Variants, Post-Vaccination Infections, and Implications for Case Investigation and Contact TracingContinuing Education: Aug 17, 2021

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What region are you working in ?

Zoom poll

Goal of this session

Prepare staff of local health departments to

effectively communicate information about

the Delta variant, post-vaccination infections

(PVIs), and related public health guidance for

testing, isolation, and quarantine, during

CICT interviews.

Learning objectivesBy the end of this session, you will be able to:

Use health coaching and cultural humility to navigate challenging situations and de-escalate client frustrations during CICT interviews

Give accurate guidance for isolation, quarantine, and testing for vaccinated and unvaccinated individuals

Describe epidemiological trends relating to the Delta variant and PVIs

Respond to frequently asked questions about PVIs and the Delta variant

Agenda Intro 12:30-12:35

Epidemiology of Variants and PVIs 12:35-12:50

Health Coaching Tools for Talking about Variants and PVIs 1:05-1:30

Responding to FAQs 1:30-1:55

Feedback Survey and Closing 1:55-2:00

Epidemiology of the Delta Variant and PVIs

Shira Shafir, PhD, MPH

UCLA Fielding School of Public Health

Learning objectives

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Describe transmissibility and severity of illness of the Delta variant

Discuss effectiveness of vaccines against the Delta variant

Describe the risk of PVIs and the severity of illness when they occur

Discuss guidance for isolation, quarantine, and testing among vaccinated and unvaccinated individuals

Key take home points

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Delta is the most identified variant in California

People need to be fully vaccinated

Vaccines workThe more people who get vaccinated the better

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COVID-19 variant proportions in California, Feb-Jul 2021

11Image Source:https://www.nytimes.com/2021/06/22/health/delta-variant-covid.html?.?mc=aud_dev&ad-keywords=auddevgate&gclsrc=aw.ds&gclid=CjwKCAjwpMOIBhBAEiwAy5M6YAIjUDSGifZyII_FABpG4VSY733nz2qouBGFu29WbR7ZUuJ109LtxRoCv3EQAvD_BwE

Transmissibility of Delta

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R0 of Delta

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Original COVID-19 Strain Delta Variant

Risk of disease, hospitalization and death in the unvaccinated vs. vaccinated: national estimates.

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Fully vaccinated

Unvaccinated

Post-vaccination cases, hospitalizations and deaths in California

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● Unvaccinated: 51 per 100,000

● Vaccinated: 8.2 per 100,000

Out of 21.6 million fully vaccinated 57,491 post-vaccination cases (0.3%)

● At least 1,615 post-vaccination cases were hospitalized

● 65% of cases have missing data

● At least 141 people have died

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Increasing percentage of hospitalizations are among vaccinated individuals

% of hospitalized who were fully vaccinated % of in-hospital deaths who were fully vaccinated

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Serious illness among unvaccinated

Serious illness among fully vaccinated

For every 102K Unvaccinated

There have been a TOTAL of 1,603 new hospitalizations

And 417 COVID-19 deaths

For every 102K Vaccinated

There have been 100 symptomatic breakthrough infections

And ONE death

Things that I thought I “knew” that changed with Delta

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Virus has an Ro of about 3

~70-80% vax will reach herd immunity

Prolonged exposure (>15 min) needed for spread

Risk factors of bad outcomes known

mRNA vaccine overall efficacy ~95%

mRNA efficacy vs. severe cases >99%

Immunity is long lasting

Vaxxed people can’t spread virus

Delta has an Ro of 7-8

Herd immunity needs >85% vax; may be impossible

Less prolonged exposure (5min, perhaps less) can

result in spread

Delta cases may be more serious on average

mRNA vaccine overall efficacy vs. Delta ~85%

Efficacy vs. severe cases ~95%, lower in hi-risk groups

Immunity (from vax or illness) wanes in ~6 months

Vaxxed people probably can spread

Source: @bob_wachter

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COVID-19 case rate by percent of state population fully vaccinated, July 22-28.

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Isolation guidance for unvaccinated

* May be 20 days in severe disease

Symptomatic● 10 days* from the date of

symptom onset ● and no fever for 24 hours● and symptoms improved

or resolved

Asymptomatic

● At least 10 days since the date of positive test

● and continue to have no symptoms

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Isolation guidance for vaccinated/PVI

If 14+ days since final dose

● Standard 10-day isolation guidance recommend

● Some LHJs may conduct further investigation of possible PVI and report to CDPH and CDC

If less than 14 days since final dose*

● Standard isolation guidance● Not a true post-vaccination

infection since they would not have their full immune response yet.

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Quarantine guidance for unvaccinated

Quarantine Period

● End quarantine after Day 10 from the date of last exposure without testing.

● Strict adherence to face covering, social distancing, and symptom monitoring through Day 14.

Symptoms● If the person develops

symptoms, they should switch to self-isolation

Negative test● A negative test during this

period does not reduce the duration of quarantine, except for essential workers, dependent on local LHJ policies.

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Quarantine guidance for vaccinated.

Symptomatic● If the person develops

COVID-19 symptoms, they need to get a test

Asymptomatic

● No quarantine ● No need to get tested

Fully vaccinated

Partially or not vaccinated

Isolation/Quarantine Decision Tree for Cases and Contacts **Not considered a PVI

because they are not fully vaccinated at the

time of exposure

*LHJ may conduct further investigation of possible

Post-Vaccination Infection (PVI) and report to CDPH or CDCGuidance may vary by Local Health Jurisdiction (LHJ) and for healthcare workers

and those in congregate settings. Prioritize LHJ recommendations.

No symptoms

Yes, has symptoms

No symptoms

Yes, has symptoms

No quarantine or testing required. Monitor for symptoms for at least 14 days from the date of last exposure. CDC recommends testing 3-5 days after exposure and to wear a mask in public,

indoor settings until negative test.

Get tested for COVID-19 as soon as possible and isolate until tested.

Quarantine for at least 10 days from the date of last exposure. Monitor for symptoms, wear a mask, and social distance for 14 days from the date of last exposure. Testing is not required. A

negative test does not reduce the duration of quarantine.

Get tested for COVID-19 as soon as possible and isolate until tested.

Updated 8/11/21

Exposed to someone

with COVID-19

Tested negative for

COVID-19

Tested negative for

COVID-19

Tested positive for COVID-19

Fully vaccinated*

Partially vaccinated**

Not vaccinated

No symptoms

Yes, has symptoms

Isolate for at least 10 days from the date of the positive test AND continue to have no symptoms.

Isolate for at least 10 days from the date symptoms started AND have no fever for 24hrs without use of anti-fever medications AND all symptoms are improving or have resolved (possibly 20 days in severe cases if recommended by their doctor).

Fully vaccinated:14+ days since final dose

Partially vaccinated:Less than 14 days since final dose

Not vaccinated:No doses received

Live Q&A

Health Coaching Tools for Talking about Delta and PVIsPat MejiaUCSF Center for Excellence in Primary Care

Learning objectives

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Increase or maintain a case’s confidence in the vaccine’s effectiveness following a PVI

De-escalate a case’s frustrations following a PVIs

Support vaccinated and unvaccinated individuals to follow recommendations for I&Q

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Rene is a 21-year-old college student who was recently exposed to COVID-19. When you ask him during a CI interview if he has been vaccinated, Rene sounds irritated and says, “I wish everyone would just back off about this! I mean, seriously, what’s the point?! My dad got the vaccine and he still got sick.”

How do you think Rene is feeling? What do you say next?

Meet Rene

HearH “Could you tell me more about your concerns?”

Express gratitudeE “That’s a great question. You’ve been thinking carefully about this!”

Ask and AnswerA “Let me see if I’m hearing you correctly...” “Would it be okay if I share some information about your concern?”

Using the HEAR Technique

RespondR “Post-vaccination infections are getting a lot of attention in the news, but they are still very rare…”

Meet Sonia

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Sonia is a 58-year old grandmother who works at a supermarket and was recently diagnosed with COVID-19. Sonia is vaccinated, but she’s having chills and is developing a cough.

When you share that she appears to have a post-vaccine infection and should isolate, she blows up: “You need to double-check those results! There is no way I can have it - I’ve been vaccinated!”

How is Sonia feeling? What do you say next?

Sonia (continued)

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Sonia says, “How could this happen?! I did everything I was supposed to do to keep my family safe. I listened to everything you people said. I live with my mom, and she has lupus. I already lost my uncle and a cousin to this virus. I can’t handle it if I brought this thing into my home to my mom. Why should I trust anything you say now?!”

What do you say next?

Sonia (continued)

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Sonia says, “Well, I thought that I didn’t need to quarantine, but now I’m not feeling so good, and I’m not sure. And what do I do about my mom? I’m so scared for her! She was vaccinated but I don’t know if it worked since she has lupus and is older. What can I do to protect her?”

What do you say next?

Looking through the lens of cultural humility

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Cultural humility is …

• A continuous, lifelong process where the individual examines their own beliefs, cultural identities, biases, and values as well as the beliefs and cultures of others.

•Relinquishing the role of expert to becoming the student ... (Tervalon, 1998)

Checking in on yourself

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What feelings did Rene or Sonia’s reactions bring up for you?

What do you do when you have a conversation that triggers strong emotions for you?

How do you take care of yourself when you have an emotionally charged conversation?

Key take home points

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When you encounter angry or emotional responses, pause to listen deeply

Observe how calls effect you

Resist the urge to become argumentative or defensive

ResourcesDownload these materials from the COP website and practice with your team

• Activity Guide with Role Play Scenarios

• Cheat sheet on the HEAR technique https://cepc.ucsf.edu/hear-technique-tool-engaging-people-skeptical-about-covid-19-vaccine

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Responding to FAQs about the Delta Variant and PVIsJae EganCalifornia Department of Public Health

Stacy VoganUCSF - California Prevention Training Center

Luis Gutierrez-MockUCSF - Pandemic Initiative for Equity & Action

Learning objectives

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Identify and prioritize key talking points for the most common FAQs about the Delta variant and PVIs

Demonstrate possible responses to FAQs about post-vaccine infections and variants.

FAQs that we are hearing about PVIs

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I’m already fully vaccinated. Do I still need to isolate even

if I don’t have symptoms?

I'm already fully vaccinated. What are the chances that I can catch

COVID?

If I’m already fully vaccinated, how likely

am I to get sick if a household member becomes infected?

What questions are cases and contacts asking you about PVIs?

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Live demo: PVIs FAQ

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How would you respond to this FAQ?Raise your hand to volunteer

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FAQs that we are hearing about variants

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How do I know if I have the Delta

variant?

Is Delta worse than other variants?

Are the symptoms of Delta different?

What questions are cases and contacts asking you about variants ?

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Live demo: variants FAQ

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How would you respond to this FAQ?Raise your hand to volunteer

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FAQs that we are hearing about variants, PVIs, and children

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What does this mean for

back-to-school this fall?

My kids didn’t go to school last year.

What do I do if they get sick or their

classmates get sick?

What questions are parents asking you about variants, PVIs, and children?

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Live demo: FAQs about children

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How would you respond to this FAQ?Raise your hand to volunteer

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Best practices

Focus on key points and keep it simple. Be ready for variations !

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Ask questions and paraphrase the issue/question to make sure you understand the core issue

Thank the person for sharing the question/issue

If the person hasn’t asked your opinion, ask permission before sharing information

ResourcesDownload these materials from the COP website and practice with your team

• Activity Guide with Role Play Scenarios

• FAQ Job Aid

• Isolation and Quarantine Decision Tree

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Key take home points: summary

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Vaccines work. People need to be fully vaccinated. The more people vaccinated the better.

Listen to yourself, and observe how challenging calls affect you.

When you encounter angry or emotional responses, pause to listen deeply. Use the HEAR technique.

Download the activity guide and job aids. Practice what we discussed today with your team, family, or friends.

Session feedback - Zoom polls

1. Did you learn something valuable during this session?

● Yes

● No

2. Did this session meet your expectations ?

● Yes

● No

● I did not know what to expect

Session feedback - Zoom polls

3. How would you rate the usefulness of M1 -

Epidemiology of Variants and PVIs?

● Very useful

● Somewhat useful

● Neutral

● Somewhat useless

● Not at all useful

Session feedback - Zoom polls

4. How would you rate the usefulness of M2 - Health Coaching

● Very useful

● Somewhat useful

● Neutral

● Somewhat useless

● Not at all useful

Session feedback - Zoom polls

5. How would you rate the usefulness of M3 - FAQs

● Very useful

● Somewhat useful

● Neutral

● Somewhat useless

● Not at all useful

• We believe in YOU and we believe in EACH OTHER

• Together, we have made a tremendous impact in our communities in the past 18+ months.

• Together, we will continue to make an impact in the months ahead !

In closing - we got this !

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