New COVID-19 Subvariants Emerge While Monkeypox Cases Grow, What Can You Do to Be Prepared?

With over 6,900 cases of monkeypox across 51 countries, and the emergence of new COVID-19 Omicron subvariants BA4 and BA5, we must continue to maintain heightened public health mitigation and preparedness measures through the coming summer months.

COVID-19 cases in the United States (US) are at their highest levels since April and the increase comes as Americans have gathered for Independence Day celebrations amidst the emergence of the more transmissible, and potentially more serious, Omicron BA.4 and BA.5 subvariants. A preliminary study from the University of Tokyo shows that the new variants may have evolved to cause more serious infection of lung cells than previous Omicron variants which resulted in mostly mild cold-like symptoms. This may be the reason why countries with widespread BA4 and BA5 outbreaks, such as the United Kingdom (UK), Belgium, France, Germany, Portugal,and Israel, all with largely vaccinated populations and strong public health data tracking, are seeing sharp increases in hospitalizations. In addition to rising COVID-19 cases and hospitalizations from new emerging variants, monkeypox cases have tripled in the last two weeks.

What is Monkeypox?

Monkeypox was first discovered in 1958 when two outbreaks of a pox-like disease occurred in monkeys being used for research. While the origin of the virus remains unknown, it was given its name due to it first appearing in monkeys. The current 2022 monkeypox outbreak is the first time in 64 years since discovery that we have seen community spread from human to human on such a large scale outside the continent of Africa.

Monkeypox presents with normal viral symptoms such as fever, malaise, headache, and weakness. This is followed by swelling of lymph nodes, rash, and the presentation of lesions. The illness typically lasts between two and four weeks and can be potentially fatal. Thus far, community spread of the virus appears to occur when another person comes in close contact with lesions, body fluids, respiratory droplets, and/or contaminated materials, such as bedding from an infected person. There are limited quantities available of vaccines used to eradicate smallpox that appear effective against monkeypox; however, the Centers for Disease and Control and Prevention (CDC) is not yet recommending widespread vaccination but rather a more heightened focus on educating communities on how monkeypox is contracted and steps to be taken to prevent further human to human transmission if monkeypox is in your community. These steps include avoiding the following with individuals with monkeypox:

Avoid close, skin to skin contact.
Do not kiss, hug, or have sexual contact.
Do not share eating utensils or cups.
Do not handle or touch bedding, towels, or clothing of a sick person.

While cases of monkeypox continue to rise, most public health experts believe it will not be as widespread as the COVID-19 pandemic as it does not appear to be as transmissible at this time.

What Can Communities Do to Stay Safe?

Whether it is monkeypox, new variants of COVID-19, or any future emerging infectious disease, the mitigation and preparedness measures with widespread viruses circulating in a community remain the same. Proven measures include:

Masking. Wearing a well fitted N95 or KN95 mask when in an indoor crowded setting not only will continue to protect against COVID-19 but other respiratory viruses such as cold and flu.
Increase ventilation indoors. While outdoors is always better than indoors, creating air exchanges indoors to move any viral particles out of the air goes a long way. Open windows or doors to allow for fresh air to circulate inside the space. In spaces without windows, consider investing in an air purification system. There are many systems available, and you should look for one that creates air movement while utilizing high level HEPA filtration to clean the air.
Wash your hands often. Frequent hand washing is one of the best ways to prevent the spread of COVID-19, monkeypox, and other viruses. Throughout the day, we all touch many common surfaces and then scratch our faces, eyes, or rub our noses without realizing. Viral particles spread from common surfaces to our hands. Hand washing or use of alcohol-based hand sanitizer when you cannot wash your hands must be done for 20 seconds to kill viruses. In addition, when washing your hands, it is important to clean all surfaces including palms, under nails, between fingers, the back of your hands, and even up to your wrists. Remember to wash your hands before you prepare food and eat, after using the bathroom, and after touching any common surfaces.
Get Vaccinated. Three doses of a MRNA vaccine continue to show strong results keeping people out of hospitals and with only mild disease if they contract COVID-19. We must continue to develop our vaccines to better defend against emerging COVID-19 variants.
Isolate. When we get sick with any illness, we should isolate ourselves from others.

Communities should have strategies in place for:

Community education: Outreach and education should focus on helping people make the best-informed decisions to protect their health and the health of their loved ones. This means putting out prevention strategies for avoiding viruses and disease as well as real time data on level of risks in one’s community.
Efficient testing capacity with minimal turnaround time: Lessons learned from early 2020 when COVID-19 first emerged taught us the importance of testing availability, capacity, and rapid results turnaround in being able to quickly identify individuals with COVID-19 and isolate them from others. Last week, the White House announced that commercial labs in communities can begin testing for monkeypox. This significantly expands testing capacity as up until last week, clinicians performing monkeypox testing had to send samples to a CDC laboratory which slowed results processing times. Communities should continue to promote the importance of testing for COVID-19 or monkeypox if one thinks they were potentially exposed to help stop the spread of further viruses. Continued federal funding will be needed for states to maintain testing capacity.
Increase vaccination capacity: Plan now for administering new vaccines that may better neutralize emerging COVID-19 strains. We may not need to fully stand-up mass vaccination sites, but we will need to expand capacity come late summer, early fall when a new vaccine is scheduled to arrive. As it relates to vaccination for monkeypox, the US continues to order hundreds of thousands of vaccines but is not yet recommending widespread administration. This could change quickly and communities should plan now if mass administration of vaccines are recommended.
Increased treatment capacity: Over the last year, the US has been a few weeks behind Western European countries, like the UK, when it comes to mirroring COVID-19 trends and surges. If this continues to be the case, we must be prepared now for a rise in hospitalizations week over week and maintain healthcare capacity to care for potentially more severe disease from the BA4 and BA5 Omicron subvariants.

Emerging infectious diseases such as COVID-19 and monkeypox will continue to be with us for the foreseeable future. The faster we can adapt to basic virus mitigation measures being a part of our lives the faster we can drive down illnesses, help save lives, and keep our vulnerable populations protected.

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Hagerty Health & Wellness Tips – Staying Safe this Holiday Season

The holidays are approaching, and many families will gather to celebrate together. For the past 22 months, we have hunkered down hoping COVID-19 would go away. While this holiday season there are 50 percent less daily COVID-19 cases than last year, we still must take measures to ensure holiday celebrations can be shared safely, particularly when it comes to protecting our elderly and vulnerable populations. For those who are vaccinated the thinking has changed. It is now about personal risk level and finding ways to be as safe as possible while continuing celebrations and traditions as COVID-19 will be with us for many years to come. Collectively, we can all play a role in adapting to our new normal this holiday season and stay safe and healthy this fall and winter by taking the following steps:

Get your COVID-19 vaccine and booster. This will be the year of Happy Vax Giving, a term coined to represent the safe gathering of vaccinated friends and family. To date, approximately 59 percent of our country is vaccinated which allows this year’s holiday season to be different from last when it comes to gatherings and celebrations. For those individuals who have received two mRNA vaccines or one does of the Johnson & Johnson vaccine, consider getting the booster shot before the holiday season especially if you are above age 65, have underlying medical conditions or work in a high risk area. If there are family members and friends expected to celebrate with you that are not yet vaccinated, consider encouraging them to do so.
Get your flu shot. This could be the most important flu vaccine you ever get. The US Centers for Disease Control and Prevention (CDC) suggests getting your flu shot now. Every year, flu circulates widely in communities. The symptoms are like COVID-19 and in some cases can lead to complications requiring hospitalization. The flu is circulating widely across the country and impacting those who are not vaccinated. On University of Michigan’s campus, flu is sweeping through the student population. However, of those who contracted the flu, 77 percent were not vaccinated. Public health experts worry what will happen if flu circulates widely at the same time as COVID-19. The term twindemic has already been written about by many media outlets. It refers to two pandemics happening simultaneously and could stretch our health care systems and our doctors and nurses to the breaking point.
Consider COVID-19 testing. While the vaccine has proven to be effective against severe illness from COVID-19, there is evidence that vaccinated individuals can still carry and spread COVID-19. Therefore, another measure that can be taken to give you and others comfort is getting tested either with a rapid antigen or PCR test prior to gatherings. Encourage all at the gathering to also get tested.
Continue to wear a mask. Specifically, in settings where you do not know others’ vaccination status or areas of high community spread. Evidence shows wearing a N-95 or KN95 mask saves lives. It is often said “I wear a mask to protect you, you wear a mask to protect me.” A study published in Health Affairs compared the COVID-19 growth rate before and after mask mandates in 15 states. It found that daily spread of COVID-19 dropped by 2 percent as more and more masks were worn. In reviewing COVID-19 deaths across 198 countries, another study found that those countries that societal norms favor mask wearing had lower death rates. Lives will be saved by wearing a mask when physical distancing or when knowing one’s vaccination status is not possible.
Increase ventilation indoors. While outdoors is always better than indoors, the colder climates particularly in the Northeast and Midwest often make this difficult. Therefore, this fall and winter as you gather indoors with vaccinated individuals think about ways to increase ventilation. Even opening a window or door allows for fresh air to circulate inside the space. Creating air exchanges to move any viral particles out of the air goes a long way. In spaces without windows, consider investing in an air purification system. There are many systems available, and you should look for one that creates air movement while utilizing high level HEPA filtration to clean the air.
Wash your hands often. Frequent hand washing is one of the best ways to prevent the spread of COVID-19. Throughout the day, we all touch many common surfaces and then scratch our faces, eyes or rub our noses without even realizing it. In addition, with mask wearing we now frequently adjust and touch our masks. Viral particles spread from common surfaces to our hands or on the outside of our masks. According to the CDC hand washing or use of alcohol-based hand sanitizer when you can’t wash your hands must be done for 20 seconds to kill the COVID-19 virus. In addition, when washing your hands, it is important to clean all surfaces including palms, under nails, between fingers, back of your hands and even up to your wrists. Remember to wash your hands before you prepare food and eat, after using the bathroom, and after touching any common surfaces.
Find ways to maintain your physical and mental wellbeing. Staying physically fit and mentally healthy is more challenging than ever before. Social isolation, lack of physical activity and the anxiety brought on by living through a pandemic, losing loved ones and friends, economic loss, and more have taken their toll. Seek help from family, friends, professionals, or search for support online. Find activities that can bring joy. Take care of your physical health by finding ways to eat healthy, exercise,, meditate, or move around your home. This fall and winter staying physically fit and maintaining mental health is even more important than ever before as studies show a direct correlation to a stronger immune system.

Jeff Bokser is Hagerty Consulting’s Vice President of Healthcare Programs with strategic expertise in all aspects of healthcare operations, finance, crisis management, and recovery. Jeff has over 20 years of experience as a senior leader at NewYork-Presbyterian and Yale New Haven Health. He advanced performance and increased revenue in clinical and nonclinical settings and led innovation in daily operations and care delivery processes. Jeff is nationally recognized in the healthcare sector for his transformational leadership in the areas of emergency and crisis management; security and safety; pandemic and surge planning; and business continuity. Jeff was the system-level executive responsible for Emergency Medical Services, Emergency Management, Business Continuity, Crisis Management, Safety, Security, and Regulatory Compliance for the entire continuum of the NewYork-Presbyterian Hospital & Healthcare System enterprise. He served as Incident Commander guiding 40,000+ employees through numerous internal and external emergency response and recovery operations including Hurricane Sandy, Ebola, H1N1, and 9/11.

Above Average Hurricane Season Expected, While Wildfires Could Pose Significant Challenges in the West

On Thursday, May 20, the National Oceanic and Atmospheric Administration (NOAA) National Hurricane Center (NHC) released its initial 2021 Atlantic Hurricane Season Outlook, marking the second consecutive season to begin amidst the COVID-19 pandemic. While this year likely won’t surpass the record-breaking 2020 season that resulted in 30 named storms, the most in recorded history, scientists have indicated another above-average season is brewing; citing a combination of warmer sea surface temperatures in the Atlantic Ocean and Caribbean Sea, weaker Atlantic trade winds, and an enhanced West African monsoon.

In terms of activity, NOAA predicted a total of six to 10 hurricanes, with a potential for three to five storms reaching a major Category 3 or higher. Earlier this week, NOAA also released their predictions for the Central Pacific, pointing to a below-normal season with two to five named tropical cyclones expected through November.

News & Features: NOAA

If the past two years have taught us anything in emergency management, it’s that the days of focusing on a single incident response are over. Weather-related events are increasing in frequency and strength, the Nation’s critical infrastructure is in a dire state, and the need to address cascading impacts is becoming more and more prominent.

Last year, the disaster workforce assembled to address new challenges associated with hurricane and wildfire season during a pandemic ‒ most notably the Federal Emergency Management Agency’s (FEMA’s) declaration of “Evacuation & Sheltering Assistance under an Emergency Declaration in a COVID-19 Environment,” and addressing disaster fatigue and burnout amongst the emergency management workforce and public. While there is hope on the horizon, emergency managers, elected officials, and the public must now be prepared to address the threat of natural disasters while ensuring vaccination efforts continue to move forward.

Amplifying the dual threat of hurricane season and COVID-19, this year’s recent La Niña period has presented warmer, drier-than-normal conditions throughout the West and Southwest United States (US), leading to severe drought, dry vegetation, and below-average snowpack across many states and across the different regions. According to NOAA’s National Centers for Environmental Information (NCEI) and the National Interagency Fire Center, four Southwest states experienced their driest April-to-March period in over a century. All of these signs point to significant wildfire potential throughout these regions in the coming months.

Although the Atlantic hurricane season does not officially begin until June 1, tropical depression, flooding, and wildfire activity has already begun in the Southern and Western regions of the US.

Hurricanes and Tropical Storms

The first tropical storm of 2021, Tropical Storm Andres, developed in the Pacific in early May. The US NHC routinely starts naming storms on June 10, but Pacific storms sometimes emerge on or before the official start of the Pacific hurricane season on May 15. This is the third time in the last five years that a tropical storm has emerged before the official start of the season.

Despite the early start this year, NOAA predicted the Central Pacific region will experience near- or below-normal activity in 2021. The season will be followed by NOAA’s newly upgraded Global Forecast System (GFS), which uses updated weather models to advance understanding of hurricane genesis forecasting and heavy rainfall.

Tropical Storm Andres forming in the Pacific: Earth Observatory

The Moderate Resolution Imaging Spectroradiometer (MODIS) on the National Aeronautics and Space Administration’s (NASA’s) Aqua Satellite acquired a natural-color image of Tropical Storm Andres in the early afternoon of May 9. For most of the day and stretching into May 10, the storm sustained winds of 40 miles per hour (mph), with gusts reaching up to 50 mph. The storm weakened by the afternoon of May 10, retreating west-northwest from the edge of Baja, California.

Wildfires

Given the ongoing drought throughout much of the Western US, wildfire activity has already started to accelerate. According to incident information released by the Los Angeles County Fire Department (LACFD), the Palisades Fire started impacting Los Angeles County on Friday, May 14. At present, the Palisades Fire is currently 72 percent contained and is expected to be fully contained by May 26. To date, the fire has burned roughly 1,158 acres of the Palisades region. The LACFD said the current focus is containment, with firefighters on the scene noting the fire could potentially spread into vegetation that hasn’t burned in over 60 years. At present, there are no reports of civilian injuries or fatalities, and no damaged or destroyed structures.

Public Fire Information Website: National Interagency Wildfire Center

Flooding

In addition to the US facing risks from hurricanes, tropical storms, and wildfires, the NOAA National Weather Service (NWS) has reported major and moderate flooding throughout coastal Louisiana and Texas since May 17. Heavy rains are forecast to continue through the evening of May 21, with 2 to 3 inches of rainfall expected.

Nazrin B-va: Unsplash

The NWS issued a Flash Flood Watch for Louisiana and Southeast Texas through Friday evening. The NWS New Orleans extended their Flash Flood Warning for the Louisiana parishes of Southern Ascension, Northeastern Assumption, Southeastern Iberville, Southwest Livingston, and St. James until Friday evening, indicating that flooding is ongoing. Additionally, overnight, the NHC announced a 40 percent chance of development within the next five days for a tropical disturbance in the Gulf of Mexico ‒ potentially bringing more rain to the already saturated Gulf Coast region.

240pm Radar Update: Watching convection develop in an unstable area of the northern Gulf with strong surface convergence. Maybe be making it’s way onshore later this evening across SELA and will need to watch closely as heavy rainfall will be likely. #lawx pic.twitter.com/hozWnCqcYb

— NWS New Orleans (@NWSNewOrleans) May 20, 2021

NWS New Orleans : Twitter

Are you prepared?

Many of the challenges we faced during last year’s hurricane and wildfire season will remain prominent throughout 2021, but there are activities the whole community can undertake to prepare for this season. So, as citizens and public servants what can you do to play your part?

SLTT GOVERNMENTS

Review response and recovery plans and utilize relationships built during COVID-19;
Emphasize public messaging – communicate early and often;
Pre-position contracts for debris removal; and
Anticipate sheltering needs during a lingering COVID-19 environment.

THE PUBLIC

Plan your evacuation route;
Visit Ready.gov to make a plan for a variety of disasters, including hurricanes, flooding, and wildfires;
Review your insurance policies and gather insurance documents to determine if you’re covered under region-specific emergencies, such as flooding or hurricanes;
Take an inventory of your personal property;
Keep non-perishable emergency supplies on hand; and
Take steps to protect your home or business.

Hagerty Can Help

As the emergency management workforce and the Nation as a whole are continuously confronted with billion-dollar weather and climate events and cascading impacts of other unforeseen crises, we must continue to adapt and prepare for multiple hazards, using the recent lessons learned to improve our dual and multi response capabilities. Not sure where to start? Whether it’s related to preparedness, response, recovery, or mitigation, Hagerty Consulting is able to provide expertise and tailored solutions for your community or organization’s needs before, during, and after disasters.

Caleb Smith is a managing associate with Hagerty’s Washington, D.C. office, where he supports various workforce development initiatives for FEMA. Prior to joining Hagerty, Caleb served in roles with FEMA both as a consultant and public servant where he focused on National Flood Insurance Program (NFIP) outreach, and supported individual assistance and stakeholder engagement in response to hurricanes Harvey, Irma, Maria, and Florence. He is also a new member of Hagerty’s Situational Status (SitStat) Team.

One Year Later: How a Global Pandemic Has Changed Our Lives and What Comes Next

THURSDAY, MARCH 11, 2021 AS OF 4:30 PM EST

One year ago today, the World Health Organization (WHO) declared the novel coronavirus (COVID-19) a pandemic. At that time, worldwide, over 4,600 people were confirmed dead as a result of COVID-19 and approximately 125,000 people were confirmed to be infected with the virus. In the organization’s message, the WHO proclaimed COVID-19 was a global pandemic and encouraged aggressive action from all nations to combat the virus. The world went into lockdown, with countries closing off borders, flights being grounded, and major cities enforcing stay-at-home orders.

To date, there have been over 118.2 million confirmed COVID-19 cases worldwide, with the global death toll reaching approximately 2.6 million this week. This coming Saturday, March 13, 2021, marks the one-year anniversary since the United States (US) declared the novel coronavirus (COVID-19) a national emergency, two days after the WHO pandemic declaration.

HOW THE IMPACTS OF COVID-19 CHANGED THE WORLD

Essential workers in fields ranging from trash collection, food services, transportation, and medicine have been working on the front lines since before the pandemic declaration. Dr. Angela Chen, an ER physician at The Mount Sinai Hospital and the first doctor to diagnose New York City’s first confirmed COVID-19 case on March 1, 2020, spoke with NPR on the COVID-19 wave that decimated the City. Frontline healthcare workers initially struggled to create wards dedicated for COVID-19 patients to control the spread of a then-unknown disease. “The amount of tragedy and death that we saw — nothing in my training prepared me for it,” Chen said.

Media briefing on #COVID19 with @DrTedros. #coronavirus https://t.co/aPFXT3ex5y

— World Health Organization (WHO) (@WHO) March 11, 2020

On March 11, 2020, the World Health Organization officially tweeted that COVID-19 is a global pandemic: Twitter.com

Government agencies were among the first to shut down at the onset of the pandemic. On March 12, 2020, The Associated Press (AP) reported Congress closed the US Capitol, House, and Senate office buildings to the public, with an initial reopening date of April 1, 2020. California was one of the first states to enact stay-at-home orders, with The New York Times reporting that Alameda, Contra Costa, Marin, San Francisco, San Mateo, Santa Clara and Santa Cruz counties issued a three-week shelter-at-home order on March 16, 2020. California Governor Gavin Newsom called for the closure of restaurants and bars, and banned visits to hospitals and nursing homes unless in the case of severe circumstances, while New York Governor Andrew Cuomo ordered all nonessential businesses to close on March 20, 2020.

The US economy struggled, and still continues to struggle, under the burden of unemployment and recession. According to the International Monetary Fund, US residents out of work reached an annual rate of 8.9 percent. The Organisation for Economic Co-operation and Development (OECD) estimated COVID-19 resulted in a 60 percent decline in international tourism in 2020, with a potential to decline up to 80 percent when all of the data for 2020 were aggregated.

Veronica Benavides: Unsplash

NBC’s WKYC-3 in Cleveland, Ohio, provided a timeline of how sports and world events were canceled, starting on March 11, 2020, when a game between the Utah Jazz and Oklahoma City Thunder was postponed halfway through the game after Jazz Center Rudy Gobert was revealed to have tested positive for the virus. The following day, the NHL announced a delay to the season, while college conferences throughout the US canceled NCAA basketball tournaments. By March 24, the International Olympic Committee (IOC) postponed the 2020 Summer Olympics in Tokyo, Japan until July 23, 2021. Wimbledon had been scheduled for June 29 to July 12, 2020, but tournament organizers declared the event canceled for the duration of 2020 – the first cancelation for the event since World War II, according to The New York Times. While countries and states were placed in lockdown, there were still those who needed to continue their work, risking their health and safety in service to others.

Today, the number of Americans who know someone deceased from COVID-19 is increasing. According to the Axios-Ipsos Coronavirus Index, 34 percent, or roughly one-in-three Americans, knows someone who has died as a result of the virus. The past year has created unprecedented challenges for every industry, across every avenue of the US’ society, yet the medical community’s global efforts have helped to limit the spread of the virus and provide respite for long-term recovery.

THE CURRENT STATE OF COVID-19 AND WHAT THE FUTURE HOLDS

Shortly after the 2021 new year, vaccination efforts increased across the US. As of today, approximately 18.8 percent of the US population has received their first dose of the vaccine, and 9.8 percent have gotten their second dose. According to the CDC, the three pharmaceutical companies with emergency use authorization (EUA) to produce the vaccine include Pfizer-BioNTech, Moderna, and Johnson & Johnson. Even more companies and vaccinations, such as AstraZeneca and Novavax, are going through late-stage trials to be approved for distribution. Daily infection rates in the US have been steadily trending downwards since mid-January of this year.

Many individuals have started to look towards a brighter future, which may not be as far off as it seemed just last year. Today, President Biden signed a $1.9 trillion stimulus package into law, which will provide relief for thousands of Americans including much needed federal funding for schools and higher educational institutions; small businesses; tribal, state, and local governments; and more.

The one-year anniversary of an unprecedented global event is a memorial to the lives that have been lost, tested, and derailed. The sacrifices and work by so many people on the front lines and behind the scenes is a testament to our nation’s strength. As we move forward, may we take the lessons learned to prepare and protect the world from ever experiencing a pandemic on this level again.

Joely Bertram is an Associate in the Preparedness Division working out of Hagerty’s office in Washington, D.C.

Molly Harris is an Associate at Hagerty who works within the Communication and Operations Teams.

Ruth Anne Holiday is a Managing Associate at Hagerty, supporting both the Preparedness and Recovery Divisions.

Sarah Herchenbach is a Marketing Associate at Hagerty and leads the Situational Status Blog Team.

Hagerty Reflects on COVID-19: One Year Later

MONDAY, JANUARY 25, 2021 AS OF 4:00 PM EST

On January 24, 2020, Hagerty wrote our first COVID-19 Situation Status (SitStat) Blog post titled, “Novel Coronavirus Spreads throughout Asia and is Confirmed in the US.” At the time, there were only two confirmed cases of COVID-19 throughout the United States (US) and little was known about COVID-19s impact on the human body, its Basic Reproduction Rate (R 0 ), or the impact the impending pandemic would have on our society.

To date, the US has had 25.1 million confirmed cases of COVID-19 and the death toll across the country has reached 419,263. Currently, the US is leading countries across the world in active COVID-19 cases. Globally, the Johns Hopkins Coronavirus Resource Center reports that there have been over 99.3 million confirmed cases of COVID-19; with India ranked second in total confirmed cases (10.6 million) and Brazil ranked third with 8.8 million total confirmed cases. More than 2.1 million people have died from the disease worldwide.

Employees Assist at a COVID-19 Testing Site: Hagerty

On January 21, 2021, President Joe Biden released the National Strategy for the COVID-19 Response and Pandemic Preparedness, a 200-page plan outlining seven goals to make the country more resilient to COVID-19. This National Strategy “provides a roadmap to guide America out of the worst public health crisis in a century” and “outlines an actionable plan across the federal government to address the COVID-19 pandemic, including 12 initial executive actions issued by President Biden on his first two days in office.” Specific elements include “mounting a safe, effective, and equitable vaccination campaign; protecting those most at risk and advancing equity (including across racial, ethnic, and rural/urban lines); and immediately expanding emergency relief and exercising the Defense Production Act.”

Vaccine distribution (a key area of focus within the National Strategy) continues across the US after becoming available in December of 2020. In order to ensure the most effective and efficient transition to a pre-2020 state, individuals must consider maintaining public health measures after receiving the vaccination. The New York Time s quoted Dr. Jeffrey Shaman, an epidemiologist at Columbia University, who stressed, “If we start thinking, ‘We’ve got a vaccine, there’s a light at the end of the tunnel, we can stop [public health measures] in a couple of months’ — that’s way too soon.” The vaccine provides collective protection, herd immunity; therefore, individuals should continue to wear masks, wash hands, and social distance to avoid another resurgence of the virus. Many public health officials stress that the fight is not over and we will continue to operate in a pandemic environment until at least July of 2021.

COVID-19 Testing Site: Hagerty

COVID-19 has had lasting repercussions across the globe. The Guardian reported that the virus has resulted in $3.7 trillion in lost earnings for workers across the world, according to findings from the International Labour Organization (ILO). Women and younger workers have faced the greatest loss in hours and job losses, with the ILO noting in its yearly analysis of the global jobs market that 8.8 percent of working hours were lost in 2020, relative to 2019. The percentage is the equivalent to 255 million full-time positions.

The emergence of new contagious variants of the virus has pushed the medical community to vaccinate as many people as possible while fostering research on the efficacy of existing vaccines against the new viral strains. CBS News spoke with researchers at a high-risk biohazard lab in Durban, South Africa, where Senior Researcher Alex Sigal of the Africa Health Research Institute and Germany’s Max Planck Institute for Infection Biology said the new South African COVID-19 strain might reduce the efficacy of antibodies in patients infected with the original virus strain by a significant amount. “Ten-fold would be conservative,” Sigal told CBS News, cautioning those infected during the first wave would have little protection against the new strain. United Kingdom (UK) Prime Minister Boris Johnson also cautioned the new COVID-19 variant in the UK could prove more dangerous than the original strain, according to CNBC.

With the evolution of new strains, pharmaceutical companies such as Moderna have started work on vaccines to protect against COVID-19 variants. In laboratory tests, Moderna reported its COVID-19 vaccine creates an immune response that protects against the COVID-19 variants first identified in the UK and South Africa, according to The Washington Post. Moderna reported a response reduction to the new variants, leading the company to call for incorporating a third shot to the two-dose regimen to increase the current vaccine’s potency. In an interview with Squawk Box for CNBC, Moderna CEO Stephane Bancel added that due to the changing variants, “we decided to take into the clinic, out of an abundance of caution, a new vaccine.” The New York Times also reported setbacks stemming from China’s COVID-19 vaccines; with officials in Brazil and Turkey reporting that Chinese companies such as Sinovac have been slow to ship vaccine doses and ingredients, while Malaysian and Singaporean officials have reassured citizens the vaccines would only be approved after the government proved they were safe and effective.

Hagerty Assists at a COVID-19 Testing Site: Hagerty

Throughout the past year, Hagerty has and continues to work with health departments, healthcare associations, and emergency management agencies to prepare for and respond to the COVID-19 pandemic. Since March 2, 2020, Hagerty professionals have been directly embedded in the response to COVID-19 nationwide, supporting clients from New York to California. Hagerty continues to help create and implement innovative public health and emergency management best practices, having observed first-hand the health, safety, and security issues facing federal, state, and local government entities nationwide. From our vast experience during the pandemic, Hagerty provides clients with a robust and deeply nuanced approach to real-world incident preparedness, response, mitigation, and recovery.

Hagerty’s COVID-19 Response and Recovery

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COVID-19 Vaccinations Are Coming! How to Proactively Plan for Federal Reimbursement of Vaccine Distribution, Management, and Administration Costs

In response to the growing threat of the COVID-19 virus, on March 12, 2020, the President declared a national emergency under the Stafford Act and, and subsequently, Major Disaster Declarations in all fifty states and some of the U.S. territories. In the months since, COVID-19 cases have continued to climb nationwide and state, local, tribal, and territorial (SLTT) governments, as well as certain private nonprofits (PNPs) (e.g., hospitals), have engaged in numerous emergency response activities. Many of these entities have begun planning for pandemic response and Emergency Protective Measure (EPM) cost recovery, while simultaneously facing another important financial question – who will pay for the significant costs associated with the distribution and administration of the COVID-19 vaccine?

The federal government, through Operation Warp Speed, has stated that the cost of the vaccine itself plus a standard vaccine administration personal protective equipment (PPE) kit will be covered directly by the federal government; however, many SLTT governments and health care providers must still determine how the costs for distribution and administration of the COVID-19 vaccine will be managed. Last week, the Federal Emergency Management Agency (FEMA) became one of the first federal agencies to specifically address how it will reimburse for COVID-19 vaccine-related costs. In this post, we will examine FEMA’s guidelines and offer suggestions to begin planning for your longer-term cost recovery now.

Spotlight: FEMA’s Role in COVID-19 Vaccine Cost Reimbursement

As previously outlined, FEMA offers reimbursement for certain eligible costs related to COVID-19 emergency activities under the FEMA Public Assistance (PA) Program to provide relief to SLTTs and PNPs. The FEMA PA Program is complex, and PA policies have evolved over the course of the pandemic. Many eligibility issues remain unclear and the role that different federal agencies will play in vaccine-related cost recovery has yet to be fully determined. However, FEMA’s recent COVID-19 Pandemic: Vaccination Eligibility FAQ sheds some light on how SLTTs and healthcare providers can plan for the eventual vaccine distribution and what activities may be eligible for FEMA PA reimbursement specifically. Here is what you should know about what may be eligible for FEMA PA reimbursement:

PPE, other equipment, and supplies for storing, handling, distributing/transporting, and administering COVID-19 vaccinations:

PPE includes items necessary for proper handling and administration of vaccines as well as handling dry ice for storage and transportation needs;
Equipment includes, coolers, freezers, temperature monitoring devices, and portable vaccine storage units for transportation;
Supplies include emergency medical supplies (for emergency medical care needs that may arise in the administration of the vaccine), sharps containers (for medical waste), and supplies necessary for proper storage like cannisters of liquid nitrogen or dry ice; and
Transportation support includes refrigerated trucks and transport security when reasonable and necessary.

2. Facility support costs, including leasing space for storage and/or administration of vaccines, utilities, maintenance, and security.

3. Additional staff if necessary, including medical and support staff not paid for by another funding source, consistent with FEMA PA labor policies.

4. Onsite infection control measures including PPE for staff as well as cloth face coverings for patients, temperature scanners, physical barriers (e.g., plexiglass dividers), and disinfection of the facility in accordance with the Centers for Disease Control and Prevention (CDC) guidance.

5. Emergency medical care associated with vaccine administration (e.g., to address allergic reactions to the vaccine or other emergency medical needs that arise in the administration of the vaccine).

6. Medical waste disposal.

7. Communications to disseminate public information regarding vaccinations.

Considerations for Your COVID-19 Vaccine Cost Recovery Efforts

Although some federal agencies are still determining how vaccine-related distribution and administration (and the related costs) will be finalized, there are steps that SLTTs can take now to set up for a more successful cost recovery in the future. As with many recovery efforts, tracking all costs and procedures related to the COVID-19 vaccine distribution and administration separately from other COVID-19-related costs that have been or will be incurred will be critical to maximize cost recovery. More specifically, we recommend SLTT government agencies consider these five key costs, activities, and practices now as part of your COVID-19 vaccination planning efforts to maximize your cost recovery outcomes in the future:

Staffing: Utilizing budgeted labor (i.e., existing force account staff) versus unbudgeted labor (i.e., hiring temporary workers or contract employees) can have significantly different cost recovery implications. Some federal programs, such as FEMA PA, will generally only reimburse overtime for budgeted labor, but may reimburse straight-time and overtime for unbudgeted labor. It is important to consider your staffing options and how that may impact your long-term cost recovery.
Procurement and Contracting: Improper procurement is one of the primary reasons that federal funding – particularly funding provided through programs like FEMA PA – may be clawed back or deobligated. Ensuring that the costs your State agency is incurring related to COVID-19 vaccinations follow procurement procedures and contracting practices that are incompliance with federal regulations and guidance will maximize your chances for federal cost recovery later.
Documentation: Documentation of decision points and rationale related to COVID-19 vaccine storage, administration, staffing, and distribution can be critical to some of the eligibility of your COVID-19 vaccine cost recovery. In addition to documenting key decisions, it is critical to maintain all cost-related documentation including, but not limited to:
- Equipment and supplies related to storage, distribution, or administration of the COVID-19 vaccine; and
- Communications or dissemination of public information regarding COVID-19 vaccination.
- Gloves and other PPE not provisioned directly by the federal government in the administration of COVID-19 vaccines.
Duplication of Benefits: Federal agencies are legally prohibited from duplicating benefits from other sources (such as services or awards granted by the Department of Health and Human Services (HHS), including CDC, or other federal agencies, other federal awards or insurance). If your agency receives funding from another source for the same work or activities, FEMA reduces the Applicant’s amount of eligible costs by the other funding source’s amount.
Unmet Financial Needs: Keep in mind, if you are seeking FEMA PA for reimbursement for COVID-19 vaccine-related costs, barring any possible legislative changes, the Coronavirus Relief Fund (CRF) will not be available to cover a portion of the cost-share. In many states, CRF dollars have been critical for either offsetting the local cost-share that is part of the FEMA PA program. Without this federal funding source to help offset this local cost share, state agencies should consider other potential programs and funding streams to offset this financial burden.

The complexity of the pandemic response and recovery will continue to increase as the virus continues to spread, the timeline stretches, and funding programs continue to change or be added. Plans and organization enacted now will prevent the need to untangle information after the fact and increase the chances of maximizing reimbursement.

Hagerty Can Help!

Our professionals have supported state and local governments and over 100 hospitals and healthcare systems nationwide in their response to the ongoing COVID-19 pandemic. Over the past several months, our professionals have assisted our clients as they address immediate treatment needs and medical surge requirements; implement important community and facility mitigation measures; and establish vaccine distribution, management, and administration plans. We are also ensuring our clients have access to immediate resources to facilitate the ongoing response, short-term financial recovery, as well as long-term cost-recovery to ensure future readiness. Contact us to discuss how we can help you meet your preparedness, response, and recovery needs.

Hagerty Consulting (Hagerty) is an emergency management consulting firm that helps clients prepare for, respond to, and recover from disasters. For over twenty years, we have supported our clients in their preparations for, response to, and recovery from some of the nation’s largest disaster response and recovery missions including 9/11, Hurricane Katrina, Hurricane Sandy, Hurricane Irma, Hurricane Michael, the Camp Fire, as well as the COVID-19 pandemic, amongst others.

The Public Health Importance of the Operational Readiness Review and Expansion Recommendations

The Centers for Disease Control and Prevention (CDC) has developed the Public Health Emergency Preparedness and Response (PHEP) Capabilities: National Standards for State, Local, Tribal, and Territorial Public Health. Commonly referred to as PHEP Capabilities, the 2018 edition builds on lessons learned since 2011 and, most crucially, enlarged the medical countermeasure strategy to include mass vaccination. These standards inform the Operational Readiness Review (ORR) – a tool used by state and local health departments to critically analyze their medical countermeasure (MCM) dispensing operations and capacity for federal public health preparedness grant funding. The ORR, which initially only focused on four capabilities, is set to expand to all 15 capabilities. This expansion can be further built-out, and can provide an opportunity to reevaluate how communities address each capability and how state and local public health departments’ planning efforts post-COVID-19 should account for all capabilities.

CDC’s PHEP and Response Capabilities – 2018 Update: Source

The ORR Overview

At their core, ORRs are conducted to provide an evidence-based assessment process to identify strengths and challenges with operational readiness. The PHEP Cooperative Agreement (CoAg) requires awardees to complete the ORR process for federal public health preparedness grant funding.

The initial ORR process focused predominantly on large scale medical countermeasure distribution and dispensing with prophylaxis in the event of an intentional release of anthrax. The 2018 PHEP capabilities expanded scenario planning to include Pandemic Influenza, including medical countermeasure distribution for mass vaccination events. With the expansion of the 2018 PHEP capabilities, the ORR required a reimagining of its own for 2020.

The Projected 2021 ORR Expansion

The COVID-19 pandemic has highlighted gaps in public health planning, preparedness, and incident response. This moment provides a unique opportunity to take an essential step and expand the ORR process even more and improve our national capacity to accurately assess program standards across jurisdictions, offer meaningful data to demonstrate program impact, identify regional partnership opportunities, and provide an accurate picture of national public health readiness.

The inclusion of all 15 capabilities within the ORR was scheduled for Budget Period (BP) 2 in 2020, with medical countermeasure operational readiness on or by 2022. All Tier 1 capabilities were proposed to be established by 2024. As COVID-19 has strained public health preparedness resources, CDC has waived the requirement to complete the ORR for BP2. Further expansion of the ORR process and technology now would help the CDC and the PHEP program better understand recipient planning and operational strengths, areas of improvement, and technical assistance needs across all capabilities.

Recommendations for Further ORR Expansion Amidst COVID-19

The plans to expand the ORR in 2019 and 2020 did not anticipate the COVID-19 pandemic radically shifting priorities for public health practitioners. As we turn our preparedness efforts towards a new threat, the expanded ORR would play an important role in determining the nation’s next steps in preparedness, including:

Community Recovery should include economic recovery efforts that align with public health initiatives. Currently, PHEP Capability 2 focuses heavily on mental and behavioral health; however, the pace of a community’s economic recovery can have cascading impacts on the overall response and pre-incident preparedness, to include their resident’s mental and behavioral health.
Emergency Public Information and Warning must include substantial questions regarding rumor control and dispelling misinformation. Currently, PHEP Capability 4 has been crucial in fighting against misinformation and rumor control. Continuing to expand on this capability, building ORR questions directing awardees to critically analyze their capacity, and strengthening the use of social media and rumor control would develop public health’s ability to properly inform the public of their risks and how to stay safe.
Nonpharmaceutical Interventions must be highlighted in the ORR, with specific requests for metrics associated with compliance. Nonpharmaceutical interventions (PHEP Capability 11) have been an essential part of public health preparedness for a long time; however, implementation strategies have varied widely across the country and there has not been a standard way to measure their effectiveness. As we have seen during this pandemic, nonpharmaceutical interventions, such as social distancing, isolation, quarantine, and hygiene, are imperative for flattening the infection curve. Additionally, each awardee has had varying compliance metrics for the adoption of mask-wearing and social distancing within their jurisdiction. These metrics – including how many individuals were compliant and what proven behavioral change initiatives increased compliance – should be identified and reflected in the ORR to address future capabilities and improve communication of requirements.
Public Health Surveillance and Epidemiological Investigation should include the operability of contact tracing on a large scale. PHEP Capability 13 should consist of tracking, tracing, and testing a large portion of the population. States and local governments scrambled to find a proper strategy for contact tracing and often still have difficulties.

Conclusion

COVID-19 has highlighted challenges in preparedness programs and the ORR provides an established resource to review operational readiness across all 15 capabilities. Reimagining the ORR based on lessons-learned in tandem with COVID-19 After Action Reports (AARs) will position the nation for quick adaption of corrective actions.

Hagerty Can Help!

Hagerty Consulting can help your public health department with a wide array of COVID-19 preparedness and response operations, including medical countermeasure dispensing planning, AARs, and exercises. Hagerty can provide an impartial review of PHEP capabilities for your departments’ ORR, thus building a more resilient preparedness cadre.

Hagerty has developed interim response assessments and AARs during the COVID-19 pandemic to redirect response efforts, adopting best-practice methods quickly in the process. The ORR and AARs are required elements of the PHEP CoAg and serve as a trustworthy source for enhancing public health preparedness in real-time and future responses. Expanding upon the systems we already have at our disposal, and strengthening their potential use, will build upon our national capacity to respond to the next pandemic.

Alexandra Koch is a managing associate and public health emergency management professional with strong knowledge and experience in public health emergency preparedness and response. As a ORISE Fellow at the Centers for Disease Control and Prevention’s Division of State and Local Readiness she validated Public Health Emergency Preparedness (PHEP) Cooperative Agreement (CoAg) awardee data and assisted in the rewrite efforts for the 2019 – 2024 PHEP CoAg. She also has assisted Fulton County Board of Health for their Anthrax dispensing plans by optimizing POD locations using RealOpt.

US REACHES SINGLE-DAY RECORD IN COVID-19 CASES WHILE EUROPE INITIATES SECOND LOCKDOWN

THURSDAY, NOVEMBER 5, 2020 AS OF 04:30 PM EST

To-date, the United States (US) has had 9.49 million confirmed cases of COVID-19 and the death toll across the country has reached 233,767. Currently, the US is leading countries across the world in active COVID-19 cases. Globally, the Johns Hopkins Coronavirus Resource Center reports that there are 48.25 million confirmed cases of COVID-19; with India ranked second in total confirmed cases (8.36 million) and Brazil ranked third with 5.59 million total confirmed cases.

On Wednesday, the US reported 100,000 new COVID-19 cases in a single day — the highest number of new cases recorded in a single day since the pandemic began. According to the Centers for Disease Control (CDC) COVID Data Tracker, Illinois is leading the country in COVID-19 cases in the past seven days, with a total of 48,579 new cases. Additionally, 23 states have documented more active cases in the past week than in any other week-long period prior — with Nebraska, Maine, Indiana, Minnesota, and Colorado also setting single-day case records on Wednesday, November 4.

As cases continue to climb, applications for unemployment benefits have reached a historic high. The US Department of Labor (DOL) reported 751,000 citizens applied for unemployment in the past week, adding that 21.5 million people in total were still receiving some type of unemployment assistance.

Additionally, approximately 56 million school-aged children resumed education programs in August and September, with many schools opting for online-only or hybrid programming with some online components. The CDC reported 277,285 COVID-19 cases in children between March and September — adolescents ages 12 to 17 accounting for almost double the number of cases than those ages five to 11.

Unsplash: Thomas de Luze

Across Europe, countries have taken different measures to prevent the further spread of COVID-19. France has entered a second national lockdown, while Germany and the Netherlands have implemented partial lockdowns. Italy has scheduled sweeping new measures such as organizing the country into red, orange, and green zones – with red zones indicating the greatest level of infection and requiring shop closures. In the United Kingdom (UK), holiday traditions are showing signs of change as businesses organize virtual holiday gatherings for their employees. Additionally, British actor, James Bartlett, developed a website where young children can hold a Zoom call with Santa Claus before Christmas.

In India, Union Territory (UT) Director of Health Services Amandeep Kaur Kang spoke with The Tribune India and cautioned about Diwali celebrations which could lead to a second COVID-19 surge in the country.

Unsplash: SJ Objio

As the pandemic enters its eighth month, pharmaceutical companies rush to develop a vaccine. AstraZeneca, Johnson & Johnson, and Pfizer signed on to the International Federation of Pharmaceutical Manufacturers & Associations’ COVID-19 Vaccine Maker Pledge in September. The pledge commits manufacturers to “high ethical and sound scientific principles,” as determined by regulatory agencies around the world. In mid-October, the Food and Drug Administration (FDA) called for holds on vaccine trials at AstraZeneca and Johnson & Johnson due to “adverse reactions” and “unexplained illnesses,” respectively. As of October 27, clinical trials have resumed globally for both companies under guidance from the FDA.

Continue social distancing, wearing a face covering, and washing your hands frequently to help protect yourself and others around you from #COVID19. Learn more: https://t.co/1SadSf21K4. #COVIDStopsWithMe pic.twitter.com/Cu3i8BgDSx

— HHS.gov (@HHSGov) November 4, 2020

US Department of Health and Human Services (HHS): Twitter

Hagerty Consulting’s Vice President of Healthcare and University Programs, Jeff Bokser, provided further guidance on COVID-19 preventative measures:

“As COVID-19 cases continue to spike across the country, hospitals are overwhelmed trying to create capacity to care for patients. We all play a role in protecting our own health to reduce the spread of the virus and the strain on our healthcare system by consistently doing the following:

Wear a mask when physical distancing is not possible;
Remain vigilant and keep physical distance from others;
Wash your hands frequently and avoid touching your eyes, nose, and face; and
Avoid gatherings and stay outdoors as much as possible.

We are all feeling what is being called “COVID-19 fatigue” but following these measures will help get the virus under control, keep you and your families safe, and allow our communities and healthcare system to return to a sense of normalcy.”

Additionally, the CDC and ready.gov have issued general guidance and best practices to limit the spread of germs and the virus. All households should utilize the following best practices to limit virus spread and transmission:

Avoid contact with individuals who are sick or exhibiting symptoms of COVID-19;
Stay home when you are sick to protect others;
Cover your mouth and nose with a tissue when coughing or sneezing;
Wash your hands frequently and after leaving any public environment;
Avoid touching your eyes, nose, or mouth; and
Practice other good health habits, including managing sleep, getting physical exercise, managing stress, drinking fluids, and eating nutritious foods.

Stay healthy and well this winter with Hagerty’s easy-to-use health and wellness checklist:

The World Health Organization (WHO) has also issued COVID-19-specific guidance that is especially applicable to the upcoming holiday season. The following practices should be utilized when attending or hosting a small holiday or public gathering: Avoid the “3 Cs,” spaces that are closed, crowded, or involve close contact.

The Hagerty Team will continue providing information and updates on current events and disasters impacting the nation. For more precautionary information and guidance, please visit the CDC or WHO website.