Coronavirus Tidbits #244, May 7, 2023
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.
Reminder, Resilience: One Family's Story... is increasingly pertinent, as some of our politicians shift rightward. All proceeds go to Holocaust education.
The Buzz On Preventing Insect Bites: How To Repel Ticks And Mosquitoes
Daily Update for the United States
New Cases (Weekly Total) New Deaths (Weekly Total) New Hospitalizations
88,330 (12,619/day) 1,052 (150/day) 1,402
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WHO Ends public health emergency
Tedros declared "Covid-19 over as a global health emergency" though the pandemic is not over. "WHO recorded 2.8 million new cases globally, and more than 17,000 deaths, from April 3 to 30, the most recent numbers available. As many countries have reduced their testing for Covid, these numbers also probably represent a significant undercount."
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CDC scales back testing
CDC will cease tracking community levels of Covid and the percentage of tests that come back positive, a metric used to calculate transmission rates,
They will cont to count hospitalizations, but not demographics. The data the C.D.C. still plans to collect will not provide enough actionable information at the state and local level, said Sam Scarpino, a public health expert at Northeastern University.
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Dr. Rochelle Walensky is retiring as head of CDC in June
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Many hospitals, UPMC and Hopkins among them, eliminate mask mandates within the hospitals.
This puts vulnerable patients at risk...the hospitals don't care. They responded that patients can request that staff mask around them. (leaving a vulnerable patient to alienate the staff taking care of them).
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The White House announced that it will end COVID-19 vaccine requirements for federal employees and international air travelers on May 11, the same day the public health and national emergencies for the pandemic are scheduled to end.
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May 11, CMS will no longer provide blanket coverage for the cost of over-the-counter COVID-19 tests, the agency said. Those enrolled in Medicare Part B will continue to have coverage with no out-of-pocket expenses for appropriate lab-based COVID-19 PCR and antigen tests, however, when a healthcare provider orders these tests.
Those enrolled in Medicaid or the Children's Health Insurance Program will continue to have access to COVID-19 over-the-counter and lab testing through the end of September, CMS said. After then, coverage may vary by state.
Private insurance plans, CMS noted, are not required by federal law to cover COVID-19 testing after May 11.
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US Causes of death - COVID the 4th-leading cause of death
COVID-19, the third leading cause of death in 2021, fell to fourth place in 2022, after heart disease, cancer, and unintentional injury (largely overdoses).
The age-adjusted rate of heart disease deaths increased for the third straight year since 2020.
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A new CDC report found that although the all-cause death rate dropped by 5.3% between 2021 and 2022, COVID remained the fourth-leading cause of death — underlying cause of 186,702 deaths and a contributing factor in another 58,284. washingtonpost.com/health/2023/05
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There's been a great deal of outrage and anxiety among the #LongCovid patients, in particular, about the removal of mask mandates in healthcare settings. On top of being worried about getting a new Covid infection, some physicians have been mocking the patients. There is a move to have letters written to their universities.
Patients walk out of a @StanfordMed #LongCovid trial after medical staff stop masking while tending to LC participants. 1/ pic.twitter.com/vhPQLbbaxg— Laura Baranik (@laurabaranik) April 29, 2023
Stanford Was Conducting a Long COVID Study. Then the Staff Stopped Masking.
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Rise in healthcare-associated infections during COVID
the average standard infection ratios for central line-associated bloodstream infections (CLABSIs), methicillin-resistant Staphylo
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@theodorepak April 30 on Covid testing new hospital admissions
Many US hospitals have or will soon stop testing all admitted patients for COVID-19, per recent @SHEA_Epi recs In this op-ed, Chanu Rhee & Mike Klompas
40,600 people likely caught Covid while hospital inpatients in England
One in seven patients treated for Covid between 1 August 2020 and 21 March got it while in hospital
2. Presymptomatic and asymptomatic patients pose the highest risk. Viral loads are highest just before symptoms (if any) start. So most transmissions are from people without symptoms. If you don't screen all admissions, you'll never catch it in time.
3. Transmission risk in shared patient rooms is high. The transmission rate from a patient with undiagnosed COVID-19 to an uninfected patient in the same room is 20-40%. Most US hospitals have lots of shared rooms. Patients don't pick their roommates.
4. Hospital-acquired COVID-19 still causes substantial morbidity and mortality. In vulnerable inpatients, Omicron is far from "mild." Crude mortality rates are 3-13%. We take huge measures to stop nosocomial infxns (MRSA, Cdiff) with much lower M&M... phw.nhs.wales/services-and-t
5. More testing is associated with fewer nosocomial cases and better outcomes. When England and Scotland stopped universal admission testing in Aug-Sep 2022, hospital-onset cases rose significantly compared to community-onset infections.
6. Potential downsides of asymptomatic testing are real, but can be mitigated. The cost ($55/patient in 1 study) is minimal compared to 1 inpatient-day ($3-10k) False positives occur, but retesting and d/c'ing precautions can be automated (as @MassGenBrigham has done for years)
7. Hospitals have an ethical responsibility to protect patients from COVID-19. Forcing all patients to accept ↑risk of COVID-19 when they enter hospitals, for minimal benefit ($55?) violates non-maleficence and beneficence.
As COVID-19 has disproportionately harmed Black, Latinx, and Native American populations in the US, and continues to pose ↑risk to elderly, immunocompromised, and disabled people... Prematurely ending COVID-19 precautions will worsen systematic healthcare inequity in the US.
Side note: Universal masking in hospitals is also under fire, so invoking other protective layers as a reason to end admission testing is increasingly credulous. Ending masking & testing is like steering toward the icebergs AND shutting your eyes
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What really killed COVID-19 patients: It wasn't a cytokine storm, suggests study
Secondary bacterial infection of the lung (pneumonia) was extremely common in patients with COVID-19, affecting almost half the patients who required support from mechanical ventilation. By applying machine learning to medical record data, scientists at Northwestern University Feinberg School of Medicine found that secondary bacterial pneumonia that does not resolve was a key driver of death in patients with COVID-19. It may even exceed death rates from the viral infection itself.
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"There’s a roughly 20 percent chance during the next two years of an outbreak rivaling the onslaught of illness inflicted by the omicron variant."
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West Nile Virus is Endemic in Phoenix
West Nile is endemic now in Phoenix In 2021, Maricopa County, which includes the city of Phoenix, reported 1,487 WNV cases, 1,014 hospitalizations, and 101 (7%) deaths. This unfortunate data compared with only 3 #WNV cases in 2020.
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FDA approves nation's first RSV vaccine for people 60 and older
RSV is a highly contagious virus that infects the lungs and airways of people of all age-groups. RSV usually begins circulating in fall, peaking in winter. RSV is a common cause of lower respiratory tract disease (LRTD), which can cause life-threatening pneumonia and swelling of the small airways.
94.1% reduction in risk of severe illness
The vaccine, made by GlaxoSmithKline and sold under the brand name Arexvy, was approved on the basis of data from an ongoing randomized, controlled trial conducted among this age-group in in the United States and abroad showing its efficacy and safety. The approval follows the March 1 recommendation from the FDA's vaccine advisory group, which has also recommended Pfizer's RSV vaccine for the same age-group.
So far in the study, about 12,500 participants have received Arexvy, and 12,500 have received a placebo. Among all participants, the vaccine reduced the risk of RSV-related LRTD by 82.6% and lowered the risk of severe LRTD by 94.1%, the announcement said. The most common adverse effects among Arexvy recipients were injection-site pain, fatigue, muscle pain, headache, and joint stiffness and pain.
In another study, which involved concomitant administration of Arexvy and an FDA-approved flu vaccine, two participants developed acute disseminated encephalomyelitis, a rare type of inflammation of the brain and spinal cord, and one died. In a separate study, one participant developed Guillain-Barré syndrome (a rare disorder in which the body’s immune system damages nerve cells) 9 days after receiving Arexvy.
still an incredible, negligent last of testing.
1-4— Michael Olesen 💉😷🇺🇸🇺🇦 (@maolesen) May 5, 2023
I started working on getting a template set up for adding XBB.1.16 to US states. I was working with my CA file as a starting point and something really jumped out at me related to healthcare associated (HAI) COVID. pic.twitter.com/UfifoIeNFT
The light green is total inpatient beds occupied, the dark green are those occupied due to COVID. The red line is HAI COVID (I used a 28-day moving av4rage to dampen the noise). HAI COVID numbers are on the right Y-axis.
We would expect to see higher amounts of COVID spread in the hospital during surges, and we have consistently seen that in the past. However, now HAI COVID is at the highest level since the start of the pandemic, even though COVID beds are in about the fourth lowest valley.
We MUST get mandatory respiratory protection back in healthcare settings. This is a disservice to patients, staff, and visitors. Worse, the CDC making the move to make tracking HAI optional is almost criminal. I don't know how they can justify doing so when the data is clear.
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Nearly half of HCWs with COVID-19 worked despite symptoms
“We saw quite a few health care workers (HCWs) come to work knowing they had COVID-19 symptoms,” Katherine LinsenmeyerMD, attending physician at Veterans’ Affairs Boston Healthcare System and assistant professor of medicine at Boston University, told Healio. “These HCWs both knew that COVID-19 was very transmissible and had paid leave available, so we wanted to understand why they continued to work.”
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- Meanwhile the rate of heroin-involved OD remained relatively stable during the 5 year period,— Sheila Vakharia PhD MSW (@MyHarmReduction) May 3, 2023
- Oxycodone-involved OD rate decreased by 20+%
**At this point, any talk of the overdose crisis without acknowledging prevalent stimulant use misses the mark
Tips, general reading for public:
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Did you think I’d show up to the hearing on Supreme Court ethics without receipts? pic.twitter.com/QjdF7T0rIl— Sheldon Whitehouse (@SenWhitehouse) May 2, 2023
Don't listen to the liars. Here is everything you need to know about why the shootings keep happening. In the past 20 years we have doubled the number of guns in America to over 400,000,000 and AR 15 sales have gone from less than 2% to 25%. #AmericanCarnage pic.twitter.com/6xlYHOZ4FH— Fred Guttenberg (@fred_guttenberg) May 7, 2023
‘A budget is a moral document’: why does the #NYPD need $29m a day?
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Feel good du jour:
I went to a cello concert in a cave. What song is this? 🥰 pic.twitter.com/vZ6R9vMcoW— Zed Zha, MD is pitching (@DrZedZha) April 30, 2023
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The Monster Pho restaurant owner shares what many get wrong about refugees and how his background has fueled his passion to help others in need.
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Father stork brings a blanket to warm up mother stork while she broods.. 😊 pic.twitter.com/3Xk1v8RfiC— Buitengebieden (@buitengebieden) May 3, 2023
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Tiny dolls appeared in mailbox with a note: ‘We’ve decided to live here’
Baby gorilla learning to pound its chest.. 😅 pic.twitter.com/9sRnkIwvRJ— Buitengebieden (@buitengebieden) May 6, 2023
The Coronation of the King.. 😏https://t.co/kcvEydMLo4— Buitengebieden (@buitengebieden) May 6, 2023
Quote of the day: “If you hold onto anger, you’re just going to swap one prison for another,” Lamar Johnson, on his 28-year wrongful imprisonment.
washingtonpost.com/lifestyle/2023 #anger #forgiveness #injustice.
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Bits of beauty: