Observatory and Fast Facts

Nov. 23, 2021

CMS issues rule requiring healthcare staff to be vaccinated against COVID-19

The Centers for Medicare & Medicaid Services (CMS) issued an emergency regulation requiring COVID-19 vaccination of staff members at healthcare facilities.

The rule applies to facilities that participate in the Medicare and Medicaid programs.

“Ensuring patient safety and protection from COVID-19 has been the focus of our efforts in combatting the pandemic and the constantly evolving challenges we’re seeing,” said CMS Administrator Chiquita Brooks-LaSure. “Today’s action addresses the risk of unvaccinated healthcare staff to patient safety and provides stability and uniformity across the nation’s healthcare system to strengthen the health of people and the providers who care for them.”

The prevalence of COVID-19, in particular the Delta variant, within healthcare settings increases the risk of unvaccinated staff contracting the virus and transmitting the virus to patients, CMS said. In addition, patients’ safety and access to care also suffers when healthcare staff cannot work because they are ill or because of exposure to COVID-19, the agency said.

These requirements will apply to approximately 76,000 providers and cover over 17 million healthcare workers across the country, CMS said.

Facilities must establish a policy ensuring all eligible staff have received the first dose of a two-dose COVID-19 vaccine or a one-dose COVID-19 vaccine prior to providing any care, treatment, or other services by December 5, 2021. By January 4, 2022, staff members must be fully vaccinated. The regulation also provides for exemptions based on recognized medical conditions or religious beliefs, observances, or practices. Facilities must develop a similar process or plan for permitting exemptions in alignment with federal law.

CMS said it will ensure compliance with these requirements through established survey and enforcement processes. If a provider or supplier does not meet the requirements, it will be cited by a surveyor as being non-compliant and have an opportunity to return to compliance before additional actions occur.

Breastfeeding could prevent cognitive decline

UCLA Health researchers found that women older than the age of 50 who had breastfed their babies performed better on cognitive tests compared to women who had never breastfed. The findings, published in Evolution, Medicine and Public Health, suggest that breastfeeding may have a positive impact on postmenopausal women’s cognitive performance and could have long-term benefits for the mother’s brain.

When cognition becomes impaired after the age of 50, it can be a strong predictor of Alzheimer’s Disease (AD), the leading form of dementia and cause of disability among the elderly — with women comprising nearly two-thirds of Americans living with the disease.

Many studies also show that phases of a woman’s reproductive life-history, such as menstruation, pregnancy, breastfeeding and menopause can be linked to a higher or lower risk for developing various health conditions like depression or breast cancer, yet few studies have examined breastfeeding and its impact on women’s long-term cognition.

“What we do know is that there is a positive correlation between breastfeeding and a lower risk of other diseases such as type-2 diabetes and heart disease, and that these conditions are strongly connected to a higher risk for AD,” said Helen Lavretsky, MD, the senior author of the study and Professor in the Department of Psychiatry and Biobehavioral Sciences at the Semel Institute for Neuroscience and Human Behavior at UCLA.

The researchers analyzed data collected from women participating in two cross-sectional randomized controlled 12-week clinical trials at UCLA Health: 115 women chose to participate, with 64 identified as depressed and 51 non-depressed. All participants answered a survey and completed a comprehensive battery of psychological tests measuring learning, delayed recall, executive functioning and processing speed.

Importantly, none of the participants had been diagnosed with dementia, or other psychiatric diagnoses, such as bipolar disorder, alcohol or drug dependence, neurological disorders or had other disabilities.

Key findings from the researchers’ analysis of the data collected from questionnaires on the women’s reproductive history revealed that about 65% of non-depressed women reported having breastfed, compared to 44% of the depressed women. All non-depressed participants reported at least one completed pregnancy compared to 57.8% of the depressed participants.

Results from the cognitive tests also revealed that those who had breastfed, regardless of whether they were depressed or not, performed better in all four of the cognitive tests measuring for learning, delayed recall, executive functioning and processing compared to women who had not breastfed.

Separate analyses of the data for the depressed and non-depressed groups also revealed that all four cognitive domain scores were significantly associated with breastfeeding in the women who were not depressed. But in the women who were depressed, only two of the cognitive domains — executive functioning and processing speed — were significantly associated with breastfeeding.

Interestingly, the researchers also found that longer time spent breastfeeding was associated with better cognitive performance. Women who had breastfed the longest had the highest cognitive test scores.

Scientists identify the cause of Alzheimer’s progression in the brain

Researchers have used human data to quantify the speed of different processes that lead to Alzheimer’s disease and found that it develops in a very different way than previously thought. Their results could have important implications for the development of potential treatments, according to a news release from the University of Cambridge.

The international team, led by the University of Cambridge, found that instead of starting from a single point in the brain and initiating a chain reaction that leads to the death of brain cells, Alzheimer’s disease reaches different regions of the brain early. How quickly the disease kills cells in these regions, through the production of toxic protein clusters, limits how quickly the disease progresses overall.

The researchers used post-mortem brain samples from Alzheimer’s patients, as well as PET scans from living patients, who ranged from those with mild cognitive impairment to those with late-stage Alzheimer’s disease, to track the aggregation of tau, one of two key proteins implicated in the condition.

In Alzheimer’s disease, tau and another protein called amyloid-beta build up into tangles and plaques — known collectively as aggregates — causing brain cells to die and the brain to shrink. This results in memory loss, personality changes, and difficulty carrying out daily functions.

By combining five different datasets and applying them to the same mathematical model, the researchers observed that the mechanism controlling the rate of progression in Alzheimer’s disease is the replication of aggregates in individual regions of the brain, and not the spread of aggregates from one region to another.

The results, reported in the journal Science Advances, open up new ways of understanding the progress of Alzheimer’s and other neurodegenerative diseases, and new ways that future treatments might be developed.

For many years, the processes within the brain which result in Alzheimer’s disease have been described using terms like ‘cascade’ and ‘chain reaction.’ It develops over decades, and a definitive diagnosis can only be given after examining samples of brain tissue after death.

For years, researchers have relied largely on animal models to study the disease. Results from mice suggested that Alzheimer’s disease spreads quickly, as the toxic protein clusters colonize different parts of the brain.

The researchers believe this is the first time that human data has been used to track which processes control the development of Alzheimer’s disease over time. It was made possible in part by the chemical kinetics approach developed at Cambridge over the last decade which allows the processes of aggregation and spread in the brain to be modeled, as well as advances in PET scanning and improvements in the sensitivity of other brain measurements.

The researchers say their methodology could be used to help the development of treatments for Alzheimer’s disease, which affects an estimated 44 million people worldwide.

Fully vaccinated people can contract and pass on COVID-19 at home

Fully vaccinated people can contract and pass on COVID-19 in the home but at lower rates than unvaccinated people. These are the findings of a study of COVID-19 transmission between household contacts, led by Imperial College London and the U.K. Health Security Agency (HSA) and reported in a news release.The study was published in The Lancet Infectious Diseases.

It finds that people who have received two doses of vaccine have a lower, but still appreciable, risk of becoming infected with the Delta variant in the home compared with people who are unvaccinated. The authors stress that vaccination also reduces the risk of severe illness, hospitalization and death from COVID-19.

The analysis found that around 25% of vaccinated household contacts tested positive for COVID-19 compared with roughly 38% of unvaccinated household contacts.

Vaccinated people cleared the infection more quickly than those who are unvaccinated, but their peak viral load — the greatest amount of SARS-CoV-2 virus found in their nose and throat — was similar to that seen in unvaccinated people, which may explain why they can still readily pass on the virus in household settings.

Despite transmission between vaccinated people being possible, the researchers say it is essential for people who are unvaccinated, and those who are now eligible for boosters, to get vaccinated against COVID-19 to protect themselves from severe disease and hospitalization.

In the study, carried out by the NIHR Health Protection Research Unit in Respiratory Infections at Imperial College London, researchers enrolled 621 participants, identified by the U.K. contact tracing system, between September 2020 and September 2021, which was before vaccine boosters had become widely available in the U.K.

All participants had mild COVID-19 illness or were asymptomatic (showing no symptoms) and took swabs from their nose and throat each day for 14-20 days.

Of the 621 participants, 163 tested positive for COVID-19. Whole genome sequencing confirmed that 71 were infected with the Delta variant.

The analysis found that viral load declined most rapidly among vaccinated people infected with the Delta variant compared with unvaccinated people with Delta, Alpha, or pre-Alpha.

  However, the peak levels of virus in vaccinated people were similar to those in unvaccinated people. The researchers believe this may explain why the Delta variant is still able to spread despite vaccination.