“I got the vaccine…now what can I do?”

https://mailchi.mp/85f08f5211a4/the-weekly-gist-february-5-2021?e=d1e747d2d8

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A family member in her 70s called with the great news that she received her first dose of the COVID vaccine this week. She mentioned that she was hoping to plan a vacation in the spring with a friend who had also been vaccinated, but her doctor told her it would still be safest to hold off booking travel for now: “I was surprised she wasn’t more positive about it. It’s the one thing I’ve been looking forward to for months, if I was lucky enough to get the shot.” 

It’s not easy to find concrete expert guidance for what it is safe (or safer?) to do after receiving the COVID vaccine. Of course, patients need to wait a minimum of two weeks after receiving their second shot of the Pfizer or Moderna vaccines to develop full immunity.

But then what? Yes, we all need to continue to wear masks in public, since vaccines haven’t been proven to reduce or eliminate COVID transmission—and new viral variants up the risk of transmission. But should vaccinated individuals feel comfortable flying on a plane? Visiting family? Dining indoors? Finally going to the dentist?
 
It struck us that the tone of much of the available guidance speaks to public health implications, rather than individual decision-making. Take this tweet from CDC director Dr. Rochelle Walensky. A person over 65 asked her if she could drive to visit her grandchildren, whom she hasn’t seen for a year, two months after receiving her second shot. Walensky replied, “Even if you’ve been vaccinated, we still recommend against traveling until we have more data to suggest vaccination limits the spread of COVID-19.” 

From a public health perspective, this may be correct, but for an individual, it falls flat. This senior has followed all the rules—if the vaccine doesn’t enable her to safely see her grandchild, what will? It’s easy to see how the expert guidance could be interpreted as “nothing will change, even after you’ve been vaccinated.”

Debates about masking showed us that in our individualistic society, public health messaging about slowing transmission and protecting others sadly failed to make many mask up.

The same goes for vaccines: most Americans are motivated to get their vaccine so that they personally don’t die, and so they can resume a more normal life, not by the altruistic desire to slow the spread of COVID in the community and achieve “herd immunity”. 

In addition to focusing on continued risk, educating Americans on how the vaccinated can make smart decisions will motivate as many people as possible to get their shots.

Turning the tide in the battle against the virus

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The national COVID indicators all continued to move in the right direction this week, with new cases down 16 percent, hospitalizations down 26 percent, and deaths (while still alarmingly high at more than 3,000 per day) down 6 percent from the week prior.

More good news: both nationally and globallythe number of people vaccinated against COVID now exceeds the total number of people infected with the virus, at least according to official statistics—the actual number of coronavirus infections is likely several times higher.

On the vaccine front, Johnson & Johnson filed with the Food and Drug Administration (FDA) for an Emergency Use Authorization for its single-dose COVID vaccine, which could become the third vaccine approved for use in the US following government review later this month. The J&J vaccine is reportedly 85 percent effective at preventing severe COVID disease, although it is less effective at preventing infection than the Pfizer and Moderna shots.

Elsewhere, TheLancet reported interim Phase III results for Russia’s Sputnik V vaccine trials, showing it to be 91 percent effective at preventing infection, and a new study found the Oxford-AstraZeneca vaccine to be 75 percent effective against the more-contagious UK virus variant.

Amid the positive vaccine news, the Biden administration moved to accelerate the vaccination campaigninvoking the Defense Production Act to boost production and initiating shipments directly to retail pharmacies. With the House and Senate starting the budget reconciliation process that could eventually lead to as much as $1.9T in stimulus funding, including billions more for vaccines and testing, it feels as though the tide may be finally turning in the battle against coronavirus.

While the key indicators are still worrisome—we’re only back to Thanksgiving-week levels of new cases—and emerging variants are cause for concern, it’s worth celebrating a week that brought more good news than bad.

Best to follow Dr. Fauci’s advice for this Super Bowl weekend, however: “Just lay low and cool it.”

Deborah Birx says Trump received a “parallel set of data” on the coronavirus

https://www.washingtonpost.com/politics/2021/01/25/health-202-hospitals-drag-feet-new-regulations-disclose-costs-medical-services/

The former White House coronavirus response coordinator told CBS News’s “Face The Nation” that she saw Trump presenting graphs about the coronavirus that she did not help make. Someone inside or outside of the administration, she said, “was creating a parallel set of data and graphics that were shown to the president.”

Birx also said that there were people in the White House who believed the coronavirus was a hoax and that she was one of only two people in the White House who routinely wore masks.

Birx was often caught between criticism from Trump, who at one point called her “pathetic” on Twitter when she contradicted his more optimistic predictions for the virus, and critics in the scientific community who thought she did not do enough to combat false information about the virus from TrumpThe Post’s Meryl Kornfield reports.

“Colleagues of mine that I’d known for decades — decades — in that one experience, because I was in the White House, decided that I had become this political person, even though they had known me forever,” she told CBS. “I had to ask myself every morning, ‘Is there something that I think I can do that would be helpful in responding to this pandemic?’ And it’s something I asked myself every night.”

Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told the New York Times that Trump repeatedly tried to minimize the severity of the virus and would often chide him for not being positive enough in his statements about the virus. 

Fauci also described facing death threats as he was increasingly vilified by the president’s supporters. “One day I got a letter in the mail, I opened it up and a puff of powder came all over my face and my chest,” he said. The powder turned out to be benign.

Fauci: Lack of facts ‘likely did’ cost lives in coronavirus fight

Fauci: Lack of facts 'likely did' cost lives in coronavirus fight | TheHill

Anthony Fauci on Friday said that a lack of facts “likely did” cost lives over the last year in the nation’s efforts to fight the coronavirus pandemic.

In an appearance on CNN, the nation’s leading infectious diseases expert was directly asked whether a “lack of candor or facts” contributed to the number of lives lost during the coronavirus pandemic over the past year.

“You know it very likely did,” Fauci said. “You know I don’t want that … to be a sound bite, but I think if you just look at that, you can see that when you’re starting to go down paths that are not based on any science at all, that is not helpful at all, and particularly when you’re in a situation of almost being in a crisis with the number of cases and hospitalizations and deaths that we have.”

“When you start talking about things that make no sense medically and no sense scientifically, that clearly is not helpful,” he continued.

President Biden on Thursday unveiled a new national coronavirus strategy that is, in part, aimed at “restoring trust in the American people.”

When asked why that was important, Fauci recognized that the past year of dealing with the pandemic had been filled with divisiveness.

“There’s no secret. We’ve had a lot of divisiveness, we’ve had facts that were very, very clear that were questioned. People were not trusting what health officials were saying, there was great divisiveness, masks became a political issue,” Fauci said.

“So what the president was saying right from the get-go was, ‘Let’s reset this. Let everybody get on the same page, trust each other, let the science speak.’”

Fauci, who was thrust into the national spotlight last year as part of former President Trump‘s coronavirus task force, often found himself at odds with the former president. Trump frequently downplayed the severity of the virus and clashed publicly with Fauci.

Speaking during a White House press briefing on Thursday, Fauci said it was “liberating” to be working in the Biden administration.

There have been more than 24,600,000 coronavirus infections in the U.S. since the pandemic began, according to a count from Johns Hopkins University. More than 410,000 people have died.

Cartoon – History Repeating Itself (Covid-19)

Editorial Cartoon: COVID-19 returns | Opinion | dailyastorian.com

Cartoon – Less “I” and more “US.”

Trump's coronavirus press conference less than inspiring - The San Diego  Union-Tribune

Early evidence on disparities in vaccine acceptance

https://mailchi.mp/128c649c0cb4/the-weekly-gist-january-22-2021?e=d1e747d2d8

Distributing a COVID-19 Vaccine Across the U.S. – A Look at Key Issues –  Issue Brief – 9563 | KFF

Although only 17 states are currently reporting data on the racial and ethnic breakdown of vaccine recipients, the early data indicate that there are significant disparities in who is getting vaccinated, with the share of Black and Latino people among vaccinees lower than their share of the total population in those states.

Alarmingly, in our recent conversations with health system executives, those same disparities seem to be present among healthcare workers employed by hospitals and health systems. Anecdotally, across a half-dozen health systems we’ve spoken with in the past week, most report that they’ve had about 70 percent of their workers agree to get the first dose of the COVID-19 vaccine.

However, that number looks significantly different when broken down by race and ethnicity: on average, the uptake rate among White, Asian, and Pacific Islander workers has been closer to 90-95 percent, while among Black and Latino workers, it’s been closer to 30-40 percent. Bear in mind these are employees of health systems—in many cases they’re frontline caregivers—and given their work environments you might expect them to be less hesitant to get the vaccine.

That 30-40 percent uptake rate is very worrisome, in two ways: caregivers outside of hospital settings, especially home care and nursing home workers, likely include a larger number of workers hesitant to get vaccinated. And in the general population, among whom health literacy is presumably much lower than among healthcare workers, it’s precisely those populations who are at highest risk of COVID infection, hospitalization, and death. (A further complication: health systems made it easy for their employees to get the shot. With vaccines for the general population still scarce, at-risk populations will inevitably have the most difficult time getting signed up, even if they want the vaccine.)

If health systems are the canary in the coal mine for vaccine hesitancy rateswe’re in for a tough challenge in getting the most vulnerable populations vaccinated in the months to come.

The new administration unveils a national COVID strategy

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Biden unveils national COVID-19 strategy | NHK WORLD-JAPAN News

As one of his first official actions upon taking office Wednesday, President Biden signed an executive order implementing a federal mask mandate, requiring masks to be worn by all federal employees and on all federal properties, as well as on all forms of interstate transportation. Yesterday Biden followed that action by officially naming his COVID response team, and issuing a detailed national plan for dealing with the pandemic. Describing the plan as a “full-scale wartime effort”, Biden highlighted the key components of the plan in an appearance with Dr. Anthony Fauci and COVID response coordinator Jeffrey Zients.

The plan instructs federal agencies to invoke the Defense Production Act to ensure adequate supplies of critical equipment, including masks, testing equipment, and vaccine-related supplies; calls for new national guidelines to help employers make workplaces safe for workers to return to their jobs, and to make schools safe for students to return; and promises to fully fund the states’ mobilization of the National Guard to assist in the vaccine rollout.

Also included in the plan is a new Pandemic Testing Board, charged with ramping up multiple forms of COVID testing; more investment in data gathering and reporting on the impact of the pandemic; and the establishment of a health equity task force, to ensure that vulnerable populations are an area of priority in pandemic response.
 
But Biden can only do so much by executive order. Funding for much of his ambitious COVID plan will require quick legislative action by Congress, meaning that the administration will either need to garner bipartisan support for its proposed American Rescue Plan legislation, or use the Senate’s budget reconciliation process to pass the bill with a simple majority (with Vice President Harris casting the tie-breaking vote). Even that may prove challenging, given skepticism among Republican (and some moderate Democratic) senators about the $1.9T price tag for the legislation. 

We’d anticipate intense bargaining over the relief package—with broad agreement over the approximately $415B in spending on direct COVID response, but more haggling over the size of the economic stimulus component, including the promised $1,400 per person in direct financial assistance, expanded unemployment insurance, and raising the federal minimum wage to $15 per hour.

Some of the broader economic measures, along with the rest of Biden’s healthcare agenda and his larger proposals to invest in rebuilding critical infrastructure, may have to wait for future legislation, as the administration prioritizes COVID relief as its first—and most important—order of business.

A Warning From California

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FDA and FTC Issue Warning Letters to Seven Companies Selling Fraudulent  COVID-19 'Treatments' | BioSpace

Over the last year, COVID-19 has taught us painful lessons about the pitfalls of wishful thinking. Early in the pandemic, some people speculated that the virus would slow down over as the weather got warmer over the summer months; instead, the U.S. experienced a deadly wave of new cases. A few months ago, I hoped that here in Southern California, it would be easier for people to avoid spreading the virus than in colder parts of the country, because people can socially distance outdoors more easily year-round. Instead, our outbreak is now among the world’s deadliest—on Monday, California became the first state to report more than 3 million cases of the virus. Here in Los Angeles County, so many people are dying that officials temporarily lifted air quality regulations to permit more cremations, the Los Angeles Times reports.

California’s struggles to contain COVID-19 can at least partly be attributed to pandemic fatigue—after nearly a year of wearing masks and avoiding contact with others, people’s resolve is simply wearing thin. However, while we may feel done with the virus, it isn’t done with us—between 70 and nearly 120 people per 100,000 have died of COVID-19 in California every day in the last week, while more than 3,200 have died each day nationwide; the U.S. just today passed the grim milestone of 400,000 COVID-19 deaths.

If California can’t get its outbreak under control, more pain could lie ahead. Officials have discovered that new variants of the virus are spreading in the Golden State, including a more transmissible strain first identified in the U.K., where caseloads are skyrocketing and hospitals are overwhelmed. What’s happening here in California could be a bellwether for the rest of the country, as the virus continues its spread mostly unchecked across the country and world.

Regardless of which variant is spreading, experts say the defensive measures remain the same: we need to keep wearing our masks (new research shows just how effective they are), maintaining physical distance from others, and spend as much time as possible at home. It’s natural to want to give up—or even bend just a little—and spend time with friends and family we haven’t seen in ages, or do other risky things. That temptation is all the more real now that multiple highly effective vaccines are here, and the end of the pandemic seems within sight. But the vaccination process has gone frustratingly slowly so far, and not enough of us have the necessary protection to let our collective guard down, especially given the presence of at least one highly transmissible mutation.

With those alarming new variants spreading across the globe, it’s probably time to recalibrate our behavior in favor of safety—until more people are inoculated, it’s vital for us to reduce spread through other proven means. In the coming weeks, Californians and Americans elsewhere must buckle down, with their eyes on the final mission: ensuring that as many people as possible survive to see the end of the pandemic.

VACCINE TRACKER

While 28.4 million doses of the COVID-19 vaccine have been shipped to various U.S. states as of this morning, only about 10.6 million doses have been administered thus far, according to TIME’s vaccine trackerrepresenting 3.2% of the overall U.S. population.

India launched its nationwide coronavirus vaccine rollout on Saturday, starting with healthcare workers, according to the New York Times. Prime Minister Narendra Modi has said that the 1.3 billion-person country aims to vaccinate 300 million healthcare and other front line workers by July. More than 10.5 million people have been infected in India, and more than 152,500 people have died.

Yesterday, New York Governor Andrew Cuomo asked Pfizer whether his state could purchase vaccines directly from the pharmaceutical company, thus bypassing the federal government. But Dr. Celine Gounder, who’s advising President-elect Joe Biden on the pandemic, said that such a strategy could create problems. “I think we’ve already had too much of a patchwork response across the states,” Grounder said in an interview with CNBC today; she also argued that Cuomo’s idea could create a bidding war among states for vaccines.

TODAY’S CORONAVIRUS OUTLOOK

The Global Situation

More than 95.5 million people around the world had been diagnosed with COVID-19 as of 3 p.m. E.T. today, and more than 2 million people have died. On Jan. 18, there were 514,013 new cases and 9,276 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 is every country with over 1.5 million confirmed cases:

Hua Chunying, a spokeswoman for China’s foreign ministry, is pushing back on findings from an independent World Health Organization report that was critical of Beijing’s early response to the COVID-19 outbreak. China’s early lockdowns, Chunying said, helped reduce deaths and infections, Al Jazeera reports. Still, China has been criticized for failing to adequately disclose the scope and nature of the outbreak when it first began.

German leaders have agreed to extend a lockdown for businesses and schools until Feb. 14 and to require medical masks on public transportation, Reuters reports. While Germany is now reporting fewer than half as many new cases as it was a month ago, experts have raised concerns about new coronavirus variants that are thought to be more contagious, some of which have been detected in the country.

The Situation in the U.S.

The U.S. had recorded more than 24 million coronavirus cases as of 3 p.m. E.T. today. More than 400,000 people have died. On Jan. 18, there were 141,999 new cases and 2,422 new deaths confirmed in the U.S.

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

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

President-elect Joe Biden plans to continue a travel ban on non-U.S. citizens from European countries and Brazil, reversing outgoing President Donald Trump’s order to end the ban on Jan. 26, six days into Biden’s presidency. Jennifer Psaki, Biden’s incoming press secretary, tweeted that the Biden administration plans “to strengthen public health measures around international travel.” A week ago, the U.S. Centers for Disease Control and Prevention ordered that almost all airline passengers must have a negative coronavirus test or proof of recovery before entering the U.S.