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COVID-19: Transmission Methods, Vaccine Allocation, Remdesivir Update

The Centers for Disease Control and Prevention (CDC) has updated its guidance about the spread of COVID-19 with a scientific brief about the epidemiology of SARS-CoV-2. Evidence shows most SARS-CoV-2 infections are spread through contact with an infected person or exposure to respiratory droplets within a range shorter than six feet, and not through airborne transmission, according to the brief.

While airborne transmission is infrequent, it is possible in some situations, including:

  • in enclosed spaces;
  • after prolonged exposure to respiratory particles, often created through expiratory exertion by shouting, singing, or exercising; and
  • in environments with inadequate ventilation or air handling that allows small respiratory droplets to build up.

The agency continues to recommend proper ventilation and avoidance of crowded spaces to mitigate spread.

Equitable Vaccine Allocation Framework

The National Academies of Sciences, Engineering, and Medicine (NASEM) on Oct. 2 released a framework and recommendations to CDC and the National Institutes of Health (NIH) to ensure an eventual COVID-19 vaccine is allocated first to groups and individuals most susceptible to infection.

The framework includes four allocation phases:

  1. Phase 1 targets high-risk health workers and first responders, followed by people with comorbid and pre-existing conditions that put them at significantly higher risk, and adults ages 65 and older living in congregate living settings;
  2. Phase 2 includes K-12 school staff; child care workers; critical workers in high-risk settings in essential industries, such as food supply and public transit; people in prisons and jails; people with comorbid and pre-existing conditions that put them at moderately higher risk; people in homeless shelters or group homes; and adults over age 65 not included in Phase 1;
  3. Phase 3 includes young adults between ages 18 to 30; children under 18; and “workers in industries and occupations important to the functioning of society,” such as universities, entertainment, and goods-producing industries, with moderately high exposure risk; and
  4. Phase 4 includes everyone else residing in the United States who did not have access to the vaccine in previous phases.

Within each phase, NASEM urges the federal government to use the CDC Social Vulnerability Index, the COVID-19 Community Vulnerability Index, or a similar scale to target the effects of systemic racism and socioeconomic factors that contribute to the disproportionate impact of COVID-19 on people of color.

In its recommendations to CDC and NIH, NASEM urges the federal government to:

  • provide vaccines with no out-of-pocket costs;
  • create and fund a COVID-19 vaccine risk communication and community engagement program;
  • launch a vaccine promotion campaign;
  • create an evidence base to inform COVID-19 vaccine promotion and acceptance; and
  • allocate a portion of the COVID-19 vaccine globally through Gavi, the Vaccine Alliance.

Pilot Program for COVID-19 Testing

The Department of Health and Human Services and The Rockefeller Foundation have signed an agreement to identify and share effective approaches for using rapid point-of-care (POC) antigen tests to screen for COVID-19 in communities, with a focus on safely reopening K-12 schools. The partnership establishes a pilot program in which HHS will provide at least 120,000 Abbott BinaxNOW COVID-19 Ag Card POC SARS-CoV-2 diagnostic tests to pilot sites.

The initial pilot cities are Louisville, Ky.; Los Angeles; New Orleans; and Tulsa, Okla. In addition, Rhode Island has been selected as a pilot state.

EUA Update for Remdesivir

As of Oct. 1, hospitals can purchase Veklury (remdesivir) directly from the drug’s distributor. Previously, the U.S. government oversaw the allocation and distribution of remdesivir due to the drug’s limited supply. The Food and Drug Administration revised its emergency use authorization (EUA) to reflect changes in the distribution and allocation of remdesivir.

Visit the America’s Essential Hospitals coronavirus resource page for more information about the outbreak.

Contact Senior Director of Policy Erin O’Malley at or 202.585.0127 with questions.


About the Author

Emily Schweich is a communications manager at America's Essential Hospitals.

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