Coronavirus Tidbits #190 May 1, 2022

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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:

We’re Facing A Critical Shortage Of Medical Laboratory Professionals

https://www.forbes.com/sites/judystone/2022/04/28/were-facing-a-critical-shortage-of-medical-laboratory-professionals/

News 

the Centers for Disease Control and Prevention (CDC) released new seroprevalence data suggesting that as many as three in four children ages 17 and under in the United States has been infected with COVID-19, most during the Omicron surge.

https://www.cidrap.umn.edu/news-perspective/2022/04/global-covid-deaths-drop-lowest-early-pandemic-months

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Moderna applies for authorization of vaccine for young children

In a welcome development for many parents of young children, Moderna announced today that it has submitted a request to the Food and Drug Administration for emergency use authorization (EUA) of its COVID-19 vaccine for children 6 months to under 6 years of age.

The request is based on a 25-microgram two-dose primary series of mRNA-1273. The application is based on favorable results seen during a phase 2/3 trial. No major safety events were recorded.

As reported last month, the efficacy of the vaccine in this age group against Omicron strain COVID-19 infections is not as high compared to previous strains:  51% (95% confidence interval [CI], 21 to 69) for children 6 months to 2 years and 37% (95% CI, 13 to 54) for kids ages 2 to 6 years.

The Centers for Disease Control and Prevention COVID Data Tracker shows 66.1% of Americans are fully vaccinated against COVID-19, 77.5% have received at least one dose of vaccine, and 45.7% of those eligible have received their first booster dose.

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Dr. Alexander Wong  @awong37 While the vaccine efficacy numbers seem modest, remember that Omicron was literally EVERYWHERE over the last few months, and much more contagious compared to previous variants like Alpha or Delta. Also, nearly all public health protections were removed in this time frame. (4/9) ~ ~ ~

FDA signals it will approve Moderna for young kids

The Food and Drug Administration (FDA) Vaccines and Related Biological Products Advisory Committee (VRBPAC) will meet multiple times in June to consider different emergency use authorizations (EUAs) for COVID-19 vaccines.

The FDA’s Director of the Center for Biologics Evaluation and Research, Peter Marks, MD, PhD, said the officials won’t delay the Moderna decision for use in young kids to align with a decision on Pfizer in that age-group.

The FDA will first look at an EUA for the Novavax vaccine, followed by Moderna and Pfizer EUAs for children ages 6 months to 5 years. At the end of the month, the agency will meet to address strain-specific vaccines, a topic broached during an Apr 6 meeting.

https://www.cidrap.umn.edu/news-perspective/2022/04/south-africa-braces-fifth-covid-surge-another-major-chinese-city-tracks

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Higher COVID-19 death rates in the southern U.S. due to behavior differences

During the pre-Omicron phases of the COVID-19 pandemic, regions of the U.S. had markedly different mortality rates, primarily due to differences in mask use, school attendance, social distancing, and other behaviors. Had the entire country reacted to the pandemic as the Northeast region, more than 316,000 deaths might have been avoided, 62% of those avoidable deaths being in the South.

https://medicalxpress.com/news/2022-04-higher-covid-death-southern-due.html?

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CDC: 58% of Americans have had COVID-19

New COVID-19 seroprevalence data from the Centers for Disease Control and Prevention (CDC) show that the Omicron surge infected a huge swath of Americans, with overall seroprevalence rising from 33.5% in December of 2021 to 57.7% in February 2022.

The data, which reflect the presence of SARS-CoV-2 antibodies in the blood, indicating a previous infection, were published today in Morbidity and Mortality Weekly Report.

The increase was seen most dramatically in children. In kids ages 0 to 11, seroprevalence jumped from 44.2% to 75.2%, and in kids 12 to 17, it rose from 45.6% to 74.2%.

“As of February 2022, approximately 75% of children and adolescents had serologic evidence of previous infection with SARS-CoV-2, with approximately one third becoming newly seropositive since December 2021,” the CDC and other US authors of the report said.

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America’s Frontline Doctors’ Prescriber Stripped of State Licenses

A physician who was prescribing ivermectin through the America’s Frontline Doctors’ telemedicine platform no longer holds an active medical license in any state.

medpagetoday.com/special-reports/exclusives/98407

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New modeling shows that ‘shielding’ strategies instead of lockdowns would have led to tens of thousands more deaths

https://medicalxpress.com/news/2022-04-shielding-strategies-lockdowns-tens-thousands.html via @medical_xpress #GreatBarringtonDeclaration

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Six in ten people hospitalized with COVID-19 still have a least one symptom a year later, long COVID study reveals

Six in ten people with COVID-19 still have at least one symptom a year later, a new study being presented at this year’s European Congress of Clinical Microbiology & Infectious Diseases (ECCMID) in Lisbon, Portugal (23-26 April) has found.

https://medicalxpress.com/news/2022-04-ten-people-covid-symptom-year.html?

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Study: SARS-CoV-2 virus shedding varied widely in the mildly ill

Viral loads often peaked in saliva days before they did so in nasal swabs, which the researchers said indicates that saliva may be the better sample for early COVID-19 diagnosis. The Alpha variant’s viral loads and clearance dynamics didn’t differ significantly from those of previous strains,

 they found a broad range of individual infectiousness, with a greater than 57-fold difference between the most and least infectious.

Findings may inform surveillance, control strategies

There were no significant links between participants’ symptoms and disease course, a finding that challenges the assumption that those who have more symptoms are always more infectious.

https://www.cidrap.umn.edu/news-perspective/2022/04/study-sars-cov-2-virus-shedding-varied-widely-mildly-ill

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How states handled the COVID-19 crisis? New analysis shows Utah, Nebraska, and Vermont were best with Montana and Florida right behind

The Report Card on the States measures and compares state performance on three metrics: the economy, education, and mortality from the virus. It answers the question: how did states do in balancing the health of their citizens, allowing their economies to remain operational and keeping job losses low, and keeping their schools open so that school-aged children did not suffer long term educational setbacks?

Each of these three metrics were equally weighted. The states that received an F grade were New Jersey, New York, California, Illinois and Washington, D.C. These states performed poorly on every measure. They had high age-adjusted death rates; they had high unemployment and significant GDP losses, and they kept their schools shutdown much longer than almost all other states.

The top performers were Utah, Nebraska, and Vermont with Montana and Florida right behind.

The study verifies other studies which have found that locking down businesses, stores, churches, schools, and restaurants had almost no impact on health outcomes across states. States with strict lockdowns had virtually no better performance in Covid death rates than states that remained mostly open for business.

The study also found that keeping schools closed had almost no impact on the death rates of children or adults, but it did severe damage to the educational progress of students.

Read more at CUP

You can read the full study here: https://committeetounleashprosperity.com/wp-content/uploads/2022/04/Which-States-Handled-the-Covid-Pandemic-Best.pdf

http://outbreaknewstoday.com/how-states-handled-the-covid-19-crisis-new-analysis-shows-utah-nebraska-and-vermont-were-best-with-montana-and-florida-right-behind-48400/

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Contracting COVID-19 might increase your risk of type 1 diabetes

Researchers found that patients who were infected with SARS-CoV-2, the coronavirus that causes COVID-19, were 42% more likely to develop Type 1 diabetes than those who did not contract COVID-19 during the study period.

The risk is highest among the youngest of pediatric patients (those under the age of 1 were at an increased risk of 584%) and elevated among older adult patients with COVID-19. The researchers also observed differences across race and ethnicity, with risk of Type 1 diabetes associated with a COVID-19 infection being most pronounced among American Indian/Alaskan Native (130% increased risk), Asian/Pacific Islander (101%), and Black patients (59%).

https://medicalxpress.com/news/2022-04-covid-diabetes.html

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Antibiotic use in young children tied to reduced vaccine response

In a first-of-its-kind study, researchers have found that antibiotic use in young children is associated with lower vaccine-induced antibody responses to several childhood vaccines.

The study, published yesterday in Pediatrics, found that children 2 years of age and younger who had received antibiotics had lower levels of antibody protection from the diphtheria-tetanus-acellular pertussis (DTaP) and pneumococcal conjugate vaccine (PCV) than those who received no antibiotics. They also found that antibiotic courses that were accumulated over time were negatively associated with vaccine-induced antibody levels.

While previous studies in mice and adult humans have suggested a link between antibiotics and the immune response to vaccination, the study is the first to find such a link in children. The study authors say the findings suggest an outcome that could leave children vulnerable to vaccine-preventable diseases and highlight the need for more research on antibiotics and vaccine-induced immunity.

https://www.cidrap.umn.edu/news-perspective/2022/04/antibiotic-use-young-children-tied-reduced-vaccine-response

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Retina is not spared by SARS-CoV-2

The list of diseases caused by SARS-CoV-2 infection is growing and now includes the retina. This is what is suggested by a prospective study by the Geneva University Hospitals (HUG) and the University of Geneva (UNIGE), in collaboration with the Adolphe de Rothschild Memorial Clinical Research Center for Ophthalmology. This research reveals that 11% of people hospitalized for respiratory distress due to COVID-19 disease have retinal damage. This study can be found in the Journal of Clinical Medicine.

Since the first pandemic wave of SARS-CoV-2, scientists and physicians have observed neurological and vascular damage in infected individuals. Since the retina is part of the nervous system and offers a direct and non-invasive observation pathway to the vessels, a research team from the HUG, the UNIGE and the Adolphe de Rothschild Memorial Clinical Research Centre in Ophthalmology performed fundus examinations on patients admitted to the HUG Internal Medicine Department for pneumonia due to COVID-19 and placed on oxygen therapy.

https://medicalxpress.com/news/2022-04-retina-sars-cov-.html

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Zero-COVID strategy puts China between a rock and a hard place

Policy crossroads offers Xi Jinping no easy path

OPINION

Minxin Pei

April 28, 2022 05:00 JST

A screen shows Xi Jinping during an exhibition on the fight against the outbreak at Wuhan Parlor Convention Center: The omicron surge is happening at the worst possible moment for President Xi.   © Reuters

Minxin Pei is professor of government at Claremont McKenna College and a nonresident senior fellow of the German Marshall Fund of the United States.

When the COVID-19 pandemic first broke out in Wuhan in January 2020, it was widely seen as Chinese President Xi Jinping’s gravest crisis. But his government quickly quashed the outbreak with harsh lockdowns and a zero-COVID strategy that no other country in the world could emulate.

On paper at least, China has good reason to tout its approach. The number of COVID cases and fatalities in China is much lower than in most other countries. This record of success has led Chinese leaders to stick to the zero-COVID strategy and flaunt it as evidence of the superiority of their one-party regime over disorganized and fractious liberal democracies.

But as President Xi is finding out, the trouble with the zero-COVID strategy is that it works until it does not. This approach may have been the right call in dealing with less infectious strains of the virus. But it is now proving to be ineffectual, if not counterproductive, when it comes to fighting the far more contagious but less lethal omicron variant.

Since the surge of the omicron variant hit China a month ago, Beijing has placed more than 340 million people under varying degrees of lockdown. Its largest and most important financial center, Shanghai, has been under lockdown for nearly a month now.

The human and economic toll of China’s zero-COVID strategy is mounting daily. Lockdowns have paralyzed a huge chunk of the Chinese economy and will depress its growth this year. The International Monetary Fund now expects China to grow 4.4% this year. A more pessimistic forecast puts Chinese gross domestic product growth at only 3.8%.

In face of the omicron surge, Xi has two equally unpalatable choices.

One option is to follow the lead of Australia and New Zealand, the two countries that abandoned the zero-COVID strategy after the omicron surge. The pressure for such a change, of course, is intensifying as officials and business leaders warn about an unfolding economic calamity and residents in locked-down cities circulate heartbreaking stories about food shortages, the incompetence of local officials and being denied health care.

 Abandoning the zero-COVID strategy has clear benefits. China can avert a collapse of economic activities, mitigate the social costs of an outdated strategy and demonstrate that Beijing is actually capable of self-correction.

But this option also entails huge risks. Opening up will, unavoidably, result in an explosive spike in COVID infections, hospitalizations and fatalities. China’s inadequate health care system will be overwhelmed, at least for a few months.

Although critics of the zero-COVID strategy can counter that the success of China’s current approach is largely illusory, a surge in COVID infections and deaths, as well as pictures of a strained health care system, could incite a different kind of public ire and do untold damage to Beijing’s carefully cultivated image of itself as master of a competent regime.

The political and ideological costs of giving up the zero-COVID strategy will be even higher.

The ruling Chinese Communist Party would be effectively conceding that it really does not have a superior system with regard to Western liberal democracies. President Xi, a consistent champion of the zero-COVID strategy, may also have to take responsibility for maintaining the current course despite mounting evidence of its unsustainability.

The other option is to stick to the zero-COVID strategy, regardless of costs. In the short term, the government may succeed in slowing down the spread of the omicron variant and containing its impact.

But as the experience of Shanghai’s lockdown shows, even the most draconian measures will be unlikely to eradicate omicron, and China will soon confront a moment of truth when the six-week lockdown, the record set by Wuhan in 2020, devastates the economy but fails to wipe out the virus.

Worse still, the debacle of Shanghai’s messy and costly lockdown is almost certain to be repeated elsewhere.

Should Beijing, where the omicron variant is spreading, also have to be locked down, the political fallout would be far more consequential because the people living in the Chinese capital are known for their political activism and savvy.

Since most of China’s ruling elites and their families also live in Beijing, it is hard to imagine that experiencing weeks of virtual house arrest will not change their views on how best to deal with the pandemic.

The worst nightmare for China is that even extended lockdowns fail to contain the omicron surge, but that economic activity grinds to a complete halt in most parts of the country over the coming months.

A debacle of this magnitude will likely compel Chinese leaders to change course after a heroic but ultimately futile effort to sustain their zero-COVID strategy.

https://asia.nikkei.com/Opinion/Zero-COVID-strategy-puts-China-between-a-rock-and-a-hard-place

Diagnostics:

Comparison of Home Antigen Testing With RT-PCR and Viral Culture During the Course of SARS-CoV-2 Infection

Key Points

Question  How does the diagnostic performance of home antigen tests change during the course of SARS-CoV-2 infection?

Findings  In this prospective cohort study of 225 adults and children with reverse transcription-polymerase chain reaction (RT-PCR)-confirmed SARS-CoV-2 infection, antigen test sensitivity was 64% and 84% when compared with same-day RT-PCR and viral culture, respectively. Antigen test sensitivity peaked 4 days after illness onset (77%); a second test 1 to 2 days later showed improved sensitivity (81%-85%).

Meaning  The study results suggest that symptomatic individuals with an initial negative home antigen test result for SARS-CoV-2 infection should test again 1 to 2 days later because test sensitivity seems to peak several days after illness onset.

https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2791915

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Drugs and Vaccines:

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The Covid-19 Outpatient Treatment Roadmap

is a multifaceted tool for information on outpatient treatment options to support clinicians in the ongoing battle against Covid-19. As part of the CDC-funded Infectious Diseases Society of America’s Covid-19 Real-Time Learning Network, this resource outlines federal emergency use authorizations, guideline recommendations from national standard setting organizations, and more. As knowledge of Covid-19 continues to evolve, treatments and recommendations change. Visit the roadmap for a clear breakdown of the latest guidelines.

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Pfizer COVID-19 third dose vaccine protection against hospitalization from omicron wanes after 3 months: study

A study released April 22 in The Lancet Respiratory Medicine shows that a booster dose of the Pfizer COVID-19 vaccine provides strong protection, roughly 80% to 90%, in the first few months against hospital admissions and emergency department visits caused by the delta and omicron variants. However, against omicron, this protection wanes over time-even after a third dose.

“Pfizer BioNTech COVID-19 booster doses significantly improve protection against omicron, although that protection seems to wane after 3 months against emergency room visits, and even for hospitalization,”…”Trends in waning against delta-related outcomes were generally similar to omicron, but with higher effectiveness at each time point than those seen for omicron.”

https://medicalxpress.com/news/2022-04-pfizer-covid-dose-vaccine-hospitalization.html

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Paxlovid

In a statement, the WHO said it based the recommendation on new data from two randomized controlled trials that included 3,078 patients, which suggested that Paxlovid can cut the risk of hospitalization by 85% among high-risk groups.

The WHO said its recommendation applies to those who are at highest risk for severe disease, such as those who are unvaccinated, older, or immunocompromised. It added that data showed benefits were negligible in lower-risk patients.

https://www.cidrap.umn.edu/news-perspective/2022/04/who-backs-paxlovid-high-risk-covid-patients

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Devices:

Epidemiology/Infection control:

COVID-19 third leading cause of death in US in 2021

and deaths from COVID-19 increased by 1% in 2021 over 2020, according to new data from the National Vital Statistics System released today by the Centers for Disease Control and Prevention (CDC).

Only heart disease and cancer killed more Americans than COVID-19, with provisional death tolls from each cause totaling 693,000, 605,000, and 415,000, respectively. Those were also the three leading killers in 2020.

Approximately 60,000 more people died from COVID-19 in 2021 than the first year of the pandemic. In both years, the death rates from COVID-19 were highest in Americans ages 85 and older.

Overall death rates were highest among non-Hispanic American Indian/Alaskan Native and non-Hispanic Black or African American people, the CDC said in a statement.

https://www.cidrap.umn.edu/news-perspective/2022/04/covid-19-third-leading-cause-death-us-2021

Tips, general reading for public:

Ventilate.

Mask.

Vax.

Politics:

Covid:

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Biden:

Biden is also nominating Ana Reyes, a Williams & Connolly partner who immigrated to the U.S. as a child, to become the first Hispanic woman and openly LGBTQ person to ever serve as a federal district court judge in D.C.

The other district court nominees are Elizabeth Hanes, a former public defender and current magistrate judge who would serve in the Eastern District of Virginia, and Anne Nardacci, a Boies Schiller partner who would serve in the Northern District of New York.

According to the progressive group Demand Justice, today’s nominations mean that Biden will have nominated as many public defenders to be federal circuit court judges than all past presidents combined.

Musk:

on Musk buying Twitter:

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GOP:

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Guns:

LGBT

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Books

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Florida:

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Georgia

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California

Ukraine

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Feel good du jour:

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Comic relief:

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https://twitter.com/buitengebieden/status/1520445588105576450?s=20&t=GO2UY-OMZ77HSngqrMnI1w

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https://twitter.com/buitengebieden/status/1520295996634411011?s=20&t=GO2UY-OMZ77HSngqrMnI1w

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https://twitter.com/buitengebieden/status/1519019574519291904?s=20&t=GO2UY-OMZ77HSngqrMnI1w

Perspective/Poem

Bits of beauty:

Yellow trillium
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