"Stealth Omicron"

"Stealth Omicron" (formally known as "BA.2") got its nickname because it's a version of Omicron that's harder to differentiate in tests from other variants, not because it has less noticeable symptoms or doesn't show up as COVID-19 in tests. Your at-home COVID-19 test should work just as well against "Stealth Omicron" as the original Omicron variant, and there's currently no evidence that it's more dangerous or that you'll have different symptoms. There is some evidence that it may be more transmissible, but there isn't enough data to come to a conclusion at this point.

Essentially, the original version of Omicron (BA.1) has a feature that makes it easy for PCR tests to tell apart from other variants, which helped scientists to quickly track Omicron's spread around the world. "Stealth Omicron" (BA.2) doesn't have that feature, so it takes more work for PCR tests to determine that it's BA.2. That distinction is unrelated to how COVID-19 is detected overall, so it just makes it a bit harder for researchers to quickly track the spread of BA.2 relative to BA.1, Delta, and other COVID-19 variants and subvariants.

Much of the early information about its spread comes from Denmark, which is better equipped to track variants and subvariants than many other countries. BA.2 has been found in Denmark, the United Kingdom, and more than 50 other countries. Cases have been detected in several states in the US (California, Texas, Connecticut, and Washington), and it's likely to continue to spread.

The best precautions are the same as for any other variant of COVID-19: Get vaccinated and boosted, wear an N95, KN95, or KF94 mask, avoid large gatherings, and follow other public health recommendations.

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Racism Abounds in Nursing

This week, the National Commission to Address Racism in Nursing released results from a survey conducted in October. Results showed that nurses of color reported incidents of racism from patients, families, peers, and supervisors. The survey was sent to members of the American Nursing Association and other nursing organizations and 5,623 individuals responded. Nearly half of respondents stated that there was “a lot” of racism in nursing and 63% stated that they have personally experienced racism in the workplace. This includes 92% of Black nurses, 69% of Hispanic nurses, 73% of Asian nurses, and 74% of other or multiple races stating they have personally experienced racism at work. The survey also shows that racism has limited nurses from training, promotions, and compensation. Some quotes from participants state that they have called out racism and nothing has been done, they have been called racial slurs by patients, and have not been recognized compared to their white counterparts. Racism is the foundation of the United States and it undergirds every system - even healthcare. We continue to see implicit bias or other Diversity, Equity and Inclusion (DEI) trainings put in place, but they are not enough. This survey shows that there is still a long way to go to treat BIPOC nurses with the respect that they deserve from all levels. 

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Free N95 and KN95 Masks

The Michigan Department of Health and Human Services announced that it would be distributing 10 million free KN95 masks to residents of the state. Distribution will be through MDHHS offices, local health departments, Area Agencies on Aging, Community Action Agencies, Federally Qualified Health Centers, and Programs of All-Inclusive Care for the Elderly.

Locally, the Ingham County Health Department will have free KN95 masks available from Monday, January 31st through Friday, February 4th. Five adult masks will be distributed in each package, and there is a limit of one package per person. Limited quantities will be available each day on a first-come, first-served basis from 8:30am-5:00pm at Door #3 of the Ingham County Health Department (5303 South Cedar Street, Lansing).

Meijer and Kroger announced that they are partnering with the U.S. Department of Health and Human Services to give away free N95 masks, three per customer.

N95 and KN95 masks are disposable, but can generally be reused a few times before losing their effectiveness. Cloth masks are not considered to be particularly effective at stopping the spread of the Omicron variant of COVID-19, and it's important to switch to N95, KN95, or KN94 masks as soon as possible. For a full explanation of these masks, read our summary.

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Updated Transgender Federal Prison Policy 

Earlier this month, the Biden administration updated policies around transgender individuals who are incarcerated. These policies return to what was practiced during the Obama administration, with some additional updates. This comes after Biden’s campaign promised to address the widespread abuse trans individuals face in prisons. The new policy requires all staff to use pronouns of the inmate’s choosing and forbids repeated misgendering. Updates also include how incarcerated individuals can access support and gender-affirming care, including hormones and gender-affirming surgery. Lastly, it rolls back the Trump administration guidelines of mandating trans individuals be placed based on only assigned sex at birth. States now have control on deciding by a case-by-case basis how to place trans individuals - which will hopefully come with some oversight. These updates are a step in the right direction, but more needs to be done to keep trans individuals safe. 

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What "Endemic" Means

Recently, headlines have stated that COVID-19 is likely to become "endemic," but what that means seems to be widely misunderstood. For epidemiologists, if a disease is "endemic," it currently has an overall rate in the population that isn't rising or falling. It doesn't mean that a disease is mild, that it should be accepted, or that people should take fewer precautions, and it's not inevitable that a disease becomes endemic. It also doesn't mean that case rates won't increase or decrease in the future, or that we can't eradicate it entirely. Smallpox was endemic for centuries before it was eradicated by vaccines, and killed untold millions in that time.

According to Aris Katzourakis, a professor who studies viral evolution and genomics at the University of Oxford, "a disease can be endemic and both widespread and deadly. Malaria killed more than 600,000 people in 2020. Ten million fell ill with tuberculosis that same year and 1.5 million died. Endemic certainly does not mean that evolution has somehow tamed a pathogen so that life simply returns to 'normal'."

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Vaccine Update

In recent correspondence published in the New England Journal of Medicine (NEJM), individuals representing Moderna wrote about how effective their mRNA vaccine and booster shot had been in providing protection against COVID-19 infection. When Moderna looked at neutralizing titer levels in a small number of individuals who were vaccinated, they found that after the initial two-dose series, neutralization titers against the Omicron variant were 35 times lower than those against the D614g variant, one of the earliest variants of the SARS-CoV-2 virus identified in the U.S. After a booster shot, however, the neutralization titers against the Omicron variant were 20 times higher than after the initial two doses. It is also important to note that the booster dose of the Moderna vaccine is half the dose of the initial two shots of the vaccine. They also noted that neutralizing titers declined 6 months after administration of a booster dose. While a decline of neutralization titers does indicate decreasing levels of protection after 6 months, this data does provide some information showing that the vaccines do help provide protection against the Omicron variant. In response to this recent data, Moderna also announced that they had just started their Phase 2 Trial of an Omicron-specific booster shot, comparing those who got the original vaccine and a booster with those who received the initial two-dose series followed by this Omicron specific booster. 

On that same note, Pfizer also recently started their clinical trial for an Omicron-specific booster in adults 18 to 55 years of age. They will be looking to evaluate up to 1,420 participants in three different groups with different combinations of getting the initial two dose series, the Omicron-specific vaccines, and some who have not yet been vaccinated only receiving the Omicron-specific vaccine. The groups, copied from the press release, are outlined below:

While it is still too early to tell how effective this Omicron-specific booster will be, it may hopefully be an example of how mRNA vaccines can be flexible and thus, quickly adapted to make safe, effective vaccines that work well against new variants. This also shows that, in the meantime, getting vaccinated and getting a booster shot if you are eligible very likely provides protection against the Omicron variant, and thus you should get vaccinated if and when possible, in addition to continuing to wear masks, socially distance, and practice proper hand hygiene to protect yourself and others. As always, reach out if you have any questions!

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LGBTQ+ Youth and Young Adults in Colorado More Likely to Be Vaccinated; Racial Differences Found

Out Boulder County recently conducted a survey of youth and young adults regarding COVID-19 vaccinations. All respondents were between 12 and 24 years old and were Colorado residents, with data collected between August and October of 2021. 57% of respondents were LGBTQ+. While they found that LGBTQ+ youth/young adults were more likely to be vaccinated than their non-LGBTQ+ peers, the results were driven by white youth/young adults (who were far more likely to be vaccinated if they were LGBTQ+), while LGBTQ+ BIPOC youth/young adults were slightly less likely to be vaccinated than non-LGBTQ+ BIPOC youth/young adults.

Among the findings:

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Daily COVID-19 Deaths Highest in Almost a Year

Daily deaths due to COVID-19 in the United States are now at their highest level in nearly a year, with the average number of deaths per day over a 7-day period hitting 2,300 on Thursday. The last time COVID-19 deaths were that high was the middle of February, 2021.

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Deaths Outpaced Births in Michigan in 2020

2020, the first year of the COVID-19 pandemic, was the first year in recorded Michigan history in which the state had more deaths than births. It's almost certainly due to COVID-19: In 2020, 104,149 babies were born and 117,087 people died. The difference, 12,938, is likely made up of people who died of COVID-19, since 11,362 people were listed by the Health Department as having died of COVID-19 in the state, and we know that COVID-19 deaths have been undercounted for a variety of reasons.

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Federal Medical Team Coming to Assist Sparrow Hospital In COVID-19 Surge

The federal government will be sending a medical team of up to 25 people to help at Sparrow Hospital in Lansing, which is struggling under the load of COVID-19 cases. Sparrow is currently at 100% of capacity due to the surge in COVID-19 cases, and will be the sixth hospital in the state to have a federal team sent during the pandemic.

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MSU Restarting In-Person Classes Monday

Michigan State University, which has consistently put students, faculty, and staff at risk throughout the pandemic, announced that in-person classes will resume on Monday. Due to the massive surge in COVID-19 cases, MSU had announced that the first three weeks of the semester would be online, and while the COVID-19 situation remains critical (nearby Sparrow Hospital is currently at 100% capacity and is awaiting a federal relief team), the University has decided to stick to the original date of in-person classes resuming.

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State of Michigan Launches Guide to Insurance Coverage of At-Home COVID-19 Tests

With confusion over health insurance coverage of at-home COVID-19 tests widespread, the State of Michigan's Department of Insurance and Financial Services has created a web page that provides basic information.

The basics:

For anyone on Medicare or Medicaid, information is available on the "How to get your At-Home Over-The-Counter COVID-19 Test for Free" page on the Centers for Medicare & Medicaid Services website.

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