CORONAVIRUS INFO PROVIDED BY DR. JIM HARRIS – 4/29/2022

I WISH YOU A NICE WEEKEND

FROM HOPKINS:

1. ANNUAL BOOSTERS The US FDA has authorized second booster, or fourth, doses for parts of the US population, raising questions over how frequently boosters will be required moving forward. Several companies, including Novavax and Moderna, have begun initiatives to develop joint influenza and COVID-19 shots, creating what would be a new annual vaccine administered each fall. But several US scientists and researchers recently urged more involved dialogue regarding future plans for the use of SARS-CoV-2 vaccine boosters, pushing back on the idea of annual boosters and calling for more data on the value of annual SARS-CoV-2 booster doses. While there is no evidence suggesting any harm from additional booster doses, the experts have shared several concerns that could stem from a policy requiring annual vaccinations. First, they worry that an emphasis on boosters diminishes the long-lasting protection that current vaccine doses provide against severe COVID-19 disease. Second, experts worry that a lack of evidence in regulatory decision making could set a dangerous precedent moving forward. The group specifically urged the FDA to measure T-cell responses, in addition to antibody responses, when conducting SARS-CoV-2 vaccine trials. Lastly, they noted the lack of response for both first and second booster doses signals fatigue from the US public. More than 100 million US residents have received the first COVID-19 booster, roughly 50% of eligible people. Some worry that “booster fatigue” will be a problem, adding to calls for a more prudent, data-driven approach to annual boosters. 

FROM THE WASHINGTON POST:

Vaccines for young kids could be available as soon as June, FDA official says

AND LASTLY:

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P.O. Box 721

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75688

CORONAVIRUS INFO PROVIDED BY DR. JIM HARRIS – 4/28/2022

FROM NYT 

Officials watch and wonder as the hottest U.S. coronavirus hot spot swells to two dozen counties.

”…Health experts say that people in the hot spot, which includes cities like Buffalo, Rochester, Syracuse and Binghamton, should be increasing their precautions. “These are areas where C.D.C. recommends people should wear a mask in public indoor settings due to an increasing level of severe disease and the potential for significant health care strain,” Dr. Rochelle P. Walensky, the C.D.C. director, told reporters on Tuesday….No one is quite sure why a new wave of coronavirus cases, caused by the highly contagious Omicron subvariants BA.2.12 and BA.2.12.1, took hold first in central New York….it broke the pattern of past surges. “It didn’t make a lot of sense…Being in the middle of the state, we see the peaks halfway through, or at the end.”

REVIEWS FROM BECKERS:

1. Fauci: US ‘out of the pandemic phase’

”….”So, if you’re saying, are we out of the pandemic phase in this country, we are. What we hope to do, I don’t believe — and I have spoken about this widely — we’re not going to eradicate this virus. If we can keep that level very low, and intermittently vaccinate people — and I don’t know how often that would have to be…”

2. Cedars-Sinai physicians using VR to treat chronic pain

”…A Cedars-Sinai physician in Los Angeles is running a virtual reality initiative and is discovering how the new technology can be useful to those dealing with chronic pain, The New York Times reported April 26…Virtual reality is becoming a tool to treat chronic pain, an issue that affects around 50 million Americans. In November 2021, the FDA gave approval for one VR product to be marketed as a treatment for chronic pain.  

FROM JAMA:

The COVID-19 Pandemic Rages on for People Who Are Immunocompromised

”…To help protect people with compromised immune systems, the US Food and Drug Administration in December authorized a combination of 2 anti–SARS-CoV-2 monoclonal antibodies, tixagevimab and cilgavimab (Evusheld), for preexposure prophylaxis (PrEP). But some candidates for the treatment, as well as some of their physicians, still don’t know who should get it….“In general, my recommendation is for all transplant patients to get antibody testing” after vaccination against COVID-19…”

FROM THE WASHINGTON POST

Guide to the pandemic Track confirmed cases, hospitalizations and deaths in the U.S. and the spread around the world. U.S. vaccine distribution and delivery, tracked by state. Guides: Booster shots | Vaccines | Variants | Masks

(J. Harris: Scroll down and click on the site)

FROM REUTERS:

Measles cases jump 79% in 2022 after COVID hit vaccination campaigns Measles cases jumped by 79% in the first two months of this year compared to 2021, after COVID-19 and lockdowns disrupted child vaccination campaigns around the world, according to data from UNICEF and the World Health Organization (WHO).

FROM nature:ATTENTION DEER HUNTERS

NEWS FEATURE 26 April 2022 COVID is spreading in deer. What does that mean for the pandemic?

”…It’s not yet clear whether the virus can spread in long chains of infection among deer, or whether deer-to-human transmission could spark outbreaks. But researchers are growing increasingly concerned about the animals becoming a viral reservoir, serving as a recalcitrant source of outbreaks and potentially breeding new variants. Some researchers think that the highly infectious Omicron variant spent time in an animal reservoir before popping up in people…..Researchers have been concerned about wildlife infections since the beginning of the COVID-19 pandemic, but tracking the movements of such a promiscuous virus is tricky. To target surveillance efforts, they started by looking at ACE2, a host-cell protein that the virus typically uses to enter cells. Animals with an ACE2 receptor similar to that found in humans were considered at risk. Teams around the world then began experimentally infecting those animals to see whether they were susceptible and could pass the infection along. Among the prospects were cats, deer mice …and raccoon dogs … as well as white-tailed deer….other ungulates, such as cows, sheep and goats, are fairly resistant to infection, …..Another route might be contaminated waste water that trickles into the animals’ water sources. Although many studies have found viral RNA in sewage, they haven’t isolated infectious SARS-CoV-2. Also, it’s not just urban deer that are getting infected; some live in the middle of nowhere, say researchers….Deer-to-human transmission, if confirmed, would be concerning, as would reinfection among deer — something Kuchipudi might have observed. From sampling this past December and January, he identified a deer infected with Omicron that also had antibodies against Delta7. “If the animals are able to be reinfected, just like people, then the virus will not fade out; it will continue to circulate,” he says….”

AND LAST BUT NOT LEASED:

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P.O. Box 721

Scottsville Texas

75688

CORONAVIRUS INFO PROVIDED BY DR. JIM HARRIS – 4/21/2022

THERE’S NOT MUCH HAPPENING LOCALLY. SEE YOU NEXT WEEK SOMETIME.

 FROM BECKERS:

New booster data validates Moderna’s bivalent vaccine strategy

FROM NEJM:

A single dose of AZD7442 had efficacy for the prevention of Covid-19, without evident safety concerns.

AND LASTLY:

HOWEVER, BILL IS MARRIED.

“He has Van Gogh’s ear for music.” – Billy Wilder

“I’ve had a perfectly wonderful evening. But I’m afraid this wasn’t it.” – Groucho Marx

The exchange between Winston Churchill & Lady Astor: She said, “If you were my husband I’d give you poison.” He said, “If you were my wife, I’d drink it.”

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75688

CORONAVIRUS INFO PROVIDED BY DR. JIM HARRIS – 4/20/2022

HELLO,

The exodus of young nurses

Moderna says trial results suggest redesigned vaccines can better protect against variants.

”… findings show it can design a vaccine that offers better, longer-lasting protection than its initial product…But the company said it was also testing another version of the vaccine that it expected would do even better, with results expected in late May or early June….Moderna said its research showed the promise of a so-called bivalent vaccine, even against other variants besides the two versions of the virus specifically targeted. In this case, researchers combined the existing vaccine with one designed to attack the Beta variant, which was first detected in late 2020. They found the combination provided a stronger defense not only against those forms of the virus, but also against the Delta and Omicron variants, the company said...Volunteers who got a booster shot of the reconfigured vaccine produced more than two times the level of antibodies against the Omicron variant compared with those who got a booster dose of the existing Moderna vaccine. The added protection persisted for six months against the Omicron variant but fell against Delta to essentially the same level as that elicited by the existing vaccine, the study showed.

Unvaccinated children hospitalized at twice the rate during Omicron surge -U.S. study

18 APRIL 2022 AREAS WITH BA.2 VARIANT:

FROM BOSTON GLOBE  TODAY:

How to weigh your risks as mask mandates lift

”…Does wearing a mask provide adequate protection even if people around you aren’t masked?…

Yes, provided you’re wearing a high-quality mask such as an N95 or KN95, said Dr. Robert M. Wachter, professor and chair of the Department of Medicine at the University of California, San Francisco.

“Individuals have the tools to protect themselves quite well,

Wachter said that he doesn’t have any concerns about removing the mandate, but that he wishes the decision had been made by public health officials and medical experts. When a judge with little public health knowledge makes such a call, it sets “a dangerous precedent” that could limit the government’s ability to respond to future surges or pandemics, Wachter said….

…The experts interviewed were unanimous in urging people to continue wearing masks on public transit, for their own protection as well as that of others…..Which are safer — buses, trains, subways, or planes?  

The difference, experts agreed, is not so much in the mode of transportation but the circumstances: whether the vehicle is well-ventilated, how crowded it is, how long the trip is, and what the transmission rates are in the community. A bus with windows open is safer than one with windows closed…“Probably the most important factor is, ‘What are the chances the person sitting within a few feet of me has COVID?’ ”…For children ages 2 to 5, who are heading on an important trip, he’d take them if they could be trusted to stay masked. But if the trip can be postponed, it would make sense to wait until a vaccine is approved for that age group. For younger toddlers and babies, Wachter would cancel the trip — not because the child might get sick and die, which is highly unlikely, but because growing evidence suggests long-term harm from COVID exposure, including heart attacks, strokes, and diabetes….

What will it take to get to the point that normal routines feel safe?“There’s no reason I can think of that things will be much safer a year or two from now,”…

That will happen, Wachter said, when people simply get tired and stop talking about it. “I can’t see what would happen that would make the risk materially lower than it is now,” he said. “Maybe a better vaccine comes out, but how many people are going to take it? Maybe the [next] variant gets milder, but it’s just as likely it gets nastier.”

AND LASTLY:

“People who live long, who will drink from the cup of life to the very bottom…

Must expect to meet with some of the usual dregs…”

                                                                             Benjamin Franklin, housebound, age 84

 “His mother should have thrown him away and kept the stork.” – Mae West

 “Some cause happiness wherever they go; others, whenever they go.” – Oscar Wilde

 “He uses statistics as a drunken man uses lamp-posts… for support rather than illumination.” – Andrew Lang (1844-1912)

HAVE YOU EVER SEEN A PRETTIER PUPPY? 

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75688

CORONAVIRUS INFO PROVIDED BY DR. JIM HARRIS – 4/18/2022

There have only been 3 Covid admissions in TSA G in the last 2 days. There won’t be any significant counts until Tuesday or Wednesday. Anyway, the Norwegian has a cold (that she caught from me). She thinks she has located a picture of Mary Gold (Milton Tomato’s girlfriend). 

I’ll check back later this week.

FROM HOPKINS SELECTIONS:

1. Clinical Practice

Covid Booster Shot Bolsters Protection in 5-to-11-year-olds, Pfizer and BioNTech Say (Washington Post)

A booster shot of the Pfizer-BioNTech vaccine increases immune defenses against the coronavirus in school-aged children, particularly against the omicron variant, the companies announced Thursday. Pfizer and BioNTech say they intend in coming days to request authorization from the Food and Drug Administration for a booster for 5-to-11-year-olds. The additional shot was given six months after children were fully vaccinated.

2. 2 New Omicron Variants are Spreading in N.Y. and Elsewhere. Here’s What We Know (NPR)

On Wednesday, health officials in New York said that two new omicron variants are spreading rapidly in the state. The variants appear to be causing a small surge in cases in central New York state, the department of health said. Known as BA.2.12 and BA.2.12.1, the variants are closely related to the BA.2 variant – a version of omicron that has caused surges across Europe and is now dominant across the U.S. Together the two new variants now comprise 90% of cases in central New York.

LASTLY:

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CORONAVIRUS INFO PROVIDED BY DR. JIM HARRIS – 4/16/2022

I WISH YOU A GLORIOUS EASTER

FROM THE NEJM:

Oral Nirmatrelvir for High-Risk, Nonhospitalized Adults with Covid-19

”…Nirmatrelvir is an orally administered severe acute respiratory syndrome coronavirus 2 main protease (Mpro) inhibitor with potent pan–human-coronavirus activity in vitro….Our data show that treatment with nirmatrelvir plus ritonavir early in Covid-19 illness can decrease progression to severe disease and quickly reduce SARS-CoV-2 viral load….Treatment of symptomatic Covid-19 with nirmatrelvir plus ritonavir resulted in a risk of progression to severe Covid-19 that was 89% lower than the risk with placebo, without evident safety concerns.

FROM BECKERS:

1. 10 places where COVID-19 cases are projected to jump the most

2. Arkansas hospital replaces CEO

Magnolia (Ark.) Regional Medical Center has appointed a new leader to replace CEO Rex Jones, who is exiting his role in late April.

The hospital announced in February that Mr. Jones is stepping down to take on a new position with the Arkansas Rural Health Partnership, a nonprofit organization formed in 2008 to improve healthcare delivery in rural Arkansas. His last day at the hospital will be April 24.

The board has selected Brett Kinman to succeed Mr. Jones. Mr. Kinman, who has more than 25 years of healthcare management experience, will step into the position in May.

Mr. Kinman most recently served as administrator of Christus Good Shepherd Medical Center in Marshall, Texas, and Christus St. Michael Hospital in Atlanta, Texas.

FROM MY SHYSTER LAWYER WHOSE INITIALS ARE SIMILAR TO “CR”

1. Los Angeles Covid Test Positivity Rising Rapidly; Only Time Will Tell If Hospitalizations Follow Suit

2. Is herd immunity for Covid-19 still possible?

(J. Harris: Excellent article for herd immunity and new vaccine needs.)

FROM THE NYT:

Coronavirus cases strain England’s bid to reduce hospital treatment backlogs, doctors say.

”…So many health professionals and patients have tested positive for the coronavirus in England that the situation has made it hard to address a backlog of more than six million people awaiting hospital treatment for other conditions, health leaders said on Thursday….As the restrictions were lifted, though, the highly transmissible Omicron subvariant known as BA. 2 was spreading through the country, and reports of new cases soared again. Britain’s Office of National Statistics estimated that almost 4.4 million people in England and Wales were infected in a single week in late March, and the percentage of test results that were coming back positive reached record highs….”

South Korea will end virtually all Covid restrictions, except for a mask mandate

”…South Korea plans to phase out virtually all of its coronavirus restrictions, except for a mask mandate, starting next week, ending the curbs on business and social life that it has maintained in some form for two years….“It’s inevitable that we’ll have to keep wearing a mask indoors for a long time, ….South Korea first imposed coronavirus restrictions in March 2020, applying them to churches and some industries where the risk of infection was considered high. A wave of infections driven by the BA.2 Omicron subvariant has been ebbing in recent weeks; on Friday, the health ministry reported an average of 160,191 daily cases over the past seven days, down from 404,998 about a month ago….”

FROM THE LANCET

Estimating global, regional, and national daily and cumulative infections with SARS-CoV-2 through Nov 14, 2021: a statistical analysis

and

Understanding of COVID-19 from infection–fatality ratio

J. Harris: (Statistics are not an area of expertise for me. The world wide covid numbers through Nov, 2022 are presented. Since each variant is a little different, I wonder how useful these numbers are? In addition, the infections have already killed off the sickest of the older population. We have several readers who know how to work a slider rule. Maybe we can get some outside opinions. 0

”…Another important concept, the infection–fatality ratio (IFR), has been rarely mentioned. The IFR is crucial for risk perception, policy making for epidemic control, and estimation of COVID-19 burden. The IFR is calculated as COVID-19 deaths divided by the number of people infected with SARS-CoV-2, the denominator of which cannot be directly obtained and could be estimated with data from seroprevalence surveys…..The authors explored the IFR variation from three dimensions including age, geography, and time, which all have important and specific public health implications…. For now, vaccination is the most important intervention to reduce resurgence and transmission of COVID-19 epidemics and lower the number of new fatalities.6,  7 Other promising SARS-CoV-2 antivirals are extending pandemic control to pharmaceutical intervention. With more promising weapons to fight against COVID-19, whether IFR will continue to reduce after the prevaccination era needs to be answered by future studies. As the COVID-19 pandemic continues, society has to be prepared for and adapt to the potential for living with SARS-CoV-2 in the coming years…”

AND LASTLY:

1. “He is simply a shiver looking for a spine to run up. – Paul Keating

2. “He loves nature in spite of what it did to him.” – Forrest Tucker

3. “Why do you sit there looking like an envelope without any address on it?” – Mark Twain

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CORONAVIRUS INFO PROVIDED BY DR. JIM HARRIS – 4/15/2022

WHO HAS SOME IDEAS ABOUT HOW TO GET A GOOD TURN OUT OF LOCALS WHO NEED COVID VACCINATION AND BOOSTERS? 

FROM THE NYT:

1. The F.D.A. authorizes the first Covid-19 breath test

”…The Food and Drug Administration granted emergency use authorization to the first Covid-19 test that can detect the coronavirus in a breath sample, within a few minutes and with a high degree of accuracy, the agency said Thursday….The InspectIR Covid-19 Breathalyzer, which is about the size of a piece of carry-on luggage, can produce results in less than three minutes and can be used in doctor’s offices, hospitals and mobile testing sites by trained operators. A single machine can analyze about 160 samples per day….The device was tested in a study made up of 2,409 individuals both with and without symptoms of the virus. 

…If a test comes back positive on the Breathalyzer, it should be confirmed with a molecular test, such as a P.C.R. lab test….

2. ‘Too smelly to sleep’: Thirteen days in a Shanghai isolation facility.

”…Ms. Cheng said she had once admired the government’s goal of keeping the virus out of China. It meant that for more than two years, she could live a normal life, even as cities and countries around the world had to lock down…Now, she’s not so sure…“This time I feel it is out of control and it’s not worth controlling the cases because it is not so dangerous or deadly,” she said, referring to the highly contagious Omicron variant. “It’s not worth sacrificing so many resources and our freedom.”

FROM NY MAGAZINE  (MORE ON CHINA)

Locked Down in Shanghai

”…Over the past two years, Shanghai’s success in managing the pandemic was made possible by a resource-intensive hybrid approach: data-driven contact tracing combined with a human infrastructure of coordination work. Local neighborhood committees staffed with volunteer workers took care of people in their communities, especially the elderly. These mostly female workers feed, maintain, and analyze data in the back end of the health apps. It is this particular human-machine configuration that has enabled the Chinese to lead largely COVID-free lives….Shanghai expected this system to work again, even against Omicron….all changed in March. Shanghai’s hybrid approach of pairing data-driven tracking with bottom-up human care work was replaced with the sort of brute force that had been deployed in smaller cities. At this moment, Shanghai remains broadly locked down, though it has improved its ability to deliver food and essential goods to residents..But Beijing can’t win this battle entirely either. 

(J. Harris: Good luck in the boondocks.) 

How Do I Know If It’s Allergies or COVID-19?

(J. Harris: This is a nice, layman’s article that I found helpful, personally.)

FROM THE BOSTON GLOBE

New COVID-19 vaccine study challenges stereotypes of who is getting the shots

”…“Although ‘vaccine hesitancy’ dominates media coverage, in fact, language barriers, lack of regular health providers, absence of paid time off to get vaccinated and recover, and lack of trust in the health system all play a role in undermining vaccine coverage,” …Income, the team found, was also a strong predictor of vaccination coverage. A $10,000 increase in a ZIP code’s median household income was associated with higher vaccination and booster rates. From the lowest to the highest income levels, booster coverage increased from under 30 percent to over 60 percent….The upshot… is that There are going to be a lot of people in poorer, lower-education ZIP codes — regardless of racial composition — who are going to suffer in future COVID waves because of low vaccination and booster rates.”

FROM HOPKINS:

1. The Pandemic Has Trapped Millions in Unending Grief (The Atlantic) The number of people who have died of COVID-19 in the United States has always been undercounted because such counts rely on often-inaccurate death certificates. But the total, as the CDC and other official sources suggest, will soon surpass 1 million. That number—the sum of a million individual tragedies—is almost too large to grasp. In just two years, COVID has become the third most common cause of death in the U.S., which means that it is also the third leading cause of grief in the U.S. Each American who has died of COVID has left an average of nine close relatives bereaved, creating a community of grievers larger than the population of all but 11 states. Deaths from COVID have been unexpected, untimely, particularly painful, and, in many cases, preventable.

2. Bipartisan Group of Senators Introduce Preventing Future Pandemics Act to Counter Zoonotic Disease Spread (Homeland Preparedness News) By supporting conservation in other nations, a bipartisan group of senators has proposed – through the Preventing Future Pandemics Act of 2022 (S.4074) – that the risk of zoonotic disease transmission could be reduced for humans. As introduced, the bill would authorize the U.S. government to collaborate with other countries voluntarily to develop Global Health Security Zoonoses Plans. Such plans would act as outlines for tackling new zoonotic pathogens with pandemic potential, clamping down on them before spillover into human transmission could occur. Collaboration between the private sector and government and the strengthening of conservation practices would be at the core of the legislation’s efforts. In addition to dealing with zoonotic issues, the resulting plans would identify incentives and improve policies for biosecurity and hygienic standards in the wildlife trade and guarantee technical support for those involved in and affected by these decisions.

FROM NEJM:

iCovid-19 Boosters — Where from Here?

”…People are now confused about what it means to be fully vaccinated. It is easy to understand how this could happen. Arguably, the most disappointing error surrounding the use of Covid-19 vaccines was the labeling of mild illnesses or asymptomatic infections after vaccination as “breakthroughs.” As is true for all mucosal vaccines, the goal is to protect against serious illness — to keep people out of the hospital, intensive care unit, and morgue. The term “breakthrough,” which implies failure, created unrealistic expectations and led to the adoption of a zero-tolerance strategy for this virus. If we are to move from pandemic to endemic, at some point we are going to have to accept that vaccination or natural infection or a combination of the two will not offer long-term protection against mild illness….It is now incumbent on the CDC to determine who most benefits from booster dosing and to educate the public about the limits of mucosal vaccines. Otherwise, a zero-tolerance strategy for mild or asymptomatic infection, which can be implemented only with frequent booster doses, will continue to mislead the public about what Covid-19 vaccines can and cannot do….)

(J. Harris: This editorial is readable and worth the short time it takes.)

FROM THE LANCET:

Understanding of COVID-19 from infection–fatality ratio

Another important concept, the infection–fatality ratio (IFR), has been rarely mentioned. The IFR is crucial for risk perception, policy making for epidemic control, and estimation of COVID-19 burden. The IFR is calculated as COVID-19 deaths divided by the number of people infected with SARS-CoV-2, the denominator of which cannot be directly obtained and could be estimated with data from seroprevalence surveys….The authors explored the IFR variation from three dimensions including age, geography, and time, which all have important and specific public health implications…. For now, vaccination is the most important intervention to reduce resurgence and transmission of COVID-19 epidemics and lower the number of new fatalities… Other promising SARS-CoV-2 antivirals are extending pandemic control to pharmaceutical intervention. With more promising weapons to fight against COVID-19, whether IFR will continue to reduce after the prevaccination era needs to be answered by future studies. As the COVID-19 pandemic continues, society has to be prepared for and adapt to the potential for living with SARS-CoV-2 in the coming years….”

(MORE OF THESE STATS LATER).

LASTLY:

     1. “I feel so miserable without you; it’s almost like having you here” – Stephen Bishop

     2. “He is a self-made man and worships his creator.” – John Bright

     3. “I’ve just learned about his illness. Let’s hope it’s nothing trivial.” – Irvin S. Cobb

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CORONAVIRUS INFO PROVIDED BY DR. JIM HARRIS – 4/14/2022

FROM NYT : (TODAY)

Two new Omicron subvariants are spreading quickly in New York State.

”…Two new versions of Omicron, the coronavirus variant that has swept through the world in the past few months, are circulating in New York State and may be responsible for rising infections in the region over the past few weeks,…In March, the subvariants — called BA.2.12 and BA.2.12.1 — accounted for more than 70 percent of new cases in central New York State, a figure that has now risen above 90 percent….So far, the new viruses do not appear to cause more severe disease than previous variants, the officials said…”

(J. Harris: This was anticipated by most of the big boys who play with the viruses and the spread follows the early trends of spread from Europe then to the US. We know what to do! Stay vaccinated, boosted, and careful.)

FROM THE WASHINGTON POST:

As colleges grapple with climbing cases – especially along the East Coast – some campuses have decided to bring back masking and testing requirements. Just one week after adopting a mask-optional policy, George Washington University brought back a mask requirement through the end of the semester after 190 people tested positive since April 4. American University similarly reverted to a mask mandate until May 9 after a spike in cases following spring break…”

FROM THE HISTORY CHANNEL: ( THE HISTORY CHANNEL IS BACK!)

How the World Learned to Manage the Flu

”…What does it mean for a disease to be “endemic”?It doesn’t mean the disease disappeared. When epidemiologists use the word “endemic,” they mean that a disease is occurring “at an expected level in a location during a period of time…Endemic” also doesn’t mean that a disease has ceased to be harmful. Malaria, tuberculosis and influenza are all serious and potentially fatal endemic diseases that occur every year. Since the 1940s, countries have built robust international health networks that identify flu strains in order to keep them under control, and avoid the kind of devastation that happened during the 1918 pandemic…”

(J. Harris: Worth taking a look. Hx of CDC and WHO and flu vaccines covered consisely for quick read.)

FROM BECKERS:

1. ‘We are at a really good moment’: 3 takeaways from the new COVID-19 chief’s 1st week

Despite a rise in infections nationwide, the White House new COVID-19 response coordinator, Ashish Jha, MD, expressed optimism about the current state of the pandemic in the U.S. during his first week on the job….

“If you think about where we are as a country, we are at a really good moment,” said Dr. Jha, who is on leave from his position as dean of Brown University’s School of Public Health in  Providence, R.I., told NPR on April 11. “Infection numbers are relatively low. We have fewer people in the hospital right now than at any point in the pandemic. So it is really important to start with, where are we? We’re in reasonably good shape….”

Three takeaways from his conversation with NPR:

1.” A different moment: The goal at this point in the pandemic is not to eliminate all infections. “The goal has got to be to keep infections down and protect people from serious illness,” Dr. Jha said. “We’re in a very different moment than where we were a couple of years ago, where a COVID-19 infection necessarily meant people were at potentially very high risk of having bad outcomes. That is no longer the case if you are vaccinated and boosted,” he told NPR.

2. Lean on local restrictions: Dr. Jha suggested” the responsibility of deciding whether to reinstate pandemic restrictions will largely fall on the shoulders of local governments moving forward. Following a 50 percent rise in cases in the previous 10 days, Philadelphia on April 11 became the first major city in the country to announce it will reinstate its indoor mask mandate April 18…These are decisions that should always be made on a local level, so I like that feature of what Philadelphia is doing,” he said. “[These decisions] should be driven really by the realities on the ground. I can very much imagine in the weeks and months ahead, as you see local cases go up, public health measures go into place. And as infections and hospitalizations fall, public health measures get released. That’s a pretty reasonable way to manage the pandemic.”

3. Preparation over prediction: ”To best navigate the possibility of future surges and  [other variants], the nation must prepare during calmer periods, Dr. Jha said. “What we need to be doing right now is preparing for those moments by vaccinating people, by making sure that we have plenty of tests and therapies available. That’s got to be the strategy — not so much predicting exactly what’s going to happen when but preparing for any eventuality that Mother Nature throws at us.” A potential barrier to adequate preparation is stalled pandemic funding in Congress that would cover the cost of testing, vaccines and treatments.’…”

BECKERS SELECTIONS CONTINURED :

2. Healthcare Consumer Market Report

FROM HOPKINS:

1. COVID-19 ESTIMATES IN AFRICA A new meta-analysis of standardized seroprevalence studies indicates that the true number of SARS-CoV-2 infections across Africa may be 97 times higher than the number of reported confirmed cases. The study—led by the WHO Solidarity Response Fund and the German Federal Ministry of Health COVID-19 Research and Development and posted to the preprint server medRxiv—evaluated more than 150 seroprevalence studies from January 2020 to December 2021 and suggests that more than two-thirds of the African population have been infected with SARS-CoV-2. From Q2 2020 to Q3 2021, seroprevalence increased markedly from 3% to 61.5%. According to the study, which is undergoing peer review, rather than the reported 8.2 million cumulative cases in September 2021, there were actually more than 800 million infections. The study also determined that seroprevalence was higher in urban areas than rural areas, with varied seroprevalence among African sub-regions, where Middle, Western, and Eastern Africa exhibited higher seroprevalence. …

…that testing strategy and capacity is a significant factor in the discrepancy between reported cases and the estimated true number of infections. Testing across the continent has largely focused on symptomatic people, particularly where there were supply constraints, resulting in an undercount of exposures and infections. Dr. Moeti highlighted the need for sustained routine testing and surveillance capacity on the continent in order to identify cases among the estimated 67% of people with COVID-19 in Africa who are asymptomatic and monitor for emerging variants. 

2. EARLY REINFECTION : A report published April 8 in the US CDC’s Morbidity and Mortality Weekly Report (MMWR) describes 10 individuals who were reinfected with the Omicron variant of SARS-CoV-2 within 90 days of initial infection with the Delta variant. The report represents a significant finding, as reinfection within 90 days of infection is not well understood. Early reports of reinfection were difficult to verify because a positive reading on a nucleic acid amplification test (NAAT) could signal prolonged viral shedding from the initial infection rather than a new infection if taken within 3 months of acute infection. For the report, researchers conducted whole genome sequencing on 10 individuals—8 children and 2 adults—to determine which variant caused the initial and subsequent infections. Only 1 of the patients had received a 2-dose primary vaccine regimen, 2 had received 1 dose, and 7 were unvaccinated. Of 8 patients with available data on symptoms, 6 experienced symptoms during both infections. The authors noted that the patients may have been at increased risk for infection due to lack of vaccination and the high likelihood of exposure to SARS-CoV-2 in schools and the work and living settings of the adults.

FROM HOPKINS (MORE TOMORROW)

Prevalence, Characteristics, and Outcomes of COVID-19–Associated Acute Myocarditis (Circulation) Acute myocarditis (AM) prevalence among hospitalized patients with COVID-19 was 2.4 per 1000 hospitalizations considering definite/probable and 4.1 per 1000 considering also possible AM. The median age of definite/probable cases was 38 years, and 38.9% were female. On admission, chest pain and dyspnea were the most frequent symptoms (55.5% and 53.7%, respectively). Thirty-one cases (57.4%) occurred in the absence of COVID-19–associated pneumonia. Twenty-one (38.9%) had a fulminant presentation requiring inotropic support or temporary mechanical circulatory support. The composite of in-hospital mortality or temporary mechanical circulatory support occurred in 20.4%. At 120 days, estimated mortality was 6.6%, 15.1% in patients with associated pneumonia versus 0% in patients without pneumonia (P=0.044). During hospitalization, left ventricular ejection fraction, assessed by echocardiography, improved from a median of 40% on admission to 55% at discharge (n=47; P<0.0001) similarly in patients with or without pneumonia. Corticosteroids were frequently administered (55.5%).

AND HAPPILY:

 “I didn’t attend the funeral, but I sent a nice letter saying I approved of it.” – Mark Twain

“He has no enemies, but is intensely disliked by his friends.” – Oscar Wilde

 “I am enclosing two tickets to the first night of my new play; bring a friend, if you have one.” -George Bernard Shaw to Winston Churchill

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CORONAVIRUS INFO PROVIDED BY DR. JIM HARRIS – 4/13/2022

FROM:  verywellhealth.com 

(J. Harris: Nice little civilian magazine with numerous pertinent, understandable articles. The articles I read, I agreeded with.)

How Long Does An Omicron Infection Last in the Body?

”…people were most infectious with Omicron three to six days after symptom onset. However, it’s important to note that they can be contagious before that, and that not everyone will develop symptoms…Another study on Delta and Omicron infections in the NBA found that on average, Omicron infections lasted for about 10 days, while Delta infections lasted for about 11 days.2 Whether or not the difference in timeframe could be attributed to characteristics of the variants themselves, or to factors like vaccinations and natural immunity was unclear, according to the researchers….the severity of Delta and Omicron hospitalizations were comparable for people admitted to the hospital, but that people with Omicron appeared less likely to be admitted to the hospital to begin with…Still, experts say there’s not a big difference between an Omicron infection and a Delta infection…”…[ROUTINE] COVID-19 testing doesn’t show you which variant you have—that data is only for the sake of public health surveillance, and it wouldn’t change your treatment protocol at this time anyway…”

FROM REUTERS:

1.  Nearly 86% of U.S. COVID caused by BA.2 Omicron subvariant -CDC

”…The BA.2 Omicron subvariant of the coronavirus is now responsible for 86% of U.S. COVID-19 cases and more than 90% of infections in the Northeast, according to data on Tuesday from the U.S. Centers for Disease Control and Prevention (CDC)….For the week ending April 2, BA.2 made up 75.4% of the variants identified in the country, up from a previous estimate of 72.2%, according to CDC estimates…”

FROM BECKERS

1. COVID-19 cases up in 26 states, hospitalizations up in 10

2. WHO monitoring ‘sister variants’ of omicron: 4 notes

From HOPKINS

1. MORE ABOUT THE NEW VARIANTS: NEW OMICRON SUBVARIANTS The WHO is tracking cases of 2 new sublineages of the Omicron variant, adding BA.4 and BA.5 to the monitoring list alongside BA.1, BA1.1, BA.3, and the globally dominant BA.2. Dr. Tulio de Oliveira, Director of the Centre for Epidemic Response & Innovation (CERI) in South Africa, tweeted about the presence of BA.4 and BA.5 in South Africa, one of the first countries to identify the original Omicron variant in November 2021. The series of tweets said the sublineages have been found in samples from Botswana, Belgium, Germany, and the UK but not yet caused a rise in cases in South Africa. BA.4 and BA.5 have mutations on their spike proteins similar to BA.2, in addition to several other mutations. De Oliveira said that where the subvariants differ from each other is in amino acid mutations outside of the spike protein and work is underway to further characterize the 2 Omicron sublineages. 

2. HOW TO GET THE COMMUNITIES WASTEWATER TESTED FOR VARIANTS

AND LASTLY:

 “He has never been known to use a word that might send a reader to the dictionary.”-William Faulkner (about Ernest Hemingway)

“Poor Faulkner. Does he really think big emotions come from big words?”- Ernest Hemingway (about William Faulkner)

“Thank you for sending me a copy of your book; I’ll waste no time reading it.” – Moses Hadas

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CORONAVIRUS INFO PROVIDED BY DR. JIM HARRIS – 4/12/2022

Because I have several  readers who are physicians  in active practice, I sometimes include articles that some readers  might not enjoy. Allegedly, I save some of the physicians some time. 

From BECKERS:

Fauci, Gottlieb urge self-interpretation amid COVID-19 case undercounts, relaxed mask rules

”…Drs. Fauci’s and Gottlieb’s remarks suggest the U.S. has reached a pandemic stage where self-determination among the public is more emphasized than ever — first to interpret the risk of COVID-19 transmission in their communities, then to decide what mitigation measures to take……I think that we’re dramatically undercounting cases,” Dr. Gottlieb told CBS News. “We’re probably only picking up one in seven or one in eight infections. So when we say there are 30,000 infections a day, there’s probably closer to a quarter of a million infections a day.”…”This is not going to be eradicated and it’s not going to be eliminated,” Dr. Fauci said of COVID-19. “And what’s going to happen is that we’re going to see that each individual is going to have to make their calculation of the amount of risk that they want to take in going to indoor dinners and in going to functions, even within the realm of a green zone map of the country where you see everything looks green but it’s starting to tick up. So you’re going to make a question and an answer for yourself, for me as an individual, for you as an individual. What is my age? What is my status? Do I have people at home who are vulnerable that if I bring the virus home there may be a problem?”

(J. Harris: So we’re back to where we started from: ultimately, responsibility for Covid protection is a personal/family >neighborhood > city >county > state > national >>>then world medical problem — with emphasis on personal and family. We’ve learned a lot and will be able live with Covid. We’ll have to.)

FROM NYT:

1. The city of Philadelphia will reinstate an indoor mask mandate, the first major U.S. city to do so this spring.

”With new coronavirus cases low but rising sharply in recent days, the city of Philadelphia announced on Monday that it will reinstate an indoor mask mandate a little more than a month after lifting it, becoming the first major U.S. city to do so…“This is our chance to get ahead of the pandemic,” said Cheryl Bettigole, the city’s health commissioner, in a news conference…’

‘2. New Drug Slashed Deaths Among Patients With Severe Covid, Maker Claims

”…The new drug, sabizabulin, reduced deaths among hospitalized Covid-19 patients so drastically in a clinical trial that independent safety monitors recommended stopping it early, officials at Veru Inc., the drug’s maker, said. The trial was halted on Friday…..Sabizabulin was given in a 9-milligram dose in a capsule that was taken once a day. It doesn’t require refrigeration, and the capsule can be given by mouth or opened up so that the contents can be added to a feeding tube…The drug is intended only for hospitalized patients at this point, so making it accessible to patients in the United States will be simpler than making it available to outpatients, which requires distributing it to pharmacies and educating general doctors about its use….”

3. (This AM) Experts say it is unclear whether rising cases in the northeastern U.S. are the start of a larger surge. Image

”…Covid outbreaks in elite circles in Washington, D.C., and on Broadway have received a lot of news media attention in recent days, but they appear to be only one part of a broader regional rise in infections: States in the Northeast are now reporting an uptick in cases…“There’s definitely something coming,” William Hanage, an epidemiologist at Harvard, told The Morning. “But depending on all the moving parts, it might be a ripple relative to previous waves….”

4. Virus outbreaks are pushing some U.S. universities to reinstate mask mandates.

”…A small number of U.S. colleges and universities are reinstating mask policies, citing coronavirus outbreaks on campus…But now, while some universities, such as Harvard, are letting professors decide what protocol to follow in the classroom, others are imposing new mask rules:…Rice University reinstated its mask policy for classrooms, regardless of vaccination status. Those who are unvaccinated also must continue to wear a mask in other indoor areas…”

FROM THE LANCET:

1. Estimating global, regional, and national daily and cumulative infections with SARS-CoV-2 through Nov 14, 2021: a statistical analysis

 Conclusion

COVID-19 has had a staggering impact on the world, with 3·39 billion (95% UI 3·08–3·63) people infected with SARS-CoV-2 at least once as of Nov 14, 2021. These findings highlight the potential for COVID-19 to have a continued and profound impact on the world’s population. The vast differences in cumulative proportion of the population infected across countries and territories can help policy makers identify locations whose transmission-prevention strategies should be emulated, as well as those populations at greatest risk of future infection—a factor that should be considered in global vaccine prioritisation. Our statistical approach to estimating SARS-CoV-2 infection, which can be applied routinely and will allow for rapid availability of estimates, will be crucially important for research, science, and policy efforts towards pandemic preparedness, response, and control in the coming months and years. It has and continues to be made freely available to all on a routine basis.

2. AN ANTISPIKE VACCINE TESTED IN CUBA

”…In conclusion, the results of the phase 1-2 trial indicated that Abdala vaccine against SARS-CoV-2 was safe, well tolerated and induced humoral immune responses against SARS-CoV-2 among adults from 19 to 80 years of age. Our findings indicate that the a SARS-CoV-2 recombinant spike protein vaccine studied (Abdala) is a promising candidate that warrants testing in phase 3 studies, in a larger number of individuals older than 19 years of age and a three-dose schedule of 50 μg on days 0-14-28, evaluating vaccine efficacy in the prevention of symptomatic COVID-19 and progression to serious and critical forms of the disease….”

FROM HOPKINS SUGGESTIONS:

1. The Next Leap in Coronavirus Vaccine Development Could Be a Nasal Spray (Washington Post) As the omicron variant of the coronavirus moved lightning-fast around the world, it revealed an unsettling truth. The virus had gained a stunning ability to infect people, jumping from one person’s nose to the next. Cases soared this winter, even among vaccinated people. That is leading scientists to rethink their strategy about the best way to fight future variants, by aiming for a higher level of protection: blocking infections altogether. If they succeed, the next vaccine could be a nasal spray.

2. Mechanical Control of Innate Immune Responses Against Viral Infection Revealed in a Human Lung Alveolus Chip (Nature Communications) Here we use a human lung alveolus chip that experiences cyclic breathing-like deformations to investigate whether physical forces influence innate immune responses to viral infection. Influenza H3N2 infection of mechanically active chips induces a cascade of host responses including increased lung permeability, apoptosis, cell regeneration, cytokines production, and recruitment of circulating immune cells. Comparison with static chips reveals that breathing motions suppress viral replication by activating protective innate immune responses in epithelial and endothelial cells, which are mediated in part through activation of the mechanosensitive ion channel TRPV4 and signaling via receptor for advanced glycation end products (RAGE). RAGE inhibitors suppress cytokines induction, while TRPV4 inhibition attenuates both inflammation and viral burden, in infected chips with breathing motions. Therefore, TRPV4 and RAGE may serve as new targets for therapeutic intervention in patients infected with influenza and other potential pandemic viruses that cause life-threatening lung inflammation.

FROM THE CDC:

COVID-19 Vaccines for Children and Teens

(J. Harris: An assortment of short readable articles related to youth and vaccines)

AND LASTLY FROM DR. MCCLURG IN AUSTIN:

These insults are from an era before the English language got boiled down to 4-letter words:

1. “He had delusions of adequacy ” Walter Kerr

2. “He has all the virtues I dislike and none of the vices I admire.”- Winston Churchill

3. “I have never killed a man, but I have read many obituaries with great pleasure. – Clarence Darrow

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