CORONAVIRUS INFO PROVIDED BY DR. JIM HARRIS – 9/24/2020

September 24, 2020

Yesterday, Harrison County reported 8 new cases, Gregg 7, and Smith County 22. 

From Johns Hopkins:

1. WEDDING RECEPTION OUTBREAK An August wedding in Maine has been linked to more than 175 associated cases and 8 deaths, including many who did not attend the wedding. Notably, none of the associated deaths attended the wedding. Six of the 8 deaths were residents of a nearby long-term care facility, where an employee who lives with someone who attended the wedding is believed to have introduced the virus. Associated cases have been identified in multiple long-term care facilities and the county jail. The outbreak at the jail has been attributed to an employee who attended the wedding, and it has resulted in at least 84 cases, including nearly half of the incarcerated population and employees as well as 17 household contacts of employees.

The wedding reportedly had 62-65 attendees and an indoor ceremony and reception, which violated the state prohibition on gatherings of more than 50 people, and attendees reportedly did not adhere to recommendations regarding physical distancing or mask use. All attendees had their temperatures checked before entering; however, this failed to identify infectious individuals. The Maine CDC issued an “imminent health hazard” citation to the event facility where the reception was held for failing to maintain social distancing measures, allowing too many people to congregate, and neglecting to collect contact information from wedding guests. The facility reportedly suspended all operations due to the outbreak. This case study highlights the potential for transmission at individual events to spill over into the community as well as the limitations of temperature or symptom monitoring to identify infectious individuals.(J. Harris: This could happen tomorrow at any site in the US. Good tracking and testing made the situation informative — as well as frightening. The contagiousness of the virus is still as prevalent as it was in August. So, space out, avoid crowds, and wear your mask.)

2. Long-term hydroxychloroquine use in patients with rheumatic conditions and development of SARS-CoV-2 infection: a retrospective cohort study

From The Atlantic:The Core Lesson of the COVID-19 Heart Debate (The Atlantic) Autopsies have found traces of the coronavirus’s genetic material in the heart, and actual viral particles within the heart’s muscle cells. Experiments have found that SARS-CoV-2 can destroy lab-grown versions of those cells. Several studies have now shown that roughly 10 to 30 percent of hospitalized COVID-19 patients had high levels of troponin—a protein released into the blood when the heart’s muscle cells are damaged. Such patients are more likely to die than others with no signs of heart injury.
Massive genetic study shows coronavirus mutating and potentially evolving amid rapid U.S. spread
“…The new report, however, did not find that these mutations have made the virus deadlier or changed clinical outcomes. All viruses accumulate genetic mutations, and most are insignificant, scientists say. The new report, however, did not find that these mutations have made the virus deadlier or changed clinical outcomes. All viruses accumulate genetic mutations, and most are insignificant, scientists say…. A larger batch of sequences was published earlier this month by scientists in the United Kingdom, and, like the Houston study, concluded that a mutation that changes the structure of the “spike protein” on the surface of the virus may be driving the outsized spread of that particular strain…“Although we don’t know yet, it is well within the realm of possibility that this coronavirus, when our population-level immunity gets high enough, this coronavirus will find a way to get around our immunity,….If that happened, we’d be in the same situation as with flu. We’ll have to chase the virus and, as it mutates, we’ll have to tinker with our vaccine.”The genetic data show the virus arrived in Houston many separate times, presumably at first by air travel. Notably, 71 percent of the viruses that arrived initially were characterized by a now famous mutation, which appears to have first originated in China, that scientists increasingly suspect may give the virus a biological advantage in how it spreads. It is called D614G, referring to the substitution of an amino acid called aspartic acid (D) for one called glycine (G) in a region of the genome that encodes the spike protein…’

Yesterday, Harrison County reported 8 new cases, Gregg 7, and Smith County 22. From Johns Hopkins:1. WEDDING RECEPTION OUTBREAK An August wedding in Maine has been linked to more than 175 associated cases and 8 deaths, including many who did not attend the wedding. Notably, none of the associated deaths attended the wedding. Six of the 8 deaths were residents of a nearby long-term care facility, where an employee who lives with someone who attended the wedding is believed to have introduced the virus. Associated cases have been identified in multiple long-term care facilities and the county jail. The outbreak at the jail has been attributed to an employee who attended the wedding, and it has resulted in at least 84 cases, including nearly half of the incarcerated population and employees as well as 17 household contacts of employees.
The wedding reportedly had 62-65 attendees and an indoor ceremony and reception, which violated the state prohibition on gatherings of more than 50 people, and attendees reportedly did not adhere to recommendations regarding physical distancing or mask use. All attendees had their temperatures checked before entering; however, this failed to identify infectious individuals. The Maine CDC issued an “imminent health hazard” citation to the event facility where the reception was held for failing to maintain social distancing measures, allowing too many people to congregate, and neglecting to collect contact information from wedding guests. The facility reportedly suspended all operations due to the outbreak. This case study highlights the potential for transmission at individual events to spill over into the community as well as the limitations of temperature or symptom monitoring to identify infectious individuals.(J. Harris: This could happen tomorrow at any site in the US. Good tracking and testing made the situation informative — as well as frightening. The contagiousness of the virus is still as prevalent as it was in August. So, space out, avoid crowds, and wear your mask.)
2. Long-term hydroxychloroquine use in patients with rheumatic conditions and development of SARS-CoV-2 infection: a retrospective cohort study

From The Atlantic:The Core Lesson of the COVID-19 Heart Debate (The Atlantic) Autopsies have found traces of the coronavirus’s genetic material in the heart, and actual viral particles within the heart’s muscle cells. Experiments have found that SARS-CoV-2 can destroy lab-grown versions of those cells. Several studies have now shown that roughly 10 to 30 percent of hospitalized COVID-19 patients had high levels of troponin—a protein released into the blood when the heart’s muscle cells are damaged. Such patients are more likely to die than others with no signs of heart injury.
Massive genetic study shows coronavirus mutating and potentially evolving amid rapid U.S. spread
“…The new report, however, did not find that these mutations have made the virus deadlier or changed clinical outcomes. All viruses accumulate genetic mutations, and most are insignificant, scientists say. The new report, however, did not find that these mutations have made the virus deadlier or changed clinical outcomes. All viruses accumulate genetic mutations, and most are insignificant, scientists say…. A larger batch of sequences was published earlier this month by scientists in the United Kingdom, and, like the Houston study, concluded that a mutation that changes the structure of the “spike protein” on the surface of the virus may be driving the outsized spread of that particular strain…“Although we don’t know yet, it is well within the realm of possibility that this coronavirus, when our population-level immunity gets high enough, this coronavirus will find a way to get around our immunity,….If that happened, we’d be in the same situation as with flu. We’ll have to chase the virus and, as it mutates, we’ll have to tinker with our vaccine.”The genetic data show the virus arrived in Houston many separate times, presumably at first by air travel. Notably, 71 percent of the viruses that arrived initially were characterized by a now famous mutation, which appears to have first originated in China, that scientists increasingly suspect may give the virus a biological advantage in how it spreads. It is called D614G, referring to the substitution of an amino acid called aspartic acid (D) for one called glycine (G) in a region of the genome that encodes the spike protein…’

Yesterday, Harrison County reported 8 new cases, Gregg 7, and Smith County 22. From Johns Hopkins:1. WEDDING RECEPTION OUTBREAK An August wedding in Maine has been linked to more than 175 associated cases and 8 deaths, including many who did not attend the wedding. Notably, none of the associated deaths attended the wedding. Six of the 8 deaths were residents of a nearby long-term care facility, where an employee who lives with someone who attended the wedding is believed to have introduced the virus. Associated cases have been identified in multiple long-term care facilities and the county jail. The outbreak at the jail has been attributed to an employee who attended the wedding, and it has resulted in at least 84 cases, including nearly half of the incarcerated population and employees as well as 17 household contacts of employees.
The wedding reportedly had 62-65 attendees and an indoor ceremony and reception, which violated the state prohibition on gatherings of more than 50 people, and attendees reportedly did not adhere to recommendations regarding physical distancing or mask use. All attendees had their temperatures checked before entering; however, this failed to identify infectious individuals. The Maine CDC issued an “imminent health hazard” citation to the event facility where the reception was held for failing to maintain social distancing measures, allowing too many people to congregate, and neglecting to collect contact information from wedding guests. The facility reportedly suspended all operations due to the outbreak. This case study highlights the potential for transmission at individual events to spill over into the community as well as the limitations of temperature or symptom monitoring to identify infectious individuals.(J. Harris: This could happen tomorrow at any site in the US. Good tracking and testing made the situation informative — as well as frightening. The contagiousness of the virus is still as prevalent as it was in August. So, space out, avoid crowds, and wear your mask.)
2. Long-term hydroxychloroquine use in patients with rheumatic conditions and development of SARS-CoV-2 infection: a retrospective cohort study

From The Atlantic:The Core Lesson of the COVID-19 Heart Debate (The Atlantic) Autopsies have found traces of the coronavirus’s genetic material in the heart, and actual viral particles within the heart’s muscle cells. Experiments have found that SARS-CoV-2 can destroy lab-grown versions of those cells. Several studies have now shown that roughly 10 to 30 percent of hospitalized COVID-19 patients had high levels of troponin—a protein released into the blood when the heart’s muscle cells are damaged. Such patients are more likely to die than others with no signs of heart injury.
Massive genetic study shows coronavirus mutating and potentially evolving amid rapid U.S. spread
“…The new report, however, did not find that these mutations have made the virus deadlier or changed clinical outcomes. All viruses accumulate genetic mutations, and most are insignificant, scientists say. The new report, however, did not find that these mutations have made the virus deadlier or changed clinical outcomes. All viruses accumulate genetic mutations, and most are insignificant, scientists say…. A larger batch of sequences was published earlier this month by scientists in the United Kingdom, and, like the Houston study, concluded that a mutation that changes the structure of the “spike protein” on the surface of the virus may be driving the outsized spread of that particular strain…“Although we don’t know yet, it is well within the realm of possibility that this coronavirus, when our population-level immunity gets high enough, this coronavirus will find a way to get around our immunity,….If that happened, we’d be in the same situation as with flu. We’ll have to chase the virus and, as it mutates, we’ll have to tinker with our vaccine.”The genetic data show the virus arrived in Houston many separate times, presumably at first by air travel. Notably, 71 percent of the viruses that arrived initially were characterized by a now famous mutation, which appears to have first originated in China, that scientists increasingly suspect may give the virus a biological advantage in how it spreads. It is called D614G, referring to the substitution of an amino acid called aspartic acid (D) for one called glycine (G) in a region of the genome that encodes the spike protein…’

J. Harris’ version of Transmission of SARS-CoV-2: A Review of Viral, Host, and Environmental Factors Click here to read the document

When a man opens a car door for his wife, it’s either a new
car or a new wife.
~ Prince Philip

If a 7-Eleven is open 24 hours a day, 365 days a year, why are there locks on the doors?

CORONAVIRUS INFO PROVIDED BY DR. JIM HARRIS – 9/23/2020

September 23, 2020

Recently in East Texas: Monday Harrison County reported 1 new case and 4 on Tuesday, while Gregg had 40 and 20 and Smith 60 and 15 on the same days.

image.png
Click here to enlarge the table

(J. Harris: notice that the green area above, which I consider the most important and which represents Covid Hospitilizations in Texas. It shows a great deal of stability at present, except in the Paris, Lufkin, Austin, and  Waco areas.)

From Johns Hopkins:

1. Measurement of SARS-CoV-2 RNA in Wastewater Tracks Community Infection Dynamics(Nature Biotechnology) We measured severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA concentrations in primary sewage sludge in the New Haven, Connecticut, USA, metropolitan area during the Coronavirus Disease 2019 (COVID-19) outbreak in Spring 2020. SARS-CoV-2 RNA was detected throughout the more than 10-week study and, when adjusted for time lags, tracked the rise and fall of cases seen in SARS-CoV-2 clinical test results and local COVID-19 hospital admissions. Relative to these indicators, SARS-CoV-2 RNA concentrations in sludge were 0–2 d ahead of SARS-CoV-2 positive test results by date of specimen collection, 0–2 d ahead of the percentage of positive tests by date of specimen collection, 1–4 d ahead of local hospital admissions and 6–8 d ahead of SARS-CoV-2 positive test results by reporting date. Our data show the utility of viral RNA monitoring in municipal wastewater for SARS-CoV-2 infection surveillance at a population-wide level. In communities facing a delay between specimen collection and the reporting of test results, immediate wastewater results can provide considerable advance notice of infection dynamics.

2. EYEGLASSES Researchers from China published findings from study investigating whether the use of eyeglasses provides protection against SARS-CoV-2 transmission. The study, published in JAMA: Ophthalmology, included a cohort of 276 hospitalized COVID-19 patients in Hubei Province in January-March. Among these patients, 5.8% routinely wore eyeglasses—defined as more than 8 hours per day—compared to an estimated 31.5% among the general public. The researchers hypothesize that wearing glasses could reduce the amount that people touch their eyes, which could reduce SARS-CoV-2 transmission. While protective eyewear is recommended for healthcare professionals, peer-reviewed evidence is limited regarding any potential protective effect for the general public. Further research is necessary to better characterize any effect of eyeglasses on mitigating SARS-CoV-2 transmission risk outside the context of the healthcare setting.

3. SARS-CoV-2–Associated Deaths Among Persons Aged <21 Years — United States, February 12–July 31, 2020 Among 121 SARS-CoV-2–associated deaths among persons aged <21 years reported to CDC by July 31, 2020, 12 (10%) were infants and 85 (70%) were aged 10–20 years. Hispanic, non-Hispanic Black and non-Hispanic American Indian/Alaskan Native persons accounted for 94 (78%) of these deaths; 33% of deaths occurred outside of a hospital. Persons aged <21 years exposed to SARS-CoV-2 should be monitored for complications. Ongoing surveillance for SARS-CoV-2–associated infection, hospitalization, and death among persons aged <21 years should be continued as schools reopen in the United States. (CDC MMWR, 9/18/2020)

Indicators for Dynamic School Decision-Making
(J. Harris: A guide for school to use with COVID.)

The N95 shortage America can’t seem to fix
(J. Harris: Small world. A local Norwegian housekeeper’s father built the 3M Plant mentioned in South Dakota  in this story — over 40 years ago.)

Apple is designing a new automatic car. But they’re having trouble installing Windows!

How did the picture end up in jail? It was framed!

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CORONAVIRUS INFO PROVIDED BY DR. JIM HARRIS – 9/21/2020

September 21, 2020

Harrison County is averaging a little over 4 new cases daily for the last several days. 

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Click here to enlarge this table

(J. Harris: notice the above area figures show a decrease in the total hospital census of Covid patients but no improvement in the number of cases in ICU in or area. The number of ICU beds available is aboutis about the same as last month. So, we’re stagnant right now. We did not have increased cases associated with labor day, and STATEWIDE cases are down about 50% over the last month or so. However, FLU season is coming. Please get your Flu shot.There is still no COVID prevention better than Masks and distance and good sense.)

SOMETHINGS NEW ABOUT TRANSMISSION OF COVIDD: Transmission of SARS-CoV-2: A Review of Viral, Host, and Environmental Factors

(From Annals of Internal Medicine)

(J. Harris: I wrote and erased a summary of this article. You need to read it. I’ve read it 3 times so far, and learn something new each time. If you read and digest this article, you will know more about COVId that 99.9% of the people in this world know about it! I believe that it was purposefully written in an understandable manner without any gibberish and “doctor speak” —-and there are few abbreviations. I’m now going to put in on “Word” and play with it some more. I have to stop reading, make my mind quit racing ahead, and reread virtually every paragraph. It’s loaded. 

I’m not going to send anything out for awhile so that you can read the WHOLE ARTICLE and one good letter to the editor following the article. If you have comments or questions, send me an email).Great News: I’ve volunteered for the vaccine trials for Covid-19 which apparently were made by a Russian Pharmaceutical company.
I received my first shot and wanted to let ya’ll know that it’s completely safe with иo side effects whatsoeveя, and that I feelshκι χoρoshό я чувствую себя немного странно и я думаю, что вытащил ослиные уши.

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CORONAVIRUS INFO PROVIDED BY DR. JIM HARRIS – 9/20/2020

September 20, 2020

From MNM:

Harrison County’s COVID-19 numbers experienced a great leap on Friday with 13 new cases reported…School Cases Also on Friday, Marshall Independent School District reported three active cases — two at Marshall Early Childhood Center and one at Marshall High School. Of the cumulative total of eight cases for MISD campuses, five have been recoveries, which include one recovery at MECC, two recoveries at MHS and two recoveries at Marshall Junior High School.

  HERD IMMUNITY (From THE LANCET)      (.”How did herd immunity enter the language of public health? The phrase seems to have first appeared in the work of American livestock veterinarians concerned about “contagious abortion”—epidemics of spontaneous miscarriage—in cattle and sheep. By the 1910s, it had become the leading contagious threat to cattle in the USA. Farmers destroyed or sold affected cows. Kansas veterinarian George Potter realised that this was the wrong approach. Writing with Adolph Eichhorn in 1916 in the Journal of the American Veterinary Medical Association, he envisioned “herd immunity”. As he wrote in 1918, “Abortion disease may be likened to a fire, which, if new fuel is not constantly added, soon dies down. Herd immunity is developed, therefore, by retaining the immune cows, raising the calves, and avoiding the introduction of foreign cattle.”…..With potential vaccines still likely to be many months away, and with lockdowns and social distancing causing social and economic disruption, there are no ideal options. British public health expert Raj Bhopal likened the situation to being in zugzwang, “a position in chess where every move is disadvantageous where we must examine every plan, however unpalatable”. He sought to overcome the animal connotations of “herd immunity” by encouraging the use of “population immunity” instead. Changing the label of herd immunity might remove the connotations but not fix the problem. Without a vaccine, many people would have to die from COVID-19 before population immunity is achieved.” J. Harris: Click here to read an article that explains “Population Immunity” and which is a good read including attempts at achieving immunity in Diptheria before the vaccine was available,) ….

FROM JOHHS HOPKINS1. Fast Coronavirus Tests: What They Can and Can’t Do (Nature) The United States leads the world in COVID-19 deaths but lags behind many countries — both large and small — in testing capacity. That could soon change. (J. Harris: another good review of tests and testing).
2. Lilly’s Covid-19 Antibody Helps Some Patients Rid their Systems of Virus Sooner in Early Analysis (STAT) A drug being developed by Eli Lilly helped sick patients rid their systems of the virus that causes Covid-19 sooner and may have prevented them from landing in the hospital, according to newly released data. The drug is what is known as a monoclonal antibody, which experts view as being among the most likely technologies to help treat Covid-19. It’s a manufactured version of the antibodies that the body uses as part of its response to a virus.
3. Why Can’t America Make Enough N95 Masks? 6 Months Into Pandemic, Shortages Persist(NPR) Since the coronavirus pandemic began, President Trump and industry officials have talked a lot about the need to ramp up domestic manufacturing of critical protective gear. But six months on, there are still shortages of all kinds of PPE, like N95 respirator masks, while face shields are easy to find. The disconnect can be traced, in part, to the lack of a coherent national plan.
4. Transmission of SARS-CoV-2: A Review of Viral, Host, and Environmental Factors(Annals of Internal Medicine) This article presents a comprehensive review of the evidence on transmission of this virus. Strong evidence from case and cluster reports indicates that respiratory transmission is dominant, with proximity and ventilation being key determinants of transmission risk. In the few cases where direct contact or fomite transmission is presumed, respiratory transmission has not been completely excluded. Infectiousness peaks around a day before symptom onset and declines within a week of symptom onset, and no late linked transmissions (after a patient has had symptoms for about a week) have been documented. The virus has heterogeneous transmission dynamics: Most persons do not transmit virus, whereas some cause many secondary cases in transmission clusters called “superspreading events.” 
Why a “Wear No Mask” Preacher Changed his Mind

UT researcher: 20% of Houston may already have been infected with COVID

France Encourages Use Of Transparent Masks To Help Those With Hearing Loss

‘A Very Serious Situation’: WHO Says Coronavirus Cases Are Rising In Europe Again
The World Health Organization warned on Thursday that weekly coronavirus case numbers are rising in Europe at a higher rate than during the pandemic’s peak in March.
(J. Harris: Short article, worth the read. We still have a ways to go.)

What do you call a girl with one leg that’s shorter than the other? Ilene.

What did syrup to the waffle? I love you a waffle lot!

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CORONAVIRUS INFO PROVIDED BY DR. JIM HARRIS – 9/18/2020

September 18, 2020

HOT OFF THE PRESS[Marshall News Messenger] Governor Abbott provides update on state openings

WAS THE USPS GOING TO SEND FREE MASKS TO ALL AMERICANS?
Suboptimal US Response to COVID-19 Despite Robust Capabilities and Resources
(J. Harris: This is a “Viewpoint”   article from the “Journal of the American Medical Association”  that outlines and briefly discusses in an understandable manner some of the problems that the US (and others) have had in combating COVID. It is worth the time to read and consider. I agree with most if not all of it.)

FROM JOHNS HOPKINS

1. Bridging the Gap at Warp Speed — Delivering Options for Preventing and Treating Covid-19(NEJM) Much attention has been directed to OWS’s goal of delivering substantial quantities of safe and effective vaccines by early 2021. But the initiative also aims to combat Covid-19 by improving the use of existing therapies and providing additional treatment options. We hope in this way to ameliorate the pandemic as we wait for the U.S. population to be fully immunized.

2. Synthetic Biologists Have Created a Slow-growing Version of the Coronavirus to Give as a Vaccine(MIT Technology Review) Now, researchers say, synthetic biology has led to a way to create a weakened form of the pandemic coronavirus that causes covid-19. Although the idea remains a long-shot in the vaccine race, an attenuated coronavirus could be formulated into inexpensive nose drops for use around the world. The startup company behind the new version of SARS-CoV-2, called Codagenix, is working with Serum Institute of India, based in Pune, which bills itself as the world’s largest vaccine maker. Plans are for the first volunteers to sniff up the synthetically designed virus starting in November, in initial human safety tests in the UK.

3. As Controversies Swirl, CDC Director is Seen as Allowing Agency to Buckle to Political Influence (STAT) Public health experts at the CDC who led the country’s responses to countless threats over decades — the deadly emergence of HIV, the anthrax attacks of the autumn of 2001, SARS, the H1N1 flu pandemic, and Ebola — have been sidelined and silenced by the administration in the midst of President Trump’s reelection campaign. On multiple occasions, guidance documents written by CDC staff — recommendations that are meant to be the most up-to-date distillation of the emerging science on the SARS-CoV-2 virus — have been revised by political appointees in Washington to reflect administration goals.(J. Harris: One of the most important and trusted publications sent without charge weekly by the CAC and read by working doctors, every week,  is the MMWR: ” In recent days, first Politico and then other news organizations have reported that officials in Washington have been attempting to revise or delay the publication of scientific reports in the CDC’s online journal Morbidity and Mortality Weekly Report. MMWR, as it is better known, is a bedrock of public health. It is where the first reports of AIDS cases in the United States were published; it is where public health workers seeking the latest on an outbreak or a disease first turn.

4. Viable SARS-CoV-2 in the Air of a Hospital Room with COVID-19 Patients (International Journal of Infectious Diseases) Viable SARS-CoV-2 was isolated from air samples collected 2 to 4.8 m away from the patients. The genome sequence of the SARS-CoV-2 strain isolated from the material collected by the air samplers was identical to that isolated from the newly admitted patient. Patients with respiratory manifestations of COVID-19 produce aerosols in the absence of aerosol-generating procedures that contain viable SARS-CoV-2, and these aerosols may serve as a source of transmission of the virus.

In Vitro Efficacy of a Povidone-Iodine Nasal Antiseptic for Rapid Inactivation of SARS-CoV-2

How much does the heaviest skeleton weigh? A skele ton.

Why can’t you hear a pterodactyl go to the bathroom? Because the P is silent.

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CORONAVIRUS INFO PROVIDED BY DR. JIM HARRIS – 9/11/2020

September 11, 2020

JOHNS HOPKINS SUPPLIED:
1. Clinical Outcomes in Young US Adults Hospitalized With COVID-19 (JAMA) Young adults age 18 to 34 years hospitalized with COVID-19 experienced substantial rates of adverse outcomes: 21% required intensive care, 10% required mechanical ventilation, and 2.7% died. This in-hospital mortality rate is lower than that reported for older adults with COVID-19, but approximately double that of young adults with acute myocardial infarction.4 Morbid obesity, hypertension, and diabetes were common and associated with greater risks of adverse events. Young adults with more than 1 of these conditions faced risks comparable with those observed in middle-aged adults without them. More than half of these patients requiring hospitalization were Black or Hispanic, consistent with prior findings of disproportionate illness severity in these demographic groups.
(J. Harris: If you’re thinking that getting it over with now and catching  COVID and then getting back to work wouldn’t be too bad, read the above. Even young adults have a 2.7% chance of dying as well as a 21% chance of requiring ICU care as well as the potential for multiorgan permanent damage and lots of debt. Wear your mask and space out. We’re getting there. Be patient.)
2. Adverse Outcomes and Mortality in Users of Non-steroidal Anti-inflammatory Drugs Who Tested Positive for SARS-CoV-2: A Danish Nationwide Cohort Study (PLOS Medicine) Concerns over the safety of non-steroidal anti-inflammatory drug (NSAID) use during severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have been raised. We studied whether the use of NSAIDs was associated with adverse outcomes and mortality during SARS-CoV-2 infection. Use of NSAIDs was not associated with 30-day mortality, hospitalization, ICU admission, mechanical ventilation, or renal replacement therapy in Danish individuals who tested positive for SARS-CoV-(J. Harris: Aspirin, Motrin, Aleve, and other non-steroidal anti-inflammatory drugs (NSAIDs) do not seem to cause any adverse effects with COVID infection.
Reassuring the Public and Clinical Community About the Scientific Review and Approval of a COVID-19 Vaccine
On September 8 the CEOs of 9 pharmaceutical companies released a joint pledge that they are committed to “developing and testing potential vaccines for COVID-19 in accordance with high ethical standards and sound scientific principles.”…..
Important safeguards should be established to reassure the clinical community and the public about any vaccine approval. The FDA should explain the role of the data and safety monitoring boards (DSMBs) for the vaccine trials, the first “independent” group that reviews the data, and any correspondence between the DSMB and the project investigators should be shared with the public. Two additional groups have an important consultant responsibility to the government and the public: the FDA Vaccines and Related Biological Products Advisory Committee11,12 and the Advisory Committee on Immunization Practices (ACIP).13 These advisory groups are composed of medical, scientific, health policy, and public health experts who review data and develop recommendations for the use of vaccines…
The FDA should share all allowable and available data about a vaccine candidate with the FDA vaccine advisory committee and ACIP prior to making any decision about an Emergency Use Authorization (EUA) or approval. Typically, the FDA’s vaccine committee makes recommendations prior to agency action, and ACIP soon afterward. In this challenging situation, the FDA should seek the input of both committees prior to making a decision. An FDA decision consistent with the advice of these independent experts will then reassure the public. However, if the FDA goes in a different direction, the agency will need to explain the reasons well to avoid confusion and vaccine hesitancy. If either panel is excluded from reviewing data, the FDA may struggle to convince the public and clinical community about the strength of the evidence, and vaccine uptake may be adversely affected.

Important safeguards should be established to reassure the clinical community and the public about any vaccine approval. The FDA should explain the role of the data and safety monitoring boards (DSMBs) for the vaccine trials, the first “independent” group that reviews the data, and any correspondence between the DSMB and the project investigators should be shared with the public. Two additional groups have an important consultant responsibility to the government and the public: the FDA Vaccines and Related Biological Products Advisory Committee11,12 and the Advisory Committee on Immunization Practices (ACIP).13 These advisory groups are composed of medical, scientific, health policy, and public health experts who review data and develop recommendations for the use of vaccines.

(J. Harris: The public as well as civilian health care providers must have confidence that the Vaccines that are being developed are safe and effective. Civilian physicians, which is to say, working doctors who are not on the government payroll, must be satisfied that the Vaccine(s) selected are safe and worthwhile. If civilian physicians are unable to reassure their patients and convince them to take the Vaccine, then the people, understandably, won’t take them. 

Some of us remember the Swine Flu fiasco when President Gerald Ford was ill-advised by his medical experts as well as by revered historical vaccination doctors in 1976, an election year. In those days, private physicians like myself  FIRMLY believed in and trusted The Centers for Disease Control and Prevention (CDC), The National Institutes of Health (NIH), and The Food and Drug Administration. We knew many of the doctors who ran those agencies, and we trusted them. Everyone involved well knew the horrors of “Spanish Flu;”  that knowledge was  still fresh and familiar to practicing physicians and to  most American citizens in those 1976 days. 

That fall, I administered many, many Swine Flu shots and fortunately had no mishaps — and no flu.  I was lucky, but retrospectively, I made a mistake in giving the vaccinations. I wasn’t alone, and until recently, I have not reconsidered my decision then to try and prevent another H1N1 flu epidemic. But my revered experts were wrong in’76 as was Washington. 

 WE will get it right this time. The world’s need for an effective and safe vaccine is acute and desperate. This Pandemic is real — and dreadful. A good vaccine is mandatory and will be forthcoming. It should be possible to share it worldwide. 

What do you call a belt made of watches?     A waist of time!

What do sprinters eat before a race? Nothing. They fast.

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CORONAVIRUS INFO PROVIDED BY DR. JIM HARRIS – 9/7/2020

September 7, 2020

On Friday, there were 4 new COVID cases in Harrison County and 8 in Gregg, and 18 in Smith County. 

FROM JOHNS HOPKINS:
1. It appears that the case fatality, both globally and for individual continents, is converging around 3%. However, there remains considerable variation between countries. Six (6) countries continue to report COVID-19 case fatality greater than 10%. Notably, 4 of these countries—Belgium, France, Italy, and the UK—were severely affected early in the pandemic, and all 4 are reporting decreasing trends. Yemen is reporting the world’s highest case fatality (29%)…. Mexico’s case fatality has largely leveled off since early August, holding steady at approximately 11%. A number of other countries around the world are reporting case fatality greater than 5%. The majority of these countries are reporting decreasing trends; however, in addition to Yemen, Iran and Egypt have both reported increasing case fatality since approximately mid-June. As a reminder, the case fatality ratio is determined not just by the virus, but also by case ascertainment and factors related to underlying population health and medical care.

UNITED STATES

The US CDC reported 6.09 million total cases (41,193 new) and 185,092 deaths (1,009 new). The United States’ average mortality fell below 900 deaths per day for the first time since July 24. In total, 19 states (no change) are reporting more than 100,000 cases, including California with more than 700,000 cases; Florida and Texas with more than 600,000; New York with more than 400,000; and ArizonaGeorgia, and Illinois with more than 200,000.

2. ‘Carnage’ in a Lab Dish Shows How the Coronavirus May Damage the Heart (STAT News) Maybe we should think of Covid-19 as a heart disease. When SARS-CoV-2 virus was added to human heart cells grown in lab dishes, the long muscle fibers that keep hearts beating were diced into short bits, alarming scientists at the San Francisco-based Gladstone Institutes, especially after they saw a similar phenomenon in heart tissue from Covid-19 patients’ autopsies.  Their experiments could potentially explain why some people still feel short of breath after their Covid infections clear and add to worries that survivors may be at risk for future heart failure.

3. Association of Vitamin D Status and Other Clinical Characteristics With COVID-19 Test Results (JAMA)  In this cohort study of 489 patients who had a vitamin D level measured in the year before COVID-19 testing, the relative risk of testing positive for COVID-19 was 1.77 times greater for patients with likely deficient vitamin D status compared with patients with likely sufficient vitamin D status, a difference that was statistically significant. These findings appear to support a role of vitamin D status in COVID-19 risk; randomized clinical trials are needed to determine whether broad population interventions and interventions among groups at increased risk of vitamin D deficiency and COVID-19 could reduce COVID-19 incidence. (J. Harris: “The Mayo Clinic states that the recommended dietary allowance of vitamin D for most adults is 600 international units a day (IU). Doctors may prescribe higher doses to treat medical conditions such as vitamin D deficiency, diabetes, and cardiovascular disease, for a short period of time. Daily use of high-dose vitamin D supplements for several months is toxic.” If you are taking Vit. D capsules from your doctor, they are usually 5,000-10,000 units each. If you are taking a multivitamine, it probably contains at least 600 units. DON’T TAKE MEGA DOESE OF VIT. D. If in doubt, your doctor can run a simple Vit. D level in your blood. 

In hotel rooms I worry. I can’t be the only guy who sits on the furniture naked.~ Jonathan Katz

Why don’t oysters donate to charity? Because they’re shellfish.

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CORONAVIRUS INFO PROVIDED BY DR. JIM HARRIS – 9/4/2020

September 4, 2020

Thursday, Harrison County had 7 new COVID cases whild Gregg had 16 and Smith 30.
TEXAS Rt

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I’m a contact tracer in San Francisco. You won’t believe the stories I hear.

Association Between Administration of Systemic Corticosteroids and Mortality Among Critically Ill Patients With COVID-19
SUMMARY: “In this prospective meta-analysis of clinical trials of critically ill patients with COVID-19, administration of systemic corticosteroids, compared with usual care or placebo, was associated with lower 28-day all-cause mortality.”(J. Harris: Dexamethasone is a concentrated, inexpensive type of ‘cortisone’ which has for many years been used widely via injection into the patient’s veins in respiratory distress situations of many types. This complicated article with statistics and results from many countries, centers, and hospitals  makes some sense out of many different studies, doses, degrees of illness, and other variables. Yes, Dexamethasone helps survival. How much? I’m not sure, but I’d definitely want to take it were I  very ill with COVID. After this report, it will be unethical to withhold the drug inthe future experinmental purposes, so better data, doses, and indications will be forthcoming soon. 
VENTILLATION AND COVID TRANSMISSION REVISITED
With cold weather, schools, and closed windows coming, a review is in order. 
Five Military Sites Chosen for Phase III Trial of COVID Vaccine Candidate

A common North American mouse can catch and spread the coronavirus in labs, studies show(J. Harris: This is a potential but not a current problem at this time.)

COVID-19 and mRNA Vaccines—First Large Test for a New ApproachCurrent antiviral vaccine designs can be described as falling into 2 camps: protein based or gene based. 
1. Protein-based vaccines deliver the immune system–stimulating antigen to the body. This category includes whole-inactivated (killed) vaccines, as in the polio and flu shots, and subunit vaccines and virus-like particles, like in the hepatitis B and human papillomavirus vaccines.

2. Gene-based vaccines take a different tack. They carry the genetic instructions for the host’s cells to make the antigen, which more closely mimics a natural infection. In the case of coronaviruses, the antigen of interest is the surface spike protein the virus uses to bind and fuse with human cells. “You’re not giving them the protein—you’re giving them the genetic material that then instructs them how to make that spike protein, to which they make an antibody response that hopefully is protective,…Unlike conventional vaccines, mRNA vaccines aren’t grown in eggs or cells, a time-consuming and costly process. At their essence, these vaccines are simply chemicals catalyzed in test tube or a tank. This makes them easier to develop quickly and—at least theoretically—at scale, although they’ve never been mass-produced before.Even among the gene-based platforms, distinct advantages exist. In cutting out the viral vector, both DNA and mRNA vaccines eliminate the risk of preexisting immunity against it, which can limit effectiveness.’… mRNA vaccines also have a leg up on DNA vaccines. In a DNA vaccine, the genetic material must first enter the host cell’s nucleus. From there, messenger RNA is created, which travels out of the nucleus into the cytoplasm, where protein is formed from it. However, genetic information can only enter the nucleus when the cell is dividing, making the process inefficient…Researchers are trying to solve this problem using electric pulses to increase DNA uptake into cells at the time of vaccination. But the mRNA platform simply bypasses that step. “Ninety-five percent of cells that meet the RNA take it up and make protein, so it’s an incredibly efficient process,” …So far, in early COVID-19 trials, mRNA platforms have turned up encouraging results. “Certainly, these vaccines look like they’re generating the immune response that we need, and the reaction profiles have not been associated with severe reactions…But,  “the real proof of the pudding will be the phase 3 trials where we see if the vaccine actually prevents disease.” The US Food and Drug Administration has said that a COVID-19 vaccine will need at least 50% efficacy to be approved.

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(J. Harris: Note our local numbers are up a little. Opening school and the impending holiday may exacerbate our vulnerable situation. National experts are making dire predictions. Space out and wear your masks. Get your flu shots. Please.)

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CORONAVIRUS INFO PROVIDED BY DR. JIM HARRIS – 9/3/2020

September 3, 2020

The MNM reports zero new cases in Harrison County, 10 in Gregg,  and 20 in Smith County. 

These are the top coronavirus vaccines to watch
(J. Harris: This vaccine summary from the Post is worth keeping and following; it features a simple vaccine classification and, hopefully, will be continually updated. World wide cooperation and unlimited budgets should speed up functional vaccine availability and use. Very encouraging)

Seroprevalence of SARS-CoV-2 Among Frontline Health Care Personnel in a Multistate Hospital Network — 13 Academic Medical Centers, April–June 2020

“Among a convenience sample of HCP (HEALTH CARE PERSONNEL) who routinely cared for COVID-19 patients in 13 U.S. academic medical centers from February 1, 2020, 6% had evidence of previous SARS-CoV-2 infection, with considerable variation by location that generally correlated with community cumulative incidence. Among participants who had positive test results for SARS-CoV-2 antibodies, approximately one third did not recall any symptoms consistent with an acute viral illness in the preceding months, nearly one half did not suspect that they previously had COVID-19, and approximately two thirds did not have a previous positive test result demonstrating an acute SARS-CoV-2 infection. These findings suggest that some SARS-CoV-2 infections among frontline HCP are undetected and unrecognized, possibly because of the minimally symptomatic or subclinical nature of some infections, underreporting of symptoms, or nonsystematic testing of some personnel with symptomatic infections.

MORE FOR JOHNS HOPKINS:1. Unexpected Health Insurance Profits and the COVID-19 Crisis(JAMA Health Forum) The coronavirus disease 2019 (COVID-19) pandemic has placed unprecedented financial stress on most of the US health care system, including physician practices, emergency medical service systems, and hospitals. But there is one notable exception: health insurance companies. Sharp declines in elective care during the pandemic have reduced health care expenditures and contributed to earnings that are twice as large as those earned last year.Unexpected Health Insurance Profits and the COVID-19 Crisis(JAMA Health Forum) The coronavirus disease 2019 (COVID-19) pandemic has placed unprecedented financial stress on most of the US health care system, including physician practices, emergency medical service systems, and hospitals. But there is one notable exception: health insurance companies. Sharp declines in elective care during the pandemic have reduced health care expenditures and contributed to earnings that are twice as large as those earned last year.

2. Association Between Administration of Systemic Corticosteroids and Mortality Among Critically Ill Patients With COVID-19 A Meta-analysis (JAMA) In this prospective meta-analysis of clinical trials of critically ill patients with COVID-19, administration of systemic corticosteroids, compared with usual care or placebo, was associated with lower 28-day all-cause mortality. (MORE ON THIS TOMORROW)
See also:Steroids Can Be Lifesaving for Covid-19 Patients, Scientists Report (New York Times)

3. Humoral Immune Response to SARS-CoV-2 in Iceland (New England Journal of Medicine) Our results indicate that antiviral antibodies against SARS-CoV-2 did not decline within 4 months after diagnosis. We estimate that the risk of death from infection was 0.3% and that 44% of persons infected with SARS-CoV-2 in Iceland were not diagnosed by qPCR. (MORE LATER ABOUT ICELAND)
4. 
Can Europe tame the pandemic’s next wave? (Science) “We’re at risk of gambling away our success,” virologist Christian Drosten warned in the German newspaper Die Zeit last month. His message referred to Germany, but it could have been addressed to all of Europe. After beating back COVID-19 in the spring, most of Europe is seeing a resurgence.

5.COVID-19 case fatality in the US has been declining since its peak (approximately 6%) in mid-May, but it is beginning to level off…..States that were severely affected during the summer resurgence—including Arizona (2.5%), California (1.8%), Florida (1.8%), and Texas (2.1%)—have fared much better in terms of case fatality; however, they had the advantage of advanced warning that provided additional time to improve preparedness and acquire necessary resources (eg, PPE, ventilators) as well as increased testing capacity, which identified many more cases than early in the pandemic. Additionally, the summer resurgence was spread across a larger geographic area, which mitigated to some extent the patient surge on individual health systems. A number of states remain at or below 1% case fatality, including Alaska, Hawai’i, North Dakota, and Utah.The Importance of Reestablishing a Pandemic Preparedness Office at the White House


(J. Harris: A brief history of American attempts at pandemic vigilance. It seems that the “Pandemic Office” in the White House, was started by Clinton and then closed only to be reopened and closed and opened as needed for the various epidemic threats by George W Bush and Obama and finally closed by Trump. This article from JAMA suggests that the Office of Global Affairs in the Department of Health and Human Services (DHHS) is the appropriate agency to maintain medical supplies and to oversee the CDC and FDA and to work closely with the military in the future. I don’t know what the function of the Surgeon General is to be, perhaps to look good in a uniform and pal around in the White House. There are so many agencies and Chiefs and causes and claims as well as so much confusion, but maybe that’s the price of living in a democracy with freedom of independent thought. It’s pretty easy to run a “tight ship” if it’s small and tidy and the weather is good….Nevertheless, when I am Czar, I plan to tighten things up a bit).

My ex-wife still misses me. (But her aim is starting to improve).

I just found out that I’m color blind. The news came completely out of the green!.

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CORONAVIRUS INFO PROVIDED BY DR. JIM HARRIS – 9/2/2020

September 2, 2020

From MNM: On Monday there were 5 new Covid

FROM MNM: Harrison County Judge Chad Sims reported six new COVID-19 cases on Tuesday….He noted that of the county’s cumulative total of 806 positive cases, 35 have been fatalities, 741 have been recoveries and 30 are considered active cases.

TESTING RECOMMENDATIONS FROM THE INFECTIOUS DISEASES SOCIETY OF AMERICA 

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MORE FROM JOHNS HOPKINS:
1.FDA Broadens Emergency Use Authorization for Veklury (Remdesivir) to Include All Hospitalized Patients for Treatment of COVID-19 (FDA) The U.S. Food and Drug Administration broadened the scope of the existing emergency use authorization (EUA) for the drug Veklury (remdesivir) to include treatment of all hospitalized adult and pediatric patients with suspected or laboratory-confirmed COVID-19, irrespective of their severity of disease. Based on the Agency’s ongoing review of the EUA, including its review of the totality of scientific information now available, the FDA has determined that it is reasonable to believe Veklury may be effective for the treatment of suspected or laboratory-confirmed COVID-19 in all hospitalized adult and pediatric patients. The Agency’s review has also concluded that the known and potential benefits of Veklury outweigh the known and potential risks for these uses.

2.Infectious Diseases Specialists to FDA: Don’t Cut Corners in COVID-19 Vaccine Approval (IDSA) The Infectious Diseases Society of America and its HIV Medicine Association are urging the Food and Drug Administration to ensure rigorous safety and efficacy data support the approval of a COVID-19 vaccine before its widespread use by the public. In an Aug. 26 letter to FDA Commissioner Stephen Hahn, M.D., and Center for Biologics Evaluation and Research Director Peter Marks, M.D., PhD, the groups strongly recommend that full licensure of a vaccine is preferable to an Emergency Use Authorization, particularly in light of public distrust of vaccines. If an EUA is the route to market for a vaccine, however, IDSA and HIVMA stress that supporting data must first be scrutinized by internal and independent experts. At a minimum, the groups urge, a Phase 3 trial should be completed before FDA approval.

3. New Trump Pandemic Adviser Pushes Controversial ‘Herd Immunity’ Strategy, Worrying Public Health Officials (Washington Post) One of President Trump’s top medical advisers is urging the White House to embrace a controversial “herd immunity” strategy to combat the pandemic, which would entail allowing the coronavirus to spread through most of the population to quickly build resistance to the virus, while taking steps to protect those in nursing homes and other vulnerable populations, according to five people familiar with the discussions. The approach’s chief proponent is Scott Atlas, a neuroradiologist from Stanford’s conservative Hoover Institution, who joined the White House earlier this month as a pandemic adviser. He has advocated that the United States adopt the model Sweden has used to respond to the virus outbreak, according to these officials, which relies on lifting restrictions so the healthy can build up immunity to the disease rather than limiting social and business interactions to prevent the virus from spreading.

4. Studies Highlight Dynamic Impact of COVID-19 on Antibiotic Use (CIDRAP) Since the novel coronavirus pandemic began, limited data from small studies in several countries have indicated high rates of antibiotic prescribing in COVID-19 patients and low rates of bacterial co-infections, raising concerns about unnecessary antibiotic use and the pandemic’s potential impact on antimicrobial resistance (AMR). In the study, published in Clinical Infectious Diseases, researchers looked at data on more than 1,700 hospitalized COVID-19 patients treated at 38 Michigan hospitals from Mar 13 to Jun 18 and found that more than half received early antibiotic therapy, with antibiotic use as high as 84% in some hospitals. But only a small fraction of those patients had bacterial co-infections.
https://apnews.com/ad394137fb0068ee4e8ac5ca703094b5 Click to copy RELATED TOPICS Virus Outbreak Africa International News South Africa Lifestyle COVID-19 takes loved ones, then the rituals to mourn them

How a Bus Ride Turned Into a Coronavirus Superspreader Event
(from JAMA originally)
The Most American COVID-19 Failure Yet
“Less than 1 percent of sick people fail to respond to contact tracers in Iceland, Ævar Pálmi Pálmason, who leads the country’s tracing effort, told me. In New Zealand, 86 percent of people contacted by tracers respond within 48 hours. “The U.S. contact-tracing effort has been a dismal failure compared with many of its peer countries,” says Lawrence Gostin, a professor of global-health law at Georgetown University.
“It’s literally too late to do contact tracing in Texas,” … That month, Texas had 15,000 new cases on some days….How are you going to go back and find all those old contacts? You can’t really trace if everyone and their cousin has it.”

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