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)

for links to POSTS 1-146 in chronological order, highlight and click on

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“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)

• A.CDC director warns coronavirus variants could spark another avoidable surge, By Jacqueline Howard and Christina Maxouris, https://www.cnn.com/2021/03/22/health/us-coronavirus-monday/index.html
• B.Dr. Fauci Just Warned of a “Fourth Wave” of COVID, by Alek Korab, https://www.yahoo.com/lifestyle/dr-fauci-just-warned-fourth-163036448.html?guccounter=1
• C.We’re facing a fourth wave of coronavirus, despite vaccines. Here’s why, By Tracey Anne Duncan, https://www.mic.com/p/were-facing-a-fourth-wave-of-coronavirus-despite-vaccines-heres-why-68358498
• D.US experts warn new Covid variants and states reopening may lead to fourth wave, by Jessica Glenza, https://www.theguardian.com/world/2021/mar/05/new-covid-variants-us-states-reopening-fourth-wave
• E.Why Lifting State Mask Mandates Could Trigger a Fourth COVID-19 Wave, by  Julia Ries, https://www.healthline.com/health-news/why-lifting-state-mask-mandates-could-trigger-a-fourth-covid-19-wave
• F.’It’s like we’re trying our best to help the virus’: A fourth wave is looming if US fails to contain COVID-19 variants, experts say, by Karen Weintraub, https://www.usatoday.com/story/news/health/2021/02/16/covid-19-us-fourth-wave-variants-coronavirus/4460958001/
• G.COVID-19’s fourth wave is hitting the US hard, BY REID WILSON, https://thehill.com/homenews/state-watch/545566-covid-19s-fourth-wave-is-hitting-the-us-hard
• H.Covid 19: Why we can’t risk another wave, https://www.bmj.com/content/372/bmj.n609
• I.As U.S. braces for fourth pandemic wave, one governor asks for more vaccines in hot spots, By Erin Cunningham, Marisa Iati and Reis Thebault, https://www.washingtonpost.com/nation/2021/03/30/coronavirus-covid-live-updates-us/
• J.Why a 4th COVID-19 wave may look different than previous surges, By Arielle Mitropoulos, https://abcnews.go.com/Health/4th-covid-19-wave-previous-surges/story?id=76655910
• K.The race between variants & vaccines: Where things stand today, by Mackenzie Bean and Gabrielle Masson, https://www.beckershospitalreview.com/public-health/the-race-between-variants-vaccines-where-things-stand-today.html
• L.Florida more than doubles its tally of variant cases; Mexico’s death toll ranks second-highest in the world: Live COVID-19 updates, by John Bacon, Jordan Culver and Jorge L. Ortiz, https://www.usatoday.com/story/news/health/2021/03/28/covid-news-40-million-vaccine-doses-either-awaiting-use-wasted/7033428002/
• M.Epidemiologist Dr. Michael Osterholm on what the UK variant means for the pandemic’s 3rd act, by Mackenzie Bean, https://www.beckershospitalreview.com/public-health/epidemiologist-dr-michael-osterholm-on-what-the-uk-variant-means-for-the-pandemic-s-3rd-act.html
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