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You should hide under your bed till covid is gone...which means FOREVER!
Coronavirus updates August 1, 2021
- Thread starter missy
- Start date
You should hide under your bed till covid is gone...which means FOREVER!
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From one of my physician's regular emails to all her patients.
"
Over the past four weeks, the delta variant has made up 90% of tested Covid cases in NYC. Delta is twice as contagious as regular Covid, so this makes sense. The good news is that the vaccines are holding up well. The delta variant causes more severe disease, but only in unvaccinated people. Close to 100% of deaths and hospitalizations for Covid recently have been among the unvaccinated. A CDC report shows that, since July 26, there have been only 6,587 reports of breakthrough infections that resulted in hospitalization or death among 163 million fully vaccinated people — that’s significantly less than 0.01%.
Breakthrough infections in fully vaccinated people are on the rise, but folks are typically asymptomatic or only mildly symptomatic. I have had many patients with no symptoms at all who tested positive for Covid on random spot checks at work or before travel. I have also had many patients with a mild sore throat or the sniffles who tested positive for Covid. If you are having any symptoms, no matter how mild, please get checked for Covid just in case. No one in our current pandemic situation can determine in the absence of testing that they “only have a cold.”
I ask every patient who enters the office if they have been in contact with anyone with Covid symptoms in the past 2 weeks, or if they themselves have any symptoms. A surprising number of people have answered that they’ve had no symptoms or exposures, but during the course of the appointment they give a cough or sniffle. When I inquire about it they say, “Oh, it’s just a cold. My child had it last week and gave it to me.” I then have to close off all of the spaces that have been occupied by that patient until the air can be cleared and the space can be disinfected. I will not turn you away if you answer “yes” to Covid-exposure questions; we will just relocate to my courtyard or to my new exam room just off the courtyard. I will change into more protective PPE (personal protective equipment) and I will provide you with Covid testing in addition to addressing the reason for which you made the appointment. Please be upfront about any possible Covid symptoms or exposures!
I will repeat for emphasis: No one can determine whether a respiratory illness is an ordinary cold or a mild case of Covid or without PCR testing. I understand that it is hard to comprehend, but the same disease killing millions of people can also manifest as just a minor cold, especially among people who have been vaccinated. No matter how mild it may seem, every respiratory illness must be presumed Covid until proven otherwise with negative PCR testing. The same viral strain that gives one person the sniffles can kill another person if it is allowed to spread.
The CDC also recommends that everyone over age 2 who enters a medical facility should be wearing a properly fitted mask with a wired nose bridge that can conform around the nose. A properly fitted mask protects you and others much more effectively than a loose mask with open gaps. I will be happy to provide patients with 3-ply surgical masks that conform to these standards during their office visit.
Here is information from the CDC on how to properly fit a mask:
https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/mask-fit-and-filtration.html
I have a new favorite mask that you might want to try: https://airqueen.com/
It feels like nothing. I can wear it all day with no issue at all. No discomfort. No mask acne. No glasses fog. It does not get sucked into the mouth with deep inhalation.
There are adult and pediatric models available.
I still wear an N95 or KN95 mask if I am entering a situation with someone who is not vaccinated or whose status I do not know—like the folks in a grocery store. Even if DeBlasio says otherwise, I still recommend that all people continue masking in public indoor spaces and consider masking in crowded public outdoor spaces, given how easily the delta variant spreads.
The “Key To NYC” mandate says that everyone entering restaurants, bars, gyms, and entertainment venues must show proof of at least one vaccine, but they do not have to prove that they are fully vaccinated. Proceed with caution in indoor spaces, especially indoor spaces, like restaurants, where others are unmasked.
Covid Vaccine Boosters
Starting on September 20, booster shots will be available for people who were previously vaccinated with Pfizer or Moderna. The booster shots should be given at least 8 months after the original vaccine course was completed. Booster shots for Pfizer and Moderna are available now for the immunocompromised.
This is the booster announcement recently issued by the CDC:
Currently, CDC is recommending that moderately to severely immunocompromised people receive an additional dose. This includes people who have:
There are no recommendations yet on boosters for the Johnson & Johnson vaccine, but the data are being analyzed and it is expected that a booster of this vaccine will be recommended as well. There are currently no recommendations that those who received the Johnson & Johnson should get a booster of Pfizer or Moderna. Mixing vaccines is actively discouraged by the CDC and FDA, as there have been no safety studies.
Many patients are asking my opinion about booster shots and mixing vaccines because news articles inevitably end with, “Ask your doctor what is right for you as an individual.” I do not know what secret information these news outlets think doctors have access to that is different from what they are reporting. The only information out there is from the CDC and FDA, which both say don’t mix vaccines. But some people, including some researchers, have done it anyway.
Note that patients in NYC are not eligible to obtain Pfizer or Moderna vaccines if they previously received Johnson & Johnson. This rule can be skirted by joining a study or crossing state lines. Other states do not have access to NY vaccine data. If a patient decides to go ahead and obtain an added Pfizer or Moderna shot, covertly and off-label, then both doses are recommended—not just one booster shot.
Here is a Time magazine report on the state of the Johnson & Johnson vaccine, which includes a link to join a study for mixing vaccines:
https://time.com/6078081/mixing-covid-vaccine-doses/
Covid Vaccines for Children
No official announcements have been made on when vaccines will be available for children under the age of 12. The only information I have heard is that it might happen by late fall 2021, and definitely by 2022. The studies seem to be going well, with no major adverse effects or issues by all reports.
"
"
Over the past four weeks, the delta variant has made up 90% of tested Covid cases in NYC. Delta is twice as contagious as regular Covid, so this makes sense. The good news is that the vaccines are holding up well. The delta variant causes more severe disease, but only in unvaccinated people. Close to 100% of deaths and hospitalizations for Covid recently have been among the unvaccinated. A CDC report shows that, since July 26, there have been only 6,587 reports of breakthrough infections that resulted in hospitalization or death among 163 million fully vaccinated people — that’s significantly less than 0.01%.
Breakthrough infections in fully vaccinated people are on the rise, but folks are typically asymptomatic or only mildly symptomatic. I have had many patients with no symptoms at all who tested positive for Covid on random spot checks at work or before travel. I have also had many patients with a mild sore throat or the sniffles who tested positive for Covid. If you are having any symptoms, no matter how mild, please get checked for Covid just in case. No one in our current pandemic situation can determine in the absence of testing that they “only have a cold.”
I ask every patient who enters the office if they have been in contact with anyone with Covid symptoms in the past 2 weeks, or if they themselves have any symptoms. A surprising number of people have answered that they’ve had no symptoms or exposures, but during the course of the appointment they give a cough or sniffle. When I inquire about it they say, “Oh, it’s just a cold. My child had it last week and gave it to me.” I then have to close off all of the spaces that have been occupied by that patient until the air can be cleared and the space can be disinfected. I will not turn you away if you answer “yes” to Covid-exposure questions; we will just relocate to my courtyard or to my new exam room just off the courtyard. I will change into more protective PPE (personal protective equipment) and I will provide you with Covid testing in addition to addressing the reason for which you made the appointment. Please be upfront about any possible Covid symptoms or exposures!
I will repeat for emphasis: No one can determine whether a respiratory illness is an ordinary cold or a mild case of Covid or without PCR testing. I understand that it is hard to comprehend, but the same disease killing millions of people can also manifest as just a minor cold, especially among people who have been vaccinated. No matter how mild it may seem, every respiratory illness must be presumed Covid until proven otherwise with negative PCR testing. The same viral strain that gives one person the sniffles can kill another person if it is allowed to spread.
The CDC also recommends that everyone over age 2 who enters a medical facility should be wearing a properly fitted mask with a wired nose bridge that can conform around the nose. A properly fitted mask protects you and others much more effectively than a loose mask with open gaps. I will be happy to provide patients with 3-ply surgical masks that conform to these standards during their office visit.
Here is information from the CDC on how to properly fit a mask:
https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/mask-fit-and-filtration.html
I have a new favorite mask that you might want to try: https://airqueen.com/
It feels like nothing. I can wear it all day with no issue at all. No discomfort. No mask acne. No glasses fog. It does not get sucked into the mouth with deep inhalation.
There are adult and pediatric models available.
I still wear an N95 or KN95 mask if I am entering a situation with someone who is not vaccinated or whose status I do not know—like the folks in a grocery store. Even if DeBlasio says otherwise, I still recommend that all people continue masking in public indoor spaces and consider masking in crowded public outdoor spaces, given how easily the delta variant spreads.
The “Key To NYC” mandate says that everyone entering restaurants, bars, gyms, and entertainment venues must show proof of at least one vaccine, but they do not have to prove that they are fully vaccinated. Proceed with caution in indoor spaces, especially indoor spaces, like restaurants, where others are unmasked.
Covid Vaccine Boosters
Starting on September 20, booster shots will be available for people who were previously vaccinated with Pfizer or Moderna. The booster shots should be given at least 8 months after the original vaccine course was completed. Booster shots for Pfizer and Moderna are available now for the immunocompromised.
This is the booster announcement recently issued by the CDC:
Currently, CDC is recommending that moderately to severely immunocompromised people receive an additional dose. This includes people who have:
- Been receiving active cancer treatment for tumors or cancers of the blood
- Received an organ transplant and are taking medicine to suppress the immune system
- Received a stem cell transplant within the last 2 years or are taking medicine to suppress the immune system
- Moderate or severe primary immunodeficiency (such as DiGeorge syndrome, Wiskott-Aldrich syndrome)
- Advanced or untreated HIV infection
- Active treatment with high-dose corticosteroids or other drugs that may suppress your immune response
There are no recommendations yet on boosters for the Johnson & Johnson vaccine, but the data are being analyzed and it is expected that a booster of this vaccine will be recommended as well. There are currently no recommendations that those who received the Johnson & Johnson should get a booster of Pfizer or Moderna. Mixing vaccines is actively discouraged by the CDC and FDA, as there have been no safety studies.
Many patients are asking my opinion about booster shots and mixing vaccines because news articles inevitably end with, “Ask your doctor what is right for you as an individual.” I do not know what secret information these news outlets think doctors have access to that is different from what they are reporting. The only information out there is from the CDC and FDA, which both say don’t mix vaccines. But some people, including some researchers, have done it anyway.
Note that patients in NYC are not eligible to obtain Pfizer or Moderna vaccines if they previously received Johnson & Johnson. This rule can be skirted by joining a study or crossing state lines. Other states do not have access to NY vaccine data. If a patient decides to go ahead and obtain an added Pfizer or Moderna shot, covertly and off-label, then both doses are recommended—not just one booster shot.
Here is a Time magazine report on the state of the Johnson & Johnson vaccine, which includes a link to join a study for mixing vaccines:
https://time.com/6078081/mixing-covid-vaccine-doses/
Covid Vaccines for Children
No official announcements have been made on when vaccines will be available for children under the age of 12. The only information I have heard is that it might happen by late fall 2021, and definitely by 2022. The studies seem to be going well, with no major adverse effects or issues by all reports.
"
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I've been looking at this site recently to see statistics, in case anyone wants to check it out. there is also a drop down on the left where you can choose a state.
usafacts.org
US Coronavirus vaccine tracker
Each state has a different plan — and different challenges — in distributing vaccines. Learn more about who is getting vaccinated by parsing the data by age, sex and race.
usafacts.org
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Biden Announces New Actions to Fight COVID
Orders education secretary to take measures against governors who block mask mandates
www.medpagetoday.com
"
WASHINGTON -- President Biden announced several additional actions Wednesday aimed at fighting increasing numbers of COVID-19 cases, largely from the Delta variant of the virus.
"Today, I'm directing the Secretary of Education to take additional steps to protect our children," the president said during an address from the East Room. "This includes using all of his oversight authorities -- and legal action if appropriate -- against governors who are trying to block and intimidate local school officials and educators. As I said before, if you aren't going to fight COVID-19, at least get out of the way of everyone else who's trying." Biden appeared to be referring to governors such as Ron DeSantis (R-Fla.), who has barred local school districts from enforcing mask mandates and threatened to withhold the pay of local school officials who tried to enforce them.
"We're not going to sit by as governors try to block and intimidate educators protecting our children," the president said. "For example, if a governor wants to cut the pay of a hard-working education leader who requires masks in the classroom, the money from the American Rescue Plan can be used to pay that person's salary, 100%." He urged people to "put politics aside; let's follow the educators and the scientists who know a lot more about how to teach our children and keep them safe than any politician. This administration is always going to take the side of our children."
"This isn't about politics, it's about keeping our children safe," said Biden. "I'll stand with those who are trying to do the right thing. Last week I called school superintendents in Florida and Arizona to thank them for doing the right thing and requiring masks in their school. One of them said, 'We teach science, so we follow the science.' The other said, 'We have a guiding principle: students first.' I couldn't agree more with what they both said."
In addition, "to work in a nursing home, and serve people on Medicare or Medicaid, you will also be required to get vaccinated," said Biden. "More than 130,000 residents in nursing homes have sadly, sadly, over the period of this virus, passed away. At the same time, vaccination rates among nursing home staff significantly trail the rest of the country. Studies show that [having] highly vaccinated nursing home staff is associated with at least 30% less COVID-19 cases among long-term care residents. With this announcement, we're using the power of the federal government, as a payer of healthcare costs. We should reduce those risks to our most vulnerable seniors."
The president also reminded the audience that "yesterday, I instructed the Federal Emergency Management Agency to extend full reimbursement through the end of the year to state deployments of National Guard in support of COVID-19 response. Nearly 18,000 National Guard members are supporting our response nationwide from caring for patients to administering vaccines to running testing sites to distributing supplies." This action will help states "shore up their budgets, meet the needs of their communities, and continue on our economic recovery," he added.
Earlier Wednesday, members of the White House COVID-19 Response Team announced that the Biden administration will be making booster shots available to recipients of either the Moderna or Pfizer vaccines; shots will be given 8 months after the second vaccine has been administered, starting on September 20. The move is pending approval by the FDA and by the CDC's Advisory Committee on Immunization Practices.
"These booster shots are free," he emphasized. "You will be able to get the booster shots at any one of approximately 80,000 vaccination locations nationwide. It will be easy: show your vaccination card and you'll get a booster. No other ID, no insurance, no state registry requirement."
"My administration has been planning for this possibility in this scenario for months," Biden said. "We purchased enough vaccines and vaccine supplies so that when your 8-month mark comes up, you'll be ready to get your vaccination." Addressing recent remarks by WHO Director General Tedros Adhanom Ghebreyesus, he said, "I know there are some world leaders who say Americans shouldn't get a third shot until other countries got their first shot. I disagree. We can take care of America and help the world at the same time."
Biden noted that during June and July, while 50 million vaccines were administered in the U.S., "we donated 100 million shots to other countries. That means that America has donated more vaccine to other countries than every other country in the world combined. During the coming months, fall and early winter ... the United States will donate more than 200 million additional doses to other countries, to keep us on our way to meeting our pledge of more than 600 million vaccine donations -- over half a billion."
The president also praised elected officials who have instituted vaccination requirements for some retail establishments and state employees, including governors and mayors in California, Maryland, Massachusetts, New York, Oregon, and Washington. "Vaccination requirements have been around for decades," he said. "Students, healthcare professionals, and our troops are typically required to receive vaccines to prevent everything from polio to smallpox and measles, mumps, and rubella. In fact, the reason most people in America don't worry about polio, smallpox, measles, mumps, or rubella today is because of vaccines. It only makes sense to require a vaccine that stops the spread of COVID-19."
Biden ended his speech on an optimistic note. "We can do this," he said. "All those of you who are unvaccinated, please get vaccinated -- for yourself and for your loved ones, your neighborhood, for your community. To the rest of America, this is no time to let our guard down. We just need to finish the job with science, with facts, and with confidence."
"
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Good for him!
www.medpagetoday.com
As healthcare providers and public health experts struggle with how to get more people vaccinated against COVID-19, one doctor in Alabama is taking a different approach.
Jason Valentine, MD, a family medicine physician at Mobile's Infirmary Health Diagnostic and Medical Clinic, announced in a Facebook post that he would no longer see patients who are not vaccinated against COVID, AL.com reported.
Valentine's post -- which could no longer be viewed as of Wednesday afternoon -- included a picture of him standing next to a sign that said his new requirement would take effect October 1, according to AL.com. Since posting the message, three unvaccinated patients have asked him where they could receive the vaccine, Valentine said.
About his patients inquiring about his decision, Valentine said, "I told them COVID is a miserable way to die and I can't watch them die like that," AL.com reported.
The doctor further posted a copy of a letter that he said he was in the process of mailing to his patients. According to AL.com, the letter, detailing his decision, read in part: "We do not yet have any great treatments for severe disease, but we do have great prevention with vaccines. Unfortunately, many have declined to take the vaccine, and some end up severely ill or dead. I cannot and will not force anyone to take the vaccine, but I also cannot continue to watch my patients suffer and die from an eminently preventable disease." The letter added that records for patients opting for another provider would be transferred.
Only about 36% of Alabama's population is fully vaccinated against COVID, according to the latest data from the CDC. The state remains among those with the lowest overall vaccination rates in the nation.
Currently, all but one county in Alabama is categorized as an area of high transmission, according to the state's Department of Health. The state clocked more than 2,600 new cases Monday, and nearly 1,900 on Tuesday. The number of hospitalized patients has continued to climb since the end of June. It now tops 2,700, and is approaching the state's previous peak of more than 3,000 in January.
On Tuesday, Infirmary Health tweeted that they currently had 316 COVID inpatients in its hospitals, noting that 84% of these patients were unvaccinated.
Earlier in the week, Don Williamson, MD, the former state health officer who now heads the Alabama Hospital Association, said that the state had 1,562 ICU beds and 1,560 hospitalized patients needing intensive care, the AP reported. COVID patients accounted for nearly half of the state's ICU patients, Williamson noted, adding that the vast majority of hospitalized COVID patients were unvaccinated.
It remains to be seen whether other physicians will be taking a similar approach to Valentine's post. Neither Valentine nor Infirmary Health immediately responded to a request for comment.
Alabama Doc Puts His Foot Down on the Unvaccinated
Jason Valentine hopes to reach those unwilling to get the COVID vaccine by turning them away
www.medpagetoday.com
As healthcare providers and public health experts struggle with how to get more people vaccinated against COVID-19, one doctor in Alabama is taking a different approach.
Jason Valentine, MD, a family medicine physician at Mobile's Infirmary Health Diagnostic and Medical Clinic, announced in a Facebook post that he would no longer see patients who are not vaccinated against COVID, AL.com reported.
Valentine's post -- which could no longer be viewed as of Wednesday afternoon -- included a picture of him standing next to a sign that said his new requirement would take effect October 1, according to AL.com. Since posting the message, three unvaccinated patients have asked him where they could receive the vaccine, Valentine said.
About his patients inquiring about his decision, Valentine said, "I told them COVID is a miserable way to die and I can't watch them die like that," AL.com reported.
The doctor further posted a copy of a letter that he said he was in the process of mailing to his patients. According to AL.com, the letter, detailing his decision, read in part: "We do not yet have any great treatments for severe disease, but we do have great prevention with vaccines. Unfortunately, many have declined to take the vaccine, and some end up severely ill or dead. I cannot and will not force anyone to take the vaccine, but I also cannot continue to watch my patients suffer and die from an eminently preventable disease." The letter added that records for patients opting for another provider would be transferred.
Only about 36% of Alabama's population is fully vaccinated against COVID, according to the latest data from the CDC. The state remains among those with the lowest overall vaccination rates in the nation.
Currently, all but one county in Alabama is categorized as an area of high transmission, according to the state's Department of Health. The state clocked more than 2,600 new cases Monday, and nearly 1,900 on Tuesday. The number of hospitalized patients has continued to climb since the end of June. It now tops 2,700, and is approaching the state's previous peak of more than 3,000 in January.
On Tuesday, Infirmary Health tweeted that they currently had 316 COVID inpatients in its hospitals, noting that 84% of these patients were unvaccinated.
Earlier in the week, Don Williamson, MD, the former state health officer who now heads the Alabama Hospital Association, said that the state had 1,562 ICU beds and 1,560 hospitalized patients needing intensive care, the AP reported. COVID patients accounted for nearly half of the state's ICU patients, Williamson noted, adding that the vast majority of hospitalized COVID patients were unvaccinated.
It remains to be seen whether other physicians will be taking a similar approach to Valentine's post. Neither Valentine nor Infirmary Health immediately responded to a request for comment.
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- Messages
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Highly-vaccinated Israel is besieged by another wave of SARS-CoV-2 infectionsafter relaxing restrictions in June. (New York Times)
CDC is creating a new forecasting and outbreak analytics center in response to criticisms that the agency doesn't share data quickly enough. (Washington Post)
As of Thursday at 8:00 a.m. EDT, the unofficial COVID-19 toll was 37,158,309 cases and 624,260 deaths, increases of 137,758 and 931, respectively, versus this time a day ago.
Australia's two most populous states broke records for new SARS-CoV-2 infections. (AP)
Google, Apple, and Samsung are working on a way to make vaccine records accessible through digital wallets. (NBC News)
To get around the Texas ban on mask mandates, one school district is working masks into the dress code. (NPR)
The Miami-Dade school district is openly flouting Florida's ban on mask mandates. (Reuters)
COVID vaccines are supposed to be free of charge to patients, but surprise bills are appearing nonetheless. (Philadelphia Inquirer)
Neurological problems are emerging for people who initially had mild COVID-19 illness. (National Geographic)
California is requiring proof of vaccination or negative COVID tests for attendance at large events until at least November.
Researchers estimate that the vaccines had prevented 139,393 coronavirus deathsby May 9. (Health Affairs)
U.S. intelligence offers and diplomats stationed in Germany are among those affected by Havana Syndrome. (Wall Street Journal)
CDC is creating a new forecasting and outbreak analytics center in response to criticisms that the agency doesn't share data quickly enough. (Washington Post)
As of Thursday at 8:00 a.m. EDT, the unofficial COVID-19 toll was 37,158,309 cases and 624,260 deaths, increases of 137,758 and 931, respectively, versus this time a day ago.
Australia's two most populous states broke records for new SARS-CoV-2 infections. (AP)
Google, Apple, and Samsung are working on a way to make vaccine records accessible through digital wallets. (NBC News)
To get around the Texas ban on mask mandates, one school district is working masks into the dress code. (NPR)
The Miami-Dade school district is openly flouting Florida's ban on mask mandates. (Reuters)
COVID vaccines are supposed to be free of charge to patients, but surprise bills are appearing nonetheless. (Philadelphia Inquirer)
Neurological problems are emerging for people who initially had mild COVID-19 illness. (National Geographic)
California is requiring proof of vaccination or negative COVID tests for attendance at large events until at least November.
Researchers estimate that the vaccines had prevented 139,393 coronavirus deathsby May 9. (Health Affairs)
U.S. intelligence offers and diplomats stationed in Germany are among those affected by Havana Syndrome. (Wall Street Journal)
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- Sep 17, 2008
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Palm Beach County has also made optional masking mandatory, no exceptions. https://cbs12.com/news/local/well-n...during-palm-beach-county-school-board-meeting
Our Governor has also said that if a child has coronavirus and is asymptomatic (i.e, shows no symptoms) or, has been near a child with coronavirus, whats the harm in them going to school. Thats like saying whats the harm of them coming into your house dipsh*t.
Over150 900 kids are out of school and climbing in our county, and they are planning on turning on the cameras so these kids don't miss out on school.
They're also going to be punished for it but I hope they don't back down, too much is at stake.
Our Governor has also said that if a child has coronavirus and is asymptomatic (i.e, shows no symptoms) or, has been near a child with coronavirus, whats the harm in them going to school. Thats like saying whats the harm of them coming into your house dipsh*t.
Over
They're also going to be punished for it but I hope they don't back down, too much is at stake.
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MamaBee
Super_Ideal_Rock
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This is a great letter. I love my doctor but wish she would have written a letter to us like this.
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@MamaBee , It was announced yesterday that nursing homes who receive any Federal funding will be requiring all staff to be vaccinated. I’m hoping this applies to the nursing home your mom is at.
MamaBee
Super_Ideal_Rock
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Yes @Calliecake! I think it does! I told my mom that there may be a drove of people quitting. I’m hoping that they reconsider. Thanks for remembering about my mom.
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I’m hoping there isn’t a mass exit @MamaBee . I would imagine before too long vaccines will be requirements for employment at many places, not just hospitals and nursing homes. It makes no sense that those treating sick people or working with the elderly should be able to do so while being unvaccinated.
MamaBee
Super_Ideal_Rock
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I agree @Calliecake I asked my mom to ask anyone that comes into her room if they are vaccinated. She said an occupational therapist that worked closely with her is unvaccinated. One nurse said she was afraid to get the vaccine..My mom asked her if she was afraid to get Covid. She said yes…
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I agree @Calliecake I asked my mom to ask anyone that comes into her room if they are vaccinated. She said an occupational therapist that worked closely with her is unvaccinated. One nurse said she was afraid to get the vaccine..My mom asked her if she was afraid to get Covid. She said yes…
Is there a way you can keep this occupational therapist away from your mom and request someone else treat her?
My dad‘s wife is a home healthcare nurse. She just got her first shot of the vaccine about a week ago and has been taking care of patients in their homes for months. It’s insane.
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Vax Campaign Averted Nearly 140,000 US Deaths Through May: Study
But researchers at RAND, Indiana University admit it's difficult to establish causality between vaccination rate and mortality rate in individual states.
www.medscape.com
"
From mid-December 2020 through early May 2021, there were 139,393 fewer deaths from COVID-19 and about 3.1 million fewer confirmed cases in the United States than would have been expected without the COVID-19 vaccination campaign, finds a new report published online today in Health Affairs.
New York had 11.7 fewer COVID-19 deaths per 10,000 adults and Hawaii had 1.1 fewer deaths per 10,000 than would have occurred without vaccinations, the study shows. The rest of the states fell somewhere in between, with the average state experiencing five fewer COVID-19 deaths per 10,000 adults.
At a national level, this means that instead of the 550,000 COVID-19 deaths that occurred by early May, there would have been 709,000 deaths in the absence of a vaccination campaign, according to the study.
Researchers from RAND and Indiana University created models to estimate the number of COVID-19 deaths that would have happened without vaccinations. The difference between the actual number of deaths and those estimates provides a measure of the number of COVID-19 deaths averted by the vaccination campaign.
Information about vaccine doses administered in each state came from the Bloomberg COVID-19 Vaccine Tracker, and data on COVID-19 deaths for each state came from The New York Times' Coronavirus (COVID-19) Data in the United States database.
The study spanned the period from December 21, 2020 to May 9, 2021. The US Food and Drug Administration issued its first emergency use authorization (EUA) for a COVID-19 vaccine to Pfizer/BioNTech on December 11, followed by an EUA for the Moderna vaccine on December 18 and one for Johnson & Johnson's vaccine on February 27, 2021.
Varied by State
There were wide variations in the speed and extent of the vaccination campaigns in various states, the researchers found. For example, West Virginia was the first state to reach 10 doses per 100 adults, reaching that goal on January 16, 2021, and Idaho was the last state to hit that mark, on February 4, 2021. Alaska was the first to reach 20 doses per 100 adults, on January 29, and Alabama was the last to do it, on February 21.On May 6, California was the first state to administer 120 doses per 100 adults, but many states have still not reached that milestone.
The median number of days between the milestones of 10 and 20 doses per 100 adults was 19 days, and the median number of days between 20 and 40 doses per 100 adults was 24 days.
Hard to Establish Causality
The researchers emphasized that "establishment of causality is challenging" in comparing individual states' vaccination levels with their COVID-19 mortality rates.Aside from the study being observational, they pointed out, the analysis "relied on variation in the administration of COVID-19 vaccines across states…Vaccine administration patterns may be associated with declining mortality because of vaccine prevention of deaths and severe complications as state-level vaccine campaigns allocated initial doses to the highest-risk populations with the aim of immediately reducing COVID-19 deaths."
Nevertheless, the authors note, "clinical trial evidence has shown that COVID-19 vaccines have high efficacy. Our study provides support for policies that further expand vaccine administration, which will enable larger populations to benefit."
Study Confirms Vaccine Benefit
Aaron Glatt, MD, chair of medicine at Mount Sinai South Nassau in Oceanside, New York, and a spokesman for the Infectious Disease Society of America, told Medscape Medical News that the study is important because it confirms the benefit of COVID-19 vaccination.Regardless of whether the study's results are statistically valid, he said, "I don't think anyone can argue the benefit isn't there. It's a question of how important the benefit is."
Glatt is not surprised that there are variations across states in the number of COVID-19 deaths averted through vaccination. "Clearly, in states where there was a lot of disease, a significant amount of vaccination is going to impact that tremendously."
The authors note their paper has some limitations. For one thing, they couldn't determine what share of the estimated reduction in COVID-19 deaths was a result of the proportion of the population that was vaccinated or had antibodies and what share was a result of lower population-level risk for COVID-19 transmission.
Vaccination vs Natural Immunity
In addition, the researchers weren't able to identify the roles of vaccination, natural immunity, and changes in mobility in the numbers of COVID-19 deaths.Glatt says that's understandable, since this was a retrospective study and the researchers didn't know how many people had been infected with COVID-19 at some point. Moreover, he adds, scientists don't know how strong natural immunity from prior infection is, how long it endures, or how robust it is against new variants.
"It's clear to me that there's a benefit in preventing the second episode of COVID in people who had a first episode of COVID," he said. "What we don't know is how much that benefit is and how long it will last."
The researchers also didn't know how many people had gotten both doses of the Pfizer or the Moderna vaccine, and how many of them had received only one. This is an important piece of information, Glatt said, but the lack of it doesn't impair the study's overall finding.
"Every vaccine potentially prevents death," he stressed. "The more we vaccinate, the more deaths we'll prevent. We're starting to see increased vaccinations again. There were a million of them yesterday. So people are recognizing that COVID hasn't gone away, and we need to vaccinate more people. The benefit from the vaccination hasn't decreased. The more we vaccinate, the more the benefit will be."
Health Affairs. Published online August 18, 2021.
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Booster shots in USA starting September.
Booster shots to ramp up protection against COVID-19 infection are slated to begin the week of Sept. 20, the Biden administration announced at a press briefing Wednesday.
Those who received the Pfizer-BioNTech and Moderna vaccines would be eligible to get a booster shot 8 months after they received the second dose of those vaccines, officials said. Information on boosters for those who got the one-dose Johnson & Johnson vaccine will be forthcoming.
"We anticipate a booster will [also] likely be needed," said U.S. Surgeon General Vivek Murthy, MD. The J&J vaccine was not available in the U.S. until March, he said, and ''we expect more data on J&J in the coming weeks, so that plan is coming."
The plan for boosters for the two mRNA vaccines is pending the FDA's conducting of an independent review and authorizing the third dose of the Moderna and Pfizer-BioNTech vaccines, as well as an advisory committee of the CDC making the recommendation.
"We know that even highly effective vaccines become less effective over time," Murthy said. "Having reviewed the most current data, it is now our clinical judgment that the time to lay out a plan for the COVID-19 boosters is now."
Research released Wednesday shows waning effectiveness of the two mRNA vaccines.
At the briefing, Murthy and others continually reassured listeners that while effectiveness against infection declines, the vaccines continue to protect against severe infections, hospitalizations, and death.
"If you are fully vaccinated, you still have a high degree of protection against the worst outcomes," Murthy said.
Analysis of nursing home COVID-19 data from the CDC's National Healthcare Safety Network showed a significant decline in the effectiveness of the full mRNA vaccine against lab-confirmed COVID-19 infection, from 74.7% before the Delta variant (March 1-May 9, 2021) to 53% when the Delta variant became predominant in the U.S. The analysis during the Delta dominant period included 85,000 weekly reports from nearly 15,000 facilities.
Another study looked at more than 10 million New York adults who had been fully vaccinated with either the Moderna, Pfizer, or J&J vaccine by July 25. During the period from May 3 to July 25, overall, the age-adjusted vaccine effectiveness against infection decreased from 91.7% to 79.8%.
Vaccine effectiveness against hospitalization remains high, another study found. An analysis of 1,129 patients who had gotten two doses of an mRNA vaccine showed vaccine effectiveness against hospitalization after 24 weeks. It was 86% at weeks 2-12 and 84% at weeks 13-24.
"Antibody levels decline over time," he said, "and higher antibody levels are associated with higher efficacy of the vaccine. Higher levels of antibody may be needed to protect against Delta."
A booster increased antibody levels by ''at least tenfold and possibly more," he said. And higher levels of antibody may be required to protect against Delta. Taken together, he said, the data supports the use of a booster to increase the overall level of protection.
The plan for booster shots is an attempt to stay ahead of the virus, officials stressed
Like others, she also broached the ''moral and ethical argument of giving people third doses, when they're already well protected and while the rest of the world is waiting for their primary immunization."
Swaminathan does see a role for boosters to protect immunocompromisedpeople but noted that ''that's a small number of people." Widespread boosters ''will only lead to more variants, to more escape variants, and perhaps we're heading into more dire situations."
SOURCES:
White House press briefing, Aug. 18, 2021.
Booster shots to ramp up protection against COVID-19 infection are slated to begin the week of Sept. 20, the Biden administration announced at a press briefing Wednesday.
Those who received the Pfizer-BioNTech and Moderna vaccines would be eligible to get a booster shot 8 months after they received the second dose of those vaccines, officials said. Information on boosters for those who got the one-dose Johnson & Johnson vaccine will be forthcoming.
"We anticipate a booster will [also] likely be needed," said U.S. Surgeon General Vivek Murthy, MD. The J&J vaccine was not available in the U.S. until March, he said, and ''we expect more data on J&J in the coming weeks, so that plan is coming."
The plan for boosters for the two mRNA vaccines is pending the FDA's conducting of an independent review and authorizing the third dose of the Moderna and Pfizer-BioNTech vaccines, as well as an advisory committee of the CDC making the recommendation.
"We know that even highly effective vaccines become less effective over time," Murthy said. "Having reviewed the most current data, it is now our clinical judgment that the time to lay out a plan for the COVID-19 boosters is now."
Research released Wednesday shows waning effectiveness of the two mRNA vaccines.
At the briefing, Murthy and others continually reassured listeners that while effectiveness against infection declines, the vaccines continue to protect against severe infections, hospitalizations, and death.
"If you are fully vaccinated, you still have a high degree of protection against the worst outcomes," Murthy said.
Data Driving the Plan
CDC Director Rochelle Walensky, MD, cited three research studies published today in the CDC's Morbidity and Mortality Weekly Report that helped to drive the decision to recommend boosters.Analysis of nursing home COVID-19 data from the CDC's National Healthcare Safety Network showed a significant decline in the effectiveness of the full mRNA vaccine against lab-confirmed COVID-19 infection, from 74.7% before the Delta variant (March 1-May 9, 2021) to 53% when the Delta variant became predominant in the U.S. The analysis during the Delta dominant period included 85,000 weekly reports from nearly 15,000 facilities.
Another study looked at more than 10 million New York adults who had been fully vaccinated with either the Moderna, Pfizer, or J&J vaccine by July 25. During the period from May 3 to July 25, overall, the age-adjusted vaccine effectiveness against infection decreased from 91.7% to 79.8%.
Vaccine effectiveness against hospitalization remains high, another study found. An analysis of 1,129 patients who had gotten two doses of an mRNA vaccine showed vaccine effectiveness against hospitalization after 24 weeks. It was 86% at weeks 2-12 and 84% at weeks 13-24.
Immunologic Facts
Immunologic information also points to the need for a booster, said Anthony Fauci, MD, the chief medical advisor to the president and director of the National Institute of Allergy and Infectious Diseases."Antibody levels decline over time," he said, "and higher antibody levels are associated with higher efficacy of the vaccine. Higher levels of antibody may be needed to protect against Delta."
A booster increased antibody levels by ''at least tenfold and possibly more," he said. And higher levels of antibody may be required to protect against Delta. Taken together, he said, the data supports the use of a booster to increase the overall level of protection.
Booster Details
"We will make sure it is convenient and easy to get the booster shot," said Jeff Zients, the White House COVID-19 response coordinator. As with the previous immunization, he said, the booster will be free, and no one will be asked about immigration status.The plan for booster shots is an attempt to stay ahead of the virus, officials stressed
Big Picture
Not everyone agrees with the booster dose idea. At a World Health Organization briefing Wednesday, WHO's Chief Scientist Soumya Swaminathan, MD, an Indian pediatrician, said that the right thing to do right now ''is to wait for the science to tell us when boosters, which groups of people, and which vaccines need boosters."Like others, she also broached the ''moral and ethical argument of giving people third doses, when they're already well protected and while the rest of the world is waiting for their primary immunization."
Swaminathan does see a role for boosters to protect immunocompromisedpeople but noted that ''that's a small number of people." Widespread boosters ''will only lead to more variants, to more escape variants, and perhaps we're heading into more dire situations."
SOURCES:
White House press briefing, Aug. 18, 2021.
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Wow.
www.medpagetoday.com
In the wake of reports that some California doctors are handing out fake mask exemptions to students, the Medical Board of California (MBC) issued a stern warning on Tuesday.
"A physician who grants a mask or other exemption without conducting an appropriate prior exam and without a finding of a legitimate medical reason supporting such an exemption within the standard of care may be subjecting their license to disciplinary action," the agency said.
The board, which licenses some 150,000 physicians, added that it encourages anyone who feels that a physician is granting mask exemptions inappropriately to file a complaint with the medical board. A letter from a physician certifying that the student has a health condition in which wearing a mask would cause harm is required for a student to return to school without mouth or face protection.
The California Medical Association (CMA), in support of the advisory, wagged its finger at the practice.
They noted a number of "reports of rogue physicians selling bogus mask exemptions," adding that they are "deeply troubled" that some physicians "have decided to ignore the science surrounding the spread of COVID-19 and place the lives of children and their families in danger."
In a statement, CMA president Peter N. Bretan Jr., MD, said, "There are very few medical reasons and situations that would exempt an individual from masking requirements. It strains credulity to think that a single physician would have dozens or hundreds of patients with valid medical claims for such an exemption."
"Unfortunately, we know there are bad actors who are willing to operate outside the accepted standards of care in order to turn a personal profit. This needs to stop," he added. "Physicians have an obligation and a duty to uphold the oath we all take when we assume the awesome responsibility of practicing medicine. We need strong, immediate action to ensure bad actors are not given carte blanche to interpret the law as they wish."
The warnings from the MBC and the CMA came after a news report that Michael Huang, MD, a private practitioner in Roseville had been selling mask exemptions to students in the Eureka Union School District, including an exemption from the rule that those students who don't wear masks must wear face shields. According to the report, David Herbert, CEO of Sutter Independent Physicians, said concerned parents had complained about the number of students who were excused from wearing masks on the basis of health concerns.
The report quoted Herbert as saying that he fired Huang in late 2020. Huang told a reporter that he was unaware of any accusation against him about his practice and denied writing mask exemptions without a medical reason. However, he acknowledged to a reporter that he could not wear a mask during work because of his asthma, and that was the reason he was let go.
The MBC also intends to extend a strong arm against doctors who spread false or misleading information about COVID-19. Earlier this month, a statement from the Federation of State Medical Boards advised all physician and PA licensees that spreading false or misleading information about COVID-19 vaccines could result in disciplinary action.
In a statement, Carlos Villatoro, public information manager for the MBC, said that according to California rules, the licensing agency may consider such physician activities "unprofessional conduct and could be grounds for disciplinary action."
Calif. Medical Board: Stop Issuing Bogus Mask Exemptions to Students
Agency threatens discipline amid reports some doctors are selling back-to-school exemptions
www.medpagetoday.com
In the wake of reports that some California doctors are handing out fake mask exemptions to students, the Medical Board of California (MBC) issued a stern warning on Tuesday.
"A physician who grants a mask or other exemption without conducting an appropriate prior exam and without a finding of a legitimate medical reason supporting such an exemption within the standard of care may be subjecting their license to disciplinary action," the agency said.
The board, which licenses some 150,000 physicians, added that it encourages anyone who feels that a physician is granting mask exemptions inappropriately to file a complaint with the medical board. A letter from a physician certifying that the student has a health condition in which wearing a mask would cause harm is required for a student to return to school without mouth or face protection.
The California Medical Association (CMA), in support of the advisory, wagged its finger at the practice.
They noted a number of "reports of rogue physicians selling bogus mask exemptions," adding that they are "deeply troubled" that some physicians "have decided to ignore the science surrounding the spread of COVID-19 and place the lives of children and their families in danger."
In a statement, CMA president Peter N. Bretan Jr., MD, said, "There are very few medical reasons and situations that would exempt an individual from masking requirements. It strains credulity to think that a single physician would have dozens or hundreds of patients with valid medical claims for such an exemption."
"Unfortunately, we know there are bad actors who are willing to operate outside the accepted standards of care in order to turn a personal profit. This needs to stop," he added. "Physicians have an obligation and a duty to uphold the oath we all take when we assume the awesome responsibility of practicing medicine. We need strong, immediate action to ensure bad actors are not given carte blanche to interpret the law as they wish."
The warnings from the MBC and the CMA came after a news report that Michael Huang, MD, a private practitioner in Roseville had been selling mask exemptions to students in the Eureka Union School District, including an exemption from the rule that those students who don't wear masks must wear face shields. According to the report, David Herbert, CEO of Sutter Independent Physicians, said concerned parents had complained about the number of students who were excused from wearing masks on the basis of health concerns.
The report quoted Herbert as saying that he fired Huang in late 2020. Huang told a reporter that he was unaware of any accusation against him about his practice and denied writing mask exemptions without a medical reason. However, he acknowledged to a reporter that he could not wear a mask during work because of his asthma, and that was the reason he was let go.
The MBC also intends to extend a strong arm against doctors who spread false or misleading information about COVID-19. Earlier this month, a statement from the Federation of State Medical Boards advised all physician and PA licensees that spreading false or misleading information about COVID-19 vaccines could result in disciplinary action.
In a statement, Carlos Villatoro, public information manager for the MBC, said that according to California rules, the licensing agency may consider such physician activities "unprofessional conduct and could be grounds for disciplinary action."
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"
The U.S. has problems with the young and middle-aged refusing to get vaccinated, but at least American seniors have had the good sense to get shots. That’s smart, since they’re the group most at risk from Covid.
Half a world away in Hong Kong, though, it’s actually the reverse. The elderly are the most reluctant. The city has plenty of free BioNTech and Sinovac vaccines, but just about a third of people aged 65 and over have gotten inoculated, compared to about 90% in Japan and the U.S. Hong Kong’s seniors trail regional rival Singapore, too.
One problem, according to experts, is ultra-cautious doctors advising elderly patients to wait. Physicians appear to have heeded a government recommendation in March for older people with chronic health problems to defer vaccinations until they get their conditions under control. About five months later, nine out of 10 Hong Kongers aged 80 and above are still unvaccinated.
An 84-year old resident receives his second Pfizer dose on April 7.
Photographer: Marc Fernandes/NurPhoto
“If they are concerned about any side effects, the elderly are referred to their family doctors, who may not want to deal with any issues with liability and are therefore more likely to tell them to be more cautious,” says Ben Cowling, head of epidemiology at the University of Hong Kong.
The government is now trying to turn things around by emphasizing vaccine safety, allowing walk-in shots for seniors and offering cash incentives to doctors. Many local companies have been dangling rewards for vaccinated people of all ages, including “lucky-draw” prizes of gold bars, a Tesla Model 3 and apartments costing more than $1 million.
But unless things speed up, vaccinating the elderly may take two years. That leaves seniors vulnerable as the highly contagious delta variant spreads worldwide and hinders efforts to reopen the financial hub—which has strict border curbs and quarantines in place to keep out Covid—to the rest of the world.—Bruce Einhorn
"
The U.S. has problems with the young and middle-aged refusing to get vaccinated, but at least American seniors have had the good sense to get shots. That’s smart, since they’re the group most at risk from Covid.
Half a world away in Hong Kong, though, it’s actually the reverse. The elderly are the most reluctant. The city has plenty of free BioNTech and Sinovac vaccines, but just about a third of people aged 65 and over have gotten inoculated, compared to about 90% in Japan and the U.S. Hong Kong’s seniors trail regional rival Singapore, too.
One problem, according to experts, is ultra-cautious doctors advising elderly patients to wait. Physicians appear to have heeded a government recommendation in March for older people with chronic health problems to defer vaccinations until they get their conditions under control. About five months later, nine out of 10 Hong Kongers aged 80 and above are still unvaccinated.
An 84-year old resident receives his second Pfizer dose on April 7.
Photographer: Marc Fernandes/NurPhoto
“If they are concerned about any side effects, the elderly are referred to their family doctors, who may not want to deal with any issues with liability and are therefore more likely to tell them to be more cautious,” says Ben Cowling, head of epidemiology at the University of Hong Kong.
The government is now trying to turn things around by emphasizing vaccine safety, allowing walk-in shots for seniors and offering cash incentives to doctors. Many local companies have been dangling rewards for vaccinated people of all ages, including “lucky-draw” prizes of gold bars, a Tesla Model 3 and apartments costing more than $1 million.
But unless things speed up, vaccinating the elderly may take two years. That leaves seniors vulnerable as the highly contagious delta variant spreads worldwide and hinders efforts to reopen the financial hub—which has strict border curbs and quarantines in place to keep out Covid—to the rest of the world.—Bruce Einhorn
Track the virus
Delta Reverses March Back to the Office
The worst of the coronavirus pandemic may be receding into the rear-view mirror, but office workers are little closer to returning to their desks full-time. The spread of the delta variant has forced many U.S. employers that had been hoping to get staff back to their desks after Labor Day to delay those plans until at least October—or even next year. Read the full story here."
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UK regulator approves first drug designed to fight Covid-19 — LBC
The UK medicines regulatory body has approved the first treatment in Britain using man-made antibodies to treat and prevent coronavirus.
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The Delta Surge is Affecting Mental health.
www.medscape.com
Delta Whiplash: How the New Surge Is Affecting Mental Health
With the tremendous surge in cases brought by the Delta variant, this summer has been anything but sunny and carefree.
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Lacking Beds, Hospitals Ship COVID-19 Patients to Other States
In addition to urban hospitals, small rural hospitals and medical centers in coronavirus hotspots also need help, which has created a scramble to find hospital beds for patients wherever possible.
www.medscape.com
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Hospitals in several states are full of COVID-19 patients and no longer have beds available, so they're sending patients to other states for treatment — sometimes hundreds of miles away on ambulances, helicopters and planes, according to The Associated Press.
Large hospitals in urban areas were already running short on space and staff before the most recent surge in patients due to the contagious Delta variant. Now small rural hospitals and medical centers in coronavirus hotspots also need help, which has created a complicated scramble to find hospital beds for patients wherever possible.
CoxHealth, for instance, has a hospital in Springfield, Missouri, that is treating patients from as far away as Alabama.
"Just imagine not having the support of your family near, to have that kind of anxiety if you have someone grow acutely ill," Steve Edwards, CEO of CoxHealth, told the AP.
More than 85,000 COVID-19 patients are hospitalized across the U.S., according to the latest data from The New York Times. Arkansas, Florida, Hawaii, Louisiana, Mississippi and Oregon hit record-high levels for COVID-19 hospitalizations during the past week, and Alabama ran out of intensive care unit beds on Wednesday, the newspaper reported.
In Arizona, a special COVID-19 hotline is receiving frantic phone calls from hospitals in Arkansas, California, Texas and Wyoming that need to find beds for patients, the AP reported. Many times, there's no place to send people.
"We just can't get them out," Dennis Shelby, CEO of the Wilson Medical Center in Kansas, told the AP.
Officials at the 15-bed hospital called 40 other medical centers in several states to find a bed for a COVID-19 patient. They finally found one about 220 miles away. Across Kansas, sick COVID-19 patients in small rural hospitals are waiting about 10 hours to be flown elsewhere, the AP reported, including to Colorado, Illinois, Texas and Wisconsin.
The delays can have deadly consequences for patients, especially for those who need specialists or have urgent health concerns such as heart attacks or strokes.
"Imagine being with your grandma in the ER who is having a heart attack in western Kansas and you are saying, ‘Why can't we find a bed for her?'" Richard Watson, founder of Motient, a company that is helping hospitals in Kansas to manage patient transfers, told the AP.
"We are watching this happen right in front of us," he said.
Even if hospitals have beds, they may lack the staff to care for more patients, the AP reported. Many locations are facing staffing shortages since health care professionals experienced burnout during earlier surges of the pandemic.
Looking ahead toward the fall, health care workers are concerned about what could come next as COVID-19 cases and hospitalizations continue to rise due to the Delta variant. In Iowa, for instance, doctors are worried about the aftermath of the Iowa State Fair, which extends through this weekend and is expected to draw 1 million people.
"How are we going to be able to handle that?" Clint Hawthorne, an emergency medicine specialist in Des Moines, told the AP.
"There's not a good answer to that," he said.
Sources:
The Associated Press: "With no beds, hospitals ship patients to far-off cities."
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That was the biggest fear here, that the hospitals would get overwhelmed, and patients would not have access to a bed or ventilator. Emergency pop up hospitals were put up around the country, with several thousand bed capacities. Fortunately, due to our strict lockdowns, none of these were really needed, and the hospitals coped when Covid was at it’s peak here.
Unfortunately, because the hospitals were on stand by for treating Covid patients, we’ve now got a huge backlog of people waiting for treatment for other conditions.
Unfortunately, because the hospitals were on stand by for treating Covid patients, we’ve now got a huge backlog of people waiting for treatment for other conditions.
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first shot? then you're doing well. lots of people don't necessarily report feeling anything.
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Fake Covid !. her test result came back from the lab was negative. Home test was +, lab test was -.
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The delta variant of the coronavirus continues to infect and kill across the globe with no end in sight. There are close to 700,000 confirmed new infections and 10,000 fatalities each day. For a world that never agreed on how to respond to the challenges posed by Covid-19, the mutation has spelled accelerating misery and sorrow. New Zealand extended its lockdown, as did Sydney, while U.S. states that repudiated precautions, such as Florida and Texas, are using more than 90% of their intensive care capacity as more of the unvaccinated—and a small number of vaccinated—are sickened. Meanwhile, Apple told its employees not to return to the office until next year. Things aren’t a whole lot better on the vaccine front: Covid shots are less effective against delta. Maybe U.S. President Joe Biden should have been a lot tougher on implementing vaccine mandates, Jonathan Bernstein writes in Bloomberg Opinion.
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Perspective
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Now that more than half of U.S. adults have been vaccinated against SARS-CoV-2, masking and distancing mandates have been relaxed, and Covid-19 cases and deaths are on the decline, there is a palpable sense that life can return to normal. Though most Americans may be able to do so, restoration of normality does not apply to the 10% to 30% of those who are still experiencing debilitating symptoms months after being infected with Covid-19.1 Unfortunately, current numbers and trends indicate that “long-haul Covid” (or “long Covid”) is our next public health disaster in the making.
What form will this disaster take, and what can we do about it? To understand the landscape, we can start by charting the scale and scope of the problem and then apply the lessons of past failures in approaching postinfection chronic disease syndromes.
The Centers for Disease Control and Prevention (CDC) estimates that more than 114 million Americans had been infected with Covid-19 through March 2021. Factoring in new infections in unvaccinated people, we can conservatively expect more than 15 million cases of long Covid resulting from this pandemic. And though data are still emerging, the average age of patients with long Covid is about 40, which means that the majority are in their prime working years. Given these demographics, long Covid is likely to cast a long shadow on our health care system and economic recovery.
The cohort of patients with long Covid will face a difficult and tortuous experience with our multispecialty, organ-focused health care system, in light of the complex and ambiguous clinical presentation and “natural history” of long Covid. There is currently no clearly delineated consensus definition for the condition; indeed, it is easier to describe what it is not than what it is.
Long Covid is not a condition for which there are currently accepted objective diagnostic tests or biomarkers. It is not blood clots, myocarditis, multisystem inflammatory disease, pneumonia, or any number of well-characterized conditions caused by Covid-19. Rather, according to the CDC, long Covid is “a range of symptoms that can last weeks or months…[that] can happen to anyone who has had Covid-19.” The symptoms may affect a number of organ systems, occur in diverse patterns, and frequently get worse after physical or mental activity.
No one knows what the time course of long Covid will be or what proportion of patients will recover or have long-term symptoms. It is a frustratingly perplexing condition.
The pathophysiology is also unknown, though there are hypotheses involving persistent live virus, autoimmune or inflammatory sequelae, or dysautonomia, all of which have some “biological plausibility.”2 Intriguing links between long Covid and postural orthostatic tachycardia syndrome (POTS) have also been made. But conventional evidence connecting possible causes to outcomes is currently lacking.
To understand why long Covid represents a looming catastrophe, we need look no further than the historical antecedents: similar postinfection syndromes. Experience with conditions such as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), fibromyalgia, post-treatment Lyme disease syndrome, chronic Epstein–Barr virus, and even the 19th-century diagnosis of neurasthenia could foreshadow the suffering of patients with long Covid in the months and years after infection.
The health care community, the media, and most people with long Covid have treated this syndrome as an unexpected new phenomenon. But given the long arc and enigmatic history of “new” postinfection syndromes, the emergence of long Covid should not be surprising.
Equally unsurprising has been the medical community’s ambivalence about recognizing long Covid as a legitimate disease or syndrome. Extrapolating from the experience with other postinfection syndromes, the varied elements of the biomedical and media ecosystems are coalescing into two familiar polarized camps. One camp believes that long Covid is a new pathophysiological syndrome that merits its own thorough investigation. The other believes it is likely to have a nonphysiological origin. Some commentators have characterized it as a mental illness, and those embracing this psychogenic paradigm are reluctant to endorse a substantial societal focus on research or to follow traditional organ-specific clinical pathways to addressing patients’ concerns.
All of which augurs poorly for many people with long Covid. If the past is any guide, they will be disbelieved, marginalized, and shunned by many members of the medical community. Such a response will leave patients feeling misunderstood, aggrieved, and dissatisfied. Because of a lack of support from the medical community, patients with long Covid and activists have already formed online support groups. One such organization, the Body Politic Covid-19 Support Group, has attracted more than 25,000 members.
Some of the disregard can be attributed to the fact that long Covid has disproportionately affected women. Our medical system has a long history of minimizing women’s symptoms and dismissing or misdiagnosing their conditions as psychological. Women of color with long Covid, in particular, have been disbelieved and denied tests that their White counterparts have received.3,4
What needs to be done to help these patients and competently address this surge? Unless we proactively develop a health care framework and strategy based on unified, patient-centric, supportive principles, we will leave millions of patients in the turbulent breach. The majority will be women; many will have chronic, incapacitating conditions and will bounce around the health care system for years. The media will continue to report extensively on the travails and heroics of the long-haul phenomenon that lacks apparent remedy or end.
There is, therefore, an urgent need for coordinated national health policy action and response, which we believe should be built on five essential pillars. The first is primary prevention. As many as 35% of eligible Americans may ultimately choose not to be vaccinated against Covid-19. Vaccine education campaigns should emphasize the avoidable scourge of long Covid and target high-risk, hesitant populations with culturally attuned messaging.
Second, we need to continue to build out a formidable, well-funded domestic and international research agenda to identify causes, mechanisms, and ultimately means for prevention and treatment of long Covid. This effort is already under way. In February, the National Institutes of Health (NIH) launched a $1.15 billion, multiyear research initiative, including a prospective cohort of patients with long Covid who will be followed to study the trajectory of their symptoms and long-term effects. The World Health Organization (WHO) is working to harmonize global research efforts, including the development of standard terminology and case definitions.5 Many countries and research institutions have identified long Covid as a priority and launched ambitious clinical and epidemiologic studies.
Third, there are valuable lessons to apply from extensive prior experience with postinfection syndromes. The relationship of long Covid to ME/CFS has been brought into focus by the CDC, the NIH, the WHO, and Anthony Fauci, the chief medical advisor to President Joe Biden and director of the National Institute of Allergy and Infectious Diseases. Going forward, research may yield complementary insights into the causation and clinical management of both conditions. The CDC has developed guidelines and resources on the clinical management of ME/CFS that may also be applicable to patients with long Covid.
Fourth, to respond holistically to the complex clinical needs of these patients, more than 30 U.S. hospitals and health systems — including some of the most prestigious centers in the country — have already opened multispecialty long Covid clinics. This integrative patient care model should continue to be expanded.
Fifth, the ultimate success of the research-and-development and clinical management agendas in ameliorating the impending catastrophe is critically dependent on health care providers’ believing and providing supportive care to their patients. These beleaguered patients deserve to be afforded legitimacy, clinical scrutiny, and empathy.
Addressing this postinfection condition effectively is bound to be an extended and complex endeavor for the health care system and society as well as for affected patients themselves. But taken together, these five interrelated efforts may go a long way toward mitigating the mounting human toll of long Covid.
Disclosure forms provided by the authors are available at NEJM.org.
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Confronting Our Next National Health Disaster — Long-Haul Covid
List of authors.- Steven Phillips, M.D., M.P.H.,
- and Michelle A. Williams, Sc.D.
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Now that more than half of U.S. adults have been vaccinated against SARS-CoV-2, masking and distancing mandates have been relaxed, and Covid-19 cases and deaths are on the decline, there is a palpable sense that life can return to normal. Though most Americans may be able to do so, restoration of normality does not apply to the 10% to 30% of those who are still experiencing debilitating symptoms months after being infected with Covid-19.1 Unfortunately, current numbers and trends indicate that “long-haul Covid” (or “long Covid”) is our next public health disaster in the making.
What form will this disaster take, and what can we do about it? To understand the landscape, we can start by charting the scale and scope of the problem and then apply the lessons of past failures in approaching postinfection chronic disease syndromes.
The Centers for Disease Control and Prevention (CDC) estimates that more than 114 million Americans had been infected with Covid-19 through March 2021. Factoring in new infections in unvaccinated people, we can conservatively expect more than 15 million cases of long Covid resulting from this pandemic. And though data are still emerging, the average age of patients with long Covid is about 40, which means that the majority are in their prime working years. Given these demographics, long Covid is likely to cast a long shadow on our health care system and economic recovery.
The cohort of patients with long Covid will face a difficult and tortuous experience with our multispecialty, organ-focused health care system, in light of the complex and ambiguous clinical presentation and “natural history” of long Covid. There is currently no clearly delineated consensus definition for the condition; indeed, it is easier to describe what it is not than what it is.
Long Covid is not a condition for which there are currently accepted objective diagnostic tests or biomarkers. It is not blood clots, myocarditis, multisystem inflammatory disease, pneumonia, or any number of well-characterized conditions caused by Covid-19. Rather, according to the CDC, long Covid is “a range of symptoms that can last weeks or months…[that] can happen to anyone who has had Covid-19.” The symptoms may affect a number of organ systems, occur in diverse patterns, and frequently get worse after physical or mental activity.
No one knows what the time course of long Covid will be or what proportion of patients will recover or have long-term symptoms. It is a frustratingly perplexing condition.
The pathophysiology is also unknown, though there are hypotheses involving persistent live virus, autoimmune or inflammatory sequelae, or dysautonomia, all of which have some “biological plausibility.”2 Intriguing links between long Covid and postural orthostatic tachycardia syndrome (POTS) have also been made. But conventional evidence connecting possible causes to outcomes is currently lacking.
To understand why long Covid represents a looming catastrophe, we need look no further than the historical antecedents: similar postinfection syndromes. Experience with conditions such as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), fibromyalgia, post-treatment Lyme disease syndrome, chronic Epstein–Barr virus, and even the 19th-century diagnosis of neurasthenia could foreshadow the suffering of patients with long Covid in the months and years after infection.
The health care community, the media, and most people with long Covid have treated this syndrome as an unexpected new phenomenon. But given the long arc and enigmatic history of “new” postinfection syndromes, the emergence of long Covid should not be surprising.
Equally unsurprising has been the medical community’s ambivalence about recognizing long Covid as a legitimate disease or syndrome. Extrapolating from the experience with other postinfection syndromes, the varied elements of the biomedical and media ecosystems are coalescing into two familiar polarized camps. One camp believes that long Covid is a new pathophysiological syndrome that merits its own thorough investigation. The other believes it is likely to have a nonphysiological origin. Some commentators have characterized it as a mental illness, and those embracing this psychogenic paradigm are reluctant to endorse a substantial societal focus on research or to follow traditional organ-specific clinical pathways to addressing patients’ concerns.
All of which augurs poorly for many people with long Covid. If the past is any guide, they will be disbelieved, marginalized, and shunned by many members of the medical community. Such a response will leave patients feeling misunderstood, aggrieved, and dissatisfied. Because of a lack of support from the medical community, patients with long Covid and activists have already formed online support groups. One such organization, the Body Politic Covid-19 Support Group, has attracted more than 25,000 members.
Some of the disregard can be attributed to the fact that long Covid has disproportionately affected women. Our medical system has a long history of minimizing women’s symptoms and dismissing or misdiagnosing their conditions as psychological. Women of color with long Covid, in particular, have been disbelieved and denied tests that their White counterparts have received.3,4
What needs to be done to help these patients and competently address this surge? Unless we proactively develop a health care framework and strategy based on unified, patient-centric, supportive principles, we will leave millions of patients in the turbulent breach. The majority will be women; many will have chronic, incapacitating conditions and will bounce around the health care system for years. The media will continue to report extensively on the travails and heroics of the long-haul phenomenon that lacks apparent remedy or end.
There is, therefore, an urgent need for coordinated national health policy action and response, which we believe should be built on five essential pillars. The first is primary prevention. As many as 35% of eligible Americans may ultimately choose not to be vaccinated against Covid-19. Vaccine education campaigns should emphasize the avoidable scourge of long Covid and target high-risk, hesitant populations with culturally attuned messaging.
Second, we need to continue to build out a formidable, well-funded domestic and international research agenda to identify causes, mechanisms, and ultimately means for prevention and treatment of long Covid. This effort is already under way. In February, the National Institutes of Health (NIH) launched a $1.15 billion, multiyear research initiative, including a prospective cohort of patients with long Covid who will be followed to study the trajectory of their symptoms and long-term effects. The World Health Organization (WHO) is working to harmonize global research efforts, including the development of standard terminology and case definitions.5 Many countries and research institutions have identified long Covid as a priority and launched ambitious clinical and epidemiologic studies.
Third, there are valuable lessons to apply from extensive prior experience with postinfection syndromes. The relationship of long Covid to ME/CFS has been brought into focus by the CDC, the NIH, the WHO, and Anthony Fauci, the chief medical advisor to President Joe Biden and director of the National Institute of Allergy and Infectious Diseases. Going forward, research may yield complementary insights into the causation and clinical management of both conditions. The CDC has developed guidelines and resources on the clinical management of ME/CFS that may also be applicable to patients with long Covid.
Fourth, to respond holistically to the complex clinical needs of these patients, more than 30 U.S. hospitals and health systems — including some of the most prestigious centers in the country — have already opened multispecialty long Covid clinics. This integrative patient care model should continue to be expanded.
Fifth, the ultimate success of the research-and-development and clinical management agendas in ameliorating the impending catastrophe is critically dependent on health care providers’ believing and providing supportive care to their patients. These beleaguered patients deserve to be afforded legitimacy, clinical scrutiny, and empathy.
Addressing this postinfection condition effectively is bound to be an extended and complex endeavor for the health care system and society as well as for affected patients themselves. But taken together, these five interrelated efforts may go a long way toward mitigating the mounting human toll of long Covid.
Disclosure forms provided by the authors are available at NEJM.org.
"
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- Jun 8, 2008
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