We have a way to respond and save lives: vaccinations, which prevent infection and have also shown they are effective in preventing transmission. There will be enough vaccines by summer to vaccinate every American, including children as young as 12. But summer is not here yet. And the recent spoilage of 15 million doses of Johnson & Johnson’s one-dose vaccine means we will need 30 million more doses of two-shot vaccines soon, to make up for the loss.
The supply we need is right in front of us. We need only to adopt the sensible, evidence-based policy used in the United Kingdom: Vaccinate as many people as possible with just one dose, by delaying the second dose of Pfizer and Moderna vaccines. Having adopted this strategy, the U.K. has vaccinated 46% of the population and effectively avoided a second surge of the highly contagious B.1.1.7 variant. This is the same strain that is spreading through Michigan, Minnesota and other surging states.
The United States does not have far to go. About 110 million Americans have received at least one shot. We need to vaccinate 40 million more people to reach the U.K. level. We are administering nearly 3 million doses a day. If we temporarily delay second doses and continue at that rate, we can get to the U.K. level in about two weeks. That is our best hope of quelling the fourth wave ignited by the B.1.1.7 variant. Because we did not start this strategy earlier, it is probably too late for Michigan, New York, New Jersey and the other Northeastern states. But it might be just in time for the South and California — the next places the more infectious strain will go if historical patterns repeat…
Some complain that postponing second doses is not “following the science.”..
Others worry that postponing second doses encourages the development of new variants…
Still others complain that postponing second doses will prompt hesitancy or confusion. (A)
“As Covid-19 cases spike and coronavirus variants continue to spread, the Biden administration is facing renewed calls to delay second vaccine doses and blanket more of the U.S. population with an initial shot.
Advocates of a strategy focused on first doses include Democratic and Republican senators, Trump administration surgeon general Jerome Adams, and at least four physicians or epidemiologists who advised President Biden on pandemic response issues prior to his inauguration, including the prominent surgeon and author Atul Gawande.
Despite the new advocacy, and its own warnings of “impending doom,” the Biden administration has given no indication it will budge. But the shift in opinion underscores the growing alarm at a possible fourth wave of U.S. Covid-19 cases — and frustration with the federal government’s lack of flexibility…
Gawande wrote this week that the Biden administration should delay second vaccine doses until 12 weeks following the first dose, as opposed to the current three- or four-week interval. Two other members, Emanuel and Michael Osterholm, have argued for delaying second doses since February. A fourth, Céline Gounder, recently announced she was reconsidering her stance after months of vocally opposing the strategy.
The latest push comes as U.S. case rates have begun to tick upward, and as some states, including Michigan, have begun to experience a surge in hospitalizations reminiscent of July 2020 and January 2021. The U.S. has reported roughly 60,000 new cases per day for the last week, far below the country’s January peak but similar to last summer’s surge.
The Biden administration has stayed the course despite new evidence suggesting that even a single dose of the vaccines manufactured by Moderna or the Pfizer-BioNTech partnership is highly effective at reducing Covid-19 infections. Risk of infection, according to a recent study, falls by 80% two weeks after an initial shot. The figure increases to 90% two weeks after a second dose.
A growing number of public health experts have used the new data to argue that the strategy is clear-cut. In the short term, they contend, giving twice as many people 80% protection against the virus would do dramatically more to stop the spread than giving the current number 90% protection…
Tony Fauci, the country’s chief infectious diseases researcher, has argued that there isn’t solid evidence to back a delayed-dose strategy. Even if an initial first dose gives good protection against Covid-19, he said at a recent White House briefing, it’s unclear how long that protection would last.
Beyond posing an unnecessary risk to individuals’ immunity, Fauci has also warned that pivoting midway through the vaccine rollout could send the message that there’s no need to return for a second shot, whether it’s three or 12 weeks after their first.
Fauci has also warned that delaying second doses could help foster the growth of “escape” variants, or strains of the SARS-CoV-2 virus that are more likely to evade existing vaccines’ protectiveness.
A paper published this week in Nature, however, argued the opposite: There is little evidence that so-called “dose-sparing” strategies help to select for escape variants. The math, its authors note, is simple.
“[If] individuals who receive half as much vaccine (one versus two doses, or half the quantity of antigen per dose) achieve more than half the protection from clinical infection of those given a full regimen, then spreading the vaccine among more individuals will produce greater reductions in the number of clinical infections,” they wrote.” (B)
“When you’re talking about doing something that may have real harm, you need empirical data to back that,” said Dr. Céline R. Gounder, an infectious-disease specialist at Bellevue Hospital Center and a member of Mr. Biden’s coronavirus advisory board. “I don’t think you can logic your way out of this.”…
Sarah E. Cobey, an epidemiologist and evolutionary biologist at the University of Chicago, said she thought that the United States had lost a precious opportunity to save many lives with such a strategy. “We’ve missed a window, and people have died,” she said.
But even now, Dr. Emanuel said, it’s worth delaying doses. The United States is giving out roughly three million vaccines a day, but nearly half are going to people who have already received one shot. The nation’s entire supply, he argued, should instead be going to first-timers.
If that happened, it would take two or three weeks for the United States to catch up with Britain, according to his team’s calculations. The extra protection would not just save the lives of the vaccinated but would help reduce transmission of the virus to people yet to get any protection.
Still, some scientists say it’s premature to credit the delayed vaccination schedule for Britain’s drop in cases.
“They’ve done a few other things, like shut down,” Dr. Fauci said.
“I think the real test will be whether we see a rebound in cases now that the U.K. is reopening,” Dr. Gounder said.
Instead of experimenting with vaccination schedules, critics say it would be wiser to get serious about basic preventive measures like wearing masks. “It’s crucial that we don’t just reopen into a big national party,” Dr. Borio said.
She and others are also worried by recent studies that show that a single dose of Moderna or Pfizer-BioNTech does not work as well against certain variants, such as B.1.351, which was first found in South Africa.
“Relying on one dose of Moderna or Pfizer to stop variants like B.1.351 is like using a BB gun to stop a charging rhino,” said John P. Moore, a virologist at Weill Cornell Medicine.
Dr. Moore said he also worried that delaying doses could promote the spread of new variants that can better resist vaccines. As coronaviruses replicate inside the bodies of some vaccinated people, they may acquire mutations that allow them to evade the antibodies generated by the vaccine.
But Dr. Cobey, who studies the evolution of viruses, said she wasn’t worried about delayed doses breeding more variants. “I would put my money on it having the opposite effect,” she said.
Last week, she and her colleagues published a commentary in Nature Reviews Immunology in defense of delaying doses. Getting more people vaccinated — even with moderately less protection — could translate into a bigger brake on the spread of the virus in a community than if fewer people had stronger protection, they said. And that decline wouldn’t just mean more lives were saved. Variants would also have a lower chance of emerging and spreading.
“There are fewer infected people in which variants can arise,” she said.” .” (C)
“Delaying the dose could make way for more people to get their first shots and stem the coronavirus’s spread, proponents say. Opponents say there’s not enough data to show if that one-shot protection is long-lasting enough. And they worry that changing timing now could confuse people, undermine trust and lead to more widespread hesitancy to get the vaccine…
Arguing for delay
Those numbers justify temporarily postponing second doses to ensure that more people get their first shots, says Robert Wachter, who heads the Department of Medicine at the University of California, San Francisco.
“That’s not a hard math question,” he says. “You’ll save far, far more lives — on the order of tens of thousands more lives — giving those extra vaccine doses to people for their first shot, getting them from zero to 85 percent protected, than using that same capacity [for] giving people their second shot and getting them from 85 to 95 [percent efficacy].”
The real driving force behind proposals to delay the second shots is that there just isn’t enough vaccine to go around. It’s all about getting jabs into as many arms as possible, Skowronski says.
Postponing the second dose doesn’t mean cancelling it, she says. It’s just a delay that could allow for more widespread distribution of the vaccine, especially to people at high risk of hospitalization and death from COVID-19.
Even though no one knows how long protection from a single shot will last, immunity doesn’t disappear overnight. That buys time, she says.
“We should be ensuring as many people as possible, by whatever means possible, get the first dose before we double back and try to top up with a second dose,” Skowronski says. “Every second dose we administer is essentially depriving someone else of the substantial protection they could have got from that vaccine supply as a first dose.”
Arguing against delay
Yes, the data overall suggest the first doses work pretty well, but scientists don’t know how durable that protection is, says virologist Onyema Ogbuagu. That may not be as much of a problem in countries like Israel and the United Kingdom, which have been vaccinating people pretty quickly. But in the United States, the vaccine rollout has been creeping and crawling, Ogbuagu says. Because of that slow progress, “you could be six months or 10 months into vaccination and the first people you vaccinated could become vulnerable again.”
The second shot should make immunity last longer. “The role of the second dose is, without question, an advantage,” he says. “It optimizes the efficacy and durability.” Ogbuagu, who oversees COVID-19 clinical trials at Yale School of Medicine, was involved in testing the Pfizer vaccine’s efficacy.
Earlier Phase I and II safety trials also tested people’s immune responses to the mRNA vaccines. Those data showed that antibody levels after the first shot are respectable but often don’t get close to matching levels seen in people who have recovered from COVID-19, Ogbuagu says. “But the pattern after the second dose is just so striking, antibody levels just skyrocket,” often exceeding levels from recovered patients, he says.
He also notes that the dosing data from the AstraZeneca trial came from a part of the study wasn’t planned and other unknown things might be influencing the outcome, A new clinical trial mixing the Pfizer and AstraZeneca vaccines will test in which order the shots should be given, and whether a four- or 12-week interval between doses produces better efficacy. That trial will produce more reliable data on which to base a decision about shot schedules. For now, though, “we have to deal with the unknowns,” he says, “and I think the benefits of giving that second shot outweigh giving just the first one and hoping for the best.”
There’s another big worry: Even under a best case scenario, some people are bound to get sick after getting vaccinated. The vaccines aren’t perfect and some new variants of the coronavirus can evade antibodies generated by the jabs. Some researchers are concerned that delaying a second dose could help produce new variants (SN: 1/14/21).
And if infections happen while monkeying with untried dosing intervals, it could undermine public confidence in the shots, worries Nicole Lurie, a strategic adviser for the Coalition for Epidemic Preparedness Innovations, an organization that funds vaccine development.
It may feed a narrative that health officials didn’t fully follow the science as promised, Lurie says. If public confidence erodes to the point that people turn down vaccines, “then in the long run, you’re doing the nation a disservice.” (D)
“One dose may not always be enough
The study found that one-dose strategies may, as expected, reduce case numbers in the short term by more rapidly immunizing a greater number of individuals. However, if immune responses after one dose are less robust, subsequent epidemic peaks may be larger.
“More optimistically, we find that as vaccine capacity increases, increasing vaccination rates or changing the dosing regime to closer to the recommended two-dose schedule can mitigate these longer term epidemiological effects, which is important for public health planning,” adds Wagner…
“At least one variant has already emerged that may be adapted for partial immune escape,” notes Holmes. “Simple theory underlines that the evolution and transmission of variants by infected hosts with intermediate levels of immunity may be important. Therefore, the strength and duration of immunity, and particularly the effect of these on retransmission, are key parameters to determine” adds Grenfell.
One intuitive finding that the paper emphasizes is that very low rates of vaccine administration may be associated with larger case numbers and, possibly, more elevated potential for viral adaptation. “This strongly underlines the importance of equitable global vaccine distribution, as immune escape in one location will rapidly spread,” explains C. Jessica E. Metcalf, a co-author on the paper, and an Associate Professor in EEB and the School of Public and International Affairs at Princeton and an associated faculty member at the High Meadows Environmental Institute.
“The models are relatively simple conceptually, but they illustrate the complexities of the problem and highlight the challenges that we still face,” notes Michael Boots, a Professor of Integrative Biology at UC Berkeley who was not affiliated with the present study. “This important piece of work provides a framework that we can use to inform our approach going forward and moreover identifies the key knowledge gaps that we need to address,” adds Boots.” (E)
“Washington will rush federal resources to support vaccinations, testing and treatments, but not vaccines, to Michigan in an effort to control the state’s worst-in-the-nation COVID-19 outbreak, the White House said Friday…
President Joe Biden outlined the federal actions late Thursday in a call with Whitmer to discuss the dire situation in the state, according to senior administration officials. The response will not include a “surge” of vaccine doses, a move Whitmer has advocated and which is backed by Michigan legislators and members of Congress.
Instead, Biden talked about how the federal government was planning to help Michigan better utilize doses already allocated to the state, as well as to increase testing capacity and provide more medications used to treat the sick.
Whitmer, a Democrat, confirmed that she asked Biden on the call to send more vaccine doses to Michigan, particularly the single-dose Johnson & Johnson shot.
“I made the case for a surge strategy,” she said. “At this point, that’s not being deployed, but I am not giving up.”
“Today it’s Michigan and the Midwest,” she added. “Tomorrow, it could be another section of our country. I really believe that the most important thing we can do is put our efforts into squelching where the hot spots are.”
Doses are allocated to states proportionally by population, but Whitmer has called for extra doses to be shifted to states, like hers, that are experiencing a sharp rise in cases. The Biden administration isn’t ready to make such changes.
“We’re going to stick with the allocation system of allocating by state adult population,” said White House COVID-19 coordinator Jeff Zients, calling it “the fair and equitable way” to distribute vaccines. He said the administration was looking to help Michigan administer more of its vaccines efficiently…
Federal officials said providing more doses would not be as immediately effective in curbing Michigan’s virus spike as increasing testing, restoring measures like mask wearing, and foregoing high-risk activities. That’s because vaccines take at least two weeks to begin providing immunity.
Biden told Whitmer that his administration stands ready to send an additional 160 Federal Emergency Management Agency and CDC personnel to Michigan to assist in vaccinations, on top of the 230 federal personnel already deployed to the state to support pandemic response operations.
He’s also directing the administration to prioritize the distribution of doses through federal channels, like the retail pharmacy program and community health centers, to areas of the state Whitmer identifies.
“We are at war with this virus, which requires leaders from across the country to work together,” said White House spokesperson Chris Meagher. “We’re in close contact with Gov. Whitmer, who is working hard to keep Michigan safe, and working in close coordination through a range of options that can help stop the spread of the virus.”
Michigan ranked 35th among states in its vaccination rate. About 40% of Michigan residents ages 16 and older have gotten at least one vaccine dose.
The governor’s recommended high school closure drew mixed reaction in education circles. Her administration closed high schools for a month during the state’s second surge late last fall.
“Research has shown schools can be safe places for in-person learning, so long as community spread is under control — but with higher risk in our communities comes higher risk in classrooms,” said Michigan Education Association President Paula Herbart, whose union urged a similar two-week suspension of in-person learning at elementary and middle schools and colleges.
Restaurants, meanwhile, questioned Whitmer’s recommendation not to eat inside but welcomed the call for more vaccines.
“We trust our operators to continue to provide a safe environment indoors or out in the coming weeks and we trust Michiganders to do their part to act responsibly and respectfully to help us all achieve that outcome,” said Justin Winslow, president and CEO of the Michigan Restaurant & Lodging Association.” (F)
“When it comes to getting the coronavirus vaccine, Mississippi residents have an abundance of options. On Thursday, there were more than 73,000 slots to be had on the state’s scheduling website, up from 68,000 on Tuesday.
In some ways, the growing glut of appointments in Mississippi is something to celebrate: It reflects the mounting supplies that have prompted states across the country to open up eligibility to anyone over 16.
But public health experts say the pileup of unclaimed appointments in Mississippi exposes something more worrisome: the large number of people who are reluctant to get vaccinated.
“It’s time to do the heavy lifting needed to overcome the hesitancy we’re encountering,” said Dr. Obie McNair, an internal medicine practitioner in Jackson, the state capital, whose office has a plentiful supply of vaccines but not enough takers.
Though access remains a problem in rural Mississippi, experts say that the state — one of the first to open eligibility to all adults three weeks ago — may be a harbinger of what much of the country will confront in the coming weeks, as increasing supplies enable most Americans who want the vaccine to easily make appointments.
The hesitancy has national implications. Experts say between 70 percent to 90 percent of all Americans must be vaccinated for the country to reach herd immunity, the point at which the virus can no longer spread through the population.
When it comes to rates of vaccination, Mississippi still has a way to go, with just a quarter of all residents having received at least one dose compared to the nationwide average of 33 percent, according to state data. Other southern states, among them Tennessee, Arkansas, Alabama and Georgia, have similarly low rates of vaccination. “(G)
“There will be 86% fewer Johnson & Johnson vaccine doses allocated to states next week, new data from the Centers for Disease Control and Prevention show, highlighting the company’s yo-yoing vaccine supply from week to week…
Next week, 1.5 million J&J doses will be distributed, including 700,000 doses that will go out through the state allocation system, and another 800,000 that will be handed out through other federal programs, which have grown significantly during the Biden administration.
Supply of the Johnson & Johnson vaccine has been lumpy since its FDA authorization on Feb. 27. The CDC allocated 2.8 million doses to states the next week, followed by no doses the week after that, according to the CDC’s state allocation database. Then, there were fewer than a half-million doses in each of the next two weeks. (The state allocation table is not a complete accounting of doses distributed, however, because many are allocated through other federal programs and not included in the data.)
It’s no secret that Johnson & Johnson has been having manufacturing difficulties. Although its Aug. 5 Operation Warp Speed contract says it expected to deliver 37 million doses by the end of March, that goal had shrunk to 20 million doses, as Dr. Richard Nettles, vice president of medical affairs for the company’s pharmaceutical division, told a congressional subcommittee on Feb. 23.
The Biden administration stepped in with help in early March, when it brokered a deal between J&J and a pharmaceutical, Merck, to increase the vaccine supply.” (H)
“The U.K.’s bold call to delay giving people a second dose of a Covid-19 vaccine has put it out in front in the race to inoculate the world against the disease.
Behind that decision: a group of 16 scientists who advocated a controversial move to overrule some vaccine manufacturers’ guidelines in order to get more first doses to more people.
The gamble appears to have paid off, with incoming data pointing to durable protection against falling ill after just one vaccine dose. But while some countries, such as Canada, have followed the U.K.’s lead, others including the U.S. are refusing, saying to do so could pose a risk to public health.
The decision by British authorities holds lessons for other countries as they fight to contain the pandemic. Indeed, the dosing debate raises difficult questions about whether some governments and their scientific advisers—for instance in the European Union, where vaccination campaigns are painfully slow—are being too risk averse.
In December, as a highly infectious Covid-19 variant ripped across the U.K., the group of scientists sitting on Britain’s Joint Committee on Vaccination and Immunisation concluded that delaying a second vaccine dose by up to 12 weeks could save lives.” (I)
“The race to beat the coronavirus variants, and to get as many people vaccinated as quickly as possible has intensified a debate in the scientific community about what the best strategy is to end the pandemic.
The question at the heart of the debate: would delaying a second dose of the Pfizer and Moderna Covid-19 vaccine get more people protected more quickly?..
A January editorial published in the Annals of Internal Medicine explained the reason for the delayed dose strategy this way: “A single-dose SARS-CoV-2 vaccine approach deals directly with the shortage of vaccines by vaccinating twice the number of people while maximizing the probability of achieving herd immunity.”
The math is pretty simple, Dr. Michael Osterholm, the director for the Center for Infectious Disease Research and Policy at the University of Minnesota, said.
If you have two people in a room and you give one person two doses they get 90% protection, but the other person gets none. Give each a single dose, in three weeks they both have 80% protection.
“Right now, with the surge that’s about to occur, this is what we want to do right now,” Osterholm told CNN Monday. “Get as many people protected as we can so they don’t get severe illness and hospitalizations and death.”
Dr. Atul Gawande, a member of the Biden administration’s coronavirus transition team, and a surgeon who works at the Harvard’s School of Public Health, said that behavioral measures alone aren’t going to be enough to curb the spread, especially in places seeing surges like in the Midwest and Northeast.
“In these areas where we are having a surge, vaccine appointments go in minutes,” Gawande said. “We need to be vaccinating a lot more people.”
Gawande had been on the fence about it, but as more contagious variants have spread, he started to think a delayed second dose would protect the population more quickly. He said many more people in these areas will need to be vaccinated to bring an end to the surge. The strategy would also reduce the number of variants.
Dr. Ashish Jha had been calling for the delayed second dose strategy for months, but the Dean of Brown University’s School of Public Health now thinks it may be too late.
“By the end of May we’re going to have more vaccines than arms for them to go into,” Jha told CNN Monday. “I don’t know that strategy has quite the same value as it did before.”
Unless something changes with the supply, Dr. Kent Sepkowitz, an infectious disease specialist at Memorial Sloan Kettering Cancer Center in New York, agrees.
“If the stockpile is running low, than yeah, I think we ought to prioritize ‘pretty good’ vaccination for more people than ‘super duper’ protection for the fewer,” Sepkowitz told CNN Monday. “If, however, the vaccine supply isn’t so sparse, than I think we ought to plow ahead with what we’re doing.”…
Dr. William Schaffner, an infectious disease specialist at Vanderbilt University, said with so much supply at this point in the pandemic, the more effective strategy may be to concentrate on helping the hesitant get vaccinated.
“The eager beavers, the early acceptors, they’re still coming in, but we’re getting to the end of that group,” Schaffner said. “We’re now reaching out to the people who are more skeptical that they need the vaccine.”” (J)
PREQUEL
POST 133. February 23, 2021. CORONAVIRUS. “Going off your meds is a surefire way to aggravate your doctor. What if a whole country did it?” The United Kingdom has veered into uncharted territory by changing tack and introducing a revised COVID-19 vaccination protocol, one that involves distributing the second dose at 12 weeks, rather than the prescribed 21 days.”
PART 1. January 21, 2020. CORONAVIRUS. “The Centers for Disease Control and Prevention on Tuesday confirmed the first U.S. case of a deadly new coronavirus that has killed six people in China.”
PART 2. January 29, 2020. CORONAVIRUS. “If it’s not contained shortly, I think we are looking at a pandemic..”….. “With isolated cases of the dangerous new coronavirus cropping up in a number of states, public health officials say it is only a matter of time before the virus appears in New York City.”
PART3. February 3, 2020. “The Wuhan coronavirus spreading from China is now likely to become a pandemic that circles the globe…”..Trump appeared to downplay concerns about the flu-like virus …We’re gonna see what happens, but we did shut it down..” (D)
PART 4. February 9, 2020. Coronavirus. “A study published Friday in JAMA found that 41% of the first 138 patients diagnosed at one hospital in Wuhan, China, were presumed to be infected in that hospital.….
PART 5. February 12, 2020. CORONAVIRUS. “In short, shoe-leather public health and basic medical care—not miracle drugs—are generally what stop outbreaks of emerging infections..”
POST 6. February 18, 2020. Coronovirus. “Amid assurances that the (ocean liner) Westerdam was disease free, hundreds of people disembarked in Cambodia…” “ One was later found to be infected”…. “Over 1,000… passengers were in…transit home”…. “This could be a turning point””
PART 7. February 20, 2020. CORONAVIRUS. With SARS preparedness underway in NJ LibertyHealth/ Jersey City Medical Center, where I was President, proposed that our 100 bed community hospital with all single-bedded rooms, be immediately transformed into an EMERGENCY SARS ISOLATION Hospital.
PART 8. February 24, 2020. CORONAVIRUS. “…every country’s top priority should be to protect its health care workers. This is partly to ensure that hospitals themselves do not become sites where the coronavirus is spread more than it is contained.”
PART 9. February 27, 2020. CORONAVIRUS. Responding to a question about the likelihood of a U.S. outbreak, President Trump said, “I don’t think it’s inevitable…”It probably will. It possibly will,” he continued. “It could be at a very small level, or it could be at a larger level.”
Part 10. March 1, 2020. CORONAVIRUS. Stop Surprise Medical Bills for Coronavirus care. (&) Lessons Learned (or not) In California and Washington State from community acquired cases.
PART 11. March 5, 2020. CORONAVIRUS. “Gov. Andrew Cuomo… would require employers to pay workers and protect their jobs if they are quarantined because of the coronavirus.”
Part 12. March 10, 2020. CORONAVIRUS. “Tom Bossert, Donald Trump’s former homeland security advisor…(said) that due to the coronavirus outbreak, “We are 10 days from the hospitals getting creamed.”
Part 13.. March 14, 2020. CORONAVIRUS. “If I’m buying real estate in New York, I’ll listen to the President….If I’m asking about infectious diseases, I’m going to listen to Tony Fauci,”
PART 14. March 17, 2020. CORONAVIRUS. “ “Most physicians have never seen this level of angst and anxiety in their careers”…. One said “I am sort of a pariah in my family.”
PART 15. March 22, 2020. CORONAVIRUS. “…Crimson Contagion” and imagining an influenza pandemic, was simulated by the Trump administration….in a series of exercises that ran from last January to August.
PART 16. March 27, 2020. CORONAVIRUS. I am not a clinician or a medical ethicist but articles on Coronavirus patient triage started me Googling………to learn about FUTILE TREATMENT
PART 17. April 2, 2020. CORONAVIRUS. Florida allows churches to continue holding services. Gun stores deemed “essential.” “New York’s private and public hospitals unite to manage patient load and share resources.
PART 18. April 9, 2020. CORONAVIRUS. “The federal government’s emergency stockpile of personal protective equipment (PPE) is depleted, and states will not be receiving any more shipments, administration staff told a House panel.
PART 19. April 13, 2020 CORONOAVIRUS. “…overlooked in the United States’ halting mobilization against the novel coronavirus: the personal aides, hospice attendants, nurses and occupational or physical therapists who deliver medical or support services to patients in their homes.”
POST 22. April 29, 2020. CORONAVIRUS. ..the “ACS released a list of 10 issues that should be addressed before a healthcare organization resumes elective surgeries[JM1] ….”
POST 23. May 3, 2020. CORONAVIRUS. … what Dr. Fauci really wants,…”is just to go to a baseball game. That will have to wait. The level of testing for the virus is not adequate enough to allow for such mass gatherings.’ (K)
POST 24. May 7, 2020. CORONAVIRUS. Former New Jersey governor Chris Christie said: “there are going to be deaths no matter what”… but that people needed to get back to work.
POST 25. May 10, 2020, CORONAVIRUS. “It is scary to go to work,” said Kevin Hassett, a top economic adviser to the president. “I think that I’d be a lot safer if I was sitting at home than I would be going to the West Wing.”
POST 26. May 14, 2020. CORONAVIRUS, “Deep cleaning is not a scientific concept”….”there is no universal protocol for a “deep clean” to eradicate the coronavirus”
POST 27. May 19, 2020. CORONAVIRUS. “Hospital…executives…are taking pay cuts…to help offset the financial fallout from COVID-19.” As “front line” layoffs and furloughs accelerate…
POST 28. May 23, 2020. CORONAVIRUS. ““You’ve got to be kidding me,”..”How could the CDC make that mistake? This is a mess.” CDC conflates viral and antibody tests numbers.
PART 29. May 22, 2020. CORONAVIRUS. “The economy did not close down. It closed down for people who, frankly, had the luxury of staying home,” (Governor Cuomo). But not so for frontline workers!
POST 30. June 3,202. CORONAVIRUS. “The wave of mass protests across the United States will almost certainly set off new chains of infection for the novel coronavirus, experts say….
Post 32. June 16, 2020. CORONAVIRUS. Could the Trump administration be pursuing herd immunity by “inaction”? “ If Fauci didn’t exist, we’d have to invent him.”
POST 34. June 26, 2020. CORONAVIRUS. CDC Director Redfield… “the number of coronavirus infections…could be 10 times higher than the confirmed case count — a total of more than 20 million.” As Florida, Texas and Arizona become eipicenters!
POST 35. June 29, 2020. CORONAVIRUS. Pence: “We slowed the spread. We flattened the curve. We saved lives..” While Dr. Fauci “warned that outbreaks in the South and West could engulf the country…”
POST 36. July 2, 2020. CORONAVIRUS. “There’s just a handful of interventions proven to curb the spread of the coronavirus. One of them is contact tracing, and “it’s not going well,” (Dr. Anthony Fauci)..
POST 37. June 8, 2020. CORONAVIRUS. When “crews arrive at a hospital with a patient suspected of having COVID-19, the hospital may have a physical bed open for them, but not enough nurses or doctors to staff it.”
POST 38. July 15, 2020. CORONAVIRUS. Some Lessons Learned, or not. AdventHealth CEO Terry Shaw: I wouldn’t hesitate to go to Disney as a healthcare CEO — based on the fact that they’re working extremely hard to keep people safe,” (M)
POST 39. July, 23,2020. CORONAVIRUS. A Tale of Two Cities. Seattle becomes New York (rolls back reopening) while New York becomes Seattle (moves to partial phase 4 reopening)
POST 40. July 27, 2020. CORONAVIRUS.” One canon of medical practice is that you order a test only if you can act on the result. And with a turnaround time of a week or two, you cannot. What we have now is often not testing — it’s testing theater.”
POST 41. August 2, 2020. CORONAVIRUS. “Whenever a vaccine for the coronavirus becomes available, one thing is virtually certain: There won’t be enough to go around. That means there will be rationing.”
POST 44. September 1, 2020. CORONAVIRUS. “The CDC…modified its coronavirus testing guidelines…to exclude people who do not have symptoms of Covid-19.” (While Dr. Fauci was undergoing surgery.) A White House official said: “Everybody is going to catch this thing eventually..”
POST 45. September 9, 2020. CORONAVIRUS. Trump on Fauci. ‘You inherit a lot of people, and you have some you love, some you don’t. I like him. I don’t agree with him that often but I like him.’
POST 46. September 17, 2020. CORONAVIRUS. “Bill Gates used to think of the US Food and Drug Administration as the world’s premier public-health authority. Not anymore. And he doesn’t trust the Centers for Disease Control and Protection either….”
POST 47. September 24, 2020. CORONAVIRUS. “Perry N. Halkitis, dean of the School of Public Health at Rutgers University…called New York City’s 35 percent rate for eliciting contacts “very bad.” “For each person, you should be in touch with 75 percent of their contacts within a day,” he said”
POST 48. October 1, 2020. “…you can actually control the outbreak if you do the nonpharmaceutical interventions (social distancing and masks). In the United States we haven’t done them. We haven’t adhered to them; we’ve played with them.” (A)
POST 49. October 4, 2020. CORONAVIRUS. RAPID RESPONSE. “The possibility that the president and his White House entourage were traveling superspreaders is a nightmare scenario for officials in Minnesota, Ohio, New Jersey and Pennsylvania…”
POST 50. October 6, 2020. CORONAVIRUS. Monday October 5th will go down as one of the most fraught chapters in the history of American public Health (and national security).
POST 51. October 12, 2020. Rather than a hodge-podge of Emergency Use Authorizations, off-label “experimentation”, right-to-try arguments, and “politicized” compassionate use approvals maybe we need to designate REGIONAL EMERGING VIRUSES REFERRAL CENTERS (REVRCs).
POST 52. October 18, 2020. ZIKA/ EBOLA/ CANDIDA AURIS/ SEVERE FLU/ Tracking. “… if there was a severe flu pandemic, more than 33 million people could be killed across the world in 250 days… Boy, do we not have our act together.” —”- Bill Gates. July 1, 2018
POST 54. October 22, 2020. CORONAVIRUS. POST 54A. New Jersey’s Coronavirus response, led by Governor Murphy and Commissioner of Health Persichilli started with accelerated A+ traditional, evidence-based Public Health practices, developed over years of experience with seasonal flu, swine flu, Zika, and Ebola.
POST 55. October 26, 2020. CORONAVIRUS. The Testing Conundrum: “ It’s thus very possible to be antigen negative but P.C.R. positive, while still harboring the virus in the body..”
POST 57. November 3, 2020. CORONAVIRUS. Dr. Deborah Birx: the US is entering its “most deadly phase” yet, one that requires “much more aggressive action,”
POST 58. November 4, 2020. CORONAVIRUS. “…the president has largely shuttered the White House Coronavirus Task Force and doubled down on anti-science language…”
POST 59. November 5, 2020. Coronavirus. “The United States on Wednesday recorded over 100,000 new coronavirus cases in a single day for the first time since the pandemic began..
POST 61. November 7, 2020. CORONAVIRUS. “Joe Biden’s top priority entering the White House is fighting both the immediate coronavirus crisis and its complex long-term aftermath…” “Here are the key ways he plans to get US coronavirus cases under control.”
POST 62. November 8, 2020. CORONAVIRUS. “The United States reported its 10 millionth coronavirus case on Sunday, with the latest million added in just 10 days,…”
POST 63. November 9, 2020. CORONAVIRUS. “New York City-based Mount Sinai Health System has opened a center to help patients recovering from COVID-19 and to study the long-term impact of the disease….”
POST 64. November 10, 2020. CORONAVIRUS. “It works! Scientists have greeted with cautious optimism a press release declaring positive interim results from a coronavirus vaccine phase III trial — the first to report on the final round of human testing.”
POST 65. November 11, 2020. CORONAVIRUS, “The Centers for Disease Control and Prevention took a stronger stance in favor of masks on Tuesday, emphasizing that they protect the people wearing them, rather than just those around them…
POST 66. November.12, 2020. CORONAVIRUS.”… as the country enters what may be the most intense stage of the pandemic yet, the Trump administration remains largely disengaged.”… “President-elect Biden has formed a special transition team dedicated to coordinating the coronavirus response across the government…”
POST 67. November 13, 2020. CORONAVIRUS. “When all other options are exhausted, the CDC website says, workers who are suspected or confirmed to have COVID-19 (and “who are well enough to work”) can care for patients who are not severely immunocompromised — first for those who are also confirmed to have COVID-19, then those with suspected cases.”
POST 68. November 14, 2020. CORONAVIRUS. The CDC “now is hewing more closely to scientific evidence, often contradicting the positions of the Trump administration.”..” “A passenger aboard the first cruise ship to set sail in the Caribbean since the start of the pandemic has tested positive for coronavirus..”
POST 69. November 15, 2020. CORONAVIRUS. “Colorado Gov. Jared Polis will issue a new executive order outlining steps hospitals will need to take to ready themselves for a surge in COVID-19 hospitalizations and directing the hospitals to finalize plans for converting beds into ICU beds, adding staffing and scaling back on or eliminating elective procedures….
POST 70. November 16, 2020. CORONAVIRUS. “White House coronavirus task force member Dr. Atlas criticized Michigan’s new Covid-19 restrictions..urging people to “rise up” against the new public health measures.
POST 71. November 17, 2020. CORONAVIRUS. ”Hospitals overrun as U.S. reports 1 million new coronavirus cases in a week.” “But in Florida, where the number of coronavirus infections remains the third-highest in the nation, bars and schools remain open and restaurants continue to operate at full capacity.”
POST 72. November 18, 2020. CORONAVIRUS. “The Health and Human Services Department will not work with President-elect Joe Biden’s (PANDEMIC) team until the General Services Administration makes a determination that he won the election,….”
POST 73. November 19, 2020. CORONAVIRUS. “…officials at the CDC…urged Americans to avoid travel for Thanksgiving and to celebrate only with members of their immediate households…” When will I trust a vaccine? to the last question I always answer: When I see Tony Fauci take one….”
POST 74. November 20, 2020. CORONAVIRUS. Pfizer…submitted to the FDA for emergency use authorization for their coronavirus vaccine candidate. —FDA issued an EUA for the drug baricitinib, in combination with remdesivir, as WHO says remdesivir doesn’t do much of anything.
POST 75. November 21, 2020. CORONAVIRUS. “The president and CEO of one of the nation’s largest non-profit health systems says he won’t be wearing a mask at work because he’s recovered from COVID-19, and doing so would only be a “symbolic gesture” because he considers himself immune from the virus….
POST 76. November 23, 2020. CORONAVIRUS. “No battle plan survives contact with the enemy.” Ventilators..”just keep people alive while the people caring for them can figure out what’s wrong and fix the problem. And at the moment, we just don’t have enough of those people.”
POST 77. November 26, 2020. CORONAVIRUS. Pope Francis: “When I got really sick at the age of 21, I had my first experience of limit, of pain and loneliness.”.. “….Aug. 13, 1957. I got taken to a hospital…”….” I remember especially two nurses from this time.”…” They fought for me to the end, until my eventual recovery.”
POST 78. November 27, 2020. CORONAVIRUS. “Kelby Krabbenhoft is no longer president and CEO of Sioux Falls, S.D.-based Sanford Health.” “…for not wearing a face covering… “ because “He considered himself immune from the virus.”
POST 79. November 28, 2020. CORONAVIRUS. Mayo Clinic. “”Our surge plan expands into the garage…”..””Not where I’d want to put my grandfather or my grandmother,” … though it “may have to happen.”
POST 81. December 1, 2020. CORONAVIRUS. “Dr. Atlas, … who espoused controversial theories and rankled government scientists while advising President Trump on the coronavirus pandemic, resigned…”
POST 82. December 3, 2020. CORONAVIRIUS. The NBA jumped to the front of the line for Coronavirus testing….while front line nurses often are still waiting. Who will similarly “hijack” the vaccine?
POST 83. December 4, 2020. CORONAVIRUS. “California Gov. Gavin Newsom says he will impose a new, regional stay-at-home order for areas where capacity at intensive care units falls below 15%.”… East Tennessee –“This is the first time the health care capability benchmark has been in the red..”
POST 84. December 6, 2020. CPRONAVIRUS. “ More than 100,000 Americans are in the hospital with COVID-19…” “We’re seeing C.D.C. …awaken from (its) politics-induced coma…”…Dr. Fauci “to be a chief medical adviser in Biden’s incoming administration..”.. “Trump administration leaves states to grapple with how to distribute scarce vaccines..”
POST 85. December 7, 2020. CORONAVIRUS. “…Florida, Gov. DeSantis’ administration engaged in a pattern of spin and concealment that misled the public on the gravest health threat the state has ever faced..”.. “NY Gov. Cuomo said…the state will implement a barrage of new emergency actions..”… Rhode Island and Massachusetts open field hospitals… “Biden Names Health Team to Fight Pandemic”
POST 86. December 9, 2020. If this analysis seems a bit incomprehensible it is because “free Coronavirus test” is often an oxymoron! with charges ranging from as little as $23 to as much as $2,315… Laws (like for free Coronavirus tests) are Like Sausages. Better Not to See Them Being Made. (Please allow about 20 seconds for the text to download. Thanx!)
POST 87. December 10, 2020. CORONAVIRUS. “…Rudolph W. Giuliani, the latest member of President Trump’s inner circle to contract Covid-19, has acknowledged that he received at least two of the same drugs the president received. He even conceded that his “celebrity” status had given him access to care that others did not have.”
POST 88. December 11, 2020. CORONAVIRUS. “As COVID-19 cases surge, the federal government is releasing data about hospital capacity at facilities around the country….”The new data paints the picture of how a specific hospital is experiencing the pandemic,”…
PART 89. December 12, 2020. CORONAVIRUS. THE VACCINE!!! “Now this is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning.” Winston Churchill
POST 90. December 14, 2020. CORONAVIRUS. “…the first doses of a Covid-19 vaccine have been given to the American public..”…” Each person who receives a vaccine needs two doses, and it’s up to states to allocate their share of vaccines.”
POST 91. December 15, 2020. CORONAVIRUS. “UPMC will first give (vaccination) priority to those in critical jobs. That includes a range of people working in critical units, from workers cleaning the emergency room and registering patients to doctors and nurses.. “Finally, if needed, UPMC will use a lottery to select who will be scheduled first.”
POST 92. December 17, 2020. CORONAVIRUS. “..each state — and each hospital system — has come up with its own (vaccination) plan and priorities. The result has been a sometimes confusing constellation of rules and groupings that has left health care workers wondering where they stand.” (Trump appointee July 4th email “…we need to establish herd, and it only comes about allowing the non-high risk groups expose themselves to the virus. PERIOD,”)
POST 93. December 19, 2020. CORONAVIRUS. On NPR Congresswoman Shalala (D-Florida) said she wouldn’t jump the vaccination line in Miami; then added she would get vaccinated in Washington this week. This, even though Congress has failed to pass “essential” Coronavirus legislation. So who are our “essential” workers?
POST 94. December 21, 2020. CORONAVIRUS. “A doctor at an L.A. County public hospital said the number of COVID-19 patients is “increasing exponentially, without an end in sight.”.. “I haven’t done ICU medicine since I was a resident — you don’t want me adjusting your ventilator,” he said. “That’s the challenge, actually — it isn’t so much space, it’s staff…”
POST 96. December 26, 2020. CORONAVIRUS. “Achieving herd immunity against the coronavirus could require as much as 90 percent of the population to be vaccinated, Anthony Fauci…”…”..he hesitated to state a number as high as 90% weeks ago because many Americans still seemed skeptical about vaccine….”
POST 97. December 27, 2020. “A new variant of the coronavirus that has been spreading through the UK and other countries has not yet been detected in the United States..”.. . But if new-wave medicines like antivirals and antibody therapy contributed to the development of viral variants, it will be “a reminder for all the medical community that we need to use these treatment options carefully.”
POST 99. December 29, 2020. CORONAVIRUS. “ICUs are being overwhelmed across many parts of California. Statewide aggregate ICU availability has been at 0% since Christmas Eve…. a surge on top of a surge on top of a surge.”… “hospitals are getting close to the point where they would begin putting COVID-positive patients under the care of COVID-positive staff who are asymptomatic.”
POST 100. December 29, 2020. CORONAVIRUS. Front line hospital workers – in the ER, ICUs, EMS, acute medical care, behavioral health – are amongst the most courageous, heroic and dedicated colleagues you will ever meet.
POST 101. December 30, 2020.CORONAVIRUS. Is there a point where the increasing Coronavirus trajectory so far exceeds the slow growth of the vaccination rate that reaching herd immunity through vaccinations becomes less likely?
POST 102. January 2, 2020. CORONAVIRUS. “We’ve taken the people with the least amount of resources and capacity and asked them to do the hardest part of the vaccination — which is actually getting the vaccines administered into people’s arms,” said Dr. Ashish Jha, the dean of Brown University’s School of Public Health. “Ultimately, the buck seems to stop with no one,”…
POST 103. January 4, 2021. CORONAVIRUS. Dr. Fauci said “that the United States would not follow Britain’s lead in front-loading first vaccine injections, potentially delaying the administration of second doses…Dr. Moore – ”British officials “seem to have abandoned science completely now and are just trying to guess their way out of a mess.”
POST 104. January 6, 2021. CORONAVIRUS. “Paramedics in Southern California are being told to conserve oxygen and not to bring patients to the hospital who have little chance of survival…”
POST 105. January 8, 2021. CORONAVIRUS. POST 105. January 8, 2021. CORONAVIRUS. “Facing a shortage of vaccinators, the Association of Immunization Managers… recommends relaxing regulation or adjusting licensing requirements. At least two states, Massachusetts and New York, have changed their laws in recent weeks to expand those who are eligible to give shots.”
POST 106. January 9, 2021. CORONAVIRUS. The riots at the Capitol could have been a superspreader event. “From what I saw… you had a large congregation of individuals who were in close contact for an extended period of time and almost universally unmasked…. many coming and going on buses as well, also unmasked, and hanging out in hotel lobbies.”
POST 107. January 8, 2021. CORONAVIRUS. “Our job is to make sure the vaccine isn’t politicized the way masks were politicized,” Rep. Alexandria Ocasio-Cortez, D-N.Y., said after getting her vaccine. South Carolina Rep.-elect Nancy Mace, a Republican, wrote that “Congress shouldn’t be putting themselves first in line for the COVID-19 vaccination when the average American can’t get it.”
POST 108. January 9, 2021. CORONAVIRUS. (vaccination)”Line-cutters will be named and shamed. It’s inevitable, as will be the congressional hearings and front-page investigative stories ferreting out who saved their own skin at the expense of others.”
POST 109.January 9, 2021. CORONAVIRUS. “President-elect Joe Biden will aim to release nearly every available dose of the coronavirus vaccine when he takes office, a break with the Trump administration’s strategy of holding back half of US vaccine production to ensure second doses are available.
POST 110. January 13, 2021. CORONAVIRUS. ““The (federal) government is changing the way it allocates Covid vaccine doses, now basing it on how quickly states can administer shots and the size of their elderly population.”… “New York State sent a letter to hospitals saying if they don’t use their vaccine allocations by the end of this week, they won’t receive any further allocations.”
POST 111. January 14, 2021. CORONAVIRUS. “Visitors from Toronto to New York to Buenos Aires have long flocked to Florida for sun, surf and shopping. Now they are coming for the Covid-19 vaccine….
POST 112. January 14, 2021. CORONAVIRUS. CHINA – “Eleven million people are under lockdown in Hebei province after a new cluster of coronavirus infections.
PART 113. January 17, 2021. CORONAVIRUS. The Next President Actually Has a Covid Plan… New York City and other places in the state expect to exhaust their supply of doses as early as next week… Charles Barkley said during the “NBA on TNT” broadcast that pro athletes should get the first round of the vaccine…..
POST 114. January 18, 2021. CORONAVIRUS. “When government programs that have been unattended, underfunded and bogged down by red tape suddenly have to meet a huge demand in a crisis, they can’t cope and people suffer….”
POST 115. January 21, 2020. CORONAVIRUS. A year ago today an unnumbered POST was headlined “The Centers for Disease Control and Prevention on Tuesday confirmed the first U.S. case of a deadly new coronavirus that has killed six people in China.” The CORONAVIRUS CONTENT TRACKING PROJECT started with HISTORIOGRAPHY and over time moved to LESSONS LEARNED, RAPID RESPONSE, and THE VACCINATION PROGRAM. Now 115 POSTS later – the BIDEN CORONAVIRUS PLAN.
POST 116. January 22, 2021. President Biden – “We’re entering what may be the toughest and deadliest period of the virus. We must set aside politics and finally face this pandemic as one nation.”
POST 117. January 23, 2021. CORONAVIRUS. 1.Dr. Fauci:“The idea that you can get up here….”and.. let the science speak”… “It is somewhat of a liberating feeling.” 2.updated CDC guidance:”.. providers could give the second dose up to six weeks after the first dose..” 3.Dr. Fauci: people would be “taking a chance” if they follow the CDC’s updated guidance.
POST 118. January 24, 2021. CORONAVIRUS. “Unfortunately, we’ve let this virus spread extensively and are launching the vaccination campaign at the height of the threat,” Dr. Meyers said. “The more the virus spreads before the vaccine reaches people, the fewer deaths we can prevent with the vaccine.”
POST 119. January 27, 2010. CORONAVIRUS. Amazon is offering its help to President Joe Biden with the rollout of COVID-19 vaccines. Washington’s governor, Jay Inslee, included the help of companies like Starbucks, Costco and Microsoft in a plan to vaccinate 45,000 residents a day.
POST 120. January 28, 2021. CORONAVIRUS. “The fact that four vaccines backed by the federal government seem to be less effective against the (South African) B.1.351 variant has unsettled federal officials and vaccine experts alike. Facing this uncertainty, many researchers said it was imperative to get as many people vaccinated as possible — quickly. Lowering the rate of infection could thwart the contagious variants while they are still rare, and prevent other viruses from gaining new mutations that could cause more trouble.”
POST 121. January 30, 2021. CORONVIRUS. Will our communities become stratified by which vaccine is distributed? 95%ters v. 72%ters? Will the easier distribution of the J&J vaccine drive its inequitable distribution to” hard-hit, marginalized, and medically underserved communities.” (thanx! to XJ/LA)
POST 123. February 4, 2021. CORONAVIRUS. “Nursing homes across the country are facing the same struggle, as workers have been more reluctant than residents to be vaccinated…
POST 124. February 5, 2021. CORONAVIRUS. Dr. Osterholm ” …it may be time to..go with a ‘first-dose only’ approach, so more people over the age of 65 can have at least some protection right away. He said that would require delaying second doses until this summer.” Dr.Fauci “warned against this practice, and cautioned people about “the danger” that could come with focusing only on the first dose.”
POST 125. June 9, 2021. CORONAVIRUS. “States are rolling back Covid-19 restrictions as new cases trend down from record highs across the country. But experts warn it might be too much too soon as variants pose an increased risk and the pandemic… is far from over.”
POST 126. February 11, 2021. CORONAVIRUS. “There will be more coronavirus outbreaks in the future. Bats and other mammals are rife with strains and species of this abundant family of viruses. Some of these pathogens will inevitably spill over the species barrier and cause new pandemics. It’s only a matter of time.” (A)
POST 127. February 12, 2021. CORONAVIRUS. “… Trump only agreed to be hospitalized when aides told him that he could walk to Marine One or he could wait until his case progressed and he would be carried out.”
POST 128. February 14, 2021. CORONAVIRUS. “The Centers for Disease Control and Prevention released new research on Wednesday that found wearing a cloth mask over a surgical mask offers more protection against the coronavirus, as does tying knots on the ear loops of surgical masks…
POST 129. February 15, 2021, CORONAVIRUS. “ “The CDC released its much-anticipated, updated guidance to help school leaders decide how to safely bring students back into classrooms, or keep them there.”…” For politicians, parents and school leaders looking for a clear green light to reopen schools, this is not it.”
POST 130. February 16, 2021. CORONAVIRUS. “A second person who had contracted the Ebola virus died this week in the Democratic Republic of Congo, marking another outbreak just three months after the nation outlasted the virus’s second-worst outbreak in history…”
POST 131. February 17, 2021. CORONAVIRUS. “It really is right now – a race between how quickly new variants, particularly the U.K. variant, can spread in the United States and how quickly we can get people vaccinated”
POST 132. February 20, 2021. CORONAVIRUS. “In Texas, where over 2.5 million people are still without power, the state health department said this week’s vaccine shipments wouldn’t arrive until Wednesday at the earliest.”
POST 133. February 23, 2021. CORONAVIRUS. “Going off your meds is a surefire way to aggravate your doctor. What if a whole country did it?” The United Kingdom has veered into uncharted territory by changing tack and introducing a revised COVID-19 vaccination protocol, one that involves distributing the second dose at 12 weeks, rather than the prescribed 21 days.”
POST 134. February 24, 2021. CORONAVIRUS. The first tranche of the J&J (single dose) vaccine must go to K-12 teachers, so schools can open safely in the first 100 days of the Biden Administration. The federal government…”can set up its own vaccination centers in regions with eligible populations it’s trying to target.” We owe our front-line teachers nothing less!
POST 135. February 27, 2021. CORONAVIRUS. “As Chief Executive Officers of New York’s major health care systems, we would like to provide facts to clear up confusion in the public and the media regarding decisions to discharge patients to nursing homes during New York’s spring coronavirus surge.”
POST 136. March 2, 2021. CORONAVIRUS. ““The governors of Texas and Mississippi both announced on Tuesday they would be lifting their states’ mask mandates and rolling back many of their Covid-19 health mandates..”…while “The US could experience a “fourth surge” of coronavirus before the majority of the country is vaccinated.”
POST 137. March 4, 2021. CORONAVIRUS. “The clamor for hard-to-get Covid-19 vaccines has created armies of anxious Americans who have resorted to hunting for leftovers on the fringes of the country’s patchwork vaccination system. They haunt pharmacies at the end of the day in search of an extra, expiring dose. They drive from clinic to clinic hoping that someone was a no-show to their appointment. They cold-call pharmacies like eager telemarketers: Any extras today? Maybe tomorrow? Some pharmacists have even given them a nickname: vaccine lurkers.” (H)
POST 138. March 6, 2021. CORONAVIRUS. “New cases are decreasing in the third wave because we are past the holidays, not because of vaccinations. It is a common misconception that the decrease we are seeing in new cases, hospitalizations, and deaths in the U.S. is due to vaccinations. The two aren’t related; at least yet.”
POST 139. March 8, 2021. CORONAVIRUS. CDC Issues First Set of Guidelines on How Fully Vaccinated People Can Visit Safely with Others…” In practice, that means fully vaccinated grandparents may visit unvaccinated healthy adult children and healthy grandchildren of the same household without masks or physical distancing.” (C)
POST 140. March 9, 2021. CORONAVIRUS. “In West Virginia, they are bracing for the second wave….. Not coronavirus but opioid overdoses, with one scourge driving a resurgence of the other.
POST 141. March 11, 2021. CORONAVIRUS. Today is the first anniversary of the WHO declaration that the novel coronavirus was a Public Health Emergency of International Concern… “To truly prepare itself against the next pandemic, the U.S. has to reimagine what preparedness looks like.”
POST 142. March 15, 2021. CORONAVIRUS. “Candida auris is a superbug, a pathogen that can evade drugs made to kill it—and early signs suggest the COVID-19 pandemic may be propelling infections of the highly dangerous yeast. That’s because C. auris is particularly prominent in hospital settings, which have been flooded with people this year due to the coronavirus.”
POST 143. March 17, 2021. CORONAVIRUS. “The Trump administration sought to suppress Covid-19 testing in the United States last year by softening guidance from the Centers for Disease Control and Prevention on who needed to be tested, a House panel said Monday.”
POST 144. March 20, 2021. CORONAVIRUS. ““The vaccine hesitancy we are seeing isn’t just about Covid vaccines,”… “It is a general reflection of Americans’ lack of trust in science, the pharmaceutical industry, and large health care institutions. We need a full court press on science and vaccine education right now to prevent more aggressive Covid-19 variants from developing and taking hold.”
POST 145. March 25, 2021. CORONAVIRUS. “Efforts to disseminate Covid-19 vaccines as widely as possible are hitting an unexpected obstacle: health-care workers who decline the shots.
POST 146. March 30, 2021. CORONAVIRUS. Dr. Osterholm told Becker’s: “This is the perfect storm,”…”Here is Europe locking down and having problems containing B.1.1.7, even with vaccinations and previous infection histories. Here we are opening up as wide as we can. We are literally just walking into the mouth of the virus saying, ‘Don’t worry.'” (M)
POST 147. April 5, 2021. CORONAVIRUS. “The pandemic helped cement the shift to “a philosophy of really focusing on the role of the physician in reasoning through ambiguous and unknown problems as the focus of education, rather than teaching students that the role of physician was to memorize a body of knowledge that was already in existence and good enough for what usually happens.”
POST 148. April 7, 2021. CORONAVIRUS. While the Biden administration accelerates vaccinations to ward off numerous variants and as more young people are being hospitalized, states, even with increasing case rates are on paths to fully reopen. Politics v. public health!
POST 149. April 10, 2021. CORONAVIRIUS. “From Michigan to Massachusetts, COVID-19 cases and hospitalizations are on the rise again. Deaths will soon follow. “ ”.. the Biden administration is facing renewed calls to delay second vaccine doses and blanket more of the U.S. population with an initial shot.”
“Doctors are warning that specifically with the B.1.1.7 variant, which was first identified in the UK, children could play a major role in the rate of transmission.
A report out of the National Institutes of Health stated it is “considerably more contagious” than the original virus, with evidence showing an increased risk of severe illness and death.
“Please understand, this B.1.1.7 variant is a brand new ball game,” said Dr. Michael Osterholm, an epidemiologist.
Osterholm said this variant is making him re-evaluate his own advice about sending kids back to school. In Florida, thousands of students have been back in the classroom since last fall.
Nationally, more and more young people are being hospitalized as cases of this new variant rise. And Osterholm said, “kids now are really major challenges in terms of how they transmit.”
“It infects kids very readily. Unlike previous strains of the virus, we didn’t see children under 8th grade get infected often or they were not frequently very ill, they didn’t transmit to the rest of the community,” Osterholm said.” (A)
“Michigan reported 8,413 new Covid-19 cases on Saturday, bringing the state’s total pandemic case count to 692,206, according to the state’s health department.
Saturday’s daily case count is the highest the state has reported since December 7, when the reported case count was 9,350, state statistics show.
Just eight weeks ago, state data showed the daily reported case count was as low as 563 cases.
Michael Osterholm, director of the University of Minnesota Center for Infectious Disease Research and Policy, said the Upper Midwest is beginning to see its fourth surge.
“I think it was a wake-up call to everyone yesterday when Michigan reported out at 8,400 new cases, and we’re now seeing increasing number of severe illnesses, ICU hospitalizations, in individuals who are between 30 and 50 years of age who have not been vaccinated,” Osterholm said Sunday on NBC’s “Meet the Press.”
Osterholm said that over the past year, there have been surges of cases that cycle between US regions, starting in the Upper Midwest and Northeast, which then subside, and move to the southern sunbelt states, which then subside and go back to the original regions.
Michigan also reported 57 Covid-19 deaths Saturday, with 51 of the deaths having been identified during a vital records review that the state conducts three times per week, the health department said. The state has recorded 9,947 Covid-19 deaths since the pandemic began.
In the first three weeks of March, hospitalizations due to Covid-19 rose 633% for unvaccinated people between the ages of 30-39 and 800% for those aged 40-49, according to the Michigan Health and Hospital Association.
Dr. Justin Skrzynski, a Covid hospitalist for Beaumont Health in Royal Oak, Michigan, said a random sampling of the Covid-19 tests in the state that are sent for DNA analysis indicate a worrying sign — a sharp increase in the variant first found in the UK, which experts say may be more contagious and possibly more lethal.
More than 12,500 cases of the B.1.1.7 variant have been reported across the United States, according to CDC data, including more than 1,200 in Michigan.
Michigan had the second-highest number of cases of the variant, after Florida.
“Right now the regular Covid test we do still just shows Covid/no Covid. But we do send a lot of those out to the state, and we are seeing something like 40% of our patients now with B.1.1.7,” he told CNN’s Miguel Marquez.” (B)
“At an event for veterans in Chesterfield Township, (Michigan Governor) Whitmer said the surge is not a failure of policy, it’s a failure of following protocols. She reiterated that the state is moving as fast as it can to vaccinate people.
“If we see serious hospital numbers or increased variants, we may have to make some changes,” she said.
In an interview with 7 Action News, Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, said it’s “very likely” Michigan may have opened up too soon which could be causing the massive surge in COVID-19 cases.
Fauci said the pressure to pull back could be causing the spike.
“I think the idea of pulling back prematurely, under pressure, it’s understandable why you might want to do that, but the results, I think, are being manifested in what you’re seeing in Michigan,” he said.
“I hesitate to criticize anything the governor did because she’s really quite a good governor,” Fauci said.
In response, Whitmer said that while she respects Dr. Fauci, Michigan is not in the same position compared to other states that have dropped mask mandates.
“We’ve had a very strategic response to the virus,” she said. “Variants are here, and with that, increased abandonment of protocols and mobility.”
The state shut down in mid-November due to a surge, but reopened bars and restaurants in February to 25% capacity, then increased it to 50% on March 5.
The number of active cases in the state coincides with the surge in new cases. It went from 32,400 active cases on March 1 to 86,700 active cases on March 31, the highest number of active cases since early January.” (C)
“Michigan Gov. Gretchen Whitmer (D), battling a surge of coronavirus infections in her state, appealed on Tuesday to White House officials to shift away from a strict population-based formula for vaccine allocation and instead rush more doses to hard-hit parts of the country.
“I know that some national public health experts have suggested this as an effective mitigation tool,” she said during the White House coronavirus response team’s weekly call with governors, according to a recording of the conversation obtained by The Washington Post. “And I know we’d certainly welcome this approach in our state.”
The inquiry reflects growing unease among state officials on the front lines of what health experts say could be a new wave of the virus already afflicting parts of Europe. And it illustrates the pressure President Biden is under, even from members of his own party, to show he is taking steps to address disquieting trends after a prolonged period of declining infections.
The accelerating pace of inoculations has not been sufficient to fend off case increases as more-transmissible variants circulate in the United States, especially among young people who have fallen sick in outbreaks tied to schools. As of Monday, Michigan’s seven-day average of new daily cases stood at 5,157, a 58 percent increase from a week ago and the steepest increase nationwide, according to Post data. The state, where restrictions were recently relaxed, also reported the largest growth in that same time frame in coronavirus hospitalizations, which rose by more than 47 percent.
But Jeff Zients, the White House’s coronavirus coordinator, told Whitmer the Biden administration is not inclined to change its formula for allocating vaccines. The federal government sends all three authorized vaccines to states and other jurisdictions based on the size of their populations, while setting aside separate portions for retail pharmacies, federally run mass vaccination sites and community health centers…
As manufacturing continues to ramp up, some experts have suggested further changes to how vaccines are distributed.
Citing outbreaks in particular states such as Michigan, Scott Gottlieb, a former commissioner of the Food and Drug Administration, said over the weekend that the Biden administration should “surge vaccine into those parts of the country.”
With “the incremental vaccine that’s coming onto the market, I think the Biden administration can allocate to parts of the country that look hot right now,” he said on CBS News’s “Face the Nation.”
By diverting some of the expanded supply to hot spots, the government could avoid cutting any current allocations to states, he told The Post on Tuesday.
Arnold Monto, an epidemiologist at the University of Michigan and the chairman of the FDA’s vaccine advisory committee, said the government may also need to adjust its formula to reflect waning demand for the shots in some parts of the country while others face continued scarcity.
“I’m not sure what the solution is, but clearly there are some problems with distribution,” he said.
Data released this week by the Michigan Department of Health and Human Services shows hundreds of students and staff have been infected at schools throughout the state — with the most significant outbreak occurring among 36 students at Lake Superior State University in Sault Ste. Marie in Michigan’s Upper Peninsula.
Earlier this month, Whitmer loosened capacity limits for restaurants and other businesses, and eased restrictions on both indoor and outdoor gatherings. Joneigh Khaldun, the state’s chief medical executive, told reporters last week that there was no single metric officials were using to decide whether to reimpose restrictions.” (D)
“While vaccinations in Michigan are helping to protect senior citizens and other vulnerable people, the upswing is driving up hospitalizations among younger adults and forcing a halt to in-person instruction at some schools.
“It’s a stark reminder that this virus is still very real. It can come roaring back if we drop our guard,” said Democratic Gov. Gretchen Whitmer, who does not plan to tighten restrictions on indoor dining, sports and other activities that were eased in recent months….
“It’s very troublesome and very worrisome,” said Dr. Dawn Misra, an epidemiology and biostatistics professor at Michigan State University.
She cautioned that the trend should not be blamed solely on a variant that has been identified more in Michigan than in all but one other state, Florida, noting that lags and disparities in the amount of genetic analysis being done on the virus around the U.S. make comparisons difficult.
“We’re doing a lot of things that lead to increases in risk. That’s where it’s coming from,” said Misra, who urged health officials to emphasize strategies such as double-masking…
Michigan will soon require regular testing of all teen athletes amid outbreaks that occurred after a months long ban on contact sports was lifted. About 100 teams are sitting out the boys’ and girls’ state basketball tournaments.
And some schools are temporarily closing or delaying their long-anticipated reopenings.
The Lansing school district, which has 10,000 students, had planned to resume face-to-face learning for the first time next week, starting with grades four through six. But the reopening was pushed off to April 12, after spring break, because of rising virus cases in the community.
“We’re back to where we were right after Christmas with some of our numbers,” Superintendent Sam Sinicropi said Thursday. “I understand the importance of kids being there and staff being there. But we’re going to make the call because of what’s happening in our area.” (E)
“Michigan could reduce coronavirus deaths by 2,500 over the next three months by reenacting COVID-19 restrictions and doubling the current rate of vaccine administration for a two-week period, estimates a University of California researcher.
“With regard to the reopening pause, this might be possible by closing indoor dining, indoor bars and indoor gyms for two weeks,” wrote Joshua Schwab, a Berkeley biostatistician.
In an April 3 post, Schwab said his calculations estimated that enacting both strategies — tighter restrictions and faster pace of vaccine administration, each for two weeks — would reduce new hospital admissions by 23,000 and deaths by 2,500 from April 3 to July 1.
Just doubling vaccine administration would reduce hospital admissions by 10,000 and deaths by 1,200, Schwab wrote.
Restrictions on restaurants, bars and gyms would reduce hospital admissions by 16,000 and deaths by 1,700, he projected.
Without interventions, Schwab projects that COVID-19 hospitalizations will peak around May 1 at around 5,500 inpatients or more than 700 new inpatients a day.
That would exceed the previous peak of 4,300 during the first week of November. Michigan hospitals had more than 3,300 coronavirus inpatients on Monday, April 5.
In regards to deaths, Schwab estimates the state will have more than 20,000 coronavirus deaths by July 1 if no interventions are taken. The state has 16,239 confirmed coronavirus deaths as of Monday, April 5.” (F)
“In the race against COVID’s spread, a vaccine for adolescents might offer an opportunity to sprint toward herd immunity — especially as COVID cases surge among the youngest Michiganders.
In a little more than five weeks, cases involving Michigan residents 19 and younger jumped from 1,526 on Feb. 20 to 6,783 on March 27, a more than four-fold increase, according to state data. Michiganders 10 to 19 years old now make up nearly 16 percent of state COVID cases, up from 8.5 percent before January, the data shows.
It’s not just the more contagious B.1.17. variant that’s causing problems, experts told Bridge Michigan. Prep sports have resumed. And there’s some evidence teens and young adults are less likely to follow safety protocols such as mask-wearing and social distancing as those who feel more at risk, experts said.
“They don’t tend to get terribly sick, but the infection rates are going up in this population,” said Dr. Arnold Monto, an infectious disease expert at the University of Michigan and national authority on the coronavirus.
“I think the schools have done a great job” in ensuring students follow safety protocols, said Dr. Catherine Bodnar, medical director at Midland Health Department. The outbreaks, she said, are taking root “before and after school and even before and after practice.”..
To be sure, COVID has mostly spared Michigan’s youngest demographic from serious illness. Nearly 90 percent of its COVID-linked deaths are among those 60 and older, according to state data.
Though rare, however, COVID can cause life-threatening symptoms even among the young and healthy. At least 95 Michigan children with COVID infections were diagnosed with multisystem inflammatory syndrome, also known as MIS-C, according to state data. At least 33 children died nationally from MIS-C, according to the U.S. Centers for Disease Control & Prevention.
The condition can inflame heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs, and other parts of the body. Of the 95 who died, 65 were admitted to an intensive care unit, according to the same data.
“MIS-C is rare, that’s fair. But that’s not to say that it’s not a risk,” said Veronica McNally, founder of Michigan’s I Vaccinate campaign, which aims to increase vaccines among children, and a consumer representative to the CDC’s Advisory Committee for Immunization Practices, or ACIP.
More than 300 children have died nationally from COVID-19, according to the CDC.” (G)
“Many children and teenagers who developed the mysterious inflammatory syndrome that can emerge several weeks after contracting the coronavirus never had classic Covid-19 symptoms at the time of their infection, according to the largest study so far of cases in the United States.
The study, led by researchers from the Centers for Disease Control and Prevention, found that in over 1,000 cases in which information about whether they got sick from their initial Covid-19 illness was available, 75 percent of the patients did not experience such symptoms. But two to five weeks later, they became sick enough to be hospitalized for the condition, called Multisystem Inflammatory Syndrome in Children (MIS-C), which can affect multiple organs, especially the heart.
Published Tuesday in JAMA Pediatrics, the study said that “most MIS-C illnesses are believed to result from asymptomatic or mild Covid-19” followed by a hyper-inflammatory response that appears to occur when the patients’ bodies have produced their maximum level of antibodies to the virus. Experts do not yet know why some young people, and a smaller number of adults, respond this way.
“It means primary-care pediatricians need to have a high index of suspicion for this because Covid is so prevalent in the society and children often have asymptomatic disease as their initial Covid infection,” said Dr. Jennifer Blumenthal, a pediatric intensivist and pediatric infectious disease specialist at Boston Children’s Hospital, who was not involved in the study.” (H)
“California is aiming to fully reopen its economy June 15, more than a year after the COVID-19 pandemic upended the lives and businesses of millions across the state.
Officials emphasize the move hinges on two factors: a sufficient vaccine supply and stable and low hospitalization numbers.
There also will not be a full return to pre-pandemic life. Notably, California’s mask mandate will remain in place.
But officials expressed confidence that the state, through continued improvement in its coronavirus metrics and the steady rollout of vaccines, is now positioned to begin actively planning for what comes after COVID-19.
“With the expectation of an abundance of doses coming in from the federal government through the end of this month and into May, we can confidently say by June 15 that we can start to open up as business as usual — subject to ongoing mask wearing and ongoing vigilance,” Gov. Gavin Newsom said during a news conference in San Francisco on Tuesday.
“So this is a big day.”
Vaccinated and eager for normal life, Californians are venturing out. Is it too much too soon?
June 15 is expected to be the end of California’s current reopening roadmap, which sorts counties into one of four color-coded tiers based on three metrics: coronavirus case rates, adjusted based on the number of tests performed; the rate of positive test results; and a health-equity metric intended to ensure that the positive test rate in poorer communities is not significantly higher than the county’s overall figure.
“The entire state will move into this phase as a whole. This will not be county-by-county,” Dr. Mark Ghaly, California’s health and human services secretary, said in a call with reporters.
In a statement, officials said those sectors included in the state’s reopening blueprint will be allowed to “return to usual operations in compliance with Cal/OSHA requirements and with common-sense public health policies in place, such as required masking, testing and with vaccinations encouraged. Large-scale indoor events, such as conventions, will be allowed to occur with testing or vaccination verification requirements.”
Ghaly emphasized that, “if we see any concerning rise in our hospitalizations, we will take the necessary precautions. But right now, we are hopeful in what we’re seeing as we continue to build on the 20 million vaccines already administered.”
Though state officials said they will keep a watchful eye on vaccine supply and hospitalizations — including how many fully vaccinated people end up requiring that level of care — they did not establish any hard benchmarks to determine whether California is ready to progress.
“We don’t have a specific number, per se, on the hospitalizations, but are looking at impacts on hospital capacity and the delivery systems’ ability to continue to deliver routine care,” Ghaly said.
On Monday, 1,989 coronavirus-positive patients were hospitalized in California — with 493 of them in intensive care. The state hasn’t seen numbers that low since last spring.
Part of the reason June 15 was chosen as the target date, Ghaly said, was that it falls two months after the state will extend vaccine eligibility to anyone 16 and older.
“We wanted to be able to provide at least a couple of weeks, two to three weeks, for individuals interested in getting vaccinated who suddenly become eligible on April 15 to get in line to get their vaccines started,” he said.” (I)
“On NBC’s Meet the Press, Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, called the B.1.1.7 variant a “brand-new ballgame” because of how quickly it has spread among children, citing roughly 750 Minnesota schools that have reported the variant in just the last two weeks.
Osterholm also suggested the U.S. may need to consider new lockdowns before school lets out this summer, saying vaccination alone won’t curb rising cases in the next six to eight weeks and telling Fox News Sunday that “there isn’t a country in the world right now that has seen a big increase in this [variant] that is not locking down.”
“We’re going to have to reconsider what we’re doing,” Osterhold said, noting that the new variant is between 50% to 100% more infectious than previous strains and causes more severe illness about 55% of the time.
He also said experts are “very worried” that variants can evolve in a way that evades the protection of a vaccine and called for the U.S. to rev up its global response measures to vaccinate low- and middle-income countries in order to help curb the development of new strains that could challenge vaccine efficacy; so far, the World Health Organization has said the current slate of vaccines is expected to provide “at least some protection” against new strains….
“I think that there’s enough immunity in the population that you’re not going to see a true fourth wave of infection,” Scott Gottlieb, the former head of the Food and Drug Administration, said Sunday. Roughly 162 million vaccines have been administered domestically, and about 60 million Americans, or nearly 20% of the nation’s population, are fully vaccinated, according to the CDC.” (J)
PART 1. January 21, 2020. CORONAVIRUS. “The Centers for Disease Control and Prevention on Tuesday confirmed the first U.S. case of a deadly new coronavirus that has killed six people in China.”
PART 2. January 29, 2020. CORONAVIRUS. “If it’s not contained shortly, I think we are looking at a pandemic..”….. “With isolated cases of the dangerous new coronavirus cropping up in a number of states, public health officials say it is only a matter of time before the virus appears in New York City.”
PART3. February 3, 2020. “The Wuhan coronavirus spreading from China is now likely to become a pandemic that circles the globe…”..Trump appeared to downplay concerns about the flu-like virus …We’re gonna see what happens, but we did shut it down..” (D)
PART 4. February 9, 2020. Coronavirus. “A study published Friday in JAMA found that 41% of the first 138 patients diagnosed at one hospital in Wuhan, China, were presumed to be infected in that hospital.….
PART 5. February 12, 2020. CORONAVIRUS. “In short, shoe-leather public health and basic medical care—not miracle drugs—are generally what stop outbreaks of emerging infections..”
POST 6. February 18, 2020. Coronovirus. “Amid assurances that the (ocean liner) Westerdam was disease free, hundreds of people disembarked in Cambodia…” “ One was later found to be infected”…. “Over 1,000… passengers were in…transit home”…. “This could be a turning point””
PART 7. February 20, 2020. CORONAVIRUS. With SARS preparedness underway in NJ LibertyHealth/ Jersey City Medical Center, where I was President, proposed that our 100 bed community hospital with all single-bedded rooms, be immediately transformed into an EMERGENCY SARS ISOLATION Hospital.
PART 8. February 24, 2020. CORONAVIRUS. “…every country’s top priority should be to protect its health care workers. This is partly to ensure that hospitals themselves do not become sites where the coronavirus is spread more than it is contained.”
PART 9. February 27, 2020. CORONAVIRUS. Responding to a question about the likelihood of a U.S. outbreak, President Trump said, “I don’t think it’s inevitable…”It probably will. It possibly will,” he continued. “It could be at a very small level, or it could be at a larger level.”
Part 10. March 1, 2020. CORONAVIRUS. Stop Surprise Medical Bills for Coronavirus care. (&) Lessons Learned (or not) In California and Washington State from community acquired cases.
PART 11. March 5, 2020. CORONAVIRUS. “Gov. Andrew Cuomo… would require employers to pay workers and protect their jobs if they are quarantined because of the coronavirus.”
Part 12. March 10, 2020. CORONAVIRUS. “Tom Bossert, Donald Trump’s former homeland security advisor…(said) that due to the coronavirus outbreak, “We are 10 days from the hospitals getting creamed.”
Part 13.. March 14, 2020. CORONAVIRUS. “If I’m buying real estate in New York, I’ll listen to the President….If I’m asking about infectious diseases, I’m going to listen to Tony Fauci,”
PART 14. March 17, 2020. CORONAVIRUS. “ “Most physicians have never seen this level of angst and anxiety in their careers”…. One said “I am sort of a pariah in my family.”
PART 15. March 22, 2020. CORONAVIRUS. “…Crimson Contagion” and imagining an influenza pandemic, was simulated by the Trump administration….in a series of exercises that ran from last January to August.
PART 16. March 27, 2020. CORONAVIRUS. I am not a clinician or a medical ethicist but articles on Coronavirus patient triage started me Googling………to learn about FUTILE TREATMENT
PART 17. April 2, 2020. CORONAVIRUS. Florida allows churches to continue holding services. Gun stores deemed “essential.” “New York’s private and public hospitals unite to manage patient load and share resources.
PART 18. April 9, 2020. CORONAVIRUS. “The federal government’s emergency stockpile of personal protective equipment (PPE) is depleted, and states will not be receiving any more shipments, administration staff told a House panel.
PART 19. April 13, 2020 CORONOAVIRUS. “…overlooked in the United States’ halting mobilization against the novel coronavirus: the personal aides, hospice attendants, nurses and occupational or physical therapists who deliver medical or support services to patients in their homes.”
POST 22. April 29, 2020. CORONAVIRUS. ..the “ACS released a list of 10 issues that should be addressed before a healthcare organization resumes elective surgeries[JM1] ….”
POST 23. May 3, 2020. CORONAVIRUS. … what Dr. Fauci really wants,…”is just to go to a baseball game. That will have to wait. The level of testing for the virus is not adequate enough to allow for such mass gatherings.’ (K)
POST 24. May 7, 2020. CORONAVIRUS. Former New Jersey governor Chris Christie said: “there are going to be deaths no matter what”… but that people needed to get back to work.
POST 25. May 10, 2020, CORONAVIRUS. “It is scary to go to work,” said Kevin Hassett, a top economic adviser to the president. “I think that I’d be a lot safer if I was sitting at home than I would be going to the West Wing.”
POST 26. May 14, 2020. CORONAVIRUS, “Deep cleaning is not a scientific concept”….”there is no universal protocol for a “deep clean” to eradicate the coronavirus”
POST 27. May 19, 2020. CORONAVIRUS. “Hospital…executives…are taking pay cuts…to help offset the financial fallout from COVID-19.” As “front line” layoffs and furloughs accelerate…
POST 28. May 23, 2020. CORONAVIRUS. ““You’ve got to be kidding me,”..”How could the CDC make that mistake? This is a mess.” CDC conflates viral and antibody tests numbers.
PART 29. May 22, 2020. CORONAVIRUS. “The economy did not close down. It closed down for people who, frankly, had the luxury of staying home,” (Governor Cuomo). But not so for frontline workers!
POST 30. June 3,202. CORONAVIRUS. “The wave of mass protests across the United States will almost certainly set off new chains of infection for the novel coronavirus, experts say….
Post 32. June 16, 2020. CORONAVIRUS. Could the Trump administration be pursuing herd immunity by “inaction”? “ If Fauci didn’t exist, we’d have to invent him.”
POST 34. June 26, 2020. CORONAVIRUS. CDC Director Redfield… “the number of coronavirus infections…could be 10 times higher than the confirmed case count — a total of more than 20 million.” As Florida, Texas and Arizona become eipicenters!
POST 35. June 29, 2020. CORONAVIRUS. Pence: “We slowed the spread. We flattened the curve. We saved lives..” While Dr. Fauci “warned that outbreaks in the South and West could engulf the country…”
POST 36. July 2, 2020. CORONAVIRUS. “There’s just a handful of interventions proven to curb the spread of the coronavirus. One of them is contact tracing, and “it’s not going well,” (Dr. Anthony Fauci)..
POST 37. June 8, 2020. CORONAVIRUS. When “crews arrive at a hospital with a patient suspected of having COVID-19, the hospital may have a physical bed open for them, but not enough nurses or doctors to staff it.”
POST 38. July 15, 2020. CORONAVIRUS. Some Lessons Learned, or not. AdventHealth CEO Terry Shaw: I wouldn’t hesitate to go to Disney as a healthcare CEO — based on the fact that they’re working extremely hard to keep people safe,” (M)
POST 39. July, 23,2020. CORONAVIRUS. A Tale of Two Cities. Seattle becomes New York (rolls back reopening) while New York becomes Seattle (moves to partial phase 4 reopening)
POST 40. July 27, 2020. CORONAVIRUS.” One canon of medical practice is that you order a test only if you can act on the result. And with a turnaround time of a week or two, you cannot. What we have now is often not testing — it’s testing theater.”
POST 41. August 2, 2020. CORONAVIRUS. “Whenever a vaccine for the coronavirus becomes available, one thing is virtually certain: There won’t be enough to go around. That means there will be rationing.”
POST 44. September 1, 2020. CORONAVIRUS. “The CDC…modified its coronavirus testing guidelines…to exclude people who do not have symptoms of Covid-19.” (While Dr. Fauci was undergoing surgery.) A White House official said: “Everybody is going to catch this thing eventually..”
POST 45. September 9, 2020. CORONAVIRUS. Trump on Fauci. ‘You inherit a lot of people, and you have some you love, some you don’t. I like him. I don’t agree with him that often but I like him.’
POST 46. September 17, 2020. CORONAVIRUS. “Bill Gates used to think of the US Food and Drug Administration as the world’s premier public-health authority. Not anymore. And he doesn’t trust the Centers for Disease Control and Protection either….”
POST 47. September 24, 2020. CORONAVIRUS. “Perry N. Halkitis, dean of the School of Public Health at Rutgers University…called New York City’s 35 percent rate for eliciting contacts “very bad.” “For each person, you should be in touch with 75 percent of their contacts within a day,” he said”
POST 48. October 1, 2020. “…you can actually control the outbreak if you do the nonpharmaceutical interventions (social distancing and masks). In the United States we haven’t done them. We haven’t adhered to them; we’ve played with them.” (A)
POST 49. October 4, 2020. CORONAVIRUS. RAPID RESPONSE. “The possibility that the president and his White House entourage were traveling superspreaders is a nightmare scenario for officials in Minnesota, Ohio, New Jersey and Pennsylvania…”
POST 50. October 6, 2020. CORONAVIRUS. Monday October 5th will go down as one of the most fraught chapters in the history of American public Health (and national security).
POST 51. October 12, 2020. Rather than a hodge-podge of Emergency Use Authorizations, off-label “experimentation”, right-to-try arguments, and “politicized” compassionate use approvals maybe we need to designate REGIONAL EMERGING VIRUSES REFERRAL CENTERS (REVRCs).
POST 52. October 18, 2020. ZIKA/ EBOLA/ CANDIDA AURIS/ SEVERE FLU/ Tracking. “… if there was a severe flu pandemic, more than 33 million people could be killed across the world in 250 days… Boy, do we not have our act together.” —”- Bill Gates. July 1, 2018
POST 54. October 22, 2020. CORONAVIRUS. POST 54A. New Jersey’s Coronavirus response, led by Governor Murphy and Commissioner of Health Persichilli started with accelerated A+ traditional, evidence-based Public Health practices, developed over years of experience with seasonal flu, swine flu, Zika, and Ebola.
POST 55. October 26, 2020. CORONAVIRUS. The Testing Conundrum: “ It’s thus very possible to be antigen negative but P.C.R. positive, while still harboring the virus in the body..”
POST 57. November 3, 2020. CORONAVIRUS. Dr. Deborah Birx: the US is entering its “most deadly phase” yet, one that requires “much more aggressive action,”
POST 58. November 4, 2020. CORONAVIRUS. “…the president has largely shuttered the White House Coronavirus Task Force and doubled down on anti-science language…”
POST 59. November 5, 2020. Coronavirus. “The United States on Wednesday recorded over 100,000 new coronavirus cases in a single day for the first time since the pandemic began..
POST 61. November 7, 2020. CORONAVIRUS. “Joe Biden’s top priority entering the White House is fighting both the immediate coronavirus crisis and its complex long-term aftermath…” “Here are the key ways he plans to get US coronavirus cases under control.”
POST 62. November 8, 2020. CORONAVIRUS. “The United States reported its 10 millionth coronavirus case on Sunday, with the latest million added in just 10 days,…”
POST 63. November 9, 2020. CORONAVIRUS. “New York City-based Mount Sinai Health System has opened a center to help patients recovering from COVID-19 and to study the long-term impact of the disease….”
POST 64. November 10, 2020. CORONAVIRUS. “It works! Scientists have greeted with cautious optimism a press release declaring positive interim results from a coronavirus vaccine phase III trial — the first to report on the final round of human testing.”
POST 65. November 11, 2020. CORONAVIRUS, “The Centers for Disease Control and Prevention took a stronger stance in favor of masks on Tuesday, emphasizing that they protect the people wearing them, rather than just those around them…
POST 66. November.12, 2020. CORONAVIRUS.”… as the country enters what may be the most intense stage of the pandemic yet, the Trump administration remains largely disengaged.”… “President-elect Biden has formed a special transition team dedicated to coordinating the coronavirus response across the government…”
POST 67. November 13, 2020. CORONAVIRUS. “When all other options are exhausted, the CDC website says, workers who are suspected or confirmed to have COVID-19 (and “who are well enough to work”) can care for patients who are not severely immunocompromised — first for those who are also confirmed to have COVID-19, then those with suspected cases.”
POST 68. November 14, 2020. CORONAVIRUS. The CDC “now is hewing more closely to scientific evidence, often contradicting the positions of the Trump administration.”..” “A passenger aboard the first cruise ship to set sail in the Caribbean since the start of the pandemic has tested positive for coronavirus..”
POST 69. November 15, 2020. CORONAVIRUS. “Colorado Gov. Jared Polis will issue a new executive order outlining steps hospitals will need to take to ready themselves for a surge in COVID-19 hospitalizations and directing the hospitals to finalize plans for converting beds into ICU beds, adding staffing and scaling back on or eliminating elective procedures….
POST 70. November 16, 2020. CORONAVIRUS. “White House coronavirus task force member Dr. Atlas criticized Michigan’s new Covid-19 restrictions..urging people to “rise up” against the new public health measures.
POST 71. November 17, 2020. CORONAVIRUS. ”Hospitals overrun as U.S. reports 1 million new coronavirus cases in a week.” “But in Florida, where the number of coronavirus infections remains the third-highest in the nation, bars and schools remain open and restaurants continue to operate at full capacity.”
POST 72. November 18, 2020. CORONAVIRUS. “The Health and Human Services Department will not work with President-elect Joe Biden’s (PANDEMIC) team until the General Services Administration makes a determination that he won the election,….”
POST 73. November 19, 2020. CORONAVIRUS. “…officials at the CDC…urged Americans to avoid travel for Thanksgiving and to celebrate only with members of their immediate households…” When will I trust a vaccine? to the last question I always answer: When I see Tony Fauci take one….”
POST 74. November 20, 2020. CORONAVIRUS. Pfizer…submitted to the FDA for emergency use authorization for their coronavirus vaccine candidate. —FDA issued an EUA for the drug baricitinib, in combination with remdesivir, as WHO says remdesivir doesn’t do much of anything.
POST 75. November 21, 2020. CORONAVIRUS. “The president and CEO of one of the nation’s largest non-profit health systems says he won’t be wearing a mask at work because he’s recovered from COVID-19, and doing so would only be a “symbolic gesture” because he considers himself immune from the virus….
POST 76. November 23, 2020. CORONAVIRUS. “No battle plan survives contact with the enemy.” Ventilators..”just keep people alive while the people caring for them can figure out what’s wrong and fix the problem. And at the moment, we just don’t have enough of those people.”
POST 77. November 26, 2020. CORONAVIRUS. Pope Francis: “When I got really sick at the age of 21, I had my first experience of limit, of pain and loneliness.”.. “….Aug. 13, 1957. I got taken to a hospital…”….” I remember especially two nurses from this time.”…” They fought for me to the end, until my eventual recovery.”
POST 78. November 27, 2020. CORONAVIRUS. “Kelby Krabbenhoft is no longer president and CEO of Sioux Falls, S.D.-based Sanford Health.” “…for not wearing a face covering… “ because “He considered himself immune from the virus.”
POST 79. November 28, 2020. CORONAVIRUS. Mayo Clinic. “”Our surge plan expands into the garage…”..””Not where I’d want to put my grandfather or my grandmother,” … though it “may have to happen.”
POST 81. December 1, 2020. CORONAVIRUS. “Dr. Atlas, … who espoused controversial theories and rankled government scientists while advising President Trump on the coronavirus pandemic, resigned…”
POST 82. December 3, 2020. CORONAVIRIUS. The NBA jumped to the front of the line for Coronavirus testing….while front line nurses often are still waiting. Who will similarly “hijack” the vaccine?
POST 83. December 4, 2020. CORONAVIRUS. “California Gov. Gavin Newsom says he will impose a new, regional stay-at-home order for areas where capacity at intensive care units falls below 15%.”… East Tennessee –“This is the first time the health care capability benchmark has been in the red..”
POST 84. December 6, 2020. CPRONAVIRUS. “ More than 100,000 Americans are in the hospital with COVID-19…” “We’re seeing C.D.C. …awaken from (its) politics-induced coma…”…Dr. Fauci “to be a chief medical adviser in Biden’s incoming administration..”.. “Trump administration leaves states to grapple with how to distribute scarce vaccines..”
POST 85. December 7, 2020. CORONAVIRUS. “…Florida, Gov. DeSantis’ administration engaged in a pattern of spin and concealment that misled the public on the gravest health threat the state has ever faced..”.. “NY Gov. Cuomo said…the state will implement a barrage of new emergency actions..”… Rhode Island and Massachusetts open field hospitals… “Biden Names Health Team to Fight Pandemic”
POST 86. December 9, 2020. If this analysis seems a bit incomprehensible it is because “free Coronavirus test” is often an oxymoron! with charges ranging from as little as $23 to as much as $2,315… Laws (like for free Coronavirus tests) are Like Sausages. Better Not to See Them Being Made. (Please allow about 20 seconds for the text to download. Thanx!)
POST 87. December 10, 2020. CORONAVIRUS. “…Rudolph W. Giuliani, the latest member of President Trump’s inner circle to contract Covid-19, has acknowledged that he received at least two of the same drugs the president received. He even conceded that his “celebrity” status had given him access to care that others did not have.”
POST 88. December 11, 2020. CORONAVIRUS. “As COVID-19 cases surge, the federal government is releasing data about hospital capacity at facilities around the country….”The new data paints the picture of how a specific hospital is experiencing the pandemic,”…
PART 89. December 12, 2020. CORONAVIRUS. THE VACCINE!!! “Now this is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning.” Winston Churchill
POST 90. December 14, 2020. CORONAVIRUS. “…the first doses of a Covid-19 vaccine have been given to the American public..”…” Each person who receives a vaccine needs two doses, and it’s up to states to allocate their share of vaccines.”
POST 91. December 15, 2020. CORONAVIRUS. “UPMC will first give (vaccination) priority to those in critical jobs. That includes a range of people working in critical units, from workers cleaning the emergency room and registering patients to doctors and nurses.. “Finally, if needed, UPMC will use a lottery to select who will be scheduled first.”
POST 92. December 17, 2020. CORONAVIRUS. “..each state — and each hospital system — has come up with its own (vaccination) plan and priorities. The result has been a sometimes confusing constellation of rules and groupings that has left health care workers wondering where they stand.” (Trump appointee July 4th email “…we need to establish herd, and it only comes about allowing the non-high risk groups expose themselves to the virus. PERIOD,”)
POST 93. December 19, 2020. CORONAVIRUS. On NPR Congresswoman Shalala (D-Florida) said she wouldn’t jump the vaccination line in Miami; then added she would get vaccinated in Washington this week. This, even though Congress has failed to pass “essential” Coronavirus legislation. So who are our “essential” workers?
POST 94. December 21, 2020. CORONAVIRUS. “A doctor at an L.A. County public hospital said the number of COVID-19 patients is “increasing exponentially, without an end in sight.”.. “I haven’t done ICU medicine since I was a resident — you don’t want me adjusting your ventilator,” he said. “That’s the challenge, actually — it isn’t so much space, it’s staff…”
POST 96. December 26, 2020. CORONAVIRUS. “Achieving herd immunity against the coronavirus could require as much as 90 percent of the population to be vaccinated, Anthony Fauci…”…”..he hesitated to state a number as high as 90% weeks ago because many Americans still seemed skeptical about vaccine….”
POST 97. December 27, 2020. “A new variant of the coronavirus that has been spreading through the UK and other countries has not yet been detected in the United States..”.. . But if new-wave medicines like antivirals and antibody therapy contributed to the development of viral variants, it will be “a reminder for all the medical community that we need to use these treatment options carefully.”
POST 99. December 29, 2020. CORONAVIRUS. “ICUs are being overwhelmed across many parts of California. Statewide aggregate ICU availability has been at 0% since Christmas Eve…. a surge on top of a surge on top of a surge.”… “hospitals are getting close to the point where they would begin putting COVID-positive patients under the care of COVID-positive staff who are asymptomatic.”
POST 100. December 29, 2020. CORONAVIRUS. Front line hospital workers – in the ER, ICUs, EMS, acute medical care, behavioral health – are amongst the most courageous, heroic and dedicated colleagues you will ever meet.
POST 101. December 30, 2020.CORONAVIRUS. Is there a point where the increasing Coronavirus trajectory so far exceeds the slow growth of the vaccination rate that reaching herd immunity through vaccinations becomes less likely?
POST 102. January 2, 2020. CORONAVIRUS. “We’ve taken the people with the least amount of resources and capacity and asked them to do the hardest part of the vaccination — which is actually getting the vaccines administered into people’s arms,” said Dr. Ashish Jha, the dean of Brown University’s School of Public Health. “Ultimately, the buck seems to stop with no one,”…
POST 103. January 4, 2021. CORONAVIRUS. Dr. Fauci said “that the United States would not follow Britain’s lead in front-loading first vaccine injections, potentially delaying the administration of second doses…Dr. Moore – ”British officials “seem to have abandoned science completely now and are just trying to guess their way out of a mess.”
POST 104. January 6, 2021. CORONAVIRUS. “Paramedics in Southern California are being told to conserve oxygen and not to bring patients to the hospital who have little chance of survival…”
POST 105. January 8, 2021. CORONAVIRUS. POST 105. January 8, 2021. CORONAVIRUS. “Facing a shortage of vaccinators, the Association of Immunization Managers… recommends relaxing regulation or adjusting licensing requirements. At least two states, Massachusetts and New York, have changed their laws in recent weeks to expand those who are eligible to give shots.”
POST 106. January 9, 2021. CORONAVIRUS. The riots at the Capitol could have been a superspreader event. “From what I saw… you had a large congregation of individuals who were in close contact for an extended period of time and almost universally unmasked…. many coming and going on buses as well, also unmasked, and hanging out in hotel lobbies.”
POST 107. January 8, 2021. CORONAVIRUS. “Our job is to make sure the vaccine isn’t politicized the way masks were politicized,” Rep. Alexandria Ocasio-Cortez, D-N.Y., said after getting her vaccine. South Carolina Rep.-elect Nancy Mace, a Republican, wrote that “Congress shouldn’t be putting themselves first in line for the COVID-19 vaccination when the average American can’t get it.”
POST 108. January 9, 2021. CORONAVIRUS. (vaccination)”Line-cutters will be named and shamed. It’s inevitable, as will be the congressional hearings and front-page investigative stories ferreting out who saved their own skin at the expense of others.”
POST 109.January 9, 2021. CORONAVIRUS. “President-elect Joe Biden will aim to release nearly every available dose of the coronavirus vaccine when he takes office, a break with the Trump administration’s strategy of holding back half of US vaccine production to ensure second doses are available.
POST 110. January 13, 2021. CORONAVIRUS. ““The (federal) government is changing the way it allocates Covid vaccine doses, now basing it on how quickly states can administer shots and the size of their elderly population.”… “New York State sent a letter to hospitals saying if they don’t use their vaccine allocations by the end of this week, they won’t receive any further allocations.”
POST 111. January 14, 2021. CORONAVIRUS. “Visitors from Toronto to New York to Buenos Aires have long flocked to Florida for sun, surf and shopping. Now they are coming for the Covid-19 vaccine….
POST 112. January 14, 2021. CORONAVIRUS. CHINA – “Eleven million people are under lockdown in Hebei province after a new cluster of coronavirus infections.
PART 113. January 17, 2021. CORONAVIRUS. The Next President Actually Has a Covid Plan… New York City and other places in the state expect to exhaust their supply of doses as early as next week… Charles Barkley said during the “NBA on TNT” broadcast that pro athletes should get the first round of the vaccine…..
POST 114. January 18, 2021. CORONAVIRUS. “When government programs that have been unattended, underfunded and bogged down by red tape suddenly have to meet a huge demand in a crisis, they can’t cope and people suffer….”
POST 115. January 21, 2020. CORONAVIRUS. A year ago today an unnumbered POST was headlined “The Centers for Disease Control and Prevention on Tuesday confirmed the first U.S. case of a deadly new coronavirus that has killed six people in China.” The CORONAVIRUS CONTENT TRACKING PROJECT started with HISTORIOGRAPHY and over time moved to LESSONS LEARNED, RAPID RESPONSE, and THE VACCINATION PROGRAM. Now 115 POSTS later – the BIDEN CORONAVIRUS PLAN.
POST 116. January 22, 2021. President Biden – “We’re entering what may be the toughest and deadliest period of the virus. We must set aside politics and finally face this pandemic as one nation.”
POST 117. January 23, 2021. CORONAVIRUS. 1.Dr. Fauci:“The idea that you can get up here….”and.. let the science speak”… “It is somewhat of a liberating feeling.” 2.updated CDC guidance:”.. providers could give the second dose up to six weeks after the first dose..” 3.Dr. Fauci: people would be “taking a chance” if they follow the CDC’s updated guidance.
POST 118. January 24, 2021. CORONAVIRUS. “Unfortunately, we’ve let this virus spread extensively and are launching the vaccination campaign at the height of the threat,” Dr. Meyers said. “The more the virus spreads before the vaccine reaches people, the fewer deaths we can prevent with the vaccine.”
POST 119. January 27, 2010. CORONAVIRUS. Amazon is offering its help to President Joe Biden with the rollout of COVID-19 vaccines. Washington’s governor, Jay Inslee, included the help of companies like Starbucks, Costco and Microsoft in a plan to vaccinate 45,000 residents a day.
POST 120. January 28, 2021. CORONAVIRUS. “The fact that four vaccines backed by the federal government seem to be less effective against the (South African) B.1.351 variant has unsettled federal officials and vaccine experts alike. Facing this uncertainty, many researchers said it was imperative to get as many people vaccinated as possible — quickly. Lowering the rate of infection could thwart the contagious variants while they are still rare, and prevent other viruses from gaining new mutations that could cause more trouble.”
POST 121. January 30, 2021. CORONVIRUS. Will our communities become stratified by which vaccine is distributed? 95%ters v. 72%ters? Will the easier distribution of the J&J vaccine drive its inequitable distribution to” hard-hit, marginalized, and medically underserved communities.” (thanx! to XJ/LA)
POST 123. February 4, 2021. CORONAVIRUS. “Nursing homes across the country are facing the same struggle, as workers have been more reluctant than residents to be vaccinated…
POST 124. February 5, 2021. CORONAVIRUS. Dr. Osterholm ” …it may be time to..go with a ‘first-dose only’ approach, so more people over the age of 65 can have at least some protection right away. He said that would require delaying second doses until this summer.” Dr.Fauci “warned against this practice, and cautioned people about “the danger” that could come with focusing only on the first dose.”
POST 125. June 9, 2021. CORONAVIRUS. “States are rolling back Covid-19 restrictions as new cases trend down from record highs across the country. But experts warn it might be too much too soon as variants pose an increased risk and the pandemic… is far from over.”
POST 126. February 11, 2021. CORONAVIRUS. “There will be more coronavirus outbreaks in the future. Bats and other mammals are rife with strains and species of this abundant family of viruses. Some of these pathogens will inevitably spill over the species barrier and cause new pandemics. It’s only a matter of time.” (A)
POST 127. February 12, 2021. CORONAVIRUS. “… Trump only agreed to be hospitalized when aides told him that he could walk to Marine One or he could wait until his case progressed and he would be carried out.”
POST 128. February 14, 2021. CORONAVIRUS. “The Centers for Disease Control and Prevention released new research on Wednesday that found wearing a cloth mask over a surgical mask offers more protection against the coronavirus, as does tying knots on the ear loops of surgical masks…
POST 129. February 15, 2021, CORONAVIRUS. “ “The CDC released its much-anticipated, updated guidance to help school leaders decide how to safely bring students back into classrooms, or keep them there.”…” For politicians, parents and school leaders looking for a clear green light to reopen schools, this is not it.”
POST 130. February 16, 2021. CORONAVIRUS. “A second person who had contracted the Ebola virus died this week in the Democratic Republic of Congo, marking another outbreak just three months after the nation outlasted the virus’s second-worst outbreak in history…”
POST 131. February 17, 2021. CORONAVIRUS. “It really is right now – a race between how quickly new variants, particularly the U.K. variant, can spread in the United States and how quickly we can get people vaccinated”
POST 132. February 20, 2021. CORONAVIRUS. “In Texas, where over 2.5 million people are still without power, the state health department said this week’s vaccine shipments wouldn’t arrive until Wednesday at the earliest.”
POST 133. February 23, 2021. CORONAVIRUS. “Going off your meds is a surefire way to aggravate your doctor. What if a whole country did it?” The United Kingdom has veered into uncharted territory by changing tack and introducing a revised COVID-19 vaccination protocol, one that involves distributing the second dose at 12 weeks, rather than the prescribed 21 days.”
POST 134. February 24, 2021. CORONAVIRUS. The first tranche of the J&J (single dose) vaccine must go to K-12 teachers, so schools can open safely in the first 100 days of the Biden Administration. The federal government…”can set up its own vaccination centers in regions with eligible populations it’s trying to target.” We owe our front-line teachers nothing less!
POST 135. February 27, 2021. CORONAVIRUS. “As Chief Executive Officers of New York’s major health care systems, we would like to provide facts to clear up confusion in the public and the media regarding decisions to discharge patients to nursing homes during New York’s spring coronavirus surge.”
POST 136. March 2, 2021. CORONAVIRUS. ““The governors of Texas and Mississippi both announced on Tuesday they would be lifting their states’ mask mandates and rolling back many of their Covid-19 health mandates..”…while “The US could experience a “fourth surge” of coronavirus before the majority of the country is vaccinated.”
POST 137. March 4, 2021. CORONAVIRUS. “The clamor for hard-to-get Covid-19 vaccines has created armies of anxious Americans who have resorted to hunting for leftovers on the fringes of the country’s patchwork vaccination system. They haunt pharmacies at the end of the day in search of an extra, expiring dose. They drive from clinic to clinic hoping that someone was a no-show to their appointment. They cold-call pharmacies like eager telemarketers: Any extras today? Maybe tomorrow? Some pharmacists have even given them a nickname: vaccine lurkers.” (H)
POST 138. March 6, 2021. CORONAVIRUS. “New cases are decreasing in the third wave because we are past the holidays, not because of vaccinations. It is a common misconception that the decrease we are seeing in new cases, hospitalizations, and deaths in the U.S. is due to vaccinations. The two aren’t related; at least yet.”
POST 139. March 8, 2021. CORONAVIRUS. CDC Issues First Set of Guidelines on How Fully Vaccinated People Can Visit Safely with Others…” In practice, that means fully vaccinated grandparents may visit unvaccinated healthy adult children and healthy grandchildren of the same household without masks or physical distancing.” (C)
POST 140. March 9, 2021. CORONAVIRUS. “In West Virginia, they are bracing for the second wave….. Not coronavirus but opioid overdoses, with one scourge driving a resurgence of the other.
POST 141. March 11, 2021. CORONAVIRUS. Today is the first anniversary of the WHO declaration that the novel coronavirus was a Public Health Emergency of International Concern… “To truly prepare itself against the next pandemic, the U.S. has to reimagine what preparedness looks like.”
POST 142. March 15, 2021. CORONAVIRUS. “Candida auris is a superbug, a pathogen that can evade drugs made to kill it—and early signs suggest the COVID-19 pandemic may be propelling infections of the highly dangerous yeast. That’s because C. auris is particularly prominent in hospital settings, which have been flooded with people this year due to the coronavirus.”
POST 143. March 17, 2021. CORONAVIRUS. “The Trump administration sought to suppress Covid-19 testing in the United States last year by softening guidance from the Centers for Disease Control and Prevention on who needed to be tested, a House panel said Monday.”
POST 144. March 20, 2021. CORONAVIRUS. ““The vaccine hesitancy we are seeing isn’t just about Covid vaccines,”… “It is a general reflection of Americans’ lack of trust in science, the pharmaceutical industry, and large health care institutions. We need a full court press on science and vaccine education right now to prevent more aggressive Covid-19 variants from developing and taking hold.”
POST 145. March 25, 2021. CORONAVIRUS. “Efforts to disseminate Covid-19 vaccines as widely as possible are hitting an unexpected obstacle: health-care workers who decline the shots.
POST 146. March 30, 2021. CORONAVIRUS. Dr. Osterholm told Becker’s: “This is the perfect storm,”…”Here is Europe locking down and having problems containing B.1.1.7, even with vaccinations and previous infection histories. Here we are opening up as wide as we can. We are literally just walking into the mouth of the virus saying, ‘Don’t worry.'” (M)
POST 147. April 5, 2021. CORONAVIRUS. “The pandemic helped cement the shift to “a philosophy of really focusing on the role of the physician in reasoning through ambiguous and unknown problems as the focus of education, rather than teaching students that the role of physician was to memorize a body of knowledge that was already in existence and good enough for what usually happens.”
POST 148. April 7, 2021. CORONAVIRUS. While the Biden administration accelerates vaccinations to ward off numerous variants and as more young people are being hospitalized, states, even with increasing case rates are on paths to fully reopen. Politics v. public health!
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“Jerrel Catlett’s eyes narrowed on the large intestine, a gloppy, glow stick-like object whose color matched the stool stored inside of it. He chose to isolate the organ, and it expanded on his screen as the body parts surrounding it receded — the gall bladder bright green with bile, the ribs white and curved like half moons.
“My old boss used to tell me that when I did this, I’d be so wowed by how complex the human body is,” said Mr. Catlett, 25, a first-year student at Icahn School of Medicine at Mount Sinai, gesturing to the image of a body on his laptop screen. “But it feels like there’s something missing from the experience right now.”
For generations, medical students were initiated to their training by a ritual as gory as it was awe-inducing: the cadaver dissection. Since at least the 14th century, physicians have honed their understanding of human anatomy by examining dead bodies. But amid the coronavirus pandemic, the cadaver dissection — like many hands-on aspects of the medical curriculum — turned virtual, using a three-dimensional simulation software.
Of the country’s 155 medical schools, a majority transitioned at least part of their first and second-year curriculums to remote learning during the pandemic. Nearly three-quarters offered lectures virtually, according to a survey by the Association of American Medical Colleges, and 40 percent used virtual platforms to teach students how to interview patients about their symptoms and take their medical histories. Though the cadaver dissection posed a trickier challenge, nearly 30 percent of medical schools, including Mount Sinai, used online platforms to teach anatomy.
Though medical students in many states have been eligible for and able to receive the vaccines, some have not yet fully shifted back to in-person learning, with school administrators saying they preferred to wait until Covid case rates decline further. Some in-person training, like practicing clinical skills, has largely resumed.” (A)
“In terms of the potential impact of postponing rotations, the Liaison Committee on Medical Education (LCME) offered this advice to faculty members: “From national data that you have shared, the LCME knows that most of our medical schools have several elective weeks (or) months in the last year or phase of the curriculum. Should you need to interrupt or postpone clerkships or other required clinical experiences because of the real and important pressures and stresses of the clinical environment, these elective weeks are available to adjust your students’ clinical training schedules without having to delay completion of these required experiences before graduation.”
Away rotations tend to offer exposure to different specialties and facilities to medical students late in their training. The AAMC is encouraging medical schools to help find “local alternatives” for students who planned away rotations in the coming months. The organization also recommends medical schools postpone rotations for students coming in from other medical schools.
While it seems most schools are heeding the AAMC advice, one contributor to the discussion found that students have concerns about how the lack of away rotations may impact their residency applications.
“I am worried that students may feel caught between the perceived or explicit expectations of their schools and those of residency programs, while public health and personal safety fit somewhere between them,” said Daniel Corson-Knowles, MD, Director of Phase 3 curriculum at Indiana University School of Medicine.
A National Board of Medical Examiners (NBME) Subject Exam—commonly called a shelf exam—is often administered with each clerkship rotation. The NBME’s vice president addressed the status of those exams, which are delivered to large groups in-person, in a recent statement.
“We recognize that preparing for and taking scheduled assessments at medical schools during [COVID-19] outbreak is causing uncertainty for everyone,” said Agata Butler, vice president of the NBME. “NBME is actively working with our service providers to coordinate operating plans. We are also investigating all possible options for assessment delivery and are certainly viewing this with urgency.”
To date, the NBME has suspended one exam under its umbrella. The United States Medical Licensing Exam Step 2 Clinical Skills portion was put on hold on March 16.
The teachable moment
Discussion participants universally called for putting student safety at the top of mind in terms of any educational decision that is made, but they also worried about sending the right message.
“While it is important to try to protect students, we also should help them understand that providing care to patients does sometimes require placing oneself at risk,” said David Henderson, MD, associate dean for multicultural and community affairs, at the University of Connecticut School of Medicine and Dentistry, one of the 37 member schools of AMA’s Accelerating Change in Medical Education Consortium.
“Recalling the reluctance of some providers to treat HIV infected patients early in the epidemic, are we considering the message that we may be sending students about the obligation to treat all patients, with the proper precautions and protections, of course, regardless of the nature of the illness as we craft educational policies. I have heard that some schools are considering restricting student involvement with patients with COVID-19. I am not sure such broad bans send the proper message about our basic responsibility to patients.”
“It is important to acknowledge that clinical students are more than learners—they serve many value-added roles in the provision of care,” Dr Lomis said in a statement. “As the U.S. health system responds to this challenge, we may well rely upon our talented, dedicated students as a critical element of our provider workforce. We have been preparing them for this.” (B)
“There is uncertainty regarding how long this situation will persist and increasing recognition that there may be periods in the future after reengagement in a “new normal” environment, in which quarantines and social distancing may again be required. The challenge is in providing authentic patient experiences for medical students as a key component of medical education under these circumstances. If schools defer clinical immersion experiences, there could be 2 full cohort classes of students in the clinical environment simultaneously and education could be adversely affected by the density of learners (which is already a problem in many geographic locations). Regarding accreditation, the Liaison Committee on Medical Education has provided resources to help medical schools.6
The medical education environment is cross-generational. The former mindset that physicians would work when they were ill was considered to be altruistic and professional, with prioritization of the patient above the physician. However, the situation that COVID-19 represents is different. Clinicians who come to work while they are ill, as well as those who may be asymptomatic and silently incubating the virus, might facilitate transmitting the virus to others. Therefore, the culture of professionalism and altruism must be redefined and take into consideration the effects of potential actions, even with good intentions. This is all the more difficult because of the lack of COVID-19 testing and limited availability of PPE.
Additional unknown academic issues will require attention, including standardized examinations when testing centers are closed, the timeline for residency applications for current third-year students, and the ability to meet requirements for certain subspecialties prior to applying to residency (eg, away rotations).
However, learners across the continuum of education have participated in many ways to care for patients and communities in this crisis. In medical schools across the country, students are volunteering in call centers, creating patient education materials, and helping with grocery shopping, among other activities, while adhering to physical separation, safe travel (walking, biking, or personal car), and supervision.
Recognizing the possibility that the COVID-19 pandemic could result in a health care worker shortage, students may need to be engaged as part of the workforce and embedded in the clinical environment. This situation could change rapidly, and medical schools will need to be nimble and flexible in their response. Some schools are considering early graduation with preparation of fourth-year students to engage as either volunteers or as residents earlier in the clinical environment. The latter may require university flexibility with regard to the conferring of degrees as well as revised processes for licensure.
While in the midst of this COVID-19 crisis, it is crucial that the academic educational community learns from the experience and prioritizes a forward-thinking and scholarly approach as practical solutions are implemented. Reflection and evaluation must follow. For educators, the expression “make your work count twice” (the first time for the job you are doing and the second to get the work published and disseminated [eg, creating a curriculum that you plan to use for scholarship by publishing it]) and the plan for educational scholarship has never been more imperative. One area in which students can serve and have a positive effect is as educators to their peers, patients, and communities, using the tools available through social media and other modalities to help influence behaviors in a positive way.
The COVID-19 epidemic may represent an enduring transformation in medicine with the advancement of telehealth, adaptive research protocols, and clinical trials with flexible approaches to achieve solutions. There are many examples whereby learning from difficult experiences (eg, emergence of HIV, response to disasters) changed discovery, science, and patient care. Students and educators can help document and analyze the effects of current changes to learn and apply new principles and practices to the future. This is not only a time to contribute to the advancement of medical education in the setting of active curricular innovation and transformation, but it may be a seminal moment for many disciplines in medicine.” (C)
“One top priority for leaders is ensuring that students finish clerkships that were upended when learning went virtual in March.
At Morehouse School of Medicine (MSM), last year’s third-year students started their fourth year later than usual so they could first take could take a catch-up clinical skills boot camp. To avoid overcrowding clerkships, the new third-year students temporarily studied remotely, explains Ngozi Anachebe, MD, PharmD, associate dean for admissions and student affairs.
A similar bottleneck is being handled differently by Icahn School of Medicine at Mount Sinai (ISMMS). “We’re allowing third- and fourth-year students in the same clerkships,” says Michelle Sainté Willis, senior associate dean for medical education administration. “Third-years are going to be training alongside more experienced students, so we’ve been working hard to ensure a supportive environment for those newbies.”..
At ISMMS, leaders have been hosting weekly town halls so learners can get updates and ask questions. “All of our senior team is on, and students can address any domain, from financial aid to curriculum,” says Sainté.
Housing is among the many concerns. ISMMS has been working to reduce occupancy in its 600-person residence hall to help prevent disease spread, Sainté explains. Still, leaders there recognize that some students — even first- and second-year students, who are studying 100% remotely — may need a place to live.
“A person can’t necessarily study medicine in their two-bedroom apartment with their parents and siblings,” says Sainté. “We set up a special process for anyone who felt their current environment was not conducive to learning.” Once on-site, residential students have many rules to follow to help them stay safe.” (D)
“UCSF’s professional programs, which enroll about 2,000 students each year, face unique challenges compared to primarily undergraduate institutions because the education is so hands-on, says Elizabeth Watkins, PhD, vice chancellor of Student Academic Affairs and dean of the UCSF Graduate Division. In addition, PhD students across the Graduate Division and other departments are embedded in biomedical research labs throughout campus and face their own challenges in completing research projects.
As the thousands of students head back to UCSF this fall, educators across campus have had to balance innovative distance learning opportunities with safely bringing learners back together for experiences that must take place in simulation labs, clinical settings, research labs, and more.
Through it all, education leaders across UCSF have seized on the current situation to make the curriculum more relevant to the times.
“There’s going to be change, and it’s been catalyzed by the pandemic,” said Davis. “There’s nothing like a crisis to make you focus on your principles.”
Each of the schools has been experimenting with how to translate the hands-on UCSF learning style to an environment in which face-to-face communication may pose dangers.
Under normal circumstances, each school provides skills labs where students practice with drills, become familiar with glucose monitors or learn to work with catheters. In some instances, the learning has become almost fully remote, while in other cases it is split between online instruction and in-person work on campus in small groups.
The School of Pharmacy, for example, has moved almost all education online, sending students devices like glucose monitors and then using Zoom to teach hands-on demonstrations and letting students practice together in small, online breakout groups.
The School of Dentistry has provided students with kits that allow them to practice with their drills at home, and the school and has invested in new cameras to shoot classroom demos in detail. The recorded demos done during online classes will go into a library of resources that will be available to students in future years as well.
UCSF nursing and medical students are also practicing skills using advanced virtual patient simulations that help them learn to evaluate patients and propose diagnoses and treatments.
“The virtual simulations provide our students with interactive, life-like patient experiences that allow them to practice critical skills such as diagnostic reasoning and patient assessment,” said School of Nursing Dean Catherine L. Gilliss, PhD, RN, FAAN. “Adopting these types of innovative tools allows us to continue to prepare the next generation of nurse leaders.”
Medical students, who in their second year usually get to practice clinical skills in encounters with actors playing a patient, are able to meet with some of those “patients” online.
“It’s good because we still get the experience of working through a case with an unknown patient who has a whole bunch of symptoms, and we have to figure out the mystery,” said second-year medical student Joshi about the simulations and actor encounters. “It’s important for us to learn, because the future of practicing medicine will involve a lot more telemedicine. But it doesn’t fully replace the clinical experience of being able to do a physical exam.”
Adopting these types of innovative tools allows us to continue to prepare the next generation of nurse leaders.
In collaboration with the Kanbar Center, the School of Nursing and Medicine have transitioned these patient interactions to virtual telehealth visits. Students still get the experience of interacting with a live standardized patient and receive real time feedback from their faculty through Zoom.
Some learning experiences, however, must be done in person.
Graduate students pursuing PhDs typically spend much of their time working with colleagues in the lab. This year’s crop of new students are doing rotations in labs that are operating at only 50 percent capacity in order to maintain social distancing, meaning that their time in the lab will be significantly reduced.” (E)
“The challenges and procedures vary by year and discipline. Ninety-four students are beginning their first year in the Doctor of Physical Therapy (DPT) program, the school’s second-largest student cohort, after the MD program.
“People who want to train as physical therapists are typically people who seek personal connections and caregiving,” says Tiffany Hilton, PT, PhD, assistant program director and director of curriculum for the DPT program. “The isolation and distancing have been difficult. Most of the first-years are in a new environment where they want to make connections, but that’s hard right now. But we’re doing everything we can to prioritize the student experience and give them the education they need to be excellent physical therapists.”
The constraints required by the pandemic can be cumbersome, says Glenda Holcomb, a second-year DPT student.
“When we practice physical therapy skills, some techniques require the subject to lie face down on the table, and that’s a bit awkward when you’re wearing a face shield,” Holcomb says. “But we’re all in the same boat, so that helps. I have my ‘village,’ my little group of friends, and we’re able to get together and study safely, practice skills, and so on. That’s important. It’s easy for your mental health to go haywire in these times, and you have to find ways to connect.”
The Duke Physician Assistant (PA) program, one of the largest in the country with a total of 180 students and nearly 40 faculty, had to rapidly revise its education and clinical rotation offerings last spring to meet the new reality. “The wonderful curriculum that we had nicely prepared to deliver is not a remote, virtual curriculum,” says Program Director Jacqueline S. Barnett, DHSc, MHS, PA-C. “We did not want to try to force a square into a circle, but we had to take that square curriculum and chisel it into a circle to make it fit into this new virtual paradigm.”
The PA faculty has crafted a curriculum with virtual electives and scrambled to schedule rotations for clinical-year students. Some PA students chose a rotation working with the Durham County Department of Public Health to conduct COVID-19 contact tracing. Tara Blackley, MBA, MPH, deputy public health director of the Durham County Department of Public Health, called them “an incredible asset.” The incoming class of 92 PA students is doing mostly online instruction supplemented by small-group in-person activities. For in-person activities, students submit symptom monitoring and use appropriate PPE.” (F)
“The pandemic’s onset was a teachable moment for any health professional. In her JAMA Viewpoint essay, Dr. Lucey outlined what that meant for medical students and how it could be adapted going forward.
The pandemic helped cement the shift to “a philosophy of really focusing on the role of the physician in reasoning through ambiguous and unknown problems as the focus of education, rather than teaching students that the role of physician was to memorize a body of knowledge that was already in existence and good enough for what usually happens,” Dr. Lucey said. “That’s a really important philosophic difference. The first approach really creates physician problem-solvers who are capable of addressing both enduring and emerging threats to health.”
When the physician workforce proved to be overwhelmed in certain hot spots, states called on medical schools to graduate their fourth-year students months early to help bolster the response. The measures required navigating somewhat cumbersome red tape but demonstrated that move could be an option in the future.
“The pandemic showed us an example of why we need to think about early graduation for our students, and it showed us all the hurdles we will need to jump over to do it,” Dr. Lucey said. “It’s a shock to the system that asks the question: if we are willing to attest that our students are competent to graduate early in the pandemic, could we not also do so as a matter of usual practice?”
The pandemic caused the cancellation of most away or visiting rotations. That could create a more level playing field going forward, since not all students can access such experiences.
COVID-19 shows why health systems science matters so much
“The opportunity to go around the country and do audition rotations is a clear legacy practice,” Dr. Lucey said. “When you talk with people about it, it’s not clear who it benefits the most. Does it benefit the students or the programs?”
In spite of the absence of away rotations, “I don’t believe that programs will see a big difference in the quality of that they recruit and match into their programs,” Dr. Lucey said. “As such, it is possible that we will be rethinking whether these rotations should be restarted next season.”
Medical schools were proactive in communicating expectations and restrictions with students. Going forward, Dr. Lucey envisions a more dedicated approach to student outreach during turbulence. She pointed to the civil unrest surrounding police brutality that took place on the heels of the pandemic as a potential example of a time in which that new approach had paid off in medical education.
“It created another really existential disruption to the way many of our learners were approaching their education,” Lucey said. “Our faculty of color and students of color, and the allies that work with them, were really shaken to the bone by this vivid reminder of the elements of structural racism that exist within our communities. In situations like this, leaders of educational programs need to be facile with crisis communication strategies that support all stakeholders during these crises.”
The AMA has curated a selection of resources to assist residents, medical students and faculty during the COVID-19 pandemic to help manage the shifting timelines, cancellations and adjustments to testing, rotations and other events at this time. “ (G)
“In 2013 the American Medical Association (AMA) started the “Accelerating Change in Medical Education Initiative” to help pave the way for medical schools of the future. Today, 37 medical schools are part of this consortium with the goal of disseminating ideas to positively transform medical education. One of the tasks of the group has been to make technology work for learning, something that the Covid-19 pandemic put front and center.
The proliferation of technology and distance learning will result in an explosion of even more simulation resources, such as watching practical videos on basic surgical techniques like knot tying and suturing. Wolters Kluwer provides digital learning resources such as illustrated books, exams and digitized anatomy atlases. Some companies have really upped the ante when it comes to leveraging the latest tech for medical training. Level Ex, a medical video game company, recently launched levels in their platform to help diagnose Covid-19 patients. OssoVR is on the leading edge of providing immersive virtual surgical training experiences and currently has over 20 residency partners.
Finding the right balance of in-person learning combined with digital platforms will most likely become the norm for current and future medical students. As businesses around the globe have resorted to remote work, as long as the right technology is available and output remains consistent, it could very well turn into a winning combination for medical school students, too.
The Schmidt College of Medicine at Florida Atlantic University embraced and swiftly adjusted to the challenge at hand. Dr. Wood shared, “In the face of this pandemic, medical schools have had to respond with rapid and transformational change. Yet with great change comes great opportunity. There has been a steep learning curve for our medical educators but an impactful one. We exponentially increased the integration of technology and educational platforms into our curriculum in a matter of weeks. We launched virtual multidisciplinary clinical skills training sessions so medical students could enhance their history taking and telehealth skills. Students interact remotely with standardized patients online as faculty observe and provide feedback. Educators use a mix of synchronous and asynchronous learning modalities to keep students engaged. I believe training in telehealth and virtual learning will remain a meaningful part of our medical education program.”
The addition and focus of telehealth curriculum will remain post-Covid-19 and will certainly be weaved into the academic and even clinical setting. Many would agree that the proliferation of telehealth in all capacities is a good change that Covid-19 brought about.
This global pandemic has shed even more light the importance of social determinants of health, and while the virus doesn’t discriminate, the impact it has varies based on numerous socioeconomic factors. Areas of medicine like population health may become stronger points of focus in medical school curriculum and for students pursuing such avenues.” (H)
“Several months into this disruption, our focus has shifted toward creating a new normal. While a return to contact patient care and teaching remains highly desirable, we are carefully evaluating various formats for delivering other parts of the curriculum. What seems certain is that a return to a typical pre–COVID-19 teaching platform is unlikely, and that many creative changes are here to stay. Large-scale adoption of online education during the pandemic shows that it is possible to achieve a number of teaching objectives virtually. Faculty previously resistant to technology-enhanced learning now have evidence of its ability to meet the needs of preclinical students who value adaptive and self-directed study; some may need to review specific content several times, whereas others will proceed more rapidly. Augmented intelligence and machine learning will support this model by achieving the goal of a more tailored outcomes-based education. Undoubtedly, this undertaking will result in additional innovations, flexibility, and experimentation in areas such as anatomy, problem-based learning, clinical skills education, assessment of student well-being, and mentorship or career advising.
Many improvements to medical education are a natural consequence of disruptive moments. As we reflect on the COVID-19 pandemic, changes to the medical curriculum that ensure more focus on infection control, pandemic modeling, population and public health, telemedicine, and health equity are desirable. New learners need modern tools to prepare for a response to unexpected medical events in the future. In addition, we have witnessed the spreading value of resilience, grit, and tolerance for uncertainty on the front lines of patient care. We must continue to select for these qualities in future matriculants.
Despite the temptation for unfettered innovation, we also know that some elements of the curriculum cannot change. The heroic actions of health care workers currently treating patients with COVID-19 reaffirm professionalism and community service as core attributes of a well-taught student. Clinical competency also depends on reliable assessment tools that ensure that our graduates are prepared to enter residency training with the knowledge and skills to provide safe and effective patient care.
Sinek reminds us that “working hard for something we don’t care about is called stress, while working hard for something we love is called passion” (5). The latter is achieved by witnessing selflessness and a desire to make a difference, core traits that inspired our students to pursue careers in medicine in the first place. As we look toward the future, medical education may never be the same again, and our accrediting agencies will have to join in the adaptation. We now have an opportunity to create a better medical school experience with improved flexibility and outcomes that still ensures competence from this increasingly complex effort.” (I)
The Coronavirus Effect on 12 Types of Health Care Graduate Programs. (J)
PART 1. January 21, 2020. CORONAVIRUS. “The Centers for Disease Control and Prevention on Tuesday confirmed the first U.S. case of a deadly new coronavirus that has killed six people in China.”
PART 2. January 29, 2020. CORONAVIRUS. “If it’s not contained shortly, I think we are looking at a pandemic..”….. “With isolated cases of the dangerous new coronavirus cropping up in a number of states, public health officials say it is only a matter of time before the virus appears in New York City.”
PART3. February 3, 2020. “The Wuhan coronavirus spreading from China is now likely to become a pandemic that circles the globe…”..Trump appeared to downplay concerns about the flu-like virus …We’re gonna see what happens, but we did shut it down..” (D)
PART 4. February 9, 2020. Coronavirus. “A study published Friday in JAMA found that 41% of the first 138 patients diagnosed at one hospital in Wuhan, China, were presumed to be infected in that hospital.….
PART 5. February 12, 2020. CORONAVIRUS. “In short, shoe-leather public health and basic medical care—not miracle drugs—are generally what stop outbreaks of emerging infections..”
POST 6. February 18, 2020. Coronovirus. “Amid assurances that the (ocean liner) Westerdam was disease free, hundreds of people disembarked in Cambodia…” “ One was later found to be infected”…. “Over 1,000… passengers were in…transit home”…. “This could be a turning point””
PART 7. February 20, 2020. CORONAVIRUS. With SARS preparedness underway in NJ LibertyHealth/ Jersey City Medical Center, where I was President, proposed that our 100 bed community hospital with all single-bedded rooms, be immediately transformed into an EMERGENCY SARS ISOLATION Hospital.
PART 8. February 24, 2020. CORONAVIRUS. “…every country’s top priority should be to protect its health care workers. This is partly to ensure that hospitals themselves do not become sites where the coronavirus is spread more than it is contained.”
PART 9. February 27, 2020. CORONAVIRUS. Responding to a question about the likelihood of a U.S. outbreak, President Trump said, “I don’t think it’s inevitable…”It probably will. It possibly will,” he continued. “It could be at a very small level, or it could be at a larger level.”
Part 10. March 1, 2020. CORONAVIRUS. Stop Surprise Medical Bills for Coronavirus care. (&) Lessons Learned (or not) In California and Washington State from community acquired cases.
PART 11. March 5, 2020. CORONAVIRUS. “Gov. Andrew Cuomo… would require employers to pay workers and protect their jobs if they are quarantined because of the coronavirus.”
Part 12. March 10, 2020. CORONAVIRUS. “Tom Bossert, Donald Trump’s former homeland security advisor…(said) that due to the coronavirus outbreak, “We are 10 days from the hospitals getting creamed.”
Part 13.. March 14, 2020. CORONAVIRUS. “If I’m buying real estate in New York, I’ll listen to the President….If I’m asking about infectious diseases, I’m going to listen to Tony Fauci,”
PART 14. March 17, 2020. CORONAVIRUS. “ “Most physicians have never seen this level of angst and anxiety in their careers”…. One said “I am sort of a pariah in my family.”
PART 15. March 22, 2020. CORONAVIRUS. “…Crimson Contagion” and imagining an influenza pandemic, was simulated by the Trump administration….in a series of exercises that ran from last January to August.
PART 16. March 27, 2020. CORONAVIRUS. I am not a clinician or a medical ethicist but articles on Coronavirus patient triage started me Googling………to learn about FUTILE TREATMENT
PART 17. April 2, 2020. CORONAVIRUS. Florida allows churches to continue holding services. Gun stores deemed “essential.” “New York’s private and public hospitals unite to manage patient load and share resources.
PART 18. April 9, 2020. CORONAVIRUS. “The federal government’s emergency stockpile of personal protective equipment (PPE) is depleted, and states will not be receiving any more shipments, administration staff told a House panel.
PART 19. April 13, 2020 CORONOAVIRUS. “…overlooked in the United States’ halting mobilization against the novel coronavirus: the personal aides, hospice attendants, nurses and occupational or physical therapists who deliver medical or support services to patients in their homes.”
POST 22. April 29, 2020. CORONAVIRUS. ..the “ACS released a list of 10 issues that should be addressed before a healthcare organization resumes elective surgeries[JM1] ….”
POST 23. May 3, 2020. CORONAVIRUS. … what Dr. Fauci really wants,…”is just to go to a baseball game. That will have to wait. The level of testing for the virus is not adequate enough to allow for such mass gatherings.’ (K)
POST 24. May 7, 2020. CORONAVIRUS. Former New Jersey governor Chris Christie said: “there are going to be deaths no matter what”… but that people needed to get back to work.
POST 25. May 10, 2020, CORONAVIRUS. “It is scary to go to work,” said Kevin Hassett, a top economic adviser to the president. “I think that I’d be a lot safer if I was sitting at home than I would be going to the West Wing.”
POST 26. May 14, 2020. CORONAVIRUS, “Deep cleaning is not a scientific concept”….”there is no universal protocol for a “deep clean” to eradicate the coronavirus”
POST 27. May 19, 2020. CORONAVIRUS. “Hospital…executives…are taking pay cuts…to help offset the financial fallout from COVID-19.” As “front line” layoffs and furloughs accelerate…
POST 28. May 23, 2020. CORONAVIRUS. ““You’ve got to be kidding me,”..”How could the CDC make that mistake? This is a mess.” CDC conflates viral and antibody tests numbers.
PART 29. May 22, 2020. CORONAVIRUS. “The economy did not close down. It closed down for people who, frankly, had the luxury of staying home,” (Governor Cuomo). But not so for frontline workers!
POST 30. June 3,202. CORONAVIRUS. “The wave of mass protests across the United States will almost certainly set off new chains of infection for the novel coronavirus, experts say….
Post 32. June 16, 2020. CORONAVIRUS. Could the Trump administration be pursuing herd immunity by “inaction”? “ If Fauci didn’t exist, we’d have to invent him.”
POST 34. June 26, 2020. CORONAVIRUS. CDC Director Redfield… “the number of coronavirus infections…could be 10 times higher than the confirmed case count — a total of more than 20 million.” As Florida, Texas and Arizona become eipicenters!
POST 35. June 29, 2020. CORONAVIRUS. Pence: “We slowed the spread. We flattened the curve. We saved lives..” While Dr. Fauci “warned that outbreaks in the South and West could engulf the country…”
POST 36. July 2, 2020. CORONAVIRUS. “There’s just a handful of interventions proven to curb the spread of the coronavirus. One of them is contact tracing, and “it’s not going well,” (Dr. Anthony Fauci)..
POST 37. June 8, 2020. CORONAVIRUS. When “crews arrive at a hospital with a patient suspected of having COVID-19, the hospital may have a physical bed open for them, but not enough nurses or doctors to staff it.”
POST 38. July 15, 2020. CORONAVIRUS. Some Lessons Learned, or not. AdventHealth CEO Terry Shaw: I wouldn’t hesitate to go to Disney as a healthcare CEO — based on the fact that they’re working extremely hard to keep people safe,” (M)
POST 39. July, 23,2020. CORONAVIRUS. A Tale of Two Cities. Seattle becomes New York (rolls back reopening) while New York becomes Seattle (moves to partial phase 4 reopening)
POST 40. July 27, 2020. CORONAVIRUS.” One canon of medical practice is that you order a test only if you can act on the result. And with a turnaround time of a week or two, you cannot. What we have now is often not testing — it’s testing theater.”
POST 41. August 2, 2020. CORONAVIRUS. “Whenever a vaccine for the coronavirus becomes available, one thing is virtually certain: There won’t be enough to go around. That means there will be rationing.”
POST 44. September 1, 2020. CORONAVIRUS. “The CDC…modified its coronavirus testing guidelines…to exclude people who do not have symptoms of Covid-19.” (While Dr. Fauci was undergoing surgery.) A White House official said: “Everybody is going to catch this thing eventually..”
POST 45. September 9, 2020. CORONAVIRUS. Trump on Fauci. ‘You inherit a lot of people, and you have some you love, some you don’t. I like him. I don’t agree with him that often but I like him.’
POST 46. September 17, 2020. CORONAVIRUS. “Bill Gates used to think of the US Food and Drug Administration as the world’s premier public-health authority. Not anymore. And he doesn’t trust the Centers for Disease Control and Protection either….”
POST 47. September 24, 2020. CORONAVIRUS. “Perry N. Halkitis, dean of the School of Public Health at Rutgers University…called New York City’s 35 percent rate for eliciting contacts “very bad.” “For each person, you should be in touch with 75 percent of their contacts within a day,” he said”
POST 48. October 1, 2020. “…you can actually control the outbreak if you do the nonpharmaceutical interventions (social distancing and masks). In the United States we haven’t done them. We haven’t adhered to them; we’ve played with them.” (A)
POST 49. October 4, 2020. CORONAVIRUS. RAPID RESPONSE. “The possibility that the president and his White House entourage were traveling superspreaders is a nightmare scenario for officials in Minnesota, Ohio, New Jersey and Pennsylvania…”
POST 50. October 6, 2020. CORONAVIRUS. Monday October 5th will go down as one of the most fraught chapters in the history of American public Health (and national security).
POST 51. October 12, 2020. Rather than a hodge-podge of Emergency Use Authorizations, off-label “experimentation”, right-to-try arguments, and “politicized” compassionate use approvals maybe we need to designate REGIONAL EMERGING VIRUSES REFERRAL CENTERS (REVRCs).
POST 52. October 18, 2020. ZIKA/ EBOLA/ CANDIDA AURIS/ SEVERE FLU/ Tracking. “… if there was a severe flu pandemic, more than 33 million people could be killed across the world in 250 days… Boy, do we not have our act together.” —”- Bill Gates. July 1, 2018
POST 54. October 22, 2020. CORONAVIRUS. POST 54A. New Jersey’s Coronavirus response, led by Governor Murphy and Commissioner of Health Persichilli started with accelerated A+ traditional, evidence-based Public Health practices, developed over years of experience with seasonal flu, swine flu, Zika, and Ebola.
POST 55. October 26, 2020. CORONAVIRUS. The Testing Conundrum: “ It’s thus very possible to be antigen negative but P.C.R. positive, while still harboring the virus in the body..”
POST 57. November 3, 2020. CORONAVIRUS. Dr. Deborah Birx: the US is entering its “most deadly phase” yet, one that requires “much more aggressive action,”
POST 58. November 4, 2020. CORONAVIRUS. “…the president has largely shuttered the White House Coronavirus Task Force and doubled down on anti-science language…”
POST 59. November 5, 2020. Coronavirus. “The United States on Wednesday recorded over 100,000 new coronavirus cases in a single day for the first time since the pandemic began..
POST 61. November 7, 2020. CORONAVIRUS. “Joe Biden’s top priority entering the White House is fighting both the immediate coronavirus crisis and its complex long-term aftermath…” “Here are the key ways he plans to get US coronavirus cases under control.”
POST 62. November 8, 2020. CORONAVIRUS. “The United States reported its 10 millionth coronavirus case on Sunday, with the latest million added in just 10 days,…”
POST 63. November 9, 2020. CORONAVIRUS. “New York City-based Mount Sinai Health System has opened a center to help patients recovering from COVID-19 and to study the long-term impact of the disease….”
POST 64. November 10, 2020. CORONAVIRUS. “It works! Scientists have greeted with cautious optimism a press release declaring positive interim results from a coronavirus vaccine phase III trial — the first to report on the final round of human testing.”
POST 65. November 11, 2020. CORONAVIRUS, “The Centers for Disease Control and Prevention took a stronger stance in favor of masks on Tuesday, emphasizing that they protect the people wearing them, rather than just those around them…
POST 66. November.12, 2020. CORONAVIRUS.”… as the country enters what may be the most intense stage of the pandemic yet, the Trump administration remains largely disengaged.”… “President-elect Biden has formed a special transition team dedicated to coordinating the coronavirus response across the government…”
POST 67. November 13, 2020. CORONAVIRUS. “When all other options are exhausted, the CDC website says, workers who are suspected or confirmed to have COVID-19 (and “who are well enough to work”) can care for patients who are not severely immunocompromised — first for those who are also confirmed to have COVID-19, then those with suspected cases.”
POST 68. November 14, 2020. CORONAVIRUS. The CDC “now is hewing more closely to scientific evidence, often contradicting the positions of the Trump administration.”..” “A passenger aboard the first cruise ship to set sail in the Caribbean since the start of the pandemic has tested positive for coronavirus..”
POST 69. November 15, 2020. CORONAVIRUS. “Colorado Gov. Jared Polis will issue a new executive order outlining steps hospitals will need to take to ready themselves for a surge in COVID-19 hospitalizations and directing the hospitals to finalize plans for converting beds into ICU beds, adding staffing and scaling back on or eliminating elective procedures….
POST 70. November 16, 2020. CORONAVIRUS. “White House coronavirus task force member Dr. Atlas criticized Michigan’s new Covid-19 restrictions..urging people to “rise up” against the new public health measures.
POST 71. November 17, 2020. CORONAVIRUS. ”Hospitals overrun as U.S. reports 1 million new coronavirus cases in a week.” “But in Florida, where the number of coronavirus infections remains the third-highest in the nation, bars and schools remain open and restaurants continue to operate at full capacity.”
POST 72. November 18, 2020. CORONAVIRUS. “The Health and Human Services Department will not work with President-elect Joe Biden’s (PANDEMIC) team until the General Services Administration makes a determination that he won the election,….”
POST 73. November 19, 2020. CORONAVIRUS. “…officials at the CDC…urged Americans to avoid travel for Thanksgiving and to celebrate only with members of their immediate households…” When will I trust a vaccine? to the last question I always answer: When I see Tony Fauci take one….”
POST 74. November 20, 2020. CORONAVIRUS. Pfizer…submitted to the FDA for emergency use authorization for their coronavirus vaccine candidate. —FDA issued an EUA for the drug baricitinib, in combination with remdesivir, as WHO says remdesivir doesn’t do much of anything.
POST 75. November 21, 2020. CORONAVIRUS. “The president and CEO of one of the nation’s largest non-profit health systems says he won’t be wearing a mask at work because he’s recovered from COVID-19, and doing so would only be a “symbolic gesture” because he considers himself immune from the virus….
POST 76. November 23, 2020. CORONAVIRUS. “No battle plan survives contact with the enemy.” Ventilators..”just keep people alive while the people caring for them can figure out what’s wrong and fix the problem. And at the moment, we just don’t have enough of those people.”
POST 77. November 26, 2020. CORONAVIRUS. Pope Francis: “When I got really sick at the age of 21, I had my first experience of limit, of pain and loneliness.”.. “….Aug. 13, 1957. I got taken to a hospital…”….” I remember especially two nurses from this time.”…” They fought for me to the end, until my eventual recovery.”
POST 78. November 27, 2020. CORONAVIRUS. “Kelby Krabbenhoft is no longer president and CEO of Sioux Falls, S.D.-based Sanford Health.” “…for not wearing a face covering… “ because “He considered himself immune from the virus.”
POST 79. November 28, 2020. CORONAVIRUS. Mayo Clinic. “”Our surge plan expands into the garage…”..””Not where I’d want to put my grandfather or my grandmother,” … though it “may have to happen.”
POST 81. December 1, 2020. CORONAVIRUS. “Dr. Atlas, … who espoused controversial theories and rankled government scientists while advising President Trump on the coronavirus pandemic, resigned…”
POST 82. December 3, 2020. CORONAVIRIUS. The NBA jumped to the front of the line for Coronavirus testing….while front line nurses often are still waiting. Who will similarly “hijack” the vaccine?
POST 83. December 4, 2020. CORONAVIRUS. “California Gov. Gavin Newsom says he will impose a new, regional stay-at-home order for areas where capacity at intensive care units falls below 15%.”… East Tennessee –“This is the first time the health care capability benchmark has been in the red..”
POST 84. December 6, 2020. CPRONAVIRUS. “ More than 100,000 Americans are in the hospital with COVID-19…” “We’re seeing C.D.C. …awaken from (its) politics-induced coma…”…Dr. Fauci “to be a chief medical adviser in Biden’s incoming administration..”.. “Trump administration leaves states to grapple with how to distribute scarce vaccines..”
POST 85. December 7, 2020. CORONAVIRUS. “…Florida, Gov. DeSantis’ administration engaged in a pattern of spin and concealment that misled the public on the gravest health threat the state has ever faced..”.. “NY Gov. Cuomo said…the state will implement a barrage of new emergency actions..”… Rhode Island and Massachusetts open field hospitals… “Biden Names Health Team to Fight Pandemic”
POST 86. December 9, 2020. If this analysis seems a bit incomprehensible it is because “free Coronavirus test” is often an oxymoron! with charges ranging from as little as $23 to as much as $2,315… Laws (like for free Coronavirus tests) are Like Sausages. Better Not to See Them Being Made. (Please allow about 20 seconds for the text to download. Thanx!)
POST 87. December 10, 2020. CORONAVIRUS. “…Rudolph W. Giuliani, the latest member of President Trump’s inner circle to contract Covid-19, has acknowledged that he received at least two of the same drugs the president received. He even conceded that his “celebrity” status had given him access to care that others did not have.”
POST 88. December 11, 2020. CORONAVIRUS. “As COVID-19 cases surge, the federal government is releasing data about hospital capacity at facilities around the country….”The new data paints the picture of how a specific hospital is experiencing the pandemic,”…
PART 89. December 12, 2020. CORONAVIRUS. THE VACCINE!!! “Now this is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning.” Winston Churchill
POST 90. December 14, 2020. CORONAVIRUS. “…the first doses of a Covid-19 vaccine have been given to the American public..”…” Each person who receives a vaccine needs two doses, and it’s up to states to allocate their share of vaccines.”
POST 91. December 15, 2020. CORONAVIRUS. “UPMC will first give (vaccination) priority to those in critical jobs. That includes a range of people working in critical units, from workers cleaning the emergency room and registering patients to doctors and nurses.. “Finally, if needed, UPMC will use a lottery to select who will be scheduled first.”
POST 92. December 17, 2020. CORONAVIRUS. “..each state — and each hospital system — has come up with its own (vaccination) plan and priorities. The result has been a sometimes confusing constellation of rules and groupings that has left health care workers wondering where they stand.” (Trump appointee July 4th email “…we need to establish herd, and it only comes about allowing the non-high risk groups expose themselves to the virus. PERIOD,”)
POST 93. December 19, 2020. CORONAVIRUS. On NPR Congresswoman Shalala (D-Florida) said she wouldn’t jump the vaccination line in Miami; then added she would get vaccinated in Washington this week. This, even though Congress has failed to pass “essential” Coronavirus legislation. So who are our “essential” workers?
POST 94. December 21, 2020. CORONAVIRUS. “A doctor at an L.A. County public hospital said the number of COVID-19 patients is “increasing exponentially, without an end in sight.”.. “I haven’t done ICU medicine since I was a resident — you don’t want me adjusting your ventilator,” he said. “That’s the challenge, actually — it isn’t so much space, it’s staff…”
POST 96. December 26, 2020. CORONAVIRUS. “Achieving herd immunity against the coronavirus could require as much as 90 percent of the population to be vaccinated, Anthony Fauci…”…”..he hesitated to state a number as high as 90% weeks ago because many Americans still seemed skeptical about vaccine….”
POST 97. December 27, 2020. “A new variant of the coronavirus that has been spreading through the UK and other countries has not yet been detected in the United States..”.. . But if new-wave medicines like antivirals and antibody therapy contributed to the development of viral variants, it will be “a reminder for all the medical community that we need to use these treatment options carefully.”
POST 99. December 29, 2020. CORONAVIRUS. “ICUs are being overwhelmed across many parts of California. Statewide aggregate ICU availability has been at 0% since Christmas Eve…. a surge on top of a surge on top of a surge.”… “hospitals are getting close to the point where they would begin putting COVID-positive patients under the care of COVID-positive staff who are asymptomatic.”
POST 100. December 29, 2020. CORONAVIRUS. Front line hospital workers – in the ER, ICUs, EMS, acute medical care, behavioral health – are amongst the most courageous, heroic and dedicated colleagues you will ever meet.
POST 101. December 30, 2020.CORONAVIRUS. Is there a point where the increasing Coronavirus trajectory so far exceeds the slow growth of the vaccination rate that reaching herd immunity through vaccinations becomes less likely?
POST 102. January 2, 2020. CORONAVIRUS. “We’ve taken the people with the least amount of resources and capacity and asked them to do the hardest part of the vaccination — which is actually getting the vaccines administered into people’s arms,” said Dr. Ashish Jha, the dean of Brown University’s School of Public Health. “Ultimately, the buck seems to stop with no one,”…
POST 103. January 4, 2021. CORONAVIRUS. Dr. Fauci said “that the United States would not follow Britain’s lead in front-loading first vaccine injections, potentially delaying the administration of second doses…Dr. Moore – ”British officials “seem to have abandoned science completely now and are just trying to guess their way out of a mess.”
POST 104. January 6, 2021. CORONAVIRUS. “Paramedics in Southern California are being told to conserve oxygen and not to bring patients to the hospital who have little chance of survival…”
POST 105. January 8, 2021. CORONAVIRUS. POST 105. January 8, 2021. CORONAVIRUS. “Facing a shortage of vaccinators, the Association of Immunization Managers… recommends relaxing regulation or adjusting licensing requirements. At least two states, Massachusetts and New York, have changed their laws in recent weeks to expand those who are eligible to give shots.”
POST 106. January 9, 2021. CORONAVIRUS. The riots at the Capitol could have been a superspreader event. “From what I saw… you had a large congregation of individuals who were in close contact for an extended period of time and almost universally unmasked…. many coming and going on buses as well, also unmasked, and hanging out in hotel lobbies.”
POST 107. January 8, 2021. CORONAVIRUS. “Our job is to make sure the vaccine isn’t politicized the way masks were politicized,” Rep. Alexandria Ocasio-Cortez, D-N.Y., said after getting her vaccine. South Carolina Rep.-elect Nancy Mace, a Republican, wrote that “Congress shouldn’t be putting themselves first in line for the COVID-19 vaccination when the average American can’t get it.”
POST 108. January 9, 2021. CORONAVIRUS. (vaccination)”Line-cutters will be named and shamed. It’s inevitable, as will be the congressional hearings and front-page investigative stories ferreting out who saved their own skin at the expense of others.”
POST 109.January 9, 2021. CORONAVIRUS. “President-elect Joe Biden will aim to release nearly every available dose of the coronavirus vaccine when he takes office, a break with the Trump administration’s strategy of holding back half of US vaccine production to ensure second doses are available.
POST 110. January 13, 2021. CORONAVIRUS. ““The (federal) government is changing the way it allocates Covid vaccine doses, now basing it on how quickly states can administer shots and the size of their elderly population.”… “New York State sent a letter to hospitals saying if they don’t use their vaccine allocations by the end of this week, they won’t receive any further allocations.”
POST 111. January 14, 2021. CORONAVIRUS. “Visitors from Toronto to New York to Buenos Aires have long flocked to Florida for sun, surf and shopping. Now they are coming for the Covid-19 vaccine….
POST 112. January 14, 2021. CORONAVIRUS. CHINA – “Eleven million people are under lockdown in Hebei province after a new cluster of coronavirus infections.
PART 113. January 17, 2021. CORONAVIRUS. The Next President Actually Has a Covid Plan… New York City and other places in the state expect to exhaust their supply of doses as early as next week… Charles Barkley said during the “NBA on TNT” broadcast that pro athletes should get the first round of the vaccine…..
POST 114. January 18, 2021. CORONAVIRUS. “When government programs that have been unattended, underfunded and bogged down by red tape suddenly have to meet a huge demand in a crisis, they can’t cope and people suffer….”
POST 115. January 21, 2020. CORONAVIRUS. A year ago today an unnumbered POST was headlined “The Centers for Disease Control and Prevention on Tuesday confirmed the first U.S. case of a deadly new coronavirus that has killed six people in China.” The CORONAVIRUS CONTENT TRACKING PROJECT started with HISTORIOGRAPHY and over time moved to LESSONS LEARNED, RAPID RESPONSE, and THE VACCINATION PROGRAM. Now 115 POSTS later – the BIDEN CORONAVIRUS PLAN.
POST 116. January 22, 2021. President Biden – “We’re entering what may be the toughest and deadliest period of the virus. We must set aside politics and finally face this pandemic as one nation.”
POST 117. January 23, 2021. CORONAVIRUS. 1.Dr. Fauci:“The idea that you can get up here….”and.. let the science speak”… “It is somewhat of a liberating feeling.” 2.updated CDC guidance:”.. providers could give the second dose up to six weeks after the first dose..” 3.Dr. Fauci: people would be “taking a chance” if they follow the CDC’s updated guidance.
POST 118. January 24, 2021. CORONAVIRUS. “Unfortunately, we’ve let this virus spread extensively and are launching the vaccination campaign at the height of the threat,” Dr. Meyers said. “The more the virus spreads before the vaccine reaches people, the fewer deaths we can prevent with the vaccine.”
POST 119. January 27, 2010. CORONAVIRUS. Amazon is offering its help to President Joe Biden with the rollout of COVID-19 vaccines. Washington’s governor, Jay Inslee, included the help of companies like Starbucks, Costco and Microsoft in a plan to vaccinate 45,000 residents a day.
POST 120. January 28, 2021. CORONAVIRUS. “The fact that four vaccines backed by the federal government seem to be less effective against the (South African) B.1.351 variant has unsettled federal officials and vaccine experts alike. Facing this uncertainty, many researchers said it was imperative to get as many people vaccinated as possible — quickly. Lowering the rate of infection could thwart the contagious variants while they are still rare, and prevent other viruses from gaining new mutations that could cause more trouble.”
POST 121. January 30, 2021. CORONVIRUS. Will our communities become stratified by which vaccine is distributed? 95%ters v. 72%ters? Will the easier distribution of the J&J vaccine drive its inequitable distribution to” hard-hit, marginalized, and medically underserved communities.” (thanx! to XJ/LA)
POST 123. February 4, 2021. CORONAVIRUS. “Nursing homes across the country are facing the same struggle, as workers have been more reluctant than residents to be vaccinated…
POST 124. February 5, 2021. CORONAVIRUS. Dr. Osterholm ” …it may be time to..go with a ‘first-dose only’ approach, so more people over the age of 65 can have at least some protection right away. He said that would require delaying second doses until this summer.” Dr.Fauci “warned against this practice, and cautioned people about “the danger” that could come with focusing only on the first dose.”
POST 125. June 9, 2021. CORONAVIRUS. “States are rolling back Covid-19 restrictions as new cases trend down from record highs across the country. But experts warn it might be too much too soon as variants pose an increased risk and the pandemic… is far from over.”
POST 126. February 11, 2021. CORONAVIRUS. “There will be more coronavirus outbreaks in the future. Bats and other mammals are rife with strains and species of this abundant family of viruses. Some of these pathogens will inevitably spill over the species barrier and cause new pandemics. It’s only a matter of time.” (A)
POST 127. February 12, 2021. CORONAVIRUS. “… Trump only agreed to be hospitalized when aides told him that he could walk to Marine One or he could wait until his case progressed and he would be carried out.”
POST 128. February 14, 2021. CORONAVIRUS. “The Centers for Disease Control and Prevention released new research on Wednesday that found wearing a cloth mask over a surgical mask offers more protection against the coronavirus, as does tying knots on the ear loops of surgical masks…
POST 129. February 15, 2021, CORONAVIRUS. “ “The CDC released its much-anticipated, updated guidance to help school leaders decide how to safely bring students back into classrooms, or keep them there.”…” For politicians, parents and school leaders looking for a clear green light to reopen schools, this is not it.”
POST 130. February 16, 2021. CORONAVIRUS. “A second person who had contracted the Ebola virus died this week in the Democratic Republic of Congo, marking another outbreak just three months after the nation outlasted the virus’s second-worst outbreak in history…”
POST 131. February 17, 2021. CORONAVIRUS. “It really is right now – a race between how quickly new variants, particularly the U.K. variant, can spread in the United States and how quickly we can get people vaccinated”
POST 132. February 20, 2021. CORONAVIRUS. “In Texas, where over 2.5 million people are still without power, the state health department said this week’s vaccine shipments wouldn’t arrive until Wednesday at the earliest.”
POST 133. February 23, 2021. CORONAVIRUS. “Going off your meds is a surefire way to aggravate your doctor. What if a whole country did it?” The United Kingdom has veered into uncharted territory by changing tack and introducing a revised COVID-19 vaccination protocol, one that involves distributing the second dose at 12 weeks, rather than the prescribed 21 days.”
POST 134. February 24, 2021. CORONAVIRUS. The first tranche of the J&J (single dose) vaccine must go to K-12 teachers, so schools can open safely in the first 100 days of the Biden Administration. The federal government…”can set up its own vaccination centers in regions with eligible populations it’s trying to target.” We owe our front-line teachers nothing less!
POST 135. February 27, 2021. CORONAVIRUS. “As Chief Executive Officers of New York’s major health care systems, we would like to provide facts to clear up confusion in the public and the media regarding decisions to discharge patients to nursing homes during New York’s spring coronavirus surge.”
POST 136. March 2, 2021. CORONAVIRUS. ““The governors of Texas and Mississippi both announced on Tuesday they would be lifting their states’ mask mandates and rolling back many of their Covid-19 health mandates..”…while “The US could experience a “fourth surge” of coronavirus before the majority of the country is vaccinated.”
POST 137. March 4, 2021. CORONAVIRUS. “The clamor for hard-to-get Covid-19 vaccines has created armies of anxious Americans who have resorted to hunting for leftovers on the fringes of the country’s patchwork vaccination system. They haunt pharmacies at the end of the day in search of an extra, expiring dose. They drive from clinic to clinic hoping that someone was a no-show to their appointment. They cold-call pharmacies like eager telemarketers: Any extras today? Maybe tomorrow? Some pharmacists have even given them a nickname: vaccine lurkers.” (H)
POST 138. March 6, 2021. CORONAVIRUS. “New cases are decreasing in the third wave because we are past the holidays, not because of vaccinations. It is a common misconception that the decrease we are seeing in new cases, hospitalizations, and deaths in the U.S. is due to vaccinations. The two aren’t related; at least yet.”
POST 139. March 8, 2021. CORONAVIRUS. CDC Issues First Set of Guidelines on How Fully Vaccinated People Can Visit Safely with Others…” In practice, that means fully vaccinated grandparents may visit unvaccinated healthy adult children and healthy grandchildren of the same household without masks or physical distancing.” (C)
POST 140. March 9, 2021. CORONAVIRUS. “In West Virginia, they are bracing for the second wave….. Not coronavirus but opioid overdoses, with one scourge driving a resurgence of the other.
POST 141. March 11, 2021. CORONAVIRUS. Today is the first anniversary of the WHO declaration that the novel coronavirus was a Public Health Emergency of International Concern… “To truly prepare itself against the next pandemic, the U.S. has to reimagine what preparedness looks like.”
POST 142. March 15, 2021. CORONAVIRUS. “Candida auris is a superbug, a pathogen that can evade drugs made to kill it—and early signs suggest the COVID-19 pandemic may be propelling infections of the highly dangerous yeast. That’s because C. auris is particularly prominent in hospital settings, which have been flooded with people this year due to the coronavirus.”
POST 143. March 17, 2021. CORONAVIRUS. “The Trump administration sought to suppress Covid-19 testing in the United States last year by softening guidance from the Centers for Disease Control and Prevention on who needed to be tested, a House panel said Monday.”
POST 144. March 20, 2021. CORONAVIRUS. ““The vaccine hesitancy we are seeing isn’t just about Covid vaccines,”… “It is a general reflection of Americans’ lack of trust in science, the pharmaceutical industry, and large health care institutions. We need a full court press on science and vaccine education right now to prevent more aggressive Covid-19 variants from developing and taking hold.”
POST 145. March 25, 2021. CORONAVIRUS. “Efforts to disseminate Covid-19 vaccines as widely as possible are hitting an unexpected obstacle: health-care workers who decline the shots.
POST 146. March 30, 2021. CORONAVIRUS. Dr. Osterholm told Becker’s: “This is the perfect storm,”…”Here is Europe locking down and having problems containing B.1.1.7, even with vaccinations and previous infection histories. Here we are opening up as wide as we can. We are literally just walking into the mouth of the virus saying, ‘Don’t worry.'” (M)
POST 147. April 5, 2021. CORONAVIRUS. “The pandemic helped cement the shift to “a philosophy of really focusing on the role of the physician in reasoning through ambiguous and unknown problems as the focus of education, rather than teaching students that the role of physician was to memorize a body of knowledge that was already in existence and good enough for what usually happens.”
“Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention, said Monday that she’s worried the US could see “another avoidable surge” of Covid-19 if mitigation measures — such as mask-wearing, physical distancing and avoiding crowds or travel — are not followed.
“As I’ve stated before, the continued relaxation of prevention measures while cases are still high and while concerning variants are spreading rapidly throughout the United States is a serious threat to the progress we have made as a nation,” Walensky said at a White House briefing.
“Increasingly, states are seeing a growing proportion of their Covid-19 cases attributed to variants,” Walensky said. She said two newly identified variants — B.1427 and B.1429 — are estimated to account for 52% of cases in California, 41% in Nevada and 25% in Arizona.
The B.1.1.7 variant, first identified in the United Kingdom, is estimated to be responsible for 9% of cases in New Jersey and 8% in Florida, Walensky said.
“We must act now, and I am worried that if we don’t take the right actions now, we will have another avoidable surge — just as we are seeing in Europe right now and just as we are so aggressively scaling up vaccination.”” (A)
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“Dr. Fauci echoed these sentiments on Meet the Press later in the morning. “I don’t think there’s much that’s going to prevent us from having quantitatively the number of vaccines that the President promised” unless there’s some major production glitch, said Fauci. “More of a concern than I have is that we’ll have what’s called variant increases where you may have another surge. If you look at the numbers that have gone down, they’ve gone down so nicely in a very steep decline, but in the last couple of weeks, we’ve had a plateauing of infections. And the thing that concerns me as, because it’s history, it proves that I should be concerned is that when you get a plateau at a level around 60,000 new infections per day, there’s always the risk of another surge. And that’s the thing we really want to avoid because we are going in the right directions.”
“That’s why I get so anxious,” said Fauci, “when I hear pulling back completely on public health measures, like saying no more masks, no, nothing like that. I mean, that is a risky business.”
“Even though the decline was steep, we absolutely need to avoid the urge to say, ‘Oh, everything is going great,’ which it is going in the right direction,” said Dr. Fauci. “But once you declare victory, you know, that metaphor that people say, if you’re going for a touchdown, don’t spike the ball on the five yard line waiting till you get into the end zone. And we’re not in the end zone yet. And that’s one of the issues, is always the risk of a surge. That’s exactly what the Europeans have experienced.”” (B)
“For months, COVID-19 cases were declining as we impatiently waited for the shots to come. But now the vaccine rollout is in full swing, and yet the U.S. saw an average of 61,821 new COVID-19 cases per day last week, a 12% increase compared with the week before, CNBC reported. To make matters worse, the CDC reported that hospitalizations are also increasing. What’s going on here?
“We’re in a delicate and tenuous period of transition,” William Schaffner, an epidemiologist and professor of preventive medicine at Vanderbilt University, told CNBC. He added that part of the problem is that some states are simultaneously reopening for business and dropping mask mandates too soon. Some people may have gotten a little too comfortable after their first shot, which doesn’t offer full protection. And you’ve probably already heard about the spring break situation in Miami and other vacation destinations where partiers are thronging maskless…
There are also, as I’m sure you’ve heard, scary new variants at play. Florida has reported more than 1,000 coronavirus cases of the B.1.1.7 variant, which was first found in the U.K.. Experts warned that we might be able to keep the variants localized if people stayed put, but if folks keep flocking to places where the variants abound — which are potentially more infectious — and then take them back to their home states, we’re inevitably going to continue to see increases, according to CNBC. And while experts think the current vaccines may hold up against variants, the truth is that the virus, the variants, and the vaccines are all still too new for anyone to know for sure.” (C)
“Everybody’s focused on the big declines in the number of cases, pretending the plateau is not really substantive, and oblivious to the impact of B117,” a highly transmissible variant first identified in the UK, said Dr Peter Hotez, a vaccine researchers and dean for the national school of tropical medicine at College of Medicine in Houston, Texas.
The potential plateau, highly transmissible new variants, and decision to reopen when vaccines have reached relatively few people “has all the makings of a fourth wave, and gives me a lot of pause for concern,” said Hotez.
On Wednesday, following a crippling winter ice storm Greg Abbott, the Republican governor of Texas, ended all pandemic restrictions and opened the state “100%”. The Republican governor of Mississippi soon followed suit, and lifted mask mandates on all activities except schools and large arenas.
Just 16.3% of the US population has been vaccinated against Covid-19, or roughly 54 million people according to data from the US Centers for Disease Control and Prevention (CDC). In Texas, vaccines have reached just 13.6% of the population.
The moves prompted immediate outcry. Houston’s mayor, Sylvester Turner, called lifting pandemic restrictions a “systemwide state leadership failure”, while Joe Biden called the decision “Neanderthal thinking”.
Nevertheless, intense pressure to reopen businesses has also led many Democratic-led cities and states to begin tiptoeing toward reopening. Massachusetts ended capacity limits in restaurants, though social distancing remains in place, and allowed live music to resume.
New York City is expected to reopen movie theaters this Friday with restrictions. Because New York City is a leading Hollywood market, the move is likely to pressure Los Angeles to do the same. And San Francisco reopened aquariums, fitness centers, indoor dining and museums this week.
The changes happened even as the CDC director, Dr Rochelle Walensky, warned reopening too quickly could threaten “the hard-earned ground we have gained”. (D)
“What are the risks of letting our guard down now?
The most obvious threat is that Texas could see a fourth surge this spring.
Throughout the pandemic, we’ve observed how an uptick in cases triggers a surge. After cases peak, they eventually drop off before spiking yet again.
“Ending practices that have contributed to better outcomes places the state at increased vulnerability,” Castrucci said.
Some models are predicting a fourth wave will strike around May as the SARS-CoV-2 variant identified in the United Kingdom (B.1.1.7) becomes more widespread.
If people stop wearing masks and ignore public health protocols, they put both themselves and others at risk.
That potentially “means a surge on our medical system, and that means limited resources for people who are sick and those who have other ailments, such as strokes, heart attacks, a fracture, a car crash,” Fagbuyi said, noting this could lead to more lockdowns.
The other big concern is that unchecked transmission could lead to the emergence of new virus variants, according to Fagbuyi.
“There’s an increased likelihood of having more variants and different types of the virus that then can undermine our responses and put us back in the same situation and maybe even worse,” Fagbuyi said.” (E)
“”I’m very worried we’re letting our foot off the brakes,” said Atul Gawande, a surgeon at Brigham and Women’s Hospital and a professor at the Harvard T.H. Chan School of Public Health…
“It’s like we’re trying our best to help the virus rather than stopping it,” said Theodora Hatziioannou, a virologist and research associate professor at the Rockefeller University in New York City.
More contagious variants of the virus have raced across Europe, South Africa and Latin America. They have all arrived in the U.S., and one first identified in the United Kingdom is likely to be dominant here by the end of next month, according to the U.S. Centers for Disease Control and Prevention…
Another variant, which originated in Southern California, has been spreading rapidly across the U.S., according to a study, although it’s not clear whether it’s more contagious or more dangerous. Many more may be here, too, according to one early review, though again, the significance of all these variants isn’t clear.
The two vaccines available, one by Pfizer-BioNTech and the other by Moderna, appear to be effective against these variants, said Hatziioannou, who published a study on the subject.
But these variants are likely to make targeted drugs such as monoclonal antibodies less effective. They will continue to change and eventually will evade vaccines and diagnostic tests if they keep spreading, she said…
The variants make estimates more difficult, he said, as do the rising rate of vaccination, the relaxation of some COVID-19 public health measures, the lack of demographic information on who’s getting vaccinated and the limited genetic surveillance, which makes it harder to know exactly what the variants are doing.
“All those meet together to make it a very murky picture over the next few months,”… (F)
A fourth wave of coronavirus infections is beginning to mount in states across the nation as health experts and officials beg pandemic-exhausted Americans to stay vigilant.
The United States has reported an average of 65,000 new cases in the last seven days, according to data from the Centers for Disease Control and Prevention (CDC), up about 10,000 cases per day since the most recent nadir two weeks ago.
Those figures are well below the January apex of the third wave of infections, when a quarter-million people a day were testing positive for the virus.
But while millions of Americans are receiving vaccinations, progress toward herd immunity has not kept pace with the new spike. Cases are rising in about half the states, led by big spikes in New York and especially New York City, Michigan, New Jersey, Connecticut and Pennsylvania…
After a year of errors and missteps in handling the pandemic, the vaccination campaign stands out as a distinct bright spot.
The number of Americans who have received a vaccine against the coronavirus is growing by more than 2 million a day, according to CDC data. The United States is vaccinating a larger share of its population than any nation other than Israel, the United Arab Emirates, Chile and the United Kingdom.
More than 17 million doses have been administered in California, and more than 11 million have been given in Texas. More than a third of residents of smaller states like New Mexico, Connecticut, South Dakota, Alaska and Maine have received at least one dose.
Vaccine administration rates are highest among the elderly, who received top priority as early rounds of vaccines were rolled out over the last several months. But millions more must be vaccinated before the United States reaches some form of herd immunity.
“It’ll be at least another six to eight weeks before we get that kind of coverage,” said Celine Gounder, an infectious diseases specialist at New York University’s Grossman School of Medicine and a member of the Biden administration’s COVID-19 advisory board. “We’re almost there, it’s just not the time to give up.” (G)
“At least 22 states have seen their seven-day case average jump by at least 10% in the last week, according to an ABC analysis data collected by the Department of Health and Human Services, and the number of patients hospitalized appears to have also stopped falling, plateauing around 33,000, after falling by more than 70% since early January.
Although nationwide test positivity continues to tick up, testing is declining. The average number of tests has decreased by 12.2% nationally, while the average test positivity increased from 4.2% to 4.8%.
With less tests, fewer cases are being discovered, leaving the possibility that states are missing potential community spread.
“I worry that we have plateaued, as we lose ground against emerging variants and increase transmission by reopening and relaxing mitigation measures, like restrictions on indoor activities,” Neil J. Sehgal, assistant professor of health policy and management at the University of Maryland School of Public Health.
Although it is still unclear what may be behind these rising metrics, experts suggest it may be related to the emergence of more contagious coronavirus strains…
“Increasingly, states are seeing a growing proportion of their COVID-19 cases attributed to variants,” Walensky said on Monday.
Although the U.S. is still sequencing very few COVID-19 cases, over 8,300 cases of the variant first found in the U.K., B.1.1.7, has now been discovered in all 50 states.
Health experts in Michigan have also correlated the state’s rising metrics to the variants. According to the CDC, Michigan currently ranks second in the nation for the most reported cases of the B.1.1.7 variant, with under 1,000 confirmed cases.
Even with cases increasing, dozens of states have moved to reopen, with governors relaxing restrictions on many businesses like restaurants and gyms.
Air travel has also reached pre-pandemic levels, and with millions of young Americans traveling for spring break, there are concerns that the virus could spread further and be brought to other states when travelers return home.
However, experts say with many of the most at-risk Americans dosed, this potential wave may not be as lethal or significant as previous ones.
“With a large proportion of the vulnerable individuals now vaccinated, that fourth wave in cases may not translate into a fourth wave in deaths,” Baker said.
Even if a fourth wave is “likely,” Sehgal said, “I don’t think it will be anywhere near the magnitude of the wave like we saw after the winter holidays, nor as deadly.” (H)
“With new coronavirus infections rising across the United States once again, at least one governor in a hot spot state appealed to the Biden administration for extra vaccine doses to help staunch the worsening spread.
Michigan Gov. Gretchen Whitmer (D), citing a strategy floated by some experts, asked the White House on Tuesday to consider rushing doses to hard-hit parts of the country, including her state, rather than allocating vaccines based on population.
The request comes as virus cases continue to rise, jumping by 13 percent nationwide in the past week, according to data compiled by The Washington Post. The average daily number of new infections — more than 64,000 — is at its highest level in nearly a month, interrupting what was a weeks-long downward trend.
Michigan, which relaxed pandemic restrictions earlier this month, has recorded the nation’s largest recent increase in cases, reporting a 52 percent jump from a week ago. The state’s daily average of more than 5,400 new cases is higher than it has been since December, and there has been a surge in the number of people hospitalized with coronavirus infections. Some officials have blamed the virus variant first found in Britain, which is more transmissible and possibly more lethal.” (I)
““Getting back to normal” is what we all want, but this won’t be easy for the health service and those working in it. Recovering from the pandemic will be as challenging as the pandemic itself, say Christina Pagel and Edward Palmer.8 The past year has taken a heavy toll on all healthcare workers, with high rates of mental ill health and post-traumatic stress. Doctors have been particularly hard hit.9 Redeployment to unfamiliar roles and disruption to training have added to the burdens of delivering care. Healthcare leaders must ensure that staff have time to rest, recuperate, and reflect. And they must urgently look beyond the immediate demands of the current outbreak to act now on measures that will increase recruitment and retention, without which there will be little hope of delivering high quality care for all.
There are many reasons for doing everything possible to avoid another wave of the pandemic. The impact on healthcare staff and the future of our health services are two of them.” (J)
“We all want to return to our everyday activities and spend time with our family, friends, and loved ones. But we must find the fortitude to hang in there for just a little bit longer,” Dr. Walensky urged Americans March 22. “We are at a critical point in this pandemic, a fork in the road, where we as a country must decide which path we are going to take … And I am worried that if we don’t take the right actions now, we will have another avoidable surge, just as we are seeing in Europe right now and just as we are so aggressively scaling up vaccination.” (K)
“A former White House coronavirus adviser says most virus deaths could have been prevented, while a current adviser has an optimistic view of how the summer in the U.S. will play out.
Dr. Deborah Birx, in an interview for CNN’s documentary “Covid War: The Pandemic Doctors Speak Out,” said deaths in the first wave of the pandemic were likely inevitable but that the death toll from later surges could have been greatly reduced with more stringent mitigation efforts. And Dr. Anthony Fauci, chief medical adviser to President Joe Biden, warned again Sunday the nation could be at risk of a new surge.
But Fauci also said the fast-rising number of vaccinations could mean fans could be attending baseball games this summer.
“As we get a really, really low level of infection, you’re going to start seeing a pulling back on some of those restrictions,” he said. “I think if we do it correctly and we get the vaccines out at the rate we’re doing, that will happen.” (L)
“This is the perfect storm,” Dr. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota in Minneapolis, told Becker’s. “Here is Europe locking down and having problems containing B.1.1.7, even with vaccinations and previous infection histories. Here we are opening up as wide as we can. We are literally just walking into the mouth of the virus saying, ‘Don’t worry.'” (M)
