POST 214. November 20, 2021. CORONAVIRUS. “This virus is doing what this virus does,” said Michael Osterholm… “We don’t understand why surges start, we don’t understand why they end.” (A)

POST 214. November 20, 2021. CORONAVIRUS. “This virus is doing what this virus does,” said Michael Osterholm… “We don’t understand why surges start, we don’t understand why they end.” (A)

“Clearly case numbers are still climbing all the indications we have in terms of test positivity rate would suggest we still have more to go with this surge before we hit the peak,” he said.” (B)

“This thing is no longer just throwing curveballs at us — it’s throwing 210 mile an hour curveballs at us,” said Michael Osterholm, an epidemiologist at the University of Minnesota. He said that the virus had repeatedly defied predictions and continues to do so.” (O)

for links to POSTS 1-214 in chronological order highlight and click on

https://doctordidyouwashyourhands.com/2021/11/coronavirus-tracking-links-to-posts-1-214/

“A month ago, new coronavirus cases in the United States were ticking steadily downward and the worst of a miserable summer surge fueled by the Delta variant appeared to be over. But as Americans travel this week to meet far-flung relatives for Thanksgiving dinner, new virus cases are rising once more, especially in the Upper Midwest and Northeast.

Federal medical teams have been dispatched to Minnesota to help at overwhelmed hospitals. Michigan is enduring its worst case surge yet, with daily caseloads doubling since the start of November. Even New England, where vaccination rates are high, is struggling, with Vermont, Maine and New Hampshire trying to contain major outbreaks.

Nationally, case levels remain well below those seen in early September, when summer infections peaked, and are below those seen last Thanksgiving. But conditions are worsening rapidly, and this will not be the post-pandemic Thanksgiving that Americans had hoped for. More than 90,000 cases are being reported each day, comparable to early August, and more than 30 states are seeing sustained upticks in infections. In the hardest-hit places, hospitalizations are already climbing…

The new rise in cases comes at a complicated moment. Last Thanksgiving, before vaccines were available, federal and local officials had firmly urged Americans to forgo holiday gatherings. But in sharp contrast, public health officials, including Dr. Anthony S. Fauci, the nation’s leading infectious-disease expert, have mostly suggested this year that vaccinated people could gather in relative safety.” (O)

“COVID-19 cases are climbing nationally as the U.S. barrels into its second holiday season during the pandemic, with most families planning this year to gather for Thanksgiving….

“There is concern that the rate of infection spreading is already so high as we head into the holiday season,” said Amber D’Souza, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health.

“We’re definitely headed into our next surge,” she added.

Nationally, the seven-day average for new COVID-19 cases is nearing 95,000, a 33 percent increase from two weeks prior, according to data from The New York Times. In the past two weeks, cases have increased in 39 states and D.C., and they have doubled in Massachusetts and Rhode Island. “ (C)

“As cases of Covid-19 rise throughout the U.S., health officials warn that an increasing number of fully vaccinated people are being hospitalized or going to the emergency room. The concern about waning immunity against severe Covid infection comes as the Food and Drug Administration is expected to authorize a Pfizer-BioNTech vaccine booster shot for all adults 18 and older.

 “What we’re starting to see now is an uptick in hospitalizations among people who’ve been vaccinated but not boosted,” Dr. Anthony Fauci, the director of the National Institute for Allergy and Infectious Disease, said Tuesday in an interview. “It’s a significant proportion, but not the majority by any means.”

On Wednesday, Dr. Rochelle Walensky, the director of the Centers for Disease Control and Prevention, reported a decline in vaccine effectiveness among the elderly and residents of long-term care facilities, many of whom were the first to be eligible to be vaccinated last winter.

“Although the highest risk are those people who are unvaccinated, we are seeing an increase in emergency department visits among adults 65 and older, which are now again higher than they are for younger age groups,” Walensky said Wednesday at a White House Covid briefing.

Walensky also pointed to new data on long-term care facilities from the agency’s National Healthcare Safety Network comparing rates of Covid disease between people who are vaccinated with two doses and those who have received extra doses.

“The rate of disease is markedly lower for those who received their booster shot, demonstrating our boosters are working,” she said.

Fauci and Walensky stressed that the majority of hospitalizations and deaths are still among unvaccinated people in the U.S.” (D)

“To protect both patients and staff, healthcare personnel (HCP) were among the first groups in the United States recommended to receive the COVID-19 vaccine. We analyzed data reported to the U.S. Department of Health and Human Services (HHS) Unified Hospital Data Surveillance System on COVID-19 vaccination coverage among hospital-based HCP. After vaccine introduction in December 2020, COVID-19 vaccine coverage rose steadily through April 2021, but the rate of uptake has since slowed; as of September 15, 2021, among 3,357,348 HCP in 2,086 hospitals included in this analysis, 70.0% were fully vaccinated. Additional efforts are needed to improve COVID-19 vaccine coverage among HCP.” (E)

“For the fourth week in a row, the rate of new global COVID-19 cases rose, mainly led by surges in Europe but also influenced by spikes in the Americas and Western Pacific countries, the World Health Organization (WHO) said yesterday in its weekly pandemic update.

Cases were up 6% last week compared with the week before, and though deaths were stable or declining in much of the world, fatality levels rose in Europe.

Of the top five countries that reported the most cases last week, four are in Europe: Russia, Germany, the United Kingdom, and Turkey. However, the United States continues to lead the world with the most weekly cases.

Nearly half of European countries saw cases rise 10% or more last week, with surge locations distributed evenly across the region. Countries in Eastern Europe, where vaccine uptake is lower, were the first to report new illness spikes.” (F)

“Austria on Friday became the first Western democracy to announce that it would mandate Covid vaccinations for its entire adult population as it prepared for a nationwide lockdown starting Monday.

The extraordinary measure by Austria, which only days ago separated itself from the rest of Europe by introducing a lockdown for the unvaccinated, who are driving a surge of infections, made for another alarming statement about the severity of the fourth wave of the virus in Europe, now the epicenter of the pandemic.

But it also showed that increasingly desperate governments are losing their patience with vaccine skeptics and shifting from voluntary to obligatory measures to promote vaccinations and beat back a virus that shows no sign of waning, rattling global markets at the prospect that still tentative economic recoveries will be undone.

Some European countries, including Germany, which once seemed a model of how to manage the virus, are now facing their worst levels of infections in the nearly two years since the pandemic began.

The surge, health authorities say, is being driven by stubborn resistance to getting vaccinated in deep pockets of the population, cold weather driving people indoors and loosened restrictions, rather than new variants.

“For a long time — maybe too long — I and others assumed that it must be possible to convince people in Austria to voluntarily get vaccinated,” Chancellor Alexander Schallenberg of Austria said on Friday. “We therefore have reached a very difficult decision to introduce a national vaccine mandate.” (G)

‘Faced with rising infections and an anticipated surge in holiday travel, the Centers for Disease Control and Prevention on Friday endorsed booster shots of the coronavirus vaccines for all Americans over 18.

The recommendation fulfills President Biden’s pledge in August to make the extra doses available to all adults, and caps months of scientific debate over whether most people really needed boosters. The shots are already available at many drugstores, doctors’ offices and vaccination centers.

The C.D.C. said that Americans over age 50, as well as those 18 and older living in long-term care facilities, “should” get booster shots of the Pfizer-BioNTech or Moderna vaccines. All other adults over age 18 “may” get booster doses, the agency decided.

Recipients of Johnson & Johnson’s one-dose vaccine already were cleared to get a booster at least two months after the initial shot.

Earlier on Friday, the Food and Drug Administration authorized booster shots for all Americans over age 18. But the C.D.C. usually sets the clinical guidelines adopted by the medical profession.

A panel of scientific advisers approved the expansion of eligibility earlier on Friday, and the agency’s director, Dr. Rochelle Walensky, endorsed the recommendation early in the evening.

Many experts worried that extra doses were not needed by most adults to prevent serious illness and death, and that a push for boosters could constrain global vaccine supplies even as people in many poor countries have not received their first doses.” (H)

“Mask wearing is one of the most effective public health measures for preventing covid-19, reducing incidence of the disease by 53 per cent, according to a review of published research.

Stella Talic at Monash University in Australia and her colleagues carried out a meta-analysis using data from 72 studies to assess the effectiveness of non-pharmaceutical interventions – measures that don’t involve drugs – at containing the virus.

Handwashing was also estimated to reduce covid-19 incidence by 53 per cent, but this result was not statistically significant because only a small number of studies on it were included. Physical distancing was found to reduce incidence by 25 per cent.

“It is likely that further control of the covid-19 pandemic depends not only on high vaccination coverage and its effectiveness but also on ongoing adherence to effective and sustainable public health measures,” Talic and her colleagues write in the British Medical Journal.” (I)

 “Amid the turmoil of the last two years — a period that included a deadly pandemic, mass layoffs, an ugly presidential election and an attack on the United States Capitol — some of the fiercest political debates in America have been waged over a nearly weightless piece of fabric: the face mask.

American officials were slow to embrace face masks as a strategy for slowing the spread of the coronavirus. When they finally did, masks became a potent symbol of the pandemic — a common-sense public health measure turned political flashpoint and a visible reminder that life was anything but normal.

Now, with the summer’s Delta surge in the rearview mirror and the vaccination of school-age children underway, many Americans are wondering when the masks might finally come off.

 “The best science does support mask-wearing as a valid strategy to reduce Covid-19,” said Dr. Stephen Luby, an infectious disease expert and epidemiologist at Stanford University. “The issue is: Well, how long do we do this, and in how many contexts?” He added, “Do we all wear masks the rest of our lives?”

Some public officials are already mapping out an endgame. On Tuesday, Mayor Muriel Bowser of Washington, D.C., announced that indoor mask requirements would be loosened. The next day, Florida

Eric Adams, New York City’s mayor-elect, “wants to drop the mask mandate in schools when health officials determine it’s safe,” his spokesman said in an email.

That time has not yet come, experts said.

“Cases are starting to rise again, and we have not yet conquered this virus,” said Anne Rimoin, an epidemiologist at the University of California, Los Angeles. “We may be tired of Covid and Covid restrictions and public health measures, but this virus is certainly not done with us yet.”

The Centers for Disease Control and Prevention recommends that even fully vaccinated people wear masks in public indoor spaces where community transmission of the virus is “substantial or high.” Currently, roughly 85 percent of U.S. counties meet that threshold, which is defined as at least 50 new cases weekly per 100,000 residents.

It will be safer to ease mask requirements early next year, scientists said, after more children have been fully vaccinated and the holiday travel season has passed. And voluntary mask-wearing will continue to be helpful in certain circumstances, as well as in future cold and flu seasons, they noted.

“I don’t think we’re going to want to put all our masks away,” Dr. Luby said.” (J)

“Amid a rise in COVID-19 cases across the U.S., hospitalizations among fully vaccinated people are also increasing, raising questions about waning vaccine immunity and whether booster doses will eventually be required to be considered fully vaccinated. ..

Earlier this month, CDC director Rochelle Walensky, MD, said the agency had no plans to change its definition of fully vaccinated.

Real-world studies from Israel indicate boosters lower people’s chance of breakthrough COVID-19 infection and severe illness. Data showed a third dose of Pfizer’s vaccine in people ages 60 and older reduced the risk of infection by 86 percent and the risk of severe disease by 92 percent.” (K)

“”I hate to say it, but I suspect we’re at the start of a new winter surge,” says Dr. George Rutherford, an epidemiologist at the University of California, San Francisco…

The growth in cases isn’t unexpected, given the patchwork of COVID-19 immunity across the U.S., where about 60% of the population is fully vaccinated.

Americans are moving around like they were before the pandemic, mask wearing is low compared to last year, people are spending more time indoors because of cooler weather, and protection against infection, both from vaccinations and prior infection, is waning, says Ali Mokdad, professor of Health Metrics Sciences at the University of Washington’s Institute of Health Metrics and Evaluation.

“You put all of this together — and what you see in Europe where many countries with higher vaccination rates than the United States are seeing a surge — of course, it’s going to happen,” he says.

And unlike last year, the U.S. has to contend with a much more contagious version of the virus “that makes it really hard to snuff out chains of transmission,” not to mention “human nature, which is wanting us to get back to pre-pandemic life,” says Reich at UMass Amherst.

Just how bad the situation gets will come down to complex dynamics around immunity. Southern states endured a brutal wave over the summer and that may have built up enough immunity from infection to shield them from another big resurgence this winter. Areas that did not face the same kind of surge, in particular states in the northern half of the country, are now dealing with an increase, but many also have the benefit of higher vaccination coverage.

“The real question is, how big will it get and will it really be substantial? And my sense is in New England, it’s going to hit a wall of vaccinated people,” says Dr. Ashish Jha, dean of Brown University’s School of Public Health.

“I think the Midwest and the Great Plains — which have lower vaccination rates but have not seen a big delta surge — they may very well end up seeing quite a few infections in the weeks and months ahead.”

Even if hospitals see fewer COVID-19 patients overall, it’s already clear that many are less prepared to handle the demands of the pandemic compared to last year.

“Every hospital I have talked to in the last month has severe shortages of staff, especially nurses,” says Dr. Bruce Siegel, president of America’s Essential Hospitals, which represents hundreds of public hospitals in the U.S…

As we head into the holidays, COVID risk increases, with more people traveling and socializing indoors. But “we also have some things that are helping, like more vaccines and kids getting vaccinated,” says Brown’s Jha. “So we’re in a stalemate. I don’t expect us to have a horrible surge, but I can certainly imagine parts of the country that see modest-sized surges as people get together and as the weather stays cold.” (M)

 “New York Gov. Kathy Hochul recommended Americans who have family and friends over for indoor Thanksgiving celebrations remain masked and socially distant, a potentially improbable suggestion at this stage in the pandemic.” (L)

“Disney has put on pause a coronavirus vaccine mandate for employees of its Florida theme park after the State Legislature and the governor made it illegal for employers to require all workers get the shots, a company spokesperson confirmed Saturday.

Walt Disney World could have been facing fines under the policy now on hold, illustrating how even one of the most iconic tourism brands in the state has to deal with the headwinds of political debate over the pandemic response.

The Republican-controlled Florida Legislature delivered the bill blocking Covid-19 vaccine mandates on Wednesday and Gov. Ron DeSantis signed it into law on Thursday, casting the measures as an effort to protect workers who could lose their jobs for lack of compliance…

The new Florida law prohibits employers from enforcing strict vaccine mandates, allowing employees to choose exemptions that include health or religious concerns, pregnancy or anticipated pregnancy, and having had the virus and recovered from it. Unvaccinated workers could instead undergo periodic testing or wear protective equipment, at the employers’ cost. Fines for violation could cost $10,000 a day per employee violation for businesses with fewer than 99 employees or up to $50,000 per employee violation for larger businesses.

Government entities and school districts are also restricted by the Covid mandate ban.

Disney World previously struck a deal with employees to require theme park workers be fully vaccinated against Covid to keep their jobs, and the company defended that rule in a statement Saturday. “We believe that our approach to mandatory vaccines has been the right one as we’ve continued to focus on the safety and well-being of our cast members and guests,” the statement said in part.

More than 90 percent of active cast members in Florida had verified they were vaccinated, the company said, before it sent a memo to employees halting the mandate.” (N)

A.Holiday COVID alarm as cases rise 20%, by Caitlin Owens and Kavya Beheraj, https://www.axios.com/coronavirus-thanksgiving-america-vaccines-2f873ccf-a168-4a0c-9d66-ffa2c9585585.html

B.Gather Only With Vaccinated Family Members For Holidays, Dr. Osterholm Says, By Liz Collin, https://minnesota.cbslocal.com/2021/11/20/gather-only-with-vaccinated-family-members-for-holidays-

C.COVID-19 cases rise with Thanksgiving gatherings on the way, BY JUSTINE COLEMAN, https://thehill.com/policy/healthcare/582438-covid-19-cases-rise-with-thanksgiving-gatherings-on-the-way

D.Hospitalizations rising among fully vaccinated in U.S., Fauci says, By Akshay Syal, https://www.nbcnews.com/health/health-news/hospitalizations-rising-fully-vaccinated-us-fauci-says-rcna5907

E.COVID-19 vaccination coverage among hospital-based healthcare personnel reported through the Department of Health and Human Services Unified Hospital Data Surveillance System, United States, January 20, 2021-September 15, 2021, by Hannah E. Reses et al, https://www.ajicjournal.org/article/S0196-6553(21)00673-8/fulltext

F.Global COVID-19 cases continue to climb, by Lisa Schnirring, https://www.cidrap.umn.edu/news-perspective/2021/11/global-covid-19-cases-continue-climb

G.Austria Announces Covid Vaccine Mandate, Crossing a Threshold for Europe, By Jason Horowitz and Melissa Eddy, https://www.nytimes.com/2021/11/19/world/europe/austria-covid-vaccine-mandate-lockdown.html?referringSource=articleShare

H.C.D.C. Endorses Covid Vaccine Booster Shots for All Adults, By Apoorva Mandavilli, https://www.nytimes.com/2021/11/19/health/covid-boosters-cdc.html?referringSource=articleShare

I.Covid-19 news: Mask wearing cuts infections by 53 per cent, By Michael Le Page, Clare Wilson, Jessica Hamzelou, Sam Wong, Graham Lawton, Adam Vaughan, Conrad Quilty-Harper, Jason Arunn Murugesu and Layal Liverpool, https://www.newscientist.com/article/2237475-covid-19-news-mask-wearing-cuts-infections-by-53-per-cent/

J.When Can the Covid Masks Finally Come Off?, By Emily Anthes, https://www.nytimes.com/2021/11/20/health/covid-mask-mandate.html?referringSource=articleShare

K.Will the definition of ‘fully vaccinated’ change?, by Erica Carbajal, https://www.beckershospitalreview.com/public-health/will-the-definition-of-fully-vaccinated-change.html

L.Axios AM, By Mike Allen ·Nov 20, 2021

M.U.S. COVID cases start to rise again as the holidays approach, by WILL STONE, https://www.npr.org/sections/health-shots/2021/11/16/1056232480/u-s-covid-cases-rising-holidays

N.Disney puts worker vaccine mandate on pause after Florida ban on restrictions., By Víctor Manuel Ramos, https://www.nytimes.com/2021/11/20/health/disney-vaccine-mandate-florida-

O.As Thanksgiving Approaches, U.S. Virus Cases Tick Upward Once More, By Mitch Smith, https://www.nytimes.com/2021/11/22/us/us-covid-cases-rising-thanksgiving.html?referringSource=articleShare