An unsettling start to the school year

https://mailchi.mp/a2cd96a48c9b/the-weekly-gist-october-1-2021?e=d1e747d2d8

As a long hoped-for sign of the “return to normal”, most children went back to in-person learning this fall. And with the patchwork of COVID safety protocols and masking policies across school districts, classrooms became a learning lab for scientists studying the efficacy of masking and other precautions.

Unsurprisingly, getting a bunch of unvaccinated kids back together caused a surge in pediatric COVID cases. But recent Centers for Disease Control and Prevention (CDC) data from 500 counties demonstrate just how effective mask mandates have been at mitigating outbreaks.

The graphic above shows that cases in counties without school mask mandates increased at nearly three times the rate of those with mask mandates. In the five-week period spanning the start of the school year, cases in counties without a mask mandate rose by 62.6 cases per 100K children, while cases in counties with a mask mandate rose by only 23.8 per 100K. COVID outbreaks are incredibly disruptive to learning; according to a recent KFF survey, nearly a quarter of parents report their child has already had to quarantine at home this school year following a possible COVID exposure.

Even once vaccines are approved for children under 12, recent data suggest that a majority of parents will be hesitant to vaccinate their child. Just over half of 12- to 17-year-olds have received at least one dose of the vaccine so far, and only a third of parents of 5- to 11-year-olds plan to vaccinate their child right away, once the shot is approved.

Many want more information, or are worried about side effects—concerns that will best be assuaged by their pediatricians and other trusted sources of unbiased information.

Cartoon – The Covid Grille

Noah Smith: Why the delta variant threatens to undermine the economic  recovery | Columnists | wacotrib.com

Do Covid-19 ‘booster’ shots really work? Here’s what early data shows.

Booster shots for COVID-19: Will we need to get one every year? | khou.com

As Israel faces a surge in Covid-19 cases due to the delta variant, data from the Israeli Health Ministry shows that a third dose of Pfizer-BioNTech’s Covid-19 vaccine significantly improved protection against hospitalization or serious disease.

Background

The rollout of Covid-19 vaccines in Israel was one of the fastest and most comprehensive in the world. By March 25, more than half of Israel’s population was fully vaccinated, and by June, the country had lifted all coronavirus-related restrictions.

However, in the summer, Israel saw a surge in Covid-19 cases, which experts believe was fueled by two factors: waning protection from the vaccine and the spread of the highly contagious delta variant.

“The most influential event was so many people who went abroad in the summer—vacations—and brought the delta variant very, very quickly to Israel,” Siegal Sadetzki, a former public health director in Israel, said.

Even so, the rate of severe Covid-19 cases among the vaccinated remains low. As of Thursday, according to data from the Health Ministry, the rate of severe Covid-19 cases was nine times higher among unvaccinated people over the age of 60 than among vaccinated people in the same age range.

Similarly, the rate of severe Covid-19 cases among unvaccinated people under 60 was about twice the rate of severe cases among vaccinated people under 60.

But because so many people in the country have been vaccinated, even a low rate of severe breakthrough infections has led to a significant surge in hospitalizations. NPR reports that half of the seriously ill patients in Israel hospitalized with Covid-19 had been fully vaccinated at least five months ago, and the majority of them are over the age of 60 with comorbidities.

Data shows booster shots provide significantly increased protection

On July 30, Israel began administering booster shots of the Pfizer-BioNTech vaccine to those over the age of 60. On Thursday, the country dropped that age eligibility to 40.

Data from the Health Ministry indicate that a third dose of the Pfizer-BioNTech vaccine provided four times the protection against infection as two doses in people aged 60 and over, Reuters reports. (According to Reuters and NPR, the findings are similar to data released by Israel’s HMO Maccabi Healthcare Services last week, which found that among 149,144 people, a third Pfizer shot among recipients above age 60 reduced the odds of infections by 86% and cut the risk of severe infection by 92%.)

Similarly, a third dose offered about five to six times the protection of two doses against serious illness and hospitalization in people aged 60 and over, according to the Health Ministry data.

According to Reuters, the data underlying these figures was presented at a health ministry panel meeting on Thursday and later published on the ministry’s website. Full details of the study, however, still have not been released.

The debate over booster shots continues

The news comes as experts in the United States continue their debate over the necessity of booster shots. On Wednesday, the Biden administration announced that Americans who had received an mRNA vaccine would be able to get a booster shot beginning in September, pending approval by FDA and a recommendation by CDC.

However, health experts are divided on whether booster shots are necessary, a debate that prompted CDC’s Advisory Committee for Immunization Practices (ACIP) to push back its meeting to discuss booster shots by one week, Bloomberg reports.

“The data [is] coming in rapidly, and we want to make sure we follow our process for review and to ensure we can have a robust deliberation at the next open meeting,” Grace Lee, chair of ACIP, said.

Joshua Barocas, associate professor of medicine at the University of Colorado, said he believes the “federal government is simply trying to stay ahead of the curve.” However, Barocas said, “I have not seen robust data yet to suggest that it is better to boost Americans who have gotten two vaccines than invest resources and time in getting unvaccinated people across the world vaccinated.”

The World Health Organization has also called for wealthier countries to not offer booster shots to their population and instead help poorer countries get vaccinated.

Surgeon General Vivek Murthy said the United States’ efforts to provide boosters to its population won’t interfere with efforts to provide other countries with shots.

“We have to protect American lives and we have to help vaccinate the world, because that is the only way this pandemic ends,” Murthy said.

He did acknowledge that providing booster shots to Americans could “take away” from the supply of vaccines for the rest of the world, but added that the United States has been working to improve the global vaccine supply and production recently to make sure that doesn’t happen.

“We don’t have a choice,” Murthy said. “We have to do both.”

Overwhelmed hospitals are sending Covid-19 patients 500+ miles away for care

Coronavirus: Video Shows Overwhelmed Hospital ICU in Bergamo, Italy

As some states set Covid-19 hospitalization records, many overwhelmed hospitals are outsourcing patients on planes, helicopters, and ambulances to distant cities and states for treatment, Heather Hollingsworth and Jim Salter write for the Associated Press.

Transfers hundreds of miles away

As of last week, the number of Covid-19 patients in most hospitals remained below winter surge levels, Hollingsworth and Salter report. However, Florida, Arkansas, Oregon, Hawaii, Louisiana, and Mississippi recently set pandemic hospitalization records.

And unlike in the winter surge, many hospitals were already strained this summer due to patients catching up on previously deferred care, according to Hollingsworth and Salter.

“We are seeing Covid patients and we are seeing car accidents and we are seeing kids come in with normal seasonal viral infections. And we are seeing normal life come into the emergency department along with the extra surge of Covid patients, so it is causing that crisis,” said Mark Rosenberg, president of the American College of Emergency Physicians.

Amid the influx of patients, many of these overwhelmed hospitals are looking to neighboring cities and states for relief. For instance, in Arizona, a Covid-19 hotline is receiving calls from hospitals in Wyoming, Arkansas, Texas, and California in search of bed space, Hollingsworth and Salter report—although the hotline often cannot provide any help.

In Kansas, officials at the Wilson Medical Center in Kansas had to call 40 other facilities in several states seeking a bed for a Covid-19 patient before finally finding an available bed about 220 miles away. Across the state, according to Motient, a company contracting with Kansas to manage transfers, Covid-19 patients generally have to wait an average of 10 hours before being flown to another hospital location, which could be in Wisconsin, Illinois, Colorado, or Texas.
“That is just the worst day that you can have in the emergency room as a provider,” Richard Watson, Motient’s founder, said, “to be taking care of a patient that you are totally helpless to give them what you know they need.”

Similarly, in Washington state, the 25-bed Prosser Memorial Hospital, doesn’t have an intensive care unit, so critically ill patients are being sent as far as eastern Idaho—600 miles away.

Staffing shortages, low vaccination rates add to the problem

Finding a hospital to take in patients has become more difficult due to recent staffing shortages, according to Robin Allaman, CNO at the Kearny County Hospital in Kansas.

“Most [hospitals] are saying it isn’t that they don’t have an open bed, it is that they don’t have nursing staff to care for them,” he said. Officials at his hospital called health systems in Nebraska, Oklahoma, and New Mexico before one in Colorado Springs, Colo.—200 miles away—agreed to take a recent patient.

Watson said these delayed transfers can have dire consequences for patients, especially those who need to see specialists, who often are available only in larger hospitals. “Imagine being with your grandma in the ER who is having a heart attack in western Kansas and you are saying, ‘Why can’t we find a bed for her?’ We are watching this happen right in front of us. ‘This is America. Why don’t we have hospital bed for her?’ Well, here we are,” he said.

And while experts had hoped that the vaccines would prevent hospitals from becoming overwhelmed again, Justin Lessler, a professor of epidemiology at Johns Hopkins University, said there hasn’t been the reduction in hospitalizations that officials had hoped for. That’s in part because the delta variant seems to be more severe, particularly in younger people, whose vaccination rates are lower.

Steve Edwards—CEO of CoxHealth, whose hospital in Springfield, Mo., is treating patients from as far away as Alabama—added, “Just imagine not having the support of your family near, to have that kind of anxiety if you have someone grow acutely ill.”

How the delta variant took over the US

https://thehill.com/policy/healthcare/567843-how-the-delta-variant-took-over-the-us

3 Things You Need to Know About the Delta Variant - COVID-19, Featured,  Health Topics - Hackensack Meridian Health

The delta variant has overtaken the U.S. in a matter of weeks as it spreads around the world in what President Biden’s chief medical adviser Anthony Fauci called a “global outbreak” of the strain.

The highly contagious variant of COVID-19 is considered at least two times more contagious than the previously dominant alpha strain, and experts say the increased transmissibility has likely fueled the surge in COVID-19 cases, hospitalizations and deaths nationwide.

But much is still unknown about delta as scientists scramble to better understand the strain.

Here’s what we know about the delta strain and how it blunted earlier momentum in the fight against the coronavirus.


Delta is more transmissible than previous COVID-19 strains

Delta’s contagiousness is considered key to its domination, having spread to at least 117 countries after first being detected in India. Like other viruses, COVID-19 is evolving, particularly through unplanned mutations.

A study from the United Kingdom in May suggested the delta strain could be 60 percent more transmissible than the alpha variant, which was already more contagious than the original strain.

But experts are split on that figure, with some saying delta could be more transmissible and others saying it could be less.

“You don’t necessarily want to attribute that all to the virus. You know, a lot of it may reflect the people as well,” said David Dowdy, an associate professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health.

Researchers aren’t certain about what makes the delta variant more transmissible, but there are some clues.

Michael Farzan, head of the Department of Immunology and Microbiology at Scripps Research, said one of the variant’s advantages is that it can more strongly attach to a certain receptor when spreading in the body.

“This is one of the reasons why the virus … in a person gets made at a higher level, meaning that there’s a lot more being spit out or coughed out, meaning that it’s more likely to hit the next person,” he said.

The Centers for Disease Control and Prevention (CDC) has its own figures illustrating how the strain became so prevalent this summer. The agency’s latest projection is that 97.4 percent of all coronavirus cases come from all the different lineages of the delta variant, as of the week ending last weekend.

That marks an astronomical increase from the 1.6 percent estimated at the beginning of May and the 14.1 percent from the beginning of June.

Most people infected with COVID-19 at this point won’t know for sure whether they contracted the delta strain since available testing doesn’t make the distinction between strains — it only shows whether the virus itself is present.


It has a higher magnitude of viral loads

Health experts are examining the delta variant’s viral load, the measure of how much virus a person carries and can potentially transmit, compared to previous COVID-19 strains.

A study from China suggested that the strain’s viral load could be more than 1,000 times higher than the original strain, which Fauci on Thursday said “is a mechanistic reason why you have such a tremendous increase in transmissibility.”

Basically a higher viral load can make it more likely that an infected person can “shed” the virus, allowing someone nearby to contract it.

“If a little droplet that you sent out, it has more particles and that means it’s more likely to infect the next person over and it’s more likely to infect the next person over more times,” Farzan said.

Dowdy of Johns Hopkins cautioned that other variables, including people’s behavior, may be influencing how scientists understand delta’s viral load. With more people relaxing their COVID-19 precautions and interacting with others indoors, those same people could contract more of the virus than they might otherwise.

A study of a Massachusetts outbreak indicated that delta led to fully vaccinated people having a similar viral load compared to the unvaccinated, sparking the CDC to update its mask guidance late last month.

The outbreak on Cape Cod, where nearly three-quarters of confirmed cases were among fully vaccinated people, suggested that vaccinated people could potentially transmit and spread the delta variant. But researchers said at the time that microbiological studies would be needed to confirm whether vaccinated individuals can transmit the strain.


Vaccines are still effective against delta

Studies have found that at least five vaccines, including all three used in the U.S., are effective against the delta variant in lab and real-world settings, Fauci said on Thursday.

It was previously unclear whether the Johnson & Johnson vaccine, which requires only one dose instead of two, was equally effective. But a study released last week found the immune response lasted at least eight months, resulting in the first real-world data for the vaccine, Fauci said.

Recent studies have indicated that vaccines may see a very slight dip in effectiveness against symptomatic versions of the coronavirus caused by the delta variant. The COVID-19 vaccines, like any other, are also not perfect at preventing all delta infection and illness.

But scientists agree that studies have demonstrated that the vaccinated population is less likely to get infected and much less likely to be hospitalized or die from the delta variant than the unvaccinated.

“The only reason our case numbers are lower now than they were back in December is because half of our population has been fully vaccinated,” Dowdy said.


Still more to learn
 

Experts acknowledge there is much more to learn about the delta variant.

“A big thing is we still don’t know how much of what we’re seeing is due to the virus versus due to behavior,” Dowdy said. “That makes a big difference because things that are due to the virus, we can’t really change as a society.”

Although there’s a growing number of studies, not all scientists are certain that the variant itself necessarily causes more serious illness among the unvaccinated, leading to more hospitalizations and deaths. It’s also unclear whether the strain is sparking more severe illness among children as pediatric hospital admissions have picked up.

Additionally, scientists have more analysis to do on under-researched mutations that may give the virus more of an advantage, Farzan said.

Driven by the Delta Variant, the Fourth Wave of COVID-19 in the U.S. Could Be Worse Than the Third. In Some States, It Already Is

Why the delta variant is hitting kids hard in the U.S. and how we can  prevent that in Canada | CBC News

Just a month ago, even as signs of a fourth wave of COVID-19 infections in the U.S. were blossoming in the lower Midwest, the memory of a long, miserable winter kept us warm. Even places with burgeoning case rates were far below their catastrophic peaks over the holidays, when a combination of cold weather and defiant travelers contributed to a third wave in infections and deaths that drowned out the previous two spikes in April and July of 2020.

This is regrettably no longer the case. In four states—Hawaii, Louisiana, Mississippi and Florida—the current number of daily new COVID-19 infections, averaged across seven days, has surpassed that winter peak, even with a substantial percentage of the population having received a complete dosage of the COVID-19 vaccine (though not nearly as many as public officials would prefer).

Hawaii is something of an anomaly, as its winter peak was not nearly as high as in colder, more accessible regions. But several other states threaten to join this quartet in the near future. Oregon’s daily rate of new infections is at 36.5 per 100,000 residents, or 99% of the peak value on Dec. 3, 2020. Nationwide, the rate is 37.7, just under 50% of the winter peak of 76.5.

While plenty of states remain far below the winter peaks, as the Delta variant tears across the country, we can expect more and more states to experience a fourth wave that crests higher than the third, even as new outbreaks are inspiring more vaccine holdouts to hold out their biceps and breakthrough infections, while frightening and non-trivial, remain reasonably rare.

What is perhaps most sobering about this surge is that COVID-19-related deaths, which typically lag behind case surges by about two weeks, are starting to rise again. No state has yet surpassed the winter peak in deaths, but at 65%, Louisiana very well may. That figure is still 15% nationwide, well below the Jan. 13, 2021 peak of 1.04 fatalities per 100,000 people. It is currently at 0.16.

When it comes to the pandemic, no one wants to sound like Chicken Little. The sky might not be falling. But neither is the national case rate, or the number of people dying.

Hot vax summer is turning out to be a damp squib

https://mailchi.mp/ef14a7cfd8ed/the-weekly-gist-august-6-2021?e=d1e747d2d8

Pandemic of the Unvaccinated - YouTube

With US COVID case counts hitting levels not seen since February, hospitalizations climbing rapidly in many states—topping the number seen nationally during last summer’s surge—and mortality figures beginning to edge worrisomely upward, it’s increasingly clear that talk of a “hot vax summer” was premature at best.

While this week the nation crested President Biden’s July 4th goal of 70 percent of Americans getting at least one dose of the vaccine, attention has now turned in earnest to the need to dramatically accelerate vaccinations the face of the highly contagious Delta variant.

Of particular concern: a report from the Centers for Disease Control and Prevention (CDC) suggesting that vaccinated people who become infected with the variant may be able to spread the disease at a greater rate than previously thought.

Although it’s clear that we’re largely experiencing a “pandemic of the unvaccinated” at this point, it wasn’t reassuring to learn that the CDC has been citing pre-Delta data (from January to July) on hospitalizations to bolster its reassurances to vaccinated Americans about the low numbers of “breakthrough” cases in hospitals, nor to hear (as we have, anecdotally) from hospital leaders that vaccinated patients now account for 15 percent of COVID admissions.

Attention has rapidly turned to the need for booster shots, with the Food and Drug Administration (FDA) reported to be readying a plan for early September, focused on the over-65 population and those whose immune systems are compromised. Already, Zuckerberg San Francisco General Hospital has begun supplemental mRNA boosters for those who received the one-dose Johnson & Johnson shot earlier this year.

Meanwhile, in an attempt to reassure those still harboring concerns about getting an “experimental” vaccine, the FDA is fast-tracking its full approval process for Pfizer’s vaccine, which can’t come soon enough. 

The ticking clock: students of all ages, vaccinated or otherwise, return to school in less than a month. Will we be ready?

About 99.999% of fully vaccinated Americans have not had a deadly Covid-19 breakthrough case, CDC data shows

https://www.cnn.com/2021/07/31/health/fully-vaccinated-people-breakthrough-hospitalization-death/index.html?fbclid=IwAR0zCYf_qFiMcaHs0D0HbdHNrWkHzt4j6mmxWgfDD_-r5GkmJA9tm-MgaAU

About 99.999% of fully vaccinated Americans have not had a deadly Covid-19  breakthrough case, CDC data shows

More than 99.99% of people fully vaccinated against Covid-19 have not had a breakthrough case resulting in hospitalization or death, according to the latest data from the US Centers for Disease Control and Prevention.The data highlights what leading health experts across the country have highlighted for months: Covid-19 vaccines are very effective at preventing serious illness and death from Covid-19 and are the country’s best shot at slowing the pandemic down and avoiding further suffering.The CDC reported 6,587 Covid-19 breakthrough cases as of July 26, including 6,239 hospitalizations and 1,263 deaths. At that time, more than 163 million people in the United States were fully vaccinated against Covid-19.

Divide those severe breakthrough cases by the total fully vaccinated population for the result: less than 0.004% of fully vaccinated people had a breakthrough case that led to hospitalization and less than 0.001% of fully vaccinated people died from a breakthrough Covid-19 case.

Most of the breakthrough cases — about 74% — occurred among adults 65 or older.

Since May, the CDC has focused on investigating only hospitalized or fatal Covid-19 cases among people who have been fully vaccinated. The agency says the data relies on “passive and voluntary reporting” and is a “snapshot” to “help identify patterns and look for signals among vaccine breakthrough cases.”

“To date, no unexpected patterns have been identified in the case demographics or vaccine characteristics among people with reported vaccine breakthrough infections,” according to the CDC.

The agency shared a study this week that showed the Delta variant produced similar amounts of virus in vaccinated and unvaccinated people if they get infected. Experts continue to say that vaccination makes it less likely you’ll catch Covid-19 in the first place. But for those who do, the findings suggest they could have a similar tendency to spread it as unvaccinated people. That study also convinced CDC leaders to update the agency’s mask guidance on Tuesday, recommending that fully vaccinated people also wear masks indoors when in areas with “substantial” and “high” Covid-19 transmission to prevent further spread of the Delta variant. Guidance for unvaccinated people remains to continue masking until they are fully vaccinated. Beyond severe cases, an analysis of official state data from the Kaiser Family Foundation showed that breakthrough cases of any kind are also extremely rare.vAbout half of states report data on Covid-19 breakthrough cases, and in each of those states, less than 1% of fully vaccinated people had a breakthrough infection, ranging from 0.01% in Connecticut to 0.9% in Oklahoma.

The KFF analysis also found that more than 90% of cases — and more than 95% of hospitalizations and deaths — have been among unvaccinated people. In most states, more than 98% of cases were among the unvaccinated.

Pace of vaccinations is going up

Health care workers assist a patient in the ICU inside Little Company of Mary Medical Center on July 30, 2021 in Torrance, California

But experts say those vaccinated, while they may be able to transmit the virus, remain very well protected against getting seriously ill. Amid the latest surge of Covid-19 cases nationwide fueled by the Delta variant, local leaders across the US are reporting that the majority of new infections and hospitalizations are among unvaccinated people. The Delta variant is now so contagious, one former health official recently warned that people who are not protected — either through vaccination or previous infection — will likely get it. Amid concerns over the rising cases and the dangerous strain, the country has seen a steady rise in the pace of vaccinations in the past three weeks — and an even sharper increase in states that had been lagging the most, according to a CNN analysis of CDC data.

The seven-day average of new doses administered in the US is now 652,084, up 26% from three weeks ago. The difference is even more striking in several southern states: Alabama’s seven-day average of new doses administered is more than double what it was three weeks ago. The state has the lowest rate of its total population fully vaccinated in the US, at roughly 34%. Arkansas, with just 36% of its population fully vaccinated, has also seen its average daily rate of doses administered double in the last three weeks. Louisiana, which had by far the most new Covid-19 cases per capita last week and has only fully vaccinated 37% of its population, saw daily vaccination rates rise 111% compared to three weeks ago.

Meanwhile, Missouri, which has been among the hardest-hit states in the latest Covid-19 surge, now has a daily average of new vaccinations 87% higher than three weeks ago.

Roughly 57.5% of the US population has received at least one Covid-19 vaccine dose and about 49.5% is fully vaccinated, CDC data shows.

Cartoon – Covid Brain Fog Logic

Covid-19 Ward' | Kaiser Health News

Cartoon – Typhoid Marty

Mike Luckovich's Editorial Cartoons at www.cartoonistgroup.com - Cartoon  View and Uses