POST 224. December 29, 2021. CORONAVIRUS. “crisis standards of care protocols in Maryland – “It also allows us to slim down documentation,… allows unconventional staffing models such as using nurses that have not been bedside. It also sets the expectations for the community that it’s not business as usual.”

for links to POSTS 1-224 in chronological order highlight and click on

https://doctordidyouwashyourhands.com/2021/12/coronavirus-tracking-links-to-posts-1-224/

POST 223. December 28, 2021. CORONAVIRUS. Links for a case study on Crisis Standards of Care.

https://doctordidyouwashyourhands.com/2021/12/post-223-december-28-2021-coronavirus-links-for-a-case-study-of-crisis-standards-of-care/

“Alan Hawes pulls up images on his computer that are raw and intimate, like the anguished eyes of a 72-year-old man in a hospital bed, trapped behind a mask…

Alan Hawes, formerly a photojournalist and now a nurse at the Medical University of South Carolina, documented daily life for patients and hospital workers in the hospital’s intensive care unit.

Now he works as a registered nurse at the Medical University of South Carolina in Charleston, and the man in the picture was a patient…

With the permission of hospital officials, health care workers and COVID-19 patients, Hawes began taking photos on his own time. Many of the images are showcased on the hospital’s Facebook page and have been featured in local news.

Those images include a respiratory therapist peering through the blinds from inside a patient’s window. She is trying to get another health care worker’s attention. She needs help to care for the patient but can’t leave the room because she is in full protective gear. Hawes says he took this shot because “it just kind of shows how isolated we are when we’re in those rooms.”” (V)

“NFL chief medical officer: Symptomatic players driving COVID-19 spread; no indications of asymptomatic spread.” (L)

Why is it that the NFL and NBA can test players every day but you can’t find Rapid Test for home use?

DECEMBER 21st

“A lot remains to be learned about Omicron, but the U.S. Centers for Disease Control and Prevention (CDC) has warned that it is likely to cause breakthrough infections. Early studies suggest COVID-19 vaccines will continue to dramatically limit severe disease and death, but may not be as good at preventing symptomatic disease caused by Omicron, compared to other strains. The variant also arrived at an inopportune time, when vaccine-related immunity was starting to wane for people who had gotten their shots early in the year and hadn’t yet been boosted.” (A)

“Strained hospitals bracing for a COVID-19 surge caused by the quickly spreading Omicron variant could face another grim possibility: preliminary experiments suggest that most of the antibody treatments for the disease are powerless against Omicron1,2,3,4.

Doctors use artificial versions of natural antibodies to stave off severe COVID-19 in high-risk people who are infected with the coronavirus. But a slew of publications posted on preprint servers report laboratory evidence that Omicron is totally or partially resistant to all currently available treatments based on these monoclonal antibodies. The publications have not yet been peer reviewed, but some of the companies that manufacture antibody therapies already concede that their products have lower potency against Omicron than against other variants.” (B)

“The White House will buy and distribute 500 million rapid Covid-19 tests for free beginning in January, according to Biden administration officials.

The move comes amid a wave of new cases, a large majority of which stem from the Omicron variant of the virus that causes Covid. Health officials across the country reported nearly 238,000 cases on Monday, nearing the totals recorded during the deadly surge in August and September.

The first shipment of tests will arrive at some point in January, the White House said. Americans will be able to request that rapid tests be shipped to their home, free of charge, via a new government website.” (C)

“Even as President Biden on Tuesday outlined new plans for battling the highly contagious Omicron variant, public health experts warned that the measures would not be sufficient to prevent a grim rise in infections and hospitalizations over the next few weeks. (D)

DECEMBER 22nd

“The Food and Drug Administration on Wednesday authorized use of a new antiviral pill that can be taken at home to help prevent people sick with COVID-19 from becoming severely ill.

Paxlovid, made by Pfizer, reduced the risk of severe disease by nearly 90% in clinical trials and appeared to be safe. Taken as a pill soon after COVID-19 symptoms start, it is intended for people at high risk for severe disease, including those over 65, people with obesity or diabetes and anyone with a weakened immune system, as well as high-risk children ages 12 and up.

On Wednesday, White House COVID-19 response coordinator Jeff Zients said the U.S. government has purchased 10 million treatment courses of Paxlovid, with 265,000 set to be available to Americans in January. The pills take 6-8 months to produce, according to Pfizer.” (E)

“The Supreme Court said on Wednesday evening that it would hold a special hearing next month to assess the legality of two initiatives at the heart of the Biden administration’s efforts to address the coronavirus in the workplace.

The court said it would move with exceptional speed on the two measures, a vaccine-or-testing mandate aimed at large employers and a vaccination requirement for certain health care workers, setting the cases for argument on Friday, Jan. 7. The justices had not been scheduled to return to the bench until the following Monday…  (R)

DECEMBER 23^rd

“The Covid omicron variant is less likely to result in hospitalization than earlier strains and appears to be milder in comparison, according to early data released this week.

On Tuesday, a new study from South Africa showed that people infected with omicron are 80% less likely to be admitted to a hospital when compared with other strains. The authors of the study, which has not been peer-reviewed, cautioned that this may be in part due to higher immunity among the population, either as a result of previous infection and/or vaccination.” (F)

“As the Biden administration tries to stanch yet another wave of the coronavirus pandemic, senior White House officials have also been considering a proposal to ensure the nation is better prepared for the next infectious disease outbreak.

Key to the plan is the creation of a taxpayer-funded “vaccine hub” where experienced drug makers would partner with the government, reliably churning out millions of doses under federal oversight…

Three times over the past three decades, presidential administrations explored plans for a vaccine overhaul like the one President Biden is now considering, only to be thwarted by pharmaceutical lobbying, political jockeying and cost concerns, a New York Times investigation found…” (G)

DECEMBER 24^th

“The US Centers for Disease Control and Prevention is shortening the isolation time for health care workers who test positive for Covid-19, as it anticipates a surge in hospitalizations due to the Omicron variant.

The agency’s new guidelines say health care workers with Covid-19 may return to work after seven days if they are asymptomatic and test negative, and that the “isolation time can be cut further if there are staffing shortages,” according to a statement Thursday…

In its new guidelines, CDC added that the negative test result should come within 48 hours of going back to work, and that this shortened time frame may also apply to some symptomatic staff — provided they are “mildly symptomatic” and their symptoms are improving.

The agency also specified that health care workers don’t need to quarantine “following high-risk exposures” if they’ve gotten all recommended vaccinations, including a booster shot. Quarantine refers to when people who have been exposed to the virus but have not yet been diagnosed with an infection need to avoid others.

The CDC stressed that the new guidelines don’t extend to the general public and only apply to the health care workforce.” (H)

“The US Food and Drug Administration on Thursday authorized Merck’s antiviral pill, molnupiravir, to treat Covid-19 “for the treatment of mild-to-moderate coronavirus disease (COVID-19) in adults with positive results of direct SARS-CoV-2 viral testing, and who are at high risk for progression to severe COVID-19, including hospitalization or death, and for whom alternative COVID-19 treatment options authorized by the FDA are not accessible or clinically appropriate…

Molnupiravir was narrowly recommended by the FDA’s advisers in a 13-10 vote at the end of November after data showed it cut the risk of hospitalization or death by 30% among high-risk adults. This was lower than an earlier analysis suggesting that number could be about 50%.” (I)

“The Omicron variant, which is now dominant in the United States and spreading faster than any variant yet, has already pushed daily coronavirus case counts higher than the peak of the recent Delta wave. By most estimates, the country is in for a significant winter surge…

The highly transmissible variant is causing near-vertical case growth in multiple U.S. cities, with figures doubling about every two to three days. Officials expect it to break records. The all-time high for average daily cases was 251,232, set in January. By some estimates, the United States could reach one million cases a day, even before the end of the year.” (J)

“So why is there still such rampant transmission of coronavirus in Britain, given that every person in the country has unlimited access to these tests?

Because rapid tests are excellent at confirming when a person is in a contagious stage of infection, but don’t perform well at identifying people in the very early stages of an infection, how they are used is incredibly important. People in Britain are encouraged to use these tests up to 24 hours before doing an activity. But having a negative rapid test does not necessarily mean that you are not infected with coronavirus. A negative test means you do not have levels of the virus that make you infectious at the very moment you took the test. This can change in a matter of hours if someone is in the early stages of an infection. That’s why you should not rely on a negative rapid test for a week’s worth of events.” (K)

“With millions traveling or planning to join large family gatherings, there is a rush to get tested — and many people are running out of luck, either with getting tests at clinics or with buying at-home test kits…

The demand is only going to grow, said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.

“We do have some testing. But what we’re going to need, I think, over the course of the next two to eight weeks is going to be remarkable. We are going to see this big surge nationwide,” he predicted.

And while the Biden administration plans to provide 500 million new tests by next month, the holiday test surge is happening now.

A former assistant secretary of the US Health and Human Services Department is concerned the co pledge on tests will not meet the demand, he said.

“Unless we have a billion or 2 billion a month, I think we’re still going to have to be selective to make sure that we keep people who can die from the disease from dying from the disease,” Adm. Dr. Brett Giroir told CNN.” (P)

DECEMBER 25^th

“The NFL is battling the latest COVID-19 surge with an understanding that symptomatic individuals are driving transmission within the team environment, chief medical officer Dr. Allen Sills said Thursday, with no indications of asymptomatic spread.

That position represents a significant departure from the pandemic-long stance of public health authorities, who have warned about the possibility of individuals spreading the virus without being aware they are infected.

Sills first told the NFL Network that the league has not seen verifiable asymptomatic spread this season, and later fleshed out his point in an interview with ESPN…

“Clearly if you want to look at the overall pattern and concern about transmission, it is not being driven by people who have no idea that they are infected and they are infecting scores of others. This is being driven by people with symptoms and the exposures during that symptomatic period.” (L)

“Right as the new Omicron variant is poised to increase rapidly across the US, the federal government has effectively run out of the only monoclonal antibody treatment that works against it, and at least one major hospital system is now halting all mAb infusions.

Late last month, the federal government paused shipments of GlaxoSmithKline and Vir’s mAb treatment sotrovimab in order to conserve supplies of the only treatment that might work against the Omicron variant. Last week, however, HHS told Endpoints News that the move to hold back sotrovimab was unrelated to Omicron, and due to a surplus of Eli Lilly mAbs, which aren’t effective against Omicron.

But late Friday, HHS confirmed to Endpoints that the government was withholding the supplies due to the Omicron variant (and apologized for providing inaccurate information a day earlier).

HHS also simultaneously announced that it’s shipping its remaining 55,000 doses of sotrovimab, which will begin arriving in the states on Tuesday until more supplies hopefully become available the week of Jan. 3.” (M)

“Despite stringent measures supposed to minimize Covid outbreaks on ocean cruises, 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…..” (N)

“New York Governor Kathy Hochul announced Friday that the state would allow frontline workers in health care and other “critical” services who test positive for COVID-19 to shorten quarantine times if they are fully vaccinated and asymptomatic. The decision comes a day after the Centers for Disease Control and Prevention also adjusted isolation guidance for health care workers.

Under the new state guidelines, employers can allow workers to return after five days in isolation “in limited circumstances where there is a critical staffing shortage.” Previously, a 10-day quarantine was recommended. On Thursday, the CDC announced health care workers who tested positive could return to work after seven days, and the period could be shortened if there are staffing challenges..” ” (O)

“As Covid-19 cases continue to rise and the Omicron variant sweeps the world, some nations are rolling out fourth doses of coronavirus vaccine for the most vulnerable people.

Israeli Prime Minister Naftali Bennett’s office announced this week that adults 60 and older, medical workers and people with suppressed immune systems could receive a fourth dose if at least four months have passed since their third dose…

“I think it’s too premature to be talking about a fourth dose,” Fauci told Michael Wallace and Steve Scott of WCBS Newsradio 880.

“One of the things that we’re going to be following very carefully is what the durability of the protection is following the third dose of an mRNA vaccine,” Fauci said. Moderna and Pfizer/BioNTech are mRNA vaccines.

“If the protection is much more durable than the two-dose, non-boosted group, then we may go a significant period of time without requiring a fourth dose,” Fauci said. “So, I do think it’s premature — at least on the part of the United States — to be talking about a fourth dose.”” (Q)

“Former President Donald Trump pushed back on a questioner’s skepticism about the effectiveness and safety of the Covid-19 vaccine in a new interview, saying that the “vaccine works” and “people aren’t dying when they take the vaccine.”…

“The ones that get very sick and go to the hospital are the ones that don’t take their vaccine. But it’s still their choice, and if you take the vaccine, you are protected,” he said.” (S)

“The state of New York issued an urgent advisory to pediatricians on Christmas Eve, pressing them to ensure their patients are vaccinated after COVID hospitalizations in children rose four-fold in less than three weeks…

At this point, the daily number of new COVID hospitalizations is growing more than 30% a day in New York City alone. But the state called out a particular problem in the city with kids, with a four-fold increase in admissions for kids ages 18 and under between Dec. 5 and this week, a span of less than three weeks.

Over the same period, total New York City COVID hospitalizations grew 170%, suggesting that younger kids are getting much sicker at a higher rate now…” (T)

DECEMBER 26th

“The coronavirus that causes Covid-19 can spread within days from the airways to the heart, brain and almost every organ system in the body, where it may persist for months, a study found.

In what they describe as the most comprehensive analysis to date of the SARS-CoV-2 virus’s distribution and persistence in the body and brain, scientists at the U.S. National Institutes of Health said they found the pathogen is capable of replicating in human cells well beyond the respiratory tract.

The results, released online Saturday in a manuscript under review for publication in the journal Nature, point to delayed viral clearance as a potential contributor to the persistent symptoms wracking so-called long Covid sufferers. Understanding the mechanisms by which the virus persists, along with the body’s response to any viral reservoir, promises to help improve care for those afflicted, the authors said.” (U)

“The classic “epi curve” shows cases rising exponentially until so many people are immune that the spread of the virus has to slow. Then cases fall exponentially. But if soft lockdowns help suppress that viral spread, then cases will drop off sooner, while many people are still susceptible. In other words, “when you see a peak and see it go down, it doesn’t mean the risk has abated,” says Joshua Weitz, who studies viral dynamics at Georgia Tech. According to work by Weitz and his colleagues, this helps explain why COVID cases have peaked and plateaued multiple times over the course of the pandemic. Those peaks also tend to be asymmetrical, with steeper rises than falls. This too may be related to behavior: People might become more careful when they see an initial surge in cases but let their guard down when pandemic fatigue sets in. Just as our voluntary actions can act as a brake on rising cases, they can also slow a wave’s decline. Omicron is surging at a time when Americans are already weary of the pandemic, so this soft lockdown may not last very long. And in communities where people are very over COVID, it may not happen at all.” (W)

DECEMBER 27^th

“As the omicron surge pummels a pandemic-weary nation, the first antiviral pills for Covid-19 promise desperately needed protection for people at risk of severe disease. However, many people prescribed Pfizer’s or Merck’s new medications will require careful monitoring by doctors and pharmacists, and the antivirals may not be safe for everyone, experts caution.

The Food and Drug Administration authorized Pfizer’s Paxlovid for mild to moderate Covid in people as young as 12 who have underlying conditions that raise the risk of hospitalization and death from the coronavirus, such as heart disease or diabetes. However, one of the two drugs in the antiviral cocktail could cause severe or life-threatening interactions with widely used medications, including statins, blood thinners and some antidepressants. And the FDA does not recommend Paxlovid for people with severe kidney or liver disease.

Because of experts’ concerns about the potential side effects of Merck’s molnupiravir, the FDA has restricted its use to adults and only in scenarios in which other authorized treatments, including monoclonal antibodies, are inaccessible or are not “clinically appropriate.” (X)

“The CDC warned that the “current increases in Omicron cases are likely to lead to a national surge in the coming weeks with peak daily numbers of new infections that could exceed previous peaks.”

Right now, January appears to be the most likely date for the COVID-19 surge from the omicron variant. The CDC predicted that the U.S. will see a surge of omicron variant cases before January after the holiday season wraps up, according to The Washington Post.

But the CDC said “scenarios with lower immune evasion” predict that the surge “could be lower and begin as late as April 2022.”

Either way, a COVID-19 surge from the omicron variant will damage the U.S. hospital system, according to the CDC.

“Projected large surges in cases indicate surges of hospital demand even if the severity is reduced, because of the large number of anticipated cases occurring in a short period of time,” the CDC said.” (Y)

““For two years, infections always preceded hospitalizations which preceded deaths, so you could look at infections and know what was coming,” Ashish K. Jha, dean of Brown University and a former Harvard health expert said during an appearance on ABC’s “This Week” on Sunday. “Omicron changes that. This is the shift we’ve been waiting for in many ways.”

The country has shifted, Jha said, to a place where people who are vaccinated and especially those who have received a booster shot “are gonna bounce back” if they become infected with the coronavirus.

“That’s very different than what we have seen in the past,” he said. “So I no longer think infections, generally, should be the major metric.”…

“But we really need to focus on hospitalizations and deaths now,” he said.”  (Z)

“Boris Johnson is expected to examine crucial hospital data on Monday before making any new announcement on Covid measures, but has no plans to recall his cabinet, with ministers still deeply sceptical of further legal curbs…

Key evidence that the government will examine on Monday includes data on the length of stay in hospitals, the transition rates to ICU and new death figures. There is concern among some government figures about undeclared positive cases – including those asymptomatic but also those isolating after a lateral flow test whose results are not recorded by the NHS because they do not take a PCR.” (AA)

“New York City’s sweeping mandate requiring nearly all private-sector businesses to ban unvaccinated employees from the workplace has taken effect amid a spike in coronavirus infections.

Workers at roughly 184,000 businesses were required to show proof they have received at least one dose of a COVID-19 vaccine by Monday. Businesses that don’t comply could face fines starting at $1,000, but Mayor Bill de Blasio has said imposing penalties will be a last resort.” (BB)

“Boston hospitals are on an “unsustainable” path as COVID-19 cases, driven by the extremely contagious omicron variant, skyrocket across the region, warns a local emergency medicine doctor.

“I think all public officials should use this data to look and see where they can expand hospital capacity and where they can stop the spread of the virus,” said Jeremy Faust, an emergency physician at Brigham and Women’s Hospital who’s helping track hospital capacity for different states and counties.

Several Massachusetts counties are at risk of exceeding normal hospital capacity, and Suffolk County over the holiday weekend was in the “unsustainable” category, according to Faust.

Faust explained Sunday that “unsustainable” means area hospitals could get overloaded based on current hospital capacities and surging COVID-19 case counts.” (CC)

“U.S. health officials on Monday cut isolation restrictions for Americans who catch the coronavirus from 10 to five days, and similarly shortened the time that close contacts need to quarantine…

Now, the CDC is changing the isolation and quarantine guidance for the general public to be even less stringent…

Given the timing with surging case counts, the update “is going to be perceived as coming in response to pressure from business interests,” Wiley said. But some experts have been calling for the change for months, because shorter isolation and quarantine periods appeared to be sufficient to slow the spread, she said.” (DD)

“The Centers for Disease Control and Prevention said Monday that people who test positive for Covid-19 but have no symptoms should isolate for five days, down from the previous recommendation of 10 days.

The agency attributed the change to growing evidence that the virus is most infectious in the two or three days after symptoms arise.

In addition to cutting the time in half for isolation, the CDC said that for people who are asymptomatic, an additional five days of wearing a mask when around others is recommended.

“Therefore, people who test positive should isolate for five days and, if asymptomatic at that time, they may leave isolation if they can continue to mask for five days to minimize the risk of infecting others,” the CDC said in a statement.

The agency also recommended that unvaccinated people or those who are more than six months out from their second mRNA dose and not yet boosted should quarantine for five days after exposure to the virus followed by “strict mask use for an additional 5 days.””(EE)

“Hospitals across Maryland are shutting down regular operations to deal with COVID-19 sickness.

As of Monday, there are more than 30,000 new COVID-19 cases in Maryland since Thursday. More than 1,700 patients are in Maryland hospitals, which is forcing many facilities to shut down standard operations.

On Friday, the University of Maryland Upper Chesapeake Health implemented crisis standards of care protocols, meaning fewer nurse-to-patient ratios and rescheduling elective surgeries, among other things…

The University of Maryland Baltimore Washington Medical Center on Monday announced it’s declaring a hospital disaster and implementing Crisis Standards of Care (CSC) protocols.

Officials say their hospitals are reaching emergency levels

Officials at the University of Maryland Upper Chesapeake Health and Carroll Hospital Center said they’re in a dire situation.

“It also allows us to slim down documentation, it allows us to use unconventional staffing models, if you will, using nurses that have not been bedside. It also sets the expectations for the community that it’s not business as usual,” said Dr. Fermin Barrueto, senior vice president of medical affairs and chief medical officer for the University of Maryland Upper Chesapeake Health.” (FF)

“For nearly two years, Americans have looked carefully at coronavirus case numbers in the country and in their local states and towns to judge the risk of the disease…

Many people are going to get omicron — but those that are vaccinated and boosted are unlikely to suffer dire symptoms.

As a result, hospitalizations and deaths are the markers that government officials need to monitor carefully to ensure the safety of communities as the nation learns to live with COVID-19.

“This is the new normal,” said Leana Wen, a public health professor at George Washington University and former Baltimore health commissioner. “This is what we will have to accept as we transition from the emergency of COVID-19 to living with it as part of the new normal.”

David Dowdy, an epidemiologist at Johns Hopkins Bloomberg School of Public Health, said that Americans all need to shift to focus on hospitalizations over cases as we enter into another year of the pandemic.

“I think that we need to start training ourselves to look, first of all, at hospitalizations. I think hospitalizations are a real-time indicator of how serious things are,” he said…

“Omicron in a way is the first test of what it means to live with COVID-19,” said Wen. “And by that I mean we are going to see many people getting infected but as long as our hospital systems are not overwhelmed and as long as vaccinated people are generally protected against severe outcomes, that is how we end the pandemic phase and switch into the endemic phase.” (GG)

“The N.B.A. has altered its coronavirus protocols to allow players and coaches who have tested positive but are asymptomatic to return to their teams sooner as a surge in cases has depleted several teams of their best players.

The new rules will also permit those with low viral loads to follow this new protocol, even if they still test positive, according to a memo obtained by The New York Times…

The N.B.A.’s announcement coincided with the recommendation from the C.D.C. on Monday that isolation times be reduced to five days from 10 for people without symptoms.

More than 100 players entered the league’s health and safety protocols — triggered by a positive or inconclusive coronavirus test, or potential exposure — in December alone, with the Omicron variant sweeping through the league. The league increased testing for several days after Thanksgiving, leading to a rise in cases, and will now begin another period of increased testing following Christmas Day.” (HH)

UPDATES AT DEADLINE

“The decision by federal health officials to shorten isolation periods for Americans infected with the coronavirus drew both tempered support and intense opposition from scientists on Tuesday, particularly over the absence of a testing requirement and fears that the omission could hasten the spread of the highly contagious Omicron variant.

The new guidance, coming amid a crush of new infections that has starved many hospitals of workers, seemed to some scientists like a necessary step to shore up work forces in essential industries. And encouraging people to leave isolation early after testing negative could spare them the hardships of prolonged periods at home.

But letting hundreds of thousands of infected people forgo those tests — even if, crucially, their symptoms were not entirely gone — risks seeding new cases and heaping even more pressure on already overburdened health systems, experts said in interviews on Tuesday.

“To me, this feels honestly more about economics than about the science,” said Yonatan Grad, an associate professor of immunology and infectious diseases at the Harvard T.H. Chan School of Public Health, who has tracked coronavirus infections in the National Basketball Association.

“I suspect what it will do is result in at least some people emerging from isolation more quickly, and so there’ll be more opportunities for transmission and that of course will accelerate the spread of Covid-19,” he added, noting that people were unlikely to adhere strictly to masking advice after leaving isolation.” (II)

“Covid-19 antigen tests may be less capable of detecting the fast-spreading Omicron variant, the Food and Drug Administration cautioned on Tuesday.

The new warning is based on preliminary studies by the National Institutes of Health’s Rapid Acceleration of Diagnostics initiative using patient samples with live virus — analysis that “represents the best way to evaluate true test performance in the short-term,” according to FDA.” (JJ)

“The average number of daily COVID-19 cases in the United States has hit a record high of 258,312 over the past seven days, according to a Reuters tally.” (KK)

• A.Omicron overpowers key COVID antibody treatments in early tests, by Max Kozlov, https://www.nature.com/articles/d41586-021-03829-0
• B.We Need to Start Thinking Differently About Breakthrough Infections, BY JAMIE DUCHARME, https://time.com/6130704/breakthrough-infections-omicron/?utm_medium=email&utm_source=sfmc&utm_campaign=newsletter+brief+default+ac&utm_content=+++20211222+++body&et_rid=171550176&lctg=171550176
• C.White House to buy, ship 500 million rapid tests for free beginning in January, By Lev Facher,  https://www.statnews.com/2021/12/21/white-house-to-buy-ship-500-million-rapid-tests-for-free-beginning-in-january/
• D.Omicron Will Surge Despite Biden’s New Plan, Scientists Say
• E.FDA authorizes new antiviral treatment, a Pfizer pill; Omicron variant projected to bring ‘enormous surge’: Latest COVID updates, by Bill Keveney, Ryan W. Miller and Claire Thornton, https://www.usatoday.com/story/news/health/2021/12/22/covid-cases-vaccines-test-kits-omicron-boosters/8989209002/
• F.Three new studies suggest omicron has lower hospitalization risk and is milder than other variants, by Ryan Browne, https://www.cnbc.com/2021/12/23/omicron-variant-has-lower-risk-of-hospitalization-studies-suggest.html
• G.Beneath a Covid Vaccine Debacle, 30 Years of Government Culpability, By Chris Hamby and Sheryl Gay Stolberg, https://www.nytimes.com/2021/12/23/us/covid-vaccine-biden-trump.html
• H.CDC shortens isolation time for health care workers with Covid-19, By Michael Nedelman and Veronica Stracqualursi, https://www.cnn.com/2021/12/24/politics/cdc-updates-isolation-guidance-health-care-workers/index.html
• I.FDA authorizes second antiviral pill to treat Covid-19, By Jamie Gumbrecht, Amanda Sealy and Jacqueline Howard, https://www.cnn.com/2021/12/22/health/pfizer-antiviral-pill-authorized/index.html
• J.Omicron Drives U.S. Virus Cases Past Delta’s Peak, Charlie Smart and Amy Schoenfeld Walker, https://www.nytimes.com/interactive/2021/12/23/us/omicron-case-count.html?referringSource=articleShare
• K.A Message From Britain on Using Rapid Tests, By Alan McNally, https://www.nytimes.com/2021/12/23/opinion/rapid-tests-omicron-britain.html?referringSource=articleShare
• L.NFL chief medical officer: Symptomatic players driving COVID-19 spread; no indications of asymptomatic spread, by Kevin Seifert, https://www.espn.com/nfl/story/_/id/32930584/data-shows-asymptomatic-individuals-not-spreading-covid-19-nfl-chief-medical-officer-says
• M.UPDATED: US ships out all remaining supplies of the only Covid mAb treatment that works against Omicron, by Zachary Brennan, https://endpts.com/us-ships-out-all-remaining-supplies-of-the-only-covid-treatment-that-works-against-omicron/
• N.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
• O.Hochul announces shortened isolation time for health care and ‘critical’ workers who test positive for COVID-19, BY JESSICA GOULD, https://gothamist.com/news/hochul-announces-shortened-isolation-time-health-care-and-critical-workers-who-test-positive-covid-19
• P.Finding a Covid-19 test is a struggle right now in the US as Omicron and holiday plans collide, By Aya Elamroussi, https://www.cnn.com/2021/12/22/health/us-coronavirus-wednesday/index.html
• Q.Is a fourth Covid-19 vaccine dose needed? US health officials say not yet, By Jacqueline Howard,  https://www.cnn.com/2021/12/24/health/fourth-dose-covid-19-vaccine-us/index.html
• R.Supreme Court to Hold Special Hearing on Biden Vaccine Mandates, By Adam Liptak, https://www.nytimes.com/2021/12/22/us/politics/osha-vaccine-mandate-supreme-court.html?referringSource=articleShare
• S.Trump touts effectiveness of Covid-19 vaccine, By Veronica Stracqualursi and David Wright, https://www.cnn.com/2021/12/23/politics/trump-vaccine-covid-effectiveness/index.html
• T.‘Striking Increase’: NY Urgent Advisory as Child COVID Hospitalizations Quadruple, https://www.nbcnewyork.com/news/coronavirus/striking-increase-ny-urgent-advisory-to-pediatricians-as-child-covid-hospitalizations-quadruple/3467510/
• U.Coronavirus Can Persist for Months After Traversing Body, By Jason Gale, https://www.bloomberg.com/news/articles/2021-12-26/coronavirus-can-persist-for-months-after-traversing-entire-body#:~:text=Coronavirus%20Can%20Persist,the%20authors%20said.
• V.Intimate portraits of a hospital COVID unit from a photojournalist-turned-nurse, by VICTORIA HANSEN, https://www.npr.org/sections/health-shots/2021/12/26/1066395049/intimate-portraits-of-a-hospital-covid-unit-from-a-photojournalist-turned-nurse#:~:text=Intimate%20portraits%20of,VICTORIA%20HANSEN
• W.Omicron Is Pushing America Into Soft Lockdown, By Sarah Zhang, https://www.theatlantic.com/health/archive/2021/12/omicron-soft-lockdown/621121/
• X.Pfizer antiviral pills may be risky with other medications, By Benjamin Ryan, https://www.nbcnews.com/health/health-news/pfizer-covid-pills-covid-symptoms-may-risky-drugs-rcna9683
• Y.Omicron variant will create a surge in January or April, CDC predicts, By Herb Scribner, https://www.deseret.com/coronavirus/2021/12/25/22848343/omicron-variant-surge-january-april-cdc-predictions
• Z.Health expert: Surge in COVID-19 cases should no longer be ‘major metric’ of pandemic, BY DOMINICK MASTRANGELO, https://thehill.com/homenews/587329-health-expert-surge-in-covid19-cases-should-no-longer-be-major-metric-of-pandemic
• AA.Boris Johnson to examine hospital data before decision on Covid rules, by Jessica Elgot and Denis Campbell, https://www.theguardian.com/world/2021/dec/26/boris-johnson-to-examine-hospital-data-before-decision-on-covid-rules
• BB.Ban against unvaccinated workers begins in NYC, https://fox8.com/news/ban-against-unvaccinated-workers-begins-in-nyc/#:~:text=Ban%20against%20unvaccinated,a%20last%20resort.
• CC.‘Unsustainable’: Boston hospitals could face ‘disaster’ as coronavirus wastewater shoots up and virus cases explode, by By RICK SOBEY, https://www.bostonherald.com/2021/12/26/unsustainable-boston-hospitals-could-face-disaster-as-coronavirus-wastewater-shoots-up-and-virus-cases-explode/
• DD.US officials recommend shorter COVID isolation, quarantine, By MIKE STOBBE, https://apnews.com/article/coronavirus-pandemic-science-business-health-rochelle-walensky-d7d609c9c01e200d250df7ca7282c9d6
• EE.CDC shortens Covid isolation period to 5 days for people without symptoms, By Dartunorro Clark, https://www.nbcnews.com/politics/politics-news/cdc-shortens-isolation-period-asymptomatic-people-who-test-positive-covid-n1286653
• FF.Maryland hospitals in contingency protocols amid surge of COVID-19 patients, Theo Hayes, https://www.wbaltv.com/article/maryland-hospitals-covid-19-patients-surge/38621968#
• GG.Experts say COVID-19 cases don’t tell whole story, BY ALEX GANGITANO AND BRETT SAMUELS, https://thehill.com/homenews/administration/587405-experts-say-covid-19-cases-dont-tell-whole-story
• HH.The N.B.A. cuts isolation time as dozens test positive., By Tania Ganguli, https://www.nytimes.com/2021/12/27/sports/basketball/nba-isolation-guidelines-requirements.html?referringSource=articleShare
• II. Will Shortened Isolation Periods Spread the Virus?, By Benjamin Mueller, https://www.nytimes.com/2021/12/28/health/covid-isolation-period-omicron.html?referringSource=articleShare
• JJ.FDA: Antigen tests may have reduced sensitivity detecting Omicron, By DAVID LIM, https://www.politico.com/news/2021/12/28/fda-antigen-tests-reduced-sensitivity-omicron-526217
• KK.U.S. Coronavirus Cases Hit Record High,https://www.usnews.com/news/top-news/articles/2021-12-29/u-s-coronavirus-cases-hit-record-high