SARS-CoV-2 and COVID-19 (20)

New Study Finds Covid Spikes After N.F.L. Games With Fans
As the N.F.L. makes plans to return to stadiums at full capacity this season, researchers published findings that “fan attendance at N.F.L. games led to episodic spikes” in the number of Covid-19 cases.
Ken Belson | April 6, 2021

Major League Baseball, the N.B.A. and other sports leagues have started to let fans back into their stadiums and arenas, with most teams limiting attendance to 10 to 20 percent of capacity, but some allowing more. The N.F.L. has even grander plans. Last week, Commissioner Roger Goodell said the league hoped to open all of its stadiums at full capacity when the season kicked off in September.

...Yet new research* submitted to The Lancet, a scientific journal, in late March suggested that there was a link between the games that had large numbers of fans in the stands and an increase in the number of infections in locales near the stadiums. The study, which was submitted for peer review, is one of the most comprehensive attempts to address the potential impact of fans at N.F.L. games...

https://www.nytimes.com/2021/04/06/sports/football/nfl-stadium-capacity-covid.ht...
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* Kurland, Justin and Piquero, Alexis and Leal, Wanda E. and Sorrell, Erin M. and Piquero, Nicole Leeper, COVID-19 Incidence Following Fan Attendance: A Case Study of the National Football League 2020-2021 Season. Available at SSRN: https://ssrn.com/abstract=3805754 or http://dx.doi.org/10.2139/ssrn.3805754 or https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3805754

Lancet PREPRINT

Abstract
...Interpretation: The results of this primary analysis of COVID-19 incidence levels in the context of mass gatherings at sporting events provides compelling evidence that the presence of fans at NFL home games during the 2020/2021 season led to increased levels of COVID-19 cases and rates both in the counties in which the venues are nested within, and the surrounding counties in which fans likely travel from to attend. The increased spikes in COVID-19 cases and rates among those games attended by fans, particularly for large crowds of over 20,000 suggest that return to sporting and other mass gathering events should be handled with extreme caution and may indeed be premature. Within the context of large-scale sporting events, a more moderate, phased-in approach may be required to initially limit crowds until a sufficient level of herd immunity is reached. Still, even then, professional sports leagues and related large indoor/outdoor events need to continue to monitor public health data especially as variants circulate and data from the long-term effectiveness of vaccines emerges...

"...high-throughput microfluidic screening of antigen-specific B-cells led to the identification of LY-CoV555 (also known as bamlanivimab), a potent anti-spike neutralizing antibody from a hospitalized, convalescent patient with coronavirus disease 2019 (COVID-19)...mean half-life of 13 days, and clearance of 0.22 mL/hr/kg...In a rhesus macaque challenge model, prophylactic doses as low as 2.5 mg/kg reduced viral replication in the upper and lower respiratory tract in samples collected through study Day 6 following viral inoculation...clinical testing...prevention and treatment...."

Bryan E. Jones et al. 2021. The neutralizing antibody, LY-CoV555, protects against SARS-CoV-2 infection in non-human primates.
Science Translational Medicine 05 Apr 2021: eabf1906 DOI: 10.1126/scitranslmed.abf1906 https://stm.sciencemag.org/content/early/2021/04/05/scitranslmed.abf1906

Abstract
Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) poses a public health threat for which preventive and therapeutic agents are urgently needed. Neutralizing antibodies are a key class of therapeutics which may bridge widespread vaccination campaigns and offer a treatment solution in populations less responsive to vaccination. Herein, we report that high-throughput microfluidic screening of antigen-specific B-cells led to the identification of LY-CoV555 (also known as bamlanivimab), a potent anti-spike neutralizing antibody from a hospitalized, convalescent patient with coronavirus disease 2019 (COVID-19). Biochemical, structural, and functional characterization of LY-CoV555 revealed high-affinity binding to the receptor-binding domain, angiotensin converting enzyme 2 binding inhibition, and potent neutralizing activity. A pharmacokinetic study of LY-CoV555 conducted in cynomolgus monkeys demonstrated a mean half-life of 13 days, and clearance of 0.22 mL/hr/kg, consistent with a typical human therapeutic antibody. In a rhesus macaque challenge model, prophylactic doses as low as 2.5 mg/kg reduced viral replication in the upper and lower respiratory tract in samples collected through study Day 6 following viral inoculation. This antibody has entered clinical testing and is being evaluated across a spectrum of COVID-19 indications, including prevention and treatment.

COVID-19 Drives Surge of Excess Deaths in 2020
Connor Iapoce | April 6, 2021

...the United States experienced 22.9% more deaths than expected, with a total mortality of 2,801,439, from March 2020 to January 2021.

This percentage greatly exceeds the average annual increase observed in recent years of ≤2.5%...522,368 (deaths) were estimated to be excess.

...Particular demographic groups were unequally impacted by the pandemic, reflecting racial disparities in COVID-19 mortality...non-Hispanic black individuals...

Geographic regions experienced surges in excess related to seasons throughout the year...But by the end of 2020, deaths were exceeding against investigators’ model-based estimations in all regions of the country....

Excess deaths could also result from immediate or delayed mortality from undocumented COVID-19 infection, as well as secondary non-COVID-19 deaths during surges....heart disease and Alzheimer disease...

In an editorial accompanying the study, Alan M. Garber, MD, PhD, of Harvard University, championed the data found by Woolf and Chapman, comparing the pandemic to war and the failed response of the United States to combat its effects on mortality rates.

“Just as military leaders prepare their armies for fighting the last war, society will always be better prepared to fight the pandemics of the past than the unknown pandemics yet to come,” Garber said.

Garber believes despite the progress in creating vaccines and treating those with the disease, the increase in the risk of death and misclassifications and inconsistencies in reporting have caused death rates to go up, both directly and indirectly.

“The US and other countries are most likely to learn from the pandemic if they understand the consequences of failure,” Garber said. “The work of Woolf and colleagues illustrates what is at stake: despite the scientific, medical, and public health progress of recent decades, the loss of life attributable to the COVID-19 pandemic exceeds the mortality of major wars.”

The research letter, “Excess Deaths From COVID-19 and Other Causes in the US, March 1, 2020, to January 2, 2021,” was published online in JAMA.

https://www.hcplive.com/view/covid-19-drives-surge-excess-deaths-2020

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Steven H. Woolf et al. 2021. Excess Deaths From COVID-19 and Other Causes in the US, March 1, 2020, to January 2, 2021. JAMA. Published online April 2, 2021. doi:10.1001/jama.2021.5199

ABSTRACT

...Discussion

The 22.9% increase in all-cause mortality reported here far exceeds annual increases observed in recent years (≤2.5%). The percentage of excess deaths among non-Hispanic Black individuals (16.9%) exceeded their share of the US population (12.5%),5 reflecting racial disparities in COVID-19 mortality. Excess deaths surged in the east in April, followed by extended summer and early winter surges concentrated in southern and western states, respectively. Many of these states weakly embraced, or discouraged, pandemic control measures and lifted restrictions earlier than other states.1,6

Excess deaths not attributed to COVID-19 could reflect either immediate or delayed mortality from undocumented COVID-19 infection, or non–COVID-19 deaths secondary to the pandemic, such as from delayed care or behavioral health crises. Death rates from several non–COVID-19 diseases (eg, heart disease, Alzheimer disease) increased during surges. The model does not adjust directly for population aging, which could contribute to an overestimate of excess deaths. Other study limitations include reliance on provisional data, inaccurate death certificates, and modeling assumptions.

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Alan M. Garber. 2021. Learning From Excess Pandemic Deaths (Editorial). JAMA. Published online April 2, 2021. doi:10.1001/jama.2021.5120 https://jamanetwork.com/journals/jama/fullarticle/2778362

Kashif Pirzada, MD (Toronto ER) @KashPrime | 8:14 AM · Apr 8, 2021
Even with new measures announced, its going to take a few weeks for things to settle down. This is happening all over the Toronto area now. Surgeries are still happening, but surgical recovery rooms are being used for Covid patients.

And we keep adding people to the ICU at an incredible rate every day...
Image ( https://twitter.com/KashPrime/status/1380131856692215809/photo/1 )

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Kashif Pirzada, MD (Toronto ER) @KashPrime | 11:13 AM · Apr 6, 2021:
I want to shed some light on why we are up in arms (margd: petition to Ontario govt) about our ICU numbers. The ICU is basically the backstop of a hospital, where the sickest patients go to get 'intensive' therapy to get stabilized and hopefully discharged home or to rehabilitation facilities.
Image ( https://twitter.com/KashPrime/status/1379452221558042630/photo/1 )

This is where incredible resources, expertise and equipment are used to do what would have been impossible even 20 years ago. Beds are scarce as a result. The CCU is a similar unit but meant for heart attack and other cardiac patients. Staff are full time 1:1 and highly trained
Image ( https://twitter.com/KashPrime/status/1379452225165099017/photo/1 )

This is the situation now (margd: April 6, 2021) in Ontario. Roughly half of ICU beds are occupied by Covid patients, surgeries are getting cancelled, and the wards are filling up. In Toronto, most of the ICUs are already full with Covid and other patients.
Image ( https://twitter.com/KashPrime/status/1379452228667371531/photo/1 )

This is us in a few weeks; ICU patients will be moved to the CCU, into the PACU to use monitoring equipment there, even the OR. New staff will have to be drafted in, but won't have the training to work effectively. The ER will fill up, and there'll be no space to see anyone.
Image ( https://twitter.com/KashPrime/status/1379452232517685256/photo/1 )

This is Brazil now, every possible space in the hospital is being used to keep Covid patients alive. Ambulances can't leave new patients, and anyone with any other problem, be it broken bones, appendix rupture, cancer, is out of luck. This is what we are fighting to avoid.
Image ( https://twitter.com/KashPrime/status/1379452235818659846/photo/1 )

Here is a possible scenario in a couple of weeks: You have one ICU bed left. Which patient gets it? Now you have some idea of why we, as frontline ER and critical care physicians, are dreading the next few weeks...

386 votes·1 hour left ( https://twitter.com/KashPrime/status/1379452240252010498 )
71.3% 42 y.o pregnant with a PE
20.4% 31 y.o man with Covid
1% 69 y.o woman with Covid
7.2% 55 y.o with heart attack
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Is Ontario's Crisis Triage Discriminatory? (31:28)
Who received priority care during a pandemic?
The Agenda with Steve Paikin
https://www.tvo.org/video/is-ontarios-crisis-triage-discriminatory

Transcript: https://www.tvo.org/video/is-ontarios-crisis-triage-discriminatory

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South Sudan launches Covid-19 vaccine (Radio Tamazuj)

South Sudan on Tuesday launched the Covid-19 vaccination exercise in three centers in Juba. The launch at the Juba Teaching Hospital was officiated by South Sudan’s Minister of Health, Elizabeth Acuei, who became the first government official in the country to take the vaccine. Dr. Pawil Arop Yor, the acting Director of Juba Teaching Hospital became the first health worker to be innoculated... Speaking to journalists during the vaccine launch, Minister Acuei reassured that the vaccine is safe...

First images of cells exposed to COVID-19 vaccine reveal native-like Coronavirus spikes
University of Southampton | -Apr-2021

New research has for the first time compared images of the protein spikes that develop on the surface of cells exposed to the Oxford-AstraZeneca vaccine to the protein spike of the SARS-CoV-19 coronavirus. The images show that the spikes are highly similar to those of the virus and support the modified adenovirus used in the vaccine as a leading platform to combat COVID-19.

...The Scientists exposed a range of cells in vitro to the Oxford-AstraZeneca vaccine. Using an imaging technique known as cryo-electron microscopy (cryoEM) they took thousands of images which they then combined to build up a clear picture of the resulting protein spikes on the cells. Professor Peijun Zhang, of the University of Oxford and the Electron Bio-Imaging Centre (eBIC) at Diamond Light Source, who led the imaging work said, "CryoEM is an immensely powerful technique which enabled us to visualise the dense array of spikes that had been manufactured and presented on the surface of the cells".

Further chemical analysis of the glycans that coat the newly developed protein spikes revealed that they bear a high resemblance to those surrounding the SARS-CoV-2 spikes. This is an essential feature of the vaccine as it means that it can deliver close mimics of the coronavirus that are important in triggering the immune response needed to protect against COVID-19...
https://www.eurekalert.org/pub_releases/2021-04/uos-fio040721.php

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Yasunori Watanabe et al. 2021. Native-like SARS-CoV-2 Spike Glycoprotein Expressed by ChAdOx1 nCoV-19/AZD1222 Vaccine. Am. Chem. Soc. Central Society April 2, 2021. https://doi.org/10.1021/acscentsci.1c00080 https://pubs.acs.org/doi/10.1021/acscentsci.1c00080

Abstract
Vaccine development against the SARS-CoV-2 virus focuses on the principal target of the neutralizing immune response, the spike (S) glycoprotein. Adenovirus-vectored vaccines offer an effective platform for the delivery of viral antigen, but it is important for the generation of neutralizing antibodies that they produce appropriately processed and assembled viral antigen that mimics that observed on the SARS-CoV-2 virus. Here, we describe the structure, conformation, and glycosylation of the S protein derived from the adenovirus-vectored ChAdOx1 nCoV-19/AZD1222 vaccine. We demonstrate native-like post-translational processing and assembly, and reveal the expression of S proteins on the surface of cells adopting the trimeric prefusion conformation. The data presented here confirm the use of ChAdOx1 adenovirus vectors as a leading platform technology for SARS-CoV-2 vaccines.
Synopsis

Eric Topol @EricTopol | 2:03 PM · Apr 8, 2021:

The history of the covid vaccines, by Tony Fauci
https://science.sciencemag.org/content/372/6538/109

Crediting @kkariko
@WeissmanLab
@BarneyGrahamMD
@WardLab1
@KizzyPhD
@McLellan_Lab
and others for all the background work that led to this biomedical triumph
@ScienceMagazine

Image ( https://twitter.com/EricTopol/status/1380219819455176704/photo/1 )

>7 margd: contd. Surely Dr. Kariko will be nominated for Nobel Prize in Medicine. Her pioneering work may lead to vaccines for HIV and (universal) influenza, as well as COVID-19.

Kati Kariko Helped Shield the World From the Coronavirus
Gina Kolata | April 8, 2021

Collaborating with devoted colleagues, Dr. Kariko laid the groundwork for the mRNA vaccines turning the tide of the pandemic.

She grew up in Hungary, daughter of a butcher. She decided she wanted to be a scientist, although she had never met one. She moved to the United States in her 20s, but for decades never found a permanent position, instead clinging to the fringes of academia.

Now Katalin Kariko, 66, known to colleagues as Kati, has emerged as one of the heroes of Covid-19 vaccine development. Her work, with her close collaborator, Dr. Drew Weissman of the University of Pennsylvania, laid the foundation for the stunningly successful vaccines made by Pfizer-BioNTech and Moderna.

For her entire career, Dr. Kariko has focused on messenger RNA, or mRNA — the genetic script that carries DNA instructions to each cell’s protein-making machinery. She was convinced mRNA could be used to instruct cells to make their own medicines, including vaccines.

But for many years her career at the University of Pennsylvania was fragile. She migrated from lab to lab, relying on one senior scientist after another to take her in. She never made more than $60,000 a year...

https://www.nytimes.com/2021/04/08/health/coronavirus-mrna-kariko.html

Eric Topol @EricTopol
Just published @NEJM are 2 papers on vaccine-induced immune thrombotic thrombocyopenia (VITT) related to the Astra Zeneca vaccine

Andreas Greinacher et al. Thrombotic Thrombocytopenia after ChAdOx1 nCov-19 Vaccination. NEJM April 9, 2021
DOI: 10.1056/NEJMoa2104840 https://nejm.org/doi/full/10.1056/NEJMoa2104840?query=featured_home
( https://twitter.com/EricTopol/status/1380540172383571974/photo/1)

(No link to paper just photo of first page:) https://twitter.com/EricTopol/status/1380540172383571974/photo/2
16 cases characterized, platelet-factor 4 mediated

"Although rare, VITT is a new phemonenon with devastating effects for otherwise healthy young adults and requires a thorough risk-benefit analysis."

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4 similar cases have now been reported with the J&J vaccine
J&J Covid Vaccine Reviewed by EU Regulator After Blood Clots
https://www.bloomberg.com/news/articles/2021-04-09/eu-regulator-investigating-bl...

"Adenovirus technologies such as that used by AstraZeneca and others have been associated with clotting in other settings"

(margd: in addition to AstraZeneca and J&J, Russian and Chinese vaccines use adenovirus vector...)

Sofia Moutinho (Science Mag) @Sofialmdo | 6:41 PM · Apr 9, 2021:

Preliminary study suggest one dose of CoronaVac is still about 50% effective against symptomatic COVID-19
in a Manaus, where more than 85% of cases are caused by the highly transmissible variant P.1.

Chinese COVID-19 vaccine maintains protection in variant-plagued
First real-world data estimate Chinese vaccine is 50% effective in city where P.1 variant is widespread
sciencemag.org
https://www.boomlive.in/world/self-described-virologist-bossche-makes-false-covi...

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Susanne H Hodgson et al. 2021. What defines an efficacious COVID-19 vaccine? A review of the challenges assessing the clinical efficacy of vaccines against SARS-CoV-2. The Lancet Published:October 27, 2020 DOI:https://doi.org/10.1016/S1473-3099(20)30773-8 https://www.thelancet.com/article/S1473-3099(20)30773-8/fulltext

Summary
The novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused more than 1 million deaths in the first 6 months of the pandemic and huge economic and social upheaval internationally. An efficacious vaccine is essential to prevent further morbidity and mortality. Although some countries might deploy COVID-19 vaccines on the strength of safety and immunogenicity data alone, the goal of vaccine development is to gain direct evidence of vaccine efficacy in protecting humans against SARS-CoV-2 infection and COVID-19 so that manufacture of efficacious vaccines can be selectively upscaled. A candidate vaccine against SARS-CoV-2 might act against infection, disease, or transmission, and a vaccine capable of reducing any of these elements could contribute to disease control. However, the most important efficacy endpoint, protection against severe disease and death, is difficult to assess in phase 3 clinical trials. In this Review, we explore the challenges in assessing the efficacy of candidate SARS-CoV-2 vaccines, discuss the caveats needed to interpret reported efficacy endpoints, and provide insight into answering the seemingly simple question, “Does this COVID-19 vaccine work?”...

U.S. cases involving Brazil variant on the rise, according to CDC data
Erin Cunningham, Kim Bellware and Meryl Kornfield | April 9, 2021

The Washington Post is providing this important information about the coronavirus for free. For more free coverage of the coronavirus pandemic, sign up for our Coronavirus Updates newsletter where all stories are free to read.

As new U.S. coronavirus cases trend upward — with nearly 80,000 new infections reported Thursday — health officials are warning about the spread of multiple, more transmissible variants, some of which have seeded outbreaks in states such as Michigan and California.

On Thursday, the U.S. Centers for Disease Control and Prevention released new data on emerging variants, including those first identified in Brazil, Britain and South Africa. The B.1.1.7 variant initially detected in Britain accounts for almost 20,000 cases in all 50 states — and has become the dominant strain, officials say.

For the first time, however, the P.1 variant that originated in Brazil has taken the No. 2 spot. At least 434 people in the United States have been infected with the variant, which has devastated Brazil, with the largest number of cases found in Massachusetts, Illinois and Florida.

https://www.washingtonpost.com/nation/2021/04/09/coronavirus-covid-live-updates-...

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NYC:

Commissioner Dave A. Chokshi, MD @NYCHealthCommr | 1:31 PM · Apr 8, 2021:
NEW: @nycHealthy just released data on variants in NYC: https://on.nyc.gov/3t4B5xz
Key takeaways:
(1) Nearly 80% of cases sequenced this week are variants
(2) We are seeing an increase in the more contagious P.1 variant, from 0.6% of samples in the previous week to 1.3% in this report

Image-highlighted photo of report below ( https://twitter.com/NYCHealthCommr/status/1380211763631824905/photo/1 )
New York City COVID-19 Cases Caused by SARS-CoV-2 Variants Report (4.6.2021)
https://www1.nyc.gov/assets/doh/downloads/pdf/covid/covid-19-data-variants-04062...

Eric Feigl-Ding @DrEricDing | 2:43 AM · Apr 10, 2021
...#B117 also surging, but keep in mind other variants don’t have a shortcut PCR test like #B117–likely more variants...

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'Worst case scenario' critical care triage being considered as COVID cases spike in Ontario
Elizabeth Payne | Apr 09, 2021

As COVID-19 cases hit record highs in Ontario, doctors are preparing to make life and death decisions about who will get critical care.

...An emergency triage protocol* was developed for the province early on in the pandemic by the Critical Care COVID Command Centre. The provincial government is discussing implementing the protocol, although several officials told this paper that it could be used by hospitals without provincial implementation if the situation requires it. (it would only be used in a “worst-case scenario after reasonable efforts to expand capacity and redistribute resources are exhausted”)

The protocol has been circulating in hospitals for weeks...

...if COVID-19 pushes hospitals to crisis levels, Ontario hospitals have been instructed that, when faced with tie-breaking situations — one empty bed in the ICU, and two, four or more critically sick people with more or less equal chances of surviving competing for it — random selection** should be applied.

Each person would be assigned a number. The administrator on call would enter the numbers in a random number generator like random.org, and then click the “generate” button...

https://ottawacitizen.com/news/local-news/worst-case-scenario-critical-care-tria...

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* Clinical Triage Protocol for Major Surge in COVID Pandemic
Ontario Health Critical Care COVID Command Centre | March 28, 2020.
19 p
https://emergencymedicinecases.com/wp-content/uploads/2020/04/Clinical-Triage-Pr...

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** Random Selection Process ( https://twitter.com/DrEricDing/status/1380756630137110530/photo/1 )

A plan of last resort: Choosing who lives and dies if ICUs turn into virus war zones
Sharon Kirk | Jan 25

https://www.theguardian.pe.ca/lifestyles/health/a-plan-of-last-resort-choosing-w...

Migrant farm worker airport COVID-19 vaccine pilot starts Saturday in Toronto
The Canadian Press | Posted April 10, 2021

Ontario will start offering COVID-19 vaccines to migrant farm workers arriving at Toronto’s international airport through a pilot project today.

The government says the pilot will offer shots to 200 workers arriving on a flight from Mexico.

Officials from the ministries of health and agriculture, health-care practitioners and representatives from the Mexican Consulate will be at Pearson International Airport to meet the group, offering doses after the workers pass through customs.

Read more: Migrant farm worker COVID-19 vaccine pilot project to occur at Toronto Pearson airport on weekend

The arriving workers will be offered doses of the Moderna vaccine, which will be administered in a screened-off area after they take a mandatory COVID-19 test upon arriving.

The government says it will follow up with farms to administer the second dose through the local public health unit where the individuals work.
Story continues below advertisement

The program will become permanent after implementing lessons learned from today’s initial pilot, with plans to offer shots to more arriving workers next week...

https://globalnews.ca/news/7750311/migrant-farm-worker-covid-vaccine-pilot-toron...

Good news for asthmatics with budesonide (Pulmicort) inhalers?

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ETA:

Kashif Pirzada, (Toronto Emergency) MD @KashPrime | 12:01 PM · Apr 11, 2021
This is based on the STOIC trial results published in Lancet a few days ago. Cheap, effective intervention that reduces severity by 91% - 1 severe infection in the study group vs 11 in the control, with few side effects. From the study leader author:

Quote Tweet
Sanjay Ramakrishnan @SanjayResp · Apr 10
STOIC trial now published @LancetRespirMed. So excited to share the findings of our trial of inhaled budesonide for early #COVID19 A (long) thread:
https://twitter.com/SanjayResp/status/1380810888337358850
https://threadreaderapp.com/thread/1380810888337358850.html

Kashif Pirzada:
You can use this table to convert equivalent doses to other inhaled steroids if (and when) Budesonide runs out. This would be equivalent to:
Beclomethisone 800 twice daily
Fluticasone 500 twice daily
Ciclesonide 400 twice daily
Image ( https://twitter.com/KashPrime/status/1381281922903605248/photo/1 )

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Sanjay Ramakrishnan et al. 2021. Inhaled budesonide* in the treatment of early COVID-19 (STOIC): a phase 2, open-label, randomised controlled trial. The Lancet Respiratory Medicine (Published:April 09, 2021) DOI:https://doi.org/10.1016/S2213-2600(21)00160-0 https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(21)00160-0/fullt...

Summary
Background
Multiple early reports of patients admitted to hospital with COVID-19 showed that patients with chronic respiratory disease were significantly under-represented in these cohorts. We hypothesised that the widespread use of inhaled glucocorticoids among these patients was responsible for this finding, and tested if inhaled glucocorticoids would be an effective treatment for early COVID-19.

Methods
...adults within 7 days of the onset of mild COVID-19 symptoms. ...Budesonide dry powder was delivered using a turbohaler at a dose of 800 μg per actuation. Participants were asked to take two inhalations twice a day until symptom resolution. The primary endpoint was COVID-19-related urgent care visit, including emergency department assessment or hospitalisation... The secondary outcomes were self-reported clinical recovery (symptom resolution), viral symptoms measured using the Common Cold Questionnare (CCQ) and the InFLUenza Patient Reported Outcome Questionnaire (FLUPro), body temperature, blood oxygen saturations, and SARS-CoV-2 viral load. ...

Findings
...Clinical recovery was 1 day shorter in the budesonide group compared with the usual care group (median 7 days...in the budesonide group vs 8 days...in the usual care group... The mean proportion of days with a fever in the first 14 days was lower in the budesonide group (2%...) than the usual care group (8%...) and the proportion of participants with at least 1 day of fever was lower in the budesonide group when compared with the usual care group. As-needed antipyretic medication (reduces fever) was required for fewer proportion of days in the budesonide group compared with the usual care group (27% ... vs 50%...) Fewer participants randomly assigned to budesonide had persistent symptoms at days 14 and 28 compared with participants receiving usual care (difference in proportions 0·204... to 0·334...). The mean total score change in the CCQ and FLUPro over 14 days was significantly better in the budesonide group compared with the usual care group (CCQ mean difference −0·12...to −0·02 ...; FLUPro mean difference −0·10...to −0·00... Blood oxygen saturations and SARS-CoV-2 load, measured by cycle threshold, were not different between the groups. Budesonide was safe, with only five (7%) participants reporting self-limiting adverse events.

Interpretation
Early administration of inhaled budesonide reduced the likelihood of needing urgent medical care and reduced time to recovery after early COVID-19....

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* Budesonide (BUD), sold under the brand name Pulmicort among others, is a medication of the corticosteroid type.1 It is available as an inhaler, pill, nasal spray, and rectal forms. The inhaled form is used in the long-term management of asthma and chronic obstructive pulmonary disease (COPD). The nasal spray is used for allergic rhinitis and nasal polyps. The pills in a delayed release form and rectal forms may be used for inflammatory bowel disease including Crohn's disease, ulcerative colitis, and microscopic colitis. (Wikipedia)

Eric Topol @EricTopol | 2:23 PM · Apr 9, 2021:
We've been neutralizing antibody-centric with respect to vaccine efficacy.
A new study in 20 healthcare workers points to the importance of the T-cell spike-specific response kicking at 10 days,
coincident when efficacy is established

Image ( https://twitter.com/EricTopol/status/1380587299855945730/photo/1 )
Image ( https://twitter.com/EricTopol/status/1380587299855945730/photo/2 )

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Shirin Kalimuddin et al. 2021. Early T cell and binding antibody responses are associated with Covid-19 RNA vaccine efficacy onset. Cell Med (Published: April 08, 2021) DOI:https://doi.org/10.1016/j.medj.2021.04.003 https://www.cell.com/med/fulltext/S2666-6340(21)00152-5

Recommend Med to Your Library
Highlights

• Protective immunity must develop coincidentally with vaccine efficacy onset
• 80% of vaccinees develop Spike-binding antibodies at day 10 after the first dose
• 100% of vaccinees develop Spike-specific T cells at the same time point
• Lack of neutralizing antibodies suggest they are not necessary to prevent Covid-19

Summary
...Results
Spike-specific T cells and binding antibodies were detectable 10 days after the first dose of vaccine, in contrast to receptor-blocking and SARS-CoV-2 neutralising antibodies which were mostly undetectable at this early time-point.

...Conclusions
Our findings suggest that early T cell and binding antibody responses, rather than either receptor-blocking or virus neutralizing activity, induced early protection against Covid-19.

China considers mixing Covid-19 vaccines to offer more protection

Gao Fu, the head of the country’s CDC, says the health authorities are looking at ways to overcome relatively low efficacy rates
Another option under consideration is to change the interval between doses, adjust the dosage or offer an extra jab

Josephine Ma |10 Apr, 2021

https://www.scmp.com/news/china/science/article/3129053/china-considers-mixing-c...

Coronavirus: WHO chief criticises 'shocking' global vaccine divide (BBC)

The World Health Organization (WHO) has criticised what it describes as a "shocking imbalance" in the distribution of coronavirus vaccines between rich and poor countries... "On average in high-income countries, almost one in four people have received a Covid-19 vaccine. In low-income countries, it's one in more than 500"...

One can just imagine what the Polio-epidemic era would have been like if modern-day GOPers had been around during that period of time. Who would they have been blaming for the outbreak? Would Dr. Salk have been honored as a hero by them? What would the commentators on FOX News have been ranting about?

The warning signs of a longer pandemic
Sam Baker | 4/12/2021

...Although the pace of vaccinations is still strong, there’s a growing fear that it’s about to slow down. In some parts of the country, particularly the South, demand for shots has already slowed down enough to create a surplus of available doses.

...But if we don’t control the virus well enough, then even years into the future, we could be living through more new variants — some of which might be more deadly, some of which might be more resistant to vaccines, some of which might be more dangerous for certain specific populations.

That would translate into an ongoing risk of illness or potentially death for unvaccinated people and new races to reformulate vaccines as new variants keep emerging.

And it would lead to a world in which today’s vaccine-eager population would have to stay on top of those emerging risks, get booster shots when they’re available, and perhaps revive some of the pandemic’s social-distancing measures, in order to stay safe...

Go deeper: Explore Axios' coronavirus variant tracker ( https://www.axios.com/variants-tracker/ )

https://www.axios.com/coronavirus-pandemic-variants-vaccines-ffd86d47-2a74-4285-...

Eric Topol @EricTopol | 8:28 AM · Apr 12, 2021:
A new randomized trial of #SARSCoV2 monoclonal antibodies (N~1,500)
reduced symptomatic infections in household contacts from 7.8% to 1.5% (81% risk reduction).
This is the 1st time prevention of disease in contacts has been shown w/ mAbs (monoclonal antibodies).

Covid-19 Drug Prevents Symptomatic Disease in Study, Regeneron Says
by @joewalkerWSJ
The drugmaker says it will ask federal health regulators to clear use among people who haven’t been vaccinated...
https://wsj.com/articles/covid-19-drug-prevents-symptomatic-disease-in-study-reg...

Risk of blood clots from AZ, birth control pills, cigarettes, COVID infection:
Image ( https://twitter.com/cbarbermd/status/1381407627884695556/photo/1 )

----------------------------------------------------------------------------------

Michael Mina Retweeted
Carolyn Barber, MD @cbarbermd | 8:43 PM · Apr 11, 2021:
Replying to @VincentRK *

Thank you. Very helpful. Retweeting this which lines up with your UK data.
Image ( https://twitter.com/cbarbermd/status/1381407627884695556/photo/1 )

________________________________________________________________

* Vincent Rajkumar @VincentRK
( Professor, Mayo Clinic; Editor, Blood Cancer Journal; Oncologist; Health Costs; COVID threads @SurvivedCOVID )
https://twitter.com/VincentRK/status/1381357909880283136
https://threadreaderapp.com/thread/1381357909880283136.html ( 16h, 12 tweets, 4 min read )

Astra Zeneca vaccine & blood clots. Summary...

Herd immunity may take 4.6 years due to vaccine nationalism
Jennifer Huizen on April 9, 2021

Vaccine access and vaccination rates are high in high-to-upper-income countries but remain low to nonexistent among lower-income and lower-resource countries.

At current global vaccination rates, it will take 4.6 years to achieve worldwide herd immunity against COVID-19. This lengthy time gap will likely allow variants of the virus to develop and spread, potentially rendering current vaccines ineffective.

Treating vaccines as public goods rather than market commodities is the way to improve vaccine equity. This may involve scaling up existing vaccination distribution programs, developing new ones, and temporarily waiving vaccine patent protections...

https://www.medicalnewstoday.com/articles/herd-immunity-may-take-4-6-years-due-t...

---------------------------------------------------------------

Ingrid T. Katz et al. 2021. From Vaccine Nationalism to Vaccine Equity — Finding a Path Forward ( Perspective ). NEJM
List of authors. N Engl J Med Apr 8, 2021; 384:1281-1283 DOI: 10.1056/NEJMp2103614 https://www.nejm.org/doi/full/10.1056/NEJMp2103614

...Vaccinating the world is not only a moral obligation to protect our neighbors, it also serves our self-interest by protecting our security, health, and economy. These goals will not be accomplished by making the world wait for wealthy countries to be vaccinated first. By investing in multilateral partnerships with a sense of shared commitment and employing a global allocation strategy that increases supply and manufacturing, we can meet the urgent challenge of Covid-19, while creating sustainable infrastructures and health systems for the future. Getting the world vaccinated may well be the critical test of our time.

__________________________________________________

Coronavirus pandemic ‘a long way from over’: WHO
Al Jazeera | 12 Apr 2021

Confusion and complacency in addressing COVID-19 mean the pandemic is a long way from over, but it can be brought under control in months with proven public health measures, the head of the World Health Organization has said.

“We, too, want to see societies and economies reopening, and travel and trade resuming,” WHO Director-General Tedros Adhanom Ghebreyesus told a news briefing on Monday. “But right now, intensive care units in many countries are overflowing and people are dying – and it’s totally avoidable...The COVID-19 pandemic is a long way from over. But we have many reasons for optimism. The decline in cases and deaths during the first two months of the year shows that this virus and its variants can be stopped,” he added, saying transmission was being driven by “confusion, complacency and inconsistency in public health measures.”...

https://www.aljazeera.com/news/2021/4/12/coronavirus-pandemic-a-long-way-from-ov...

__________________________________________________

Eric Topol @EricTopol | 2:28 PM · Apr 12, 2021:

Adding another 2.6 million vaccination today in the US, which is a new record for Monday reporting,
and gets us to ~4 times the number of Americans with at least one dose compare with number of confirmed cases

In the News: Schizophrenia may increase the risk of death from COVID-19
Morgan Meissner | April 6, 2021

...Researchers found that people with schizophrenia seem to be at particularly high risk. Those who received a diagnosis within the past year were more than seven times more likely to contract COVID-19 than people without a mental health disorder.

According to the results of another recent study published in JAMA Psychiatry, schizophrenia was also one of the most significant risk factors for dying from COVID-19, second only to age....

...there are several factors that might put people with schizophrenia at increased risk of COVID-19 and complications, including:

living in crowded settings, such as group homes
lack of protective equipment, such as masks
poor access to healthcare
a higher prevalence of underlying medical conditions, such as heart disease and diabetes

“However, these factors were unlikely to account for the increased risk of death associated with schizophrenia in our study,” (Katlyn Nemani, MD, a psychiatrist at New York University (NYU) Grossman School of Medicine and the lead author on the study) explained. After adjusting for these factors, people with schizophrenia were still 2.7 times more likely to die from COVID-19 than people without schizophrenia...

https://www.medicalnewstoday.com/articles/schizophrenia-increases-covid-death-ri...
------------------------------------------------------------

Katlyn Nemani et al. 2021. Association of Psychiatric Disorders With Mortality Among Patients With COVID-19. JAMA Psychiatry. Jan 27 2021;78(4):380-386. doi:10.1001/jamapsychiatry.2020.4442

Abstract
Importance
Objective
Design, Setting, and Participants
Exposures

Main Outcomes and Measures Mortality, defined as death or discharge to hospice within 45 days following a positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) test result.

Results Of the 26 540 patients tested, 7348 tested positive for SARS-CoV-2 (mean...age, 54...years; 3891 (53%) women). Of eligible patients with positive test results, 75 patients (1.0%) had a history of a schizophrenia spectrum illness, 564 (7.7%) had a history of a mood disorder, and 360 (4.9%) had a history of an anxiety disorder. After adjusting for demographic and medical risk factors, a premorbid diagnosis of a schizophrenia spectrum disorder was significantly associated with mortality (odds ratio (OR), 2.67...). Diagnoses of mood disorders (OR, 1.14...) and anxiety disorders (OR, 0.96...) were not associated with mortality after adjustment. In comparison with other risk factors, a diagnosis of schizophrenia ranked behind only age in strength of an association with mortality.

Conclusions and Relevance In this cohort study of adults with SARS-CoV-2–positive test results in a large New York medical system, adults with a schizophrenia spectrum disorder diagnosis were associated with an increased risk for mortality, but those with mood and anxiety disorders were not associated with a risk of mortality. These results suggest that schizophrenia spectrum disorders may be a risk factor for mortality in patients with COVID-19.

The Mystery of Breakthrough COVID-19 Infections
There is nothing surprising about cases like mine, but they do have a psychological impact.
Masha Gessen | April 10, 2021

...On March 23rd, The New England Journal of Medicine published a letter to the editor from a group of researchers in Southern California who had found that the risk of infection in fully vaccinated health-care workers there was higher than in the original vaccine trials, but still extremely low—around one per cent. Breakthrough infections have been reported in Florida, Michigan, and Washington. Much of the time, these cases are caught through routine testing of health-care workers, and the infections are asymptomatic. Symptomatic cases like mine are more unusual...

https://www.newyorker.com/news/our-columnists/the-mystery-of-breakthrough-covid-...

-------------------------------------------------------------

SARS-CoV-2 Infection after Vaccination in Health Care Workers in California (Letter to Editor). NEJM March 23, 2021
DOI: 10.1056/NEJMc2101927 https://www.nejm.org/doi/full/10.1056/NEJMc2101927

Bar graph of European countries # cases rolling 7 day average, April 11, 2021 (Johns Hopkins U)
https://twitter.com/DrEricDing/status/1381523131844673536/photo/1

Ignore the pessimism: Covid vaccines are quietly prevailing (Guardian)

Nightmare scenarios involving deadly new variants are making us all too gloomy – but there’s a scientific case for optimism...

I think that even with apparent clotting risks, the adenovirus vaxxes (AZ, J&J) are worth taking NOW when COVID-19 is rampant. The risk-benefit will change in future, I suspect. Still, some clots associated with AZ & J&J, though exceedingly rare, can be deadly. Important to QUICKLY develop ID and treatment protocols
(1) to avoid unnecessary loss of life and
(2) to keep confidence of potential vaccinees in order not to stall progress against virus.

Like AstraZeneca, and at least a couple Russian and Chinese vaccines, the J&J vaccine is what is known as a non-replicating viral vector vaccine, using a common (cold) virus called adenovirus, which may be causing the clotting.

Your take, Stellar?

------------------------------------------------------------------------

U.S. Calls for Pause on Johnson & Johnson Vaccine After Clotting Cases
Noah Weiland, Sharon LaFraniere and Carl Zimmer | April 13, 2021

The Food and Drug Administration and the Centers for Disease Control will stop using the vaccine at federal sites and urge states to do so as well while they examine the safety issues.

Federal health agencies on Tuesday called for an immediate pause in use of Johnson & Johnson’s single-dose (more easily stored) coronavirus vaccine* after six recipients in the United States developed a rare disorder involving blood clots within about two weeks of vaccination.

All six recipients were women between the ages of 18 and 48. One woman died and a second woman in Nebraska has been hospitalized in critical condition.

Nearly seven million people in the United States have received Johnson & Johnson shots so far, and roughly nine million more doses have been shipped out to the states, according to data from the Centers for Disease Control and Prevention.

...Dr. Peter Marks, director of the Food and Drug Administration’s Center for Biologics Evaluation and Research, and Dr. Anne Schuchat, principal deputy director of the C.D.C., said in a joint statement. “Right now, these adverse events appear to be extremely rare.”...

...Federal officials are concerned that doctors may not be trained to look for the rare disorder if recipients of the vaccine develop symptoms of it. The federal health agencies said Tuesday morning that “treatment of this specific type of blood clot is different from the treatment that might typically be administered” for blood clots....

https://www.nytimes.com/2021/04/13/us/politics/johnson-johnson-vaccine-blood-clo...

>27 margd: A lot of the debate has been over whether the clotting risk is really above the baseline risk and if so by how much. The established approach to vaccine safety risk is that the standard needs to be higher than for medicines treating medical conditions, as vaccines are given to healthy people. So it is important to establish exactly what the risk is that we are dealing with, and a pause is probably called for given the uncertainties. And further, if this is not done there’s a good chance of exacerbating vaccine refusal. My own take given these numbers is that this is a very small risk, and that the pause will be temporary. In any case it’s unfortunate, and I have a larger concern that this finding might increase hesitancy for the mRNA vaccines too among people who are already on the fence.

>28 stellarexplorer: I also wonder if people susceptible to this rare apparent clotting with adenovirus vaxxes would likewise be more likely to clot if infected with SARS-CoV-2? It will be ages I suppose before researchers tease THAT out!

Kimberly Prather, Ph.D. (aerosols UC San Diego) @kprather88 | 12:44 PM · Apr 12, 2021:
UK hospital study showing those with surgical masks more likely to be infected than those w/ N95 masks
(suggests aerosol inhalation).

Image ( https://twitter.com/kprather88/status/1381649460296441864/photo/1 )
Lisa M Brosseau

Shields, A. et al, SARS-CoV-2 seroprevalence and asymptomatic viral carriage in healthcare workers: a cross-sectional study. Thorax 2020. https://thorax.bmj.com/content/thoraxjnl/early/2020/08/28/thoraxjnl-2020-215414....

https://www.mediaite.com/tv/tucker-carlson-casually-suggests-to-viewers-maybe-co....
Tucker Carlson Casually Suggests to Viewers Maybe Covid-19 Vaccine ‘Doesn’t Work and They’re Simply Not Telling You That’

R. Murdoch pays Tucker big bucks to proclaim the virtues of white supremacy and weave conspiracy theories on his faux news network. Both men are psychos and dangers to the well-being of clueless, gullible Americans and our democracy going forward. Greed is the glue which holds Murdoch and his network hires together.

Denmark is now doing close to half a million COVID-19 tests a day - most of them rapid antigen tests.
That's ~8% of the population - every. single. day.

Is this the key to keeping B.1.1.7 in check? Which they have managed to do so far (and cases are decreasing).

Image ( https://twitter.com/K_G_Andersen/status/1382204543308492801/photo/1 )

- Kristian G. Andersen @K_G_Andersen | 1:30 AM · Apr 14, 2021

Andrew L. Croxford (immunologist) @andrew_croxford | 9:16 AM · Apr 14, 2021:
I’m really, really concerned that if we (the developed world) tank international confidence in the cheapest, most easily distributed/stored (& provided-at-cost for AZ) vaccines we will regret it.

I’m coining a phrase > “Vaccine Decadence”

>29 margd: Are people susceptible to this rare apparent clotting with adenovirus vaxxes likewise more likely to clot if infected with SARS-CoV-2?

Eric Topol @EricTopol | 9:10 AM · Apr 14, 2021
What are cerebral venous sinus thromboses (CVST), a very unusual form of brain blood clots?
(as occurred in @HillaryClinton )
https://wsj.com/articles/j-j-covid-19-vaccine-pause-spotlights-science-of-rare-c...

Very rare w/ adenovirus vector vaccines
Zero in >180 million doses of mRNA vaccines, via @MoNscience
Image ( https://twitter.com/EricTopol/status/1382320434583015424/photo/1 )
Image ( https://twitter.com/EricTopol/status/1382320434583015424/photo/2 )

The other link is that CVST occurs very rarely with natural covid infections, in young, healthy individuals, but without thrombocytopenia, which may ultimately help elucidate its mechanism*

---------------------------------------------------------------------

* D.D. Cavalcanti et al. 2021. Cerebral Venous Thrombosis Associated with COVID-19. American Journal of Neuroradiology June 2020, DOI: https://doi.org/10.3174/ajnr.A6644 http://www.ajnr.org/content/early/2020/06/18/ajnr.A6644

Abstract

SUMMARY: Despite the severity of coronavirus disease 2019 (COVID-19) being more frequently related to acute respiratory distress syndrome and acute cardiac and renal injuries, thromboembolic events have been increasingly reported. We report a unique series of young patients with COVID-19 presenting with cerebral venous system thrombosis. Three patients younger than 41 years of age with confirmed Severe Acute Respiratory Syndrome coronavirus 2 (SARS-Cov-2) infection had neurologic findings related to cerebral venous thrombosis. They were admitted during the short period of 10 days between March and April 2020 and were managed in an academic institution in a large city. One patient had thrombosis in both the superficial and deep systems; another had involvement of the straight sinus, vein of Galen, and internal cerebral veins; and a third patient had thrombosis of the deep medullary veins. Two patients presented with hemorrhagic venous infarcts. The median time from COVID-19 symptoms to a thrombotic event was 7 days (range, 2–7 days). One patient was diagnosed with new-onset diabetic ketoacidosis, and another one used oral contraceptive pills. Two patients were managed with both hydroxychloroquine and azithromycin; one was treated with lopinavir-ritonavir. All patients had a fatal outcome. Severe and potentially fatal deep cerebral thrombosis may complicate the initial clinical presentation of COVID-19. We urge awareness of this atypical manifestation.

>32 margd: I have a test center within walking distance and a negative test less than 72 hour old is required if I want to show up physically at my workplace.
So we are nudging people to get tested if they want a hair cut or want to eat outside a restaurant rather than just buy some take-away. And yes, it seems to keep the contact number at 0.9999 :-)

Recent numbers for complications with Astra Zeneca are about 1 in 40000 it seems and there's not really any correlation with age or sex, so Astra Zeneca is dropped here.
It will postpone the vaccination plan a few weeks and all who wants to be vaccinated is now expected to have gotten their second shot by early August.
Here's a link to the latest news on it (In Danish, though).
https://www.dr.dk/nyheder/politik/danmark-stopper-med-vaccinere-med-astrazeneca

>35 bnielsen: Hang in there. These new variants exploit any openings... The 3-county region in Ontario where we have a cottage was doing excellently with public health measures when they were dealing with the original strain. Now B117 is infecting university students and schools--and the wider community. Still doing well compared to so many places, but striking the difference the new variant has made. Vaccines just beginning to arrive in large amounts in Canada, so hopefully with summer and U students headed home, authorities will regain control. I'm afraid in most places here in North America, we'll drag defeat from the jaws of victory... I may have mentioned that my grandmother was a nurse in WW1 France, then returned to Canada in time to fight flu of her day. I think she would be amazed at our vaxxes and therapeutics, but appalled at our lack of discipline in applying public health measures:

MICHIGAN (B117):
Eric Topol @EricTopol | 1:25 PM · Apr 14, 2021:
Michigan's covid case ascent is back on, with a record number of hospitalizations and kids in the hospital.
This is a bad precedent for how to manage a major surge when we now have 2-dimensions of defense.
No other states in this range.

Image-confrirmed cases in MI, NJ, and NY ( https://twitter.com/EricTopol/status/1382384442493206528/photo/1 )
Image-Mich. record hi hospitalization of kids ( https://twitter.com/EricTopol/status/1382388018154131459/photo/1 )
-----------------------------------------------------------------

BRITISH COLUMBIA (P1)
Shut down travel between provinces to control spread of variants, experts say
B.C. centre of largest outbreak of the P1 variant of concern outside of Brazil — and it’s spreading East
CBC Radio · Apr 14, 2021

...While the B117 strain is driving much of the third wave in Ontario and elsewhere, the P1 variant, associated with Brazil, is surging in B.C. and spreading in Alberta and Ontario.

...P1 is as much as 2.5 times more transmissible than the original COVID strain and the B.C. Centre for Disease Control said the variant may be able to re-infect people who have previously had COVID-19.

... Dr. Srinivas Murthy, an infectious diseases and critical care doctor in Vancouver and assistant professor of medicine at UBC, said P1 is driving an alarming spike in B.C., filling up ICUs. He said the world is now watching B.C. as the centre of the largest outbreak of P1 outside of Brazil..."we're seeing exponential growth (of P1) right now"...

The good news? Despite initial concerns that existing vaccines may not work as well against P1, Murthy said all indications are that the approved vaccines work against the strain and are only "a bit less" effective against P1 than the original strain...

https://www.cbc.ca/radio/whitecoat/shut-down-travel-between-provinces-to-control...

Germany to give different second vaccine to AstraZeneca recipients under 60
France 24 | 14/04/2021
https://www.france24.com/en/europe/20210414-germany-to-give-different-second-vac...

South Korea to resume wider use of AstraZeneca coronavirus vaccine, exclude people under 30
Josh Smith | April 11, 2021
https://www.reuters.com/article/us-health-coronavirus-southkorea-idUSKBN2BY04Z

Blood taken from kids before the #COVID19 pandemic contains memory B cells that bind #SARSCoV2, a new Stanford
study finds. Results highlight prominence of early childhood #Bcell clonal expansions & cross-reactivity for future responses to novel pathogens

- Science Magazine @ScienceMagazine | 2:05 AM · Apr 15, 2021

----------------------------------------------------------------

Fan Yang et al. 2021. Shared B cell memory to coronaviruses and other pathogens varies in human age groups and tissues.
Science 12 Apr 2021: eabf6648 DOI: 10.1126/science.abf6648 https://science.sciencemag.org/content/early/2021/04/09/science.abf6648

Abstract
Vaccination and infection promote the formation, tissue distribution, and clonal evolution of B cells, which encode humoral immune memory. We evaluated convergent antigen-specific antibody genes of similar sequences shared between individuals in pediatric and adult blood, and deceased organ donor tissues. B cell memory varied for different pathogens. Polysaccharide antigen-specific clones were not exclusive to the spleen. Adults had higher clone frequencies and greater class-switching in lymphoid tissues than blood, while pediatric blood had abundant class-switched convergent clones. Consistent with reported serology, pre-pandemic children had class-switched convergent clones to SARS-CoV-2 with weak cross-reactivity to other coronaviruses, while adult blood or tissues showed few such clones. The results highlight the prominence of early childhood B cell clonal expansions and cross-reactivity for future responses to novel pathogens.

...Image-Fig 1 ( https://twitter.com/ScienceMagazine/status/1382575682325262336/photo/1 )

...Childhood immune responses are particularly important in an individual’s life, as they form the initial memory B cell pool that shapes future responses (29). We find that in comparison to adults, children have higher frequencies of convergent B cell clones in their blood for pathogens they have encountered. Notably, pre-pandemic children also had class-switched convergent clones to SARS-CoV-2 and its viral variants, but not EBOV (Ebola Virus), at higher frequencies than adults. We hypothesize that previous HCoV (Human Corona viruses, responsible for ~ 20% of colds) exposures may stimulate cross-reactive memory, and that such clonal responses may have their highest frequencies in childhood...

J&J vaccine and blood clots:

Céline Gounder, MD, ScM, FIDSA (NYU prof) @celinegounder | 8:38 PM · Apr 14, 2021:
https://twitter.com/celinegounder/status/1382493473933307918

1/ Apologies for not posting this sooner. I've been tied up juggling multiple jobs (Bellevue + media + congressional testimony + other), but I think it's important to get this out there now. I could have last night, but...

2/ The Food and Drug Administration and Centers for Disease Control and Prevention called for a pause on use of the J&J vaccine in this country. Six cases of blood clots have been reported among a million women between the ages of 18 and 48 who have received the vaccine.

3/ To put this in context, women who are not taking birth control pills have a 1 to 5 in 10,000 per year risk of getting a blood clot. This risk increases by more than 4x during and immediately after pregnancy.

4/ Putting this another way: pregnancy increases a woman’s risk of a blood clot by 400 times more than does getting the Johnson and Johnson vaccine. Meanwhile an estimated 1 in 5 people hospitalized for COVID develop blood clots.

5/ It’s normal for people to worry, but we’re really bad at weighing risks. We tend to overemphasize the risk of an action, like getting vaccinated, and underemphasize the risk of inaction, like not wearing a mask in a pandemic or not wearing your seatbelt in the car.

6/ We worry about the risks of something new, like vaccines, but play down the risks we’re used to, like getting in a car accident while driving to work.

7/ The blood clots observed among these six women who received the J&J vaccine are similar to those seen among patients in Europe after receiving the AstraZeneca COVID vaccine.

8/ Both vaccines are based on modified adenoviruses, as are the Russian Sputnik V vaccine and the Chinese CanSino vaccine. Adenoviruses cause the common cold, but the adenoviruses in these vaccines have been “gutted” so can’t replicate.

9/ They’ve been modified to deliver the recipe for SARS-CoV-2 spike protein to human cells. When our immune system sees the spike protein, it learns to recognize SARS-CoV-2 and fight it off.

10/ Many of us now wonder whether the adenovirus vectors (what we call these “gutted” adenoviruses) could be setting off an abnormal immune response that causes low platelet counts and blood clots, what some are now calling “vaccine-induced immune thrombotic thrombocytopenia.”

11/ Heparin, commonly used to treat blood clots, can also rarely cause similar complications. Vaccine Adverse Event Reporting System (VAERS), which is co-sponsored by the CDC & FDA, should be commended for their careful surveillance for side-effects related to the COVID vaccines.

12/ These blood clots are so rare that they weren’t detected in large clinical trials involving tens of thousands of participants across three continents.

13/ Some have criticized the FDA and CDC for recommending a pause on use of the Johnson and Johnson vaccine in the United States. To be clear: the FDA didn’t revoke its emergency use authorization for the J&J vaccine. It didn’t take the vaccine off the market.

14/ And healthcare providers are still free to administer the Johnson and Johnson vaccine after discussing the potential risks and benefits with their patients.

15/ Firstly, the FDA and CDC had to inform the public of these possible side-effects so that patients, doctors, and other healthcare providers know what to be on the lookout for and how to treat complications.

16/ It’s common and normal for people to experience headache, fatigue, fevers, chills, and muscle pain in the first couple days after vaccination.

17/ But if someone has headache, abdominal pain, leg pain, or shortness of breath one or two weeks after vaccination, that’s cause for concern, and clinicians should screen such patients for blood clots.

18/ When we as healthcare providers care for a patient with a blood clot, the first drug we usually reach for is heparin. But heparin is the wrong treatment here. In this setting, heparin could make things worse and could even be deadly.

19/ Remember, heparin can cause a similar syndrome, but the good news is that we have many other drugs to choose from.

20/ Secondly, it’s essential that the FDA and CDC prove themselves to be trustworthy. Worries about vaccine safety and efficacy and a lack of trust in the health system and government drive low confidence in vaccines.

Jeremy Faust * MD MS @jeremyfaust | 11:30 PM · Apr 14, 2021:
https://twitter.com/jeremyfaust/status/1382536835856015361

Let's talk about the background risk of CVST (cerebral venous sinus thrombosis) versus in those who got J&J vaccine.
We are going to focus in on women ages 20-50.
We are going to compare the same time period and the same disease (CVST).
DEEP DIVE
KEY NUMBERS!

Spoiler: After an engaging convo with @ashishkjha ** tonight, I now believe we already have enough info to END the pause on J&J for everyone over 50, probably enough for all men (assuming we don't get a rush of bad news in the next couple of days), and women 20-50 in most situations

We have 6 CVST out of 1,402,712 doses in women 20-50.
That’s the known quantity we can work from.
That’s around 1 out of 233,785 in the 21-day post vaccination period (or 0.43 per 100,000 women 20-50 in the 21-day post vaccination period).

Meanwhile, the background rate of CVST is 0.5 to 2.0 per 100,000 per year for women 20-50.
Image ( https://twitter.com/jeremyfaust/status/1382536837391126536/photo/1 )
Let’s say it is 1.0 per 100,000 to make it easy for the rest of the numbers.

But that's annual background rate of CVST in women 20-50
We need to get the 21-day background rate in order to compare it to the J&J risk (because that's how long the risk appears to last after jab).
So we multiply 1 per 100,000 by 0.056 (because 21 days is 5.6% of a year).
1.0 per 100k x 0.056 = 0.056 CVST per 100,000 women 20-50 in any given 21-day period.
THAT, my friends, is our background rate.
0.056 per 100k women ages 20-50, over 21-day risk period.
(Note: comparing the same time periods matters greatly. You can't do yearly vs 21 days!)
Jeremy Faust MD MS (ER physician)

Recall the we found that the 21-day rate of post-J&J CVST is 0.43 per 100,000 women ages 20 to 50.
So, we divide to get the relative rate…
0.43/0.056= 7.6.
That means that in the 21-day post-vaccine period, women 20-50 are 7.6 more likely to have CVST than background.
But....

The real range might be 3.8-15.2x.
That just depends on whether the true background rate of CVST is 1 per 100k versus lower (say 0.5 per 100k) vs higher (2.0 per 100k).
This sounds alarming until you realize the risk of COVID-19, *even in this age group*.
Let's look at that.

In 2019, there were 67 million women in the US ages 20-50 (Census data).
If we don't get rid of COVID, eventually most would get it.
Let's say 80% eventually would get it (because of herd immunity).
That means 54 million women age 20-50 would get COVID.
How many would die?

Just for the sake of 'reductio ad absurdum,' allow us to imagine that just 1 in 10,000 in this demographic would die of COVID.
That's a low estimate ON PURPOSE to make a point.
5,400 deaths would occur from COVID, if all US women 20-50 were infected.
Many more in the ICU, etc.

Now let's imagine that all 67 million US women ages 20-50 women get J&J instead of COVID.
The fatality rate so far from J&J-related CVST is 1 in 1.4 million.
That means J&J induced CVST would kill 0.00000071 x 67 million = 48 people.
hmm....

Let's look at the scorecard.
If COVID infects all US women ages 20-50: kills 5,400 (and actually it's far higher; recall I used the ridiculously low infection fatality rate of 1 out of 10,000, just to make the numbers super conservative)
J&J-induced CVS: kills 48.

That means that J&J would save 5,352 lives of women ages 20-50 in the US, if it were our only option, compared to COVID.
So far, the COVID death rates for US women ages 20-50 is ~670 PER MONTH (>8000 total).
That means that every day 22 women ages 20-50 are dying of COVID.

CVST associated with the vaccine has killed one US woman TOTAL so far.
That one death is tragic, but way outnumbered by the daily COVID deaths.
(Recall I said 5400 COVID deaths if all women 20-50 got the disease. But in fact the real rate would be 5-10x worse, depending on IFR)

What does it all mean?
I had a really interesting convo tonight with @ashishkjha.
He asked point blank if I would give J&J to a 55 year old man who won't get access to another option for weeks or month.
My answer: HECK YES.
But what about women 20-50?
Depends. On what?

1. How prevalent is COVID in the region (the higher, the more urgent vaccination is)
2. How long until they can get an alternative.
3. Do they have risk factors for bad COVID.
In most cases the answer would still be YES, but not in all cases.

But could the rates of vaccine-related CVST actually be worse?
I am starting to doubt it.
Why?
Because if so, the rate of reported SEVERE CVST would go up VERY quickly after the "pause" was announced.
Every clinician in the US is looking for this, even in retrospect.

If many severe cases have not been reported en masse in the last couple days, they are unlikely to be many.
Caveat: There is likely to be an increase in the number of MILD CVST-like events, other clots.
(If this happens, I hope media don't confuse mild and severe disease)

But those won't really change the risk calculation--a mild problem is, well, mild.
What we need to watch is not just clots, but clots that cause dangerous problems.
Similarly, we are not comparing this to mild COVID, but to SEVERE COVID. I've been careful to do that here, yes?
So in my view, it is likely that within 72 hours of the pause, we will know 90% of what we need to know about whether this condition is an ORDER OF MAGNITUDE worse than we thought with respect to SEVERE life threatening or organ-harming effects.

Unless things are FAR worse than what we already seem to know, the J&J pause should end for:
1. Everyone over 50
2. Likely for men of all ages.
Ok so what about women 20-50?

And it's even likely a good idea that we should end the pause for women ages 20-50 soon, though I think in a couple of weeks we'll better know how often mild CVST is occurring (again, the number of mild cases is likely to increase, and the number of severe cases by very little)

So: why give J&J to women 20-50?
Basically if there's no alternative available soon in that particular area.
If there's an alternative, sure why not save that 1 in a million life.
But if there's not, why surrender MANY more to COVID while awaiting a late-arriving alternative.

In sum, we are waiting more data.
But I suspect that we already have enough to have resumed J&J.
I think ACIP is in a tough spot here.
If they ended the pause tonight, they might not gather enough information to reassure people.
But sadly, doing so delayed life-saving doses.

Last thing: I am thinking aloud in this public forum.
If I were advising FDA or CDC, I'd INVITE dissent.
I am curious what people think.
Thanks to @ashishkjha and @Atul_Gawande*** for pressing me to think aloud on this.
I hope it's worthwhile, illuminates, and spurs debate.

* Jeremy Faust MD MS (ER physician) @jeremyfaust
Health Policy/Public Health @BrighamWomens @HarvardMed

** Ashish K. Jha, MD, MPH @ashishkjha
Professor, Dean @Brown_SPH ( Brown University School of Public Health’s )

*** Atul Gawande @Atul_Gawande
Surgeon, Writer, Researcher

Why are so many babies dying of Covid-19 in Brazil?
Nathalia Passarinho and Luis Barrucho ( BBC Brazil ) | 4/14/2021

More than a year into the pandemic, deaths in Brazil are now at their peak. But despite the overwhelming evidence that Covid-19 rarely kills young children, in Brazil 1,300 babies have died from the virus.

...Experts say the sheer number of Covid cases in the country - the second-highest number in the world - have increased the likelihood that Brazil's babies and young children are affected.

...Such a high infection rate has overwhelmed Brazil's entire health care system. Across the country, oxygen supplies are dwindling, there is a shortage of basic medicines and in many ICUs across the country there are simply no more beds.

...the infection rate is being driven by a variant called P.1 which emerged in Manaus, in northern Brazil, last year, and is thought to be much more contagious. Twice the number of people died last month than in any other month of the pandemic, and the upward trend is continuing.

Another problem driving the high rates in children is a lack of testing.

...it is easier to miss, or misdiagnose, the symptoms of children suffering from Covid-19, as the disease tends to present differently in younger people...abdominal pain, and chest pain...

But it's also about poverty and access to health care...comorbidities and socioeconomic vulnerabilities...

...Scientists stress the risk of death in this age group is still "very low" - the current figures suggest only 0.58% of Brazil's 345,287 Covid deaths to date have been of 0-9 year olds - but that is more than 2,000 children.

...The Royal College of Paediatrics and Child Health advises parents seek urgent help if their child is:

Becoming pale, mottled and feeling abnormally cold to the touch
Has pauses in their breathing (apnoeas), has an irregular breathing pattern or starts grunting
Has severe difficulty in breathing, becoming agitated or unresponsive
Is going blue round the lips
Has a fit/seizure
Becomes extremely distressed (crying inconsolably despite distraction), confused, very lethargic (difficult to wake) or unresponsive
Develops a rash that does not disappear with pressure (the 'Glass test')
Has testicular pain, especially in teenage boys

https://www.bbc.com/news/world-latin-america-56696907

https://twitter.com/BBCWorld/status/1382493584562253827 (3:18)

Zero COVID...

Canada Is One Big Pandemic Response Experiment. It Proves ‘Zero COVID’ Is Best
So concludes a major French study that scanned many nations.
Andrew Nikiforuk | 2 Apr 2021

An extensive French study has surveyed nations’ responses to COVID-19 and concludes that those taking an aggressive “Zero COVID” approach fared better than others by both health and economic measures.

The study rests its analysis in part on the experience of Canada, where six large provinces face steeply rising infection rates tied to evolved variants of the virus, while provinces and territories that hewed closer to the Zero COVID approach do not.

Zero COVID, also called Go for Zero or elimination, employs a range of tactics designed to drive infection rates to negligible. Such tactics include one hard serious lockdown followed by strategic testing, active surveillance and tight border controls.

Canada’s experience fits patterns identified in the study released this week by the Paris-based Institut économique Molinari that compared the performance of nations representing 82 million people since the beginning of the pandemic...

Three distinct responses (mitigation, elimination, no action)...
On the mitigation see-saw...
The lingering cost of ‘half-measures’...

https://thetyee.ca/News/2021/04/02/Canada-One-Big-Pandemic-Response-Experiment-Z...

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Cécile Philippe & Nicolas Marques. April 2021. The Zero Covid strategy protects people and economies more effectively. Institut Économique Molinari | Paris-Bruxelles. 28 p. https://www.institutmolinari.org/wp-content/uploads/sites/17/2021/03/etude-zero-...

CONTENTS
1. SUMMARY
2. INTRODUCTION
3. TWO STRATEGIES FOR DEALING WITH EPIDEMICS
4. TOOLS USED DIFFERENTLY
5. THOSE WHO DID BEST BENEFITED THE MOST IN BOTH HEALTH AND ECONOMIC TERMS
6. ZERO COVID: AN INVESTMENT THAT PAYS OFF
7. ZERO COVID: MOBILITY THAT STANDS UP BETTER OVER TIME
8. THE KEY ROLE OF CONTROLLING UNCERTAINTY AND VISIBILITY
9. CONCLUSION
10. RECOMMENDATIONS
11. FIGURES & TABLES
12. BIBLIOGRAPHY
13. NOTES

1. SUMMARY
The report shows France to be more affected
France is more affected by the epidemic than the OECD countries that have chosen the Zero Covid strategy or something similar, constituting a representative sample of 82 million people in developed countries. Deaths per million people are 42 times higher in France, indicating 63,000 preventable deaths by the end of 2020 or 86,000 as of March 20, 2021. Last year, GDP declined five times more in France, representing lost earnings of €2,200 per French citizen.

The zero covid strategy benefits the economy
Short-term positive effects: Countries pursuing a Zero Covid strategy experienced a less severe economic decline in the second quarter of 2020 than the countries that allowed the virus to spread to such an extent that their health systems were saturated (-4.5% versus -11.7%). The Zero Covid strategy is showing lasting positive effects: In the fourth quarter of 2020, the countries applying this strategy had almost returned to normal economic activity. Their GDP was down only slightly (-1.2%) compared to 2019. Meanwhile, the decline in GDP was greater (-3.3%) in countries that had not eradicated the virus.

Zero covid: mobility that stands up better over time
Mobility data from Google show that “workplace” traffic in the second quarter of 2020 fell by less in the countries applying the Zero Covid strategy (-14 % compared to -36 %). These data also show that Zero Covid countries retained a significant advantage with a 15% reduction in mobility in January-February 2021 compared to 28% in countries not applying a Zero Covid strategy. Google data show that traffic in “cafés, restaurants, hotels, non-food businesses and leisure and cultural activities in general” was down by 14% in January and February 2021, compared to 2020, in the countries applying the Zero Covid strategy. This is a much smaller decline than in the countries applying a mitigation strategy (down 35%).

Zero covid helps control uncertainty
Cross-referencing of quarterly economic and health data confirms the superiority of the elimination strategy in terms of anticipation. People in those countries benefit from a level of visibility enabling them to project their societies and economies into the future.

In contrast, the course taken by the G10 countries has produced fluctuations, with the epidemic rebounding in the fourth quarter of 2020 everywhere except Japan, which is moving closer to Zero Covid. The mitigation strategy is causing them to seesaw, making it difficult to project into the future and thereby penalising societies and economies. This is especially problematic for businesses that depend on significant social interaction, which have been closed for months, as representatives of the hotel, restaurant, culture and recreation sectors have stated repeatedly.

In February 2021, Google searches for the word “Restaurant” were 64% lower than in February 2019. This decline was five times greater than in the Zero Covid countries, where restaurants are open and searches are down only 13% from February 2019.

Participation in economic and social life is a function of people’s confidence in being able to take part without running the risk of falling ill, contaminating others or seeing health services overwhelmed.

It is not only government-imposed restrictions that reduce movement. Voluntary decisions by individuals to cut back on social life in the face of a fast-spreading virus also play a key role. The Swedish example shows the importance of this phenomenon since, even without a lockdown, the decline in mobility was significant. This explains why Sweden’s economic contraction was close to the levels observed in Scandinavian countries that went into formal lockdown. Where the elimination strategy is implemented, the end of the tunnel becomes predictable, and it is then possible to make reliable long-term plans, resulting in stronger economic performance and lower mortality.

Recommendations
1. Invite an open dialog about the adoption of a Zero Covid strategy to include experts from countries that have implemented it thus far.
2. Rally the diplomatic network and parliamentarians representing French citizens abroad to broaden feedback on Zero Covid strategies.
3. Assign mandates to assess the advantages and disadvantages of strategies for fighting SARS-CoV2 by calling, in particular, upon French public organisations that analyse public policy (Conseil d’analyse économique, CESE, France stratégie, etc.)
4. Organise feedback from French communities that have implemented the Zero Covid approach (New Caledonia, etc.).
5. Support pilot projects in parts of France when local executives are receptive to the advantages of the Zero Covid strategy.
6. Bring the Zero Covid strategy into analysis of risks related to the health crisis at both the French and European levels. The European Union can be a major player in the strategy’s coordination.

...The case of Canada is interesting. The country has followed an elimination strategy in four of its provinces (New Brunswick, Nova Scotia, Prince Edward Island and Newfoundland and Labrador) as well as in its three northern territories (Yukon, Nunavut and Northwest Territories). Meanwhile, a mitigation strategy has been followed in the rest of the country (Alberta, British Columbia, Manitoba, Ontario, Quebec and Saskatchewan).

The Google data show that traffic in “retail and recreation” spaces declined by 24% in January and February 2021, compared to 2020, in the places applying the Zero Covid strategy. This is far less than the 42% decline observed in the rest of Canada, where the mitigation strategy is applied. Canada thus benefits from a pilot test area that shows the superiority of the Zero Covid strategy and its feasibility in a democratic continental country... (Table 4)...

COVID-19 and air pollution: What is the link?
Timothy Huzar | April 14, 2021

Research links air pollution with the worsening of a variety of cardiovascular and pulmonary diseases.

Evidence suggests an association between air pollution and worse COVID-19 outcomes.

This may account for the disproportionate effect of COVID-19 on marginalized racial and ethnic groups.

In a new literature review, researchers have outlined the evidence connecting air pollution and worse COVID-19 outcomes.

The authors of the article, which appears in the Annals of the American Thoracic Society, argue that stricter air pollution standards and taking action to end the disproportionate amount of air pollution in marginalized neighborhoods are needed.

https://www.medicalnewstoday.com/articles/covid-19-and-air-pollution-what-is-the...

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Stephen A. Mein et al. 2021. COVID-19 Pandemic: A Wake-Up Call for Clean Air ." Annals of the American Thoracic Society, 0(ja), pp. – https://doi.org/10.1513/AnnalsATS.202012-1542VP https://www.atsjournals.org/doi/pdf/10.1513/AnnalsATS.202012-1542VP

Risk of rare blood clotting higher for COVID-19 than for vaccines
Oxford U | April 15, 2021

COVID-19 leads to a several-times higher risk of cerebral venous thrombosis (CVT) blood clots than current COVID-19 vaccines.

Researchers at the University of Oxford have today reported that the risk of the rare blood clotting known as cerebral venous thrombosis (CVT) following COVID-19 infection is around 100 times greater than normal, several times higher than it is post-vaccination or following influenza.

The study authors, led by Professor Paul Harrison and Dr Maxime Taquet from Oxford University’s Department of Psychiatry and the NIHR Oxford Health Biomedical Research Centre, counted the number of CVT cases diagnosed in the two weeks following diagnosis of COVID-19, or after the first dose of a vaccine. The then compared these to calculated incidences of CVT following influenza, and the background level in the general population.

They report that CVT is more common after COVID-19 than in any of the comparison groups, with 30% of these cases occurring in the under 30s. Compared to the current COVID-19 vaccines, this risk is between 8-10 times higher, and compared to the baseline, approximately 100 times higher.

The breakdown comparison for reported cases of CVT in COVID-19 patients in comparison to CVT cases in those who received a COVID-19 vaccine is:

In this study of over 500,000 COVID-19 patients, CVT occurred in 39 in a million patients.
In over 480,000 people receiving a COVID-19 mRNA vaccine (Pfizer or Moderna), CVT occurred in 4 in a million.
CVT has been reported to occur in about 5 in a million people after first dose of the AZ-Oxford COVID-19 vaccine.
Compared to the mRNA vaccines, the risk of a CVT from COVID-19 is about 10 times greater.
Compared to the AZ-Oxford vaccine, the risk of a CVT from COVID-19 is about 8 times greater.

However, all comparisons must be interpreted cautiously since data are still accruing.

Paul Harrison, Professor of Psychiatry and Head of the Translational Neurobiology Group at the University of Oxford, said: ‘There are concerns about possible associations between vaccines, and CVT, causing governments and regulators to restrict the use of certain vaccines. Yet, one key question remained unknown: ‘What is the risk of CVT following a diagnosis of COVID-19?’.

‘We’ve reached two important conclusions. Firstly, COVID-19 markedly increases the risk of CVT, adding to the list of blood clotting problems this infection causes. Secondly, the COVID-19 risk is higher than we see with the current vaccines, even for those under 30; something that should be taken into account when considering the balances between risks and benefits for vaccination.’

Dr Maxime Taquet, also from the Translational Neurobiology Group, said: ‘It’s important to note that this data should be interpreted cautiously, especially since the data on the Oxford-AstraZeneca vaccine come from EMA monitoring, whereas the other data uses the TriNetX electronic health records network. However, the signals that COVID-19 is linked to CVT, as well as portal vein thrombosis – a clotting disorder of the liver – is clear, and one we should take note of.’

An important factor that requires further research is whether COVID-19 and vaccines lead to CVT by the same or different mechanisms. There may also be under-reporting or mis-coding of CVT in medical records, and therefore uncertainty as to the precision of the results.

Full data are available from the OSF website.

https://www.ox.ac.uk/news/2021-04-15-risk-rare-blood-clotting-higher-covid-19-va...

>40 margd: This is exactly the analysis I’ve been waiting for - thank you

>45 stellarexplorer: I bet Jeremy Faust's cocktail napkins are works of art, worthy of framing!

Here's a disappointing development. While Ivanka is far from my favorite person, she did a good thing publicizing her vaccine in apparent attempt to convince Rs to do likewise. Snarky article dissed her for it, but even more scary that MAGA-world trounced her as well:

Ivanka Trump’s Vaccine Selfie Didn’t Go Over as Planned
Things really backfired for Princess Purses.
Bess Levin | April 15, 2021
https://www.vanityfair.com/news/2021/04/ivanka-trump-vaccine-selfie

(I might as well pile on--my eyes got itchy contemplating the layers of mascara, eyeliner, and false eyelashes the woman now sports. How long must it take to apply--and remove??)

99.992% of fully vaccinated people have dodged COVID, CDC data shows
No vaccine is 100% effective. But the COVID vaccines seem pretty darn good.
Beth Mole - 4/15/2021, 5:46 PM

...Among more than 75 million fully vaccinated people in the US, just around 5,800 people reported a “breakthrough” infection, in which they became infected with the pandemic coronavirus despite being fully vaccinated.

(CDC) numbers suggest that breakthroughs occur at the teeny rate of less than 0.008 percent of fully vaccinated people—and that over 99.992 percent of those vaccinated have not contracted a SARS-CoV-2 infection.

The figures come from a nationwide database that the CDC set up to keep track of breakthrough infections and monitor for any concerning signs that the breakthroughs may be clustering by patient demographics, geographic location, time since vaccination, vaccine type, or vaccine lot number. The agency will also be keeping a close eye on any breakthrough infections that are caused by SARS-CoV-2 variants, some of which have been shown to knock back vaccine efficacy.

...The vast majority of people in the US have been vaccinated with one of the mRNA vaccines, made by Moderna and Pfizer-BioNTech, which both had around 95 percent efficacy in Phase III clinical trials. Less than five percent of vaccinated people in the US have received the Johnson & Johnson adenovirus-based vaccine, which had a slightly lower efficacy of 72 percent in the US.

The extraordinary calculation that 99.992 percent of vaccinated people have not contracted the virus may reflect that they all simply have not been exposed to the virus since being vaccinated. Also, there are likely cases missed in reporting. Still, the data is a heartening sign.

https://arstechnica.com/science/2021/04/99-992-of-fully-vaccinated-people-have-d...

>35 bnielsen: Yes, I could have mentioned that most Covid-19 infections here now are B117, i.e. the British variant. So it seems that we can keep it on a stable number of infections and a low number of Covid-19 in ICU's. So things are looking relatively good here. Some of the restrictions are being lifted in these days but with a close look at the test numbers.

Trisha Greenhalgh et al. 2021. Ten scientific reasons in support of airborne transmission of SARS-CoV-2. The Lancet. Published:April 15, 2021 DOI:https://doi.org/10.1016/S0140-6736(21)00869-2 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00869-2/fullt...

(1) superspreading events account for substantial SARS-CoV-2 transmission

(2) long-range transmission of SARS-CoV-2 between people in adjacent rooms but never in each other's presence has been documented in quarantine hotels

(3) asymptomatic or presymptomatic transmission of SARS-CoV-2 from people who are not coughing or sneezing is likely to account for at least a third, and perhaps up to 59%, of all transmission globally and is a key way SARS-CoV-2 has spread around the world

(4) transmission of SARS-CoV-2 is higher indoors than outdoors10
and is substantially reduced by indoor ventilation

(5) nosocomial (hospital-acqquired) infections have been documented in health-care organisations, where there have been strict contact-and-droplet precautions and use of personal protective equipment (PPE) designed to protect against droplet but not aerosol exposure

(6) viable SARS-CoV-2 has been detected in the air

(7) SARS-CoV-2 has been identified in air filters and building ducts in hospitals with COVID-19 patients

(8) studies involving infected caged animals that were connected to separately caged uninfected animals via an air duct have shown transmission of SARS-CoV-2 that can be adequately explained only by aerosols

(9) no study to our knowledge has provided strong or consistent evidence to refute the hypothesis of airborne SARS-CoV-2 transmission

(10) there is limited evidence to support other dominant routes of transmission—ie, respiratory droplet or fomite

...In conclusion, we propose that it is a scientific error to use lack of direct evidence of SARS-CoV-2 in some air samples to cast doubt on airborne transmission while overlooking the quality and strength of the overall evidence base. There is consistent, strong evidence that SARS-CoV-2 spreads by airborne transmission. Although other routes can contribute, we believe that the airborne route is likely to be dominant. The public health community should act accordingly and without further delay.

When 1 of 585 Americans have died from covid (0.17%),
I don't understand why we would hold up the use of a vaccine
with (less than) 1 per 300,000 (0.0003%) risk of a serious side-effect
- Eric Topol @EricTopol | 5:00 PM · Apr 15, 2021

Elderly South Sudanese Bishop Receives COVID-19 Jab, Seeks to Dispel Fear of Vaccine (aci africa)

The Bishop emeritus of South Sudan’s Torit Diocese has, in a bid to dispel fears over COVID-19 vaccination exercise, become the first known prominent religious leader in the East-Central African nation to receive the jab... Bishop Paride Taban, 85, said that he was driven by faith to take the vaccine despite the fears that surround it. Bishop Taban exuded confidence that many, including other religious leaders, would now follow his example and that the “propaganda surrounding the vaccine” in the nine-year-old country would be dispelled...

I thought this article would focus on anti-vaxxer hostility to Bill Gates ("troll"). Instead, it documents the businessman-philanthropist's devotion to intellectual property (IP) in efforts to provide global access to vaccines. An argument perhaps for taxing billionaires and not instead allowing them to determine how their gains are spent--in what otherwise looked like a generous, beneficial contribution?

How Bill Gates Impeded Global Access to Covid Vaccines
Through his hallowed foundation, the world’s de facto public health czar has been a stalwart defender of monopoly medicine.
Alexander Zaitchik/April 12, 2021

...Advocates for pooling and open science, who seemed ascendant and even unstoppable early in the crisis, have been outmatched and outmaneuvered by the most powerful man in global public health.

...When a reporter raised the issue in February, she described Gates “raising his voice slightly and laughing in frustration,” before snapping, “It’s irritating that this issue comes up here. This isn’t about IP (Intellectual Property).”

...Gates is certain he knows better. But his failure to anticipate a crisis of supply, and his refusal to engage those who predicted it, have complicated the carefully maintained image of an all-knowing, saintly mega-philanthropist...

His latest move is to institutionalize the ACT-Accelerator as the central organizing institution in future pandemics...

In early March, senior Gates staff joined pharma executives for a “Global C19 Vaccine Supply Chain and Manufacturing Summit” convened by Chatham House in London. The main agenda item: plans for a new arm within the ACT-Accelerator, the Covid Vaccine Capacity Connector, that seeks to address the tech-transfer question within the usual frame of monopoly rights and bilateral licensing.

“The tech transfer debate is being decisively seized and shaped by those who want to set the terms and conditions under which knowledge can be transferred,” writes Priti Patnaik in her Geneva Health Files newsletter. A Gates-directed tech-transfer mechanism without meaningful input from WHO members states, she writes, would be a “body blow” to C-TAP and similar future initiatives that promote open licensing and knowledge sharing to maximize production and access.

There are signs of overdue scrutiny of Gates’s role in public health and lifelong commitment to exclusive intellectual property rights...

Any change in media coverage of Gates’s second career may produce a delayed echo within the world he has come to dominate. Here Gates not only controls the narratives, he controls most of the payroll. This may sound conspiratorial or overblown to outsiders but not to campaigners who have witnessed Gates’s ability to shift gravity on major issues.

“If you said to an ordinary person, ‘We’re in a pandemic. Let’s figure out everyone who can make vaccines and give them everything they need to get online as fast as possible,’ it would be a no-brainer,” says ( James Love, founder and director of Knowledge Ecology International, a Washington, D.C.–based group that studies the broad nexus of federal policy, the pharmaceutical industry, and intellectual property ). “But Gates won’t go there. Neither will the people dependent on his funding. He has immense power. He can get you fired from a U.N. job. He knows that if you want to work in global public health, you’d better not make an enemy of the Gates Foundation by questioning its positions on I.P. and monopolies. And there are a lot of advantages to being on his team. It’s a sweet, comfortable ride for a lot of people.”

https://newrepublic.com/article/162000/bill-gates-impeded-global-access-covid-va...

I can see need for a booster as first challenging variants appear, but don't look for investors in traditional pharmaceutical companies to support universal, durable vaccines against Coronavirus (influenza, etc.)?

Moderna CEO Stephane Bancel tells Maria Bartiromo vaccine booster shots 'are going to be required'
Manufacturer not worried about vaccines' effect against variants for now, Bancel says
Michael Quinlan |
https://www.foxnews.com/health/moderna-ceo-coronavirus-vaccine-booster-shots-req...

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Pfizer CEO: Third coronavirus vaccine dose likely needed within 6 to 12 months
CXNN Wire | Friday, April 16, 2021

...(Albert Bourla, CEO of Pfizer,) said it remains to be seen how often this would have to happen, but "a likely scenario is that there will be likely a need for a third dose somewhere between six and 12 months and then from there, there will be an annual re-vaccination. But all this needs to be confirmed."

https://abc7.com/pfizer-vaccine-covid-dose/10520223/

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Dr. Fauci: ‘We very well may need to get booster shots’ for Covid — here’s when
Cory Stieg | Apr 15 2021

...“The way to get the answer (when/whether booster shots are indicated) is to just follow people closely enough to determine when that level of efficacy or protection diminishes, both with regard to the level of the antibodies as well as clinical data with regard to breakthrough infections,” Fauci said. (Breakthrough cases refer to when people who are vaccinated get infected.)

...More infectious Covid mutations could also necessitate regular boosters. “We may have cycles where we have to keep boosting people — either boosting them with the original vaccine, which gives you enough antibodies to spill over to the variants, or develop a vaccine that’s specific for one or more of the variants”...

https://www.cnbc.com/2021/04/15/dr-fauci-when-we-will-need-booster-shots-for-cov...

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Covid live updates: Fauci says universal vaccine is the endgame to combat new variants
CNBC.com | April 15, 2021

...White House health advisor Anthony Fauci, Centers for Disease Control and Prevention Director Rochelle Walensky, and the Biden administration Covid response chief science officer David Kessler faced at times heated questions before the House Select Subcommittee on the Coronavirus Crisis.

Fauci...said that the medical and scientific communities hope to develop a universal coronavirus vaccine that can cover all possible variants...

https://www.cnbc.com/2021/04/15/covid-live-updates-fauci-health-officials-testif...

Prof Peter Hotez MD PhD (Baylor) @PeterHotez | 7:53 AM · Apr 17, 2021:
Extraordinary links between COVID19 vaccine refusal and allegiance to the Republican Party: All during last summer’s surge across the South and then in Upper Midwest in fall, COVID19 was a Red State disease looks as though COVID19 will become Red yet again

In @jclinicalinvest I explain the origins of Republican defiance to vaccines, a phenomenon that began to accelerate in 2015.
Peter J. Hotez et al. 2021. America’s deadly flirtation with antiscience and the medical freedom movement (Viewpoint). Journal of Clinical Investigations (Published February 25, 2021). https://www.jci.org/articles/view/149072

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Least Vaccinated U.S. Counties Have Something in Common: Trump Voters
Danielle Ivory, Lauren Leatherby and Robert Gebeloff | April 17, 2021

(See graphic at website...)

About 31 percent of adults in the United States have now been fully vaccinated. Scientists have estimated that 70 to 90 percent of the total population must acquire resistance to the virus to reach herd immunity. But in hundreds of counties around the country, vaccination rates are low, with some even languishing in the teens.

The disparity in vaccination rates has so far mainly broken down along political lines. The New York Times examined survey and vaccine administration data for nearly every U.S. county and found that both willingness to receive a vaccine and actual vaccination rates to date were lower, on average, in counties where a majority of residents voted to re-elect former President Donald J. Trump in 2020. The phenomenon has left some places with a shortage of supply and others with a glut...

https://www.nytimes.com/interactive/2021/04/17/us/vaccine-hesitancy-politics.htm...
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* Peter J. Hotez et al. 2021. America’s deadly flirtation with antiscience and the medical freedom movement (Viewpoint). Journal of Clinical Investigations (Published February 25, 2021). https://www.jci.org/articles/view/149072

The initial United States government response to the coronavirus disease 2019 (COVID-19) pandemic was marked by a frequent disconnect between government policies and the recommendations of scientific experts. A disinformation campaign from the Trump White House convinced many Americans that COVID-19 injuries and its death toll were exaggerated, leading many to ignore public health recommendations... Those who dismissed the severity of COVID-19 were more likely to shun face masks and ignore recommendations to socially distance from non–household members... Such individuals were more likely Republicans than Democrats by a wide margin..., and under a flag of health or medical freedom, an outright defiance of masks and social distancing came to symbolize allegiance to President Trump... This contributed to the rampant spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections, which have taken the lives of one-half million Americans... Misguided ideologies from populist regimes in Brazil, Mexico, Nicaragua, Philippines, and Tanzania bear varying degrees of resemblance to health freedom and contribute to the global COVID-19 death toll... Here, I explore the anti-science movement in America, emphasizing our unique historical connections to health and medical freedom...

Origins of health freedom in America...
Antivaccines...
National antivaccine groups and specific targeting...
COVID-19 health freedom...

The double mutation variant—classified as #B1617–
was the most common in the samples sequenced in India in recent 60 days at 24%.
This new variant found in Maharashtra may be becoming the most prevalent among all variants in India. (See red)

https://hindustantimes.com/india-news/double-mutant-now-most-common-of-variantsd... *
Image-proportions of India variants Jan 1-Apr 4, 2021 ( https://twitter.com/DrEricDing/status/1383737643452669958/photo/1 )

- Eric Feigl-Ding @DrEricDing | 7:02 AM · Apr 18, 2021

-------------------------------------------------------

* 'Double mutant' most common variant now: India's genome data
The analysis shows for the first time how the detection of various variants of the coronavirus may have changed.
Binayak Dasgupta, Anonna Dutt | APR 17, 2021

...The double mutation virus – now classified as B.1.617 – was the most common in the samples sequenced in the 60 days prior to April 2 at 24%. The variant was first detected on October 5 and was relatively obscure till it began popping up on increasing number of samples January onwards, the India situation report on outbreak.info showed. On April 1, it accounted for 80% of all analysed genome sequences of mutant variants sent by India to the global repository GISAID...

https://hindustantimes.com/india-news/double-mutant-now-most-common-of-variantsd...

___________________________________________

7 cases of Indian COVID variant detected in Israel
Health Ministry says strain found among unvaccinated travelers, adds that ‘there is still no clear information’ on the variant or its impact
TOI staff |16 April 2021

https://www.timesofisrael.com/7-cases-of-indian-covid-variant-detected-in-israel...

Let this sink in—Peru’s pandemic excess deaths is so high, it has lost ~1 in 200 residents.
That’s equivalent to ~1.5 mil US excess deaths - almost triple the US if same population size.
And the deaths are further climbing. Excess deaths more reliable when testing low.
Image-graphs excess deaths Peru, Lima ( https://twitter.com/DrEricDing/status/1383750538966175745/photo/1 )

-Eric Feigl-Ding @DrEricDing | 7:53 AM · Apr 18, 2021

People with rare blood clots after a COVID-19 jab share an uncommon immune response
Some who get AstraZeneca’s or Johnson & Johnson’s shots make antibodies that spark clots
Erin Garcia de Jesús | April 16, 2021 at 1:08 pm

...Studies suggest that some inoculated people develop an immune response that attacks a protein called platelet factor 4 or PF4, which makes platelets form clots. Those platelets get used up before the body can make more. So these patients wind up with both the rare clots and low levels of blood platelets.

Of 23 patients who received AstraZeneca’s jab and had symptoms of clots or low platelets, 21 tested positive for antibodies to PF4, researchers report April 16 in the New England Journal of Medicine. Of those, 20 people developed blood clots. The finding adds to previous studies that found the same antibodies in additional patients who got AstraZeneca’s shot and had the dangerous clots.

Five out of six women who had clots after receiving Johnson & Johnson’s shot in the United States also had PF4 antibodies, health officials said April 14 during an Advisory Committee on Immunization Practices meeting...

“Because we are aware of this syndrome… we know how to treat it,” says Jean Connors, a clinical hematologist at Harvard Medical School and Brigham and Women’s Hospital in Boston...And unlike the people who developed the clots before officials pinpointed the link, “we can diagnose it faster and treat it more appropriately if it does happen, so that the outcomes will be better.”

That’s because the vaccine-induced clots are similar to a condition called heparin-induced thrombocytopenia, or HIT. Patients with HIT develop blood clots when treated with the commonly used anti-coagulant drug heparin. Heparin attaches to the PF4 protein, and some people develop an immune response that attacks the two molecules.

Treating vaccinated patients who have PF4 antibodies with heparin is like “adding fuel to the fire” and may cause them to develop more clots, Connors says...

Health care workers can test for PF4. And if a patient tests positive, there are many other anti-coagulants other than heparin that clinicians can use for treatment, Connors says.

Citations

M. Scully et al. Pathologic antibodies to platelet factor 4 after ChAdOx1 nCoV-219 vaccination. New England Journal of Medicine. Published online April 16, 2021. doi: 10.1056/NEJMoa2105385.

A. Greinacher et al. Thrombotic thrombocytopenia after ChAdOx1 nCoV-19 vaccination. New England Journal of Medicine. Published online April 9, 2021. doi: 10.1056/NEJMoa2104840. N. H. Schultz et al. Thrombosis and thrombocytopenia after ChAdOx1 nCoV-19 vaccination.New England Journal of Medicine. Published online April 9, 2021. doi: 10.1056/NEJMoa2104882.

https://www.sciencenews.org/article/covid-vaccine-blood-clot-immune-astrazeneca-...

Surveillance and Pfizer vaccine effective against B117 in Israel:

A. Munitz et al. 2021. BNT162b2 Vaccination Effectively Prevents the Rapid Rise of SARS-CoV-2 Variant B.1.1.7 in high risk populations in Israel. CELL Reports Medicine (Open Access Published:April 17, 2021) DOI:https://doi.org/10.1016/j.xcrm.2021.100264

Graphical Abstract
https://twitter.com/EricTopol/status/1383802994269974533/photo/1

Highlights
• The B.1.1.7 variant is 45% more transmissible than the wild-type strain in Israel.
• Active surveillance markedly reduces the transmission of B.1.1.7 in nursing homes.
• Prioritized vaccination prevents B.1.1.7-associated infections in the elderly.
• Proactive surveillance combined with prioritized vaccination are achievable.

Summary
Since the emergence of the SARS-CoV-2 pandemic, various genetic variants have been described. The B.1.1.7 variant, which emerged in England during December 2020, is associated with increased infectivity. Therefore its pattern of spread is of great importance.
The Israeli government established three national programs: massive RT-PCR testing, focused surveillance in nursing homes and robust prioritized vaccination with BNT162b2. To define the impact of the aforementioned programs, we analyze data from ∼300,000 RT-PCR samples collected from December 6th 2020 to February 10th 2021.

We reveal that the B.1.1.7 is 45% (95% CI:20-60%) more transmissible than the wild-type strain, and become the dominant in Israel within 3.5 weeks. Despite the rapid increase in viral spread, focused RT-PCR testing and prioritized vaccination programs are capable of preventing the spread of the B.1.1.7 variant in the elderly. Therefore, proactive surveillance combined with prioritized vaccination are achievable, and reduce severe illness and subsequent death.

As the world turns, the virus keeps reminding us how formidable it is to contain
Highest global cases per capita since the pandemic began

Image-graph of cases by continent, Mar 2020 Apr 17, 2021
( https://twitter.com/EricTopol/status/1383795384862986243/photo/1 )

-Eric Topol (Scripps physician scientist)@EricTopol | 10:51 AM · Apr 18, 2021
------------------------------------------------------------

Dan Hart @a9dph ·1h
Africa remains relatively unscathed in comparison to all other continents. Is there a plausible explanation for this?

Eric Topol
Here's @DrTomFrieden's response to that question from our recent conversation (public health response, younger, reporting, possible under-diagnosis of deaths)

Image ( https://twitter.com/EricTopol/status/1383797551816605700/photo/2 )
from
Eric J. Topold and Tom R. Frieden. April 15, 2021.Tom Frieden on COVID: CDC Fumbles, Blood Clots, and New Approaches. Medscape April 18, 2021. https://www.medscape.com/viewarticle/948541

Two months ago India confirmed 11,300 cases per day.

This shows the rise of confirmed cases since then.
A straight line on a logarithmic axis tells you that you are looking at exponential growth with a constant growth rate.

Now India confirms more than 200,000 cases a day.
Image ( https://twitter.com/MaxCRoser/status/1383738806331863044/photo/1 )

- Max Roser (Oxford U) @MaxCRoser | 7:06 AM · Apr 18, 2021

It’s About Time for Us to Stop Wearing Masks Outside
Briefly passing someone on the sidewalk just isn’t risky.
Shannon Palus | April 17, 2021
https://slate.com/technology/2021/04/masks-outside-covid-risk-low.html

------------------------------------------------------

How did it come to this?
Justin Ling: We are here because politicians have ignored the core facts of the COVID-19 virus and the main strategies that will clearly fight the pandemic
Justin Ling April 16, 2021
https://www.macleans.ca/opinion/how-did-it-come-to-this/
__________________________________________

I dunno--these no-spread-outdoors studies mostly pre-date the new variants? I'm fully vaxxed, but I pull up my mask still when I encounter anyone on nature trail. (Otherwise, my mask dangles from my neck on double-clipped string.)

Alexandra Freeman (U Cambridge) @alex_freeman | 10:48 AM · Apr 7, 2021:
Our graphics to illustrate the potential benefits and potential harms of the AstraZeneca vaccine as announced by the MHRA* this afternoon.
(* Medicines and Healthcare Products Regulatory Agency, UK)
Benefits accrued over 16 weeks, at three different levels of exposure to the virus.

Image ( https://twitter.com/alex_freeman/status/1379808289278545922/photo/1 )
Image ( https://twitter.com/alex_freeman/status/1379808289278545922/photo/2 )
Image ( https://twitter.com/alex_freeman/status/1379808289278545922/photo/3 )

from
U Cambridge Winton Centre for Risk and Evidence Communication
News - Communicating the potential benefits and harms of the Astra-Zeneca COVID-19 vaccine
https://wintoncentre.maths.cam.ac.uk/news/communicating-potential-benefits-and-h...

______________________________________________________

Kashif Pirzada, MD @KashPrime | 4:05 PM · Apr 18, 2021
A very similar one put out by Thrombosis Canada:
Image ( https://twitter.com/KashPrime/status/1383874409799184385/photo/1 )

‘Ripe for fraud’: Coronavirus vaccination cards support burgeoning scams
Officials warn that falsified cards could endanger lives and undermine efforts to end the pandemic
Dan Diamond | April 18, 2021

One listing offered eBay customers an “Authentic CDC Vaccination Record Card” for $10.99. Another promised the same but for $9.49. A third was more oblique, offering a “Clear Pouch For CDC Vaccination Record Card” for $8.99, but customers instead received a blank vaccination card (and no pouch).

...a man who works as a pharmacist in the Chicago area — and all were illegal, federal regulators say. The account sold more than 100 blank vaccination cards in the past two weeks...

The listings are a “perfect example” of burgeoning scams involving coronavirus vaccination cards that could undermine people’s safety, as well as the success of the nation’s largest mass vaccination effort, said North Carolina Attorney General Josh Stein. Individuals might use them to misrepresent their vaccination status at school, work or in various living and travel situations, potentially exposing others to risk...

https://www.washingtonpost.com/health/2021/04/18/scams-coronavirus-vaccination-c...

You’re Vaccinated. Your Kids Are Not. What Now?
We asked public health experts to help answer some of your most pressing questions.

First, when can I expect my kid to get vaccinated?
Can we socialize with friends and family who are vaccinated?
Can we socialize with others who aren’t vaccinated?
Is it safe to travel with or without my kids?
Can we dine indoors or go back to the gym?
Take a deep breath — these decisions are hard.

https://www.nytimes.com/2021/04/13/well/family/parents-vaccinated-not-kids.html

Chile's vaccination program, one of the best in the world, w/ more than 50% of population ≥ 1 dose
Results (Sinovac) in 10.5 million people:
16% effective against infection after 1 dose; 67% effective after 2nd dose.

First Dose of Chinese Covid-19 Vaccine Offers Little Protection, Chile Learns
The country vaccinated at record clip with shots developed by China’s Sinovac, then cases and deaths rose. Health experts say Chile dropped precautions too soon.
Ryan Dube | April 18, 2021
https://wsj.com/articles/first-dose-of-chinese-covid-19-vaccine-offers-little-pr...

Image-graph cases per week, Jan-April 2021 ( https://twitter.com/EricTopol/status/1383990821184184325/photo/1 )

- Eric Topol @EricTopol | 11:48 PM · Apr 18, 2021

--------------------------------------------------

Ignacio Silva Ayarza (MD) @Ignacio_Silva_A | 12:08 AM · Apr 19, 2021:
Chile prioritized vaccination of people more than 60 years of age and chronically ill patients, and
a clear decrease in ICU admissions has been seen in this group, despite immunosenescence and age-specific comorbidities.
Vaccines work, whether they are Chinese, North American or European

Image ( https://twitter.com/Ignacio_Silva_A/status/1383995974343823361/photo/1 )
Image ( https://twitter.com/Ignacio_Silva_A/status/1383995974343823361/photo/2 )

>55 margd: B1617, first reported in India, contd.

Eric Feigl-Ding @DrEricDing | 4:04 AM · Apr 19, 2021:
The new “double mutation” variant from India #B1617
is surging fast in UK—5x increase in % of #COVID19 cases in just 2 weeks.
Same with the South Africa #B1351 variant.

When did they increase? After schools reopened.
And keep in mind—it’s rising despite high vaccinations.

Image--proportion of four new variants in UK, not including B117's 98-99%
( https://twitter.com/DrEricDing/status/1384055231432986628/photo/1 )

2) How does the India variant compare to #B117?
It seems to be increasing faster than any other variant in the UK. It’s outcompeting it.
Image--log scale ( https://twitter.com/DrEricDing/status/1384056092502597636/photo/1 )

3) I know the variants are getting hard to keep track. But here is a handy shortcut info graphic.
Image--variants w mutations & possible functions ( https://twitter.com/DrEricDing/status/1384059659288416259/photo/1 )

4) UK is now able to track all of these carefully because it is sequencing 20,000 cases a week to identify variants. This is a huge volume given UK cases are relatively low.

COVID-19 Genomics UK Consortium
https://www.cogconsortium.uk/

_________________________________________________

Jeffrey Barrett (statistical geneticist) @jcbarret · 16h:
https://twitter.com/jcbarret/status/1383872820724174854
A few thoughts on the B.1.617 variant, first seen in India in late 2020,
recently seen in >100 margd: cases in the UK, and very much in the news here.
TLDR: we should watch carefully, but I don't think any of our best lines of evidence on variants are yet cause for concern.
(THREAD...)

Deepti Gurdasani*@dgurdasani1 | 8:41 PM · Apr 18, 2021:
https://twitter.com/dgurdasani1/status/1383943696681299972
Really want this to be true, but am concerned about this variant- Here's why.
1. L452R mutation has been associated with T cell escape & higher infectivity
2. rapid increase in frequency of B.1.617 in India closely mirrors the increase in cases temporally & geographically
(THREAD...)

* Senior Lecturer @QMUL (Queen Mary U of London). Epidemiology, statistical genetics, machine learning.

>57 margd: J&J vaccine and clots, contd.

Doctors say clot treatment advice key to U.S. resuming J&J COVID vaccines
Deena Beasley | April 19, 2021

...The U.S. Food and Drug Administration has said patients who exhibit clot-related symptoms after receiving the J&J vaccine should not be given heparin, a blood thinner that is widely used to treat clotting disorders, at least until additional testing to determine whether they have low platelet counts. The rare combination of clotting and low platelets signals a condition called heparin-associated thrombocytopenia (low platelet count), and giving heparin can cause harm.

The FDA warned healthcare providers that use of heparin in these cases could even be fatal and advised them to strongly consider non-heparin anticoagulants and high-dose intravenous immune globulin (IVIG) instead.

"You would need to do a few tests with anyone who has symptoms like this, and based on those tests, you would be reasonably positioned to treat without putting the person at risk,” Dr. Jeffrey Berger, a cardiologist focused on blood clotting disease at New York University...

https://www.reuters.com/business/healthcare-pharmaceuticals/doctors-say-clot-tre...

Ashish K. Jha, MD, MPH (Dean Brown SPH) @ashishkjha | 9:13 PM · Apr 18, 2021

Infection numbers in US so unusual
We've been stuck between 55K-70K per day for 2 months!
Longest we've been flat

Crazy part? Two dramatic things going on at once
B117 took over, causing cases to explode
Vaccinations going great, causes cases to plummet

And so....we're flat

Image--Feb 21-Apr 4+ rolling 7-day average of new confirmed cases
( https://twitter.com/ashishkjha/status/1383951802035445761/photo/1 )

----------------------------------------------------

D&K @KristenRemaro · 12h
And don’t forget 55% of new cases are in 5 states.
That’s a big disparity with rest of country. It’s a ebb and flow.
If NE/Upper Midwest get under control cases could plummet quite quickly.

Covid-19: South Sudan to dispose of 60,000 doses of expired AU donated vaccines (Radio Tamazuj)

South Sudan’s ministry of health says it is planning to dispose of the expired 60,000 doses of African Union and MTN partnership donated vaccines this week... South Sudan’s Drugs and Food Control Authority (DFCA) announced that the AU and MTN donated vaccines had expired in the cold chain before use. It says the 60,000 vaccine doses had a safe life of only 14 days when they arrived in the country...

>55 margd: >66 margd: India, contd.

Non-stop cremations cast doubt on India's counting of COVID dead
Alasdair Pal | April 19, 2021

...with hospitals full and oxygen and medicines in short supply in an already creaky health system, several major cities are reporting far larger numbers of cremations and burials under coronavirus protocols than official COVID-19 death tolls, according to crematorium and cemetery workers, media and a review of government data.

India on Monday registered a record 273,810 new daily infections and 1,619 deaths. Its total number of cases now stands at more than 15 million, second only to the United States.

Reliable data is at the heart of any government response to the pandemic, without which planning for hospital vacancies, oxygen and medicine becomes difficult, experts say.

Government officials say the mismatch in death tallies may be caused by several factors, including over-caution.

A senior state health official said the increase in numbers of cremations had been due to bodies being cremated using COVID protocols "even if there is 0.1% probability of the person being positive".

"In many cases, patients come to hospital in an extremely critical condition and die before they are tested, and there are instances where patients are brought dead to hospital, and we do not know if they are positive or not," the official said...

https://www.reuters.com/world/india/non-stop-cremations-cast-doubt-indias-counti...

These Countries Did Well With Covid. So Why Are They Slow on Vaccines?
Japan, South Korea and Australia have inoculated tiny percentages of their populations. The delays risk unwinding their relative successes.
Motoko Rich, Livia Albeck-Ripka and Makiko Inoue | April 17, 2021

All through last year, as first Europe and then the United States suffered catastrophically high coronavirus infections and deaths, Pacific Rim countries staved off disaster through an array of methods. South Korea tested widely. Australia and New Zealand locked down. In Japan, people donned masks and heeded calls to isolate.

Now, the roles have been reversed. These countries that largely subdued the virus are among the slowest in the developed world to vaccinate their residents, while countries like Britain and the United States that suffered grievous outbreaks are leapfrogging ahead with inoculations.

The United States has fully vaccinated close to a quarter of the population, and Britain has given first shots to nearly half of its residents. By contrast, Australia and South Korea have vaccinated less than 3 percent of their populations, and in Japan and New Zealand, not even 1 percent of the population has received a shot.

To some extent, the laggards are taking advantage of the luxury of time that their comparatively low infection and death counts afford. And they all rely on vaccines developed — and, for now, manufactured — elsewhere...

https://www.nytimes.com/2021/04/17/world/asia/japan-south-korea-australia-vaccin...

___________________________________________________

Canada, too, did relatively well, until P1 hit BC and B117 hit Ontario, etc... Vaccines are now arriving.

I suspect that the 20% of countries for which there is no US travel advisory are the ones which don't want US... :(

State Department To Issue Travel Warnings Amid 'Unprecedented' COVID-19 Risks
Vanessa Romo | April 19, 2021

The U.S. State Department on Monday announced plans to expand travel advisories, urging U.S. citizens to stay home as the COVID-19 pandemic continues to pose "unprecedented risks" around the globe.

The updated travel guidelines are intended to curb visits "to approximately 80% of countries worldwide" which are currently experiencing dramatic spikes in cases, the department said in a statement. New guidance is expected be released later this week.

The latest recommendations come as the coronavirus "continues to pose unprecedented risks to travelers," and the new guidelines "better reflect the Centers for Disease Control and Prevention's science-based Travel Health Notices," according to the notice.

The State Department added: "As always, we are closely monitoring conditions around the globe, and will regularly update our destination-specific advice to U.S. travelers as conditions evolve."...

https://www.npr.org/2021/04/19/988940638/state-department-to-issue-travel-warnin...
----------------------------------------------------------------

US State Dept.
https://travel.state.gov/content/travel/en/international-travel/before-you-go/ab...
https://twitter.com/AndrewSolender/status/1384232146596888578/photo/1

CDC
https://wwwnc.cdc.gov/travel/noticescovid19

Scientists show that one dose of mRNA COVID19 vaccine induces optimal antibody and B cell responses in previously infected people. Two doses are needed for immunologically naïve people--particularly for neutralizing titers against the B.1.351 variant

Rishi R. Goel et al. 2021. Distinct antibody and memory B cell responses in SARS-CoV-2 naïve and recovered individuals following mRNA vaccination. Science Immunology 15 Apr 2021: Vol. 6, Issue 58, eabi6950 DOI: 10.1126/sciimmunol.abi6950 https://immunology.sciencemag.org/content/6/58/eabi6950

Abstract

Novel mRNA vaccines for SARS-CoV-2 have been authorized for emergency use. Despite their efficacy in clinical trials, data on mRNA vaccine-induced immune responses are mostly limited to serological analyses. Here, we interrogated antibody and antigen-specific memory B cells over time in 33 SARS-CoV-2 naïve and 11 SARS-CoV-2 recovered subjects. SARS-CoV-2 naïve individuals required both vaccine doses for optimal increases in antibodies, particularly for neutralizing titers against the B.1.351 variant. Memory B cells specific for full-length spike protein and the spike receptor binding domain (RBD) were also efficiently primed by mRNA vaccination and detectable in all SARS-CoV-2 naive subjects after the second vaccine dose, though the memory B cell response declined slightly with age. In SARS-CoV-2 recovered individuals, antibody and memory B cell responses were significantly boosted after the first vaccine dose; however, there was no increase in circulating antibodies, neutralizing titers, or antigen-specific memory B cells after the second dose. This robust boosting after the first vaccine dose strongly correlated with levels of pre-existing memory B cells in recovered individuals, identifying a key role for memory B cells in mounting recall responses to SARS-CoV-2 antigens. Together, our data demonstrated robust serological and cellular priming by mRNA vaccines and revealed distinct responses based on prior SARS-CoV-2 exposure, whereby COVID-19 recovered subjects may only require a single vaccine dose to achieve peak antibody and memory B cell responses. These findings also highlight the utility of defining cellular responses in addition to serologies and may inform SARS-CoV-2 vaccine distribution in a resource-limited setting.

>55 margd: >66 margd: >70 margd: India, contd. ( R is the number of people that one infected person will pass on a virus to, on average. )

Kashif Pirzada, MD (Emergency Toronto) @KashPrime | 7:55 AM · Apr 20, 2021:
8 states in India with a R greater than 2. They are rapidly heading towards catastrophe with their new variant. We can probably expect two things: 1) no more AZ shipments for awhile 2) more cases coming to us by plane

Quote Tweet

Bhramar Mukherjee (Epidemiology U Michigan) @BhramarBioStat · 18h:
Eight states (in India) have an R above 2.0. It feels like a sandstorm in a desert, you just bury your head till it is over. I wish there was a comprehensive statement on the spatio-temporal distribution of the new variants in India supported by transparent data. I guess I am daydreaming.
Image--table, India states' R values ( https://twitter.com/BhramarBioStat/status/1384227091206475777/photo/1 )
__________________________________________________________

ETA:
Israel logs Indian COVID-19 variant, sees some vaccine efficacy against it
Reuters | April 20, 2021

Israel has registered eight cases of a coronavirus variant first identified in India and believes that the Pfizer/BioNTech (PFE.N), (22UAy.DE) vaccine is at least partially effective against it, an Israeli health official said on Tuesday.

..."The impression is that the Pfizer vaccine has efficacy against it, albeit a reduced efficacy," the ministry's director-general, Hezi Levy, told Kan public radio, saying the number of cases of the variant in Israel now stood at eight.

...Britain and Ireland have also said they are investigating the variant after detecting it within their borders...

https://www.reuters.com/world/india/israel-logs-indian-covid-19-variant-sees-som...
___________________________________________________________

ETA:
Delhi Hospitals Say Down To Just Hours Of Oxygen: 10 Facts
Edited by Anindita Sanyal | April 20, 2021

...Delhi Chief Minister Arvind Kejriwal tweeted, "Serious oxygen crisis persists in Delhi. I again urge centre to urgently provide oxygen to Delhi. Some hospitals are left with just a few hours of oxygen".

...The oxygen crunch issue has reached the Delhi High Court, which pulled up the Centre today, questioning why it was waiting till April 22 to bar oxygen use for industrial use and divert it for Covid patients. "Economic interests can't override human lives. Else we are heading for a disaster," the court said...

https://www.ndtv.com/india-news/delhi-hospitals-say-down-to-just-hours-of-oxygen...

Anthea L. Katelaris et al. 2021.Epidemiologic Evidence for Airborne Transmission of SARS-CoV-2 during Church Singing, Australia, 2020 (Early Release). CDC Emerging Infectious Diseases Volume 27, Number 6—June 2021 Volume 27, Number 6—June 2021

Abstract
An outbreak of severe acute respiratory syndrome coronavirus 2 infection occurred among church attendees after an infectious chorister sang at multiple services. We detected 12 secondary case-patients. Video recordings of the services showed that case-patients were seated in the same section, up to 15 m from the primary case-patient, without close physical contact, suggesting airborne transmission.

‘I’m still a zero’: Vaccine-resistant Republicans warn that their skepticism is worsening
Dan Diamond | April 20, 2021

Stop talking about the possibility of coronavirus booster shots. Don’t bully people who are vaccine holdouts. And if you’re trying to win over skeptics, show us anyone besides Dr. Fauci.

That’s what a focus group of vaccine-hesitant Trump voters urged politicians and pollsters during the weekend, as public health officials work to understand potential roadblocks in the campaign to inoculate Americans against the coronavirus...more than 40 percent of Republicans have consistently told pollsters they’re not planning to be vaccinated — a group that could threaten efforts to tamp down the virus’s spread, public health officials fear.

...the group largely shrugged off federal regulators’ decision last week to pause Johnson & Johnson’s coronavirus vaccine for safety reviews...focus group participants...asked why doctors were halting a potentially useful medical treatment, given that the reported side effects were so rare.

...focus group participants said they were far more concerned by recent news that they may need ongoing shots to ward off the coronavirus.

...(some thought) Trump should be receiving more plaudits — and that the shots should even be called the “Trump vaccine” — but that alone didn’t appear to change their opinion.

...Most participants said they would want a fake vaccination card that would allow them to claim they had received shots, after Luntz granted them anonymity to speak honestly.

...unfortunately Dr. Fauci has been politicized, and we need different messengers

...Many participants blasted a media environment that they said was relentlessly negative. (bullying, humiliating)...some Democrats’ hectoring and ridicule of GOP vaccine holdouts had backfired, adding that it was wrong to argue with vaccine skeptics like a political debate...

https://www.washingtonpost.com/health/2021/04/20/vaccine-hesitant-republicans/

Included here for ivermectin studies thus far.
(I have stash of ivermectin leftover from treating a fox for scabies--horrible way to die, IMHO! )

The World Health Organization doesn’t recommend ivermectin as a COVID-19 treatment; the drug’s safety and effectiveness remains uncertain in COVID-19 patients

CLAIM
“WHO data shows that ivermectin reduces COVID-19 mortality by 81%, but they won’t recommend it?”

VERDICT
MISLEADING

SOURCE: Joe Martino, Collective Evolution, 13 Apr. 2021

DETAILS
Cherry-picking: Most data supporting ivermectin’s efficacy in COVID-19 patients came from studies with small sample sizes and weak designs. When considering only the more rigorously designed randomized controlled trials, ivermectin didn’t show a significant benefit.
Unsupported: There is currently insufficient evidence to establish whether ivermectin is safe and effective in COVID-19 patients.

KEY TAKE AWAY
Repurposing existing drugs is a helpful strategy that can accelerate the approval of new treatments against a disease. However, simply because a drug works against one disease isn’t evidence that it will work for another. Therefore, even existing drugs used for one disease still need to demonstrate that they are safe and effective in the context of another disease. While some studies suggest that ivermectin might have a beneficial effect in COVID-19 patients, they don’t provide sufficient evidence to recommend ivermectin as a COVID-19 treatment due to potential biases and small sample sizes...

https://healthfeedback.org/claimreview/the-world-health-organization-doesnt-reco...

David R. Martinez, Ph.D.(UNC) @David_RMartinez | 2:11 PM · Apr 20, 2021
Worried about the #SARSCoV2 variants like the South African B.1.351 ?
Good news is that the #CoV vaccine like the one from #Moderna and #Pfizer
can protect against the B.1.351 variant in aged (highly vulnerable) mice. And so can our universal #mRNA vaccines!
Image ( https://twitter.com/David_RMartinez/status/1384570529898668035/photo/1 )

Quote Tweet
David R. Martinez, Ph.D. @David_RMartinez · Mar 30
We have added more LIVE VIRUS UK B117 and mink neutralization variant data, in addition to SA B1.351 VOC,
comparing our universal CoV mRNA vaccine strategy to the SARS-CoV-2 mRNA vax.
All three variants are efficiently neutralized despite a small reduction against the SA B1.351.
Image ( https://twitter.com/David_RMartinez/status/1377003140206239754/photo/1 )

Our data is updated: http://ourworldindata.org/covid-vaccinations

Share of people with at least 1 dose:
Israel 62%
UAE 51%
UK 49%
Chile 41%
US 40%
Bahrain 37%
Hungary 35%
Uruguay 31%
Serbia 27%
Canada 25%
Finland 24%
Singapore 23%
Estonia 22%
Lithuania 21%

Image-bar graph ( https://twitter.com/redouad/status/1384802402897993728/photo/1 )

- Edouard Mathieu @redouad | 5:33 AM · Apr 21, 2021

India

New B.1.618 variants now among most sequenced
The variant has been reported in Bengal from where some of the highest numbers of sequencing have been carried out.
Binayak Dasgupta, Anonna Dutt, New Delhi | APR 21, 2021

A previously unknown Sars-Cov-2 variant has now started to emerge in samples analysed in India by scientists to check for mutations, according to experts and new analyses that show one of these changes is the same one found in the Brazilian and South African variants of the coronavirus.

This particular change is known as E484K, and it has been strongly linked with the virus becoming more resistant to antibodies created by vaccines or a past infection. It has been found in a variant now labelled as B.1.618, which has been reported in West Bengal, from where some of the highest numbers of sequencing has been carried out.

Details about its spread come days after genome sequencing data indicated a large presence of another known variant first found in India, the B.1.617, often referred to as the “double mutant”.

Both these variants are now considered variants of interests (VOIs), and scientists are studying whether it can make the coronavirus more transmissible, more lethal, or more resistant – clues that are crucial to determine whether the intensity of India’s current wave of infections is because of these.

Data submitted from India to the global repository GISAID shows the B.1.618, at 12%, is the third most common variant sequenced in the last 60 days. The B.1.617, at 28%, is the most common among sequences, followed by B.1.1.7 (the UK variant), the India Mutation Report by Scripps Research showed, citing the GISAID data.

“The particular variant had appeared some time ago in West Bengal, however we did not study the mutations and its clinical significance in detail as the so-called double mutant variant (B.1.617) out-competed it. The B1.618 variant has plateaued at about 25% of the total mutations reported from Bengal; B1.617 has become predominant. Across the country, there are some districts in states such as Maharashtra where the prevalence of the variant in as many as 80% samples,” said Dr Saumitra Das, director, National Institute of Biomedical Genomics, which is one of the 10 laboratories in India’s consortium on Sars-CoV-2 genome sequencing (INSACOG)...

https://www.hindustantimes.com/india-news/new-b-1-618-variant-now-among-most-seq...

_______________________________________________________

John Burn-Murdoch (Financial Times) @jburnmurdoch | 4:15 AM · Apr 21, 2021:
https://twitter.com/jburnmurdoch/status/1384782949879517185

(1) NEW: a deep-dive into the situation in India, where a devastating second wave is overwhelming hospitals and crematoriums, eclipsing global records as it goes https://ft.com/content/683914a3-134f-40b6-989b-21e0ba1dc403

250,000 new cases every day, and test positivity is soaring suggesting many are still missed
Image ( https://twitter.com/jburnmurdoch/status/1384782949879517185/photo/1 )

(2) To put this into a global context, much has been made of the resurgences in Europe and North America over recent weeks, but India’s wave has accelerated straight past all of them.

The situation there really is beyond what we’re seeing anywhere else worldwide.
Image ( https://twitter.com/jburnmurdoch/status/1384782954526818308/photo/1 )

(3) In many parts of the country including the capital Delhi, cases are doubling every five days. Compared to the steady rise seen in the first wave last year, the current climbs are almost vertical.
Image ( https://twitter.com/jburnmurdoch/status/1384782959329386497/photo/1 )

(4) And in many places, test positivity is rising at the same pace. Even as more and more tests are done, the share of them that come back positive is still climbing, suggesting tens of thousands of cases are going undetected.
Image ( https://twitter.com/jburnmurdoch/status/1384782965360799745/photo/1 )

(5) All of this is feeding through into a crisis in hospitals beyond what we’ve seen anywhere else in the world over the whole pandemic.

ICUs are twice as full in Nagpur as they ever got in Lombardy last March. Mumbai’s ICU’s are more full than Liège was in Belgium’s brutal peak.
Image ( https://twitter.com/jburnmurdoch/status/1384782970867834888/photo/1 )

(6) The stories on the ground are grim.

Authorities have taken emergency measures, requiring tha(t) any and all oxygen produced anywhere in the state be sent to hospitals as supplies run out.
Image ( https://twitter.com/jburnmurdoch/status/1384782975125049344/photo/1 )

(7) With thousands simply unable to find a hospital bed, death tolls are mounting at a similarly rapid pace.

But a look at this chart shows another issue: although official Covid death counts are rising, the numbers themselves remain incredibly low.

And I stress in-*credible*
Image ( https://twitter.com/jburnmurdoch/status/1384782979734589440/photo/1 )

(8) Essentially, none of those numbers are correct; all are vast undercounts.

I collated local news reports (HT @muradbanaji ) across seven districts, finding that overall, numbers of Covid victims who have been cremated are 10x larger than official Covid death counts in same areas.
Image ( https://twitter.com/jburnmurdoch/status/1384782984138694658/photo/1 )

(9) If applied nationally, that would mean that instead of 1,700 deaths per day, India is currently seeing 17,000.

And as more reports come in, that undercounting estimate has been rising, so the true toll may be higher still.

(10) Read our full story here with @b_parkyn @jyots43 @SJFindlay @AnnaSophieGross for more, including the debate over the role of the new variant B.1.617 in driving the surge

‘It is much worse this time’: India’s devastating second wave
Benjamin Parkin, Jyotsna Singh and Stephanie Findlay in New Delhi, and John Burn-Murdoch | 4/20/2021
New variant suspected of stoking surge that is overwhelming hospitals and crematoriums
https://www.ft.com/content/683914a3-134f-40b6-989b-21e0ba1dc403

Don't linger after you flush: Public toilets may spread COVID-19 aerosols, study finds
Nicole Bogart | April 20, 2021

...droplets were detected at heights of up to five feet (1.5 metres) for 20 seconds or longer after flushing

... researchers detected a smaller number of droplets in the air even when the toilet was flushed with a closed lid, suggesting that aerosol droplets can escape through small gaps between the cover and the seat.

"After about three hours of tests involving more than 100 flushes, we found a substantial increase in the measured aerosol levels in the ambient environment with the total number of droplets generated in each flushing test ranging up to the tens of thousands," study co-author Siddhartha Verma said in a press release issued Tuesday.

"Both the toilet and urinal generated large quantities of droplets smaller than three micrometers in size, posing a significant transmission risk if they contain infectious microorganisms. Due to their small size, these droplets can remain suspended for a long time."

When combined with heavy foot traffic, confined space, and a lack of adequate ventilation, researchers say this could make public restrooms a “hotbed” for virus transmission...

https://www.ctvnews.ca/health/coronavirus/don-t-linger-after-you-flush-public-to...
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Jesse H. Schreck et al. 2021, Aerosol generation in public restrooms featured. Physics of Fluids 33, 033320 (22 March 2021); https://doi.org/10.1063/5.0040310 https://aip.scitation.org/doi/10.1063/5.0040310

ABSTRACT
Aerosolized droplets play a central role in the transmission of various infectious diseases, including Legionnaire's disease, gastroenteritis-causing norovirus, and most recently COVID-19. Respiratory droplets are known to be the most prominent source of transmission for COVID-19; however, alternative routes may exist given the discovery of small numbers of viable viruses in urine and stool samples. Flushing biomatter can lead to the aerosolization of micro-organisms; thus, there is a likelihood that bioaerosols generated in public restrooms may pose a concern for the transmission of COVID-19, especially since these areas are relatively confined, experience heavy foot traffic, and may suffer from inadequate ventilation. To quantify the extent of aerosolization, we measure the size and number of droplets generated by flushing toilets and urinals in a public restroom. The results indicate that the particular designs tested in the study generate a large number of droplets in the size range 0.3 μm–3 μm, which can reach heights of at least 1.52 m. Covering the toilet reduced aerosol levels but did not eliminate them completely, suggesting that aerosolized droplets escaped through small gaps between the cover and the seat. In addition to consistent increases in aerosol levels immediately after flushing, there was a notable rise in ambient aerosol levels due to the accumulation of droplets from multiple flushes conducted during the tests. This highlights the need for incorporating adequate ventilation in the design and operation of public spaces, which can help prevent aerosol accumulation in high occupancy areas and mitigate the risk of airborne disease transmission...
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Yun-yun Li et al. 2021. Can a toilet promote virus transmission? From a fluid dynamics perspective featured
Physics of Fluids 32, 065107 (16 June 2020); https://doi.org/10.1063/5.0013318 https://aip.scitation.org/doi/10.1063/5.0013318

ABSTRACT
Currently, a novel coronavirus named “SARS-CoV-2” is spreading rapidly across the world, causing a public health crisis, economic losses, and panic. Fecal–oral transmission is a common transmission route for many viruses, including SARS-CoV-2. Blocking the path of fecal–oral transmission, which occurs commonly in toilet usage, is of fundamental importance in suppressing the spread of viruses. However, to date, efforts at improving sanitary safety in toilet use have been insufficient. It is clear from daily experience that flushing a toilet generates strong turbulence within the bowl. Will this flushing-induced turbulent flow expel aerosol particles containing viruses out of the bowl? This paper adopts computational fluid dynamics to explore and visualize the characteristics of fluid flow during toilet flushing and the influence of flushing on the spread of virus aerosol particles. The volume-of-fluid (VOF) model is used to simulate two common flushing processes (single-inlet flushing and annular flushing), and the VOF–discrete phase model (DPM) method is used to model the trajectories of aerosol particles during flushing. The simulation results are alarming in that massive upward transport of virus particles is observed, with 40%–60% of particles reaching above the toilet seat, leading to large-scale virus spread. Suggestions concerning safer toilet use and recommendations for a better toilet design are also provided...

Laurie Garrett ended her book The Coming Plague: Newly Emerging Diseases in a World Out of Balance predicting a respiratory virus breaking out in a metropolis like Mexico City...

Laurie Garrett @Laurie_Garrett | 10:00 AM · Apr 21, 2021:
https://twitter.com/Laurie_Garrett/status/1384869565558034432
There's just no good news here.
From WHO #COVID19 #pandemic view.
Image--graph, # weekly cases by continent & region
( https://twitter.com/Laurie_Garrett/status/1384869565558034432/photo/1 )

---------------------------------------------------
>77 margd: Ivermectin, contd.
I hadn't heard about this Ivermectin use before as explanation for Africa's (reported) experience thus far with COVID-19. Youth, public health, reporting--but not Ivermectin.

Have a Red heart @mathildaheart | 10:31 AM · Apr 21, 2021:
There is a drug called Ivermectin that many in sub saharan Africa take regularly due to black fly bites that cause “river blindness”. There have been multiple studies of effectiveness to treat and to prevent Covid using this drug

BNO Newsroom @BNODesk | 1:32 PM · Apr 21, 2021:
BREAKING: India reports more than 300,000 coronavirus cases in one day for the first time

Some areas have not yet reported their figures, but it's at least 305,000

ETA: 314,835 infections added in the past 24 hours
https://apnews.com/article/asia-pacific-india-coronavirus-health-business-88e0e1...
____________________________________________________

Kashif Pirzada, MD (Emergency, Toronto) @KashPrime | 12:04 PM · Apr 21, 2021
Check in with your friends who have family in hotspots abroad. An incredible tragedy is taking place in India, Brazil, the Philippines... nearly every family, including ours, has lost relatives, and many more will follow :(
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India’s Second Covid Wave Is Completely Out of Control
Complacency and lack of preparation by the government pushed the country into an unprecedented crisis.
Ramanan Laxminarayan* | April 20, 2021
https://www.nytimes.com/2021/04/20/opinion/india-covid-crisis.html
*Dr. Laxminarayan is an economist and an epidemiologist.
____________________________________________________

Triple Mutation Strain Detected in 4 Indian States: Why Mutant Strain is Dangerous & Needs Effective Monitoring?
Edited by Ritu Singh | April 21, 2021

Two of these triple-mutant varieties have been found in samples collected from Maharashtra, Delhi, West Bengal and Chhattisgarh, and this might aggravate India's Covid crisis further...

https://www.india.com/health/triple-mutation-strain-detected-in-4-indian-states-...

An unvaccinated worker set off an outbreak at a U.S. nursing home where most residents were immunized.
Roni Caryn Rabin | April 21, 2021

An unvaccinated health care worker set off a Covid-19 outbreak at a nursing home in Kentucky where the vast majority of residents had been vaccinated, leading to dozens of infections, including 22 cases among residents and employees who were already fully vaccinated, a new study reported Wednesday.

Most of those who were infected with the coronavirus despite being vaccinated did not develop symptoms or require hospitalization, but one vaccinated individual, who was a resident of the nursing home, died, according to the study released by the Centers for Disease Control and Prevention.

Altogether, 26 facility residents were infected, including 18 who had been vaccinated, and 20 health care personnel were infected, including four who had been vaccinated. Two unvaccinated residents also died...

https://www.nytimes.com/2021/04/21/health/vaccine-nursing-homes-infections.html

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Cavanaugh AM, Fortier S, Lewis P, et al. COVID-19 Outbreak Associated with a SARS-CoV-2 R.1 Lineage Variant in a Skilled Nursing Facility After Vaccination Program — Kentucky, March 2021. MMWR Morb Mortal Wkly Rep. ePub: 21 April 2021. DOI: http://dx.doi.org/10.15585/mmwr.mm7017e2 https://www.cdc.gov/mmwr/volumes/70/wr/mm7017e2.htm?s_cid=mm7017e2_w

...Vaccination of SNF (skilled nursing facilities) residents and HCP (health care personnel ) is essential to reduce the risk for symptomatic COVID-19, as is continued focus on infection prevention and control practices...

...Low acceptance of vaccination among SNF HCP might increase the likelihood of SARS-CoV-2 introduction and transmission within a facility. Nationally, a median of 37.5% of HCP working in long-term care facilities had received at least 1 dose of vaccine by mid-January 2021.... Although the vaccination rate in this SNF surpassed this early national rate, approximately one half of HCP were vaccinated. To protect SNF residents, it is imperative that HCP, as well as SNF residents, be vaccinated. A continued emphasis on strategies for prevention of disease transmission, even among vaccinated populations, is also critical. Timely implementation of infection control strategies after outbreak identification likely contributed to the rapid decline in new cases during the second week of the outbreak.

The findings in this report are subject to at least three limitations.

First, the health status of residents who declined vaccination might have differed from those who consented to vaccination. Thus, hospitalization and death outcomes might be biased when comparing the groups without controlling for underlying health conditions.

Second, underlying health status and advance directives might affect decisions for resident hospitalization; therefore, association of vaccination with hospitalization in this SNF population might have limited generalizability.

Finally, because of the reduced sensitivity of antigen testing in asymptomatic populations,... it is possible that some asymptomatic cases were not identified. If this introduced differential bias for identification of cases in either the vaccinated or unvaccinated groups, actual VE (vaccine effectiveness) for the prevention of SARS-CoV-2 infections could differ from measured effectiveness...

BNO Newsroom @BNODesk | 3:54 PM · Apr 21, 2021:
Positivity rate in New York drops to 2.1%, the lowest since November 5

It's for today. The 7-day average is 2.69%

ETA: Re "very good safety profile", that it may be, but there were not enough people in the J&J Phase 3 file to detect extremely rare clotting.

Eric Topol @EricTopol | 5:00 PM · Apr 21, 2021:
The J&J vaccine Phase 3 trial is published @NEJM today
At post more than 14 days 67% efficacy;
more than 28 days 75% (85% vs severe/critical) and strong efficacy vs B.351 (South Africa) variant;
very good safety profile
Image ( https://twitter.com/EricTopol/status/1384975362203918337/photo/1 )
Image ( https://twitter.com/EricTopol/status/1384975362203918337/photo/2 )
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Jerald Sadoff et al. 2021. Safety and Efficacy of Single-Dose Ad26.COV2.S Vaccine against Covid-19. NEJM (April 21, 2021)
DOI: 10.1056/NEJMoa2101544 https://www.nejm.org/doi/full/10.1056/NEJMoa2101544

Abstract

...Conclusions
A single dose of Ad26.COV2.S (J&J vaccine) protected against symptomatic Covid-19 and asymptomatic SARS-CoV-2 infection and was effective against severe–critical disease, including hospitalization and death. Safety appeared to be similar to that in other phase 3 trials of Covid-19 vaccines...

No evidence that Pfizer or Moderna vaccines are unsafe during pregnancy, a preliminary study says.
Emily Anthes | April 21, 2021

In an early analysis of coronavirus vaccine safety data, researchers at the Centers for Disease Control and Prevention have found no evidence that the Pfizer-BioNTech or Moderna vaccines pose serious risks during pregnancy.

The findings are preliminary and cover just the first 11 weeks of the U.S. vaccination program. But the study, which included self-reported data on more than 35,000 people who received one of the vaccines during or shortly before pregnancy, is the largest yet on the safety of the coronavirus vaccines in pregnant people...

...Pregnant women who develop symptoms of the disease are more likely to become seriously ill, and more likely to die, than nonpregnant women with symptoms.

Because of those risks, the C.D.C. has recommended that coronavirus vaccines be made available to pregnant women, though it also suggests that they consult with their doctors when making a decision about vaccination.

The new study*, which was published on Wednesday in The New England Journal of Medicine, is based largely on self-reported data from V-safe, the C.D.C.’s coronavirus vaccine safety monitoring system. Participants in the program use a smartphone app to complete regular surveys about their health, and any side effects they might be experiencing, after receiving a Covid-19 vaccine...

https://www.nytimes.com/2021/04/21/health/pregnant-covid-vaccine.html

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Tom T. Shimabukuro et al. 2021. Preliminary Findings of mRNA Covid-19 Vaccine Safety in Pregnant Persons. NEJM (April 21, 2021)
DOI: 10.1056/NEJMoa2104983 https://www.nejm.org/doi/full/10.1056/NEJMoa2104983

Abstract
Background
Many pregnant persons in the United States are receiving messenger RNA (mRNA) coronavirus disease 2019 (Covid-19) vaccines, but data are limited on their safety in pregnancy.

Methods
From December 14, 2020, to February 28, 2021, we used data from the “v-safe after vaccination health checker” surveillance system, the v-safe pregnancy registry, and the Vaccine Adverse Event Reporting System (VAERS) to characterize the initial safety of mRNA Covid-19 vaccines in pregnant persons.

Results
A total of 35,691 v-safe participants 16 to 54 years of age identified as pregnant. Injection-site pain was reported more frequently among pregnant persons than among nonpregnant women, whereas headache, myalgia, chills, and fever were reported less frequently. Among 3958 participants enrolled in the v-safe pregnancy registry, 827 had a completed pregnancy, of which 115 (13.9%) resulted in a pregnancy loss and 712 (86.1%) resulted in a live birth (mostly among participants with vaccination in the third trimester). Adverse neonatal outcomes included preterm birth (in 9.4%) and small size for gestational age (in 3.2%); no neonatal deaths were reported. Although not directly comparable, calculated proportions of adverse pregnancy and neonatal outcomes in persons vaccinated against Covid-19 who had a completed pregnancy were similar to incidences reported in studies involving pregnant women that were conducted before the Covid-19 pandemic. Among 221 pregnancy-related adverse events reported to the VAERS, the most frequently reported event was spontaneous abortion (46 cases).

Conclusions
Preliminary findings did not show obvious safety signals among pregnant persons who received mRNA Covid-19 vaccines. However, more longitudinal follow-up, including follow-up of large numbers of women vaccinated earlier in pregnancy, is necessary to inform maternal, pregnancy, and infant outcomes....

INDIA :(

O2 status in major Delhi govt. & private hospitals (2.5-20h), April 22, 2021
( https://twitter.com/DrEricDing/status/1385185691345330178/photo/1 )
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Coronavirus India Live Updates: As it stands, we all know this country is being run by God, says Delhi HC
Express Web Desk | Bengaluru, Chennai, Kolkata, Mumbai, New Delhi | Updated: April 22, 2021

...The Delhi High Court on Thursday directed the centre to ensure that allocation order and the MHA order allowing free movement of medical oxygen be implemented immediately, and its non-compliance would invite criminal action, it said. Pulling up the Centre, its said though the government had passed allocation order, it “did not seem to implement it seriously”. “As it stands, we all know this country is being run by God,” said Delhi HC.

With states accusing each other of blocking the passage of oxygen supply, the Ministry of Home Affairs on Thursday ordered that there will be no restriction on the movement of medical oxygen between the states and the transport authorities shall be instructed to accordingly allow free inter-state and intra-state movement of oxygen-carrying vehicles.

Meanwhile, Prime Minister on Thursday held high-level meeting on oxygen supply and availability across India. In the meeting, he called for using innovative ways to provide oxygen support to health facilities...

https://indianexpress.com/article/india/coronavirus-india-live-updates-maharasht...

Florian Krammer (Virologist Icahn) @florian_krammer | 6:16 AM · Apr 22, 2021
I am actually interested to see how this turns out post-pandemic between Moderna, Pfizer, BioNTech Curevac, U Penn etc.
I would expect a huge fight over who owns and controls the IP (intellectual property).

Quote Tweet
Tahir Amin (IP lawyer) @realtahiramin · 17h
Fact check: @natashaloder. I tweeted about this when Moderna made its statement.
https://twitter.com/realtahiramin/status/1314236281124159489

If you read the statement* closely, Moderna DID NOT waive all its IP on its vaccines.
Only that it would not enforce COVID-19 related patents on the vaccines. Big difference.

* Image ( https://twitter.com/realtahiramin/status/1384940448372989952/photo/1 )

In case of interest, antibody production after mRNA vaccination (anecdote):

DH and I gave blood ~3 weeks after 2nd Pfizer dose, and were tested for antibodies:
Jan/Feb 2020- we THINK we had mild COVID-19.
July 2020- neg for COVID antibodies (Red Cross)
Nov 2020- neg for COVID antibodies (Red Cross)
March 7 & 23, 2021- two doses Pfizer COVID vaccine
April 2021- "reactive" for COVID-19 antibodies (Red Cross)

Our experience confirms that one doesn't need side effects for immune response. Other than sore arm, DH had no side effects from Pfizer vaxx. I was fatigued and achy for 24 hrs after 1st dose. I THINK some mild aches cleared up after vaxx. (YAY!)

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American Red Cross | Blood Services
What Does My (COVID-19 Antibody) Test Result Mean?

(1) Reactive test result:
Indicates that only your initial antibody test was reactive for COVID-19 antibodies, while the second test that we performed was not reactive or was not able to be completed. This result means that you likely received the COVID-19 vaccine and did not have a COVID infection. Another less common explanation for a reactive result is that we were unable to complete both tests. It takes one to three weeks after the first dose of a COVID-19 vaccine to reach a detectable level of antibodies.

If your test result is reactive, the Red Cross may contact you to request additional information and conduct further testing as part of a research study.

(2) Positive test result: Indicates the detection of specific antibodies to the virus that causes COVID-19. A positive test result indicates that you were likely exposed to the virus, regardless of whether you experienced symptoms or received a COVID19- vaccine.

If your test result is positive, the Red Cross may contact you to request additional information and conduct further testing as part of a research study.

(3) Negative test result: Indicates that you have not developed antibodies to the virus that causes COVID-19, or you may have antibodies that are present at levels below the test’s threshold for detection. It takes one to three weeks after an infection or vaccination to reach a detectable level of antibodies.d Donor app or online donor portal. In some situations, final test results may take longer to appear.
...
For additional information about your test result, you may download or view the manufacturer’s fact sheet for the ORTHO Clinical Diagnostics VITROS® Total Test or the Roche Diagnostics Test...

COVID-19 Antibody Testing Partners
Thank you to our generous partners for their support of our COVID-19 antibody testing initiative.
National General Insurance

https://www.redcrossblood.org/donate-blood/dlp/covid-19-antibody-test-details.ht...

(US) Faces ‘Hand-to-Hand Combat’ to Get Reluctant Americans Vaccinated
Sheryl Gay Stolberg and Annie Karni | April 21, 2021

...health officials around the country are hitting what appears to be a soft ceiling: More than half the nation’s adults have received at least one dose, but it is going to take hard work — and some creative changes in strategy — to convince the rest.

State health officials, business leaders, policymakers and politicians are struggling to figure out how to tailor their messages, and their tactics, to persuade not only the vaccine hesitant but also the indifferent...Officials in many states are looking past mass vaccination sites and toward having patients get vaccinated by their own doctors...

...If it takes too long to reach “herd immunity,” the point at which the spread of the virus slows, worrisome new variants could emerge that evade the vaccine.

On Wednesday, President Biden urged all employers in the United States to offer full pay to their workers for time off to be inoculated and to recover from any aftereffects. He also announced a paid leave tax credit to offset the cost for companies with fewer than 500 employees, and appealed to the unvaccinated to get their shots.

...the distribution is uneven: ...New Hampshire... 59 percent of its citizens ... Mississippi and Alabama are languishing at 30 percent.

...Some companies are contemplating their own vaccine clinics and educating their workers about the benefits of protecting themselves against a virus that has killed more than 568,000 people in the United States. Others are talking about giving their workers incentives, like cash gift cards ...

...The Equal Employment Opportunity Commission has told employers that they can require vaccination to protect public health...

https://www.nytimes.com/2021/04/21/us/politics/coronavirus-vaccine-rates.html

We know a lot about Covid-19. Experts have many more questions
Helen Branswell | April 20, 2021

What accounts for the wide variety of human responses to this virus?
How much immunity is enough immunity?
How often will reinfections happen and what will they be like?
Put another way, how long will immunity last?
How are viral variants going to impact the battle against Covid-19?
What is long Covid, who is at risk of developing it, and can it be prevented?
What’s the deal with Covid and kids?
How big a role do asymptomatically infected people actually play in SARS-2 transmission?
What does the future hold for SARS-2, evolutionarily and otherwise?
Can we figure out who might become a superspreader?
Can we learn more quicker from the study of the genetic sequences of SARS-2 viruses?
The impact of the nonpharmaceutical interventions
The differences between SARS-2 and its older cousin, SARS-1
Last but not least: Where did SARS-2 come from?

https://www.statnews.com/2021/04/20/we-know-a-lot-about-covid-19-experts-have-ma...

Why India has been overwhelmed by a second Covid surge - BBC Newsnight (15:47)
BBC • Apr 22, 2021
https://www.youtube.com/watch?v=ip01I2tSNUI
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My Gawd...

Dr. Tom Frieden (frmr US CDC director) @DrTomFrieden | 9:37 AM · Apr 23, 2021:
Our thoughts are with India. This video is hard to watch.
From BBC News (World)
2:44 ( https://twitter.com/DrTomFrieden/status/1385588650981928960 )
______________________________________

314,000 daily cases: India struggles with the world's worst coronavirus outbreak | COVID-19 Special
DW • Apr 22, 2021
https://www.youtube.com/watch?v=ls__On6Pz_4

Vaccines Are Effective Against the New York Variant, Studies Find
Apoorva Mandavilli | April 22, 2021

For weeks, New Yorkers have witnessed the alarming rise of a homegrown variant of the coronavirus that has kept the number of cases in the city stubbornly high. City officials have repeatedly warned that the variant may be more contagious and may dodge the immune response.

On that second point, at least, they can now breathe easier: Both the Pfizer-BioNTech and Moderna vaccines will effectively prevent serious illness and death from the variant, two independent studies suggest...

https://www.nytimes.com/2021/04/22/health/covid-ny-variant-vaccine.html

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Hao Zhou et al. 2021. B.1.526 SARS-CoV-2 variants identified in New York City are neutralized by vaccine-elicited and therapeutic monoclonal antibodies. bioRxiv (March 24, 2021) 22 double-spaced p. https://doi.org/10.1101/2021.03.24.436620 https://www.biorxiv.org/content/10.1101/2021.03.24.436620v1.full.pdf

Preprint not yet peer-reviewed.

Abstract
DNA sequence analysis recently identified the novel SARS-CoV-2 variant B.1.526 that is spreading at an alarming rate in the New York City area.Two versions of the variant were identified, both with the prevalent D614G mutation in the spike protein together with four novel point mutations and with an E484K or S477N mutation in the receptor binding domain, raising concerns of possible resistance to vaccine-elicited and therapeutic antibodies. We report that convalescent sera and vaccine-elicited antibodies retain full neutralizing titer against the S477N B.1.526 variant and neutralize the E484K version with a modest 3.5-fold decrease in titer as compared to D614G. The E484K version was neutralized with a 12-fold decrease in titer by the REGN10933 monoclonal antibody but the combination cocktail with REGN10987 was fully active. The findings suggest that current vaccines and therapeutic monoclonal antibodies will remain protective against the B.1.526 variants.The findings further support the value of wide-spread vaccination.

"Breakthrough" infection rates below 1%. Most asymptomatic.

Eric Topol @EricTopol | 10:06 AM · Apr 22, 2021:
With addition of the new reports yesterday,
the "breakthrough" infection rate after full mRNA vaccination has been consistently below 1%.
Most are without symptoms, only detected by testing.
Not included is the CDC report of 0.008% among 66 million people (no reference)
Image--table of "breakthrough" study outcomes ( https://twitter.com/EricTopol/status/1385233588132581380/photo/1 )
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The Really Surprising Thing About Fully Vaccinated People Who Get COVID-19
The number of so-called “breakthrough” cases we’re seeing is even lower than expected.
Yasmin Tayag | April 22, 2021
https://slate.com/technology/2021/04/covid-19-vaccine-breakthrough-infections-cd...

Home tests--"When compared to cases detected through routine surveillance, we report here a longer period of decline and a younger age distribution. Representative community sampling for SARS-CoV-2 can substantially improve situational awareness and feed into the public health response even at low prevalence."

Eric Topol @EricTopol | 10:24 AM · Apr 23, 2021:
The value of large-scale, self-administered ("community") covid testing, irrespective of symptoms,
to track and stay ahead of outbreaks
https://science.sciencemag.org/content/early/2021/04/22/science.abf0874*
Image--1st p article w Topol highlights ( https://twitter.com/EricTopol/status/1385600513803120642/photo/1 )
Image--Fig S3 Estimation day of minimum epidemic ( https://twitter.com/EricTopol/status/1385600513803120642/photo/1 )

----------------------------------------------------

* Steven Riley et al. 2021. Resurgence of SARS-CoV-2: detection by community viral surveillance. Science 23 Apr 2021:
eabf0874 DOI: 10.1126/science.abf0874 https://science.sciencemag.org/content/early/2021/04/22/science.abf0874

Abstract
Surveillance of the SARS-CoV-2 epidemic has mainly relied on case reporting which is biased by health service performance, test availability and test-seeking behaviors. We report a community-wide national representative surveillance program in England involving self-administered swab results from 594,000 individuals tested for SARS-CoV-2, regardless of symptoms, from May to beginning of September 2020. The epidemic declined between May and July 2020 but then increased gradually from mid-August, accelerating into early September 2020 at the start of the second wave. When compared to cases detected through routine surveillance, we report here a longer period of decline and a younger age distribution. Representative community sampling for SARS-CoV-2 can substantially improve situational awareness and feed into the public health response even at low prevalence.

Covid-19 vaccine tracker: the global race to vaccinate
Updated 10 minutes ago (~ noon 4/23/2021) by FT Visual & Data Journalism team

At least 976,226,843 doses of coronavirus vaccines have been administered around the world, data from 214 locations show.

After a year of breakneck research into more than 230 vaccine candidates, seven coronavirus vaccines are now in use in at least one country. Israel has been the fastest to roll out inoculations. More than half of its population have already received at least one dose of vaccine, and more than a third having received both doses...

(Table vaccinations by "location")

https://ig.ft.com/coronavirus-vaccine-tracker/?areas=gbr&areas=isr&areas...

Sounds like Moderna, at least, is feeling pressure to transfer technology? India?

UPDATE 1-Moderna CEO says world faces 2022 COVID vaccine production surplus
Reuters | April 23, 2021

...Manufacturers should focus on producing as many vaccines as possible this year, but the world faces a potential surplus next year in capacity, Moderna's CEO said on Friday.

Speaking at a virtual event on vaccine manufacturing, Stephane Bancel said that additional technology transfers might dent their ability to meet production targets. Moderna is on track to make up to 1 billion doses this year and 1.4 billion next year, he said.

...He also said that Moderna was in talks with the COVAX vaccine-sharing facility which is providing doses to lower income countries, adding: "I hope we are in the final stretch to get an agreement with COVAX."...

https://finance.yahoo.com/news/1-moderna-ceo-says-world-121906974.html

How long before we all understand that SARS-CoV-2 COVID is airborne? (8:56)
Weighing the evidence for whether COVID infections are mainly spread through tiny aerosol particles
CBC Radio · Posted: Apr 23, 2021
https://www.cbc.ca/radio/quirks/apr-24-mars-helicopter-narwhal-tusks-and-polluti...
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Graph: aerosol volume v. particle size, singing-nose-breathing ( https://twitter.com/DrEricDing/status/1385813720220282880/photo/1 )
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Julian W Tang et al. 2021. Covid-19 has redefined airborne transmission. BMJ 2021;373:n913 (Published 14 April 2021)
doi: https://doi.org/10.1136/bmj.n913 https://www.bmj.com/content/373/bmj.n913

India’s massive COVID surge puzzles scientists
The virus is spreading faster than ever before in India despite previous high infection rates in megacities, which should have conferred some protection.
Smriti Mallapaty | 21 April 2021

...Just months earlier, antibody data had suggested that many people in cities such as Delhi and Chennai had already been infected, leading some researchers to conclude that the worst of the pandemic was over in the country.

Researchers in India are now trying to pinpoint what is behind the unprecedented surge, which could be due to an unfortunate confluence of factors, including the emergence of particularly infectious variants, a rise in unrestricted social interactions, and low vaccine coverage. Untangling the causes could be helpful to governments trying to suppress or prevent similar surges around the world...

...One explanation might be that the first wave primarily hit the urban poor. Antibody studies might not have been representative of the entire population and potentially overestimated exposure in other groups

...But some researchers say that the speed and scale of the current outbreak suggest a new ingredient: emerging variants of the virus.

...Some say that...people letting their guards down is a bigger driver.

...less than 10% of India’s population (vaxxed), so there is still a long way to go...I

Some people might have become infected while getting vaccines, says (Zarir Udwadia, a clinician-researcher in pulmonary medicine at P D Hinduja Hospital & Medical Research Centre in Mumbai), because crowds often share clinic waiting areas with ill people who are waiting to be seen.

https://www.nature.com/articles/d41586-021-01059-y

KOLKATA: One of two persons undergoing RT-PCR tests in Kolkata (is positive).
http://timesofindia.indiatimes.com/articleshow/82236519.cms
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Eric Feigl-Ding @DrEricDing | 5:24 AM · Apr 25, 2021
This is bad—50% #COVID19 positivity in Kolkata and its suburbs.
“Laboratories in Kolkata and surrounding areas are reporting a positivity rate of 45%-55% while in other parts of the state the positivity is 24%, up from 5% at the beginning of this month”
https://timesofindia.indiatimes.com/city/kolkata/every-second-person-getting-tes...
Image-5-day moving average cases in Kolkata, April 23-27 ( https://twitter.com/DrEricDing/status/1386249817211424770/photo/1 )
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Eric Feigl-Ding @DrEricDing | 4:42 AM · Apr 21, 2021:
UNDERREPORTING DEATHS is become serious and more extreme.
In many parts of India, case reports of #COVID19 cremations vastly exceed the official Indian government count.
We may soon enter a pandemic phase in India akin to 1918 Spanish Flu.
(Ht @muradbanaji @jburnmurdoch)
Image--bar graph of official deaths v cremations, by district ( https://twitter.com/DrEricDing/status/1384789570957500416/photo/1 )

SageDog @SageDog5 | 5:53 AM · Apr 21, 2021:
The real numbers are worse. Official numbers are for all residents, Hindus & Muslims. Only Hindus cremate. Muslims bury.
If they are ignoring burials, especially in heavily Muslim areas like Lucknow, they are overlooking a lot of deaths.

ehab.ahmed @ehabahmeddarrag | 4:46 AM · Apr 21, 2021:
In Egypt we have the same
All our Facebook pages is about people death we know personally
I know last week 7 death personally
Government have same numbers daily since pandemic started they just change 2 or 3 daily new
Coronavirus in 90% of families here at least 1 case every 5 people
_______________________________________________

Pakistan offers help to India amid COVID surge, FM says 'believe in humanity first'
Times Now Digital | Apr 25, 2021

Islamabad: ...PM Imran Khan expressed solidarity with the people of India in their combat against the virus...

Taking to his official Twitter handle, (Foreign Minister Shah Mahmood Qureshi ) wrote, "As a gesture of solidarity with the people of India in the wake of the current wave of COVID19, Pakistan has officially offered relief & support to India, including ventilators, Bi PAP, digital X ray machines, PPEs & other related items. We believe in a policy of Humanity First."...

https://www.timesnownews.com/india/article/pakistan-offers-help-to-india-amid-co...
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Defence ministry to airlift 23 oxygen generation plants from Germany amid acute shortage
PTI | New Delhi | April 23, 2021

The decision by the ministry came four days after Defence Minister Rajnath Singh announced granting emergency financial powers to the three services and other defence agencies to make necessary procurement to enhance medical infrastructure in view of the pandemic...

https://indianexpress.com/article/coronavirus/defence-ministry-to-airlift-23-oxy...
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UPDATE 3-U.S. racing to send aid to India as COVID-19 cases soar
Andrea Shalal | April 24, 2021

WILMINGTON, Del., April 24 (Reuters) - The United States is deeply concerned by a massive surge in coronavirus cases in India and will race additional support to the Indian government and health care workers, a White House spokeswoman said on Saturday.

"We are in active conversations at high levels and plan to quickly deploy additional support to the Government of India and Indian health care workers as they battle this latest severe outbreak. We will have more to share very soon," the spokeswoman told Reuters via email.

Washington is under increasing pressure to do more to help India, the world's largest democracy and a strategic ally in President Joe Biden's efforts to counter China, as it grapples with a record-setting surge in coronavirus infections.

The U.S. Chamber of Commerce on Friday called on the Biden administration to release millions of stored doses of AstraZeneca vaccine for shipment to India, Brazil and other hard hit countries....

https://www.reuters.com/world/india/us-deploy-support-india-govt-healthcare-work...

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India in Saudi Arabia @IndianEmbRiyadh | 12:27 PM · Apr 24, 2021:
Embassy of India is proud to partner with Adani group and M/s Linde in shipping much needed 80MT liquid oxygen to India.
Our hear(t)felt thanks to Ministry of Health Kingdom of Saudi Arabia for all their help, support and cooperation...
(photos of O2 tanks dockside)

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All India Radio News @airnewsalerts | 9:05 AM · Apr 24, 2021:
C17 Aircraft with 4 cryogenic containers for storage of liquid #Oxygen from Singapore landed at Panagarh air base in West Bengal.
0:54 ( https://twitter.com/airnewsalerts/status/1385942901641736200 )

Interesting perspectives from US, Germany, Africa, India on vaccine nationalism. (One could add EU, UK, Canada):

‘Americans first’: US cites domesti ..
http://timesofindia.indiatimes.com/articleshow/82219263.cms

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Saket Gokhale @SaketGokhale | 12:19 AM · Apr 25, 2021
Nailing the lies & propaganda of the Modi Govt & Serum Institute of India:

Over the last few days, there’s been an organized campaign by the Govt of India blaming the shortage of vaccines on an export embargo of raw materials by the United States.

But wait - that’s not true

Here’s Adar Poonawalla of SII admitting on CNBC TV18 just 2 days ago that the US embargo on raw materials DOES NOT AFFECT PRODUCTION OF COVISHIELD.

The embargo affects “Covovax” which is a vaccine under development that’s not yet been approved anyway.

Don’t fall for fake narratives where Modi govt is blaming the US falsely for its own incompetence. This is their new agenda to divert attention from Modi’s failures.

Shortage of Covishield is entirely the fault of SII & Modi govt. The US embargo has NOTHING to do with it.

0:43--MSNBC ( https://twitter.com/SaketGokhale/status/1386173220445986826 )

>100 margd: Every morning the news from India is worse than it was the previous day. It's like a flashback to Italy last Spring. :o(

>103 clamairy: And we in the prideful west may also be giving variants the opening they need...

Millions Are Skipping Their Second Doses of Covid Vaccines
Rebecca Robbins | April 25, 2021

Nearly (5 million) 8 percent of those who got initial Pfizer or Moderna shots missed their second doses. State officials want to prevent the numbers from rising.

...That is more than double the rate among people who got inoculated in the first several weeks of the nationwide vaccine campaign.

Even as the country wrestles with the problem of millions of people who are wary about getting vaccinated at all, local health authorities are confronting an emerging challenge of ensuring that those who do get inoculated are doing so fully.

...some said they feared the side effects, which can include flulike symptoms. Others said they felt that they were sufficiently protected with a single shot.

...A number of vaccine providers have canceled second-dose appointments because they ran out of supply or didn’t have the right brand in stock...

https://www.nytimes.com/2021/04/25/business/covid-vaccines-second-doses.html
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Gottlieb: Declines in cases, hospitalizations should signal a relaxation in COVID-19 restrictions
Joseph Choi - 04/25/21
https://thehill.com/homenews/sunday-talk-shows/550167-gottlieb-declines-in-cases...
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Michigan became hotspot as variants rose and vigilance fell
COREY WILLIAMS, DAVID EGGERT AND LINDSEY TANNER | April 25 , 2021
https://apnews.com/article/health-michigan-coronavirus-a9cdf0590d94786b198c22b7b...
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Two Saturdays in a row in, site of (Ontario's first?) B117 outbreak in nursing home that killed many...

Barrie (Ontario) police to step up enforcement at anti-lockdown rally
Kim Phillips, April 16, 2021
City police ticketed between 10 and 15 people at rally for breaching stay-at-home order; One woman was arrested for obstructing police...
https://barrie.ctvnews.ca/barrie-police-to-step-up-enforcement-at-anti-lockdown-...

Anti-protest protesters rally in Barrie to 'defend freedom' (6 photos)
City police ticketed between 10 and 15 people at rally for breaching stay-at-home order; One woman was arrested for obstructing police
Bob Bruton | April 24, 2021

Lockdown protestors literally stood and sat upon names of the COVID-19 dead during Saturday’s ‘freedom rally’ in downtown Barrie.

Earlier that morning, someone chalked the names and ages of 100 people who have died from the virus on all levels of cement at Meridian Place, located just below Memorial Square, which honours Barrie’s war dead.

Along with the names were a number of chalked messages to the rally organizers and supporters — ‘Wear a mask’, ‘Don’t Erase Them! (Their Lives Mattered)’ and ‘You are killing our downtown community’. Other messages said there were 23,756 deaths in Canada from COVID, including 7,789 in Ontario alone.

...Barrie city police said about 300 people attended Saturday’s rally...

https://www.orilliamatters.com/local-news/anti-protest-protesters-rallly-in-barr...

Why Opening Windows Is a Key to Reopening Schools
Nick Bartzokas, Mika Gröndahl, Karthik Patanjali, Miles Peyton, Bedel Saget and Umi Syam | Feb. 26, 2021
https://www.nytimes.com/interactive/2021/02/26/science/reopen-schools-safety-ven...

(interactive demo)

Among other assists to India, US is providing $1bn to increase capacity of Indian vaccine mfr BioE to produce "People's Vaccine" (for the world, end of 2022) and hopefully for emergency use in India this summer. Cost will be only $1.50 as it uses familiar old-school technology used in the recombinant hepatitis B vaccine that’s been around for four decades

Andy Slavitt (WH Sr Advisor for COVID Response) @ASlavitt · 17h
Important statement regarding support for India in combatting COVID-19.
Image--April 25, 2021 WH statement India ( https://twitter.com/ASlavitt/status/1386370305623568387/photo/1 )

Wow, many thanks @ASlavitt for US Govt support to @biological_e (India) to scale up production of our recombinant protein COVID19 vaccine developed at our TexasChildrens Center for Vaccine Development @BCM_TropMed *
(Bio E is also working to scale up and produce the J&J vaccine)
- Prof Peter Hotez MD PhD (Baylor U) @PeterHotez3:49 PM · Apr 25, 2021

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* Meet the Texas Doctor Developing a “People’s Vaccine” to Help Inoculate Billions Around the World
Democracy Now | April 22, 2021

...Dr. Peter Hotez, co-director of the Center for Vaccine Development at Texas Children’s Hospital and dean of the National School of Tropical Medicine at Baylor College of Medicine...is part of a team at Baylor University that is working with a private Indian company to develop a low-cost COVID-19 vaccine. The task of developing a simple vaccine is “daunting,” Dr. Hotez says. “We’re talking about 5 billion doses of vaccine. And the question is: Where do you get 5 billion doses of vaccine?” he says. “We’re trying to come through with something that uses the same old-school technology as the recombinant hepatitis B vaccine that’s been around for four decades.”...

DR. PETER HOTEZ:...What we need is a simple, easy-to-use, low-cost, some people call it people’s vaccine for the world, because the task is daunting. We have 1.1 billion people in sub-Saharan Africa, roughly 650 million people in Latin America, at least, you know, close to half a billion or more in low-income areas of Asia. So, you multiply that times two, we’re talking about 5 billion doses of vaccine. And the question is: Where do you get 5 billion doses of vaccine? You know, the mRNA technology is extremely exciting, but it’s new. And whether or not you could ever scale it to that in time for this pandemic is really questionable. So, what else can we come up with?

There’s the adenovirus-vectored vaccines from AstraZeneca and J&J. There’s going to be some issues around vaccine acceptance. Hopefully, that will resolve. But in the meantime, we’re trying to come through with something that uses the same old-school technology as the recombinant hepatitis B vaccine that’s been around for four decades. It’s a microbial fermentation-expressed recombinant protein in yeast, and it looks really good. It’s in Phase — finishing now Phase 2 clinical trials in India, and great protection in nonhuman primates. And now working with Biological E., one of the big private companies, like Serum Institute of India, and they’re based in Hyderabad, they’re now scaling it up to a billion doses. And that’s really exciting. And hopefully it could be released for emergency use authorization by the summer in India.

But then, what about the rest of the world? Biological E. is committed to, I think, providing about 70% of its vaccines to the COVAX sharing facility. But could we get another group to come along and help us with another 4 billion doses? And it would be great if the U.S. government could have a role in that and help reassert some leadership in global health.

NERMEEN SHAIKH: Dr. Hotez, the Biological E. vaccine is reportedly going to cost only $1.50 per dose. Could you talk about why it is — some people have raised the question of why it is that a more accessible, cheaper vaccine, that could easily be transported and stored — why such a vaccine was not invested in earlier, not developed earlier, and whether that could have happened with investment from rich countries.

DR. PETER HOTEZ: Yeah, no, it’s an important — you ask probably the most important question. And we asked it ourselves, because we had been developing coronavirus vaccines for the last 10 years. We work on vaccines for diseases of the poor, that — vaccines that no one else will make. We have a vaccine for schistosomiasis in clinical trials, that’s a huge problem in Africa, for Chagas disease in Latin America. And we adopted a coronavirus vaccine program 10 years ago, because at that time nobody cared about coronavirus vaccines. It was also orphaned. And we figured out how to deliver the spike protein as a low-cost recombinant protein vaccine.

And when we got the COVID-19 sequence in January, our team, which is just co-headed by myself and Maria Elena Bottazzi — we’ve worked together for 20 years — we turned that around really quickly. And then we couldn’t raise money for it, because everybody was so focused on innovation. It was all about innovation, and they wanted mRNA and adenovirus-vectored vaccines. And I said, “That’s great, but what if you can’t scale it, or what if there’s a safety signal? Don’t you want a simple, low-cost vaccine as a backup?” And we just couldn’t get anybody to move. So I wound up raising money privately from philanthropies here in Texas, like the Kleberg Foundation and Tito’s Vodka, of all places, and the JPB Foundation. They came through. I raised about $4 or $5 million. And then we were able to make that — scale up that vaccine and transfer it to Biological E. I often think, though, if I hadn’t had to spend the first few months of the pandemic going out trying to raise money, we could have maybe had something ready to go right now.

So, you know, I think — I can’t complain about the vaccines that we do have. I myself have gotten the Pfizer-BioNTech vaccine, and I’m very grateful for it. But there wasn’t enough attention paid to an unfussy, simple, durable, easy-breezy vaccine for resource-poor countries, which is what we’ve been doing. And hopefully, now we can move this along pretty quickly. Now CEPI, the Coalition for Epidemic Preparedness Innovations, is really helping Biological E. They’re helping support the manufacture, and I’m really grateful for that. And so we’re trying to move as quickly as we can right now...

https://www.democracynow.org/2021/4/22/covid_19_vaccine_global_rollout

Sounds like CDC will come out with something like this today.
Trust they are keeping transmissibility of new variants in mind!

Do We Still Need to Keep Wearing Masks Outdoors?
Tara Parker-Pope | April 22, 2021

Science shows that the risk of viral transmission outside is very low. The “two-out-of-three rule” can help you decide whether to mask up.

...(Linsey Marr, a professor of civil and environmental engineering at Virginia Tech and one of the world’s leading experts on viral transmission) uses a simple two-out-of-three rule for deciding when to wear a mask in public spaces or when she doesn’t know everyone’s vaccination status. In these situations, she makes sure she’s meeting two out of three conditions: outdoors, distanced and masked. “If you’re outdoors, you either need to be distanced or masked,” she said. “If you’re not outdoors, you need to be distanced and masked. This is how I’ve been living for the past year. It all comes down to my two-out-of-three rule.”

Use the 2-out-of-3 Rule
To lower risk for Covid-19, make sure your activity meets two out of the following three conditions:
outdoors, distanced and masked.
Outdoors + Distanced = No Mask Needed
Outdoors + No Distance = Mask Needed
Not Outdoors + Distanced = Mask Needed
NYT diagram ( https://twitter.com/EricTopol/status/1386670770680520706/photo/1 )

When masks are needed outdoors
If you stop to have an extended conversation with someone who isn’t vaccinated, masks are recommended. Even outdoors, your risk of breathing someone else’s air increases the longer and closer you stand to them. One of the few documented cases of outdoor transmission happened in China early in the pandemic, when a 27-year-old man stopped to chat outside with a friend who had just returned from Wuhan, where the virus originated. Seven days later, he had his first symptoms of Covid-19.

How one restaurant’s experiment may help diners breathe safely
Chris Mooney, Aaron Steckelberg and Jake Crump
April 14, 2021

A restaurant in California’s Big Sur tries a comprehensive approach to clean its air...The Big Sur restaurant now featured some new pandemic touches:
18 tabletop mini-purifiers,
10 precisely distributed HEPA air purifiers,
an upgraded heating and air conditioning system, and
four sensors measuring the air quality in real time...

https://www.washingtonpost.com/health/interactive/2021/indoor-air-quality-safety...

Vaccine hesitancy: the ten worst states...

Eric Topol @EricTopol
The 10 outlier states with 2 things in common.
They're all red and vulnerable.
And that makes the country vulnerable for future outbreaks
https://wsj.com/articles/amid-expanded-covid-19-vaccine-eligibility-signs-emerge... by @randyyeipWSJ @joshulick @linds_huth

Image-bar graph 10 states with high vaccine hesitancy ( https://twitter.com/EricTopol/status/1386677717723009030/photo/1 )

>104 margd: I can tell you anecdotally that 8% seems low here on this side of Michigan. Just got my second shot a few days ago, and the difference between second shot day and first shot day was utterly bonkers. Presumably a lot of people scheduled shot 2 at other days or times, and presumably some of them may have gotten J&J the first time, but my overall sense from eyeballing the operation (particularly the observation stage) was that the throughput was roughly 50% that of 14 days earlier at roughly the same time of day.

This clinic (at DeVos Place convention center) was supposed to be one of the larger operations in the country, and while shot one took over 2 hours, this time I was in and out in 45 minutes, including 15 minutes' observation and 10 minutes walking inside the building. A pleasant surprise, but with the lingering worry: where the hell did everybody else go?

>110 davidgn: Uh oh... Ours were at an urgent care associated with our MD so appts and no waiting. They are not getting expected numbers at Ford Field though where oldest son went for first dose. Second is May 1 so I must ask him if any difference from first day.

>110 davidgn: If a lot of those in line 2 weeks ago were there for their second shot then the smaller line the last time could be natural and not mean that a lot of people were skipping their second shot.

>112 jjwilson61: Good thinking. Crowd skewed pretty young, and there's a good chance many of them wouldn't have been eligible for a second shot at the time, but still, that probably does explain a large chunk of the discrepancy. A lot of vaccination capacity now going unused, though, in any case.

Florian Krammer @florian_krammer
According to this preprint, B.1.617* is causing a 2-fold drop in neutralization of convalescent sera and sera from Covaxin** vaccinated individuals. While this needs further confirmation, it is a good initial sign.
https://biorxiv.org/content/10.1101/2021.04.23.441101v1.full.pdf
4:44 AM · Apr 27, 2021

* Lineage B.1.617, also known as VUI (Variant Under Investigation)-21APR-01, is one of the known variants of SARS-CoV-2, the virus that causes COVID-19. It was first identified in India on 5 October 2020 and is a "double mutation" variant. "Double mutation" refers to B.1.617's mutations in the SARS-CoV-2 spike protein's coding sequence at E484Q and L452R. (Wikipedia)

** BBV152 (also known as Covaxin) is an inactivated virus-based COVID-19 vaccine being developed by Bharat Biotech in collaboration with the Indian Council of Medical Research Clinical research Phase I and II trials. (Wikipedia)

*** Pragya D. Yadav et al. 2021. Neutralization of variant under investigation B.1.617 with sera of BBV152 vaccinees. BioRxiv (April 23, 2021) 11p https://doi.org/10.1101/2021.04.23.441101 https://www.biorxiv.org/content/10.1101/2021.04.23.441101v1.full.pdf

Preprint. Not Reviewed.

Abstract
The drastic rise in the number of cases in Maharashtra, India has created a matter of concern for public health experts. Twelve isolates of VUI lineage B.1.617 were propagated in VeroCCL81 cells and characterized. Convalescent sera of the COVID-19 cases and recipients of BBV152 (Covaxin) were able to neutralize VUI B.1.617.

...So far 21 countries have detected the B.1.617 variant, most of which have been reported from India...

Quebec schools without air purifiers have 3 to 4 times more COVID-19 cases, says dad running citizen count
Selena Ross | April 23, 2021. Updated Saturday, April 24, 2021

MONTREAL -- It's been about four months since Montreal schoolchildren began, unintentionally, to take part in what may end up being a huge naturally occurring science experiment: how well air purifiers work.

Since January, most English public schools in the Montreal area have had air purifiers, air exchangers or some other form of extra air-quality device if they don't have built-in mechanical ventilation.

French public schools in the same types of buildings have not had air purifiers.

The provincial government continues to say that air purifiers aren't necessary or proven to work, but the citizen paying the closest attention to the numbers says that based on his data so far, it seems they do.

"I can measure that," Olivier Drouin, who runs the website Covid Ecoles Quebec, told CJAD radio on Friday.

"I can measure that with not just two or three sample data... with 1,000 schools, and with 60 schools plus that have air purifiers," he said.

More specifically, he's found that the schools without air purifying devices have more than three times as many COVID-19 cases as the others, he said...

https://montreal.ctvnews.ca/quebec-schools-without-air-purifiers-have-3-to-4-tim...

Vaccinated Americans don’t need masks outdoors in small groups, when dining outside, or biking and running, the C.D.C. says.
Roni Caryn Rabin and Emily Anthes | April 27, 2021
https://www.nytimes.com/2021/04/27/health/cdc-new-mask-guidance.html
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Choosing Safer Activities
Updated Apr. 27, 2021
https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/participate-in-activ...

US to share AstraZeneca shots with world after safety check
ZEKE MILLER | 4/26/2021

...About 10 million doses of AstraZeneca vaccine have been produced but have yet to pass review by the FDA to “meet its expectations for product quality,” Zients said, noting the U.S. regulator is recognized as the “gold standard” for safety around the world. That process could be completed in the next several weeks. About 50 million more doses are in various stages of production and could be available to ship in May and June pending FDA sign-off.

The U.S. has yet to finalize where the AstraZeneca doses will go, Zients said. Neighbors Mexico and Canada have asked the Biden administration to share more doses, while dozens of other countries are looking to access supplies of the vaccine.

...The AstraZeneca doses will be donated by the U.S. government, which has contracted with the company for a total of 300 million doses — though the company has faced production issues

In part because the AstraZeneca vaccine is not expected to play a significant factor in the U.S. virus response, the White House was also moving to share raw materials for the production of the AstraZeneca vaccine with India, which has emerged as a global hotspot for the virus, by diverting some of its orders to the vaccine manufacturer Serum Institute of India.

(White House COVID-19 coordinator Jeff Zients) told the AP that the Biden administration was working to satisfy other “key requests” from the Indian government, namely for personal protective equipment, tests, therapeutics and supplies of oxygen and respiratory assistance devices.

...Epidemiologists from the Centers for Disease Control and Prevention were also expected to soon travel to India to assist the country with its virus response.

The additional quality review before the U.S. shares the AstraZeneca doses were in order because of issues at the facility that produced them (margd: the facility mixed up Astrazeneca and J&J ingredients--US subsequently asked J&J to take over the plant)

...AstraZeneca is still looking to identify a new U.S. production facility for its future doses.

The U.S. government ordered enough (AstraZeneca) for 150 million Americans before issues with the vaccine’s clinical trial held up clearance. The company’s 30,000-person U.S. trial didn’t complete enrollment until January, and it still has not filed for an emergency-use authorization with the FDA...

https://apnews.com/article/politics-health-business-government-and-politics-coro...

The most promising coronavirus vaccine you’ve never heard of
Novavax’s rise comes as pressure to increase the supply of Covid-19 vaccines is growing amid concerns that unequal access globally will extend the pandemic.
SARAH OWERMOHLE and CARMEN PAUN | 04/27/2021

...the Novavax vaccine proved just as potent as those mRNA shots in a U.K. trial, and the company is now preparing to file for U.S. authorization in a matter of weeks — potentially leapfrogging AstraZeneca, a former frontrunner.

...The company has pledged to provide 100 million doses of its shot to the U.S. later this year, after receiving $1.6 billion for development and manufacturing. It’s also one of a handful of manufacturers to promise significant deliveries worldwide, including 1.1 billion doses for low- and middle-income countries like India, where cases are skyrocketing.

The next few months will determine whether Novavax can overcome its bumpy start and deliver on those increasingly high expectations. The company has enlisted production partners worldwide after struggling to scrape together the tens of thousands of doses needed for its clinical trials. Those hired factories are still getting up to speed with Novavax’s vaccine technology, which uses moth cells to brew batches of the coronavirus spike protein. In non-pandemic times, such retrofitting can take years. The company is aiming to pump out 150 million doses a month by the second half of the year...

... COVAX, the global vaccine equity effort that aims to supply the world’s poorest countries...ha(s) deals for about 1.1 billion doses of the Novavax shot, nearly on par with their orders of the AstraZeneca vaccine...counting on the Novavax shot to meet its target of providing vaccines for at least a fifth of participating countries’ populations by the end of the year...

...manufacturing problems...temporary U.S. restriction on raw materials such as bags and filters...White House said on Sunday that it has found some sources of raw materials that will be made available to India

...a shortage of 2,000-litre bags in which the vaccine cells were grown was a significant hurdle for global supply

...The Novavax shot was just 55.4 percent effective against the B.1.351 variant, first found in South Africa, during a mid-stage trial in that country. More data on the vaccine’s performance against different variants could be released when Novavax files for use in the U.S. or Europe...

https://www.politico.com/news/2021/04/27/novavax-coronavirus-vaccine-484731

Fingers crossed that Pfizer's protease inhibitor PF-07321332, which could be made available to the public by the end of this year, is effective, safe, and cheap...

Pfizer CEO says a pill you can take at home to treat COVID could be ready by end of 2021
Cheryl Teh | 4/27/2021

Pfizer CEO Albert Bourla...said he expected this experimental oral drug would be effective against multiple variants of the virus and be used to treat COVID patients at the onset of the illness, way before they require critical care. He also added that one of the drug's major benefits was saving people trips to the hospital to get treatment for COVID.

...protease inhibitors...binds to viral enzymes, stopping the virus from replicating in human cells. These inhibitors attack the "spine" of the COVID virus and prevent it from further multiplying in our respiratory system.

...early-stage clinical trials for the drug, currently known as "PF-07321332," have been underway since March.

...the pharmaceutical company intends to have PF-07321332 be administered to patients in combination with small doses of Ritonavir, an antiviral that is currently being used to treat HIV. Ritonavir will act as a "booster" to increase the amount of PF-07321332 in a patient's bloodstream and make the dose more effective.

...human trials...are kicking off...a 145-day long trial period, with 28 additional days for "screening and dosing."

...In...animal studies, no significant risks or safety events of concern were identified, and the study drug did not cause side-effects at any of the dose levels that will be used in clinical studies...

https://www.insider.com/pfizer-ceo-pill-to-treat-covid-ready-by-end-2021-2021-4

Apparently, the US and Brazil are not the only countries to have suffered incompetent leadership... :(

COVID: India to allow Amarnath pilgrimage despite surge in cases
Samaan Lateef (Srinagar) | 26.04.2021
Critics have said the annual Amarnath pilgrimage could lead to a devastating wave of the coronavirus in India-administered Kashmir, which has underequipped health care facilities.

The local government in India-administered Kashmir is contemplating setting up makeshift shelters and facilities for 600,000 Hindu pilgrims for the annual Amarnath pilgrimage, which it intends to host this summer despite the ongoing coronavirus pandemic.

The pilgrims will visit the Amarnath cave shrine, perched 3,880-meters (12,730 feet) above sea level in the Himalayas...

Recently, hundreds of devotees, including nine top saints, tested positive for COVID-19 in the northern city of Haridwar, where hundreds of thousands of devotees gathered to participate in the Kumbh Mela festival.

Television images of a crowd of devotees taking a ritual bath together in the Ganges River in blatant violation of social distancing rules triggered calls for authorities to call off the event. However, the suggestions were scorned by the local government, which gave preference to the festival, ignoring the reality that the virus was spreading faster...

Even after the Kumbh Mela proved to be a superspreader event, resulting in a major surge in new infections and deaths in India, authorities have yet to heed the lessons from the virus.

This year, the ruling Bharatiya Janata Party (BJP) lost one of its senior leaders — Jammu and Kashmir former minister Thakur Puran Singh — to COVID-19. Singh had gone to participate in Kumbh Mela, and showed signs of infection upon his return.

...Since August 2019, officials have been pushing to exhibit a sense of normality in Kashmir by inviting film actors, conducting fashion shows and opening tourist spots.

Kashmir has meager health care facilities, with just 2,599 COVID beds, including 324 intensive care unit beds, for a population of 13 million. At least 1,220 of those beds are already occupied.

...oxygen levels are low at high altitudes...

https://www.dw.com/en/covid-india-to-allow-amarnath-pilgrimage-despite-surge-in-...

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Covid: Yogi orders crack down on hospitals flagging oxygen shortage
Many hospitals in Lucknow and other parts of the state had put up notices declaring an oxygen shortage and advising families to shift patients elsewhere
Piyush Srivastava | 27.04.21

Chief minister Yogi Adityanath has sent out a clear message to the state’s hospitals: keep your mouth shut about any oxygen crisis or face action.

At an online meeting on Sunday evening, Adityanath asked senior administrative and police officers, including divisional commissioners and inspectors-general, to crack down on hospitals that discharge patients citing an oxygen shortage or complain to the media about the crisis, a senior health department official said...

https://www.telegraphindia.com/india/coronavirus-outbreak-yogi-orders-crack-down...

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Florian Krammer @florian_krammer | 4:48 AM · Apr 28, 2021:
I really hope that India's wave has hit its highest point.
But I am worried that the slowing we have seen in the last few days is just because they are maxing out on testing capacity.
Image ( https://twitter.com/florian_krammer/status/1387327930435620865/photo/1 )

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Eric Feigl-Ding @DrEricDing | 6:58 PM · Apr 27, 2021:
Heart-wrenching—A mother in her 50s dies of #COVID19 after she had low oxygen.
But there’s no ambulance, so her dead body is carried by motorbike—by her son & son-in-law,
her corpse wedged in-between her sons, ferrying her home. Heart-breaking for India.

0:43 ( https://twitter.com/DrEricDing/status/1387179479102107651 )
From TeluguBulletin.com
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Ankur Bhardwaj @Bhayankur | 10:18 PM · Apr 27, 2021:
India’s Corona crisis in one picture: Dead bodies in a queue at a cremation ground, waiting to make the final journey in Delhi.
Photo in Bhaskar today.
Image ( https://twitter.com/Bhayankur/status/1387229798989111299/photo/1 )

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There be thieves, apparently... :(

Eric Feigl-Ding @DrEricDing | 9:06 PM · Apr 27, 2021:
HEAVY ESCORT... for some head of state VIP? No. Oxygen tanker truck in India destined for a hospital.
2021 is so surreal.
0:13 ( https://twitter.com/DrEricDing/status/1387211636835065858 )
From Yogita Limaye

ETA: 0:08 ABC cylinders of O2, $80 before pandemic, now going for $1000+ ( https://twitter.com/DrEricDing/status/1387077480255795205 )

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There be saints, also...
An 85 year old man gave up his hospital bed to a 42YO father. The 85YO died three days later.
(I'll post report if/when I re-find it. )
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India Blames a Virus Variant as Its Covid-19 Crisis Deepens
Jeffrey Gettleman, Shalini Venugopal and Apoorva Mandavilli
Photographs by Atul Loke
April 28, 2021

...Beyond the variants, scientists believe there are other, possibly more obvious factors that could be powering India’s deadly second wave.

India has just scraped the surface in terms of vaccinating its population, with less than 2 percent fully vaccinated. Experts also blame lax public behavior after last year’s first wave and missteps by Prime Minister Narendra Modi, such as recently holding large political rallies that may have spread the disease and sent a message to the people that the worst was over.

...Preliminary evidence suggests that the variant is still responsive to vaccines, although slightly less so. India relies heavily on the Oxford-AstraZeneca vaccine, which clinical trials show is less powerful than the vaccines made by Pfizer-BioNTech and Moderna and could perhaps be more easily thwarted by mutations.

...In India, a number of doctors point to anecdotal evidence that people who have been fully vaccinated are getting sick. Those doctors also say they are seeing children with serious symptoms, such as severe diarrhea, acidosis and falling blood pressure, even among otherwise healthy patients...

https://www.nytimes.com/2021/04/28/world/asia/india-covid19-variant.html

Eric Topol @EricTopol | 9:18 AM · Apr 28, 2021:
The most impressive US accomplishment of the 1st 100 @POTUS days is having built a wall to fend off a major B.1.1.7 strain surge. Vaccine immunity in more than 140 million people provided the requisite defense against this more formidable version of the virus.
Image-graph of confirmed cases in US ( https://twitter.com/EricTopol/status/1387395872103694344/photo/1 )
Image-bar graph of US variants, 1/30-4/16/2021 ( https://twitter.com/EricTopol/status/1387395872103694344/photo/2 )

It will be remembered as an extraordinary time when Americans came together to vaccinate up to 4.6 million people in a day, with tens of thousands of volunteers helping to get one another protected

Now for the 1st time the goal of containment is in sight, which will be harder, getting tens of million more vaccinated with incentives, education & taking on the aggressive anti-vaxx movement

And the vital need to turn outward, to help the rest of the world build a similar wall
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ETA
Josh Peek @jegpeek | 2:23 PM · Apr 28, 2021:
Replying to @EricTopol
it's being driven by highly vaccinated counties
Image ( https://twitter.com/jegpeek/status/1387472482899218434 )

Video: Gaza hospitals short of oxygen for COVID-19 patients
The Electronic Intifada | 23 April 2021

In March, active coronavirus cases in the Gaza Strip more than tripled.

During that month, Gaza’s health authorities confirmed the first cases of the more transmissible B117 variant first discovered in the UK, which has caused major surges in many countries.

UN monitoring group OCHA has noted a significant increase in patients being admitted to intensive care units and requiring ventilation in the occupied West Bank and Gaza in recent weeks.

Gaza’s health sector has been devastated over the course of the Israeli blockade, assisted by Egypt, that is now entering its 14th year, and successive Israeli military assaults.

Human rights groups have warned that the pandemic would stretch Gaza’s medical system beyond capacity.

...Health authorities in the Gaza Strip have reported a shortage in oxygen supplies for COVID-19 patients, especially during surges of cases.

...While certain hospitals have small oxygen production plants, they do not have the capacity to produce the oxygen supplies that coronavirus patients need when cases are high.

“There’s a deficit of about 50 to 60 percent for oxygen-generating plants,” Khalid Abu Jayyab, head of maintenance at the same hospital, told The Electronic Intifada during a coronavirus surge earlier this year...“We are suffering a severe shortage during the pandemic...The Israeli occupation and siege bears full responsibility.”...

https://electronicintifada.net/content/video-gaza-hospitals-short-oxygen-covid-1...

>122 margd: The Israeli occupation and siege bears full responsibility.

This bears repeating. While the Israeli authorities boast proudly of rapidly vaccinating a large percentage of their population and really slowing the spread of COVID, they continue to impose punitive restrictions on the Palestinians which prevent them from protecting themselves against COVID. They have failed to understand that no single nation can defeat COVID. As long as it is spreading in Palestine or India or wherever, we are all at risk.

The evidence for benefit was already overwhelming and it just keeps getting better
https://cdc.gov/mmwr/volumes/70/wr/mm7018e1.htm?s_cid=mm7018e1_w *
Image ( https://twitter.com/EricTopol/status/1387451485651234821/photo/1 )
-Eric Topol @EricTopol | 12:59 PM · Apr 28, 2021

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* Tenforde MW, Olson SM, Self WH, et al. 2021. Effectiveness of Pfizer-BioNTech and Moderna Vaccines Against COVID-19 Among Hospitalized Adults Aged ≥65 Years — United States, January–March 2021. MMWR Morb Mortal Wkly Rep. ePub: 28 April 2021. DOI: http://dx.doi.org/10.15585/mmwr.mm7018e1

Summary
What is already known about this topic?
Clinical trials suggest high efficacy for COVID-19 vaccines, but evaluation of vaccine effectiveness against severe outcomes in real-world settings and in populations at high risk, including older adults, is needed.

What is added by this report?
In a multistate network of U.S. hospitals during January–March 2021, receipt of Pfizer-BioNTech or Moderna COVID-19 vaccines was 94% effective against COVID-19 hospitalization among fully vaccinated adults and 64% effective among partially vaccinated adults aged ≥65 years.

What are the implications for public health practice?
SARS-CoV-2 vaccines significantly reduce the risk for COVID-19–associated hospitalization in older adults and, in turn, might lead to commensurate reductions in post-COVID conditions and deaths.

I had 24h of fatigue and aches after one Pfizer shot, while DH suffered nothing more than sore arm. As blood donors three weeks after second dose, both of us tested "reactive" in red Cross antibody test.

You Don’t Have to Suffer to Benefit From Covid Vaccination — But Some Prefer It
Arthur Allen | April 28, 2021

...To be sure, there is some evidence of stronger immune response in younger people — and in those who get sick when vaccinated. A small study at the University of Pennsylvania showed that people who reported systemic side effects such as fever, chills and headache may have had somewhat higher levels of antibodies. The large trial for Pfizer’s vaccine showed the same trend in younger patients.

But that doesn’t mean people who don’t react to the vaccine severely are less protected, said Dr. Joanna Schaenman, an expert on infectious diseases and the immunology of aging at the David Geffen School of Medicine at UCLA. While the symptoms of illness are undoubtedly part of the immune response, the immune response that counts is protection, she said. “That is preserved across age groups and likely to be independent of whether you had local or systemic side effects or not.”

The immune system responses that produce post-vaccination symptoms are thought to be triggered by proteins called toll-like receptors, which reside on certain immune cells. These receptors are less functional in older people, who are also likely to have chronic, low-grade activation of their immune systems that paradoxically mutes the more rapid response to a vaccine.

But other parts of their immune systems are responding more gradually to the vaccine by creating the specific types of cells needed to protect against the coronavirus. These are the so-called memory B cells, which make antibodies to attack the virus, and “killer T cells” that track and destroy virus-infected cells.

Many other vaccines, including those that prevent hepatitis B and bacterial pneumonia, are highly effective while having relatively mild side effect profiles, Schaenman noted.

Whether you have a strong reaction to the vaccine “is an interesting but, in a sense, not vital question,” said Dr. William Schaffner, a professor of infectious disease at Vanderbilt University Medical Center. The bottom line, he said: “Don’t worry about it.”...

https://khn.org/news/article/covid-vaccination-side-effects-suffering-effectiven...

Good news re Moderna cold chain requirements--if approved by FDA. Also, 2021 production target increased from 700 to 800 million.

Moderna Covid vaccine can remain stable at refrigerated temperatures for 3 months, company says
Newswire | April 29, 2021

Moderna’s Covid-19 vaccine can remain stable at temperatures found in refrigerators for 3 months, the company said Thursday,* citing new data.

The mRNA vaccine is currently approved to be stored in the refrigerator between 36 and 46 degrees Fahrenheit for up to 30 days and up to seven months in the freezer at minus 4 Fahrenheit, according to the company.

...If authorized by the Food and Drug Administration, the new storage temperature could “facilitate easier distribution to doctor’s offices and other smaller settings,” the company wrote in a press release.

It also said it is working on new formulations of its vaccine that could extend the shots refrigerated shelf life even further.

Moderna’s Covid vaccine is one of three authorized for use in the U.S. The vaccine from Pfizer and BioNTech may be stored at refrigerated temps for up to five days, according to the Centers for Disease Control and Prevention. Johnson & Johnson’s vaccine can be stored in a regular refrigerator for up to three months.

To public officials, the authorization of J&J’s shot was a blessing since it could be used in hard-to-reach places that may not have reliable refrigeration, such as tribal lands, poorer neighborhoods as well as rural and border communities. In addition to refrigeration requirements, it requires just one dose.

The update from Moderna comes weeks after the FDA announced that it gave the company clearance to speed up output of its Covid vaccine by letting it fill a single vial with up to 15 doses. It was previously permitted for 10 doses, enough to inoculate five people since the vaccine requires two shots given a month apart...it is increasing its minimum Covid vaccine production target for 2021 to 800 million doses, up from 700 million.

https://newswirenews.com/moderna-covid-vaccine-can-remain-stable-at-refrigerated...
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* https://investors.modernatx.com/news-releases/news-release-details/moderna-annou...

New Blood Tests Should Show How Long A COVID-19 Vaccine Will Protect You
Joe Palca | April 28, 2021
Heard on All Things Considered

Transcript
...what if new vaccines are needed to deal with dangerous variants of the coronavirus? ...researchers are trying to come up with tests that can be performed using a blood sample that will determine not only whether a vaccine will work but also for how long.

One approach for determining these so-called correlates of protection is underway at the University of Oxford. Researchers there are deliberately exposing volunteers to the coronavirus. The volunteers are all healthy young adults who have previously gotten sick with COVID-19.

...What the Oxford researchers want to learn is what level of antibodies is enough to provide protection against future infection.

...Knowing that cutoff level, also called the cutoff titer, should be particularly useful for figuring out how long the protection afforded by a vaccine will last. If, for example, you have antibody titers above that threshold 18 months after being vaccinated, then you can expect the vaccine will still be working.

...the antibody cutoff becomes what's called a correlate of protection, that is the levels of antibodies in the blood that will indicate whether a new vaccine would protect someone without having to test it in tens of thousands of volunteers.

...another effort to get at the antibody levels needed to achieve protection. Researchers are comparing antibody levels in (1,600) people who received the Moderna vaccine but still got COVID-19 with levels in people who received the vaccine but didn't get sick.

...The results will show whether there is a specific antibody level that will let you say with confidence a new vaccine will work without testing it in tens of thousands of people...

https://www.npr.org/sections/health-shots/2021/04/28/991651498/new-blood-tests-s...

>87 margd: contd. Vaccinating pregnant women

Uh oh, this is second time CDC Director got ahead of her skis? ( https://www.thedailybeast.com/cdc-director-dr-rochelle-walensky-says-unclear-whe... )

CDC now says it does NOT yet recommend pregnant women get COVID-19 vaccines despite its director said the agency endorses the shots for expectant mothers
Natalie Rahhal | 27 April 2021

'CDC recommends that pregnant people receive the COVID-19 vaccine,' director Dr Rochelle Walensky said in a Friday White House press briefing

The CDC's online guidance has not been updated to reflect this recommendation

In a statement shared with CBS News, the agency walked back her statement

It said it still advises that pregnant women should be given the option to get the shot, but doesn't have enough evidence to recommend it

CDC gathered data on 35,000 pregnant women who had Moderna's or Pfizer's shots

Rates of miscarriage, stillbirth, complications, birth defects and premature birth were all comparable between women who had the shots and those who had not

None of the women received a J&J vaccine, as the study concluded before it was approved. The shot is paused for investigations of blood clots in women

https://www.dailymail.co.uk/health/article-9518731/CDC-walks-directors-recommend...

See How the Vaccine Rollout Is Going in Your County and State
NYT | Updated April 28, 2021
https://www.nytimes.com/interactive/2020/us/covid-19-vaccine-doses.html

COVID seasonality;
"a country, which is located 1000 km closer to the equator, could expect 33% fewer cases per million inhabitants...According to our results, countries are expected to see a decline in new COVID-19 cases during summer and a resurgence during winter. However, our results do not imply that the disease will vanish during summer or will not affect countries close to the equator. Rather, the higher temperatures and more intense UV radiation in summer are likely to support public health measures to contain SARS-CoV-2."
(margd: early in pandemic, more "naive" potential hosts, so more disease in summer than what we may expect as we go along)

Simiao Chen et al. 2021. Climate and the spread of COVID-19. Scientific Reports volume 11, Article number: 9042 (27 April 2021) https://www.nature.com/articles/s41598-021-87692-z

Abstract
Visual inspection of world maps shows that coronavirus disease 2019 (COVID-19) is less prevalent in countries closer to the equator, where heat and humidity tend to be higher. Scientists disagree how to interpret this observation because the relationship between COVID-19 and climatic conditions may be confounded by many factors. We regress the logarithm of confirmed COVID-19 cases per million inhabitants in a country against the country’s distance from the equator, controlling for key confounding factors: air travel, vehicle concentration, urbanization, COVID-19 testing intensity, cell phone usage, income, old-age dependency ratio, and health expenditure. A one-degree increase in absolute latitude is associated with a 4.3% increase in cases per million inhabitants as of January 9, 2021... Our results imply that a country, which is located 1000 km closer to the equator, could expect 33% fewer cases per million inhabitants. Since the change in Earth’s angle towards the sun between equinox and solstice is about 23.5°, one could expect a difference in cases per million inhabitants of 64% between two hypothetical countries whose climates differ to a similar extent as two adjacent seasons. According to our results, countries are expected to see a decline in new COVID-19 cases during summer and a resurgence during winter. However, our results do not imply that the disease will vanish during summer or will not affect countries close to the equator. Rather, the higher temperatures and more intense UV radiation in summer are likely to support public health measures to contain SARS-CoV-2.

A broadly neutralizing RBD (receptor-binding domain) antibody, DH1047, which protects against SARS-CoV, bat pre-emergent CoVs, and SARS-CoV-2 B.1.351 challenge in mice is a rational target for pan Group 2B coronavirus vaccines.

David Martinez et al. 2021. A broadly neutralizing antibody protects against SARS-CoV, pre-emergent bat CoVs, and SARS-CoV-2 variants in mice. BioRxiv (April 28, 2021) doi: https://doi.org/10.1101/2021.04.27.441655 https://www.biorxiv.org/content/10.1101/2021.04.27.441655v1

This article is a preprint and has not been certified by peer review .

Abstract
SARS-CoV in 2003, SARS-CoV-2 in 2019, and SARS-CoV-2 variants of concern (VOC) can cause deadly infections, underlining the importance of developing broadly effective countermeasures against Group 2B Sarbecoviruses, which could be key in the rapid prevention and mitigation of future zoonotic events. Here, we demonstrate the neutralization of SARS-CoV, bat CoVs WIV-1 and RsSHC014, and SARS-CoV-2 variants D614G, B.1.1.7, B.1.429, B1.351 by a receptor-binding domain (RBD)-specific antibody DH1047. Prophylactic and therapeutic treatment with DH1047 demonstrated protection against SARS-CoV, WIV-1, RsSHC014, and SARS-CoV-2 B1.351 infection in mice. Binding and structural analysis showed high affinity binding of DH1047 to an epitope that is highly conserved among Sarbecoviruses. We conclude that DH1047 is a broadly neutralizing and protective antibody that can prevent infection and mitigate outbreaks caused by SARS-like strains and SARS-CoV-2 variants. Our results argue that the RBD conserved epitope bound by DH1047 is a rational target for pan Group 2B coronavirus vaccines.

Under Michigan Governor Whitmer’s re-opening plan, the state -- which currently sits at 35.9% vaccinations completed and 48.8% initiated--will re-open as follows:

When will Michigan ditch its mask mandate? Whitmer officially ties reopening measures to vaccination rates
Emily Lawler | April 29, 2021

● Two weeks after 55% of Michiganders (4,453,304 residents) over 16 get one dose, in-person work will be allowed in all business sectors.

● Two weeks after 60% of Michiganders (4,858,150 residents) over 16 get at least one dose, indoor capacity at sports stadiums will increase to 25%; indoor capacity at conference centers, banquet halls and funeral homes will increase to 25%; gym capacity will increase to 50%; and bars and restaurants will no longer be required to close early.

● Two weeks after 65% of Michiganders (5,262,996 residents) over 16 get at least one dose, all indoor capacity limits will be lifted, but social distancing between parties will be maintained. Limits on residential social gatherings will also be relaxed.

● Two weeks after 70% of Michiganders (5,667,842 residents) over 16 get at least one dose, the gathers and facemask order will be lifted and the Michigan Department of Health and Human Services “will no longer employ broad mitigation measures unless unanticipated circumstances arise, such as the spread of vaccine-resistant variants.”

However, case rates may also factor in regionally. In a press release, Whitmer’s office noted if the 7-day case rate average is above 250 per million in a Michigan Economic Recovery Committee region, MDHHS may delay implementation of the reopenings in that region.

https://www.mlive.com/coronavirus/2021/04/when-will-michigan-ditch-its-mask-mand...

>106 margd: contd.

FACT SHEET: Biden-Harris Administration Delivers Emergency COVID-19 Assistance for India
April 28, 2021 (update)

Immediate U.S. Emergency COVID-19 Assistance
Oxygen Support
Oxygen Concentrators
Oxygen Generation Units (PSA Systems)
Personal Protective Equipment
Vaccine-Manufacturing Supplies
Rapid Diagnostic Tests (RDTs)
Therapeutics
Public Health Assistance

U.S. Support for India from the Outset of the Pandemic

U.S.-India Health Partnership: Seven Decades Strong

https://www.whitehouse.gov/briefing-room/statements-releases/2021/04/28/fact-she...

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Secretary of Defense Lloyd J. Austin III @SecDef | 10:15 AM · Apr 29, 2021:
Right now, a @usairforce C-5M Super Galaxy and a C-17 Globemaster III are en route to India from @Travis60AMW.
They’re carrying oxygen cylinders/regulators, rapid diagnostic kits, N95 masks, and pulse oximeters.
Thanks to @USAID for the supplies & to all involved in the effort.
0:56 ( 10:15 AM · Apr 29, 2021 )

!!! Israel vaccinated their adults against #COVID19 and #SARSCoV2 infections in children under 16 years (who are not vaccinated) disappeared! Who else still believes that children are driving the infection? Schools now fully open in Israel @RanBalicer

Image-graph cases Israel by age group, Jan 16-April 17, 2021
( https://twitter.com/ShamezLadhani/status/1387685148368543744/photo/1 )
https://ourworldindata.org/vaccination-israel-impact

- Shamez Ladhani (epidemiologist)@ShamezLadhani4:28 AM · Apr 29, 2021

>134 margd: Related?

Justin Lessler et al. 2021. Household COVID-19 risk and in-person schooling. Science 29 Apr 2021:eabh2939 DOI: 10.1126/science.abh2939 https://science.sciencemag.org/content/early/2021/04/28/science.abh2939

Abstract
In-person schooling has proved contentious and difficult to study throughout the SARS-CoV-2 pandemic. Data from a massive online survey in the United States indicates an increased risk of COVID-19-related outcomes among respondents living with a child attending school in-person. School-based mitigation measures are associated with significant reductions in risk, particularly daily symptoms screens, teacher masking, and closure of extra-curricular activities. A positive association between in-person schooling and COVID-19 outcomes persists at low levels of mitigation, but when seven or more mitigation measures* are reported, a significant relationship is no longer observed. Among teachers, working outside the home was associated with an increase in COVID-19-related outcomes, but this association is similar to other occupations (e.g., healthcare, office work). While in-person schooling is associated with household COVID-19 risk, this risk can likely be controlled with properly implemented school-based mitigation measures.

*the most common mitigation measure reported was student mask mandates (88%, unweighted), followed by teacher mask mandates (80%), restricted entry (e.g., no parents or caregivers allowed into school) (66%) and extra space between desks (63%)

ETA: infection/illness v mitigations ( https://twitter.com/ScienceMagazine/status/1389467363498774528/photo/1 )

Mexico’s real COVID-19 death toll now stands at over 321,000
AP | March 28, 2021
MEXICO CITY (AP) — Mexico’s government acknowledged Saturday that the country’s true death toll from the coronavirus pandemic now stands above 321,000, almost 60% more than the official test-confirmed number of 201,429.

Mexico does little testing, and because hospitals were overwhelmed, many Mexicans died at home without getting a test. The only way to get a clear picture is to review “excess deaths” and review death certificates.

On Saturday, the government quietly published such a report, which found there were 294,287 deaths linked to COVID-19 from the start of the pandemic through Feb. 14. Since Feb. 15 there have been an additional 26,772 test-confirmed deaths.
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The higher toll would rival that of Brazil, which currently has the world’s second-highest number of deaths after the United States. But Mexico’s population of 126 million is far smaller than either of those countries...

https://apnews.com/article/coronavirus-pandemic-latin-america-mexico-c0577354d8b...

Pfizer begins export of U.S.-made COVID-19 vaccines (1:20)
Reuters•Apr 30, 2021

Pfizer begins exporting U.S.-made COVID-19 vaccine to Mexico

https://www.youtube.com/watch?v=mHwaWStUJ5I

________________________________________

ETA Also, to Canada: https://www.reuters.com/business/healthcare-pharmaceuticals/pfizer-export-us-mad...

Indian government should heed its scientists on COVID
Researchers have spoken out against policies that have exacerbated the country’s coronavirus crisis. Policymakers must listen.
TV Padma | 30 April 2021

https://www.nature.com/articles/d41586-021-01140-6

"After one dose (Pfizer), individuals with *prior infection* showed enhanced T cell immunity, antibody secreting memory B cell response to spike and neutralizing antibodies effective against B.1.1.7 and B.1.351."

Catherine J. Reynolds et al. 2021. Prior SARS-CoV-2 infection rescues B and T cell responses to variants after first vaccine dose. Science 30 Apr 2021:eabh1282 DOI: 10.1126/science.abh1282 https://science.sciencemag.org/content/early/2021/04/29/science.abh1282

Abstract

SARS-CoV-2 vaccine rollout has coincided with the spread of variants of concern. We investigated if single dose vaccination, with or without prior infection, confers cross protective immunity to variants. We analyzed T and B cell responses after first dose vaccination with the Pfizer/BioNTech mRNA vaccine BNT162b2 in healthcare workers (HCW) followed longitudinally, with or without prior Wuhan-Hu-1 SARS-CoV-2 infection. After one dose, individuals with prior infection showed enhanced T cell immunity, antibody secreting memory B cell response to spike and neutralizing antibodies effective against B.1.1.7 and B.1.351. By comparison, HCW receiving one vaccine dose without prior infection showed reduced immunity against variants. B.1.1.7 and B.1.351 spike mutations resulted in increased, abrogated or unchanged T cell responses depending on human leukocyte antigen (HLA) polymorphisms. Single dose vaccination with BNT162b2 in the context of prior infection with a heterologous variant substantially enhances neutralizing antibody responses against variants.

Indians looking into these:

MIT Emergency Ventilator
Updated 15 April 2020

...We are in process of continually testing and refining our prototypes to increase robustness. The basic concept consists of two arms that gently close in sync to compress the bag. This must be coupled with a closed loop control system. Major mechanical design requirements include:

Be nice to your bag and its hoses – Up to 7 day ✕ 24 hour ✕ 60 minute ✕ 30 bpm ✕ 2 stroke = 604,800 cycles will be needed for 7 day usage. Any design must secure the bag and gently grasp and squeeze it from both sides to reduce the risk of material fatigue. The grippers must be smooth and shaped to maximise air expelled without damaging the bag. The bag must be supported with flexibility to allow motion during operation.

Fail-Safe operation – If the machine fails, a clinician must be able to immediately shut down, open the device manually, remove the bag and convert to manual bagging.

Keep It Simple – Empower and support others to fabricate. We are focusing on the lowest specification system and open-souring our design information for adaptation to local supply chains.

Multiple drive motor and sensing possibilities! Enable multiple configurations to meet local supply chain capabilities.

The overall dimensions and operation are now set and any skilled mechanical designer will be able to execute this design and adjust it to suit locally available materials and fabrication technologies. We have ready access to waterjet and laser cutters and 80/20 components, however we are now focusing on designs that can be CNC milled, stamped, molded, welded and bolted as per your supply chain and capability.

Version 3.1 herein is our most recent prototype design. Older prototypes are available in Past Designs.

Version 3.1 – Testing / Pre-Production...

https://e-vent.mit.edu/mechanical/

Vitamin D deficiency in India
Dr. John Campbell • Apr 26, 2021
https://www.youtube.com/watch?v=1Q_mhJRFtxg
---------------------------------------------------

P Aparna et al. 2018. Vitamin D deficiency in India. J Family Med Prim Care. J Family Med Prim Care. 2018 Mar-Apr; 7(2): 324–330.
doi: 10.4103/jfmpc.jfmpc_78_18 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6060930/

Abstract
Vitamin D is a fat-soluble vitamin playing a vital role in human physiology. Vitamin D deficiency is prevalent worldwide. This deficiency has many consequences which are still being explored, apart from the well-known skeletal complications. With this review, we aim to summarize the existing literature on Vitamin D status in India and understand the enormity of the problem. The prevalence of Vitamin D deficiency ranged from 40% to 99%, with most of the studies reporting a prevalence of 80%–90%. It was prevalent in all the age groups and high-risk groups alike. With the consequences of Vitamin D deficiency, namely, autoimmune diseases, cardiovascular diseases, cancer, and tuberculosis being explored, we can imagine the burden it would cause in our country. We need to create awareness among the public and healthcare providers about the importance of Vitamin D and the consequences of deficiency. Our Indian diet generally fails to satisfy the daily requirement of Vitamin D for a normal adult. This stresses on the need for fortifying various food with Vitamin D, through the national programs. This silent epidemic should be addressed appropriately with concrete public health action.

New Zealand has pledged half a million doses of COVID-19 vaccines to Fiji.

#FBCNews #FijiNews #Fiji #COVID19Fiji #FJunited
-FBC News Fiji @FBC_News | 3:02 AM · May 1, 2021

Trevor Bedford (scientist Fred Hutchinson Cancer Research Center) @trvrbb | 10:51 AM · Apr 26, 2021:
https://twitter.com/trvrb/status/1386694440023068677

There are effectively two #COVID19 epidemics in the US at this moment; one largely resolving epidemic comprised of non-variant viruses and one growing epidemic of B.1.1.7. Together they have resulted in a near-plateau of cases throughout much of the spring. 1/10

If we look at virus frequencies in the US using data in @GISAID, we can see that the 7-day weighted frequency of B.1.1.7 has been growing consistently since January and is now over 50% in the US. 2/10
Image-graph #cases variants Jan 1-April 1
( https://twitter.com/trvrb/status/1386694443114196992/photo/1 )

This pattern is repeated across individual states. These six were chosen as states with plentiful genomic data and to provide geographic diversity. B.1.1.7 is dominating throughout the US, except for New York and surroundings where B.1.526 is co-circulating. 3/10
Image-graph #cases variants Jan 1-April 1, Ca, CO, FL, MI, NY Wa
( https://twitter.com/trvrb/status/1386694449594466306/photo/1 )

...

Covid-19 crisis: India urgently needs a nationwide shelter-at-home directive – but a humane one
Sunil Solomon, Lakshmi Ganapathi, Ramnath Subbaraman & Shruti Mehta | Apr 29, 2021

The most urgent reason for this recommendation is to stop further deterioration of India’s healthcare infrastructure.

...Shelter-at-home recommendations are strategies that help buy time by slowing down the surge of patients overwhelming the health system and by providing an opportunity to scale-up vaccination. They are not a permanent solution. The shelter-at-home recommendation could be lifted on a planned basis, relying on rigorous surveillance data and vaccination coverage. Such an intervention has the potential to save lives during the greatest public health crisis faced in modern India; but it must build in robust social protections for India’s most vulnerable for this cure not to be worse than the disease...

https://scroll.in/article/993572/covid-19-crisis-india-urgently-needs-a-nationwi...

NYT: global map, average daily cases per 100,000 in past week
https://twitter.com/EricTopol/status/1388874021693902849/photo/1

COVID-19 Is a Vascular Disease: Coronavirus’ Spike Protein Attacks Vascular System on a Cellular Level
Salk Institute | May 2, 2021

...In the new study,* the researchers created a “pseudovirus” that was surrounded by SARS-CoV-2 classic crown of spike proteins, but did not contain any actual virus. Exposure to this pseudovirus resulted in damage to the lungs and arteries of an animal model—proving that the spike protein alone was enough to cause disease. Tissue samples showed inflammation in endothelial cells lining the pulmonary artery walls.

The team then replicated this process in the lab, exposing healthy endothelial cells (which line arteries) to the spike protein. They showed that the spike protein damaged the cells by binding ACE2. This binding disrupted ACE2’s molecular signaling to mitochondria (organelles that generate energy for cells), causing the mitochondria to become damaged and fragmented.

Previous studies have shown a similar effect when cells were exposed to the SARS-CoV-2 virus, but this is the first study to show that the damage occurs when cells are exposed to the spike protein on its own.

...The researchers next hope to take a closer look at the mechanism by which the disrupted ACE2 protein damages mitochondria and causes them to change shape....

https://scitechdaily.com/covid-19-is-a-vascular-disease-coronavirus-spike-protei...

---------------------------------------------------------------

* Yuyang Lei et al. 2021. SARS-CoV-2 Spike Protein Impairs Endothelial Function via Downregulation of ACE 2. Circulation Research 31 March 2021;128:1323–1326 DOI: 10.1161/CIRCRESAHA.121.318902 https://www.ahajournals.org/doi/10.1161/CIRCRESAHA.121.318902

>146 margd: Not shocking, but if true, illuminating and pretty terrifying. The world was so lucky this virus wasn’t more lethal, with the multiplicity of mechanisms for damaging the body. I say lucky even as millions have died globally, but it’s dumb luck that this wasn’t 10% lethal like SARS, or ~33% lethal like MERS, ETC. We may not be so lucky next time.

>147 stellarexplorer: Yup. Hope when this is over, governments invest in anticipatory research, including vaccines!

#110-113 Oldest son had his second shot of Pfizer Saturday May 1 at Ford Field in Detroit, operated by (National Guard--Air Force medics?) His medic told him they were seeing 200-500 per day, when they anticipated 2,000-10,000, if I understood correctly. Apparently most, like my son, were from out-of-town. (By appointment, but sometimes walk-ins, if I recall correctly.)

Detroit mayor, formerly a hospital administrator, is looking for new strategies for getting Detroiters vaxxed:

New plan aims to bring mobile vaccine clinics to Detroit neighborhoods
Hank Winchester | April 22, 2021

...In Detroit, vaccination rates are at about 25%, about 10% less than Michigan’s vaccination rate.

...Walk-up vaccination sites in the city are nearly empty. Mayor Mike Duggan announced Thursday a plan that aims to vaccinate a lot more people.

The announcement was made at the Detroit Association of Black Organization’s COVID vaccination site at the Sheffield Center.

Sheffield Center had a long line of people ready to be vaccinated, so what worked there that isn’t working in other sites? Name recognition. The Rev. Horace Sheffield is a trusted name in the city.

Duggan said he plans to reach out to other high-profile leaders in Detroit and help them get people vaccinated. He also said they are considering mobile units that would bring the vaccine directly to neighborhoods, going door-to-door.

https://www.clickondetroit.com/consumer/help-me-hank/2021/04/22/new-plan-aims-to....

Previously infected vaccinees broadly neutralize SARS-CoV-2 variants of concern
Sally Robertson | May 2 2021

...while two doses of the Pfizer BioNTech BNT162b2 vaccine boosted anti-spike antibody titers ten-fold in ten previously infected individuals, these titers were not significantly higher than those elicited in twenty age- and sex-matched previously uninfected vaccinees.

However, in the previously infected individuals, vaccination generated significantly higher levels of neutralizing activity against every SARS-CoV-2 lineage tested than in the previously uninfected vaccinees. Neutralizing antibody titers were 3.5 times higher against the original lineage, 5.2 times higher against B.1.1.7, 6.5 times higher against B.1.351 and 4.3 times higher against P.1.

Importantly, there was no significant difference between the post-vaccination neutralizing antibody titers against the B.1.351 variant in previously infected individuals and those against the original viral strain in previously uninfected individuals.

The team says this finding suggests that first-generation COVID-19 vaccines could retain almost complete efficacy against even the most resistant VoCs when administered following natural infection.

...The researchers say the findings support a recent report that natural infection with B.1.351 induces a similar cross-reactive neutralizing antibody response against B.1.351, P.1, and the original SARS-CoV-2...

https://www.news-medical.net/news/20210502/Previously-infected-vaccinees-broadly...

------------------------------------------------------------------------

Hans C. Leier et al. 2021. Previously infected vaccinees broadly neutralize SARS-CoV-2 variants. MedRxiv (29 April 2021)
doi: https://doi.org/10.1101/2021.04.25.21256049 https://www.medrxiv.org/content/10.1101/2021.04.25.21256049v1

This article is a preprint and has not been certified by peer review

...Pre-vaccination sera from previously infected participants provided higher levels of neutralization against USA-WA1/2020 ...than against the three VOCs ..., consistent with previous reports of convalescent sera.... Similarly, post-vaccination sera from uninfected participants showed greater neutralization of USA-WA1/2020 than of the VOCs ... However, post-vaccination serum from previously infected individuals possessed significantly higher neutralizing activity against every SARS-CoV-2 lineage relative to post-vaccination serum from uninfected participants: neutralizing antibody titers increased by a factor of 3.5 against USA-WA1/2020... by a factor of 5.2 against B.1.1.7... ; by a factor of 6.5 against B.1.351 ...; and by a factor of 4.3 against P.1 ... Notably, there was no significant difference ... between the post-vaccination neutralizing antibody titers of previously infected participants against B.1.351... and those of uninfected participants against USA-WA1/2020 ..., suggesting that first-generation COVID-19 vaccines could retain near-complete efficacy against even the most resistant VOCs when administered following natural infection.

US to launch trade talks on COVID-19 vaccine distribution
DARLENE SUPERVILLE | May 2nd 2021

The U.S. top trade negotiator will begin talks with the World Trade Organization on ways to overcome intellectual property issues that are keeping critically needed COVID-19 vaccines from being more widely distributed worldwide

...U.S. Trade Representative Katherine Tai will be starting talks with the trade organization "on how we can get this vaccine more widely distributed, more widely licensed, more widely shared," said White House chief of staff Ron Klain.

...national security adviser Jake Sullivan...said the administration believes pharmaceutical companies "should be supplying at scale and at cost to the entire world so that there is no barrier to everyone getting vaccinated."...

https://abc3340.com/news/nation-world/us-to-launch-trade-talks-on-covid-19-vacci...