Coronavirus updates November 2022

[missy]

Good morning. Here's the November thread. 2022 edition. Hoping next year we don't need these threads anymore.

Here's the latest plus some miscellaneous issues



"
Anticipating a winter surge, the Biden administration extended the COVID-19 public health emergency through Jan. 11, 2023. (ABC News)

Another 3.3 million Americans received their booster jab over the past week, bringing the total number of boosted to 14.8 million, according to CDC data. (Reuters)


The Supreme Court let a ruling stand which allows the Transportation Security Administration to mandate mask-wearing on planes, trains and other forms of transportation. (The Hill)

CDC Director Rochelle Walensky, MD, MPH, developed COVID rebound after being treated with Paxlovid, the agency announced.

The FDA said that clinicians providing abortion pills to patients before they are pregnant -- a prescribing method known as advance provision -- are acting without the agency's authorization, and that they could be putting patients at risk. (Politico)



A judge in North Dakota stopped the state's abortion ban from going into effect, saying it's likely the law will face constitutional challenges once it's implemented. (AP)

Missouri's health department is investigating whether a hospital violated federal law by denying a woman an abortion in a medical emergency. (ABC News)

Ob/gyn residency programs in states that restrict abortion face a difficult choice when it comes to educating their trainees on abortion: risk prosecution or losing their accreditation. (New York Times)

Pfizer said its respiratory syncytial virus (RSV) vaccine for pregnant women was 81.8% effective in preventing severe infection in infants, stating it will submit an application for approval to the FDA by the end of this year.

Scientists are exploring therapies that target human proteins for the treatment of COVID-19. (Washington Post)

Shanghai Disneyland closed indefinitely yesterday due to the COVID pandemic. (NPR)

A record number of cholera outbreaks has been reported across the globe, forcing health agencies to ration their limited supply of vaccines. (New York Times)



The FDA warned of a shortage of tracheostomy tubes, urging providers to reuse tubes or use appropriate alternatives.

Abiomed announced that the FDA granted pre-market approval to its Impella RP Flex with SmartAssist, an implanted device to treat acute heart failure for up to 2 weeks.

The CDC issued a Health Alert Network advisory emphasizing the importance of cleaning and monitoring dental waterlines, following multiple nontuberculous Mycobacteria (NTM) infections in children who were exposed to water with high levels of bacteria at pediatric dental clinics.

Voters in Arkansas, Maryland, Missouri, North Dakota, and South Dakota -- four of which are among the most conservative states in the nation -- will decide whether or not to legalize recreational marijuana in the upcoming election. (NPR)

A man accused of intentionally setting fire to a Tennessee Planned Parenthood clinic died in August, officials said. (AP)

Experts explain why the latest wellness trend -- parasite cleanses -- is "modern snake oil." (Washington Post)

An Iowa egg farm home to 1.1 million chickens has been infected with bird flu. (ABC News)
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[missy]

"

The big story​

Nearly three years since the beginning of the Covid-19 outbreak, and after endless debate about the origins of the virus, the only thing experts in national security and epidemiology can agree on is that both of these hypotheses could be true: Either an animal transmitted the virus to a human or a laboratory accident caused the first infection. Accepting that ambiguity could determine how we fare in the next pandemic.

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[dk168]

Not being able to pin down the definitive root cause of how the virus jumped from animal to human is a concern.

We may never know.

DK

 

[missy]

Not being able to pin down the definitive root cause of how the virus jumped from animal to human is a concern.

We may never know.

DK

True. I think in ten years we might know so much more than we do now. Also we’ll know much more about the vaccines. Time is the true test and only time.

 

[missy]

"

A journey to long Covid​

This year, I’ve been crisscrossing the US, meeting people affected by long Covid and the experts trying to unravel exactly what causes it and how to treat it. While the evidence is still emerging, what’s clear already is that the social and economic impacts are profound. Harvard economist David Cutler puts the cost of long Covid at $3.7 trillion in the US alone. And the condition could impair more than 140 million people worldwide. Tuesday’s story is the first of a few I’ve written on this topic. It explores some of the ways long Covid is disrupting patients’ lives and the potential solutions being studied. We’ll be telling you more in the coming weeks. To me, the five women discussed in the story represent long Covid’s stock and trade: none of them were hospitalized for acute Covid, and all suffer a number of overlapping symptoms, including fatigue, an inappropriate heartbeat upon standing and other problems of the autonomic nervous system that controls functions like blood pressure. They’re also all females in their 20s through 60s. That’s the group mostly affected by long Covid, Yale University immunobiologist Akiko Iwasakitold me. The group’s demographic features offer clues about what’s driving their chronic symptoms, according to Avi Nath, clinical director of the National Institute for Neurological Disorders and Stroke. Many diseases caused by abnormal immune responses, such as lupus, occur more frequently in women around the age of 40 and are thought to sometimes be set off by infections. SARS-CoV-2 infection might be the trigger that’s sent the immune system haywire in many of these long Covid patients, Nath said. He’s running a small, controlled trial testing two kinds of immunotherapy to treat the condition. Another trial supported by the National Institutes of Health will investigate whether Pfizer’s Paxlovid antiviral can quell long-haul symptoms by rooting out lingering vestiges of the coronavirus that may provoke the immune system. These are among more than two dozen patient trials starting up or underway that promise to yield important insights over the next year or so into the drivers of long Covid as well as therapeutic strategies for blunting its impact. We’ve only just begun to scratch the surface in understanding Covid’s lasting effects. What’s clear already is that the consequences of this viral disease will be vast and enduring — unless scientists find ways to mitigate them. — Jason Gale

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[missy]

"

Some Universities Require Bivalent COVID Booster​

— Harvard and Yale are among the few schools that make latest booster mandatory​

by Jennifer Henderson, Enterprise & Investigative Writer, MedPage Today November 2, 2022

As the U.S. braces for the possibility of a winter surge in COVID-19 cases, some colleges and universities are requiring their students to receive the new bivalent booster shot.
Among those schools are Harvard University, Tufts University, and Wellesley College in Massachusetts; Yale University in Connecticut; and Fordham University in New York City.
Institutions of higher education have said they hope to help stave off high transmission during the spring semester by being proactive when it comes to the latest COVID booster, which protects against both the ancestral strain of the virus as well as the Omicron BA.4/5 variants.

Michael Jordan, MD, MPH, executive medical director of occupational health services and university infection control health director at Tufts, told MedPage Today in an email that the institution's requirement for all eligible faculty, staff, and students to get the bivalent booster is "in accordance with the university's current COVID-19 vaccine policies and aligned with U.S. CDC guidance and based upon sound public health principles."
Jordan said the school continues to "see new cases on our campuses" and that "signals suggest that cases are starting to increase across the United States including in some counties of Massachusetts."
"The updated (bivalent) booster will provide our students, faculty, and staff protection against the two Omicron sub-variants which are currently the predominant circulating viral strains," he said.
Jordan added that the school's goal is "to keep our entire community healthy and safe from widespread, severe infection, including those who are immunocompromised or unvaccinated due to religious or medical accommodation."

Wellesley College didn't have a representative available for comment, but Sheilah Horton, PhD, vice president and dean of students, outlined its requirement and its reasoning in a letter to students dated October 11. Horton described the requirement as a "critical step to ensure that we avoid an outbreak early in the spring semester."
At Fordham University, Bob Howe, associate vice president for communications and special adviser to the university president, told MedPage Today in an email that the bivalent booster requirement isn't necessarily a new one.
"We have been requiring boosters since they were first rolled out, and have been using the CDC's definition of up-to-date as the requirement since December 2021," Howe said.
Notably, there have been reports of pushback regarding bivalent booster requirements at colleges and universities, according to Inside Higher Ed.
It also appears that few other institutions have enacted such a requirement.
Anita Barkin, PhD, MSN, NP-C, co-chair of the COVID-19 Task Force at the American College Health Association (ACHA), told MedPage Today that, anecdotally, the association has not seen a widespread increase in requirements for boosters at colleges and universities across the country.

In some cases, that may be the result of variations in what state laws dictate about COVID vaccine requirements on college campuses, she noted.
Barkin said if institutions do require students and faculty to get the bivalent booster, their rationale should be clearly communicated.
"The American College Health Association has been very clear in stating that we support vaccination, the initial series and the boosters," Barkin said. Their main reason for doing so is to "protect our most vulnerable students and staff and faculty."
When asked about students who may have recently recovered from COVID-19, Barkin noted that there are generally exemptions -- such as medical or religious exemptions -- when it comes to vaccination policies. Thus there should be some flexibility in terms of potentially allowing a student to delay vaccination or boosting in the wake of a documented infection, she said.
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[missy]

"

Vax Protection Against Omicron More Durable for Adolescents Than Young Kids​

— Approved vaccines for young children "no match" for Omicron's immune evasion, researcher says​

by Zaina Hamza, Staff Writer, MedPage Today November 2, 2022

Protection with mRNA vaccination for COVID-19 faded rapidly against infections from the Omicron variant in younger children, though proved more durable in adolescents, likely due to the higher dose, real-world data from Qatar suggested.
In kids ages 5-11, vaccine effectiveness with a primary series of Pfizer's vaccine (Comirnaty) was 25.7% (95% CI 10.0-38.6), falling from 49.6% immediately after the second 10-μg dose to a negligible and non-significant 11% after 3 months, according to Hiam Chemaitelly, PhD, of Weill Cornell Medicine-Qatar in Doha, and colleagues.

The number needed to vaccinate in order to prevent one documented Omicron infection was 333 in this group, they wrote in the New England Journal of Medicine.
"Currently approved vaccines for children 5-11 years provide protection against infection," Chemaitelly told MedPage Today, but this protection "was no match" for Omicron's immune evasion.
In adolescents ages 12-17, the 30-μg primary vaccine series -- the same dose of Pfizer's vaccine given to adults -- yielded an overall vaccine effectiveness of 30.6% (95% CI 26.9-34.1), but many in this group had received their vaccine months earlier.
Vaccine effectiveness was highest, at 51.3%, for adolescents who had most recently received their second dose, and 35.5% for the those who received their vaccinations during the time frame when the vaccine was rolled out for the younger group of kids, the researchers reported.
The number needed to treat to prevent one infection among those ages 12-17 was 30.3 before Omicron and 20.8 during Omicron.

"The 30-μg dose in adolescents was associated with stronger and more durable protection, a finding that suggests a role for the antigen dose in determining protection," wrote Chemaitelly and co-authors.
"Our findings suggest the need to reconsider the value and strategies of vaccinating healthy children in the Omicron era with the use of currently available vaccines," the group concluded.
Chemaitelly and colleagues compiled data from three matched retrospective cohort studies from Qatar that included 18,728 children ages 5-11 vaccinated with the approved two-dose (10 μg) primary series from February to July 2022 (Omicron period); 23,317 adolescents ages 12-17 vaccinated with the approved two-dose (30 μg) series for this age group during a pre-Omicron period (February to November 2021); and finally 17,903 adolescents vaccinated during a period that included Omicron (February 2021 to July 2022).
Each were matched 1:1 with an unvaccinated control group based on their demographics, and number of coexisting conditions. Vaccinated participants were also matched by the month of their second dose with a negative COVID test result in the unvaccinated controls. Effectiveness of the vaccine was measured starting from 14 days after the second vaccine dose. Children with a previous documented SARS-CoV-2 infection were excluded.

Cumulative incidence of infection in children ages 5-11 was lower among the vaccinated subset (2.1% vs 2.4% among controls at 110 days), as was the case for adolescents in the pre-Omicron period (0.8% vs 4.1%, respectively, at 135 days) and the longer period that included Omicron (15.9% vs 20.7% at 195 days).
In the 5-11 group, vaccine effectiveness against Omicron was stronger in the youngest kids :

• 5-7 years: 46.3% (95% CI 21.5-63.3)
• 8-11 years: 16.6% (95% CI -4.2 to 33.2)

And a similar pattern played out for adolescents ages 12 to 17 during Omicron:

• 12-14 years: 35.6% (95% CI 31.2-39.6)
• 15-17 years: 20.9% (95% CI 13.8-27.4)

Vaccine effectiveness for adolescents was highest in the pre-Omicron cohort, at 87.6% (95% CI 84.0-90.4), and the protection here waned slowly.
"Protection was approximately 95% right after receipt of the second dose and remained strong at more than 50% for at least 5 months," wrote Chemaitelly and colleagues. "Protection and waning patterns that were associated with the 30-μg dose among adolescents paralleled those among adults, although protection seemed to be slightly stronger among adolescents than among adults."

Across the three cohorts, the incidence of infections that progressed to severe, critical, or deadly COVID-19 were rare, including none in the 5-11 group; none in the pre-Omicron 12-17 group; and three cases in the Omicron adolescent group (one critical case among the vaccinated and unvaccinated subsets, and one severe case in the unvaccinated group).
The authors acknowledged limitations to the data, including potential unmeasured confounding. Testing frequency and guidelines differed among cohorts, though sensitivity analyses adjusting for these differences still found similar results. Also, since only a few infections were indicative of severe COVID-19, they could not adequately estimate vaccinate effectiveness against severe disease.



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[missy]

"

Biosecurity Incident in Wuhan; Subpar RSV Surveillance; Inside Healthcare PE Firm​

— This past week in healthcare investigations​

by Kristina Fiore, Director of Enterprise & Investigative Reporting, MedPage Today November 2, 2022

Welcome to the latest edition of Investigative Roundup, highlighting some of the best investigative reporting on healthcare each week.
Biosecurity Incident in Wuhan
In November 2019, reports from the Wuhan Institute of Virology (WIV) made references to a biosafety incident there, according to a report by Vanity Fairand ProPublica that published simultaneously with the Senate Health, Education, Labor and Pensions (HELP) Minority Committee's report last week.

Over 5 months, the two news outlets reviewed the committee's findings and conducted their own analyses of the evidence.
Central to the investigation were more than 500 documents downloaded from WIV's website, most of which were "party branch dispatches" from 2017 to the present.
Like many scientific institutes in China, WIV is state-run and -funded, and the research carried out there "must advance the goals of the Chinese Communist Party [CCP]," the article stated. The CCP operates party branches inside the WIV that meet regularly, and these groups file reports -- intended for watchful higher-ups -- that are uploaded to the WIV website, according to the article.
The documents were analyzed for the committee by Toy Reid, who has expertise in CCP "party speak," and the news outlets verified his work with outside experts.
A dispatch from party branch members at WIV's biosafety level 4 lab dated November 12, 2019 appeared to reference a biosecurity breach, and a week later, on November 19, 2019, WIV got a visitor from Beijing.

The visit from Ji Changzheng, the safety and security director from the Chinese Academy of Sciences, was billed as a safety training seminar for a small, high-level audience, according to the news outlets. But Reid interpreted the 1.5-page summary uploaded to WIV's website on November 21, 2019 as "out of the ordinary and event-driven."
Changzheng said he had "important oral remarks and written instructions" from Chinese President Xi Jinping and Chinese Premier Li Keqiang to address a "complex and grave situation," and during the meeting references were made to "hidden" safety dangers. Reid interpreted the documents to mean that the Chinese leader himself had been briefed on an ongoing crisis at WIV.
All of the outside experts contacted by Vanity Fair and ProPublica agreed that the event appeared to be urgent, non-routine, and related to a biosafety emergency.
The report also details intense pressure from the government to produce scientific breakthroughs despite a lack of resources, and raises questions about the country's ability to perform high-level biosecurity research safely.

"The WIV is under the thumb of the party state," Reid told Vanity Fair and ProPublica. "Just because you can't see the political pressures they're under doesn't mean they're not under them. American scientists have been slow to realize that."
Subpar RSV Surveillance
The nation's surveillance systems for infectious diseases including influenza and respiratory syncytial virus (RSV) are lacking, and could benefit from more real-time information, CNN reported.
Currently, national surveillance data for RSV are based on voluntary reporting from a few dozen labs that represent about a tenth of the population. While that's usually sufficient, more local, real-time information would be helpful in an atypical "sick season," such as the current one.
Efforts are underway to build on the lessons of the COVID-19 pandemic and make key data more granular and available much more quickly. Wastewater surveillance, for instance, first identified an uptick in RSV cases in August, CNNreported.

Those analyses were conducted by a private company called WastewaterSCAN, which monitors dozens of city and county sewage systems across 20 states.
"For things like influenza and RSV, you don't necessarily have to know about every person. But it is important to know- are you starting to see circulation, is it increasing, how long are we seeing circulation for, is it peaking, and when is it going down," Janet Hamilton, executive director of the Council of State and Territorial Epidemiologists, told CNN.
How One Healthcare Private Equity Firm Operates
Despite casting itself as a "noble force," private equity firm Welsh, Carson, Anderson & Stowe has relentlessly pursued profits in healthcare, attracting legal and regulatory challenges, according to a STAT News investigation.
Referred to as "Welsh Carson," it's one of the largest private equity firms specializing in healthcare. STAT News examined lawsuits, government audits, and financial documents, and interviewed more than 50 people about the firm to understand how it works.

The firm has recruited powerful people within the healthcare industry, such as Tom Scully, who has been with Welsh Carson for almost two decades. After a career in healthcare lobbying, Scully became head of CMS for President George W. Bush from 2001 to 2003. He now sits on boards of at least seven companies, giving the firm "unparalleled access to information and networks that directly affect their businesses," the report stated.
"People who've spent decades working in the industry are valuable because they know which companies to invest in and, once the ink is dry, how to maximize profitability," the article stated.
The investigation focused on four of the 14 companies in Welsh Carson's healthcare portfolio: a physician staffing firm, a senior care provider, a Medicaid managed care provider, and a micro-hospital chain.
Physician staffing firm U.S. Anesthesia Partners is under investigation by the Federal Trade Commission over questions about its market power, according to the report. Since anesthesiologists have equity in the company, they're driven to boost patient volumes, as higher revenues mean more profits for shareholders, including the doctors themselves, the report stated.

Elder care provider InnovAge is facing a U.S. Department of Justice fraud investigation, a Colorado fraud investigation, and shareholder lawsuits. Sources alleged serious staffing issues as the company boosted enrollees but didn't increase staff to meet demand.
The firm bought a large minority stake in a subsidiary of the Medicaid managed care provider CareSource. Being involved with CareSource's management services organization allows CareSource to continue to market itself as a non-profit to state Medicaid agencies, even as the private equity firm influences decisions about coverage, according to the report. There's concern that members will face greater barriers to care so the company can take home greater profits, STAT reported.
Finally, micro-hospital chain Emerus is facing allegations in a lawsuit filed by a patient that it significantly overcharged for lab tests. Patients interviewed by STAT complained about the high cost of care they received at the hospital because of those tests.
STAT concluded that the firm has "ruthlessly chased profit by pouring gas on companies that have capitalized on the bloat and exploitative practices within the United States' $4 trillion health care system -- often at the expense of patients, employers, and taxpayers."
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[missy]

‘A Silent Killer’: COVID-19 Shown to Trigger Inflammation in the Brain - Neuroscience News

COVID-19 infection activates the same inflammatory response in the brain as Parkinson's disease, a new study reports.

neurosciencenews.com

​

‘A Silent Killer’: COVID-19 Shown to Trigger Inflammation in the Brain​

Nov 1, 2022

Summary: COVID-19 infection activates the same inflammatory response in the brain as Parkinson’s disease, a new study reports.

Source: University of Queensland

Research led by The University of Queensland has found COVID-19 activates the same inflammatory response in the brain as Parkinson’s disease.

The discovery identified a potential future risk for neurodegenerative conditions in people who’ve had COVID-19, but also a possible treatment.

The UQ team was led by Professor Trent Woodruff and Dr. Eduardo Albornoz Balmaceda from UQ’s School of Biomedical Sciences, and virologists from the School of Chemistry and Molecular Biosciences.

“We studied the effect of the virus on the brain’s immune cells, ‘microglia’ which are the key cells involved in the progression of brain diseases like Parkinson’s and Alzheimer’s,” Professor Woodruff said.

“Our team grew human microglia in the laboratory and infected the cells with SARS-CoV-2, the virus that causes COVID-19.

“We found the cells effectively became ‘angry,’ activating the same pathway that Parkinson’s and Alzheimer’s proteins can activate in disease, the inflammasomes.”

Dr. Albornoz Balmaceda said triggering the inflammasome pathway sparked a “fire” in the brain, which begins a chronic and sustained process of killing off neurons.

“It’s kind of a silent killer, because you don’t see any outward symptoms for many years,” Dr. Albornoz Balmaceda said.



“It may explain why some people who’ve had COVID-19 are more vulnerable to developing neurological symptoms similar to Parkinson’s disease.”

The researchers found the spike protein of the virus was enough to start the process and was further exacerbated when there were already proteins in the brain linked to Parkinson’s.

“So if someone is already pre-disposed to Parkinson’s, having COVID-19 could be like pouring more fuel on that ‘fire’ in the brain,” Professor Woodruff said.

“The same would apply for a predisposition for Alzheimer’s and other dementias that have been linked to inflammasomes.”

But the study also found a potential treatment.

The researchers administered a class of UQ-developed inhibitory drugs which are currently in clinical trials with Parkinson’s patients.

“We found it successfully blocked the inflammatory pathway activated by COVID-19, essentially putting out the fire,” Dr. Albornoz Balmaceda said.

“The drug reduced inflammation in both COVID-19-infected mice and the microglia cells from humans, suggesting a possible treatment approach to prevent neurodegeneration in the future.”

Professor Woodruff said while the similarity between how COVID-19 and dementia diseases affect the brain was concerning, it also meant a possible treatment was already in existence.

“Further research is needed, but this is potentially a new approach to treating a virus that could otherwise have untold long-term health ramifications.”

The research was co-led by Dr. Alberto Amarilla Ortiz and Associate Professor Daniel Watterson and involved 33 co-authors across UQ and internationally.

About this COVID-19 and neuroinflammation research news​

Author: Press Office
Source: University of Queensland
Contact: Press Office – University of Queensland
Image: The image is in the public domain

 

[missy]

“
Thinking through the holidays this year
KATELYN JETELINA
NOV 3



It’s been a while since I’ve shared my own chronicles of navigating this pandemic. I dread doing so, because I receive so much hate after. But it’s getting harder and harder to ignore the questions as we navigate the “choose your own adventure” phase of the pandemic. We are all just trying to figure this out as we go. And, unfortunately, the “normal” viruses are back, too.

This is what my little family is doing this holiday season to stay healthy and enjoy time with our loved ones. I hope it’s useful.


Photo by Spencer Davis on Unsplash
Goal 1: Protect the vulnerable

There are still ~2,600 Americans dying each week from COVID-19. The vast majority are older and vaccinated (but not up to date). As an epidemiologist, I refuse to accept this as the “new normal.” So my professional bias influences my priorities: Ensure the vulnerable around us (like grandparents) do not end up in the hospital with COVID-19 (or flu or RSV). This means we are going to do everything in our power to break transmission chains before gathering for the holidays. This includes…

At least three weeks before event:

Ensure everyone is up-to-date on their flu shot and fall booster (especially the older adults). The fall booster rate is currently 7.3% (20% for those aged 65+).
One week prior to the event:

Wear an N95 mask. In public. Everywhere I go. This will help ensure we don’t bring COVID-19 (or flu) to Thanksgiving dinner. It will also help make sure I don’t miss the event because I’m sick. Don’t rely on case levels to influence masking decisions; at this point, they don’t accurately reflect transmission.
Cadence testing. Use COVID19 at-home antigen tests two days before seeing grandparents and the morning of. Test everyone. Including my toddlers who scream when I approach their nose.
For people who have the virus and are asymptomatic, the average antigen test will catch 44% to 70% of cases. This isn’t perfect, so we don’t rely solely on this layer. But it sometimes works.
If I’m positive a few days before the event. We see strong evidence (here, here) that an Omicron infection lasts, on average, 8-10 days. Some people will be infectious for less, and some will be infectious for more. You won’t know unless you test. Antigen tests are very good at telling us when we’re not infectious anymore (very few false positives). If I get a negative after a positive, then I would trust that I’m not contagious anymore and go to the event. With Paxlovid, we are seeing rebounding. So for anyone who tests negative after Paxlovid, I would continue to test for another couple of days. If you turn positive again, assume you’re infectious until you turn negative again.
Day of the event:

Ventilation and filtration are powerful tools. This is especially important in the middle of winter when people head indoors. You can use a CO2 monitor if you want to take safety at your family event to the next level.
If we have symptoms, stay home. This is lonely during the holidays, but the best thing to do. When symptoms are present, COVID-19 antigen tests are great at detecting highly infectious people: the average antigen test will catch 78% to 97% of cases in the first week of symptoms. False negatives are more common at the beginning of infection, especially with Omicron. If you have symptoms and test negative, it’s a good idea to re-test in 24-48 hours. But, because flu and RSV levels are high right now, there’s a good chance it could be something other than COVID-19, too. Just stay home.
After the event:

If an older adult gets infected, make sure they know about Paxlovid and get it within 5 days of symptoms, even just the sniffles.
man wearing maroon, white, and blue stripe long-sleeved shirt lifting up baby wearing gray onesie
Photo by Johnny Cohen on Unsplash
Goal 2: Limit disruptions

We are trying as much as possible to prevent disruptions in our lives due to sickness. We want to go on our trip. We want to go to holiday parties. We want to help the crowded and broken healthcare systems right now.

This means we are all up to date on vaccines.

This also means wearing masks. (Yes, still.) I wear one probably 40% of the time when I go to Target, but if there’s an event we’re really looking forward to, I wear it religiously (I usually dial up about four days before the event). This also means wearing a mask while traveling for work so I can come home, not get sick, and spend time with my girls.

Having two little ones and avoiding sickness gets harder and harder because they are in childcare. This is just a reality that I have to accept: they may bring something home. I’m going to do all I can to not bring it home. I know parents of older kids struggle what to do because there are competing realities: masks help reduce the odds of disruption (including missed school). But peer pressure is real, and they probably don’t wear them when you’re not around, anyways.

We are booking our holiday travel. With boosters, there is very little SARS-CoV-2 could do in the next couple months to cancel our trip. (A severe mutations may be an exception.) I know people travel with COVID-19 and sickness. Staying home is the least I can do to help someone else’s grandparents. We are prepared to cancel flights if we get sick. Make this an expectation with travel this winter.

Other considerations

I’m a healthy young adult who has been incredibly lucky. I recognize not everyone has similar situations. If you…

Are the vulnerable person, like an older grandparent: The pandemic is not over for you. And I’m sorry. I would consider wearing a mask throughout winter. This will help with COVID, the flu, and (we think) RSV. If everyone who attends Thanksgiving dinner embraces Goal #1 above, the risk to you is very low.
Have a child under 6 months: The pandemic is not over for you either. And RSV and flu should be concerning, too. The biggest advice I have for you is not to let people kiss or hold your baby. They’ll live.
Have limited means: One tragic reality is that tools are being stripped away from people who can’t afford to pay for them. Free antigen tests are gone. Free masks are gone. Vaccines are still free, but many places are asking for proof of insurance. Cancelling flights can be super expensive. I recognize taking all of the steps above involves privilege. Instead, choose one or two precautions. It will help.
Bottom line

Yes, we are still in a pandemic. Yes, the “normal viruses” are back. We can enjoy the holidays this year while staying healthy: get vaccinated, mask (at least leading up to the event), ventilate, test and stay home when you’re sick. This seems like a lot— especially when it looks like the greater public isn’t doing anything— but it really isn’t. It’s still worth navigating this petri dish to ensure our loved ones are protected.

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[missy]

"

​ The latest​ Pfizer and its German partner, BioNTech, announced Thursday that Phase 1 testing has begun on an experimental flu and coronavirus vaccine combination. The vaccine combines the influenza vaccine and the omicron-targeting booster. The study will be conducted in the United States, and researchers plan on enrolling 180 volunteers ages 18 to 64. Study participants will be followed for six months. “By combining both indications in one vaccine approach, we aim to provide individuals with an efficient way to receive immunization against two severe respiratory diseases with evolving viruses that require vaccine adaptation,” Ugur Sahin, CEO and co-founder of BioNTech, said in a statement. Other manufacturers, such as Novavax and Moderna, have begun developing combination influenza and coronavirus vaccines. The updated omicron-specific coronavirus boosters increase antibodies necessary to fight the highly transmissible variant, according to Pfizer and BioNTech. “The findings reinforce the public health message that the new bivalent boosters, which were rebooted in September to match newer omicron subvariants, could help protect people this fall and winter,” my colleague Carolyn Y. Johnson reports. According to the Centers for Disease Control and Prevention, about 10 percent of adults ages 18 and older have received the updated booster. Johnson writes that the data release was not peer-reviewed or published and “does not directly address a concern raised by small studies over the last week that immune-evading variants that have recently emerged and are quickly taking over appear to be far better at eluding the virus-fighting antibodies generated by the booster.”​ ​ ​ Other important news​ Disney Cruise Line will no longer require passengers to show proof of a negative coronavirus test, regardless of vaccination status, starting Nov. 14, the company announced on its website. Sen. Rand Paul (R-Ky.) could soon chair the health committee if Republicans take control of the Senate in the midterms, my colleagues Dan Diamond and Rachel Roubein report.​

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​ Guide to the pandemic​ Track confirmed cases, hospitalizations and deaths in the U.S. and the spread around the world. U.S. vaccine distribution and delivery, tracked by state. Guides: Booster shots | Vaccines | Variants | Masks​

Your questions, answered​

Throughout the pandemic, there has been a major emphasis and effort to clean and disinfect things. These protocols have not been as controversial as wearing masks and vaccines. But is there any evidence it is really necessary? Or even that it helps? I wonder if this is a case of overkill.

As the pandemic makes its way into another fall and winter, we know that the coronavirus does not appear to spread through fomites, also known as inanimate objects that can transfer bacteria, viruses and other pathogens to different hosts.

Vigorously wiping down everything we come into contact with to avoid a coronavirus infection is probably “overkill and not necessary,” according to Scott Roberts, an infectious-disease specialist at the Yale School of Medicine.

“Even if you touch a contaminated surface with covid, there is a less than 1 in 10,000 chance of being infected if you touch that surface,” Roberts said. “The disinfection of surfaces is good for general hygiene, but since covid doesn't really spread that way, the best way to protect yourself against transmission is by wearing a mask and having proper ventilation.”

If a person is looking to prevent transmission of other respiratory infections such as RSV, which can survive on surfaces for many hours, wiping down a surface, handwashing and other hygiene practices are beneficial.

The common cold and influenza can be spread by coming into contact with contaminated surfaces. The Centers for Disease Control and Prevention recommends disinfecting frequently touched items such as cellphones, toys and doors to prevent the transmission of the viruses that cause those ailments.
"

 

[missy]

"
SARS-CoV-2 aerosols likely spread through the walls and floors at a quarantine hotel in Taiwan. (Emerging Infectious Disease)

Initial results from an ongoing clinical study showed that neutralizing antibody titers to the Omicron BA.4/BA.5 subvariants increased dramatically after a booster dose of the bivalent vaccine as compared with the original COVID-19 vaccine, Pfizer and BioNTech announced.

In a separate statement, the two companies also announced the start of the first clinical trial of a combination COVID/influenza vaccine.

SARS-CoV-2 aerosols likely spread through the walls and floors at a quarantine hotel in Taiwan. (Emerging Infectious Disease)
Initial results from an ongoing clinical study showed that neutralizing antibody titers to the Omicron BA.4/BA.5 subvariants increased dramatically after a booster dose of the bivalent vaccine as compared with the original COVID-19 vaccine, Pfizer and BioNTech announced.
In a separate statement, the two companies also announced the start of the first clinical trial of a combination COVID/influenza vaccine.

In a CDC safety analysis, side effects with the new bivalent vaccines were largely similar to the monovalent mRNA shots, with serious events rare.
A federal judge refused to grant vaccine manufacturer Moderna's motion to dismiss a patent-infringement lawsuit related to COVID-19 vaccine technology, rejecting the company's argument that the U.S. government should be the target of the lawsuit. (Fierce Pharma)
Alcohol deaths in men and women increased 26% during the first year of the pandemic, according to a new report from the National Center for Health Statistics.
Another patient every 2 minutes: The volume of pediatric patients with respiratory syncytial virus seeking emergency care at Cook Children's Medical Center in Fort Worth, Texas. (Becker's Hospital Review)
A review of the 83 monkeypox cases in U.S. children found that few of the infections were severe. (Morbidity and Mortality Weekly Report)
Five California doctors are suing Gov. Gavin Newsom (D) and the Medical Board of California over a new state law that aims to curb COVID-19 misinformation in patient care settings, according to a press release from an organization representing the physicians.

An Indiana abortion provider has filed a lawsuit to block Attorney General Todd Rokita's attempt to subpoena medical records of the doctor's patients, alleging a "fishing expedition." (Politico)
An organization founded by former Trump aide Stephen Miller has spent millions of dollars on an anti-transgender advertising campaign. (NPR)
Two phase III trials of the novel antibiotic gepotidacin ended early after meeting the primary endpoint of combined clinical and microbiologic response and demonstrating noninferiority to nitrofurantoin for uncomplicated urinary tract infection, GSK announced.
The FDA announced a recall of the Teleflex Iso-Gard Filter S filters used in respiratory equipment and breathing systems, following reports that the filters may split or detach.
The FDA also issued a safety communication advising parents and caregivers not to use infant head-shaping pillows to prevent or treat any medical condition, due to the risk of suffocation and death.
Allowing doctors to prescribe methadone directly to patients for opioid addiction could lower the quality of addiction treatment and possibly exacerbate the existing overdose epidemic, according to providers who specialize in methadone treatment. (STAT)

Samuel L. Katz, MD, a pediatrician who played a role in developing the measles vaccine, has died at age 95. (Washington Post)
The State of New York could receive as much as $524 million from settlements with drugmaker Teva related to lawsuits alleging the company contributed to the national opioid epidemic. (AP)
Paul Pelosi, husband of House Speaker Nancy Pelosi (D-Calif.), left a San Francisco hospital following recovery from a skull fracture and other injuries incurred during an assault at the family home. (CNN)
Researchers have developed a 3D model depicting a "future human" with physical problems caused by excessive use of technology. (Tech Times)
Photos of tissue from early pregnancy posted on TikTok set off a social media fire storm, but with an unexpected twist. (The Verge)

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[missy]

"

COVID vaccine hoarding might have cost more than a million lives​

Low- and middle-income nations would have had lower death rates if vaccines had been shared more equitably.

• Heidi Ledford

A health worker vaccinates a man in India against COVID-19.Credit: Prakash Singh/AFP/Getty
More than one million lives might have been saved if COVID-19 vaccines had been shared more equitably with lower-income countries in 2021, according to mathematical models incorporating data from 152 countries1.
The impact of vaccine sharing would have been even greater if the distribution of more vaccines to poorer countries had happened alongside wealthier countries keeping other mitigation measures — such as limiting gatherings and wearing masks — in place for longer. In that case, the models suggest, as many as 3.8 million lives could have been saved.
It has been widely assumed that inequitable vaccine distribution led to unnecessary loss of life. But having an estimate of the size of that loss could aid in planning for future epidemics, says Oliver Watson, an infectious-disease epidemiologist at Imperial College London. “This is another piece of evidence to show how big of an impact pushing for vaccine coverage may have had,” he says. “That’s really important for engaging political will and framing big political decisions.”

Stark gap​

By the end of last year, nearly half of the world’s population had received two doses of a COVID-19 vaccine. But those vaccines were not distributed equitably: vaccination rates were 75% in high-income countries, but less than 2% in some low-income countries. Wealthy countries ended the year with vaccine surpluses and plans to vaccinate young children, who are at relatively low risk of serious disease. Meanwhile, many poorer countries still did not have enough supply to vaccinate the people at highest risk of death from COVID-19.
Mathematical epidemiologist Sam Moore and his colleagues at the University of Warwick in Coventry, UK, used data on excess mortality and vaccine availability to model what would have happened if vaccines had been distributed according to need rather than wealth. They considered the impact of vaccination on both SARS-CoV-2 spread and the severity of COVID-19.
The team found that, assuming no other policies that reduced physical contact, more equitable vaccine coverage could have prevented 1.3 million deaths worldwide (see ‘Vaccine inequity’s grim toll’)1. More than twice that many deaths would have been avoided if higher-income countries had also stuck with other measures to reduce transmission. The results were published on 27 October in Nature Medicine.

Source: Ref. 1
The study looked only at vaccine provisions, and did not consider other factors, such as the capacity to store and administer the shots.
The results mesh well with a previous study conducted by Watson and his colleagues, which used a similar modelling technique but with different data. That study found that about 45% of COVID-19 deaths in low-income countries could have been averted if the countries had achieved 20% vaccination coverage by the end of 2021, a target set by the global vaccine-sharing campaign COVAX2.


The pandemic’s true death toll: millions more than official counts
More equitable sharing of vaccines, and a resulting drop in infections, might also have slowed the emergence of fresh SARS-CoV-2 variants, says Moore.
Policymakers could look to studies like these to lay the groundwork for better responses to the next pandemic. Although it might not be realistic to expect countries to give away vaccine supplies before vaccinating their own citizens, governments might be able to find a middle ground, Moore says. “First-world countries might vaccinate everyone over the age of 60 to protect the most vulnerable population, before helping other nations to catch up,” he says. “Even if not equitable, maybe there would be some sort of room for helping other countries once you’ve managed to get your own vaccine in place to some degree.”
doi: https://doi.org/10.1038/d41586-022-03529-3

References​

1. Moore, S., Hill, E. M., Dyson, L., Tildesley, M. J. & Keeling, M. J. Nature Med. https://doi.org/10.1038/s41591-022-02064-y (2022).
   Article Google Scholar
2. Watson, O. J. et al. Lancet Infect. Dis. https://doi.org/10.1016/S1473-3099(22)00320-6 (2022).
   Article Google Scholar

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[missy]

"

WHO releases first data on global vaccine market since COVID-19​

9 November 2022
News release

• This is the first report to capture the implications of COVID-19 for vaccine markets.
• Despite progress in recent decades, global market vaccine dynamics are not fully conducive to the development, supply and access for vital vaccines for public health.
• Vaccines prioritized by WHO are not being developed or fully invested in due to limited profit potential.
• Lower-income countries have struggled to access critical vaccines – such as against COVID-19 in 2021 and cervical cancer vaccine – that are in-demand by wealthier countries.
• Some regions depend almost entirely on others for vaccine supply.
• WHO calls on governments, manufacturers and partners to take ambitious action to guarantee equitable access to vaccines and improve responses to future pandemics.

WHO's Global Vaccine Market Report 2022, published today, shows that inequitable distribution is not unique to COVID-19 vaccines, with poorer countries consistently struggling to access vaccines that are in-demand by wealthier countries.
Limited vaccine supply and unequal distribution drive global disparities. The human papillomavirus (HPV) vaccine against cervical cancer has only been introduced in 41% of low-income countries, even though they represent much of the disease burden, compared to 83% of high-income countries.
Affordability is also an obstacle to vaccine access. While prices tend to be tiered by income, price disparities see middle-income countries paying as much – or even more – than wealthier ones for several vaccine products.
"The right to health includes the right to vaccines," said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. "And yet this new report shows that free-market dynamics are depriving some of the world's poorest and most vulnerable people of that right. WHO is calling for much-needed changes to the global vaccine market to save lives, prevent disease and prepare for future crises."
Approximately 16 billion vaccine doses, worth US$ 141 billion, were supplied in 2021, almost three times the 2019 market volume (5.8 billion) and nearly three-and-a-half times the 2019 market value (US$ 38 billion). The increase was primarily driven by COVID-19 vaccines, showing the incredible potential of how vaccine manufacturing can be scaled up in response to health needs.
Although manufacturing capacity worldwide has increased, it remains highly concentrated. Ten manufacturers alone provide 70% of vaccine doses (excluding COVID-19). Several of the top 20 most widely used vaccines (such as PCV, HPV, measles and rubella containing vaccines) each currently rely mainly on two suppliers.
This concentrated manufacturing base leads to risk of shortages as well as regional supply insecurity. In 2021, the African and Eastern Mediterranean regions were dependent on manufacturers headquartered elsewhere for 90% of their procured vaccines. Entrenched intellectual property monopolies and limited technology transfer further limit the ability of building and using local manufacturing capacity.
The health of markets is also concerning for several of the vaccines commonly needed for emergencies, such as against cholera, typhoid, smallpox/monkeypox, Ebola, meningococcal disease, where demand surges with outbreaks and is hence less predictable. The continued limited investment in these vaccines could be devastating for people’s lives.
The report highlights the opportunities for more alignment of vaccine development, production and distribution with a public health agenda, towards achieving the Immunization Agenda 2030 (IA2030)goals and informing pandemic prevention, preparedness, and response efforts.
COVID-19 proved that vaccines can be developed and distributed rapidly, with a process lasting an average of ten years but never less than four years, compressed to 11 months. The pandemic also exposed the long-standing need to recognise vaccines as a fundamental and cost-effective public good rather than a commodity.
To drive ambitious action to deliver equitable access to vaccines, the report calls on governments to act on: clear immunization plans and more aggressive investment and stronger oversight of vaccine development, production and distribution; regional research and manufacturing hubs; and pre-agreeing rules for government collaboration in times of scarcity on issues such as vaccine distribution, intellectual property and the circulation of inputs and goods.
Recommended actions for industry include: focusing research efforts on WHO priority pathogens, ensuring transparency, facilitating technology transfer, and committing to specific equity-driven allocation measures. International organizations and partners should prioritize Immunization Agenda 2030 goals, support country-driven initiatives and push for the application of resolutions on market transparency.

"

 

[missy]

"
COVID-19 Virus Increases Risk for Other Infections by Disrupting Normal Mix of Gut Bacteria

PHOTO: ARTUR PLAWGO / SCIENCE PHOTO LIBRARY/GETTY
IN THIS ARTICLE

OUR EXPERTS​

• Ken H. Cadwell, PhD
• Jonas Schluter, PhD
• Jordan E. Axelrad, MD, MPH
• Lorna E. Thorpe, MPH, PhD
• Dan R. Littman, MD, PhD
• Meike Dittmann, PhD
• Kenneth A. Stapleford, PhD
• Bo Shopsin, MD, PhD
• Victor J. Torres, PhD

CONDITIONS​

• Antibiotic-Resistant Infections

DEPARTMENTS & INSTITUTES​

• Department of Microbiology
• Department of Medicine
• Institute for Systems Genetics

NEED HELP FINDING A DOCTOR?​

Search all doctors or call 844-698-7243.
Infection with the pandemic virus, SARS-CoV-2, can reduce the number of bacterial species in a patient’s gut, with the lesser diversity creating space for dangerous microbes to thrive, a new study finds.
The study builds on the realization that widespread use of antibiotics to fight infections with disease-causing bacteria in recent decades, by killing off species most vulnerable to available drugs, has left in place more species that are resistant to antibiotics. In addition, disruptions in gut bacterial ratios have previously been linked to more severe COVID-19.
However, researchers say, it has remained unclear until now which came first, the coronavirus infection disrupting the gut microbiome or an already weakened gut making the body more vulnerable to the virus. The new study appears to favor the former explanation. The new investigation also revealed that antibiotic-resistant species can escape into the bloodstream, putting patients at greater risk for life-threatening secondary infections.
Led by researchers at NYU Grossman School of Medicine, the investigation involved 96 men and women hospitalized with COVID-19 in 2020 in New York City and in New Haven, Connecticut. Results showed that the majority of patients had low gut microbiome diversity, with a full quarter dominated by a single type of bacteria. At the same time, populations of several microbes known to include antibiotic-resistant species increased, possibly due to widespread antibiotic use early in the pandemic.
These antibiotic-resistant bacteria found in the gut were also observed to have migrated into the bloodstream in 20 percent of patients. The study authors note that further research is needed to uncover why this group was at higher risk for a secondary infection while others were not.
“Our findings suggest that coronavirus infection directly interferes with the healthy balance of microbes in the gut, further endangering patients in the process,” says study co-senior author and microbiologist Ken H. Cadwell, PhD. “Now that we have uncovered the source of this bacterial imbalance, physicians can better identify those patients with coronavirus who are most at risk of a secondary bloodstream infection,” adds Dr. Cadwell.
The new study is the first to show that the coronavirus infection alone, and not the initial use of antibiotics to treat the disease as others experts had thought, damages the gut microbiome, says Dr. Cadwell, also the Recanati Family Professor of Microbiology in the Department of Microbiology and a professor in the Department of Medicine at NYU Langone Health. He adds the study also provides the first evidence that the very same bacteria in the gut are also entering the bloodstream of patients, causing dangerous infections.
The report published online November 1 in the journal Nature Communications. For the investigation, researchers first infected dozens of mice with the coronavirus and analyzed the makeup of bacterial species in their stool samples. This step allowed them to untangle whether the coronavirus could directly disrupt the microbiome independently of hospitalization and treatment.
Next, they collected stool samples and blood tests from patients with COVID-19 at NYU Langone Health and Yale University hospitals to assess gut microbe composition and the presence of secondary infection. If any bacteria group made up a majority of the bacteria living in the gut, they were considered dominant.
“Our results highlight how the gut microbiome and different parts of the body’s immune system are closely interconnected,” says study senior author Jonas Schluter, PhD, an assistant professor in the Department of Microbiology and a member of NYU Langone’s Institute for Systems Genetics. “An infection in one can lead to major disruptions in the other.” Dr. Schluter cautions that since the patients received different kinds of treatments for their illness, the investigation could not entirely account for all factors that may have contributed to the disruption of their microbiome and worsened the course of their illness.
According to Dr. Schluter, the study team next plans to examine why certain microbial species are more likely to escape the gut during COVID-19. The researchers say they also intend to explore how different microbes interact, which may contribute to this migration into the bloodstream.
Funding for the study was provided by National Institutes of Health grants DP2 AI164318, R01 AI143639, R21 AI139374, R01 DK093668, R01 AI121244, R01 HL123340, R01 AI130945, R01 AI140754, and R01 DK124336. Further funding support was provided by the Yale School of Public Health, the Beatrice Kleinberg Neuwirth Fund, the Howard Hughes Medical Institute, the Crohn’s and Colitis Foundation, the Kenneth Rainin Foundation, the Judith and Stewart Colton Center for Autoimmunity, the Jan Vilcek/David Goldfarb Fellowship Endowment Funds, The G. Harold and Leila Y. Mathers Charitable Foundation, the Yale COVID-19 Research Resource Fund, and the Bristol Meyers Squibb Foundation.
Dr. Cadwell has served as a consultant for Vedanta and for the pharmaceutical companies Abbvie, GentiBio, and Synedgen. Dr. Schluter is cofounder of Postbiotics Plus Research, which develops microbiome therapies. The terms and conditions are being managed in accordance with the policies of NYU Langone.
In addition to Dr. Cadwell and Dr. Schluter, other NYU Langone study investigators were Mericien Venzon, PhD; Lucie Bernard, PhD; Jordan E. Axelrad, MD, MPH; Grant Hussey, BS; Alexis Sullivan, PhD; Chenzhen Lily Zhang, BS; Maria Noval, PhD; Ana Valero-Jimenez, PhD; Juan Gago, MD, MPH; Evan Wilder, MD; Lorna E. Thorpe, MPH, PhD; Dan R. Littman, MD, PhD; Meike Dittmann, PhD; Kenneth A. Stapleford, PhD; Bo Shopsin, MD, PhD; and Victor J. Torres, PhD. Other study investigators included Jon Klein, BS; Arnau Casanovas-Massana, PhD; Albert Ko, MD; and Akiko Iwasaki, PhD; at Yale University in New Haven, Conn.
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[missy]

NEJM Nov 9,2022

"

Six-Month Follow-up after a Fourth BNT162b2 Vaccine Dose​

TO THE EDITOR:​

In a prospective cohort study involving health care workers that was described previously,1 we evaluated the humoral response and vaccine effectiveness of a fourth dose of the BNT162b2 vaccine (Pfizer–BioNTech) against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during a 6-month follow-up period in which omicron (mostly BA.1 and BA.2) was the predominant variant in Israel.2 The absence of previous SARS-CoV-2 infection was verified by SARS-CoV-2 testing and serologic follow-up testing (see Table S1 and the Supplementary Methods in the Supplementary Appendix, available with the full text of this letter at NEJM.org). The humoral response (as assessed by the measurement of IgG and neutralizing antibodies) after receipt of the fourth vaccine dose was compared with that after receipt of the second and third doses. Vaccine effectiveness was assessed by comparing infection rates among participants who had received a fourth vaccine dose during various time periods (days 7 through 35, days 36 through 102, or days 103 through 181 after receipt of the fourth dose) with infection rates among those who had received three doses. Participants were to have received the third vaccine dose at least 4 months earlier. A Cox proportional hazards regression model was used, with adjustment for age, sex, and professional role; calendar time was used as the time scale to account for differences in the prevalence of infection over time (details are provided in the Supplementary Appendix). No participants died or were lost to follow-up.
Figure 1.

Six-Month Follow-up of Immunogenicity and Vaccine Effectiveness after a Fourth BNT162b2 Vaccine Dose.
Among the participants who had not had previous SARS-CoV-2 infection, 6113 were included in the analysis of humoral response and 11,176 in the analysis of vaccine effectiveness (Fig. S1 and Tables S2 and S3). Antibody response peaked at approximately 4 weeks, waned to levels seen before the fourth dose by 13 weeks, and stabilized thereafter. Throughout the 6-month follow-up period, the adjusted weekly levels of IgG and neutralizing antibodies were similar after receipt of the third and fourth doses and were markedly higher than the levels seen after receipt of the second dose (Figure 1A and 1B and Table S4).
The cumulative incidence curve is shown in Figure S2, and vaccine effectiveness is shown in Figure 1C. Receipt of the fourth BNT162b2 vaccine dose conferred more protection against SARS-CoV-2 infection than that afforded by the receipt of three vaccine doses (with receipt of the third dose having occurred at least 4 months earlier) (overall vaccine effectiveness, 41%; 95% confidence interval [CI], 35 to 47). Time-specific vaccine effectiveness (which, in our analysis, compared infection rates among participants who had not yet been infected since vaccination) waned with time, decreasing from 52% (95% CI, 45 to 5 during the first 5 weeks after vaccination to −2% (95% CI, −27 to 17) at 15 to 26 weeks.
The study has several limitations. First, although our cohort consisted of a diverse population that included older-adult volunteers, a cohort consisting of health care workers may not be representative of the general population. Furthermore, only health care workers who had not had previous SARS-CoV-2 infection were included, which further limited generalizability. Second, possible confounding of unrecognized hybrid immunity may have remained, despite thorough history-taking and serologic assessment. Third, the decision to receive the fourth dose could be linked to health-seeking behaviors that were not well-captured in our data, thus possibly resulting in additional residual confounding. Fourth, we were unable to estimate effectiveness against severe outcomes of infection owing to the absence of such outcomes in our study cohort; a third dose of the BNT162b2 vaccine has been shown to confer durable protection against such outcomes.3 Previous studies have shown increased effectiveness of a fourth dose against severe outcomes during short-term follow-up,4,5 but whether this additional effectiveness wanes similarly to the protection against infection has yet to be determined.
In this prospective cohort study, a third dose of the BNT162b2 vaccine led to an improved and sustained immunologic response as compared with two doses, but the additional immunologic advantage of the fourth dose was much smaller and had waned completely by 13 weeks after vaccination. This finding correlated with waning vaccine effectiveness among recipients of a fourth dose, which culminated in no substantial additional effectiveness over a third dose at 15 to 26 weeks after vaccination. These results suggest that the fourth dose, and possibly future boosters, should be timed wisely to coincide with disease waves or to be available seasonally, similar to the influenza vaccine. Whether multivalent booster doses will result in longer durability remains to be seen.
Michal Canetti, M.D.
Noam Barda, M.D., Ph.D.
Mayan Gilboa, M.D.
Sheba Medical Center Tel Hashomer, Ramat Gan, Israel
Victoria Indenbaum, Ph.D.
Ministry of Health, Ramat Gan, Israel
Keren Asraf, Ph.D.
Tal Gonen, M.D.
Yael Weiss-Ottolenghi, Ph.D.
Sharon Amit, M.D.
Ram Doolman, M.D.
Sheba Medical Center Tel Hashomer, Ramat Gan, Israel
Ella Mendelson, Ph.D.
Ministry of Health, Ramat Gan, Israel
Laurence S. Freedman, Ph.D.
Yitshak Kreiss, M.D.
Sheba Medical Center Tel Hashomer, Ramat Gan, Israel
Yaniv Lustig, Ph.D.
Ministry of Health, Ramat Gan, Israel
Gili Regev-Yochay, M.D.
Sheba Medical Center Tel Hashomer, Ramat Gan, Israel
[email protected]
Disclosure forms provided by the authors are available with the full text of this letter at NEJM.org.
This letter was published on November 9, 2022, at NEJM.
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[missy]

"

Universal Masking Policies in Schools and Mitigating the Inequitable Costs of Covid-19​

List of authors.

• Julia Raifman, Sc.D.,
• and Tiffany Green, Ph.D.

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.
:

 

[missy]

"

Children and COVID: New Cases Increase for Second Straight Week​

Richard Franki
November 08, 2022


New COVID-19 cases rose among U.S. children for the second consecutive week, while hospitals saw signs of renewed activity on the part of SARS-CoV-2.

The total for new cases reported during the week of Oct. 28 to Nov. 3, while still low at just under 30,000, was 21% higher than the previous week and 31% higher than 2 weeks ago (Oct. 14-20), when the count fell to its lowest level in more than a year, the American Academy of Pediatrics and the Children's Hospital Association said in their joint report.

Meanwhile, the trajectories of both emergency department visits and new hospital admissions involving COVID seem to suggest a change in direction after several weeks of declines, based on data from the Centers for Disease Control and Prevention.






The 7-day average for ED visits with diagnosed COVID was down to just 0.6% of all ED visits for 12- to 15-year-olds as late as Oct. 23 but has moved up to 0.7% since then. Among those aged 16-17 years, the 7-day average was also down to 0.6% for just one day, Oct. 19, but was up to 0.8% as of Nov. 4. So far, though, a similar increase has not yet occurred for ED visits among children aged 0-11 years, the CDC said on its COVID Data Tracker.

The trend is discernible, however, when looking at hospitalizations of children with confirmed COVID. The rate of new admissions of children aged 0-17 years was 0.16 per 100,000 population as late as Oct. 23 but ticked up a notch after that and has been 0.17 per 100,000 since, according to the CDC. As with the ED rate, hospitalizations had been steadily declining since late August.

Vaccine Initiation Continues to Slow​

During the week of Oct. 27 to Nov. 2, about 30,000 children under 5 years of age received their initial COVID vaccination. A month earlier (Sept. 29 to Oct. 5), that number was about 40,000. A month before that, about 53,000 children aged 0-5 years received their initial dose, the AAP said in a separate vaccination report based on CDC data.


All of that reduced interest adds up to 7.4% of the age group having received at least one dose and just 3.2% being fully vaccinated as of Nov. 2. Among children aged 5-11 years, the corresponding vaccination rates are 38.9% and 31.8%, while those aged 12-17 years are at 71.3% and 61.1%, the CDC said.

Looking at just the first 20 weeks of the vaccination experience for each age group shows that 1.6 million children under 5 years of age had received at least an initial dose, compared with 8.1 million children aged 5-11 years and 8.1 million children aged 12-15, the AAP said.

This article originally appeared on MDedge.com, part of the Medscape Professional Network.

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[Gloria27]

I like how you try extra hard to bury my post and make 5 posts in a row after days of not posting anything.

 

[House Cat]

I like how you try extra hard to bury my post and make 5 posts in a row after days of not posting anything.

Wouldn’t it be that there is a backlog of posts due to not posting for a few days? Just sayin...

 

[Gloria27]

Wouldn’t it be that there is a backlog of posts due to not posting for a few days? Just sayin...

No, unfortunatelly it looks like a pattern.

I made a post about a debate relating to the safety of covid vaccines that took place in the UK Parliament and it got taken down.

It's on YT on the UK Parliament official channel. I live in the UK and I care about what affects me directly and that was one of those things.

​

 

[missy]

Myocarditis Higher With Moderna COVID Vax, but Overall Risk Low​

Megan Brooks



"
A new study shows a two- to threefold higher incidence of myocarditis/pericarditis following the second dose of the Moderna Spikevax mRNA-1273 COVID-19 vaccine compared with the Pfizer BioNTech BNT162b2 vaccine.
However, the overall rates of myocarditis/pericarditis remain 'very low' for both vaccines, supporting their favorable safety profile, the researchers emphasize.
The study was published online November 7 in the Journal of the American College of Cardiology.

Confirmed: Young Men at Highest Risk​

Naveed Janjua, MBBS, PhD, with the British Columbia Center for Disease Control, Vancouver, Canada, and colleagues used data from the British Columbia COVID-19 cohort to compare the incidence of myocarditis, pericarditis, and myopericarditis following primary vaccination with the Pfizer BioNTech or Moderna mRNA vaccine.




The cohort included more than 2.2 million adults who received the Pfizer vaccine and about 871,000 who received the Moderna vaccine. Within 21 days of the second dose, there were 59 myocarditis cases (28 Pfizer and 31 Moderna) and 41 pericarditis cases (21 Pfizer and 20 Moderna).
Compared with the Pfizer vaccine, the Moderna vaccine was associated with more than twofold higher odds of myocarditis (adjusted OR [aOR]: 2.78; 95% CI, 1.67 - 4.62), pericarditis (aOR: 2.42; 95% CI, 1.31 - 4.46), and myopericarditis (aOR: 2.63; 95% CI, 1.76 - 3.93).

The overall rate of myocarditis/pericarditis per 1 million second doses was very low for both vaccine products but was higher for the Moderna vaccine than for the Pfizer vaccine (myocarditis: 35.6 vs 12.6; pericarditis: 22.9 and 9.4, respectively).
The association between the Moderna vaccine and myocarditis was stronger in men (aOR: 3.2; 95% CI, 1.77 - 5.83) and those younger than age 40 years (aOR: 5.09; 95% CI, 2.68 - 9.66) but was not present in people aged 40+ or women.
The population at highest risk for myocarditis after the second dose of Moderna vaccine is men younger than age 30 (269.6 cases per 1 million doses vs 58.1 with Pfizer), the researchers report.
They say their findings add to phase 3 clinical trial data and support findings from other passive surveillance systems that have observed an association between mRNA vaccine products and myocarditis/pericarditis. However, most prior analyses on this topic assessed the safety of mRNA vaccines separately and with no direct comparison, they point out.

In a news release, Janjua says the findings have implications for "strategizing the rollout of mRNA vaccines, which should also consider the self-limiting and mild nature of most myocarditis events, benefits provided by vaccination, higher effectiveness of the Moderna vaccine against infection and hospitalization, and the apparent higher risk of myocarditis following COVID-19 infection than with mRNA vaccination."


The researchers say further studies are needed to assess the risks of myocarditis/pericarditis with booster doses and lower-dose formulations of the Moderna vaccine.

Personalized Approach to Vaccination ?​

The co-authors of a linked editorial say this analysis, combined with previous ones, continues to show that mRNA vaccine-associated myocarditis is a "very rare" event — one that is generally mild and associated with low morbidity and mortality and imaging findings suggestive of a benign long-term course.


Taken together, the data are "reassuring in terms of vaccine safety and should help put to rest 'vaccine hesitancy' caused by concerns over cardiac adverse events," write Guy Witberg, MD, and Ilan Richter, MD, with the Cardiology Department, Rabin Medical Center, Petah-Tikva, Israel.


"Such a conclusion leans not only on the proven efficacy of the vaccines, but also on data showing that COVID-19 infection is associated with a much higher risk for myocarditis," they add.


However, Witberg and Richter think the study also represents "an important step toward this personalized and tailored approach to vaccination."





For adults with cardiovascular disease, especially those with left ventricular dysfunction, in whom minimizing the risk of myocardial insult is crucial, these data provide a "strong argument" to preferentially use Pfizer vaccine over the Moderna vaccine, they write.


Conversely, in the general population, particularly in people over age 40 and in women, the findings "support the equipoise between the 2 vaccines in terms of cardiovascular risks, allowing for health authorities to choose vaccine products according to factors such as cost and availability, which should improve resource utilization," they add.


This work was supported by the British Columbia Cent er for Disease Control and the Canadian Immunization Research Network (CIRN) through a grant from the Public Health Agency of Canada and the Canadian Institutes of Health Research. This project was also supported by funding from the Public Health Agency of Canada through the Vaccine Surveillance Reference Group and the COVID-19 Immunity Task Force. Janjua has participated in advisory boards and has spoken for AbbVie, not related to the current work. Witberg and Richter report no relevant financial relationships.

"

 

[missy]

"

Anti-Vax Doctor Simone Gold Sued by America's Frontline Doctors, the Group She Founded​

Avery Hurt
November 10, 2022




America's Frontline Doctors is suing one of its founders in a battle for control over the controversial group, which gained national notoriety for spreading misinformation about COVID-19 treatments and vaccines during the pandemic.

Dr Simone Gold
The organization and its current board chairman have sued Simone Gold, MD, alleging that she misused the nonprofit organization's funds to buy a $3.6 million Florida mansion, purchase a Mercedes-Benz and other luxury vehicles, and take trips on private planes.
The lawsuit, filed November 4 in federal court, comes just months after Gold was released from prison for her role in the January 6 US Capitol insurrection. Gold pleaded guilty to trespassing in the Capitol and was sentenced to 60 days in federal prison.

The California physician helped found America's Frontline Doctors, a so-called "medical freedom" group that has ties to right-wing groups, including the Tea Party Patriots.
The group and the board chairman, Joseph Gilbert, claim that after her release from prison, Gold attempted to reassert control of the group, take over its website, and fraudulently represent herself as its director, according to the complaint. The complaint referred to Gold as a "rogue founder," alleging that she spent almost $50,000 monthly on personal expenses using the organization's credit cards.




Gold resigned from the group's board in February ― before she pled guilty ― so that she could pursue her goal of opening health and wellness centers nationwide, according to the complaint. At that time, the board voted Gilbert to be its chairman and agreed to have Gilbert negotiate an agreement for Gold to serve as a consultant. Gold sought a "signing bonus" of $1.5 million, along with $50,000 to be paid monthly as a consulting fee, according to the complaint.
Gold, Gilbert, and Gilbert's attorneys did not respond to Medscape Medical News' requests for comment.

"

 

[missy]

"

Compliance With Healthcare Regulations: Misunderstanding COVID Pandemic Law Waivers May Put Your Practice at Risk​

Ericka L. Adler, JD, LL.M
DISCLOSURES
November 10, 2022




Since the start of the COVID pandemic in 2020, we have seen the introduction of new regulations that apply to healthcare entities — and a relaxing of others. While some COVID-era changes may permanently remain in place, such as rules related to telemedicine, others are temporary or may have already ended. Healthcare providers need to be alert for temporary changes that are coming to an end and need to also confirm that they have properly understood any waivers or changes in the law on which they previously relied.
One notable example of a change in the law during COVID is the Physician Self-Referral Law, which is commonly referred to as the Stark law (see 42 CFR §411.350, et seq.). In general, this law prohibits physicians from referring Medicare patients to an entity in which the physician or an immediate family member has a financial interest for certain designated health services (DHS).
In order to comply with Stark, strict requirements must be satisfied. One of these limitations is exactly where self-referred DHS can physically be provided by physicians in a group practice. Stark generally requires self-referred DHS to be provided in the "same building" or a "centralized building" in order for a group practice to meet the Stark "in-office ancillary services" exception.
To help healthcare practices during the COVID pandemic, state and federal regulators temporarily waived existing regulations to allow healthcare providers to adapt to COVID restrictions. One Stark waiver allows for referrals of Medicare-payable DHS to be provided in locations that would not otherwise qualify as a "same building" or "centralized building" for purposes of Stark. This waiver has allowed, for example, practices to offer Medicare-payable pathology or radiology services at any location without violating Stark for failing to meet the in-office ancillary services exception. Clinicians have welcomed the freedom to provide such services from a variety of locations. Currently, this waiver is still in effect.

Although the Stark law was relaxed during COVID, other healthcare laws have not been, setting up the potential for inadvertent violations.




For example, the Medicare Anti-Markup Payment Limitations rule (the AMPL) (see 42 CFR 414.50), which was not waived at any time, remains in full force and effect.
The AMPL is a Medicare payment limitation rule that applies whenever a practice orders a service and also serves as the billing practice (the practice making a claim for payment to Medicare), but the service is actually performed by a physician who does not "share a practice" with the billing practice.
Whether a performing physician shares a practice with the billing practice is determined by whether: (1) the performing physician furnishes "substantially all" of the physician's professional services for the billing practice (ie, at least 75% of the performing physician's professional services); or (2) the performing physician provides the service on site or "in the office" of the billing practice.

When medical practices violate the AMPL, amounts they receive can be considered overpayments and are subject to repayment to Medicare.
When a practice hires an outside physician to interpret radiology and pathology tests, often the practice does not have enough volume to sustain the performing physician 75% of the time, and the performing physician likely renders services for various practice and would not travel to be on site at each location. When this occurs, payment to the billing practice is limited to the lesser of: (i) the performing physician's net charge to the billing practice; (ii) the billing practice's actual charge to Medicare; or (iii) the fee schedule amount for the test that would be allowed if the performing physician billed Medicare directly.

So while the location requirements were waived for Stark, off-site services covered by the AMPL still needed to be billed properly in accordance with the law's requirements. Unfortunately, as a result of the Stark waiver, many practices assumed that AMPL did not apply or perhaps were not even aware of the AMPL requirements and failed to handle the billing requirements properly once staff moved off-site.

Even among healthcare lawyers, there is confusion over the application of these rules, but Centers for Medicare & Medicaid Services has confirmed that there has been no waiver of the AMPL during the COVID pandemic.


If your practice has violated the AMPL or any other law which was thought to be waived during COVID, you may have an obligation to identify and return payments to Medicare or other payers.


There is every indication that COVID waivers are coming to an end as soon as the official "public health emergency" ends. Many reversions of laws will happen with short notice, and enforcement is expected to pick up almost immediately. A particular area of concern is practitioners who brought telemedicine into their practices in the midst of the pandemic and who may find those practices are no longer compliant with post-COVID billing, privacy, and prescribing regulations.


Although it is unknown when the formal public health emergency will end and life will return to "normal," practices should prepare in advance and minimize legal risk and financial penalties, which can be significant. In addition, for any practice that is currently considering a sale transaction, compliance in these areas is key. Finding out a practice failed to provide or bill for services in accordance with relevant laws can make it a less attractive target for purchase and significantly impact the purchase terms.




"

 

[josieKat]

No, unfortunatelly it looks like a pattern.

I made a post about a debate relating to the safety of covid vaccines that took place in the UK Parliament and it got taken down.

It's on YT on the UK Parliament official channel. I live in the UK and I care about what affects me directly and that was one of those things.

​

I am pretty sure Missy has you on ignore and has no idea you posted anything.

 

[Gloria27]

I am pretty sure Missy has you on ignore and has no idea you posted anything.

I'm pretty sure she somehow checks because the posts are bang on after mine and it happened several times even at odd AM hours.

When Roe vs Wade and Ukraine topics are allowed, and posts about a debate in the UK Parliament are deleted, something's doesn't add up. The debate wasn't even political (in the way the forum policies mean political), it was about policies implemented in the UK during the pandemic, stuff that even Missy posts about all the time regarding US policies.

It is obvious someone is reporting the posts not because the posts don't follow the rules but because they don't like my posts.

Also I've been called (not overtly) a liar/ spreader of missinformation, selfish for not getting the jab and that the pandemic is because of unvaxxed people like me when I never spread anything not even covid and got the covid from the vaxxed. I don't know how those posts were not removed, they still exist.

You can check here, I'm not crying wolf, the wolf is real, post #58 and #60.

Coronavirus updates April 2022

A family member that is double vaxxed and had symptoms tested negative multiple times and then his GF tested pozitive (LFT test). Obviously he had it. Not saying everyone testing negative (with cold symptoms) has it, but I think it is possible. I think those tests are less accurate and can...

www.pricescope.com

Those posts contain actual falsehoods and missinformation (can be unintentional). Now we know the vaccine doesn't stop the spread or infection.

 

[Ella]

Folks, no conspiracy theories are allowed here and we’re tired of editing posts, so we’re removing them entirely if they break the rules. Post things from official or peer reviewed sources. YouTube videos from random people on either side this “debate” will be removed, and time outs given. Everyone has been warned already, this is the last warning.

Please act like adults and respect the policies if you’d like to continue this conversation.

 

[missy]

I am pretty sure Missy has you on ignore and has no idea you posted anything.

Hmmm I have no clue what is happening but yes thanks. You are correct. All I see is you quoted someone who I am ignoring

Back to the regularly scheduled programming

 

[missy]

"

COVID Hospitalizations Spiked in Youngest Infants During Omicron​

— However, indicators of severe disease "consistently lower" versus Delta period​

by Shannon Firth, Washington Correspondent, MedPage Today November 10, 2022

COVID-19 hospitalization rates among infants younger than 6 months jumped during the Omicron wave, outpacing hospitalizations during the earlier Delta wave, CDC researchers reported.

During the months when the Omicron BA.2/BA.5 subvariants were dominant, weekly hospitalizations per 100,000 infants younger than 6 months increased 11-fold (95% CI 4.3-33.3), rising from a low of 2.2 during the week ending April 9 to a peak of 26.0 during the week ending July 23 before then declining again, noted Sarah Hamid, PhD, of the CDC's National Center for Immunization and Respiratory Diseases, and colleagues in the Morbidity and Mortality Weekly Report.



The average weekly hospitalization rate per 100,000 for this youngest demographic during the Omicron BA.2/BA.5-predominant periods -- 13.7 -- was higher than the rate of 8.3 during the Delta-dominant period (rate ratio RR 1.6, 95% CI 1.4-1., and was similar to rates among adults ages 65 to 74 (13., and higher than rates among all other age groups, except for adults ages 75 and older, which were far higher, at 39.4 per 100,000.

COVID-19 "can and does cause severe and fatal outcomes in children, including infants," Hamid and team wrote. "To help protect infants too young to be vaccinated, prevention should focus on nonpharmaceutical interventions and vaccination of pregnant women, which might provide protection through transplacental transfer of antibodies."

Curiously, the share of hospitalized infants with indicators of severe disease -- such as longer hospital length of stay, intensive care unit admission, and need for respiratory support -- were "consistently lower" during the Omicron BA.2/BA.5 periods compared with the Delta period, the authors noted.



Still, there is "continued risk for COVID-19-associated hospitalization among infants aged <6 months, who are ineligible for vaccination," they stressed.

Possible reasons for the higher hospitalization rates among young infants during the Omicron-dominant periods include high community transmission with these subvariants, as well as the "relatively low threshold" for hospitalizing infants with signs and symptoms linked to COVID-19 compared with older children, the authors said.

Moreover, increased immunity in older age groups due to vaccination, previous infection, or both could have played a role, they added.

Hamid and colleagues used data from the Coronavirus Disease 2019-Associated Hospitalization Surveillance Network (COVID-NET) to look at weekly COVID-19-associated hospitalization rates and clinical characteristics among infants younger than 6 months across the following four periods:

• the Delta-dominant period (June 20, 2021 to Dec. 18, 2021)
• the Omicron BA.1-dominant period (Dec. 19, 2021 to March 19, 2022)
• the Omicron BA.2-dominant period (March 20 to June 18, 2022)
• the Omicron BA.5-dominant period (June 19 to Aug. 31, 2022)

They combined the BA.2 and BA.5 periods due to small sample sizes.

Demographic data related to COVID-19-associated hospitalizations were collected from 13 states. Clinical data -- such as symptoms during admission, underlying medical problems, and indicators of severe diseases -- were only available for infants younger than 6 months in 12 states.

In all, Hamid and team were able to access complete clinical data for 1,116 hospitalized infants younger than 6 months with laboratory-confirmed COVID-19, including 321, 322, and 473 infants during the Delta, Omicron BA.1, and Omicron BA.2/BA.5 periods, respectively.

Given that population estimates for infants younger than 6 months weren't available, the authors used data on half of infants younger than 1 year to calculate an estimate, ignoring "seasonality in births," which was a limitation to the study.

"Births typically peak in the summer, leading to potential small overestimates of rates during Omicron BA.2/BA.5 variant-predominant periods," they noted.

Another limitation was that changes occurred in public health policies, testing, and treatment over the study period, which the authors said they could not account for. They also did not assess rates of vaccination or previous infection among mothers, which may have given some infants higher immunity. Lastly, the COVID-NET catchment areas represent only about 10% of the U.S. population, so results based on their data may not be generalizable.

• 
  
  Shannon Firth has been reporting on health policy as MedPage Today's Washington correspondent since 2014. She is also a member of the site's Enterprise & Investigative Reporting team
• 
  
• "

 

[missy]

"

World COVID-19 Death Rate Down 90%, WHO Chief Says​

Jay Croft
November 09, 2022



Global deaths due to COVID-19 have dropped almost 90% since February, the head of the World Health Organization said Wednesday.
Last week, 9,400 deaths were reported linked to the coronavirus, Director-General Tedros Adhanom Ghebreyesus said.
That's down from 75,000 a week in February.

"We have come a long way, and this is definitely cause for optimism. But we continue to call on all governments, communities, and individuals to remain vigilant," he said at a virtual news conference from the WHO's Geneva headquarters.




"Almost 10,000 deaths a week is 10,000 too many for a disease that can be prevented and treated."
He also said poor countries still lag in vaccinations, and new variants are still a threat.
The Associated Press reported that more than 2.1 million new cases were reported to WHO for the week ending Sunday. That's down 15% from the prior week, and the number of weekly deaths fell 10% compared to the prior week.

So far, WHO has reported 629 million cases around the world and 6.5 million deaths linked to COVID-19.
Surveillance and testing have fallen with case counts, said Maria Van Kerkhove, the WHO's technical lead on COVID-19. She said the coronavirus outbreak is "still a pandemic, and it's still circulating quite rampantly around the world."
Japan had the most new cases — more than 400,000, or 42% more than in the previous week.
Sources:
Associated Press: "WHO reports 90% drop in world COVID-19 deaths since February"

"