The Mu variant is on the rise. Scientists weigh in on how much to worry.

Posted on by • Posted in Coronavirus, Coronavirus Delta Variant, Coronavirus Mu Variant, Coronavirus Mutation, Pandemic, Public Health, Public Opinion, Public Perception, Public Safety, Public Schools, Public Trust, Unvaccinated, Vaccination, Vaccine, Vaccine Efficacy, Vaccine Hesitancy Rate, Vaccine Safety, Vaccine Skepticism, Vaccine Supply • Leave a comment

https://www.nationalgeographic.com/science/article/the-mu-variant-is-on-the-rise-scientists-weigh-in-on-how-much-to-worry?cmpid=org=ngp::mc=crm-email::src=ngp::cmp=editorial::add=SpecialEdition_20210910::rid=C1D3D2601560EDF454552B245D039020

Laboratory studies suggest this variant may be better at avoiding the immune system but lags Delta when it comes to transmission and infecting cells.

One of the newest variants of COVID-19, known as Mu, has spread to 42 countries, but early studies suggest that it is less easily transmitted than the dangerous Delta variant, which has triggered a resurgence of the pandemic in the U.S. and many other countries.

Mu quickly became the dominant strain in Colombia, where it was first detected in January, but in the U.S., where the Delta virus is dominant, it has not spread significantly. After reaching a peak at the end of June, the prevalence of the Mu variant in the U.S. has steadily declined.

Scientists believe that the new variant cannot compete with the Delta variant, which is highly contagious. “Whether it could have gone higher or not if there was no Delta, that’s hard to really say,” says Alex Bolze, a geneticist at the genomics company Helix.

In Colombia, however, the Mu variant is responsible for more than a third of the COVID-19 cases. There have been 11 noteworthy variants to date, which the World Health Organization has named for the letters of the Greek alphabet. The newest variant, Mu, is the 12th. WHO has labeled this latest version of SARS-CoV-2 a Variant of Interest, a step below a Variant of Concern. 

Delta and three other variants have drawn the highest level of concern. But a Variant of Interest, like Mu still raises worries. Mu has many known mutations that can help the virus escape immunity from vaccines or previous infection.

Still, the good news is that Mu is unlikely to replace Delta in places like the U.S. where it is already predominant, says Tom Wenseleers, evolutionary biologist and biostatistician at the Catholic University of Leuven in Belgium, who previously estimated the transmissibility and impact of Alpha variant in England.

How is Mu different? 

Most genetic sequences reveal that Mu has eight mutations in its spike protein, many of which are also present in variants of concern: Alpha, Beta, Gamma, and Delta.

Some of Mu’s mutations, like E484K and N501Y, help other variants evade antibodies from mRNA vaccines. In the Beta and Gamma variants, the E484K mutation made the variants more resistant to a single dose of mRNA vaccines.

A study, not yet peer reviewed, has shown that the P681H mutation helps transmission of the Alpha variant—it may do the same for Mu. 

Mu also harbors novel mutations that haven’t been seen in variants before, so their consequences are not fully understood. Mutation at the 346 position disrupts interaction of antibodies with the spike protein, which, scientists say, might make it easier for the virus to escape.

A study using epidemiological models, not yet peer reviewed, estimates that Mu is up to twice more transmissible than the original SARS-CoV-2 and caused the wave of COVID-19 deaths in Bogotá, Colombia in May, 2021. This study also suggests that immunity from a previous infection by the ancestral virus was 37 percent less effective in protecting against Mu.

“Right now, we do not have [enough] available evidence that may suggest that indeed this new variant Mu is associated with a significant [..] change in COVID,” says Alfonso Rodriguez-Morales, the President of the Colombian Association of Infectious Diseases.

But some clues are emerging that Mu can weaken protection from antibodies generated by existing vaccines. Lab-made virus mimicking the Mu variant were less affected by antibodies from people who had recovered from COVID-19 or were vaccinated with Pfizer’s Comiranty. In this study, not yet peer reviewed, Mu was the most vaccine resistant of all currently recognized variants.

In another lab-based study, antibodies from patients immunized with Pfizer’s vaccine were less effective at neutralizing Mu compared to other variants. 

“[Mu] variant has a constellation of mutations that suggests that it would evade certain antibodies—not only monoclonal antibodies, but vaccine and convalescent serum-induced antibodies—but there isn’t a lot of clinical data to suggest that. It is mostly laboratory […] data,” said Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, at a White House press briefing on September 2.

The COVID-19 vaccines—Pfizer, Astra Zeneca, Johnson & Johnson, and Sinovac, all of which are available in Colombia—still seem to offer good protection against Mu, according to Rodriguez-Morales.

How prevalent is Mu?

The Mu variant rapidly expanded across South America, but it is difficult to know for sure how far Mu has spread, according to Paúl Cárdenas, microbiologist at Universidad San Francisco de Quito in Ecuador.

“[Latin American countries] have provided very low numbers of sequences, compared with the numbers of cases that we have,” says Cárdenas. South American countries have sequenced just 0.07 percent of their total SARS-CoV-2 positive cases, although 25 percent of global infections have occurred in the region. This contrasts with 1.5 percent of all positive cases sequenced in the U.S. and 9.3 percent of all positive cases sequenced in the U.K.

“We are not necessarily looking at the reality of the distribution of the variants [in Latin America], because of the limitations in performing genome sequencing,” says Rodriguez-Morales.

That said, except in Columbia where Mu has been spreading since late February, the variant is becoming relatively less frequent globally, including in the rest of South America.

“Additional evidence on Mu is scarce, similar to Lambda and other regionally prevalent variants, because of limited capacity for follow-up studies, and because these variants have not yet been a significant threat in high-income countries like Delta is,” says Pablo Tsukayama, a microbiologist at Universidad Peruana Cayetano Heredia in Lima, Peru. He hopes the WHO’s designation of Mu as a variant of interest will change that.

Democrats’ competing health care priorities

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https://www.axios.com/democrats-health-care-congress-medicare-politics-95831a8b-1bf5-4f5c-b277-e0e38f40b809.html?utm_source=newsletter&utm_medium=email&utm_campaign=newsletter_axiosvitals&stream=top

The Democrats’ reconciliation bill includes several major health care pieces backed by different lawmakers and advocates, setting up a precarious game of policy Jenga if the massive measure needs to be scaled back.

Between the lines: Health care may be a priority for Democrats. But that doesn’t mean each member values every issue equally.

Why it matters: As the party continues to hash out the overall price tag of its giant reconciliation bill, it’s worth gaming out which policies are on the chopping block — and which could potentially take the entire reconciliation bill down with them.

There are clear winners of each pillar of Democrat’s health plan:

  • Seniors benefit from expanding Medicare to cover dental, vision and hearing benefits.
  • Low-income people — primarily in the South and disproportionately people of color — in non-expansion states benefit if the Medicaid gap is closed, giving them access to health coverage.
  • Affordable Care Act marketplace enrollees benefit if the increased subsidy assistance that Democrats enacted earlier this year is extended or made permanent.
  • Elderly and Americans with disabilities benefit from an expansion of their home-based care options, and their caretakers benefit from a pay bump.
  • Seniors — and potentially anyone facing high drug costs — benefit if Medicare is given the authority to negotiate drug prices, although the drug industry argues it will lead to fewer new drugs.

Yes, but: Each of these groups face real problems with health care access and affordability. But when there’s a limited amount of money on the table — which there is — even sympathetic groups can get left in the dust.

Each policy measure, however, also has powerful political advocates. And when Democrats have a razor-thin margin in both the House and the Senate, every member has a lot of power.

  • Seniors are disproportionately powerful on their own, due to their voting patterns. But expanding what Medicare covers is extremely important to progressives — including Sen. Bernie Sanders.
  • Closing the Medicaid gap is being framed as a racial justice issue, given that it disproportionately benefits people of color. And although many Democrats hail from expansion states — particularly in the Senate — some very powerful ones represent non-expansion states.
  • These members include Sen. Raphael Warnock, who represents Georgia and is up for re-election next year in an extremely competitive seat, and Rep. Jim Clyburn, who arguably is responsible for President Biden winning the 2020 primary.
  • The enhanced ACA subsidies are scheduled to expire right before next years’ midterm elections. Democrats’ hold on the House is incredibly shaky already, making extending the extra help a political no-brainer.
  • Expanding home-based care options was one of the only health care components of Biden’s original framework for this package. But aside from the president’s interest in the issue, unions care a lot about it as their members stand to gain a pay raise — and Democrats care a lot about what unions care about.
  • And finally, giving Medicare the power to negotiate drug prices has the most powerful opponents, theoretically making it vulnerable to the chopping block. But it also polls very highly, and perhaps even more importantly, produces enough government savings to help pay for these other health care policies.

The bottom line: “From a political perspective, none of these health care proposals seem very expendable,” said KFF’s Larry Levitt.

  • Most — if not all of them — can be scaled to save money.
  • But there are also powerful constituencies for the other components of the bill that address issues like child care and climate change, meaning these health care measures aren’t only competing against one another.
  • And, Levitt points out, “there’s always a difference between members of Congress staking out positions and being willing to go to nuclear war over them.”

The Fourth U.S. Wave of COVID-19 Could Be Ebbing. The Fifth Might Be Worse

Posted on by • Posted in Coronavirus, Coronavirus Delta Variant, Coronavirus Mutation, Infection Control, Infection Control Plan, Infectious Virus, Pandemic, Public Health, Public Opinion, Public Perception, Public Safety, Public Schools, Public Trust, Unvaccinated, Vaccination, Vaccine, Vaccine Distribution, Vaccine Efficacy, Vaccine Hesitancy Rate, Vaccine Mandate, Vaccine Mandatory, Vaccine Safety, Vaccine Skepticism, Vaccine Supply • Leave a comment
https://time.com/6096892/fourth-covid-19-wave-us/?utm_medium=email&utm_source=sfmc&utm_campaign=newsletter+coronavirus+default+ac&utm_content=+++20210913+++body&et_rid=147206923
Fourth COVID Wave Could Be Ebbing. The Fifth Might Be Worse | Time

We May Be in for a Repeat of Last Winter

It may feel like eons ago, but try to recall summer 2020: While there were coronavirus surges in some parts of the country, national case rates were low. In some areas, the virus almost faded away entirely. But of course, the respite didn’t last. Cases began rising again in the fall of 2020, peaking at an average of more than 250,000 per day in January 2021.

The U.S. may be in for something even worse this year, my colleague Chris Wilson warns.

After a heartbreakingly bad summer, the virus’ spread appears to be ebbing, Chris writes. As of today, the U.S. is reporting about 145,000 diagnoses per day—too high for comfort, but at least a modest downward trend from over 160,000 daily cases at the end of August. In many hotspot states, diagnoses are significantly lower than they were a month or two ago.

But kids are now returning to school, cooler weather will force social gatherings indoors and holiday travel season will soon be upon us. With the highly contagious Delta variant now the dominant strain and millions of Americans still unvaccinated, we may be heading for a repeat of last year.

Of course, the situation isn’t exactly the same. More than half the population (and counting) is fully vaccinated, and many other people have at least some level of natural immunity after surviving an infection. That will certainly help keep cases down, but it may not be enough. As Chris points out, seven U.S. states set new daily case records this summer, even with vaccines widely available. As long as there are millions of unvaccinated people in the U.S., the virus will find a way to spread—particularly when it’s as contagious as the Delta variant.

So what can you do? At the risk of sounding like a broken record, the advice is the same as ever: get vaccinated if you haven’t, get your kids vaccinated if they’re old enough, wear masks if you gather with people indoors and stay home if you feel unwell.

President Joe Biden’s announcement Thursday that broadly expanded mandatory COVID-19 vaccinations or at least compulsory weekly testing is a sign, possibly, that the administration sees the writing on the wall. Even with tentative but promising signs that the fourth wave of surging cases in COVID-19 in the United States, dating back to the first days of summer, was waning, without drastic measures, the fifth will be catastrophically worse.

The new requirements are estimated to affect about 100 million people, including most federal workers and a substantial number of private sector employees—many of whom are already vaccinated. This would largely affect working-age residents (age 18-64), who currently number above 200 million, of whom 59.8% are vaccinated, according to TIME’s analysis of daily figures from the U.S. Centers for Disease Control and Prevention. That leaves more than 80 million who remain unvaccinated, though the White House orders will only cover a fraction of them.

The question is now: What happens this fall and winter, when children are at school and Americans once again travel for the holidays? In spite of desperate warnings from the CDC that people stay home for last year’s holiday, they largely did not, which led to the third spike in cases, which reached heights that dwarfed the first two. That doesn’t bode well for Christmas 2021, especially given that, in this current, fourth wave, seven states have already surpassed their previous peaks in cases (with another four doing nearly as poorly):

Within the next several days, we may see a modest surge from travel over the Labor Day weekend, but the real test will come in about two months—still all too soon. The holidays always sneak up on us. Under one possibility, many millions of Americans may be bolstered by a booster shot of the COVID-19 vaccine, though this will be scant protection for those who have yet to receive a first.

Evidence that surging cases could inspire more unvaccinated Americans to change their mind was initially encouraging, but did not extend indefinitely. Should the fourth wave recede considerably, it may take a fifth to convince a significantly greater number.

Cartoon – State of the Union (Unvaccinated)

Posted on by • Posted in Cartoon, Coronavirus, Coronavirus Delta Variant, Coronavirus Mutation, Evidence, Evidence Based Decision Making, Evidence-Based Care, Evidence-based Leadership, Evidence-Based Plan, Evidence-Based Policy, Pandemic, Public Health, Public Opinion, Public Perception, Public Safety, Public Schools, Public Trust, State of the Union, Unvaccinated, Vaccination, Vaccine, Vaccine Efficacy, Vaccine Hesitancy Rate, Vaccine Safety, Vaccine Skepticism, Vaccine Supply • Leave a comment
Dave Granlund cartoon on anti-vaccination people

Cartoon – Misplaced Trust

Posted on by • Posted in Anti-Science, Anti-Science Bias, Anti-Vaxx Movement, Cartoon, Coronavirus, Coronavirus Delta Variant, Coronavirus Mutation, Pandemic, Public Health, Public Opinion, Public Perception, Public Safety, Public Schools, Public Trust, Scientists, Sign of the Times, Trust, Trust Misplaced, Unvaccinated • Leave a comment
Shareef: Intellectualism and COVID Vaccinations | Columnists | roanoke.com

Cartoon – You can lead a horse to water

Posted on by • Posted in Cartoon, Coronavirus, Coronavirus Delta Variant, Coronavirus Mutation, Pandemic, Public Health, Public Opinion, Public Perception, Public Safety, Public Schools, Public Trust, Sign of the Times, Unvaccinated, Vaccination, Vaccine, Vaccine Efficacy, Vaccine Hesitancy Rate, Vaccine Safety, Vaccine Skepticism, Vaccine Supply • Leave a comment
Octavio N. Martinez Jr.: Equity is playing a part in vaccine hesitancy in Texas | Columnists | wacotrib.com

The next attack on the Affordable Care Act may cost you free preventive health care

Posted on by • Posted in ACA, Health Insurance Coverage Adequacy, Kelley v. Becerra, Preventable Disease, Preventative Care, Residual Costs, Roe v. Wade, Supreme Court • Leave a comment
The next attack on the Affordable Care Act may cost you free preventive health care
The next attack on the Affordable Care Act may cost you free preventive health care

Many Americans breathed a sigh of relief when the Supreme Court left the Affordable Care Act (ACA) in place following its third major legal challenge in June 2021. This decision left widely supported policies in place, like ensuring coverage regardless of preexisting conditions, coverage for dependents up to age 26 on their parents’ plan and removal of annual and lifetime benefit limits.

But the hits keep coming. One of the most popular benefits offered by the ACA, free preventive care through many employer-based and marketplace insurance plans, is under attack by another legal domino, Kelley v. Becerra. As University of Michigan law professor Nicholas Bagley sees it, “[t]his time, the law’s opponents stand a good chance of succeeding.”

We are public health and economics researchers at Boston University who have been studying how preventive care is covered by the ACA and what this means for patients. With this policy now in jeopardy, health care in the U.S. stands to take a big step backward.

What did the ACA do for preventive health?

The Affordable Care Act tried to achieve the twin ideals of making health care more accessible while reducing health care spending. It created marketplaces for individuals to purchase health insurance and expanded Medicaid to increase coverage for more low-income people.

One way it has tried to reach both goals is to prioritize preventive services that maximize patient health and minimize cost, like cancer screenings, vaccinations and access to contraception. Eliminating financial barriers to health screenings increases the likelihood that common but costly chronic conditions, such as heart disease, will be diagnosed early on.

Section 2713 of the ACA requires insurers to offer full coverage of preventive services that are endorsed by three federal groups: the U.S. Preventive Services Task Force, the Advisory Committee on Immunization Practices and the Health Resources and Services Administration. This means that eligible preventive services ordered by your doctor won’t cost you anything out of pocket. For example, the CARES Act used this provision to ensure COVID-19 vaccines would be free for many Americans.

Removing the financial barrier has drastically reduced the average cost of a range of preventive services. Our study found that the costs of well-child visits and mammograms were reduced by 56% and 74%, respectively, from 2006 to 2018. We also found that the ACA reduced the share of children’s preventive checkups that included out-of-pocket costs from over 50% in 2010 to under 15% in 2018.

Residual costs for preventive services remain

Despite these reductions in costs, there are limitations to this benefit. For example, it doesn’t cover follow-up tests or treatments. This means that if a routine mammogram or colonoscopy reveals something that requires further care, patients may have to pay for the initial screening test, too. And some patients still receive unexpected bills for preventive care that should have been covered. This can happen, for example, when providers submit incorrect billing codes to insurers, which have specific and often idiosyncratic preventive care guidelines.

We also studied the residual out-of-pocket costs that privately insured Americans had after using eligible preventive services in 2018. We found that these patients paid between $75 million to $219 million per year combined for services that should have been free for them. Unexpected preventive care bills were most likely to hit patients living in rural areas or the South, as well as those seeking women’s services such as contraception and other reproductive health care. Among patients attempting to get a free wellness visit from their doctor, nearly 1 in 5 were later asked to pay for it.

Nevertheless, the preventive health provision of the ACA has resulted in significant reductions in patient costs for many essential and popular services. And removing financial barriers is a key way to encourage patients to use preventive services intended to protect their health.

The threat of Kelley v. Becerra

The plaintiffs who brought the latest legal challenge to the ACA, Kelley v. Becerra, object to covering contraception and preexposure prophylaxis (PrEP) for HIV on religious and moral grounds. The case is currently awaiting decision in a district court in Texas, but seems to be headed to the Supreme Court.

The case rests on two legal issues: 1) violation of the nondelegation doctrine, and 2) the appointments clause of the Constitution. The nondelegation doctrine is a rarely used legal argument that requires Congress to specify how their powers should be used. It essentially argues that Congress was too vague by not specifying which preventive services would be included in Section 2713 up front. The appointments clause specifies that the people using government powers must be “officers of the United States.” In this case, it is unclear whether those in the federal groups that determine eligible preventive care services qualify.

Texas District Judge Reed O’Connor has indicated so far that he takes a kind view toward the plaintiff’s case. He could rule that this provision of the ACA is unconstitutional and put the case on a path to the Supreme Court.

Patients stand to lose more than just money

If Section 2713 were repealed, insurers would have the freedom to reimpose patient cost-sharing for preventive care. In the short run, this could increase the financial strain that patients face when seeking preventive care and discourage them from doing so. In the long run, this could result in increased rates of preventable and expensive-to-treat chronic conditions. And because Section 2713 is what allows free COVID-19 vaccines for those with private health insurance, some patients may have to pay for their vaccines and future boosters if the provision is axed.

The ACA has been instrumental in expanding access to preventive care for millions of Americans. While the ACA’s preventive health coverage provision isn’t perfect, a lot of progress that has been made toward lower-cost, higher-value care may be erased if Section 2713 is repealed.

Lower-income patients will stand to lose the most. And it could make ending the COVID-19 pandemic that much harder.

The Research on Ivermectin and Covid-19

Posted on by • Posted in Clinical Research, Coronavirus, Coronavirus Delta Variant, Coronavirus Mutation, Coronavirus Treatment, Evidence Based Decision Making, Evidence-Based Care, Evidence-based Leadership, Evidence-Based Plan, Evidence-Based Policy, Ivermectin • Leave a comment
The Research on Ivermectin and Covid-19

Interest in the antiparasitic drug Ivermectin has increased drastically as of late thanks to the belief that it can help to prevent and/or treat Covid-19. In today’s episode we examine recent data on the efficacy of Ivermectin as an antiviral and discuss the history behind how it gained this reputation.