Coronavirus Tidbits #167 11/21/21

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Announcements:

First, there is now a Resources Page here for the most commonly asked questions I’m getting.

Happy to continue to answer your questions/concerns as best I can, so don’t be shy about that.

New post:

Should You Worry About Disease Transmission in Public Bathrooms? 

https://www.medscape.com/viewarticle/963106

News 

Austria moves to full COVID-19 lockdown, national vaccine mandate

Battling an unprecedented surge like some of its neighbors, Austria’s government today announced a full lockdown, the first in Europe to take such dramatic steps amid the continent’s fourth surge.

Europe’s latest surge is its biggest, and last week, the World Health Organization’s European region recorded its highest weekly total of the pandemic: nearly 2.19 million cases.

Meanwhile, in the United States ahead of the winter holidays, cases continue to spike in the Midwest, with numbers rising in the Northeast, as well.

High vaccination level not enough

Earlier this week, Austria ordered a lockdown for unvaccinated people, but Chancellor Alexander Schallenberg said the measure didn’t boost vaccination levels enough, according to the Washington Post. About 64% of Austrians are fully vaccinated, about average for Europe, but a bit higher than the United States.

The nation’s incidence rate nearly doubled over the past 2 weeks, and Austrian media reports have described bodies accumulating in the corridors of a hospital in Upper Austria state, one of the country’s hardest-hit areas.

“Now we have to face reality,” he said at a briefing. The lockdown begins on Nov 22 and will be reevaluated after 10 days. After 20 days, the measure could shift to just unvaccinated people.

Officials said everyone eligible will be required to get the vaccine, but they didn’t say when the mandate would begin or what the minimum age would be.

Earlier this week, the Netherlands announced a partial lockdown, and a few other European countries have imposed extra measures on unvaccinated people.

https://www.cidrap.umn.edu/news-perspective/2021/11/austria-moves-full-covid-19-lockdown-national-vaccine-mandate

and

  • South Korea is experiencing another surge in infections, which comes 3 weeks after it relaxed restrictions, according to the Washington Post. The country today reported its second highest daily case number of the pandemic, though about 80% of the eligible population is fully immunized.

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Opinion | What Happens After the Worst of the Pandemic Is Behind Us?

New York Times – Zeynep Tufekci, November 18, 2021

No one is aware of when the pandemic will finish. But the worst of it might be over for the United States after this winter. For good causes – rising vaccine eligibility, boosters and new antiviral remedies – and unhealthy – excessive ranges of prior infections – it’s potential the continuing Delta surge might be the final main spike in hospitalizations and deaths for the United States.

The pandemic has proved to be an almost two-year stress take a look at that the United States flunked, with an already distrustful populace uncovered to a degree of institutional failure that added gasoline to the indignant battles over reply. Dr. Martin Cetron, a Centers for Disease Control and Prevention veteran of battles towards Ebola in Africa, described individuals’s dropping confidence throughout an epidemic as a “chapter of belief.” Right now, America is bankrupt.

It as soon as appeared that if the United States ever confronted a viral pandemic, it might be greater than as much as the problem. Just weeks earlier than the primary Covid-19 circumstances had been reported in China, the United States was ranked No. 1 out of 195 international locations in pandemic preparedness by consultants convened by Johns Hopkins University, The Economist and others. After all, the C.D.C. is among the most revered public well being establishments on this planet, and the United States is dwelling to most of the world’s main pharmaceutical corporations and educational analysis establishments.

The undeniable fact that the United States fared so poorly, regardless of all of the seeming benefits that dazzled these consultants, is a profound signal of how decayed our establishments and capability have grow to be. To perceive how we fell to this point brief and to navigate a second full Covid winter and future pandemics and challenges requiring collective motion, it’s essential to evaluate the outbreak’s early days to see why the United States – as soon as thought of the worldwide chief in public well being – is floundering in distrust, paranoia and exhaustion.

https://lightlynews.com/2021/11/19/opinion/opinion-what-happens-after-the-worst-of-the-pandemic-is-behind-us/

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Non-White race tied to higher risk for COVID infection, severity

A US meta-analysis and systematic review of data on 4.3 million patients analyzed in 68 cohort and cross-sectional studies shows that, relative to White people, Black, Hispanic, and Asian populations were at higher risk for COVID-19 infection and admission to an intensive care unit (ICU) but were less likely to die of the disease.

The study, published yesterday in JAMA Network Open, was designed to uncover the link between socioeconomic determinants of health and racial disparities in COVID-19 outcomes.

A team led by University of California at San Diego researchers searched for COVID-19 studies that included data on race and rates of infection, disease severity, and socioeconomic status published from Jan 1, 2020, to Jan 6, 2021, well before the more transmissible Delta (B1617.2) variant was predominant in the United States.

https://www.cidrap.umn.edu/news-perspective/2021/11/non-white-race-tied-higher-risk-covid-infection-severity

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China’s wildlife is a pandemic ‘waiting to happen,’ study finds

BLOOMBERG   Published Nov 13, 2021, 2:00 pm IST

A comprehensive survey of viral pathogens has found they harbor a range of diseases threatening humans and other animals

Wildlife species sold in wet markets in China were linked to the emergence of SARS and Covid-19. Now a comprehensive survey of viral pathogens has found they harbor a range of diseases threatening humans and other animals.

A study of more than a dozen species of game animals traded, sold and commonly consumed as exotic food in China identified 71 mammalian viruses, including 18 deemed “potentially high-risk” to people and domestic animals. Civets, the cat-like carnivores implicated in the spread of severe acute respiratory virus in markets in southern China almost 20 years ago, carried the most worrisome microbes, according to the research, released Friday.

Although the authors in China, the U.S., Belgium and Australia didn’t find anything resembling SARS-CoV-2, the coronavirus responsible for the Covid-19 pandemic, they showed that strains carried by bats are transmitted across the species barrier to infect other animals in spillover events that risk seeding dangerous outbreaks. They also found game animals were infected with viruses previously thought to exist only in people.

“This study highlights exactly why the wildlife trade and live animal markets are a pandemic accident waiting to happen,” said co-author Edward Holmes, an evolutionary biologist at the University of Sydney, in an email. “This paper also shows that humans regularly transmit their viruses to other animals. There’s clearly two-way virus traffic.”

Future Threats

The research, supported by the National Key Research and Development Program of China and others, shows the commitment to searching for future pandemic threats. The 40-page manuscript was released on bioRxiv, an open access preprint repository, ahead of peer-review and publication.

The comprehensive investigation of the diversity and abundance of vertebrate-associated viruses in game animals in China is the first to assess which species have the greatest potential for carrying viruses that could set off an outbreak.

https://www.deccanchronicle.com/world/neighbours/131121/chinas-wildlife-is-a-pandemic-waiting-to-happen-study-finds.html

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First known COVID case was vendor at Wuhan market, scientist claims

By CARL ZIMMERCHRIS BUCKLEY and BENJAMIN MUELLER

A scientist who has pored over public accounts of early COVID-19 cases in China reported Thursday that an influential World Health Organization inquiry had likely gotten the early chronology of the pandemic wrong. The new analysis suggests that the first known patient sickened with the coronavirus was a vendor in a large Wuhan animal market, not an accountant who lived many miles from it.

The report, published Thursday in the prestigious journal Science, will revive, although certainly not settle, the debate over whether the pandemic started with a spillover from wildlife sold at the market, a leak from a Wuhan virology lab or some other way. The search for the origins of the greatest public health catastrophe in a century has fueled geopolitical battles, with few new facts emerging in recent months to resolve the question.

The scientist, Michael Worobey, a leading expert in tracing the evolution of viruses at the University of Arizona, came upon timeline discrepancies by combing through what had already been made public in medical journals, as well as video interviews in a Chinese news outlet with people believed to have the first two documented infections.

Worobey argues that the vendor’s ties to the Huanan Seafood Wholesale Market, as well as a new analysis of the earliest hospitalized patients’ connections to the market, strongly suggest that the pandemic began there.

“In this city of 11 million people, half of the early cases are linked to a place that’s the size of a soccer field,” Worobey said. “It becomes very difficult to explain that pattern if the outbreak didn’t start at the market.”

https://www.seattletimes.com/nation-world/first-known-covid-case-was-vendor-at-wuhan-market-scientist-claims/

Diagnostics:

The cost of Covid rapid tests is ridiculous–but if you can afford them, testing before you get together for the holidays gives an added layer of protection.

Drugs and Vaccines:

Why Dexamethasone, a drug used to treat critically ill COVID-19 patients, may only benefit males

A new study from the University of Calgary shows how dexamethasone, the main treatment for severe COVID-19 lung infections, alters how immune cells work, which may help male patients, but has little to no benefit for females.

https://medicalxpress.com/news/2021-11-drug-critically-ill-covid-patients.html?

Dexamethasone modulates immature neutrophils and interferon programming in severe COVID-19, Nature Medicine (2021). DOI: 10.1038/s41591-021-01576-3

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COVID-19 vaccine elicits weak antibody response in people taking immunosuppressant

People who received two doses of the Pfizer COVID-19 vaccine while on TNF inhibitors-a class of immunosuppressants used to treat rheumatoid arthritis and other autoimmune conditions-generated less powerful and shorter-lived antibodies against the virus that causes COVID-19 than healthy people and those on other kinds of immunosuppressants,

https://medicalxpress.com/news/2021-11-covid-vaccine-elicits-weak-antibody.html?

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No, vaccinated people are not ‘just as infectious’ as unvaccinated people if they get COVID

Some recent studies have shown similar peak viral loads in vaccinated people compared to unvaccinated people who contract COVID. This has raised concerns for the efficacy of vaccines for preventing transmission.

While the peak viral load may be similar, vaccinated people are likely to have lower viral load overall, and therefore be less contagious.

Given vaccines speed the clearance of COVID from the body, vaccinated people have less opportunity to spread the virus overall.

A vaccinated person is less likely to get COVID in the first instance, is less contagious, and is contagious for a shorter time, resulting in significantly less spread of the virus through a highly vaccinated community.

https://medicalxpress.com/news/2021-11-vaccinated-people-infectious-unvaccinated-covid.html?

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Fact Check-Most cases of myocarditis after COVID-19 vaccines are not irreversible

By Reuters Fact Check

Medical experts on the basis of evidence so far disagree with claims made on social media that myocarditis following the COVID-19 vaccine is irreversible. Social media claims that “over the years,” many children diagnosed with myocarditis will die are unfounded, representatives from the Myocarditis Foundation say.

Posts making claims regarding the mortality rate of children diagnosed with COVID-19-linked myocarditis are viewable here , here .

….Medical experts, however, said the evidence so far showed those with myocarditis after COVID-19 vaccines recover quickly.

Both the Pfizer/BioNTech and Moderna Inc vaccines have been linked to rare cases of heart inflammation called myocarditis, especially in young men (here).

However, the benefits of mRNA shots in preventing COVID-19 continue to outweigh the risks, European and U.S. regulators and the World Health Organization have said (here).

https://www.reuters.com/article/factcheck-myocarditis-covid19-vaccine/fact-check-most-cases-of-myocarditis-after-covid-19-vaccines-are-not-irreversible-idUSL1N2S924L?

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Pfizer’s COVID-19 Oral Antiviral Cost $529 per Course

Pfizer will receive $5.29 billion from the U.S. government

https://www.precisionvaccinations.com/2021/11/18/pfizers-covid-19-oral-antiviral-cost-529-course

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Study: Immune-suppressed NOT at higher risk of poor COVID outcomes

A large US study finds that hospitalized COVID-19 patients taking medications that suppress the immune system, including cancer patients, are not at overall higher risk for dying of their infection or requiring invasive mechanical ventilation than those not taking these drugs.

Early in the pandemic, immunosuppressed patients were thought to be at elevated risk of poor COVID-19 outcomes. Some damage to the lungs and other organs in severe infections are believed to result from overactivation of the immune system, and by summer 2020, physicians were treating severe COVID-19 with immunosuppressive drugs such as dexamethasone, the researchers noted.

Only rituximab tied to death, ventilation

In the retrospective study, published this week in The Lancet Rheumatology, a team led by Johns Hopkins University researchers analyzed the electronic health records of 222,575 adults hospitalized at 42 health systems for treatment of COVID-19 from Jan 1, 2020, to Jun 11, 2021.

https://www.cidrap.umn.edu/news-perspective/2021/11/study-immune-suppressed-not-higher-risk-poor-covid-outcomes

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Pfizer to allow more nations to make COVID drug Paxlovid

Pfizer today announced that it has signed a voluntary licensing agreement to expand production of its new COVID-19 treatment, Paxlovid, for low- and middle-income countries, which follows a similar announcement from Merck for molnupiravir.

The deal will allow the drug combo to be manufactured in 95 countries, covering 53% of the world population. The companies will waive royalties on drug sales in those countries as long as COVID-19 remains a public health emergency of international concern.

Paxlovid, a SARS-CoV-2 protease inhibitor given orally, is designed to be given at the first sign of illness at home to avoid serious illness or death. The drug blocks the SARS-CoV-2 protease that the virus needs to replicate. It is given with a low dose of ritonavir, an HIV antiviral that can boost the level of other protease inhibitors. The two drugs are given twice a day for 5 days.

Interim clinical data suggests a 89% reduction in hospitalization and death from any cause when Paxlovid was taken 3 days after COVID-19 symptom onset, compared with placebo. Researchers saw similar results when taken within 5 days of symptom onset.

[Problem will be getting a diagnosis within that window]

https://www.cidrap.umn.edu/news-perspective/2021/11/pfizer-allow-more-nations-make-covid-drug-files-eua-fda

Devices:

Automated text messaging service significantly improves outcomes in patients with COVID

Patients with COVID-19 who enrolled in an automated text messaging system with twice daily check-ins were 68% less likely to die than those who did not use it, according to an ACP press release.

The automated text messaging system called COVID Watch offered its users the ability to report intensifying symptoms at any time to a team of health care professionals, the press release said.

Reference: Delgado MK, et al. Ann Intern Med. 2021;doi:10.7326/M2102019.

“At the start of the pandemic, when the world’s attention was focused on patients in ICUs and on ventilators, we recognized that for every patient with COVID-19 in an ICU, there might be 50 people with COVID-19 in the community,” M. Kit Delgado, MD, an assistant professor of emergency medicine and epidemiology at Penn Medicine, told Healio Primary Care. “Those patients were scared and also needed to be watched over because they could soon be one of those patients in an ICU or on a ventilator.”

Penn Medicine already had technology in place that allowed for automated messaging, saving the health system the initial time, money and staffing resources that would be needed to set up COVID Watch, according to Delgado.

https://www.healio.com/news/primary-care/20211115/automated-text-messaging-service-significantly-improves-outcomes-in-patients-with-covid19

Epidemiology/Infection control:

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How widespread is Covid in animals and what are the risks to humans?

Two studies showing high levels of Covid-19 infection among wild deer in the US have renewed concerns about the virus spreading through animal populations.

The findings, released this month, come as more reports of Covid in pets and captive animals are emerging. Lincoln Children’s Zoo in Nebraska lost three rare snow leopards to the disease earlier this month.

Though the Sars-Cov-2 virus causes few or no symptoms in most non-human animals, some scientists fear that wildlife might become a reservoir of infection – and possibly viral mutation – that could be transmitted back to people. It could also threaten endangered species….

How widespread is Covid in animals?

The World Organisation for Animal Health, known as OIE, has recorded 598 Covid outbreaks in animals affecting 14 species in 30 countries up to the end of October. Almost all have involved captive animals in close contact with humans – with farmed mink in Denmark the most affected.

No one knows how prevalent Covid is in wildlife because there has been little testing. The two new studies of white-tailed deer in the US are the first to show extensive infection in wild populations.

Susceptibility varies substantially and unpredictably between species. “We are very fortunate that studies show the main farm animals – pigs, cattle and sheep – to be quite resistant to infection, unlike white-tailed deer,” said Keith Hamilton, OIE’s head of preparedness and resilience.

https://worldnewsera.com/news/finance/how-widespread-is-covid-in-animals-and-what-are-the-risks-to-humans/

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COVID Can Cause Strange Eye and Ear Symptoms

From conjunctivitis to vertigo, coronavirus infections can affect disparate senses

Scientific American  By Emily Sohn on November 17, 2021

Red eyes, ringing ears, sensitivity to light, trouble hearing: although a loss of taste and smell have become well-known sensory symptoms of COVID, accumulating research suggests that vision and hearing are also frequent targets of SARS-COV-2, the virus that causes the disease.

More than 10 percent of people who get COVID develop some type of eye or ear symptom, according to the latest data, and both categories are among the complaints that can end up persisting for a long time.

https://www.scientificamerican.com/article/covid-can-cause-strange-eye-and-ear-symptoms/

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Growing Public Health Concern of COVID-19 Chronic Olfactory Dysfunction

Amish M. Khan, BS1, et al. JAMA Otolaryngol Head Neck Surg.  doi:10.1001/jamaoto.2021.3379

As the world enters the second year of the COVID-19 pandemic, chronic (ie, >6 months) olfactory dysfunction (COD) has emerged as one of the symptoms of long-term COVID-19.1 The loss of olfaction has been associated with decreased general quality of life, impaired food intake, inability to detect harmful gas and smoke, enhanced worries about personal hygiene, diminished social well-being, and the initiation of depressive symptoms.2,3

a 5.3% to 12% relative increase. COVID-19 affects a younger demographic group than other causes of OD.

https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2786433?utm_source=

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Tips, general reading for public:

StayAtHome

Wash your hands.

Rinse and repeat.

Politics:

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Interesting perspective–I’m just not sure how to change the messaging to help Dems

The idea that so many people would ignore all of that, and even shrug off the potential end of democracy and its replacement with fascism and autocracy simply because they are annoyed by late Amazon deliveries or sick of wearing masks or angry about price hikes seems off to some.

It shouldn’t. The truth is, Democrats are almost always at a disadvantage because they are the party of government, while Republicans are the party of messaging and memes and feelings. They don’t really DO government; they do tax cuts for the rich and complain about government.

So when you’re annoyed about government, you’re generally annoyed about Democrats. And when you’re complaining about government, Republicans are chiming in with you. They’re like the absentee parent who’s never there to feed or discipline you but shows up occasionally with gifts.

And the gifts they show up with are all about feelings. Sick of COVID? They’ll tell you to ignore COVID. Hate masking up? They’ll ban mask mandates. Don’t want the shot? They’ll rail against the shot (even though they all took the shot. If you get COVID? That’s a YOU problem.)

Hate high gas prices? They have no policy to fix it but will scream with you and demand more Americuhn Oil!! “But that would ruin the environment,” Democrats will warn! Republicans will share your annoyance at Dems’ green-moaning and scream “F- the Earth! Drill baby, drill!!”

Can’t remember the right pronouns? Republicans will roll their eyes with you. Call “them” whatever you want. It’s your world! Sick of being politically correct? Wanna tell a racist joke or perform N-words in Paris with the hard “R” with your friends? The GOP is with you! Say it!

Can’t stand it when you call customer service and hear “press 2 for Spanish?” Republicans feel you. And if you feel no empathy for the brown men, women and children fleeing poverty and violence to cross our southern border because America is “full”? The GOP will build the wall!

Can’t stand it when you call customer service and hear “press 2 for Spanish?” Republicans feel you. And if you feel no empathy for the brown men, women and children fleeing poverty and violence to cross our southern border because America is “full”? The GOP will build the wall!

For Republicans, your heroes are their heroes, even if they shat in the Capitol and tried to overturn an election. I mean, whoever you vote for should always win anyway. It feels so much better when you win. And you’re the REAL Americans so you should always win and feel good.

Whatever feels bad for you, Republicans are against. They hate that damn kneeling like you do and want those Blacks to just shut up and play. It feels bad when people say our Founders owned slaves so Republicans will ban that for you, so history always makes you feel good.

Democrats are the provider party; the good and stable parent who gets you healthcare and immunizations and child tax credits so you won’t be poor and good roads and bridges and wifi so you can do school at home during COVID. They are the “be careful dear, button your coat” party.

Republicans are the “I won’t tell your mom if you whip off your coat and roll around in the snow but also I won’t take you to the hospital if you catch pneumonia because I gotta go hang out with my boys and anyway doctors are for the weak. Just take this supplement,” party.

They’re the fun dad who doesn’t pay child support because “that’s HER kid-she had it, I just had fun making it,” party. The fun dad who let’s you smoke from their weed stash but won’t bail you out if you get arrested for it because “personal responsibility.”

Democrats are the good, stable parent who takes all the heat for enforcing bedtime and not letting you eat Starbursts for dinner. The one you “can’t stand” til one day you actually go LIVE with “fun dad.” And 4 years later 700k people are dead from COVID and the economy is shite.

So you go back to the good parent, who does the unpleasant work of fixing things but they also go back to telling you what to do and they’re not fun, so America forgets how unstable, incompetent, abusive and even frightening absentee dad was, and want to go live with him again.

And around and around we go. This is American politics.

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How America’s largest Catholic hospital system is moonlighting as a private equity firm

Ascension (140+ hospitals), is quietly building an unprecedented and strikingly unusual $1 billion private equity operation, using its wealth to invest like a Wall Street firm. Tax-exempt, yet how little such a system has to disclose about whether or how its profits are benefiting the nation’s poorest and most vulnerable patients.

in 2015, Ascension started gutting services at a hospital in Washington, D.C., that served low-income patients.

Ratio of charity care to expenses: 2.5% from 2017 to 2020, and dropping to 1.9% in fiscal year 2021. The most recent national weighted average for non-profit hospitals is 2.3%

in 2017, Ascension shut down Providence hospital’s maternity ward, a move that soon left the east side of Washington with no labor and delivery services. The next year, Ascension suddenly announced it would close all hospital services, including the emergency room. It converted the hospital to an urgent care center over the opposition of the hospital’s board and local government leaders.

Also chose a very aggressive debt-collection agency.

Top execs make $7-10 million/yr each

https://www.statnews.com/2021/11/16/ascension-investigation-moonlighting-private-equity-firm/ (Paywalled)

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Feel good du jour:

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Comic relief:

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Perspective/Poem

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Bits of beauty:

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