CORONAVIRUS INFO PROVIDED BY DR. JIM HARRIS – 12/14/2022

CORONAVIRUS INFO PROVIDED BY DR. JIM HARRIS – 12/14/2022

FROM THE MARSHALL NEWS MESSENGER:

FROM HOPKINS SUGGESTIONS:

1. EPI UPDATE The WHO COVID-19 Dashboard reports 643 million cumulative cases and 6.62 million deaths worldwide as of December 8. Global weekly incidence remained relatively stable last week, decreasing 1.3% compared to an increase of 16.8% the previous week. A total of 3.04 million cases were confirmed the week of November 28. Weekly incidence fell over the previous week in Africa (-64%)*, South-East Asia (-27%), Western Pacific (-10%), and the Eastern Mediterranean (-4%). The Americas (+14%) and Europe (+4.5%) regions experienced increasing weekly incidence. Global weekly mortality decreased from the previous week, down 17%.

*The WHO dashboard notes that data from the Africa region are incomplete.

UNITED STATES

The US CDC is reporting 98.8 million cumulative cases of COVID-19 and 1.08 million deaths. Incidence for the week ending November 30 remained relatively stable over the previous week, falling to 303,101 cases from 306,856 cases for the week ending November 23. Weekly mortality fell significantly for the week ending November 30, with 1,780 reported deaths compared to 2,634 deaths the week ending November 23. The decline could be a result of delayed reporting due to the US Thanksgiving holiday.

2. MASK USE The US CDC is once again encouraging people to wear masks to help reduce the spread of respiratory illnesses, as hospitalizations rise due to the so-called “tripledemic” of COVID-19, RSV, and flu. The nation appears to be at the start of another COVID-19 wave, with hospitalizations reaching a 3-month high last week. Hospitals are already feeling strain from earlier-than-normal increases in RSV and flu cases and hospitalizations. The US is experiencing the highest levels of hospitalization from flu that it has seen in a decade this early in the season. Experts warn that holiday gatherings present a prime opportunity for respiratory viruses to spread and urge people to take precautions, including mask use, physical distancing, testing, and increased air ventilation. While it is unlikely that widespread mask mandates will return, masking in crowded areas can lower the risk of infection and help decrease the burden on overwhelmed hospitals. 

One more reason to don a mask during the colder months could be to help keep your nose warm. A study published this week in the Journal of Allergy and Clinical Immunology suggests that exposure to cold temperatures hinder immune responses in the upper respiratory tract by killing nearly half of the virus and bacteria-fighting cells in the nostrils, allowing viruses or bacteria to evade this initial immune response. 

3. Authorities are urging indoor masking in major cities as the ‘tripledemic’ rages (NPR) Public health officials are revisiting the topic of indoor masking, as three highly contagious respiratory viruses take hold during the holiday season. Over the past few weeks, a surge in cases of COVID, the flu and respiratory syncytial virus — known as RSV — has been sickening millions of Americans, overwhelming emergency rooms and even causing a cold medicine shortage. The triple threat has been called a “tripledemic” by some health experts. Rochelle Walensky, director of the Centers for Disease Control and Prevention, noted this past week that the simultaneous combination of viruses has been straining healthcare systems across the country.

4. Wrangling Over the International Pandemic Pact Has Begun (Think Global Health) Health officials met this week in Geneva to discuss a rough draft of a pandemic treaty, an international plan to avoid another disaster on the scale of COVID-19. This is the first of many drafts to come, in a process that began with a decision made in December 2021 by the World Health Organization’s (WHO) 194 member states to develop something like a treaty—perhaps an accord, agreement, or other ‘instrument’—to govern the global pandemic response. The project is spearheaded by the WHO and is slated for completion in May 2024.

FROM THE ANNALS OF INTERNAL MEDICINE;

Nirmatrelvir Plus Ritonavir for Early COVID-19 in a Large U.S. Health System

”…In the EPIC-HR (Evaluation of Protease Inhibition for Covid-19 in High-Risk Patients) trial, nirmatrelvir plus ritonavir led to an 89% reduction in hospitalization or death among unvaccinated outpatients with early COVID-19. The clinical impact of nirmatrelvir plus ritonavir among vaccinated populations is uncertain….The overall risk for hospitalization or death was already low (1%) after an outpatient diagnosis of COVID-19, but nirmatrelvir plus ritonavir reduced this risk further.

”(During the study period, 12 541 (28.1%) patients were prescribed nirmatrelvir plus ritonavir, and 32 010 (71.9%) were not. Patients prescribed nirmatrelvir plus ritonavir were more likely to be older, have more comorbidities, and be vaccinated. The composite outcome of hospitalization or death occurred in 69 (0.55%) patients who were prescribed nirmatrelvir plus ritonavir and 310 (0.97%) who were not (adjusted risk ratio, 0.56 [95% CI, 0.42 to 0.75]). Recipients of nirmatrelvir plus ritonavir had lower risk for hospitalization (adjusted risk ratio, 0.60 [CI, 0.44 to 0.81]) and death (adjusted risk ratio, 0.29 [CI, 0.12 to 0.71]).”

FROM BECKERS:

1. Variants: Based on projections for the week ending Dec. 10, the CDC estimates that BQ.1.1 accounts for 36.8 percent of cases and BQ.1 accounts for 31.1 percent of cases nationally. All other lineages are decreasing in proportion this week compared to last week.

2. As of Dec. 7, a total of 1,080,472 COVID-19 deaths have been reported in the United States.

 3. About 64 percent of sites across the country are reporting moderate to high virus levels in wastewater. Of these sites, 38 percent are reporting some of the highest levels for those sites since Dec. 1, 2021.

4. About 27 percent of sites are seeing a decrease in virus levels and about 65 percent are reporting an increase.

FROM A READER WHO HAS LITERALLY TRAVELED THE WORLD:

Newsletter: You’re done with masks? That’s too bad, because COVID isn’t done with us

FROM YOUR LOCAL EPIDEMIOLOGIST:

Will trust in science survive the pandemic?

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

AREA COUNTS ARE UP AGAIN:(FROM THE NYT)

FROM THE CDE: DO I NEED ANOTHER BOOSTER:

DO I NEED A BOOSTER CLIC

Then Click the green tab asking “FIND OUT WHEN TO GET A BOOSTER.”

Then you can call your doctor, your pharmacist, or the health department:

MARSHALL/HARRISON COUNTY HEALTH DEPARTMENT

903 938 8338

I just called them and plan to get my 5th Covid vaccination tomorrow from 8-11 or 1-4. They are doing something else today (Thursday). Wear your mask in the building). 

FROM THE NEJM:

Efficacy of Antiviral Agents against Omicron Subvariants BQ.1.1 and XBB

”…Our data suggest that the omicron sublineages BQ.1.1 and XBB have immune-evasion capabilities that are greater than those of earlier omicron variants, including BA.5 and BA.2. The continued evolution of omicron variants reinforces the need for new therapeutic monoclonal antibodies for Covid-19.”

FROM YOUR LOCAL EPIDEMIOLOGIST:

Fall bivalent boosters: Science update round 3

”…We have lab data for fall boosters. We have real world data. And what’s coming in looks good—not perfect, but good. We have lots of reason to believe they will work even better against severe disease, especially among those over 50 years old. Go get your fall booster. We are at the beginning of a wave.”

From last week:” ..There’s a lot we can do: mask, test before seeing loved ones, get that airflow moving, stay home when you’re sick. The least you can do for a healthy season is get a flu and fall COVID-19 booster. If you haven’t gotten one yet, it’s never too late…”

FROM THE NYT:

Reversing ‘zero Covid’

FROM HOPKINS SUGGESTIONS:

1. Models predict massive waves of disease and death if China lifts ‘zero COVID’ policy (Science) Surprised and stung by protests against draconian “zero-COVID” policies, Chinese authorities are gingerly moving to ease the burden of lockdowns, quarantines, and constant testing. But 3 years into the pandemic, China shows no sign of planning a major course change. Mathematical models suggest why: The country is still ill-prepared for living with SARS-CoV-2. Easing restrictions today would likely trigger a massive wave of infections, overwhelm health care facilities, and bring a high death toll.

2. For the uninsured, Covid care has entered a new stage of crisis (New York Times) Difficulty getting care for Covid-19 has become an increasingly common problem for poor, uninsured Americans. After paying about $25 billion to health care providers over the course of the pandemic to reimburse them for vaccinating, testing and treating people without insurance, the federal government is running low on funds for Covid care for the nearly 30 million Americans who are uninsured. The Biden administration is asking Congress to replenish its coffers, but its pleas to lawmakers this year have so far been unsuccessful.

3. A liver drug reduces SARS-CoV-2 entry into cells (Nature) A widely used drug called UDCA reduces SARS-CoV-2 infection in human organoid structures, animals and human organs maintained outside the body. Individuals using UDCA for liver conditions are less likely to develop severe COVID-19 than are people who did not use it. UDCA treatment could help to protect people with suppressed immune systems and offer protection against vaccine-resistant variants. However, this study is not a clinical trial, and our findings must be validated and confirmed in large groups of individuals who are studied over time.

4. Science & Technology

U.S. FDA accepts priority review the Biologics License Applications for Pfizer’s respiratory syncytial virus vaccine (RSV) candidate for the prevention of RSV disease in older adults (Pfizer) Pfizer Inc. announced today that the U.S. FDA accepted a Biologics License Application (BLA) for priority review of its RSV vaccine candidate for the prevention of lower respiratory tract disease caused by RSV in individuals 60 years of age and older. Priority Review designation by the FDA reduces the standard BLA review period by four months. The Prescription Drug User Fee Act goal date for a decision by the FDA on the vaccine candidate application is in May 2023. 

AND LAST BUT NOT LEASED: 

DO NOT READ THIS JOKE:

Steve lived all his life in the Florida Keys and is on his deathbed and knows the end is near. His nurse, his wife, his daughter and two sons are with him. He asks for two witnesses to be present, and a camcorder be in place to record his last wishes, and when all is ready, he begins to speak:

“My son, Doug, I want you to take the Ocean Reef houses”

“My daughter Kelly, you take the apartments between mile markers 100 and Tavernier.”

“My son, Kevin, I want you to take the offices over in the Marathon Government Center.”

“Cathy, my dear wife, please take all the residential buildings on the bay side on Blackwater Sound.”

The nurse and witnesses are blown away as they did not realize his extensive holdings, and as Steve slips away, the nurse says, “Your husband must have been such a hard-working man to have accumulated all this property.”

The wife replies, “No. He was a hardworking dreamer who had a paper route.”

Remember, next time you hate your life, it’s all about perspective. For, instance, I have a friend who reads 2-3 books a week, works out twice a day, and has people who want to have sex with him all the time, yet complains about how much he hates prison.

Have a Wonderful Holiday Season!

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Ode to a Fallen Leaf

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Ode to a Fallen Leaf 

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By Ron Munden 

As winter approaches, trees drop their leaves.  Several years ago I read an article in a nature publication that explained why it is important for leaves to fall from the trees and cover the ground.  They make a compelling argument that people should allow leaves to remain on the ground throughout  the winter to ensure a healthy lawn in the Spring.

Each Fall when our yard workers come and begin the celebration known as “Leaf Blowing” I think back to that article.

This Sunday morning the workers gathered to begin the blowing of the leaves.  This happens every two weeks for a two or three month period.  This week it was a hard fought battle between the trees and our workforce.  As quickly as the workers could clear the leaves from a patch of ground the trees deposited another layer into that space.  By Monday it was difficult to find any area that was still free of leaves.

Why do we do this?  As stated above everything I read  says that Mother Nature wants the leaves on the ground for the entire winter, not two weeks.  Every two weeks I ask myself why I spend $80 to have something done that I think is bad for the environment.  My only justification is that I am doing my small part to redistribute wealth in this society.

That is the justification I give but it’s not the real reason.  The truth is we practice this celebration of “leaf blowing” because the Jones down the road do the same thing and we just can’t let the Jones outdo us. 

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CORONAVIRUS INFO PROVIDED BY DR. JIM HARRIS – 12/6/2022

CORONAVIRUS INFO PROVIDED BY DR. JIM HARRIS – 12/6/2022

Hello,

FROM THE MARSHALL NEWS MESSENGER:

New COVID-19 cases in county low as state cases spike

FROM THE LANCET:

Why hybrid immunity is so triggering

”…If one must make any political arguments with hybrid immunity, it should be that people who had no access to vaccines yet must urgently get them…”

(J. Harris: And, you don’t want to flirt with Long Covid.)

FROM BECKERS:

Flu activity, state by state

FROM HOPKINS SUGGESTIONS:

1. US PANDEMIC MORTALITY On average, more than 300 people in the US die each day from COVID-19. While the death toll is significantly lower than during the peak of the Delta wave, the number is 2 to 3 times higher than the average number of deaths from flu. Increasingly, COVID-19 is becoming a disease of the elderly. In summer 2021, about 58% of COVID-19 deaths occurred among adults aged 65 or older. Today, that proportion is 9 of 10 COVID-related deaths, according to US CDC data. This upward trend is expected to continue, and despite the nation’s pursuit of normalcy, is set to cause significant disruptions to the health system.

Mortality trends have shifted throughout the pandemic. A study published this week in the Annals of Internal Medicine by investigators at Brigham and Women’s Hospital in Boston, Massachusetts (US), found that the proportion of younger people who died from COVID-19 in 2021 surpassed that of 2020, with the median age of COVID-related deaths falling from 78 years old in 2020 to 69 years old in 2021. Researchers calculated years of life lost (YLL) and compared timeframes in 2020 and 2021. Using this calculation, the team was able to assess premature deaths based on the number of years an individual would have lived. In 2021, there were about 21% fewer deaths compared to 2020. However, YLL per COVID-19 death increased by 36%. Better understanding age shifts in COVID-19 mortality can help inform prevention and treatment approaches, public policy, and community measures to minimize the impacts of this increasingly preventable disease. 

2. LONG COVID Nearly a third of people in the US with COVID-19 will develop long-term symptoms, according to a recent report from the US Department of Health and Human Services (HHS). Health experts are warning that this collection of post-acute symptoms, commonly known as long COVID, could be the next public health crisis—so far impacting as many as 23 million people, a number expected to grow as COVID-19 continues to circulate. In addition to increased medical expenses, individuals and families dealing with long COVID could face a reduced quality of life, reduced income, higher household debt, and lower retirement savings, further widening existing inequalities and costing the US economy US$3.7 trillion, according to one estimate. A Swiss study published in Nature Communications examined the prevalence of post-COVID conditions among children, with the findings suggesting that risk factors for lingering symptoms included older age, lower socioeconomic status, and having an existing chronic health condition, particularly asthma. 

With little known about the underlying causes of lasting symptoms and a lack of a clear definition, healthcare professionals are stuck between wanting more evidence for effective therapies and trying to treat vulnerable and suffering patients. Some people with long COVID are turning to expensive and untested therapies, from vitamin supplements to stem cell treatments. The US NIH created the RECOVER Initiative to learn more about the long-term effects of COVID-19 and recently announced a clinical trial to investigate the antiviral Paxlovid for treatment of long COVID, with results expected in 2024. But many experts argue a more agile research model is needed to more quickly address the growing problem.

3. FUTURE OF VACCINES Global efforts are underway to prepare vaccine research, development, and production facilities for the next pandemic. This week, the Coalition for Epidemic Preparedness Innovations (CEPI) launched its 100 Days Mission, a US$3.5 billion plan to invest in vaccine research and development and achieve equitable access to vaccines for emerging viruses with pandemic potential, with the goal of producing a safe and effective vaccine within 100 days. This effort, if successful, would significantly shorten the time it took scientists to develop shots for COVID-19, a record 326 days. In Africa, Afrigen Biologics & Vaccines, the Biovac Institute, and a variety of partners are working to bring mRNA vaccines—for COVID-19 and other diseases—to the continent and adapt them for the setting, such as doing away with the need for deep freezing and making them more stable at room or refrigerated temperatures. Those involved in the effort hope more African national governments will prioritize vaccine development and manufacturing, ultimately allowing them to own the intellectual property on domestically produced vaccines that can help protect their own populations.

4. SARS-CoV-2 Serology and Self-Reported Infection Among Adults — National Health and Nutrition Examination Survey (CDC MMWR) During August 2021–May 2022, 41.6% of a c.onvenience sample of adults had both anti-spike antibodies (indicating previous infection or vaccination) and anti-nucleocapsid antibodies (indicating previous infection only); 43.7% of these persons were possibly asymptomatically infected. Prevalence of serologic patterns consistent with vaccination without infection was lower among adults who were younger, Hispanic and non-Hispanic Black or African American adults, and persons with less education.

5. As Officials Ease Covid Restrictions, China Faces New Pandemic Risks (NYT) As one country after another succumbed to outbreaks this year, China kept the coronavirus at bay, buying valuable time to prepare for the inevitable: a variant of the virus so shifty and contagious that China, too, would struggle to contain it. But rather than laying the groundwork for that scenario, China stepped up its commitment to “zero Covid,” deploying snap lockdowns and contact tracing. Now, the costs of that approach are piling up, putting China in a bind from which there appears to be no easy escape, scientists said in interviews.

6. Pfizer and BioNTech Submit Application to U.S. FDA for Emergency Use Authorization of Omicron BA.4/BA.5-Adapted Bivalent COVID-19 Vaccine in Children Under 5 Years (Pfizer) Pfizer Inc. (NYSE: PFE) and BioNTech SE (Nasdaq: BNTX) today announced that the companies have submitted an application to the U.S. Food and Drug Administration (FDA) for emergency use authorization (EUA) of their Omicron BA.4/BA.5-adapted bivalent COVID-19 vaccine as the third 3-µg dose in the three-dose primary series for children 6 months through 4 years of age. With the high level of respiratory illnesses currently circulating among children under 5 years of age, updated COVID-19 vaccines may help prevent severe illness and hospitalization.

7. Severe COVID could cause markers of old age in the brain (Nature) Severe COVID-19 is linked to changes in the brain that mirror those seen in old age, according to an analysis of dozens of post-mortem brain samples. The analysis revealed brain changes in gene activity that were more extensive in people who had severe SARS-CoV-2 infections than in uninfected people who had been in an intensive care unit (ICU) or had been put on ventilators to assist their breathing — treatments used in many people with serious COVID-19. The study, published on 5 December in Nature Aging, joins a bevy of publications cataloguing the effects of COVID-19 on the brain.

FROM BECKERS:

1. FDA revokes Eli Lilly’s COVID-19 drug’s authorization

2. With 95% efficacy, drug could eradicate rare sleeping sickness, researchers say

(J. Harris: For guys  THOSE who hunt in Africa)

3. Long COVID may cost US economy $3.7 trillion

”…Long Covid will be around long after the pandemic subsides, impacting our communities, our health-care system, our economy and the well-being of future generations,” a November HHS report said. “We can reduce the severity and breadth of that impact, however, if we act collectively and urgently.”

(J. Harris: Read this short article.)

4. Paxlovid safe for pregnant COVID-19 patients, study finds

NEW NIH COVID TREATMENT GUIDELINES

What’s New in the Guidelines on the COVID-19 Treatment Guidelines website.

FROM YOUR LOCAL EPIDEMIOLOGIST:

State of Affairs: December 6, 2022

AND LAST BUT NOT LEASED:

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CORONAVIRUS INFO PROVIDED BY DR. JIM HARRIS – 12/1/2022

US, Texas, and East Texas Covid Case Counts are going up again. Here we go again, but we have some immunity, Vaccines available, Flu shots, Masks, and soap. We are also more likely to use more informed and better judgment. 

FROM THE NEW YORK TIMES 1 DEC, 2022

FROM YOUR LOCAL EPIDEMIOLOGIST:

COVID-19 in China and global concern

(J. Harris: Great read regarding China and what likely will happen!)

FROM THE ANNALS OF INTERNAL MEDICINE:

1. Medical Masks Versus N95 Respirators for Preventing COVID-19 Among Health Care Workers (Hopkins summary)

Study on masks vs N95 respirators for health workers spurs concerns (CIDRAP) A study today in the Annals of Internal Medicine suggests that medical masks may offer similar effectiveness as N95 respirators in protecting healthcare workers (HCWs) exposed to COVID-19 patients in certain settings, but experts caution against that interpretation of the results. The World Health Organization (WHO) recommends continuous wear of either medical masks or N95s when caring for COVID-19 patients, while the US Centers for Disease Control and Prevention (CDC) advises using N95s.

2. Outpatient Treatment of Confirmed COVID-19

”…Some antiviral medications and monoclonal antibodies may improve outcomes for outpatients with mild to moderate COVID-19. However, the generalizability of the findings to the currently dominant Omicron variant is limited….”

3. Major Update 2: Antibody Response and Risk for Reinfection After SARS-CoV-2 Infection—Final Update of a Living, Rapid Review

”…Evidence for a sustained antibody response to SARS-CoV-2 infection is considerable for both Delta and Omicron variants. Prior infection protected against reinfection with both variants, but, for Omicron, protection was weaker and waned rapidly. This information may have limited clinical applicability as new variants emerge…”

4. Temporal Improvements in COVID-19 Outcomes for Hospitalized Adults: A Post Hoc Observational Study of Remdesivir Group Participants in the Adaptive COVID-19 Treatment Trial (94 hospitals in 10 countries (86% U.S. participants)

FROM HOPKINS SELECTIONS

1. ‘Zombie virus’ resurrected after being frozen for 48,500 years (Independent) Thawing of frozen landscapes has the potentional to unleash infectious “zombie viruses” that have been locked underground for thousands of years, according to new research. One quarter of the Northern hemisphere has permanently frozen ground beneath it, and is facing irreversible thawing due to the climate crisis. This decomposing landscape releases carbon dioxide and methane into the atmosphere, adding more heat to the planet. The new study, led by microbiologist Jean-Marie Alempic from the French National Centre for Scientific Research, looked at samples collected from permafrost in the Russian province of Siberia. From these, scientists were able to awaken 13 new viruses which they labelled “zombie viruses” – including one which remained infectious after more than 48,500 years in deep permafrost. The study, which is yet to be peer-reviewed, noted that there has been limited research into “live” viruses found in permafrost.

2 CDC Awards over $3 billion to bolster public health workforce, infrastructure (The Hill) The U.S. Centers for Disease Control and Prevention (CDC) announced it will award over $3 billion to strengthen the public health workforce and infrastructure of state, local and territorial health departments. The funding is the first-of-its kind, while all U.S. citizens live in a jurisdiction that will receive funds under the new grant. The announcement comes as the United States faces a growing shortage of healthcare workers. The Association of American Medical Colleges estimates that by 2033, the country will have a shortage of up to 124,000 physicians, including both primary care physicians and specialists.

AND LAST BUT NOT LEASED: HOME GROWN GROANERS: 

1. What did one ocean say to the other ocean?

Nothing, it just waved.

2.Did you hear about the fire at the circus?

It was in tents!

3. When does a joke become a ‘dad’ joke?

When it becomes apparent.

NO JOKE: WHY NOT USE PARTS OF GOOD SHEPHERD MARSHALL HOSPITAL 

FOR LONG COVID REHABILITATION???

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