CLAIM
Vaccine killed 3.5X more Americans than COVID virus
DETAILS
Conflates factual statement and opinion: The claim is based on an online survey that asked Internet users if they believed someone in their household died of the COVID-19 vaccine. These answers werent independently verified, for example by examining medical records and deaths certificates of those who died. Flawed reasoning: Excess mortality data indicates that there were roughly 1.2 million excess deaths in the U.S. between the beginning of 2020 to the end of August 2023. The claim that the vaccine killed 3.5 times more people than COVID-19 isnt compatible with the data, given that the CDC already reported roughly 1.1 million COVID-19 deaths in the U.S. to date, which are counted among the excess deaths.
KEY TAKE AWAY
To date, there have been more than 1.1 million COVID-19 deaths in the U.S. COVID-19 vaccines are highly effective at reducing the risk of severe disease and deathWhile the COVID-19 vaccines have been linked to potentially serious side effects, such as a particular blood clotting disorder and myocarditis, the risk of blood clots and heart inflammation is higher after COVID-19 than after the vaccines. Overall, the benefits of the COVID-19 vaccines outweigh their risks.
The article stated that this claim originated from tech entrepreneur Steve Kirsch, whose opposition to vaccination is well-known. Kirsch published a Substack post whose headline was highly similar to that of The Peoples Voice.
The headline from The Peoples Voice is false right off the bat, given that Kirsch didnt publish a study. Instead, his figures came from a survey that he disseminated to his Substack subscribers.
In the survey, Kirsch asked respondents how many people in their household and extended family they believed had died from the COVID-19 vaccine.
Based on the responses he received, he concluded that the COVID-19 vaccines had killed 3.5 times more Americans than COVID-19 did: Analysis of the first 9,620 responses found 804 deaths from COVID and 2,830 deaths from the COVID vaccine. Those results were generated from a minimum of 108,000 people covered by the survey [] No fancy math is needed to calculate the ratio: 2830/804=3.5X.
One of the main problems with the survey is its sample population. Kirschs well-known opposition to vaccination means that many of those who follow and subscribe to him on Substack are likely to be anti-vaccine themselves. This tendency could motivate them to give answers that support the narrative that COVID-19 vaccines are dangerous.
This didnt seem to deter Kirsch however, as he stated he had collected the contact information of the respondents and claimed this would enable him to independently verify their answers.
But its unclear how this method would enable him to independently ensure that the responses were accurate, as this would involve validating the answers with the respondent, who is likely to be anti-vaccine in the first place. A better way of validating the answers would have been to examine the medical records and death certificates of those who died.
The surveys lack of rigor and reliability is evident in the responses that gave answers that are inconsistent with each other. For example, 33 records indicate no one in the respondents household had gotten vaccinated against COVID-19, but the same respondents also answered that at least one person in their household died from the COVID-19 vaccine (Figure 1).
Figure 1. Screenshot of the survey responses collected by Kirsch on Airtable, filtered by % vaxxed (the proportion of people in the household who received a COVID-19 vaccine) and Died vax (the number of people the respondent believes died from the vaccine). % vaxxed was set to None, and Died vax was set to is any of: 1, 2, 3, 4 or more. Data retrieved on 31 October 2023.
Similarly, 31 records indicated no household members received the vaccine, but the same respondents also reported that one or more members of their household had been injured by the COVID-19 vaccine (see Figure 2 below).
Figure 2. Screenshot of the survey responses collected by Kirsch on Airtable, filtered by % vaxxed (the proportion of people in the household who received a COVID-19 vaccine) and Injured vax (the number of people the respondent believes was injured by the vaccine). % vaxxed was set to None, and Injured vax was set to is any of: 1, 2, 3, 4, 5 or more. Data retrieved on 31 October 2023.
Deaths from serious known side effects of the COVID-19 vaccines, such as thrombosis with thrombocytopenia (TTS), have been recorded. A CDC presentation in December 2021 reported nine deaths linked to TTS after receiving the J & J COVID-19 vaccine. A March 2023 article by pediatric cardiologists Frank Han and Jennifer Huang reported that up to four potentially mRNA vaccine-related deaths from myocarditis in adults have been reported worldwide. For context, more than 270 million people have received at least one dose of vaccine in the U.S.; worldwide, this number has exceeded five billion.
But Kirschs claim that 3.5 times more Americans died from the COVID-19 vaccine than from COVID-19 is simply incompatible with mortality data.
The U.S. Centers for Disease Control and Prevention (CDC) reported that roughly 1.1 million people have died of COVID-19 in the U.S. to date (see Figure 3 below). If we multiplied this figure by 3.5, based on Kirschs claim, then roughly 3.8 million people died from COVID-19 vaccines.
Figure 3. The CDCs COVID-19 Data Tracker. Total deaths are reported at the bottom-right corner. Data retrieved on 31 October 2023. Source: CDC.
For reference, Our World in Data has compiled data on excess mortality from all causes in the U.S., which can be found here, although definitive estimates for 2023 arent available as the data is still incomplete.
Figure 4. Excess mortality in the U.S. from the beginning of 2020 until the end of August 2023. Retrieved on 31 October 2023. According to this data, there have been approximately 1.2 million excess deaths in the U.S. Source: Our World in Data.
If Kirschs claim were true, it would mean that excess deaths from 2020 up until now are roughly 4.9 million (the sum of all COVID-19 deaths so far and alleged vaccine deaths). This figure outstrips actual excess mortality data so far (Figure 4) by about four times. Kirschs assertion that the COVID-19 vaccines killed 3.5X more Americans than COVID virus, when carried to its logical conclusion, has no basis in reality.
The claim that COVID-19 vaccines increase the risk of death isnt substantiated by the data and scientific studies. For example, economist Philip Schellekens put together graphs correlating the level of vaccine coverage and excess mortality in various countries (see one example in Figure 5 below). These show that excess mortality wasnt higher in countries with greater vaccine coverage compared to countries with lower vaccine coverage.
Figure 5. A correlation of excess mortality per 100,000 people with the level of vaccine coverage, including primary vaccine doses and booster doses (as a proportion of the population). Source: Philip Schellekens.
And published studies so far havent found a higher risk of all-cause mortality in vaccinated people compared to unvaccinated people. A study that looked at excess mortality in the U.S. and other peer countries between June 2021 and March 2022 found that excess all-cause mortality was greater in the ten least-vaccinated states than in the ten most-vaccinated states[1]. A CDC study examining the period between December 2020 and July 2021[2] found that COVID-19 vaccine recipients had lower rates of non-COVID-19 mortality.
Out of 418 patients, 21 (5.0%) patients were excluded for either short (<3 months) follow-up duration (N=9, 2.2%) or lack of information about MERS-CoV proof (N=5, 1.2%) or COVID-19 proof (N=7, 1.7%). A total of 397 were included in the current analysis, and they were followed for an average 15 months during COVID-19 pandemic, which was on average 4.9 years from the MERS-CoV infection. Out of the included patients, 93 (23.4%) had positive MERS-CoV PCR tests, 61 (15.4%) had symptomatic MERS-CoV infection, and 48 (12.1%) had positive COVID-19 PCR tests (Fig.1).
Diagram of developing COVID-19 infection by MERS-CoV status
As shown in Table1, the mean age was 46.419.3 years. Approximately 54.8% were females, 62.8% were Saudi, and 40.6% were healthcare workers. The main presentations were respiratory symptoms (37.3%) and fever (23.9%), while almost half (51.6%) of patients were asymptomatic. Approximately 8.8% required ICU admission, and 2.8% required Mechanical Ventilation. MERS-CoV was significantly associated with non-Saudi patients, healthcare workers, having respiratory symptoms or fever, having severe disease, and requiring ICU admission or Mechanical Ventilation.
As shown in Table2, the mean age was 51.219.7 years. Approximately 54.2% were females, 70.8% were Saudi, and 31.3% were healthcare workers. The main presentations were respiratory symptoms (66.7%), and fever (33.3%), with the majority (77.1%) of patients having mild/moderate disease (no hypoxia). The main complications were an acute respiratory failure (8.3%) and septic shock (6.3%). The main comorbidity included hypertension (35.4%), diabetes (29.2%), heart diseases (14.6%), lung diseases (14.6%), and renal disease, including hemodialysis (14.6%). Approximately 27.1% required hospital admission, 8.3% needed ICU admission, and 4.2% required Mechanical Ventilation. Diagnosing COVID-19 was significantly associated with developing respiratory symptoms, fever, constitutional symptoms, severe disease, acute respiratory failure, or septic shock, and requiring hospital or ICU admission.
By the end of follow-up, the incidences per 1000 person-years of COVID-19 infection (20.1 versus 28.7), hospital admission (14.1 versus 18.9), and ICU admission (2.0 versus 6.0) were lower in patients with positive MERS-CoV compared with those with negative MERS-CoV, but without reaching statistical significance (Fig.2). The risk of COVID-19 disease was reduced but still insignificant when comparing patients with symptomatic MERS-CoV versus those with negative or asymptomatic MERS-CoV. Table3 shows detailed outcomes, including COVID-19 infection, disease severity, complications, mortality, hospital/ICU admission, use and duration of Mechanical Ventilation, and hospital/ICU length of stay. All outcomes were better in patients with positive or symptomatic MERS-CoV infection but without reaching statistical significance. For example, COVID-19 infection (6.6% versus 13.1%, p=0.150), severe disease (1.6% versus 3.0%, p=0.584), and mortality (1.6% versus 3.3%, p=0.701) were lower in patients with symptomatic MERS-CoV versus those with negative or asymptomatic MERS-CoV. On the other hand, the follow-up time in patients with symptomatic MERS-CoV was significantly longer (5.5 versus 4.9 years, p=0.002). There was no association between COVID-19 infection by followed up time, irrespective of MERS-CoV status.
Incidence of the study outcomes per 1000 patient years at the end of follow up period by baseline MERS-CoV status
As shown in Table4, Cox regression analysis adjusted for the follow-up time in addition to age, gender, and major comorbidity at COVID assessment showed a marginally significant lower risk of COVID-19 infection (hazard ratio=0.533, p=0.085) and hospital admission (hazard ratio=0.411, p=0.061) in patients with positive MERS-CoV. Interestingly, the risk of COVID-19 disease was further reduced and became significant in patients with symptomatic MERS-CoV, COVID-19 infection (hazard ratio=0.324, p=0.034), and hospital admission (hazard ratio=0.317, p=0.042). Similarly, COVID-19-free survival at the end of the follow-up period was better in patients with positive MERS-CoV (p=0.085) and those with symptomatic MERS-CoV (p=0.034) (Fig.3).
Adjusted Cox regression analysis of COVID-19 free survival at the end of follow up period by baseline MERS-CoV status*Adjusted for age at COVID, gender, and major comorbidity (hypertension, diabetes, heart diseases, lung diseases, and renal disease/hemodialysis)
The COVID-19 public health emergency may have ended, but vaccine manufacturers are still hard at work updating immunizations against the SARS-CoV-2 virus. In an interview with Drug Topics, Seth Toback, MD, senior vice president, medical affairs, at Novavax, discussed the development of the companys protein-based COVID-19 vaccine and shared some counseling pearls that pharmacists can use when discussing vaccination with their patients.
Can you briefly explain the mechanism of action of the Novavax COVID-19 vaccine?
The Novavax COVID19 Vaccine, Adjuvanted, is a protein subunit vaccine produced using established technology that has also been used in some seasonal influenza, human papillomavirus (HPV), and hepatitis B vaccines. The vaccine presents a harmless piece of the spike protein part of the SARS-CoV-2 virus to the immune system, which triggers an immune response.
The vaccine also includes an adjuvant, called Matrix-M, which enhances the immune response to the spike protein. Matrix-M is proprietary to Novavax, and comes from saponins, naturally occurring compounds in the bark of the Quillaja Saponaria (Soapbark) tree, which is commonly found in Chile.
After learning how to respond to the spike protein, the immune system is able to respond quickly if/when exposed to the actual virus spike protein, and therefore can help protect against COVID-19.
Overall, protein-based vaccines deliver the protein ready-made, directly to your immune system.
What is the history of protein-based vaccines? Are there any benefits to these types of vaccines?
Protein-based vaccines, such as the hepatitis B vaccine introduced in the 1980s, have a long history of use. As mentioned previously, they contain harmless pieces of the pathogensuch as proteins or protein fragmentsrather than the whole organism. They do not contain any live virus.
Protein-based vaccines have a long track record of safety and efficacy, and have been used for years with well-documented safety profiles. Additionally, protein-based vaccines can be stored and transported at standard refrigerator temperatures, which can simplify logistics and distribution. This could represent a convenience to pharmacists from a workflow perspective.
The FDA, the CDC, and ACIP all signed off on changes to the recommended COVID-19 vaccination schedule. Is the Novavax vaccine an appropriate option for patients who have received previous mRNA immunizations?
On October 3, 2023, Novavax received Emergency Use Authorization (EUA) for the 2023-2024 formulation of its COVID-19 vaccine for individuals aged 12 years and older in the United States.1 This authorization from the FDA, along with the CDC Advisory Committee on Immunization Practices (ACIP) recommendation from the September 12, meeting,2 makes Novavaxs vaccine the only protein-based, non-mRNA COVID-19 vaccine option available in the United States.
Eligible patients can receive the vaccine, regardless of what COVID-19 vaccine type they received in the past. For individuals previously vaccinated with any COVID-19 vaccine, a single dose of the Novavax COVID-19 vaccine can be administered at least 2 months after receipt of their last COVID-19 vaccine.
We know there is still some hesitancy around COVID-19 vaccines in general. Given that hesitancy, what are some takeaways and counseling pearls around the Novavax COVID-19 vaccine that you can share with pharmacists?
Pharmacists play a critical role in addressing COVID-19 vaccine hesitancy and providing accurate, timely information to patients. The pandemic certainly underscored the value of the knowledge and accessibility that pharmacists offer to their communities and public health overall. They have been and will continue to be a trusted resource for their patients.
With so many immunizations occurring at pharmacies, pharmacists are in an optimal position to engage in a dialogue with patients about vaccines, understand any hesitancies they may have, and correct any misinformation. By offering a safe, nonjudgmental environment, pharmacists can ask open-ended questions to seek to understand underlying concerns. As a result, patients can feel heard and respected, and pharmacists can provide tailored counseling in a compassionate manner.
When speaking with appropriate patients about the Novavax COVID-19 Vaccine, Adjuvanted (2023-2024 Formula), there is some information patients may want to know:
Lastly, it may be helpful to remind patients that per CDC guidance, the Novavax COVID-19 vaccine can be co-administered with the flu and RSV vaccines to eligible patients.
Pharmacists can refer to the Vaccine Provider Fact Sheet at https://novavax.widen.net/s/9tkdmzh9z6/us-eua-fact-sheet-hcp and visit https://us-hcp.novavaxcovidvaccine.com for more information. They can also refer patients to the Vaccine Recipient Fact Sheet at https://novavax.widen.net/s/9mtxjf6rjv/us-eua-fact-sheet-recipients and https://us.novavaxcovidvaccine.com for more information.
Are there any other key points youd like to touch on that we havent covered?
Overall, Novavax is excited to offer patients a choice in their COVID-19 vaccination type, a COVID-19 vaccine that is based on a well-established vaccine technology. The Novavax team also recognizes with gratitude the enormous role pharmacists play in providing immunization services and helping educate their communities.
Every two weeks since mid-September, the Centers for Disease Control has told the Vermont Department of Health how many of the newly formulated COVID-19 vaccines they can send to the state. Then, the department distributes the shots to doctors offices across Vermont.
Since the process started, there havent been enough updated COVID-19 vaccines to go around.
We're not able to meet all of the requests from provider practices, said state epidemiologist Patsy Kelso. We will over time, but we just don't have access to enough vaccine right now.
So far, Vermont has received about 14,000 doses of the updated COVID-19 vaccine for kids under 12, and just over 13,000 doses for adults.
This is a new system of distributing COVID-19 vaccines since the federal government is no longer picking up the bill, where the state is working with insurance companies to supply vaccines to doctors offices at no cost to people under 65.
State epidemiologist Patsy Kelso
Pharmacies can get vaccines through a different process, by purchasing them directly from drug manufacturers or through separate federal programs, so they havent had the same limitations.
There's generally a wide availability and access at pharmacies, Kelso said.
But pharmacies in Vermont cant administer vaccines to kids under 5. And not all insurance companies will cover the cost of a vaccine at pharmacies, including the Vermont Medicaid program Dr. Dynasaur, according to Kelso.
As of this week, about 4% of Vermonters under 18 have had the updated COVID-19 vaccine, and about 8% of the state overall.
The state will get its next allocation from the CDC on Nov. 6.
We wont know until then how many doses will be available, Kelso said.
Have questions, comments or tips?Send us a message or contact reporter Lexi Krupp:
Hot Topics in IPC with Saskia v. Popescu, PhD, MPH, MA, CIC, FAPIC
Influenza and COVID-19 Activity
This is the winter where we expect a tripledemicCOVID-19, influenza, and respiratory syncytial virus, but are we there yet? Its still early in the respiratory virus season (usually, it starts to hit in later November), but some of the indicators are pointing to hopefully a moderateand not severerespiratory syndrome. In terms of COVID-19, the CDC is reporting some key metrics we can take into consideration.
First, the US has an 8.7% test positivity, a slight downward trend from October 15 to 21, 2023, which is the latest reported. Regarding emergency department visits diagnosed with COVID-19, the rate is sitting at 1.3%, down 4.6% from the previous week. What is concerning, though, is that 2.7% of all deaths in the US are due to COVID-19 (during the October 15 to 21 week), which is an increase of 12.5%. In terms of wastewater reporting, the number of sites reporting has dropped, which is concerning, and theres been an increase in virus levels, all of which should be worrisomedata is critical!
This week in influenza, were seeing a relative hold at 1.7% of clinical lab results being positive for influenza (most being influenza A H1N1). There have been over 44k specimens tested during week 42 (again, the week ending October 21st). What is often a canary in the coal mine is outpatient respiratory illness rates; this is up and sitting at 2.5%, and something to watch. If we consider what our colleagues in Australia experienced during their influenza season, it will likely be moderate and hopefully end earlier.
All in all, this is an important time to ensure staff are vaccinated, masking and visitor restriction protocols are in place, and you have solid data metrics to determine actions. Regarding vaccinations, were still seeing challenges for many individuals getting the newest booster and with pandemic fatigue. Its still important for folks to get vaccinated. While its likely we wont see a COVID-19 winter similar to what weve already experienced, over time, this drop in immunity due to lackluster vaccination rates could cause larger issues. Its also helpful to ensure staff have disinfecting wipes out and are reminded that this is for them to. Use them to wipe down the workstations, high-touch surfaces, etc.
Mechanical Ventilation and Drug-Resistant Pathogens
Theres an insightful article that has been recently published in the Journal of the American Medical Association that discussed the results of a point prevalence study of those patients receiving mechanical ventilation and test positivity for Candida auris, Acinetobacter baumannii(A baumannii), as well as carbapenem-resistantA baumannii(CRAB). In their findings, the researchers noted that among the 482 patients who had samples collected, 30.7% (148/482) grewA baumannii; 88 of the 148 (59.5%) of theseA baumanniiwere CRAB. In acute care hospitals, 8.2% (23/282) of patients sampled hadA baumanniicompared with 62.5% (125/200) in long-term care facilities (RR, 7.66 [95% CI, 5.11-11.50],P<.001). For CRAB, 6.4% (18/282) of patients sampled in acute care hospitals were colonized compared with 35.0% (70/200) of patients in long-term care facilities (RR, 5.48 [95% CI, 3.38-8.91],P<.001).
I discussed the findings with one of the researchers, Anthony Harris, MD, MPH, which you can read here in Infection Control Todays sister brand, ContagionLive ultimately, we need to start doing more surveillance on vented patients and consider stronger infection prevention and control interventions.
Another tidbit of Knowledge You Might Find Interesting
Chronic Wasting Disease (CWD) Reported in Michigan Deer Thats right, a 4-year-old doe was diagnosed with CWD, which has been found in several Michigan counties.
pressmaster stock.adobe.com
COVID-19 vaccination before conception, whether received by a male or female partner, does not lead to a higher miscarriage rate, according to a study published late last month in Human Reproduction. The analysis was conducted among 1,815 female participants who conceived between December 2020 and November 2022, including 1,570 couples who provided data on male partner vaccination.
Illness from COVID-19 poses a greater risk to pregnant individuals, but COVID-19 vaccines have been shown to effectively reduce the severity of the virus. There is no clear evidence that COVID-19 vaccines cause miscarriage, yet vaccine-hesitant individuals of reproductive age continue to report concerns about safety related to pregnancy and fertility.
Several observational studies have shown that there is no increased risk of miscarriage following COVID-19 vaccination. However, none of these studies have specifically focused on the effects of male partner vaccination on miscarriage.
A group of researchers, including first author Jennifer J. Yland, Ph.D., then at the Boston University School of Public Health, have conducted a prospective cohort study to examine the association between preconception COVID-19 vaccination and miscarriage.
The Pregnancy Study Online (PRESTO) is a research study that began in 2013 and is still ongoing. It involves couples in the USA and Canada who are trying to conceive without fertility treatment. Participants complete questionnaires at various intervals and are given home pregnancy tests.
In the new cohort study, participants reported information on pregnancy outcomes, including miscarriages, and provided details on their pregnancies. Miscarriages were categorized as early (before week 8 of gestation) or late (weeks 819 of gestation). Information on COVID-19 vaccination and infection was also collected. Vaccines received during pregnancy were not included in the exposure definition.
The study found that almost one-quarter of pregnancies resulted in miscarriage, with 75% of those miscarriages occurring before 8 weeks gestation. Additionally, 75% of eligible female participants had received at least one dose of a COVID-19 vaccine before the time of conception.
Statistical analysis showed an incidence rate ratio (IRR) comparing female participants who received at least one dose of the vaccine before conception versus those who had not been vaccinated was 0.85 (95% CI: 0.63, 1.14). This suggests that there was no significant difference in the risk of miscarriage between vaccinated and unvaccinated women.
Furthermore, the analysis found no indication of an increased risk of either early miscarriage or late miscarriage associated with COVID-19 vaccination. The IRR for male partner vaccination, comparing the risk of miscarriage between those with vaccinated partners and those without, was 0.90 (95% CI: 0.56, 1.44). This suggests that there was no significant association between male partner vaccination and the risk of miscarriage.
Overall, these results suggest that COVID-19 vaccination, whether received by the female participant or their male partner, was not associated with an increased risk of miscarriage.
A limitation of the study is the self-reported information on vaccination and infection history that may be inaccurate. However, the study design and use of home pregnancy testing helped minimize the chances of missing any miscarriages. Also,as with any observational study, there is a possibility of unaccounted factors influencing the results.
But this is among the first, it not the first, prospective study that involving enrolling volunteers before conception and the following up regularly to examine the connection between COVID-19 vaccination before pregnancy and miscarriage. The study included a wide range of gestational ages at loss (4-19 weeks) and a high percentage of early losses (less than 8 weeks: 75%).
The results showed that vaccination did not have any harmful effects on miscarriage. In fact, the rate of miscarriage among vaccinated individuals was similar to that of participants who conceived before the COVID-19 pandemic.
The study was supported by several funding sources, including the National Institute of Child Health and Human Development, the National Institute of Health, the National Institute of Allergy and Infectious Diseases, and the National Science Foundation.
Free flu and COVID-19 vaccination clinic Friday in Fresno
by Stephen Hawkins
FILE - A pharmacist injects a patient with a booster dosage of the Moderna COVID-19 vaccine at a vaccination clinic in Lawrence, Mass., on Wednesday, Dec. 29, 2021. U.S. regulators have authorized updated COVID-19 boosters, the first to directly target today's most common omicron strain. The move on Wednesday, Aug. 13, 2022, by the Food and Drug Administration tweaks the recipe of shots made by Pfizer and rival Moderna that already have saved millions of lives. (AP Photo/Charles Krupa, File)
FRESNO, Calif. (FOX26)
Cultiva La Salud in partnership with UCSF Fresno as a medical provider is holding a Flu and COVID-19 vaccination clinic aimed at uninsured and underinsured people on Friday in downtown Fresno.
The clinic will be held at Bethany Church, located at 2305 Stanislaus Street at M Street from 4:00 p.m. to 7:00 p.m.
According to data from the Centers for Disease Control and Prevention influenza-related hospitalizations were 20% higher among Latinos compared to white adults.
Families are encouraged to receive the flu shot, and the Moderna and Pfizer updated COVID-19 vaccines at no cost.
Children six months and older will obtain the Pfizer vaccine authorized by the CDC and FDA.
Individuals six years and older vaccinated with the updated COVID-19 vaccine will get a $ 25 gift card and children six months to five years old getting the updated COVID-19 vaccine will get a $ 50 gift card while supplies last.
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Disclaimer: Early release articles are not considered as final versions. Any changes will be reflected in the online version in the month the article is officially released.
Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA (F. Ahmed, B. Flannery, J.R. Chung, A. Uzicanin); University of Pittsburgh, Pittsburgh, Pennsylvania, USA (M.P. Nowalk, R.K. Zimmerman, T. Bear); Vanderbilt University Medical Center, Nashville, Tennessee, USA (C.G. Grijalva, H.K. Talbot); Kaiser Permanente Southern California, Pasadena, California, USA (A. Florea, S.Y. Tartof); Texas A&M University College of Medicine, Temple (M. Gaglani); Baylor Scott and White Health, Temple, Texas, USA (M. Gaglani, M. Smith); Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA (H.Q. McLean, J.P. King); University of Michigan, Ann Arbor, Michigan, USA (E.T. Martin, A.S. Monto); Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA (C.H. Phillips, K.J. Wernli)
COVID-19 cases in the United States, first reported on January 22, 2020, began to increase in March 2020 (1). The pandemic resulted in a substantial number of employed persons being laid off or furloughed, especially during spring 2020, and increased prevalence of teleworking (24). Employers were advised to actively encourage employees with symptoms of any acute respiratory illness (ARI) to stay home (5). Both SARS-CoV-2 and influenza viruses can be transmitted by infected persons who are asymptomatic, presymptomatic, or symptomatic (6,7); staying home while ill can reduce workplace virus transmission by reducing contacts between infectious and healthy persons (8). That policy is considered an everyday preventive action that should be implemented year-round, but especially during annual seasonal influenza seasons and pandemics (9).
Data collected during the early COVID-19 pandemic (March 26, 2020November 5, 2020) showed that employed adults with previous telework experience were less likely than those without to work at the worksite (onsite) while sick (10). However, whether persons worked onsite within the early days of illness when infectiousness is higher has remained unclear (7,11,12). We aimed to assess the effects before and during the COVID-19 pandemic of employees previous experience with various work-location practices on work attendance patterns within the first 3 days of illness among persons with any ARI, including COVID-19 and influenza. Institutional review boards at the Centers for Disease Control and Prevention and all participating sites approved the study. The enrollees provided informed consent.
During November 12, 2018June 30, 2022, the US Influenza Vaccine Effectiveness Network enrolled adults 1964 years of age from network-affiliated sites in 7 states. During November 12, 2018March 18, 2020, persons seeking care for an ARI with cough within 7 days of illness onset were enrolled after local influenza circulation was identified from outpatient facilities affiliated with network sites in 5 states: Michigan (Ann Arbor and Detroit); Pennsylvania (Pittsburgh); Texas (Temple and surrounding areas in central Texas); Washington (Puget Sound region); and Wisconsin (Marshfield, Wausau, and Weston). For the period October 14, 2020June 30, 2022, case definition was broadened to include persons seeking treatment at outpatient or telehealth facilities within 10 days of illness onset with cough, fever, loss of taste or smell, or seeking clinical COVID-19 testing. Two additional sites, southern California region and Nashville, Tennessee, participated during October 2021June 2022. For our study, we considered November 2018March 2020 the period of prepandemic influenza seasons and October 2020June 2022 the COVID-19 pandemic period. Detailed study methods have been published elsewhere (1315).
Data were collected from patients at enrollment throughout the entire study period (November 2018June 2022): date of illness onset, symptoms since illness began (including fever/feverishness), age, sex, race/ethnicity, education, self-rated general health status, cigarette smoking, and number of children <12 years of age living in household. Respiratory specimens were collected from all participants at enrollment and tested for influenza viruses using real-time reverse transcription PCR (rRT-PCR); during the COVID-19 period (20202022), specimens were also tested for SARS-CoV-2 using RT-PCR. Persons enrolled on or after January 15, 2022, were asked if they had taken an at-home rapid COVID-19 test while ill and whether the result was positive.
All participants were asked to complete a follow-up survey, either online or over the phone, 12 weeks after enrollment. Throughout the 4-year study period, participants were asked at follow-up whether they had fully or mostly recovered from their illness and about employment status, type of employment (hourly, salaried, or other), hours they expected to work and hours usually worked from home in a typical week, and whether the employer discouraged workers with influenza-like symptoms from coming to work (Appendix Table 1). They were also asked if and where they worked on each of the first 3 days of illness (the first day being the day that symptoms started). Participants were asked about work status for the day before illness onset during November 2018May 2019 at the Pennsylvania site and at all participating sites for the subsequent study years (Appendix Table 2). For the period November 2018September 2021, two sites, in Washington and Wisconsin, did not collect data about work status while ill from participants who typically worked remotely before illness onset. For prepandemic influenza seasons, participants were asked at follow-up whether they worked in a healthcare setting with direct patient contact; that question was asked at enrollment during the COVID-19 pandemic period.
To categorize work experience before illness onset for our study, we used responses to questions about the number of hours participants expected to work and usually worked from home in a typical week (Appendix Figure 1). We categorized as having only onsite experience employed persons who reported that they usually worked no hours from home. We categorized as having hybrid (both onsite and remote) experience persons who stated that hours worked from home were usually fewer than total hours they expected to work. We categorized remaining persons as having only remote experience.
We categorized daily work attendance based on whether persons scheduled to work did or did not work. We categorized persons as scheduled to work for a given day regardless of number of hours for which they were scheduled. Among persons scheduled to work, we categorized those who worked for any number of hours, even if not total hours scheduled, as having worked and remaining persons as having not worked (Appendix Figure 2). We categorized persons who reported work location for a given day as onsite or hybrid as having worked onsite.
We classified laboratory-confirmed influenza and SARS-CoV-2 viruses on the basis of positive results from PCR tests. We categorized persons with respiratory symptoms but negative PCR test results for influenza or SARS-CoV-2 as having other ARI.
Among participants, 61% (12,941/21,133) completed the follow-up survey within 28 days of illness onset (Appendix Figure 3). Survey completion rates were 39% for Texas, 43% for Michigan, 60% for Washington, 75% for California, 75% for Pennsylvania, 79% for Wisconsin, and 89% for Tennessee. Among those who completed the follow-up survey, 69% (8,936/12,941) worked 20 h/wk before their illness. After excluding persons missing information on hours usually worked from home before illness or with indeterminate or missing laboratory results, we included 91% (8,132/8,936) in the analysis.
We used 2 testing to assess differences between frequencies of categorical variables and Wilcoxon rank-sum test to compare differences in spread and medians (16). We computed adjusted odds ratios (aOR) for each day by fitting multilevel logistic regression models to account for clustering of participants within study sites using PROC GLIMMIX in SAS version 9.4 (SAS Institute, https://www.sas.com). We ran 2 sets of regressions for employed persons who were scheduled to work. For the first set of regressions, the dependent variable was having worked at any location. For the second set of regressions, which examined work location to assess the workers potential to infect coworkers, the dependent variable was worked onsite. Because persons with remote-only experience before illness onset were unlikely to work onsite while ill, we excluded them from analyses pertaining to work location.
We used a backward selection process using change in 2 log likelihood to assess model fit to determine retention of independent variables in the models and ultimately dropped age, sex, education, and number of children in the household. We then assessed interactions between remaining independent variables (Tables 14; Appendix Tables 7, 8, 9).
During the prepandemic influenza seasons, 1,245 persons had confirmed influenza and 2,362 other ARI (Appendix Figure 4). During the COVID-19 pandemic period, 114 persons had influenza, 1,888 had COVID-19, and 2,523 had other ARI. Among persons in the study with any respiratory illness, 82.6% with influenza, 61.4% with COVID-19, and 49.6% with other ARI reported having fever.
Among all participants, 14.0% (1,139) had only remote experience before illness onset, 18.5% (1,503) had hybrid experience, and 67.5% (5,490) had only onsite experience (Appendix Table 3). Hourly workers made up a significantly lower percentage of persons with remote-only (29.9%) or hybrid (21.8%) experience than onsite-only experience (66.6%) (p<0.001). Percentages of participants working in healthcare by location of work experience varied: 7.1% of remote-only, 15.5% of hybrid, and 25.4% of onsite-only personnel (p<0.001). Percentage of participants with at least a bachelors degree was significantly higher among persons with remote-only (71.3%) or hybrid (79.5%) experience than those with onsite-only experience (43.5%; p<0.001). Among 1,139 persons with remote-only experience during the study period, most (88.9%) were enrolled during the pandemic period. Among the 1,503 persons with hybrid experience, median hours worked from home in a typical week before illness onset was significantly higher during the pandemic period (16 h/wk) than during prepandemic influenza seasons (8 h/wk; p<0.001).
Approximately three fourths of participants were scheduled to work on each of the first 3 days after illness onset (Appendix Table 4). Persons with previous remote-only or hybrid experience were significantly more likely than those with only onsite experience to work at any location on the second and third days of illness (Table 1). For example, on the third day of illness during the pandemic period, the percentage who worked at any location was 72.4% for persons with remote-only experience, 65.2% for persons with hybrid experience, and 37.4% for those with onsite-only experience (p<0.001). Among all persons who worked at any location on scheduled work days, median time worked was 8 (interquartile range 88) hours for the day before illness and 8 (interquartile range 68) hours for each of the first 3 days of illness (Appendix Table 5). Analysis of the location of work showed that participants were significantly more likely to work remotely on the day before illness onset through the first 3 days of illness during the pandemic period than prepandemic influenza seasons (Table 2). For example, on the third day of illness, 18.5% of persons worked remotely during the pandemic period, compared with 8.8% during the prepandemic influenza seasons.
Participants with hybrid experience were less likely to work onsite than persons with onsite-only experience on the day before through the first 3 days of illness (Table 3); effect magnitude was more pronounced during the pandemic period than prepandemic influenza seasons. For example, for the third day of illness, hybrid versus onsite-only aOR was greater for the pandemic (aOR 0.38, 95% CI 0.290.49) than the prepandemic period (aOR 0.69, 95% CI 0.540.87; p<0.001 for the work experiencestudy period interaction term). Conversely, participants were less likely to work onsite during the pandemic period than prepandemic influenza seasons and effect magnitude was more pronounced among persons with hybrid than onsite-only experience. For example, for the third day of illness, pandemic versus prepandemic aOR was greater among persons with hybrid (0.32) than onsite-only (0.59) experience (Table 3). Persons with hybrid experience were more likely to work remotely during the pandemic period than they were during the prepandemic period (Appendix Table 6). In contrast, persons with onsite-only experience were more likely not to work on scheduled-to-work days during the pandemic than during the prepandemic period. Findings were similar even when we restricted data for the regression models to nonhealthcare personnel or the sites that contributed data for all 4 study years (Appendix Tables 7, 8). Findings were also similar when we restricted the analysis to the sites with highest survey completion rates (Appendix Table 9).
We stratified the analysis by PCR test results, which showed that the proportion of employees who did not work while ill was greater for persons with influenza or COVID-19 than for persons with other ARI (Appendix Table 10). During prepandemic influenza seasons, 64.4% of persons with influenza and 40.3% for persons with other ARI did not work on the third day of illness (p<0.001). During the pandemic period, 66.7% of persons with COVID-19 and 48.3% of persons with other ARI did not work on the third day of illness (p<0.001).
For the prepandemic influenza seasons, persons with influenza were significantly less likely than persons with other ARI to work onsite on the second (aOR 0.51, 95% CI 0.430.61) and third (aOR 0.39, 95% CI 0.320.47) days of illness (Table 4). For the pandemic period, participants with COVID-19 were also significantly less likely than persons with other ARI to work onsite on the second (aOR 0.59, 95% CI 0.490.73) or third (aOR 0.31, 95% CI 0.250.39) days of illness. Among persons with influenza, COVID-19, or other ARI, those with fever were less likely to work onsite than those with no fever (Appendix Table 11).
Among persons with COVID-19, substantial percentages worked onsite while ill: 51.2% on day 1, 22.3% on day 2, and 14.1% on day 3 (Table 4). COVID-19positive PCR test results were available for 1.3% (12/940) by the first day of COVID-19 illness, 10.7% (97/910) by the second day, and 23.5% (211/899) by the third day (Table 5). Persons for whom a positive COVID-19 PCR test result was available by the second day of illness were significantly less likely to work onsite on that day than those whose positive PCR result was available on the third day or later (5.2% vs. 25.0%; p<0.001) (Table 5). Persons for whom a positive PCR test result was available by the third day of illness were significantly less likely to work onsite on that day than those whose positive PCR result was available later than the third day of illness (4.7% vs. 17.2%; p<0.001). Among persons for whom positive PCR test results were available after the second or third day of illness, the percentage who worked onsite was slightly higher when we excluded persons with COVID-19positive at-home test results by the second or third day of illness (Appendix Table 12).
During both prepandemic and pandemic periods, adults with remote-only or hybrid experience were more likely to work within the first 3 days of illness compared with those with onsite-only experience. It is notable, however, that persons with hybrid experience were significantly less likely to work onsite on the day before illness through the first 3 days of illness than those with only onsite experience. The effect magnitude of hybrid compared with onsite-only experience on working onsite while ill was more pronounced for the pandemic period than for the prepandemic period. Persons with influenza or COVID-19 were significantly less likely to work onsite on the second and third days of illness than were persons with other ARI. For persons for whom a positive COVID-19 PCR test result was available by the second or third day of illness, few reported working onsite.
Persons with previous remote-only or hybrid experience were significantly more likely to work at any location while ill than those with only onsite experience, enabling a greater level of continuity of work while ill. Greater likelihood of working at any location among persons with hybrid experience than those with only onsite experience has been reported in studies conducted during the 20172018 influenza season and during the early part of the COVID-19 pandemic (MarchNovember 2020) (10,17). Remote-only or hybrid experience before illness can enable persons to work remotely if they are well enough, instead of taking sick days.
It is possible that persons without experience working from home were more likely to work in occupations in which remote-only or hybrid work is less feasible and, therefore, workers are less likely to have the option or incentive to work remotely. Those workers might include persons with jobs in hospitality and leisure, transportation, utilities, construction, production, and agriculture (18,19).
Employers were required to provide paid sick leave to workers with COVID-19 during the pandemic (20). It is unlikely that persons with only onsite experience worked less than persons with hybrid experience after testing SARS-CoV-2positive because they received paid sick leave. This pattern of persons with only onsite experience working less than persons with hybrid experience was also observed for influenza and ARI before the pandemic.
Persons with previous hybrid experience were less likely to work onsite the day before illness onset through the first 3 days of illness than persons with only onsite experience, thus reducing the likelihood of workplace exposures to respiratory viruses. A study conducted during the 201718 influenza season concurred with that finding, but the study did not examine the likelihood of working onsite on the day before illness (17). A study conducted during the early part of the COVID-19 pandemic found that persons with hybrid experience were less likely to work onsite while ill than were persons with only onsite experience (10), an effect more pronounced during the pandemic than the prepandemic period. That difference may have been because of the greater prevalence of telework regardless of illness status during the pandemic (3,4). During the pandemic period, intense public health messaging to stay home when ill, employer policies discouraging or prohibiting employees with ARI symptoms from working onsite, and provision of flexible paid leave for persons with COVID-19 illness may have contributed to the greater effect (5,20).
Persons with laboratory-confirmed influenza or COVID-19 were significantly less likely than persons with other ARI to work onsite on the second and third days of illness. Previous studies have reported similar findings but did not assess the likelihood of working onsite on each of the first 3 days of illness (10,17). Those findings might be attributable to more severe manifestations of illness in persons with influenza or COVID-19 (15). The finding that the likelihood of working onsite was similar in persons with influenza or COVID-19 compared with persons with other ARI on the first day of illness, as well as the greater likelihood of working onsite on the first day of illness compared with the second or third day of illness, might have been because illness had begun when participants were already at work. For persons ill with COVID-19, having positive PCR test results by the second or third day of illness might have reduced the likelihood of working onsite for several reasons, including being concerned for coworkers, being advised to isolate by case investigators, having employers discourage or prohibit persons with COVID-19 from entering the worksite, and having employers provide flexible sick leave. However, COVID-19positive PCR test results were available for only a small proportion of persons within the first 3 days of illness because of the lag between illness onset and seeking medical care. At-home rapid COVID-19 tests may enable early testing for persons with symptoms of ARI. Use of at-home tests among persons with COVID-19like illness in the United States increased from 6% during August 23December 11, 2021, to 20% during December 19, 2021March 12, 2022 (21).
Strengths of our study were that we included data from 8,000 persons over a 4-year study period that encompassed both prepandemic and pandemic periods. We obtained respiratory specimens that enabled laboratory confirmation of influenza and SARS-CoV-2. Also, we assessed work attendance within the presymptomatic phase, when persons can be infectious, and the first 3 days of illness, when infectiousness is greatest. One limitation of the study was that 39% of participants did not complete the follow-up survey. However, findings were similar when we restricted the analysis to the sites with the highest survey completion rates. Second, we assessed the proportion of employees who worked at any location within the first 3 days of illness as an indicator of maintenance of workflow. We did not assess how illness may have diminished productivity among persons working while ill versus those working while well. Third, we assessed work attendance only among persons with medically attended ARIs. Findings may not be generalizable to persons who were asymptomatic or who did not seek medical care.
Future research should ascertain productivity in persons who work while ill with influenza or COVID-19. In addition, an assessment of the likelihood of working onsite among persons with ARI who do not seek medical care is needed. Research is also needed on how type of occupation and other workplace policies affect work attendance of sick employees.
In conclusion, working-age adults continue to be at risk for severe COVID-19 (22). Our study findings show that hybrid work experience before illness onset might give workers the opportunity to continue working but also reduce time worked onsite early in illness, when infectiousness is high. When feasible for a given occupation, employers should consider hybrid and remote work policies that might reduce likelihood of workplace exposures to influenza and SARS-CoV-2 viruses. Such work policies could minimize interaction with infectious persons in workplaces during both the presymptomatic and symptomatic phases of illness and help control spread of respiratory viruses.
Dr. Ahmed is a senior science officer at the Division of Global Migration Health, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. His research interests include prevention and control of emerging infectious diseases, including pandemic influenza and COVID-19.
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We gratefully acknowledge the contributions of the following persons: Chandni Raiyani, Kayan Dunnigan, Kempapura Murthy, Mufaddal Mamawala, Spencer Rose, Amanda McKillop, Teresa Ponder, Ashley Graves, Martha Zayed, Natalie Settele, Jason Ettlinger, Courtney Shaver, Monica Bennett, Elisa Priest, Jennifer Thomas, Eric Hoffman, Marcus Volz, Kimberly Walker, Manohar Mutnal, Arundhati Rao, Michael Reis, Keith Stone, Madhava Beeram, and Alejandro Arroliga. Krissy Moehling Geffel, Rachel Taber, Jonathan Raviotta, Louise Taylor, Michael Susick, GK Balasubramani, Theresa M. Sax, Dayna Wyatt, Stephanie Longmire, Meredith Denny, Zhouwen Liu, Yuwei Zhu. Sally Shaw, Jeniffer Kim. Edward Belongia, Hannah Berger, Jennifer Meece, Carla Rottscheit, Erik Kronholm, Jackie Salzwedel, Julie Karl, Anna Zachow, Linda Heeren, Joshua Blake, Jennifer Moran, Christopher Rayburn, Stephanie Kohl, Christian Delgadillo, Vicki Moon, Megan Tichenor, Miriah Rotar, Kelly Scheffen. Erika Kiniry, Stacie Wellwood, Brianna Wickersham, Matt Nguyen, Rachael Doud, Suzie Park, and Mike Jackson.
This work was supported through cooperative agreements funded by the US Centers for Disease Control and Prevention and by infrastructure funding from the National Institutes of Health (UL1 TR001857) at the University of Pittsburgh.
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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Few people are rolling up their sleeves for the new COVID vaccine, even as peak respiratory virus season is looming.
The latest data from the Massachusetts Department of Public Health shows just 9% of residents have received the shot since the latest boosters started to roll out in mid-September.
A greater share, 21%, have received a flu vaccine, but thats still tracking behind previous years, according to public health officials.
We're not doing as well as we should be in flu vaccines compared to prior years, Dr. Robbie Goldstein, commissioner of the Department of Public Health, told hospital leaders this week. We are dramatically lower in our COVID vaccination rates than we have been in prior years. And RSV vaccination a new vaccine is really lagging where we had expected it to be.
The RSV vaccine is available for people at high risk of illness from RSV, or respiratory syncytial virus, while the COVID and flu shots are recommended for almost all Americans 6 months and older, according to the Centers for Disease Control and Prevention.
Each vaccine is really important and helps us protect ourselves, our communities and our health care [system], Goldstein said.
The COVID vaccine was reformulated this fall to better match the current strains of the virus, similar to the way the flu vaccine is regularly updated. But supply delays made for a bumpy start to this COVID vaccination effort, causing delays for people eager to get the shots in the days immediately after they were approved.
Theres a lot more vaccine available now. CVS officials, for example, say they are "well positioned" to meet patient demand. But doctors acknowledge that interest in the vaccine may be waning as the public tires of COVID and tires of getting shots.People who previously had only mild cases of COVID may not feel the need to roll up their sleeves for another vaccine.
Theres a sense of complacency,said Dr. Philip Landrigan, director of the Program for Global Public Health and the Common Good at Boston College. People are just not as uptight about COVID as they were.
Landrigan said hes hopeful more people will opt for shots in the coming days. Doctors generally recommend getting the COVID and flu vaccines by November.
Around this time of the year, people realize that the days are getting shorter, the days are getting colder, we're all going to spend more time indoors in close quarters, he said. That often is the stimulus that persuades people it's time to go out and get the vaccine.
Dr. Larry Madoff, medical director of the Bureau of Infectious Disease and Laboratory Sciences at the state's Department of Public Health, also urged people to get vaccinated, noting hybrid immunity from prior infection and vaccinations is the most protective.
Even if you've had COVID, you should still get vaccinated, he said. It adds to your protection, makes it less likely that you'll get long COVID, makes it less likely that you'll have a severe infection.
People recently infected can wait up to three months before getting a booster shot, according to the CDC.
State data shows a greater share of older people are getting vaccinated. Twenty-five percent of people age 65 to 79 had received COVID boosters by Oct. 21, compared with about 2% of children under 5.
There are also disparities by race and ethnicity. Almost 10% of white residents in Massachusetts have received COVID shots this fall, compared with less than 3% of Black or Hispanic residents.
Nationally, CDC officials said last week that about 7% of adults and 2% of children have received the new shots.
COVID levels were on the rise for much of the summer and early fall. COVID, flu and RSV are currently at low levels in Massachusetts, according to state health officials, but all three viruses are expected to flare up during the colder months.
Doctors and hospitals are hoping to avoid a tripledemic, in which all three respiratory viruses peak around the same time, straining the health care system.
Around this time last year, hospitals were struggling to treat an influx of young children severely ill from RSV. This year, there are two new options to protect babies from the virus. One is the vaccine, which pregnant women can take in the third trimester to provide immunity to infants in the first six months of life. The other is a preventive monoclonal antibody treatment that is administered to babies after birth.
The preventive drug, nirsevimab, is in short supply nationally, and CDC officials have asked doctors to prioritize the treatment for younger babies and those with heart or lung conditions that put them at higher risk.
Nobody is pleased with the shortage, said Dr. Rick Malley, senior infectious disease physician at Boston Children's Hospital. But he noted that medication shortages are common.
Malley said there is another, older preventive treatment available for babies who dont have access to nirsevimab, though it requires monthly injections instead of a one-time shot. He also urged pregnant women to get the RSV vaccine, which in most cases is expected to provide enough protection for their babies to forgo nirsevimab.
Many pediatricians and infectious disease doctors are very excited" about the new preventive treatment, Malley said. We think it could really have a significant impact on the health of children. We hope that this shortage will be short-lived.
