COVID-19 Viral Shedding Possible After 10 Days, Longer with Omicron

In a recent study looking at data out of Japan, peak viral shedding for those with COVID-19 due to the Omicron variant was around 3-6 days after diagnosis or symptom onset. This differs from previous data which suggested that viral shedding was highest starting a couple of days prior to symptom onset and lasting about 3 days after symptom onset. To clarify, viral shedding is an important indicator of how likely an individual may spread a virus once they are infected. This indicates that compared to previous variants, COVID-19 from the Omicron variant may be more infectious for a while even after an individual is symptomatic. Another study out of the United Kingdom looked at 176 individuals who had COVID-19 due to many different variants of the SARS-CoV-2 virus and found that over 10% of these individuals were still positive for the virus over 10 days after initial infection with viral loads at levels high enough to potentially continue the spread of the virus.

These studies provide an important insight into how long an individual who has COVID-19 may still be infectious, and while this data is mostly in symptomatic individuals, it does raise concern particularly from the recent isolation period changes from the CDC. To recap, those who are mildly symptomatic or asymptomatic with COVID-19 can end isolation 5 days after symptom onset per the CDC. Those with moderate COVID-19 illness as defined here should still isolate for at least 10 days. These isolation periods may be too short and may possibly contribute to further COVID-19 infections.

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Update on COVID-19 Protection from Vaccination and Prior Infection

Several recent Morbidity and Mortality Weekly Reports (MMWR) were published by the CDC highlighting real-world data on what kind of protection vaccinations, as well as previous COVID-19 infection, has for individuals.

A MMWR published on January 19 looked at COVID-19-associated deaths in California and New York from May to November 2021 and found that within that period, prior to June when the Delta variant became the dominant strain, cases and hospitalizations for those who had prior COVID-19 infection was higher than those who were vaccinated. By early October, after the Delta variant had been the dominant variant for a few months, individuals who survived a previous infection had lower case rates than those who were only vaccinated. This study thus suggests that previous COVID-19 infection provided more protection against another COVID-19 infection than from vaccination alone. It is important to note, however, that this is in individuals who survived their initial COVID-19 infection. When factoring this in, it is clear that vaccination still provided protection and was safer than protection from previous COVID-19 infection. Also, cases and hospitalizations were far higher in those who were unvaccinated.

A few other studies were released soon after showing effectiveness of protection, particularly within the time frame that the Omicron variant became the dominant variant. One MMWR looked at 25 United States Jurisdictions from April 4, 2021 to December 25, 2021 and looked at cases and death rates in millions of people based on state and local health department data. Within that time frame, cases and deaths were lowest in those who had received a booster dose of a COVID-19 vaccine, with protection highest in individuals 50 years of age and older. Another MMWR looked at emergency department and urgent care clinic visits from August 26, 2021 to January 5, 2022 and looked at vaccine effectiveness against hospitalization. This study looked at most of the data available since the Omicron variant became the dominant strain as well. Within those dates, vaccine effectiveness dropped to 57% in people who had received their second dose of a COVID-19 vaccine more than 6 months earlier. A third dose, however, returned that protection to about 90% in preventing hospitalization from COVID-19 due to the Omicron variant. This protection provided by a third dose was effective for both the Delta and the Omicron variant. A third study published in the Journal of the American Medical Association (JAMA) looked at vaccination status and how it related to symptomatic COVID-19 infection. The study looked at over 70,000 tests from individuals who had symptomatic COVID-19 infection and found that individuals who had three doses of a mRNA COVID-19 vaccine were least likely to have symptomatic COVID-19, though more had symptomatic COVID-19 if infected with the Omicron variant, suggesting that vaccination, while still providing protection, was less effective in protecting against COVID-19 due to the Omicron variant versus infection from the Delta variant. In all of these studies, those who were unvaccinated were the most likely to have severe COVID-19 infection.

All of these studies looking at real-world, population-wide data confirm that vaccination is still the safest and most effective way to protect yourself and others from COVID-19. Please get a COVID-19 vaccine and get your booster shot if and when you can while continuing to wear good masks, practice proper hand hygiene, and socially distance when possible. If you are unvaccinated or know anybody who is vaccine-hesitant, please feel free to reach out to us with any questions, comments or concerns and we will do our best to answer.

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HIV and COVID-19 Vaccines

Many HIV-positive people have been concerned about the safety and effectiveness of COVID-19 vaccines. POZ recently published a summary of research on the topic, as well as advice for people living with HIV. Among their recommendations and findings:

    • It's essential for people living with HIV to get fully vaccinated against COVID-19. An additional dose is part of the vaccine regimen for people with advanced or untreated HIV, and boosters are needed by everyone.

    • COVID-19 vaccines are safe for people with HIV, and side effects have been found to be similar to HIV-negative people.

    • After getting vaccinated, people with well-controlled HIV produce similar levels of antibodies against the virus that causes COVID-19 to those who are HIV-negative.

    • People with a low CD4 count and those with a detectable viral load of HIV do not appear to develop a strong response to the vaccine, meaning it's less likely to be effective.

For those with untreated HIV, starting treatment is a critical way to boost vaccine effectiveness.

Those on treatment who still have a low CD4 count or detectable HIV viral load should talk to their doctor about optimizing their regimen.

For those whose HIV treatment hasn't increased their CD4 levels sufficiently, COVID-19 PrEP may help, and monoclonal antibody treatments and antiviral pills can help prevent serious illness from COVID-19.

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COVID-19 Causing People in Michigan Prisons To Wait Longer For Release

The surge in COVID-19 cases has forced some individuals in Michigan prisons to wait longer to be released. This is due to classes being canceled that individuals need to take in order to be released, such as violence prevention or drug abuse. The Michigan Department of Corrections (MDOC) says these classes can’t be offered virtually and that they are trying to take extra precaution to limit the spread of the virus. While keeping individuals safe is important, keeping people locked up for longer is inhumane. This is no fault of the individuals in prison, but yet they are continuing to suffer at the hands of the state. This is not the first time the state has had this happen - similar issues popped up in 2020. Keeping individuals in prison also increases the chance that they could contract COVID-19. The MDOC is waiting for KN95s for staff and those imprisoned, but prisons are already seeing high numbers of cases. A different solution must be put in place because the current way is impacting lives for the worse.

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Black Immigrants in the U.S. on the Rise

This week, Pew Research Center released a report stating that one in ten Black individuals living in the United States are immigrants. This rate is up from 3% in the 1980s and is projected to reach 16% by 2060. Between 1980 and 2019, the number of Black individuals grew by 20 million in the country, with 19% of that growth being immigrants. It is projected that in coming years, Black immigrants will make up about a third of the Black population growth in the U.S. The Black immigrant population is also projected to grow more rapidly than the U.S.-born Black population from 2020 to 2060. The biggest growth of the Black immigrant population has been from Africa. In 2000, 560,000 African-born Black individuals were in the U.S. and in 2019, that number increased to 1.9 million. This trend is expected to continue. These numbers are significant and still might not be the whole picture. Analysis from earlier this year suggests that there might have been widespread undercounting in the 2020 Census, especially with Black individuals. One estimate is that Black individuals might have been undercounted as much as three times higher than in the 2010 Census. The Trump administration also ended counting early and abruptly for the 2020 Census and the impacts of that are not entirely known at this point. Regardless, the demographics of the United States are continually becoming more diverse, the country must acknowledge this and change in order to adequately support every human in the country. Critically, this also highlights the intersectionality of Black and immigrant populations and identities in the U.S., which is often overlooked. Diversity, equity, and inclusion efforts frequently treat Black communities and immigrant communities as separate groups, despite the significant overlap between the two. Black immigrants face unique challenges, and their existence should not be ignored.

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Head of MSU Native American Institute Sues University for Discrimination, Harassment, and Retaliation

On Wednesday, the Interim Director of the Michigan State University Native American Institute, Christie Poitra, filed a federal lawsuit against MSU for its role in perpetuating and failing to address discrimination and harassment against her, as well as for retaliating against her. Poitra is Latina and a first-generation

descendant of the Turtle Mountain Band of Chippewa Indians. Poitra’s former supervisor, John Norder, was reported to the institution's Office of Institutional Equity in 2018 for his sexual harassment of her. In addition to sexual harassment, Norder also made inappropriate comments about Poitra's disability and weight. While the university has a policy stating that investigations should take no longer than 120 days, the office took over 540 days to complete its investigation. Despite being found to have violated the school's Relationship Violence and Sexual Misconduct Policy, he was only suspended for one month, and continues to work at MSU.

While MSU touts the Native American Institute as an example of its commitment to diversity, Poitra is reportedly among the lowest-paid leaders of an Institute at the university. She has been Interim Director since 2019, and has yet to be given the full title of Director. According to the lawsuit, "MSU has left Dr. Poitra continuously exposed to discrimination, harassment, and retaliation; failed to enforce its own no-contact directive against her abuser; forced her to shoulder significantly more work than any reasonable individual should be expected to perform; denied her equitable pay and professional title; and shrunk the budget of and even threatened to dissolve NAI."

MSU has a long and well-documented history of failing to address sexual harassment and abuse, leading to absolutely tragic outcomes. It also has a long history of systemic racism, sexism, and other forms of discrimination. BIPOC, people with disabilities, and others from marginalized and minoritized communities are more likely to be victims or survivors of sexual harassment or abuse, and those at the intersections of multiple such identities are particularly at risk. The university has a responsibility to address all of these issues independently and collectively, but has consistently failed to take appropriate actions.

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Black Drivers More Likely to Be Stopped, Searched, and Arrested by Michigan State Police

This week, an independent study conducted by researchers at the Michigan State University School of Criminal Justice, commissioned by the Michigan State Police, "concluded that racial and ethnic disparities were present and consistent across nearly all Michigan counties in the 2020 traffic stop data." Most notably, the researchers found that Black drivers were more likely to be stopped, searched, and arrested than White drivers, even after accounting for other factors. The report was the result of an agreement the Michigan State Police made with the ACLU in 2017 to collect racial and demographic data on people pulled over. In June of 2021, the ACLU of Michigan filed a lawsuit against Michigan State Police for racial profiling.

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COVID-19 Vaccinations Do Not Reduce Fertility

A new study confirmed that COVID-19 vaccines do not reduce fertility, but COVID-19 infections can. The study, accepted by the the American Journal of Epidemiology, found that vaccination had no significant impact on fertility or conception rates in males or females, regardless of vaccine type (Pfizer, Moderna, or Johnson & Johnson). Many people still fear that COVID-19 vaccines will make them infertile, due to misinformation and disinformation that has circulated widely, and hopefully this research will allay those fears. The study also found that COVID-19 infections resulted in short-term reductions in fertility in males, once again confirming prior research. Given that vaccination makes infection less likely and makes infections less severe, the results are simple: Getting vaccinated against COVID-19 doesn't reduce fertility, and instead is the best way to protect it.

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Nearly 1 Million COVID-19 Infections Among U.S. Children Last Week

According to the American Academy of Pediatrics, almost one million children were infected with COVID-19 last week in the United States. Children now make up over 20 percent of weekly COVID-19 cases. Cases are typically less severe in children than in adults, but that doesn't mean that children are not at risk, nor does it mean that they should have fewer protections. While attention is often focused on death rates (which, while lower for children, should still be a major cause of concern), long-term health impacts of COVID-19 should not be ignored. "Long COVID" is not well understood, but many people appear to suffer from significant health impacts for more than just a few days or weeks, and it's possible that severe infections could result in health complications that last years. A study from Norway found that children ages 1-5 who had had a COVID-19 infection went to primary care doctors more often, and that the increase lasted up to six months.

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MDHHS Distributing COVID-19 Tests to Schools

The Michigan Department of Health and Human Services will be distributing over 200,000 COVID-19 test kits to schools, long-term care facilities, and jails in the state, with another 100,000 expected to be added this week. A shortage in tests across the U.S. is already creating significant problems for schools in the state, and things may get worse. Some school districts, like Midland Public Schools, have already had to switch back to online instruction due to a shortage in available tests. It's unclear whether the state has enough tests stockpiled, or will be able to acquire enough, to keep high-priority sites like schools, long-term care facilities, and jails, supplied. If there aren't enough tests available, efforts to protect children, teachers, and school staff, as well as people who are incarcerated and people living or working in long-term care facilities, will be undercut.

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4 Free At-Home COVID-19 Tests For All U.S. Homes

As we announced last week, every home in the United States can get four free at-home COVID-19 tests from the federal government. To order your tests, visit and submit the form. Orders are expected to ship in 1-2 weeks.

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This Week's QM Round-Up Contributors (in alphabetical order):

    • Vanessa Burnett (she/they) M.P.H; Health Equity Consultant, Michigan Public Health Institute

    • Wilfredo Flores (he/him/his), fifth-year PhD candidate in Writing and Rhetoric, M.A. Technical Communication

    • Grey L. Pierce (they/them); M.A., Cognitive Psychology; Chair, Power of We Consortium

    • Francis Yang (he/him/his), M.S.-Global Medicine, Third-year medical student