POST 222. December 20, 2021. CORONAVIRUS. So why my “inside baseball” focus on COVID-19 from the perspective of a retired hospital CEO?
-In 1975 as the Mount Sinai administrator at Elmhurst Hospital: “On December 29, 1975, a bomb detonated near the TWA baggage reclaim terminal at LaGuardia Airport in New York City. The blast killed 11 people and seriously injured.“ https://en.wikipedia.org/wiki/1975_LaGuardia_Airport_bombing74Hospitalhttps://en.wikipedia.org/wiki/1975_LaGuardia_Airport_bombing
-In 1989 when I became President & CEO of Jersey City Medical Center we had one of the first dedicated AIDS units staffed with only one FT nurse and per diem nurses, full every day with terminally ill patients.
-In 1993 at JCMC: “The 1993 World Trade Center bombing was a terrorist attack on the World Trade Center in New York City, carried out on February 26, 1993, when a truck bomb detonated below the North Tower of the complex.” We sent all out ambulances into NYC and didn’t get them back for 3 or 4 days. https://en.wikipedia.org/wiki/1993_World_Trade_Center_bombing
-In the mid-1990s we had a five-alarm arson fire at JCMC and it was brought under control as we started evacuating patients, which was unlikely to be fully successful due to our very old facility.
-On September 11th JCMC treated and admitted the most patients after two NYC hospitals and screened thousands at the waterfront who were ferried over from NYC. https://doctordidyouwashyourhands.com/2018/09/9041/
-After I left JCMC it was hard hit by Super Storm Sandy even though the new hospital was built at the 100 year flood plain level. “When the superstorm struck on Oct. 29, the first floor of the Grand Street hospital flooded within two minutes.” https://www.nj.com/hudson/2013/02/nj_health_commissioner_applaud.html
But all of these events together do not surpass the now two-year COVID experience at hospitals across our country like JCMC, such as Mount Sinai where I worked for ten years and Elmhurst which were the two NYC epicenters of the first surge.
So at this holiday season I constantly worry about JCMC/ Mount Sinai/ Elmhurst staff and am thankful for their dedication, determination, and perseverance. YOU ARE MY HEROES! Be safe.
for links to POSTS 1-222 in chronological order highlight and click on
“America was not prepared for COVID-19 when it arrived. It was not prepared for last winter’s surge. It was not prepared for Delta’s arrival in the summer or its current winter assault. More than 1,000 Americans are still dying of COVID every day, and more have died this year than last. Hospitalizations are rising in 42 states. The University of Nebraska Medical Center in Omaha, which entered the pandemic as arguably the best-prepared hospital in the country, recently went from 70 COVID patients to 110 in four days, leaving its staff “grasping for resolve,” the virologist John Lowe told me. And now comes Omicron.
“Will the new and rapidly spreading variant overwhelm the U.S. health-care system? The question is moot because the system is already overwhelmed, in a way that is affecting all patients, COVID or otherwise. “The level of care that we’ve come to expect in our hospitals no longer exists,”…
And even if Omicron is milder, greater transmissibility will likely trump that reduced virulence. Omicron is spreading so quickly that a small proportion of severe cases could still flood hospitals. To avert that scenario, the variant would need to be substantially milder than Delta—especially because hospitals are already at a breaking point.”…
Here, then, is the problem: People who are unlikely to be hospitalized by Omicron might still feel reasonably protected, but they can spread the virus to those who are more vulnerable, quickly enough to seriously batter an already collapsing health-care system that will then struggle to care for anyone—vaccinated, boosted, or otherwise. The collective threat is substantially greater than the individual one. And the U.S. is ill-poised to meet it.” (L)
VP Harris: “We didn’t see Delta coming. I think most scientists did not — upon whose advice and direction we have relied — didn’t see Delta coming. We didn’t see Omicron coming. And that’s the nature of what this, this awful virus has been, which as it turns out, has mutations and variants.” (A)
“Fauci said on Sunday that while officials had anticipated a new variant, they had not expected the number of mutations from the omicron variant.
“We definitely saw variants coming. I think what one referred to, what was not anticipated was the extent of the mutations and the amino acid substitutions in omicron, which is really unprecedented,” Fauci said. “It kind of came out of nowhere, where you have a virus that has 50 mutations, 30 of which are in the spike protein and 10 or 12 of which are in the receptor binding domain. I mean, to me, that’s really quite unprecedented.”” (B)
“A former COVID-19 adviser for President Biden’s transition on Thursday warned of a “viral blizzard” that is about to hit the U.S. as COVID-19 cases rise and concerns about the omicron variant continue to fester.
Michael Osterholm, who served on Biden’s coronavirus advisory team during the transition, said in an appearance on CNN that the health care system could be overwhelmed as omicron becomes more prevalent in the U.S.
“I think we’re really just about to experience a viral blizzard,” Osterholm told CNN’s Erin Burnett. “I think in the next three to eight weeks, we’re going to see millions of Americans are going to be infected with this virus, and that will be overlaid on top of delta, and we’re not yet sure exactly how that’s going to work out.”
“What you have here right now is a potential perfect storm,” Osterholm said. “I’ve been very concerned about the fact that we could easily see a quarter or a third of our health care workers quickly becoming cases themselves.”” (C)
“A growing body of preliminary research suggests the Covid vaccines used in most of the world offer almost no defense against becoming infected by the highly contagious Omicron variant.
All vaccines still seem to provide a significant degree of protection against serious illness from Omicron, which is the most crucial goal. But only the Pfizer and Moderna shots, when reinforced by a booster, appear to have initial success at stopping infections, and these vaccines are unavailable in most of the world.
The other shots — including those from AstraZeneca, Johnson & Johnson and vaccines manufactured in China and Russia — do little to nothing to stop the spread of Omicron, early research shows. And because most countries have built their inoculation programs around these vaccines, the gap could have a profound impact on the course of the pandemic.
A global surge of infections in a world where billions of people remain unvaccinated not only threatens the health of vulnerable individuals but also increases the opportunity for the emergence of yet more variants. The disparity in the ability of countries to weather the pandemic will almost certainly deepen. And the news about limited vaccine efficacy against Omicron infection could depress demand for vaccination throughout the developing world, where many people are already hesitant or preoccupied with other health problems.
Most evidence so far is based on laboratory experiments, which do not capture the full range of the body’s immune response, and not from tracking the effect on real-world populations. The results are striking, however…
“We may be seeing a situation where countries say, ‘If developed countries don’t want these vaccines, then we don’t want these vaccines,’” he said. “That, of course, would be the wrong interpretation, if it turns out that these vaccines prevent against severe disease and death.”” (D)
“Dr. Francis Collins, the outgoing director of the National Institutes of Health, told CNN’s Anderson Cooper on Friday that the Omicron variant could result in as many as a million new cases a day.
Collins suggested the impact of that level of spread on an already stressed health care system remains uncertain.
“The big question is, are those million cases going to be sick enough to need health care and especially hospitalization?” Collins said on CBS’ “Face the Nation” on Sunday, his last day as NIH director.
Covid-19 hospitalizations trended upward over the past month as medical facilities in some parts of the country have been inundated with patients infected with the Delta variant. Now, the presence of Omicron — which scientists believe to be more contagious though most cases so far appear to be mild — may push some strained health care systems to the brink.
“It is quite likely that we are going to see in some sections of the country, a significant stress on the hospital system as well as on the health care workers who are getting exhausted by all of this,” Dr. Anthony Fauci told ABC’s “This Week” on Sunday, noting that a more transmissible form of Covid-19, such as Omicron, will have a greater impact on the tens of millions of Americans who have not been vaccinated..” (E)
“The recent COVID-19 surge continues to steadily increase New Jersey’s hospitalized populations. But nearly two years into the pandemic, the state’s hospitals have faced struggles with staffing nurses, according to New Jersey Health Commissioner Judith Persichilli.
Nurses who have worked the pandemic over the last 22 months are getting burnt out — especially those who worked with COVID patients during the worst outbreaks and have seen friends and colleagues fall sick or die from the virus, Persichilli says.
Some nurses are also aging out. Several who were close to retirement decided to move on, and other nurses are getting bought out.
“(Nurses can get) very attractive packages from staffing agencies for individuals to leave the employ of a hospital and work as an agency nurse or sometimes depending on where they’re working a traveling nurse,” Persichilli said. “That’s a difficult circumstance because in some cases they’re not only bought out, they’re then sold back to the hospitals that they had just left. That’s a situation that it’s really somewhat out of our control.” (F)
“Thousands more people died in New Jersey than in a normal year last year, even when COVID is taken into account, a trend partly explained by delays in seeking hospital care for such life-and-death emergencies as heart attacks and stroke.
The 2020 death toll of 95,715 people far exceeded deaths in prior years, which never numbered more than 76,000. But even allowing for the 16,458 deaths whose primary cause was listed as COVID-19, the number of deaths from other causes was 4.3% higher than in normal years.
This hidden impact of the pandemic on mortality in New Jersey, a measure known as “excess deaths,” shows the disruptive influence of COVID-19 across many aspects of health care, according to an analysis by the New Jersey Hospital Association.
And it begins to answer a question asked by many primary care and emergency physicians in the early months of the pandemic: What happened to all the heart attack patients? Where are the stroke patients?
The answer, it seems, is they were at home. And a significant number of them died there…
Hospital admissions for heart attacks and strokes were down sharply, while the number of people who died at home from those diagnoses increased dramatically.
For example, New Jersey hospitals reported 3,800 fewer hospital admissions for heart attacks in 2020 than the average for three prior years, while deaths at home from diseases of the heart increased by 1,569, or 26%. And 1,600 fewer people sought hospital care for strokes or brain bleeds, while deaths at home from such causes increased by 48%, to 844 in 2020.” (R)
“The omicron variant’s rapid spread is raising concern about a post-holiday surge in COVID hospitalizations in New Jersey, said N.J. Health Commissioner Judy Persichilli during a conference call with NJHA member CEOs yesterday.
Two different models shared by DOH show that N.J. hospitals could be caring for anywhere from 5,500 and 8,900 COVID inpatients at the projected peak of Jan. 14-15. About 1,400 of them are expected to require ICU-level care.” (S)
“Last week, IU Health requested help from the Indiana National Guard for the latest surge in COVID-19 cases.
The Guard is now supporting 13 of the health system’s 16 hospitals and will be deployed to two additional facilities next week. The request for aid doesn’t include Riley Children’s Hospital.
IU Health said there are 518 COVID-19 patients receiving care throughout its statewide network, marking an all-time high number of COVID-19 patients at IU Health.
There are 496 patients in ICU-level care; 339 of those are COVID-19 patients. IU Health has added more space for patients needing ICU-level care.
“As our COVID-19 numbers and volume of high-acuity patients continue to rise, the demand and strain on our team members, nurses and providers have never been greater,” IU Health said in a statement. “ (N)
“The governors of Maine and New Hampshire announced Wednesday that they are activating the National Guard to help expand capacity at hospitals amid a serious winter COVID-19 surge.
New Hampshire also announced that it is bringing in Federal Emergency Management Agency teams as early as this week to assist at hospitals.
Maine’s governor activated as many as 75 members of the Maine National Guard on Wednesday to help expand capacity at health care facilities.
The state is dealing with a surge in COVID-19 that has challenged its hospitals. A record of 379 people were hospitalized Wednesday with the virus.
Democratic Gov. Janet Mills said the guard members will be used in non-clinical support roles. That will include supporting nursing facilities and helping to administer monoclonal antibodies to prevent serious illness from the virus and keep patients out of critical care, Mills said.
Mills and other state officials said those steps will free up hospital beds. The announcement came as the state’s largest hospital, Maine Medical Center, said it has postponed about 50% of surgeries because of the burden of COVID-19 on the facility….
The New Hampshire National Guard will also deploy 70 members to hospitals to help with needs such as clerical work, food service, and more, Republican Gov. Chris Sununu said.
“The winter surge is definitely upon us,” the governor said. “We know cases and hospitalizations continue to rise. We want everyone to get vaccinated because that’s the way out of this, without a doubt.”
Sununu said FEMA will be sending 24 healthcare professionals to Elliot Hospital in Manchester as early as this weekend. A second FEMA team of 30 paramedics will be arriving in the state by the end of next week, and will be assigned to hospitals with the highest COVID burden.
In addition, the governor said he is deploying 70 National Guard members to hospitals in the coming weeks to help with back room and clerical duties, freeing up hospital employees to focus on more critical tasks. They will be deployed to the hospitals with the most severe need.
“This is an all-hands-on-deck effort,” Sununu said. “The reality of what’s happening inside the hospitals is scary stuff.”…
New Hampshire became the state with the highest COVID-19 case rate in the country last week, registering a seven-day positivity rate of 13.4%. That positivity dropped slightly to 12.3% over the past week, state health officials said, but cases remain very high, averaging 1,200 to 1,300 a day.” (O)
“But amid Michigan’s worst-yet coronavirus surge, there’s not enough supply of monoclonal antibodies nor are there enough health care workers to administer them.
“Based on the amount of medication being allocated to Michigan by the federal government, as well as the amount of medication being used throughout the state, there is not enough supply at this time,” Lynn Sutfin, a spokesperson for the state Department of Health and Human Services, told the Free Press.
“Michigan requested additional allocations … from the federal allocation team and received 800 additional courses of RegenCoV based on that request.”
At Grand Rapids-based Spectrum Health, as many as 1,000 calls a day streamed in for monoclonal antibodies at peak demand in late November. But the hospital system could only give 400-450 treatments a week…
“There’s two limiting variables for monoclonal antibodies. No. 1 is the supply of monoclonal antibodies, which for the most part has been our biggest limitation. But No. 2 is to have enough staff to be able to administer it because it is labor intensive…
Nurses typically administer the treatment, which takes about an hour-and-a-half from start to finish. But there’s a statewide nursing shortage as the pandemic stretches into its second year and many hospitals are beyond capacity limits…
There’s a waiting list at Beaumont Health for the therapy. About 600-700 requests for treatment come in each week, but the health system has been able to administer only about 145, said spokesman Mark Geary.”..
“One of our infusion centers expanded their hours to 3:30 in the morning … because there was a subset of ER nurses who were so concerned about what they were seeing in the ER that they wanted to start doing something to prevent patients from needing to be in the hospital. So they are … coming in four hours early for this shift.” (T)
“Between 8,000 and 12,000 shipping containers carrying medical supplies to various parts of the U.S. are on a delay of up to 37 days due to ongoing transportation congestion, according to new data from the Health Industry Distributors’ Association.
Why it matters: Per their projections, medical supplies arriving at a U.S. port on Christmas Day won’t be delivered to hospitals and other care settings until February 2022. That could delay critical supplies at a time when health care is already expected to most need them due to surges from Delta and Omicron.” (G)
“As the pandemic wears on, with new concerns and uncertainty around the Omicron variant, attention toward therapeutics is intensifying — particularly oral medications that could be offered readily to outpatients to keep their disease from worsening.
“An effective oral agent has been a holy grail,” Acting FDA Commissioner Janet Woodcock, MD, told Medscape Medical News. Monoclonal antibodies work, but “you need more fuss and bother to get set up to have an infusion. Oral drugs would obviously be much more accessible.”…
Experts are evaluating safety and efficacy data for three oral drugs: antiviral pills being developed by Merck/Ridgeback Biotherapeutics (molnupiravir) and Pfizer (Paxlovid), and a decades-old generic drug (fluvoxamine) that typically treats obsessive-compulsive disorder and depression but has shown benefits in several published trials of COVID-19 outpatients — and costs under $10.
The fate of Merck’s drug remains uncertain amid muted support from a US Food and Drug Administration (FDA) advisory panel, which voted 13 to 10 last month to recommend the pill’s emergency use authorization (EUA).” (H)
“Despite stringent measures supposed to keep ocean cruises Covid-free, operator Royal Caribbean says at least 48 people on board one of its ships that docked in Miami at the weekend have tested positive for the virus.
The Symphony of the Seas, the world’s biggest cruise ship, was carrying more than 6,000 passengers and crew on a week-long journey around the Caribbean when a guest tested positive, prompting wider contact tracing, according to Royal Caribbean.
Cruise ships had been touted as the one of the “safest” vacations available back in summer 2021 when the cruise industry restarted in the US with new Covid protocols, following an extensive pandemic shutdown.
The Symphony of the Seas was carrying 6,091 passengers and crew members. In a statement, Royal Caribbean said that a guest tested positive during the voyage, and subsequent cases were detected following contact tracing.
It said 95% on board were fully vaccinated. Of the people who’ve since tested positive, 98% were fully vaccinated. The total number of cases amounted to 0.78% of the on board population.” (I)
“The Biden administration was bracing for a bad Covid winter surge long before the Omicron variant. Now, with two competing strains and a burst of new cases, officials are rethinking what it means to be fully vaccinated — and how to steel the public for the possibility they’ll need fourth shots.
It’s not just an exercise in semantics. Changing the criteria and messaging could influence how quickly workplaces and public events reopen, and how much a crisis-weary and in some cases confused population responds to pleas to get booster shots.
Discussions within the administration are focused on whether a third shot should be considered part of the original Covid-19 vaccine regimen. That would change what it means to be fully protected against the virus and immediately raise questions about the need for more shots, just as breakthrough cases are confusing many people about what vaccines can and cannot do.
There is “no doubt in anyone’s mind” that the original regimen plus a booster is ideal, especially with Omicron looming, said one health official familiar with the discussions. But “[Biden officials are] not going to change that anytime soon, because there’s too many legal aspects hanging on this issue of what is fully vaccinated.”
Vaccine manufacturers are focusing on the same questions. Pfizer officials said Friday that they are exploring whether to make a booster dose part of their regimen. CEO Albert Bourla has even floated the potential need for a fourth dose, though administration officials dismiss that prospect as premature.” (P)
“Administration of an additional primary dose or a booster dose is not required to be considered fully vaccinated for public health purposes at this time,” according to the CDC’s website, last updated last week.
Meanwhile, private businesses, states and other local jurisdictions could establish their own definitions of “fully vaccinated” to include booster doses well before the federal government, Dr. Scott Gottlieb, a former commissioner of the US Food and Drug Administration, told CNBC’s Rebecca Quick on “Squawk Box” on Friday.
“I think states are going to have a hard time doing it, so long as the booster is under an emergency use authorization and it’s unclear when FDA is going to give full approval to the booster — probably some time soon,” Gottlieb said.
But the federal government has “tied a lot of decisions to the definition of what it means to be fully vaccinated, and changing that definition is a difficult endeavor, at least from their perception,” Gottlieb said. “So, I think that they’re going to be reluctant to do that. I wouldn’t expect them to do that, certainly until the booster is fully licensed but maybe until next fall.”” (Q)
“The upcoming New Year’s Eve will mark the second anniversary of the first reported COVID-19 case in Wuhan, China. Since then, more than 272 million cases of the disease have been reported worldwide and over 5 million people have died of COVID-19.
To combat the health crisis, countries around the globe have administered more than 8.5 billion doses of COVID-19 vaccine and drugmakers have developed new treatments.
Here are some of the key moments of the COVID-19 pandemic from the past two years:”
DEC. 31 2019
The Wuhan Municipal Health Commission, China, reported a cluster of pneumonia cases in Wuhan, the capital city of the Hubei Province. (https://bit.ly/3dUsKqv)…
As of Dec. 17, the death toll from COVID-19 stood at 5.6 million.” (J)
“SAGINAW, Mich. — On the top floor of the hospital, in the unit that houses the sickest Covid-19 patients, 13 of the 14 beds were occupied. In the one empty room, a person had just died.
Through surge after surge, caregivers in the unit at Covenant HealthCare in Saginaw, Mich., have helped ailing patients say goodbye to their relatives on video calls. The medical workers have cried in the dimly lit hallways. They have seen caseloads wane, only to watch beds fill up again. Mostly, they have learned to fear the worst.
“You come back to work and you ask who died,” said Bridget Klingenberg, an intensive care nurse at Covenant, where staff levels are so strained that the Defense Department recently sent reinforcements. “I don’t think people understand the toll that that takes unless you’ve actually done it.”
The highly contagious Omicron variant arrives in the United States at a moment when there is little capacity left in hospitals, especially in the Midwest and Northeast, where case rates are the highest, and where many health care workers are still contending with the Delta variant. Some researchers are hopeful that Omicron may cause less severe disease than Delta, but health officials still worry that the new variant could send a medical system already under pressure to the breaking point.
About 1,300 Americans are dying from the coronavirus each day. The national case, death and hospitalization rates remain well below those seen last winter, before vaccines were widely available. But suddenly, positive tests are growing. State officials in New York reported more than 20,000 coronavirus cases on Friday, which they said was more than on any other day of the pandemic. In Connecticut and Maine, reports of new infections have grown by around 150 percent in the last two weeks. In Ohio and Indiana, hospitalization rates are approaching those seen during last winter’s devastating wave.” (K)
“Jeffrey Zients, the response team coordinator, urged unvaccinated Americans to do their part to prevent Omicron outbreaks. “For the vaccinated, you’ve done the right thing, and we will get through this,” he said.
“For the unvaccinated,” Zients warned, “you’re looking at a winter of severe illness and death for yourselves, your families, and the hospitals you may soon overwhelm.”
A total of 160,000 unvaccinated people have “needlessly lost their lives” since June, he said. That number will continue to go up unless unvaccinated people take the necessary steps to protect themselves and their families, he said, advocating for both vaccination and mask-wearing in public indoor settings.
Zients underscored that vaccines do work against Omicron. While breakthrough infections are possible for the vaccinated, those infections are more likely to be asymptomatic or mild, he noted.
“This is not a moment to panic, because we know how to protect people and we have the tools to do it,” Zients said. “The more people get vaccinated, the less severe this Omicron outbreak will be.”” (M)
“President Biden on Tuesday unveiled new plans to fight the spread of the highly contagious Omicron variant of the coronavirus, saying the government would make 500 million rapid at-home tests freely available to Americans, increase support for hospitals and add testing sites in regions that need additional capacity.
Starting in January, Mr. Biden said, Americans will be able to request rapid tests through a website and have them delivered, free of cost. The timing of when those tests will arrive on doorsteps and how they will be delivered is not yet clear.
In addition, 1,000 members of the military will be deployed to help staff medical facilities caring for COVID-19 patients. There are also plans to send out additional ventilators and equipment from the national stockpile besides expanding hospital capacity to handle infected patients.
In a speech at the White House, Mr. Biden said the government will establish new testing sites and use the Defense Production Act to help manufacture more tests. There will also be pop-up vaccination sites, hundreds of new people to administer the vaccines and new rules that make it easier for pharmacists to work across state lines.” (U)
“President Biden told unvaccinated Americans Tuesday that getting the COVID vaccine is “your patriotic duty” and “an obligation to your country.”” (V)
BREAKING NEWS AS WE GO TO POSTING!
“As a surge in coronavirus cases continues to batter Britain, hospitals, clinics and ambulance services say it is winnowing their staffs, especially through the highly contagious Omicron variant. The wave of infections has put severe pressure on the National Health Service, already under strain from worker shortages caused by underfunding, Brexit and the exhaustion from nearly two years of battling the pandemic.
For the moment, there is not the kind of shortage of beds that plagued hospitals during the peaks of the pandemic. But the pressure on the system caused by staff illnesses is evident across Britain. One London-based doctor responsible for scheduling said that so many of his colleagues were calling in sick from the virus that he could not update the work roster fast enough. A primary care physician based in Leicester found himself the only senior doctor able to work in his practice this week.
As cases surge in their communities, many health care workers are contracting the virus outside their workplaces, from contact with family members or in their day-to-day lives.” (W)
“England said on Wednesday that it was reducing the number of days that people are required to isolate after showing Covid-19 symptoms to seven days from 10 days — a change that officials said was based on updated guidance from health experts, and that could help alleviate staff shortages in several critical sectors as more people test positive…
A surge in coronavirus cases has winnowed the staffs of hospitals, clinics, rail services, fire departments and ambulance services across England, where most pandemic restrictions have been lifted since the summer….”(X)
- A.Kamala Harris, in interview, says administration did not anticipate Omicron variant, BY NOAH BIERMAN, https://www.latimes.com/politics/story/2021-12-17/kamala-harris-in-interview-says-administration-did-not-anticipate-omicron-variant
- B.Fauci: Record coronavirus deaths in US from omicron likely, BY CAROLINE VAKIL, https://thehill.com/homenews/sunday-talk-shows/586480-fauci-record-coronavirus-deaths-in-us-from-omicron-likely
- C.Former Biden COVID-19 adviser: ‘Viral blizzard’ about to hit the US, BY LEXI LONAS, https://thehill.com/policy/healthcare/586274-former-biden-covid-19-adviser-viral-blizzard-about-to-hit-the-us
- D.Most of the World’s Vaccines Likely Won’t Prevent Infection From Omicron, By Stephanie Nolen, https://www.nytimes.com/2021/12/19/health/omicron-vaccines-efficacy.html?referringSource=articleShare
- E.US could be in store for a ‘grim beginning’ to the new year, experts warn, as dual variants of Covid-19 spread, By Travis Caldwell, https://www.cnn.com/2021/12/20/health/us-coronavirus-monday/index.html
- F.NJ Hospitals Struggle To Staff Nurses Amid COVID Surge, by Josh Bakan, https://patch.com/new-jersey/morristown/nj-hospitals-struggle-staff-nurses-amid-covid-surge
- G.New supply chain crisis: medical supplies, by Tina Reed, https://www.axios.com/supply-chain-crisis-medical-supplies-covid-69287c7a-3c11-4401-9ee3-3478c3a9ab90.html
- H.The Challenge and Promise of Getting Oral COVID Drugs Into Practice, by Esther Landhuis, https://www.medscape.com/viewarticle/965099
- I.48 test positive for Covid on world’s biggest cruise ship, by Andy Rose and Francesca Street, https://www.cnn.com/travel/article/cruise-ship-royal-caribbean-covid/index.html
- J.Key moments of COVID-19 pandemic, https://www.reuters.com/business/healthcare-pharmaceuticals/key-moments-covid-19-pandemic-2021-12-20/
- K.Doctors and Nurses Are ‘Living in a Constant Crisis’ as Covid Fills Hospitals, By Mitch Smith, https://www.nytimes.com/2021/12/17/us/covid-hospitals-omicron.html?referringSource=articleShare
- L.America Is Not Ready for Omicron, By Ed Yong, https://www.theatlantic.com/health/archive/2021/12/america-omicron-variant-surge-booster/621027/
- M.’Winter of Severe Illness, Death’ for the Unvaccinated, White House Warns, by Shannon Firth, https://www.medpagetoday.com/infectiousdisease/covid19vaccine/96275
- N.National Guard deployed to 13 IU Health hospitals to help with ‘all-time high number’ of COVID-19 patients, by Matt Adams, https://fox59.com/news/coronavirus/national-guard-deployed-to-13-iu-health-hospitals-to-help-with-all-time-high-number-of-covid-19-patients/
- O.Maine, NH Activate National Guard to Assist With COVID Surge: What to Know, https://www.nbcboston.com/news/local/maine-nh-activate-national-guard-amid-covid-surge-what-to-know/2586165/
- P.Bad Covid winter brings questions about what’s ‘fully vaccinated’, By SARAH OWERMOHLE and ADAM CANCRYN, https://www.politico.com/news/2021/12/18/covid-omicron-booster-vaccines-525308
- Q.Why changing the definition of ‘fully vaccinated’ could be difficult, By Jacqueline Howard, https://www.cnn.com/2021/12/20/health/fully-vaccinated-definition-cdc-explainer/index.html
- R.Pandemic’s ‘hidden toll’: More deaths from heart attacks, strokes in NJ due to care delays, by Lindy Washburn, https://www.northjersey.com/story/news/coronavirus/2021/12/20/nj-covid-deaths-2020-heart-attack-stroke/8931209002/
- S.Fwd: NewsLink Today December 21, 2021 – Vol. 17 No. 134
- T.Michigan can’t meet demand for COVID-19 monoclonal antibody treatments, by Kristen Jordan Shamus, https://www.freep.com/story/news/health/2021/12/18/covid-19-monoclonal-antibody-treatment-infusion-michigan/8940907002/
- U.Biden unveils Omicron plan, including free at-home COVID tests and more troops for hospitals, https://www.cbsnews.com/news/biden-omicron-variant-speech-covid-19-watch-live-today-2021-12-21/
- V.Biden: It’s “your patriotic duty” to get vaccinated, by Shawna Chen, https://www.axios.com/biden-covid-testing-omicron-patriotic-duty-896bdb56-8304-4d5e-b099-398400cd0252.html
- W.U.K. System Strained as Health Care Workers Get Covid Themselves, By Megan Specia, https://www.nytimes.com/2021/12/22/world/europe/britain-health-care-covid-nhs.html
- X.Strained by staff shortages, England reduces isolation requirements for people with the virus., https://www.nytimes.com/live/2021/12/22/world/omicron-covid-vaccine-tests#england-shortens-the-isolation-period-for-people-who-test-positive-as-rising-cases-cause-disruptions-across-europe
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partner night time time: no matter how long you have been properly, you should never take off going on years. saved a single night to relieve yourselves to a wonderful night out. post your children to cameraman member’s household for the night time. organising a nights sexual category in addition,yet hobby can still be extra.
be victimized with any where else but inside bed: Clear your kitchen counter top out since ‘Bake a Cake’ so to speak. request tangled; don’t fret about clear until day of the week.
impulsive cuddles are always beneficial. for a woman, make out her dad in guiding, covering your family forearms just as much as your pet and even pressing juggs to protect against the puppy’s away. the feeling individual teat can be quite major first turn on.
REMINISE love-making meets: recollect history pill suffers from you would spend with your companion. definitely important and so re enact the situations while you had a lot of ‘FUN’.
consider your second half: clear the human brain to see how many hours of achievement you may give your lover. Make a bet on it; See if available your second half howl!
bathe circumstances are really considerable first turn on. You don’t need to panic about adolescents or next noise level n the potty.
PLAY a personal game: Find a sport you enjoy, Or an up-to-date competition. install a remove consideration for it and a coming in contact with, getting, since licking consideration. shortly, you will end up involved with any single other sites normally include.
learn A vision: contribute a mind trip with your lover. you could be surprised to discovered that your relationshipr has precisely the same ideal. position practicing can essence things up.
unclean points: ship your significant other a sexy, grubby text message quite possibly electronic mail. let you know that some other next, it is always on top of!
worry: for you to separated styles each morning, whisper to your honey what you want to do to him/her tonite. assist step, must use thrills in which gain ’till the end through the day.
change it UP: make use of locations before going to sleep, and it could be specified rules; reminiscent of ownership few or it may be jaws evenings.
receive a good BOOK: assess a love-making point booklet actually addicts guidebook alongside and check out some interesting things in concert. may possibly be notable you can allow girl decide upon your wife’s most wanted.
head LOBE gratifying: gently licking the head lobe and as well,as well as the deep breathing below this companions knee this kind of a fantastic way to the mood get in.
invasion very own humans: incredibly little transforms anyone relating to more to be bombarded and also their particular girlfriend. The person being in control perhaps be the change you really should spruce your bedroom antics older.
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to get aroused: driving a car to be able to detected may well stimulating. avoid getting insanely incorrect, other than have a great time.
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