Coronavirus Tidbits #170 12/12/21

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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.

Two new posts:

Travel Bans: More Security Theater 

https://www.medscape.com/viewarticle/964043

Specialists Think It’s Up to the PCP to Recommend Flu Vaccines. But Many Patients Don’t See a PCP Every Year

https://www.medscape.com/viewarticle/964258

News 

Omicron News:

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I recommend this entire thread explaining how a new variant may appear milder even with no change in underlying virulence. This can occur because, when calculating the fraction of cases that are severe, the denominator now includes many re-infections that had previously been averted.

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In its latest risk assessment, the UK’s Health Security Agency (HSA) yesterday said that, based on test findings and case numbers, Omicron is showing a significant growth advantage over Delta and will likely become dominant.

21=>now57 countries report Omicron cases.

“The travel restrictions come at the height of the end-of-year tourist season, ravaging Africa’s economies, with a knock-on impact that is potentially devastating to the health of Africans,” she said.

Yesterday at the WHO’s headquarters briefing, Director-General Tedros Adhanom Ghebreyesus, PhD, praised France and Switzerland for lifting their bans and urged other countries to follow suit.

[It is shameful that Biden still has travel restrictions against Africa.]

At today’s briefing, WHO officials said the uneven distribution of vaccines is creating ideal conditions for variants to emerge and spread, with those with the least access at the greatest danger. They said Africa has received only 3% of the world’s COVID-19 vaccine supply and that only 6 of 54 counties have met the goal of vaccinating 40% of their population by the end of the year. Currently, about 7.8% of Africa’s population is fully vaccinated.

https://www.cidrap.umn.edu/news-perspective/2021/12/africas-covid-19-numbers-surge-hospital-cases-stay-low

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Immune escape:

…three separate labs that tested the Omicron (B.1.1.529) COVID-19 variant against vaccines reported significant immune escape based on reduced antibody titers, which were followed by similar findings from Pfizer that also suggest a third dose shores up antibody titers….

the first study came from a group at Africa Health Research Institute in South Africa, led by Alex Sigal, PhD, which found a 40-fold reduction in antibody neutralization, both in people who had two doses of the Pfizer-BioNTech vaccine as well as in people who had hybrid immunity from both natural infection and a dose of Pfizer vaccine.

A short time later, a team based at Sweden’s Karolinska Institute found a sevenfold reduction in blood samples from random donors and a fivefold reduction in samples from those who had earlier COVID-19 infections.

virologist Sandra Ciesek, MD, a virologist and gastroenterologist with University Hospital Frankfurt, reported that her experiments showed a 37-fold reduction in neutralization against Omicron in the blood of people who had received three doses of Pfizer, when compared with Delta. She also found no measurable Omicron neutralization 6 months after two-dose regimens of Pfizer, Moderna, or a mix of Pfizer and AstraZeneca.

Then Pfizer today released its preliminary findings, which suggest three doses of the vaccine neutralizes the Omicron variant, with the third dose increasing neutralizing antibodies 25-fold compared to two doses of the vaccine against the wild-type virus (see related CIDRAP News story). The company said it is working on a variant-specific vaccine against Omicron, which is hopes to have available by March 2022, if needed.

[Remember, this doesn’t reflect cell-mediated immunity, which should also help.]

Taken together, although the preliminary studies raise red flags, they also hint that Omicron’s escape from neutralization is incomplete. Several virology and epidemiology experts on Twitter commented on the new findings, which they said are concerning. However, some emphasized that a degree of neutralization was still present and that hybrid immunity (earlier infection and vaccinated) neutralized Omicron, a potentially encouraging sign for boosters.

https://www.cidrap.umn.edu/news-perspective/2021/12/multiple-early-studies-find-notable-omicron-vaccine-evasion

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Pfizer-BioNTech says COVID booster should protect against Omicron

Early today Pfizer and BioNTech announced that initial lab tests show three doses of their COVID-19 vaccine neutralize the Omicron (B.1.1.529) variant, while two doses demonstrated significantly reduced neutralization titers.

The companies said they believe two doses will still be protective against severe disease. The companies also said they began developing an Omicron-specific vaccine on Nov 25, and plan to have that vaccine ready for mass distribution by March 2022. Pfizer and BioNTech said they will produce 1 billion COVID-19 vaccines next year.

https://www.cidrap.umn.edu/news-perspective/2021/12/pfizer-biontech-says-covid-booster-should-protect-against-omicron

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COVID booster cuts death rate by 90%, Israeli study finds

(HealthDay)-Booster doses of Pfizer’s coronavirus vaccine set recipients up to effectively withstand the ravages of both the Delta and Omicron variants, a group of new studies suggest.

https://medicalxpress.com/news/2021-12-covid-booster-death-israeli.html?

And in UK, Four months after people received a second dose of the Pfizer-BioNTech vaccine, the shots were roughly 35 percent effective in preventing symptomatic infections caused by Omicron, A third dose of the Pfizer-BioNTech vaccine, though, lifted the figure to roughly 75 percent.

https://www.nytimes.com/live/2021/12/10/world/covid-omicron-vaccines#britain-omicron

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Scientists find ‘stealth’ version of Omicron that may be harder to track

Variant lacks feature that allows probable cases to be distinguished among positive PCR tests

The Guardian Ian Sample and Peter Walker   Tue 7 Dec 2021 14.11 EST

Scientists say they have identified a “stealth” version of Omicron that cannot be distinguished from other variants using the PCR tests that public health officials deploy to gain a quick picture of its spread around the world.

The finding came as the number of cases of the original Omicron variant detected in the UK rose by 101 to 437 in a single day and Scotland announced a return to working from home.

The stealth variant has many mutations in common with standard Omicron, but it lacks a particular genetic change that allows lab-based PCR tests to be used as a rough and ready means of flagging up probable cases.

The variant is still detected as coronavirus by all the usual tests, and can be identified as the Omicron variant through genomic testing, but probable cases are not flagged up by routine PCR tests that give quicker results.

Researchers say it is too early to know whether the new form of Omicron will spread in the same way as the standard Omicron variant, but that the “stealthy” version is genetically distinct and so may behave differently.

The stealth variant was first spotted among Covid virus genomes submitted in recent days from South Africa, Australia and Canada, but it may already have spread more widely. Among the seven cases identified so far, none are in the UK.

https://www.theguardian.com/world/2021/dec/07/scientists-find-stealth-version-of-omicron-not-identifiable-with-pcr-test-covid-variant?utm_source=

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Most won’t change behavior for Omicron

Only about 30% of Americans say they’re likely to stop dining indoors at restaurants in response to the new variant, and fewer than one-in-four say they’re likely to cancel holiday travel plans. according to a new Axios-Ipsos poll.

Most Americans, however, welcome broader measures to prevent spread of Omicron. Sixty-nine percent said they agreed with businesses requiring masks indoors.

https://www.cidrap.umn.edu/news-perspective/2021/12/us-covid-vaccination-rates-rise-19-states-now-confirm-omicron

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Vaccinated People Clear COVID Faster, Less Time with High Virus Levels

by Jack Feehan and Vasso Apostolopoulos December 4, 2021

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.

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.

How concerned should we be? Are vaccinated people just as contagious as unvaccinated? What does this mean for future plans for reopening?

These studies only show a similar peak viral load, which is the highest amount of virus in the system over the course of the study.

But vaccinated people clear the virus faster, with lower levels of virus overall, and have less time with very high levels of virus present.

Therefore, vaccinated people are, on average, likely to be less contagious.

Let us explain.

https://globalbiodefense.com/2021/12/04/vaccinated-people-clear-covid-faster-less-time-with-high-virus-levels/

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Meaghan Kall @kallmemeg

1. VACCINE EFFECTIVENESS (symptomatic infection) *caveat: early estimates* Real-world surveillance data shows a significant reduction in VE for Omicron vs Delta

* 2x AZ, VE is ZERO

* 2x Pfizer, VE is ~30% BUT! Boosters increase VE to 70-75% (Pfizer, in the 1st month)

2. REINFECTIONS Likewise, with an immune evading virus you expect to see an increase in re-infections. And we do.

7% (25/361) Omicron cases were re-infections, vs 0.4% (336/85,460) Delta

After adjustment, this equals a 3- to 8-fold increased risk of re-infection with Omicron

3. LABORATORY NEUTRALISATION STUDIES

Omicron gives 20- to 40-fold reduction in nAbs compared to the viruses used to develop vaccines

4. HOUSEHOLD TRANSMISSION (caveat: early data)

Analysis of transmission in residential households (121 Omicron, 72,882 Delta)

19% of Omicron cases resulted in household outbreaks vs 8.5% of Delta cases

Adjusted odds of household transmission for Omicron: 3.2 (95%CI 2.0-5.0)

For comparison the adjusted odds was 1.7 when this analysis was done for Delta vs Alpha. https://pubmed.ncbi.nlm.nih.gov/34729548/

5. SECONDARY ATTACK RATES (SAR) Analysis using NHS T&T contact tracing data

Household SAR 2-fold higher for Omicron (21.6%) vs Delta (10.7%)

The risk of a close contact becoming a secondary case (adjusted odds ratio 2.1 (95% CI: 1.5-2.8)

6. GROWTH ESTIMATES Taken together, it is no surprise that we are seeing exponential growth in Omicron cases (using SGTF as proxy) 3 day doubling time (0.35/day) Rt= 3.7 (3.3-4.2)

so far is there are no hospitalisations or deaths associated with Omicron. This is encouraging news, probably largely due to vaccines and high levels of immunity.

But also, it’s very early days.

Thread: https://t.co/dUHpQB9gx1

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Other news:

COMMENTARY: 8 things US pandemic communicators still get wrong

Peter M. Sandman, PhD|

Dec 09, 2021

As we approach 2 years of COVID-19, US pandemic messaging has settled into some counterproductive patterns. I want to address eight of these risk communication mistakes that public health officials and experts keep making. Turning them around can rebuild trust and help save lives.

In August 2020, CIDRAP published my commentary titled, “Public health’s share of the blame: US COVID-19 risk communication failures.” I tracked what I saw-and still see-as a series of missteps by public health officials in the early months of the pandemic:

  1. Over-reassuring the public
  2. Panicking and overreacting
  3. Flubbing the rationale for lockdowns
  4. Abandoning “flatten the curve”
  5. Insisting that public health should be in charge

Except for misstep 5, which is still super important, this list of risk communication mistakes now reads like ancient history. It’s hard to remember back that far.

I have produced updated lists from time to time (see this one from March 2021, for example). The most recent was a Nov 15, 2021, Zoom presentation to the Minnesota Department of Health that spurred this commentary.

The eight risk communication mistakes in this commentary aren’t necessarily the biggest challenges public health officials and experts face-maybe not even their biggest risk communication challenges. But they are likely to be among the most remediable of their risk communication challenges, since they stem from their own behavior. I think these mistakes keep happening, they do real damage, but they can be remedied-so revisiting them isn’t just backward-looking.

One of the most stunning surprises of the COVID pandemic has been the growing importance of trust-or, rather, mistrust. A sizable slice of the American public has come to mistrust the public health establishment and the pandemic responses it recommends.

It has long been a truism for me that when low trust is a problem, we should focus on our own behavior: “They don’t trust us” is a less useful starting point than “We’re not earning their trust.” I think these eight risk communication mistakes are a big piece of how US public health has forfeited some trust.

https://www.cidrap.umn.edu/news-perspective/2021/12/commentary-8-things-us-pandemic-communicators-still-get-wrong

Diagnostics:

still an incredible, negligent last of testing.

Testing for COVID-19 at home

The emergence of a new COVID-19 variant, omicron, has heightened safety protocols and plans to help people stay safe from illness as researchers and experts learn more about the newest strain of SARS-CoV-2. This includes plans to expand access to COVID-19 over-the-counter tests for people to use at home in the U.S.

At home tests should be used in combination with masking and distancing, if possible. And, be mindful of when you are going to self-administer the test. Do it the day of the event, because that’s going to give you the best information of whether someone has high amounts of the virus in their system at that time.

But note, there is a high rate of false negatives, so do not rely on this alone and ignore masking!

https://medicalxpress.com/news/2021-12-covid-home.html?

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Incredibly bad plan and short-sightedness from Biden admin on testing

Drugs and Vaccines:

Convalescent serum should be reserved for those severely ill

In a treatment guideline update, the World Health Organization (WHO) today recommended against the use of convalescent plasma for treating patients who aren’t severely ill with COVID-19. It said its expert review found no evidence of benefit for less severe cases, but there was uncertainty about benefits for patients with more serious infections. The WHO said the treatment should be used only in clinical trials for those with severe and critical COVID-19.

https://www.cidrap.umn.edu/news-perspective/2021/12/countries-see-signs-growing-community-omicron-spread

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Monoclonal antibodies

Looks like #Omicron fully evades the REGN mAbs. Same with Lilly. And only one of the two AZ mAbs (just given EUA yesterday) neutralize it. Sotrovimab from Vir going strong against Omicron. Preprint: https://t.co/aVbZ8kRpfa

https://twitter.com/David_RMartinez/status/1469394436014714888?s=20

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Understanding COVID-19 vaccine hesitancy in Jordan, the West Bank, and Syria

Analysis of a December 2020 survey conducted in Jordan, the West Bank, and Syria finds that about two-thirds of participants were unwilling or hesitant to get vaccinated against COVID-19. Sima Zein of the American University of Madaba, Jordan, and colleagues present these findings in the open-access journal PLOS Neglected Tropical Diseases.

participants with higher levels of education were less willing to be vaccinated.

https://medicalxpress.com/news/2021-12-covid-vaccine-hesitancy-jordan-west.html?

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Slovakia to pay people over 60 if they are vaccinated

Slovakia’s Parliament approved a plan on Thursday to give people 60 and older up to 300 euros ($339) if they are vaccinated against COVID-19. [meanwhile some u.s. states are paying people to be not vaxxed.]

https://medicalxpress.com/news/2021-12-slovakia-people-vaccinated.html?

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COVID-19 vaccine for kids ages five to 11: What families need to know

Ever since Canada approved the child-sized Pfizer-BioNTech vaccine against COVID-19 and started to distribute nearly three million doses, some parents have jumped at the chance to get their kids vaccinated, while others still have questions.

https://medicalxpress.com/news/2021-12-covid-vaccine-kids-ages-families.html?

Devices:

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Ventilation:

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CO2 monitors are being stressed more often, but they are expensive. I’ll be writing more on this soon.

You can also improve ventilation markedly by making these inexpensive Corsi-Rosenthal box fans w a fan and good furnace filters.

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I’ll also have a post out next week on these and the incontrovertible data that Covid is airborne:

and

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Epidemiology/Infection control:

the current 7-day average number of new daily cases is 103,824 per day, up significantly from the prior week’s average of 87,603 cases. The nation is tracking approximately 1,100 deaths per day. The US reported 192,917 new COVID-19 cases yesterday, and 1,382 deaths, according to the Johns Hopkins COVID-19 tracker.

COVID cases spike even as US hits 200M vaccine milestone

The number of Americans fully vaccinated against COVID-19 reached 200 million Wednesday amid a dispiriting holiday-season spike in cases and hospitalizations that has hit even New England, one of the most highly inoculated corners of the country.

https://medicalxpress.com/news/2021-12-covid-cases-spike-vaccine-milestone.html?

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New data shows public health benefit to closing indoor dining

Closing indoor dining during the first two waves of the pandemic was associated with a 61% decline in new COVID-19 cases over a six-week span, preventing an estimated 142 daily cases per city, compared with cities that reopened indoor dining during that period, according to recently published data from experts at the Dornsife School of Public Health. The team looked at data from March to October 2020 in 11 U.S. cities, including Philadelphia, Atlanta and Dallas. The results were published last month in the journal Epidemiology.

https://medicalxpress.com/news/2021-12-health-benefit-indoor-dining.html?

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Tips, general reading for public:

StayAtHome

Wash your hands.

Rinse and repeat.

Politics:

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Judge issues nationwide injunction against Biden’s vaccine mandate for federal contractors

A federal judge on Tuesday issued a nationwide injunction against a vaccine mandate for federal contractors, ruling that President Joe Biden probably exceeded his authority by imposing the requirement.

Judge R. Stan Baker, who’s based in Georgia, temporarily blocked implementation of the administration after a lawsuit from numerous states and a trade group argued that letting the mandate take effect on Jan. 4 would cause “irreparable injury” to workers who could be forced out of their jobs.

The judge wrote that allowing the rule to move forward “would force Plaintiffs to comply with the mandate, requiring them to make decisions which would significantly alter their ability to perform federal contract which is critical to their operations.”

The court setback is the latest in a string of rulings hampering the administration’s efforts to force more people to get vaccinated against the coronavirus.

https://www.msn.com/en-us/news/us/judge-issues-nationwide-injunction-against-biden-s-vaccine-mandate-for-federal-contractors/ar-AARzOwH?

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Disinformation Group America’s Frontline Doctors Allegedly Staked Out California Med Board President Kristina Lawson and stalked her.

https://www.medpagetoday.com/special-reports/exclusives/96097?

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Prescribing the abortion pill without restrictions is safe and effective, study finds

Abortion remains safe after Canada removed restrictions on the medical abortion pill mifepristone in November 2017.

https://medicalxpress.com/news/2021-12-abortion-pill-restrictions-safe-effective.html?

and so…

Texas Cracks Down on Abortion Pills by Mail

A new Texas law went into effect Wednesday that would fine doctors up to $10,000 for prescribing pills for medical abortion through the mail or via telehealth appointment, and could even give a penalty of jail time, Kaiser Health News reported.

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Feel good du jour:

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Comic relief:

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Here is the Instagram account of the creative dad who produced these amusing photos | https://instagram.com/onadventurewithdad?

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Perspective/Poem

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Bits of beauty:

 

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