Category Archives: Coronavirus Delta Variant

The omicron variant: The ‘good,’ ‘bad,’ and ‘ugly’ scenarios

Posted on by • Posted in Clinical Research, Coronavirus, Coronavirus Delta Variant, Coronavirus Mutation, Coronavirus Omicron Variant, Unvaccinated, Vaccination, Vaccine, Vaccine Booster, Vaccine Efficacy, Vaccine Safety, Vaccine Supply • Leave a comment

https://www.advisory.com/daily-briefing/2021/11/30/omicron-future

Will there be a winter lockdown? Experts set out three scenarios - the good, the bad and the ugly

Déjà vu.

That’s what we felt when news broke about a new coronavirus variant, named omicron, being designated as a “variant of concern.” It’s been nearly two years since Covid-19 was declared a global pandemic, and we’re yet again wondering what the future holds.

Once again, there are no clear answers. But we do know enough to begin mapping out the space of possibilities.

We know enough to ask, as we have at past moments in the pandemic: What are the (relatively) “good,” “bad,” and “ugly” scenarios? 

Full disclosure: Even in the day it took us to draft this post, we’ve had to rethink our beliefs in light of emerging information. Still, even if these predictions are shaky, we believe there’s value in reflecting on the futures that could arise—and how health care stakeholders can prepare for each one.

The (relatively) ‘good’ scenario: Our existing vaccines and treatments still work, and omicron doesn’t cause worse disease.

It would be misguided to label any outcome as truly “good” in a pandemic that has already killed more than 775,000 Americans and more than 5 million people worldwide.

Still, some possible futures are clearly better than others—and the best-case scenarios are those in which the omicron variant doesn’t fundamentally change the course of the pandemic.

America has already given 74% of people aged 5+ at least one vaccine dose. If those vaccines are as effective against omicron as other variants, that will be a promising sign for the pandemic’s future.

It’s even possible that omicron’s emergence could drive increased vaccine and booster uptake, as happened in the initial weeks of the delta surge. It could even advance efforts to vaccinate the world, a task that President Biden deemed a “moral obligation” in his early remarks on the omicron variant.

So how likely are current vaccines to work against the omicron variant? One reason for optimism is that most early cases and hospitalizations in South Africa appear to have occurred in unvaccinated individuals. Another is that vaccines have worked well against all past variants, including delta. Still, experts caution that omicron carries more mutations than past variants, and many of those mutations exist in areas associated in lab experiments with immune escape. In the coming weeks, we’ll have more data on whether the vaccines protect against the variant.

Another “good” possibility would that omicron doesn’t make people as sick as other variants (or, put more formally, that it’s not especially virulent). Here, too, there’s reason for optimism. Early reports out of South Africa indicate that most infected individuals have suffered only minor or asymptomatic illnesses.

But there’s also reason for caution: Because the variant has emerged so recently, it’s possible that most cases simply haven’t had time to progress to hospitalization and death. According to WHO, there’s simply no evidence to suggest that omicron’s symptoms are any better or worse than those caused by past variants.

On the whole, we think a relatively good scenario remains plausible, especially in highly vaccinated regions. Additionally, our current preparedness measures—like increased testing and vaccinations, as well as even renewed calls from Dr. Francis Collins from the NIH for mask wearing indoors—may help us get ahead of omicron’s spread, at least in the U.S. But there’s also a risk that things will turn worse.

The ‘bad’ scenario: Omicron is highly transmissible and slightly more virulent than previous variants, but existing vaccines and treatments still work well.

In the “bad” scenario, the omicron variant’s course could look very similar to that taken by the delta variant in the summer. It could rapidly spread throughout the nation and world, with the most severe impacts on unvaccinated populations.

Transmissibility could be a key factor in this scenario, and data on the variant’s basic reproduction ratio (R0) a metric used to describe the contagiousness or transmissibility of infectious agents, will help us further understand potential impact. The original coronavirus had a R0 of 2.79, and the delta variant had a R0 of 5.08. If the omicron variant’s R0 exceeds this number (and is more virulent), we may find ourselves in a “bad” scenario. Experts have speculated that omicron is likely highly transmissible since it carries mutations found on the very contagious delta variant, as well as other mutations hypothesized to increase transmissibility. The variant’s apparently rapid rise in South Africa also suggests it spreads easily, although experts warn we don’t yet know for sure.

If omicron turns out to be the most transmissible variant yet, we should expect another wave of cases among the unvaccinated, likely accompanied by an increase in breakthrough infections. However, so long as our vaccines still are effective, most breakthrough infections will be mild, as was the case during the delta surge.

Even in this “bad” scenario, we’re still much better off than in past coronavirus waves. In just the last several weeks, we’ve seen the emergence of new, promising treatments—notably, oral antivirals that reduce the risk of hospitalization and severe illness. Pfizer’s antiviral, Paxlovid, was shown to provide an 89% risk reduction in outpatients. Merck’s antiviral, molnupiravir, was recently shown to reduce the risk of hospitalization and death from Covid-19 by 30%.

Because of the way these treatments work in the body, experts feel confident they’ll remain effective against the omicron variant. It’s possible that, at least at first, they could be reserved for unvaccinated people or high-risk groups or sent to areas with the greatest prevalence of the variant. It’s likely that FDA will discuss these possibilities as it reviews these drugs’ applications for emergency use authorization. It will also be essential that we can overcome some of the big obstacles for anti-viral treatments, such as access, rapid testing, and sufficient tracking.

Still, while post-exposure drugs will play an important role in a “bad” scenario, the key to preventing a truly “ugly” outcome will be vaccines. The World Health Organization and the Biden administration both echoed this message, recently urging people to get vaccinated and boosted to prevent further spread. Additionally, CDC just strengthened its booster recommendations, saying all eligible adults “should” get boosted (where previous guidance said they “may” get boosted) and Pfizer announced it is seeking approval of boosters for people ages 16 and 17.

The sooner vaccines are distributed throughout America and the world, the better the outcome will be—at least so long as the vaccines themselves remain effective.

The ‘ugly’ scenario: Vaccines falter, and omicron’s virulence is dangerously high.

The biggest question, then, is: What happens if our current vaccines falter?

Here’s where we want to be cautious. Most experts say omicron is extremely unlikely to fully evade existing vaccines. Scott Gottlieb, former FDA commissioner, recently said that “… if you talk to people in vaccine circles… they have a pretty good degree of confidence that a booster vaccine so three full doses of vaccine is going to be fairly protective against this new variant.” It would be irresponsible, and unhelpful, for us to speculate—in absence of any evidence, and against scientists’ best predictions—that vaccines could simply stop working.

But it’s possible that omicron will show a degree of immune escape.

If so, then many people who are vaccinated could fall ill. They in turn could pass the virus to others. And if omicron proves to be as virulent as or worse than past variants, many of those infected—especially those who are unvaccinated—will suffer and die.

This would render the next 100 days truly “ugly,” as manufacturers race to develop new vaccines and boosters against the new variant, and an already exhausted health care system copes with yet another devastating wave of cases.

In this scenario, health care leaders, policymakers, and public health officials will need to re-evaluate preventive strategies. We could once again see draconian measures such as lockdowns and sustained capacity mandates. However, President Biden recently announced that the U.S. will not resort to lockdowns or shutdowns as a result of omicron, making this possibility unlikely.

Even this scary scenario wouldn’t quite bring us back to March 2020. We know dramatically more than we did then about how to detect, contain, and treat Covid-19, and manufacturers stand ready to adapt their vaccines with all due haste.

But this scenario would be horrific, and the next few months would feel all too much like déjà vu.

Parting thoughts

When we’ve written these predictions about the pandemic in the past, we struggled to see how our individual actions could meaningfully inflect our trajectory toward a good, bad, or ugly outcome.

But whether one or none of these scenarios play out, it is important to step back and consider how we can rely on lessons we’ve learned over the past two years. Lessons such as encouraging vaccine uptake by going into the community, combatting structural inequities by acknowledging and acting, helping out vulnerable countries around the world, supporting the health care workforce, and much more.

If you are feeling overwhelmed after reading through these various scenarios, stuck in the treacherous mental waters of the unknown, you are not alone. It is okay to acknowledge the confusion of constantly emerging data as we learn how to proceed. But this is also true: these unknowns will not be the end of us. Somehow, amid the chaos of constant pandemic updates and new death tolls, we continue to move forward as a collective—doing our best to stay prepared, protected, and proactive.

And for us, that is a reason for hope.

Omicron: What we know (and still don’t) about the new variant

Posted on by • Posted in Clinical Research, Coronavirus, Coronavirus Delta Variant, Coronavirus Mutation, Coronavirus Omicron Variant, Vaccination, Vaccine, Vaccine Booster, Vaccine Efficacy, Vaccine Safety, Vaccine Supply • Leave a comment
https://www.advisory.com/daily-briefing/2021/12/02/omicron-update?utm_source=public_db&utm_medium=email&utm_campaign=2021dec02&utm_content=public_headline_public_x_x_x_x&elq_cid=4778863&x_id=
Michigan braces for omicron as COVID-19 hospitalizations climb

The new omicron variant is “more of a Frankenstein” than previous virus coronavirus variants, according to one virologist, and vaccine experts are at odds over how well current vaccines will provide protection against it.

A ‘Frankenstein’ variant

According to Alex Sigal, a virologist heading a team of researchers at the Africa Health Research Institute, the new variant is “probably the most mutated virus we’d ever seen.” However, Sigal added that he believes existing Covid-19 vaccines will continue to protect people against severe disease and hospitalization.

Similarly, Ugur Sahin, BioNTech co-founder, said that the Pfizer-BioNTech vaccine not only creates antibodies that prevent infection from occurring, but also creates T lymphocytes that attack cells after the body has been infected. Sahin argued that, even if omicron can evade antibodies, it would likely be vulnerable to T lymphocytes.

“Our message is: Don’t freak out, the plan remains the same: Speed up the administration of a third booster shot,” Sahin said.

Luke O’Neill, an immunologist and chair of biochemistry at Trinity College Dublin, said Sahin’s assumption makes sense from an immunological perspective. “There is optimism that the T-cells will hold the line—they are very good at stopping severe disease,” O’Neill said.

However, Stanley Plotkin, a scientist who has developed many vaccines, said Sahin’s assumptions were “gratuitous and without any proof.” Plotkin said so far there’s little evidence to suggest T-cells could fully protect against severe symptoms if a virus evades antibodies.

Further, Stéphane Bancel, CEO of Moderna, said, “There is no world, I think, where [the effectiveness] is the same level … we had with [the] Delta [variant] … I think it’s going to be a material drop. I just don’t know how much because we need to wait for the data. But all the scientists I’ve talked to … are like, ‘This is not going to be good.'”

However, former FDA commissioner Scott Gottlieb on Monday said, “There’s a reasonable degree of confidence in vaccine circles that [with] at least three doses … the patient is going to have fairly good protection against this variant.”

Angelique Coetzee, national chair of the South African Medical Association, said that so far, vaccinated patients who have tested positive for omicron “have no complication.” She noted that the nation’s hospitals were not overwhelmed by omicron patients, and most of those hospitalized were not fully vaccinated. Additionally, most patients she had seen did not lose their sense of taste and smell, and had only a slight cough, the New York Times reports.

“I have seen vaccinated people and not really very sick,” Coetzee said. “That might change going forward, as we say, this is early days. And this is maybe what makes us hopeful.”

Could omicron ‘outcompete’ delta?

Separately, Adrian Puren, acting executive director of South Africa’s National Institute for Communicable Diseases, said he believes omicron could become more pervasive than the delta variant. “We thought what will outcompete delta? That has always been the question, in terms of transmissibility at least … perhaps this particular variant is the variant,” Puren said.

William Schaffner, a professor of preventive medicine at Vanderbilt University School of Medicine, said that while nothing is certain yet, “it looks as though [omicron] will be as infectious as delta.”

As for how long it will take to answer questions about omicron, including its transmissibility and virulence, Tara Smith, an epidemiologist at Kent State University, said at minimum “it will take a month to get some preliminary data, and quite possibly longer to really know the fuller picture. We also won’t know about real-world experience in vaccine breakthroughs until that time.”

TODAY’S CORONAVIRUS OUTLOOK

Posted on by • Posted in Coronavirus, Coronavirus Delta Variant, Coronavirus Mutation, Coronavirus Omicron Variant, Pandemic, Vaccination, Vaccine, Vaccine Booster, Vaccine Safety, Vaccine Supply • Leave a comment

Here’s how the world as a whole is currently trending:

More than 570.6 million doses of the COVID-19 vaccine have been shipped to various U.S. states as of yesterday afternoon, of which more than 459.2 million doses have been administered, according to TIME’s vaccine tracker. About 59.3% of Americans have been completely vaccinated.

Nearly 263 million people around the world had been diagnosed with COVID-19 as of 12 a.m. E.T. today, and more than 5.2 million people have died. On Nov. 30, there were 615,787 new cases and 7,704 new deaths confirmed globally.

Here’s how the world as a whole is currently trending:

Here’s where daily cases have risen or fallen over the last 14 days, shown in confirmed cases per 100,000 residents:

And here’s every country that has reported over 5 million cases:

The U.S. had recorded more than 48.5 million coronavirus cases as of 12 a.m. E.T. today. More than 780,000 people have died. On Nov. 30, there were 116,588 new cases and 1,539 new deaths confirmed in the U.S.

Here’s how the country as a whole is currently trending:

The recent dip and rise in daily cases is likely due to reduced reporting during the holiday weekend; historically, the U.S. has seen similar short-term, apparent drop offs that were later shown to be outliers.

That said, here’s where daily cases have risen or fallen over the last 14 days, shown in confirmed cases per 100,000 residents:

All numbers unless otherwise specified are from the Johns Hopkins University Center for Systems Science and Engineering, and are accurate as of Dec. 1, 12 a.m. E.T. To see larger, interactive versions of these maps and charts, click here.

Do Current COVID-19 Tests Still Detect Omicron?

Posted on by • Posted in Clinical Testing, Coronavirus, Coronavirus Delta Variant, Coronavirus Mutation, Coronavirus Omicron Variant • Leave a comment

While no cases of the new coronavirus variant, Omicron, have been reported in the U.S. yet, it’s only a matter of time. In fact, Dr. Anthony Fauci, chief medical advisor on COVID-19 to President Biden, says it’s likely the virus is already in the country, given how much travel is occurring between countries as pandemic restrictions have started to lift in recent months.

Even if the variant were here, could existing tests tell if someone were infected by it? Testing experts say yes and no. The majority of tests used by commercial and public health labs can detect SARS-CoV-2, but they can’t confirm which version of the virus is present. That’s because the tests intentionally target parts of the virus that don’t change much. Variants are designated based on differences in mutations—in Omicron’s case, especially those in spike protein, a part of the virus that changes frequently to bypass drugs and immune cells, and thus are difficult to test for. So the majority of the tests available will show if a person is carrying the virus—but there’s no way to tell whether that virus is Omicron.

For that, a doctor would have to send your sample to a lab that can then sequence genetically to look for the genetic signatures unique to Omicron.

There is one commercial test, from Thermo Fisher Scientific, that can perform the two-fer: both detect the presence of the virus and give testers an inkling that what they’re dealing with might be the Omicron variant. The company’s test targets three different parts of SARS-CoV-2: two relatively stable regions, and the more variable spike protein. It turns out that Omicron will show positive matches on the two more stable regions, a pattern similar to the one from the Alpha variant, but will show a mismatch on the spike protein portion.

The Delta variant, which is now responsible for nearly 99% of new cases around the world, does not share this omission, and produces a three-for-three match on all three regions targeted by Thermo Fisher’s PCR test. That means, given Delta’s dominance, if a sample produces all three matches, it’s likely Delta; if it results in only two positive matches, it’s likely to be Omicron. To confirm, researchers can then send those samples in for sequencing to definitively look for Omicron’s genetic profile.

“This happens to be good fortune that this pattern can flag the presence of Omicron,” says Mark Stevenson, executive vice president and chief operating officer at Thermo Fisher. “It’s a good early warning system.” Clients using the company’s test in South Africa alerted Thermo Fisher last Wednesday that they were seeing those unusual patterns, even before the country’s health officials announced the spurt of new cases. Stevenson expects public health labs in Europe and the U.S. are now also using the test to look for the first cases of the Omicron variant.

At Qiagen, a global testing company that makes assays for both diagnostic testing and research purposes, the team immediately evaluated their test against the samples of genetic sequences of Omicron uploaded by public health experts into the public GISAID database. “We’ve seen no drop in performance in our products,” says Dr. Davide Manissero, chief medical officer at Qiagen.

Similarly, the research team at diagnostic testing company BD ran tests of its COVID-19 assays using the Omicron sequences in GISAID. “We are confident that our rapid antigen and PCR tests for COVID-19 will detect the novel variant,” Dave Hickey, president of BD Life Sciences, said in a statement.

If you prefer to rely on the at-home tests available over-the-counter at pharmacies that can provide results in a few minutes, those are also still useful, at least for letting you know if you might be positive. Like most PCR tests, the at-home kits cannot determine if someone is infected with the Omicron variant specifically, but they will turn positive for anyone infected with any version of the virus.

Covid Natural Immunity vs Vaccine Immunity

Posted on by • Posted in Coronavirus, Coronavirus Delta Variant, Coronavirus Mutation, Coronavirus Omicron Variant, Natural Immunity, Pandemic, Public Health, Public Opinion, Public Perception, Unvaccinated, Vaccination, Vaccine, Vaccine Booster, Vaccine Efficacy, Vaccine Immunity, Vaccine Safety, Vaccine Supply • Leave a comment
Covid Natural Immunity vs Vaccine Immunity
Covid Natural Immunity vs Vaccine Immunity | The Incidental Economist

There’s a lot of talk about “natural immunity” to Covid-19, and some people are refusing vaccination on the grounds that they’ve got this natural immunity thanks to a previous Covid-19 infection. In this episode we take a look at how infection and vaccination compare in terms of immunity, reinfection, and overall health risks and benefits.

The less-discussed consequence of healthcare’s labor shortage

Posted on by • Posted in Center for Medicare and Medicaid Services (CMS), Centers for Disease Control & Prevention (CDC), Coronavirus, Coronavirus Delta Variant, Coronavirus Mutation, Coronavirus Omicron Variant, Health System, Hospital, Hospital Industry, Infection Control, Infection Control Plan, Infectious Virus, Labor Shortages, Labor Spend Management, Leadership, Leadership Commitment, Leadership Culture, Leadership Values, Leadership Vision, Pandemic, Patient Centered Care, Patient Engagement, Patient Outcomes, Patient Safety, Patient Satisfaction, Quality, Quality Measures, Quality of Care, Quality Reporting, Workforce Safety • Leave a comment
https://www.beckershospitalreview.com/patient-safety-outcomes/the-less-discussed-consequence-of-healthcare-s-labor-shortage.html?origin=BHRE&utm_source=BHRE&utm_medium=email&utm_content=newsletter&oly_enc_id=2893H2397267F7G
Patient Safety and Quality Care Movement - YouTube

The healthcare industry’s staffing shortage crisis has had clear consequences for care delivery and efficiency, forcing some health systems to pause nonemergency surgeries or temporarily close facilities. Less understood is how these shortages are affecting care quality and patient safety. 

A mix of high COVID-19 patient volume and staff departures amid the pandemic has put hospitals at the heart of a national staffing shortage, but there is little national data available to quantify the shortages’ effects on patient care. 

The first hint came last month from a CDC report that found healthcare-associated infections increased significantly in 2020 after years of steady decline. Researchers attributed the increase to challenges related to the pandemic, including staffing shortages and high patient volumes, which limited hospitals’ ability to follow standard infection control practices. 

“That’s probably one of the first real pieces of data — from a large scale dataset — that we’ve seen that gives us some sense of direction of where we’ve been headed with the impact of patient outcomes as a result of the pandemic,” Patricia McGaffigan, RN, vice president of safety programs for the Institute for Healthcare Improvement, told Becker’s. “I think we’re still trying to absorb much of what’s really happening with the impact on patients and families.”

An opaque view into national safety trends

Because of lags in data reporting and analysis, the healthcare industry lacks clear insights into the pandemic’s effect on national safety trends.

National data on safety and quality — such as surveys of patient safety culture from the Agency for Healthcare Research and Quality — can often lag by several quarters to a year, according to Ms. McGaffigan. 

“There [have been] some declines in some of those scores more recently, but it does take a little while to be able to capture those changes and be able to put those changes in perspective,” she said. “One number higher or lower doesn’t necessarily indicate a trend, but it is worth really evaluating really closely.”

For example, 569 sentinel events were reported to the Joint Commission in the first six months of 2021, compared to 437 for the first six months of 2020. However, meaningful conclusions about the events’ frequency and long-term trends cannot be drawn from the dataset, as fewer than 2 percent of all sentinel events are reported to the Joint Commission, the organization estimates.

“We may never have as much data as we want,” said Leah Binder, president and CEO of the Leapfrog Group. She said a main area of concern is CMS withholding certain data amid the pandemic. Previously, the agency has suppressed data for individual hospitals during local crises, but never on such a wide scale, according to Ms. Binder.  

CMS collects and publishes quality data for more than 4,000 hospitals nationwide. The data is refreshed quarterly, with the next update scheduled for October. This update will include additional data for the fourth quarter of 2020.

“It is important to note that CMS provided a blanket extraordinary circumstances exception for Q1 and Q2 2020 data due to the COVID-19 pandemic where data was not required nor reported,” a CMS spokesperson told Becker’s. “In addition, some current hospital data will not be publicly available until about July 2022, while other data will not be available until January 2023 due to data exceptions, different measure reporting periods and the way in which CMS posts data.”

Hospitals that closely monitor their own datasets in more near-term windows may have a better grasp of patient safety trends at a local level. However, their ability to monitor, analyze and interpret that data largely depends on the resources available, Ms. McGaffigan said. The pandemic may have sidelined some of that work for hospitals, as clinical or safety leaders had to shift their priorities and day-to-day activities. 

“There are many other things besides COVID-19 that can harm patients,” Ms. Binder told Becker’s. “Health systems know this well, but given the pandemic, have taken their attention off these issues. Infection control and quality issues are not attended to at the level of seriousness we need them to be.”

What health systems should keep an eye on 

While the industry is still waiting for definitive answers on how staffing shortages have affected patient safety, Ms. Binder and Ms. McGaffigan highlighted a few areas of concern they are watching closely. 

The first is the effect limited visitation policies have had on families — and more than just the emotional toll. Family members and caregivers are a critical player missing in healthcare safety, according to Ms. Binder. 

When hospitals don’t allow visitors, loved ones aren’t able to contribute to care, such as ensuring proper medication administration or communication. Many nurses have said they previously relied a lot on family support and vigilance. The lack of extra monitoring may contribute to the increasing stress healthcare providers are facing and open the door for more medical errors.

Which leads Ms. Binder to her second concern — a culture that doesn’t always respect and prioritize nurses. The pandemic has underscored how vital nurses are, as they are present at every step of the care journey, she continued. 

To promote optimal care, hospitals “need a vibrant, engaged and safe nurse workforce,” Ms. Binder said. “We don’t have that. We don’t have a culture that respects nurses.” 

Diagnostic accuracy is another important area to watch, Ms. McGaffigan said. Diagnostic errors — such as missed or delayed diagnoses, or diagnoses that are not effectively communicated to the patient — were already one of the most sizable care quality challenges hospitals were facing prior to the pandemic. 

“It’s a little bit hard to play out what that crystal ball is going to show, but it is in particular an area that I think would be very, very important to watch,” she said.

Another area to monitor closely is delayed care and its potential consequences for patient outcomes, according to Ms. McGaffigan. Many Americans haven’t kept up with preventive care or have had delays in accessing care. Such delays could not only worsen patients’ health conditions, but also disengage them and prevent them from seeking care when it is available. 

Reinvigorating safety work: Where to start

Ms. McGaffigan suggests healthcare organizations looking to reinvigorate their safety work go back to the basics. Leaders should ensure they have a clear understanding of what their organization’s baseline safety metrics are and how their safety reports have been trending over the past year and a half.

“Look at the foundational aspects of what makes care safe and high-quality,” she said. “Those are very much linked to a lot of the systems, behaviors and practices that need to be prioritized by leaders and effectively translated within and across organizations and care teams.”

She recommended healthcare organizations take a total systems approach to their safety work, by focusing on the following four, interconnected pillars:

  • Culture, leadership and governance
  • Patient and family engagement
  • Learning systems
  • Workforce safety

For example, evidence shows workforce safety is an integral part of patient safety, but it’s not an area that’s systematically measured or evaluated, according to Ms. McGaffigan. Leaders should be aware of this connection and consider whether their patient safety reporting systems address workforce safety concerns or, instead, add on extra work and stress for their staff. 

Safety performance can slip when team members get busy or burdensome work is added to their plates, according to Ms. McGaffigan. She said leaders should be able to identify and prioritize the essential value-added work that must go on at an organization to ensure patients and families will have safe passage through the healthcare system and that care teams are able to operate in the safest and healthiest work environments.

In short, leaders should ask themselves: “What is the burdensome work people are being asked to absorb and what are the essential elements that are associated with safety that you want and need people to be able to stay on top of,” she said.

To improve both staffing shortages and quality of care, health systems must bring nurses higher up in leadership and into C-suite roles, Ms. Binder said. Giving nurses more authority in hospital decisions will make everything safer. Seattle-based Virginia Mason Hospital recently redesigned its operations around nurse priorities and subsequently saw its quality and safety scores go up, according to Ms. Binder. 

“If it’s a good place for a nurse to go, it’s a good place for a patient to go,” Ms. Binder said, noting that the national nursing shortage isn’t just a numbers game; it requires a large culture shift.

Hospitals need to double down on quality improvement efforts, Ms. Binder said. “Many have done the opposite, for good reason, because they are so focused on COVID-19. Because of that, quality improvement efforts have been reduced.”

Ms. Binder urged hospitals not to cut quality improvement staff, noting that this is an extraordinarily dangerous time for patients, and hospitals need all the help they can get monitoring safety. Hospitals shouldn’t start to believe the notion that somehow withdrawing focus on quality will save money or effort.  

“It’s important that the American public knows that we are fighting for healthcare quality and safety — and we have to fight for it, we all do,” Ms. Binder concluded. “We all have to be vigilant.”

Conclusion

The true consequences of healthcare’s labor shortage on patient safety and care quality will become clear once more national data is available. If the CDC’s report on rising HAI rates is any harbinger of what’s to come, it’s clear that health systems must place renewed focus and energy on safety work — even during something as unprecedented as a pandemic. 

The irony isn’t lost on Ms. Binder: Amid a crisis driven by infectious disease, U.S. hospitals are seeing higher rates of other infections.  

“A patient dies once,” she concluded. “They can die from COVID-19 or C. diff. It isn’t enough to prevent one.”

How to Talk about Vaccines at Thanksgiving

Posted on by • Posted in Coronavirus, Coronavirus Delta Variant, Coronavirus Mutation, Happy Thanksgiving, Infection Control, Infection Control Plan, Infectious Virus, Pandemic, Public Health, Public Opinion, Public Perception, Public Trust, Sign of the Times, Unvaccinated, Vaccination, Vaccine, Vaccine Booster, Vaccine Distribution, Vaccine Efficacy, Vaccine Safety, Vaccine Supply • Leave a comment
May be an image of 6 people and text that says 'How to talk about vaccines at Thanksgiving The big thing to know when talking to family and friends about vaccine falsehoods during the holidays: It's better to respond with facts than to offer corrections.'

“Please pass the green beans.” “What kind of pie is that?”“What about spike proteins!?”These are some of the phrases that may be uttered during your Thanksgiving and holiday dinners this season. But! We have prepared a glossary for you. Swipe through a quick guide to some of the most misused terms around vaccines that PolitiFact has noticed in our fact-checking. And because we know that shouts of “that’s wrong!” don’t go over smooth like gravy, we’re including an expert’s advice on how to talk about vaccine falsehoods with family and friends.The big thing to know: It’s better to respond with facts than to offer corrections.”If they said something like ‘the vaccine is dangerous,’ include a statistic about how 75% of the people in their state have gotten vaccinated and none have died, or how severe and dangerous COVID-19 is,” said Rupali Limaye, an associate scientist at Johns Hopkins School of Public Health. “And, ultimately, make sure you’re saying it all with empathy.”

May be an image of text that says '"Spike protein" The human body and other organisms are made up of a variety of proteins, and SARS-COV-2, the virus that causes COVID-19, has its own. The virus' spike protein, which allows the virus to penetrate cells and cause infection, has sharp bumps that protrude from the surface of the virus' outer envelopes. COVID-19 vaccines introduce a piece of the protein- but not the harmful part of the virus which the immune system quickly identifies, attacks and destroys as a foreign invader.'
May be an image of text that says '"mRNA" The Pfizer and Moderna COVID-19 vaccines use messenger RNA to deliver an instruction manual to cells for making the coronavirus' spike protein. They're different from conventiona vaccines that use part of a bacterium or virus to induce protein production. The mRNA is fragile and quickly broken down in the body once the cells learn the blueprint, which is usually within three days of receiving the vaccine. The molecule does not we repeat, does not enter the nucleus of cells and alter a person's DNA.'
May be an image of text that says '"VAERS" VAERS stands for the Vaccine Adverse Effects Reporting System, a critical reporting tool for the federal government to collect and analyze data on after-effects from all vaccines, not just COVID-19. Unlike other government data sources, VAERS is designed so that anyone- parents, patients and health care professionals can report health effects that occur after a vaccination, whether or not those effects were caused by the vaccine. The reports aren't verified before they're entered, and anyone with a computer can access the data.'
May be an image of text that says '"Syncytin-1" Syncytin-1, a protein found in humans and some animals, is most known for helping develop the placenta, the temporary organ that helps nourish a fetus during pregnancy. Syncytin-1 and the coronavirus spike protein have almost nothing in common, making the vaccine highly unlikely to trigger a reaction. "If someone says they heard the vaccine causes infertility, would just respond with something direct- like that there are no studies that show a link between the vaccines and infertility Zero," an expert said.'
May be an image of text that says '"Ivermectin" vermectir is an anti-parasitic medication that has been widely touted as a COVID-19 treatment despite health authorities warning against COVID-19 patients self-medicating with the drug. When people started to believe it could treat COVID- 19, some of them ingested forms of the drug made for animals, causing a dramatic uptick in calls to poison control. Officials warn that more research is still needed on ivermectin's effectiveness as a COVID-19 treatment.'
May be an image of text that says 'A final word about words The best way to talk through different views on vaccines with loved ones is by making your point in a personal context that takes the focus off them. "Think of family member they want to protect, so it's not all about them," said Rupali Limaye, an associate scientist at Johns Hopkins School of Public Health." "Like 'Hey, I'm really concerned about grandma and just want to make sure we are doing all we can to protect her. It leaves the pressure off them but they still have some skin in the game."'

Axios-Ipsos poll: Thanksgiving Roulette

Posted on by • Posted in Coronavirus, Coronavirus Delta Variant, Coronavirus Mutation, Happy Thanksgiving, Infection Control, Infection Control Plan, Infectious Virus, Pandemic, Public Health, Public Opinion, Public Perception, Public Safety, Sign of the Times, Unvaccinated, Vaccination, Vaccine, Vaccine Booster, Vaccine Efficacy, Vaccine Safety, Vaccine Supply • Leave a comment

https://www.axios.com/axios-ipsos-poll-thanksgiving-covid-7a043049-d25c-4d3a-9bab-2853973f67af.html

Axios-Ipsos poll: Americans are ready to play COVID roulette for Thanksgiving

Two-in-three Americans will celebrate this Thanksgiving with friends or family outside their immediate households, and about half of those say their gatherings could include unvaccinated people, according to the latest installment of the Axios/Ipsos Coronavirus Index.

Why it matters: Vaccinations and booster shots are giving more people confidence to resume traditions like sitting around a packed table with masks off. But many are doing so with heightened awareness of what they don’t know when it comes to their holiday companions.

  • This year, 31% see a large or moderate risk in seeing friends or family for Thanksgiving — way down from 64% a year ago.
  • People’s assessment of overall risk of returning to their normal pre-COVID lives is also down, with 44% seeing it as a large to moderate risk this year compared with 72% last year.
  • But when Americans are asked how concerned they still feel about the virus, the numbers haven’t diminished all that much: 69% compared with 85% a year ago.

What they’re saying: “We’re just in a holding pattern,” said Cliff Young, president of Ipsos U.S. Public Affairs.

  • “They’re going to Thanksgiving because they have to, they have to see their family and friends, it’s human nature,” Young said. “But Americans are still deploying mitigating strategies.”
  • Ipsos pollster and senior vice president Chris Jackson said the vaccines “have attenuated some of that risk. But there’s a larger sense of anxiety or concern that hasn’t been dealt with.”

By the numbers: 67% of U.S. adults surveyed said they’ll see friends or family outside their households. That’s 73% of Republicans, 70% of independents and 63% of Democrats.

  • 30% of them said the guests will include unvaccinated people, and another 17% said they don’t know whether other guests will be vaccinated or not.
  • 38% said they’ll be with people who don’t regularly wear masks outside the home, while another 21% said they didn’t know if their guests regularly wear masks.
  • 4% said they’ll be seeing people who’ve been exposed to COVID-19 in the last two weeks; another 28% aren’t sure if people at their gatherings have been exposed.

Between the lines: There’s a modest partisan gap around openness to returning to the communal Thanksgiving table — but a gulf around who you’re willing to sit with.

  • 41% of Republicans expect to spend the holiday with someone who’s unvaccinated, compared with 17% of Democrats.
  • When we asked unvaccinated respondents, 56% of those who will celebrate Thanksgiving with friends and family outside the home expect the guests to include other unvaccinated people.

The big picture: This week’s findings show overwhelming support (86%) for every vaccinated American who wants a booster being able to get one. But only about one in four respondents said they knew much about an anti-viral COVID-19 pill awaiting FDA approval.

  • 23% hadn’t heard about the pill at all, and half had heard of it but said they didn’t know much about it.
  • When the unvaccinated were asked whether they’d rather get a shot to prevent the virus, or wait to catch the virus and then take an approved pill to treat it, the pill drew a slight edge (17% versus 12%) and 15% had no preference, while a majority — 53% — said they’d prefer to take neither.
  • That suggests the pill won’t be a silver bullet — and offers more evidence that there is a segment of American society that doesn’t trust science or government to tell them what to do.

Booster strategy could backfire

Posted on by • Posted in Centers for Disease Control & Prevention (CDC), Coronavirus, Coronavirus Delta Variant, Coronavirus Mutation, Evidence Based Decision Making, Evidence-Based Care, Evidence-Based Policy, Food and Drug Administration (FDA), Health Policy, Infection Control, Infection Control Plan, Infectious Virus, Vaccination, Vaccine, Vaccine Booster, Vaccine Efficacy, Vaccine Safety, Vaccine Supply • Leave a comment

https://www.axios.com/covid-vaccine-boosters-thanksgiving-5851be4a-79a7-423a-93bb-390d1eb7d4d3.html

Federal officials waited months before making all American adults eligible for a COVID-19 booster shot — meaning millions of Americans may not have the strongest possible protection as they head into holiday travel.

Why it matters: Critics say the confusing process undermined what has now become a critical effort to stave off another wave of the pandemic.

  • Most vaccinated people, even without a booster, still have very strong protection against serious illness or death. But a third shot drastically increases people’s defenses against even mild infections, which could in turn help reduce the virus’ spread.
  • And some vulnerable vaccinated adults are at risk of serious breakthrough cases.

What they’re saying: “We have a consensus. Boosters are very important in maintaining people’s defenses against COVID. We need to get as many people vaccinated and boosted [as possible] as the winter sets in,” David Kessler, the chief science officer of Biden’s COVID response, said in an interview.

Context: Preliminary data released months ago suggested a significant decline in the vaccines’ effectiveness at preventing infection, although they held up well against severe disease.

  • Based on that data, the Biden administration had hoped to begin allowing booster shots in September for any American adult who was at least eight months removed from their second dose.
  • The CDC and the FDA opted instead to only authorize boosters for seniors, people with high-risk medical conditions and people at high risk of infection, before opening them last week to everyone at least six months out from their initial shots.

In the meantime, red and blue states alike decided to ignore the CDC and open up booster eligibility on their own, and breakthrough infections have become increasingly common.

  • Millions of people who weren’t technically eligible for boosters got them anyway, and a large portion of the most vulnerable patients still haven’t gotten one.
  • Where it stands: Only 41% of vaccinated Americans 65 and older have received a booster shot, as have 20% of all vaccinated adults, per the CDC.

“Some of us were there several months ago. Some wanted more data. In the end, there’s a convergence of opinions. It’s the way an open scientific public health process should work,” Kessler said.

Between the lines: The U.S. drug approval process — with its insistence on high-quality data and careful expert reviews — is the world’s gold standard precisely because it moves deliberately. Regulators have been trying this whole time to figure out how to adapt that system to a fast-moving pandemic.

Some federal officials, as well as many outside experts, said there wasn’t enough data to make a broad booster recommendation earlier this fall.

  • Early on, many public health experts also argued that it was unethical to give Americans a third shot while much of the rest of the world awaited their first shots.
  • Israel embraced boosters before the U.S. beginning over the summer, and its emerging data has been key to making the case that boosters are needed and can help bring surges under control. However, experts still don’t know how long the enhanced protection they give will last.

What they’re saying: “Some argued early on that the primary series was good enough and we should conserve doses for the world. What’s emerging is that all people in the world are going to need to be boosted,” a senior administration official said.

  • “Everyone has a different threshold for how much data they need in making a decision,” the official added. “What made this different is that there’s a pandemic underway, and many saw we were heading into a winter surge.”