the Cal/OSHA standard, you have additional obligations including the following:

You should review your local public health department outbreak reporting requirements (if any) to see if they align with the new CDPH definition of outbreak. In addition, dont forget that employers that have 20 or more cases in a 30-day period are considered in major outbreak and have additional responsibilities under the Cal/OSHA non-emergency regulation.

Conclusion

Make sure you are subscribed toFisher Phillips Insight Systemto get the most up-to-date information. We are continuing to monitor evolving COVID-19 requirements and will provide updates as appropriate. If you have further questions on how to comply, contact your Fisher Phillips attorney, the author of this Insight, orany attorney in any one ofour six California offices.

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California Changes Definition of COVID-19 Outbreak Easing the ... - Fisher Phillips

Preparedness matters: Accounting for age and national capabilities to diagnose COVID-19 deaths reveals that pre-pandemic investments in capacity saved livesthough U.S. remains an outlier.

The vast majority of countries that entered the COVID-19 pandemic with strong capacity to prevent, detect, and respond to disease threats achieved lower pandemic mortality rates than less prepared nations, according to a major new study published today in BMJ Global Health. The analysis was led by researchers from the Brown University School of Public Health, the Bill & Melinda Gates Foundation, and the Nuclear Threat Initiative (NTI).

The study found that when accounting for two key differences between countriesthe age of their populations and their capacity to diagnose COVID-19 cases and deathsthe pandemic clearly was less deadly in countries that rank high on the Global Health Security Index, which measures the pandemic preparedness capacities of 195 countries.

The researchers sought to understand how different countries performed during the COVID-19 pandemic and how that relates to their pandemic preparedness capacity as measured by the GHS Index.

To answer this question, they assessed countries pandemic performance by examining comparative mortality ratios, which involved adjusting countries excess deaths to account for differences in the age of each countrys population. Excess deaths are calculated by comparing the number of deaths that occurred during the pandemic to pre-pandemic death trends. When the researchers took this approach, they found a significant correlation between higher levels of pandemic preparedness capacity and lower excess COVID-19 mortality. Overall, these findings correct earlier observations that countries that scored high on preparedness, including in the GHS Index, paradoxically experienced the worst overall COVID outcomes and the highest COVID-19 death rates.

Our analysis confirms what you would expect, which is that preparing for pandemics before they occur means we can save more lives during a global health emergency, said Dr. Jennifer Nuzzo, Director of the Pandemic Center at the Brown University School of Public Health and the senior author of the study. Countries that took significant action before the pandemic to invest in capacity to prevent, detect and respond to these types of events were much more effective at protecting the health of their populations and had much better outcomes overall.

The study is the first comprehensive analysis of the comparative mortality ratio that accounts for a key factor that can distort national death rates: the age-related demographics of the population. Accounting for age is important when measuring pandemic response performance because countries with older populations tend to have higher baseline mortality rates. The use of the comparative mortality ratio also accounts for the fact that some countries with weak disease detection and reporting systems tend to under-report COVID cases and deathswhich can distort the data and make it look like better prepared countries did worse than those with fewer capacities. The authors note that the failure to account for age and reporting capabilities has led some to the erroneous conclusion that strong pandemic preparedness capacity has had little impact on COVID outcomes.

It is crucial to get the details right when analyzing the relationship between pandemic preparedness capacity and outcomes, said Dr. Jaime M. Yassif, Vice President of Global Biological Policy and Programs at NTI. As countries evaluate their COVID-19 performance, we can now point to clear evidence of the immense value of building essential pandemic preparedness capacity and the deadly consequences of failing to do so.

Although most highly prepared countries appear to have used their capacities well, the United States emerged as a key outlier. Despite ranking highest in the Index, 62 countries had lower comparative mortality ratios than the United States, illustrating that the way a country uses the tools and resources at its disposal also impact its overall performance.

The study highlights one factor that could help explain the United States performance. It entered the pandemic with relatively poor scores in what the GHS Index calls the risk environment, which includes measures of a countrys capacity to develop and implement policies that can affect its ability to marshal a timely, effective response. The study explains that in the United States, these deficiencies were manifest in a disorganized COVID-19 response that was likely hampered by different control measures in different states, rules that slowed down the distribution of testing equipment, and inconsistent messaging that may have undermined compliance with pandemic control measures like social distancing and vaccination.

Separately, the study found that top performers in the GHS Index risk environment categoryincluding Iceland, Australia and New Zealandalso posted some of the lowest mortality rates during the pandemic.

This study offers compelling evidence that lack of preparedness tragically led to greater loss of life during the COVID-19 pandemic, and these vulnerabilities will continue to hold populations at risk when new infectious disease threats inevitably emerge in the future, said Dr. Oyewale Tomori, a virologist and former president of the Nigerian Academy of Science who is closely involved in a number of global initiatives to improve pandemic response. This evidence, borne from the GHS Index, highlights the importance of getting every countryespecially low-income onesto have complete, properly analyzed information to drive efficient and effective pandemic response. This underscores the value of ongoing GHS Index assessments.

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Media contact: Cathy Gwin, 202-270-5942, [emailprotected]

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New Study Shows Robust Pandemic Preparedness Strongly Linked ... - Nuclear Threat Initiative

Guidelines from the American Academy of Pediatrics (AAP) were created to screen for urinary tract infections (UTIs), bacteremia, and bacterial meningitis in febrile infants 860 days old. While some research suggests the presence of a respiratory virus reduces the risk of developing these infections, the role of viral testing is undetermined.

One study, recently published in JAMA Network Open, was conducted to assess the prevalence of urinary tract infections (UTIs), bacteremia, and bacterial meningitis in febrile infants systematically tested for viral infections, including COVID-19. The investigators found that infants with nonCOVID-19 viruses had a lower risk of infections compared to those with no detectable virus, while infants with COVID-19 had the lowest risk.

The secondary analysis prospectively collected data from febrile infants aged 860 days who were evaluated at an urban tertiary pediatric emergency department between March 2020December 2022. The infants underwent viral testing, including for COVID-19; standardized clinical, laboratory, and follow-up data were collected. The investigators compared the prevalence of infections and invasive bacterial infections (IBIs) between infants with no virus detected, COVID-19 infections, and nonCOVID-19 infections.

A total of 931 infants included in the analysis, averaging 38 days of age, 58.8% male, and 46.0% requiring hospitalization. Of the infants, 107 (11.5%) had UTIs, bacteremia, or bacterial meningitis, and 20 (2.2%) had IBIs. Viruses were detected in 65.6% of the infants, and 17.5% had COVID-19. The prevalence of infections was lower in infants with nonCOVID-19 viruses compared to those with no detectable virus, and the lowest prevalence was observed among infants with COVID-19. IBIs were significantly fewer in both the COVID-19 and nonCOVID-19 groups than in the virus-negative infants.

This cohort study provides valuable insights into the prevalence of infections in febrile infant. To our knowledge, this cohort study is the first to assess the prevalence of UTI, bacteremia, and bacterial meningitis among febrile young infants systematically tested for viral infections, wrote the study authors.

The findings align with previous studies and support the AAP recommendations that a confirmed nonCOVID-19 virus should not impact the initial evaluation of febrile infants. However, the study also highlights the very low risk of IBIs in infants with COVID-19, which can assist clinicians in individualizing management and making informed decisions in collaboration with parents.

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COVID-19 Infection Reduces the Risk of UTIs, Bacteremia, and ... - Contagionlive.com

EMA, the European Commission, and HMAs are phasing out the flexible regulations put into place during the pandemic.

The European Medicines Agency (EMA) announced on July 6, 2023 that the agency, the European Commission (EC), and the Heads of Medicines Agencies (HMA) are starting the process for ending regulatory flexibilities for medicines that were put in place during the COVID-19 pandemic. This action follows the World Health Organizations end to the public health emergency.

The European regulators put these measures into place in the areas of marketing authorizations, API and finished product manufacturing, quality requirements, and related regulatory procedures. This was done to mitigate disruptions to the drug supply chain that might have been caused by delays in facility inspections and other procedures. These measures will now be phased out, according to EMA.

From now on, the regulatory flexibilities that were introduced jointly by the HMA, EC, and EMA specifically during the COVID-19 pandemic should no longer be granted. For already approvedlabellingflexibilities, e.g., the English-onlylabellingfor COVID-19 vaccines, their application will be extended until the end of 2023, in order to ensure a smooth phase-out and avoid any supply difficulties or other disruptions due to a sudden change in applicable requirements. After 2023, the regular mechanisms foreseen in the legislation in relation tolabellingexemptions should be followed, the agency stated in a press release.

EMA also stated that on-site good manufacturing (GMP) and distribution practice (GDP) inspections have restarted that were either previously postponed or done remotely during the pandemic. The validity of GMP and GDP certificates has been extended to the end of 2023, and the approach to 2024 certificates will be discussed by the GMDP Inspectors Working Group in upcoming months. This Group has also reviewed experiences with remote working arrangements of qualified persons during the pandemic, and will issue guidance on how those specific arrangements can be applied in the future, EMA stated in the release.

The agency went on to say that experiences learned through the handling of the pandemic will be collected and considered so the agency can inform best practices for future health challenges.

Source: EMA

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Europe Phases Out COVID-19 Flexible Regulations - Pharmaceutical Technology Magazine

When thinking about traveling this year, certain factors may give you pause: for instance, general pain and stiffness that comes from traveling with autoimmune arthritis, plus the risk of COVID-19 that youve had to grapple with for the past three years (especially if youre immunocompromised).

However, after years of canceling plans during the pandemic, you might be itching to see more of the world again and we certainly dont blame you.

Here, rheumatologists weigh in with their best tips on what to consider before booking your tickets.

First, rest assured: Our experts largely agreed that there are ways to make travel with autoimmune arthritis possible, even if you experience chronic pain.

If patients with rheumatoid arthritis enjoy traveling, they should be open to it, says Brett Smith, DO, a rheumatologist at Tennessee Direct Rheumatology and East Tennessee Childrens Hospital. While patients have a disease that alters their daily life, we also want them to enjoy life and not hold back.

The key for managing pain on your trip is planning in advance, bringing enough of the medications and supplies youll need, and keeping in contact with your doctor. The type of travel youre embarking on will make a difference in how you manage aches along the way, too.

If youre driving for an hour, thats different than if youre taking a plane across the country, says Lawrence Brent, MD, Professor of Medicine at the Lewis Katz School of Medicine and Associate Director of the Rheumatology Fellowship Program at Temple University Hospital. Navigating airports can be very challenging for someone not only in terms of pain, but also mobility.

Although theyre certainly not impossible to manage, Dr. Brent notes that airports are not always accommodating to those who have difficulty getting around.

You can do it, but its going to take you much longer, says Dr. Brent. It all depends on how much you want to do the trip and what you think you can do plus your pain tolerance, which is very individual. If youre going with someone who can help, that makes a big difference.

During your trip, do your best to continue moving. You already know that with arthritis, particularly rheumatoid arthritis, stiffness is a common occurrence and the longer you sit still, the more stiffness youll experience.

If you do choose to fly this summer, opt for an aisle seat so you have easier access to get up and walk around during your flight. (Get a head start before your trip with these 30 tips and tricks to prevent arthritis morning stiffness.) You may also find it helpful to bring a pillow to make hard airplane seats a little more comfortable.

Its also worth considering the climate of the destination youre headed to: Warmer environments can be more beneficial for pain, stiffness, and function, so take that into consideration when choosing a destination, says Dr. Smith.

Talk to your doctor about getting enough medication ahead of time, so youre prepared if you experience a flare or are delayed during your travels.

I usually offer patients with rheumatoid arthritis [or another type of inflammatory arthritis] a short course of steroids to take with them, just in case they have a flare, says Dr. Smith.

Of course, youll also want to triple check your luggage before you leave to make sure you have everything you need to take your medication.

Oral pills are easy, but if youre taking a self-injection, make sure you have the appropriate packing materials and enough to last you through the trip and maybe a couple of weeks extra, says Nilanjana Bose, MD, MBA, a rheumatologist at Lonestar Rheumatology.

Talk to your doctor about how youll stay in touch during your trip. Most physicians have online portals, so even if youre traveling abroad, all you need is access to the internet to contact them.

Although there are many ways to safely and comfortably travel even if you experience chronic pain, there are a few times in which your doctor may recommend rescheduling the trip: If youve had a recent respiratory illness or a recent flare of your disease, or youve had your medicines adjusted, you might consider changing your travel schedule, says Dr. Brent.

Likewise, if youve just been diagnosed with a new underlying condition, you may want to pause to ensure you can adequately manage it before jetting off.

If youre immunocompromised, theres no one easy answer to whether you should travel or not in the age of COVID-19. Its a decision that needs to be made between you and your doctor, but here are a few things to consider:

If youre immunocompromised and decide to travel, follow all necessary precautions such as spending time outside rather than in indoor public spaces, wearing a mask or respirator (like the N95 mask), and keeping your distance from others, per the CDC.

Carrying a bottle of hand sanitizer can also be an easy solution to lower the risk of infection while traveling, says Dr. Smith.

These preventive measures are helpful not only for avoiding COVID-19, but other illnesses like cold and flu. And of course, the benefit of traveling during this time of year is that you dont have to be in crowded indoor spaces quite as much.

During the summer, you have the advantage of people being outside more, so you have more fresh air and youre not cooped together like you are in the winter, says Dr. Brent.

In addition to your regular COVID-19 vaccines and boosters, plus those that protect against pneumonia and shingles, consider what other vaccines may protect you from disease during your trip.

If you are traveling to an international location, update your vaccines according to public health guidelines and consult your rheumatologist about the potential need to hold any medications prior to or after vaccination, says Dr. Smith. Additionally, only eat and drink from reliable food and water sources while traveling.

Consider what viruses might be circulating in the community youll be visiting.

If there is an endemic infection with an outbreak at the travel location, consider rescheduling the trip, says Dr. Smith. If you have an active infection close to travel time, also consider rescheduling your trip just to be cautious, since health care access will depend on the destination.

And of course, if you have symptoms of COVID-19 or any other illness, speak to your doctor right away.

One last piece of advice from Dr. Smith: Most importantly, try to enjoy life. If that can include travel for you this summer, bon voyage. If not, still aim to enjoy little moments of adventure in your own community, whether its trying a new outdoor fitness class, visiting a park youve never been to before, or simply video chatting with a far-away friend.

Join the Global Healthy Living Foundations free COVID-19 Support Program for chronic illness patients and their families. We will be providing updated information, community support, and other resources tailored specifically to your health and safety.Join now.

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Travel Pains and COVID: How to Decide if You're Ready to Travel - CreakyJoints

If you are experiencing depression and anxiety due to the COVID-19 pandemic, you are certainly not alone. Many are grieving loved ones who have died. Some coronavirus survivors have been left with debilitating health problems, and many others have lost jobs and businesses.

Even those who have not experienced severe loss have endured months of disrupted schedules, canceled milestone celebrations and daily logistical challenges. Little wonder so many are feeling lonely, frustrated and vulnerable, physically, emotionally and financially.

As the pandemic continues and hope for its end is in sight, there are ways to identify mental health issues and get the help you or a loved one needs. Here is some useful insight from neuropsychologist Tracy Vannorsdall, Ph.D., who talks about the impact of the coronavirus and the pandemic on anxiety and depression, what to look for and what kinds of therapy may be available to help you or someone you care about.

Vannorsdall says research supports what doctors are seeing in their offices. Certainly, the pandemic is causing distress, she says.

There has been a general uptick in emotional distress, anxiety and depression, she says. Were also seeing more patients for problems with alcohol consumption and sleep disorders, both of which help us regulate our emotions and can contribute to mood difficulties. People with preexisting vulnerabilities to mental or physical health problems are particularly at risk.

She says patterns of anxiety and depression seem to occur in waves much like COVID-19 itself: When the number of new coronavirus cases starts to surge, so do peoples anxiety and depression. But, she adds, there are reasons for optimism.

We benefit when we have a sense of control, the sense that we can do something to affect our situation. As more knowledge and prevention strategies such as vaccines emerge and more of life returns to normal, people may be feeling less helpless than they did earlier in the pandemic.

Depression and anxiety can be serious, but both conditions are treatable. Vannorsdall emphasizes four ways to maximize your mental health and keep anxiety and depression from taking over:

When the pandemic started, many peoples days felt unstructured and monotonous, but more recently, thats changing. Were getting back to a new sense or normal and falling back into a structure, says Vannorsdall. Compared to 2020, we are more used to being productive at home and have developed a pattern to our day with routines for work and school. For those who are struggling, taking simple steps to regain some structure can restore a sense of equilibrium, she says. Get up at the same time each day. Get dressed. Give yourself at least one accomplishable goal to complete each day.

The mind-body connection is essential. Engage in self-care, Vannorsdall advises. Prioritize good sleep, good nutrition, fresh air and exercise. Find a safe way to socialize and stay connected with friends and family.

Substance overuse is a risk among people who have anxiety and depression, Vannorsdall says, adding that substance use disorder can become a serious problem in and of itself.

If you or someone you love has symptoms of anxiety or depression, help is available. In addition to in-person counseling, new options can put therapy as close as your phone or laptop.

Telehealth has exploded, says Vannorsdall. That is a true silver lining of the pandemic. Teletherapy and telehealth platforms have expanded access and helped patients engage with professionals without having to physically go to a doctors office. Its much more convenient for the patient, and evidence shows that it is quite effective.

Whether you are working with a therapist or not, giving yourself some data and noticing patterns is useful, she says. There are apps that can help you track your mood, sleep and anxiety levels, or you can keep a written diary to help you stay in tune with factors that affect your levels of sadness or anxiety.

It might. Vannorsdall, who cares for patients with long COVID at the Johns Hopkins Post-Acute COVID-19 Team (JH PACT) clinic, collaborates with health care professionals from a range of disciplines to help patients recover from the long-term effects of COVID-19 and its treatment.

Severe COVID-19 can be devastating to patients. In addition to organ damage and persistent symptoms, loss of physical, emotional and even economic well-being can leave long haulers depressed and anxious.

Treatment in an intensive care unit, or ICU, is a risk factor, too. Post-intensive care syndrome can affect people who spend a long time in the ICU and can leave them with enduring, disabling anxiety and panic if not treated.

Vannorsdall says researchers are studying the inflammatory reactions caused by coronavirus infection and their effects on the brain. It is possible that COVID-19 itself causes physical changes that can manifest as problems with cognition thinking, remembering and reasoning.

One of the challenges to managing lingering COVID symptoms is how differently individuals fare with the disease and recovery. People are being treated by the PACT group for a variety of symptoms. Were seeing elevated rates of anxiety, depression and functional decline and cognitive changes lasting several months out.

The trajectory of recovery isnt clear yet, but short-term interventions are working to help COVID-19 survivors, even those with persistent symptoms and physical changes.

Vannorsdall adds that some patients treated for COVID-19 have been living with anxiety and depression since before the pandemic. Having COVID got them into the health care system, where they can be diagnosed and treated.

Everyone has bad days when sadness, lack of motivation or worry get the best of them, especially in dealing with the COVID-19 pandemic.

But, Vannorsdall points out, there are warning signs of anxiety and depression that should never be ignored:

If you notice these in someone you know, it may be time to speak up. Vannorsdall says its not always easy, but she has some suggestions.

Its often challenging to know how to intervene in a way that a person might be open to, and theres no one size fits all, she says. But sometimes you can appeal to a struggling person in terms of that one aspect of their life that they really value, such as their children, their family, their work, or something else they feel is worth getting better for.

We often need to help reframe peoples conception of mental illness and health treatment, she says. People can remind themselves or their loved ones that the mind and body cant be considered separate entities. There is an underlying biology to emotional distress. A person isnt weak for having a mental health problem, and deserve relief as they would for any physical pain.

Vannorsdall says the general outlook has already begun to improve in terms of our collective well-being. Were getting back to a new sense of normal, she says. We have adapted to many changes, such as working and learning from home, and established new routines since the pandemic began.

In the beginning, there was so much that we didnt know. Many people felt apprehensive. Now, we realize that with vaccines and safety precautions, we can take action to protect ourselves. We are no longer totally at the mercy of this coronavirus.

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COVID Depression and Anxiety | Johns Hopkins Medicine

1. Man declared dead due to Covid found 'shockingly' alive after 2 years in MP  Hindustan Times
2. A man who died due to Covid is found alive after two years in Madhya Pradesh  Mint
3. Delhi Covid cases: What CM Arvind Kejriwal said as positivity rate touches 27.77 per cent  India TV News

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Man declared dead due to Covid found 'shockingly' alive after 2 years in MP - Hindustan Times

1. Senate votes to end Covid-19 emergency, 3 years after initial declaration  CNN
2. What the end of the COVID-19 national emergency means  The Hill
3. House Democrats frustrated after Bidens reversal on COVID-19 emergency measure  Fox News

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Senate votes to end Covid-19 emergency, 3 years after initial declaration - CNN

DC COVID-19 centers closing Friday: Here's what you need to know  WJLA

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DC COVID-19 centers closing Friday: Here's what you need to know - WJLA

Can grade retention help with COVID-19 learning recovery in schools?  Brookings Institution

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Can grade retention help with COVID-19 learning recovery in schools? - Brookings Institution