POST 84. December 6, 2020. CORONAVIRUS. “ 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..”

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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..”

“DOCTOR” is looking for an organizational partner – e.g., hospital system, MPH/ MPA/ MBA health care administration program, School of Public Health. Please contact [email protected]

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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..”

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“The number of hospital beds occupied by COVID-19 patients far outpaces peaks in mid-April and July of about 59,000. Early last month, the number of hospitalizations again reached that mark and has been on an upward progression ever since…

Even with a vaccine in sight, the U.S. continues to grapple with a major surge in new coronavirus infections. Health officials are imploring Americans to stay home for the holidays.

The Centers for Disease Control and Prevention Director Robert R. Redfield warned Wednesday that things are likely to get worse over the winter months. He predicted deaths could reach “close to 450,000” by February if Americans fail to take more health precautions, such as wearing a mask.” (A)

“With coronavirus infections soaring across the nation, federal health officials on Friday urged Americans in the most forceful language yet to take steps to protect themselves — starting with consistent, proper use of masks — and pressed local governments to adopt 10 public health measures deemed necessary to contain the pandemic.

The guidance reflected deep concern at the agency that the pandemic is spiraling further out of control and that many hospitals are reaching a breaking point, potentially disrupting health care across the country.

Agency officials have issued increasingly stark warnings in the waning weeks of the Trump administration, and President-elect Joseph R. Biden Jr. has promised a new national strategy to turn back the virus. On Thursday, Mr. Biden said he would call on Americans to wear facial coverings for 100 days.

To some experts, the C.D.C.’s appeal appeared to augur a more comprehensive and coordinated national approach to controlling the pandemic — one consistent with messages from Mr. Biden and his advisers.

“We’re seeing C.D.C. and other public health institutions awaken from their politics-induced coma,” said Dr. Thomas R. Frieden, who served as the agency’s director under President Barack Obama.

“This is them aligning themselves more with science, which also aligns them more with the Biden administration,” he added.

While none of the directives are new, experts said the rising case numbers demonstrated a need for a more uniform approach, rather than the patchwork of restrictions adopted by states.

“The role of the C.D.C. is to lead with the science,” said Dr. Celine Gounder, an infectious-disease physician and member of Mr. Biden’s Covid advisory group. “In the absence of strong national guidance from the C.D.C., we’ve had a variety of responses across the country, some more scientifically grounded than others.”

The scientific evidence supporting the effectiveness of certain health measures, such as wearing masks, has been accumulating, and those measures are urgently needed now to stop the spread, C.D.C. officials said.

Though the agency has issued all of the recommendations in earlier guidance, the new summary represented the first time the C.D.C. had published a multipronged list of strategies for states, a sort of battle plan.

“This idea of a 50-state solution is completely impractical when we live in one nation,” said Jennifer Nuzzo, an epidemiologist at Johns Hopkins University’s Bloomberg School of Public Health. “We are not going to get past this pandemic unless we have a concerted national approach.”

The new recommendations place high priority on keeping schools open, from kindergarten through 12th grade, saying schools should be both “the last settings to close” and “the first to reopen” because of the critical role they play in providing meals and support services to children. Closures take a disproportionate toll on low-income families, the agency noted…

In a shift, the C.D.C. also urged states and local jurisdictions to encourage and enforce these behaviors, including mandating the wearing of masks in public spaces and on public transportation…

Having all 10 measures in one document is helpful and underscores the message that no one strategy can hinder the spread of the virus, experts said. But the document was thin on some details, said Dr. Nahid Bhadelia, medical director of the special pathogens unit at Boston Medical Center.” (B)

“These combined strategies will protect health care, essential businesses, and schools, bridging to a future with high community coverage of effective vaccines and safe return to more activities in a range of settings…

These strategies include

1) universal face mask use,

2) maintaining physical distance from other persons and limiting in-person contacts,

3) avoiding nonessential indoor spaces and crowded outdoor spaces,

4) increasing testing to rapidly identify and isolate infected persons,

5) promptly identifying, quarantining, and testing close contacts of persons with known COVID-19,

6) safeguarding persons most at risk for severe illness or death from infection with SARS-CoV-2, the virus that causes COVID-19,

7) protecting essential workers with provision of adequate personal protective equipment and safe work practices,

8) postponing travel,

9) increasing room air ventilation and enhancing hand hygiene and environmental disinfection, and

10) achieving widespread availability and high community coverage with effective COVID-19 vaccines.

In combination, these strategies can reduce SARS-CoV-2 transmission, long-term sequelae or disability, and death, and mitigate the pandemic’s economic impact. Consistent implementation of these strategies improves health equity, preserves health care capacity, maintains the function of essential businesses, and supports the availability of in-person instruction for kindergarten through grade 12 schools and preschool.

Individual persons, households, and communities should take these actions now to reduce SARS-CoV-2 transmission from its current high level. These actions will provide a bridge to a future with wide availability and high community coverage of effective vaccines, when safe return to more everyday activities in a range of settings will be possible…

No single strategy can control the pandemic; rather, a multipronged approach using all available evidence-based strategies at the individual and community levels can break transmission chains and address high levels of community transmission; reduce related illnesses, long-term sequelae, and deaths; and mitigate the pandemic’s economic impact….” (C)

“Local public health authorities determine and establish the quarantine options for their jurisdictions. CDC currently recommends a quarantine period of 14 days. However, based on local circumstances and resources, the following options to shorten quarantine are acceptable alternatives.

Quarantine can end after Day 10 without testing and if no symptoms have been reported during daily monitoring.

With this strategy, residual post-quarantine transmission risk is estimated to be about 1% with an upper limit of about 10%.

When diagnostic testing resources are sufficient and available (see bullet 3, below), then quarantine can end after Day 7 if a diagnostic specimen tests negative and if no symptoms were reported during daily monitoring. The specimen may be collected and tested within 48 hours before the time of planned quarantine discontinuation (e.g., in anticipation of testing delays), but quarantine cannot be discontinued earlier than after Day 7.

With this strategy, the residual post-quarantine transmission risk is estimated to be about 5% with an upper limit of about 12%.” (D)

THE BIDEN PLAN TO COMBAT CORONAVIRUS (COVID-19) AND PREPARE FOR FUTURE GLOBAL HEALTH THREATS (E)

President-elect Joe Biden said Thursday that he had asked Dr. Anthony Fauci earlier in the day to stay on in his role and to be a chief medical adviser in Biden’s incoming administration.,

“I asked him to stay on in the exact same role he’s had for the past several presidents, and I asked him to be a chief medical adviser for me as well, and be part of the Covid team,” Biden told CNN’s Jake Tapper in the first joint interview of Biden and Vice President-elect Kamala Harris since being elected.

Biden added that Ron Klain, the incoming White House chief of staff, knew Fauci well and had been talking to him “all the time.” Speaking on NBC’s “Today” show Friday morning, Fauci said he accepted the offer “right on the spot.”

Fauci previously told CNN that he had worked “very closely” with Klain during the Ebola outbreak when Klain was tasked with coordinating the Obama administration’s response to the crisis. He praised Klain as an “excellent choice” for White House chief of staff and said he was “absolutely terrific at the Ebola situation, where we had a very successful ultimate endgame with Ebola.”

Fauci told CNN later Thursday that he had an hour-long meeting at the White House that day with Biden’s agency review team. Team members who met with Fauci with included Jeffrey Zients, Biden’s choice for coronavirus czar, as well as two co-chairs of Biden’s 12-member coronavirus advisory board: Dr. David Kessler, the former commissioner of the US Food and Drug Administration, and former US Surgeon General Dr. Vivek Murthy.

Among the topics they discussed were vaccine distribution and the state of the pandemic, according to Fauci, who said it was a good meeting and that it is “the way transition should work.” (F)

“Joe Biden said Thursday that he will ask Americans to commit to 100 days of wearing masks as one of his first acts as president, stopping just short of the nationwide mandate he’s pushed before to stop the spread of the coronavirus.

The move marks a notable shift from President Trump, whose own skepticism of mask wearing has contributed to a politicization of the issue. That’s made many people reticent to embrace a practice that public health experts say is one of the easiest ways to manage the pandemic, which has killed more than 276,000 Americans.

The president-elect has frequently emphasized mask wearing as a “patriotic duty” and during the campaign floated the idea of instituting a nationwide mask mandate, which he later acknowledged would be beyond the ability of the president to enforce.

Speaking with CNN’s Jake Tapper, Biden said he would make the request of Americans on Inauguration Day, Jan. 20.” (G)

‘The Trump administration is shunting to the states hard decisions about which Americans will get the limited early supplies of coronavirus vaccines — setting up a confusing patchwork of distribution plans that could create unequal access to the life-saving shots.

Federal and state officials agree that the nation’s 21 million health care workers should be first in line. But there is no consensus about how to balance the needs of other high-risk groups, including the 53 million adults aged 65 or older, 87 million essential workers and more than 100 million people with medical conditions that increase their vulnerability to the virus.

The Trump administration has told states that they have ultimate authority for determining who gets vaccinated first. It has also decided to allocate scarce early doses based on states’ total populations, forcing hard choices in states with a greater proportion of residents at high risk — including Black, Indigenous and Latino communities that have suffered disproportionate rates of hospitalization and death from Covid-19.

Public health experts say that could undermine already shaky public confidence in the vaccine effort, whose success depends on convincing large numbers of Americans to get immunized.

“States are going to have to pick and choose who gets the first doses,” said Josh Michaud, an associate director for global health policy at Kaiser Family Foundation who has reviewed nearly every state’s distribution plan. “It’s very obvious that states are in different places when it comes to planning and identifying who those people are.”…

The Centers for Disease Control and Prevention normally lays out the guidelines for who should get priority for each vaccine, based on recommendations from a group of experts known as the Advisory Committee on Immunization Practices. The panel had not been scheduled to finalize its recommendations until after the first vaccine was authorized by the FDA. But that changed abruptly over the weekend, with the panel now set to meet Tuesday to hammer out advice for the highest priority groups — health care workers and residents of nursing homes and long-term care facilities.

“Typically there is a window of time after ACIP recommendations and before the vaccine hits the shelf,” said Nancy Messonnier, director of CDC’s National Center for Immunization and Respiratory Diseases, during the panel’s meeting last week. “This time we’re talking about an almost instantaneous rollout.”…

“This is all going to be very messy,” Michaud said. “There’s no question that plans on paper are one thing, but putting it into practice and getting vaccines into the arms of people is a whole different ballgame. It’s going to be a Herculean task.” (H)

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• A.U.S. Hits 100,000 COVID-19 Hospitalizations, Breaks Daily Death Record, by JACLYN DIAZ, https://www.npr.org/sections/coronavirus-live-updates/2020/12/02/941902471/u-s-hits-100-000-covid-19-hospitalizations-breaks-daily-death-record
• B.As Virus Spreads, C.D.C. Draws Up an Urgent Battle Plan, By Roni Caryn Rabin and Apoorva Mandavilli, https://www.nytimes.com/2020/12/04/health/coronavirus-cdc-recommendations.html?referringSource=articleShare
• C.Summary of Guidance for Public Health Strategies to Address High Levels of Community Transmission of SARS-CoV-2 and Related Deaths, December 2020, https://www.cdc.gov/mmwr/volumes/69/wr/mm6949e2.htm
• D.Options to Reduce Quarantine for Contacts of Persons with SARS-CoV-2 Infection Using Symptom Monitoring and Diagnostic Testing, https://www.cdc.gov/coronavirus/2019-ncov/more/scientific-brief-options-to-reduce-quarantine.html
• E.THE BIDEN PLAN TO COMBAT CORONAVIRUS (COVID-19) AND PREPARE FOR FUTURE GLOBAL HEALTH THREATS, https://joebiden.com/covid-plan/
• F.Biden said he asked Fauci to stay on and be a chief medical adviser in his administration, by By Jim Acosta, Jim Sciutto and Kate Sullivan, https://www.cnn.com/2020/12/03/politics/anthony-fauci-biden-transition/index.html
• G.Among first acts, Biden to call for 100 days of mask wearing, https://www.latimes.com/world-nation/story/2020-12-03/among-first-acts-biden-to-call-for-100-days-of-mask-wearing
• H. Trump administration leaves states to grapple with how to distribute scarce vaccines, By SARAH OWERMOHLE, RACHEL ROUBEIN and ZACHARY BRENNAN, https://www.politico.com/news/2020/11/30/trump-states-handle-vaccines-440798