Category Archives: Coronavirus Mutation

Could new FLiRT variants lead to a summer COVID-19 surge?

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https://www.advisory.com/daily-briefing/2024/06/03/flirt-variant

Although COVID-19 cases are currently declining, some health experts have voiced concerns that circulating FLiRT variants could lead to a spike in cases as more people gather in the summer months.

What are the FLiRT variants?

Over the winter, the dominant COVID-19 variant was JN.1, which spread globally. However, a new variant called KP.2, or FLiRT due to the location of its mutations, began to emerge in March.

There are several different FLiRT variants, including KP.2, KP.1.1, and KP.3. In a two-week period ending May 11, KP.2 made up 28.2% of COVID-19 cases in the United States, while KP.1.1 made up over 7% of cases.

According to some health experts, KP.2 and KP.1.1 could be more transmissible than previous COVID-19 variants. So far, early data suggests that KP.2 may be “rather transmissible” since its new mutations help “its ability to transmit, but also now evades some of the pre-existing immunity in the population,” said Andrew Pekosz, a virologist at Johns Hopkins University.

Currently, there’s no evidence to suggest that the FLiRT variants cause more severe illness than previous COVID-19 variants. Some of the symptoms associated with the FLiRT variants include fever or chills, cough, sore throat, fatigue, a loss of taste or smell, and brain fog.

“The CDC is tracking SARS-CoV-2 variants KP.2 and KP.1.1, sometimes referred to as ‘FLiRT,’ and working to better understand their potential impact on public health,” the agency said. “Currently, KP.2 is the dominant variant in the United States, but laboratory testing data indicate low levels of SARS-CoV-2 transmission overall at this time. That means that while KP.2 is proportionally the most predominant variant, it is not causing an increase in infections as transmission of SARS-CoV-2 is low.”

Could these variants lead to another COVID-19 surge?

Currently, COVID-19 cases and deaths are declining, but health experts say the FLiRT variants’ potential to evade immunity could lead to a spike in cases as people gather for summer holidays.

Immunity may also be waning since few people received updated COVID-19 vaccines last fall. According to CDC, only 22.6% of adults reported receiving an updated vaccine since September 2023, though vaccination increased by age and was highest among those ages 75 and older.

“We’ve got a population of people with waning immunity, which increases our susceptibility to a wave,” said Thomas Russo, chief of infectious disease at the Jacobs School of Medicine and Biomedical Sciences at the University of Buffalo.

Otto Yang, associate chief of infectious diseases at the University of California, Los Angeles‘ David Geffen School of Medicine, said that while healthcare systems can manage COVID-19 waves, immunocompromised and older adults at a higher risk of developing severe disease are often overlooked.

“Those people unfortunately carry a heavy burden,” Yang said. “I’m not sure there is a good solution for them, but one thing could be better preventive measures.”

However, COVID-19 protections that were common in the past, including testing before events and mask requirements, have now fallen by the wayside, the Washington Post reports. Even events with preventive measures in place have faced difficulties enforcing them.

“Culturally we are coming away from it as a society, so it gets much harder to ask people to really be consistent, because they aren’t doing it anywhere else,” said D Schwartz, who organized a large LGBTQ+ community gathering event in Washington, D.C. “You go into a movie theater now, you see maybe five people wearing a mask.”

Declining data collection has also impacted how people view the current COVID-19 situation. Although CDC still tracks coronavirus levels in wastewater and the percentage of ED visits with a diagnosed case of COVID-19, hospitals stopped reporting confirmed COVID-19 cases in April.

“We’re kind of shooting blind now,”

said Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine and co-director of the Texas Children’s Hospital Center for Vaccine Development. Hotez also noted that a lack of data collection will make it harder to convince Americans that COVID-19 is enough of a threat to require continued vaccination.

“If a wave materializes this summer, we’re less poised to navigate the rough waters,” said Ziyad Al-Aly, an epidemiologist and long COVID researcher at the Veterans Affairs health system in St. Louis.

FDA approves updated COVID vaccines

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https://mailchi.mp/e1b9f9c249d0/the-weekly-gist-september-15-2023?e=d1e747d2d8

On Monday, the Food and Drug Administration authorized new COVID vaccines from Moderna and Pfizer-BioNTech, and the Centers for Disease Control and Prevention followed Tuesday by recommending the shots be given as a single dose for most people five years of age and older. Children older than six months but younger than five, as well as completely unvaccinated people of any age, may be eligible for multiple doses. 

These vaccines were formulated to target the XBB.1.5. variant,

which was the dominant strain in January but has since receded, although initial results suggest they remain effective against all currently circulating variants. Pharmacies and healthcare providers are expected to have the updated vaccines available by early next week. 

The Gist: Due to the end of the COVID public health emergency in May, this COVID vaccination campaign will be the first not directly bankrolled by the federal government. 

While insurers are still required to cover vaccinations without cost-sharing, the uninsured may find free shots, which the Biden administration says it will still provide at certain locations, harder to access. 

Unlike past COVID boosters, reframing this shot as an annual vaccine that patients receive along with their flu shots should help with the rollout, as around 50 percent of Americans got a flu shot in 2022 while only 17 percent received the bivalent COVID booster.

With COVID cases and hospitalizations currently rising, promoting widespread uptake is critical to dampening a likely winter COVID spike.

However, public health officials will have to overcome many Americans’ wearied indifference toward COVID to motivate them to get vaccinated.

So, Is the Pandemic Over Yet?

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In his second State of the Union speech on Feb. 7, President Joe Biden made it clear that the Administration is moving into the next phase of the COVID-19 pandemic—one in which the threats of disease and death are considerably diminished, and therefore no longer require the resources and urgent allocation of funds that the previous two years have.

“While the virus is not gone…we have broken COVID’s grip on us,” Biden said. “And soon we’ll end the public health emergency.”

The President outlined his reasons for not renewing the COVID-19 national and public health emergencies when they expire on May 11, which have been extended every 90 days since they were established in 2020. The decision represents a de-escalation in the way the government is treating the pandemic.

But health experts say now is not the time to let down our collective guard on SARS-CoV-2. “I don’t believe the virus has gotten the memo that the pandemic is winding down,” says Dr. Jeffrey Glenn, director of the Stanford Biosecurity and Pandemic Preparedness Initiative.

“There is a disconnect between the broad perception that the pandemic is behind us, and focusing on getting back to life as it was pre-pandemic,” says Wafaa El-Sadr, founder and director of the International Center for AIDS Care and Treatment Programs (ICAP) at Columbia University’s Mailman School of Public Health. “But the reality is that we still continue to have substantial transmission and deaths due to COVID in the U.S., and we are in a situation where the virus will be with us for a long time.”

Even when the emergency states end, therefore, the pandemic will not be over, they and others say.

One reason is that the definition of a “pandemic” is primarily based on the breadth and speed of a virus’ spread, and the amount of the world affected by a pathogen. It’s only partially related to the severity of disease caused by a virus like SARS-CoV-2, or even the amount of immunity a population may have against it.

By that main criterion, COVID-19 is still very much with us, with around 200,000 new cases and 1,000 deaths a day globally. The latest Omicron variants quashed any hope of the pandemic ending any time soon. While they do not cause more serious infections than past variants, they have mastered the challenge of hopping more efficiently from one infected person to another.

Even though the pandemic is far from over, many health experts agree that ending the U.S. national emergencies is justified at this point. When these measures were first implemented in 2020, most people were immunological sitting ducks for the virus. The declarations were designed to devote financial resources and personnel to controlling the impact of infections on the population’s health as much as possible by shoring up the health care system and later by providing free vaccinations. U.S. officials decided to end the national and public health emergencies in May primarily because most people have either been vaccinated or have recovered from an infection (or both), so the population’s immunity stands at a higher level. COVID-19 cases—both overall and the severe kind—have declined considerably since those early days.

But the continuing stream of infections means that the virus is still reproducing and churning out mutations. So far, those variants haven’t caused more serious disease—but that’s purely by chance, which makes public health experts uncomfortable with declaring victory just yet. Even though COVID-19 cases are no longer inundating most hospitals, that means it’s time to rethink the COVID-19 response, not abandon it.

The best way forward at this point is to refine and target COVID-19 services to optimize the chances of controlling the virus where it may be causing the most health problems. “I think we need to move away from universal guidance on vaccines and boosters and mitigation measures where everybody gets the same guidance, to a more differentiated and tailored approach based on the different characteristics—both socioeconomic and clinical—of different groups of people,” says El-Sadr. “We are at a different moment in the pandemic, so the moment is now for a different message.”

That message isn’t to put COVID-19 completely behind us, but to move forward armed with the lessons we’ve learned from our experience—the most important of which is never to underestimate SARS-CoV-2.

New booster works against dominant Covid strain

Posted on by • Posted in Coronavirus, Coronavirus Mutation, Coronavirus Omicron Variant XBB.1.5, Infectious Virus, Public Health, Public Opinion, Public Perception, Vaccination, Vaccine, Vaccine Booster, Vaccine Distribution, Vaccine Efficacy • Leave a comment

https://www.politico.com/news/2023/01/25/bivalent-covid-booster-xbb-1-5-00079451?mkt_tok=ODUwLVRBQS01MTEAAAGJjU7308C9Y8wCxfUFTmF9l2n7GDK3ejZuigdebwgFj9OOr5ffXWyONZ2UpDkMVbgp0t6zGmmGbBdM0Vd7yn0Wf61hb_mHhXcbSfFlK5F-tKyN

A new CDC study has found that the Covid-19 bivalent booster reduces the risk of symptomatic infection from the most common subvariant circulating in the U.S. right now by about half.

Additional new data, set to be published on the CDC website on Wednesday, also shows that individuals who received an updated vaccine reduced their risk of death by nearly 13 fold, when compared to the unvaccinated, and by two fold when compared to those with at least one monovalent vaccine but no updated booster.

CDC officials said during a briefing on Wednesday that the new findings were “reassuring.” But only 15.3 percent of eligible Americans — or about 50 million people — have received the new shot, which was rolled out in September.

Meanwhile, the highly transmissible Omicron subvariant XBB.1.5 — nicknamed “the Kraken” by some — is now the dominant SARS-CoV-2 strain in the U.S., projected by the CDC to make up just over 49 percent of cases in the country as of last week.

Earlier this month, the WHO said XBB.1.5 is the most transmissible variant to date, and is circulating in dozens of countries. Though a catastrophic wave has not emerged in the U.S. yet, there has nevertheless been a spike in deaths this month, with an average of 564 people dying of Covid-19 each day as of Jan. 18, compared with an average of 384 around the same time in December.

The new vaccine efficacy study, which used data from the national pharmacy program for Covid testing, found that the bivalent booster provided 48 percent greater protection against symptomatic infection from the XBB and XBB.1.5 subvariants among people who had the booster in the previous two to three months, compared with people who had only previously received two to four monovalent doses.

It also provided 52 percent greater protection against symptomatic infection from the BA.5 subvariant, though according to CDC estimates, BA.5 only accounted for about 2 percent of U.S. cases last week.

CDC officials cautioned that the findings reflected a population-level rate of protection, and that individual risk of infection varies.

“It’s hard to interpret it as an individual’s risk, because every individual is different,” said Ruth Link-Gelles, the author of the vaccine effectiveness study published in MMWR Wednesday. “Their immune system is different, their past history of prior infection is different. They may have underlying conditions that put them at more or less risk of COVID-19 disease.”

She also said it was unclear, given the limitations of the study, how long the bivalent booster protection will last.

“It’s too early to know how waning will happen with the bivalent vaccine,” she said. “What we’ve seen in the past is that your protection lasts longer for more severe illness. So even though you may have diminished protection over time against symptomatic infection, you’re likely still protected against more severe disease for a longer period of time.”

How bad is China’s covid outbreak?

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https://www.washingtonpost.com/world/2023/01/12/china-covid-cases-deaths/?utm_campaign=wp_to_your_health&utm_medium=email&utm_source=newsletter&wpisrc=nl_tyh

China is in the middle of what may be the world’s largest covid-19 outbreak after authorities abruptly loosened almost three years of strict pandemic restrictions in December following nationwide protests against the measures.

The sudden dismantling of China’s “zero covid” regime — enforced through mass lockdowns, testing and contact tracing — has left the country’s health system unprepared and overwhelmed. It has alarmed international health experts concerned about Beijing’s transparency and caused diplomatic friction as countries enforce travel restrictions on arrivals from China.

How many people have been infected?

So far, there are no reliable national figures for the number of people among China’s 1.4 billion population who have been infected in the current outbreak. After admitting the difficulty of tracking infections, China’s National Health Commission stopped reporting daily tallies in December.

The data is still maintained by the Chinese Center for Disease Control and Prevention, based on counts from hospitals and local health commissions. But because mandatory mass testing has been dropped, the official figure is believed to massively underestimate the rate of infection. As of Jan. 8, there have been a little more than 500,000 confirmed covid cases since the pandemic began, according to the CDC.

Statements from local governments indicate that the true number of infections is exponentially higher. Officials in Henan province estimated this week that 89 percent of the province’s 99 million residents have been infected. In Zhejiang province, officials said the province was seeing over a million new infections a day in late December. As of Jan. 8, all 31 provinces, municipalities and regions had reported covid infections, according to the CDC.

How serious is the outbreak?

The number of deaths remains unknown, even as evidence is mounting that the true death count is much higher than what has been reported — a little more than 5,200 deaths since the pandemic began and fewer than 40 since zero-covid restrictions were lifted on Dec. 7.

As of Dec. 25, the takeup of intensive care beds in secondary and tertiary hospitals across the country was about 54 percent, but that figure has since increased to 80 percent, Jiao Yahui, director of the Department of Medical Affairs of the National Health Commission, said in an interview with state broadcaster CCTV on Sunday.

Officials reassured the public by noting that the fatality rate of the coronavirus’s omicron variant is 0.1 percent. The current outbreak has mostly consisted of the omicron subvariants BA.5.2 and BF.7, the State Council Information Office said in a news conference Monday.

The lack of testing combined with the narrow definition of what counts as a covid death — positive patients who die of respiratory failure — continue to skew the statistics. Officials have said they will investigate fatalities and release the results in the future.

What is the government saying?

Authorities say the worst of the outbreak is over for Chinese cities where infections spread quickly in December. Now, they are preparing for a new surge in rural areas around the upcoming Lunar New Year holiday that begins Jan. 21.

State media has reported that cases in most major cities have started to decline. Yin Yong, acting mayor of Beijing, told CCTV on Monday that the city had reached its peak and that authorities were turning their focus to monitoring potential new coronavirus variants or subvariants of omicron, and to mitigating the impact of covid on the elderly and other vulnerable groups.

Officials also said the peak had been reached in the province of Jiangsu in late December, while in Zhejiang, authorities said, “the first wave of infections has passed smoothly,” according to Health Times, a publication managed by People’s Daily. The state-run Farmers’ Daily said that visits to 51 villages across 31 provinces showed that most residents had been infected and had recovered.

Data released by Baidu, the main search engine in China, showed that the number of searches related to covid symptoms and medical supplies had dropped since peaking in mid-December.

Yet in Henan, officials said hospitals remain overcrowded because of a rise in critical cases in the past week. Researchers at the Institute of Public Health at Nankai University in Tianjin, using data from fever clinics, project that the nationwide peak will be between Dec. 20 and Jan. 15, with two smaller peaks in the first half of this year.

Officials have predicted a second wave over the Lunar New Year holiday, when the total number of passenger trips by residents is expected to reach 2.1 billion as pent-up demand for travel is unleashed. At this point, more contagion could spread to rural areas, where severe shortages of anti-fever drugs and medical staff have been reported.

How did zero covid affect the outbreak?

China’s pursuit of zero covid, eliminating the spread of the virus through lockdowns, mandatory quarantines, travel restrictions and mass testing, has proved to be a double-edged sword. While the approach kept infections and death rates low throughout most of the pandemic, it left the Chinese population with little natural immunity to the virus.

Many elderly residents — already skeptical of vaccines, which have had a troubled past in China — did not get vaccinated, feeling that they would be protected by the zero-covid strategy. Only 40 percent of residents above the age of 80 have had booster shots.

Under China’s covid policy, the population was immunized with domestically made vaccines that are not as effective against the omicron variant as mRNA vaccines. China has yet to approve foreign mRNA vaccines, and a domestically made one is still under production.

What does this mean for the rest of the world?

Concerns about the possibility of a new variant emerging in China have prompted countries including the United States, Japan and South Korea, and many European countries, to require extra screening for arrivals from China.

Wu Zunyou, the chief epidemiologist at the CDC, told CCTV in a report published Sunday that no new variants have emerged and that new strains are being collected every day to monitor changes.

“All the strains we found so far have already been shared with international sharing platforms,” he said. “They are the ones either reported abroad, or have been introduced to China after spreading overseas. So far, no newly emerged mutated strains have been found in China.”

The World Health Organization has called on China to share more real-time data on the outbreak. Michael Ryan, the health emergencies director, said at a news conference in Geneva on Wednesday that the WHO “still believes that deaths are heavily underreported from China.” He added: “We still do not have adequate information to make a full comprehensive risk assessment.”

Beijing has criticized travel restrictions on people arriving from China imposed by other countries as “ridiculous” and politically motivated. It has threatened countermeasures and this week suspended short-term visas for Japanese and South Korean citizens.

The current “tripledemic” is putting pressure on hospitals  

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https://mailchi.mp/e44630c5c8c0/the-weekly-gist-december-16-2022?e=d1e747d2d8

Hospitals across the country are being hit with a spike in respiratory syncytial virus (RSV) and influenza cases, while still dealing with a steady flow of COVID admissions, in what’s been dubbed a “tripledemic”. The graphic above uses hospitalization data from the Centers for Disease Control and Prevention (CDC) to show that each disease has been sending similar shares of the population to hospitals across late fall, with flu hospitalizations having just overtaken COVID admissions after Thanksgiving.

These numbers reflect that we’re experiencing the worst RSV season in at least five years, and we’re set to endure the worst flu season since 2009-10. As RSV is most severe in very young children, its recent surge has revealed another capacity shortage in our nation’s hospitals: pediatric beds. From 2008 to 2018, pediatric inpatient bed counts fell by 19 percent, as hospitals shifted resources to higher revenue services. 

This strategy has now come to a head in many parts of the country, as RSV has driven pediatric bed usage rates to a recent high. (The Department of Health and Human Services’ pediatric capacity data only dates back to August 2020.) With three straight weeks of declining RSV hospitalizations, there is reason to hope that pediatric care units will soon feel a reprieve. However, flu season has yet to reach its peak, prompting calls for a return to widespread mask-wearing and a renewed emphasis on flu shots, given that more than half of Americans have not yet gotten vaccinated this season. 

Virus roundup: There are new dominant Covid-19 strains in the US

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https://www.advisory.com/daily-briefing/2022/11/28/virus-roundup?utm_source=member_db&utm_medium=email&utm_campaign=2022Nov28&utm_content=member_headline_final_x_x_x_x&elq_cid=4838956&

Monkeypox cases in women and non-binary people may be getting misdiagnosed as sexually transmitted infections (STIs), daily Covid-19 hospital admissions are expected to increase for the first time since July, and more in this week’s roundup of monkeypox and Covid-19 news.

Monkeypox:

  • Monkeypox may be getting misdiagnosed as STIs in women and non-binary people, according to a new study published in The Lancet. For the study, researchers gathered data from 69 cisgender women, 62 transgender women, and five nonbinary people assigned female at birth with confirmed monkeypox cases between May 11 and Oct. 4 across 15 countries. The study found that 73% of monkeypox infections among this group were likely acquired from sexual contact. While nearly all monkeypox infections among trans women were likely acquired through sexual contact, roughly 24% of cis women and nonbinary people were believed to have acquired an infection outside of sexual contact, such as household or occupational exposure, according to the researchers. In addition, the researchers found that around 33% of cisgender women were misdiagnosed before being diagnosed with monkeypox—and almost half received a delayed diagnosis. “It’s very likely that infections have been missed and not picked up at all,” said Chloe Orkin, a physician and researcher at Queen Mary University of London. “The lesson here is that everybody needs to know about this,” Orkin noted. While public health messages have been primarily directed toward men who have sex with men, “it’s important to recognize this is not the only group,” she added. (Mandavilli, New York Times, 11/21; Hart, Forbes, 11/17)

Covid-19:

  • CDC is forecasting an uptick in Covid-19 hospitalizations for the first time since July, according to national disease modeling. In the coming weeks, CDC’s ensemble forecast from 15 modeling groups is projecting a nationwide increase in daily Covid-19 hospital admissions, with a forecasted 2,000 to 9,000 new daily admissions on Dec. 9. As of Nov. 11, the seven-day average of new hospital admissions for Covid-19 was 3,330—a slight decrease from 3,374 the previous week. In addition, modeling from Mayo Clinic is projecting a 51.5% increase in daily Covid-19 cases over next two weeks, with average daily cases projected to increase from 37,912.7 cases on Nov. 18 to 57,441 on Dec. 2. However, CDC’s ensemble forecast from 13 modeling groups projects that Covid-19 deaths will remain stable or follow an uncertain pattern over the next month. (Bean, Becker’s Hospital Review, 11/21)
  • Earlier this month, omicron subvariants BQ.1 and BQ.1.1 surpassed BA.5 as the dominant strains of the coronavirus in the United States. Currently, BA.5 accounts for roughly 25% of new Covid-19 cases, and BQ.1 and BQ.1.1 account for an equal proportion of around 48% of cases. As BQ.1 and BQ.1.1 become more dominant, many experts are voicing concern over low vaccine uptake and evidence that suggests the dominant strains are not as susceptible to current treatments. For instance, FDA earlier this month updated its guidance for two monoclonal antibody treatments—bebtelovimab and Evusheld—warning that BQ.1 and BQ.1.1 showed significant declines in susceptibility to the treatments. (Choi, The Hill, 11/18)
  • A new study published in JAMA Network Open found that almost 15% of 62,525 hospitalized Covid-19 patients had a medical contradindication after taking Paxlovid’s antiviral combination of nirmatrelvir and ritonavir. To evaluate Paxlovid eligibility among hospitalized Covid-19 patients, researchers used a list of individual contraindications created by FDA. The patients were hospitalized in Paris University hospitals between Jan. 24, 2020, and Nov. 30, 2021. In total, over 9,100 patients—or 14.6%—experienced a medical contraindication to Paxlovid, making the treatment inadvisable. Notably, contraindication rates were higher among men (18%) than in women (11.3%). Among older patients, contradiction rates were 26.9%. “The most prevalent contraindications were severe kidney impairment and use of medications dependent on CYP3A for clearance,” researchers said. 

COVID Cases to Jump 80%; Surgery by Flashlight; Flu Hospitalizations Rising

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https://www.medpagetoday.com/infectiousdisease/covid19/101953?xid=nl_mpt_morningbreak2022-11-29&eun=g885344d0r&utm_source=Sailthru&utm_medium=email&utm_campaign=MorningBreak_112922&utm_term=NL_Gen_Int_Daily_News_Update_active

Daily COVID-19 cases in the U.S. are projected to jump 80% in the next 2 weeks, according to forecasts from the Mayo Clinic. (Becker’s Hospital Review)

Most U.S. COVID deaths are occurring in older adults, with 9 out of 10 fatalities in people age 65 and up. (Washington Post)

After protests broke out in China over COVID lockdowns, the country eased some virus restrictions but maintained its “zero-COVID” strategy. (PBS)

Chinese authorities have started inquiries into people who attended protests against the COVID lockdowns. (Reuters)

Shanghai Disneyland announced it will remain temporarily closed to comply with COVID prevention measures. (Reuters)

Surgeons in Ukraine operated on a patient in the dark using only a flashlight after Russia unleashed a missile barrage on the nation’s power grid. (NBC News)

Pharma industry groups and CVS Health expressed skepticism over a plan proposed by the FDA that would allow certain generic drugs to pick up over-the-counter indications. (Endpoints News)

Marketing biosimilars with skinny labels — labels for biosimilars or generics that include a smaller set of indications than the brand-name drugs — saved Medicare $1.5 billion from 2015 to 2020, 5% of what it spent on five biologics during that period. (JAMA Internal Medicine)

Flu hospitalizations are up nearly 30% from last week, as scientists and public health experts express concern about the virus spreading during holiday gatherings. (CNBC)

As the CDC prepares to announce nearly $4 billion to improve public health infrastructure, most of which will be allocated to local health departments, community-based health groups say they’re being left out of funding. (CNN)

A doctor in the San Francisco area pleaded guilty to using misbranded products that she sold as genuine Botox and Juvederm, the Department of Justice announced.

Houston lifted the boil water notice it had issued after a power outage led water pressure levels to dip below safe levels. (Houston Chronicle)

Roche Pharmaceuticals has withdrawn the U.S. indication for atezolizumab (Tecentriq) to treat a form of bladder cancer, after a clinical trial failed and the drug could not move from accelerated to regular approval.

The U.S. is looking to developing countries for a new paradigm of mental health care. (Vox)

A resurgence of polio cases in Indonesia has sparked a mass vaccination campaign in the country. (AP)

A tripledemic hurricane is making landfall. We need masks, not just tent hospitals

Posted on by • Posted in Centers for Disease Control & Prevention (CDC), Coronavirus, Coronavirus Mutation, Flu Season, Flu Shot, Flu Transmission, Flu-Related Hospitalizations, Health Policy, Infection Control, Infectious Virus, Pandemic, Public Health, Public Health Crisis, Public Health Emergency (PHE), Vaccination, Vaccine, Vaccine Booster, Vaccine Distribution, Vaccine Efficacy • Leave a comment
A tripledemic hurricane is making landfall. We need masks, not just tent hospitals

A viral hurricane is making landfall on health care systems battered by three pandemic years. With the official start of winter still weeks away, pediatric hospitals are facing crushing caseloads of children sick with RSV and other viral illnesses. Schools that promised a “return to normal” now report widespread absences and even closures from RSV and flu in many parts of the country, contributing to parents missing work in record numbers. With this year’s flu season beginning some six weeks early, the CDC has already declared a flu epidemic as hospitalizations for influenza soared to the highest point in more than a decade.

A storm of these proportions should demand not only crisis clinical measures, but also community prevention efforts. Yet instead of deploying public health strategies to weather the storm, the U.S. is abandoning them.

Even before the arrival of the so-called tripledemic, U.S. health systems were on the brink. But as the fall surge of illness threatens to capsize teetering hospitals, the will to deploy public health measures has also collapsed. Pediatricians are declaring “This is our March 2020” and issuing pleas for help while public health efforts to flatten the curve and reduce transmission rates of Covid-19 — or any infectious disease — have effectively evaporated. Unmanageable patient volumes are seen as inevitable, or billed as the predictable outcome of an “immunity debt,” despite considerable uncertainty surrounding the scientific underpinnings and practical utility of this concept.

The Covid-19 pandemic should have left us better prepared for this moment. It helped the public to understand that respiratory viruses primarily spread through shared indoor air. Public health practices to stop the spread of Covid-19 — such as masking, moving activities outdoors, and limiting large gatherings during surges — were incorporated into the daily routines of many Americans. RSV and flu are also much less transmissible than Covid-19, making them easier to control with common-sense public health practices.

Instead of dialing up those first-line practices as pediatric ICUs overflow and classrooms close, though, the U.S. is relying on its precious and fragile last lines of defense to combat the tripledemic: health care professionals and medical facilities.

Warnings and advisories recently issued by U.S. public health leaders, clinical leaders, politicians, and the media have consistently neglected to mention masking as a powerful short-term public health strategy that can blunt the surge of viral illness. Instead, recent guidance has exclusively promoted handwashing and cough etiquette. These recommendations run counter to recent calls to build on improved understanding of the transmission of respiratory viruses.

In the U.S.’s efforts to “move on” from thinking about Covid, it has created a “new normal” that is deeply abnormal — one in which we normalize resorting to crisis measures, such as treating patients in tents, instead of using common-sense public health strategies. Treating Covid like the flu — or the flu like Covid — has effectively meant that we treat neither illness as if it were a serious threat to health systems and to public health. Mobilizing Department of Defense troops and Federal Emergency Management Agency personnel to cover health system shortfalls is apparently more palatable than asking people to wear masks.

The tripledemic has already claimed its first child deaths in the U.S., adding to a large ongoing death toll from Covid. Allowing health systems to reach the brink of collapse will lead to many more preventable deaths among pediatric and other vulnerable patients who can’t access the care they need.

By any accounting, these losses are shocking and tragic. But they should strike us as particularly abhorrent and shameful because the tripledemic is a crisis that leaders, health agencies, and institutions have, in a sense, chosen. Over the past year, the Biden administration and its allies have repeatedly encouraged the public to stand down on public health measures, with the President even stating in September that “the pandemic is over.” By moving real risks out of view and failing to push for more robust measures to mitigate Covid, these messages have put the country on a path to its present circumstances, in which pediatric RSV patients are transferred to hospitals hundreds of miles away because there is no capacity to treat them in their own communities.

Living with viruses should mean embracing simple public health measures rather than learning to live with staggering levels of illness and death. Leaders in public health and medicine should issue timely and appropriate guidance that reflects the latest science instead of second-guessing the prevailing winds in public opinion. Instead of self-censoring their recommendations out of fear of political consequences, they should continue to promote the full range of public health strategies, including masking in crowded indoor public places during surges.

The tripledemic should bring renewed urgency to policies that will reduce the toll of seasonal illness on health, education, and the economy. Improvements in indoor air quality in public spaces, including schools, child care centers, and workplaces, can limit the spread of diseases and have many demonstrated health and economic benefits, yet the U.S. continues to lack standards to guide infrastructure or workplace safety standards. Paid leave enabling workers to stay home when they are ill can reduce the transmission of disease as well as loss of income, yet the U.S. is one of the only high-income countries without universal paid sick leave or family medical leave.

Greater effort must also be made to increase vaccination coverage for flu and Covid and bring an RSV vaccine online as quickly as possible. Only about half of high-risk adults under 65 received a flu shot last year, a gap that can be closed with more energetic vaccination campaigns. Reducing annual flu deaths using a broader range of strategies enabled by the pandemic — rather than pegging Covid deaths to them — should be the goal.

Amid the many sobering stories of the tripledemic, there is some good news. As the experience of Covid-19 has shown, it is possible to limit the toll of respiratory viruses like flu and RSV. However, this work requires resources, appropriate policies, and political will. Americans don’t need to accept winter disease surges and overrun health systems as an inevitable new normal. Instead, the country should see the tripledemic as a call to reinvigorate public health strategies in response to these threats to the health of our communities.

China’s COVID storm

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https://www.axios.com/2022/11/26/china-covid-outbreak-lockdown-economy

A new COVID calamity is hammering China, with a surge in infections prompting a return of lockdowns, including in some manufacturing areas that supply the West.

  • China reported a record number of infections this week, amid lockdowns and mass testing that are fueling unrest and darkening the country’s economic outlook. Schools in Beijing returned to online teaching.

Why it matters: In addition to the human misery for the world’s most populous country, the effects will be felt around the globe, Axios China author Bethany Allen-Ebrahimian reports from Taipei.

  • Supply chains are likely to be disrupted, causing prices to rise in an already rocky global economy.

Rare protests broke out today in China’s far western Xinjiang region. Crowds shouted at hazmat-suited guards after a deadly fire triggered anger by prolonged COVID lockdowns, Reuters reports.

  • “End the lockdown!” shouted protesters in the Xinjiang capital Urumqi, where an apartment fire killed 10.

What’s happening: The moment of truth for China’s zero-COVID policy has finally come.

  • Either party leaders will need to plunge much of the country into draconian lockdowns, as we saw at the beginning of the pandemic — or they’ll decide it’s time to learn to live with COVID.

Reality check: China’s doctors have warned Xi Jinping that the healthcare system isn’t prepared for the huge outbreak likely to follow the easing of strict anti-COVID measures, the Financial Times reports.

  • Chinese-made vaccines, which don’t use the mRNA technology employed by many produced by the West, aren’t as effective compared to those made in the U.S. And China has worrisomely low vaccination rates among older people.
  • But the number of cases in China is actually still very low for anywhere but China.

The big picture: “Zero COVID” restrictions have damaged the economy and undermined people’s trust in government.

  • That’s a stark about-face from the height of the pandemic. Then, many Chinese people felt the tight central control had protected them better than any other governance model in the world.
  • But it’s that very model that has plunged China into its current predicament. Xi tied his reputation, and the party’s legitimacy, to the success of “zero COVID.”

Between the lines: Chinese leaders made a huge, politically motivated mistake. They resisted the import of Western-made mRNA vaccines (including Pfizer and Moderna) for its citizens. These vaccines were only recently made available to foreigners.

  • That’s likely because of Beijing’s big vaccine diplomacy push: Chinese officials touted their own vaccines as the best and safest.
  • It was politically unpalatable to admit “defeat,” and allow Chinese people to get more effective — but Western-made — jabs.