by rjs, MarketWatch 666
The news posted last week for the coronavirus 2019-nCoV (aka SARS-CoV-2), which produces COVID-19 disease, has been surveyed and some important articles are summarized here. The articles are more or less organized with general virus news and anecdotes first, then stories from around the US, followed by an increased number of items from other countries around the globe. Growth of new US cases has continued to slow. Elsewhere, new cases continue rising in some countries, but were little changed globally. Economic news related to COVID-19 is found here.
Please share this article – Go to very top of page, right hand side, for social media buttons.
Summary:
I can’t get a good read on where we stand this week, with the holiday weekend and the associated interruption of reporting on the new cases and deaths data. The 7-day averages of reported new infections and deaths both turned down suddenly on Thursday, and continued falling through Friday and Saturday, but new cases were already trending down before then; in the 7 days ending Wednesday, new cases were “only” 8.7% above the 7 days ending Wednesday of the prior week, compared to a 40% week over week jump just a couple weeks earlier. So my sense is that an interim top might be in, and therefore we won’t see any new records until the new infections resulting from Thanksgiving gatherings start to show up in the data. If we don’t get an early December surge, then it’s likely that many Americans will take that as a cue to celebrate Christmas and New Years as they normally would, in which case the January surge could hit like a ton of bricks.
Globally, new cases hit a record 671,885 on Friday but the week over week totals remain little changed for the third week in a row. Global covid deaths seem to be up about 10% week over week, with a record 12,785 Covid deaths recorded on Tuesday.
The chart below from WorldoMeter shows the daily number of new cases for the US, updated through 28 November.
New cases globally were nearly the same as the prior week. (See Johns Hopkins graph below.) The growth rate has visibly slowed in the past week, although a new record 671.885 new cases was hit on Friday
Also, Johns Hopkins has a graph for global deaths (below) that shows a record 12,785 deaths on Tuesday, the second highest on record Wednesday (12,056), but then a decline the rest of the week. Deaths globally as of Wednesday were up about 10% week-over-week. It will take several more days of data to determine if the end of week decline signifies the start of a pullback.
.
Calculated Risk tracks the daily testing rate and results. The 28 November graphic:
The rate of increase in testing seems to be leveling off, but perhaps influenced by the holiday, while the percent positive has turned it’s slow downturn.
Of course, Steven Hansen summarizes and links the latest news related to the pandemic every day, 7 days a week, plus displays over a dozen important graphics updated at least daily. The most recent article at the time this is published: 28 November 2020 Coronavirus Charts and News: A Johns Hopkins Study Says The Death Rate Of Elderly People Did Not Change With The Pandemic Even Though The Elderly Account For 40% Of COVID Deaths.
This article leads the daily newsletter from Global Economic Intersection every day. Newsletter subscription is free.
Here are the rest of the articles for the past week reviewed and summarized:
Covid-19 is NOT the Flu – Dr Tiffany Doherty — (video, below) One argument we continue to hear about the reaction to Covid-19 is that “it’s just another flu”, and that we can move forward with life as usual, much like we move forward with life during flu season. While we wish that were true, it simply is not. There are major differences that necessitate a much bigger reaction to Covid-19. In today’s episode we detail both the similarities and the differences between the illnesses caused by these two viruses.
.
High blood sugar could increase COVID-19 death risk for non-diabetics, says study – Abnormally high blood sugar may worsen outcomes and mortality rates for COVID-19 patients, including those without diabetes, according to major research published in the peer-reviewed open access journal Annals of Medicine. The study, based on more than 11,000 non-critically ill hospital patients in Spain, is the largest of its kind to date. It adds to evidence that hyperglycaemia – the medical term for high blood glucose – is associated with a higher chance of death independent of a diabetes diagnosis. The findings show patients with abnormally high glucose levels were more than twice as likely to die from the virus than those with normal readings (41.4% compared to 15.7%). They also had an increased need for a ventilator and intensive care admission (ICU). The researchers are now calling for compulsory hyperglycemia screening and early treatment for anyone hospitalized with COVID-19 who is non-diabetic. They urge clinicians not to overlook the condition among patients, regardless of a prior history of diabetes. “Screening for hyperglycaemia in patients without diabetes and early treatment should be mandatory in the management of patients hospitalized with COVID-19,” “Admission hyperglycaemia should not be overlooked, but rather detected and appropriately treated to improve the outcomes of COVID-19 patients with and without diabetes.”
Diabetic eye disease associated with five-fold risk of severe COVID-19 – People with diabetes and eye disease have a five-fold increased risk of requiring intubation when hospitalised with COVID-19. The study, published today in Diabetes Research and Clinical Practice by King’s College London, identified for the first time the risk associated with diabetic retinopathy and COVID-19. Diabetic eye disease is a common complication of diabetes and is caused by damage to the small blood vessels in the eye. In 2014, the prevalence of diabetic retinopathy was 54.6% in people with Type 1 diabetes and 30.0% in people with Type 2 diabetes*. Diabetic retinopathy was reported in 67 (36%) of patients, the majority with background retinopathy. Of the 187 patients hospitalised with severe COVID-19, 26% were intubated and 45% of these patients had retinopathy. Retinopathy was associated with a five-fold increased risk for intubation. In the cohort, 32% of patients died and no association was observed between retinopathy and mortality. “This is the first time that retinopathy has been linked to severe COVID-19 in people with diabetes. Retinopathy is a marker of damage to the blood vessels and our results suggest that such pre-existing damage to blood vessels may result in a more severe COVID-19 infection requiring intensive care treatment.
COVID’s collateral damage: Germicidal lamps may damage corneas – In a paper published in the journal of Ocular Immunology and Inflammation, physicians from the Bascom Palmer Eye Institute at the University of Miami Miller School of Medicine reported that several patients using germicidal lamps in an attempt to sanitize against the coronavirus, developed painful inflammation of the cornea, a condition called photokeratitis. These consumer-available ultraviolet (UV) emitting devices were being used in an attempt to eliminate coronavirus from homes and offices. “During the height of the pandemic, we noticed an increased number of patients coming in with irritation, pain and sensitivity to light,” said first author and Bascom Palmer resident Jesse Sengillo, M.D. “We realized this was after direct exposure to germicidal lamps that emit UV light in the C range to kill bacteria and viruses. This can be quite a painful experience for the patient, but with prompt topical lubrication and antibiotics to prevent infection, patients often do very well.” UV photokeratitis occurs when the cornea is overexposed to ultraviolet radiation. This can happen at high elevation, where less UV rays are absorbed by the atmosphere, or near water, snow or other reflective surfaces in the environment. A few hours after exposure, patients experience burning in their eyes and sometimes intense light sensitivity. Numerous germicidal lamps are on the market, and while they may be safe for at-home use, customers need to pay close attention to manufacturer recommendations to prevent damage to the eyes and skin. “The patients we met were not aware of these recommendations, and many were unknowingly exposed at work” said co-author and fellow resident Anne Kunkler, M.D., B.S. “For UV-C emitting devices, it is best to leave the room while the device is on. Our patients were directly exposed to the light for various lengths of time. A few hours later, they felt discomfort and sought medical attention.”
Doctors use existing treatment earlier to save the lives of Covid-19 patients – The lives of patients hospitalised with COVID-19 are being saved by doctors who are using an existing medical treatment at an earlier stage. Dr Luigi Sedda of Lancaster University analysed the results from the team at Wrightington, Wigan and Leigh Teaching Hospitals NHS Trust (WWL). Their research has now been published in the prestigious medical journal BMJ Respiratory Open. He said: “We show that Continuous Positive Airway Pressure (CPAP) in the first days of hospitalisation seems to save between 10% to 20% of patients. However it is important to underline that this was a pilot study with a small sample size, although comforting evidence is starting to emerge elsewhere.” According to NHS England, 96% of people who died with Covid had at least one serious health condition and the majority are over the age of 80. In the case of patients with severe acute respiratory syndrome, COVID-19 may cause the lungs to swell and collapse. Using CPAP treatment, which is often used at home to help people with sleep problems, helps to keep the lungs open and makes breathing easier.
Sixty-Day Outcomes Among Patients Hospitalized With COVID-19 — This observational cohort study looked at patients hospitalized with COVID-19 (discharged between 16 March and 1 July 2020) at 38 hospitals participating in the MI-COVID19 initiative. The aim of MI-COVID19, a Michigan statewide collaboration sponsored by Blue Cross Blue Shield of Michigan (BCBSM) and Blue Care Network, is to improve care for patients hospitalized with COVID-19. Trained quality abstractors (often registered nurses) collect data from patient medical records using structured templates. At 60 days after discharge, abstractors review the medical record to collect data on clinical events, including readmission (to the index hospital or any hospital viewable in the medical record) and postdischarge death. In addition, for all patients alive and not residing in a health care or correctional facility, abstractors contact patients by telephone to complete a survey about primary care follow-up, ongoing cardiopulmonary symptoms, return to normal activity, financial impact, and emotional and mental health outcomes. At least 3 attempts are made to contact patients. The study was deemed “not regulated” by the University of Michigan institutional review board (HUM 00179611). Findings: Of 1648 patients with COVID-19 admitted to 38 hospitals, 398 (24.2%) died during hospitalization and 1250 (75.8%) survived. Of 1250 patients discharged alive, 975 (78.0%) went home whereas 158 (12.6%) were discharged to a skilled nursing or rehabilitation facility (Table 1). By 60 days after discharge, an additional 84 patients (6.7% of hospital survivors and 10.4% of intensive care unit [ICU]-treated hospital survivors) had died, bringing the overall mortality rate for the cohort to 29.2%, and 63.5% for the 405 patients who received treatment in an ICU. Within 60 days of discharge, 189 patients (15.1% of hospital survivors) were rehospitalized.
We now have the best evidence yet that coronavirus immunity lasts 6 to 8 months after infection, and perhaps even years — We now have the best answer yet to a crucial, lingering question about COVID-19: how long immunity lasts. New research suggests that recovered coronavirus patients likely have a robust immune memory that persists for at least eight months. This memory relies on more than just antibodies – it also involves white blood cells known as T cells and B cell that have impressive powers of recollection. Combined, these layers of protection enable the immune system to recognize and re-attack the coronavirus should it ever invade again, thereby preventing another infection.To assess how long immunity to the virus lasts across these various layers of the immune system, scientists measured how many – and what types of – immune cells recovered coronavirus patients had months after they got sick. Their research, though not yet peer-reviewed, offers hope that those who’ve already gotten infected likely won’t be ill again for quite some time.”Most people are making most parts of the immune response to this virus, and those parts are still around six to eight months later,” Shane Crotty, a virologist at La Jolla Institute for Immunology in California and a co-author of the study, told Business Insider. “That looks like generally good news for having protective immunity.”Some research has suggested that coronavirus antibodies – blood proteins that protect the body from subsequent infection – fade within a few months. But concerns about those findings can discount the role of killer T cells, which identify and destroy infected cells, as well as helper T cells that inform B cells about how to craft new antibodies.”All of those elements are designed to work together: If in any given person one’s not so great, the other arms of the immune system can compensate. So it makes sense to measure everything,” Crotty said.
CDC warns eight COVID-19 infections are missed for every one counted — The record surge in coronavirus cases across the US is likely far worse, with an estimated eight infections unreported for every one infection counted, according to a government report – which would put the true tally closer to 100 million. The Centers for Disease Control and Prevention (CDC) calculated that by the end of September there had really been as many as 53 million Americans contract the deadly bug – just under eight times the confirmed cases reported at the time.Of those, the CDC believes about 45 million were sick at some point and about 2.4 million were hospitalized.The true tally is likely now far higher, with November continually breaking case records across the US – with now 12,778,256 cases officially reported, according to Johns Hopkins University data Thursday morning.If the CDC is correct about the number of missed cases, that would put the true number of infections in the US now closer to 100 million.As well as record numbers of infections, the US is also seeing more people hospitalized by the contagion than ever before – as well as record numbers of deaths in at least nine states.It comes as mass travel for Thanksgiving against CDC guidance is feared to create even more disaster. “It’s potentially the mother of all superspreader events,” former White House medical team adviser Dr. Jonathan Reiner told CNN of the holiday.
Why Ventilation Is Key to Battling Coronavirus (video, 5:52) As the weather gets colder and people head indoors, the risk of catching Covid-19 is rising. WSJ explains why air ventilation and filtration are one of our biggest defenses against the coronavirus this winter.
MMR vaccine could protect against COVID-19 — The measles-mumps-rubella (MMR) vaccine has been theorized to provide protection against COVID-19. In a new study published in mBio, an open-access journal of the American Society for Microbiology, researchers provide further proof of this by showing that mumps IgG titers, or levels of IgG antibody, are inversely correlated with severity in recovered COVID-19 patients previously vaccinated with the MMR II vaccine produced by Merck. MMR II contains the Edmonston strain of measles, the Jeryl Lynn (B-level) strain of mumps, and the Wistar RA 27/3 strain of rubella. “We found a statistically significant inverse correlation between mumps titer levels and COVID-19 severity in people under age 42 who have had MMR II vaccinations,” said lead study author Jeffrey E. Gold, president of World Organization, in Watkinsville, Georgia. “This adds to other associations demonstrating that the MMR vaccine may be protective against COVID-19. It also may explain why children have a much lower COVID-19 case rate than adults, as well as a much lower death rate. The majority of children get their first MMR vaccination around 12 to 15 months of age and a second one from 4 to 6 years of age.”
AstraZeneca reports its new vaccine is highly effective – More promising vaccine news poured in on Monday, with drugmaker AstraZeneca announcing its COVID-19 vaccine candidate displayed “positive high-level results” following clinical trials. The results are comparable to efficacy rates announced by fellow pharmaceutical companies Moderna and Pfizer.The company stated in a press release that the vaccine candidate, called AZD1222, was given to thousands of volunteers in interim doses. When given as a half dose followed by a full dose within a month, the vaccine showed an efficacy rate of 90 percent for a portion of the sample population.When adding two full doses within a month, the efficacy rate stood at about 62 percent. The combined analysis from these two studies averaged to a 70 percent efficacy rate,“These findings show that we have an effective vaccine that will save many lives,” said Andrew Pollard, a professor at Oxford University and member of the vaccine development team. “Excitingly, we’ve found that one of our dosing regimens may be around 90% effective and if this dosing regime is used, more people could be vaccinated with planned vaccine supply.”AZD1222 uses replication-defective viruses developed from a weakened version of the common cold virus as well as genetic material from COVID-19 to help the body stimulate an immune reaction when the coronavirus is detected.No severe side effects were reported during the trials. AstraZeneca noted that it will begin submitting its data to various regulatory agencies across the world, including the U.S. Food and Drug Administration for emergency usage. It will also submit the AZD1222 for an Emergency Use Listing with the World Health Organization to make the vaccine available for low-income countries.The results published on Monday featured data from volunteers based in the UK and Brazil, but AstraZeneca is conducting other trials across the globe.
Pfizer launches trial for deliveries of COVID-19 vaccine in four states – A week after the pharmaceutical company revealed optimistic data regarding the efficacy of its COVID-19 vaccine candidate, Pfizer has launched a delivery program to alleviate the accompanying temperature storage challenges. Pfizer made headlines as one of the first major pharmaceutical companies to have data from clinical trials exhibiting a 90 percent efficacy rate in preventing a COVID-19 infection. Reuters reports that this trial delivery program was established to help get the vaccine distributed across multiple locations while remaining at its necessary temperature. The vaccine reportedly must be consistently stored at minus 70 degrees Celsius (minus 94 Fahrenheit), which is well below the standard for vaccines of 2 to 8 degrees Celsius (36 to 46 degrees Fahrenheit). “We are hopeful that results from this vaccine delivery pilot will serve as the model for other U.S. states and international governments, as they prepare to implement effective COVID-19 vaccine programs,” Pfizer told reporters in a statement Monday. The four states to receive initial deliveries of the vaccine include Rhode Island, Texas, New Mexico and Tennessee. Reuters notes that these locations were selected based on their size difference, population diversity, urban and rural sprawl of residents, and vaccine infrastructure. These states will only serve as pilots to gauge how well the vaccine can travel across a range of geographic landscape and will not receive preferential treatment by the vaccine company, namely with a first round of dosages. Developed in conjunction with BioNTech, Pfizer’s vaccine candidate could have help with distribution from the Trump administration through Operation Warp Speed. Notably, however, Pfizer and BioNTech did not accept any federal funding when creating the vaccine. It did strike a deal to supply the U.S. government with the first 100 million doses of the vaccine, pending approval by the U.S. Food and Drug Administration. Pfizer reportedly plans on filing for the emergency use authorization designation, likely around the third week of November and as more trial data emerges.
Oxford-AstraZeneca Vaccine Is Cheaper than Pfizer’s and Moderna’s and Doesn’t Require Supercold Temperature – The biopharmaceutical company AstraZeneca has released data on what is now the third promising vaccine candidate against COVID-19 – and it has several advantages over those of its competitors, Pfizer and Moderna. On Monday, AstraZeneca released interim analysis of its phase 3 trial data of 23,000 volunteers from the U.K. and Brazil. These results show that the test vaccine is between 70% and 90% effective in stopping COVID-19, depending on the vaccine doses administered. Although less effective than the reported results from the Pfizer or Moderna COVID-19 vaccine candidates, this vaccine is still more effective than annual influenza vaccines that reduce the risk of flu by between 40% and 60%. Notably none of the vaccinated participants needed hospitalizations or reported severe disease. AstraZeneca’s vaccine was originally planned to be given in two full doses, four weeks apart, as injections in the upper arm. A third of the volunteers were injected with a dummy saline placebo. One of the few details that AstraZeneca released is that of 131 cases of COVID-19, only 30 cases were detected among 11,636 who were given the vaccine; 101 cases occurred among the volunteers who got the placebo. That suggests that the vaccine is 70% effective overall. However, an error in the early stages of the trial meant that some participants received only a half-dose in the first round. In the group of 2,741 volunteers who received a lower dose of the vaccine candidate followed a month later by a full booster dose, the efficacy was 90%, according to AstraZeneca. The efficacy was only 62% among the 8,895 volunteers who received both full doses. It is not clear why the half-dose plus the full dose sequence of the vaccine performs better than two full doses. One explanation could be that since the vaccine is based on a common, although nonhuman, cold virus, the immune system probably attacks and destroys it when the first dose is too large. It is also possible that progressively increasing the dose more closely mimics a natural coronavirus infection. Beginning with a lower first dose might be a better way of kicking the immune system into action; then a stronger, more effective immune response occurs after the second full booster dose. Despite enormous progress in human immunology, scientists still don’t understand the best strategies for inducing protective immunity. AstraZeneca will now seek approval from the FDA to also evaluate the half-dose protocol in the ongoing U.S. trial. The current trial involves 30,000 participants and is evaluating only the two full-dose regimen. AstraZeneca’s trials in the U.S. were halted temporarily in early September after a study participant in the U.K. fell ill, but resumed in the U.K., Brazil, South Africa and Japan.
Some things don’t add up about the Astrazeneca trial results. AstraZeneca just released interim results from the placebo-controlled, randomized trial of the vaccine they co-developed with scientists at Oxford University. Here is the AP story on the press release and some commentary from Nature, and the Oxford University press release. Many of the reports emphasize how this vaccine, based on inserting genetic material for the spike protein into a viral vector from a chimpanzee adenovirus, is cheaper and easier to distribute than the two mRNA-based vaccines, with the AstraZeneca priced at $2.50/dose as opposed to the BioNTech/Pfizer at $20/dose or Moderna at $15-$20/dose, and the AstraZeneca Vaccine not requiring the extreme cold temperatures for transport and storage that the mRNA vaccines require. However, before this vaccine is widely distributed all around the world, its efficacy and safety need to be confirmed. The press release suggests the vaccine has been shown to be efficacious, but there are numerous questions about these results and details about the underlying trials that need to be clarified before we can understand whether we can indeed be confident in its efficacy. The results state that the overall efficacy of the virus was 70%, but that the efficacy was 90% if the regimen was given as a “half dose” followed by a “full dose” after the month, and it was 62% if the “full dose” was given both time points. It was reported that the study involves a total of 11,363 participants, 2741 in the part of the study including the reduced “half dose” and 8622 in the part of the study including the “full dose”. From these, I have reverse engineered what the study results might be based on an assumption that each part has both vaccine and control patients at equal randomization, and provide the corresponding 95% confidence intervals on efficacy based on these assumptions to give us an idea of the precision of the results. So we see that the half-dose looks very promising, with efficacy of 90% getting close to what was found for the mRNA vaccines, but given the relatively small sample size, there is considerable uncertainty with 95% confidence interval spanning from 67% to 98%, But looking at the full dose, the efficacy was only 62% and the 95% confidence interval only spans from 41% to 77%. This 62% efficacy is above the USA FDA’s required 50% threshold, but is much lower than what was seen in the mRNA vaccine studies and for the half-dose in this study. They also report a combined efficacy of 70% aggregating information across both doses, but as I detail below, there are many reasons why it is likely not appropriate to simply aggregate this information together in this way.
AstraZeneca admits the best results in its COVID-19 vaccine study came from a dosing error, and experts are raising new questions about the shot – AstraZeneca and the University of Oxford’s coronavirus vaccine’s high efficacy may have been in part due to a dosing error. In the press release on the vaccine’s efficacy released on Monday, the vaccine candidate had a higher efficacy – up to 90% – in the group that received a half dose and then a full dose. But the candidate vaccine was just 62% effective in the group that received two full doses. Mene Pangalos, head of biopharmaceuticals research and development at AstraZeneca, admitted to Reuters on Monday that some participants received a half dose and then a full dose due to a dosing error. Pangalos called it a “useful mistake” in a later interview with the New York Times, published on Wednesday. Oxford University said in a statement on Wednesday that some of the vials in the trial did not have the right concentration of vaccine. The university said the problem was discussed with regulators and they decided to complete the late-stage trial in two groups, according to the AP. COVID vaccine: When will it arrive? Will it work? How soon will it end the pandemic?Experts say the small number of people in the low dose group – some 2,741 – make it difficult to know if the effectiveness is a statistical quirk. Also, none of the people in the low dose group were over 55 years old and younger people tend to have a stronger immune response than those who are older. A spokesperson for the University of Oxford told Euronews that “as a result of a difference in the manufacturing process” the phase I trial method was “shown to over-estimate the dose on the new batches of vaccine resulting in a half dose of the vaccine being administered as the first dose”. After discussing with the regulator, the two different concentrations were tested in phase III trials. David Salisbury, an associate fellow of the global health program at Chatham House said another area of confusion is that the press release pooled results from the two groups to reach an average of 70% efficacy. “You’ve taken two studies for which different doses were used and come up with a composite that doesn’t represent either of the doses,″ Salisbury told the AP. “I think many people are having trouble with that.″
Vaccine trials didn’t monitor one variable: volunteers’ behavior. ‘Masks and social distancing were left up to us,’ a participant said. – Jenny Hamilton, a 57-year-old former police officer, joined Pfizer’s coronavirus vaccine trial in August. After getting each of the two shots, she recorded what she felt in an app: low-grade fevers, fatigue, and muscle aches. When Hamilton reported “severe” tiredness, a study coordinator quickly texted her to see how she was doing. But the coordinators didn’t track Hamilton’s social interactions after she got injected – nor those of any other volunteer. That’s true in other vaccine trials as well: Moderna did not give volunteers any specific instructions about mask wearing or social distancing. And neither trial assessed volunteers’ individual exposure levels (based on, say, their family members’ activity). That means there could be unintended variations between the groups that got a placebo and those that got the real vaccine. But experts don’t expect these variations to significantly alter the findings, since the volunteers were randomly – and blindly – assigned to one group or the other. Pfizer and Moderna both set rules about who could participate in the trials in the first place. Pfizer’s volunteers had to be “at risk for acquiring COVID-19” – people like frontline workers and those who use mass transit. Participants in Moderna’s trial also had to have a considerable risk of exposure. “They needed participants to interact moderately in the community, such as grocery shopping once a week, picking up food in restaurants, take out, or dining in once in a while,” Hamilton told Business Insider. “Masks and social distancing were left up to us.” Clinical vaccine trials are designed to hunt for COVID-19 cases or adverse side effects among participants. In their trials, both Pfizer and Moderna randomly assigned half the participants to get a saline shot, while the other half got the actual COVID-19 vaccine. Neither researchers nor volunteers knew which type of shot they were getting. If the vaccine is successful, very few people in the vaccine group should get sick. Indeed, that’s what happened. Pfizer’s trial recorded 162 COVID-19 cases in the placebo group, and just eight in the vaccine group. That suggest its vaccine is 95% effective in preventing the disease. Moderna’s trial, meanwhile, observed 90 COVID-19 cases in the placebo group and five in the vaccine group, suggesting its vaccine is 94.5% effective. Although the researchers have no way to tell how people behaved after they received their shots, both companies’ trials rely on randomization to control for that potential variation. That’s how they prevent differences in individual behavior from skewing the results. “Behavioral differences by geography, say between a city with a stay-at-home order and one without, shouldn’t bias the trial results because the trials are randomized at the individual level,” Doshi said. If trial participants engage in riskier behavior, it becomes easier to tell if a vaccine actually prevents them from getting COVID-19. “In many ways, you don’t want them to get sick, but on the other hand, you’re only going to know if the vaccine works if a certain number of them get sick,” But participating in a vaccine trial may also change how people normally behave – particularly if they think they can guess whether they got the vaccine or placebo due to the appearance or absence of side effects.
Covid vaccine: CDC should warn people the side effects from shots won’t be ‘walk in the park’ Public health officials and drugmakers need to warn people that coronavirus vaccine shots may have some rough side effects so they know what to expect and aren’t scared away from getting the second dose, doctors urged during a meeting Monday with CDC advisors. The recommendations come as states prepare to distribute the potentially life-saving vaccinations as early as next month. Dr. Sandra Fryhofer of the American Medical Association said both Pfizer’s and Moderna’s Covid-19 vaccines require two doses at varying intervals. As a practicing physician, she said she worries whether her patients will come back for a second dose because of the potentially unpleasant side effects they may experience after the first shot. “We really need to make patients aware that this is not going to be a walk in the park,” Fryhofer said during a virtual meeting with the Advisory Committee on Immunization Practices, or ACIP, an outside group of medical experts that advise the CDC. She is also a liaison to the committee. “They are going to know they had a vaccine. They are probably not going to feel wonderful. But they’ve got to come back for that second dose.” Participants in Moderna and Pfizer’s coronavirus vaccine trials told CNBC in September that they were experiencing high fever, body aches, bad headaches, daylong exhaustion and other symptoms after receiving the shots. While the symptoms were uncomfortable, and at times intense, the participants said they often went away after a day, sometimes sooner, and that it was better than getting Covid-19. Both companies acknowledged that their vaccines could induce side effects that are similar to symptoms associated with mild Covid-19, such as muscle pain, chills and headache. One North Carolina woman in the Moderna study who is in her 50s said she didn’t experience a fever but suffered a bad migraine that left her drained for a day and unable to focus. She said she woke up the next day feeling better after taking Excedrin but added that Moderna may need to tell people to take a day off after a second dose. “If this proves to work, people are going to have to toughen up,” she said. “The first dose is no big deal. And then the second dose will definitely put you down for the day for sure. … You will need to take a day off after the second dose.”
Dutch Study Involves Exposing Hundreds Of People To COVID-19 To Test Effectiveness Of Vaccines – – The latest group of intrepid scientists to test the boundaries of virology and medical ethics belongs to the Leiden University Medical Center in the Netherlands. A team of Dutch researchers has already recruited a team of more than 240 volunteers for what’s called a “human challenge” study. For those who aren’t familiar with the concept, a “challenge” study involves deliberately exposing subjects – animals, or (in this case) human volunteers – to the virus to test the effectiveness of various vaccine candidates. One could call it a ‘trial by fire’. So far, Moderna and Pfizer have touted headline numbers claiming their vaccines are 95% effective. Only time will tell whether these vaccines actually prevent infection in 19 out of 20 recipients. Meanwhile, the “dosing error” that led AstraZenaca and Oxford to offer conflicting assessments of its adenovirus-vector vaccine depending on different dosing regimens is only the one of the trial’s shortcomings. It has also been revealed that the vaccine’s best data was gleaned from a group of exclusively younger patients, meaning older more vulnerable patients may be at risk of seeing serious infections develop anyway. The plan for the “challenge study” is being championed by an organization called 1Day Sooner, which is dedicated – as its name suggests – to accelerating the quest for an effective COVID-19 vaccine. Quarantine facilities in London have already been reserved by the group, which said it expects the trials to begin in January – provided regulators grant their blessing.With vaccine development and administration still a far-off prospect for millions of Americans, the Trump Administration has promised to start vaccinating health-care workers and the most vulnerable patients by mid-December.Officials have said vaccines will begin to ship out hours after the FDA grants emergency use approval to Pfizer and/or Moderna. Markets appear to have already internalized this outcome, evidenced by the Dow’s record close yesterday.1Day Sooner has allies in the biotech space that are willing to supply the equipment the company would need to conduct the study. One British biotech firm said last month that it was already in advanced talks with HMG over permission to create and provide strains of the virus for what would be a groundbreaking study.Though Reuters didn’t name it in the version of its report published online, the biotech firm referenced above appears to be Open Orphan, a British firm that one Twitter user said “is the only company in the world with a commercial human challenge study model for Covid 19.”
Putin Can’t Take Russia’s ‘Safe’ Covid-19 Vaccine, Kremlin Says President Vladimir Putin told fellow world leaders last week that both of Russia’s Covid-19 vaccines, including one he championed as the world’s first inoculation against the disease, are safe and effective. That doesn’t mean he’s taken a jab. “We have not yet begun widespread vaccination and the head of state can’t take part in vaccination as a volunteer. It’s impossible,” Kremlin spokesman Dmitry Peskov told reporters Tuesday, in response to a question on whether Putin had been inoculated. “The president can’t use an uncertified vaccine.” Developers of Russia’s flagship vaccine, Sputnik V, said Tuesday that initial testing showed it was 91.4% effective in preventing infections, although it has not yet published final results in a peer-reviewed journal. Among volunteers who started the vaccination process earlier, preliminary data indicated efficacy of over 95%, according to the Russian Direct Investment Fund. Russia has the world’s fifth-highest number of cases globally, passing 2 million last week. Putin announced the registration of Sputnik V in August and a second inoculation was approved in October, even as Phase 3 trials to establish safety and efficacy are still taking place.
People who recover from Covid-19 can be reinfected with new strain, study shows — People who caught and recovered from Covid-19 may be reinfected with a different strain of the pathogen, a new study from South Korea shows. Researchers found that a young woman infected with one strain of the coronavirus was, just weeks after recovering, reinfected with a different strain of the virus.The findings indicate that the patient’s immune response to the first strain did not protect her from the second and highlight how mutations could make controlling Covid-19 more difficult than first thought. South Korea is at the centre of efforts to understand reinfection after reports in April that scores of people who recovered from the virus later went on to test positive for Covid-19 again. Researchers sequenced the genetic material, or RNA, of two types of coronavirus found in an affected 21-year-old woman: one type from when she was initially infected and the other from when she was reinfected. The findings, released in Clinical Infectious Diseases, detailed key differences in the genetic material coding for the spike protein, a structure that sits on the outside of the coronavirus – giving the virus its crown-like appearance. Using computerised analysis, the researchers produced an evolutionary tree for several samples of the virus. They found that the types from the woman were different strains that belonged to different clusters. These clusters are characterised by particular changes or mutations in the genetic material of the pathogen.The first type of coronavirus the woman was infected with belonged to an evolutionary grouping or clade called V, while the strain she was reinfected with was from clade G.“The viral RNA from the positive retest was clustered into a subgroup distinct from that of the initial infection, suggesting that there was a reinfection of Sars-CoV-2 with a subtype that was different from that of the primary strain,” the study’s authors wrote.
Study finds meatpacking plants were responsible for 8 percent of coronavirus cases in opening phase of pandemic in the USA recent university study found that outbreaks at meatpacking plants were responsible for nearly 8 percent of all COVID-19 cases in the United States during the early months of the pandemic. Charles Taylor of Columbia University and Christopher Boulos and Douglas Almond of the University of Chicago found a strong statistical correlation between infections in broader communities and their “proximity to livestock plants.” Between 236,000 and 310,000 coronavirus cases through July 21 occurred near a meatpacking plant, comprising 6 percent to 8 percent of infections at the time. Between 4,300 and 5,200 coronavirus deaths were in counties near large meat-processing facilities, representing about 3-4 percent of all US deaths.“The vast majority” of the cases recorded, the researchers conclude, were “likely related to community spread outside these plants.” Workers in a Hog Slaughter and Processing Plant (Wikimedia Commons) By July 21, when correcting for risk factors including racial and ethnic background, average income, household size, portions of workers in frontline jobs, elderly population and population in prisons and nursing homes, the researchers found residents of counties with meatpacking plants had a 51 percent higher rate of infections and a 37 percent increase in death rates. The study also found that meat processing facilities that received waivers from the United States Department of Agriculture (USDA) to increase production line speeds resulted in more county-wide cases. To add insult to injury, the USDA submitted a proposal earlier this month to raise maximum line speeds nationwide for chicken processing Ashley Peterson, Senior Vice President of Scientific and Regulatory Affairs for the National Chicken Council (NCC), attempted to downplay the study by claiming that the “vast majority” of infections and deaths documented in the study were people who did not work at poultry or meat plants, proclaiming that it “highlights the fact that individuals are more likely exposed to COVID-19 due to community spread.” This, however, is precisely the point: Outbreaks at meatpacking plants themselves have been key drivers of broader community transmission. In data recorded and reported by the Proceedings of the National Academy of Sciences of the United States of America (PNAS), there is “a strong positive relationship between livestock-processing plants and local community transmission of COVID-19, suggesting that these plants may act as transmission vectors into the surrounding population and accelerate the spread of the virus beyond what would be predicted solely by population risk characteristics.”
National Guard members sent to El Paso to help at overwhelmed morgue – Three dozen Texas National Guard troops were deployed to El Paso County to aid in “mortuary affairs support” amid a surge in coronavirus cases and deaths in the state.The Texas Division of Emergency Management said a total of 36 troops had been deployed, according to CNN. El Paso Mayor Dee Margo (R) said city and county officials have established a central location for a morgue in the city.The troops are set to replace the jail inmates the county previously deployed to transport the bodies of those who died from the virus in the area, CNN reported.Chris Acosta, a spokesperson for El Paso County Sheriff’s Office, confirmed last week that while inmates are typically not compensated for such work, the inmates in question volunteered on the condition that they be compensated.“As we’ve seen a rapid increase in cases and hospitalizations, we are unfortunately also seeing a spike in deaths,” Margo tweeted Friday. “We have been working closely with funeral homes and mortuaries to assist with increased capacity and coordination of resources.” “The Texas Military will provide us with the critical personnel to carry out our fatality management plan and we are very grateful to them for their ongoing support,” Margo added.The county is one of the Lone Star State’s hotspots for the virus, reporting 1,074 new cases Saturday and eight additional deaths, for a total of 853 dead overall. The state has recorded a total of 1.13 million cases and just under 21,000 deaths.
Hundreds of bodies from New York virus surge still stored in freezer trucks – Hundreds of bodies remain in storage in freezer trucks in New York months after their deaths during the first wave of the coronavirus pandemic in the spring, The Wall Street Journal reported. City officials told the Journal that there are about 650 bodies in storage on the 39th Street Pier in Brooklyn’s Sunset Park. The Office of the Chief Medical Examiner said the bodies are largely those of people who could not afford a burial or whose next of kin could not be located. Such bodies would ordinarily have been buried on Hart Island, according to the newspaper, but Mayor Bill de Blasio (D) pledged in April that those burials would not occur during the coronavirus pandemic. Some 230 victims’ relatives have not yet been located, the chief medical examiners’ office said. Officials said relatives have not had the money to collect the bodies in other cases. The city nearly doubled the burial subsidy it offers in May, the Journal noted, but the $1,700 offered is still far short of the $9,000 average cost for a traditional burial or the $6,500 cost of a service and cremation. Dina Maniotis, the chief medical examiner’s office’s executive deputy commissioner, told the newspaper that while anyone has the right to request a free burial on Hart Island, numerous family members are not clear on their options. “This has been traumatic,” she said. “We are working with them as gently as we can and coaxing them along to make their plans. Many of them will decide they want to go to Hart Island, which is fine.” Aden Naka, the office’s deputy director of forensic investigations, added that the unit is only equipped to handle about 20 deaths per day, about one-tenth of those it was faced with at the height of the pandemic in the city.
650 bodies stored in freezer trucks for months in New York City disaster morgue – The Wall Street Journal reported Sunday that hundreds of bodies have been kept in a disaster morgue on the Brooklyn waterfront for months, after New York City was overwhelmed by the impact of the COVID-19 pandemic. About 650 remain, and as a second wave of the virus hits the New York City area, the macabre “backlog” of bodies is likely to rise. Just as the pandemic overwhelmed the city’s health care system, it also overwhelmed the city’s death care system, with bodies overwhelming morgues and funeral homes. Thousands of New Yorkers lived within view of a refrigerated truck brought in to store bodies on the street or in a parking lot during the height of the pandemic. Hundreds of those bodies ended up on the 39th Street Pier in Sunset Park, Brooklyn, after delays in identifying them and making proper arrangements. The New York City Office of Chief Medical Examiner (OCME) is trying to identify relatives for about 230 of the deceased, with others remaining in storage as their aggrieved family members make funeral arrangements. In many cases, these family members have themselves had COVID-19; some have died from it. Even in terms of staffing, the OCME was simply unequipped to deal with the surge in deaths: 15 forensic investigators and seven staff working to identify next of kin were dealing with 200 deaths a day rather than the normal 20. Calls from family members asking about death certificates or trying to view a body skyrocketed to 1,000 daily from only dozens before the pandemic, prompting the addition of staff from the city’s Department of Health and Mental Hygiene. The Wall Street Journal relates the case of Lea-Anne Carafa, who was contacted by the OCME on July 28 to tell her that “her husband, Frank Joseph Carafa, from whom she was separated, had died and been found in bed almost three months earlier, on May 6.” As much as the delays in identifying bodies and contacting relatives have created a situation in which hundreds of people have not been buried for months, the concurrent health and economic crises are also delaying burials.
TSA screens 2M flyers in two days after warning against travel – The Transportation Security Administration (TSA) has screened more than 2 million flyers on Friday and Saturday, in the two days after the federal government issued a warning against Thanksgiving travel. TSA data indicates that more than 1 million travelers were screened on Friday, the second day to reach beyond 1 million since March. Friday’s traveling numbers amounted to almost 40 percent of the TSA screenings conducted on the same weekday last year. On Saturday, the TSA reported that it screened 984,369 travelers, almost 45 percent of the screenings completed on the same weekday in 2019. The more than 2 million travelers over the past two days is much less than the amount who traveled for the holiday on Friday and Saturday last year. But it still shows that many plan to follow through with their plans to travel for Thanksgiving despite the Centers of Disease Control and Prevention (CDC) recommending against it. The CDC issued its warning against traveling for Thanksgiving on Thursday, one week before the holiday, as the number of COVID-19 cases in the country are continuing to surge. In its announcement, the agency officially recommended Americans only spend Thanksgiving with people living in their households, meaning those who have lived in the same home for at least 14 days before the holiday. The CDC said those who do not follow these recommendations should wear masks, stay six feet apart from those not in their household and hold small gatherings outside. The TSA has consistently screened less than 1 million people every day since March, except for Oct. 18, which came at the end of Columbus Day weekend, as the travel industry has taken a huge hit amid the pandemic. Travel organization AAA predicted that there will be an “at least” 10 percent decrease in Thanksgiving travel due to the coronavirus crisis. TSA Administrator David Pekoske said he thinks the busiest travel days for the holiday will be the Wednesday before Thanksgiving and the Sunday after, according to CNN. The U.S. reached 250,000 total COVID-19 deaths last week, since the beginning of the pandemic in the spring. The country tracked a single-day record for hospitalization on Saturday with 82,227 currently hospitalized and for cases on Friday with 192,805 new confirmed cases.
US records 20 straight days of 100,000 new coronavirus infections – The U.S. on Sunday marked the 20th straight day of more than 100,000 new confirmed COVID-19 infections, according to data compiled by Johns Hopkins University.More than 12.2 million cases have been confirmed in the U.S. as of Sunday, a staggering number that surpasses every other country’s total. The U.S. has confirmed more than 3 million cases more than India, the country with the second-highest number of infections. India has seen more than 9 million cases and has recorded a rate of 60,000 cases per day for weeks.Deaths in the U.S. also continue to climb and most recently passed a quarter of a million, another grim statistic that sits far higher than the levels recorded in other countries.CNN reported Sunday that roughly a quarter of the U.S.’s total cases have been reported this month, a sign indicating the virus’s continued rapid spread in many areas of the country.Despite the U.S.’s struggles with controlling the virus’s spread, President Trump touted U.S. successes in the arena of pandemic response at a Group of 20 meeting on Saturday, according to White House officials.”During his remarks, President Trump highlighted how the United States marshaled every resource at its disposal to respond to the crisis, as well as the unprecedented economic recovery of the United States on a foundation of tax and regulatory cuts, energy independence, and fair trade deals,” said White House spokeswoman Kayleigh McEnany.
Iowa hospitals overwhelmed, Wisconsin health care system on brink of collapse amid exponential rise in COVID-19 casesIowa officials reported on Sunday that the number of deaths from COVID-19 rose to more than 200 for the first time during any seven-day period of the pandemic. In the first weeks of November, Iowa recorded more than 30,000 cases of COVID-19. The state has just over 3 million residents. Until last week, Republican Governor Kim Reynolds had remained a holdout against even the mildest form of disease mitigation, a statewide mask mandate, in the service of big agribusiness, including the meatpacking companies. The state has been accused of obscuring the real scope of the outbreak in its effort to keep workers on the job and try to limit social opposition. The Iowa Gazette reports the state is using a formula that includes numbers not available to the public, producing positivity rates lower than what can be calculated with public data. KCRG reports the state government is barring local public health departments from releasing information on hospital capacity. COVID-19 hospitalizations in Iowa have shot up from under 500 in mid-October to about 1,400 late last week, mid-November. Hospitals in rural Iowa have been overwhelmed with patients and staff are suffering burnout. Iowa nurse Whitney Neville told The Atlantic, “It was doable over the summer but now it’s just too much. Last Monday we had 25 patients waiting in the emergency department. They had been admitted but there was no one to take care of them.” The state reported on Friday that 77 percent of those incarcerated in the Anamosa State Penitentiary have tested positive since March, many having recovered, and 124 prison staff have been infected. Iowa ranks fourth in the nation for prison infections. Family members of those incarcerated at the Anamosa told Iowa Public Radio that they fear speaking out publicly will result in their loved ones being retaliated against. More than 3,400 prisoners and staff have been infected and 8 prisoners and 1 staffer have died throughout the state’s prison system. The official response to the outbreak in Anamosa prison is to keep the facility on lockdown 23 hours a day, moving the few prisoners who tested negative out of the facility, transforming the entire prison into a sick ward. Anamosa was surpassed by North Central Correctional Facility in Rockwell City for the worst outbreak, with 90 percent of inmates testing positive for the disease. Last week, the state of Wisconsin marked its deadliest week of the pandemic. From Nov. 14 – 20, deaths from COVID-19 averaged 54 per day, a 17 percent increase from the prior week. The state surpassed 350,000 cumulative cases as of Saturday and 3,000 cumulative deaths. Three of the state’s highest daily death tolls were recorded last week: Nov. 17 saw the highest with 92 deaths, a record for the state, followed by 83 deaths Nov. 19 and 78 deaths on Nov. 20. In the state there have been 1,000 deaths in November alone. The Institute for Health Metrics and Evaluation predicted deaths from COVID-19 in Wisconsin will reach 4,000 by the first week of December, 5,000 by the year’s end, and 8,000 by March 1, 2021. Like Illinois to the south, COVID-19 is now the third leading cause of death in the state.
1,000 U.S. Hospitals Are ‘Critically’ Short On Staff – And More Expect To Be Soon — More than 1,000 hospitals across the United States are “critically” short on staff, according to numbers released this week by the Department of Health and Human Services. Those hospitals, which span all 50 states, Washington, D.C. and Puerto Rico, represent about 18% of all hospitals that report their staffing status to HHS. And that number is expected to grow: 21% of all hospitals reporting say they anticipate having critical staffing shortages in the next week. The worst-hit state is North Dakota with 51% of hospitals that reported saying they’re facing shortages; seven states say over 30% of their hospitals are in trouble. This is the first time the federal agency has released this data, which includes limited reports going back to summer. The federal government consistently started collecting this data in July. After months of steadily trending upward, the number of hospitals reporting shortages crossed 1,000 this month and has stayed above since. The data, however, are still incomplete. Not all hospitals that report daily status COVID-19 updates to HHS are reporting their staffing situations, so it’s impossible to tell for sure how much these numbers have increased. While the data is a welcome addition to the arsenal of information that public health officials have to fight COVID-19, it highlights the shortcomings of what the federal government has made available to the public. Though the government has precise daily figures for COVID-19 hospitalizations at thousands of the country’s hospitals, it shares only a small subset of this information to people outside government.
Colorado Reps. Perlmutter, Lamborn test positive for COVID-19 – Two members of Colorado’s congressional delegation in two days announced they had tested positive for COVID-19. Rep. Ed Perlmutter, a Democrat from Arvada who represents the 7th District, announced the news in a press releaseTuesday.“As of now, I am asymptomatic and I’m feeling good,” Perlmutter said. “I am currently in Washington D.C. and plan to isolate in my apartment while continuing to work and voting remotely.” The office of Rep. Doug Lamborn, a Republican from Colorado Springs who represents the 5th District, issued a press release Wednesday about his positive test. The release said Lamborn is “experiencing mild symptoms.” “He has been in contact with the U.S. House Attending Physician and is following all CDC guidelines and isolating at his home in Colorado Springs,” the release says. Members of Lamborn’s staff in October tested positive for COVID-19, according to The Denver Post.
6th Arizona state lawmaker tests positive for COVID-19 – (AP) – A sixth member of the Arizona Legislature has confirmed he tested positive for COVID-19. Rep. Andrés Cano, a Democrat, announced on social media Wednesday that he is not symptomatic and is in isolation. “COVID-19 cases are spiking throughout our Nation, and nobody is immune – even when precautions are taken,” said Cano, who was reelected earlier this month. “We are in this together and we can protect each other. I urge my fellow Arizonans to take care of their loved ones by avoiding large gatherings and wearing a mask at all times.” Last week, Democratic Rep. Arlando Teller of Chinle announced he also tested positive and was isolating. The most serious case involved Rep. Lorenzo Sierra, who spent several days on a ventilator after becoming ill in October. He has now recovered. Rep. Raquel Teran also became ill in October, while Sen. Lupe Contreras and Rep. JoAnne Osborne revealed their infections earlier in the year. Sierra, Contreras and Teran are Democrats and Osborne is a Republican. More than 190 state lawmakers nationwide have tested positive for the disease and four have died, according to a tally by The Associated Press.
Cleveland coronavirus cases up 1,200 percent since early October – The Cleveland area has seen its number of coronavirus cases skyrocket by 1,259 percent in the past seven weeks according to the Ohio Department of Health, as cases across the country continue to climb. On Oct. 1, when Ohio Gov. Mike DeWine (R) released an advisory alert map, the Cleveland/Akron area was reporting an average of 83 cases a day, according to the Cleveland Plain Dealer. Now, the area is averaging 1,134 cases a day. The Buckeye State, like many states in recent weeks, on Friday broke its record for new cases in a single day, reporting 8,808 cases. So far, 343,286 coronavirus cases and 5,984 deaths have been reported in Ohio. Last week Franklin County, where the state’s capital of Columbus is located, was elevated to the highest public emergency level, indicating a risk of “severe exposure and spread.” The recommendation for residents in a county at this level is to “only leave home for supplies and services.” Last week, Columbus health officials announced a month-long health advisory, urging residents to only leave the home for essential needs, work and school. “I’m not going to mince words: We have entered a dangerous time in our fight against COVID-19. This surge is much scarier than we saw in the spring or again in the summer,” Columbus Mayor Andrew Ginther (D) said after the advisory was announced. When the advisory system was first released on Oct. 1, 11 counties were classified as Level 3. Now, of Ohio’s 88 counties, 15 are at Level 2, one is at Level 4 and the rest are Level 3. In a tweet last week, DeWine warned that “Other counties may not yet be seeing continuous, uninterrupted increases in the same way that is causing Franklin to move to purple, but make no mistake – almost all counties are seeing more cases and more healthcare use that could threaten the medical system if they continue.”
Close to 1,000′ Cleveland Clinic caregivers infected with Covid-19 – The Cleveland Clinic’s Chief Caregiver Officer Kelly Hancock urged her community to follow social distancing and mask guidelines as Covid-19 grips hundreds of those working inside of one of America’s best hospitals. “We had a record today, we saw nearly 12,000 new cases in the state of Ohio of Covid-positive patients, and so when you think about the increase and the hospitalizations that results in, it’s incredible,” Hancock said during a Monday evening interview on “The News with Shepard Smith.” “We’re experiencing close to 1,000 of our caregivers who’ve been affected by Covid-19, and unable to come in and care for those patients.” The Cleveland Clinic reported that 970 caregivers are out due to the virus, triple the number from two weeks ago. In the greater Cleveland area, Covid-19 cases are on the rise, according to the Ohio Department of Health. There was an average of 83 new cases between September 23-29, but between November 11-17 the average was 1,134 new cases. Hancock told host Shepard Smith that despite the infections of its health-care workers, that the Cleveland Clinic is still able to uphold its standard of care for patients. “Right now we have adequate staffing, we’re able to mobilize our caregivers to the areas they’re needed most, but we continue to meet frequently throughout the day to continue to assess the situation for both our caregivers, as well as the bed capacity,” Hancock said. The United States recorded more than 3 million new coronavirus cases this month alone. That’s a quarter of all the country’s cases to date, according to a CNBC analysis of Johns Hopkins data. The U.S. has averaged 1,500 deaths per day over the past week, which is an average of more than one death every minute for the past week. Hospitalizations have been up for 29 straight days, and over that time, the number of people hospitalized for the virus doubled, according to the Covid Tracking Project. Hancock urged that America’s health-care workers need all the help they can get right now. She advised people to avoid large gatherings during the holidays, to wear masks appropriately, and frequent hand washing. “All of this is really concerning for all of us and we need to do all of this to ensure that we can keep our caregivers at work,” said Hancock.
‘Hospitals Know What’s Coming: The Hospital Best-Prepared for COVID-19 Is Nearly Overwhelmed – Perhaps no hospital in the United States was better prepared for a pandemic than the University of Nebraska Medical Center in Omaha. After the SARS outbreak of 2003, its staff began specifically preparing for emerging infections. The center has the nation’s only federal quarantine facility and its largest biocontainment unit, which cared for airlifted Ebola patients in 2014. The people on staff had detailed pandemic plans. They ran drills. UNMC is “arguably the best in the country” at handling dangerous and unusual diseases. There’s a reason many of the Americans who were airlifted from the Diamond Princess cruise ship in February were sent to UNMC.In the past two weeks, the hospital had to convert an entire building into a COVID-19 tower, from the top down. It now has 10 COVID-19 units, each taking up an entire hospital floor. Three of the units provide intensive care to the very sickest people, several of whom die every day. One unit solely provides “comfort care” to COVID-19 patients who are certain to die. “We’ve never had to do anything like this,” . “We are on an absolutely catastrophic path.” To hear such talk from someone at UNMC, the best-prepared of America’s hospitals, should shake the entire nation. In mid-March, when just 18 Nebraskans had tested positive for COVID-19, Shelly Schwedhelm, the head of the hospital’s emergency-preparedness program, sounded gently confident. Or, at least, she told me: “I’m confident in having a plan.” But now about 2,400 Nebraskans are testing positive for COVID-19 every day – a rate five times higher than in the spring. More than 20 percent of tests are coming back positive, and up to 70 percent in some rural counties – signs that many infections aren’t being detected. The number of people who’ve been hospitalized with the disease hastripled in just six weeks. UNMC is fuller with COVID-19 patients – and patients, full stop – than it has ever been. “We’re watching a system breaking in front of us and we’re helpless to stop it,” says Kelly Cawcutt, an infectious-disease and critical-care physician.Cawcutt knows what’s coming. Throughout the pandemic, hospitalizations have lagged behind cases by about 12 days. Over the past 12 days, the total number of confirmed cases in Nebraska has risen from 82,400 to 109,280. That rise represents a wave of patients that will slam into already beleaguered hospitals between now and Thanksgiving. “I don’t see how we avoid becoming overwhelmed,”
“We Feel Like We Are Drowning” – Rural Hospitals Overwhelmed By Shortages Of Bed, Staff – As the coronavirus ravages rural parts of the US, areas it largely ignored during the spring and summer, hospitals are being overwhelmed. We pointed out earlier that only four US states have hospitalization rates below 100 per million, with the Midwest being the worst hit region, though down in Texas, El Paso has stood out for the severity of its outbreak, and the degree to which deaths have overwhelmed the city’s morgues, forcing Gov. Greg Abbott to send in the national guard. On Tuesday, Reuters published a story recounting stories from some of the most overburdened hospitals in the country right now. They can be found in places like rural Lakin, Kansas, or other “critical access” hospitals spread out across a dozen states in the midwest and the mountain west. Sparsely populated states like North and South Dakota are being hit particularly hard. Since mid-June, daily new COVID-19 cases reported in the midwest have increased by 20x. For the week ending Nov. 19, North Dakota reported an average of 1,769 daily new cases per 1 million residents, while South Dakota recorded nearly 1,500 per million residents, Wisconsin and Nebraska around 1,200, and Kansas nearly 1,000. Even during New York’s worst week from April, the state never averaged more than 500 new cases per million people. California hasn’t topped 253.Across the Midwest, hospital directors told Reuters that they’re at capacity, or dangerously close. Most have tried to increase availability by repurposing wings or cramming multiple patients in a single room, and by asking staffers to work longer hours and more frequent shifts. Kearny County Hospital in rural Lakin, Kansas is one such example. The hospital is classified as a “critical access hospital” by federal authorities since it’s the only hospital servicing a patch of southwestern Kansas, not far from the border with economically desolate Oklahoma. Some medical workers complained to Reuters that they see a “disconnect” between the grim scene inside the ICU, and families who are out planning Thanksgiving dinner parties, while some young people continue frequenting bars. “There’s a disconnect in the community, where we’re seeing people at bars and restaurants, or planning Thanksgiving dinners,” said Dr. Kelly Cawcutt, an infectious disease doctor at the University of Nebraska Medical Center. As health workers, she said, “we feel kind of dejected.” Dr. Drew Miller, the chief medical officer at Kearny, told Reuters about how he almost lost a 30-year-old patient who needed to be moved to the ICU, but there were no beds. The man survived after he briefly stopped breathing. Dr. Miller said he was astonished when the patient’s pulse returned. Still, while some forecasters see even more dire numbers ahead, Dr. Miller warned “I don’t think the worst is here yet.”
America Is on Track to Hit a COVID-19 Death Record – How Many Americans Are About to Die? The United States has made huge advances in fighting the coronavirus. The astonishingly high death rates the country saw during the spring have fallen, and Americans are much more likely now than they were then to survive a COVID-19 hospitalization. New treatments have, in some cases, helped speed recovery – President Donald Trump has trumpeted his own bout with the virus as proof that there is a “cure” for the illness. (There is not.) These developments have given Americans the impression that no matter how high cases surge, deaths might not reach the heights of the spring. But the truth is grimmer. The story people want to believe about how much treatments have improved in recent months does not hold up to quantitative scrutiny. The U.S. health-care system has not reduced the deadliness of the coronavirus since July, according to a new estimate by a prominent COVID-19 researcher, which accounts for the lags in public reporting of cases and deaths. Instead, the virus has, with ruthless regularity, killed at least 1.5 percent of all Americans diagnosed with COVID-19 over the past four months. This rate is a major improvement, down more than tenfold from the earliest days of the pandemic, when deaths were high and the extreme limits on coronavirus testing held down the number of diagnosed cases. But in this new phase of the pandemic, when testing is more widely available and a much higher proportion of cases are diagnosed to begin with, it is also terrible, terrible news. Because the case-fatality rate has stayed fixed for so long and there are now so many reported cases, predicting the virus’s death toll in the near term has become a matter of brutal arithmetic: 150,000 cases a day, times 1.5 percent, will lead to 2,250 daily deaths. In the spring, the seven-day average of daily deaths rose to its highest point ever on April 21, when it reached 2,116 deaths. With cases rising as fast as they are, the U.S. could cross the threshold of 2,000 daily deaths within a month. Without a miraculous improvement in care, the United States is about to face the darkest period of the pandemic so far.
Projected US coronavirus deaths more than 400,000 by March – The U.S. has been breaking daily coronavirus case records regularly in November, with the current number of cases at more than 11 million and the number of deaths nearing 250,000, according to the New York Times. By one research group’s calculations, the number of deaths in the U.S. could surpass 400,000 by March 2021.The Institute for Health Metrics and Evaluation publishes projections of COVID-19 deaths, infections, testing, hospital resource use, mask use and social distancing. You can view the charts for the global situation or broken down to country or even further by region within a country.In the U.S., if restrictions are eased, the model projects deaths to reach more than 586,000 by March 1, 2021. If things stay the same, deaths would be at nearly 439,000 over the same time period. Lastly, if mask mandates were put into effect, they estimate there would be about 370,000 deaths due to COVID-19. The business-as-usual and mask mandate scenarios also include an assumption that if daily deaths reach 8 per million people then restrictions like closing nonessential businesses would be reinstated for six weeks. The researchers behind these projections update their model regularly, incorporating data collected by other groups. They also estimate that stress on hospitals will peak in December and January, according to a briefing. The scenarios are based on observations of mask wearing and physical distancing. The researchers say that declining vigilance in these behaviors may account for recent increases in coronavirus cases, in addition to seasonality.
Mayo Clinic Puts Hospital Beds In Ambulance Garage, Lobbies As COVID-19 Surges – As the crush of new COVID-19 hospitalizations stretches hospitals around the state to their limits, the Mayo Clinic Health System is taking unprecedented steps to expand capacity at its northwestern Wisconsin locations. Those include moving beds into waiting rooms, surgical spaces and even a parking garage. It’s been just more than a week since the Mayo Clinic announced 100 percent of its hospital beds in Northwestern Wisconsin were full. That number fluctuates by the hour, but emergency room physician Paul Horvath said hospitals and emergency rooms have been forced into what is known as “diversion status.” “I worked a shift in one of the emergency departments the other evening,” Horvath said, “and literally every bed in northwest Wisconsin was full, and hospitals just weren’t able to admit new patients. Which means that I had the challenge of managing ICU level care in my ER for hours, which is obviously not routine.”A recent surge of 20 patients at Mayo’s hospital in Barron forced staff to move some patients into a room designated for preparing people for surgery, said Horvath. He said when emergency departments fill up, paramedics have to find new places to bring patients that are further away and may not have the same level of staff or equipment to treat the critically ill.Horvath said from a patient’s perspective, the team of doctors and nurses all look the same in their layers of personal protective equipment. Beeping monitors and the hurried, labored breathing of patients makes communication more difficult too. Horvath said he sometimes feels like he’s yelling at patients and staff to cut through the noise. Sue Cullinan is an emergency room doctor at Mayo Clinic’s Eau Claire hospital. On Oct. 12, she recorded video diary entries detailing how the hospital was preparing for the ongoing surge of new admissions. “Our surge plan expands into the garage, it opens up more beds, we’re expanding into lobbies, we’re putting people where we wouldn’t normally put patients,” said Cullinan. “Not where I’d want to put my grandfather or my grandmother,” she said, though it “may have to happen.” On Nov. 22, the Wisconsin Department of Health Services reported 208 new hospitalizations due to COVID-19. There are 2,076 patients hospitalized for COVID-19 across the state, according to DHS. At the same time that health systems are being inundated with new patients, they’re responding with fewer staff. A Mayo Clinic Health System spokesman told WPR as of Nov. 20, there were 239 Wisconsin staff out of work due to COVID-19 infections or exposure.
Nurse: “We Are Screaming at the Top of Our Lungs and So Few Are Listening” — Uri Friedman of The Atlantic popped off a chewy little thought bomba couple of weeks back. Surveying the national landscape under COVID, he argued that in the age of the pandemic, a new metric for “national strength” must be cultivated: the resilience of a population under duress. It is this metric, Friedman argued – not a nation’s military prowess or economic muscle – that matters the most right now. And by this metric, the United States has failed the COVID test thoroughly. Friedman’s insight feels all the more relevant as we pass into the COVID crucible of mass Thanksgiving travel. While holiday travel this year hasdropped several percentage points due to pandemic concerns, many millions will still risk breathing the air on planes and trains in order to spend time with family and friends. They do so at a grimly consequential moment: COVID took almost 2,500 lives just yesterday, and has been infecting nearly 200,000 people a day for the last week. It is, at present, worse than at any moment since the crisis began. The United States is proving time and time again its inability to succeed in relation to this metric. It is facile to scapegoat Thanksgiving travelers, a vivid example though they may be, because this failure began with the first infection and has spread with it from one side of the nation to the other. When a large segment of a population is gulled by its leaders into thinking protective masks are an anti-freedom political statement to be shunned, even as the bodies pile up inside refrigeration trucks at the morgues, that is a gross and dispiriting failure of popular resilience from top to bottom. Nowhere has the weight of our national failure of resilience landed heavier than in the medical facilities that are taking this new COVID spike straight in the teeth. The pandemic may have revealed our weaknesses as a country, but it has also shined a bright spotlight on our strengths. Within the confines of a broken, profit-motivated health care system is an army of deeply devoted professionals who have thrown their bodies on the gears of this viral machine since it began. I spoke to two working nurses this week, one on the East Coast and one on the West. Kathleen Logan, a nurse practitioner in acute inpatient and primary care, works in Massachusetts. T., who asked that their name be withheld out of concern for job security, is an RN at a hospital in the Pacific Northwest. “I don’t understand why they won’t listen to us,” lamented T. regarding the mobs of holiday travelers. “We are screaming at the top of our lungs and so few are listening. We don’t have a well-functioning health care system in the best of times. I wonder what it will look like in three to four weeks?” “I’m getting scared again just like the worst part of the first surge,” said Logan. “We are reusing ‘sanitized’ N95 masks, which is just disgusting. It’s been documented that the integrity of the mask is depleted with each sanitization, so I don’t participate in it. I leave it in the UV light and spray it down with disinfectant.”
“Come, be a hero.” – A word from a Los Angeles physician and professor of emergency medicine: In my world, there is a lot of anger – most of it kept professionally hidden.In emergency rooms and intensive care units across the country, frontline nurses, respiratory therapists and doctors like me have been in danger every day for eight months. Smothered in PPE, we’re doused in coronavirus every day while we take care of the very sick, the worried well and the dying. Some of the dead aren’t patients; some are colleagues, friends and our own families.We are furious and we are exhausted. And now we face again the flooding of our hospitals.We’re tired of seeing patients who got the virus after their kid’s “limited” birthday party or because they went out to a restaurant dinner with “close friends” or flew to a celebration in a state “that didn’t have much COVID.”It didn’t have to be this way.We bent the curve, then let it bend right back. Distracted and tired, our focus faded.Fall is aptly named. People aren’t made to be perfect, but damn, we should be better than this.What you do – how we ALL act in the next six weeks – will make the difference between an inconvenient fall and a disaster that will take years to overcome.Until months AFTER the vaccines arrive, the same simple steps will be required. Not just in California, but also across our un-United States.Wear a mask whenever you leave the house. Stop doing dumb stuff, like going to parties, destination weddings and the French Laundry. Stop listening to know-nothings who spout “science” on YouTube and Twitter. Stop being crybabies about a little inconvenience. We already have more than 250,000 reasons to weep – and to be thankful we are alive and can still do something about it. […] As I put on my PPE before a shift in the ER, I think of seasick WWII soldiers, riding toward a beach as other young men on shore tried to kill them in the surf. Compared to what they faced, what I do is easy. Then, no one knew how long the war would last or if they would survive. People back home collected rubber and bacon grease for years, gave up countless liberties and luxuries, and no one ever called the war a hoax, even if they never saw a Nazi in their backyard.We’re eight months into COVID. World War II lasted six years and a day. The Great Depression lasted 10 years. The 1918 flu lasted two years and two months.Are we really that soft? That careless? That selfish? It’s great news that a vaccine is likely to come soon, but don’t depend on it to save you and the people you love. Like the last man shot in war, you might get the virus before you get the vaccine.There is still time to save lives. Stay at home, and when you have to go out, wear your mask everywhere. Break the virus chain. Do it for yourself. Do it for those you love. Do it for your country.Come, be a hero.
Texas reports 14,000 new coronavirus cases, a daily record – State health officials on Tuesday reported 13,998 new coronavirus cases, a daily record. The number of infections and hospitalizations in Texas continues to climb, placing a growing strain on hospital capacity and staffing, according to the Texas Department of State Health Services. The previous record for new daily cases – 12,597 – was set on Saturday. Before that, the record, 12,256 cases, was set on Thursday. Over the past seven days, Texas has averaged 10,601 new cases and 151 fatalities reported each day. On Tuesday, the state reported 162 newly recorded coronavirus fatalities. Nearly 8,500 COVID-19 patients were being treated in Texas hospitals on Tuesday, the most since Aug. 4. The statewide hospitalization figure has steadily increased since early October. The pandemic high, 10,893 hospitalizations, occurred on July 22. Coronavirus patients have occupied more than 15% of the total hospital bed capacity in five of the state’s 22 trauma service areas – El Paso, Midland-Odessa, Amarillo, Lubbock and Laredo – for at least a week, a threshold that triggers tighter restrictions. The rising case numbers and hospitalizations in Texas are part of a nationwide coronavirus surge. Health officials are urging people to avoid traveling for the holidays and to keep gatherings limited to their immediate households.
Record-setting day: 13 outlying North Texas counties set COVID-19 daily highs on Tuesday – Texas health officials reported 13,988 new COVID-19 cases in Texas on Tuesday, which is a daily record-high. While Dallas, Tarrant, Collin and Denton counties are all dealing with a rise in cases, 13 outlying counties in North Texas set new record-highs for daily COVID-19 cases on Tuesday. Cooke County reported 174 daily cases Tuesday, which is more than five times the previous record. Kaufman County more than doubled its previous high with 381 new COVID-19 cases Tuesday while Ellis County added more than 500 daily cases for the first time. All of the COVID-19 data comes from the Texas Department of State Health Services. Ellis County added a record-high 507 new COVID-19 cases on Tuesday, almost double the previous record of 280 that happened on Nov. 10. The current 14-day average for COVID-19 cases is 79. This is also a county record. Kaufman County added a record-high 381 new COVID-19 cases on Tuesday, more than double the previous record of 160 that happened on Aug. 18. The current 14-day average for COVID-19 cases is 58. This is also a county record. Rockwall County added a record-high 252 new COVID-19 cases on Tuesday, almost double the previous record of 136 that happened on Aug. 18. The current 14-day average for COVID-19 cases is 41. This is also a county record. Johnson County added a record-high 312 new COVID-19 cases on Tuesday, almost double the previous record of 184 that happened on July 8. The current 14-day average for COVID-19 cases is 72. This is also a county record.
Why are millions of Americans traveling for Thanksgiving as the pandemic rages? – The coronavirus pandemic is breaking records every day in the United States, filling up intensive care units, overwhelming hospital systems and exhausting health care workers. A record 203,000 Americans tested positive for COVID-19 on Friday, and the seven-day average is above 170,000. Despite significant advances in treating the disease, more than 1,500 people are dying every day, the highest level since May. The Centers for Disease Control and Prevention (CDC) predicts that the US will record 300,000 deaths by the middle of December, and there could be as many as 21,000 new coronavirus hospitalizations each day. Workers walk out wearing protective gear as they leave for the day on a shift change at Life Care Center earlier this year in Kirkland, Wash., near Seattle. (AP Photo/Elaine Thompson) The CDC has issued a severe warning against traveling for Thanksgiving, one of the busiest travel weeks of the year. It recommends that people restrict their dinner plans to those who live in their households in order to limit the further spread of the virus. “The tragedy that could happen is that one of your family members is coming to this family gathering and they could end up severely ill, hospitalized or dying. And we don’t want that to happen,” Dr. Henry Walke, the CDC’s COVID-19 incident manager explained at a press conference last week. Under these conditions, many people are choosing not to travel. The number of people flying for Thanksgiving is down by more than half from last year. However, the Transportation Security Administration reported that more than three million people passed through airport security checkpoints between Friday and Sunday, making it the busiest travel weekend since March, when restrictions and lockdowns were implemented to control the COVID-19 pandemic. Crowded security lines snaked through terminals as travelers packed onto airplanes to head home to see their families. All told, the American Automobile Association projects that 50 million people will travel by car, air and rail throughout the United States during the Thanksgiving holiday period stretching from November 25 through November 29. While this represents a 10 percent decline from 2019, the consequences of such a mass travel event will likely be catastrophic. The pandemic saw its initial widespread transmission when five million people traveled out of the city of Wuhan in Hubei Province, where the first cases of COVID-19 were detected, to celebrate Chinese Lunar New Year with family. The virus quickly spread from China to the rest of the world.
November 24 COVID-19 Test Results; Record Hospitalizations, Deaths Increasing –Note: Week-over-week case growth has slowed, and will probably show a decline over the holiday weekend. However, it is likely that cases will pickup again the following week. The US is now averaging over 1 million tests per day. Based on the experience of other countries, for adequate test-and-trace (and isolation) to reduce infections, the percent positive needs to be well under 5% (probably close to 1%), so the US still needs to increase the number of tests per day significantly (or take actions to push down the number of new infections). There were 1,519,223 test results reported over the last 24 hours.There were 166,672 positive tests. Over 28,500 US deaths have been reported so far in November. See the graph on US Daily Deaths here. This data is from the COVID Tracking Project.The percent positive over the last 24 hours was 11.0% (red line is 7 day average). The percent positive is calculated by dividing positive results by the sum of negative and positive results (I don’t include pending).And check out COVID Exit Strategy to see how each state is doing. The second graph shows the 7 day average of positive tests reported and daily hospitalizations.The dashed line is the previous hospitalization maximum. Note that there were very few tests available in March and April, and many cases were missed, so the hospitalizations was higher relative to the 7-day average of positive tests in July.
• 7-day average cases are at a new record.
• 7-day average deaths at highest level since May.
• Record Hospitalizations.
US coronavirus cases, hospitalizations and deaths explode during past two weeks – The number of COVID-19 cases, hospitalizations and deaths in the United States have exploded in the past two weeks. Hospitalizations currently stand at 85,836, according to the COVID Tracking Project, a new record for the fourteenth day in a row. The number of active cases has risen to more than five million and is on track to double every six to eight weeks. The number of daily deaths now exceeds 1,500 a day on average, more than 300 more than the summer peak and rapidly approaching the harrowing tolls of March, April and May. In total, there have been just under 13 million confirmed cases of COVID-19 in the United States and more than 265,000 deaths. Moreover, an analysis from the New York Times shows that in reality at least 326,000 people have died from the pandemic, accounting for those who have officially died from the virus and the total number of “excess deaths” since March. Such above normal death rates are now reported in all fifty states. Similar statistics are present on a global scale. Since the first case of the pandemic in December 2019, there have been 60 million cases worldwide, including 17 million which are currently active, up from 14 million two weeks ago. In total, 1.4 million men, women and children have died from the deadly contagion, a number which is currently estimated by the Institute for Health Metrics and Evaluation to rise to 1.8 million by Christmas Day. The overflowing morgues and mass graves in New York City, images that have become infamous, are on the verge of being repeated, this time in every state, county and municipality in the country. One of the sharpest expressions of the crisis in the United States is the number of hospitalizations nationwide, which have quickly surpassed 85,000, rising from just over 23,000 two weeks ago. The figure is expected to rise even more as tens of millions travel during the Thanksgiving holiday weekend. In addition to the record number of hospitalizations, there are also a record number of people in intensive care, 16,811. The number of people currently on ventilators, 5,411, is at its highest level since May. The rise in hospitalizations has been accompanied by the increasing shortage of nursing staff needed to operate the ventilators and help keep patients alive. A recent report from Kaiser Health News notes that, because of the vast spread of the virus, shortages of nurses in a given city or region that were in previous months filled by nurses traveling from other areas are no longer being filled. Instead, a bidding war has erupted among hospitals and health care systems across the country, offering up to $10,000 per week in places like North Dakota, where the governor recently told nurses to stay on the job even if they are infected with COVID-19. This makes it nearly impossible for rural and poor areas to get such nurses because of the high pay they can find at hospitals in more affluent neighborhoods.
Michigan COVID-19 hospitalizations pushing medical facilities to occupancy limits – As the number of confirmed COVID-19 cases in the state of Michigan surged past 325,000 on Thanksgiving, medical facilities across the state were reaching their bed-capacity limits for the treatment of coronavirus patients needing hospitalization. According to data published by the Michigan Department of Health and Human Services (MDHHS), statewide bed occupancy reached 75 percent as of November 23 with a total of 4,022 COVID-19 patients in 136 hospitals. The data also showed that 869 coronavirus patients were in hospital intensive care units. With case fatality rate of 2.7 percent, the state reported a total of 9,170 deaths from the pandemic as of Wednesday. The bed occupancy figures reported by MDHHS are compiled by the Michigan Health & Hospital Association (MHA) and the hospitals are required to enter it into the state’s EMResource data system. The percentage of staffed inpatient beds occupied for each hospital includes all patients regardless of their COVID-19 status. This data revealed that bed occupancy in 53 Michigan hospitals was at 75 percent or greater. It also showed that six hospitals hit 100 percent occupancy and these hospitals – all outside the Detroit metropolitan area – are located in Grand Rapids, Saginaw, Standish, Bay City and St. Joseph, treating a total of 384 COVID-19 patients. A particularly dire situation is developing in Saginaw with Covenant HealthCare reporting the largest number of COVID-19 patients anywhere in Michigan, with 205 being treated at the facility. The hospital services approximately 20 counties in mid-Michigan and is the largest acute care facility in the region.“Like other hospitals across the state, staffing is the biggest challenge when it comes to capacity. Our space can be reconfigured to support different types of patients, but when it comes to staff with specialized skillsets, we have a finite amount.”
The Coming Deadly Covid Winter – Yves Smith – You don’t have to be the son of a fortune teller to sometimes say, “I can see the future. To me, it as if it is already here.” The trajectory of Covid in the US, in combination with the baked-in features of our inept policy responses, means that the general outlines of what will happen over the next few months are close to inevitable. The only element in doubt is the severity of the outcomes. Mind you, nothing below should come as a surprise, yet the press and experts seem reluctant to look at the obvious and see where it leads. If you want proof of leadership/elite failure in the US, you need to look no further than the collective shrug of the shoulders at the way Covid hospitalizations are already at or near the point where ICU capacity are under strain in more and more states. Despite exhortations by officials (not matched by their actions, see Gavin Newsom, Andrew Cuomo, and Nancy Pelosi) even those Americans who curtailing the size of their Thanksgiving gatherings haven’t gotten the memo: festivities outside your daily circle risks spread. The press is full of stories of people who though they’d found a safe way to see friends and relatives by gathering outside, yet they wound up infecting each other because they spent enough time indoors (food prep, bathroom breaks, cleanup). And that’s before you get to indoor celebrations and travel. So pretty much everyone with an operating brain cell is expecting an increase in infections in the weeks after Thanksgiving. Yet I don’t see any reason to see much of a change of heart or habits for the Christmas/New Year period, which means a further rise in disease levels and deaths by mid-late January. Washington is busy having Biden-gasms rather than go into overdrive to reduce the damage of an ongoing national disaster. And to complete this sorry picture, Covid out of control means increased health impairment and deaths on other fronts: patients, particularly those in high risk groups like the immunocompromised, putting off medical treatments and avoiding emergency rooms, and even breakdowns in care. The CDC estimated that of the excess deaths from January 26 to October 3,only 2/3 resulted directly from Covid. And this estimate didn’t factor in that reduced road travel due to lockdowns would reduce traffic fatalities. Alabama, for instance, had negative excess deaths in April because Covid hadn’t really arrived yet and car-related deaths fell. Once emergency rooms across a state are in crisis, officials will be forced into imposing some version of a lockdown to reduce the load on the medical system and save doctors’ and nurses’ lives. So we’re set to see a repeat of the spring: leaky containment programs that only go far enough to take the pressure off hospitals, as opposed to get infection levels low enough so that contact tracing + quarantines + masking can keep it at a low level.
Cuomo Calls Supreme Court Ruling On Churches ‘Irrelevant’ – Responding to the Supreme Court’s 5-4 decision to block New York from setting capacity limits at houses of worship during the pandemic, Gov. Andrew Cuomo (D) said the ruling was ‘irrelevant.” During a Thanksgiving Day conference call with reporters, Cuomo said the order was moot because the religious institutions involved in the lawsuit are no longer in designated red and orange zones in Queens and Brooklyn – therefore the restrictions, capping attendance at houses of worship – no longer apply.”The Supreme Court made a ruling. It’s more illustrative of the Supreme Court than anything else,” said Cuomo (via the NY Post), while knocking the Supreme Court’s (arguably) conservative bias given the addition of Justice Amy Coney Barrett.”It’s irrelevant of any practical impact because of the zone they were talking about is moot. It expired last week,” he added. “It doesn’t have any practical effect.” “The lawsuit was about the Brooklyn zone. The Brooklyn zone no longer exists as a red zone. That’s muted. So that restriction is no longer in effect. That situation just doesn’t exist because those restrictions are gone.”
Coronavirus updates: Los Angeles County issues stay-at-home order; US hits 13 million cases; Ohio State coach tests positive — A national surge in COVID-19 cases continues as the United States recorded its 13 millionth case on Black Friday, a day typically marked by crowds of bargain hunters. This year, however, many shoppers across the country turned to online deals, keeping crowds thin. Even so, experts worried that testing disruptions over the holiday will lead Americans to falsely believe the virus’ spread has slowed. That’s because testing sites have shorter hours and fewer people are expected to be swabbed. “I just hope that people don’t misinterpret the numbers and think that there wasn’t a major surge as a result of Thanksgiving, and then end up making Christmas and Hanukkah and other travel plans,” Dr. Leana Wen, a professor at George Washington University and an emergency physician, told the Associated Press. The U.S. has reported more than 13 million cases and over 264,000 deaths, according to Johns Hopkins University data. This week, five states set death records and 23 states had higher case counts than last week. The global totals: more than 61 million cases and 1.4 million deaths. Los Angeles County announced a new stay-home order Friday as coronavirus cases surge out of control in the nation’s most populous county. The three-week order takes effect Monday, and comes as the county confirmed 24 new deaths and 4,544 new cases of COVID-19. The five-day average of new cases was 4,751. The order advises residents to stay home “as much as possible” and to wear a face covering when they go out. It also bans people from gathering with people who aren’t in their households, whether publicly or privately. Exceptions are made for church services and protests, “which are constitutionally protected rights,” the county Department of Public Health said in a statement. Businesses and outdoor trails are also allowed to remain open.
As Americans gather for Thanksgiving, the world watches with dread and disbelief – Washington Post – Foreign observers are watching with trepidation – and at times disbelief – as coronavirus cases surge across the United States, and masses of Americans are choosing to follow through with plans to visit family and friends for this week’s Thanksgiving holiday anyway. It’s been a grueling year. Many have gone months without seeing their loved ones. Thanksgiving travel is down and many families are opting against their usual festivities. But as the pandemic drags on, with shorter days and chillier weather forcing more people indoors, the social isolation is becoming more difficult to bear. Decisions over whether to gather have turned divisive, as experts warn that Thanksgiving includes the key ingredients – a shared, indoor meal and inter-household mixing – that could spark an even worse surge in cases in the coming weeks. It’s a scenario that officials in other countries are trying to avert ahead of other upcoming holidays, such as Christmas and New Year’s. “From Australia, this looks like a mindbogglingly dangerous chapter in the out-of-control American COVID-19 story,” Ian Mackay, an associate professor of virology at the University of Queensland, wrote in an email. “Sadly, for some, this will be a Thanksgiving that is remembered for all the wrong reasons.” Mackay compared large numbers of Americans traveling for Thanksgiving to China’s Lunar New Year celebrations in early 2020 that inadvertently helped spread the virus at a crucial early stage. In some ways, this might be worse. “This time we all know where the virus is, we know how bad it can be, and we can be sure that this event will cause more sickness and some deaths,” Mackay said. The virus “will thrive among all the chances to trigger superspreading events among households and larger gatherings and parties. This is its way.” Yap Boum, a Cameroonian epidemiologist and regional representative for Epicenter Africa, the research arm of Doctors Without Borders, said the willingness of some Americans to risk their and their family’s health to gather for a single day has left him befuddled. “From my perspective, I found it really crazy,” he said of large numbers of Americans choosing to travel for Thanksgiving. “On one hand, you see the people dying, on the other hand … you see that the vaccine is close. Why can’t you wait despite, of course … the mental challenge?” International news outlets and foreign journalists are covering Thanksgiving travel in the United States extensively, with a mixture of concern, bewilderment and schadenfreude. “No nation suffers as much from corona as America – and yet in a few days a large part of the population here will meet to celebrate,” a U.S. correspondent for Germany’s Die Welt newspaper wrote this week. “Like mask-wearing, Thanksgiving has become another front in the country’s partisan left- and right-wing culture wars,” the Sydney Morning Herald observed. Noting that many people were still planning to travel by air this week, London-based journalist James Ball tweeted that the United States was in “absolutely deadly, delusional denial about Coronavirus.” “It goes well, well beyond Trump,” added Ball, who works as an editor at the Bureau of Investigative Journalism.
Global COVID-19 Cases Top 60 Million, US Deaths Top 260,000- Live Updates – As Americans hunker down for the Thanksgiving holiday, albeit with fewer family and friends than usual crowded around the table, recent data appeared to show that the 7-day average of new cases in the US has edged higher to 169,690. However, at the same time, the growth in daily new cases has slowed considerably ahead of the Thanksgiving holiday, with the weekly growth rate falling from over 40% around two weeks ago to 10% now, in a sign that modest state-run virus restrictions and behavioral changes are having an effect. The slowing is broad-based, with less than 40% of US states seeing daily cases rise ahead of testing over the past week, down from 90% earlier this month. The US COVID death toll has topped 260,000 just days after passing the 250k mark over the weekend. Meanwhile, global COVID cases have topped 60 million, as expected. Globally, the number of deaths record yesterday topped 12.75k in just 24 hours, a new record high, as deaths finally start to catch up to increases in case numbers and hospitalizations. In terms of news, Reuters reported that the US government is considering removing bans on entry into the US for non-citizens who recently visited Brazil, the UK and the EU. While lifting these restrictions could lead to a resurgence in tourism, it’s more likely that it won’t have much of a near-term impact, as most airlines have cut international flights to the bone. Other bans, including on travelers from China and Iran, will remain in place. According to Reuters, the plan has received the approval of the White House Coronavirus Task Force. Many administration officials argue the restrictions no longer make sense given that most countries aren’t subject to any travel bans. Officials believe lifting the restrictions could bolster the struggling airline industry, which has seen international travel fall by 70% this year. The Trump Administration infamously dragged its feet before imposing travel restrictions in Europe, though Trump was one of the first leaders to impose restrictions on travelers from China. Reuters also interviewed family members of college students traveling home for the holiday, some of whom described asking their children to quarantine despite a negative test. Finally, German Chancellor Angela Merkel proposed tighter restrictions during a Wednesday meeting with regional leaders including suggesting further reduction on the number of customers allowed in shops and tighter measures in schools in certain ‘hotspots’.
November 28 COVID-19 Test Results; Record Hospitalizations – Note: The data will be unusual over the holiday weekend. The US is now averaging over 1 million tests per day. Based on the experience of other countries, for adequate test-and-trace (and isolation) to reduce infections, the percent positive needs to be well under 5% (probably close to 1%), so the US still needs to increase the number of tests per day significantly (or take actions to push down the number of new infections).There were 1,419,105 test results reported over the last 24 hours. There were 152,098 positive tests. Almost 35,000 US deaths have been reported so far in November. See the graph on US Daily Deaths here. This data is from the COVID Tracking Project. The percent positive over the last 24 hours was 10.7% (red line is 7 day average). The percent positive is calculated by dividing positive results by the sum of negative and positive results (I don’t include pending). And check out COVID Exit Strategy to see how each state is doing. The second graph shows the 7 day average of positive tests reported and daily hospitalizations. The dashed line is the previous hospitalization maximum.Note that there were very few tests available in March and April, and many cases were missed, so the hospitalizations was higher relative to the 7-day average of positive tests in July.
Covid Profits of Pharmaceutical Monopolies vs Peoples’ Lives – The governments of India and South-Africa backed by about 100 countries and counting are calling for a waiver on patents over COVID-19 related medicines and equipment. Headquarters countries of Big Pharma are opposing it. The debate is going on at the WTO and will be decided soon. As reported by MSF/Médicines Sans Frontières or Doctors Without Borders: “Monopolies are often an obstacle between people and the lifesaving health tools they need. [Intellectual property like]patents and other exclusivities limit supply and keep prices high. In this unprecedented global emergency, governments have taken an incredibly strong stance at the World Trade Organization (WTO), proposing to allow countries to temporarily waive the obligations of enforcing patents, trade secrets, and other types of intellectual property (IP) during the COVID 19 pandemic so that everyone everywhere has access to lifesaving treatments, vaccines, tests and medical tools needed to beat back this pandemic.” MSF reports 99 of the WTO’s 164 Member States currently back the proposal and MSF calls on all governments to support the WTO waiver in forthcoming deliberations. Case studies developed by Médicines Sans Frontières with Third World Network show IP obstacles impact access to essential medical products that go way beyond patents on vaccines and pose a barrier to COVID-19 technologies in both developed and developing countries. Diagnostic testing is critical when we are looking to contain the spread of COVID-19. And globally there have been shortages of testing materials. So in the Netherlands, there was a shortage of testing materials because often the diagnostic infrastructure, the testing or the diagnostic, is dependent on proprietary materials. And in the case of Netherlands early on they were unable to ramp up the testing because Roche was unable to supply the relevant materials. And they refused initially to disclose the recipe for the testing material until there was public pressure and the European commission considered investigating the behavior of Roche. So this shows that the business as usual approaches of pharma companies is hindering access.
South Korea tightening virus restrictions on Seoul – South Korean officials this weekend announced new, tighter lockdown rules for the greater Seoul area as daily coronavirus cases spike in the country. The surge in cases, which include five days of more than 300 new infections, is “extremely grave and serious,” Health Minister Park Neung-hoo said Sunday, according to The Associated Press. Park added that officials have identified at least 62 virus clusters in recent weeks. Park said the new rules, which take effect Tuesday and will be in place for the two weeks, will include the closure of nightclubs and the prohibition of late-night dine-in restaurant service. Athletic events will only be open at 10 percent of venue capacity, and drinking or eating will also be banned inside of cafes and gyms. South Korea, which kept its infection rates among the lowest of any country in the spring, has seen a pronounced increase since it rolled back most of its restrictions in October to reopen nightclubs and bars. The country reported 330 new cases on Sunday for a national total of 30,733. More than 500 people in the country have died from the virus. The announcement comes a day after officials were reported to be considering new measures. The Korean Society of Infectious Diseases warned Friday that without them, the country could surpass 1,000 cases daily. “COVID-19 transmissions are occurring in large numbers simultaneously across the country, and in some regions, the pace of infections has already overwhelmed local capacities for contact tracing,” the medical group said in a statement. In addition to the Seoul area, officials have reported outbreaks in several other high-population urban centers like Asan, Daejeon, Gwangju and Busan. “Our anti-coronavirus efforts are facing a crisis, and the situation is particularly serious in the Seoul metropolitan area,” Prime Minister Chung Sye-kyun said last week. “The heightened curbs would cause greater inconvenience in our daily lives … but we all know from our experiences that there would be an even bigger crisis if we don’t act now,” he said.
COVID-19 infections spread rapidly in Spain amid government inaction – Tens of thousands of people continue to be infected with the coronavirus in Spain every day. Despite a slight dip in the number of daily cases reported, infection rates remain extremely high: 15-20,000 a day, according to official statistics. Spain has now recorded around 1.6 million coronavirus cases since the start of the pandemic. It surpassed one million cases on October 21; in the space of just 20 days, the case total increased by 50 percent, reaching 1.5 million on 17 November. Last Tuesday, Spain reported 435 deaths from the virus in a 24-hour period, the highest daily fatality figures in the autumn. Between 250 and 400 people have died of COVID-19 across Spain every day over the last two weeks. At the end of last week, the 14-day cumulative incidence rate stood at 436 per 100,000 inhabitants, a decrease from the start of November, when this key indicator stood at 529. Despite these dangerously high figures, the Podemos-Socialist Party (PSOE) government has refused to take the action required to curb the virus, imposing only limited and ineffectual curfew measures, with some areas of the country even scaling back restrictions. After implementing limited closures in October across the hospitality and leisure sector to combat the pandemic, the Catalan government announced last Thursday that regional restrictions would start to be relaxed. This week, bars and restaurants will be able to reopen at 30 percent of their capacity and with an enforced closure time of 9:30 p.m. Cinemas, theatres and similar venues will also be allowed to open again at 50 percent of usual capacity. While the number of cases reported in Catalonia has gradually started to decline, thousands of infections are still being discovered each week. In the week ending 17 November, 13,907 cases were discovered in this region alone, with 414 deaths from the virus. There has been little change in the number of COVID-19 patients admitted to hospital, with 2,402 admissions during this period, compared to 2,661 and 2,720 reported in the previous two weeks. Furthermore, the proportion of COVID-19 tests which return a positive result stands at 7.75 percent, meaning that the virus is still far from under control in Catalonia. According to criteria published by the World Health Organization (WHO) in May, a positive rate of less than 5 percent is an indicator that the epidemic is under control in a country. Across Spain, the average coronavirus test positivity rate is 11.9 percent, rising to 17 percent or above in four areas: Andaluc’a, Aragón, Castilla y León and Valencia. A test positivity rate this high indicates that many cases are probably going undetected. Meanwhile, the proportion of Intensive Care Unit hospital beds occupied by coronavirus patients stands at over 30 percent in Spain and at more than 50 percent in the regions of Aragón, Melilla and La Rioja. The vast majority of Spain’s provinces are considered to be at “Extreme Risk” – the highest level – according to the government’s own four-stage framework.
All intensive care beds occupied in Switzerland after COVID-19 infections explode – Last week, a press release from the Swiss Society for Intensive Care Medicine (SGI) caused a sensation. It announced that “All persons – especially those who are particularly at risk from the novel coronavirus – are asked to consider in a living will whether or not they would like to receive life-prolonging measures in the event of a serious illness.” This request is tantamount to a declaration of bankruptcy of the much-vaunted Swiss health care system. Many elderly people or those with existing conditions rightly understand it as an appeal for them to give up one of the country’s scarce intensive care beds in favour of younger, healthier people and to voluntarily depart this life. The same circular also states that all 876 certified intensive care beds in Switzerland are “currently practically fully occupied.” This development was “tragic since it was avoidable,” Geneva-based virologist Isabella Eckerle commented. A justified assessment. This latest turn in the pandemic is not a natural disaster, but the foreseeable result of deliberate political decisions. Under pressure from big business and the banks, the Swiss government has expressly refrained from imposing a lockdown to break the second wave of the pandemic. In mid-September, Finance Minister Ueli Maurer (Swiss Peoples Party, SVP), declared, “Switzerland cannot afford a second lockdown. We don’t have the money for that.” The government’s maxim was clearly to do everything possible to get the economy running again and maintain corporate profits. Since then, not only have all businesses and also schools and day-care centres been kept open, but also bars, restaurants, theatres and museums. In October, a regulation meant to ban events with more than 1,000 people was overturned. Not surprisingly, the virus has spread throughout society and is now fully circulating among seniors and other at-risk groups. The consequences are outbreaks in old people’s and nursing homes, overcrowded intensive care units and rapidly rising death rates. “In Switzerland, all intensive care beds are occupied” – Der Spiegel in Germany reported last Thursday. The official Swiss news portal nau.ch quickly protested and assured its readers that this was not true. “Fake news about Swiss intensive care units” was the headline of an article Thursday evening on the website. It claims that the intensive care units could be expanded at any time with “ad hoc” beds. It was just the “foreign media” who had claimed the opposite. Despite these protests, the situation is increasingly catastrophic. Switzerland has become a COVID-19 hotspot in Europe. The country currently has a 14-day incidence per 100,000 inhabitants of 933 cases, putting it between the Czech Republic (1,002) and Slovenia (939), almost twice as high as Sweden (556).
Greece’s hospitals face collapse in the second coronavirus wave – The second wave of the pandemic has brought the Greek health care system, which has been bled dry for decades, to the brink of collapse. With death and infection figures skyrocketing, doctors and nurses are sounding the alarm. Public-sector unions have called for a 24-hour strike for today because they fear the seething mood in the workforce will explode. On November 10, hospital workers organized small protests in Athens, Thessaloniki and other cities, and in October thousands of students went on strike and protested against the Greek government’s criminal coronavirus policies. With 1,815 deaths and over 95,000 infections among a population of 10.4 million inhabitants, this was the new high point of the pandemic in Greece on Tuesday evening. In November alone, almost twice as many people have already died from the virus than in the entire period from the beginning of the pandemic until October combined. On Saturday, the daily death toll reached a record 108, and 549 people are currently connected to respirators. Greece was not as badly affected in the first phase of the pandemic as other countries, thanks to a quick and tough lockdown. But since the summer, the numbers have been shooting up because the government, under the right-wing Nea Dimokratia (ND, New Democracy), opened up the economy and schools prematurely and comprehensively. Only in November was another partial lockdown imposed and schools and kindergartens closed. People are only allowed to leave the house for specified reasons, such as going to work or doctor’s visits. Restaurants, cultural facilities and stores except supermarkets and pharmacies are closed. However, the measures do not include industry, wholesale outlets and hotels and, moreover, they came much too late. The virus was already raging in all parts of society. According to the Ministry of Health on Friday, at least 82 percent of intensive care beds in Greece are occupied and hospitals will be unable to bear the burden of the new cases. They can only keep their heads above water at the moment because doctors and nursing staff are doing everything they can to make the impossible possible and to keep things going under the most adverse conditions. The situation is particularly serious in northern Greece. “We are in a desperate state, the intensive care units are full,” Special trains are standing by in Thessaloniki to transport coronavirus patients to other cities and even to Athens, 500 kilometres away.
‘Zombie’ minks rise from Denmark’s mass graves after COVID-19 slaughter – They’re tails from the crypt. Minks massacred amid a coronavirus outbreak in Denmark appeared to rise from the grave like zombies due to a bizarre biological phenomenon, according to a report Wednesday.Thousands of the animals were slaughtered and dumped in a makeshift mass tomb near the town of Holstebro after they were found to be carrying a mutated COVID-19 strain earlier this month,according to Agence France-Presse.But, in the rush to dispose of them, the furry critter corpses were buried just 3 feet deep – and were pushed to the surface by gases released during the decomposition process, the outlet reported.The hair-raising sight was spotted in a military training field, not far from a lake in the country’s western region – infuriating local elected officials, who called the flawed burial a potential public health nightmare. But the country’s environmental ministry, which was responsible for the burial, called the spine-tingling screw-up a “temporary problem tied to the animals’ decaying process,” according to the outlet. They noted the animals should have been buried under at least 5 feet of dirt.
.