Coronavirus Update March 2022

[missy]

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Public Health Experts Pitch Their Own Path to the 'Next' Normal​

— Detailed plan focuses on 12 key areas for living with COVID-19​

by Kristina Fiore, Director of Enterprise & Investigative Reporting, MedPage Today ; Jennifer Henderson, Enterprise & Investigative Writer, MedPage Today March 7, 2022

Last Updated March 07, 2022

Less than a week after the White House released its updated COVID-19 preparedness plan, a group of more public health experts issued a white paper with their own ideas for moving the nation into what they call the "next" normal.

While there's quite a bit of overlap between the two plans, the 136-page document by the COVID Roadmap Group outlines additional details and strategies for living with COVID-19 in the future.



Among its authors are high-profile names, including many who've become authorities on COVID-19 during the pandemic, such as Ezekiel Emanuel, MD, PhD; Trevor Bedford, PhD; Kizzmekia Corbett, PhD; Akiko Iwasaki, PhD; John Moore, PhD; Michael Mina, MD, PhD; Paul Offit, MD; Jennifer Nuzzo, DrPH; and Michael Osterholm, PhD, MPH. (MedPage Today editor-in-chief Jeremy Faust, MD, is listed as a contributor/reviewer.)

The group began working on the plan at the start of the year, Emanuel told MedPage Today. The U.S. has gone a year with one strategic plan, he said. However, after expanding vaccination, surges of two different variants, and new therapies, the country is now at a very different place.

"We needed to have a new strategic plan for the country," Emanuel said. "Having an outside group, which is bipartisan, has a certain advantage."

The group identified 12 key areas of focus, including:

Air Quality



According to the report, the pandemic revealed the poor air quality inside buildings. All public buildings should have their air quality monitored and publicly graded. Schools, commercial buildings, and large apartment complexes should have MERV 13 filtration, and every classroom and childcare facility in the U.S. should have either MERV 13 or HEPA filters.

Therapeutics

The virus is expected to develop resistance to any single antiviral drug, so effective therapy most likely will require a cocktail of two or three drugs. The report calls for a new "Warp Speed" program with advanced purchase agreements and other financial and regulatory incentives to produce an oral antiviral cocktail.

Like the official White House plan, the report also calls for a test-to-treat pathway, so that all Americans who have a positive PCR or at-home test can be treated within a day or enrolled in a clinical trial.

Vaccines

Officials should continue incentives to rapidly develop novel vaccine platforms, including mucosal vaccines and combination vaccines, with the ultimate goal of developing a pan-coronavirus vaccine. The government should also expand the industrial base for domestic and international manufacturing of vaccines, and aim to deliver vaccines around the world.



Testing/Surveillance

Testing is not at the level needed to provide a full and real-time picture of case counts in the U.S., the report stated. PCR and rapid tests should screen for all respiratory viruses, not just SARS-CoV-2. Rapid tests also need to be ubiquitous, accessible, and free or very cheap (under $3 per test).

The report also calls for an investment in four comprehensive, real-time surveillance systems:

• Monitor pathogens in the environment (wastewater and air) and animals (deer, rats, others)
• Track emerging variants
• Assess population immunity against respiratory viruses
• Track hospitalizations, ICU admissions, and fatalities

Long COVID

The U.S. should have a national research program on long COVID that includes health, vaccination, and sociodemographic data. Researchers must get a better hold on the frequency of long COVID, whether asymptomatic or mild COVID is less likely to lead to long COVID, how well vaccines protect against long COVID, potential treatments for the condition, and immunological factors that predispose to or protect against long COVID.



Workforce

The authors of the report recognize that there are a record number of healthcare jobs unfilled and that burnout among healthcare workers is "dangerously high." They noted that staffing shortages are the main limitation to the ability of the healthcare system to provide care. They proposed creating a pool of flexible healthcare workers to deploy in emergencies.

Equity

The report acknowledged the pandemic's disproportionate impact on people of color, rural communities, and other underserved groups, and calls for solutions and strategies to "prioritize health equity and the reduction of health disparities, with the end goal of building an equitable public health system capable of reaching underserved and historically neglected populations."

Other key areas the group cited were health data infrastructure, personal protective equipment, public health infrastructure, schools/childcare, and communications.

As for the White House report, there are many points the group agrees with, and in some ways, the primary points aren't that different, Emanuel noted. However, there are some areas, such as surveillance, that he and the group believe should include more extensive interventions.



For instance, according to the group, animals that can be significant reservoirs for the virus should be included in surveillance, as should population immunity and determining whether cellular immunity is durable for a long period of time. There is also a need to upgrade and collect data from at-home COVID-19 tests, possibly through incorporating QR codes or other patient engagement tools similar to those deployed by high-tech companies.

"This roadmap reimagines how America may live with COVID, which requires getting to and sustaining the next normal, and allows for the return of the routines and joys of everyday life for a majority of the population," the group wrote.

The report acknowledged that the U.S. isn't quite there yet. The combined death toll from influenza and respiratory syncytial virus (RSV) can peak above 60,000 per year, which translates to 165 deaths per day or 1,150 deaths per week. However, the current COVID death toll is still about 15 times that, with 17,500 deaths per week in February -- "a toll exceeded only by the great modern killers of heart disease and cancer," they noted.



The group sketched out three possible future scenarios, taking population immunity into account:

• Their optimistic scenario sees a 20% attack rate with a 0.03% infection fatality rate (IFR), for an annual mortality range of 15,000 to 30,000
• Their intermediate scenario predicts a 40% attack rate, with an IFR of 0.05%, for some 30,000 to 100,000 deaths annually
• Their pessimistic scenario sees an 80% attack rate with a 0.1% IFR, totaling 100,000 to 300,000 deaths per year

"Even the pessimistic forecast projects significantly fewer annual deaths than the approximately 475,000 that the nation experienced in 2021," they wrote.

Overall, the report concluded that the "next" normal can be an improvement over life before the virus emerged.

"There is likely to be a better work-life balance with more teleworking and less commuting, a reimagining of the education system, a platform for rapid development of highly effective vaccines and therapeutics, better indoor air quality, fewer respiratory infections of all kinds, and more effective surveillance to anticipate and respond to new viral threats," the group wrote.



"Getting to this better place by creating some of the tools outlined in this report will require Congressional and state legislation, as well as significant resources. Funding is especially critical," they added. "Financing both the response to COVID and preparation for future biosecurity threats will be a wise investment with high returns to the nation."

For Emanuel, that mindset is critically important.

"Even if a COVID-like pandemic is once in a century, these kinds of investments are high return," he said. "We need to think more like a business. This is capital investment that is going to generate more return to society."

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Long COVID Patients May Develop Nerve Damage: Study​

Carolyn Crist

Some patients with long COVID may have long-lasting nerve damage that could lead to fatigue, sensory changes, and pain in the hands and feet, according to a new study published in the journal Neurology: Neuroimmunology & Neuroinflammation.

The nerve damage, which has been seen even among mild coronavirus cases, appears to be caused by immunity problems triggered by infection.

"This is one of the early papers looking into causes of long COVID, which will steadily increase in importance as acute COVID wanes," Anne Louise Oaklander, MD, the lead study author and a neurologist at Massachusetts General Hospital, said in a statement.


"Our findings suggest that some long COVID patients had damage to their peripheral nerve fibers and that damage to the small-fiber type of nerve cell may be prominent," she said.


The research team analyzed data from 17 COVID-19 survivors with lingering symptoms who had no history or risks of neuropathy, or nerve damage or disease. The patients were from 10 states and territories, and all but one had mild infections.

They found that 10 patients — or 59% — had at least one test that confirmed neuropathy. Two patients had rare neuropathies that affected muscle nerves, and 10 were diagnosed with small-fiber neuropathy, which is a cause of chronic pain. Common symptoms included fatigue, weakness, changes in their senses, and pain in their hands and feet.

For treatment, 11 patients were given immunotherapies such as corticosteroids or intravenous immunoglobulins, and the five patients who received repeated immunoglobulin G treatments appeared to benefit. Over time, 52% of patients improved, though none had all of their symptoms go away.


If patients have long COVID symptoms that aren't improving or can't be explained otherwise, Oaklander said, they should discuss the possibility of neuropathy with their doctor, a neurologist, or a neuromuscular specialist.

"Research from our team and others is clarifying what the different types of post-COVID neuropathy are and how best to diagnose and treat them," she said. "Most long COVID neuropathies described so far appear to reflect immune responses to the virus that went off course."

Oaklander noted that researchers haven't been able to do clinical trials to evaluate specific post-COVID neuropathy treatments. But some existing treatments may help.

"Some patients seem to improve from standard treatments for other immune-related neuropathies," she said.




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[missy]

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A modest gap​ ​

Daily life in red and blue America has continued to be quite different over the past few months. It’s a reflection of the partisan divide over Covid-19. Consider:​

In the country’s most liberal cities, many people are still avoiding restaurants. The number of seated diners last month was at least 40 percent below prepandemic levels in New York, Philadelphia, Minneapolis, San Francisco, Portland, Ore., and Cambridge, Mass., according to OpenTable. By contrast, the number of diners has fully recovered in Las Vegas, Miami, Nashville, Phoenix, Charlotte, N.C., and Austin, Texas, as well as in Oklahoma, Nebraska and New Hampshire. Residents of liberal cities like New York, Washington and San Jose, Calif., are still spending significantly more time at home and less at the office than before the pandemic began, according to Opportunity Insights, a Harvard-based research group. In more conservative places, the rhythms of daily life have returned nearly to normal. During the Omicron wave, schools in heavily Democratic areas were more likely to close some classrooms or require that students stay home for extended periods. Mask wearing remains far more common in liberal communities than conservative ones.

These stark differences have created a kind of natural experiment: Did Omicron spread less in the parts of the U.S. where social distancing and masking were more common?​

The answer is surprisingly unclear.​

Nationwide, the number of official Covid cases has recently been somewhat higher in heavily Democratic areas than Republican areas, according to The Times’s data. That comparison doesn’t fully answer the question, though, because Democratic areas were also conducting more tests, and the percentage of positive tests tended to be somewhat higher in Republican areas.​

No single statistic offers a definitive answer. When I look at all the evidence, I emerge thinking that liberal areas probably had slightly lower Omicron infection rates than conservative areas. But it is difficult to be sure, as these state-level charts — by my colleague Ashley Wu — suggest:​

Charts show 7-day averages. | Sources: New York Times database; Edison Research​

The lack of a clear pattern is itself striking. Remember, not only have Democratic voters been avoiding restaurants and wearing masks; they are also much more likely to be vaccinated and boosted (and vaccines substantially reduce the chances of infection). Combined, these factors seem as if they should have caused large differences in case rates.​

They have not. And that they haven’t offers some clarity about the relative effectiveness of different Covid interventions.​

Vaccines, above all​ ​

The first lesson is that Covid vaccines are remarkably effective at preventing severe illness. Here are the same four states from the above charts, this time with death rates instead of case rates:​

Sources: New York Times database; Edison Research​

The messiness of the previous charts has given way to an obvious pattern: Covid death has been far more common in red America. Over the past three months, the death rate in counties that Donald Trump won in a landslide has been more than twice as high as the rate in counties that Joe Biden won in a landslide, according to Charles Gaba, a health care analyst.​

The second lesson is that interventions other than vaccination — like masking and distancing — are less powerful than we might wish. How could this be, given that scientific evidence suggests that mask wearing and social distancing can reduce the spread of a virus?​

Early in the Omicron wave, at least one expert accurately predicted this seeming paradox. Dr. Christopher Murray, the founder of the Institute for Health Metrics and Evaluation at the University of Washington, wrote an article for The Lancet, a medical journal, arguing that interventions like masks would have “limited impact on the course of the Omicron wave.”​

I followed up with him by email, and he offered a helpful explanation. Although masks reduce the chances of transmission in any individual encounter, Omicron is so contagious that it can overwhelm the individual effect, he said.​

I’ve come to think of the point this way: Imagine that you carry around a six-sided die that determines whether you contract Covid, and you must roll it every time you enter an indoor space with other people. Without a mask, you will get Covid if you roll a one or a two. With a mask, you will get Covid only if you roll a one.​

You can probably see the problem: Either way, you’ll almost certainly get Covid.​

This analogy exaggerates your chances of getting infected, but it still highlights the basic reason that masks and distancing have had a limited effect. “It really is a function of the extreme intensity of Omicron transmission,” Murray told me.​

Getting a shot in New Jersey.Bryan Anselm for The New York Times​

A 95 percent drop​ ​

Together, these two lessons can point the way to a sensible approach to Covid in the coming months.​

One, nothing matters nearly as much as vaccination. A continued push to persuade skeptics to get shots — and to make sure that people are receiving booster shots — will save lives.​

Two, there is a strong argument for continuing to remove other restrictions, and returning to normal life, now that Omicron caseloads have fallen 95 percent from their peak. If those restrictions were costless, then their small benefits might still be worth it. But of course they do have costs.​

Masks hamper people’s ability to communicate, verbally and otherwise. Social distancing leads to the isolation and disruption that have fed so many problems over the past two years — mental health troubles, elevated blood pressure, drug overdoses, violent crime, vehicle crashes and more.​

If a new variant emerges, and hospitals are again at risk of being overwhelmed, then reinstating Covid restrictions may make sense again, despite their modest effects. But that’s not where the country is today. "​

 

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An mRNA patent clash is brewing​

Moderna is heading for a clash with the South African government and the World Health Organization over patent claims that vaccine advocates say could threaten the continent’s access to Covid-19 shots. Medecins Sans Frontiers and other health and relief groups are calling on the vaccine maker to abandon three patent applications filed years ago in South Africa, saying they could impede a WHO-backed effort to make messenger RNA shots for low-income countries at a hub in Cape Town. The patents effectively give Moderna the right to stop anyone from making or selling an mRNA vaccine in South Africa, says Charles Gore, the director of the Medicines Patent Pool, which is helping the WHO establish the mRNA hub. Other countries have already shot down similar applications from the company, he says. Moderna has already rebuffed Afrigen Biologics & Vaccines, part of the mRNA hub, when it asked for help making a low-cost version of the company’s vaccine for distribution in poor nations, some of which have immunized just 0.5% of their populations. While Afrigen now says it can make the shot based on publicly available information, Moderna’s patent filings in South Africa hang over the humanitarian effort. Petri dishes inside the Afrigen Biologics & Vaccines laboratory facility in Cape Town. Photographer: Dwayne Senior/Bloomberg Moderna has said it won’t enforce its patents during the pandemic. The company said in a statement that it’s “committed to continuing to be part of the solution in terms of the equitable access” to Covid-19 vaccines and that its intellectual property won’t “create a barrier to equitable mRNA Covid vaccine access in those countries most in need.” Yet vaccine advocates still see problems in the company’s stance: Moderna can determine on its own when it sees the pandemic as having ended, at which point it could potentially try to legally block copycat vaccines. They say Moderna may require Afrigen to pay for a commercial license, boosting the cost of the shots for some of the world’s poorest nations. Various South African government departments are working with the WHO, the mRNA hub and the Medicines Patent Pool to try resolve these issues, says Nicholas Crisp, deputy director general in the country’s Department of Health. If a solution can’t be found, the government could potentially seek to revoke the patents or issue a compulsory license, allowing the hub to produce an mRNA vaccine, according to Gore. Both could potentially lead to lengthy and costly procedures. While the hub will focus initially on a Covid-19 shot, its ultimate purpose is to target the diseases that plague Africa such as HIV, tuberculosis and malaria with mRNA shots it plans to develop. The patents could block those from being produced, says Petro Terblanche, Afrigen’s managing director. — Antony Sguazzin "

 

[autumngems]

Here in NC (military base) we are mask-free as of this past Monday (except for child care facilties). woohooo

 

[missy]

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Another Casualty of COVID-19: Evidence-Based Medicine​

— Physician laments decline in research quality, critical appraisal during pandemic​

by Charles Bankhead, Senior Editor, MedPage Today March 9, 2022


MIAMI BEACH -- COVID-19 has not only exacted a heavy human and economic toll, but the pandemic effectively "killed evidence-based medicine in this country," a New York oncologist argued in a presentation here.
During the first 18 months of the pandemic, more than 200,000 COVID-related articles were published in various types of journals, said Patrick Borgen, MD, of Maimonides Medical Center in New York City. Submissions to publishing giant Elsevier increased by 58% from February to May 2020 as compared with the same period in 2019.

The "appalling" loss of life and morbidity during the early months of the pandemic, driven by a lack of effective therapies, led to "an explosion of people trying to help, through hundreds of thousands of publications."
"I like to argue that we were building the plane while we were flying it during COVID, that we were grasping at therapeutic straws," Borgen said during a departure from scientific presentations at the Miami Breast Cancer Conference. "This is known as apophenia: the tendency to identify meaningful patterns where none truly exist. It's a part of human nature, and I believe it's exactly what happened."
"I don't think that the explosion of publications was nefarious. I don't believe that it was self-serving. I believe that it was apophenia. We were desperately looking for help," he stated.
The publishing tidal wave continued into 2021, reaching almost 250,000 publications by the end of the first quarter, including 235,000 primary studies. Hydroxychloroquine accounted for 250 studies, most involving fewer than 100 patients. During that time the peer review process "was put on steroids," said Borgen. An analysis of 11 highly cited journals showed that the median time for peer review decreased from 90 days in 2019 to 19 days for COVID-related articles in 2020.

COVID-related literature flourished on preprint websites, which accept unpublished articles that have not been peer reviewed. More than 30,000 articles about the pandemic have been published as preprints, said Borgen. MedRxiv, launched in June 2019, had 11,000 submissions during the first year of its existence, fueled by the pandemic. The site published 90% of submissions, but only 10% subsequently appeared in peer-reviewed publications. Moreover, the website removed only 18 articles (0.002%) after posting.
"If you're a young writer looking for an emerging story, you go to preprints," said Borgen. "Many of [the preprints] were picked up by the media and disseminated as evidence-based medicine."
As an example, he cited an early study of convalescent plasma, showing that patients with hematologic malignancies who received convalescent plasma had a 13% improvement in survival. One widely read news article said the study showed that patients who received convalescent plasma were 86% less likely to die of COVID-19.

On March 16, 2020, MedRxiv posted the manuscript for a 36-patient study of hydroxychloroquine's ability to clear the virus from nasal swabs. After 6 days, two of 16 patients in the control group had clean swabs as compared with 12 of 20 who received hydroxychloroquine. The results were reported as "highly positive" for hydroxychloroquine.
Also on March 16, the article was submitted to the International Journal of Antimicrobial Agents (whose editor was a co-author of the article), approved for publication March 17, published on March 20, and tweeted by former President Trump on March 21. The FDA approved an Emergency Use Authorization (EUA) on March 28.
"This is the fastest EUA approval in the history of the United States," said Borgen. "Nothing else has ever come close. Based on a study of 30 patients with nasal swab PCR clearance."
"If you look at all of the trials on hydroxychloroquine, they are profoundly biased across eight domains of bias ... and the one that led to the EUA approval was clearly the most biased of all the studies."

As a final example of COVID's adverse impact on scientific research and reporting, Borgen cited a literature review and meta-analysis published by three economists, who evaluated the effectiveness of lockdowns on COVID-19 mortality. The authors whittled an initial list of 18,590 publications down to 34 published studies.
The authors concluded that lockdowns have had little or no public health benefits, imposed enormous economic and social costs, were ill-founded, and "should be rejected as a pandemic policy instrument."
Borrowing from a critique that described the study as "not a met-analysis but a simple narrative review," Borgen said, "Whether or not you believe [the authors' conclusions], this study didn't show it. They didn't address the biology of the virus. They didn't address modes of transmission. They didn't address the time delay between exposure and development of symptoms. They simply showed it from the economic literature."
"It excluded all of the science and yet it was picked up by 1,300 news media outlets and disseminated as good science," he noted.

In closing, Borgen said a fundamental mistrust of medical science has arisen from a polarized society. In general, medical school has "very poor training in evidence-based medicine."
"We've got to have our trainees, our fellows, residents, and medical studies better at critically appraising literature," he said. "That's really the fix; better education and emphasizing how important it is to be your judge. In breast cancer, am I going to take this study at face value, am I going to simply believe what the media tells me about it?"
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[missy]

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Two years into the coronavirus pandemic, many long-haul covid-19 patients who are unable to work are being denied disability benefits for a condition that is not well understood. Doctors have estimated that as many as 1.3 million Americans are too sick to return to work. Still, many are unable to prove it with medical test results, which many insurers require for disability claims.

Florida is discouraging parents from vaccinating healthy children against the coronavirus, contradicting guidance from federal health authorities. The state released official guidance Tuesday that said the risks of administering the coronavirus vaccine may outweigh the benefits. The guidance comes a day after Gov. Ron DeSantis (R) and state Surgeon General Joseph Ladapo announced the new state policy, prompting outcry from public health experts who called it “reckless” and “dangerous.”

Although federal health authorities no longer recommend masking for the vast majority of the country now that coronavirus cases are declining, researchers from the Centers for Disease Control and Prevention found that mask requirements in schools did reduce cases of covid-19 during the delta surge. In a large study released Tuesday, the CDC looked at 233 school districts in the United States and found that those with mask requirements had a 23 percent lower incidence of cases of covid-19. The authors concluded that masks remain an important tool to prevent the spread in schools, particularly in communities with high levels of disease.

The omicron surge is over in the United States, but the variant is still infecting tens of thousands of Americans each day and made up 100 percent of new infections during the week ending March 5, the CDC stated.

Internationally, Hong Kong, which had kept coronavirus cases low, is now struggling with the highest covid-19 death rate in the developed world. The highly transmissible omicron variant has hit the city’s unvaccinated and elderly residents especially hard, and more than 2,300 people have died since the start of the most recent wave.

Other important news​

As some popular vacation spots are reopening to the world, the CDC is recommending Americans avoid traveling to New Zealand, Hong Kong and Thailand as covid-19 is currently surging in those countries.


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First 'Before-and-After' COVID Brain Imaging Study Shows Structural Changes​

Kelli Whitlock Burton

Even mild cases of COVID-19 are associated with brain changes including decreased gray matter, an overall reduction in brain volume, and cognitive decline, a new imaging study shows.

In the first study to use magnetic resonance brain imaging, before and after COVID-19, investigators found "greater reduction in grey matter thickness and tissue-contrast in the orbitofrontal cortex and parahippocampal gyrus, greater changes in markers of tissue damage in regions functionally connected to the primary olfactory cortex and greater reduction in global brain size." However, the researchers urge caution when interpreting the findings.

Gwenaëlle Douaud, PhD, Wellcome Center for Integrative Neuroimaging, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom, and colleagues describe these brain changes as "modest."


"Whether these abnormal changes are the hallmark of the spread of the pathogenic effects in the brain, or of the virus itself, and whether these may prefigure a future vulnerability of the limbic system in particular, including memory, for these participants, remains to be investigated," the researchers write.


The findings were published online today in the journal Nature.

Gray Matter Loss​

The investigators analyzed data from the UK Biobank, a large-scale biomedical database with genetic and health information for about 500,000 individuals living in the UK.


They identified 785 adults aged 51-81 years who had undergone two brain MRIs about 3 years apart. Of these, 401 tested positive for SARS-CoV-2 before the second scan.

Participants also completed cognitive tests at time of both scans.

Biobank centers use identical MRI scans and scanning methods, including six types of MRI scans to image distinct regions of the brain and brain function.

Results showed that although some loss of gray matter over time is normal, individuals who were infected with SARS-CoV-2 showed a 0.2% to 2% brain tissue loss in the parahippocampal gyrus, the orbitofrontal cortex, and the insula — all of which are largely involved in the sense of smell.


Participants who had contracted COVID also showed a greater reduction in overall brain volume and a decrease in cognitive function.

Most of those with COVID had only mild or moderate symptoms. However, the findings held even after the researchers excluded patients who had been hospitalized.

More Research Needed​

"These findings might help explain why some people experience brain symptoms long after the acute infection," Max Taquet, PhD, National Institute for Health Research Oxford Health BRC senior research fellow, University of Oxford, said in a press release.

Taquet, who was not a part of the study, noted the causes of these brain changes remain to be determined. Questions remain as to "whether they can be prevented or even reverted, as well as whether similar changes are observed in hospitalized patients," children, younger adults, and minority groups.

"It is possible that these brain changes are not caused by COVID-19 but represent the natural progression of a disease that itself increased the risk of COVID-19," Taquet said.

Other experts expressed concern over the findings and emphasized the need for more research.

"I am very concerned by the alarming use of language in the report with terms such as 'neurodegenerative,' " Alan Carson, MD, professor of neuropsychiatry at the Center for Clinical Brain Sciences at the University of Edinburgh, Scotland, said in a press release.

"The size and magnitude of brain changes found is very modest and such changes can be caused by a simple change in mental experience," Carson said.

"What this study almost certainly shows is the impact, in terms of neural changes, of being disconnected from one's sense of smell," he added.
The study was funded by the Wellcome Trust Collaborative. Full financial conflict information for the study authors is included in the original article. Taquet has collaborated previously with some of the investigators.

Nature. Published online March 8, 2022.
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[missy]

WHO Says COVID Boosters Needed, Reversing Previous Advice​

Carolyn Crist
March 09, 2022

"
A World Health Organization advisory group said Tuesday it "strongly supports urgent and broad access" to COVID-19 vaccines and boosters, especially for people who face high risks for severe disease.

The recommendation reverses previous statements from the WHO that stressed worldwide vaccine equity for first doses over booster distribution in rich countries. On Tuesday, the WHO pulled back on its earlier statements by saying boosters were recommended once countries had enough supplies and could protect their most vulnerable citizens, according to The Associated Press.

The WHO group concluded that COVID-19 vaccines provide high levels of protection against severe disease and death as the contagious Omicron variant continues to spread around the world. Although the variant has decreased in some countries, such as the U.S., several countries in the WHO's Western Pacific region are facing high cases and deaths.


"While global cases are declining, there are reduced testing resources and capacities in some areas," the WHO said. "The epidemiological situation remains heterogeneous, with a number of regions and countries reporting increases in new weekly cases, while others are now reporting declines."


The updated recommendations came from the WHO Technical Advisory Group on COVID-19 Vaccine Composition, which is made up of 18 experts who focus on how well vaccines work and variants of concern, such as the Delta and Omicron variants. The WHO said it continues to monitor the global spread of Omicron, as well as the subvariant BA.2, which has reinfected some people after they had a case of Omicron and has become the dominant lineage of Omicron in several countries.

Vaccines appear to be effective against Omicron and BA.2, the WHO said. Several studies have pointed to evidence that booster doses restore waning immunity and protect against serious COVID-19. Booster programs in countries such as the U.S., U.K., and Canada have prevented the surge in Omicron infections from leading to hospitalizations and deaths, the AP reported.

The WHO said new variants will likely emerge, and new vaccines will likely be needed since the current authorized vaccines are based on the first coronavirus strain that circulated at the beginning of the pandemic.


"Since then, there has been continuous and substantial virus evolution, and it is likely that this evolution will continue, resulting in emergence of new variants," the WHO said. "The composition of current COVID-19 vaccines may therefore need to be updated."

Sources​

The Associated Press: "WHO says COVID boosters needed, reversing previous call."

World Health Organization: "Interim Statement on COVID-19 vaccines in the context of the circulation of the Omicron SARS-CoV-2 Variant from the WHO Technical Advisory Group on COVID-19 Vaccine Composition (TAG-CO-VAC), 8 March 2022."


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[missy]

Masks Protected Children From COVID Last Fall: CDC Study​

Carolyn Crist
March 09, 2022

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School mask mandates helped to protect children and teachers from the coronavirus last fall, according to a new study released by the CDC.
Public school districts in Arkansas with mask requirements had 23% lower rates of the coronavirus among students and staff than districts without mandates from August to October 2021 as the Delta variant spread.
The CDC has faced criticism in the past for overstating the benefits of masking at schools based on previous studies, according to The New York Times .Some studies have found that mask mandates work in schools, while others have found that mask requirements don't lower the rates of the coronavirus in children.
But the latest CDC research appears to have avoided the study design problems noted in other studies and has supported the evidence for using masks to protect children, the newspaper reported.

"It passes the smell test," Louise-Anne McNutt, PhD, a former CDC researcher and now an epidemiologist at the State University of New York at Albany, told the newspaper.

"The estimates of the impact of masks are consistent with other studies that show masks have a modest, but important, reduction of SARS-CoV-2 transmission," she said.
The research team compared the rates of COVID-19 cases at 233 public school districts in Arkansas between Aug. 23 and Oct. 16. About a third had full mask mandates, a fifth required masks in certain settings or groups, and half had no mask requirements. They also looked at COVID-19 rates in the surrounding community, social and economic status, and staff and student vaccination rates.
During the study period, statewide COVID-19 community transmission levels declined from substantial to moderate, and vaccination coverage increased. Average weekly district-level case rates among students and staff were consistently higher than community case rates and decreased over time from 745 cases per 100,000 people in late August and early September to 137 cases per 100,000 people in mid-October. During the same time, vaccination coverage increased from 13.5% to 18.6% among staff and older students.

The research team found that districts with full mask mandates had lower COVID-19 rates, relative to the case rates in the surrounding community, than districts without mandates. Overall, districts with full mask requirements had 23% lower COVID-19 rates, compared with districts with no requirements, including 24% lower among staff and 23% lower among students. The researchers also found that partial masking policies didn't help as much as full mask mandates.


Among 26 districts that switched from a no-mask policy to a full or partial requirement during the study period, case rates dropped more than would have been expected based on community cases at the time, the study authors wrote. A week after a mask policy was put in place, case rates among students and staff decreased significantly.

"In areas with high COVID-19 community levels, masks are an important part of a multicomponent prevention strategy in K-12 settings," the study authors wrote.

The study still had several limitations. Since it was done from August to October, researchers aren't sure whether the same results held once the Omicron variant became the dominant form of the coronavirus at the end of the year.

What's more, the study couldn't account for other prevention efforts at schools, such as quarantine rules, classroom ventilation, and whether people followed physical distancing guidelines. Future studies could match nearby schools in the same community that had different masking policies to study their effects, Jason Abaluck, PhD, a behavioral and health economics professor at the Yale University School of Management who led a study on masking in Bangladesh, told the Times.

"Figuring out how severe an outbreak has to be to warrant mask mandates in schools requires making best guesses about the costs, which remain highly uncertain given existing evidence," he said.

Those costs could include discomfort, Abaluck noted, as well as difficulties in communicating at school. At the same time, the study marks an improvement on previous research, he said.

"This study and the broader literature on masking suggests that in places where hospitalization and deaths are very high, the benefits of mask wearing in schools may be considerable," he said.

Sources​

CDC: "SARS-CoV-2 Incidence in K-12 School Districts with Mask-Required Versus Mask-Optional Policies — Arkansas, August-October 2021."

The New York Times: "Masking helped protect children from the virus last fall, a C.D.C. study suggests."

"

 

[missy]

"

COVID's Death Toll 3 Times Worse Than Official Counts​

— In U.S. alone, excess deaths were 300,000 higher than those attributed to virus​

by Molly Walker, Deputy Managing Editor, MedPage Today March 10, 2022

The global COVID-19 death toll may be three times higher than official tallies suggest, according to a systematic analysis of excess mortality during the pandemic.
From Jan. 1, 2020 to Dec. 31, 2021, global deaths directly attributed to COVID-19 reached 5.9 million, yet estimates put excess deaths during this period at a staggering 18.2 million (95% uncertainty interval [UI] 17.9-19.6), Haidong Wang, PhD, of the University of Washington in Seattle, and the COVID-19 Excess Mortality Collaborators reported in The Lancet.

India had the highest number of excess deaths (4.07 million, 95% UI 3.71-4.36), an estimated eight times higher than its 489,000 reported COVID-19 deaths, which was followed by the U.S. (1.13 million, 95% UI 1.08-1.1, where the official count reached 824,000 by the end of 2021.
The excess mortality rate in the U.S. (179.3 per 100,000) was about on par with Brazil (186.9 per 100,000), the study found.
"Understanding the true death toll from the pandemic is vital for effective public health decision-making," Wang said in a statement. "Studies from several countries including Sweden and the Netherlands, suggest COVID-19 was the direct cause of most excess deaths, but we currently don't have enough evidence for most locations."
The researchers undertook a massive effort, deriving models by using all-cause mortality reports for 74 countries and territories and 266 "subnational locations," which included 31 locations in low and middle-income countries. These locations reported all-cause death from 2020-2021, and up to 11 years prior. They also obtained excess mortality reports for 12 states in India.

Overall, the global rate of estimated excess mortality from COVID was 120.3 deaths per 100,000, with 21 countries exceeding 300 excess deaths per 100,000. The highest estimated excess mortality rate from COVID was in Bolivia at 734.9 deaths per 100,000, followed by Bulgaria, Eswatini, North Macedonia, and Lesotho. Iceland had the lowest excess mortality rate (-47.8 per 100,000). Australia, Singapore, New Zealand, and Taiwan also had negative excess mortality rates.
Behind India and the U.S. for most excess deaths were Russia (1.07 million), Mexico (798,000), Brazil (792,000), Indonesia (736,000), and Pakistan (664,000). Wang's group noted that these seven countries accounted for more than half of the excess deaths globally during the study period.
Wang's team acknowledged the "convincing evidence" that rates of anxiety and depression rose during the pandemic, which might lead to increases in death by suicide, but added that "to date, evidence of increased suicide mortality is scarce apart from in Japan, where reported suicide deaths increased during the pandemic."

"The most compelling evidence to date of a change in cause-specific mortality in the pandemic period is the decrease, especially in the Northern Hemisphere, in flu and respiratory syncytial virus (RSV) deaths seen in the months of January to March, 2021," they added. "Given the scarce and inconsistent evidence of the effect of the COVID-19 pandemic on cause-specific deaths, and the extremely scarce high-quality data on causes of death during the pandemic, our excess mortality estimates reflect the full impact of the pandemic on mortality around the world ... not just the deaths directly attributable to SARS-CoV-2 infection."
Limitations to the data include that different modeling strategies were used to estimate excess mortality rate, and that they did not estimate excess mortality rate by week or month.


Molly Walker is deputy managing editor and covers infectious diseases for MedPage Today. She is a 2020 J2 Achievement Award winner for her COVID-19 coverage. Follow
Disclosures
This study was supported by the Bill & Melinda Gates Foundation, J. Staunton, T. Gillespie and J. and E. Nordstrom.
Wang disclosed no conflicts of interest.
Other co-authors disclosed support from the Benificus Foundation for collection of data on state-level social distancing policies in the U.S., employment at the Institute for Health Metrics and Evaluation and the University of Washington, WHO, Gates Ventures, the Japanese government, and the Bill & Melinda Gates Foundation.
Primary Source"

 

[Gloria27]

What's going on with "Science", heard he is in the witness protection program, anyone know anything about that?

 

[TooPatient]

I am sitting here awake and waiting for an update. While I wait, I can't help but wonder how many people have died from other causes that were caused by shortages due to covid. How many people couldn't get care due to a lack of beds, lack of medication, lack of medical staff, or just plain fear of going to be seen? The number must be huge.

For those wondering, my grandfather has been getting a very high resting heart rate. 180+. In order to bring it down, they give a med. That also drops his blood pressure. They give a med to bring that up. One of both of those meds is running low in the hospital and they don't have enough to keep him going on it. From the sounds of it, they may not have enough to get him through tonight. We just don't know yet.

 

[Karl_K]

@TooPatient am praying for you grandfather and your family and you.

 

[missy]

I can't help but wonder how many people have died from other causes that were caused by shortages due to covid

It's a question that has been on my mind for the past two years. I don't know if we will ever know the true answer but the number I am sure is staggering.

COVID-19’s indirect effects are claiming more lives than we realize - UNC Gillings School of Global Public Health

January 26, 2022 Social isolation, economic insecurity, barriers to health care access – Gillings epidemiologists have found that these indirect consequences of the pandemic are claiming lives that are not being reported in COVID-19 surveillance data, especially among populations of color and...

sph.unc.edu

“Indirect” Mortality During the COVID-19 Pandemic - Ambulatory Anesthesia Services | OBS Anesthesia Management Groups

Official death tolls from COVID-19 are thought to be an undercount, with likely significant indirect mortality during the pandemic.

radiusanesthesia.com

The pandemic’s true death toll: millions more than official counts

Countries have reported some five million COVID-19 deaths in two years, but global excess deaths are estimated at double or even quadruple that figure.

www.nature.com

@TooPatient I am keeping your grandfather in my thoughts and sending you gentle hugs. I am so sorry.

 

[missy]

Waiting for the next variant​

In this week's edition of the Covid Q&A, we look at new variants on the horizon. In hopes of making this very confusing time just a little less so, each week Bloomberg Prognosis picks one reader question and puts it to experts in the field. This week’s question comes to us from Emily in New York City. I haven't seen reports for a few weeks as to whether another variant is emerging. Should we be concerned? Will we be blindsided by another variant? It feels like we’ve been here before, doesn’t it? Everyone gets vaccinated, the world starts to tip-toe back toward normal and then boom, the delta variant hits. Then cases recede, we all make plans to spend Christmas with our families, and omicron rears its hyper-contagious head. “Viruses mutate as part of evolution and natural selection, just as we all do,” says Jessica Justman, an epidemiologist at Columbia University Medical Center. “But with SARS-CoV-2, we have been actively looking for the evidence, so we are more aware of the mutations and the variants than with most other viruses that cause human disease.” What Justman is talking about is viral surveillance. It’s a critical component of our Covid defense strategy, allowing us to spot potentially new outbreaks early and respond accordingly. Recently surveillance has found an omicron subvariant called BA.2. It’s more transmissible, but not more severe, than the main BA.1 omicron strain, says Justman. And preliminary studies indicate vaccines appear to be as effective against it as they are against the main omicron strain, she says. A technician uses a pipette while preparing test samples at a lab in New Delhi. Photographer: T. Narayan/Bloomberg But Justman also noted an early report out of Australia that describes the development of drug-resistant mutations in Covid patients who received the monoclonal antibody sotrovimab. “If the strain with these mutations were to spread, it could potentially become another variant of concern,” she says. Yet another report this week describes a new strain that combines features of omicron and delta. That one also has potential to become a variant of concern, says Justman. As to what else might be lurking on the horizon, Jeremy Kamil, a virologist at Louisiana State University Health Sciences Center, says that’s harder to predict. “I would very much expect the next major variant of concern to come out of left field, as was the case with all previous variants of concern,” he says. “The common ways this would happen would be from a variant circulating for a long period of time in an under-surveilled, poorly vaccinated part of the world, or from long-term carriage and/or evolution in an immune- compromised person, or by circulation and long-term evolution in an animal population like mink, rodents or deer before spilling back into humans,” he says. In order for a new variant to rise to a level of concern, it would need to be able to escape the antibodies that have so effectively neutralized previous variants. What all this means is that it’s hard to predict what the future might hold for Covid. So far, the only thing predictable about the virus has been that it is extremely unpredictable. “The best-case scenario would be for SARS-CoV-2 to shift into a flu-like pattern, with relatively low hospitalization and mortality rates in the wintertime,” says Justman. “A worst-case scenario would be for the virus to continue to mutate in ways that evade immunity while remaining highly transmissible and infecting large numbers of the population.” In other words, she says, “We need to hope for the best and prepare for the worst.” Thanks to all of you for writing in this week! Next Sunday, we'll be answering the best question we receive again. So if you have any, we want to hear from you. Write to us at [email protected] — Kristen V. Brown The headline in yesterday’s newsletter oversimplified how it described the efficacy of this season’s flu shot. While the vaccine’s efficacy against mild and moderate disease is low, the research Bloomberg cited said that the shot’s protection against more severe disease — a key benefit of vaccines — is unknown.

 

[MamaBee]

My husband, David, and I all have scratchy throats. We feel run down and feel warm. We’re on our way home from our other house in Maryland. We drove there after we left my son and DIL’s house on Sunday evening. We stayed there with my DIL and two grandchildren to help her out because my son was on a business trip…The 22 month old had a cold..but she took him to get a PCR test two days before we got there on Saturday. She thought it might be allergies. It was negative. She said that she and the 5 year old were completely fine. He just received his first vaccine on Friday. His nose was runny just like the baby. She thought the runny nose was a side effect from the vaccine..Nope..She also developed a cold and congestion.
I hope we don’t have Covid..ugh

 

[canuk-gal]

HI:

@MamaBee hope your family is OK! Can you test?

I felt yucky--run down--when I came home when my Mom passed. I took two rapid tests--2 days apart--and they were both negative.

Sharon

 

[MamaBee]

HI:

@MamaBee hope your family is OK! Can you test?

I felt yucky--run down--when I came home when my Mom passed. I took two rapid tests--2 days apart--and they were both negative.

Sharon

@canuk-gal I’m relieved to hear you tested negative. I understand why you would feel run down. TG it wasn’t Covid.

I have a ton of tests at home..My husband is driving us to Pa now. Once we get there I’ll test us. I guess I’ll test again tomorrow and Thursday. I never get a sore or scratchy throat..I’m crossing all my fingers and toes!

 

[missy]

I hope you and your family are feeling much better @MamaBee!








"

Covid’s death toll is worse than we thought​

The global death toll from Covid-19 was probably more than three times worse than officially recorded. As many as 18.2 million people probably died during the first two years of the pandemic, according to the first peer-reviewed global estimate of excess deaths. In their study published in the Lancet last week, researchers at the Institute for Health Metrics and Evaluation at the University of Washington pointed to a lack of testing and unreliable mortality data to explain the discrepancy with official estimates of roughly 5.9 million deaths. They found Covid drove a 17% jump in deaths worldwide. “At the global level, this is quite the biggest mortality shock since the Spanish flu,” Christopher J.L. Murray, the director of the Seattle-based institute, told me. The flu pandemic that began in 1918 killed at least 50 million people. The evidence suggests that the vast majority of the mortality surge is a direct result of Covid-19, Murray said. But some deaths may also have occurred indirectly, caused by a lack of access to health care and other essential services during the pandemic, or from behavioral shifts that led to suicide or drug abuse. A health worker handles the body of a Covid-19 victim in a mortuary refrigerator. Photographer: Samsul Said/Bloomberg Although much of the undercounting of the true mortality impact of the pandemic occurred in low- and middle-income countries, even some rich nations may have missed fatal Covid cases. For instance, excess mortality in Japan from Jan. 1, 2020, to Dec. 31, 2021, was estimated at 111,000 — six times more than the 18,400 Covid deaths officially reported. Even though reported suicide deaths there increased during the pandemic, that's unlikely to account for the discrepancy, Murray said. “So what is it?” he said. “We'll have to wait and see for when the cause of death data comes out. But there's very clearly more excess deaths, dramatically more than the reported Covid deaths.” As concern shifts to the aftermath of Covid-19 — including rising incidence of heart failure, lethal blood clots, kidney impairment, diabetes and possibly dementia due to complications of a coronavirus infection — authorities need accurate cause-of-death data to inform ways to protect their citizens and prepare for future increases in health-care demand. Only 36 countries have released cause-of-death data for 2020 so far. “The pandemic has made clear that keeping track of how many people are dying, and the reason for those deaths, is vital for governments to formulate better-informed policies and improved health outcomes,” says Jennifer Ellis, who leads the Data for Health program at Bloomberg Philanthropies, which works with low- and middle-income countries to strengthen information gathering. — Jason Gale "

 

[Gloria27]

As concern shifts to the aftermath of Covid-19 — including rising incidence of heart failure, lethal blood clots, kidney impairment, diabetes and possibly dementia due to complications of a coronavirus infection — authorities need accurate cause-of-death data to inform ways to protect their citizens and prepare for future increases in health-care demand. "

Is this within the vaccinated population?
Sounds similar to the long list of advers events from the recently released Pfizer data.

 

[missy]

Is this within the vaccinated population?
Sounds similar to the long list of advers events from the recently released Pfizer data.

No, it is with the unvaccinated population...long term Covid effects.

Those who are vaccinated have a much greater survival rate, much less chance of severe Covid if they get Covid and much lower risk of Covid side effects.

COVID-19 Incidence and Death Rates Among Unvaccinated ...

This report describes COVID-19 incidence rate ratios for unvaccinated versus fully vaccinated persons with and without booster vaccine doses during the emergence of the Omicron variant.

www.cdc.gov

https://www.pennmedicine.org/coronavirus/vaccine/vaccine-faqs

 

[missy]

FYI

UpToDate

www.uptodate.com

 

[Gloria27]

I must be really good at dodging this thing according to the CDC's unvaxxed infection and survival rate predictions.

 

[missy]

I must be really good at dodging this thing according to the CDC's unvaxxed infection and survival rate predictions.

I am pleased you remain well Gloria. May that continue.

 

[mellowyellowgirl]

The kid inevitably caught Covid as it made the rounds at school.

Started with a sore throat that was incredibly painful to swallow. The weird thing was it would hit him suddenly. He was eating dinner and then he said he would be hit with a stabbing pain.

RAT was positive.

He had crazy fever dreams that night. Very wrought. Had to take some paracetamol. Woke up the next day and was slumped on the couch. Could barely open his eyes.

I gave him two slices of bread and a paracetamol which he chalked down, I had to carry him upstairs and tuck him in.

Now here's the super weird thing. Two hours later I heard singing and he was out of bed looking disheveled but super peppy. Watched TV, ate fish and chips for lunch, read a novel and played until bedtime. Had a super snotty nose though.

Next day, woke up with snotty nose but seemed absolutely fine. Was energetic and could eat like normal. Did some comprehension to make sure that Covid had not made him stupid. Scored 100% so Covid had not made him stupid yet.

Next day: Crazy zoomies around the house driving me insane. Did lots of maths and performed very well on a writing task. No Covid stupidity yet.

He's served out his quarantine period now. I must say we've had worse colds (night coughing was always an issue for us with colds) and the flu was waaaay worse!!! So much worse!!!

 

[Gloria27]

I am pleased you remain well Gloria. May that continue.

Thank you, Missy.

 

[missy]

Homologous and Heterologous Covid-19 Booster Vaccinations | NEJM

Original Article from The New England Journal of Medicine — Homologous and Heterologous Covid-19 Booster Vaccinations

www.nejm.org

 

[missy]

"

Boosters, the next chapter​

Are we ready for another booster shot? Drugmakers, at least, think the time is near for all of us to roll up our sleeves again. Moderna asked the U.S. Food and Drug Administration late Thursday to grant emergency authorization for a fourth shot of its messenger RNA vaccine for all adults. That's a much broader request than the one submitted just days earlier by rivals Pfizer and BioNTech, who asked that regulators bless an additional dose for ages 65 and up. And it came just days after Moderna's president seemed to throw some cold water on the idea that most people would need another dose soon (Stephen Hoge reportedly said a second booster is probably only needed for older people or those whose immune systems are compromised, and that most others could be more selective). It appears likely regulators could act quickly on both submissions: The FDA said it would convene its outside vaccine advisers soon to deliberate on the merits of further shots (and it's not out of the question that the agency could act on the narrower Pfizer request without consulting the advisory panel). Doses of the Moderna booster at a Southern Nevada Health District testing site in Las Vegas. Photographer: Bridget Bennett/Bloomberg The companies are relying on data from Israel and other countries where fourth shots are already being administered to make their case, but this time around the need for another shot could end up being much less clear-cut. There could be an argument to hold out for shots that target the omicron variant, which caused the spike in cases over the winter, or for a hybrid vaccine that combines a variant-seeking formulation with the older one that millions of people have received. And though a fourth shot could provide a quick turbo-charge of neutralizing antibodies, what its effects are on more enduring kinds of immunity will remain unknown for some time. There are political considerations as well: Congress must restore funding it recently cut off if the government is to bankroll another big immunization effort. With cases down, it gets easier for lawmakers to hold out. But a jump in new infections (recent wastewater samples suggest that a rise in cases could be in the offing) may quickly shift that calculus. —Tim Annett

​ ​ ​ ​ Track the recovery​

Soaring Airfares Shock Travelers After Pandemic​ The much-awaited easing of Covid cases and restrictions is coinciding with a jump in jet-fuel costs, as Russia’s invasion of Ukraine prompted the U.S. to ban imports of Russian crude and pushed oil prices as high as $130 a barrel. That, plus higher demand for trips, means airline-ticket costs are increasing for consumers, many of whom are already facing higher prices in areas like groceries, gas and rent payments. Read the full story here. "

 

[dk168]

Peeps in my social circle are getting Covid.

I guess it is difficult in social settings when it is not practical to wear masks and social distance.

Like me, they are triple vaccinated and their symptoms were mild like mine.

DK