The end of the pandemic “is in sight”

Some good news: The world had its lowest COVID death toll last week since March 2020, the World Health Organization said.

  • The end of the pandemic “is in sight,” said WHO Director-General Tedros Adhanom Ghebreyesus.
  • But “we are not there yet.”

Zoom out: Last summer’s Delta variant demolished the first sense of relief after vaccines.

  • “If we don’t take this opportunity now, Tedros said while calling for more vaccinations and testing, “we run the risk of more variants, more deaths, more disruption and more uncertainty.”

The bottom line: The next surge could come by surprise.

  • Johns Hopkins University is scaling back its COVID metrics due to a slowdown in local data reporting, the university confirmed to Axios.

Chengdu locks down 21.2 million people as Chinese cities battle Covid-19

https://www.cnbc.com/2022/09/01/chengdu-locks-down-21point2-million-people-as-chinese-cities-battle-covid-19.html

KEY POINTS

  • One of China’s biggest cities, Chengdu, announced a lockdown of its 21.2 million residents as it launched four days of citywide Covid-19 testing, as some of country’s most populous and economically important urban centers battle outbreaks.
  • All residents in Chengdu, the capital of Sichuan province, were ordered to stay largely at home from 6 p.m. on Thursday, with households allowed to send one person per day to shop for necessities, the city government said in a statement.

The southwestern Chinese metropolis of Chengdu announced a lockdown of its 21.2 million residents as it launched four days of citywide Covid-19 testing, as some of the country’s most populous and economically important cities battle outbreaks.

Residents of Chengdu, the capital of Sichuan province, were ordered to stay home from 6 p.m. on Thursday, with households allowed to send one person per day to shop for necessities, the city government said in a statement.

Chengdu, which reported 157 domestically transmitted infections on Wednesday, is the largest Chinese city to be locked down since Shanghai in April and May. It remained unclear whether the lockdown would be lifted after the mass testing ends on Sunday.

Other major cities including Shenzhen in the south and Dalian in the northeast have also stepped up Covid restrictions this week, ranging from work-from-home requirements to the closure of entertainment businesses in some districts.

The moves curtail the activities of tens of millions of people, intensifying the challenges for China to minimize the economic impact of a “dynamic-zero” Covid policy that has kept China’s borders mostly shut to international visitors and make it an outlier as other countries try to live with the coronavirus.

Most of the curbs are intended to last a few days for now, although two provincial cities in northern China have extended curbs slightly beyond initial promises.

Chengdu’s lockdown sparked panic buying of essentials among residents.

“I am waiting in a very long queue to get in the grocery near my home,” 28-year-old engineer Kya Zhang said, adding that she was worried about access to fresh food if the lockdown is extended.

Hwabao Trust economist Nie Wen said that because Chengdu acted quickly to lock down, it was unlikely to see a repeat of Shanghai’s two-month ordeal.

Non-essential employees in Chengdu were asked to work from home and residents were urged not to leave the city unless needed. Residents who must leave their residential compounds for hospital visits or other special needs must obtain approval from neighborhood staffers.

Industrial firms engaged in important manufacturing and able to manage on closed campuses were exempted from work-from-home requirements.

Sweden’s Volvo Cars said it would temporarily close its Chengdu plant.

Flights to and from Chengdu were dramatically curtailed, according to Flight Master data. At 10 a.m. local time (0200 GMT) on Thursday, it showed 398 flights had been canceled at Shuangliu Airport in Chengdu, with a cancellation rate of 62%. At Chengdu’s Tianfu Airport, 79%, or 725 flights, were canceled.

Shenzhen curbs

In Shenzhen, which has the third-highest economic output among Chinese cities, the most populous district Baoan and tech hub Nanshan suspended large events and indoor entertainment for a few days and ordered stricter checks of digital health credentials for people entering residential compounds.

Nanshan is home to internet giant Tencent and the world’s biggest dronemaker, DJI, among other major Chinese companies.

More than half of Shenzhen’s ten districts, home to over 15 million people, have ordered blanket closure of entertainment venues and halted or reduced restaurant dining for a few days, with curbs in two districts initially planned to be lifted by the end of Thursday.

Shenzhen authorities have largely avoided shutting down offices and factories as they did during a week-long lockdown in March.

Data on Thursday showed that Chinese factory activity contracted for the first time in three months in August amid weakening demand, while power shortages and fresh Covid-19 flare-ups disrupted production.

In Shanghai, schools reopened on Thursday after being closed for months.

Mainland China has reported no Covid death since May, leaving the death toll at 5,226.

FDA clears updated COVID-19 vaccines ahead of fall booster campaign

The Food and Drug Administration (FDA) on Wednesday authorized updated COVID-19 booster shots specifically targeting a subvariant of omicron. 

The move comes ahead of a fall campaign to give Americans booster shots, which is expected to launch in the coming days. 

The move marks the first time the vaccines have been updated since the first shots were cleared at the end of 2020, and the updated shots are designed to catch up to evolutions in the virus.

The shots from Pfizer and Moderna target the omicron subvariants BA.4 and BA.5, as well as the original virus. 

The shots can begin going into arms once the final step in the process, a Centers for Disease Control and Prevention committee, clears them, which is expected to occur on Thursday.  

A major question, though, is how many people will actually want the new shots, given that uptake for the existing booster shots has lagged.  

Only about half of people who got the first two shots received the initial booster dose.  

“The COVID-19 vaccines, including boosters, continue to save countless lives and prevent the most serious outcomes (hospitalization and death) of COVID-19,” said FDA Commissioner Robert Califf. “As we head into fall and begin to spend more time indoors, we strongly encourage anyone who is eligible to consider receiving a booster dose with a bivalent COVID-19 vaccine to provide better protection against currently circulating variants.”

Seeking to keep up with the ever-evolving virus, the FDA did not wait for the time-consuming process of going through full clinical trials on this tweaked vaccine. But it noted that it is highly confident that the vaccines are safe and effective. The agency pointed to the millions of doses of the original vaccines that have been given, as well as data from another version of the updated vaccine, along with preliminary data on this one.  

Peter Marks, a top FDA vaccine official, compared the process to the annual updates to the flu vaccine that seek to adapt to the changes in that virus.  

“The public can be assured that a great deal of care has been taken by the FDA to ensure that these bivalent COVID-19 vaccines meet our rigorous safety, effectiveness and manufacturing quality standards for emergency use authorization,” Marks said.  

The updated Moderna vaccine is cleared for people 18 and older, and the Pfizer vaccine for people 12 and older.  

For both, people are eligible for the booster shot of the updated vaccine if it has been at least two months since their last shot.  

A deadly virus was just identified in Ghana: What to know about Marburg

Epidemiologist Luke Nyakarahuka sprays disinfectant on scientists Jonathan Towner and Brian Amman in Queen Elizabeth National Park, Uganda, in 2018. The scientists were researching how bats transmit the Marburg virus to humans.

After the coronavirus pandemic and the rise of monkeypox cases, news of another virus can trigger nerves globally. The highly infectious Marburg virus has been reported in the West African country of Ghana this week, according to the World Health Organization.

Two unrelated people died after testing positive for Marburg in the southern Ashanti region of the country, the WHO said Sunday, confirming lab results from Ghana’s health service. The highly infectious disease is similar to Ebola and has no vaccine.

Health officials in the country say they are working to isolate close contacts and mitigate the spread of the virus, and the WHO is marshaling resources and sending specialists to the country.

“Health authorities have responded swiftly, getting a head start preparing for a possible outbreak. This is good because without immediate and decisive action, Marburg can easily get out of hand,” said the WHO’s regional director for Africa, Matshidiso Moeti.

Fatality rates from the disease can reach nearly 90 percent, according to the WHO.

Here’s what we know about the virus:

What is the Marburg virus?

Marburg is a rare but highly infectious viral hemorrhagic fever and is in the same family as Ebola, a better-known virus that has plagued West Africa for years.

The Marburg virus is a “genetically unique zoonotic … RNA virus of the filovirus family,” according to the Centers for Disease Control and Prevention. “The six species of Ebola virus are the only other known members of the filovirus family.”

Fatality rates range from 24 percent to 88 percent, according to the WHO, depending on the virus strain and quality of case management.

Marburg has probably been transmitted to people from African fruit bats as a result of prolonged exposure from people working in mines and caves that have Rousettus bat colonies. It is not an airborne disease.

Once someone is infected, the virus can spread easily between humans through direct contact with the bodily fluids of infected people such as blood, saliva or urine, as well as on surfaces and materials. Relatives and health workers remain most vulnerable alongside patients, and bodies can remain contagious at burial.

The first cases of the virus were identified in Europe in 1967. Two large outbreaks in Marburg and Frankfurt in Germany, and in Belgrade, Serbia, led to the initial recognition of the disease. At least seven deaths were reported in that outbreak, with the first people infected having been exposed to Ugandan imported African green monkeys or their tissue while conducting lab research, the CDC said.

Where has Marburg been detected?

The Ghana cases are only the second time Marburg has been detected in West Africa. The first reported case in the region was in Guinea last year. The virus can spread quickly. More than 90 contacts, including health workers and community members, are being monitored in Ghana. The WHO said it has also reached out to neighboring high-risk countries to put them on alert.

Cases of Marburg have previously been reported elsewhere in Africa, including in Uganda, the Democratic Republic of Congo, Kenya, South Africa and Zimbabwe. The largest outbreak killed more than 200 people in Angola in 2005.

The virus is not known to be native to other continents, such as North America, and the CDC says cases outside Africa are “infrequent.” In 2008, however, a Dutch woman died of Marburg disease after visiting Uganda. An American tourist also contracted the disease after a Uganda trip in 2008 but recovered. Both travelers had visited a well-known cave inhabited by fruit bats in a national park.

What are the symptoms?

The illness begins “abruptly,” according to the WHO, with a high fever, severe headache and malaise. Muscle aches and cramping pains are also common features.

In Ghana, the two unrelated individuals who died experienced symptoms such as diarrhea, fever, nausea and vomiting. One case was a 26-year-old man who checked into a hospital on June 26 and died a day later. The second was a 51-year-old man who went to a hospital on June 28 and died the same day, the WHO said.

In fatal cases, death usually occurs between eight and nine days after onset of the disease and is preceded by severe blood loss and hemorrhaging, and multi-organ dysfunction.

The CDC has also noted that around day five, a non-itchy rash on the chest, back or stomach may occur. Clinical diagnosis of Marburg “can be difficult,” it says, with many of the symptoms similar to other infectious diseases such as malaria or typhoid fever.

Can Marburg be treated?

There are no vaccines or antiviral treatments approved to treat the Marburg virus.

However, supportive care can improve survival rates such as rehydration with oral or intravenous fluids, maintaining oxygen levels, using drug therapies and treating specific symptoms as they arise. Some health experts say drugs similar to those used for Ebola could be effective.

Some “experimental treatments” for Marburg have been tested in animals but have never been tried in humans, the CDC said.

Virus samples collected from patients to study are an “extreme biohazard risk,” the WHO says, and laboratory testing should be conducted under “maximum biological containment conditions.”

Anything else to know?

The WHO said this week it is supporting a “joint national investigative team” in Ghana and deploying its own experts to the country. It is also sending personal protective equipment, bolstering disease surveillance and tracing contacts in response to the handful of cases.

More details are likely to be shared at a WHO Africa online briefing scheduled for Thursday.

“It is a worry that the geographical range of this viral infection appears to have spread. This is a very serious infection with a high mortality rate,” international public health expert and professor Jimmy Whitworth of the London School of Hygiene and Tropical Medicine told The Washington Post on Monday.

“It is important to try to understand how the virus got into the human population to cause this outbreak and to stop any further cases. At present, the risk of spread of the outbreak outside of Ashanti region of Ghana is very low,” he added.

BA.5 spurs new calls to fund next-generation COVID-19 vaccines

The rise of the BA.5 variant is spurring new calls for funding for an Operation Warp Speed 2.0 to accelerate development of next-generation COVID-19 vaccines that can better target new variants. 

The BA.5 subvariant of omicron that now makes up the majority of U.S. COVID-19 cases is sparking concern because it has a greater ability to evade the protection of current vaccines than past strains of the virus did.

Pfizer and Moderna are working on updated vaccines that target BA.5 that could be ready this fall, but experts say that by the time they are ready, a new variant very well could have taken hold.  

As alternatives to vaccine makers chasing each variant, experts point to research on “pan-coronavirus” vaccines that are “variant-proof,” targeting multiple variants, as well as nasal vaccines that could drastically cut down on transmission of the virus.

There is ongoing research on these next-generation vaccines, but unlike in 2020, when the federal government’s Operation Warp Speed helped speed the development of the original vaccine, there is less funding and assistance this time around.  

COVID-19 funding that could help develop and manufacture new vaccines more quickly has been stalled in Congress for months.

“There’s no Operation Warp Speed,” said Eric Topol, professor of molecular medicine at Scripps Research. “So it’s moving very slowly. But at least it’s moving.” 

Leana Wen, a public health professor at George Washington University, wrote in a Washington Post op-ed this week that the U.S. needs “urgent investment” in next-generation vaccines and “we need an ‘Operation Warp Speed Part 2.’” 

Pfizer and Moderna are working on updated vaccines that target BA.5 that could be ready this fall, but experts say that by the time they are ready, a new variant very well could have taken hold.  

As alternatives to vaccine makers chasing each variant, experts point to research on “pan-coronavirus” vaccines that are “variant-proof,” targeting multiple variants, as well as nasal vaccines that could drastically cut down on transmission of the virus.

There is ongoing research on these next-generation vaccines, but unlike in 2020, when the federal government’s Operation Warp Speed helped speed the development of the original vaccine, there is less funding and assistance this time around.  

COVID-19 funding that could help develop and manufacture new vaccines more quickly has been stalled in Congress for months.

“There’s no Operation Warp Speed,” said Eric Topol, professor of molecular medicine at Scripps Research. “So it’s moving very slowly. But at least it’s moving.” 

Leana Wen, a public health professor at George Washington University, wrote in a Washington Post op-ed this week that the U.S. needs “urgent investment” in next-generation vaccines and “we need an ‘Operation Warp Speed Part 2.’” 

Administration health officials pointed to funding when asked about next-generation vaccines at a press briefing on Tuesday.

“We need resources to continue that effort and to accelerate that effort,” said Anthony Fauci, the government’s top infectious disease expert. “So although we’re doing a lot and the field looks promising, in order to continue it, we really do need to have a continual flow of resources to do that.” 

But COVID-19 funding has been stuck in Congress for months. Republicans have long said they do not see any urgency in approving the money. Democrats, while generally calling for the funding, have been caught up in their own internal divisions, like when a group of House Democrats objected to a way to pay for the new funding in March.

“Of course more funding would accelerate some parts of the development,” Karin Bok, acting deputy director of the National Institutes of Health’s (NIH) Vaccine Research Center, said in an interview.  

She also cautioned that development of next-generation vaccines like nasal vaccines would take longer than the original vaccines, because less groundwork has been laid over the preceding years.  

Experts stress that even for BA.5, the current vaccines still provide important protection against severe disease and hospitalization, and are urging people to get their booster shots now. But there is potential for further improvement in the vaccines as well.

Aside from funding, another obstacle is obtaining copies of the existing COVID-19 vaccines for use in research, said Pamela Bjorkman, a California Institute of Technology professor working on a next-generation vaccine. 

“I would say we’ve wasted at least six months,” with various procedural hurdles on that front, she said. “It’s just ridiculous.” 

For example, she said at one point when her team was able to get access to the AstraZeneca COVID-19 vaccine, it then took two or three months to get an import permit to send it from the United Kingdom.

“This is a hot topic,” Bok, of the NIH, said of access to existing vaccine doses for researchers. “The government is working very hard on an agreement with the companies to provide it to us and to all the investigators…that are funded by NIH.” 

Asked about providing vaccine doses for researchers and any talks with the administration on that front, a Moderna spokesperson said: “We do provide vaccine in certain investigator-initiated studies where physicians and scientists propose research they have designed and want to conduct with our support,” pointing to a South African study as an example.  

More broadly, the White House says it is working on accelerating next-generation vaccine research and will have more announcements soon.  

“Let me be very clear: We clearly need a true next-generation vaccine,” White House COVID-19 response coordinator Ashish Jha told reporters on Tuesday. 

“You’ll hear more from us in the days and weeks ahead,” he added. “This is something that we have been working quite assiduously on.” 

COVID is not done with us, part six (…seven? eight?)

https://mailchi.mp/30feb0b31ba0/the-weekly-gist-july-15-2022?e=d1e747d2d8

The rise of ubiquitous self-testing and the paucity of accurate, timely data from the CDC on COVID numbers has left us feeling our way in the dark in terms of the current state of the pandemic. Clearly there’s a new surge underway, driven by the BA.5 variant. What we can report from our experiences on the road over the past few weeks is that the wave is significant. 

We’re hearing from our health system members that inpatient COVID volumes and COVID-related ED visits are significantly up again—often double or more what they were just two months agoalthough still well below levels of past surges. Length of stay for COVID inpatients is shorter, with fewer ICU visits than during the Delta surge—about the same intensity, proportionally, as during Omicron.

But COVID-related staffing shortages are once again having a real impact on hospitals’ ability to deliver care—clinical and non-clinical staff callouts are at high levels again, as during Omicron.

One piece of good news: masking is back in vogue among many health system executive teams, likely in response to a number of “superspreader” events: gatherings of hospital staff over the past few weeks that resulted in clusters of cases. One system described an all-hands session for anesthesiologists that resulted in more than a dozen cases across the next week—forcing the hospital to cancel procedures. 

We’re worried that this BA.5 surge is just getting started, and with booster uptake stagnating and masking all but nonexistent in the general population, the late summer and early autumn situation could be significantly worse.

Be careful out there.

The summer of subvariants

As this summer heats up, so has the spread of the hot new version of COVID-19.

Why it matters: This subvariant of Omicron called BA.5 — the most transmissible subvariant yet — quickly overtook previous strains to become the dominant version circulating the U.S. and much of the world.

BA.5 is so transmissible — and different enough from previous versions — that even those with immunity from prior Omicron infections may not have to wait long before falling ill again.

What they’re saying: “I had plenty of friends and family who said: ‘I didn’t want to get it but I’m sort of glad I got it because it’s out of the way and I won’t get it again’,” Bob Wachter, chairman of the University of California, San Francisco Department of Medicine told Axios. “Unfortunately that doesn’t hold the way it once did.”

  • “Even this one bit of good news people found in the gloom, it’s like, ‘Sorry’,” Wachter said.

State of play: This week, the CDC reported BA.5 became the dominant variant in the U.S., accounting for nearly 54% of total COVID cases. Studies show extra mutations in the spike protein make the strain three or four times more resistant to antibodies, though it doesn’t appear to cause more serious illness.

  • Hospital admissions are starting to trend upward again, CDC data shows, though they’re still well below what was seen during the initial spread of Omicron.
  • It’s unclear whether that could be indicating an increase in patients in for COVID, or patients who happen to have COVID, Wachter said. “We’re up in hospitalizations around 20% but with a relatively small number of ICU patients,” Wachter said about COVID cases at UCSF.
  • In South Africa, the variant had no impact on hospitalizations while Portugal saw hospitalizations rise dramatically, Megan Ranney, academic dean at the Brown University School of Public Health told Axios.
  • “So the big unknown is what effect it’s going to have on the health care system and the numbers of folks living with long COVID,” she said.

Yes, but: “I’m certainly hearing about more reinfections and more fairly quick reinfections than at any other time in the last two and a half years,” Wachter said.

Zoom in: That is also largely the experience of the surge seen firsthand in New York City by Henry Chen, president of SOMOS Community Care, who serves as a primary care physician across three boroughs of the city.

  • With this particular variant, he said: “The symptoms are pretty much the same but a little bit more severe than the last wave. It’s more high fever, body ache, sore throat and coughing,” Chen said, adding his patient roster is mostly vaccinated.
  • But it is occurring among patients who’d gotten the virus only three or four months ago, he said.

The big picture: Another summertime wave of cases could prolong the pandemic, coming after many public health precautions were lifted and with available vaccines losing their efficacy against the ever-evolving virus.

The bottom line: The messaging isn’t to panic, but to understand the virus is likely spreading in local communities much more than individuals realize due to shrinking testing programs  and without the level of protection they might assume they have.

  • “If you don’t want to get sick, you still need to be taking at least some precautions,” Ranney said. “[COVID] is still very much among us.”

COVID vaccine strategy still murky after FDA experts meet

The COVID-19 vaccine strategy for the fall remains beset with unanswered questions after an FDA expert panel on Tuesday spent hours debating how and whether to update the shots.

Why it matters: Time is running short to develop a game plan with existing vaccines losing effectiveness against new variants and more than half of Americans still without a booster dose.

Driving the news: The Vaccines and Related Biological Products Advisory Committee voted 19-2 to recommend an Omicron-specific update to COVID-19 booster vaccines expected to be rolled out within the next few months.

But key questions were left unanswered:

  • The panel didn’t formally decide whether to update shots with the prevalent Omicron strain in circulation, currently the fast-spreading BA.4 and BA.5 subvariants, or the BA.1 lineage that emerged late last year, as the World Health Organization recommended.
  • The consensus appeared to be for a bivalent, or combination, booster combining the original COVID-19 strain that emerged in late 2019 with BA.4 and BA.5.
  • The FDA will continue to evaluate what to do about the primary series of vaccines for the fall.
  • Experts were split on whether there was enough data to recommend the updated shots for kids, or whether more studies are needed on dosage and possible side effects.
  • There also were concerns about what effect an updated vaccine would have on developing nations’ willingness to use older COVID shots to inoculate their populations.
  • And above all, it’s unclear whether all the questions about who gets which shot when will add to public confusion and apathy that’s dogged the vaccination effort in recent months.

What they’re saying: “None of us has a crystal ball and we’re trying to use every last ounce of what we can from predictive modeling and data that’s emerging to try to get ahead of a virus that’s very crafty,” said top FDA vaccine regulator Peter Marks.

  • “Unfortunately, looking in the past doesn’t help us a great deal to look in the future for [a] virus that has baffled a lot of us and made predictions almost irrelevant,” said acting panel chairman Arnold Monto, a University of Michigan epidemiologist.

The timetable: Pfizer-BioNTech said an updated mRNA vaccine could be ready in October if regulatory uncertainties are ironed out. Moderna said it could have large amounts ready in late October or early November. Novavax is still awaiting emergency use authorization for its protein-based shot, but said it could have an updated vaccine by the fourth quarter.

COVID-19 cases are on the rise. Does it matter anymore?

COVID-19 cases have risen in the U.S. to around 100,000 per day, and the real number could be as much as five times that, given many go unreported.  

But the situation is far different from the early months of the pandemic. There are now vaccines and booster shots, and new treatments that dramatically cut the risk of the virus. So how much do cases alone still matter?

That question has prompted debate among experts, even as much of America goes on with their lives, despite the recent surge in cases.  

How much concern high case numbers alone should prompt is “the trillion-dollar question,” said Bob Wachter, chair of the department of medicine at the University of California-San Francisco.  

In the early days of the pandemic, dying of COVID-19 was a concern for him, but now, in an era of vaccines and treatments, “it doesn’t even cross my mind anymore,” he said.  

But he noted there are other risks, including long COVID-19: symptoms like fatigue or difficulty concentrating that can linger for months.  

“I think long COVID is pretty scary,” he said.  

While cases have risen to around 100,000 reported per day, deaths have stayed flat, a testament to the power of vaccines and booster shots in preventing severe illness, as well as the Pfizer treatment pills Paxlovid, which cut the risk of hospitalization or death by around 90 percent.  

Hospitalizations have risen, but only modestly, to around 27,000, one of the lowest points of the pandemic, according to a New York Times tracker.  

Cases have now been “partially decoupled” from causing hospitalizations and deaths, said Preeti Malani, an infectious disease expert at the University of Michigan, such that hospitals are no longer overwhelmed. 

“[Cases are] not without any consequence, but in terms of pressure on the health system, so far we’re not seeing that, which is really what drove all of this,” she said.  

The behavior of much of America reflects a lessened concern about the risk of being infected. Restaurants and bars are packed. Many people do not wear masks even on airplanes or on the subway.  

An Axios-Ipsos poll in May found just 36 percent of Americans said there was significant risk in returning to their “normal pre-coronavirus life.” 

In the Biden administration, health officials are still advising people to wear masks in areas the Centers for Disease Control and Prevention classifies as at “high” risk. But President Biden himself is talking about the virus far less than he did at the start of his administration, and is not making sustained calls for people to wear masks.  

White House COVID-19 response coordinator Ashish Jha touted progress in defanging cases on Thursday.  

“We see cases rising, nearly 100,000 cases a day, and yet we’re still seeing death numbers that are substantially, about 90 percent lower, than where they were when the president first took office,” he told reporters.  

Some experts are pushing back on the deemphasis of case numbers, saying they still matter.  

The bunk that cases are not important is preposterous,” Eric Topol, professor of molecular medicine at Scripps Research, wrote last month. “They are infections that beget more cases, they beget Long Covid, they beget sickness, hospitalizations and deaths. They are also the underpinning of new variants.” 

Even if one does not get severely ill oneself, more cases mean more chances for the virus to spread on to someone who is more vulnerable, like the elderly or immunocompromised.  

While deaths are way down from their peak earlier in the pandemic, there are still around 300 people dying from the virus every day, a number that would have proved shocking in a pre-COVID-19 world.  

Leana Wen, a public health professor at George Washington University, recommended that people take a rapid test before visiting a more vulnerable person, as a safeguard that avoids more burdensome restrictions.  

“Cases alone do not tell the whole story,” she said, adding, “As a policy matter we need to stop using the same comparisons we were in 2020 and 2021.” 

There is still much that is unknown about long COVID-19, one of the biggest risks remaining for healthy, younger people who are vaccinated.  

recent article in the Journal of the American Medical Association estimated 10 percent to 30 percent of COVID-19 infections result in long COVID-19 symptoms, but there is no precise estimate. 

Experts also urge people who have not gotten their booster shots, or not been vaccinated at all, to do so, given that many are more vulnerable to the virus if they are not up-to-date on their shots.  

A new variant also always holds the risk of upending the current risk-benefit calculations. The virus has continued to evolve to spread more easily, and a future mutation could cause more severe illness or more greatly evade vaccines.  

Pfizer and Moderna are working on updated vaccines to better target the omicron variant, but the Biden administration warns it will not have enough money to purchase those new vaccines for all Americans this fall unless Congress provides more funding. The funding request has been stalled for months, though, itself a sign of the reduced sense of urgency around the virus fight. 

At least for now, though, while many people are getting COVID-19, fewer are getting extremely sick.  

“It’s a very risky time if you don’t want to get COVID [at all],” Wachter said. “But a relatively less risky time if your goal is to not get severe COVID or die.” 

Eyeing a rebound in emergency department volumes

https://mailchi.mp/31b9e4f5100d/the-weekly-gist-june-03-2022?e=d1e747d2d8

This week we heard from three healthcare executives that they’ve seen a recent uptick in emergency department (ED) volumes. As we’ve discussed before, ED visits plummeted at the beginning of the pandemic, and were the slowest class of care volume to rebound. Over the past year, many systems reported that ED volume had remained persistently stuck at 10 to 15 percent lower than pre-COVID levels, leading us to question whether there had been a secular shift in patient demand, with consumers choosing alternative options like telemedicine or urgent care as a first stop for minor acute care needs. 
 
An uptick in ED volume would be welcome news to many hospital executives, as the emergency department is the source of half or more of inpatient admissions for many hospitals. But according to what we’re hearing, the recent rise in emergency department patient volume has not resulted in an expected bump in inpatient volume.

“We’ve dug into it, and it seems like the jump in ED visits is a function of COVID,” one leader shared. “There’s just so much COVID out there now…even though the disease is milder, there are still a lot of patients coming to the ED. But unlike last year, most aren’t sick enough to be admitted.”

And ED visits for other causes have not rebounded in the same way: “We’re hoping patients aren’t still staying away because they’re afraid of catching the virus.” We’ll be watching closely across the summer to see how volumes trend as the pandemic waxes and wanes across the country—we’d still bet that many consumers have changed their thinking on where and how they will seek care when the need arises.