People's CDC, November 18, 2024, COVID-19 Weather Report

Vaccine conspiracy theorist RFK Jr. to head Trump HHS, CDC infection control committee doubles down on weakening protection for aerosol transmission, public comments open until Nov. 22

Nov 18, 2024

The Weather

A second Trump term may severely harm our public health and healthcare infrastructure. Trump’s recent cabinet announcements include plans to appoint antivax conspiracy theorist Robert F. Kennedy Jr. to head the Department of Health and Human services. Under the Trump administration, we can expect broad attacks on public health beyond just COVID: We may see weakening of multiple crucial public health measures including vaccine recommendations, food safety requirements, and water fluoridation for dental health. To implement his antiscience agenda, RFK Jr. plans to replace 600 workers at the NIH.

Please stay tuned for further updates and analysis on the impacts of a second Trump term on public health, including what we can do to take action. In the meantime, we encourage you to seek support within your communities and look for effective ways to support others, especially those who may be most heavily impacted by racism and bigotry that may be emboldened by the outcome of the presidential election.

CDC HICPAC Meeting Update

CDC’s Healthcare Infection Control Practices Advisory Committee (HICPAC) met Thursday and Friday, November 14 and 15, to discuss two major guidelines relevant to COVID and other infectious disease precautions in healthcare: the Isolation Precautions Guideline and the Healthcare Personnel Guideline section on Viral Respiratory Infections. As background, the Isolation Precautions Guideline has been the subject of ongoing advocacy by National Nurses United, People’s CDC, and many other public health advocates. A weakened “update” to the Isolation Precautions Guideline was approved by the HICPAC committee in November 2023. In response to public health advocacy efforts including our community’s contributions to public comment campaigns, CDC sent the guideline back to the committee for further revision, highlighting the need to address several key issues regarding the recommendations for masking and use of N95 respirators.

In the most recent November 2024 meeting, the only masked committee member, Lisa Baum (who wore an N95 respirator), was also the only committee member who consistently advocated for strengthening the guidelines to broaden the use of N95 respirators and adequately protect patients over the course of the meeting. The committee approved a response to the CDC’s questions that did not expand the use of N95 respirators to all aerosol-transmitted pathogens within the Isolation Precautions draft. Lisa Baum was the only member who voted against all the proposed responses, maintaining that the recommendations were not adequately protective of patients and staff.

The committee also discussed COVID, influenza, and general respiratory virus isolation for healthcare workers. The committee approved a reduction of COVID isolation for healthcare workers to a minimum of 3 days as well as a reduction in quarantine for exposed healthcare workers, with Lisa Baum being the only member who supported stronger quarantine and isolation approaches for healthcare workers by voting against the recommendation. In May 2024, the People’s CDC submitted a letter to the CDC with over 400 expert signatures supporting that COVID positive workers must isolate at home for at least 7-10 days and should test negative before returning in-person.

Oral public comments, including multiple People’s CDC members as well as other advocacy groups and members of the general public, were overwhelmingly in favor of strengthening infection control measures including universal masking in healthcare, using N95 respirators for aerosol-transmitted pathogens, and enhancing multilayered precautions. Video recordings for each day of the meeting can be found as follows: Thursday Nov. 14 (Public comment begins at about 9:14:14) and Friday Nov 15 (public comment begins at about 3:09:16).

Public comment is open until November 22; so there is still time to submit written comments to HICPAC. Refer to our letter template and talking points to let HICPAC know we need to strengthen infection control with universal masking, broad use of N95 respirators, and appropriate isolation for healthcare workers, as part of a multilayered approach to protecting patients and workers.

Wins

In response to your public comments, the Centers for Medicare and Medicaid Services (CMS) COVID Hospitalization reporting requirements started on November 1. Public-facing data is not yet available on the National Health Safety Network website for the new reporting, which states: “More details about public-facing data will be made available closer to the start of reporting requirements.”

The National Institutes of Health (NIH) have implemented masking in all patient care areas beginning November 4, without a stated end date, joining many healthcare settings that are implementing fall-winter universal masking requirements. NIH will also be testing inpatients for COVID, influenza, and RSV. As COVID and other aerosol-transmitted diseases pose risks year-round, we must continue to demand year-round universal masking in healthcare.

Wastewater

As of November 14, the CDC’s national wastewater map shows “Moderate,” “High,” or “Very High” levels in 14 states. South Dakota, Arizona, New Hampshire, Mississippi, Michigan, and Missouri indicate limited coverage. No data is available for Guam, North Dakota, and the US Virgin Islands. Although this continues a trend of lower levels in many states from the past several weeks, there is significant state-to-state variability. We continue to recommend masking and effective multilayered precautions, even where “Low” or “Minimal” wastewater levels are indicated. As always, wastewater level categories have not been validated against true case-level data and do not necessarily indicate risk in our day-to-day lives.

Graphic source: CDC

According to the Wastewater COVID-19 National and Regional Trends dashboard, wastewater levels continue to be within the “Low” category nationally, and significant decreases have not been seen in the last few weeks across any of the regions.

You can also get more information on wastewater testing from CDC’s state/territory trends page as well as the WastewaterSCAN dashboard.

A line graph with the title, “COVID-19 Wastewater Trends as of November 14, 2024” with “Wastewater Viral Activity Level” indicated on the left-hand vertical axis, going from 0-12, and “Week Ending” across the horizontal axis, with date labels ranging from 05/18/24 to 11/02/24. Text above the graph reads Levels Plateau at “Low” Nationally Continue to Exercise Precautions. A key at the bottom indicates line colors. National is black, Midwest is orange, South is purple, Northeast is light blue, and West is green. Overall, wastewater levels are plateauing with no significant decreases since early October. Text at the bottom reads “People’s CDC. Source: CDC.”

Graphic source: CDC

As of November 12, predicted COVID Epidemic Growth Status is likely declining nationally, with predictions of “Growing” in Minnesota and “Likely Growing” in California and Arizona, according to the CDC Center for Forecasting and Outbreak Analytics dashboard. Going forward, you may only see this map featured sporadically within the Weather Report, as we do not always find that it adds new and actionable information beyond what is available from the wastewater data. Notably, this model has been using emergency department visit data since national COVID hospitalization reporting ended on May 1, 2024. It is unclear whether this will change with the beginning of CMS’s COVID hospitalization reporting requirement on November 1, 2024.

Note, this model utilizes emergency department visit data to estimate COVID transmission’s R_t, which is an estimate of the average number of new infections caused by each infectious person. An R_tgreater than 1.0 indicates that infections are growing, while an R_t less than 1.0 indicates that they’re declining.

A map of the United States color-coded in shades of purple and gray displaying the CDC COVID Model: Current Epidemic Growth Status based on emergency department visits as of November 12, 2024, where purple tones indicate growing or likely growing, teal tones indicate declining or likely declining, and gray indicates “Stable or Uncertain.” States without predictions are represented in white. Text above the map reads “CDC estimates transmission ‘Growing’ or ‘Likely Growing’ in 3 states.” Twenty five states are light to dark teal and have “Declining” or “Likely Declining” status. Three states are light purple and have “Likely Growing” Status. Eighteen states and territories are “Not Changing” and five states are “Not Estimated.” Text at the bottom reads “People’s CDC. Source: CDC.”

Graphic source: CDC

Variants

According to the CDC’s variant tracking dashboard, recombinant variant XEC (a combination of two JN.1-derived variants: KS.1.1 and KP.3.3) is increasing and is projected to be the second most prevalent variant, behind KP.3.1.1. All of the currently displayed variants are derived from JN.1-based lineages, meaning that our current vaccines (Pfizer, Moderna, and Novavax) based on JN.1 itself (Novavax) or the more recently emerged KP.2 sublineage of JN.1 (Pfizer and Moderna) are anticipated to be well-matched and effective.

Two stacked bar charts with two-week periods for sample collection dates on the horizontal x-axis and percentage of viral lineages among infections on the vertical y-axis. Title of the first bar chart reads “Weighted Estimates: Variant proportions based on reported genomic sequencing results” with collection dates ranging from 8/3/24 to 10/12/24. The second chart’s title reads “Nowcast: model-based projected estimates of variant proportions,” dates labeled 10/27/24 and 11/9/24. Within the 10/27 Nowcast projections, KP.3.1.1 (light teal) is at 52%, XEC (green) increases to 28%, KP.2.3 (blue) decreases to 3%, MC.1 (ochre) increases to 6%, and LB.1 decreases to 3%. Other variants are at smaller percentages represented by a handful of other colors as small slivers. The legend with a list of variants, proportions, and their associated colors is on the far right of the bar charts.

Graphic source: CDC Variant Tracker

Take Action

There is still time to support strengthening infection control for aerosol-transmitted pathogens including COVID. Public comment to CDC’s HICPAC committee is open until November 22.

You can also support masking in healthcare by writing to your local, state, and federal elected officials.

We continue to rely on COVID wastewater testing to get a better understanding of COVID spread nationally and within our communities. Let your federal elected officials know that COVID wastewater monitoring must expand and continue. If you live in an area with no data or limited data, consider also writing to state and local officials to ask them to fund wastewater surveillance in your area.

We at the People’s CDC are grateful for our community’s support, solidarity, and advocacy, now and as we face dark times ahead.

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Notes: 1) The numbers in this report were current as of 11/16/2024. 2) Check out the links throughout & see our website for more at https://peoplescdc.org. 3) Subscribe to our newsletter: People’s CDC | Substack.