POST 213. November 13, 2021. CORONAVIRUS. “Since the earliest days of the pandemic, there has been one collective goal for bringing it to an end: achieving herd immunity…Now the herd is restless. And experts at the Centers for Disease Control and Prevention have set aside herd immunity as a national goal.”

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“The pandemic isn’t over. But new cases nationally have dropped below 75,000 a day, less than half the number in August. The United States will soon reopen land borders to vaccinated visitors and lift several international travel restrictions. More than 2 million people boarded flights last Sunday, not too far from pre-pandemic travel levels…

There could still be a winter surge since respiratory viruses thrive when people huddle in heated rooms. Some experts said they expect at least a modest uptick in infections over the next few weeks. Last year’s brutal winter wave of infections, which peaked in January, was just getting rolling at this point on the calendar.

And although aggregate national numbers are lower, many cold-weather states, particularly in the Mountain West, have recently seen a rise in cases and hospitalizations. Alaska, slipping into its dark winter, has the highest infection rate in the nation.

Infectious-disease experts and Biden administration officials are not about to make any definitive predictions about when the pandemic might end. The virus, SARS-CoV-2, is slippery and opportunistic. It is still mutating. It has appeared to lose traction several times over the past year and a half, only to surge anew as it took advantage of more lax behavior and the contagiousness of mutated variants.

Even so, the trends are favorable. With most people vaccinated and infection rates dropping, the United States has entered a new phase of the pandemic in which people are adapting to the persistent presence of an endemic but usually nonlethal pathogen. They really have no choice. The virus isn’t going away….

More than 1,000 people on average are still dying of covid-19 every day in the United States. Someday, the coronavirus may be viewed more like influenza, but experts say we’re not there yet…

“I’m incredibly doubtful this is our last surge, and I think some geographic areas are going to be hit again,” said Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota and a Biden transition pandemic adviser. “There’s this waning immunity issue. Is it or is it not occurring, and how much? Could we be back in the soup again when we’re in pretty darn good shape today? What will it be like in 12 months?”… (A)

“The contagious delta variant is driving up COVID-19 hospitalizations in the Mountain West and fueling disruptive outbreaks in the North, a worrisome sign of what could be ahead this winter in the U.S.

While trends are improving in Florida, Texas and other Southern states that bore the worst of the summer surge, it’s clear that delta isn’t done with the United States. COVID-19 is moving north and west for the winter as people head indoors, close their windows and breathe stagnant air.

“We’re going to see a lot of outbreaks in unvaccinated people that will result in serious illness, and it will be tragic,” said Dr. Donald Milton of the University of Maryland School of Public Health.

The forecast for Oregon by Oregon Health & Science University, issued Thursday, foresees hospitalizations remaining above 400 through the end of the year.

In recent days, a Vermont college suspended social gatherings after a spike in cases tied to Halloween parties. Boston officials shut down an elementary school to control an outbreak. Hospitals in New Mexico and Colorado are overwhelmed.

In Michigan, the three-county metro Detroit area is again becoming a hot spot for transmissions, with one hospital system reporting nearly 400 COVID-19 patients. Mask-wearing in Michigan has declined to about 25% of people, according to a combination of surveys tracked by an influential modeling group at the University of Washington.

“Concern over COVID in general is pretty much gone, which is unfortunate,” said Dr. Jennifer Morse, medical director at health departments in 20 central and northern Michigan counties. “I feel strange going into a store masked. I’m a minority. It’s very different. It’s just a really unusual atmosphere right now.”

New Mexico is running out of intensive care beds despite the state’s above-average vaccination rate. Waning immunity may be playing a role. People who were vaccinated early and have not yet received booster shots may be driving up infection numbers, even if they still have some protection from the most dire consequences of the virus.

“Delta and waning immunity — the combination of these two have set us back,” said Ali Mokdad, a professor of health metrics sciences at the University of Washington. “This virus is going to stick with us for a long, long time.”

The delta variant dominates infections across the U.S., accounting for more than 99% of the samples analyzed.

No state has achieved a high enough vaccination rate, even when combined with infection-induced immunity, to avoid the type of outbreaks happening now, Mokdad said.”  (B)

“As the Delta variant continues its global surge, experts are questioning whether the long-held goal of achieving herd immunity from Covid-19 through vaccination is still viable…

“If the question is ‘will vaccination alone allow us to dampen and control the pandemic?’ the answer is: no,” epidemiologist Mircea Sofonea told AFP.

He said herd immunity hinged on two basic factors.

“That’s the intrinsic infectiousness of the virus and the efficacy of vaccines to protect against infection. And at the moment, that efficacy isn’t there.”

Delta has shown to be roughly 60 percent more transmissible than the Alpha variant of the SARS-CoV-2 virus, and up to twice as infectious as the original strain that emerged in late 2019.

The more effective the virus becomes at infecting people, the higher the herd immunity threshold becomes.

“Theoretically, it’s a very simple calculation to make,” said epidemiologist Antoine Flahault.

For the original virus, which had a reproduction rate between zero and three — meaning each infected person infects up to three others — herd immunity could have been achieved with around 66 percent of people immunised, Flahault told AFP.

“But if the reproduction rate is eight, as with Delta, that puts us closer to 90 percent,” he said.

Were vaccines 100 percent effective at stopping Delta infections, that 90 percent could conceivably be possible. Unfortunately, they aren’t.

According to data published this week by US authorities, the efficacy of the Pfizer and Moderna mRNA vaccines at preventing infection has fallen from 91 percent to 66 percent since Delta became the dominant variant.

And studies have shown that the vaccine efficacy against infection with Delta falls over time — one of the reasons why several countries are now readying for an autumn third shot, or “booster”, vaccination campaign.

With all this taken into account, absent other health measures such as mask-wearing or social distancing, Sofonea said it would take more than 100 percent of people to be vaccinated in order to guarantee transmissions end — an obvious impossibility.

“The Delta variant will still infect people who have been vaccinated and that does mean that anyone who’s still unvaccinated, at some point, will meet the virus,” Andrew Pollard, director of Britain’s Oxford Vaccine Group, told lawmakers this month.

But even if, as Pollard termed it, the “mythical” aim of herd immunity is no longer in play, experts stressed that getting vaccinated remained paramount.”  (C)

“It’s highly unlikely that the United States, let alone the world, will be able to completely eliminate the coronavirus that causes Covid-19…

“There’s not even a measurement to say that something is an epidemic or pandemic. All of this is in the eye of the beholder — and that’s part of the issue,” Dr. Arnold Monto, a professor of epidemiology at the University of Michigan and acting chair of the US Food and Drug Administration’s Vaccines and Related Biological Products Advisory Committee, told CNN.

“So, all of this is not based on rules. It’s based typically on what you have to do to control the outbreak,” Monto said. “What is so different here is that our vaccines are much more effective than what we usually see.”

The good news, according to Monto, is the power of vaccines. The bad news comes with the power of the virus to change and evolve.

No one can predict what the future of Covid-19 could look like — and the emergence of coronavirus variants, like Delta, has shifted the trajectory, he said.

“With the change in transmission patterns, as the variants have emerged — I call it a parade of variants — we now see much more extensive transmission and much more uniform spread globally. This makes declaring the end of the pandemic more difficult,” Monto said. “Because the whole pattern of spread has changed, and there may still be pockets that really haven’t gone through the kind of waves that the rest of the world has gone through.”…

Endemic means that a disease has a constant presence in a population — but it’s not affecting an alarmingly large number of people as typically seen in a pandemic. Even in early 2020, as the pandemic was ramping up, officials at the World Health Organization predicted that the novel coronavirus “may become another endemic virus in our communities” and never go away…

To transition from pandemic to endemic, the nation has to build up immunity to the coronavirus — which means many more people need to get vaccinated, Dr. Philip Landrigan, a pediatrician and epidemiologist at Boston College, told CNN.

With some Americans still refusing to get their Covid-19 shots and some refusing to wear masks, the transition could take more time.

“We have to get somewhere well north of 80%, possibly even well north of 90% of the population with immunity either through having had infection or through having had vaccinations,” said Landrigan, who worked at the CDC for 15 years.” (D)

“Another wave of COVID-19 is sweeping across Europe, setting new records in some countries.

Records for daily infections have been shattered in recent days in Germany, the Netherlands and Austria. While deaths from COVID-19 are way down from last year in many European countries, Russia — with barely a third of its population vaccinated — has seen a steady two-month surge and now leads the world in total coronavirus deaths for the first time since the start of the pandemic…

The World Health Organization’s COVID-19 report for the week ending Nov. 7 showed that Europe, including Russia, was the only region with a rise in deaths from the virus, up 10%. Overall, new coronavirus cases were on the decline in most of the world, but were up 7% in Europe and 3% in Africa…

In Germany, where cases on Thursday surged to a new record of more than 50,000, the country’s health minister, Jens Spahn, has said his country must do “everything necessary” to break the latest wave of the disease, Deutsche Welle reported…

Nearly a third of Germany’s population is not yet fully vaccinated, according to data from Johns Hopkins University.

Countries with high vaccine rates and strict mandates have generally fared better

By contrast, Portugal and Spain — where new cases have been minimal — top the European vaccination statistics, with rates in excess of 80%. Infections are also low in France, which has kept restrictions in place since summer, including a requirement to show a vaccine passport to do nearly everything.

Austria — which has a vaccination rate similar to Germany’s and has also posted record infections in the past week — appears to be days away from imposing a lockdown for anyone who is not fully inoculated.

Chancellor Alexander Schallenberg has called a national lockdown for the unvaccinated “probably inevitable,” adding that two-thirds of the population should not have to suffer because the other third refused to be vaccinated…

In the Netherlands, a three-week partial lockdown was announced Friday, Reuters reported.

During a news conference Friday, caretaker Prime Minister Mark Rutte said the country will return to a partial lockdown starting Saturday — ordering all bars and restaurants to close at 8 p.m. and sporting events to be held without audiences.

Dutch government officials also recommended that no more than four visitors be allowed in people’s homes.

Denmark, which has also seen a recent upswing in cases, this week ordered its people to present a pass in the form of a smartphone app when they enter bars, restaurants and other public places. It is also considering fast-track legislation to require a digital “corona pass” for employers, according to Reuters.

While the United Kingdom saw a similar increase in cases last month, there are signs of a leveling off since then.” (E)

“Up to 116 hospital patients who were admitted with non-Covid illnesses in the last two weeks, were infected with the virus while in hospital as winter overcrowding now reaches critical levels.

The healthcare-acquired infections caught in hospital during their stay highlight the massive strain on services as daily cases of Covid-19 soared to 5,483 yesterday.

Another six Covid-19 patients were admitted to hospital yesterday, bringing the total to 549, of whom 96 are seriously ill in intensive care, a reduction of one overnight.

Five people a day are still dying from Covid.

In a major blow, one of the country’s biggest hospitals, the Mater in Dublin, is being forced to cancel many outpatient appointments and elective surgeries until further notice due to the pressures.

It has limited its activities to essential services since yesterday evening.

The three children’s hospitals in Dublin – Crumlin, Temple Street and Tallaght – are curtailing some elective operations for the third week running due a surge in winter respiratory illnesses.

It comes after two leading paediatric orthopaedic surgeons, Connor Greene and Damien McCormack, warned that young children denied timely care are ending up in wheelchairs.

And consultants in University Hospital Kerry held a crisis meeting with HSE executives, warning patient safety is at risk because of a shortage of beds and staff. Elective surgery at the hospital has been suspended since mid-September and a “totally inadequate” number of single rooms is increasing infection control risks, they warned….

The worry now is that hospitals across the country have yet to reach their winter peak and seriously ill patients will again have their care put on hold and risk deteriorating.

Prof Alan Irvine, president of the Irish Hospital Consultants Association, said nearly one million people are now on a hospital waiting list and even the HSE’s modest target to reduce the queues by 36,000 by the end of the year will not be met.

He warned: “The early winter surge is seeing the widespread cancellation of operations and outpatient appointments already across public hospitals.”…

Chief medical officer Dr Tony Holohan this weekend said everyone should try to continue to make every effort they can to drive down the disease and break the chains of transmission.

“Before you leave the house, think about the number of people you are going to meet, and the risk associated with the activities you have planned,” Dr Holohan said. “Keep your contacts low and avoid crowds, wear a mask correctly, meet outside if possible, avoid poorly ventilated indoor spaces and practise good hand and respiratory hygiene.”” (F)

“Japanese Prime Minister Fumio Kishida outlined on Friday an urgent plan to increase hospital beds and medical resources in preparation for a possible resurgence of COVID-19 infections this winter.

After a deadly fifth wave of infections almost overwhelmed the medical system during the summer, infections and deaths have fallen dramatically as vaccinations have increased to cover more than 70% of the population.

Emergency measures covering most of the country were lifted last month, but health experts warn that cases will likely rebound, as they did in Japan last winter. Ahead of that, the government plans to boost hospital bed capacity by about 30%, bolster in-home care, and collect data to predict which hospitals will come under pressure.

“In parallel with strengthening the medical system, from December will use IT systems to make public the number of hospital beds and conditions at each hospital,” Kishida told reporters.

Kishida said earlier this week that the “trump card” in the government’s pandemic fight was the procurement of oral treatments that could prevent the need for hospitalisation.

Japan will pay about $1.2 billion to Merck & Co Inc (MRK.N) for 1.6 million courses of the COVID-19 antiviral pill molnupiravir, according to terms announced on Wednesday.

That’s about half the supply that has been secured by the United States and compares with a total of 1.7 million coronavirus cases seen in Japan since the start of the pandemic…

To stave off the bed shortage, the health ministry has adopted a system that uses past and present infection data to predict when and where medical resources will come under strain.

“A sixth wave is a question of when rather than if,” said Yuki Furuse, a Kyoto University professor who developed the predictive tool.

“Because the current situation in Japan is calm, it seems okay to lift some restrictions now. However, I am concerned about whether people can go back to a ‘voluntary self-restraint state’ again when needed,” he added.” (G)

Especially in the months before the Delta variant became dominant, the pandemic seemed like it should be nearly over.

“When the vaccines first came out, and we started getting shots in our own arms, so many of us felt physically and emotionally transformed,” said Dr. Jeremy Greene, a historian of medicine at Johns Hopkins University School of Medicine. “We had a willful desire to translate that as, ‘The pandemic has ended for me.’”

He added, “It was a willful delusion.”

And that is a lesson from history that is often forgotten, Frank Snowden, a historian of medicine at Yale University, said: how difficult it is to declare that a pandemic has ended.

It may not be over even when physical disease, measured in illness and mortality, has greatly subsided. It may continue as the economy recovers and life returns to a semblance of normality. The lingering psychological shock of having lived in prolonged fear of severe illness, isolation and painful death takes long to fade.

Some diseases, like the 1918 flu, receded. Others, like the bubonic plague, remained, smoldering. H.I.V. is still with us, but with drugs to prevent and treat it. In each case, the trauma for those affected persisted long after the imminent threat of infection and death had ebbed.

If nothing else, the Covid-19 virus has humbled experts who once confidently predicted its course, disregarding the lessons of history.

“What we are living through now is a new cycle of collective dismay,” Dr. Greene said — a dismay that has grown out of frustration with the inability to control the virus, fury of the vaccinated at those who refuse to get the shots and a disillusionment that astoundingly effective vaccines haven’t yet returned life to normal.”..

Other pandemics, like this one, were hobbled by what Dr. Snowden calls “overweening hubris,” prideful certainties from experts that add to the frustrations of understanding how and when it will dwindle away.

With Covid, prominent experts declared at first that masks did not help prevent infection, only to reverse themselves later. Epidemiologists confidently published models of how the pandemic would progress and what it would take to reach herd immunity, only to be proved wrong. Investigators said the virus was transmitted on surfaces, then later said that, no, it was spread through tiny droplets in the air. They said the virus was unlikely to transform in a substantial way, then warned of the Delta variant’s greater transmissibility.

“We paid a heavy price for that,” Dr. Snowden said. Many people lost trust in officials amid ever-changing directives and strategies that weakened the effort to control the virus.”  (H)

“The U.S. is currently averaging around 76,000 new COVID-19 cases a day, up by nearly 20% since mid-October, according to an ABC News analysis of federal data.

North Dakota now has the country’s highest infection rate, followed by Minnesota, Alaska and Vermont.

COVID-19 hospitalizations nationwide also increased for the fourth consecutive day Friday. More than 47,000 patients with COVID-19 are currently receiving care.” (I)

“Since the earliest days of the pandemic, there has been one collective goal for bringing it to an end: achieving herd immunity. That’s when so many people are immune to a virus that it runs out of potential hosts to infect, causing an outbreak to sputter out.

Many Americans embraced the novel farmyard phrase, and with it, the projection that once 70% to 80% or 85% of the population was vaccinated against COVID-19, the virus would go away and the pandemic would be over.

Now the herd is restless. And experts at the Centers for Disease Control and Prevention have set aside herd immunity as a national goal.

The prospects for meeting a clear herd-immunity target are “very complicated,” said Dr. Jefferson Jones, a medical officer on the CDC’s COVID-19 Epidemiology Task Force.

“Thinking that we’ll be able to achieve some kind of threshold where there’ll be no more transmission of infections may not be possible,” Jones acknowledged last week to members of a panel that advises the CDC on vaccines….

On issues ranging from the use of masks to how the virus spreads, the agency has made some dramatic about-faces over the course of the pandemic. Those reversals were prompted by new scientific discoveries about how the novel virus behaves, but they’ve also provided ample fuel for COVID-19 skeptics, especially those in conservative media.

“It’s a science-communications problem,” said Dr. John Brooks, chief medical officer for the CDC’s COVID-19 response.

“We said, based on our experience with other diseases, that when you get up to 70% to 80%, you often get herd immunity,” he said.

But the SARS-CoV-2 virus didn’t get the memo.

“It has a lot of tricks up its sleeve, and it’s repeatedly challenged us,” he said. “It’s impossible to predict what herd immunity will be in a new pathogen until you reach herd immunity.”

The CDC’s new approach will reflect this uncertainty. Instead of specifying a vaccination target that promises an end to the pandemic, public health officials hope to redefine success in terms of new infections and deaths — and they’ll surmise that herd immunity has been achieved when both remain low for a sustained period.

“We want clean, easy answers, and sometimes they exist,” John Brooks said. “But on this one, we’re still learning.”…

For instance, it assumes an unrealistic uniformity in the behavior of individuals and groups, and in the virus’ ability to spread from person to person…

“Humans are not a herd,”… (J)

“Austria is placing millions of people not fully vaccinated against the coronavirus in lockdown as of Monday to deal with a surge in infections to record levels and the growing strain on intensive-care units, the government said on Sunday.

Europe is the epicentre of the COVID-19 pandemic again, prompting some governments to consider re-imposing unpopular lockdowns. Austria has one of the continent’s highest infection rates, with a seven-day incidence of 815 per 100,000 people. read more

Austria is the first European country to reinstate the same restrictions on daily movements that applied during national lockdowns before vaccines were rolled out, though this time they only affect a minority of the population.

“We are not taking this step lightly but it is necessary,” Chancellor Alexander Schallenberg told a news conference announcing the new measure, under which the unvaccinated can only leave their homes for a limited number of reasons like going to work or shopping for essentials.

Roughly 65% of Austria’s population is fully vaccinated against COVID-19, one of the lowest rates in western Europe. Many Austrians are sceptical about vaccines, a view encouraged by the far-right Freedom Party, the third biggest in parliament.

The measures on Monday will extend those brought in a week ago which banned the unvaccinated from places including restaurants, hotels, theatres and ski lifts.” (K)