If you want a massive infusion of optimism, drive out to ETBU just after sunset and have a look at the stunning campus and entire neighborhood. Anytime. If you go tonight, Saturday, there is an outdoor children’s play on the north side. Bring a chair and a sweater and a little dog food if you can manage it for your entrance ticket to the play. The campus looks better than the SMU campus. (And I know.) The lighting of the entire campus is both functional and esthetically pleasing. The landscaping is immaculate. The multiple buildings including student and faculty housing are elegant, appropriate, and well maintained. Incidentally, the view of the Hilltop Campus from the 8th floor of The Marshall Grand and its nursing school clearly demonstrates just how near and dear ETBU is to downtown Marshall. 

Evaluation of a COVID-19 Vaccine Campaign and SARS-CoV-2 Infection and Mortality Among Adults Aged 60 Years And Older in a Middle-Income Country

”…The present analysis shows that the pragmatic implementation of a vaccination plan including 3 different vaccine options in older adults in the City of Buenos Aires was associated with a significant reduction in documented COVID-19 infection and death from any cause as well as death presumably associated with COVID-19. These results suggest the need to implement mass vaccination strategies with the vaccines that each country has available in the shortest possible time….

TESTING NOTE: “People tested and reported to the national data system overwhelmingly do so because of suspected disease based on symptoms and not on population-based screening.’

(J. Harris: In a lower income population in Argentina, “Brand X” vaccines, especially when given in more that one dose, WORKED WELL.)

Contact and SARS-CoV-2 Infections Among College Football Athletes in the Southeastern Conference During the COVID-19 Pandemic

”…We report low SARS-CoV-2 interteam transmission risk in college football when rigorous and multipronged protection strategies were implemented, suggesting game play during a pandemic did not seed outbreaks across jurisdictions. Despite 12% of athletes testing positive for SARS-CoV-2, only 18 had competed during the preceding 48 hours, and no downstream infections to members of the opposing team were apparent. Actual contacts were exceedingly brief, even when accumulated over an entire game. In-game close contact was rare, not associated with SARS-CoV-2 transmission, and no CDC defined close contact exposures were observed….”

F.D.A. Clears First Coronavirus Vaccine for Young Children

(J. Harris: Vaccine should be available in doctors offices by week of 8 Nov.

SEVERAL TIMELY HOPKINS ARTICLES:

1. Children Drive Britain’s Longest-Running Covid Surge (New York Times) Britain is once again at the peak of a coronavirus surge, just over three months after all coronavirus restrictions were lifted on what Prime Minister Boris Johnson hailed as “Freedom Day.” Cases have stayed at high levels since then, with more than 20,000 new cases recorded each day. There are almost 9,000 Britons hospitalized with Covid-19 — the highest level since March, when the United Kingdom was in the midst of a long national lockdown. Unlike the rises and falls of previous periods of infection, the most recent wave shows the positive impact of Britain’s vaccination rollout: Far fewer Covid hospital admissions and deaths have followed the rise in cases than in previous waves. Still, health experts contend that the ongoing hospitalizations and deaths are burdening overstretched hospitals and could be reduced with basic measures.

2. Community Transmission And Viral Load Kinetics Of The SARS-CoV-2 Delta (B.1.617.2) Variant In Vaccinated And Unvaccinated Individuals In The UK: A Prospective, Longitudinal, Cohort Study (The Lancet) The SARS-CoV-2 delta (B.1.617.2) variant is highly transmissible and spreading globally, including in populations with high vaccination rates. We aimed to investigate transmission and viral load kinetics in vaccinated and unvaccinated individuals with mild delta variant infection in the community. Between Sept 13, 2020, and Sept 15, 2021, 602 community contacts (identified via the UK contract-tracing system) of 471 UK COVID-19 index cases were recruited to the Assessment of Transmission and Contagiousness of COVID-19 in Contacts cohort study and contributed 8145 upper respiratory tract samples from daily sampling for up to 20 days. Household and non-household exposed contacts aged 5 years or older were eligible for recruitment if they could provide informed consent and agree to self-swabbing of the upper respiratory tract.

3. What Is The Vaccine Effect On Reducing Transmission In The Context Of The SARS-CoV-2 Delta Variant? (The Lancet) COVID-19 vaccines that have obtained WHO emergency use listing appear to have high efficacy against severe disease and death, but lower efficacy against non-severe infections, and emerging evidence suggests that protection against non-severe disease declines faster following vaccination than that against severe disease and death. What is less clear is whether vaccination not only directly protects individuals but reduces the risk of infection among the contacts of vaccinated people, particularly with respect to the now dominant delta variant. Before the emergence of the delta variant, it was reported that after at least one dose of the mRNA vaccine by Pfizer or the adenoviral vector vaccine by Astra Zeneca, the risk of symptomatic cases in household contacts of vaccinated cases was about 50% lower than that among household contacts of unvaccinated cases.

From Becker:

Coronavirus can infect inner ear, study finds

AND LAST BUT NOT LEASED:

MORE MAN V WOMAN:

     You can ‘do’ your nails with a pocket knife. You have freedom of choice concerning growing a mustache… You can do Christmas shopping for 25 relatives on December 24 in 25 minutes. No wonder men are happier!

     Everything on your face stays its original color. The same hairstyle lasts for years, maybe decades. You only have to shave your face and neck. You can play with toys all your life. One wallet and one pair of shoes — one color for all seasons. You can wear shorts no matter how your legs look.

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HOT OFF THE PRESS FROM NYT

A cheap antidepressant lowers the risk of Covid hospitalization, a large study finds.

A CLOSER LOOK AT THE ANTIDEPRESSANT FOR COVID TREATMENT STUDY:

Fluvoxamine for outpatients with COVID-19: where do we stand?

”…Fluvoxamine is a selective serotonin reuptake inhibitor commonly indicated for the management of depression, obsessive-compulsive disorders, and other mental-health conditions. Owing to potential anti-inflammatory effects observed in initial experimental non-clinical studies,3 fluvoxamine has been proposed as a potential therapy for COVID-19…In trial results published in 2020, 152 outpatients with mild COVID-19 were randomly assigned to receive 100 mg fluvoxamine three times daily or matching placebo for 15 days.5 The primary outcome was clinical deterioration, defined as shortness of breath or hospitalisation for shortness of breath or pneumonia, and oxygen saturation less than 92% on room air or need for supplemental oxygen to achieve oxygen saturation of 92% or greater. Within 15 days, none of the participants who received fluvoxamine and 8·3% of those who received placebo reached the primary endpoint (absolute risk difference 8·7%; 95% CI 1·8%–16·5%; p=0·009). Despite the promising results, limitations such as low statistical power and missing data for the primary outcome precluded definitive conclusions about the efficacy of fluvoxamine for the treatment of COVID-19….[RECENTLY] TOGETHER, a randomised, adaptive, platform, placebo-controlled trial.6 A total of 1497 participants were randomly allocated to fluvoxamine, 100 mg twice daily, or matching placebo. All included participants had a positive test for SARS-CoV-2 and known risk factors for disease progression (including age ≥50 years, diabetes, hypertension, obesity, smoking, conditions associated with immunosuppression, unvaccinated status, or comorbidities such cancer, cardiovascular, pulmonary, and kidney disorders). Enrolment occurred in 11 cities in Brazil. The primary endpoint was a composite of COVID-19 emergency setting retention for greater than 6 h or hospitalisation (defined as either retention in a COVID-19 emergency setting or transfer to tertiary hospital) from COVID-19 up to 28 days. Using a Bayesian analytical approach, the authors found that the proportion of patients reaching the primary endpoint was lower for the fluvoxamine group compared with placebo (11% vs 16%; relative risk: 0·68; 95% Bayesian credible interval 0·52–0·88), with a probability of superiority of 99·8%….Despite the important findings from the TOGETHER trial, some questions related to the efficacy and safety of fluvoxamine for patients with COVID-19 remain open. The definitive answer regarding the effects of fluvoxamine on individual outcomes such as mortality and hospitalisations still need addressing. In addition, it remains to be established whether fluvoxamine has an additive effect to other therapies such as monoclonal antibodies7 and budesonide,8 and what is the optimal fluvoxamine therapeutic scheme. Finally, it is still unclear whether the results from the TOGETHER trial extend to other outpatient populations with COVID-19, including those without risk factors for disease progression, those who are fully vaccinated, and those infected with the delta variant or other variants.

VARIOUS TRADE NAMES FOR FLUVOXAMINE

 FROM THE NYT  A 10-day course of the drug costs about $4.

LASTLY:

MEN V WOMEN:

Car mechanics tell you the truth. You never have to drive to another gas station restroom because this one is just too icky. You don’t have to stop and think of which way to turn a nut on a bolt. Wrinkles add character. Wedding dress — $5,000 Tux rental — $100. People never stare at your chest when you’re talking to them.

 New shoes normally don’t cut, blister, or mangle your feet. One mood all the time. Phone conversations are over in 30 seconds flat. You know stuff about tanks. A five-day vacation requires only one suitcase. You can open all your own jars.

You get extra credit for the slightest act of thoughtfulness. If someone forgets to invite you, he or she can still be your friend. Your underwear is $8.95 for a three-pack. Two pairs of shoes are more than enough. You almost never have strap problems in public. You are unable to see wrinkles in your clothes.

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MATTHEWSON DRUG STORE HAS MODERNA VACCINE

I am told that on Tuesdays, this local drug store gives Moderna as well as FLU SHOTS

all day. 

LESS DANGER OF NEUROLOGICAL SYMPTOMS WITH VACCINE THAN WITH COVID DISEASE

Early Treatment for Covid-19 with SARS-CoV-2 Neutralizing Antibody Sotrovimab

”…Among high-risk patients with mild-to-moderate Covid-19, sotrovimab reduced the risk of disease progression. No safety signals were identified….”

FROM HOPKINS CITATIONS TODAY:

1. PANDEMIC CONTINUES During its ninth meeting regarding COVID-19, a WHO Emergency Committee of advisors agreed that the pandemic is “far from finished,” 21 months after the group initially named the disease a public health emergency of international concern (PHEIC). Noting that progress has been made in combating the virus, the group called on the international community to use all available tools to mitigate the pandemic’s impacts and recognized the additional burden on addressing humanitarian emergencies, population migration and displacement, and other crises. The committee also expressed concern over challenges responding to the pandemic in the Africa region, including access to sufficient vaccines, diagnostics, and treatments, as well as adequate surveillance and monitoring capabilities. COVID-19 likely will move from a pandemic to an endemic disease at some point in the future, although experts agree that the benchmarks for determining endemicity are unclear. The WHO Emergency Committee will meet again in 3 months, or sooner as needed, to reevaluate the state of the COVID-19 pandemic.

2. EPI UPDATE The WHO COVID-19 Dashboard reports 244.9 million cumulative cases and 4.97 million deaths worldwide as of October 28. Global weekly incidence increased by 4.81% compared to the previous week, and mortality increased by 5.27%. After falling the previous week, these increases show the curve trending upward again, with numbers of new cases and deaths close to where they were at the end of September.

Global Vaccination

The WHO reported 6.7 billion cumulative doses of SARS-CoV-2 vaccines administered globally as of October 25. A total of 3.8 billion individuals have received at least 1 dose, and 2.85 billion are fully vaccinated. 

LASTLY:

MEN ARE HAPPIER PEOPLE:

Men Are Just Happier People! What do you expect from such simple creatures? Your last name stays put. The garage is all yours. Wedding plans take care of themselves. Chocolate is just another snack. You can never be pregnant. You can wear a white T-shirt to a water park. You can wear NO shirt to a water park.

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A key F.D.A. advisory panel recommended the use of the Pfizer vaccine in 5- to 11-year-olds, who could start getting shots late next week.

Letter From Australia: A Never-Ending Pandemic?

(J. Harris: This is an excellent, readable, short letter regarding the Australian Covid experience.)

China locks down a northwestern city to subdue a small outbreak.

AND LASTLY:

GREETING S FROM THE FURHER BUNKER COMPLETE WITH GUARD DOG. We had a bit of wind this morning, but the bunker is warm and dry and the tornado went around us. 

MEANWHILE AT THE MOVIES:

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WHEN WILL OUR NEXT LOCAL COVID SPIKE OCCUR? 

A. NEVER

B. WHEN THE WEATHER GETS COLD

C. IN ABOUT 6 MONTHS WITH A NEW VARIANT

ANSWER: ???  BUT SINCE WE ARE LARGELY UNVACCINATED LOCALLY,  IT WILL OCCUR AND IT WILL ALSO INVOLVE REPEAT INFECTIONS IN UNVACCINATED FOLKS. PRIOR DISEASE IS NOT PROTECTIVE. 

A Covid update (J. Harris: Excellent. Current.)

HOSPITAL DEPARTMENT CLOSURES (MOSTY OBSTETRICS)

(J. Harris: “Small town hospitals, not necessarily ‘Rural’ often are not busy enough to remain open.”

Long-term consequences of the misuse of ivermectin data

”…On March 31, 2021, WHO advised that ivermectin should only be used within clinical trials and not as part of routine clinical practice.4 This advice was followed by the manufacturer, Merck, that stated on Feb 4, 2021, that there is “no meaningful evidence for clinical activity or clinical efficacy in patients with COVID-19 disease”.5 Despite this, ivermectin is being routinely used in some Latin American settings amid recommendations from some governments and health professionals….Sustained misinformation can lead to diversion of limited health-care and government resources to addressing rumours rather than making genuine public heath progress. Proactive health promotion and education is needed right now to ensure that locally trusted actors and communicators (including, but not limited to, health-care workers) are aware of the uncertainty around the ivermectin evidence base for managing COVID-19, and that it remains a vital medicine for managing neglected tropical disease. Where advocacy emerged from official or high-level sources during the COVID-19 pandemic, we have concerns that the likelihood of mistrust within communities will increase. International and national global health policy stakeholders must be made aware that this mistrust could be an issue that needs addressing in both the short-term and medium-term future….”

If You’re Unvaccinated for Covid Can Your Doctor Refuse to Treat You?

LASTLY:

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FROM BECKER CITATIONS:

1. What Amazon’s chief health officer says is the biggest workplace health challenge of the century

2. COVID-19 reinfection likely for unvaccinated, study suggests

”…”Reinfection can reasonably happen in three months or less… “Therefore, those who have been naturally infected should get vaccinated. Previous infection alone can offer very little long-term protection against subsequent infections…Researchers also predicted reinfection will become “increasingly common” as COVID-19 transitions into an endemic disease. 

FROM NEJM:

Uncomfortable Truths — What Covid-19 Has Revealed about Chronic-Disease Care in America

(J. Harris: A comprehensive review of the state of medical care in the US with suggestions for needed improvements. Readable.)

”…Covid-19 also made us walk backward and see the larger worldview, in the process revealing uncomfortable truths about the U.S. health care system — including our approach to managing chronic diseases…”

The Flawed Science of Antibody Testing for SARS-CoV-2 Immunity

(J. Harris: A very readable summary of Covid related antibodies and questions. I edited it a little. A few readers are interested in this area of study.)

”…“Individuals can have neutralizing antibodies and still get infected,…. “We know that higher antibody levels, specifically higher neutralizing antibody levels, are better. But we don’t know how high is high enough….So far, only one commercially available SARS-CoV-2 antibody test, from Ortho-Clinical Diagnostics, has been calibrated to the World Health Organization’s reference standard… the test sold through Epitome Risk Solutions’ subsidiary, FourthWall Testing, appeared to be an at-home version of the FDA-authorized GenScript cPass SARS-CoV-2 Neutralization Antibody Detection Kit, a surrogate assay that indirectly measures neutralizing antibodies. According to an FDA spokesperson, the cPass test does not have authorization for sample collection at home. And despite Epitome’s marketing hype, GenScript states that customers “should not interpret the results of this test as an indication or degree of immunity or protection from reinfection….[Actually],The immunological component that is associated with protection against severe disease is immunological memory B cells,.. “These cells aren’t making antibodies, but they remember that they have seen this SARS-CoV-2 spike protein before….circulating antibodies against the virus peak 2 or 3 months after natural infection or vaccination and then begin to decrease. But the immune system’s ability to mount a defense lasts longer. “Just because we’re seeing a decrease in antibody levels doesn’t necessarily mean that your immunity is gone,…We know from a lot of studies now that your memory T cells and memory B cells persist for at least 6 to 8 months and continue to evolve and mature, and none of that information is relayed by an antibody test….that reinfection with the virus activates memory B cells to differentiate into antibody-secreting cells. Because this process can take 3 to 5 days, it doesn’t stop SARS-CoV-2 infections from occurring, but it does help tamp down severe COVID-19. And that’s a success story….“The goal of the vaccine is to protect you against serious illness….Managing expectations for COVID-19 vaccines may be in order. “I think there was maybe an initial misunderstanding amongst the public that this would just halt all infections, and that’s just not the case,…     Ultimately…advice for avoiding a SARS-CoV-2 infection in the first place comes down to a now-familiar combination of measures: “getting vaccinated, frequently washing your hands, wearing a mask, and avoiding high congregate in-door settings, particularly in areas that have high case rates….”

AND LAST BUT NOT LEASED:

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