Monkeypox is in the US. Here’s what you need to know.

Amid an international string of cases, a Massachusetts man has been infected with the first case of monkeypox in the United States this year. And while the virus isn’t likely to cause a pandemic like Covid-19, experts say the outbreak is still concerning.

What is monkeypox?

Monkeypox—so called because it was first identified in laboratory monkeys—is a rare viral infection that begins with flu-like symptoms and progresses to a distinctive rash on the face and body. Most infections resolve within weeks, but some cases can be fatal, according to the World Health Organization (WHO).

People can catch monkeypox through contact with infected animals or animal products. Human-to-human transmission, meanwhile, can occur via contact with bodily fluid, sores, or items contaminated by bodily fluid, but most often occurs via large respiratory droplets, which rarely travel more than a few feet.

According to WHO, “There is no evidence, to date, that person-to-person transmission alone can sustain monkeypox infections in the human population.”

Symptoms of monkeypox are typically mild, including headaches, muscle pain, chills, and swollen lymph nodes, The Hill reports. Patients can also develop rashes on their face and body that then turn into skin lesions that eventually fall off.

Although there are no specific treatments for monkeypox, at least one vaccine has been approved in the United States to protect against both monkeypox and smallpox.

Monkeypox cases pop up around the world

On Wednesday, the Massachusetts Department of Public Health (MDPH) reported the first confirmed case this year of monkeypox in the United States in a man who had recently traveled to Canada.

According to MDPH, “The case poses no risk to the public, and the individual is hospitalized and in good condition.”

MDPH said it’s “working closely with the CDC, relevant local boards of health, and the patient’s health care providers to identify individuals who may have been in contact with the patient while he was infectious. This contact tracing approach is the most appropriate given the nature and transmission of the virus.”

Generally, monkeypox cases are very rare in the United States, however two cases were reported in the United States last year—one in Texas and one in Maryland.

Monkeypox cases have also been popping up recently around the world. The United Kingdom has reported nine monkeypox cases, Spain has reported 23 suspected cases, Portugal has reported five and is investigating another 15, and Canadian health officials are investigating at least 15 potential cases in Montreal.

British officials noted that four of the nine cases it identified were among men who have sex with men, suggesting that the virus could be spreading through sexual contract.

What experts are saying

According to Jimmy Whitworth, a professor of international public health at the London School of Hygiene and Tropical Medicine, the monkeypox virus isn’t likely to follow a similar path to Covid-19.

“This isn’t going to cause a nationwide epidemic like COVID did, but it’s a serious outbreak of a serious disease—and we should take it seriously,” he said.

Still, experts said they are concerned by the monkeypox outbreaks. Typically, monkeypox doesn’t spread easily between humans, but the fact that multiple cases are emerging in different countries at the same time is concerning, said Aris Katzourakis, a professor of evolution and genomics at the University of Oxford.

“It’s either a lot of bad luck or something quite unusual happening here,” he said.

“The fact that it’s in the U.K. in multiple unrelated clusters, plus Spain, plus Portugal, is a surprise,” said Tom Inglesby, director of the Johns Hopkins Center for Health Security at the Bloomberg School of Public Health.

According to Mateo Prochazka, an epidemiologist at the U.K. Health Security Agency, the fact that the virus appears to be spreading through sexual contact is especially strange.

“What is even more bizarre is finding cases that appear to have acquired the infection via sexual contact,” he said. “This is a novel route of transmission that will have implications for outbreak response and control.”

While experts aren’t worried about the virus being a global threat as of now, Jay Hooper, a monkeypox expert from the U.S. Army Medical Research Institute of Infectious Diseases, noted that “[e]very time there’s an outbreak—and the more people get infected—the more chances monkeypox has to adapt to people.”

“With viruses that spill over from animals, you just never know what’s going to happen,” he added.

How the pandemic may fundamentally change the health-care system

https://www.washingtonpost.com/politics/2022/03/11/how-pandemic-may-fundamentally-change-health-care-system/

Welcome to Friday’s Health 202, where today we have a special spotlight on the pandemic two years in.

🚨 The federal government is about to be funded. The Senate sent the long-term spending bill to President Biden’s desk last night after months of intense negotiations. 

Two years since the WHO declared a pandemic, what health-care system changes are here to stay?

Nurses screened patients at a drive-through testing site in March 2020. (Win McNamee/Getty Images)

Exactly two years ago, the World Health Organization declared the coronavirus a pandemic and much of American life began grinding to a halt. 

That’s when the health-care system, which has never been known for its quickness, sped up. The industry was forced to adapt, delivering virtual care and services outside of hospitals on the fly. Yet, the years-long pandemic has exposed decades-old cracks in the system, and galvanized efforts to fix them.

Today, as coronavirus cases plummet and President Biden says Americans can begin resuming their normal lives, we explore how the pandemic could fundamentally alter the health-care system for good. What changes are here to stay — and what barriers are standing in the way?

A telehealth boom

What happened: Telehealth services skyrocketed as doctors’ offices limited in-person visits amid the pandemic. The official declaration of a public health emergency eased long-standing restrictions on these virtual services, vastly expanding Medicare coverage. 

But will it stick? Some of these changes go away whenever the Biden administration decides not to renew the public health emergency (PHE). The government funding bill passed yesterday extends key services roughly five months after the PHE ends, such as letting those on Medicare access telehealth services even if they live outside a rural area.

But some lobbyists and lawmakers are pushing hard to make such changes permanent. Though the issue is bipartisan and popular, it could be challenging to pass unless the measures are attached to a must-pass piece of legislation. 

  • “Even just talking to colleagues, I used to have to spend three or four minutes while they were trying desperately not to stare at their phone and explain to them what telehealth was … remote patient monitoring, originating sites, and all this wonky stuff,”said Sen. Brian Schatz (D-Hawaii), a longtime proponent of telehealth.
  • “Now I can go up to them and say, ‘So telehealth is great, right?’ And they say, ‘yes, it is.’ ”
A new spotlight on in-home care

What happened: The infectious virus tore through nursing homes, where often fragile residents share rooms and depend on caregivers for daily tasks. Ultimately, nearly 152,000 residents died from covid-19.

The devastation has sparked a rethinking of where older adults live and how they get the services they need — particularly inside their own homes. 

  • “That is clearly what people prefer,” said Gail Wilensky, an economist at Project HOPE who directed the Medicare and Medicaid programs under President George H.W. Bush. “The challenge is whether or not it’s economically feasible to have that happen.”

More money, please: Finding in-home care — and paying for it — is still a struggle for many Americans. Meanwhile, many states have lengthy waitlists for such services under Medicaid.

Experts say an infusion of federal funds is needed to give seniors and those with disabilities more options for care outside of nursing homes and assisted-living facilities. 

For instance, Biden’s massive social spending bill included tens of billions of dollars for such services. But the effort has languished on Capitol Hill, making it unclear when and whether additional investments will come. 

A reckoning on racial disparities

What happened: Hispanic, Black, and American Indian and Alaska Native people are about twice as likely to die from covid-19 than White people. That’s according to age-adjusted data from a recent Kaiser Family Foundation report

In short, the coronavirus exposed the glaring inequities in the health-care system. 

  • “The first thing to deal with any problem is awareness,” said Georges Benjamin, the executive director of the American Public Health Association. “Nobody can say that they’re not aware of it anymore, that it doesn’t exist.”

But will change come? Health experts say they hope the country has reached a tipping point in the last two years. And yet, any real systemic change will likely take time. But, Benjamin said, it can start with increasing the number of practitioners from diverse communities, making office practices more welcoming and understanding biases. 

We need to, as a matter of course, ask ourselves who’s advantaged and who’s disadvantaged” when crafting new initiatives, like drive-through testing sites, Benjamin said. “And then how do we create systems so that the people that are disadvantaged have the same opportunity.”

‘Stealth’ omicron: What you need to know about the subvariant

What you need to know about the 'stealth omicron' subvariant | 13newsnow.com

Scientists and health officials around the world are tracking the BA.2 subvariant of omicron, which has been referred to as “stealth omicron” because it cannot easily be identified via PCR tests.

What is the omicron BA.2 subvariant?

The BA. 2 omicron subvariant is a descendant of the original BA.1 omicron variant that has caused massive global Covid-19 surges. On Monday, the World Health Organization (WHO) urged researchers to prioritize the investigation of BA.2’s characteristics to determine whether it poses new challenges for areas already overwhelmed by the pandemic.

“The BA. 2 descendant lineage, which differs from BA. 1 in some of the mutations, including in the spike protein, is increasing in many countries,” WHO said. “Investigations into the characteristics of BA. 2, including immune escape properties and virulence, should be prioritized independently (and comparatively) to BA. 1.”

Currently, there is no evidence that BA. 2 is more transmissible or evades immunity better than BA. 1, the Washington Post reports.

In fact, experts still know very little about the transmissibility of BA.2 compared with BA.1, said Jeremy Luban, a professor of molecular medicine, biochemistry, and molecular pharmacology at UMass Medical School. And according to Luban, it is too early to determine whether vaccines and existing medications will provide adequate protection against BA.2.

Like the original omicron variant, BA.2 has many mutations, including roughly 20 found in the area targeted by most vaccines. BA.2 also has unique mutations that are not found in BA.1, which could limit the effectiveness of monoclonal antibodies, Luban said.

Further, scientists have found that BA.2 is harder to detect with PCR tests than BA.1. Although researchers were able to quickly differentiate BA.1 from the delta variant using a PCR test, the BA.2 subvariant does not possess the same “S gene target failure” seen in BA.1. As a result, BA.2 looks like the delta variant on the test, according to Wesley Long, a pathologist at Houston Methodist Hospital.

“It’s not that the test doesn’t detect it; it’s just that it doesn’t look like omicron,” Long said. “Don’t get the impression that ‘stealth omicron’ means we can’t detect it. All of our PCR tests can still detect it.”

Where is BA.2 circulating?

So far, BA.2 has been identified in 40 countries, including the United States. Although there are few reported cases of BA.2 in the United States, the subvariant is widely circulating in Asia and Europe

Throughout Europe, BA.2 seems to be the most widespread in Denmark—but experts said that could be because of the country’s robust program of sequencing the virus’s genome, the Post reports. On Jan. 20, health officials said that the BA.2 cases made up more than 50% of the country’s omicron cases.

In the United States, at least three cases have been found at Houston Methodist Hospital in Texas, which is currently studying the genetic makeup of virus samples from its patients, the Post reports.

“The good news is we have only three,” said James Musser, director of the Center for Molecular and Translational Human Infectious Diseases Research at Houston Methodist. “We certainly do not see the 5% and more that is being reported in the U.K. now and certainly not the 40% that is being reported in Denmark.”

In addition, a spokesperson for the Washington Department of Health on Monday told Fox News, “Two cases of BA.2 … were detected earlier this month in Washington.”

BA.2 remains ‘an open question’

Although BA.2 is now on at least four continents, experts say this new subvariant shouldn’t be a cause for panic, as it is expected to be relatively mild, USA Today reports.

“I don’t think it’s going to cause the degree of chaos and disruption, morbidity and mortality that BA.1 did,” said Jacob Lemieux, an infectious disease specialist at Massachusetts General Hospital. “I’m cautiously optimistic that we’re going to continue to move to a better place and, hopefully, one where each new variant on the horizon isn’t news.”

Similarly, Robert Garry, a virologist at Tulane University School of Medicine, said, “Variants have come, variants have gone.” He added, “I don’t think there’s any reason to think this one is a whole lot worse than the current version of omicron.”

Still, Musser argued that BA.2 deserves close attention until scientists can learn more about it.

“We know that omicron … can clearly evade preexisting immunity” from both vaccines and exposure to other variants of the virus, he said. “What we don’t know yet is whether son-of-omicron does that better or worse than omicron. So that’s an open question.”

NIH director says omicron variant a ‘great reason’ to get booster

https://thehill.com/homenews/583275-nih-director-says-omicron-variant-a-great-reason-to-get-booster

NIH director: "No reason to panic" yet about Omicron variant - Axios

National Institutes of Health (NIH) director Francis Collins said the emergence of a new variant of the coronavirus presents a “great reason” for people in the United States to seek a booster shot. 

“There’s no reason to panic, but it’s a great reason to get boosted,” Collins said Sunday during an appearance on CNN.

The World Health Organization over the weekend held an emergency meeting regarding the new coronavirus strain first identified in South Africa, and classified it as being “of concern,” due to the variant’s large number of mutations and an increased risk of re-infection.

Several nations around the world, including the United States, have limited travel to several south African countries in recent days in an attempt to keep the variant from spreading more rapidly. 

During an earlier appearance on Fox News Sunday, Collins said it may take weeks before world health officials can determine how effective vaccines being used in the United States are against the new variant, which has been dubbed “omicron.” 

“Given that history, we expect that most likely the current vaccines will be sufficient to provide protection,” he said. “And especially the boosters will give that additional layer of protection because there’s something about the booster that causes your immune system to really expand its capacity against all kinds of different spike proteins, even ones it hasn’t seen before.” 

Collins said on CNN that the emergence of the new variant is “another reason” for people who have not received a coronavirus booster shot to do so once they are eligible. 

“The booster basically enlarges the capacity of your immune system to recognize all kinds of spike proteins its never seen,” Collins explained. “This is a great day to go and get boosted or find out how to do so.” 

WHO classifies triple-mutant COVID-19 variant from India as global health risk

WHO classifies triple mutant COVID-19 variant in India as global health risk  - The Filipino Times

The World Health Organization said Monday that the coronavirus variant first identified in India last year will be reclassified as a “variant of concern,” indicating that it has become a global health threat.

The B.1.617 variant has been found to spread more easily than the original virus, with some evidence indicating that it may evade some of the protections provided by the vaccines, according to a preliminary study. But the shots are still considered effective. The agency will provide more details on Tuesday.

The highly contagious, triple-mutant variant is also the fourth variant to be designated as a global concern, prompting enhanced tracking and analysis. The other variants are those first detected in Britain, South Africa and Brazil.

“We are classifying this as a variant of concern at a global level,” said Maria Van Kerkhove, WHO technical lead on COVID-19, per Reuters. “There is some available information to suggest increased transmissibility.”

A variant is labeled as “of concern” if it is shown to be more contagious, more deadly or more resistant to current vaccines and treatments, according to the WHO.

The global agency said the predominant lineage of B.1.617 was first identified in India in December, although an earlier version was spotted in October 2020.

The variant has already spread to other countries, and many nations – including the U.S. – have moved to end or restrict travel from India.

“Even though there is increased transmissibility demonstrated by some preliminary studies, we need much more information about this virus variant and this lineage and all of the sub-lineages,” said Maria Van Kerkhove, the WHO’s technical lead for COVID-19.

India reported a record-high of daily coronavirus cases, averaging about 391,000 new daily cases and about 3,879 deaths per day, according to Johns Hopkins University data.

COVID-19 Is Still Devastating the World—Especially India

The pandemic won’t end for anyone until it ends for everyone. That sentiment has been repeated so many times, by so many people, it’s easy to forget it’s not just a cliche—particularly if you live in one of the wealthy countries, like the U.S. and Israel, that has made significant moves toward what feels like an end to the COVID-19 era.

Israel, for example, has fully vaccinated more than half of its population and about 90% of its adults 50 and older are now immune to the virus—enough that the country is “busting loose” and “partying like it’s 2019,” as the Washington Post put it last week. The U.S. is a bit further behind, with nearly 30% of its population fully vaccinated, but the possibility of a post-pandemic reality is already coming into focus. While daily case counts remain high, they are far lower than they were even a few months ago—about 32,000 diagnoses were reported on April 25, compared to daily tallies well above 250,000 in January. Deaths have also trended downward for most of 2021. The U.S. Centers for Disease Control and Prevention has relaxed its guidance on travel and indoor gatherings, and some states have repealed mask mandates and other disease precautions.

But while people in certain affluent countries celebrate a return to vacations and parties, COVID-19 remains a dire threat in many nations around the world—nowhere more so than India. For five days in a row, the country has set and reset the global record for new cases in a single day, tallying about 353,000 on April 26.

By official counts, about 2,000 people in India are dying from COVID-19 every day as hospitals grow overtaxed and oxygen supplies run short. Experts say the true toll is likely even higher than that. People are dying as they desperately seek treatment, and crematoriums nationwide are overwhelmed.

It can be difficult to grapple with that devastating reality when people in countries like the U.S. are reuniting with loved ones and cautiously emerging from lockdown. How can both scenarios be happening at once? The answer, as it often has during the pandemic, lies in disparity. As of April 26, 83% of vaccinations worldwide had been given in high- and upper-middle-income countries, according to a New York Times data analysis. In the developing world, many countries are preparing for the reality that it could take until 2022 or even 2023 to reach vaccination levels already achieved by richer countries today. Even in India, one of the world’s leading vaccine manufacturers, fewer than 10% of people have gotten a vaccine—a cruel irony, as people in India die in the streets while those thousands of miles away celebrate receiving their second doses.

To truly defeat COVID-19, we must reckon with that cognitive dissonance, says Dr. Rahel Nardos, who is originally from Ethiopia and now works in the University of Minnesota’s Center for Global Health and Social Responsibility. As an immigrant and global health physician who lives in the U.S., Nardos says she inhabits two worlds: one in which the U.S. may feasibly vaccinate at least 70% of its population this year, and another in which many countries struggle to inoculate even 20% of their residents in the same time frame.

“It’s a huge disparity,” Nardos says. “We need to get out of our silos and start talking to each other and hearing each other.”

That’s imperative, first and foremost because it could save lives. More than 13,000 people around the world died from COVID-19 on April 24. Remaining vigilant about disease prevention and monitoring, and working to distribute vaccines in countries that desperately need them to fight back COVID-19 surges, could help prevent more deaths in the future. That’s especially critical for developing countries, many of which are so overwhelmed by COVID-19 that nearly all other aspects of health care have suffered. “We may be looking at five, 10 years before they can get back to their baseline, which wasn’t that great to begin with,” Nardos says.

There’s also a global health argument for distributing vaccines more equitably. Infectious diseases do not respect borders. If even one country remains vulnerable to COVID-19, that could allow the virus to keep spreading and mutating, potentially evolving to such a point that it could infect people who are vaccinated against original strains of the disease. Already, vaccine makers are exploring the possibility of booster shots to add extra protection against the more transmissible variants currently circulating in various parts of the world.

We aren’t at that point yet; currently authorized vaccines appear to hold up well against these variants. But if the virus keeps spreading for years in some areas, there’s no telling what will happen, says Jonna Mazet, an epidemiologist and emerging infectious disease expert at the University of California, Davis.

Evolution of those new strains could go into multiple directions. They may evolve to cause more severe or less severe disease. Some of the variants [could be] more concerning for young people,” Mazet says. “The whole dynamics of the disease change.”

And if the virus is mutating somewhere, chances are good it will eventually keep spreading in multiple areas, Mazet says. “Unless or until we have a major shift, we are still going to have large parts of every country that have a susceptible population,” she says. “The virus is going to find a way.”

The only way to stop a virus from mutating is to stop giving it new hosts, and vaccines help provide that protection. COVAX—a joint initiative of the World Health Organization; Gavi, the Vaccine Alliance; the Coalition for Epidemic Preparedness Innovations; and UNICEF—was meant to ensure that people in low-income countries could get vaccinated at the same time as people in wealthier ones. COVAX is providing free vaccines to middle- and low-income countries, using funds gained through purchase agreements and donations from richer countries. But supply and funding shortages have made it difficult for the initiative to distribute vaccines as quickly as it intended to. Many of the doses it planned to disseminate were supposed to have come from the Serum Institute of India, which delayed exporting doses in March and April as India focused on domestic vaccine rollout to combat its COVID-19 surge at home.

In the meanwhile, many poorer countries have been unable to vaccinate anywhere close to as many people as would be required to reach herd immunity. That will almost surely improve as new vaccines are authorized for use by regulators around the world, and as manufacturers scale up production, but those moves may be months away.

COVAX is also developing a mechanism through which developed countries could donate vaccine doses they don’t need. Some wealthy countries, including the U.S. and Canada, have contracts to purchase more than enough doses to vaccinate their entire populations, and have signaled their intent to eventually donate unneeded supplies—but timing is everything. That is, these countries will likely only donate once they are sure their own populations have been vaccinated at a level that ensures herd immunity.

On April 25, the Biden Administration said the U.S. would provide India with raw supplies for making AstraZeneca’s vaccine, as well as COVID-19 tests and treatments, ventilators, personal protective equipment, and funding. That’s a significant shift, since the export of raw vaccine materials was previously banned, but it still doesn’t provide India with ready-to-go vaccines. That step may be next, though. The U.S. will export as many as 60 million doses of AstraZeneca’s vaccine once the shot clears federal safety reviews, the Associated Press reports.

Gian Gandhi, UNICEF’s COVAX coordinator for supply, says he fears many wealthy countries’ vaccine donations may not come until late in 2021, just when global supply is expected to ramp up. That may cause a bottleneck effect: all doses may come in at once, rather than at a slow-but-steady pace that allows countries with smaller health care networks to distribute them. “We need doses now, when we’re not able to access them via other means,” Gandhi says.

The global situation is also critical now. Worldwide, more than 5.2 million cases and 83,000 deaths were reported during the week leading up to April 18. Indian hospitals are so overrun, crowds have formed outside their doors and desperate families are trying to source their own oxygen. Hospitals in Brazil are reportedly running out of sedatives. Iran last week broke daily case count records three days in a row. Countries across Europe remain under various forms of lockdown. Vaccines won’t change those realities immediately—but without them, the global community stands little chance of containing COVID-19 worldwide.

‘Distancing isn’t helping you’: Indoor COVID-19 exposure risk same at 6, 60 feet, MIT researcher says

Risk of COVID-19 indoors is the same at 6 feet and 60 feet apart even when  wearing a mask | Daily Mail Online

People who maintain 60 feet of distance from others indoors are no more protected than if they socially distanced by 6 feet, according to a peer-reviewed study published April 27 in the Proceedings of the National Academy of Science of the United States of America.

Cambridge-based Massachusetts Institute of Technology professors Martin Bazant and John Bush, PhD, developed a model to calculate indoor exposure risk to COVID-19 by factoring in the amount of time spent inside, air filtration and circulation, immunization, variant strains, mask use, and respiratory activity such as breathing, eating or talking.  

“We argue there really isn’t much of a benefit to the six-foot rule, especially when people are wearing masks,” Mr. Bazant told CNBC. “It really has no physical basis because the air a person is breathing while wearing a mask tends to rise and comes down elsewhere in the room so you’re more exposed to the average background than you are to a person at a distance.”

As with smoking, even people wearing masks can be affected by secondhand smoke that makes its way around the enclosed area and lingers. The same logic applies to airborne droplets of the virus, according to the study. However, the study did note that mask use by both infected and susceptible people reduces “respiratory plumes” and thus increases the amount of time people may safely spend together indoors. 

When crafting guidelines, the CDC and World Health Organization have overlooked the amount of time spent indoors, Mr. Bazant claims.  

“What our analysis continues to show is that many spaces that have been shut down in fact don’t need to be,” Mr. Bazant said. “Oftentimes, the space is large enough, the ventilation is good enough, the amount of time people spend together is such that those spaces can be safely operated even at full capacity, and the scientific support for reduced capacity in those spaces is really not very good.”  

Opening windows or installing new fans to keep air moving may be just as effective or more effective than purchasing a new filtration system, Mr. Bazant said.

The CDC currently recommends staying at least 6 feet away from other people and wearing a mask to slow the spread of COVID-19, citing the fact that the virus spreads mainly among people who are in close contact for a prolonged period.  

“The distancing isn’t helping you that much and it’s also giving you a false sense of security, because you’re as safe at six feet as you are at 60 feet if you’re indoors. Everyone in that space is at roughly the same risk, actually,” Mr. Bazant said. 

After three rounds of peer review, Mr. Bazant says he hopes the study will influence social distancing policies.

India’s devastating outbreak is driving the global coronavirus surge

India's covid surge is bringing its healthcare system to the brink -  Washington Post

NEW DELHI — More than a year after the pandemic began, infections worldwide have surpassed their previous peak. The average number of coronavirus cases reported each day is now higher than it has ever been.

“Cases and deaths are continuing to increase at worrying rates,” said World Health Organization chief Tedros Adhanom Ghebreyesus on Friday.

A major reason for the increase: the ferocity of India’s second wave. The country accounts for about one in three of all new cases.

It wasn’t supposed to happen like this. Earlier this year, India appeared to be weathering the pandemic. The number of daily cases dropped below 10,000 and the government launched a vaccination drive powered by locally made vaccines.

But experts say that changes in behavior and the influence of new variants have combined to produce a tidal wave of new cases.

India is adding more than 250,000 new infections a day — and if current trends continue, that figure could soar to 500,000 within a month, said Bhramar Mukherjee, a biostatistician at the University of Michigan.

While infections are rising around the country, some places are bearing the brunt of the surge. Six states and Delhi, the nation’s capital, account for about two-thirds of new daily cases. Maharashtra, home to India’s financial hub, Mumbai, represents about a quarter of the nation’s total.

Mohammad Shahzad, a 40-year-old accountant, was one of many desperately seeking care. He developed a fever and grew breathless on the afternoon of April 15. His wife, Shazia, rushed him to the nearest hospital. It was full, but staffers checked his oxygen level: 62, dangerously low.

For three hours, they went from hospital to hospital trying to get him admitted, with no luck. She took him home. At 3:30 a.m., with Shahzad struggling to breathe, she called an ambulance. When the driver arrived, he asked if Shahzad truly needed oxygen — otherwise he would save it for the most serious patients.

The scene at the hospital was “harrowing,” said Shazia: a line of ambulances, people crying and pleading, a man barely breathing. Shahzad finally found a bed. Now Shazia and her two children, 8 and 6, have also developed covid-19 symptoms.

From early morning until late at night, Prafulla Gudadhe’s phone does not stop ringing. Each call is from a constituent and each call is the same: Can he help to arrange a hospital bed for a loved one?

Gudadhe is a municipal official in Nagpur, a city in the interior of Maharashtra. “We tell them we will try, but there are no beds,” he said. About 10 people in his ward have died at home in recent days after they couldn’t get admitted to hospitals, Gudadhe said, his voice weary. “I am helpless.”

Kamlesh Sailor knows how bad it is. Worse than the previous wave of the pandemic, like nothing he’s ever seen.

Sailor is the president of a crematorium trust in the city of Surat. Last week, the steel pipes in two of the facility’s six chimneys melted from constant use. Where the facility used to receive about 20 bodies a day, he said, now it is receiving 100.

“We try to control our emotions,” he said. “But it is unbearable.”

AstraZeneca stumbles again in it its vaccine rollout

https://mailchi.mp/3e9af44fcab8/the-weekly-gist-march-26-2021?e=d1e747d2d8

U.S. Health Officials Raise Concerns Over AstraZeneca Vaccine Data - WSJ

It was a relatively quiet week on the COVID front—so quiet that President Biden held his first White House press conference last week and wasn’t asked a single question about the pandemic, which continues to be a race between vaccinations and virus variants.

Not that nothing happened this week: it was a rocky week for AstraZeneca, which was hoping to change the narrative over its vaccine, which has stumbled in its rollout in Europe, by reporting positive results from US trials.

After a press release announcing that the vaccine was found to be 79 percent effective against symptomatic COVID, an independent review board called the results into question, pointing out that the report was based on data that had not been fully updated. That earned a swift and unusual rebuke from the National Institutes of Health (NIH), forcing the company to correct its findings—to 76 percent.

A relatively minor difference, but the dust-up served to further undermine confidence in the company’s COVID jab, especially troubling in Europe where hesitancy and distribution have been a vexing problem, and concerns about blood clots associated with the AstraZeneca shot caused several countries to pause inoculations. Given the supply of already-approved vaccines from other manufacturers in the US, it’s not clear that the AstraZeneca shot will play a big role here, but it is critical in other parts of the world, especially as part of the global COVAX initiative targeted at developing countries, since the vaccine can be stored at normal refrigerator temperatures.

The company’s set-to with American regulators also highlighted another challenge that’s become common during the COVID pandemic: conducting scientific review by press release, as the global emergency has required the otherwise slow-moving research community to move at lightning pace.

Meanwhile, back at that relatively dull White House press conference, one piece of encouraging news: President Biden doubled his “first 100 days” goal for vaccinations to 200M shots, a goal that seems wholly achievable, given that 2.5M Americans are being vaccinated every day, on average.

Who Can and Can’t Get Vaccinated Right Now

Who Can and Can’t Get Vaccinated Right Now

Some countries have stockpiles. Others have nothing. Getting a vaccine means living in the right place — or knowing the right people.


A 16-year-old in Israel can get a vaccine.

So can a 16-year-old in Mississippi.

And an 18-year-old in Shanghai.

But a 70-year-old in Shanghai can’t get one. Older people are at high risk for severe illness from Covid-19. But Chinese officials have been reluctant to vaccinate seniors, citing a lack of clinical trial data. Neither can an 80-year-old in Kenya. Low vaccine supply in many countries means only health care employees and other frontline workers are eligible, not the elderly.

Nor a 90-year-old in South Korea. Koreans 75 and older are not eligible until April 1. Only health care workers and nursing-home residents and staff are currently being vaccinated. The government initially said it was awaiting assurances that the AstraZeneca vaccine was safe and effective for older groups.


Anyone in Haiti.

Anyone in Papua New Guinea.

Anyone in these 67 countries. These countries have not reported any vaccinations, according to Our World in Data. Official figures can be incomplete, but many countries are still awaiting their first doses.

It wasn’t supposed to be like this: Covax, the global vaccine-sharing initiative, was meant to prevent unequal access by negotiating vaccine deals on behalf of all participating nations. Richer nations would purchase doses through Covax, and poorer nations would receive them for free.

But rich nations quickly undermined the program by securing their own deals directly with pharmaceutical companies. In many countries, they have reserved enough doses to immunize their own multiple times over.

Anyone who can afford a smartphone or an internet connection in India and is over 60 can get one. Mostly wealthy Indians are being inoculated in New Delhi and Mumbai, hospitals have reported, since vaccine appointments typically require registering online. Less than half of India’s population has access to the internet, and even fewer own smartphones.

And anyone who can pay $13,000 and travel to the U.A.E. for three weeks and is 65 or older or can prove they have a health condition.

A British travel service catering to the rich offered vaccination packages abroad, and wealthy travelers to the U.A.E. have acknowledged they were vaccinated there.


member of Congress in the United States. Friends of the mayor of Manaus, Brazil. Lawmakers in Lebanon. A top-ranking military leader in Spain. The extended family of the deputy health minister in Peru. The security detail to the president of the Philippines. Government allies with access to a so-called “V.I.P. Immunization Clinic” in Argentina. Around the world, those with power and connections have often been first in line to receive the vaccine — or have cut the line altogether.


A smoker in Illinois can get one. But not a smoker in Georgia.

A diabetic in the United Kingdom can. A diabetic in Connecticut can’t.

Countries have prioritized different underlying health conditions, with the majority focusing on illnesses that may increase the risk of severe Covid-19. In the U.S., health issues granted higher priority differ from state to state, prompting some people to travel across state borders.

A pregnant woman in New York. Not a pregnant woman in Germany. Up to two close contacts of a pregnant woman in Germany. Pregnant women were barred from participating in clinical trials, prompting many countries to exclude them from vaccine priority groups. But some experts say the risks to pregnant women from Covid-19 are greater than any theoretical harm from the vaccines.


A grocery worker in Texas, no. A grocery worker in Oklahoma, yes.

Many areas aim to stop the virus by vaccinating those working in frontline jobs, like public transit and grocery stores. But who counts as essential depends on where you live.

A police officer in the U.K. A police officer in Kenya. A postal worker in California. A postal worker in North Carolina. A teacher in Belgium. A teacher in Campeche, Mexico. Other jobs have been prioritized because of politics: Mexico’s president made all teachers in the southern state of Campeche eligible in a possible bid to gain favor with the teacher’s union.


Medical staff at jails and prisons in Colombia. A correctional officer in Tennessee. A prisoner in Tennessee. A prisoner in Florida. The virus spread rapidly through prisons and jails, which often have crowded conditions and little protective equipment. But few places have prioritized inoculating inmates.


An undocumented farm worker in Southern California. A refugee living in a shelter in Germany. An undocumented immigrant in the United Kingdom. Britain has said that everyone in the country is eligible for the vaccine, regardless of their legal status.

A Palestinian in the West Bank without a work permit. Despite leading the world in per-capita vaccinations, Israel has so far not vaccinated most Palestinians, unless they have permits to work in Israel or settlements in the occupied West Bank.


An adult in Bogotá, Colombia. An adult in the Amazonian regions of Colombia that border Brazil. In most of Colombia, the vaccine is only available to health care workers and those over 80.

But the government made all adults in Leticia, Puerto Nariño, Mitú and Inírida eligible, hoping to prevent the variant first detected in Brazil from arriving in other areas. A police officer in Mexico City. A teacher in rural Mexico.The government of populist president Andrés Manuel López Obrador has prioritized vaccinating the poor and those in rural communities, despite the country’s worst outbreaks occurring in major cities.

Native populations not federally recognized in the United States. The pandemic has been particularly deadly for Native Americans. But only tribes covered by the Indian Health Service have received vaccine doses directly, leaving about 245 tribes without a direct federal source of vaccines. Some states, including Montana, have prioritized all Native populations.

Indigenous people living on official indigenous land in Brazil.


These 43 countries, mostly high income, are on pace to be done in a year. These 148 countries, mostly low income, are on pace to take until next year or even longer. Countries like the U.S. continue to stockpile tens of millions of vaccine doses, while others await their first shipments.

“The vaccine rollout has been inequitable, unfair, and dangerous in leaving so many countries without any vaccine doses at all,” said Gavin Yamey, director of Duke University’s Center for Policy Impact in Global Health.

“It’s a situation in which I, a 52-year-old white man who can work from home and has no pre-existing medical conditions, will be vaccinated far ahead of health workers or a high-risk person in a middle- or low-income country.”