Walgreens Targets 'Financial Wellness' With New Planning Feature

 Walgreens is putting its own spin on “financial wellness.” The pharmacy chain introduced a bank account and debit card, called Scarlet, which will see “personal finance planning tools” offered to customers, according to the announcement. The financial features are being offered in partnership with InComm Payments and are accessible via mobile app. 

Scarlet allows customers to set “up to six financial goals,” according to a spokesperson for InComm. The app also tracks cash flow and supports bill pay. Each account can be divided into four subaccounts, so families can separate household finances among different accounts, each linked to its own debit card. 

There currently is no investing option for the product, but this hasn’t been ruled out in future. “InComm Payments cannot comment on future plans for Scarlet product features,” said a spokesperson when asked about adding investments to Scarlet. InComm supports services like gift card programs and health benefits payments, but it also has a partnership with Flexa, announced in July, that allows merchants to accept digital currency.

“Scarlet is just the latest expansion in the Walgreens financial services portfolio,” said Maria Smith, vice president of payments & financial services at Walgreens, in a statement. Walgreens has its own mobile wallet, as well as third-party banking services and a credit card. “We look forward to deepening engagement with our customers, as we continue to support their personal and financial wellbeing,” she added.

Walgreens isn’t alone in eyeing financial goal-making as a business opportunity. Walmart partnered with venture capital firm Ribbit Capital, an investor in broker Robinhood, to form a fintech startup earlier this year. A few weeks after the announcement, it hired two Goldman Sachs bankers to run the to-be-named venture. While Walmart offers financial services like check cashing and credit cards, it doesn’t offer wealth management. 

For now, Walgreens is sticking with “banking and financial management solutions,” according to Stefan Happ, president of InComm Payments. The firm, he said, wants “to help make financial wellness habits more convenient and accessible than ever before.”

https://www.wealthmanagement.com/technology/walgreens-targets-financial-wellness-new-planning-feature

Vaccine mandates test Biden ties with labor

 President Biden’s strong ties to labor unions could be put to the test by his administration's embrace of vaccine mandates. 

Biden on Thursday unveiled a much more heavy-handed approach to combating COVID-19 compared to what the administration has favored in the past. 

In a speech, he scolded vaccine-hesitant and vaccine-resistant people for rising numbers of infections and hospitalizations, and proceeded to announce a series of vaccine mandates on health workers, federal employees and contractors, and even private companies.

If they don't comply, they could face steep fines.

Labor unions are divided over the approach, as they seek to balance the need for workplace safety with addressing anti-vaccine sentiment among some of their members. 

Many unions have walked a fine line, encouraging members to get vaccinated without endorsing mandates.

But as private sector mandates have grown in popularity, unions have increasingly stressed the need for any potential measures to be collectively bargained before going into effect. 

The response to federal mandates was no different. 

“Our union has said that we should be working with, not opposing, our employers on their vaccine requirements, and making sure that people have a voice in their implementation to make sure that they are fairly implemented and the exemptions and the accommodations that need to happen, happen,” said Randi Weingarten, president of the American Federation of Teachers (AFT).

In its most recent resolution on vaccines in schools, the AFT encouraged all educators to be vaccinated, but didn’t call for a strict nationwide mandate. 

Instead, the group said that “as employers establish those vaccination policies, employees must have a voice in addressing the impact on workers through bargaining or other forms of consultation.”

Teachers, like other unions, are reluctant to tie the hands of local chapters, and there are some areas of the country where vaccine mandates are not an option. 

And while the national organizations may favor mandates, some local unions, like the New York State United Teachers, said they oppose the idea. 

State and local public sector unions, like law enforcement, have largely been opposed to vaccine mandates, though the International Association of Fire Chiefs has embraced the policy and called for mandatory vaccination after Pfizer-BioNTech’s vaccine gained full approval. 

Public sector unions’ demands could slow Biden’s federal vaccination campaign, and their resistance indicates that similar efforts by states and municipalities to close the gaps could face roadblocks as well.

Biden’s announcement triggered swift backlash from Republicans, with a handful of GOP governors accusing him of federal overreach and vowing to fight him in court.

But broadly, the administration has union support. 

New AFL-CIO president Liz Shuler praised Biden’s plan, while adding that "workers and unions should have a voice in shaping these policies.”

“Workplace COVID-19 safety plans should also include mitigation measures like ventilation, removing infected individuals, masking and training workers. These are necessary to prevent exposures and, in combination with vaccines, will get us out of this pandemic,” she said.

The administration was initially hesitant to impose vaccine mandates, preferring to lead by example and let the private sector implement mandates on its own. But as the delta variant gained a foothold and vaccinations continued to lag, Biden changed course. 

“We’ve been patient, but our patience is wearing thin. And your refusal has cost all of us,” Biden said Thursday in comments directed towards unvaccinated people.

Senior administration officials have said the new rules could impact two-thirds of the U.S. workforce, though some public health experts think it should be more. 

The mandate announcement comes off a week of Biden stepping up his engagement with labor unions and trying to garner more support with the pro-worker community. 

He reiterated his campaign promise to be “the most pro-union president” at an event at the White House on Wednesday and visited workers at the International Brotherhood of Electrical Workers (IBEW) Local 313 in Wilmington, Del., on Monday.

Aaron Sojourner, a labor economist and associate professor at the University of Minnesota’s Carlson School of Management, said he doesn't think there's much of a risk of labor backlash.

“I think that [President Biden's] relationship with labor leaders in the labor movement, and popularity among members does make them more open to his leadership, and more willing to support the position he's advocating,” Sojourner said. 

“But I think part of why he's able to do it, and willing to do it, is because he knows this is actually something that will benefit working families, broadly, and the economy ... workers want to be healthy and safe, they want their families to be healthy and safe, and they don't want to catch COVID,” he added.

As part of Biden's new push to force the issue on vaccinations, federal employees and contractors will have 75 days to be fully vaccinated with limited exemptions for religious or medical reasons. There will be no testing option.

The American Federation of Government Employees and AFL-CIO, the largest federal union, said they expect to bargain over this change prior to implementation. 

“Since President Biden made his first major announcement about changing COVID-19 protocols for the federal workforce in response to the surging Delta variant, we have said that changes like this should be negotiated with our bargaining units where appropriate. Put simply, workers deserve a voice in their working conditions,” AFGE National President Everett Kelley said in a statement.

https://thehill.com/homenews/administration/571773-vaccine-mandates-test-biden-ties-with-labor

Schools start new year in the hole after pandemic drives down test scores

 States across the country are looking to bounce back from declines in recently released standardized test scores that underscored the challenges of remote learning during the first full school year of the pandemic.

The drops from the 2020-2021 academic year varied across states and school districts, but many jurisdictions reported larger decreases for math exams compared to other subjects like language arts. In states like Michigan and Tennessee, some of the sharpest declines were among minorities, students with disabilities and economically disadvantaged students.

Experts are also sounding the alarm over plunging participation rates, saying that with many statewide tests canceled in 2020 and fewer students taking the annual exams last spring, educators might not know until around this time next year just how much progress was lost after the coronavirus disrupted in-school learning 18 months ago.

“Non-participants tend to be more of the at-risk groups,” said Marianne Perie, an independent consultant who advises states on student assessments. “We're seeing minority, low-income and students with disabilities to be less likely to come into school and take the test, particularly in states where they weren't already in school.”

In Arizona, just 511,679 students took the state’s language skills test, and 520,912 took the math test. Two years earlier, roughly 740,000 students took each exam. Arizona canceled the exams in 2020.

“It is impossible to know how the students who did not participate in the assessment may have scored,” Arizona education officials wrote in a note accompanying the results. “Students who were not assessed may need additional supports next school year than what the results of this report implies.”

In Tennessee, officials said test scores fell more sharply in the two school districts that taught their students primarily remotely last year. But those districts, which include schools in Memphis and Nashville, teach higher proportions of at-risk students, a factor potentially driving the gap, Perie said.

“We just don't have the good data on how many hours students were remote versus how many hours they were in person,” Perie said. “That's what we need to be able to do the analysis.”

Test scores are often used to assess school performance, but the Department of Education granted the vast majority of states waivers for federal accountability and other requirements during the 2020-2021 school year.

Some states are taking steps to suspend their own educational requirements. In North Carolina, Gov. Roy Cooper (D) signed a bill on Aug. 30 to prevent last year’s standardized test results from affecting school performance grades.

Katharine Strunk, director of Michigan State University’s Education Policy Innovation Collaborative, said failing to account for the gaps among test-takers could prove problematic.

“If you're going to only hold people accountable for certain groups of students who took the test, and you're not going to think about how to adjust on those populations – and most districts won't be able to adjust on the population – I think that that's going to lead to a lot of trouble,” she said.

In Virginia, all schools are being given an “accreditation waived” rating. Officials announced late last month that 54 percent of students passed the Standards of Learning math exams, 59 percent passed science and 69 percent passed reading. The scores mark sharp drops from 2019, when about 82 percent passed math, 81 percent passed science and 78 percent passed reading.

While Virginia’s testing participation rates have typically approached 100 percent, at least 20 percent of eligible students did not take each of the three subject-specific exams last year.

Efforts to keep schools open during the pandemic is now playing out on the national stage. President Biden on Thursday announced that his administration would require the nearly 300,000 Head Start educators to be vaccinated in addition to those working at school and youth programs operated by the Department of Defense and the Bureau of Indian Education. He also called on governors to require vaccinations for all teachers and staff.

"We know that if schools follow the science and implement the safety measures – like testing, masking, adequate ventilation systems that we provided the money for, social distancing and vaccinations – then children can be safe from COVID-19 in schools," Biden said.

Republicans like Florida Gov. Ron DeSantis have pushed back on Biden's push for masks in schools, with an appeals court Friday granting DeSantis's emergency appeal to reinstate a ban on school mask mandates.

Even as test scores have slipped, advocates and experts say educators’ efforts to adapt to remote learning helped mitigate the declines.

“It wasn't a completely lost year,” said Abby Javurek, the vice president of future impact and growth at NWEA, a not-for-profit assessment creator formerly known as the Northwest Evaluation Association. “Our students did grow. They didn't grow as much as we would hope and we would expect in a normal year without all these crazy circumstances, but they did grow, and there is hope in that.”

But she added that the scoring disparities underscore longstanding educational inequities among at-risk groups.

“It really calls to attention all the work that we have to do in our communities that were already marginalized prior to the pandemic hitting,” Javurek said.

As schools grapple with the highly infectious delta variant this fall, some have temporarily canceled classes or reverted to virtual learning, posing more challenges for students in the third academic year impacted by the pandemic.

“We're not going to do anyone favors if we approach the need to accelerate learning by accelerating it in a way that has us putting significant chunks of content or just speeding through things to try to cram more in,” Javurek said. “But we will do good by our kids if we are pretty thoughtful about how we expand the learning time in some meaningful ways.”

https://thehill.com/homenews/state-watch/571789-schools-start-new-year-in-the-hole-after-pandemic-drives-down-test

In Physician-Assisted Suicide,, Lung Cancer Patients often did not consult with radiation or medical oncologists

 Patients diagnosed with lung cancer who opted for "medical assistance in dying" often proceeded without consultation with their radiation oncologist or medical oncologist, a researcher said.

In a Canadian study of 45 individuals diagnosed with lung cancer who used medical assistance in dying (also known as physician-assisted suicide), about 20% did not have a radiation oncologist involved when making the decision and 22% did not have a consultation with a medical oncologist, said Sara Moore, MD, of Ottawa Hospital Research Institute of the University of Ottawa.

In the time since medical assistance in dying became law in Canada through court intervention in 2016, about 60% of those seeking to end their life in that way had been diagnosed with cancer, Moore explained in an oral presentation at the virtual World Conference on Lung Cancer.

The designated discussant for the study, Monica Malec, MD, a geriatric and palliative care physician at the University of Chicago, said the study is the first to evaluate medical assistance in dying in patients with lung cancer, oncologists' involvement, and treatment history.

"The demand for medical assistance in dying is increasing and is becoming more readily available to patients," Malec said. "Patients are seeking this option despite the availability of more effective and more tolerable treatment options. Existing literature suggests that loss of autonomy, control, and dignity are the primary drivers for seeking medical assistance in dying rather than uncontrolled symptoms, and the decision to pursue medical assistance in dying may occur pre-illness."

Moore noted that while lung cancer accounts for 20%-25% of all cancer deaths overall, in the current study 17.5% of the patients had lung cancer diagnoses. "Lung cancer comprises slightly fewer medical assistance in dying cases than expected compared to lung cancer death rates," she said.

"Biomarker-driven targeted therapy and immunotherapy offer effective and tolerable new treatments, but a subset of patients undergo medical assistance in dying without accessing -- or, in some cases, without being assessed for -- these treatment options," Moore continued. "Most patients were assessed by an oncology specialist, though less than half received systemic therapy."

"Given the growing number of efficacious and well-tolerated treatment options in lung cancer, consultation with an oncologist may be reasonable to consider for all patients with lung cancer who request medical assistance in dying," she said.

Moore and her colleagues reviewed data from the Ottawa region, and identified 256 patients with a cancer diagnosis who had used medical assistance in dying. Non-thoracic malignancies accounted for 208 of those individuals, and three others were diagnosed with mesothelioma. The remaining 45 patients had a lung cancer diagnosis.

Thirteen of these patients had no biopsy confirmation of their disease, but nearly all (91%) of the patients who opted for medical assistance in dying were diagnosed with metastatic disease. The time from diagnosis to death in this population was 17 weeks.

The patients in the study were about 72 years old, and 64% (29 of the 45 patients with lung cancer) were women, even though men are more often diagnosed with lung cancer, Moore noted.

About equal percentages of the individuals were in relationships, single, or widowed. About 85% of the patients in the study had a history of tobacco smoking, and 36% were current smokers at the time they sought medical assistance in dying, Moore reported.

Study limitations, she said, are that the results pertain to a single region only, and there was a lack of information on patients' decision-making process.

Disclosures

Moore disclosed no relevant relationships with industry.

Malec disclosed no relevant relationships with industry.

Primary Source

World Conference on Lung Cancer

Source Reference: Moore S, et al "Medical assistance in dying (MAiD) in patients with lung cancer" WCLC 2021; Abstract OA02.03.

https://www.medpagetoday.com/meetingcoverage/iaslc/94429

Doctors Work to Treat, Understand Post-Vaccine Shoulder Injury

 Within a few hours of getting her first COVID-19 shot, Leah Jackson had severe pain in her left shoulder.

The New York City-based veterinarian said the nurse lodged the shot "extraordinarily high" into her left shoulder, hitting the bursa rather than the deltoid muscle. When the nurse got resistance, she redirected the vaccination into the joint space, Jackson said.

As a veterinarian, Jackson is well versed in giving injections: "This was just poor administration technique," she told MedPage Today.

For weeks, she had severe pain that didn't respond to over-the-counter anti-inflammatory medications. Her primary care doctor referred her to a physical medicine & rehabilitation specialist who, after confirming bursa and joint inflammation on imaging, prescribed steroid and lidocaine injections along with physical therapy.

The pain largely resolved but returned, albeit to a lesser extent, after 6 weeks, and a follow-up MRI confirmed persistent bursa inflammation.

Jackson can still do her job as a veterinarian, but it can be painful lifting animals during surgery, for instance. Sometimes it hurts while driving.

"I just can't move my arm in certain motions," she said.

Shoulder injury related to vaccine administration, or SIRVA, has been documented long before COVID-19 vaccination, and is most frequently reported after influenza vaccination. However, the medical community cautions that it's more of a medicolegal determination rather than a distinct diagnosis at this point.

The condition is also plagued by the lack of a solid evidence base, and causality is difficult to pin down.

Still, most physicians interviewed by MedPage Today say it's likely that improper injection technique could lead to shoulder injury, and that these problems should be taken seriously and treated appropriately.

"We're certainly not seeing a pandemic of SIRVA" with COVID vaccines, D.J. Kennedy, MD, chair of physical medicine & rehabilitation at of Vanderbilt University Medical Center in Nashville, told MedPage Today. "It's really rare and the literature to date is mostly case reports. But I do think it's possible, absolutely" for vaccine-related shoulder injury to occur.

What Is SIRVA?

Laura Keeling, MD, an orthopedic surgeon at MedStar Georgetown University Hospital in Washington, D.C., told MedPage Today that part of the reason SIRVA remains in the medicolegal realm is that it's "more of a constellation of symptoms and findings" rather than a specific diagnosis.

Symptoms can vary depending on where the aberrant shot landed, resulting in various manifestations such as bursitis, tendonitis, or adhesive capsulitis (also known as "frozen shoulder").

Generally, it's characterized as a "constellation of shoulder pain and reduced range of motion that occurs within 48 hours of vaccination and does not resolve within 1 week," according to a recent paper Keeling co-authored. It's also different from typical post-injection soreness, as the pain is more severe and it can impact mobility and function.

Treatments generally include anti-inflammatory drugs, corticosteroid injections, and physical therapy. Sometimes surgery is needed to treat an underlying pathology such as an exacerbated rotator cuff injury.

Patients with SIRVA often land in their primary care physician's office first. They may be referred out to a specialist such as a physiatrist or an orthopedic surgeon.

"It's the patients who have persistent symptoms who are referred to orthopedic surgeons," Keeling said. "If physical therapy and injection don't work, then primary care refers to us."

Physical medicine & rehabilitation physicians, or physiatrists, also play a large role in treating SIRVA.

"We treat based on a full evaluation including history and physical findings, and imaging if needed," Kennedy said. "Then we develop a comprehensive rehabilitation plan ... that usually involves doing range of motion and strengthening exercises on a daily basis."

Scott Noren, DDS, an oral surgeon in Ithaca, New York, said he also developed significant pain in his left shoulder after his second COVID shot in early February: "It went in pretty deep and pretty high," he told MedPage Today.

An MRI revealed fluid collecting in his joint, as well as adhesive capsulitis, he said. Physical therapy helped improve his range of motion to an extent, but his pain lingers. It's difficult to take x-rays and do long procedures as an oral surgeon: "I have pretty good pain even with just normal function now," he said.

Both Noren and Jackson said their insurance covers their medical bills, and they both feel relieved that they can still work, but they're frustrated that there's no federal protection for SIRVA related to COVID-19 vaccines.

"There's no compensation for something that's painful and debilitating that was a medical error," Jackson said.

History of SIRVA

Keeling and Brent Wiesel, MD, also an orthopedic surgeon at MedStar Georgetown University Hospital in Washington, D.C., recently published an overview of SIRVA in the Journal of the American Association of Orthopaedic Surgeons, stating that it's a "rare yet increasingly recognized complication of immunization."

They noted that the term "SIRVA" was introduced in 2010 by a team of physicians with the Vaccine Injury Compensation Program (VICP) who reported on 13 petitioners presenting with severe vaccine-related shoulder pain that persisted for longer than 6 months.

In 2012, a National Academy of Medicine report concluded that deltoid bursitis may be causally associated with immunization. Five years later, SIRVA was added to the Vaccine Injury Table, which guides allowable claims in federal vaccine court.

Since then, SIRVA claims have ballooned, rising from 10 in 2011 to 433 in 2016, according to the paper. As a total percentage of claims, SIRVA rose from 1.8% to 40.7% during that time, they reported.

Wiesel and Keeling's paper notes that since the VICP was created in the late 1980s for childhood vaccine injury, the demographic has shifted, with more than 50% of claims now involving adults.

While healthcare providers anticipate a sharp increase in reported cases in the coming year given the large volume of COVID vaccinations, Wiesel and Keeling warned that data on the condition are still limited -- they're "virtually absent from the orthopedic literature" -- and that the "current understanding of the diagnostic workup of SIRVA is limited to the medicolegal realm."

Shoulder Injury and Vaccine Court

Instead of falling under the VICP, COVID-19 vaccines are covered under the Countermeasures Injury Compensation Program (CICP). Both programs are administered by the Health Resources and Services Administration (HRSA).

A spokesperson for HRSA confirmed to MedPage Today via email that despite full FDA approval, Pfizer's COVID-19 vaccine (Comirnaty) still remains covered under the CICP and does not yet move to the VICP.

The HRSA spokesperson said the CICP covers "eligible serious injuries" -- generally, those that require hospitalization or that lead to significant disability.

Claimants must prove the vaccine caused the injury, unless it's covered under an injury table for CICP. However, such a table does not exist yet for the CICP, the spokesperson said.

"An injury table for COVID-19 medical countermeasures will be developed when there is sufficient data to meet the 'compelling, reliable, valid, medical and scientific evidence' standard indicating that the covered countermeasure directly causes a particular injury," the spokesperson stated.

When that table is developed, those who couldn't establish a "Table" injury have a year to file a request for benefits even if their previous request was denied.

"Pending establishment of COVID-19 Countermeasures Injury Table, claims may be filed as non-Table injuries and eligibility for compensation will be determined on a case-by-case basis by the Program," the spokesperson said.

Jackson and Noren said SIRVA attorneys advised that their injuries would not likely be compensated under the CICP.

Keeling and Kennedy both emphasized that while SIRVA requires further study, it does appear to be rare, and that the benefits of vaccination against COVID-19 far outweigh any potential risks.

"Despite the risk of SIRVA, given the notable personal and public health benefits of vaccinations, particularly in light of the coronavirus pandemic, we strongly recommend that patients receive vaccinations," the Wiesel and Keeling paper stated.

https://www.medpagetoday.com/special-reports/exclusives/94434

Inner-City School Vision Program Misses the Mark in Raising Most Test Scores

An intervention bringing vision screening and free eyeglasses to schools had limited success raising children's academic performance, a cluster-randomized trial found.

The first 41 Baltimore public schools randomized to receive the intervention had a few points added to i-Ready reading test results from 2016 to 2017 for their elementary and middle school students (effect size 0.09 SD units, P=0.02). Girls and special education students were among those deriving particularly large benefit from the program during the 2016-2017 school year, according to Megan Collins, MD, MPH, of Johns Hopkins University School of Medicine in Baltimore.

Yet reading on the Partnership for Assessment of Readiness for College and Careers (PARCC) test did not budge for students as a whole, nor did math scores on either i-Ready or PARCC tests. Ultimately, the intervention, known as Vision for Baltimore, failed to show any significant academic benefit after 2 years, the researchers noted in their study of 2,304 children in JAMA Ophthalmology.

"These findings underscore that for SBVPs [school-based vision programs] to maximize impact, they must not only provide eyeglasses but also ensure mechanisms for monitoring wear, replacement, and connection to community eye care clinicians for long-term care," the investigators argued.

"Now we have very compelling evidence that kids who get glasses through school-based programs can do better academically," Collins told MedPage Today in a phone interview. "It really is a call-to-action for us as a community to think about how we can expand and build upon programs like this."

The program provided vision screenings for all students in the Baltimore City Public Schools, as well as eye examinations and Warby Parker eyeglasses free-of-charge to those who required them through a mobile in-school eye-care program.

"Vision for Baltimore demonstrated success in identifying and correcting vision deficits for students in Baltimore, many of whom may have never previously accessed vision care," the study authors wrote.

In the U.S., vision screenings are required for school-age children in 39 states. However, past studies have shown that children of lower socioeconomic status may be less likely to see an eye-care specialist or use screening services.

School-based vision programs may be all the more important during the COVID pandemic, Collins suggested.

"Across the country, we have a large number of kids who missed their vision screenings last year that would have been screened at the state-mandated levels," she said. "We're also seeing way more nearsightedness in kids than we've ever seen before, largely felt to be attributed to so much screen time."

"So we have kids who haven't been screened, we have kids who are more likely to be myopic, and throw in the picture the learning loss that has happened over the past year, school-based vision programs have a very important place as we pivot towards the talk of recovery," she emphasized.

Her group's cluster-randomized clinical trial ran from 2016 to 2019 and comprised three groups of schools from the Baltimore City School District:

• 41 schools starting the intervention in the 2016-2017 school year (n=964)
• 41 schools starting in 2017-2018 (n=775)
• 38 schools starting in 2018-2019 (n=565)

Only students in grades 3-7 who required eyeglasses and whose parents consented were included in the study. Girls represented 54.7% of the study population, and Black and Hispanic students made up 77.6% and 16.8%, respectively.

In Baltimore, the i-Ready reading and math tests are given three times a year in addition to the state-mandated annual PARCC test.

Collins and colleagues noted that compliance data, whether individuals wore their eyeglasses, were not collected, which could have affected the results of the study.

In addition, they were unable to measure the impact of the program on students in kindergarten through second grade due to lack of pretest data.

"The critical years that a child is learning to read is kindergarten through third grade, and there are a lot of predictive indicators in how well [a student] is reading in third grade for their academic trajectory beyond. So one of the opportunities for future work, given that we now know that glasses help kids read, would be looking at a younger population," Collins said.

Disclosures

The study was funded by the Abell Foundation, Laura and John Arnold Foundation, and Hackerman Foundation.

Collins reported receiving personal fees from and previously serving as a consultant for Warby Parker, a company that manufactures the eyeglasses provided in the Baltimore vision program.

Primary Source

JAMA Ophthalmology

Source Reference: Neitzel AJ, et al "Effect of a randomized interventional school-based vision program on academic performance of students in grades 3 to 7: a cluster randomized clinical trial" JAMA Ophthalmol 2021; DOI: 0.1001/jamaophthalmol.2021.3544.

https://www.medpagetoday.com/ophthalmology/generalophthalmology/94463

Masks Limited COVID Transmission in Unvaxxed College Kids

 Masking worked, along with fewer exposure encounters, to help limit the incidence of COVID-19 infection among largely unvaccinated university students in Missouri, researchers found.

Among nearly 400 close contacts of students who tested positive for SARS-CoV-2, the likelihood of a positive test result was more than five times higher in situations where at least one of the two individuals was unmasked versus situations where both were masked (adjusted odds ratio [aOR] 5.4, 95% CI 1.5-36.5, P=0.008), reported Terri Rebmann, PhD, RN, of St. Louis University in Missouri, and colleagues.

Notably, multivariate analyses found that any additional exposure was linked with a 40% increase in the chances of contracting SARS-CoV-2 (aOR 1.4, 95% CI 1.2-1.6), the authors wrote in the Morbidity and Mortality Weekly Report.

"These findings reinforce that universal masking and having fewer encounters in close contact with persons with COVID-19 prevents the spread of SARS-CoV-2 in a university setting," Rebmann and coauthors noted. "Universities opening for in-person instruction could consider taking mask use into account when determining which unvaccinated close contacts require quarantine if enforced testing protocols are in place."

The St. Louis Health Department permitted the implementation of a "modified quarantine" at St. Louis University in January 2021. This protocol was "mask-dependent," where only the exposed unvaccinated-unmasked would require quarantine, while those exposed while masked were not required to quarantine. Those who came into close contact after masked exposures underwent daily health screenings, rather than quarantine.

The university enforced a mask policy in line with CDC guidelines, but also added outdoor enforcement. Unmasking was permitted exclusively while dining.

An exposure occurred when two people came within six feet of each other for at least 15 minutes over the course of 24 hours. Unmasked exposures occurred when at least one person was without a mask in close contact with others. RT-PCR testing was performed five days to a week post-exposure.

From January to May 2021, researchers performed 9,335 tests for SARS-CoV-2, and noted students may have been tested more than once. This cohort was comprised of 71% women, and 89% of students were unvaccinated.

Overall, 2.8% (n=265) of students tested positive for SARS-CoV-2, with 378 close contacts exposed. Of these, 7% (n=26) of contacts were among masked students and 93% (n=352) were among unmasked students. Overall, 31% of contacts tested positive.

However, 32% of these cases were among those with any unmasked exposure compared to 8% of those who reported masked exposures only.

The number of positive cases after unmasked exposures was also higher for the unvaccinated (33%) and those partially vaccinated (20%), compared to fully vaccinated students (0%; P=0.007). However, only 5% of students were fully vaccinated, with 6% partially vaccinated.

The analysis had several limitations, Rebmann and co-authors acknowledged. It was conducted prior to the emergence of the Delta variant, which recently demonstrated enhanced transmissibility. Due to small sample sizes, vaccination status was excluded from calculations and a single student could have been tested multiple times. Contact tracing was self-reported and most students were ineligible for vaccines during the study.

"For universities considering a similar approach, if masked unvaccinated close contacts are not required to quarantine, testing 5-7 days after exposure will be important because of the small risk for infection that could lead to secondary transmission if isolation is not implemented rapidly, especially in populations with low vaccination coverage," the authors explained.

Disclosures

Rebmann disclosed no conflicts of interest. A co-author disclosed affiliations with the St. Louis County Department of Health and industry ties to Merck and Pfizer.

Primary Source

Morbidity and Mortality Weekly Report

Source Reference: Rebmann T, et al "SARS-CoV-2 transmission to masked and unmasked close contacts of university students with COVID-19 -- St. Louis, Missouri, January-May 2021" MMWR 2021; 70(36):1245-1248.

https://www.medpagetoday.com/infectiousdisease/covid19/94464