FROM BECKER:

COVID-19 deaths up 25% nationwide: 9 CDC stats to know

FROM NYT:

1. Easy Covid entry rules help make the Dominican Republic a rare pandemic success story.

 2. New York coronavirus cases fell by 50 percent in the past week.

Eastern states that were affected early by the highly contagious variant have seen especially pronounced declines, with the seven-day daily average of new cases down more than 70 percent over the last two weeks in New York and New Jersey, according to a New York Times database.

HOW LONG DOES A GOOD MAKS LAST?

The Centers for Disease Control and Prevention has said that health workers coping with mask shortages can reuse respirator masks up to five times…Based on the five-day rule for health workers, and assuming they wear the mask all day over an eight-hour shift, that suggests about 40 hours of use per mask…”

FROM JAMA 

Assessment of a Smartphone-Based Loop-Mediated Isothermal Amplification Assay for Detection of SARS-CoV-2 and Influenza Viruses

”…The smartphone-based LAMP assay detection system consists of a hot plate, cardboard box, and LED lights.

 The system is inexpensive to set up and portable; it can be fabricated for less than $100 (in addition to the smartphone cost, which is approximately $200 used or approximately $400 new). The smartphone-based LAMP assay thus offers the potential to leverage a readily accessible technology to inexpensively deliver state-of-the-art nucleic acid diagnostics for quantitative pathogen detection at the POC. As reported in this study and by others, SARS-CoV-2 can be detected in saliva samples.27,45,46 Saliva testing has numerous advantages relative to nasopharyngeal swabs, including cost and ease of use (self-collection vs trained personnel and PPE for sample collection). Furthermore, saliva sampling circumvents the need for specialized swabs and reagents, test components that are vulnerable to supply-chain disruptions and resource limitations…….Moreover, as new variants of SARS-CoV-2 virus emerge, testing and detection remain at the forefront of pandemic control efforts. The smartphone-based LAMP assay thus offers the potential to provide a critical tool to mitigate further stages of the COVID-19 pandemic. Additionally, the LAMP assay can be readily engineered to address novel CoV-2 variants and other pathogens with pandemic potential, including influenza.

A SIMPLER ARTICLE TO EXPLAIN THE ABOVE ARTICLE FOR US OLD FOLKS (click here)

FROM HOPKINS

Global Health Security 1. ECDC Details Covid Vaccine Payoffs, Plan For Post-Peak Phase (CIDRAP) In Europe, the Omicron variant is fueling infection rates that are three times higher than at any other stage of the pandemic, and vaccination is the key to preventing serious health outcomes and disruptive staff shortages, the European Centre for Disease Prevention and Control (ECDC) said today in its latest COVID-19 risk assessment. Vaccine uptake across the European region has only reached 70%, and booster dosing is increasing rapidly, but has only reached 50% of adults, the ECDC said. Vaccine uptake among European populations is uneven, and countries with the lowest vaccination rates will face the highest pressure, the group said. The ECDC suggests booster doses be given 3 months after the primary series, a shorter interval than recommended by some health groups. Modeling estimates suggest that booster dosing though early January cut hospitalization admissions by 500,000 to 800,000. The ECDC also estimates that extending boosters to all previously vaccinated people could reduce admissions by another 300,000 to 500,000. 2. African Coronavirus Surveillance Network Provides Early Warning for World (Nature Biotechnology) South Africa’s swift genomic sequencing was instrumental in alerting the world in December to an unusual genome profile present in samples tested for coronavirus. The Network for Genomic Surveillance in South Africa first spotted the mutated variant in sequencing data from Botswana. As the outbreak continues, national laboratories and the Africa Centres for Disease Control and Prevention (Africa CDC) have joined efforts to ramp up Africa’s sequencing response. This larger Africa-wide network for viral sequencing, which was launched by Africa CDC, the World Health Organization and a group of public, private and non-profit organizations in October 2020, has made rapid progress on the continent. The aim is not only to accelerate surveillance for COVID-19, but also to build the infrastructure and the expertise in next-generation sequencing to confront future epidemic threats as well as to tackle endemic diseases, such as AIDS, tuberculosis, malaria and cholera.   AND LAST BUT NOT LEASED:

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IN AREA G  AND OTHER UNVACCINATED AREAS IN EAST TEXAS, COVID DISEASE IS NOT IMPROVED, YET

BECKERS ON FLU PLUS COVID= 28% MORTALITY

J. Harris: Have you had your flu shot? 

Children Hospitalized with COVID-19: Clinical Characteristics and Outcomes

ORIGINALLY FROM NEJM. EDITED BY JOURNAL WATCH

Many had underlying medical conditions, some were coinfected with other viruses, and nearly one third required ICU care.

As of January 2022, over 9.5 million COVID-19 cases in children have been reported in the U.S., with >30,000 hospitalizations and >750 deaths (American Academy of Pediatrics report. opens in new tab).

Researchers identified 915 children and adolescents admitted to six U.S. children’s hospitals during July and August 2021 with SARS-CoV-2 infections. These infections were identified incidentally in 19%, and 3% had multisystem inflammatory syndrome. Among the remaining 713 children, key findings included the following:

38% were 12 to 17 years old, 20% were 5 to 11, 17% were 1 to 4, and 25% were younger than 1 year.

68% had underlying medical conditions, most commonly obesity (32%); 12- to 17-year-olds had the highest obesity rate (61%).

16% had viral coinfections, most commonly respiratory syncytial virus; children <5 years had the highest coinfection rate (34%).

30% required intensive care unit (ICU) admission (median stay, 3 days).

Patients with underlying medical conditions were more likely to require ICU care than those without (35% vs. 18%), and patients with obesity had double the median hospital stay as did nonobese patients (4 vs. 2 days).

8 children required extracorporeal membrane oxygenation, and 11 (1.5%) died.

Only 1 child was fully vaccinated.

COMMENT

”This snapshot of the summer Delta variant surge demonstrates the risk for serious illness in children with COVID-19, particularly those with an underlying medical condition. It also reminds us that SARS-CoV-2 is not the only virus circulating, which complicates the clinical presentation of children with respiratory symptoms. This study was done shortly after the vaccination recommendation for adolescents and before younger children became eligible. Given the recent rise in pediatric cases and hospitalizations and the safety of vaccine in 5- to 11-year-olds (almost no serious events following >8 million doses; MMWR Morb Mortal Wkly Rep 2021; 70:1755. opens in new tab), we must encourage child vaccination to prevent hospitalization and death from COVID-19.”

Early Remdesivir to Prevent Progression to Severe Covid-19 in Outpatients

CONCLUSIONS

Among nonhospitalized patients who were at high risk for Covid-19 progression, a 3-day course of remdesivir had an acceptable safety profile and resulted in an 87% lower risk of hospitalization or death than placebo.

CORONA VIRUS UPDATE/POD CAST

Interview with Dr. David Morens on the need for developing broadly protective coronavirus vaccines.

J. Harris: This is an excellent, easy to understand, short Pod Cast from NEJM which dicusses the Corona Virus history over the years, Vaccines, Bats, needs and the like. 

Other Pod Casts are available as well. 

FROM BECKER:

Don’t count out delta just yet

(J. Harris-Data largely from “The Atlantic.”

AND LAST BUT NOT LEASED:

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Numbers on the 27th are no worse. Barely.

FROM TEXAS TRIBUNE

Omicron pushes Texas ICUs to the brink

A staffing crisis and the surge from the omicron variant have pushed the number of Texas ICU beds to a new record low. The shortage affects not just patients with the coronavirus, but every Texan seeking serious medical care.

”…The number of Texas intensive care unit beds available for adult patients is at an all-time low for the pandemic, with only 259 staffed beds open across the state as of Wednesday, as hospitals fight a historic staffing crisis and more unvaccinated people infected by the omicron variant pour into hospitals…That’s 11 fewer beds than the previous record set in September during the deadly surge of the delta variant of COVID-19…

In Dallas-Fort Worth area hospitals, most of the city’s major hospitals are all reporting ICU capacity levels over the 90% mark as of earlier this month. A little less than half of those patients have COVID-19… That proportion of COVID-19 patients in ICU matches last year’s peak in the number from last year…But while omicron is putting fewer patients into the ICU than in previous surges, there are also fewer ICU beds that are able to be staffed due to a nursing shortage, officials say — and the sheer number of omicron cases is pushing patient counts higher.

FROM NYT:

1. UPDATE: Here’s what to do if you lose your U.S. vaccination card.

2. A new poll asks: Why do some vaccinated people not get boosters?https://www.nytimes.com/live/2022/01/27/world/omicron-covid-vaccine-tests/a-new-poll-asks-why-do-some-vaccinated-people-not-get-boosters

”…People 65 and older were most likely to report being boosted, the report found…The lag reflects a pervasive pandemic fatigue that emerged elsewhere in the Kaiser poll. More than three in four adults said they believed it was inevitable that most people in the United States will contract Covid. More people reported feeling worried about the impact of the Omicron variant on the economy and hospitals than on their personal health….The poll was based on a telephone survey of 1,536 adults conducted from Jan. 11 to 23. Its booster rates are higher than those reported by the Centers for Disease Control and Prevention. According to the C.D.C.’s data, about half of fully vaccinated adults in the country have received a booster…The poll was based on a telephone survey of 1,536 adults conducted from Jan. 11 to 23. Its booster rates are higher than those reported by the Centers for Disease Control and Prevention. According to the C.D.C.’s data, about half of fully vaccinated adults in the country have received a booster…”

FROM BECKER:

1. Los Angeles braces for Super Bowl amid omicron surge

2. Next variant could be more transmissible than omicron, WHO says

”…”Omicron will not be the last variant that you will hear us talking about,” Maria Van Kerkhove, PhD, the WHO’s technical lead on COVID-19, said Jan. 25. “The next variant of concern will be more fit, and what we mean by that is it will be more transmissible, because it will have to overtake what is currently circulating……What’s more important, however, is whether future variants will cause more or less disease severity, Dr. Van Kerkhove said, adding that global health officials do expect there to be more immune escape with future variants, which means vaccines may be less effective against them. She emphasized the importance of interventions, such as ramping up global vaccination coverage, to slow the current spread and prevent the emergence of new variants.”

HOPKINS SELECTIONS ON SAME SUBJECT AS “2” ABOVE:

While there is optimism among some public health experts that the rapid rise and fall of the Omicron surge in some regions could usher in an end to the pandemic, the WHO determined last week that the COVID-19 pandemic continues to constitute a Public Health Emergency of International Concern (PHEIC). Other experts warn that as long as the threat of new variants exists, calls for reaching COVID-19 endemicity are misguided….COVID-19 hospitalizations in the US are down 7.7% this week over last, with a 7-day average of 19,640 new hospitalizations per day. The recent surge in current hospitalizations appears to have peaked around January 19, down 1.7% to an average of 142,194 for the week ending January 24. According to analysis from The New York Times, the overall downward trend in hospitalizations belies the reality in some regions, where the number of cases and hospitalizations continue to grow significantly.

(J. Harris: We’re still at the peak in Area G and nearby areas including LA and Dallas.)

FROM HOPKINS RE CDC REGARDING EFFICIECY OF VACCINES AGAINST OMICRON

”…[The study] was not able to directly assess the impact that vaccines had on disease severity markers or hospital stay lengths, but the authors posit that decreased admissions to the ICU and lower overall hospital stays during the Omicron surge can likely be attributed to higher vaccine coverage as well as higher levels of infection-acquired immunity. Supporting this hypothesis, high relative increases in hospital admittance were only observed in children 0- to 4-years-old who are currently not eligible for vaccination.

FROM HOPKINS ON MORE 4TH COVID VACCINATIONS IN OLD AND YOUNG:

ISRAEL Israel’s Ministry of Health on January 25 said its vaccine advisory panel has recommended making all adults eligible to receive a fourth dose of SARS-CoV-2 vaccine. If the ministry approves the recommendation, it would be the first country in the world to make a fourth vaccine dose available to all adults. Israel already offers fourth doses to people aged 60 and older, healthcare workers, and people with compromised immune systems. About 600,000 Israelis have already received a fourth dose. Over the weekend, the health ministry shared preliminary data from its own researchers suggesting a fourth dose provides 3 to 5 times as much protection against severe disease in older adults when compared with those in the same age group who had received a booster dose at least 4 months prior. It is not clear when the ministry’s director-general will decide on the panel’s recommendation. Israel is in the midst of a surge in new COVID-19 cases driven by the Omicron variant.

COVID-19 and the Common Cold—Preexisting Coronavirus Antibodies May Hinder SARS-CoV-2 Immunity

”…Four seasonal coronaviruses—2 of which are betacoronaviruses, like SARS-CoV-2—cause about 30% of common colds. Instead of helping to fight off COVID-19, antibodies to these pathogens may interfere with the SARS-CoV-2 immune response, a recent study of health care workers suggests…Together, these data indicate that pre-existing betacoronavirus IgA and IgG correlate with a higher antibody response to SARS-CoV-2 following infection, but not vaccination,…According to McGargill, the finding that immunity to common cold coronaviruses is boosted early after SARS-CoV-2 infection indicates that memory B cells contribute to the initial immune response. What’s more, the researchers did not observe many IgM antibodies before IgG or IgA antibodies, which also suggests that the initial antibody response is derived from memory B cells rather than more adaptable naive B cells. All this indicates that part of the SARS-CoV-2 immune response is imprinted by past bouts of the common cold…”

What the Analysis Found

• Almost all participants had prior immunity to all 4 common cold coronaviruses but the antibody levels varied dramatically among them.
• Nearly every participant had IgG antibodies to all 4 seasonal viruses. IgM antibodies were the least prevalent.
• Preexisting seasonal betacoronavirus antibodies increased after SARS-CoV-2 infection, an immunological phenomenon known as “back-boosting.” In several participants, IgG antibodies against 1 of the seasonal betacoronaviruses increased within 5 days of infection. For more than 50% of the patients, IgA antibodies against both seasonal betacoronaviruses increased within 10 days.
• However, high levels of preexisting common cold antibodies were not associated with protection from SARS-CoV-2 infection.
• In contrast, high levels of preexisting common cold antibodies were associated with higher antibody levels against SARS-CoV-2 after infection, which in turn were an indicator of greater disease severity. But few participants became severely ill, which limited the ability to examine whether the common cold antibody levels factored into severe COVID-19.
• Neither baseline seasonal antibody levels nor increased levels after vaccination correlated with postvaccination SARS-CoV-2 antibody levels.
• In the animal model, prior immunization with common cold coronavirus proteins profoundly inhibited the mice from generating SARS-CoV-2 neutralizing antibodies.
• “Together, these data indicate that pre-existing betacoronavirus IgA and IgG correlate with a higher antibody response to SARS-CoV-2 following infection, but not vaccination,” the researchers wrote. “As increased SARS-CoV-2 antibodies after infection correlated with greater disease, these findings raise the possibility that pre-existing betacoronavirus IgG and IgA negatively impact the immune response to SARS-CoV-2, which results in greater duration of antigen and therefore more SARS-CoV-2 antibodies.”
•  
• According to McGargill, the finding that immunity to common cold***** coronaviruses is boosted early after SARS-CoV-2 infection indicates that memory B cells contribute to the initial immune response. What’s more, the researchers did not observe many IgM antibodies before IgG or IgA antibodies, which also suggests that the initial antibody response is derived from memory B cells rather than more adaptable naive B cells. All this indicates that part of the SARS-CoV-2 immune response is imprinted by past bouts of the common cold.
•  
• To McGargill and her team, the data collectively suggest that variations in levels of preexisting immunity to common cold coronaviruses are 1 factor that may affect outcomes following SARS-CoV-2 infection. Prior immunity to a related, yet distinct, [COLD] coronavirus could hinder immunity to a new coronavirus.
• 
  
• TEARS, TEARS, AND TARES:

SARAH PALIN TEMPTS FATE

At a conservative conference last month in Phoenix, Ms. Palin told the crowd, “It’ll be over my dead body that I’ll have to get a shot.” 

J. Harris: Could this ridiculous woman have been in NY to audition for “Saturday Night Live?” I wonder how much it would cost to ship a body from New York to Alaska?

II’ve started telling everyone about the benefits of eating dried grapes. It’s all about raisin awareness.

• Life is like a jar of jalapeno peppers.  What you do today may be a burning issue tomorrow

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WE HAVEN’T PIVOTED YET, BUT GETTING CLOSER

Fall Influenza A(H3N2) Outbreak at a Midwestern University

J. Harris: Don’t forget your flu shot; you can get these in almost any pharmacy or clinics.

Free N95 masks are arriving at pharmacies and grocery stores. Here’s how to get yours

”…Kroger stores with pharmacies will also be doling out the masks throughout the chain’s Midwest and Southwest locations…. the first allotment of masks is expected to arrive on Thursday….Walgreens… told NPR the masks will be made available for free while supplies last…”We expect the first stores to begin offering masks on Friday, Jan. 28 and will continue on a rolling basis in the days and weeks following,… customers are limited to three masks per person. “Participating stores will have signage indicating mask availability.”

Similarly, CVS Pharmacy locations will also be offering free N95 masks in the coming weeks…”

Omicron Survives Longer on Plastic, Skin Than Other COVID Variants

Lung Transplantation for Covid-19–Related Respiratory Failure in the United States”…These findings indicate that from August 2020 through September 2021, approximately 7% of lung transplantations nationally were performed in patients with respiratory failure due to Covid-19 (Table S3). Because the 3-month survival among these patients approached that among patients who underwent lung transplantation for reasons other than Covid-19, we believe that lung transplantation may be an acceptable treatment for selected patients with irreversible respiratory failure due to Covid-19…”

There’s a new version of omicron but so far it doesn’t appear to be more dangerous”…Known as BA. 2, the new version of the virus is a descendant of the omicron variant responsible for huge surges of covid-19 in the United States and elsewhere around the globe. Virologists are referring to the original omicron variant as BA. …“The BA. 2 descendant lineage, which differs from BA. 1 in some of the mutations, including in the spike protein, is increasing in many countries,” the WHO wrote on its website. ..At least three cases have been found in the United States at Houston Methodist Hospital in Texas, which also is studying the genetic makeup of virus samples from its patients…

FROM BECKER:

1. Don’t let the term fool you — ‘Endemic’ can be dangerous

2. Omicron subvariant: What we know now

From NYT:

Here’s what to do if you lose your U.S. vaccination card.

FROM HOPKINS:

1. Clinical Outcomes Among Patients With 1-Year Survival Following Intensive Care Unit Treatment for COVID-19 (JAMA) At 1 year after ICU treatment for COVID-19, physical symptoms were reported by 182 of 245 patients (74.3% [95% CI, 68.3% to 79.6%]), mental symptoms were reported by 64 of 244 patients (26.2% [95% CI, 20.8% to 32.2%]), and cognitive symptoms were reported by 39 of 241 patients (16.2% [95% CI, 11.8% to 21.5%]). The most frequently reported new physical problems were weakened condition (95/244 patients [38.9%]), joint stiffness (64/243 patients [26.3%]) joint pain (62/243 patients [25.5%]), muscle weakness (60/242 patients [24.8%]) and myalgia (52/244 patients [21.3%]).

2. Children and COVID-19: State-Level Data Report (American Academy of Pediatrics) Reported child COVID-19 cases among children have spiked dramatically across the United States during the Omicron variant surge. Child cases continued to rise the past week, now over 1.1 million cases were reported, nearly five times the rate of the peak of last winters’ surge. For the week ending January 20th, nearly 1,151,000 child COVID-19 cases were reported. This number is a 17% increase over the 981,000 added cases reported the week ending January 13th and a doubling of case counts from the two weeks prior. Over 10.6 million children have tested positive for COVID-19 since the onset of the pandemic; over 2 million of these cases have been added in the past 2 weeks.

3. It’s Too Early to Tell Whether CBD Helps Against Covid-19 — But Researchers Worry That Won’t Stop CBD Makers (STAT News) The scientists stressed the caveats that early-stage research demands: the compounds they had studied showed hints — in cells in lab dishes and in animals — of being able to combat the coronavirus. Definite answers could only come from clinical trials. But the compounds were CBD and other marijuana and hemp derivatives, so the news took off. Kimmel and Colbert cracked jokes. The studies received coverage in outlets from Fox News to The Daily Beast.

TOMORROW COVID AND THE COMMON COLD FROM JAMA and A CLOSER LOOK AT PEDIATRIC COVID ON SATURDAY.

AND LAST BUT NOT LEASED:

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We Haven’t Peaked Out in Area G (Yet)

Booster Shots 90% Effective at Preventing Omicron Hospitalizations: CDC Data

(J. Harris: Readable WebMD  article.)

COVID ATTITUDE POLL

(J. Harris: Contains some surprises.)

Why it’s so hard for hospitals to track incidental COVID-19 cases

SOUTH KOREA CHANGES TESTING TACTICS IN FACE OF INCREASED OMICRON

Rapid antigen tests will be administered only to low-risk groups, while polymerase chain reaction, or P.C.R., tests will continue to be given to high-risk groups, including those over age 60 and people with underlying health problems. Until now, P.C.R. tests had been available to both groups……While P.C.R. tests must be processed by a lab and results can take more than 24 hours to deliver, rapid antigen tests can be taken at home, and testers can get results within minutes. Some have questioned the accuracy of the rapid tests, which are less sensitive than P.C.R. tests, but experts say both are highly reliable.

Will Omicron Leave Most of Us Immune?

“The variant is spreading widely, but won’t necessarily give us strong protection from new infections.”

By Katherine J. Wu

(J. Harris: Ms Wu is a noted Covid scholar and writer) 

”…Even before Omicron hit the United States in full force, most of our bodies had already wised up to SARS-CoV-2’s insidious spike—through infection. “This wave will not be the last…..A new antibody-dodging variant, for one, could still show up to clobber us. And nearly everyone having some form of spike in their past isn’t as protective as it might sound…..While a duo of vaccines, for instance, isn’t enough to reliably guard against less severe Omicron cases, a trio of shots seems to do the trick for most. It also pays to pace encounters judiciously. Crowd the second and third too close together, for instance, and the latter’s effect may be blunted; a several-months-long wait, meanwhile, can supercharge the body’s response by allowing immune cells sufficient time to mull what they’ve learned…

” Through first, second, and now third doses, we’ve managed to concentrate immune protection among the privileged. Shots remain proportionally sparse in poor communities, rural communities, low-resource communities; unvaccinated people also tend to concentrate geographically,.. By one estimate, a third to half of all Americans may end up infected by Omicron by mid-February. The variant will not encounter all of those people on equal immunological footing, nor will it create such footing. “Some people will be left with immune houses of straw, others of wood, others of brick…’’

Free N95 masks now available at some U.S. pharmacies; wider rollout expected soon

(J. Harris: Finally.)

Researchers identify biological factors that may increase a person’s chances of having long Covid.

(J. Harris: Note from NYT concerning article in CELL.)

Now, a team of researchers who followed more than 200 patients for two to three months after their Covid diagnoses are reporting that they have identified biological factors that might help predict whether a person will develop long Covid….The factors researchers identified included the level of coronavirus RNA in the blood early in the infection; the presence of certain antibodies that mistakenly attack tissues in the body; the reactivation of Epstein-Barr virus; and Type 2 diabetes.

FROM THE LANCET:

(J. Harris: Very readable article which, if correct, could destroy the upcoming Olympics in China. Mostly, I agree with this sensational article.)

COVID-19 will continue but the end of the pandemic is near

”…The unprecedented level of infection suggests that more than 50% of the world will have been infected with omicron between the end of November, 2021 and the end of March, 2022….Understanding the burden of omicron depends crucially on the proportion of asymptomatic infections. A systematic review based on previous SARS-CoV-2 variants suggested that 40% of [DELTA] infections were asymptomatic.3 Evidence suggests that the proportion of asymptomatic infections is much higher for omicron, perhaps as high as 80–90%…Despite the reduced disease severity per infection, the massive wave of omicron infections means that hospital admissions are increasing in many countries and will rise to twice or more the number of COVID-19 hospital admissions of past surges in some countries … In countries where all hospital admissions are screened for COVID-19, a substantial proportion of these admissions will be among individuals coming to hospital for non-COVID-19 reasons who have asymptomatic SARS-CoV-2 infection… 

‘’…Surprisingly, IHME models1 suggest that the transmission intensity of omicron is so high that policy actions—eg, increasing mask use, expanding vaccination coverage in people who have not been vaccinated, or delivering third doses of COVID-19 vaccines—taken in the next weeks will have limited impact on the course of the omicron wave. IHME estimates suggest that increasing use of masks to 80% of the population, for example, will only reduce cumulative infections over the next 4 months by 10%. Increasing COVID-19 vaccine boosters or vaccinating people who have not yet been vaccinated is unlikely to have any substantial impact on the omicron wave because by the time these interventions are scaled up the omicron wave will be largely over. Only in countries where the omicron wave has not yet started can expanding mask use in advance of the wave have a more substantial effect. These interventions still work to protect individuals from COVID-19, but the speed of the omicron wave is so fast that policy actions will have little effect on its course globally in the next 4–6 weeks. 

‘’…The omicron wave appears to crest in 3–5 weeks after the exponential increase in reported cases begins…As of Jan 17, 2022, omicron waves were peaking in 25 countries in five WHO regions and in 19 states in the USA.2 It is expected that the omicron peak will occur in most countries between now and the second week of February, 2022…The latest omicron peaks are expected to come in the countries where the omicron wave has not yet started, such as in eastern Europe and southeast Asia. Actions to increase SARS-CoV-2 testing, for example, are likely to increase disruption by having more individuals excluded from work or school, but are unlikely to impact the course of the omicron wave.

‘’…In the era of omicron…COVID-19 control strategies need to be reset. Given the speed and intensity of the omicron wave, in [author’s] view efforts to contact trace seem to be futile…. it seems unlikely that China or New Zealand will be able to permanently exclude the omicron wave….I use the term pandemic to refer to the extraordinary societal efforts over the past 2 years to respond to a new pathogen that have changed how individuals live their lives and how policy responses have developed in governments around the world. These efforts have saved countless lives globally. 

‘’…New SARS-CoV-2 variants will surely emerge and some may be more severe than omicron. Immunity, whether infection or vaccination derived, will wane, creating opportunities for continued SARS-CoV-2 transmission. Given seasonality, countries should expect increased potential transmission in winter months….After the omicron wave, COVID-19 will return but the pandemic will not….’’

AND LAST BUT NOT LEASED:

 What did the surgeon say to the patient who insisted on closing up her own incision?         Suture self.

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HELLO, 

NSC AT PRESENT, HOPEFULLY, PEAKING OUT?

FROM NYT TODAY:

Israeli experts recommend offering a fourth vaccine dose to people age 18 and over.

”…JERUSALEM — A medical panel advising the Israeli government has recommended making fourth coronavirus vaccine doses available to people age 18 and over, the Health Ministry said on Tuesday, citing what it suggested were some early signs of the effectiveness of an additional shot in helping prevent serious illness…The recommendation, which the ministry has yet to approve, comes weeks after Israel began offering fourth doses to people age 60 and over, as well as to medical workers and people with weakened immune systems, as it braced for a surge of infections from the highly contagious Omicron variant. It was the first country to offer such additional shots so broadly…The panel recommended offering a fourth shot to people age 18 and above at least five months after they recover from Covid-19 or receive a third vaccine shot. About 600,000 Israelis have already received a fourth dose.

FROM HOPKINS”

1 Rich Countries’ Access to Foreign Nurses During Omicron Raises Ethical Concerns, Group Says (Reuters) The Omicron-fuelled wave of COVID-19 infections has led wealthy countries to intensify their recruitment of nurses from poorer parts of the world, worsening dire staffing shortages in overstretched workforces there, the International Council of Nurses said. Sickness, burnout and staff departures amid surging Omicron cases have driven absentee rates to levels not yet seen during the two-year pandemic, said Howard Catton, CEO of the Geneva-based group that represents 27 million nurses and 130 national organizations. To plug the gap, Western countries have responded by hiring army personnel as well as volunteers and retirees but many have also stepped up international recruitment as part of a trend that is worsening health inequity,

2. Association Between 3 Doses of mRNA COVID-19 Vaccine and Symptomatic Infection Caused by the SARS-CoV-2 Omicron and Delta Variants (JAMA) Among individuals seeking testing for COVID-like illness in the US in December 2021, receipt of 3 doses of mRNA COVID-19 vaccine (compared with unvaccinated and with receipt of 2 doses) was less likely among cases with symptomatic SARS-CoV-2 infection compared with test-negative controls. These findings suggest that receipt of 3 doses of mRNA vaccine, relative to being unvaccinated and to receipt of 2 doses, was associated with protection against both the Omicron and Delta variants, although the higher odds ratios for Omicron suggest less protection for Omicron than for Delta.

Effect of Noninvasive Respiratory Strategies on Intubation or Mortality Among Patients With Acute Hypoxemic Respiratory Failure and COVID-19‘

Question  What is the effect of initial noninvasive respiratory strategies using continuous positive airway pressure (CPAP) or high-flow nasal oxygen (HFNO), compared with an initial strategy of conventional oxygen therapy, on the risk of tracheal intubation or mortality among hospitalized adults with acute hypoxemic respiratory failure due to COVID-19?

Findings  In this randomized clinical trial of 1273 patients, the composite primary outcome of tracheal intubation or mortality within 30 days occurred in 36% of the patients in the CPAP group compared with 44% in the conventional oxygen therapy group, a difference that was statistically significant, and occurred in 44% in the HFNO group compared with 45% in the conventional oxygen therapy group, a difference that was not significantly different.

Meaning  Among patients with acute hypoxemic respiratory failure and COVID-19, an initial strategy of CPAP significantly reduced the risk of tracheal intubation or mortality compared with conventional oxygen therapy, but there was no significant difference between an initial strategy of HFNO compared with conventional oxygen therapy.

(J. Harris: CPAP, similar to those devices that some folks use for Sleep Apnea was sometimes helpful in treating Covid respiratory problems. A complex editorial following the article discusses the issues remaining with Covid induced respiratory failure.)

From the MNM Today:

2021 report: Northeast Texas home to higher mortality rates compared to the state, country

2021 report: Northeast Texas home to higher mortality rates compared to the state, country

J. Harris: Frightening.  

CDC VACCINE WEBSITES FROM MARSHALL-HARRISON COUNTY HEALTH DEPT:

1.  https://www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html

2. The CDC defines immunocompromised at the following links:

https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/immunocompetence.html

https://www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html#considerations-covid19-vax-immunocopromised

3. If you are looking for a specific brand you can go to https://www.vaccines.gov/ enter your zip code and find a vaccine provider.

AND LAST BUT NOT LEASED:

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HELLO, Not much new on the Area G chart.    Tues/Wed numbers should help.

Omicron will peak in most states by mid-February + 5 more forecasts

(J. Harris: From Becker. Summarizes several sources. Optimistic.)

CDC VACCINE UPDATES: JAN, 2022

(J. Harris: I can’t find any good reason to mix and match Pfizer and Moderna. 

How to Reuse N95, KN95, and Other Disposable Masks

Where to Buy N95s, KN95s, and Surgical-Style Masks in 2022

Mark Cuban’s drug company launches online pharmacy

”…Mark Cuban’s generic drug company launched an online pharmacy Jan. 19..

Mr. Cuban, a billionaire entrepreneur…. established his drug company, the Mark Cuban Cost Plus Drug Co., in January 2021. The company is designed to produce low-cost versions of high-cost generic drugs and aims to “provide radical transparency in how we price our drugs…,Because the company does not partner with third-party PBMs in order to process insurance claims, the online pharmacy does not accept insurance. However, its cost-saving model means patients are often offered prices lower than what most health plans’ deductible and copay requirements would total, the release said.”

TEARS, TEARS, AND TARES:

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CORONAVIRUS INFO PROVIDED BY DR. JIM HARRIS –1/23/2022

A QUICK NOTE. NO LOCAL IMPROVEMENT YET.

EXCELLENT COVID VARIANT COMPARISON OF ILLNESSES AND RECOVERY

*****

J. Harris — A Remembrance:

    Having an infection probably builds more antibodies to that infection than does a vaccine — this is if the illness is survived. Should this “natural” immunization occur, hopefully, the victim won’t have any significant long-term dysfunctions due to the original illness. Additionally, should the original causative organism later mutate and render the old antibodies partially or completely worthless, reinfection might occur, and it does. Just like the Influenza vaccines, Covid Vaccines may require additions, subtractions, and repeat injections. 

     I’d rather have a Polio Vaccine than Polio, or a Measles Vaccine rather than Measles. I won’t mention Small Pox. Absolutely the “sickest” and one of the most tragic patients that I ever cared for was at Parkland Hospital in Dallas, just about the time we opened the first ICU there in an old pediatric diarrhea ward in the mid-1960s. A young boy, 18, a large, muscular, football player, caught Chicken Pox and it spread into his lungs. Fortunately, Parkland had a fabulous Pulmonary Department with several well-trained Pulmonologists (Internal Medicine trained plus 2 years of Pulmonary subspeciality). We even had several newfangled “Bird” IPPB Machines to help patients breathe.  

     Alas, the young man’s viral Pox Pneumonia spread to both lungs despite 24-hour care with physicians, med students, nurses, Pulmonary Tecs, nursing students, the chaplains — every who could add anything. The entire medical service was aware of his case and was pulling for him. There were no “antibiotics” for viruses at that time, (and not many even now). His lungs became so “stiff” that no amount of alternations (and repairs)  to the Bird IPPB Machines would force air into his lungs and after several miserable, agonizing days, he died. He had childhood immunity against Chicken Pox, and there was no vaccine for Chicken Pox until the 1990s. He must have been an only child; Chicken Pox is so contagious that it was hard not to catch it in childhood when it was a milder disease. Thankfully, the Chicken Pox Vaccine has saved millions of cases including some that would have developed pneumonia.  The pathology of our long-ago Parkland patient’s destroyed, gunk-filled, inelastic lungs is very similar to that seen in the lungs of severe Covid patients today.

TEARS AND TEARS: TARES

AND FROM THE DMN:

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