Coronavirus Tidbits 245 – May 14, 2023

May 13, 2023 /

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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.

Reminder, Resilience: One Family's Story... is increasingly pertinent, as some of our politicians shift rightward. All proceeds go to Holocaust education.

Available here.

 

 

 

News 

Covid:  Brace yourself--lots of big changes this week!

CDC data and reporting:

See https://www.cdc.gov/mmwr/volumes/72/wr/mm7219e1.htm#T1_down for details.

With the end of the Public Health Emergency, the CDC is drastically reducing the data it collects and reports. As of May 11, 2023:

--COVID Data Tracker will display hospital admissions, deaths, and emergency department visits data as primary surveillance metrics for COVID-19.

--test positivity data from COVID-19 Electronic Laboratory Reporting has been removed from COVID Data Tracker and archived at healthdata.gov. After May 11, the National Respiratory and Enteric Virus Surveillance System will become CDC’s new source for testing data.

--COVID Data Tracker is no longer reporting aggregate cases and deaths, COVID-19 Community Levels, COVID-19 Community Transmission Levels, or COVID-19 Electronic Laboratory Reporting (CELR) data.

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Using percentage-of-deaths-in-region as a metric for thinking about a preventable illness is absurd even leaving aside all of the risks from "mild" Covid cases.

It might readily be distorted by a rise in other deaths (e.g., guns, drunk driving) and look falsely low.

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The CDC has stopped tracking community levels of Covid and the percentage of tests that come back positive, a metric used to calculate transmission rates,

To track death rates, agency officials now will rely on the National Vital Statistics System, which is highly accurate but tends to lag behind other kinds of surveillance by two to three weeks. The C.D.C. is also scaling back the data that hospitals are required to report, including the number of cases and the race, sex and age of patients. But the agency will continue to track overall Covid hospitalizations and intensive care admissions.

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....

Collecting and reporting Covid data to the C.D.C. is time-consuming and laborious for many states and local jurisdictions, and some have already stopped doing so, limiting efforts to track the spread of the virus.

Some states are forbidden by their own laws from sharing data with the C.D.C. in the absence of an emergency.

https://www.nytimes.com/2023/05/05/health/cdc-covid-tracking.html

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“What we have right now is not a national public health system,” said Nirav Shah, the CDC’s principal deputy director. “We have a patchwork. And as a result of that, when we want to get data and synthesize it, it takes a lot of legwork that takes way too long.”

It’s up to states to decide what kind of data and how often to report to the CDC.

states control their responses to emerging infectious diseases, with state laws dictating how health data is collected and shared.

https://www.washingtonpost.com/health/2023/05/09/covid-data-public-health-emergency-ends/

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Sleep Apnea increases Long Covid

Past studies have shown that patients with obstructive sleep apnea (OSA) tend to have more severe illness when initially infected with COVID-19. OSA affects about 1 in 8 adults but is often underdiagnosed...

Published in the journal Sleep, this study found that a prior diagnosis of sleep apnea in the PCORnet group came with a 12 percent increase in risk for long-term symptoms months after patients' initial infections.

https://medicalxpress.com/news/2023-05-apnea-covid.html

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@Vaccinologist   May 12
Adults with obstructive sleep apnea showed up to a 75% increased risk of developing #LongCOVID, according to an analysis of nearly 1.8 million people; for women, the risk is up to 89% HIGHER, compared to a 59% increased risk for men.
academic.oup.com/sleep/advance-
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Masking:

Mass General retracted their "Patients can't ask for masking" statement, replacing it with "Patients can ask, but providers determine when and if masking in a clinical situation is necessary."

--@yaneerbaryam  May 13

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How much ventilation is enough? CDC updates recommendations

CDC now recommends aiming for 5 air changes per hour (ACH).

NOTE:  ASRAE's new recs are generally higher than CDC's recs. (see Devices)

This and other updates on Ventilation in Buildings at cdc.gov/coronavirus/20 /1

Enhanced strategies in plain language at cdc.gov/coronavirus/20:

1. Aim for 5 ACH

2. Upgrade filters to MERV13

3. Turn HVAC to ON when occupied

4. More outdoor air (open windows, exhaust fans)

5. Use air cleaners

6. Germicidal UV

7. CO2 sensor (<800 ppm)

(For more on this, see devices section)

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Long Covid

A pathophysiological model of #LongCovid based on persistence of the #SARSCoV2 virus, and review of all the supportive evidence thelancet.com/journals/lanre

Image

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Long Covid and Clinical Trials

Excellent overview by Hannah Davis on considerations for further trials!

https://www.medscape.com/viewarticle/991762

If you don't want to register, email me for a pdf.

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Important to acknowledge, as the emergency status passes: "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." washingtonpost.com/health/2023/05 w/

@SolidEvidence , @trvb, @BarouchLab, and @EricTopol

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Image

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#MillionsMissing ME/CFS display at Washington Monument:

Image

Diagnostics:

still an incredible, negligent last of testing.

Drugs and Vaccines:

Obesity is linked to accelerated waning of Covid vaccine protection

nature.com/articles/s4159

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RSV: We finally have a vaccine for this deadly virus

The vaccine, named Arexvy, will be given to people 60 years and older.

Globally, RSV is estimated to cause one in every 50 deaths in children under five.

RSV is harder to diagnose in  but may be more common than influenza. It can develop into conditions such as pneumonia, which can be fatal. Globally, at least 300,000 people over 65 are ill enough to be admitted to hospital with an RSV infection each year, around 4% of whom will die.

The vaccine gave 83% protection against lower respiratory tract disease caused by RSV.

https://medicalxpress.com/news/2023-05-rsv-vaccine-deadly-virus.html?

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Elderly with few antibodies may need an extra dose of COVID-19 vaccine: Study

The new mRNA vaccines have just as good a protective effect against COVID-19 for the very oldest as for younger people. This is evident in a study at Umeå University, where researchers have followed individuals in special housing around Sweden. However, the study shows that elderly people with a low antibody response after vaccination were at increased risk of dying from the omicron variants of the disease. The research is published in The Lancet Regional Health—Europe.

https://medicalxpress.com/news/2023-05-elderly-antibodies-extra-dose-covid-.html?

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Oxygen therapy found to improve heart function in patients with long COVID

A small randomized trial in patients with post-COVID syndrome has found that hyperbaric oxygen therapy promotes restoration of the heart's ability to contract properly. The research is presented at EACVI 2023, a scientific congress of the European Society of Cardiology (ESC).

https://medicalxpress.com/news/2023-05-oxygen-therapy-heart-function-patients.html?

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Moderna beats Pfizer among two-dose COVID vaccine recipients aged 60 and over, study shows

The mRNA COVID-19 vaccines developed by Pfizer and Moderna continue to save lives. But a new paper published in the journal Vaccines provides evidence that the two vaccines are not equivalent when it comes to protecting older adults against death.

[Note: Moderna is also a higher dose of vax]

https://medicalxpress.com/news/2023-05-moderna-pfizer-two-dose-covid-vaccine.html?

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What’s Long COVID look like at 2 years?

NOT GOOD In this Swedish study of previously hospitalized patients with COVID, more than 8 out of 10 of 185 people who met the diagnosis of Long COVID at 4 months (and 1 in 3 of the total 460 COVID-19 patients tracked, all of whom had positive PCR-confirmed acute COVID-19) had ongoing cognitive, muscle, and fatigue symptoms affecting everyday life at 2 years. In fact, over half of those on sick leave related to Long COVID at four months after acute infection remained unable to return to work at two years.   bit.ly/3HBhEpg  @WesElyMD  May 8

Devices, Masks, and Ventilation:

ASHRAE Control of Infectious Aerosols - Equivalent Outdoor Air Rates

The new standard is out and can be found here. osr.ashrae.org/default.aspx

(NOTE: These are generally higher than CDC's recs of only 5 air exchanges. See NEWS)

The recommended equivalent outdoor air rates can be found in Table 5-1 on page 4. They are overall very high. For reference, WHO recommends 10 litres per second (lps)/person and OSPE and Lancet recommend 13.5 lps/person.

2/5Image

Using standard densities from 62.1 at full occupancy, I've converted these rates into air changes per hour and what CO2 level you would expect to have if outdoor air was the only tool used (it won't be, but this is just for reference).
3/5
>8 ACH for classrooms. Compared to standard indoor air quality in 62.1 for educational facilities, the rate is about 3x higher. I think once and for all, we can agree that ASHRAE minimums for IAQ are woefully inadequate for infection control. We now have a better goal.
5/5
Image
Should have been more clear. This isn’t the final standard but the initial public review. Things can change before final release. - @joeyfox85 May 12

Epidemiology/Infection control:

@MeetJess   May 12
« For this week, The Economist estimates that there have been 14,000 excess deaths per day attributable to the pandemic, while the cumulative total now stands at 22 million, making COVID-19 still the third-leading cause of death globally »
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Deaths and hospitalizations sit at or near lowest levels of the pandemic, but there is no room for complacency with >1,000 deaths per week, the majority of which are preventable.
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@RajlabN   May 11
,@CDCgov Traveler-Based Genomic Surveillance for #SARSCoV2 Weekly pool positivity (809 pools tested): 22.5% #MASKUP in Airports/Planes
covid.cdc.gov/covid-data-tra

Tips, general reading for public:

Ventilate.

Mask.

Vax.

Politics:

Covid:

@pjavidan   May 6
1/ Anti-vaxxers are building a legal network. Steve “Slugworth” Kirsch helped organize and fund a conference in Atlanta for future COVID and vaccine-related litigation. npr.org/2023/05/04/117
2/ The conference aims to map strategies for anti-vaccine and litigation against COVID mitigations—targeting hospitals, school systems, medical licensing boards, and pharmaceutical companies that make vaccines.
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@Annatated   May 8
Important life-saving info: if you have a condition on the CDC's list of risk factors for COVID-19 you can get universal masking as an ADA accommodation. Here's some helpful info on how this applies to healthcare from @PeoplesCDC : drive.google.com/file/d/1FQfz1M

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Other: 

FDA updates blood donation policy to include gay, bisexual men trib.al/YdifwO4

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Lab safety expose - excellent:

@zeynep

Even when something went wrong during research with H5N1 engineered to be airborne among mammals in 2019, a US lab shrugged off precautions. If not for

@alisonannyoung's dogged reporting, we wouldn't even know. Lab safety is a global problem. No paywall: nytimes.com/2023/05/12/opi

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Abortion/Reproduction:

FDA advisers unanimously back over-the-counter birth control pill

An advisory committee for the US Food and Drug Administration (FDA) has unanimously endorsed the agency making an oral contraceptive available over the counter. If the FDA follows this advice, the medication, sold under the name Opill, will be the first birth control pill available without prescription in the United States. A final decision by the agency is expected in the coming months.

https://www.nature.com/articles/d41586-023-01580-2

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Proposed rules to protect health data

A new rulemaking by the Biden administration seeks to lessen the harmful effects of abortion bans by protecting certain health data from being used to prosecute both clinicians and patients. But in the current draft, the rulemaking is designed to reinforce the privacy of reproductive health in states where abortion is legal and does little for those seeking abortion in states where it is illegal. Further, some states, like Idaho, are implementing a law that makes it illegal to travel out of state for an abortion, effectively blocking its citizens from the potential benefits of this rulemaking.

https://www.statnews.com/2023/05/12/hipaa-abortion-health-data-privacy-draft-rulemaking/

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@NewYorkStateAG   May 9
Texas is trying to stop a federal policy to protect access to emergency abortion when someone’s life is in danger. I'm co-leading a group of AGs to fight back because nothing should interfere with the care people need during a life-threatening emergency.
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Environment:
@writermjs   May 11

GOP/TFG:

@EdKrassen   May 6
The official tapes of Trump's deposition in the E. Jean Carroll battery (rape) and defamation case have been released. Below is the most controversial portion of the deposition. First Trump is forced to watch the comments he made on the Access Hollywood tape. Then the questions start coming, Trump is asked about his statement saying that stars can “grab a woman by the [private parts]”. His response was: "Well, historically, that’s true with stars. Well, that’s what — if you look over the last million years, I guess that’s been largely true. Not always, but largely true. Unfortunately or fortunately.” He literally said "fortunately."
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@juliettekayyem   May 9
This is some post-verdict jury instruction: you could get killed or injured, certainly harassed, definitely trolled so don't identify yourself and don't identify anybody else. Trump's strongest legacy will always be violence as an extension of our democratic processes. twitter.com/jamiegangel/st
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CNN is setting TFG up to win/have a huge boost w free air time, all supportive audience, and little challenge to his lies.
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Greed:
@DrJessTaylor   May 7
A reminder that Elsevier made $10.5 BILLION in 2022 from selling your academic journals and articles behind paywalls, and make more profit than Amazon, Google, and Apple every year… And paid the academics who wrote the articles $0 And paid the reviewers of the articles $0
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@EFF   May 12
Over 40 courageous scientists resigned from an Elsevier journal last month, calling out the absurd publishing fees stifling life-saving research. eff.org/deeplinks/2023
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People going hungry because $$ being diverted from food banks to pay for the coronation of a king worth £1.8 billion
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Guns:
Powerful read aloud (video), Joaquin's First School Shooting:
A children's book to explain gun violence to childish politicians.
From Patricia and Manuel Oliver, parents of Parkland, FL shooting victim Joaquin
~ ~ ~
@Factschaser   
The modern gun control movement started in California, where the first major legislation restricting the right to carry was drafted by a conservative Republican, and signed into law in 1967 by Gov. Reagan who later supported Brady Bill’s background checks.
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@shannonrwatts   May 8
NEW: The gunman in Allen, Texas, kept a profile on a Russian social media site where he posted rants against Jews, women and racial minorities and shared selfies of his Nazi tattoos. White supremacy is an ideology, not a mental illness. nbcnews.com/news/us-news/t
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@Factschaser   May 7
The modern gun control movement started in California, where the first major legislation restricting the right to carry was drafted by a conservative Republican, and signed into law in 1967 by Gov. Reagan who later supported Brady Bill’s background checks.
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Immigration:
@itscaitlinhd   May 12
1/T-42 coverage depicting migrants as inherently threatening--ppl who will take your jobs, your safety, your health, your *something*--plays into centuries-old xenophobic stereotypes that have never been borne out by facts.
2/The resource strain at the border and in some cities (including mine) is real, but it's not the full, fact-based picture of how newcomers would impact American society. It's a tiny fraction of it.
3/Don't just take pictures of people at their worst, looking desperate. Talk to economists and business owners. Schools. Transportation. Hospitals. Find out what this really means for American life; don't vaguely imply a looming doomsday.
4/For ex., my sources in NYC migrant shelters say that newcomers are typically employed within days of their arrival, heading to work 6-7 days a week for jobs in construction, food delivery, cleaning, gardening.
...continues
[Migrants will, empirically, pick your crops, process your food, build, repair, and clean your houses, care for your children and elders….Doing jobs that are going unfilled now]
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LGBTQ:
Florida Gov. Ron DeSantis (R) has signed the “Protections of Medical Conscience Act,” a law that allows healthcare providers or payors to deny service on the basis of “a conscience-based objection,” including any ethical, moral, or religious beliefs. The bill provides no definition for what constitutes a “moral” or “ethical” belief.
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Which states have banned gender affirming care?
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@DrJustinGarcia   May 10
Honored to share my views in this ⁦@washingtonpost⁩ OpEd on what’s at stake w/ recent State defunding of renowned ⁦@kinseyinstitute⁩ at ⁦⁦@IndianaUniv⁩ “The Kinsey Institute is under attack in culture wars — again”
washingtonpost.com/opinions/2023/
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@EuphoriTori   May 9
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@BrynnTannehill   May 11
On April 25, 1933, Germany passed a racial quota law intended force most Jews out of public schools at all levels. These were largely successful.
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SCOTUS:
May 6 Republican donor Harlan Crow says in letter to Senate Finance Committee that he will not provide a list of gifts he gave Justice Thomas.
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Alabama:

@SenatorBennet came to the floor for the FOURTH time to try to confirm hundreds of routine military promotions. Senator Tuberville (R-AL) objected, again, risking our national security and readiness to push his own anti-choice agenda.
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GOP Sen. Tommy Tuberville is doubling down on his view that white nationalists should serve in the military: “White nationalists, what the heck is that? We all got different beliefs. You know I’m a Church of Christ, Catholics, we got different people...We can’t start distinguishing different types of people.”
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@MarkJacob16   May 10
Sen. Tommy Tuberville says a jury finding that Trump is a sexual predator "makes me want to vote for him twice." It's the perfect quote to meld 3 Republican themes: misogyny, violence and election fraud. al.com/politics/2023/
@reedfrich  Jan 19
Fantastic  @aldotcom
 investigation into out-of-control, traffic ticket abuse by a small town police dept. outside Birmingham, that is flagrantly preying on poor citizens to raise money, seize assets, and fund half the town's budget.
Local reporting matters! Police chief of Alabama town that had turned its local force into an obscene, money-grabbing racket resigns after damning exposé. al.com/news/2022/01/b
This fantastic exposé on a Alabama police dept. completely out of control just won a Pulitzer!
[It was worth a read]
~ ~ ~
Florida:
Florida rejects Holocaust education textbooks in clampdown on ‘woke’ instruction
~ ~ ~
Brandon Wolf   @bjoewolf   May 12
(DeSantis is blocking merchants from using such codes on purchases of guns).
~ ~ ~
@davidminpdx   
“A Louisiana man who served 29 years for a crime he did not commit has been released from prison after it was revealed… the victim had told the prosecutors in New Orleans for over two decades that the man was innocent, but she was repeatedly ignored.”
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see LGBTQ, above
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‘The point is intimidation’: Florida teachers besieged by draconian laws
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New Florida law bans covid mandates, allows healthcare denial
Also bars biz and gov't from requiring masks to enter or vaccines
~ ~ ~
@RawStory   May 9
Florida wants to pave its roads with radioactive fertilizer waste rawstory.com/florida-radioa
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Georgia:

Latest arrests of ‘Cop City’ protesters ‘feel like overreach’, experts say

Three activists protesting the planned facility were charged under a little-known Georgia law, raising first amendment concerns

https://www.theguardian.com/us-news/2023/may/13/cop-city-activists-arrests-georgia-law?

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@scalawagmag   May 8
"In 2022, the Atlanta Police Department was allotted a third of the city's $700 million budget... That same budget cycle, Atlanta Magazine reported that the city only had 29 affordable rental units for every 100 extremely low-income families." scalawagmagazine.org/2023/05/peacht

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@bluestein   May 8
Gov. Brian Kemp vetoed legislation that would have provided more needs-based financial aid to Georgia college students and would have allowed veterans to participate in a tuition-free, commercial driver’s license training program. #gapol ajc.com/politics/polit
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Idaho:
@bernabephoto  May 12
What the hell is wrong with people in these states? Idaho Fish and Game proposed a plan to kill majority of wolves. Officials just OK’d it.
idahostatesman.com/outdoors/artic
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New York:
“The Next Generation of Republican Leadership” is currently waiting his arraignment on 13 charges of wire fraud, money laundering, and theft.
~ ~ ~
@KaivanShroff   
Um…so today the House is voting on a bill to crackdown on COVID unemployment aid fraud. One of the bill’s lead sponsors? George Santos who will miss the vote to face charges for…COVID unemployment aid fraud. The Republican Party is a parody of itself.
~ ~ ~
Santos bail set at $500,000 which has been paid for by unidentified people.
~ ~ ~
Texas:
@EmbryEthan   May 8
Twice in Texas this week mothers died covering their one surviving child from the man with a rifle who just murdered her other child in front of her. 
~ ~ ~
Texas man kills girlfriend after she had an abortion in Colorado
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@GavinNewsom   May 7
This is your reminder that @GregAbbott_TX cut $211 million in mental health funding.
($210 million from the state’s Health and Human Services Commission over two years and about $160 million from the Texas Department of Public Safety for Border security)

Feel good du jour:

@HumansOfJudaism: May 4, 2023
Image

In this photo is Audrey Hepburn with Otto Frank, Anne’s father. Audrey Hepburn was born on May 4, 1929. The actress is best known for such films as Roman Holiday and Breakfast at Tiffany’s, but did you know that she turned down playing the role of Anne Frank? Here’s why. What many may not know about Hepburn is that as a teenager she helped the Dutch resistance in WWII. Both Hepburn and Frank were born in 1929. The two never met but Hepburn felt close to the young diarist, and lived 60 miles apart from each other. While Hepburn was not Jewish, she spent several years of the war in a cellar to use as a bomb shelter and even faced near starvation. During this time she managed to arrange illegal dance performances to support local families who were hiding Jews. After the war, Otto reached out to Hepburn asking if she would play the role of his daughter for the movie adaptation of the well-known diary. Hepburn felt unable to play the part, having had such a traumatic experience during the war, it would be too difficult. She said of Frank: “It’s a little bit as if this had happened to my sister . . . in a way she was my soul sister.” Photo: Luca Dotti

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Alessandra Korap Munduruku, 39, has been awarded this year's Goldman Prize, which recognises grassroots activism.

Alessandra Korap Munduruku

Her vocal campaign to protect the Munduruku territory saw her confronting mining giant Anglo American.

As a result, Anglo American withdrew 27 research applications to mine inside indigenous territories...

Asked by the BBC if she found the prospect of taking on the mining giant daunting, Alessandra Korap Munduruku said that she had derived strength from the territory she aimed to protect.

"It [Anglo American] may be powerful to you, but to me, the powerful ones are the river, the strength of our territory and our people, the ant doing its work and the resistance of our people for more than 500 years in the fight for our land."

https://www.bbc.com/news/world-latin-america-65359334.amp

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Recently homeless man leaves job interview, rescues baby in runaway stroller, then lands job

theguardian.com/us-news/2023/m

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Decades ago, U-M's Dr. Robert Bartlett was on the life-saving team when Hannah Abraham was born and went into severe respiratory distress, even needing ECMO.. Today (May 12), he handed Hannah her diploma as she graduated with her M.D./Ph.D. michmed.org/JQgwY

 

Comic relief:

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https://twitter.com/buitengebieden/status/1657122547366871045?s=20

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https://twitter.com/buitengebieden/status/1657094601809748004?s=20

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Perspective/Poem

Bits of beauty:

 

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