New Coronavirus News from 24 Nov 2022

China's iPhone City Locks Down Urban Areas as Covid Cases Rise [Bloomberg, 24 Nov 2022]

by Jacob Gu and Foster Wong

• Zhengzhou’s moves mark a step back toward China’s tough curbs
• iPhone factory workers clashed with guards Wednesday over pay

Zhengzhou, home to Apple Inc.’s largest iPhone manufacturing site, will be largely locked down for five days as officials in the Chinese city resort to tighter curbs to quell a swelling Covid-19 outbreak.

Mobility controls -- a euphemism for lockdown -- will be imposed in the main urban areas of Zhengzhou from Friday through Nov. 29 because of rising virus cases, Zhengzhou’s pandemic task force said in a statement late Wednesday. The city reported 996 infections on Wednesday, up from 813 a day earlier.

China imposes new lockdowns as local Covid cases hit record high [The Guardian, 24 Nov 2022]

Country reports 31,444 new locally transmitted cases, the highest daily figure since pandemic began

China has imposed a fresh series of Covid lockdowns, including in a city where workers at the world’s largest iPhone factory clashed with police this week, as a record daily high in coronavirus cases tests its commitment to follow the rest of the world in easing pandemic restrictions.

The national health commission reported 31,444 new locally transmitted Covid cases on Wednesday, the highest daily figure since the coronavirus was first detected in the central Chinese city of Wuhan late in 2019.

The government responded by tightening Covid restrictions in cities, including Beijing, Shanghai and Guangzhou, and ordering mass testing.

In Zhengzhou, in the central province of Henan, where there were clashes on Tuesday and Wednesday between police and protesting workers from Foxconn’s iPhone factory, authorities announced a five-day lockdown for approximately 6 million people. Residents were ordered to stay at home and carry out daily PCR tests in a “war of annihilation” against the virus.

One worker told the AFP news agency that the protests had begun over a dispute about promised bonuses at the Foxconn factory and “chaotic” living conditions.

Foxconn, the Taiwan-based owner of the factory, which employs about 200,000 people in Zhengzhou, has been desperate to keep operations going after a handful of Covid cases forced it to lock down the facility, and it recruited new workers from across the country on favourable packages to replace the thousands who last month walked away. Employees said protests started after the company changed the terms of their pay.

Videos online showed thousands of people in masks facing rows of police in white protective suits with plastic riot shields. Police kicked and hit one protester with clubs after he grabbed a metal pole that had been used to strike him.

Many employees accepted payoffs from the company and went home on Thursday. Some said on social media that they had received bonuses of 10,000 yuan (£1,150) in return for terminating their contracts.

Foxconn apologised on Thursday for what it called “an input error in the computer system” and said it would guarantee that the pay was the same as was promised in official recruitment posters. “As for the violent incident, the company would continue to communicate with the staff and government to prevent similar incidents from happening again,” a company statement said.

The strict enforcement of China’s “dynamic zero Covid” policy for almost three years has weighed on its economy and stoked frustration among the population.

On 11 November, the government announced it would shorten quarantines and ease other restrictions, a move seen to be aimed at alleviating economic pressures and cooling public discontent. But at the same time, senior officials warned cadres not to let down their guard.

Among the new measures, Guangzhou imposed a five-day lockdown in the Baiyun district from Monday to curb the surge in cases. Residents are required to stay at home and public transport has been suspended, although areas that have not reported infections for three consecutive days could lift restrictions.

The government of the north-eastern city of Changchun, in Jilin province, urged its residents to halt non-essential movement and avoid going to public places, restaurants and public gatherings.

Shanghai tightened restrictions for arrivals to the city. A notice on the city’s official WeChat account said people travelling to the city from Thursday would be tested for Covid and barred from going to restaurants and shopping centres, among other public venues, for five days after their arrival.

Beijing has imposed new testing requirements for incoming travellers and residents. It requires a negative PCR test result within 48 hours for those seeking to enter public places such as shopping malls, hotels and government buildings. Schools across the city have moved to online classes.

Although the case numbers are relatively low compared with global figures, even small outbreaks in China often lead to lockdowns of districts and cities. Authorities this week reported China’s first Covid deaths in six months, bringing the total to 5,232.

A Zhengzhou resident who was among those scrambling to buy food in a market before the lockdown said on the social media platform Sina Weibo: “All the stalls were full of people and the prices have rocketed … no one was smiling.”

While China’s borders remain largely closed, the government has drawn up measures to facilitate the exit and entry process for foreign business executives, a foreign ministry spokesperson said.

Universal Masking Policies in Schools and Mitigating the Inequitable Costs of Covid-19 | NEJM [nejm.org, 24 Nov 2022]

By Julia Raifman and Tiffany Green

Nearly 3 years into the Covid-19 pandemic, the United States leads high-income nations in Covid-19–related mortality.1 Millions of persons now have long-term neurologic, cardiopulmonary, and other disabling conditions. Essential workers continue to face high workplace exposure to Covid-19 with few protections. To prevent Covid-19 transmission, 40 states and Washington, DC, implemented universal indoor masking policies in 2020.2 Most maintained these policies until May 2021, when the Centers for Disease Control and Prevention (CDC) replaced guidance that everyone wear masks with guidance according to vaccination status.3 Understanding the effects of universal masking policies as compared with individual masking is critical to minimizing the inequitable harms caused by Covid-19 and maximizing our ability to learn, work, and socialize during the pandemic.

Universal masking and individual masking are distinct interventions.4 Universal masking lowers the amount of virus exhaled into shared air,5 reducing the total number of cases of Covid-19 and making indoor spaces safer for populations that are vulnerable to its complications.

Individual masking lowers the amount of virus that a masked person inhales from shared air, but only in environments with a relatively high amount of circulating virus and when others are unmasked. Furthermore, individual masking has little effect on population-level transmission.

Public schools are an important context in which to understand the ramifications of moving from universal to individual masking. Although quasi-experimental studies indicated that universal masking was associated with reduced Covid-19 transmission before the availability of vaccines,6,7 we previously had little causal-inference evidence regarding the effect of universal masking in schools or as part of a layered risk-mitigation strategy with vaccination, testing, and ventilation.

A study by Cowger and colleagues, the results of which are now reported in the Journal,8 provides new evidence that the removal of universal school masking policies in Massachusetts was associated with an increased incidence of Covid-19. The study used difference-in-differences methods, a rigorous form of causal inference for policies that are infeasible or unethical to assess in a randomized trial. During a 15-week period (March to June 2022), Covid-19 cases in school districts that had ended universal school masking policies (70 districts for most of the 15-week period) were compared with cases in school districts that sustained universal masking policies (2 districts for most of the 15-week period). The removal of universal school masking was associated with an additional 2882 Covid-19 cases among 46,530 staff (an estimated 81.7 cases per 1000 staff) and an additional 9168 Covid-19 cases among 294,084 students (an estimated 39.9 cases per 1000 students) during the 15 weeks. In school districts that had ended universal masking, approximately 40% of 7127 staff cases and 32% of 28,524 student cases were associated with the removal of universal masking policies.

These findings have implications for federal and state decision making regarding universal masking policies. First, most of the benefits of universal masking accrued before county Covid-19 levels reached high CDC Covid-19 Community Levels, a metric that has been used for policy decisions. Second, school districts that ended masking policies had excess cases despite being more likely to have newer buildings and ventilation systems than school districts that sustained universal masking policies.8,9 These observations highlight the importance of universal masking as a layer of protection early in Covid-19 surges. Masking policies were associated with reduced transmission despite the transmissibility of the omicron (B.1.1.529) variant and without the type of mask specified, although specifying high-quality masks could plausibly further reduce transmission.

The findings also expose a fundamental logical flaw of individual masking: assuming that individual persons will fully absorb the costs of their own masking decisions, rather than assuming that such costs will be shifted onto others and society. Cowger et al. estimated that excess cases implied a minimum of 6500 days of staff absence and 17,500 days of student absence. These absences create costly disruptions for schools and families. Much has been made of the social costs of masking and speculation about language development. Yet strategic implementation of masking policies requires consideration of the costs of not masking — and who will bear those costs. Poor and rich school districts were “differentially equipped to respond to the Covid-19 pandemic,”8 with harms concentrated in low-income and Black, Latinx, and Indigenous communities.8,9 Participatory decision making that includes parents from these communities,9,10 as well as essential workers and persons at high risk for severe Covid-19, can strengthen consideration of societal trade-offs and center equity and inclusion.

The Covid-19 pandemic will not be without continuing costs. A prepandemic normal is unattainable in the short term, no matter how urgently we desire it. The questions for policymakers are these: how high will we allow the societal costs to be, and who will bear the greatest costs? Universal masking policies distribute a small cost across society, rather than shifting the highest burdens of Covid-19 onto populations that have already been made vulnerable by structural racism and other inequities. Strategic use of universal masking policies could include community-level implementation early in surges of new Covid-19 variants and throughout the year in select classrooms to protect higher-risk children and staff. Visionary leadership that centers the populations that are most affected and prioritizes evidence, equity, and inclusion can help us navigate policy decisions that reduce the costs and inequities of Covid-19 in the years ahead.

Disclosure forms provided by the authors are available with the full text of this editorial at NEJM.org.

This editorial was published on November 9, 2022, at NEJM.org.

Lifting Universal Masking in Schools — Covid-19 Incidence among Students and Staff | NEJM [nejm.org, 24 Nov 2022]

Authored by Tori L. Cowger, Eleanor J. Murray, Jaylen Clarke, Mary T. Bassett, Bisola O. Ojikutu, Sarimer M. Sánchez, Natalia Linos, and Kathryn T. Hall

Abstract

BACKGROUND
In February 2022, Massachusetts rescinded a statewide universal masking policy in public schools, and many Massachusetts school districts lifted masking requirements during the subsequent weeks. In the greater Boston area, only two school districts — the Boston and neighboring Chelsea districts — sustained masking requirements through June 2022. The staggered lifting of masking requirements provided an opportunity to examine the effect of universal masking policies on the incidence of coronavirus disease 2019 (Covid-19) in schools.

METHODS

We used a difference-in-differences analysis for staggered policy implementation to compare the incidence of Covid-19 among students and staff in school districts in the greater Boston area that lifted masking requirements with the incidence in districts that sustained masking requirements during the 2021–2022 school year. Characteristics of the school districts were also compared.

RESULTS
Before the statewide masking policy was rescinded, trends in the incidence of Covid-19 were similar across school districts. During the 15 weeks after the statewide masking policy was rescinded, the lifting of masking requirements was associated with an additional 44.9 cases per 1000 students and staff (95% confidence interval, 32.6 to 57.1), which corresponded to an estimated 11,901 cases and to 29.4% of the cases in all districts during that time. Districts that chose to sustain masking requirements longer tended to have school buildings that were older and in worse condition and to have more students per classroom than districts that chose to lift masking requirements earlier. In addition, these districts had higher percentages of low-income students, students with disabilities, and students who were English-language learners, as well as higher percentages of Black and Latinx students and staff. Our results support universal masking as an important strategy for reducing Covid-19 incidence in schools and loss of in-person school days. As such, we believe that universal masking may be especially useful for mitigating effects of structural racism in schools, including potential deepening of educational inequities.

CONCLUSIONS
Among school districts in the greater Boston area, the lifting of masking requirements was associated with an additional 44.9 Covid-19 cases per 1000 students and staff during the 15 weeks after the statewide masking policy was rescinded.

New Coronavirus News from 8 Nov 2022

Covid, flu, RSV: Here are the best masks and masking methods for protection against the 'tripledemic' [CNBC, 8 Nov 2022]

By Renée Onque

As we get deeper into fall season, experts are warning of a potential ‘tripledemic’ – the circulation of Covid-19, the flu and respiratory syncytial virus (RSV), all at the same time.

Infections from the new “Scrabble” variants are increasing, hospitalizations from RSV are skyrocketing at a terrifying pace, and the Centers for Disease Control and Prevention warns that there are early increases of seasonal flu activity.

“Wearing a high-quality mask…when you’re indoors in public places, will certainly reduce your risk,” Dr. Céline Gounder, an infectious disease specialist and epidemiologist, told CNBC Make It.

But the type of mask you use and how you wear it are also significant and can determine how protected you will be from the viruses that are spreading, says Bill Taubner, president of Bona Fide Masks Corporation.

Here’s what Taubner says you should consider when masking.

The best masks for the most protection
The CDC ranks protective face masks in this order:
• Highest level of protection: N95s and other respirators approved by the National Institute for Occupational Safety and Health
• Great protection: KN95s
• Great protection: Well-fitting disposable surgical masks
• Decent protection: Layered finely woven products
• Least protection: Loosely woven cloth products

Similar to the CDC, Taubner recommends N95 and KN95 masks, especially in high-risk settings like hospitals or mass transit.

“The KN95 and N95 [masks] have a particulate filtration efficiency of 95% or above,” Taubner explains.

“Cloth masks [without filters], which don’t have a minimum threshold, probably test in the neighborhood of 20% or 30%.”

But it’s important to keep in mind that, depending on where you purchase your KN95 and N95 masks, you could be receiving less protection than you think, he says.

“People started testing them in labs, and they found out that the vast majority of these KN95s weren’t even coming close to meeting any of these standards,” Taubner says.

When purchasing masks, he suggests:
• Buying from a reputable company
• Seeking out companies that are transparent about their supply chain, including listing their manufacturer
• Referring to the CDC’s guidance for masks

Masking methods for the most protection
Once you have a high-quality mask, you want to also make sure that you’re wearing it correctly to reduce your risk.

Taubner recommends these masking methods for optimal use:
• Avoid leakage which are open areas at the top, bottom or sides of your mask
• Make sure your hands are clean before touching your mask
• Only touch the outside of your mask
• If applicable, push the metal nose piece down for a snug fit

Here’s when to keep and when to toss your mask
Taubner also advises against using the same mask two days in a row.

The CDC reports that “data from surface survival studies indicate that a 99% reduction in infectious SARS-CoV-2 and other coronaviruses can be expected under typical indoor environmental conditions within 3 days.”

After one use, you should store a KN95 mask in a paper or plastic bag, note the date, and reuse it after at least four days have passed, says Taubner.

When in doubt, you should look to the manufacturer’s specific recommendations for the product.

But if you’ve visited a high-risk area, it’s probably best to toss your mask after one use, he notes.

And if your mask ever becomes difficult to breathe in after multiple uses, you should throw it away as well.

N95 masks are technically single-use products, says Taubner, but the CDC offers guidance on the best way to reuse them when they’re in short supply.

Another important reminder is that certain masks, including KN95 and N95, lose their efficiency when they’ve been washed, he adds.

“Let’s put it this way, a cloth mask is better than no mask. A three-ply mask is better than a cloth mask. An N95 and a KN95 would be better than the other masks,” Taubner says.

“Some just may not give you as much protection as you’d like. But in some cases, there’s no choice.”