Coronavirus-3
COVID raises risk
of long-term brain injury, large U.S. study finds -
Reuters - 09/22/22 The year-long study, published in Nature Medicine, assessed brain health across 44 different disorders using medical records without patient identifiers from millions of U.S. veterans. Brain and other neurological disorders occurred in 7% more of those who had been infected with COVID compared with a similar group of veterans who had never been infected. That translates into roughly 6.6 million Americans who had brain impairments linked with their COVID infections, the team said. "The results show the devastating long-term effects of COVID-19," senior author Dr. Ziyad Al-Aly of Washington University School of Medicine said in a statement. Latest Updates
Al-Aly and colleagues at Washington University School of Medicine and the Veterans Affairs St. Louis Health Care System studied medical records from 154,000 U.S. veterans who had tested positive for COVID from March 1, 2020 to Jan. 15, 2021. They compared these with records from 5.6 million patients who did not have COVID during the same time frame, and another group of 5.8 million people from the period just before the coronavirus arrived in the United States. Al-Aly said prior studies looked at a narrower group of disorders, and were focused largely on hospitalized patients, whereas his study included both hospitalized and non-hospitalized patients. Memory impairments, commonly referred to as brain fog, were the most common symptom. Compared with the control groups, people infected with COVID had a 77% higher risk of developing memory problems. People infected with the virus also were 50% more likely to have an ischemic stroke, which is caused by blood clots, compared with the never infected group. Those who had COVID were 80% more likely to have seizures, 43% more likely to have mental health issues, such as anxiety or depression, 35% more likely to have headaches and 42% more likely to suffer movement disorders, such as tremors, compared with the control groups. Researchers said governments and health systems must devise plans for a post-COVID world. “Given the colossal scale of the
pandemic, meeting these challenges requires urgent and
coordinated - but, so far, absent - global, national and
regional response strategies,” Al-Aly said. It’s a Bad
Time to Be a Booster Slacker - 10/25/22 And just like that, with the passing of Labor Day, fall was upon us. Seemingly overnight, six-packs of pumpkin beer materialized on grocery shelves, hordes of city dwellers descended upon apple orchards—and America rolled out new COVID boosters. The timing wasn’t a coincidence. Since the beginning of the pandemic, cases in North America and Europe have risen during the fall and winter, and there was no reason to expect anything different this year. Spreading during colder weather is simply what respiratory diseases like COVID do. The hope for the fall booster rollout was that Americans would take it as an opportunity to supercharge their immunological defenses against the coronavirus in advance of a winter wave that we know is going to come. So far, reality isn’t living up
to that hope. Since the new booster became available in
early September, fewer than 20 million Americans have gotten
the shot, according to the CDC—just 8.5 percent of
those who are eligible. The White House COVID-19 response
coordinator, Ashish Jha, said at a press
conference earlier this month
that he expects booster uptake to increase in October as the
temperatures drop and people start taking winter diseases
more seriously. That doesn’t seem to be happening yet.
America’s booster campaign is going so badly that by
late September, only
half of Americans had heard even
“some” information
about the bivalent boosters, according to a recent survey.
The low numbers are especially unfortunate because the
remaining 91.5 percent of booster-eligible people have
already shown that they’re open to vaccines by getting
at least their first two shots—if not already at least
one booster. Rapid
Tests (See
Reporting Rapid Test Positive Results Below)
The Covid tests that you take in a doctor’s office or testing center are usually PCR tests, which are designed to identify whether you have any amount of the Covid virus. They can sometimes come back positive even if you had the virus weeks earlier and have not been infectious for a long time. The rapid tests — also known as antigen tests — are designed to tell whether you are infectious. That’s why they are such a powerful public-health tool. They can prevent somebody with the virus from spreading it to others. “For too long, people thought of testing as an extra and not the core, and it needs to be thought of as the core,” Mara Aspinall, a professor at Arizona State University and former biotechnology executive, told Kaiser Health News. Which ones? The most widely available antigen test seems to be BinaxNOW, from Abbott. You should also feel comfortable using QuickVue, Ellume and Flowflex, among others. If you search for one of these tests online and a website points you to a different brand, do some research. Others can be very expensive. Both CVS and Walgreens have search engines that let you find tests for sale near you. I recommend calling the store to confirm it still has them in stock — and then immediately going to buy it. A store may limit you to buying one test pack at a time. How? Some people find the tests easy to conduct. Others have told me that the process is tricky — more so, for example, than taking a home pregnancy test. Either way, set aside time to read the directions and watch the how-to video. “It is critically important that you carefully read any instructions for the type of test you are taking, and follow them to the letter,” Dr. Karl Laskowski, who helps oversee Covid testing at Brigham and Women’s Hospital, told Julia Taliesin of Boston.com. You will usually get a result within 15 minutes. Keep in mind that both false negatives and false positives are possible. Antigen tests typically identify 98 percent of infectious cases, according to Dr. Michael Mina, a Harvard University epidemiologist. If you get a positive result, take it seriously, and quarantine yourself until you know more. Ideally, you would try to confirm the result with a PCR test or a second rapid test — from a different brand, my colleague Tara Parker-Pope says. If the second is negative and you are vaccinated, you can probably trust the negative. When? Because most Americans have limited access to rapid tests, they need to triage their use. The two most important times to take a test are either after you may have been exposed to the virus or before you are spending time with medically vulnerable people, like those in their 70s or older. “I try to tell people it’s a snapshot good for one day only,” Tara told me. “And that you need to keep testing if you think you were exposed to Covid or if you have been traveling through airports or on trains.” If you are attending multiple gatherings this weekend and do not have enough tests, focus your testing on the days when you are seeing anybody vulnerable. For most people, the vaccines have turned Covid into a manageable disease — one that is highly unlikely to lead to severe illness and not so different from other respiratory illnesses. But for many older people, Covid remains a meaningful threat. Many Americans continue to exaggerate the threat that Covid presents to children and understate its threat to elderly people. They deserve our focus. Who? Not everybody in your household has the same chance of Covid exposure. With a limited number of tests available, it can make sense to focus on people who have the highest likelihood of having been infected — and, by extension, infecting others. Nuzzo suggests prioritizing two groups for rapid testing: people who are not fully vaccinated, like children; and those who have spent more time in settings where they might have been exposed. Even with the limitations of rapid testing in the U.S., the tests can play an important role in slowing the spread of the virus. And the situation does seem to be improving. The F.D.A. approved three more tests this week, and the Biden administration continues to spend more to expand their availability. By Christmas and New Year, tests
should be easier to find than they are this week. More on Rapid Tests
Above. Reporting
Rapid Test Positive Results 1/12/22 New services, which allow people to report positive tests and get info on isolation and quarantine, follow shift toward focus on outbreaks at high-risk settings PORTLAND, Ore. — Oregon Health Authority is moving to an opt-in model for investigating COVID-19 cases, launching a new website and hotline as a way for people who test positive for the virus to report results from an at-home test kit or testing provider. People using the new Positive COVID Test website and COVID-19 Case Support Hotline, 866-917-8881, can complete an online survey linked from the web portal to report their positive case, or get help completing the survey through the hotline. They can also get information on isolation and other ways to keep themselves and those around them safe while they recover. The launch of the services follows an OHA decision to revise its guidelines for investigating COVID-19 cases to focus less on interviewing individual cases and conducting contact tracing, and more on outbreaks in high-risk settings, such as those in congregate care, health care, K-12 education and food chain industries. “The current and rapidly growing surge of COVID-19 cases driven by the Omicron variant has outpaced the capacity of Oregon’s public health system to effectively conduct active case investigation and contact tracing, which cannot effectively slow the spread of the disease in the context of widespread community transmission,” said Dean Sidelinger, M.D., M.S.Ed., health officer and state epidemiologist at Oregon Health Authority. “As a result, given the burdens to the entire public health infrastructure and the need to pivot resources to higher priority public health measures, we are adjusting case investigation and outreach efforts. OHA will move away from individual investigation and contact tracing calls to focus on investigating outbreaks in high-risk settings,” he said. OHA is adopting an “opt-in” approach to case investigation, with a focus on ensuring people who test positive for COVID-19 or who are exposed to the virus can quickly access information and resources to safely isolate and quarantine. The first offering is the website, Oregon.gov/positivecovidtest, which contains a link to a mobile-friendly Case Investigation Survey. The survey, soon available in 12 languages – it’s now accessible in English, Spanish and Russian – can be used by anyone who tests positive to provide additional information to public health. OHA does not require individuals to report their at-home test results, but it highly recommends people do so, and let their close contacts know they may have been exposed so they can take steps to limit exposure to others. Hospitals, health care providers, laboratories and local public health authorities are required to report test results. The COVID-19 Case Support Hotline, 866-917-8881, will be open from 8 a.m. to 6 p.m. Monday through Friday, and 10 a.m. to 4 p.m. Saturday. Support staff will be available to provide general health information; answers to questions about isolation and quarantine; answers to questions about how to tell close contacts they may have been exposed to COVID-19; information about resources to help them during isolation; and help filling out the online Case Investigation Survey so callers’ positive tests can be reported. Staff will provide support in English and Spanish, with interpreter services available for additional languages. Sidelinger said those staffing the COVID-19 Case Support Hotline include members case investigation and contact tracing team from OHA’s COVID Response and Recovery Unit (CRRU), so they are well qualified to answer questions about isolation, quarantine and available resources. Availably of the hotline also will allow local public health authorities to reduce or eliminate phone-based case investigation, “allowing them to redeploy those resources to higher-value mitigation efforts.” Hotline staff will also be able to triage calls that might normally go to local public health authorities, forwarding them only if they require local follow-up. The following local public health authorities and Tribes recommend their residents and members use local contact information if they have questions or support needs after they test positive for COVID-19:
Source: www.messenger.com/t/1035075655
What to
know about the covid-19 treatment molnupiravir -
10/6/21 he world could soon be armed with another tool to fight the coronavirus pandemic: a twice-daily pill that has been shown to reduce the risk of hospitalization and death among people infected with the coronavirus. The drug, molnupiravir, offers another tool alongside vaccines for countries to manage the coronavirus pandemic. Here’s what you need to know about it: What is molnupiravir? Molnupiravir is an antiviral pill by pharmaceutical giant Merck that aims to prevent mild to moderate cases of covid-19 from becoming severe cases that result in hospitalization or death. People who have covid-19 take the drug twice a day for five days, starting within five days of the onset of symptoms. It was shown in an international clinical trial of 775 high-risk, unvaccinated people to cut the risk of hospitalization and death in half (the participants had at least one risk factor for severe covid-19, such as obesity or advanced age). The treatment was also shown in a separate trial to accelerate the clearance of infectious virus from the nose and throat, indicating that it may also help reduce the spread of the virus. Still, medical experts warn that vaccines remain the primary tool against the coronavirus, as it is better to prevent people from getting the virus than to treat it after infection. When will molnupiravir become available? Merck has submitted data to the Food and Drug Administration following the success of its trial — which was ended early because of its positive results — seeking emergency use authorization for molnupiravir. Merck and its partner Ridgeback Biotherapeutics said in a news release that, in addition to submitting their FDA application, they plan to apply for emergency use or marketing authorization in other countries “in the coming months.” Ahead of a decision by U.S. regulators, the companies have already started producing the pill, and have agreed to sell courses of the treatment to the United States and other countries if they get the green light. An FDA advisory committee will meet Nov. 30 to discuss the emergency use authorization request, setting a timeline that could have the drug available by the end of the year. How is molnupiravir different from other covid-19 drugs? Molnupiravir stands out from other covid-19 treatments for its ease of use. The use of monoclonal antibodies, a treatment that is infused or injected, did not take off widely in the United States, as medical experts say that the treatment is costly and difficult to deliver. Remdesivir, which, like molnupiravir is an antiviral drug, is administered by injection. It has been shown to shorten hospital stays, but for much of the past year it had unclear results on other aspects of covid-19 infection, such as severe illness or death. Gilead, the maker of remdesivir, said last month that it reduces risk of hospitalization. Remdesivir may not cure coronavirus, but it’s on track to make billions for Gilead In contrast, molnupiravir can be prescribed like other pills, taken at home and stored easily. An older steroid medication, dexamethasone, has been shown in rigorous, placebo-controlled trials to reduce death by a third in patients on ventilators. It is being widely used in intensive care units, often in tandem with remdesivir. Monoclonal antibody treatments are effective and free to high-risk coronavirus patients, but experts say the treatment alone cannot prevent the next surge. (Julie Yoon/The Washington Post) A drug that can treat covid-19 could be a more palatable option for those seeking treatment and turning to unproven coronavirus cures. Ivermectin, a deworming drug commonly used in livestock and sometimes in humans, gained traction among some as a covid-19 treatment after misinformation about it spread online, prompting the FDA to warn people not to use it to treat covid-19. Hydroxychloroquine, an anti-malaria drug President Donald Trump touted in the spring of 2020, won an emergency authorization from the FDA that proved to be premature. Clinical trials showed it did not work, and the FDA withdrew the authorization in June. Where will molnupiravir be used? The United States, with millions of people still unvaccinated, has made an advance purchase of $1.2 billion worth of molnupiravir — about 1.7 million treatments. Australia, Singapore and South Korea have also made purchase agreements. The simple process to deliver, store and administer the drug could prove particularly useful in poorer nations. Vaccine distribution efforts in countries that lacked a robust medical infrastructure struggled to get shots in arms, even if they had an adequate supply, as the vaccine doses require extremely cold refrigeration and people trained to administer the shots. Merck licensed the drug to five generic drugmakers in India to accelerate its availability in low- and middle-income countries. Still, some experts and public health organizations have raised concerns that without a clearly articulated plan to supply countries or to negotiate contracts, global efforts to secure the drug for poorer countries could run into the same challenges Covax, the World Health Organization-backed initiative to distribute vaccine doses equitably, ran into in distributing vaccines. “Anticipatory and preparatory
work is needed to ensure rapid availability and uptake of
any new treatments,” an independent report commissioned
by the WHO urged, noting that the United States’
advance purchases of molnupiravir presented an example of
that risk. A big Delta
unknown The question is especially relevant to children and to vaccinated adults. In both groups, earlier versions of Covid were usually manageable. For the vast majority of people, the virus resembled a typical flu, rarely causing serious illness. If Delta weren’t any more severe, it would mean that this encouraging situation had not changed. On the other hand, if Delta were substantially more severe, it could call for a much more cautious approach to everyday life. So what’s the answer? We still can’t be sure, and future data could change the picture. But the evidence so far suggests that Delta is similarly severe to earlier versions of the virus, probably with only modest differences in one direction or the other. While Delta is certainly more contagious — and its contagiousness does call for some new precautions, like more frequent mask wearing — its severity does not appear to be fundamentally different. That’s a more heartening picture than many people assume. These tentative conclusions come from three difference sources: expert opinion; research studies; and overall data on cases, hospitalizations and deaths. Let’s take them one at a time: 1. Expert opinion Because the evidence is still emerging and sometimes inconsistent, experts do not read it precisely the same way. Still, I have noticed the broad outlines of a consensus in recent interviews:
2. The research The studies evaluating Delta’s severity have been frustratingly inconsistent. “There has been mixed evidence about whether it’s more severe or not,” Dr. Rebecca Wurtz of the University of Minnesota told me. “The final word is not yet in.” Some research — like a study from Scotland — has found that the people who contract Delta get sicker on average than similar people who contracted an earlier version of the virus. Other evidence says otherwise. As Ariana Eunjung Cha of The Washington Post wrote: A recent technical paper out of Britain suggested the Delta variant does not cause more serious illness than its predecessors, but the analysis did not specifically break out children. David Rubin, a researcher at Children’s Hospital of Philadelphia who has been studying U.S. hospitalization data, said that in recent weeks, 1,200 to 1,400 children were inpatients at the peak, and while those numbers may be large, the rate of hospitalization remains the same as in the past at 0.8 to 0.9 percent. Dowdy notes that the more alarming findings tend to receive more public attention, but that doesn’t make them more likely to be right. 3. The topline data The broad Covid data is probably the biggest reason to doubt that Delta is meaningfully more severe than earlier versions of the virus. The share of Covid cases leading to hospitalization seems to have held steady or even declined in recent months. That’s true in Britain, including among children too young to be vaccinated. It’s true among both vaccinated and unvaccinated Americans in places that publish detailed numbers, like the state of Utah and the city of Seattle. And it’s true among the full U.S. population: Total cases have risen almost fifteenfold since their June nadir, while hospital admissions have risen about sixfold. By themselves, none of these comparisons prove much, because the mix of who gets Covid can change over time. But if Delta were significantly more severe, you’d expect to see some signs that hospitalizations or deaths were rising faster than new cases. Those signs are hard to find. The bottom line Figuring out how this data should affect your daily life isn’t easy, I realize. The situation is uncertain, and different people will make different decisions. Maybe this frame is helpful: For children and vaccinated adults without other major health problems, there are a lot of reassuring signs. Covid appears to present less risk than some other daily activities. Among Americans under 17, fewer than 500 have died of Covid since the pandemic began; many more — a few thousand every year — die in vehicle crashes. As Wachter said about Covid this week, “Risk is low enough to live life, high enough to be careful.” For people who do have a health condition that increases their risks — like severe obesity, a previous organ transplant or an active case of cancer — the calculations may be different. Most children hospitalized with Covid, for example, have been older teenagers with a serious pre-existing health condition, Dr. Jennifer Lighter of N.Y.U. told me. Because Delta has caused a surge in Covid cases, it represents a threat to vulnerable people. The hardest calls may be for vaccinated people who are over 65 and generally healthy. Delta’s severity does not appear to be fundamentally different for them, either. But their hospitalization rate has risen more rapidly in recent weeks than that of other groups. I understand why some older people may choose to err on the side of caution until we better understand Delta. And what about the one-quarter
of American adults who have
not received a vaccine shot? They continue to have abundant
reason to fear Covid. Least Vaccinated
States Lead Spike in Children’s Cases, Leaving Some
Hospitals Stretched Pediatric hospitalizations, driven by a record rise in coronavirus infections among children, have swelled across the country, overwhelming children’s hospitals and intensive care units in states like Louisiana and Texas. Daily Covid hospital admissions of those under 18 are higher than ever but children continue to account for the fewest new hospitalizations of any age group. Children remain markedly less likely than adults, especially older adults, to be hospitalized or die from Covid-19. But the growing number of children entering the hospital, however small compared with adults, should not be an afterthought, experts say, and should instead encourage communities to take on more efforts to protect their youngest residents. “It should concern us all that hospitalizations — indicators of severe illness — are rising in the pediatric population, when there are a lot of steps we could take to prevent many of these hospitalizations,” said Jason L. Salemi, an epidemiologist at the University of South Florida, who tracks Covid-19 hospitalization data. Public health officials and experts also caution that even small increases in the number of pediatric Covid-19 patients can put a major strain on pediatric hospitals and I.C.U.s, many of which are already overstretched with nursing shortages and an unusual summer surge of respiratory syncytial virus or R.S.V. “The average pediatric I.C.U. in the U.S. has 12 beds,” said Dr. Christopher Carroll, a pediatric intensivist at Connecticut Children’s Medical Center. “In a system that small, even a few patients can quickly overrun the capacity. And there are fewer specialty trained pediatric clinicians to pick up the slack.” The strain on hospital resources for children has prompted doctors and hospital executives to plead with adults to get vaccinated and return to mask wearing and social distancing to protect children, especially those under 12, who cannot yet be vaccinated. “What really protects children are the interventions directed at the rest of society,” said Dr. Thomas Tsai, an assistant professor in the health policy department at Harvard University. State-level vaccination coverage appears to be making a difference. States with the highest vaccination rates in the country have seen relatively flat pediatric hospital admissions for Covid-19 so far, while states with the lowest vaccine coverage have child hospital admissions that are around four times as high. Covid hospital admissions for children
are climbing in states with low immunization rates. How
many people have died from the vaccine in the U.S.? Updated
7/23/21 How do we know if someone dies after getting a vaccine? The US Food and Drug Administration (FDA) requires vaccination providers to report any death after COVID-19 vaccination to the Vaccine Adverse Event Reporting System (VAERS). When these reports are received, doctors from CDC and FDA review death certificates, autopsies, and medical records to understand what happened with each person. How many people have died after getting a vaccine? Between December 2020 and July 19th, 2021, VAERS received 6,207 reports of death (0.0018% of doses) among people who got a vaccine, but this does not mean the vaccine caused these deaths. Doctors and safety monitors carefully review the details of each case to see if it might be linked to the vaccine. There are three deaths that appear to be linked to blood clots that occurred after people got the J&J vaccine. Since we now know how to correctly treat people who develop these blood clots, future deaths related to this very rare side effect can be prevented. After careful review of the additional data, doctors have decided that there is no evidence at all that the vaccines contributed to the other patient deaths. Nonetheless, the CDC and FDA will continue to investigate every single report of death (and other adverse events) reported to VAERS. By way of comparison, getting COVID-19 while unvaccinated poses a grave risk; as of July 23, 2021, more than 610,000 deaths have been attributed to the virus in the US alone. Not everyone who dies while having COVID is counted towards this total. Suppose someone who tested positive for COVID-19 was killed in a car accident. The car accident would be the cause of death. This person would be counted as having “died with” COVID, not as having “died of” COVID. Science review: JAB Students'
mental health and emotional well-being is going to take time
to rebound. What else you need to know: None of us has lived through a pandemic before, but there are other recent traumatic events that can inform educators on how kids will react and what supports can be effective. Try this: One important takeaway from trauma research is that kids often react in ways that aren't obviously linked to the traumatic event. Knowing that is critical to how schools plan for-and execute on-supporting students, says Robin Gurwitch, a psychologist and professor at Duke University Medical Center, and a specialist in childhood trauma. Here are key insights and ideas to guide how you and your teams address mental health and well-being:
Go deeper: Mental health
experts like Gurwitch are advising educators to prepare for
a long-term commitment to student well-being. To get
started, check out these 6
ways to support kids as they
transition back to school. Research-backed
ways to recover learning How Does the 2020
Stock Market Crash Compare With Others? The stock market crash of 2020 began on Monday, March 9, with history’s largest point plunge for the Dow Jones Industrial Average (DJIA) up to that date.1? It was followed by two more record-setting point drops on March 12 and March 16. The stock market crash included the three worst point drops in U.S. history. The drop was caused by unbridled global fears about the spread of the coronavirus, oil price drops, and looming recession. Only two other dates in U.S. history had more unsettling one-day percentage falls. They were Black Monday on Oct. 19, 1987, with a 22.6% drop, and Dec. 12, 1914, with a 23.52% fall.2? Although this dramatic 2020 market crash is still fresh in everyone’s mind, let’s take a closer look at what happened and why. That will allow us to anticipate what may happen next with the economy. Fall From Record High The 2020 stock market crash began on Monday, March 9. The Dow fell 2,013.76 points that day to 23,851.02.3. It had fallen 7.79%. What some labeled as Black Monday 2020 was, at that time, the Dow’s worst single-day point drop in U.S. market history. On March 12, 2020, the Dow fell a record 2,352.60 points to close at 21,200.62. It was a 9.99% drop, almost a correction in a single day. It was the sixth-worst percent drop in history.2? On March 16, the Dow hit a new record. It lost 2,997.10 points to close at 20,188.52. That day’s point plummet and 12.93% freefall topped the original October 1929 Black Monday slide of 12.8% for one session. Prior to the 2020 crash, the Dow had just reached its record high of 29,551.42 on Feb. 12. From that peak to the March 9 low, the DJIA lost 5,700.40 points, or 19.3%. It had narrowly avoided the 20% decline that would have signaled the start of a bear market. On March 11, the Dow closed at 23,553.22, down 20.3% from the Feb. 12 high. That launched a bear market and ended the 11-year bull market that started in March 2009. Compare to Previous Black Mondays Before March 16, one previous Black Monday had a worse percentage drop. The Dow fell 22.6% on Black Monday Oct. 19, 1987.2? It lost 508 points that day, closing at 1,738.74. On Black Monday Oct. 28, 1929, the average plunged 12.8%. It lost 38.33 points to close at 260.64. It was part of the four-day loss in the stock market crash of 1929 that started the Great Depression. Causes of the 2020 Crash The 2020 crash eventually occurred because investors were worried about the impact of the COVID-19 coronavirus pandemic. COVID-19's mortality rate so far is more deadly than the seasonal flu's rate, but that’s because many more cases of the flu are reported annually. Although less deadly than SARS’s death rate in 2003, COVID-19 is spreading more quickly. On March 11, the World Health Organization (WHO) declared the disease a pandemic.4? The organization was concerned that government leaders weren’t doing enough to stop the rapidly spreading virus. Investors had been jittery ever since President Donald Trump launched trade wars with China and other countries. By Feb. 27, the Dow had skidded more than 10% from its Feb. 12 record high. It first entered a correction when it closed at 25,766.64. Effects Often, a stock market crash causes a recession. That’s even more likely when it’s combined with a pandemic and an inverted yield curve. Warning: An inverted yield curve is an abnormal situation where the return, or yield, on a short-term Treasury bill is higher than the Treasury 10-year note. It only occurs when near-term risk is greater than in the distant future. Usually, investors don't need much return to keep their money tied up just for short periods of time. They require more to keep it tied up for longer. When the yield curve inverts, however, it means investors require more return in the short term than the long term. On March 9, investors demanded a higher yield for the one-month Treasury bill than the 10-year note.5? Specifically, the yield curve was:
Investors were telling the world with this market signal that they were so worried about the impact of the coronavirus over the next month that they needed a higher return on the one-month bill than for the 10-year note. Inverted yield curves often predict a recession. The curve inverted before the recessions of 2008, 2001, 1991, and 1981. In addition, bond yields across the board were at historically low levels. Investors who sold stocks in the crash were buying bonds. Demand for bonds was so high that it drove down yields to record-low levels. How It Affects You If you have retirement savings or other funds invested in the stock market, the crash lowered the value of your holdings. When something like this happens, many people panic and sell their stocks to avoid losing more. But the risk with that strategy is that it’s difficult to know when to re-enter the market and buy again. As a result, you could lose more in the long run, if you miss important market gains in the shorter term. On average, bear markets last 22 months. But some have been as short as three months. Most financial planners recommend you sit tight and wait it out. Strong demand for U.S. Treasurys lowered yields. Interest rates for all long-term, fixed-interest loans follow the yield on the 10-year Treasury note. As a result, interest rates on auto, school, and home loans should also drop to record-low levels. Keep in mind that, even if 10-year Treasury yields fell to zero, mortgage interest rates would be a few points higher. Lenders must cover their processing costs. Important: The Federal Reserve on March 15 in a surprise move cut its benchmark interest rate a full percentage point, to zero. It also launched a bond-buying program, referred to as quantitative easing, to mitigate the expected damage to the U.S. economy from the coronavirus. Is Recession Next? The bad news is that the combination of a stock market crash and an inverted yield curve can signal a looming recession. A pandemic often slows economic growth, as businesses slow or close and people stay home to nurse their illness or avoid catching it. These factors could easily trigger a recession. So it makes sense to add to your
savings now, if possible, to make sure you have three to six
months of living expenses on hand. If you have enough cash
on hand, then buying
stocks isn’t a bad idea,
because prices are low. The driving forces behind the stock
market crash of 2020 are unprecedented, but strategies to
survive such crashes and recessions have been proven to work
throughout history. The Great
Recession, unemployment and suicide Background How have suicide rates responded to the marked increase in unemployment spurred by the Great Recession? Our paper puts this issue into a wider perspective by assessing (1) whether the unemployment-suicide link is modified by the degree of unemployment protection, and (2) whether the effect on suicide of the present crisis differs from the effects of previous economic downturns. Methods We analysed the unemployment-suicide link using time-series data for 30 countries spanning the period 1960–2012. Separate fixed-effects models were estimated for each of five welfare state regimes with different levels of unemployment protection (Eastern, Southern, Anglo-Saxon, Bismarckian and Scandinavian). We included an interaction term to capture the possible excess effect of unemployment during the Great Recession. Results The largest unemployment increases occurred in the welfare state regimes with the least generous unemployment protection. The unemployment effect on male suicides was statistically significant in all welfare regimes, except the Scandinavian one. The effect on female suicides was significant only in the eastern European country group. There was a significant gradient in the effects, being stronger the less generous the unemployment protection. The interaction term capturing the possible excess effect of unemployment during the financial crisis was not significant. Conclusions Our findings suggest that the more generous the unemployment protection the weaker the detrimental impact on suicide of the increasing unemployment during the Great Recession. View
Full Text Great
Recession tied to more than 10,000 suicides At least 10,000 more Americans and Europeans took their own lives from 2007 to 2010 than during the good economic times of the previous few years, the study found. "It's a fairly large and substantial increase over what we would have expected," said Aaron Reeves, a sociologist and post-doctoral researcher at the University of Oxford in England, who helped lead the research. "There are, broadly speaking, large mental health implications of the economic crisis that are still being felt by many people." Suicide rates didn't climb evenly. In Sweden and Austria, rates remained flat during the Great Recession, although those nations' economies struggled as much as others did – suggesting that the link between recession and suicide is not inevitable, said David Stuckler, a professor and health economist at Oxford and the paper's senior author. "These economic suicides are avoidable," he said. Sweden had strong support for people who lost their jobs or were struggling financially, Stuckler said. This finding has important implications for policymakers, said Abdulrahman El-Sayed, a doctor and assistant professor of epidemiology at the Mailman School of Public Health at Columbia University in New York City. "The social welfare aspects of economic downturns like this can't be ignored," El-Sayed said. "When our economic belts get a little too tight, we shouldn't be cutting things that help the average Joe." The study showed that men facing financial difficulties are at higher suicide risk than women, probably because society generally expects men – more than women – to be breadwinners. Men are also less likely than women to seek help when they are in trouble, often bottling up their worries, Stuckler said. Before the Great Recession, suicide rates were falling in most European countries while rising in the USA, Stuckler said, adding that he's not sure what explains the pre-recession climb. The study showed that antidepressant prescription rates rose by nearly 20% in the U.K. from 2007 to 2010 – although previous research has found that antidepressant use does not have a major impact on suicide rates. The common stereotypes of suicide are often wrong, the researchers said. Rather than being long-planned, suicides are often impulsive acts of little forethought, said Matthew Miller, co-director of Harvard University's Injury Control Research Center. Suicide attempts are equally common in urban and rural areas of the USA, he said, but more likely to succeed in rural areas, where guns are more available. People who try to commit suicide with
a gun are more likely to succeed than people who try by
other means, he said: "If you can't reach for a gun in a
moment of crisis, you're more likely to get a second
chance." NEW
Covid-19 Vaccine Accessibility -
3/17/21 (2) NACo webinar: Accelerate Vaccine Distribution for State and Local Governments Save the Date: March 24, 2021 11:00 AM Duration: 60 minutes At this event, Mazik Global and Microsoft will focus on 5 key components; scheduling, adverse monitoring, state reports, dashboards and inventory to ensure safe and successful distribution within you state and local communities. Register at this LINK: https://bit.ly/3bY0Ae4 (3) Special Session: Access to COVID-19 Vaccines: Issues and Barriers for Persons with Disabilities SAVE THE DATE: Wednesday, March 24, 2021, 11:00 a.m. – 12:00 p.m. DESCRIPTION: As the federal government and states increase distribution and delivery of vaccines for the Corona virus, barriers to these vaccines for persons with disabilities have emerged. Join us as our speakers address policies regarding the determination of who is eligible to receive the vaccines during the various phases of the rollout and the disparities that exist. In addition, this session will discuss how the ADA applies to the state/local governments and private organizations administering the vaccinations, web based and telephone systems used to search/locate and schedule a vaccine appointment, vaccination site accessibility, effective communication with recipients and modifications in policies, practices and procedures. SPEAKERS: Nancy Horton, Information Specialist, Mid-Atlantic ADA Center Andrew Imparato, Executive Director, Disability Rights California ADDITIONAL NOTES: This session will have captioning and sign language interpreter available. Continuing Education Recognition Available. Participants will have an opportunity to ask questions. (4) When Can I Walk Into a Pharmacy and Get a COVID Shot?—Walgreens' Rina Shah, PharmD, on the challenges and opportunities Listen and subscribe on Apple, Stitcher, Spotify, and Google, so you don't miss the next episode. And if you like what you hear, a five-star rating goes a long way in helping us "Track the Vax"! Vaccine distribution nationwide continues to ramp up, with nearly 2-million shots being given daily. President Biden has now said that every adult could be vaccinated by the end of May. A big promise that brings with it hope... a light at the end of the COVID-19 tunnel. (5) VA weekly COVID-19 vaccine clinics are being held at Brookings VA clinic, North Bend VA clinic, Eugene VA Health Care Center, and Roseburg VA Medical Center. For more information, please see Attachment #2 to this Email correspondence. (6) CURRY HEALTH NETWORK COVID-19 VACCINE UPDATE: More information regarding Curry Health Network's waiting list to receive a COVID-19 vaccine when doses become available:
CDC:
Delta variant now accounts for 1 in 4 cases nationwide -
CNN 7/14/21 Over the past week, states that have fully vaccinated more than half of their residents have reported an average Covid-19 case rate that is about a third of that in states which have fully vaccinated less than half of their residents, according to a CNN analysis of data from Johns Hopkins University and the Centers for Disease Control and Prevention. Alabama, Mississippi and Arkansas are the only states to have fully vaccinated fewer than 35% of their residents. Average daily case rates in each state were among the 10 worst in the country last week. Vermont leads the nation with about 66% of its population fully vaccinated -- and while case rates there increased compared to last week, the state still had the lowest case rate in the country last week, with an average of less than one new case per 100,000 people each day. Covid-19 cases rise in US hotspots States that have fully vaccinated more than half of their residents reported an average of 2.8 new Covid-19 cases per 100,000 people each day last week, compared to an average of about 7.8 cases per 100,000 people each day in states that have vaccinated less than half of their residents. "We really need to get more people vaccinated, because that's the solution," Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said Monday on "CBS This Morning." "This virus will, in fact, be protected against by the vaccine." Across the country, more than 99% of US Covid-19 deaths in June were among unvaccinated people, said Dr. Rochelle Walensky, director of the US Centers for Disease Control and Prevention. Dr. Howard Jarvis, an emergency medicine physician in Springfield, Missouri, told CNN on Monday that his sick patients are all unvaccinated. "If they're sick enough to be admitted to the hospital, they are unvaccinated. That is the absolute common denominator amongst those patients," he said. "I can see the regret on their face. You know, we ask them, because we want to know, are you vaccinated? And it's very clear that a lot of them regret (not being vaccinated)." The pace of vaccinations has dropped sharply in recent months. About 246,000 people initiated vaccination each day over the past week, down 88% from the April peak, and about 278,000 people became fully vaccinated each day over the past week, down 84% from the April peak, CDC data shows. About 56.2% of Americans 12 or older are fully vaccinated. CDC, FDA looking into risk of nerve complication after J&J shot In this March 26 file photo, a member of the Philadelphia Fire Department prepares a dose of the Johnson & Johnson Covid-19 vaccine at a vaccination site in Philadelphia. In this March 26 file photo, a member of the Philadelphia Fire Department prepares a dose of the Johnson & Johnson Covid-19 vaccine at a vaccination site in Philadelphia. Federal health officials are investigating the possibility that Johnson & Johnson's coronavirus vaccine might slightly raise the risk of a rare neurological complication known as Guillain-Barré Syndrome (GBS), a spokesperson from the CDC said in a statement to CNN on Monday. But even if the vaccine does raise the risk, it's still better to get vaccinated, the CDC stressed. "GBS is a neurological disorder in which the body's immune system damages nerve cells, causing muscle weakness or in the most severe cases paralysis. Each year in the United States, an estimated 3,000 to 6,000 people develop GBS; it is typically triggered by a respiratory or gastrointestinal infection. Most people fully recover from GBS," the spokesperson said. "Reports of GBS after receipt of the J&J/Janssen COVID-19 Vaccine in the Vaccine Adverse Event Reporting System (VAERS) are rare, but do likely indicate a small possible risk of this side effect following this vaccine. Around 100 preliminary reports of GBS have been detected in VAERS after 12.8 million doses of J&J/Janssen COVID-19 Vaccine administered. These cases have largely been reported about two weeks after vaccination and mostly in males, many aged 50 years and older." The same pattern is not seen with the other two vaccines authorized in the United States, made by Moderna and Pfizer. The spokesperson said the CDC's Advisory Committee on Immunization Practices would discuss the matter in an upcoming meeting. The US Food and Drug Administration updated the label for the vaccine Monday. "Reports of adverse events following use of the Janssen COVID-19 Vaccine under emergency use authorization suggest an increased risk of Guillain-Barré syndrome during the 42 days following vaccination," the updated label reads. 'Surprising amount of death' will occur in some US regions from increased cases, expert says As the Delta variant rapidly spreads, US hot spots have seen climbing case numbers -- and an expert warns a "surprising amount of death" from Covid-19 could soon follow. The United States is averaging about 19,455 new cases over the past seven days, a 47% increase from the week prior, according to data from Johns Hopkins University. And a third of those, CNN medical analyst Dr. Jonathan Reiner said, come from five hot spots: Florida, Louisiana, Arkansas, Missouri and Nevada. "In places like Missouri where ICUs are packed, you're going to see a surprising amount of death," Reiner said Sunday. In Arkansas, Covid-19 cases surge as state combats vaccine skepticism At Mercy Hospital in Springfield, Missouri, 91% of patients in the intensive care unit are on ventilators and many are in their 20s, 30s and 40s, Chief Administrative Officer Erik Frederick told CNN on Saturday. That is especially concerning, he said, because at the peak last year there were only 40 to 50% of ICU patients on ventilators. Typically, spikes in Covid-19 cases leads to a rise in death rates three to four weeks later as a small percentage of the infected are hospitalized and deteriorate. "We will start to see an increase in mortality in this country," Reiner said. What is particularly frustrating for many experts, Reiner said, is that the deaths are "completely avoidable" now that vaccines are available. "The vaccines we have work really well against this variant. It doesn't need to be this way," Reiner said. Pfizer to brief the US on boosters Another concern for many experts as variants spread is whether the population will need boosters for their vaccines. Pfizer will virtually brief US government officials Monday evening regarding the potential need for booster shots of its Covid-19 vaccine, a company spokesperson and two administration officials confirmed to CNN. The meeting is seen as a courtesy, and federal guidance on boosters is not expected to change immediately following the meeting, a senior health official said. Los Angeles County sees exponential growth in Covid-19 cases as Delta variant becomes dominant, worrying officials Los Angeles County sees exponential growth in Covid-19 cases as Delta variant becomes dominant, worrying officials Last week, Pfizer/BioNTech reiterated its expectation that people may need boosters to its vaccine in six months to a year, citing waning immunity they are seeing among people who got it. The company also said it would seek emergency use authorization in August from the US Food and Drug Administration for a booster. But some experts have argued the data is showing boosters are not necessary yet. "Americans who have been fully vaccinated do not need a booster shot at this time," the US Centers for Disease Control and Prevention and the FDA said. "FDA, CDC, and NIH (the National Institutes of Health) are engaged in a science-based, rigorous process to consider whether or when a booster might be necessary." Fauci also disputed the need at this time. "Given the data and the information we have, we do not need to give people a third shot, a boost, superimposed upon the two doses you get with the mRNA (Pfizer/BioNTech and Moderna vaccine) and the one dose you get with (Johnson & Johnson)," he told CNN on Sunday. Further, World Health Organization leaders asked wealthy countries Monday to hold off on giving booster doses to their residents before people in other countries can even get their first doses. "Instead of Moderna and Pfizer prioritizing the supply of vaccines as boosters to countries whose populations have relatively high coverage, we need them to go all-out to channel supply to COVAX, the Africa Vaccine Acquisition task team, and low- and middle-income countries, which have very low vaccine coverage," WHO Director-General Dr. Tedros Adhanom Ghebreyesus said in a media briefing. "We're talking about life and death situation. We've lost 600,000 Americans already, and we're still losing more people. There've been 4 million deaths worldwide," Fauci said. "This is serious business." Fauci expects vaccine mandate hesitancy to lift when vaccines are fully approved, he said. Right now, Covid-19 vaccines are being administered under emergency use authorizations, which Fauci said has made some people skeptical as to their safety and efficacy. But the amount of data that supports the importance and safety of the vaccines is more than anything experts have seen for an EUA, he said. "These vaccines are as good as officially approved with all the I's dotted and T's crossed," Fauci said. CNN's John Bonifield, Kaitlan Collins,
Maggie Fox, Eric Levenson, Amanda Sealy, Veronica
Stracqualursi, Naomi Thomas and Ben Tinker contributed to
this report. Five
Signs Rural Elders May Need A Helping Hand Nearly a year into Covid, with access to vaccines starting to reach rural areas, families who have kept a cautious distance are eager to get back to normal. But even people who have delivered groceries and set up weekly pill boxes for aging relatives all this time may find some surprises once they get past the kitchen or living room into other parts of the house. It doesn’t take a pandemic for families to miss signs that aging parents are not managing as well as they would have us believe. Sometimes the natural mood lift that comes with our visits makes it seem like there’s no need for concern. Some elders are brilliant at masking deteriorating conditions in themselves or a spouse to keep others out of their business. Or they just don’t want to be a bother, especially when their kids have plenty of other worries. Even without a pandemic, it may take a crisis (or two or three) for families to recognize and accept that their elders are not fine. Whether you live down the road or across the country, here are some warning signs that aging family members or neighbors might need more help. Odors A diminished sense of smell is common in elders, whether or not they have had Covid. So they may be surprised and even embarrassed by your concern about odors in their home or about their person. Nevertheless, finding the source of an odor can help you identify things worth a frank discussion. Strong urine odors may be a sign of incontinence, which if not managed can lead to other problems. Body odor may indicate fear of falling in the shower or even an acute illness like a urinary tract infection. Bad breath may suggest a trip to the dentist is overdue. Pet odors can indicate difficulty in managing care of canine or feline companions. General mustiness can come when someone stops letting in fresh air because they’re cold due to poor circulation. Even a strong odor of air “freshener” can be cause for further investigation, which might reveal an accumulation of garbage which in turn can attract rodents which add to the smell. A mildewy dish sponge is easily remedied, but black mold odor requires more significant intervention. Piles Key concerns to focus on here are finances and falls, especially when letting things pile up is a family trait amplified by aging. A stack of unopened bills may be a sign of depression or that a loved one is so overwhelmed by other activities of daily living (ADLs) they don’t have the time or energy for anything more. A bag of books to return to a lender “one of these days” becomes practically invisible after a while, yet the trip hazard is very real. It might help to work from a tool like this home falls prevention checklist. (15 page PDF) With luck, a parent can give you an opening to start these awkward conversations. For example, my dad once asked me to write out some checks because it was hard for him to do with the hand injured by a table saw. That’s when we realized he hadn’t been paying his credit card bill because he was reading the “balance” figure as his card reward points, not what he owed. That led us to setting up automatic payments for most of his bills. His bum hand still betrayed my dad almost every time he tried to fill in the password for an online account, but he accepted that annoyance since his bills weren’t piling up on the counter. Routines After months of “safer at home,” our elders’ routines may have changed significantly. Anyone of any age might feel discombobulated when their daily routine is disrupted. But our elders may find it harder than expected to cope. For example, for many elders the morning routine includes the need to be near a toilet when the diuretic kicks in. To cope with an early outing they may avoid drinking the liquids needed to keep systems working. In the short term, that might be okay. But dehydration leads to problems that can multiply to include dizziness, confusion, constipation and more. To understand how changes in routine might present, it helps to know what our elders’ routines actually are. Try to visit at different times of the day. That will also let you see what they look like when they aren’t spruced up for company or an outing. You might be surprised how long toenails get on someone who can’t reach to clip them any more. Also note what’s no longer routine. When a family member no longer checks the mailbox regularly, it might be time to ask your postmaster what it takes to get mail delivered right to the door. When an early riser starts sleeping late it might be time to ask how often they are up in the night and why. A coping mechanism for spouses dealing with nighttime incontinence in a partner is to wake them at regular intervals to go to the toilet. The alternative is waking to change the sheets. Either way, the sleep routine is disrupted in an upsetting and all too common way. Out-of-Place Items Signs of impaired vision, dexterity and mobility might include finding dropped medications under the table. Signs of diminished strength might include out-of-season items not returned to their usual storage space on a high shelf. Pillows on the seat of a recliner or easy chair might indicate difficulty rising from it, or that the seat springs are sprung. That walker or cane in the corner may have been recommended by a physical therapist — and news to you. And then there are the weird signs that might indicate dementia. My mother was still masking her dementia pretty well when my sister visited and Mom brought out orange soda in place of orange juice at breakfast. Other out-of-place items were clues about how much my dad was compensating for Mom’s deteriorating ability to shop, plan or prepare meals. When partial packages of hot dogs in the fridge outnumber fruits and vegetables in a household where tube steak was seldom seen, it’s time to talk. Private Places Private places might include that hard-to-reach spot behind the toilet where you may find evidence of past diarrhea or vomiting. Those are the easy ones. The hard ones feel more like an invasion of privacy. It never occurred to me to go through my parents’ private things until after their third major crisis in a year, and that was with their knowledge and consent: When my sister and I packed for their move to assisted living I found multiple unused medications for a MRSA infection we didn’t know Mom had. And it wasn’t until after my dad died that I found among his papers the number for a police report he made. It turned out to be for a telephone scam: Mom was sending prepaid credit cards to people she didn’t know and Dad called the sheriff. Neither of them ever mentioned it to me. If I had it to do over, I can’t say I would have been comfortable or even able to snoop through their things (Mom’s paranoia was great and her hearing was even better). But I can say, for what it’s worth, that my mom would not have hesitated for a moment to go through mine when I was a teenager if she thought it was necessary. And my mom supported the removal of firearms hidden in her dad’s home when she feared his behavior could pose a threat to others. There are no simple answers here, only questions you can ask to help guide actions you may have to take. It’s an uneasy balance we strive
for. We want to protect the independence of our aging rural
elders, but also feel a duty to try to help them avert
debilitating falls, impacted bowels, financial scams and
more. Pandemic-induced separations have been hard. Sadly, a
different kind of hard may be waiting in the wings.
It’s good to know what to look for after that good,
long hug you’re been waiting for. Time to
double or upgrade masks as coronavirus variants emerge,
experts say - 1/28/21 Wear your mask is becoming wear your masks. The discovery of highly transmissible coronavirus variants in the United States has public health experts urging Americans to upgrade the simple cloth masks that have become a staple shield during the pandemic. The change can be as simple as slapping a second mask over the one you already wear, or better yet, donning a fabric mask on top of a surgical mask. Some experts say it is time to buy the highest-quality KN95 or N95 masks that officials hoping to reserve supplies for health-care workers have long discouraged Americans from purchasing. As with other parts of the pandemic response, the United States lags behind other parts of the world when it comes to masks. Several Asian countries, including Singapore and South Korea, have mass-produced high-quality masks to send directly to residents. In recent weeks, European countries have begun mandating medical-grade masks in public settings as the virus strain first identified in the United Kingdom threatens to ravage communities. British scientists estimate it could be as much as 70 percent more transmissible. “The existence of more-transmissible viruses emphasizes the importance of us upping our game and doing not more of the same but better of the same,” said Tom Frieden, former director of the Centers for Disease Control and Prevention. Frieden has called for people to wear higher-quality masks. “Yes, that is confusing to people, but the key is to share what we know when we know it and be frank about what we don’t know.” Anthony S. Fauci, the nation’s top infectious-disease expert, touted double-masking during a Monday appearance on the “Today” show, saying two layers “just makes common sense that it likely would be more effective.” But on a Wednesday town hall appearance on CNN, Fauci appeared to reverse course and instead stressed following CDC guidance, which does not call for wearing two masks or N95s. New CDC Director Rochelle Walensky, appearing alongside Fauci, also warned that N95 masks are uncomfortable to wear and may dissuade consistent use if expanded to the general public. The CDC encourages Americans to choose well-fitting masks with “two or more layers of washable, breathable fabric” and to avoid surgical masks and other face coverings meant for health-care workers. President Biden has embraced masks as a core strategy for ending the pandemic, mandating face coverings on planes, in airports and in all federal buildings. But he has not called for a medical-grade-mask mandate or mass production of high-quality masks. The CDC and White House did not immediately respond to requests for comment. Some public health experts said the federal government should have prioritized certifying or manufacturing better masks earlier so Americans do not have to fend for themselves to avoid counterfeits or upgrade their own. The Trump administration in March coordinated with underwear makers to send five masks to every household, officials told The Washington Post, but the plans fell apart because of logistical concerns and other issues, including complaints that the masks looked like underwear or jockstraps. Washington , DC - January 27: Daniel Ryan, 27, is pictured wearing two masks on Wednesday, January 27, 2021 near his home in Washington, DC. Double masks are becoming a real possibility as a new virus variant makes its way from England, South Africa, and Brazil into the U.S. (Photo by Sarah L. Voisin/The Washington Post) Washington , DC - January 27: Daniel Ryan, 27, is pictured wearing two masks on Wednesday, January 27, 2021 near his home in Washington, DC. Double masks are becoming a real possibility as a new virus variant makes its way from England, South Africa, and Brazil into the U.S. (Sarah L. Voisin/The Washington Post) Abraar Karan, a physician at Brigham and Women’s Hospital and Harvard Medical School has, since last spring, called on government and industrial leaders to mass-produce comfortable, effective masks. He said the country could have avoided its current situation, with Americans learning how to better protect themselves largely alone. “This seems just like the rest of our covid tragedy: We just don’t have answers, we just put out fires constantly, and we are asking people to do things on their own,” Karan said. “You’ve always needed better masks. We needed better masks from the start.” Linsey Marr, a Virginia Tech engineering professor who has researched mask effectiveness, said the public has better tools to reduce viral loads getting into the air and into bodies. Without a medical-grade face covering, Marr said, people can get the best, simplest protection by wearing a cloth mask tightly on top of a surgical mask. They can also make a three-layer mask by cutting a high-efficiency filter, such as a vacuum bag, to place between two tightly-woven fabric masks. The difference is like getting two recommended doses of coronavirus vaccines instead of one — the additional mask offers more complete protection against the virus. “Those standard cloth masks might be around 50 percent effective in terms of protecting yourself,” Marr said. “Maybe that was good enough before when combined with distancing and trying to avoid being in crowded indoor spaces.” Masks are among the simplest tools in the fight against the coronavirus but also among the most politically fraught. Some have turned masks into a symbol of government overreach. Federal officials, including Fauci, were criticized when they urged people to cover their face after initially advising against masks in the early weeks of the pandemic. Many experts said the changing guidance made sense as the shortage of protective equipment for health-care workers eased and scientists better understood the spread of the virus — including that it is spread by asymptomatic people. But the initial confusion has been used to cast doubt on the proven efficacy of masking and the broader government response to the pandemic. “So in other words Fauci and everybody else really has no idea what to do or what is safe,” former Major League Baseball player Jordan Schafer tweeted in response to a news article about the scientist recommending two masks. “Fauci has told us not to wear a mask, to wear one mask, and now to wear two masks. Can we just get transparency please and accurate info.” Cady Fusté of Seattle started wearing a cloth mask over a surgical mask this month. She made the shift at the advice of her mother’s doctor — a double lung transplant has put her mother at a higher risk. “Science evolves. It makes total sense to me,” said Fusté, 35, who works in photo production. “If you think about it, if you can still smell someone’s perfume, it’s probably not that effective to something that’s airborne. A thin layer of cotton is probably not as ideal as a surgical mask.” Behavioral psychologists say public health authorities must be mindful of a backlash as they start to shift mask guidance. When people living through a crisis are confused, they often stick to their habits. “When you look at leaders and you see mixed messages like the ones you’ve seen in the past, you tend to latch onto the ones that make you feel comfortable,” said David Abrams, a professor of social and behavioral health at New York University and a former National Institutes of Health official. Abrams said it is essential to acknowledge that the guidance is changing and to be patient if people do not change their behavior immediately. “Let’s face it: This is changing very quickly and science is making progress and sometimes we even make mistakes and correct them,” Abrams said. “There’s nothing wrong with that or learning how to do something better. The double-masking is a good example of that.” Linda Aldoory, a public health communications researcher at the University of Maryland, said there may be no swaying people who have already lost faith in the government to change their mask behavior, which is why other messengers should be enlisted. “If we could get every famous influencer and celebrity to wear new masks and wear double masks … that might actually be a great way to start a new social norm to getting the kind of masks they want worn,” Aldoory said. Danny Ryan, a 27-year-old who works in communications in D.C., said he was swayed to switch to two cloth masks in part after he saw Biden and Vice President Harris doubling up in recent weeks. He also reconsidered the protection of a single mask after seeing his breath while waiting outside for a coronavirus test, although experts say that is not a sign of a malfunctioning mask. “It just stuck in my head —
they are wearing two masks, protecting them underneath and
maybe more above,” said Ryan, who now keeps extra masks
by his door. “To be perfectly honest, I just feel safer
doing it with updates in the news about the new
variants.” Long-Term
Neurologic Symptoms Emerge in COVID-19— Hospitalized
patients show deficits including cognitive impairment 6
months later Long-term neurologic manifestations were seen in more than a third of patients hospitalized with SARS-CoV-2 infection, a prospective study in Italy showed. In a group of hospitalized COVID-19 patients with no prior neurologic disease, 37.4% showed abnormalities on neurologic exam 6 months later -- most commonly cognitive deficits, hyposmia, and postural tremor -- according to Alessandro Padovani, MD, PhD, of the University of Brescia, and co-authors. The findings were reported in a medRxiv preprint and have not undergone peer review. Patients also noted fatigue, memory impairment, and sleep disorders, Padovani said. "The severity of SARS-CoV-2 infection was an important predictor, together with age and premorbid condition, of long-term neurological symptoms and features in the cohort." The findings are important for long-term management of COVID-19 patients, he told MedPage Today. "They showed that the severity of SARS-CoV-2 infection may impact on neurological sequelae, but also that the symptoms reported do not always reflect neurological features at examination." The study is one of the first to look specifically for new long-term neurologic manifestations in COVID-19 patients who were hospitalized. Earlier research showed that 87% of patients hospitalized with COVID-19 reported persistence of at least one lingering symptom, notably fatigue and dyspnea, 60 days after discharge. Fatigue and dyspnea also were the most prevalent symptoms reported during infection and at 3-month follow-up in an analysis of both hospitalized and non-hospitalized COVID-19 patients. Padovani and colleagues asked all COVID-19 survivors without premorbid neurologic disease who were discharged from the ASST Spedali Civili Hospital between February and April 2020 to participate in a follow-up study that included a standardized neurologic symptom checklist and a neurologic exam at 6 months. The checklist including symptoms related to central, peripheral, myopathic, and cognitive manifestations. The exam assessed cranial nerves; motor, sensory, cerebellar, and basal ganglia-related function; deep tendon reflexes; pyramidal signs; and global cognitive function using the Montreal Cognitive Assessment (MoCA). Premorbid conditions were recorded at hospital admission using the Cumulative Illness Rating Scale. Hospitalization data included severity of COVID-19 disease, classified according to the Brescia COVID Respiratory Severity Scale (BCRSS). Of 165 patients, the most common symptoms reported at follow-up were fatigue (34.1%), memory complaints (30.8%), sleep disorders (30.8%), and myalgias (29.6%), followed by depression or anxiety symptoms (26.0%), blurring or other visual disturbances (19.5%), paresthesia (18.3%), and hyposmia/dysgeusia (16.5%). In addition, 14.0% of patients reported urinary dysfunction, 13.0% confusion/dizziness, 12.2% dizziness/hypotension, 10.7% gait disturbances, and 8.5% postural instability or falls. Patients with worse BCRSS scores reported a higher number of symptoms at follow-up (P=0.004), memory complaints (P=0.015), and visual disturbances (P=0.006), after adjusting for age and premorbid conditions. Age (P=0.028) and oxygen therapy (P=0.04) best predicted memory complaints. A total of 105 patients were evaluated further by neurologic exam and cognitive screening. Of these, 42 people showed neurologic abnormalities: 19 had hyposmia/dysgeusia, 15 had enhanced physiological tremor, six had low-limb hypoesthesia, three had low-limb motor deficits, and 17 had cognitive deficits according to MoCA Italian validated norms. None of these patients had a history of cognitive impairment, Padovani noted. Neurologic abnormalities seen on exam were associated with older age (P=0.005), higher premorbid comorbidity index (P=0.001), worse BCRSS scores (P=0.05), longer hospitalization duration (P=0.002), and higher number of neurologic symptoms reported (P=0.007). Length of hospitalization (P=0.02) and premorbid comorbidity index (P=0.03) predicted neurologic abnormalities. Cognitive impairment was specifically associated with severity of COVID-19, independently of age and pre-morbid conditions. "On one hand, this suggests that hospitalization and severity of COVID-19 have a large impact in subjects with increased multi-morbidity, in line with other infectious diseases, such as community-acquired pneumonia," the researchers noted. On the other hand, the persistence of cognitive deficits "needs to be addressed in COVID-19 follow-up programs to evaluate their impact and progression over time and disentangle their potential relationship with psychosocial and psychiatric disturbances," the investigators pointed out. To that end, a global prospective study to investigate links between COVID-19 and cognitive decline was announced this week by the Alzheimer's Association, the World Health Organization, and others. The research had several limitations,
the team said. It was a single-center study with a
relatively small sample size; premorbid conditions were
based on medical records and assessment during
hospitalization without extensive neurologic screening at
baseline; and patients who developed neurologic disease
during the acute phase of SARS-CoV-2 infection were not
included. Most
Hospitalized COVID Patients Not Fully Recovered 6 Months
Post-Discharge — Fatigue, weakness are most common,
Chinese study finds - January 8, 2021 Fatigue or muscle weakness were by far the most common symptoms (63%), followed by sleep difficulties (26%), and 23% of patients said they had anxiety or depression, reported Bin Cao, MD, of China-Japan Friendship Hospital in Beijing, and colleagues, writing in The Lancet. "Our analysis indicates that most patients continue to live with at least some of the effects of the virus after leaving the hospital, and highlights a need for post-discharge care, particularly for those who experience severe infections," Cao said in a statement. "Our work also underscores the importance of conducting longer follow-up studies in larger populations in order to understand the full spectrum of effects that COVID-19 can have on people." It's the largest cohort with the longest follow-up so far for adult patients hospitalized with COVID-19, as researchers around the world examine the so-called "long COVID" phenomenon. Other recent studies focused on long-term neurologic symptoms in patients in Italy, as well as abnormalities in the lungs in British patients. Cao and colleagues also noted, "no studies have yet reported the extrapulmonary organ manifestations that could persist after damage in acute stage or are new onset after discharge." They examined data from 1,733 patients discharged from one Wuhan hospital from Jan. 7 to May 29 and followed from June 16 to Sept. 3. They were given physical examinations, interviewed about their quality of life, did a 6-minute walking test and had blood drawn. Some patients also underwent pulmonary function tests and high-resolution chest CTs. Patients' mean age was 57, and 52% were men. Median follow-up after symptom onset was 186 days. Almost 30% of patients had hypertension, 12% had diabetes, and 7% had cardiovascular disease. Almost 70% of patients required oxygen during their hospital stay and 4% were admitted to an ICU. Median hospital stay was 14 days. Researchers used a seven-stage severity scale ranging from no hospital admission to hospitalization requiring intubation or extracorporeal membrane oxygenation. A little under 30% of the most severe patients (stages 5-6 on the scale) had median 6-minute walk distance less than the lower limit of normal range at follow-up. Among 349 participants who completed the lung function test, 56% of the most severely ill patients had lung diffusion impairment. The authors also noted more severely ill patients had increased risk of fatigue or muscle weakness and anxiety or depression. Moreover, 13% of patients with normal kidney function presented with decreased estimated globular filtration rate (eGFR) at follow-up, among 822 with available eGFR data. But an accompanying editorial by Giuseppe Remuzzi, MD, of Istituto di Ricerche Farmacologiche Mario Negri in Bergamo, Italy, and colleagues cautioned on these findings, noting GFR-estimating equations "do not enable a sound assessment of renal function, which can be overestimated or underestimated compared with measured GFR." On the other hand, they noted that deep vein thrombosis was not diagnosed in any patients at follow-up, calling this an "encouraging finding," given how many patients develop the condition while hospitalized. The editorialists pointed out that only 4% of the cohort were admitted to an ICU, allowing no meaningful conclusions about the most severely ill patients. Other limitations noted by Bao and colleagues include that baseline pulmonary function and 6-min walk distance were unavailable, and new symptoms following COVID-19 were not stratified to determine if they were persistent or worsened following recovery or occurred post-discharge. As well, milder cases were not included in the study. Remuzzi and colleagues echoed the authors' calls for longer follow-up in larger populations. "These studies will improve our
understanding of the natural history of COVID-19 sequelae
and the factors or mediators involved, and enable us to
assess the efficacy of therapeutic interventions to mitigate
the long-term consequences of COVID-19 on multiple organs
and tissues," Remuzzi and colleagues wrote. COVID-19
Vaccination of Minors Without Parental Consent - JAMA In May 2021, the Pfizer-BioNTech COVID-19 vaccine received emergency use authorization from the US Food and Drug Administration in adolescents aged 12 to 15 years, with authorization for younger children expected later this year.1 Despite reported clinical trial data indicating that the vaccine is safe and 100% efficacious for this age range, some parents and guardians may remain hesitant or outright opposed to vaccinating their children, particularly in politically and culturally conservative communities.2 Children and adolescents account for approximately 22% of positive COVID-19 cases reported to date, and hospitalizations among this population have recently spiked.3 Since July 2020, weekly reported case rates for individuals aged 14 to 17 years have generally mirrored or exceeded rates among adults.4 As cases decline in adults owing to vaccination, the current case rate in teenagers now exceeds that of adults 55 years and older.5 Although COVID-19 illness is generally less severe in younger people, the disease has nonetheless caused substantial morbidity and more than 325 deaths among US children and adolescents, a burden of disease greater than that of many diseases for which vaccines are routinely recommended in this age group.6 Approximately one-third of confirmed COVID-19 cases in minors have been asymptomatic, creating an opportunity for minors to spread the virus unknowingly. The reduction of asymptomatic transmission is essential to slowing the spread of the virus, and growing evidence suggests that vaccination provides substantial public health benefits by decreasing transmission in addition to its direct, individual benefits.7 For these reasons, there is an urgent need for increased immunization in younger age groups. Vaccinating minors is critical to protecting them from the virus, reducing transmission—especially to higher-risk populations—and continuing progress toward herd immunity. Children and adolescents have the capacity to understand and reason about low-risk and high-benefit health care interventions. State laws should therefore authorize minors to consent to COVID-19 vaccination without parental permission. Minors’ Capacity to Consent to Highly Beneficial, Low-Risk Treatments Before age 14 years, minors are generally thought to lack the cognitive capacity and maturity to make rational health care judgments.8 Factors such as social pressure, emotional regulation, and planning skills affect minors’ ability to make well-considered choices. To account for these developmental facts, laws require parental permission and presume that parents know and will act in the best interest of their children. Despite this presumption, parents and minors might disagree about health care decisions. In the context of vaccination, some older minors may possess a more accurate understanding of the risks and benefits of a vaccine than their hesitant guardians. In younger children, and depending on the intervention, such cases present challenges and may entail judicial intervention. However, by age 14 years, minors’ reasoning begins to track adult decision-making, weighing in favor of respect for minors’ autonomy to make health care decisions that advance their health, particularly when these choices have a positive effect on public health. Around this age, adolescents develop cognitive processes—including a metacognitive understanding of decision-making, problem-solving skills, and an ability to commit to choices—that foster competent decisions.8 Minor Consent Laws Most state laws in the US presume that minors lack medical decision-making capacity and therefore require parental consent for most health care decisions, including vaccination. There are exceptions to this requirement for stigmatizing or sensitive interventions, but few states authorize vaccination without parental consent. In 4 states, minors can consent to immunizations for sexually transmitted infections, such as human papillomavirus and hepatitis B, without parental permission.9 In 5 states, minors are allowed to consent to any medical intervention, including vaccines. Although few states allow minors of any age to consent to such services, several states mirror existing research on capacity to consent, granting minors autonomy at or around age 14 years. Court intervention may also grant a “mature minor”—adolescents who, after clinical evaluation, are deemed to possess competence to consent or refuse treatment—broad authority over their medical decisions. Some sensitive health services currently accessible to minors may present greater risk and less benefit than the COVID-19 vaccine. Given the risks and the ongoing devastation of the pandemic, as well as the high benefit of vaccination for individual and public health, existing laws authorizing minors to consent to vaccines should be expanded to include COVID-19 vaccination and adopted nationally. Policy Recommendations To balance respect for minors’ autonomy with developmental realities and parental interests, a policy allowing minors to receive the vaccine without parental consent would use a sliding scale of decision-making authority, granting greater autonomy to minors as they age while also considering the risks and benefits of vaccination. On such a calculus, COVID-19 vaccines offer high benefit and low risk—a profile that lowers the threshold for determining whether a minor has the capacity to make this decision. The following age groupings offer a guide for minor consent rules for COVID-19 vaccination:
Even if states grant minors the power to consent to vaccination, states must also continue to promote vaccine acceptance and confidence in all age groups. Routine vaccinations among children and adolescents have declined—particularly during the COVID-19 pandemic—while antivaccine attitudes continue to grow. In an ongoing public health crisis, children and adolescents should not be placed at continued risk due to their parents’ hesitancy over COVID-19 vaccines. Although the percentage of parents who may decline to vaccinate their children is currently unknown, the reported hesitancy among adults—including the age groups that include most parents of minors—suggests that this number is likely substantial.2 Given that children and adolescents account for approximately 22% of the US population, a considerable portion of unvaccinated minors could prolong the pandemic, compromise herd immunity, and expose these minors to preventable risks.10 Prior to the COVID-19 pandemic, responses to other vaccination programs demonstrate that it is not merely a theoretical possibility that situations will arise in which well-informed adolescents will want the benefits of COVID-19 immunization despite their parents’ wishes.9 Although limiting provisions for minor consent only to COVID-19 vaccines (and perhaps only during the current public health emergency) may be more expedient and politically feasible, the ethical and public health concerns at stake are not restricted to COVID-19 vaccines. Policy makers and health officials must take action to address these concerns beyond the context of the current pandemic, even if such action occurs at a later time. Every vaccinated individual counts in the global fight against COVID-19. The ongoing pandemic and its profound consequences for health and societal functioning affirm the urgent need for states to recognize minors’ capacity to consent to vaccination to safeguard individual and public health. References 1. Mahase E?. COVID-19: Pfizer reports 100% vaccine efficacy in children aged 12 to 15. ? BMJ. 2021;373(n881):n881. doi:10.1136/bmj.n881 2. Heuerman E?. Covid vaccine hesitancy drops among all Americans, new survey shows. Accessed June 5, 2021. https://khn.org/news/article/covid-vaccine-hesitancy-drops-among-americans-new-kff-survey-shows/ 3. Chappell B?. Children now account for 22% of new U.S. COVID cases. why is that? NPR. May 3, 2021. Accessed June 5, 2021. https://www.npr.org/sections/coronavirus-live-updates/2021/05/03/993141036/children-now-account-for-22-of-new-u-s-covid-cases-why-is-that 4. Havers FP?, Whitaker M?, Self JL?, et al; COVID-NET Surveillance Team. Hospitalization of adolescents aged 12–17 years with laboratory-confirmed COVID-19—COVID-NET, 14 states, March 1, 2020–April 24, 2021. ? MMWR Morb Mortal Wkly Rep. Published online June 4, 2021. doi:10.15585/mmwr.mm7023e1 5. US Centers for Disease Control and Prevention. COVID-19 weekly cases and deaths per 100,000 population by age, race/ethnicity, and sex. Accessed April 30, 2021. https://covid.cdc.gov/covid-data-tracker/#demographicsovertime 6. US Centers for Disease Control and Prevention. Deaths involving coronavirus disease 2019 (COVID-19) with a focus on ages 0-18 years. Accessed April 18, 2021. https://data.cdc.gov/NCHS/Provisional-COVID-19-Deaths-Focus-on-Ages-0-18-Yea/nr4s-juj3/data 7. US Center for Disease Control and Prevention. Benefits of getting a COVID-19 vaccine. Accessed June 5, 2021. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/vaccine-benefits.html 8. Diekema DS?. Adolescent brain development and medical decision-making. ? Pediatrics. 2020;146(suppl 1):S18-S24. doi:10.1542/peds.2020-0818F 9. Silverman RD?, Opel DJ?, Omer SB?. Vaccination over parental objection—should adolescents be allowed to consent to receiving vaccines? ? N Engl J Med. 2019;381(2):104-106. doi:10.1056/NEJMp1905814PubMedGoogle ScholarCrossref 10. Roach ES?. Child
neglect by any other name. ? Pediatr Neurol. 2020;113:82-84.
doi:10.1016/j.pediatrneurol.2020.09.006 Hospitalization
of Adolescents Aged 12–17 Years with
Laboratory-Confirmed COVID-19 — COVID-NET, 14 States,
March 1, 2020–April 24, 2021 What is already known about this topic? Most COVID-19–associated hospitalizations occur in adults, but severe disease occurs in all age groups, including adolescents aged 12–17 years. What is added by this report? COVID-19 adolescent hospitalization rates from COVID-NET peaked at 2.1 per 100,000 in early January 2021, declined to 0.6 in mid-March, and rose to 1.3 in April. Among hospitalized adolescents, nearly one third required intensive care unit admission, and 5% required invasive mechanical ventilation; no associated deaths occurred. What are the implications for public health practice? Recent increased hospitalization rates in spring 2021 and potential for severe disease reinforce the importance of continued COVID-19 prevention measures, including vaccination and correct and consistent mask wearing among persons not fully vaccinated or when required. Most COVID-19–associated hospitalizations occur in older adults, but severe disease that requires hospitalization occurs in all age groups, including adolescents aged 12–17 years (1). On May 10, 2021, the Food and Drug Administration expanded the Emergency Use Authorization for Pfizer-BioNTech COVID-19 vaccine to include persons aged 12–15 years, and CDC’s Advisory Committee on Immunization Practices recommended it for this age group on May 12, 2021.* Before that time, COVID-19 vaccines had been available only to persons aged =16 years. Understanding and describing the epidemiology of COVID-19–associated hospitalizations in adolescents and comparing it with adolescent hospitalizations associated with other vaccine-preventable respiratory viruses, such as influenza, offers evidence of the benefits of expanding the recommended age range for vaccination and provides a baseline and context from which to assess vaccination impact. Using the Coronavirus Disease 2019-Associated Hospitalization Surveillance Network (COVID-NET), CDC examined COVID-19–associated hospitalizations among adolescents aged 12–17 years, including demographic and clinical characteristics of adolescents admitted during January 1–March 31, 2021, and hospitalization rates (hospitalizations per 100,000 persons) among adolescents during March 1, 2020–April 24, 2021. Among 204 adolescents who were likely hospitalized primarily for COVID-19 during January 1–March 31, 2021, 31.4% were admitted to an intensive care unit (ICU), and 4.9% required invasive mechanical ventilation; there were no associated deaths. During March 1, 2020–April 24, 2021, weekly adolescent hospitalization rates peaked at 2.1 per 100,000 in early January 2021, declined to 0.6 in mid-March, and then rose to 1.3 in April. Cumulative COVID-19–associated hospitalization rates during October 1, 2020–April 24, 2021, were 2.5–3.0 times higher than were influenza-associated hospitalization rates from three recent influenza seasons (2017–18, 2018–19, and 2019–20) obtained from the Influenza Hospitalization Surveillance Network (FluSurv-NET). Recent increased COVID-19–associated hospitalization rates in March and April 2021 and the potential for severe disease in adolescents reinforce the importance of continued COVID-19 prevention measures, including vaccination and correct and consistent wearing of masks by persons not yet fully vaccinated or when required by laws, rules, or regulations.† COVID-NET is a population-based surveillance system of laboratory-confirmed COVID-19–associated hospitalizations in 99 counties across 14 states,§ covering approximately 10% of the U.S. population.¶ Included in surveillance are COVID-19–associated hospitalizations among residents in a predefined surveillance catchment area who had a positive real-time reverse transcription–polymerase chain reaction or rapid antigen detection test result for SARS-CoV-2 (the virus that causes COVID-19) during hospitalization or =14 days before admission (2). Clinical and demographic data, updated monthly, were analyzed for adolescents aged 12–17 years hospitalized during January 1–March 31, 2021. Clinical and demographic characteristics were analyzed separately for patients whose primary reason for admission was likely COVID-19 and those whose primary reason for admission might not have been primarily related to COVID-19, despite receiving a positive SARS-CoV-2 laboratory test result.** Hospitalization rate data, updated weekly, were analyzed during March 1, 2020–April 24, 2021, to describe cumulative COVID-19–associated hospitalization rates in adolescents aged 12–17 years and adults aged =18 years and weekly COVID-19–associated hospitalization rates in children aged 0–4 years and 5–11 years and adolescents aged 12–17 years. In addition, cumulative COVID-19–associated hospitalization rates among adolescents aged 12–17 years during October 1, 2020–April 24, 2021 (covering most of the typical October 1–April 30 season for influenza-associated hospitalization surveillance), were compared with influenza-associated hospitalization rates in the same age group across three influenza seasons (2017–18, 2018–19, and 2019–20) using data from FluSurv-NET†† (3). Rate calculations are unadjusted and include all persons meeting the case definition (2). SAS statistical software (version 9.4; SAS Institute) was used for analyses. This activity was reviewed by CDC and was conducted consistent with applicable federal law and CDC policy.§§ Among 376 adolescents hospitalized during January 1–March 31, 2021, who received a positive SARS-CoV-2 laboratory test result, 172 (45.7%) were analyzed separately because their primary reason for admission might not have been directly COVID-19–related (Table). Among the 204 patients who were likely admitted primarily for COVID-19–related illness, 52.5% were female, 31.4% were Hispanic or Latino (Hispanic), and 35.8% were non-Hispanic Black. Overall, 70.6% had one or more underlying medical conditions, the most common of which were obesity (35.8%), chronic lung disease, including asthma (30.9%), and neurologic disorders (14.2%); 31.4% of patients required ICU admission and 4.9% required invasive mechanical ventilation, but there were no associated deaths. During March 1, 2020–April 24, 2021, the cumulative COVID-19–associated adolescent hospitalization rate (49.9) was 12.5 times lower than that in adults aged =18 years (675.6). Weekly COVID-19–associated adolescent hospitalization rates (3-week moving average) were comparable to rates among those aged 0–4 years, but higher than rates among children aged 5–11 years (Figure 1). Weekly adolescent hospitalization rates peaked at 2.1 per 100,000 during the week ending January 9, 2021, declined to 0.6 during the week ending March 13, 2021, then increased to 1.3 and 1.2 for the weeks ending April 17 and 24, 2021, respectively. Rates among adolescents in two of 14 sites (Maryland and Michigan) were highest during April 2021 compared with all other weeks within their respective sites since surveillance began on March 1, 2020. Cumulative COVID-19–associated hospitalization rates during October 1, 2020–April 24, 2021, were 2.5–3.0 times higher than seasonal influenza-associated hospitalization rates during three recent influenza seasons (October 1–April 30) (Figure 2). Discussion COVID-NET data indicate that COVID-19–associated hospitalization rates were lower in adolescents aged 12–17 years compared with those in adults but exceeded those among children aged 5–11 years during March 1, 2020–April 24, 2021. Moreover, COVID-19–associated hospitalization rates among adolescents increased during March–April 2021, and nearly one third of 204 recently hospitalized adolescents required ICU admission. Rates of COVID-19–associated hospitalization among adolescents also exceeded historical rates of seasonal influenza-associated hospitalization during comparable periods. Recent increased hospitalization rates and the potential for severe disease reinforce the importance of continued COVID-19 prevention measures among adolescents, including vaccination and correct and consistent wearing of masks. After declines in January and February 2021, weekly population-based rates of COVID-19–associated hospitalization among adolescents increased during March and April, and in two COVID-NET sites (Maryland and Michigan) the highest adolescent COVID-19–associated hospitalization rates in their respective sites since the start of the COVID-19 pandemic occurred during this period. This trend contrasts with hospitalization rates among persons aged =65 years, the group with the highest COVID-19 vaccination coverage, among whom hospitalization rates in COVID-NET stabilized during the same period.¶¶ Increased hospitalization rates among adolescents might be related, in part, to circulation of particularly transmissible SARS-CoV-2 variants,*** the larger numbers of children returning to school or other in-person indoor activities, and changes in physical distancing, wearing masks, and other COVID-19 prevention behaviors (4). SARS-CoV-2 transmission occurs more easily in high schools than in elementary schools (4), and outbreaks have been associated with high school extracurricular activities (5). Vaccination of adolescents is expected to reduce the risk for COVID-19 in these settings. Population-based COVID-19–associated hospitalization rates among adolescents were lower than were those in adults, a finding consistent with studies showing that illness is generally milder in children than in adults (6). Nevertheless, severe disease does occur, including that requiring ICU admission and invasive mechanical ventilation. Most (70.6%) adolescents in this study whose primary reason for hospitalization was COVID-19–associated illness had at least one underlying medical condition, which is lower than the percentage of hospitalized adults with an underlying medical condition (92%) (7). Nearly 30% of these adolescents had no reported underlying medical condition, indicating that healthy adolescents are also at risk for severe COVID-19–associated disease. In addition, approximately two thirds of adolescents hospitalized with COVID-19 were Hispanic or non-Hispanic Black persons, consistent with studies showing an increased incidence of COVID-19 among racial and ethnic minority populations and signifying an urgent need to ensure equitable access to vaccines for these groups (8). Vaccination is effective in preventing hospitalization among adults (9); similarly, widespread vaccination of adolescents will likely reduce COVID-19–associated hospitalizations, and potential sequelae from COVID-19 in adolescents, including multisystem inflammatory syndrome in children (MIS-C), a rare but serious complication of COVID-19 (10). During a comparable period, adolescent hospitalization rates associated with COVID-19 exceeded those for seasonal influenza, another respiratory virus that can cause hospitalization and death in adolescents and for which a vaccine is recommended in this age group.††† This widespread circulation of SARS-CoV-2 occurred despite containment measures such as school closures, wearing masks, and physical distancing, none of which had been enacted during the historical influenza seasons. Without these containment measures, the rates of COVID-19–associated hospitalization might have been substantially higher. The findings in this report are subject to at least five limitations. First, the primary reason for hospital admission was not always clear, and some (45.7%) adolescents who met the COVID-NET case definition were hospitalized for reasons that might not have been primarily related to COVID-19, despite a positive SARS-CoV-2 laboratory test result; these hospitalizations were included in rate calculations. Thus, rates of hospitalizations for COVID-19 might be overestimated. Second, laboratory confirmation depends on clinician-ordered testing and hospital testing policies for SARS-CoV-2 (COVID-NET) and influenza (FluSurv-NET); consequently, hospitalization rates might also be underestimated. Given more widespread testing for SARS-CoV-2 compared with influenza, the lack of adjustment for testing practices likely disproportionately affects influenza rates compared with COVID-19 rates. Third, adolescents hospitalized with MIS-C might not be identified if testing occurred >14 days before admission, potentially leading to an underestimate of severe COVID-19–associated disease. Fourth, the Pfizer-BioNTech COVID-19 vaccine had been approved for and administered to adolescents aged 16–17 years during this study period; therefore, rates of COVID-19–associated hospitalization in adolescents aged 16–17 years might differ from those in adolescents aged 12–15 years who were not previously eligible for vaccination, and could affect the overall hospitalization rate for all adolescents. Finally, hospitalization rates are preliminary and might change as additional data are reported. Recent increases in
COVID-19–associated hospitalization rates and the
potential for severe disease requiring ICU admission,
including invasive mechanical ventilation, among adolescents
indicate an urgent need for vaccination in combination with
correct and consistent mask wearing by persons not yet fully
vaccinated or when required by laws, rules, or regulations.
Highly effective COVID-19 vaccines are now available to
adolescents as an additional evidence-based prevention
measure (9); expansion of COVID-19 vaccination of
adolescents, with particular attention to racial and ethnic
minority groups disproportionately affected by severe
COVID-19, is expected to reduce COVID-19–associated
morbidity within this age group. Child Neglect by Any Other Name - Pediatric Neurology If 50 million people say a foolish thing, it is still a foolish thing Anatole France (1844-1924) Barely three weeks old, the baby lay fighting for life because of intracranial hemorrhages resulting not from physical trauma but from medical neglect. Child neglect includes knowingly failing to protect a child from preventable harm. His parents had refused the administration of vitamin K after birth. Why? Because they did not believe in doing things that are not "normal and natural." Sadly, failure to administer vitamin K to newborns, typically a single injection or a series of oral doses, has become commonplace in the United States, allowing a resurgence of deadly hemorrhagic disease of the newborn that had become almost nonexistent in Westernized countries. 1 Schulte et al noted that 28% of the babies born in private birthing centers in their area and 3.4% of the babies born at their own academic medical center failed to receive vitamin K after birth, with sometimes tragic results. At first normal and natural sounds like a sweetly quaint and wholesome approach, until one considers the natural reality of what it could mean to a child's chances of survival if fully implemented. In 1800, when things were certainly very "natural" only 57% of children survive to age five years. A century later that number had improved slightly to about 65%., In recent years, over 95% of children survive to age five years . 3 Much of this stunning improvement in child mortality resulted from prevention and treatment of infections through improved sanitation, the development of antibioitical and vaccines targeting one deadly and crippling diseases. No rational person would wish to experience those terrible losses again, in deed rather than letting nature take its cruel path, no matter how devastating the consequences, we should be trying to improve on the natural course to optimize each child's chances to survive and thrive. Refusal =of vitamin K administration shares with vaccine denial and unwillingness to accept the sound scientific evidence supporting the practice. Lulled into complacency by the lower frequency of deadly contagious diseases in recent decades and gullibly accepting the internet-amplified comments of prominent but misinformed celebrity "spokespeople," too many parents discount the compelling proof of the safety and effectiveness of vaccines. Some parents may be merely afraid and unaware of the facts, and they need only appropriate information and respectful guidance. These parents are merely advocating for their child's well-being. Others seem to be so firmly entrenched in their beliefs that no amount of proof will change their mind. Like their sister skeptics, the "climate deniers", the vaccine deniers defiantly dismiss any contrary information and the introduction of additional scientific evidence only seems to strengthen their considence in the correctness of their own unsubstantiated beliefs. We physicians must bear some of the blame here, as do many of our elected officials. By feebly accepting vaccine denial as even approaching a rational option, we become enablers of inappropriate choices by individuals who are ill-equipped to weigh the evidence or choose to ignore it. Not all physicians have been so complacent, of course. The American Academy of Pediatrics has consistently and strongly recommended immunizations, although they could have been more direct in discussing the ethical failure that parental denial of immunizations represents. Some individual physicians have taken a strong stand on the need for immunization despite the online bullying by militant vaccine deniers that often ensues. But on the whole, our collective response has been anemic. Admittedly, physicians are placed in a very difficult situation when dealing with vaccine deniers. Beneficence on behalf of the child, whose welfare is their primary concern, compels physicians to advocate strongly on behalf of the benefit that vaccines convey to that child. They may have a secondary obligation to educate the child’s parents about the value of immunizations, but the child’s well-being is paramount. As surrogate decision makers for their child, parents also have an ethical duty of beneficence that obliges them to embrace scientifically established procedures that will increase the child’s likelihood of health and well-being. In parallel, the physician also has an obligation to avoid the spread of preventable infections in other children in their practice. And while discharging the unimmunized child from the physician’s practice may initially seem like a plausible solution, abandoning the child because of their parents’ failure to act in their child’s best interests may not be the best approach. Physicians need to avoid “science speak.” We sometimes obscure the facts with thickheaded comments such as “there is no epidemiologic evidence for a causal association” when we should say simply and directly that an assertion is “blatantly false.” When did we start to refer to a brutal beating as “non-accidental trauma”? Even the somewhat euphemistic term “vaccine hesitancy” lends a noble-sounding aura to a very irrational and potentially deadly thought process. Trying to “engage” families to educate and convince them of the wisdom of immunization is fine for the parents who want information and are willing to accept guidance, but this approach is clearly wasted on the entrenched vaccine deniers. Perhaps our message needs to also directly articulate the concept of vaccine denial as a form of child neglect. The vaccine deniers may continue to ignore the scientific evidence, but at least there would be no room for doubt about what we physicians recommend. There is nothing good about the current novel coronavirus pandemic that is sweeping the globe, but if hundreds of thousands of coronavirus-related deaths serve to make some of the skeptics finally grasp the deadly seriousness of infections in a world without vaccines, it will have at least achieved something. A few people can remember the similar terror surrounding the epidemics of poliomyelitis before the advent of vaccines, and none of us want to see children die from bacterial meningitis again. One hopes that the vaccine deniers will opt to accept a coronavirus vaccine when it becomes available, although recent outbreaks of preventable illnesses such as mumps and measles among unimmunized individuals seem to have opened few closed minds. The administration of vitamin K is about as close as one ever gets to risk free. Similarly, the safety and efficacy of vaccines have been thoroughly established. Vaccines do not cause autism, a bogus but persistent notion that arose from a long since retracted 1998 publication containing fabricated data.4,5 About four children per 100,000 children have a febrile seizure after receiving an immunization,6 arguably fewer children than would experience a febrile seizure during the very illnesses prevented by the vaccines. A few children have medical reasons to avoid specific vaccines, but immunizations are overwhelmingly safe.7 The bottom-line question is “Does the potential benefit of an immunization exceed the likelihood of an adverse effect?” If the answer to this question is unequivocally yes, which it almost always is for immunizations, then refusal to allow vaccination after being fully informed of the facts amounts to child neglect.8 Parents are afforded broad freedom to raise their children in keeping with their own culture and values. Provided that the child is not harmed, this approach is appropriate. But injuring a child, purposely denying adequate nutrition, and failing to protect a child from preventable risk, even in the name of discipline and decorum, is taboo in most civilized cultures. Ultimately a child’s right to exist, free of avoidable injury or illness, should supersede a parent’s right to do whatever they wish when rearing their children. Parents are not always allowed to deny well-validated medical treatments for their children. A parent who attempts to deny a child chemotherapy for acute lymphocytic leukemia, for example, is typically met with a court order terminating their custody of the child until after she or he undergoes the needed chemotherapy. Chemotherapy drugs have many serious side effects, so one can easily understand how a parent might want to avoid the whole situation.9,10 But in the end, the child’s right to live, or in this example, to maximize his odds of surviving, trumps the parents’ desire to avoid chemotherapy. So why are parents allowed to forbid the administration of life-saving vaccines or vitamin K but not allowed to deny cancer chemotherapy? Leukemia represents a clear and present danger to the child, whereas vaccines reduce the risk of disease that might or might not occur. No doubt the looming certainty of death from untreated leukemia makes it easier for the authorities to summon the courage to act, but is there an acceptable threshold for allowing a preventable risk? How much avoidable risk to a child is too much to ignore? If the imminent danger argument were reasonable, then how does one explain required car seats for children? Most car trips do not result in accidents, after all, but some of them end just as tragically for the unrestrained child as would untreated leukemia. The car seat requirement is designed to maximize the odds of a child’s survival in the event of an accident, and it has nothing to do with whether the danger is imminent. Why are vaccines not viewed in a similar fashion? Of course, few things are simple. The likelihood of some preventable infections is considerably higher than others. For example, the outbreaks of measles and mumps are increasingly common, whereas polio is nonexistent in much of the world. Some of the benefits of immunizations are societal rather than individual, and vaccine denial would result in far more disease were it not for the herd immunity resulting from the responsible immunization of most children. Is it fair for an individual’s rejection of established scientific evidence to place their child and other people at risk in the name of personal freedom or preference? Is it fair to ask others to accept the human suffering and financial burden resulting from infections that could easily have been prevented? Parents also have an ethical responsibility to not promulgate preventable disease in other individuals. The argument that it is acceptable to decline vaccines because they have risks is utter nonsense, because the likelihood of preventing a disease with a vaccine is higher than the risk of a complication.8 The family’s cultural background, intentions, and level of sophistication may sometimes be relevant when defining child abuse and neglect, but never to the point of justifying a child’s injury or exposure to preventable risk. While visiting the Middle East, I once encountered a Bedouin child with failure to thrive and hypotonia. She had numerous oval pigmented lesions on her abdomen resembling burn scars. In Western countries, the sight of intentional burn marks on a malnourished child would send most of us scurrying to notify the authorities. But cautery is a commonly used folk remedy in her culture.11 Her burns had resulted from application of a hot spoon from the campfire to her abdomen, the site thought to be responsible for her poor weight gain. Was this child abuse? The family’s intent was to help the child, not to hurt her, cautery was an accepted traditional ritual in their culture, and their ability to learn about better options may have been limited. Yet she suffered avoidable burns and her failure to thrive was not quickly assessed by physicians, so she was harmed, despite the family’s benign intentions. One might argue that vaccine denial represents a similar situation. The vaccine deniers do not intend to harm their children, of course, and in some circles, withholding vaccines is so prevalent and so entrenched that it resembles a primitive cultural belief system. But most Western families who fail to immunize their children know about vaccines and have ready access to physicians and nurses who could clearly explain their risks and benefits. Yet some of them opt to deny the solid science that would give their child the best odds of staying healthy. I will at least give the Bedouins some benefit of the doubt. It is time to stop the political correctness and “science speak.” Parents should have the right to raise their children in accordance with their own preference, culture, and religious beliefs, provided that their approach does not substantially increase the child’s odds of an avoidable illness or injury. But given the extremely low risk of immunization and vitamin K administration, the bar for “substantial” risk should be extremely low. Vaccine denial may not cross a threshold that triggers harsh measures by the authorities, but there should be no acceptable preventable risk. No matter how well-intentioned the decision may be, the willful, informed avoidance of scientifically proven measures that would improve a child’s odds of optimal health and survival amounts to child neglect. Physicians must rise with one voice and say “enough!” By even considering the premise that vaccine denial can be a reasonable choice by a rational individual, we become enablers of child neglect. References Volpe J.J. Intracranial hemorrhage in early infancy--renewed importance of vitamin K deficiency. Pediatr Neurol. 2014; 50: 545-546 Sidonio R. Rise in late onset vitamin K deficiency bleeding in young infants because of omission or refusal of prophylaxis at birth. Pediatr Neurol. 2014; 50: 564-568 Google Scholar https://ourworldindata.org/child-mortality-globally Anthony A.Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children.Lancet. 1998; 351: 637-641 Google Scholar Retraction--Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Lancet. 2010; 375: 445 Jackson L.A. Febrile seizure risk after vaccination in children one to five months of age. Pediatr Neurol. 2017; 76: 72-78 Diekema D.S. Responding to parental refusals of immunization of children. Pediatrics. 2005; 115: 1428-1431 Cooper S.Neurological complications of the treatment of pediatric neoplastic disorders.Pediatr Neurol. 2018; 85: 33-42 Esfahani B. A review of chronic leukoencephalopathy among survivors of childhood cancer. Pediatr Neurol. 2019; 101: 2-10 Alkuraya I.F. Ancient
Mideast cauterization practices and developmentally delayed
children: a call for advocacy. Pediatr
Neurol. 2020; 109: 1-3 You
might start hearing about the Lambda variant. Here's what we
know about it so far. There is a lot left to learn about Lambda, but here's what we know so far: So far, it's rare in the US: The variant is not nearly as worrisome as the Delta variant in the US, which has been driving a rise in cases nationwide, but early studies suggest that it has mutations that make it more transmissible than the original strain of the coronavirus. “Lambda has mutations that are concerning but this variant remains quite rare in the US despite being around for several months,” Dr. Preeti Malani, chief health officer in the division of infectious diseases at the University of Michigan in Ann Arbor, wrote in an email on Friday. We're not sure how transmissible it is: it “It’s difficult to know for certain how transmissible Lambda is and how well vaccines work. So far, it seems that Lambda is more transmissible than the original SARS-CoV-2 virus,” which is similar to Delta and other variants, wrote Malani, an expert with the Infectious Diseases Society of America. SARS-CoV-2 is the name of the coronavirus that causes Covid-19. “Thankfully studies suggest that the currently available vaccines remain protective. We have learned during the pandemic that things can change quickly, so controlling spread of COVID-19 in general will help manage Lambda,” Malani wrote. “As long as there is uncontrolled spread of SARS-CoV-2, we will see more variants in the future. The only way out is widespread vaccination to control spread and prevent further mutation of SARS-CoV-2. It’s a race between getting enough of the world vaccinated and the development of new variants that are less responsive to counter measures.” About vaccines: So far, data remain split on how well vaccines protect against the Lambda variant, and scientists say they need to study this more. In July, researchers wrote in a lab study that they found some evidence that people who got the single-dose Johnson & Johnson Covid-19 vaccine might benefit from a booster dose to better protect them from new variants of the coronavirus, including the Lambda variant. The study was done in the lab and does not reflect real-world effects of the vaccine – and it’s published online as a preprint to the server biorxiv.org, meaning it was not subject to careful peer review. Nathaniel Landau of the New York University Grossman School of Medicine and colleagues said their tests of blood taken from vaccinated volunteers shows that at least some of the newly emerging variants may evade the protection offered by a single dose of Johnson & Johnson’s Janssen vaccine. A boost of a second dose of J&J vaccine, or even with Moderna’s or Pfizer’s, might help, the researchers reported. In the study, the variants Beta,
Delta, Delta plus and Lambda showed only “modest”
resistance against antibodies elicited by the
Pfizer/BioNTech and Moderna coronavirus vaccines, suggesting
the vaccines still work. There could
be more dangerous variants if more people don't get
vaccinated, Fauci says “Then all of us who are protected against delta may not be protected against zaida (zeta),” the director of the National Institute of Allergy and Infectious Diseases said in a Q&A with USA Today published Sunday. If an overwhelming majority of the population is vaccinated, the virus will disappear in the country, Fauci said. But having only a partially vaccinated population means that smoldering levels of infection will carry into the fall, be confused as the flu in the winter and pick back up in the spring, Fauci told USA Today. And if the rest of the world isn’t vaccinated over the next couple of years, more circulation could mean more variants, Fauci warned. Already, states are struggling to fend
off the Delta variant, a strain believed to be significantly
more transmissible than others. In 47 states, the seven-day
average of new cases is surging by at least 10% more than
the previous week, according to data from Johns Hopkins
University. And the US is averaging more than 100,000 new
Covid-19 cases every day – the highest in almost six
months, according to data from Johns Hopkins University. Some
Patients Went Into the Hospital for Care And Never Came Out
After Contracting COVID They left with COVID-19 — if they left at all. More than 10,000 patients were diagnosed with COVID in a U.S. hospital last year after they were admitted for something else, according to federal and state records analyzed exclusively for KHN. The number is certainly an undercount, since it includes mostly patients 65 and older, plus California and Florida patients of all ages. Yet in the scheme of things that can go wrong in a hospital, it is catastrophic: About 21% of the patients who contracted COVID in the hospital from April to September last year died, the data shows. In contrast, nearly 8% of other Medicare patients died in the hospital at the time. Steven Johnson, 66, was expecting to get an infection cut out of his hip flesh and bone at Blake Medical Center in Bradenton, Florida, last November. The retired pharmacist had survived colon cancer and was meticulous to avoid contracting COVID. He could not have known that, from April through September, 8% of that hospital’s Medicare COVID patients were diagnosed with the virus after they were admitted for another concern. Johnson had tested negative for COVID two days before he was admitted. After 13 days in the hospital, he tested positive, said his wife, Cindy Johnson, also a retired pharmacist. Soon he was struggling to clear a glue-like phlegm from his lungs. A medical team could hardly control his pain. They prompted Cindy to share his final wishes. She asked: “Honey, do you want to be intubated?” He responded with an emphatic “no.” He died three days later. After her husband tested positive, Cindy Johnson, trained in contact tracing, quickly got a COVID test. She tested negative. Then she thought about the large number of hospital staffers flowing into and out of his room — where he was often unmasked — and suspected a staff member had infected him. That the hospital, part of the HCA Healthcare chain, still has not mandated staff vaccinations is “appalling,” she said. “I’m furious,” she said. “How can they say on their website,” she asked, “that the safety precautions ‘we’ve put into place make our facilities among the safest possible places to receive healthcare at this time’?” Blake Medical Center spokesperson Lisa Kirkland said the hospital is “strongly encouraging vaccination” and noted that it follows Centers for Disease Control and Prevention and federal and state guidelines to protect patients. President Joe Biden has called for all hospital employees to be vaccinated, but the requirement could face resistance in a dozen states, including Florida, that have banned vaccine mandates. Overall, the rate of in-hospital spread among Medicare and other patients was lower than in other countries, including the United Kingdom, which makes such data public and openly discusses it. On average, about 1.7% of U.S. hospitalized COVID patients were diagnosed with the virus in U.S. hospitals, according to an analysis of Medicare records from April 1 to Sept. 30, 2020, provided by Dr. James Kennedy, founder of CDIMD, a Nashville-based consulting and data analytics company. Yet the rate of infection was far higher in 38 hospitals where 5% or more of the Medicare COVID cases were documented as hospital-acquired. The data is from a challenging stretch last year when protective gear was in short supply and tests were scarce or slow to produce results. The Medicare data for the fourth quarter of 2020 and this year isn’t available yet, and the state data reflects April 1 through Dec. 31, 2020. A KHN review of work-safety records, medical literature and interviews with staff at high-spread hospitals points to why the virus took hold: Hospital leaders were slow to appreciate its airborne nature, which made coughing patients hazardous to roommates and staff members, who often wore less-protective surgical masks instead of N95s. Hospitals failed to test every admitted patient, enabled by CDC guidance that leaves such testing to the “discretion of the facility.” Management often failed to inform workers when they'd been exposed to COVID and so were at risk of spreading it themselves. Spread among patients and staffers seemed to go hand in hand. At Beaumont Hospital, Taylor, in Michigan, 139 employee COVID infections were logged between April 6 to Oct. 20 last year, a hospital inspection report shows. Nearly 7% of the Medicare patients with COVID tested positive after they were admitted to that hospital for something else, the federal data shows. A hospital spokesperson said tests were not available to screen all patients last year, resulting in some late diagnoses. He said all incoming patients are tested now. Tracking COVID inside health facilities is no new task to federal officials, who publicly report new staff and resident cases weekly for each U.S. nursing home. Yet the Department of Health and Human Services reports data on COVID’s spread in hospitals only on a statewide basis, so patients are in the dark about which facilities have cases. KHN commissioned analyses of hospital billing records, which are also used more broadly to spot various hospital-acquired infections. For COVID, the data has limitations. It can pick up some community-acquired cases that were slow to show up, as it can take two to 14 days from exposure to the virus for symptoms to appear, with the average being four to five days. The records do not account for cases picked up in an emergency room or diagnosed after a hospital patient was discharged. Linda Moore, 71, tested positive at least 15 days into a hospital stay for spinal surgery, according to her daughter Trisha Tavolazzi. Her mother was at Havasu Regional Medical Center in Lake Havasu City, Arizona, which did not have a higher-than-average rate of internal spread last summer. The hospital implemented “rigorous health and safety protocols to protect all of our patients” during the pandemic, said hospital spokesperson Corey Santoriello, who would not comment on Moore’s case, citing privacy laws. Moore was airlifted to another hospital, where her condition only declined further, her daughter said. After the ventilator was removed, she clung to life fitfully for 5½ hours, as her daughter prayed for her mother to find her way to heaven. “I asked her mom and her dad and her family and prayed to God, ‘Please just come show her the way,’” Tavolazzi said. “I relive it every day.” When Tavolazzi sought answers from the hospital about where her mom got the virus, she said, she got none: “No one ever called me back.” Two Negative COVID Tests, Then ‘Patient Zero’ As the second surge of COVID subsided last September, doctors from the prestigious Brigham and Women’s Hospital published a reassuring study: With careful infection control, only two of 697 COVID patients acquired the virus within the Boston hospital. That is about 0.3% of patients - about six times lower than the overall Medicare rate. Brigham tested every patient it admitted, exceeding CDC recommendations. It was transparent and open about safety concerns. But the study, published in the high-profile JAMA Network Open journal, conveyed the wrong message, according to Dr. Manoj Jain, an infectious-disease physician and adjunct professor at the Rollins School of Public Health at Emory University. COVID was spreading in hospitals, he said, and the study buried “the problem under the rug.” Before the virtual ink on the study was dry, the virus began a stealthy streak through the elite hospital. It slipped in with a patient who tested negative twice - but turned out to be positive. She was “patient zero” in an outbreak affecting 38 staffers and 14 patients, according to a study in Annals of Internal Medicine initially published Feb. 9. That study’s authors sequenced the genome of the virus to confirm which cases were related - and precisely how it traveled through the hospital. As patients were moved from room to room in the early days of the outbreak, COVID spread among roommates 8 out of 9 times, likely through aerosol transmission, the study says. A survey of staff members revealed that those caring for coughing patients were more likely to get sick. The virus also appeared to have breached the CDC-OK’d protective gear. Two staff members who had close patient contact while wearing a surgical mask and face shield still wound up infected. The findings suggested that more-protective N95 respirators could help safeguard staff. Brigham and Women’s now tests every patient upon admission and again soon after. Nurses are encouraged to test again if they see a subtle sign of COVID, said Dr. Erica Shenoy, associate chief of the Infection Control Unit at Massachusetts General Hospital, who helped craft policy at Brigham. She said nurses and environmental services workers are at the table for policymaking: “I personally make it a point to say, ‘Tell me what you’re thinking,’” Shenoy said. “'There’s no retribution because we need to know.’” CDC guidelines, though, left wide latitude on protective gear and testing. To this day, Shenoy said, hospitals employ a wide range of policies. The CDC said in a statement that its guidelines “provide a comprehensive and layered approach to preventing transmission of SARS-CoV-2 in healthcare settings,” and include testing patients with “even mild symptoms” or recent exposure to someone with COVID. Infection control policies are rarely apparent to patients or visitors, beyond whether they’re asked to wear a mask. But reviews of public records and interviews with more than a dozen people show that at hospitals with high rates of COVID spread, staff members were often alarmed by the lack of safety practices. Nurses Sound the Alarm on COVID Spread As COVID crept into Florida in spring 2020, nurse Victoria Holland clashed with managers at Blake Medical Center in Bradenton, where Steven Johnson died. She said managers suspended her early in the pandemic after taking part in a protest and “having a hissy fit” when she was denied a new N95 respirator before an “aerosol-generating” procedure. The CDC warns that such procedures can spread the virus through the air. Before the pandemic, nurses were trained to dispose of an N95 after each patient encounter. When the suspension was over, Holland said, she felt unsafe. “They told us nothing,” she said. “It was all a little whisper between the doctors. You had potential COVIDs and you’d get a little surgical mask because [they didn’t] want to waste” an N95 unless they knew the patient was positive. Holland said she quit in mid-April. Her nursing colleagues lodged a complaint with the Occupational Safety and Health Administration in late June alleging that staff “working around possible COVID-19 positive cases” had been denied PPE. Staff members protested outside the hospital in July and filed another OSHA complaint that said the hospital was allowing COVID-exposed employees to keep working. Kirkland, the Blake spokesperson, said the hospital responded to OSHA and “no deficiencies were identified.” The Medicare analysis shows that 22 of 273 patients with COVID, or 8%, were diagnosed with the virus after they were admitted to Blake. That’s about five times as high as the national average. Kirkland said “there is no standard way for measuring COVID-19 hospital-associated transmissions” and “there is no evidence to suggest the risk of transmission at Blake Medical Center is different than what you would find at other hospitals.” In Washington, D.C., 34 Medicare COVID patients contracted the virus at MedStar Washington Hospital Center, or nearly 6% of its total, the analysis shows. Unhappy with the safety practices - which included gas sterilization and reuse of N95s — National Nurses United members protested on the hospital lawn in July 2020. At the protest, nurse Zoe Bendixen said one nurse had died of the virus and 50 had gotten sick: “[Nurses] can become a source for spreading the disease to other patients, co-workers and family members.” Nurse Yuhana Gidey said she caught COVID after treating a patient who turned out to be infected. Another nurse - not managers doing contact tracing - told her she’d been exposed, she said. Nurse Kimberly Walsh said in an interview there was an outbreak in a geriatric unit where she worked in September 2020. She said management blamed nurses for bringing the virus into the unit. But Walsh pointed to another problem: The hospital wasn’t COVID-testing patients coming in from nursing homes, where spread was rampant last year. MedStar declined a request for an interview about its infection control practices and did not respond to specific questions. While hospitals must track and publicly report rates of persistent infections like C. diff, antibiotic-resistant staph and surgical site infections, similar hospital-acquired COVID rates are not reported. KHN examined a different source of data that Congress required hospitals to document about “hospital-acquired conditions.” The Medicare data, which notes whether each COVID case was “present on admission” or not, becomes available months after a hospitalization in obscure files that require a data-use agreement typically granted to researchers. KHN counted cases, as federal officials do, in some instances in which the documentation is deemed insufficient to categorize a case (see data methodology, below). For this data, whether to deem a COVID case hospital-acquired lies with medical coders who review doctors’ notes and discharge summaries and ask doctors questions if the status is unclear, said Sue Bowman, senior director of coding policy and compliance at American Health Information Management Association. She said medical coders are aware that the data is used for hospital quality measures and would be careful to review the contract tracing or other information in the medical record. If a case was in the data KHN used, “that would mean it was acquired during the hospital stay either from a health care worker or another patient or maybe if a hospital allowed visitors, from a visitor,” Bowman said. “That would be a fair interpretation of the data.” The high death rate for those diagnosed with COVID during a hospital stay — about 21% — mirrors the death rate for other Medicare COVID patients last year, when doctors had few proven methods to help patients. It also highlights the hazard unvaccinated staffers pose to patients, said Jain, the infectious-disease doctor. The American Hospital Association estimates that about 42% of U.S. hospitals have mandated that all staff members be vaccinated. “We don’t need [unvaccinated staff] to be a threat to patients,” Jain said. “[Hospital] administration is too afraid to push the nursing staff, and the general public is clueless at what a threat a non-vaccinated person poses to a vulnerable population.” Cindy Johnson said the hospital where she believes her husband contracted COVID faced minimal scrutiny in a state inspection, even after she said she reported that he caught COVID there. She explored suing, but an attorney told her it would be nearly impossible to win such a case. A 2021 state law requires proof of “at least gross negligence” to prevail in court. Johnson did ask a doctor who sees patients at the hospital for this: Please take down the big “OPEN & SAFE” sign outside. Within days, the sign was gone. KHN Midwest correspondent Lauren Weber contributed to this report. Methodology KHN requested custom analyses of Medicare, California and Florida inpatient hospital data to examine the number of COVID-19 cases diagnosed after a patient’s admission. The Medicare and Medicare Advantage data, which includes patients who are mostly 65 or older, is from the Medicare Provider Analysis and Review (MedPAR) file and was analyzed by CDIMD, a Nashville-based medical code consulting and data analytics firm. The data is from April 1 through Sept. 30, 2020. The data for the fourth quarter of 2020 is not yet available. That data shows the number of inpatient Medicare hospital stays in the U.S., including the number of people diagnosed with COVID and the number of admissions for which the COVID diagnosis was not “present on admission.” A condition not “present on admission” is presumed to be hospital-acquired. The data is for general acute-care hospitals, which may include a psychiatric floor, and not for other hospitals such as Veterans Affairs or stand-alone psychiatric hospitals. KHN requested a similar analysis from California’s Department of Health Care Access and Information of its hospital inpatient data. That data was from April 1 through Dec. 31, 2020, and covered patients of all ages and payer types and in general, private psychiatric and long-term acute-care hospitals. Etienne Pracht, a University of South Florida researcher, provided the number of Florida COVID patients who did not have the virus upon hospital admission for all ages at general and psychiatric hospitals from April 1 through Dec. 31, 2020. KHN subtracted the number of Medicare patients in the MedPAR data from the Florida and California all-payer datasets so they would not be counted twice. To calculate the rate of Medicare patients who got COVID or died, KHN relied on the MedPAR data for April through September. That data includes records for 6,629 seniors, 1,409 of whom, or 21%, died. California data for all ages and payer types from April through December shows a similar rate: Of 2,115 who contracted COVID after hospital admission, 435, or 21%, died. The MedPAR data was also used to calculate the national nosocomial COVID rate of 1.7%, with 6,629 of 394,939 covid patients diagnosed with the virus that was deemed not present on admission. Data on whether an inpatient hospital diagnosis was present on admission is used by Medicare for payment determinations and is intended to incentivize hospitals to prevent infections acquired during hospital care. It is also used by the U.S. Agency for Healthcare Research and Quality to “assist in identifying quality of care issues.” Whether COVID is acquired in a hospital or in the community is measured in different ways. Some nations assume the virus is hospital-acquired if it is diagnosed seven or more days after admission, while statewide U.S. data counts cases only after 14 days. Medical coders who examine medical records for this inpatient billing data focus on the physician’s admission, progress and discharge notes to determine whether COVID was present on admission. They do not have a set number of days they look for and are trained to query physicians if the case is unclear, according to Sue Bowman, senior director of coding policy and compliance at the American Health Information Management Association. KHN tallied the cases in which COVID was logged in the data as not “present on admission” to the hospital. Some COVID cases are coded as “U” for having insufficient documentation to make a determination. Since Medicare and AHRQ consider the “U” to be an “N” (or not present on admission) for the purposes of payment decisions and quality indicators, KHN chose to count those cases in the grand total. In 409 of 6,629 Medicare cases and in 70 of 2,185 California cases, the “present on admission” indicator was “U.” The Florida data did not include patients whose “present on admission” indicator was “U.” Medical coders have another code, “W,” for “clinically undetermined” cases, which consider a condition present on admission for billing or quality measures. Medical coders use the “U” (leaning toward “not present on admission”) and “W” (leaning toward “present on admission”) when there is some uncertainty about the case. The Medicare MedPAR data includes about 2,500 U.S. hospitals that had at least a dozen COVID cases from April through September 2020. Of those, 1,070 reported no cases of hospital-acquired COVID in the Medicare records. Data was suppressed for privacy reasons for about 1,300 hospitals that had between one and 11 hospital-acquired COVID cases. There were 126 hospitals reporting 12 or more cases of COVID that were not present on admission or unknown. For those, we divided the number of hospital-acquired cases by the total number of patients with covid to arrive at the rate of hospital-acquired cases, as is standard in health care. KHN (Kaiser Health News) is a national
newsroom that produces in-depth journalism about health
issues. Together with Policy Analysis and Polling, KHN is
one of the three major operating programs at KFF (Kaiser
Family Foundation). KFF is an endowed nonprofit organization
providing information on health issues to the nation. Misinformation
about children and masks abounds. Know the facts. -
Education Week 8/29/21 What else you need to know: For schools, the American Academy of Pediatrics says "universal masking is the best and most effective strategy to create consistent messages, expectations, enforcement, and compliance without the added burden of needing to monitor vaccination status." Masks will also help schools avoid outbreaks of other respiratory illnesses in the upcoming cold and flu seasons. Try this: Each school community has its own attitudes and beliefs about the pandemic, but as leaders, you can be trusted and consistent messengers for science and public health best practices. Still, you may find yourself in the middle of a firestorm over masks and dealing with misinformation about them. Here's a list of talking points to turn to when challenged about the effectiveness and viability of universal masking.
Go deeper: The large-scale quarantines and whole-school or district shutdowns we've seen in the first few weeks of the year are most prevalent in communities where masks are not required. Outside widespread vaccination, masks are the best protection and assurance of a more normal school year. Another reason to mask up. Insurance providers are threatening to drop districts that don't follow public health mandates, such as state masking requirements. A district could be on the hook if a parent claims in court that their child got sick because administrators failed to follow health rules. Don't forget the other
vaccines. The typical childhood vaccines may not be top
of mind right now, but schools can't lose sight of them.
EdWeek's research and science reporter Sarah Sparks explains
that the virus
that causes COVID-19 is not as contagious as
chickenpox, not even Delta.
The estimated R-0 (the number of people on average a sick
person will infect) for Delta is 5-7. Chickenpox's R-0 is
10-12. Whooping cough is 15-17, and measles is 16-18. Children’s
hospitals around the country are experiencing a surge in
Covid-19 patients While children under 12 may have to
wait until
the end of the year to get
vaccinated, a new study by the C.D.C. is bound to fuel
debate about vaccine mandates for teachers and staff members
in schools. The report found that an unvaccinated
schoolteacher infected with Delta had spread
the virus to half of the students in a
classroom. Florida offers
a cautionary tale for dealing with the Delta variant While leaders in Florida refused
lockdowns and mask orders, they
made it a priority to vaccinate vulnerable older
people. But it wasn’t
enough — Florida has so many older people that even
vaccinating a vast majority of them left more than 800,000
unprotected. Vaccination rates among younger people were
uneven, so clusters of people remained at risk. Now, cases
in Florida are reaching
their highest peak of the pandemic. Omicron lasts
longer on surfaces and skin than previous variants:
studies The omicron variant of the SARS-CoV-2 coronavirus was responsible for a wave of cases in the U.S. and many countries around the world. Although health experts are mainly concerned about transmission through the air, understanding how long the virus can stay intact on surfaces can be helpful. Recent studies have found that the omicron variant lasts longer on surfaces and human skin than any previous variant. Health experts have agreed that the SARS-CoV-2 coronavirus causing COVID-19 is mostly transmitted through the air. However, there were concerns, especially early in the pandemic, about it getting transferred by touching surfaces containing the virus. Researchers have continued to investigate this line of inquiry to get a more complete understanding of how the virus spreads and exists in the environment. In two recent studies, teams of researchers found that the omicron variant lasted longer on surfaces and on human skin compared to other variants. The studies test omicron and previous variants on surfaces people would find in their daily lives, and one of the studies tests it on human skin samples. Both are available as pre-prints, meaning that they have yet to go through the peer-review process to be published in an academic journal. In the first study, researchers obtained human skin samples from autopsy specimens for the experiment. They also used plastic as another test surface. Virus survival time was calculated as time when they were no longer able to detect virus in the samples placed on the surfaces. The original SARS-CoV-2 strain found in Wuhan lasted 56 hours on the plastic surface. Later variants alpha, beta, gamma and delta lasted for about 191, 157, 59 and 114 hours, respectively. The omicron variant lasted 193.5 hours. On human skin, the original coronavirus lasted 8.6 hours. The later variants ranged from 11 to 19.6 hours, and omicron lasted for 21.1 hours on human skin. Our country is in a historic fight against the coronavirus. Add Changing America to your Facebook or Twitter feed to stay on top of the news. In the second study, researchers compared how long original SARS-CoV-2 and the omicron variant survived on smooth versus porous surfaces like stainless steel, polypropylene sheet, glass, facial tissue paper and printing paper. This study did not include other variants like delta in the experiments. They found that omicron was overall more stable than the original strain on all surfaces. After two days, most of the original strain was gone from the stainless steel, polypropylene sheet and glass. After four days, virus was found only on the glass surface. For the omicron variant, the researchers could recover virus from the surfaces seven days later. On the porous surfaces, the original coronavirus could not be recovered from facial tissue after 30 minutes. On printing paper, the amount of virus detected after 5 minutes was reduced by 99.68 percent and no virus could be retrieved after 15 minutes. The omicron variant could be detected on facial tissue paper and on printer paper after 30 minutes. The results from these two studies are in line with previous studies. A paper published in Nature in Jan. 2021 found the coronavirus after 21 days on plastic, 14 days on stainless steel, 7 days on nitrile gloves and 4 days on chemical resistant gloves, although at much lower quantities. More than 95 percent of the virus was gone from the stainless steel surface after 24 hours. It was greatly reduced by the four hour mark on cotton and undetectable after 24 hours. Although it is inappropriate to
directly compare the studies because of differences in how
the experiments were set up, the new studies on omicron may
shed light on how it compares to past variants of the
coronavirus. Because it can stay intact in the soil, on
various materials like plastic and steel, it’s
important to consider how it factors into risk
of infection. A better
understanding of the survival of SARS-CoV-2 and any new
variants in the environment and on surfaces may help in
limiting its spread. Omicron
keeps finding new evolutionary tricks to outsmart our
immunity - 10/25/22 But the World Health Organization hasn't given a SARS-CoV-2 variant a Greek name in almost a year, a move that's reserved for new variants that do or could have significant public health impacts, such as being more transmissible or causing more severe disease. That raises the question: Has the evolution of the virus finally started to ebb, possibly making it more predictable? The answer — according to a dozen evolutionary biologists, virologists and immunologists interviewed by NPR — is no. "SARS-CoV-2 is continuing to evolve extremely rapidly," says Trevor Bedford, a computational biologist who studies the evolution of viruses at the Fred Hutchinson Cancer Center in Seattle. "There's no evidence that the evolution is slowing down." Instead, the most consequential evolutionary changes have stayed confined to the omicron family, rather than appearing in entirely new variants. Whereas alpha, beta, gamma and the other named variants sprouted new branches on the SARS-CoV-2 family tree, those limbs were dwarfed by the omicron bough, which is now studded with a plethora of subvariant stems. "The children of omicron — so the many direct children and cousins within the diverse omicron family — those have displaced each other" as the dominant strains driving the pandemic, says Emma Hodcroft, a molecular epidemiologist at the University of Bern. "But that same family has been dominating" by outcompeting other strains. One variant to rule them all The ever-expanding omicron brood has maintained its dominance through what's known as "convergent" evolution — when entities independently develop similar traits because of similar environmental pressures, according to Manon Ragonnet-Cronin, who studies viral genetics at the University of Chicago. "We seem to be seeing for the first time evidence of widescale convergent evolution," Ragonnet-Cronin says. "We have what people are calling a swarm of omicron viruses, which have different ancestries within omicron, but which have the same set of mutations." Those mutations endow these omicron offspring with the one power they need most right now: the ability to sneak past the immunity that people have built up from getting infected, vaccinated, or both. "When you see convergence in evolution that's evolution's way of saying 'this mutation is repeatedly getting selected over and over again because it's really helpful,'" says Jesse Bloom, a computational biologist at the Fred Hutchinson Cancer Center in Seattle. Those mutations in the virus's spike protein have been increasing its ability to evade protective antibodies and continue infecting massive numbers of people. "This virus is getting a lot of lottery tickets if you will. And it looks like, with these new variants, these new mutations are like the jackpot," says Jeremy Kamil, an immunologist at Louisiana State University. The Centers for Disease Control and Prevention is tracking more than a dozen omicron subvariants right now, including BF.7, BQ.1 and BQ.1.1, some of which appear to be among the most immune-evasive yet. Fortunately, the immunity people have built up from vaccination and infection still appears to be protecting most from serious illness and death. But the newer highly contagious omicron subvariants could help drive yet another surge. They also give the virus many chances to reproduce, mutate and evolve even more. A family tree still full of surprises? While all this sounds dire, omicron's long period of dominance is giving some scientists some hope. The virus could, in one relatively optimistic scenario, keep evolving this way for a long time, drifting in more subtle evolutionary directions like the flu, without sudden shifts in how it behaves that make it more dangerous. "The fact that we've perhaps stepped out of a phase [in the pandemic] where we're getting completely new viruses from different parts of the tree sweeping in and dominating might be a sign that we're moving towards a more kind of stable future for the virus," Hodcroft says. But that would mean large numbers of people would still catch the virus. Many would still get seriously ill, die, or be left with long COVID. And because the virus is still so new, it's impossible to know how the virus might evolve in the future, experts tell NPR. "We are literally dealing with a completely novel virus here," says Kristian Andersen, an immunologist at Scripps Research. "We don't know how many other paths this particular virus might have. We just don't know at this stage." There's no way to rule out, for example, the possibility that a dramatically different variant might emerge yet again, perhaps after simmering inside someone with a compromised immune system that can't drive out the virus. That lets the virus extensively interact with the human immune system and find even more advantageous mutations. "I guarantee you that there are people
who have been persistently infected with delta and alpha who
have some really weird combinations of mutations," says
Michael Worobey, an evolutionary biologist at the University
of Arizona. "And I'm fully prepared for a delta-based or
alpha-based omicron-like event where one of those zombie
viruses that's been cooking away within someone
emerges."
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