US COVID-19 cases fall for 4th consecutive week: 9 CDC stats to know

17 Downward trend Synonyms. Similar words for Downward trend.

COVID-19 cases have declined nationwide for the fourth consecutive week, according to the CDC’s COVID data tracker weekly review published Oct. 15.

Nine numbers to know:

Reported cases

1. The nation’s current seven-day case average is 84,555, a 12.5 percent decrease from the previous week’s average.

Hospitalizations 

2. The current seven-day hospitalization average for Oct. 6-12 is 6,659, an 8.8 percent drop from the previous week’s average.

Vaccinations

3. About 218 million people — 65.6 percent of the total U.S. population — have received at least one dose of the COVID-19 vaccine, and more than 188.3 million people, or 56.7 percent of the population, have gotten both doses. 

4. About 9.3 million booster doses in fully vaccinated people have been reported.

5. The seven-day average number of vaccines administered daily was 841,731 as of Oct. 14, a  11.3 percent decrease from the previous week.

Variants

6. Based on projections for the week ending Oct. 9, the CDC estimates the delta variant accounts for more than 99 percent of all U.S. COVID-19 cases.

Deaths 

7. The current seven-day death average is 1,241, down 13.4 percent from the previous week’s average. Some historical deaths have been excluded from these counts, the CDC said.

Testing

8. The seven-day average for percent positivity from tests is 5.7 percent, down 4.1 percent from the previous week.  

9. The nation’s seven-day average test volume for the week of Oct. 1-7 was about 1.49 million, down 5.4 percent from the prior week’s average.

Hospitals still spending more on PPE, labor as result of COVID-19

Dive Brief:

  • Hospitals across the country have spent more than $3 billion on personal protective equipment since the start of the COVID-19 pandemic, though costs have steadily declined since the worst shortages experienced during the second quarter of 2020, according to an analysis from Premier, a group purchasing organization.
  • Before the pandemic, hospitals normally spent about $7 on PPE costs per patient per day. That figure shot to $20.40 during the second quarter of last year, and during the first quarter of this year was around $12.45 per patient per day, according to Premier.
  • Hospitals are also still paying more for qualified clinical labor — roughly $24 billion more in total per year compared to before the pandemic, according to another Premier analysis out last week.

Dive Insight:

PPE was in short supply early in the pandemic, spurring bidding wars and financially straining hospitals as they suffered from the budgetary fallout of canceled elective surgeries and other lucrative services.

While supply chain challenges have since eased and costs are down since their peak, hospitals are still spending more on PPE than before the pandemic, and consumption and demand remains strong in light of the delta variant, according to the report.

Premier used a database representing 30% of U.S. hospitals across all regions from September 2019 through last month to track spending trends, looking at costs for eye protection, surgical gowns, N95 respirators, face masks, exam gloves and swabs. It then calculated total costs measuring quantities used per patient, per day, multiplied by the percent change in pricing for the quarter.

Ultimately, hospitals are still using far more N95 respirators than they were prior to the pandemic.

Demand is still up for eye protection, surgical gowns and face masks, though pricing is close to pre-pandemic levels for those items. Costs for surgical gloves and N95 respirators are still above pre-pandemic levels, according to the analysis.

While most PPE costs have steadily declined for hospitals, other expenses have not, namely labor costs.

Contract labor costs have fluctuated, though they reached record highs amid COVID-19 surges, commanding record rates from providers. And nursing shortages, especially, have been so dire that hospitals are spending more on recruiting and retaining for the positions, boosting benefits and offering steep sign on bonuses.

Clinical labor costs are up 8% on average per patient, per day compared to before the pandemic, according to the earlier Premier analysis. That translates to about $17 million in additional annual labor expenses for the average 500-bed facility.

As of last month, overtime hours are up 52% since before the pandemic. The use of agency and temporary labor is up 132% for full-time employees and 131% for part-time employees.

The most expensive labor choices for hospitals are contract labor and overtime, typically adding 50% or more to an employee’s hourly rate, according to Premier.

For that report, Premier used a database with daily data from about 250 hospitals, bi-weekly data from 650 hospitals and quarterly data for 500 hospitals from October 2019 through August to analyze workforce trends among employees in emergency departments, intensive care units or nursing areas.

Labor shortages will strain hospital budgets through 2022, Moody’s says

https://www.healthcaredive.com/news/labor-shortages-pressure-hospital-budgets-expenses/607759/

Dive Brief:

  • The delta variant of the coronavirus continues to pile on staffing challenges for hospitals as they spend more resources on recruiting and retaining employees, jack up benefit options and offer steep sign-on bonuses, according to a Tuesday report from Moody’s Investors Service.
  • Those expenses will strain hospital profitability at a time when lucrative non-emergency procedures are on hold in some areas to handle incoming COVID-19 inpatients. Moody’s expects the weight on hospital budgets to continue through next year.
  • Although demand for temporary nursing staff dipped last week, it is still well beyond pre-pandemic levels, according to data gathered by Jefferies analysts. Crisis jobs — those that are rapid response or bill more than $100 an hour — represent more than three quarters of staffing firm Aya Healthcare’s openings, the third highest percentage Jefferies has recorded.

Dive Insight:

The highly contagious delta variant is wreaking havoc on the U.S. healthcare system as mostly unvaccinated people are filling ICUs more than a year and half into the pandemic. Clinicians who have throughout that time been stressed working long and difficult hours are reporting intense burnout as some mull leaving the profession altogether.

Meanwhile, vaccine mandates have gone into effect for many hospitals. Although they report that the vast majority of employees are complying, even the small losses of those who refuse can take a hit to staffing resources.
This need has driven increases to the salaries nurses can command, as well as to benefit packages, sign-on bonuses and the offer of services like child care, Moody’s said.

The report also noted that the current shortage — unlike previous ones — also includes nonclinical staff such as dietary and environmental services workers.

While Moody’s focuses on nonprofit operators, expense challenges will be an important metric to watch during the upcoming earnings season. Although all major for-profit hospital operators beat Wall Street expectations on earnings and revenue in Q2 and most posted profit increases, expenses were a rising line item.

Hospital labor expenses rise

For-profit health systems’ labor costs year over yearhttps://datawrapper.dwcdn.net/G7DCw/2/

And consultancy Kaufman Hall has warned U.S. hospitals will lose about $54 billion in net income this year, while an earlier Moody’s report predicted impacts to the country’s health system from COVID-19 will last for decades.

As the Biden administration works to encourage more vaccinations through a combination of carrots and sticks, it remains unclear when delta may peak and what future variants could bring. Even after hospitals are on more stable ground in terms of capacity, further challenges will remain as patients return for care they deferred earlier.

And there are more long-term concerns as well. “Even after the pandemic, competition for labor is likely to continue as the population ages — a key social risk — and demand for services increases,” according to the Moody’s report.

Jefferies analysts agreed, saying the demand for temp nurses will go down but remain elevated. “Additionally, the fundamental demand drivers for nurses that existed even before COVID (i.e., nurse population demographics) have been boosted by the lingering effects of the pandemic on the profession and are likely to boost demand for temp staffing post-2022,” they wrote in the Wednesday note.

Breakthrough infections might not be a big transmission risk. Here’s the evidence

Conventional wisdom says that if you’re vaccinated and you get a breakthrough infection with the coronavirus, you can transmit that infection to someone else and make that person sick.

But new evidence suggests that even though that may happen on occasion, breakthrough infections might not represent the threat to others that scientists originally thought.

Ross Kedl, an immunologist at the University of Colorado School of Medicine, will point out to anyone who cares to listen that basic immunology suggests the virus of a vaccinated person who gets infected will be different from the virus of an infected unvaccinated person.

That’s because vaccinated people have already made antibodies to the coronavirus. Even if those antibodies don’t prevent infection, they still “should be coating that virus with antibody and therefore helping prevent excessive downstream transmission,” Kedl says. And a virus coated with antibodies won’t be as infectious as a virus not coated in antibodies.

Scant evidence for easy transmission of breakthrough infections

In Provincetown, Mass., this summer, a lot of vaccinated people got infected with the coronavirus, leading many to assume that this was an example of vaccinated people with breakthrough infections giving their infection to other vaccinated people.

Kedl isn’t convinced.

“In all these cases where you have these big breakthrough infections, there’s always unvaccinated people in the room,” he says.

In a recent study from Israel of breakthrough infections among health care workers, the researchers report that in “all 37 case patients for whom data were available regarding the source of infection, the suspected source was an unvaccinated person.”

It’s hard to prove that an infected vaccinated person actually was responsible for transmitting their infection to someone else.

“I have seen no one report actually trying to trace whether or not the people who were vaccinated who got infected are downstream — and certainly only could be downstream — of another vaccinated person,” Kedl says.

There’s new laboratory evidence supporting Kedl’s supposition. Initially, most vaccine experts predicted that mRNA vaccines like the ones made by Pfizer and Moderna that are injected into someone’s arm muscle would generate only the kinds of antibodies that circulate throughout the body.

But that might not be the whole story.

“I think what was the big surprise here is that the mRNA vaccines are going beyond that,” says Michal Caspi Tal, until recently an instructor at Stanford University’s Institute for Stem Cell Biology and Regenerative Medicine and now a visiting scientist at the Massachusetts Institute of Technology.

What Tal has found is that in addition to the circulating antibodies, there was a surprisingly large amount of antibodies in mucosal membranes in the nose and mouth, two of the primary entry points for the coronavirus.

The vaccinated aren’t “sitting ducks”

Immunologist Jennifer Gommerman of the University of Toronto found this as well.

“This is the first example where we can show that a local mucosal immune response is made, even though the person got the vaccine in an intramuscular delivery,” Gommerman says.

If there are antibodies in the mucosal membranes, they would likely be coating any virus that got into the nose or throat. So any virus that was exhaled by a sneeze or a cough would likely be less infectious.

Gommerman says that until now, it seemed likely that a vaccine that was delivered directly to the mucosal tissue was the only way to generate antibodies in the nose or throat.

“Obviously a mucosal vaccination would be great too. But at least we’re not sitting ducks,” Gommerman says. “Otherwise everyone would be getting breakthrough infection.”

Now, these studies by Gommerman and Tal have yet to undergo peer review, and some have already suggested that the antibodies they have described may not confer true mucosal immunity.

But there’s other evidence that a vaccinated person’s breakthrough infection may not transmit efficiently to others.

Marion Pepper, an immunologist at the University of Washington, says a recent study from the Netherlands looked at how well virus from vaccinated people could infect cells in the lab.

Pepper says the answer was not well.

“If you actually isolate virus from people who are getting a secondary infection after being vaccinated, that virus is less good at infecting cells,” Pepper says. “It’s not known why. Is it covered with an antibody? Maybe. Has it been hit by some other kind of immune mediators, cytokines, things like that? Maybe. Nobody really knows. But the virus does seem to be less viable coming from a vaccinated person.”

More studies are emerging that suggest there’s something different about the virus coming from a vaccinated person, something that may help prevent transmission.

Whatever it is, the University of Colorado’s Kedl says it’s one more reason that getting vaccinated is a good idea.

“Because you’re going to be even more protected yourself. And you’re going to be better off protecting other people.”

Kedl says that’s what you call a win-win situation.

‘A triple whammy’: Why hospitals are struggling financially amid the delta surge

Hospitals were struggling before the pandemic. Now they face financial  disaster (opinion) - CNN

n addition to treating an influx of Covid-19 patients, many hospitals are struggling with what one administrator calls a “triple whammy” of financial burdens—stemming from plummeting revenue, higher labor costs, and reduced relief funds, Christopher Rowland reports for the Washington Post.

Hospitals in less-vaccinated areas face spiking labor costs

In areas with low vaccination rates, particularly in southern and rural communities, hospitals have been overwhelmed with Covid-19 patients, exacerbating labor shortages as workers burn out or leave for more lucrative positions, Rowland reports.

“The workforce issue is just dire,” Stacey Hughes, EVP of government relations and policy for the American Hospital Association (AHA), said. “The delta variant has wreaked significant havoc on hospitals and health systems.”

In Louisiana, Mary Ellen Pratt, CEO of St. James Parish Hospital, said many nurses quit due to the grueling conditions as Covid-19 cases spiked. “I didn’t have any extra money to incentivize my staff to pick up additional shifts,” she said. “This is coming out of bottom-line money I don’t have.”

Separately, Lisa Smithgall, SVP and chief nursing executive at Ballad Health, said the health system—which has 21 hospitals in eastern Tennessee and southwestern Virginia—has faced similar problems retaining staff amid Covid-19 surges.

“We knew we were at risk in our region because of where we live and because of our vaccination rate being so poor,” Smithgall said. “At one point, we were seeing four or five nurse resignations per week. They couldn’t do it again; they emotionally didn’t have it. They were so upset with our community.”

To fill in these growing gaps in their workforce, many hospitals have had to turn to costly contract workers, Rowland reports—a significant financial burden that further strains hospitals’ resources.

For example, Ballad Health went from hiring fewer than 75 contract nurses before the pandemic to 150 in August 2020 and 450 in August 2021. Moreover, according to Smithgall, contract nurses previously made double or triple what permanent staff nurses made, but now Ballad sometimes has to pay up to seven times as much for contract nurses as hospitals compete for workers to fill shifts.

Delayed elective surgeries deepen hospitals’ financial struggles

Many hospitals, including those in areas with high vaccination rates, have delayed elective surgeries, a crucial source of revenue, amid nationwide surges in Covid-19 cases, Rowland reports—further compounding financial struggles for many organizations.

On Aug. 26, Ballad Health postponed a long list of elective surgeries—including hernia repair, cardiac and interventional radiology procedures, joint replacements, and nonessential spine surgery—to preserve space in its hospitals and conserve workers. Ballad is now allowing elective surgeries again, but only for a limited number of procedures that do not require overnight stays.

Similarly, St. Charles Health System in Oregon postponed elective surgeries in August “while we responded to a surge that was significantly greater and much more sudden than the surge in 2020,” Matt Swafford, the health system’s VP and CFO, said.

According to Swafford, the health system lost $5 million a week through August and September, around $1 million of which was repayment of emergency advances on Medicare reimbursements from last year.

“I don’t think anybody saw this level of surge coming in 2021 after what we saw in 2020,” he said. “We’re just not equipped to be able to simultaneously respond to the urgent needs of the community [for more typical surgeries and care] at the same time that a third of our beds are occupied by highly infective Covid patients.”

Many hospitals likely to end the year at a deficit

Further compounding the issue, according to Moody’s Investors Service, is that the provider relief funds that previously made up 43% of operating cash flow at nonprofit and government-run hospitals in the United States are now dwindling down.

In addition, the latest portion of provider relief funds to be distributed must be based on expenses incurred by hospitals before March 31, 2021, which don’t account for months of the delta surge, Rowland reports.

Premier, a group purchasing and technology company serving more than 4,000 hospitals and health systems, analyzed payroll data of 650 hospitals and found that U.S. hospitals have spent a total of $24 billion a year during the pandemic to cover excess labor costs, primarily for overtime and contract nurses. This was an increase of 63% from October 2019 to July 2021, Rowland reports, with hospitals in the Upper Midwest and across the South seeing the largest increases.

“It’s going to leave them huge deficits that they are going to have to work out of for years to come,” Michael Alkire, Premier’s CEO, said.

How much worse will the ‘delta surge’ get? Watch these 7 factors.

https://www.advisory.com/daily-briefing/2021/08/09/delta-surge

Last spring, my Advisory Board colleagues and I were optimistic that the United States could be trending toward a “good” outcome in the Covid-19 pandemic. But now, the delta variant is coursing through the country. And if you’re anything like me, you’re probably asking yourself just how worried we should be. When will we hit a peak and see hospitalizations—which are on the rise in many parts of the country—decline? Amid the constant headlines of case numbers, vaccine efficacy, mask mandates, and other Covid-19 news, I think it’s crucial to step back and ask: What factors really matter?

Let’s be very specific about which factors we should be following—and which we should deprioritize. Below, I’ve identified seven factors to pay close attention to and two factors that may be more distracting than helpful.

Your top resources for Covid-19 readiness

7 factors to watch amid the delta surge

1. The transmissibility of the delta variant in the United States

One of the most striking factors underlying the delta surge is its heightened transmissibility—this is the most transmissible Covid-19 variant we have seen yet. The delta variant, B.1.617.2, now accounts for over 83% of new infections in the United States. And unlike past variants, this one is spreading among both vaccinated and unvaccinated individuals. In fact, CDC documents recently revealed that vaccinated individuals may spread the virus just as easily as unvaccinated people, given similar levels of viral load between the two groups.
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There is also a third group of people that we know even less about in the context of the variant’s transmissibility: people who are unvaccinated but potentially have some degree of natural immunity from previous coronavirus infection. Nobody knows exactly how long their immunity will last and what levels of protection they have against the delta variant. But early research has indicated that natural immunity may not supply sufficient protection against the delta variant.

Understandably, this is all worrisome. But it is important to consider the effect of infection on different populations. And that brings us to our next factor.

2.Vaccine effectiveness against serious illness from delta—and uptake among unvaccinated individuals

No vaccine can provide 100% protection—and it’s important to remember that most vaccines are designed to prevent serious illness and death, NOT to prevent infection. That is why media reports about fully vaccinated individuals getting infected with the delta variant can be misleading. The important indicator to watch for is not necessarily the infection rate, but how many of those infections lead to serious illness or death. If a breakthrough infection is usually asymptomatic or mildly symptomatic, the main concern is spreading the variant to at-risk populations—namely, unvaccinated people and those with weakened immune systems or underlying medical conditions.

The bad news is, we don’t currently have great data on this. The latest CDC data showed that less than 0.004% of fully vaccinated individuals had a breakthrough case that led to hospitalization and less than 0.001% died from a breakthrough case of Covid-19. But CDC Director Rochelle Walensky later clarified that those numbers are based on data from January through June, meaning they do not take into account the worst of the delta variant surge, which picked up in earnest in late June and early July.

But there is some reason to be optimistic: Among the 469 breakthrough cases tracked from the Provincetown outbreak in early July, only four led to hospitalization—and there were zero deaths. And preliminary studies from around the globe suggest that all three vaccines available in the United States still offer protection from the delta variant: two doses of Pfizer-BioNTech is 88% effective at preventing symptomatic Covid-19 and 96% effective against hospitalization, a single dose of Moderna’s two-dose vaccine is 72% effective at preventing symptomatic Covid-19, and Johnson & Johnson’s single-dose vaccine is 85% effective at preventing severe disease. Even among those vaccinated individuals who do end up in the hospital, we can look at new data from Singapore showing that patients hospitalized due to the delta variant are less likely to require supplemental oxygen and clear the virus faster relative to unvaccinated patients. All of this is reassuring as the data suggests vaccines are largely keeping their promise to stave off serious disease, hospitalizations, and death.
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This early research suggests that vaccine uptake will remain one of the most crucial factors in determining how worrisome the current surge is—and how it will impact the health care delivery system. After several months of decline, the national vaccination rate is now at its highest level in over a month, and we are observing the most notable increases in vaccine uptake in states with the highest case rates.

3. Vaccine immunity duration

The delta variant has not only prompted a renewed push to increase vaccinations among the previously unvaccinated, but it has also raised questions about the duration of immunity among those who may have been vaccinated several months ago. While the latest data on vaccine duration is not specific to the delta variant, it does suggest that overall efficacy may begin to decline around the six-month mark.

That information, coupled with the increase in breakthrough infections since the delta variant emerged, has accelerated the debate over whether booster shots are needed. Federal regulators are currently researching whether a booster shot is required, and recently announced plans to accelerate extra vaccine doses to immunocompromised individuals. We expect that this is an area where the research will continue to evolve quickly—researchers are learning more on a week-by-week basis. We’ll be keeping a close eye on what the latest research says and how the federal government responds in developing a plan for potential booster shots.

4. Severe Covid-19 cases among children under 12

Rates of Covid-19 infection and severe illness have been relatively low among children. However, it’s worth noting that small numbers of children have been hospitalized from the virus, and it can cause long-term side effects like MIS-C and “long Covid-19.” CDC has not yet released data showing delta variant symptoms among children, but some children’s hospitals have reported increases in hospitalizations related to the delta variant.
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Pfizer and Moderna are in the process of clinical trials testing the safety of their vaccines for children under 12. But it may be months before those trials lead to decisions, and children in some parts of the country have already begun to return to school in person. Without a vaccine, a child’s only practical defense against spreading and getting the virus is following public health guidelines like hand washing and mask wearing. But some states—Iowa, Florida, Montana, Arizona, and North Dakota—have passed laws that prevent local governments from mandating masks. Many more states have passed laws making mask mandates harder to implement, like the Kansas law allowing citizens to sue their local government over Covid-19 restrictions.

As school resumes in the United States, we will have to pay close attention to the transmissibility Covid-19 among unvaccinated children, the severity of such cases among children, and the potential long-term effects.

5. Hospitalization rates, particularly at the local level

Plain and simple—the higher the number of hospitalizations, the more worried we should be. Hospitalizations tell us how many people have more severe cases of Covid-19. But they also tell us what level of strain the U.S. health care system is under.

So, what are we seeing right now? CDC’s latest 7-day average shows nearly 50,000 people hospitalized across the United States, which is similar to rates seen last summer. Unsurprisingly, there is regional variation, with some states experiencing worse flareups than others. Most of the highly impacted regions have low vaccination rates: On Monday, there were more Covid-19 hospitalizations in Florida than at any other time in the pandemic. In Louisiana, hospitalizations have spiked to “never-before-seen levels,” breaking the previous record set in January—and leading to expectations that facilities will be overwhelmed again. As we move forward, we may see “hyperlocal outbreaks,” where low-vaccination regions surrounded by high vaccination areas could end up with concentrated outbreaks.
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It’s important to keep an eye on local vaccination rates because it’s clear that unvaccinated individuals and communities are more vulnerable. But that doesn’t mean communities with higher vaccination rates are immune. Given the fact that there is more interconnectedness than ever between communities today, and the fact that we haven’t achieved true herd immunity even in areas with relatively high vaccination rates, even “highly” vaccinated communities could see outbreaks. For example, intensive care units are filling up with Covid-19 patients in Santa Monica, California, where roughly 80% of residents are vaccinated.

At this point, it seems clear that there will be a heightened strain on hospitals relative to the previous few months of “calm”—and data from abroad suggests it may get worse before it gets better.

6. Covid-19 trends in ‘bellwether countries’

Recent decreases of Covid-19 cases in India and the U.K. are a heartening sign that recovery from a delta surge is possible. In India, cases peaked at over 400,000 a day in May. Last week, they experienced roughly 39,000 daily cases with a 48% decrease in the daily death count—a stark reduction. In the U.K., cases have dropped from roughly 47,000 in mid-July to nearly 27,000 the first week of August, even after their government lifted nearly all Covid-19 restrictions.

Sudden spikes may have been fueled by mass congregations of people: the EuroCup in England, April election rallies in India, and fourth of July celebrations in the United States. The subsequent declines in India and the UK suggest that delta could move through a crowd quickly and limiting large crowd gatherings could help stem the spread. It’s also possible that herd immunity is behind the rapid decrease, due to the combination of vaccination rates and infection levels. That could be a hopeful sign for regions of the U.S. that are struggling with high infection rates now but seeing increases in vaccinations.

But we’ll want to continue watching the research closely. Scientists aren’t yet sure exactly what lead to the rapid declines, meaning we can’t be entirely confident that the United States. will follow the same trajectory as the U.K. and India.

7. Global vaccination rates—and the emergence of new variants

The United States is just one part of an interconnected world. It impacts (and is impacted by) global trends in health. It’s overwhelmingly clear—everything we do is a collaboration, and moving through this pandemic is no exception.
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To date, about 27% of the global population has been vaccinated. The latest vaccination rate is roughly 42.5 million doses per day, which means it will take at least another five months to cover 75% of the world’s population. Just a few short months ago, the global vaccination rate had us estimating we’d need more than 4.6 years to achieve global herd immunity with two-dose vaccine regimens.

Five months is better than 4.6 years, but that assumes the vaccination rate will remain the same. With ongoing vaccine hesitancy and inequitable access in low-resource countries, we shouldn’t just assume this will be the case. If we see a drop in global vaccination rates, we will see an extension in the time it takes to reach a semblance of global herd immunity. The more time we spend in this phase, the more opportunities the coronavirus has to mutate into the next variant. And the next variant could be even more transmissible and deadlier than the delta.

Even with President Biden’s pledge to donate half a billion Pfizer vaccines to 92 low- and lower middle-income countries by June 2022, stronger efforts are needed to see a faster global impact. And efforts to increase the global vaccination rates could mean trade-offs elsewhere. For example, the World Health Organization has pled for a moratorium on booster shots until September to allow lower-resourced nations ability to receive initial vaccinations.

2 factors that may be distracting your response to the delta surge

Knowing what not to focus on is just as important as knowing what to focus on. And there are two factors in particular that have grabbed a lot of the headlines—but that actually tell us very little without additional context.

1. Covid-19 case counts

Case counts alone are no longer sufficient for tracking the severity of any variant, or the virus as a whole. But with the advent of the vaccine and better understanding of how to treat the virus, the calculus has changed, and so too should the metrics we give our attention to. It’s been clear for some time that the goal is not necessarily to eliminate Covid-19 (in fact, research increasingly suggests it’s highly likely to become endemic). Instead, we should aim to protect against severe illness and ensure our system has enough capacity to treat sick patients. Severity of illness—and corresponding hospitalization rates—are far more important metrics to track at this point.
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As detailed above, the latest research continues to suggest that vaccines are highly protective in preventing severe illness, even against the delta variant. So as more people get vaccinated, case count numbers are likely to become less accurate. They run the risk of either overestimating the problem (if most cases are only mildly symptomatic) or underestimating the problem (if we miss a lot of asymptomatic people who can still spread the virus to the more vulnerable).

2. The percentage of total infections and hospitalizations that are breakthrough cases

We’ve all seen the recent headlines highlighting the large numbers and percentage of breakthrough infections. Here’s the thing to remember: This is exactly what we would expect to see as vaccination rates increase. The number of breakthrough infections and hospitalizations will increase as more people get vaccinated. The outbreak in Provincetown highlights this well. Yes, roughly 75% of cases were among vaccinated individuals, but most individuals there were vaccinated. Naturally, a high percentage of the cases would be “breakthrough.” And remember, very few were hospitalized and no one died from a breakthrough case as a result of that outbreak.

Breakthrough infections alone are not a bad thing. Breakthrough illness, on the other hand, is more worrisome. If we see the rates of breakthrough illness increase, then it’s time to worry a bit more.

Parting thoughts

It’s easy to feel overwhelmed with the constant updates related to Covid-19. While there are more than seven factors you could follow, I believe these are the most important right now. And the clear thread that runs through all of these is that vaccines remain one of the key solutions to move through this pandemic. It’s becoming clearer that Covid-19 is unlikely to go away—new variants will arise and so will respective public health measures. But if there is one thing I can confidently say right now, it is that the more vaccinations that are administered in the United States and around the world, the less worried we can all be.

Is the delta surge truly ending? Here’s why some experts aren’t so sure.

The Delta Surge May Collapse Faster Than You Think | MedPage Today

With Covid-19 cases, hospitalizations, and deaths declining across the country, some people are hopeful about a potential end to the delta surge. However, public health experts continue to encourage safety measures and vaccinations to mitigate another potential winter surge.

Is the delta surge declining?

According to the New York Times, delta-driven coronavirus cases, hospitalizations, and deaths are declining. Since Sept. 1, the number of daily new Covid-19 cases in the United States has decreased by 35%. In the past two weeks alone, the number of new daily cases has fallen by 24% to around 101,000.

In addition, new Covid-19 deaths have decreased by 12% to 1,829 a day, and hospitalizations have decreased 20% to fewer than 75,000 a day—a first since early August, the Times reports.

“Barring something unexpected,” Scott Gottlieb, a former FDA commissioner, said, “I’m of the opinion that this is the last major wave of infection.”

Edwin Michael, a professor of epidemiology at the University of South Florida, agreed with Gottlieb’s assessment, saying, “[T]his might be the last wave, pending any new variants that arrive, and the boosters will help with that.”

According to STAT News, some experts suggest that the United States has reached an “inflection point,” in which the coronavirus is gradually transitioning from an epidemic phase to an endemic phase. As an endemic virus, the coronavirus will still cause infection, disease, and death, but it will be more manageable.

When asked whether Covid-19 could be endemic, Stephen Kissler, an epidemiologist at Harvard University‘s T.H. Chan School of Public Health, said, “We’ve still got a little work left to do, but my hope is that we’re approaching something ever closer to normalcy.”

Health experts continue to urge caution

However, even with the delta surge on an apparent decline, many public health experts continue to urge caution, saying that the pandemic is still a threat, the Times reports.

“We don’t want to celebrate even though we feel like we’re on the back end of this surge—we learned our lesson from doing that,” said Kirsten Bibbins, an epidemiologist and physician at the University of California, San Francisco. “[I]n this pandemic, you’re always waiting for the other shoe to drop.”

Ali Mokdad, an epidemiologist at the University of Washington, agreed. “We’re not out of danger,” he said. “This virus is too opportunistic and has taught us one lesson after another.”

Mokdad said he was worried people would disregard public safety precautions by wearing masks less often and traveling more, just as they did when earlier surges declined—potentially fueling a jump in cases in December and January.

Some experts are also concerned about the potential emergence of a new coronavirus variant that could kick-start another surge, much like the delta variant did at the beginning of the summer.

“There were similar conjectures [about the pandemic ending] before the delta variant appeared and knocked all our assumptions for a loop,” said Stephen Morse, an epidemiologist at Columbia University Medical Center. “We don’t know whether [a new variant will emerge], but we weren’t expecting delta either.”

In addition, there is still the possibility of a surge in cases during the winter months, STAT News reports.

According to Sen Pei, who studies the transmission dynamics of infectious disease at the University of Columbia‘s Mailman School of Public Health, viruses survive better in cooler, drier weather, and people will gather indoors more frequently in the fall and winter. Holiday gatherings could also lead to more close social contact, further increasing the risk of spreading the virus.

Vaccination remains a necessity to combat surges

Most Covid-19 deaths during the latest surge were among the unvaccinated, the Times reports. Today, around 68 million eligible Americans remain unvaccinated—leaving the United States vulnerable to future surges.

In particular, areas with low vaccination rates, along with a lack of public safety precautions, may be more likely to experience Covid-19 surges in the future, STAT News reports. According to data from the University of Iowa, rural Americans are already twice as likely to die from Covid-19 than urban Americans.

“It is becoming clearer that any challenge to hospital capacity this fall and winter is likely to be dictated by regional vaccination rates,” modelers at the Children’s Hospital of Philadelphia’s PolicyLab said.

Currently, vaccination rates in the United States have slowed to fewer than 700,000 doses a day, the Commonwealth Fund reports.

However, a simulation model of 10 states by the Commonwealth Fund found that increasing daily vaccination rates by 50% over the pace they were at in the last week of August would lead to 344,341 fewer Covid-19 cases; 19,500 fewer hospitalizations; and 6,900 fewer deaths across the next six months. These potential reductions were largely concentrated in the Southern states included in the model, such as Texas and Florida.

Vaccination works best as prevention,” the Commonwealth Fund said. “Quickly increasing population immunity now can prevent needless Covid-19 hospitalizations and deaths while keeping hospital beds open and staffed for people with other serious health problems.”

How Merck’s antiviral pill could change the game for COVID-19

https://www.nationalgeographic.com/science/article/how-mercks-antiviral-pill-could-change-the-game-for-covid-19?cmpid=org=ngp::mc=crm-email::src=ngp::cmp=editorial::add=SpecialEdition_20211001::rid=C1D3D2601560EDF454552B245D039020

Coronavirus: 'Game-changing' oral pill molnupiravir reduces COVID-19  hospitalisations by half in trial | Newshub

A new drug by Merck significantly reduces the risk of hospitalization and death in people who take it early in the course of their COVID-19 illness, according to the interim results of a major study released today. It is the first oral antiviral found to be effective against this coronavirus.

People who took this drug, called molnupiravir—four pills twice a day for five days—within five days of showing symptoms were about half as likely to be hospitalized as those taking the placebo. They were also less likely to die, with eight deaths in the placebo group reported within a month of treatment and none in those who received the medicine.

“Having a pill that would be easy for people to take at home would be terrific. If this was available through a drug store, more people could get it,” says Albert Shaw, an infectious diseases specialist at Yale Medicine in New Haven, Connecticut, who was not involved with the research. All of the antiviral medicines available today, including remdesivir and the monoclonal antibodies, must be administered through an IV in a medical setting. Monoclonal antibodies are much more effective against COVID-19 and cut the risk of hospitalization and death by up to 85 percent, but this treatment costs almost three times as much as molnupiravir.

How the antiviral works

Antiviral drugs are used against many viruses, including for herpes and the flu. These drugs take advantage of the fact that viruses need to replicate inside a person’s cells in order to sicken them. Antivirals stop the replication process so the illness doesn’t progress.

The Merck drug works by introducing RNA-like building blocks into the virus’s genome as it multiplies, which creates numerous mutations, disrupts replication, and kills the virus.

Keeping the virus from multiplying is important because the more it replicates, destroying cell after cell, the sicker a person usually becomes, says Waleed Javaid, an epidemiologist and director of infection prevention and control at Mount Sinai Downtown in New York, who was not involved in the study. Additionally, when enough virus is inside the body the immune system may go into overdrive. “At a certain point the body detects a virus it has never seen and will throw everything against it, like a tank coming at a small target.” he says. This helps the body eliminate the virus but can cause sometimes deadly collateral damage throughout the body in its wake.

The research, which was conducted in numerous sites around the world, was stopped early because the results were so promising, Merck says. The drug was even effective against variants like Delta and Mu. Based on this interim analysis in 775 people, the company plans to submit an application for Emergency Use Authorization (EUA) to the U.S. Food and Drug Administration as well as regulatory bodies in other countries in hopes the drug can be made available. When that will happen is not clear, but the U.S. government has already agreed to purchase 1.7 million courses of treatment at $700 each, Merck notes.

Who can get the drug?

It’s also not known who would ultimately be authorized to take the medicine. The study included only people who were sick and unvaccinated and had at least one risk factor for developing a severe case of COVID-19, says Aaron Weinberg, national director of clinical research at Carbon Health, a for-profit provider of primary and urgent care, and a principal investigator of the study. This includes people who are older than 60, obese, immunocompromised from another condition, or have underlying heart or pulmonary disease, among others.

If the FDA does authorize the drug, it could limit who gets it to people like those in the research, Javaid says.

Although this drug looks promising, it’s a treatment but not a prophylactic like the vaccine. The medicine does not negate the need for unvaccinated people to get their shot, Shaw says. Some people taking the pills still got sick enough to be hospitalized. And while side effects in this study were mild—generally gastrointestinal issues, Weinberg says, and at comparable rates in the treatment and placebo groups—safety issues might emerge when the drug is given more broadly, Shaw says. Meanwhile, hundreds of millions of people have already gotten the vaccines with no major consequences.

Still, the results of this study should be celebrated, Javaid says. “Saving eight lives is huge, as is halving hospitalization,” he says. Perhaps another drug being studied will later prove to be more effective, reducing hospitalization by 80 or even 100 percent, he says. “But this is better than any oral antivirals we have right now, which is none,” he says.

U.S. hits 700,000 COVID deaths

https://www.axios.com/covid-deaths-700000-us-6dd0223d-562a-41b9-a780-ef54e646b07e.html

The U.S. surpassed 700,000 deaths from the coronavirus on Friday, according to data from Johns Hopkins University.

Why it matters: A summer of division over vaccine and masking mandates only added to the surge in cases caused by the Delta variant. The U.S. went from 600,000 deaths to 700,000 in the span of three-and-a-half months.

  • Public health experts have become increasingly frustrated as thepandemic of the unvaccinatedspread across the country.
  • Roughly 70 million eligible Americans remain unvaccinated, AP reports.

Coronavirus vaccine mandates are working — for now

Coronavirus vaccine mandates imposed by employers seem to be working so far, suggesting that most vaccine holdouts would rather get the shot than lose their job, Axios’ Caitlin Owens writes.

Why it matters: Every vaccine helps in our fight against the coronavirus, although the U.S. still has a long way to go.

Driving the news: States with vaccine mandates for health care workers that have taken effect, like California and New York, have seen a large uptick in vaccinations.

  • These, of course, are blue states and have higher vaccination rates to begin with. But some health systems in red states, like Texas, have seen similar results when their mandates took effect.
  • High-profile mandates outside of the health care sector have also been successful. For instance, United Airlines achieved nearly 100% vaccination among its employees, and Tyson Foods announced that more than 90% of its workers are now vaccinated.
  • The Biden administration announced that it will require all employers with 100 or more employees to ensure their workers are vaccinated or tested weekly, but this hasn’t yet been implemented.

Yes, but: Hospitals and long-term care facilities are already stretched so thin that it won’t take a mass exodus for them to feel the effects of layoffs.

  • In New York, Gov. Kathy Hochul signed an executive order last week to help provide relief to health systems struggling with staff shortages.
  • The Biden administration announced nursing home workers will soon be required to be vaccinated, which could be a much tougher lift. Only about two-thirds of nursing home staff are vaccinated.

What they’re saying: “As we get down to the harder core unvaccinated who are more resistant, what we are seeing is that reality is a more powerful tool to change behavior than information and messaging,” said Drew Altman, president and CEO of KFF.