CORONAVIRUS INFO PROVIDED BY DR. JIM HARRIS – 8/16/2022

HELLO, AREA ICU CASES HAVE INCREASED. HARRISON COUNTY IN “MODERATE” DANGER ZONE. MASKS IN CROWDS RECOMMENDED.

A reaction to the CDC guidance [READ HOW AN EXPERT FAMILY PERSON PLANS TO HANDLE COVID NOW]

(J. Harris: In my medical opinion, this young Ph.D epidemiologist is wise beyond her years. She writes beautifully while clearly exploring and explaining pertinent and practical medical and public health issues. My highest compliment is “ELEGANT,” and she is.)

FROM HOPKINS SELECTIONS:

1. COVID Rebound is Surprisingly Common — Even without Paxlovid (Nature) After the game-changing COVID-19 antiviral Paxlovid began to be used in late 2021, researchers noticed a perplexing trend. In some people taking the drug, symptoms and detectable virus vanish, only to mysteriously return days later. After months of grasping at straws, scientists are beginning to make some headway in understanding ‘Paxlovid rebound’. Two recent studies suggest that it is surprisingly common for SARS-CoV-2 to return in untreated cases of COVID-19, while hinting that the virus’s comeback is fiercer and more common in people who take Paxlovid.

2. Covid Vaccine Designed to Target Two Variants Approved for Use in UK (The Guardian) A vaccine designed to target two different forms of Covid has been approved by the UK regulator for use as booster jabs in people over the age of 18. Manufactured by the US firm Moderna, the vaccine targets not only the original coronavirus – as is the case for vaccines currently in use – but is designed specifically to target the Omicron variant BA.1, which fuelled a wave of Covid in the UK last winter. The UK is the first country to approve the bivalent vaccine, known as “Spikevax bivalent Original/Omicron”. It is now up to the UK’s Joint Committee on Vaccination and Immunisation (JCVI) to decide whether it will, as expected, be used in the planned autumn booster programme, expected to begin in September.

FROM BECKERS:

1. Longer Paxlovid course needed to prevent rebounds, experts say

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More Black Former N.F.L. Players Eligible for Concussion Payouts

Tests for dementia were rescored under the N.F.L.’s concussion settlement to avoid race-based criteria.

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Dozens of Black retired N.F.L. players will now be eligible for payouts worth hundreds of thousands of dollars from the league’s billion-dollar concussion settlement, reversing previous decisions made because of cognitive tests that used race-based measures to determine whether the players had dementia.

The decision, included in a status report filed by the settlement administrator that was entered into the court docket Thursday, came two years after two former players sued the league to end the use of race as a criterion in evaluating the players’ claims, a process known as “race-norming.”

The settlement administrator found that 646 players who had been tested for dementia but did not qualify for cash payouts could have their tests automatically rescored without using race as a criterion.

Of those, 61 were found to have moderate or severe dementia and may receive payouts worth $500,000 or more. The payouts vary based on a player’s age and the number of years he was in the league.

Another 246 former players were found to have mild dementia and will receive additional testing to monitor their conditions. Thousands of other players have qualified for examinations that will not use race as a factor; these players could qualify for payouts in the coming months and years.

The results were the latest chapter in the landmark concussion settlement that has resulted in about $1 billion in claims being paid to players with a range of cognitive and neurological diseases including dementia. For years, former players and their families have accused the league of making it difficult, if not impossible, to receive payouts from the settlement, and they have claimed that the plaintiffs attorney who represents every player in the class-action settlement was not doing enough to fight for them.

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CORONAVIRUS INFO PROVIDED BY DR. JIM HARRIS – 8/12/2022

FROM THE EPIDEMIOLOGIST EXCELLENT ARTICLE FOR EDUCATORS AND PARENTS

A plan for the upcoming school year

(J. Harris: READABLE)

FROM BECKERS: 

 CDC UPDATES CURRENT: AUGUST 11, 2022:

”...While the CDC did away with quarantine recommendations, the new guidance says people exposed to COVID-19 should wear a high-quality mask for 10 days and get tested on day five…he new COVID-19 recommendations focus on mitigating the risk of severe disease, rather than infection itself…We’re in a stronger place today as a nation, with more tools — like vaccination, boosters and treatments — to protect ourselves and our communities, from severe illness from COVID-19…This guidance acknowledges that the pandemic is not over but also helps us move to a point where COVID-19 no longer severely disrupts our daily lives.”

FIVE CDC UPDATES

1. The guidance underscores the importance of staying up to date with vaccination, “especially as new vaccines become available.” Omicron-targeted vaccines are expected to be available in the fall.2. The six-foot standard for social distancing is no longer an explicit recommendation. The guidelines place less emphasis overall on physicial distancing as a key measure to avoid exposure, instead describing it as “just one component of how to protect yourself and others.” The updated recommendations place more onus on individuals to assess the risks and take more precautions in particular settings, such as crowded indoor spaces.

3.  The CDC no longer recommends routine screening of people without symptoms in most community settings, including schools4. Isolation guidance for people with COVID-19 remains the same: Isolate for at least five days at home and wear a high quality-mask when around others. Isolation may be ended after five days if a person is fever-free for 24 hours without medication and symptoms are improving, though a mask should be worn through day 10. Immunocompromised people and those who had more severe illness should isolate through day 10. 

5. The FDA on Aug. 9 released a safety alert advising people to perform repeat testing to avoid false negative results when using at-home rapid antigen tests. If a symptomatic person tests negative, they should test again 48 hours later. People without symptoms who may have been exposed should take up to three tests after receiving their first negative result, each separated by a 48-hour period….Be aware that at-home COVID-19 antigen tests are less accurate than molecular tests,” the FDA said. “COVID-19 antigen tests may not detect the SARS-CoV-2 virus early in an infection, meaning testing soon after you were exposed to someone with COVID-19 could lead to a false-negative result, especially if you don’t have symptoms. This is the reason why repeat testing is important.”

HOPKINS SUGGESTS:

1 Omicron Subvariants Gain More Ground, Including BA.4.6 in the Midwest (CIDRAP) Though the 7-day average for new daily COVID-19 cases is slowly declining, the more transmissible and immune-evasive Omicron subvariants became even more dominant last week, with an offshoot called BA.4.6 gaining traction in some Midwestern states. Health officials brace for a possible spike in activity after school starts and people begin gathering more indoors in the fall. In its weekly variant proportion updates, the U.S. CDC said the proportion of BA.5 viruses in sequenced samples last week rose from 84.5% to 87.1%, while BA.4 declined slightly, from 8.2% to 6.6%. However, the proportion of BA.4.6 viruses rose from 4.2% last week to 4.8% this week. The subvariant has also been reported in other US regions, especially in the east.

2. Community transmission in the US is primarily driven by the Omicron BA.5 sublineage. BA.5 is now projected to account for 87.1% of sequenced specimens. The BA.4 sublineage accounts for about 6.6% of cases, while the BA.4.6 sublineage accounts for 4.8% of cases. Together, BA.2.12.1 and BA.2 now account for only about 2.9% of cases. According to the estimate, Omicron variants represent all new cases in the US.

3. EDUCATORS MIGHT NOTE:

INDOOR AIR WORKSHOP The Environmental Health Matters Initiative (EHMI) of the National Academies of Sciences, Engineering, and Medicine will host its first virtual workshop in a 3-part series on Indoor Air Management of Airborne Pathogens on August 18 from 11:30 am to 3:30 pm EDT. These workshops—follow ups to the 2020 workshop on the airborne transmission of SARS-CoV-2—will explore strategies needed for airborne disease control and risk reduction in enclosed places by drawing on accumulated community and institutional knowledge, on-the-ground observations of indoor environments management during the pandemic, and novel and promising scientific discoveries. For more information and to register, visit https://www.nationalacademies.org/event/07-21-2022/indoor-air-management-of-airborne-pathogens-lessons-practices-and-innovations.

 4. IMMUNE EVASION Immune escape, or immune evasion, is driving the COVID-19 pandemic’s extended life cycle. As the virus continues to infect humans, it will mutate and likely adapt to find its way around existing levels of vaccine-induced and natural immunity. The scientific community is not surprised that SARS-CoV-2 continues to evolve to evade our ever-changing immune systems, as many other viruses do the same. But because SARS-CoV-2 is a new virus to humans, attention is focused on emerging new variants and global anxiety is heightened, wondering what variant lies around the corner. 

Currently, there are many questions about whether the Omicron subvariants BA.2.75 or BA.4.6 will cause the next wave of infections. BA.2.75, which has been circulating widely in India for more than a month and has been detected in at least 20 other countries, does not currently appear likely to outcompete BA.5, the global leader of SARS-CoV-2 variants. BA.4.6, which is growing in prevalence in the US and Europe, appears to be just as transmissible as BA.2.75, but it remains unclear whether either subvariant will become predominant. Scientists continue to worry that either one of these Omicron subvariants, or an as-yet undetected variant, could gain global, regional, or local dominance. This cycle of new variant-driven waves, each with increased immune evasion, describes the global experience with COVID-19 to date, and many assume the pattern will continue into the future. This is what allowed BA.4 and BA.5 to spread widely despite widespread recent infections with the Omicron BA.1 and BA.2 subvariants. 

In addition to increased variant surveillance, more must be done to help further prepare for future increases in COVID-19 cases. The first priority is to address current infections by reducing transmission of circulating virus, limiting its chances to adapt and evade existing levels of immunity. However, limiting transmission is increasingly challenging, as many countries roll back mitigation measures and as funding for testing and vaccination programs dwindles. Many appear to be placing hope in the next generation of SARS-CoV-2 vaccines, which are expected to protect against a wider array of viral lineages. Several studies, including one conducted in non-human primates published this week in Science Translational Medicine, suggest that these vaccines may be a possibility, and they may be able to provide protection that extends to other coronaviruses, so-called pancoronavirus vaccines. While those vaccines remain a distant goal, manufacturers continue to work on current vaccine platforms that enable the fast production of variant-specific boosters. The CEO of Moderna recently compared the future of SARS-CoV-2 vaccines to the iPhone’s constant updates, with new generations developed as more data and technologies become available. 

5. NOVAVAX VACCINE Last month, the US FDA granted emergency use authorization (EUA) for a protein-based COVID-19 vaccine made by US-based manufacturer Novavax. Many public health advocates hoped that the vaccine’s authorization would lead to an increase in vaccinations among unvaccinated populations, having faith that the more traditional protein-based vaccine technology would ease concerns surrounding vaccination with vaccines using newer mRNA platforms. However, in the month since the EUA was issued, only about 7,400 doses have been administered in the US, with only 2,300 people receiving a 2-dose primary series using Novavax. According to the US CDC, 332,000 doses of the vaccine have been distributed nationwide. Originally, the vaccine was available at only 385 locations, although that number has grown to 986 sites. Notably, more than 53,000 locations have been used to provide other vaccinations throughout the pandemic. The limited uptake of the Novavax vaccine has received criticism given the large investment the company received from Operation Warp Speed. While it is too early to decide the fate of the vaccine in the US, Novavax recently reset its sales expectations, halving its forecast to US$2 billion to US$2.3 billion from US$4 billion to US$5 billion. 

AND LAST BUT NOT LEASED:

THE NORWEIGIAN REPORTS 1.5 INCHES OF RAIN. WHO SAYS PRAYER WON’T HELP. 

NEVER MIND. DON’T ANSWER THAT.

”THE DEVIL MADE ME DO IT:”

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York and National Railroad Museum

York and National Railroad Museum – 14 July 2022 – York, United Kingdom

Editor note:

More from Tom  

By Tom Allin

It was a beautiful day for a bus ride. So, we decided to take the Hop On/Off Bus tour and stop for the National Railroad Museum. The Railroad Museum is something we most likely wouldn’t have visited but all the guidebooks gave it high ratings and we found the ratings well deserved. I believe we spent close to two and a half hours at the Railroad Museum.

We have done several Hop On/Off Bus Tours. Some have been great such as Hong Kong. Others not so great such as Cape Town. The information is always good, the presenter or audio is always a crap shoot, and if the bus can’t or isn’t allowed to navigate to the sights then the ride is boring.

Note his jacket, the person sitting to his left with hood up – it was cool. Five days later the hottest recorded day in York’s history was 101 degrees.

Clifford Tower was a part of York Castle which no longer exists. This is the second Tower or Castle Keep. The first was destroyed in 1190 when the City’s Jews took refuge inside and eventually committed suicide to avoid being murdered by Christian rioters.

Use the links below to read Tom’s complete story

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CORONAVIRUS INFO PROVIDED BY DR. JIM HARRIS – 8/9/2022

COVID LEVELS IN OUR AREA ARE MODERATE AND HIGH 

SMITH AND CASS COUNTIES ARE HIGH.    USE CAUTION

FROM BECKERS:

Why US may be in for a severe flu season

”…Countries in the Southern Hemisphere are experiencing a severe flu season, which may be a harbinger of what’s to come for the U.S. this fall…

Health experts often look to the Southern Hemisphere’s flu season, which typically runs from April to September, as a predictor for the Northern Hemisphere’s upcoming flu season…Australia is facing its worst flu season in five years, with infections spiking for the first time since the COVID-19 pandemic began, according to data from Australia’s health department. Flu season also started earlier than usual in the country, giving the virus more time to circulate and infect the population….

Pharmacies and physician’s offices are expected to receive vaccine shipments in the coming weeks for the nation’s annual fall flu shot campaign. …”

Examination of SARS-CoV-2 In-Class Transmission at a Large Urban University With Public Health Mandates Using Epidemiological and Genomic Methodology

Findings  In this cohort study of 140 000 class meetings at a large US university, there were over 850 cases of SARS-CoV-2 infection identified through weekly surveillance testing of all students and faculty on campus during the fall 2021 semester. There were 9 instances of potential in-class transmission identified as identical lineages confirmed by SARS-CoV-2 genome sequencing, and none of these instances were confirmed to be in-class transmission.

Meaning  These results suggest that in-class transmission of SAR-CoV-2 in an urban university with masking and vaccine protocols in-place was negligible.

FROM JAMA:

1. Just the Plague: Reflections on State Control of Infectious Outbreaks

(J. Harris: A book review. The book is available at Amazon only in paperback at this time. I will wait for Kindle version.)

2. Animal Reservoirs—Where the Next SARS-CoV-2 Variant Could Arise

”…Understanding how the virus jumps between species—known to ecologists as a “spillover” event—is complicated but potentially critical in ending the COVID-19 pandemic….[including animals such as } big cats like tigers and lions but also domestic cats and dogs, gorillas, white-tailed deer, hamsters, farmed mink, otters, anteaters, manatees, hippopotamuses, and others… Interspecies transmission can produce new animal reservoirs where the virus can multiply or persist for prolonged periods, creating the potential for the pathogen to transmit back to human populations…”

(J. Harris: It is safer to sleep with a tomato than with a pet!)

3.Rate of SARS-CoV-2 Reinfection During an Omicron Wave in Iceland

”…Our results suggest that reinfection is more common than previously thought. Now the key question is whether infection with the Omicron variant will produce better protection against Omicron reinfection, compared with other variants…”

4. Association of Receiving a Fourth Dose of the BNT162b Vaccine With SARS-CoV-2 Infection Among Health Care Workers in Israel (Repeat I think)

”…In this multicenter cohort study of 29 611 health care workers in Israel, the breakthrough infection rate among those who received 4 doses was 6.9% compared with 19.8% in those who received 3 doses…”

Measuring work-related risk of COVID-19: comparison of COVID-19 incidence by occupation and industry – Wisconsin, September 2020-May 2021

”…During September 2020 – May 2021, the Wisconsin Department of Health Services collected occupation and industry data as part of routine COVID-19 case investigations. Adults aged 18-64 years with confirmed or probable COVID-19 in Wisconsin were assigned standardized occupation and industry codes….

Results

An estimated 11.6% of workers (347,013 of 2.98 million) in Wisconsin, ages 18-64 years, had COVID-19 from September 2020 to May 2021. The highest incidence by occupation (per 100 full-time equivalents) occurred among personal care and services workers (22.4), healthcare practitioners and support staff (20.7), and protective services workers (20.7). High risk sub-groups included nursing assistants and personal care aides (28.8), childcare workers (25.8), food and beverage service workers (25.3), personal appearance workers (24.4), and law enforcement workers (24.1). By industry, the incidence was highest in healthcare (18.6); the highest risk sub-sectors were nursing care facilities (30.5) and warehousing (28.5)…”

AND LASTLY:

My tolerance for idiots is extremely low these days. 

I used to have some immunity built up, but there must be a new strain out there?

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York City Wall — 13 July 2022 — York, United Kingdom

Editor note:

More from Tom  

We are in York; luggage is in our apartment and therefore it is time to go exploring.  

I hadn’t taken 20 steps when I could see Monks Bar in the very near distance poking out above the buildings in front of me.  Monks Bar is one of the primary gates through the old city wall.  Monks Bar was built in stages in the 1400s with the last stage – top story – completed by Richard III in 1484.  Monks Bar originally was constructed with a gated barbican and a series of murder holes from which defenders dropped rocks, etc. on to attackers.

The City Wall was primarily built in the 13th century and extensively renovated in the 1800s.

The city wall fortifications consisted of two sections of wall, one swamp, and one lake (for the king to fish).  The stone wall is very narrow and not particularly high.  However, most of the stone wall is built on top of a previous dirt mound fortification so that from outside an opposing army was looking at 20’ of a very steep dirt incline and then 10 to 15 feet of stone wall.  This made it very difficult to bring siege machines close to the wall and almost impossible to lean a ladder against the wall.  I wouldn’t want to be part of an attacking force.

Use the links below to read Tom’s complete story

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CORONAVIRUS INFO PROVIDED BY DR. JIM HARRIS – 8/4/202

COVID COUNTS ARE HIGH LOCALLY.

FROM THE NYT

1. By Jonathan Wolfe on 3 August:

”…Is the virus endemic?

Even though people across the world are trying to move on from Covid, it’s still here, all around us…Case in point: Half of all infections during the pandemic have taken place this year, … Given the current pace, it’s possible that more than 80 percent of all Covid cases will ultimately take place in 2022…

What do the coming months look like?

There are a lot of variables. [To] synthesize all of them, I would say that I think it’s likely that, for the foreseeable future, we’re living primarily with Omicron variants. That means the virus will find new ways to evade our immune response without totally eliminating the immune protections that we carried before….

In the fall, we will begin to see some limited rollout of new next-generation vaccines, but they won’t fundamentally change the trajectory of immune protection going forward. And we have very limited implementation of other social and political measures, such as mandating better air quality in schools and transportation systems and things along those lines….

”Where does that leave us? …That this is really an old person’s disease now. That was true at the beginning of the outbreak, but it’s becoming even more true now. It’s quite possible that we’ll see increasing relative vulnerability among the old, which is to say people who are in middle age are going to feel pretty safe living a totally normal life… But [older people]  may not ever. That’s because they have a much harder time building up immunity, which means they lose the benefits of the vaccines and previous exposure much more quicklyWe’re also seeing a significant death toll this year. We’ve more or less normalized it. We could have roughly equivalent numbers of especially elderly people dying as we did in the first years of the pandemic — and that’s tragic.”

FROM BECKERS:

Why we may be in ‘omicron land’ for a while

FROM HOPKINS SELECTIONS:Is the virus endemic?

Even though people across the world are trying to move on from Covid, it’s still here, all around us….attention to the US CDC’s guidance regarding isolation after COVID-19 diagnosis or a positive SARS-CoV-2 test. The CDC currently recommends isolation for a minimum of 5 days after the onset of symptoms or positive test. To end isolation, those who were symptomatic should wait until their fever has subsided for at least 24 hours and other symptoms are improving—and those leaving isolation should wear a mask in public through Day 10. Notably, the CDC indicates that individuals can test before they end their isolation, but the guidance emphasizes that testing is optional (ie, as opposed to recommended) for anyone who “wants to.” Those who elect to test and obtain a positive result should remain in isolation. The isolation and testing protocol implemented for President Biden went “above and beyond” the CDC recommendations, and CDC Director Dr. Rochelle Walensky indicated that the CDC must issue guidance that is feasible for most people to follow. Recent studies have demonstrated that many individuals continue to test positive for 6 days or longer, and most can shed the virus for 8 days or longer, which could enable them to infect others if they end isolation after 5 days. In light of this evidence, some experts have called on the CDC to revisit its guidance to slow transmission, particularly in light of the current Omicron surge.

2. ”… millions of people in the US have post-COVID-19 conditions, also known as long COVID. The US CDC estimates that nearly 1 in 5 individuals who have had COVID-19 continue to report long-term symptoms lasting 3 months or longer. Many of them have left their jobs because they have symptoms, such as fatigue or brain fog, that hinder their ability to perform daily or work tasks. Under federal guidance, people with long COVID can qualify for disability, meaning employers must offer accommodations to their workers. But many people with long COVID say negotiating accommodations or finding support from social assistance programs remains difficult. Some experts advocate for a better definition of the condition to facilitate diagnosis, more robust educational campaigns to warn people of the risk for long COVID, and more support for people with the condition. More than 100,000 US residents are diagnosed with COVID-19 everyday, some for a second or third time, and evidence suggests people who are infected more than once are at greater risk of long-term health consequences. It will be years before we fully understand the disease’s impacts on the public health, employment, and health coverage landscapes.

FROM THE ATLANTIC

This COVID Summer Is Nothing Like the Last One

”…We need multiple approaches to reduce transmission. It’s going bonkers right now, and this is not a sustainable way to coexist with this virus. I’m not saying that people need to have mask mandates forever, but when transmission rates are this high, it is a good idea to think about masking, to think about testing more often, paying attention to who is up-to-date on their vaccines and making sure that our approaches are complementing each other…

”It is true that hospitalization and death rates are down, but the more people you have infected, even a very small percentage can turn into an untenable number of hospitalizations and deaths. And every infection carries the risk of long COVID, or taking people away from school or work or their family. And the worrisome thing is, for the past few months, we’ve been at this bizarre plateau in terms of case counts not really coming back down and looking better…There’s not a lot of data to go off, so I’m going to be tentative here. I think we can expect them to be an improvement, but I can’t tell you if it’s going to be a 5 percent improvement or a 60 percent improvement. The other big asterisk on this is, what’s going to be around in September? Is it still going to be BA.5, is it going to be BA.6, or is it going to be another variant entirely?…We need multiple approaches to reduce transmission. It’s going bonkers right now, and this is not a sustainable way to coexist with this virus. I’m not saying that people need to have mask mandates forever, but when transmission rates are this high, it is a good idea to think about masking, to think about testing more often, paying attention to who is up-to-date on their vaccines and making sure that our approaches are complementing each other.

FROM EPIDEMOLOGIST:

How is monkeypox spread?

(J. Harris: This is concise and short. It will be all I have to say about Monkey Pox).

FROM THE LA TIMES:

Coronavirus Today: Experts are taking a softer stance on masking; it’s a different pandemic

(J. Harris: This is a good updated mask article. The majority of my readers are older folks with more than a few preexisting maladies — just like I have. I’m not going to goof off now and take careless chances at this late date. In addition, I don’t want to be dragging ass around in my last years with Long Covid. Masks and vaccinations and prudence have worked so far. Besides, I have to take care of both The Norwegian and Milton.)

FROM THE NEJM:

Grieving in a Pandemic

Viral and Symptom Rebound in Untreated COVID-19 Infection

”… Findings: In both the primary and secondary analyses, 12% of participants had viral rebound. Viral rebounders were older than non-rebounders (median 54 vs 47 years, P=0.04). Symptom rebound occurred in 27% of participants after initial symptom improvement and in 10% of participants after initial symptom resolution. The combination of high-level viral rebound to ≥5.0 log10 RNA copies/mL and symptom rebound after initial improvement was observed in 1-2% of participants. Interpretation: Viral RNA rebound or symptom relapse in the absence of antiviral treatment is common, but the combination of high-level viral and symptom rebound is rare.”

FROM JAMA

Association of Receiving a Fourth Dose of the BNT162b Vaccine With SARS-CoV-2 Infection Among Health Care Workers in Israel

Question: 

 Was there a benefit of vaccinating health care workers with a fourth dose of BNT162b2 vaccine during the Omicron variant outbreak of the COVID-19 pandemic?

Findings  In this multicenter cohort study of 29 611 health care workers in Israel, the breakthrough infection rate among those who received 4 doses was 6.9% compared with 19.8% in those who received 3 doses.

Meaning  These findings suggest that a fourth vaccine dose was effective in preventing breakthrough COVID-19 infections in health care workers, helping to maintain the function of the health care system during the [OMICRON] pandemic.

AND LASTLY, A SIGN SENT TO ME BY A CERTAIN NORWEGIAN:

A recent study has found women who carry a little extra weight live longer than men who mention it. 

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Black Top Farm to Manchester – 10 July 2022 – United Kingdom

Editor note:

More from Tom  

By Tom Allin

While we were eating breakfast, Jane came out of the kitchen and asked us where we were going today.  I answered we were driving to Manchester.  Immediately she said she would write out the most scenic drive for us to take to Manchester.  Then Jane’s visiting girlfriend from Manchester said not only would it be scenic but no slower due to all the Sunday traffic on the highway.  I knew anything scenic meant narrow roads but I am slowly getting used to closing my eyes, steady on the gas pedal, and praying for divine intervention.

During yesterday’s walk from the farm to Hartington and back I had a heart-to-heart talk with myself.  I reminded myself I had survived six months of driving in India – a country where driving is the art of the insane, roads are narrow with everything on them but cars, certifiable crazy taxi drivers everywhere, and don’t forget cows, oh yes and buses.

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1792 case reveals

July 27, 2022

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A 1792 case reveals that key Founders saw abortion as a private matter

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Editor’s comment:

I published this story at Tom Allin’s request.  As always I will be happy to publish rebuttals to this article.

Opening Remark:

“I have asked Ron to publish the article below.  It is written by a friend’s daughter, Dr. Sarah Poggi, who we also consider a friend.  It is always interesting to me how those who want a strict interpretation of the Constitution only want it when it fits their false facts (or leave out all the facts) rather than the historical facts.  See article below.”

Tom Allin

MADE BY HISTORY

A 1792 case reveals that key Founders saw abortion as a private matter

Thomas Jefferson, John Marshall and Patrick Henry didn’t advocate for prosecution of a woman who probably had an abortion

Perspective by Sarah Hougen Poggi and Cynthia A. Kierner 

July 19, 2022 at 6:00 a.m. EDT

A basic premise of Supreme Court Justice Samuel A. Alito Jr.’s majority opinion in Dobbs v. Jackson Women’s Health Organization was that the Constitution can protect the right to abortion only if it is “deeply rooted in our history and traditions.” This statement complements Justice Amy Coney Barrett’s concept of originalism, or the idea that the court should interpret the Constitution by trying to infer “the meaning that it had at the time people ratified it.”

Alito’s evidence that abortion was always considered a criminal act, and thus something the Constitution should not protect, consisted of a single criminal case that was prosecuted in 1652 in the (Catholic) colony of Maryland. He then jumped ahead to laws that states enacted, mostly in the mid-to-late-19th century, to criminalize abortion. This cursory survey of abortion in early America was hardly complete, especially because it ignored the history of abortion in the years in which the Constitution was drafted and ratified.

In that era, abortion was governed by Anglo-American common law. Under this framework, the procedure was legal before “quickening,” or the moment the pregnant person first felt fetal movement — a highly subjective milestone that usually occurred around 16 to 22 weeks of gestation. Yet even after quickening, few people were prosecuted for abortion, let alone convicted — Alito’s opinion certainly did not offer contradictory evidence. The reason is simple: In the early republic, abortion was largely a private matter. It was not a cause for public concern, nor was abortion considered a criminal act.

In fact, contrary to Alito’s assertions in Dobbs, three Founders from Virginia — Thomas Jefferson, Patrick Henry and John Marshall — did not seek charges in a sensational court case from that era in which evidence of an abortion was discovered.

In 1792, 18-year-old unwed Nancy Randolph was impregnated by her 22-year-old brother-in-law and cousin, Richard Randolph. Nancy lived with Richard and his wife, her sister Judith, at their Cumberland County plantation in Virginia, aptly named “Bizarre.”

In September, Nancy and Judith’s cousin and sister-in-law, Jefferson’s daughter Martha Jefferson Randolph, visited and found Nancy unwell and unwilling to undress in front of her. Martha, who believed Nancy was pregnant, recommended gum of guaiacum, an herb known to treat “menstrual obstruction,” a euphemism for pregnancy. On her return home, she sent Nancy the herb, which she warned could “produce an abortion.”

Two weeks later, Richard, Judith and Nancy visited the home of their cousins, Randolph and Mary Randolph Harrison. Nancy appeared ill and retired early to bed, awakening with a scream in the middle of the night. The next morning, Nancy’s bedclothes were bloody. Randolph Harrison saw blood on the stairs and noted “[Nancy’s] considerable paleness and a disagreeable odor.”

When an enslaved man found what appeared to be a White fetus on a woodpile, rumors spread through the community of enslaved people to Whites of all classes quickly, reaching Philadelphia, where Jefferson expressed sympathy for Nancy in a letter to daughter Martha, declaring: “I see guilt but in one person, and not in her.” Jefferson’s response was typical of that era, a time when upper class White women like Nancy were viewed as morally pure and sexually chaste by nature.

Many among the general public believed that Richard impregnated his sister-in-law — which was incest under Virginia law — and that he also murdered a living infant. His honor and life were at risk. Richard vehemently asserted his innocence in a newspaper. His public statement had little effect, and, facing mounting pressure, he surrendered to the county sheriff. Richard was charged with “feloniously murdering a child delivered of the body of Nancy Randolph or being accessory to the same.”

Medically, five pieces of evidence suggest that what happened was not murder of a living child, but rather a deliberate second-trimester abortion. First, Nancy had an abortifacient. Second, witnesses reported her enlarged abdomen, though not a full-term pregnancy. Third, Nancy’s brief cries were more consistent with latent labor than active labor. In latent labor, the cervix dilates to four-to-six centimeters, sufficient for passage of a one-to-two-pound fetus. Uncomfortable but not unbearable, and sometimes lasting days, latent labor in the second trimester ends abruptly with the expulsion of the fetus. (At full term, hours of painful active labor follow to achieve 10-centimeter dilation and pushing efforts.)

Fourth, no one reported a baby’s cry, suggesting pre-viability outside the womb. Finally, Nancy later delivered a son at term, indicating she had no risk factors for second-trimester miscarriage such as uterine or cervical anomalies. Altogether, the evidence supports the conclusion that Nancy ingested herbs to induce a second-trimester abortion and that her effort was successful.

In April 1793, Richard appeared before a tribunal of county judges who weighed the merits of serious criminal charges to decide whether they should be adjudicated in a higher court. Few defendants in the 1790s had legal counsel, but Richard and his stepfather assembled a good team: Henry, a charismatic litigator and former governor famous for his “Give me liberty or give me death” speech; Marshall, a rising star and the future U.S. Supreme Court chief justice; and William Campbell, the U.S. attorney for Virginia.

The circumstantial obstetric evidence overwhelmingly demonstrated that Nancy’s pregnancy ended that night at the Harrisons’ home. Marshall recorded Martha Randolph’s testimony that Nancy was pregnant and that she delivered the herb, noting that the gum of guaiacum was “designed” for producing an abortion. But he did not describe this as a crime.

No effort seems to have been made to determine whether the pregnancy had reached the stage of quickening. If it was post-quickening, the state could have prosecuted Nancy and Martha. Instead Henry skillfully undermined the credibility of the prosecution’s witnesses, and Marshall successfully took the untenable position that there was never a pregnancy and, thus, Richard could not be guilty of murder.

While the release of Richard — a wealthy White man with great lawyers — was not surprising, what was remarkable and relevant to today’s debates is that evidence of an intended abortion was discovered in an unwed, unpropertied woman and not fully investigated or acted upon. Nancy would later admit she had been pregnant, yet neither she nor her accomplice were ever charged.

Abortion was later criminalized in Virginia and across other states in the 19th century. But these laws reflected the development of modern gynecology more than a change in morality. The curette, introduced in 1843, was widely adopted when dilators were developed in 1871, resulting in the “D and C” procedure, in which the cervix is dilated to allow for passage of a curette, which removes tissue from the uterus. Abortion transformed from a private, female matter to the purview of male medical professionals, who excluded other providers by influencing lawmakers.

Therefore, the more historically accurate conclusion is Justice Harry A. Blackmun’s majority opinion in Roe v. Wade (1973), that “at the time of the adoption of our Constitution, and throughout the majority of the 19th century, abortion was viewed with less disfavor than under most American statutes currently in effect. Phrasing it another way, a woman enjoyed a substantially broader right to terminate a pregnancy than she does in most States today. ”

Though Marshall’s notes on Commonwealth v. Randolph are extensive, this episode is poorly documented in the county court records, and, thus, no formal case law was generated. Regardless, the episode begs examination as it involved key Founders who occupied vastly different positions on the political spectrum, both nationally and in Virginia. The Federalist Marshall believed in a strong national government. Jefferson mostly supported a decentralized system. Henry was a populist. Yet all three tacitly agreed that abortion in this case was a private matter, not a criminal act worthy of further investigation and prosecution. In a remarkable coda, Nancy went on to marry Gouverneur Morris of New York, an influential signer of the Constitution, who was well aware of her backstory.

If anything, the saga demonstrates that the concept of abortion as a private matter was “deeply rooted” in the minds of our nation’s Founders. As Americans consider their next move on the abortion issue at the state level, they should be mindful of the precedents followed by these early giants of our republic.

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CORONAVIRUS INFO PROVIDED BY DR. JIM HARRIS – 7/25/2022

COVID State of Affairs: July 25 Katelyn Jetelina

(J. Harris: Great summary, readable. I am a paid subscriber.)

From THE NYT SATURDAY:

1. Combined nasal and throat testing swabs would detect more Omicron infections, two papers suggest.

”…coronavirus tests that analyze both nasal and throat swabs … pick up more Omicron infections than those that rely on just a nasal swab….

The first paper focuses on 14 people who enrolled in the study before or at the same time that their infections began, allowing the researchers to capture the earliest stage of infection….This group of participants provided a total of 260 nasal swabs, 260 throat swabs and 260 saliva samples over the course of their infections, allowing the scientists to make multiple comparisons between the amount of virus in different specimens and people at different times…

The researchers found significant differences in the viral load of different sample types from the same individuals….

In most participants, the virus was detectable in saliva or throat swabs before it was detectable in nasal swabs. “You can have very high, presumably infectious, viral loads in throat or saliva before nasal swabs,…”

2. New sub-variant ‘Centaurus’ discovered in Australia | Coronavirus | 9 News Australia

(J. Harris: It was hoped that the BA2.75 which started in India would not be an important varisn. Now called “Centaurus” in Australia, it isn’t as deadly as some variants, but much like BA .5 in the US, it is filling up some of the hospitals. Most of the world’s deaths from Covid are in folks over about 74.)

FROM LOCAL EPIDEMOLOGIST:

1. NORVAX: MIX AND MATCH DATA. PLUS SUMMARY OF THE NEW “OLD” VACCINE

1. 3.  Time-Release Microparticles Could Deliver “Self-Boosting” Vaccines (GEN) Most vaccines, from measles to COVID-19, require a series of multiple shots before the recipient is considered to be fully vaccinated. To make that easier to achieve, MIT researchers have developed microparticles that can be tuned to deliver their payload at different time points, and which could be used to create what the scientists describe as “self-boosting vaccines.” Using these particles, which resemble tiny coffee cups sealed with a lid, researchers could design vaccines that would need to be given just once, and would then “self-boost” at a specified point in the future. The particles can remain under the skin until the vaccine is released and then break down, just like resorbable sutures. The same strategy could also feasibly be used to deliver a range of other therapeutics, including cancer drugs, hormone therapy, and biologic drugs.

2. Polio: An unfortunate reminder of the decline in routine vaccinations

(J. Harris: We have the first acute polio case in the US in quite a while.)

From THE CDC:

 Correlation Between Clinical and Wastewater SARS-CoV-2 Genomic Surveillance, Oregon, USA (CDC EID) SARS-CoV-2 variant proportions in a population can be estimated through genomic sequencing of clinical specimens or wastewater samples. We demonstrate strong pairwise correlation between statewide variant estimates in Oregon, USA, derived from both methods (correlation coefficient 0.97). Our results provide crucial evidence of the effectiveness of community-level genomic surveillance.

FROM JAMA:

1. Effect of Text Message Reminders and Vaccine Reservations on Adherence to a Health System COVID-19 Vaccination Policy

”Question  Can a behavioral nudge delivered through text messages with a reserved date for vaccination over a 2-week period accelerate employee adherence with a health system COVID-19 vaccination policy?

Meaning  This randomized clinical trial found that a behavioral nudge delivered by text message with a reserved date for vaccination accelerated adherence to a health system COVID-19 vaccination policy; however, other approaches may be needed to change overall adherence rates by the time of the policy deadline.”

2. Association Between Vaccination and Acute Myocardial Infarction and Ischemic Stroke After COVID-19 Infection

This study found that full vaccination against COVID-19 was associated with a reduced risk of AMI [HEART ATTACK] and ischemic stroke after COVID-19. The findings support vaccination, especially for those with risk factors for cardiovascular diseases.

3. Updated US Infection- and Vaccine-Induced SARS-CoV-2 Seroprevalence Estimates Based on Blood Donations, July 2020-December 2021

”…In this study of US blood donations, the combined seroprevalence from infection or vaccination reached 94.7% by December 2021. Despite this, record levels of infection and reinfections were reported as the Omicron variant became predominant in early 2022.2 The high infection rates are likely related to increased transmissibility and enhanced immune escape mutations of the Omicron variant, along with waning protection from previous vaccination and infection.3-5 During 2021, the infection-induced seroprevalence increased more in regions with low vaccination rates compared with those with high ones. The ability of SARS-CoV-2 variants to cause widespread transmission in the setting of high seroprevalence illustrates the value of COVID-19 vaccines, including recommended booster doses, to maximize protection.

FROM HOPINS SUGGESTIONS:

1. “…Published July 19 in Science, a study of spike protein function and neutralizing capability of 7 different SARS-CoV-2 vaccines against Omicron sublineages shows that a large number of the sublineage mutations lead to enhanced ACE2 binding and reduced plasma neutralizing activity. However, homologous or heterologous boosters markedly increased neutralizing antibody titers against BA.1, BA.2, BA.2.12.2, and BA.4/5 across all vaccines evaluated to provide sufficient protection against Omicron-induced severe disease. The vaccines evaluated included mRNA vaccines from Moderna and Pfizer-BioNTech, viral-vectored vaccines from J&J-Janssen, AstraZeneca-Oxford, and Sputnik V, as well as the Novavax and Sinopharm vaccines that use different platforms.

ADDITIONALLY FROM SCIENCE ARTICLE: ”…The recent evaluation of intranasal vaccine administration could also be important to not only prevent severe disease but also curtail viral infection and transmission through induction of mucosal immunity (75–78). For these reasons, it is important to monitor new variants, assess the effectiveness of currently available vaccines, and continue to test and implement new vaccination strategies that may provide stronger, longer lasting, or broader protection against SARS-CoV-2 and the entire sarbecovirus subgenus…”

2. US PANDEMIC PREPAREDNESS The administration of US President Joe Biden is reorganizing the US Department of Health and Human Services to elevate the Office of the Assistant Secretary for Preparedness and Response (ASPR) from a staff division into an independent operating division—similar to the US CDC, FDA, and NIH—responsible for leading the nation’s responses to future pandemics and health emergencies. Under the reorganization, ASPR will now be known as the Administration for Strategic Preparedness and Response, and efforts to stand up the new division will be phased in over the next 2 years. ASPR oversees the Strategic National Stockpile, the national Medical Reserve Corps, and contracts for and distribution of vaccines and certain medicines in health emergencies. Though many current and former HHS officials welcomed the move, other experts say that shifting some health emergency coordination responsibilities to ASPR could undercut response efficacy, create confusion and tension, and does not address ongoing challenges at CDC, which has much closer relationships with states. 

3. Prior Omicron Infection Protects Against BA.4 and BA.5 Variants (Nature) The Omicron BA.4 and BA.5 subvariants of SARS-CoV-2 have proven to be stealthier at evading people’s immune defences than all of their predecessors. But recent research shows that previous infection with an older variant (such as Alpha, Beta or Delta) offers some protection against reinfection with BA.4 or BA.5, and that a prior Omicron infection is substantially more effective. That was the conclusion of a study that evaluated all of Qatar’s COVID-19 cases since the wave of BA.4 and BA.5 infections began1. The work, which was posted on the medRxiv preprint server on 12 July and has not yet been peer reviewed, feeds into broader research on “how different immunities combine with each other”, says study co-author Laith Abu-Raddad, an infectious-disease epidemiologist at Weill Cornell Medicine-Qatar in Doha.

FROM SCIENTIFIC AMERICAN:

People with Long COVID May Still Have Spike Proteins in Their Blood

”...this spike protein found in the blood could be a “biomarker,” specifically for long COVID…”

”… researchers still haven’t pinned down what causes the condition or how to treat it…..Now researchers may have found a marker for the disabling condition: a piece of SARS-CoV-2, the virus that causes COVID, floating around in the blood of some long COVID sufferers well after their initial infection… detecting a fragment of SARS-CoV-2 in blood samples from long COVID sufferers up to a year after their original infection. The fragment is a spike protein, one of the protrusions around the outside of SARS-CoV-2 that give this coronavirus its namesake corona, or crownlike appearance. During an initial COVID infection, the spike protein typically breaks off into smaller pieces when it penetrates human cells, but the spike proteins observed in this study were still in one piece. The findings have not yet been peer-reviewed….“If you had an infection, and you cleared it, then normally, you would not see [the spike protein] because all the antibodies you produced would clear everything that enters the bloodstream,… Instead, …tissues such as those in the gut and brain could be a haven for SARS-CoV-2 within the body, preventing long COVID patients from fully clearing their infections and acting as a source of spike proteins. “Maybe the virus can just persist there. It evades the immune system somehow.”……[A] “The presence of circulating viral proteins may be helpful to identify which subset of long COVID patients might have the persistent viral etiology”—the version of long COVID caused by the ongoing presence of SARS-CoV-2 in the body—…The rest of the long haulers might suffer from other causes.” These other causes could include… [B] an overblown immune response that leads COVID patients’ body to develop immune proteins—“autoantibodies”—that attack its own cells in the same way they would attack an intruder such as a virus or bacterium. These autoantibodies have been found in people’s body during an initial COVID infection, as well as in the bodies of some long COVID patients…. [C]Another possibility is that a COVID infection makes people more susceptible to other viruses already present in the body, such as the Epstein-Barr virus. This pathogen lies dormant in most people but has been found reactivated in some long COVID patients…

FROM REUTERS:

Oral vaccine shows promise; hypertension ups COVID hospitalization risk

FROM BECKERS

BA.2.75 a ‘scariant,’ not the next variant to worry about, experts say

While there will likely be new COVID-19 variants to worry about in the future, omicron relative BA.2.75 is not the next big one to fret over, experts predict…

“BA.2.75 is a scariant. It’s not spreading anywhere besides a couple of provinces in India without BA.5 to compete with,” Eric Topol, MD, founder and director of the Scripps Research Translational Institute in San Diego, said in a July 19 tweet, citing a graph based on data from  global data-sharing virus platform GISAID that indicates the strain hasn’t spread much outside of several states in India. “There will be other new variants to be concerned about, but it doesn’t look like this is one of them.” 

As new variant spreads, a crucial drug to protect the most vulnerable goes vastly underused

(J. Harris: An IV drug against Covid for immunocompromised patients.)

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