First case of highly infectious coronavirus variant detected in Colorado

Colorado officials on Tuesday reported the first known case in the United States of a person infected with the coronavirus variant that has been circulating rapidly across much of the United Kingdom and has led to a lockdown of much of southern England.

Scientists have said the variant is more transmissible but does not make people sicker.

The Colorado case involves a man in his 20s, who is in isolation in Elbert County, about 50 miles southeast of Denver, and has no travel history, according to a tweet from the office of Gov. Jared Polis (D).

“The individual has no close contacts identified so far but public health officials are working to identify other potential cases and contacts through thorough contact tracing interviews,” the statement said.

A federal scientist familiar with the investigation said the man’s lack of known travel — in contrast with most confirmed cases outside the United Kingdom — indicates this is probably not an isolated case. “We can expect that it will be detected elsewhere,” said the official, who spoke on the condition of anonymity to discuss the broader context of the announcement.

The Centers for Disease Control and Prevention confirmed as much in a statement Tuesday afternoon, saying additional cases with the new variant will be detected in the United States in coming days. The variant’s apparent increase in contagiousness “could lead to more cases and place greater demand on already strained health care resources,” the agency said in a statement.

Researchers have detected the more transmissible variant in at least 17 countries outside the United Kingdom, including as far away as Australia and South Korea, as of Tuesday afternoon. Officials in Canada had previously said they had identified two cases.

Although the U.K. variant appears more contagious, it is not leading to higher rates of hospitalizations or deaths, according to a report from Public Health England, a government agency. Nor is there any sign that people who were infected months ago with the coronavirus are more likely to be reinfected if exposed to the variant, according to the report. All available evidence indicates that vaccines, and immunity built up in the population, should be protective against this variant.

The Colorado case occurred in a county of about 27,000, which is currently classified, along with much of the state, in the “red” level for the virus, denoting serious but not extreme risk.

Two weeks ago, several hundred people gathered at a community church in the county seat of Kiowa to consider whether to pursue legal actions against Polis and other state officials for imposing coronavirus-related restrictions, according to the Elbert County News. County commissioners and the county sheriff have declined to enforce restrictions emanating from Denver.

“I was expecting to see it in ski country first because those areas are where people from across Colorado, the U.S. and internationally, gather,” said Elizabeth Carlton, an assistant professor of environmental and occupational health at the Colorado School of Public Health. The absence of any apparent travel history associated with the infected person, she said, suggests he “can’t be the only case in Colorado.”

Polis, in his statement, called on Coloradans to do everything they could to prevent transmission by wearing masks, standing six feet apart when gathering with others, and interacting only with members of their immediate households.

The arrival of the new variant “doesn’t fundamentally change the nature of the threat,” said Justin Lessler, an epidemiologist at Johns Hopkins Bloomberg School of Public Health. “It’s no more deadly than the virus was before, and it doesn’t look like it infects people who are immune.”

Lessler echoed others, saying he would be “astounded” if this was the only chain of transmission of the new variant in the United States. “We know that the virus spreads easily and quickly between countries,” he said, and the fact that the infected person had no travel history indicates “this strain has gotten here sometime in the past, and there are chains of transmission ongoing.”

The variant has a higher attack rate, according to the U.K. report, which bolsters the hypothesis that the variant has out-competed other versions of the coronavirus and is now the dominant variant across much of the United Kingdom. Among people known to have been exposed to someone already infected with the variant, 15.1 percent became infected. People exposed to someone infected with the non-variant version had a 9.8 percent infection rate.

That difference suggests the variant is more transmissible, though Public Health England said more investigation is needed to bolster the hypothesis.

The working theory among many scientists is that the increased transmissibility of the variant, known as B.1.1.7, is driven by mutations that have altered the spike protein on the surface of the virus. The variant has 17 mutations — eight of which alter the spike protein.

Precisely how those changes are leading to more infections is unknown. The virus may be binding more easily to receptor cells in the human body, or replicating more easily and driving higher viral loads, enhancing viral shedding by someone who is infected. Another possibility is that people are shedding the virus for a longer period, increasing the chances of passing it along.

“Preliminary evidence suggests that the new variant does not cause more severe disease or increased mortality,” Susan Hopkins, a senior medical adviser to Public Health England, said in a statement released Tuesday.

The newly published data echo the findings in a separate study published last week, based on modeling and hospitalization data — and not yet peer-reviewed — that estimated that the variant is 56 percent more transmissible but does not appear to alter the lethality of the virus.

“The good news is that B.1.1.7 does not seem to cause much more severe disease, and there’s no evidence that it is managing to evade the immune system, which means vaccines are expected to protect against it,” William Hanage, an epidemiologists at the Harvard T.H. Chan School of Public Health, said Tuesday after reviewing the new report. “The bad news is that B.1.1.7 does appear to be much more transmissible.”

Officials in the United States have been signaling since last week that the new variant was probably already present in this country.

“I’m not surprised,” Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, said Tuesday. “I think we have to keep an eye on it, and we have to take it seriously. We obviously take any kind of mutation that might have a functional significance seriously. But I don’t think we know enough about it to make any definitive statements, except to follow it carefully and study it carefully.”

Research findings on coronavirus variants have been ambiguous at times, and scientists say they are still trying to extract reliable signals from noisy data. There have been several false alarms sounded about virus mutations in the past. A major challenge is discerning whether a virus variant is spreading rapidly because it has a competitive advantage based on genetic and structural differences, or because it is simply lucky, having arrived early to a location or leveraged a few superspreader events to gain dominance.

But with the United Kingdom seeing a severe winter surge of infections, public officials are taking no chances and have effectively locked down southern England, including London. Other countries have banned travelers from the United Kingdom.

The United States, despite having the world’s highest number of documented infections, has a weak track record in publishing genomic sequences, the process that enables researchers to track changes in the virus. Most sequences have been published by academic or private research institutions. By comparison, the United Kingdom has a national health system with a robust surveillance system.

“The U.K. made the decision in the spring to do this. The U.S. has sequencing equipment and infrastructure. As with many things in this pandemic, it was not executed the way it should have been,” said Neville Sanjana, a geneticist at New York University.

All viruses mutate randomly, and over time some of those mutations appear to confer some kind of advantage to the virus as it adapts to the human species. The novel coronavirus, SARS-CoV-2, mutates at a slow rate, and scientists do not think the genetic changes seen in the variant so far are sufficient to allow it to elude the vaccines now being administered to millions of people in many countries. But the coronavirus is a moving target and these mutations require surveillance.

Many scientists call the arrival of more transmissible mutations a wake-up call. “The lack of virus sequencing and case tracking in the USA is a scandal,” said Jeremy Luban, a virologist at the University of Massachusetts Medical School.

Francois Balloux, who directs the Genetics Institute at University College London, on Twitter predicted that within two weeks, enough data will accumulate to determine whether this new variant is indeed more transmissible. Previously, Balloux and his colleagues combed through genome sequences, looking for evidence that common variants had increased transmissibility.

“We don’t see much,” he said, referring to a report published in the journal Nature in November that found no signs of mutations that helped the virus to spread more easily. However, he said he “wouldn’t underestimate the evolutionary potential of SARS-CoV-2.”

Duke Health, Geisinger sue HHS over Medicare payments

January Healthcare Industry Lawsuits and Settlements - Elite Learning

Five hospitals recently sued HHS over its calculation of Medicare Part A disproportionate share hospital payments for patients who were enrolled in Medicare Advantage plans under Part C of the Medicare Act.

The federal lawsuit was filed Dec. 21 by Duke Raleigh (N.C.) Hospital, Durham (N.C.) Regional Hospital, Geisinger Medical Center in Danville, Pa., Geisinger Wyoming Valley Medical Center in Wilkes-Barre, Pa., and The Washington (Pa.) Hospital. 

The hospitals’ lawsuit takes issue with a Medicare policy change, adopted in 2004, that included a new methodology for allocating Medicare Part C days in the disproportionate share hospital formula. The appeals court has ruled against HHS in three actions challenging its attempts to apply its Part C days policy to deny DSH payments to hospitals. However, the hospitals argue that HHS is disregarding those decisions and a decision by the U.S. Supreme Court. 

“The agency has continued to apply the Part C days policy adopted in the now-vacated 2004 rule in violation of these decisions, including in the payment determinations at issue for the plaintiff hospitals in this case, in a recently issued proposed rule seeking to re-adopt the same 2004 policy retroactively, and in a ruling that would leave undisturbed the payment determinations from which hospitals have appealed and, as construed by the agency’s administrative Board, not permit further administrative or judicial review of those determinations,” the complaint filed Dec. 21 states. 

The hospitals argue that HHS’ attempts to apply the policy should be rejected. The hospitals are asking the court to declare the final payment determinations reflecting the policy change invalid. 

Biden to address nation on pandemic as Fauci says coronavirus surge ‘has just gotten out of control’

Fauci: U.S. may see “surge upon surge” of coronavirus in weeks ahead – The  Denver Post

President-elect Joe Biden plans to deliver an address on the coronavirus pandemic as the nation experiences what his chief medical adviser on the issue, Anthony S. Fauci, described Tuesday as a surge in cases “that has just gotten out of control in many respects.”

Biden’s remarks, planned Tuesday afternoon in Wilmington, Del., are expected to be his most extensive comments to date since early this month, when he laid out a plan for his first 100 days in office that included imploring all Americans to wear masks.

Fauci, appearing on CNN on Tuesday morning, lamented what he expects to be a post-holiday increase in cases and the strong possibility than January’s caseload will exceed even that of December. “You just have to assume it’s going to get worse,” Fauci said.

Fauci also acknowledged that the rollout of vaccines was not reaching as many Americans as quickly as the 20 million that Trump administration had pledged by the end of the month.

“We certainly are not at the numbers that we wanted to be at the end of December,” said Fauci, director of the National Institute of Allergy and Infectious Diseases. “We are below where we want to be.”

But Fauci, who accepted Biden’s invitation to play an expanded role in his administration, expressed hope that by “showing leadership from the top,” Biden could make an impact — comments that appeared to be implicit criticism of President Trump, who has said little publicly about the crisis since Election Day.

“What he’s saying is that let’s take at least 100 days and everybody, every single person put aside this nonsense of making masks be a political statement or not,” Fauci said of Biden. “We know what works. We know social distancing works. We know avoiding congregant settings works. For goodness sakes, let’s all do it, and you will see that curve will come down.”

Separately Tuesday, Vice President-elect Kamala D. Harris plans to get vaccinated in Washington. Biden received his first shot last week.

In remarks earlier this month, Biden also pledged to distribute 100 million vaccine shots in his first 100 days in office and said he wanted to open as many schools safely during the period as possible. He has also promised to sign an executive order requiring masks to be worn on federal property.

On Monday, Celine Gounder, a member of Biden’s covid-19 advisory board, said during a television appearance that Biden is also considering invoking the Defense Production Act to increase production of coronavirus vaccines,

Appearing on CNBC’s “Squawk Box,” Grounder said Biden could invoke the wartime-production law “to make sure the personal protective equipment, the test capacity and the raw materials for the vaccines are produced in adequate supply.”

During his CNN appearance, Fauci said that getting children back to school safely should remain an imperative, despite rising caseloads.

“You can’t have one size fits all, but the bottom line, what I call default position, should be that wherever we are, try as best as we can to get the children back to school and to keep them in school and to have a plan to try and keep them as safe as possible,” he said.

About 200,000 new coronavirus cases have been reported daily in recent weeks, with a record high of 252,431 on Dec. 17.

The nation’s overall caseload surpassed 19 million Sunday, even as the holidays were expected to cause a lag in reporting. Hospitalizations have exceeded 100,000 since the start of December and hit a peak of 119,000 on Dec. 23. Deaths are averaging more than 2,000 a day, with the most ever reported — 3,406 fatalities — on Dec. 17.

Kaiser Permanente halts elective surgeries at some California hospitals

Vigil outside Kaiser honors suicide victims denied mental health care –  SFBay

Twenty-one Kaiser Permanente hospitals in Northern California are suspending elective, non-urgent procedures through Jan. 4 as they continue to face a surge in COVID-19 hospitalizations, according to The Mercury News.

The Oakland, Calif.-based system announced the suspension Dec. 26, days after Chairman and CEO Greg Adams said during a news conference, “We simply will not be able to keep up if the COVID surge continues to increase. We’re at or near capacity everywhere.”

California reported a record-high 20,059 current COVID-19 hospitalizations Dec. 27, a 13 percent increase from one week prior, according to The COVID Tracking Project.

Find a running list of other health systems that have adjusted their elective surgery timelines, organized by state, here

1 of every 17 people in the U.S. has been infected, and 1 in 1,000 has died. Yet the worst may lie ahead.

1 of every 17 people in the U.S. has been infected, and 1 in 1,000 has died.  Yet the worst may lie ahead. - The New York Times

With bubble-enclosed Santas and Zoom-enhanced family gatherings, much of the United States played it safe over Christmas while the coronavirus rampaged across the country.

But a significant number of Americans traveled, and uncounted gatherings took place, as they will over the New Year holiday.

And that, according to the nation’s top infectious disease expert, Anthony S. Fauci, could mean new spikes in cases, on top of the existing surge.

“We very well might see a post-seasonal — in the sense of Christmas, New Year’s — surge,” Dr. Fauci said on CNN’s “State of the Union.”

“We’re really at a very critical point,” he said. “If you put more pressure on the system by what might be a post-seasonal surge because of the traveling and the likely congregating of people for, you know, the good warm purposes of being together for the holidays, it’s very tough for people to not do that.”

On “Fox News Sunday,” Adm. Brett P. Giroir, the administration’s testing coordinator, noted that Thanksgiving travel did not lead to an increase of cases in all places, which suggested that many people heeded recommendations to wear masks and limit the size of gatherings.

“It really depends on what the travelers do when they get where they’re going,” Admiral Giroir said. “We know the actual physical act of traveling in airplanes, for example, can be quite safe because of the air purification systems. What we really worry about is the mingling of different bubbles once you get to your destination.”

Still, U.S. case numbers are about as high as they have ever been. Total infections surpassed 19 million on Saturday, meaning that at least 1 in 17 people have contracted the virus over the course of the pandemic. And the virus has killed more than 332,000 people — one in every thousand in the country.

Two of the year’s worst days for deaths have been during the past week. A number of states set death records on Dec. 22 or Dec. 23, including Alabama, Wisconsin, Arizona and West Virginia, according to The Times’s data.

And hospitalizations are hovering at a pandemic height of about 120,000, according to the Covid Tracking Project.

Against that backdrop, millions of people in the United States have been traveling, though many fewer than usual.

About 3.8 million people passed through Transportation Safety Administration travel checkpoints between Dec. 23 and Dec. 26, compared with 9.5 million on those days last year. Only a quarter of the number who flew on the day after Christmas last year did so on Friday, and Christmas Eve travel was down by one-third from 2019.

And AAA’s forecast that more than 81 million Americans would travel by car for the holiday period, from Dec. 23 to Jan. 3, which would be about one-third fewer than last year.

For now, the U.S. is no longer seeing overall explosive growth, although California’s worsening outbreak has canceled out progress in other parts of the country. The state has added more than 300,000 cases in the seven-day period ending Dec. 22. And six Southern states have seen sustained case increases in the last week: Tennessee, Alabama, Georgia, South Carolina, Florida and Texas.

Holiday reporting anomalies may obscure any post-Christmas spike until the second week of January. Testing was expected to decrease around Christmas and New Year’s, and many states said they would not report data on certain days.

On Christmas Day, numbers for new infections, 91,922, and deaths, 1,129, were significantly lower than the seven-day averages. But on Saturday, new infections jumped past 225,800 new cases and deaths rose past 1,640, an expected increase over Friday as some states reported numbers for two days post-Christmas.