1. Higher Stroke Risk Linked to Asymptomatic COVID-19 in Younger Men (CIDRAP) Men under 50 recovering from asymptomatic COVID have double the likelihood of acute ischemic strokes (AIS) compared with men of the same age without COVID infection, according to a study last week in JAMA Network Open. Eighteen South Asian men were treated in Singapore for AIS a median of 54.5 days after their initial COVID-19 diagnosis. Twelve (67.7%) had no known pre-existing risk factors. While AIS is a known neurologic complication from symptomatic COVID-19, none of these men experienced respiratory symptoms during their infection. 

2. U.S. to Share AstraZeneca Covid-19 Vaccine Doses With World (WSJ)

The Biden administration is making plans to share millions of doses of the AstraZeneca Covid-19 vaccine and preparing a major effort to help India fight a resurgence of the virus, as calls mount for the U.S. to do more to assist developing countries in confronting the pandemic. The White House said Monday it would share as many as 60 million doses of the AstraZeneca vaccine with the rest of the world. U.S. officials also said they were exploring options to urgently dispatch oxygen and related supplies to India.

3. Brazil Rejects Russia’s Sputnik V Coronavirus Vaccine, Citing Safety Concerns (The Washington Post) Brazilian health regulators have issued a scathing rebuke of Russia’s Sputnik V coronavirus vaccine, rejecting the shot’s approval in a decision late Monday that could impact its use elsewhere in the world. The ruling from Brazil’s Health Regulatory Agency, or Anvisa, cited a range of concerns with the vaccine’s development and production, including what it said was a lack of quality control and efficacy data, as well as little if any information on the shot’s adverse effects. It was not the first time that health authorities have raised concerns about Sputnik V, which was hailed as “safe” and more than 91 percent effective in a peer-reviewed article in the Lancet in February.


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NURSING HOME OUTBREAKS Health officials in Kentucky and experts at the US CDC published a case study of an outbreak at a long-term care facility (LTCF) initiated by an unvaccinated employee. At the facility, 90% of the residents and 53% of the staff received 2 doses of SARS-CoV-2 vaccine. Routine testing identified the outbreak, which began in an unvaccinated and symptomatic healthcare worker. Ultimately, the outbreak involved 46 total cases, including 26 residents and 20 facility personnel. Notably, 18 of the residents and 4 personnel received their second dose of the vaccine more than 14 days before the outbreak. Three (3) residents died, including 2 who were unvaccinated.

The risk of infection among unvaccinated residents was 3 times higher than among vaccinated residents. Similarly, the risk among unvaccinated personnel was 4 times higher than among vaccinated personnel. For this outbreak, the vaccine’s effectiveness against SARS-CoV-2 infection was estimated to be 66% among residents and 76% among employees, and the effectiveness against symptomatic COVID-19 disease was 86.5% among residents and 87% among employees. This is in line with the expected effectiveness based on clinical trial efficacy data. The authors conclude that low vaccination coverage among employees at LTCFs could facilitate introduction of SARS-CoV-2, which could result in outbreaks, even among resident populations with high vaccination coverage. While the authorized SARS-CoV-2 vaccines are highly effective*, COVID-19 risk remains, particularly among individuals at elevated risk for exposure and severe disease. Even as vaccination coverage increases, it is critical to maintain COVID-19 risk mitigation measures until sufficient community protection is in place to bring the pandemic under control. 

*For those vaccines with publicly available Phase 3 clinical trial data. 

1115 Waiver Rescission – What It Means for Texas

(J. Harris: I’m not interested in discussing politics, but Marshall hospitals treat many uninsured patients as well as a large number of Medicaid-funded patients — whose payments are inadequate and not capable of paying a significant amount of the expenses incurred. Marshall is too close to hospitals in Longview and Shreveport to be considered “Rural,” a designation that would help us financially. Around ten years ago, a good local hospital administrator told me that Texas’ approach to Medicaid would bankrupt our hospital as well as many other smaller Texas hospitals. He was correct in his prediction. Many smaller hospitals have closed.  In my opinion, only partially informed, had  Christus not bought the Good Shepherd hospitals in Longview and Marshall, I’m not sure that either would still be functional. What do you think? What do you think about increasing Texas’ participation in Medicaid?  

The article below is written by Tom Luce who I know and trust:

Medicaid expansion picks up bipartisan support in the Texas House, but hurdles remain


If at first you don’t succeed, destroy all evidence that you tried.

Bills travel through the mail at twice the speed of checks.


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