Coronavirus and Avian Flu Tidbits #299, June 16, 2024

People to follow re transmission/rates:

Sarah Willette: more graphics

SARS-Co-V-2 Activity level in Wastewater

https://public.tableau.com/app/profile/sara.anne.willette/viz/USCompositeWastewaterData/NWSSData

Hawaii is very high; Florida "substantial"

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Sarah Willette's HPAI data are updated here: https://public.tableau.com/views/USWastewaterSCANViralActivity/HPAIviaUSDA

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COVID Positivity rate in Madrid 43.2%. The highest recorded in the entire Pandemic. Positivity rate in Mexico over 50%. The highest ever recorded Worldwide. But we were told it’s over.

35% or 3,780 people answered positively to the question on the Era’s Swift (Twitter) Page, as to whether they’d gotten sick at the show. Then they all left the show and spread it all over the city.

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June 7: Walgreens Covid positivity tracker is showing a 27.1% positive rate which is the highest since February 3!

Source https://walgreens.com/healthcare-solutions/covid-19-index

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More COVID-19 patients died in understaffed hospitals

A new study in the International Journal of Nursing Studies suggests chronically understaffed US hospitals had higher rates of COVID-19 patient deaths early in the pandemic.

The authors looked at patient-to-RN staffing ratios, proportion of bachelors-qualified RNs, and nurse work environments in the pre-pandemic period (December 2019 to February 2020) and during the pandemic (April to June 2021) to predict in-hospital and 30-day mortality.

https://www.cidrap.umn.edu/covid-19/more-covid-19-patients-died-understaffed-hospitals-new-data-reveal

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Avian Flu:

The outbreak total now stands at 87 herds in 11 states.

Report from H5N1 outbreak on farm in TX notes that farm workers were sick with flu-like symptoms as same time as cows. https://wwwnc.cdc.gov/eid/article/30/7/24-0717_article

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Global health leader critiques ‘ineptitude’ of U.S. response to bird flu outbreak among cows

STAT   By Andrew Joseph June 13, 2024

LONDON — Seth Berkley, a longtime and widely respected global health leader, said Thursday that it has been “shocking to watch the ineptitude” of the U.S. response to the avian influenza outbreak among dairy cattle, adding his voice to a chorus of critics.

In a presentation in London about vaccine development, Berkley, the former CEO of Gavi, the Vaccine Alliance, raised the issue of H5N1 bird flu when discussing whether the world was ready for another pandemic following its experience with Covid-19.

“Are we better prepared?” he said. “We could have a long discussion about this, but I would make an argument that H5N1 has suggested that we’re not. I live in Switzerland, but in my home country of the United States, it’s been shocking to watch the ineptitude of just doing the surveillance, being able to talk about it, tracking the infections, understanding where we are. Do we have vaccines? Are they the right vaccines? It is really a challenge. So I’m not sure we have learned anything.”

https://www.statnews.com/2024/06/13/global-health-leader-critiques-ineptitude-of-u-s-response-to-bird-flu-outbreak-among-cows/

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USDA reports reveal biosecurity risks at H5N1-affected dairy farms

Shared equipment and shared personnel working on multiple dairy farms are some of the main risk factors for ongoing spread of highly pathogenic H5N1 avian flu in dairy cows, the US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS) said.

https://www.cidrap.umn.edu/avian-influenza-bird-flu/usda-reports-reveal-biosecurity-risks-h5n1-affected-dairy-farms

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Study details reduced Tamiflu susceptibility in H1N1 flu cases

A study in Emerging Infectious Diseases spotlights recent H1N1 flu cases with reduced susceptibility to oseltamivir (Tamiflu), the most common antiviral used to limit symptoms from seasonal flu.

The reduction in susceptibility has been seen in viruses collected from five continents—with most cases in Europe—from May 2023 to February 2024. The viruses showed a 13-fold reduced inhibition by oseltamivir while retaining normal susceptibility to other antiviral drugs, the authors said.

The viruses that lost susceptibility to Tamiflu had acquired a novel combination of neuraminidase mutations, NA-I223V + S247N. Overall detection frequency of these two mutations was low (0.67%). Of 101 viruses with this double mutation, 67 were found in Europe.

https://www.cidrap.umn.edu/influenza-general/study-details-reduced-tamiflu-susceptibility-h1n1-flu-cases

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Farmworkers and PPE

many dairy farms are still unwilling to use even freely offered personal protective equipment (PPE). This is cause for alarm. Working with a pathogen assigned a biosafety level of 3 — meaning it “can cause serious or potentially lethal disease through respiratory transmission” — with at best BSL 2 level protections is playing with fire.

This lack of protection leaves farmworkers who interact with potentially infected animals, including dairy cows, chickens, and alpacas, at risk for infection with a virus that has killed half of the people in whom it was diagnosed. And the more H5N1 is able to interact with and infect people, the greater the risk that it might accumulate the handful of mutations it needs to become capable of human-to-human transmission, a stepping stone to a possible epidemic...

many farm owners and workers have been reluctant to test due to concerns of losing work, the undocumented status of many workers in this sector, and financial loss. Even if uptake of testing did improve, it would still identify infections only after they occur....

https://www.statnews.com/2024/06/12/h5n1-bird-flu-ppe-protection-farmworkers/

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Kudos to King County, WA, DPH for multilingual info:

Recommended PPE and how to safely remove it Prevent Avian Influenza: Keep yourself and your family save with PPE 简体字 (Chinese Simplified) | 繁體字 (Chinese Traditional) | Af Soomaali (Somali) | Español (Spanish) | Wikang Tagalog/Filipino (Tagalog) | Tiếng Việt (Vietnamese) https://kingcounty.gov/en/dept/dph/health-safety/disease-illness/avian-flu

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Other:

Drug-resistant "dual mutant" flu strains now being tracked in US

An analysis of the new H1N1 flu viruses with these two concerning mutations – which scientists call I223V and S247N, describing changes to key surface proteins of the virus – was published this week in the agency's Emerging Infectious Diseases journal.

It follows a report by scientists from Hong Kong who first tested the mutations. Their lab experiments, published in March, found the two mutations appeared to raise H1N1's resistance to the flu treatment oseltamivir, commonly sold under the brand Tamiflu by drugmaker Roche.

It is unclear how much the mutations could cut the real-world effectiveness of oseltamivir. The laboratory tests found the mutated viruses were up to 16 times less sensitive to the antiviral, a smaller dropoff than in some previous worrying mutations.

"These mutated viruses retained sensitivity to other anti-influenza medications, including a newer one, baloxavir marboxil. There are no immediate implications to change decisions for clinical care," a CDC spokesperson said.

https://www.cbsnews.com/news/drug-resistant-dual-mutant-flu-h1n1-us/

CVS generic drugs twice as likely to be recalled over safety concerns, investigation finds

Chad Van Alstin | June 12, 2024 | Health Exec | Supply Chain

An investigation by journalists into quality control of generic drugs found CVS-branded medications were recalled twice as often as its competitors, including Walgreens and Walmart.

Notable examples of recalls include contaminated water at a manufacturing facility, drugs for kids that were found to be too potent and one instance in which nasal sprays were produced on the same equipment as pesticides.

Despite the issues at CVS, the retail giant’s generic drugs represent less than 1% of recalls nationally. However, over the last decade, 15 manufacturers for CVS were found to have quality control and safety problems, according to data from the U.S. Food and Drug Administration. That’s twice as many as Walgreens.

CVS has recalled 133 drugs over the last 10 years related to safety and quality concerns. In some instances, despite warnings from the FDA, tainted drugs remained on store shelves for weeks.

For the full story, read Bloomberg’s investigation at the link below.

Industries The Big Take Dozens of CVS Generic Drug Recalls Expose Link to Taint…

https://healthexec.com/topics/healthcare-management/healthcare-logistics/cvs-generic-drugs-twice-likely-be-recalled-over-safety-concerns-investigation-finds

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The viral frontier: Nasa told ‘act now’ to tackle pathogens in space

https://www.telegraph.co.uk/global-health/science-and-disease/nasa-told-act-now-to-tackle-biological-threats-from-space/