POST 229. January 16, 2020. CORONAVIRUS. “It is now highly unlikely that the U.S. will hit the ~85-90% of Americans vaccinated to get to the other side of the pandemic…”

“..More than 15,000 people with Covid-19 have been hospitalized in the city (NYC) in the past four weeks, the most since the initial surge. About half of all patients in the city’s hospitals now have Covid-19.

“The biggest mistake the Biden administration made was to push a vaccines-only approach, rather than a ‘vaccines-plus,’ including rapid tests, improving indoor air quality, and distributing high-filtration masks ubiquitously, coupled with public indoor mask mandates for high-risk shared spaces.

“Vaccines-only suffers from a key weakness: variants. And we have now seen this play out with Omicron. We have wildfire spread as our current vaccines do not provide sterilizing immunity — meaning, people can and do still transmit the virus effectively.”” (M)

for links to POSTS 1-229 in chronological order highlight and click on

“The U.S. is likely reaching the end of the road on new vaccinations, after the U.S. Supreme Court blocked the Biden administration’s vaccine mandate for large employers.

Why it matters: Cash prizes and other incentives barely moved the needle on vaccinations. So the government turned from carrots to sticks — but now it has lost its biggest stick.

“It is now highly unlikely that the U.S. will hit the ~85-90% of Americans vaccinated to get to the other side of the pandemic,” tweeted Celine Gounder, an infectious disease expert and former Biden administration advisory board member.

By the numbers: 63% of eligible Americans are fully vaccinated and about 38% of them have gotten boosted.

About 75% of Americans have gotten at least one dose of a COVID vaccine, according to the CDC.

State of play: Employers in most of the country are still free to impose their own mandates, if they want to, but there’s not much reason to expect that to produce any major increase in vaccinations.

Only a few large companies, such as United Airlines, have required vaccines. Most employers haven’t enacted a mandate, and labor shortages could make them even less likely to do so now.” (A)

“At the same time, the court is allowing the administration to proceed with a vaccine mandate for most health care workers in the U.S.

The court’s orders Thursday during a spike in coronavirus cases was a mixed bag for the administration’s efforts to boost the vaccination rate among Americans.

The court’s conservative majority concluded the administration overstepped its authority by seeking to impose the Occupational Safety and Health Administration’s vaccine-or-test rule on U.S. businesses with at least 100 employees. More than 80 million people would have been affected.

“OSHA has never before imposed such a mandate. Nor has Congress. Indeed, although Congress has enacted significant legislation addressing the COVID–19 pandemic, it has declined to enact any measure similar to what OSHA has promulgated here,” the conservatives wrote in an unsigned opinion…

The vaccine mandate that the court will allow to be enforced nationwide covers virtually all health care workers in the country. It applies to health care providers that receive federal Medicare or Medicaid funding, potentially affecting 76,000 health care facilities as well as home health care providers. The rule has medical and religious exemptions.”  (B)

“Florida won’t be enforcing the Biden Administration’s mandatory vaccination policy for health care workers upheld by the U.S. Supreme Court, a spokeswoman for the governor’s office said Thursday.

“The state of Florida is not going to serve as the Biden Administration’s biomedical police,” Christina Pushaw, press secretary for Gov. Ron DeSantis, said in an email to the USA TODAY Network-Florida. “Firing unvaccinated healthcare workers, many of whom have infection-conferred immunity, is unethical and unscientific on its face.”

She said it also harms patients “because hospitals in California and other states are now requiring vaccinated, COVID-infected healthcare workers to treat patients due to staffing shortages — which were exacerbated by vaccine mandates. How does that keep anyone safe?”” (C)

“General Electric suspended its Covid vaccine and testing requirement on Friday after the Supreme Court blocked the Biden administration’s mandate, a company spokesperson told CNBC.

GE, which had174,000 employees at the end of 2020, has encouraged its employees to get vaccinated, the spokesperson said.

President Joe Biden, in a statement after the court’s decision, called on companies to voluntarily implement the vaccine and testing rules.” (D)

“Potentially active SARS-CoV-2 may persist beyond 10 days say researchers from the University of Exeter, facilitating onward transmission of COVID-19 after a person has completed the advised quarantine period….

Prof Lorna Harries, of the University of Exeter Medical School, who oversaw the study, said, “Our data suggest that after 5 days, about 1 in 3 people could potentially remain infectious for COVID-19; a figure that is backed up by the UK Health and Safety Authority’s own data, and could pose a potential risk of onward transmission.”” (E)

“A year ago, just two doses of a Covid-19 vaccine — or even one, in the case of Johnson & Johnson’s formulation — were thought to offer sufficient protection against the coronavirus.

Now, faced with the extraordinarily contagious Omicron variant, Israel has begun offering fourth doses to some high-risk groups. On Wednesday, the Centers for Disease Control and Prevention expanded eligibility for boosters to adolescents and backed away from describing anyone as “fully vaccinated” because two shots no longer seem adequate.

Instead, one’s vaccination status will now be “up to date” — or not. It’s no surprise that many Americans are wondering: Where does this end? Are we to roll up our sleeves for booster shots every few months?

Humbled repeatedly by a virus that has defied expectations, scientists are reluctant to predict the future. But in interviews this week, nearly a dozen said that whatever happens, trying to boost the entire population every few months is not realistic. Nor does it make much scientific sense.

“It’s not unheard-of to give vaccines periodically, but I think there are better ways than doing boosters every six months,” said Akiko Iwasaki, an immunologist at Yale University. Other strategies, she said, could “get us out of this forever-boosting kind of a situation.”

For starters, persuading people to line up for shots every few months is probably a losing proposition. About 73 percent of American adults are fully vaccinated, but so far just over a third have opted for a booster….

“We’re going somewhere fast, but we don’t know where we’re going,” said Natalie Dean, a biostatistician at Emory University in Atlanta. “Whatever the future holds, it just needs to be clear what the goal is.”” (F)

“Starting Saturday, new federal rules will require private insurers to cover the at-home coronavirus tests that Americans buy in pharmacies and other stores. The new system could, in theory, allow millions of consumers to pick up tests at thousands of locations without spending any money.

The reality, at least in the short term, is likely to be messier: Some insurers say it will probably take weeks to fully set up the system the White House envisions.

The new process will be hard, the insurers say, because over-the-counter coronavirus tests are different from the doctor’s visits and hospital stays they typically cover.

The tests do not currently have the type of billing codes that insurers use to process claims. Health plans rarely process retail receipts; instead they’ve built systems for digital claims with preset formats and long-established billing codes.

Because of this, some insurers plan to manage the rapid test claims manually at the start…

The new rules require private insurers to cover eight at-home coronavirus tests for each person, every month. The rules will not apply retroactively to at-home tests that Americans have already purchased, and do not cover patients with public insurance such as Medicare and Medicaid.” (G)

“The latest Covid-19 wave has left millions of Americans scrambling for tests, braving long lines in the cold at pop-up sites or searching furiously online for kits to use at home. But for a select group of employees at some of the country’s largest companies, tests are free and often readily available.

Without an adequate federal system for developing and distributing rapid tests, companies have put their own testing services in place.

Google will send full-time employees in the United States free at-home tests that deliver results within minutes and retail for more than $70 each. BlackRock, an investment firm that manages nearly $10 trillion in assets, offers tele-health supervision as employees self-administer rapid tests for international travel. At JPMorgan Chase, bankers, including those at its retail sites, can order at-home rapid tests from an internal company site.

Some companies are using the tests to call their staff back to the office. For others, at-home Covid testing has become the newest wellness benefit, a perk to keep employees healthy and working — even from their couches — while providing peace of mind.

The testing available to a small number of white-collar professionals underscores the difference between their pandemic experience and that of other Americans, putting them at an advantage over many, including workers at small businesses without the means to procure testing kits for their staffs. Like personal protective equipment and vaccines, tests have become the latest example of how a tool to battle the pandemic can exacerbate social and economic divides.

“We’re the epicenter of the epicenter and I can’t get test kits anywhere,” said Thomas Grech, president of the Queens Chamber of Commerce, which has roughly 1,400 members that employ about 150,000 workers in the borough.” (H)

“The Omicron variant of the coronavirus is causing Covid-19 cases to spike, with an average of more than 747,000 new cases a day, according to the latest numbers from Johns Hopkins University. That’s almost three times the average daily cases from a year ago, when the country was going through its previous peak, and it’s putting an incredible strain on hospitals and emergency rooms.

The good news since the last peak is that the US Food and Drug Administration authorized new antiviral pills. Both Paxlovid and molnupiravir were given emergency use authorization in late December to treat mild to moderate Covid-19. They interfere (through different pathways) with the virus’ ability to replicate — and they can be taken at home, before someone becomes seriously ill.

Molnupiravir reduces the rate of hospitalizations in high-risk patients by about 30% and carries some possible side effects, but Paxlovid reduces the rate of hospitalizations by around 90% and is considered safer. In other words, Paxlovid is a bit of an antiviral superstar…

The bad news? Supply is very limited for both but especially for Paxlovid. Patients and their doctors are struggling to find it.

Just 160,000 courses have been delivered across the country, and with more people now hospitalized with Covid-19 than at any other time during the pandemic, these pills are in short supply.” (I)

“The American Red Cross says the nation is facing its worst blood shortage in more than a decade, citing a drop in blood drives due to the pandemic.

The organization said on Tuesday that the “national blood crisis” is threatening patient care and forcing doctors to make tough choices about who is able to receive blood transfusions, and it’s urging people to donate.

In recent weeks, the Red Cross — which provides some 40% of the nation’s blood — has had less than a one-day supply of critical blood types and has had to limit blood product distributions to hospitals. It says that at times, up to one-quarter of hospital blood needs are not being met.

There has been a significant drop in donations during the pandemic, and weather conditions and staffing limitations have caused ongoing cancelation of planned blood drives. There’s been a 10% overall blood donation decline since March 2020, and a 62% drop in college and high school blood drives during the pandemic, it says.” (J)

“Two of the country’s largest retail pharmacies are temporarily closing stores on weekends due to an increase in the number of COVID-19 infections among staffers.

The two chains said that the rapid spread of the Omicron variant has depleted staffing at several locations nationwide, affecting customer service and delaying key services like medication prescriptions and vaccinations.

Walgreens boasts nearly 9,000 locations across 50 states, the District of Columbia, Puerto Rico, and the US Virgin Islands. CVS operates around 10,000 pharmacies throughout the country.” (K)

“Like many hospitals in New York City, the Brooklyn Hospital Center is straining under the biggest surge of Covid-19 patients since spring 2020, when ambulance sirens filled the air and more than 20,000 New York City residents died.

In the pandemic’s early days, doctors and nurses looked out on emergency rooms filled with patients who were desperate for oxygen. Today, Covid-19 patients’ symptoms are generally milder — stomach aches, fainting, dizziness, nausea, some shortness of breath — and far fewer people are dying.

But the patients keep arriving, and in droves: More than 15,000 people with Covid-19 have been hospitalized in the city in the past four weeks, the most since the initial surge. About half of all patients in the city’s hospitals now have Covid-19.

And there are simply not enough nurses to care for them all. Across New York, hospitals generally employ fewer nurses than they did at the start of the pandemic, according to the New York State Nurses Association, a union.

Some nurses, burned out by stress, have left the profession; others have taken traveling nurse jobs at considerably higher pay. And the Omicron variant’s extreme infectiousness has meant many are out sick or in isolation on any given day.” (L)

“Today, notable members of the Biden administration’s COVID-19 pandemic transition team called on the president to shift his approach to the virus, accepting that it will be endemic and that new variants could emerge and arguing that the country needs a new strategy for living with the virus 2 years after it was first identified in Wuhan, China.

In one of three articles published today in the Journal of the American Medical Association, Ezekiel Emanuel, MD, PhD, of the University of Pennsylvania; Michael Osterholm, PhD, MPH, who directs the University of Minnesota’s Center for Infectious Disease Research and Policy (CIDRAP), publisher of CIDRAP News; and Celine Gounder, MD, of New York University, argue that a new normal must be based on understanding COVID-19 as a respiratory illness, similar to influenza or respiratory syncytial virus (RSV).

Doing so would help the country develop an appropriate risk threshold that would establish peak weekly deaths, hospitalizations, and community prevalence of viral respiratory illnesses during high-severity years.

“This risk threshold triggers policy recommendations for emergency implementation of mitigation and other measures. In addition, health systems could rely on this threshold for planning on the bed and workforce capacity they need normally, and when to institute surge measures,” the authors write.

In an interview with CIDRAP News, Osterholm said members of the Biden transition team were having these discussions before the Omicron (B.1.1.529) variant emerged. The federal government has been acting in emergency mode, they said, and needs to start thinking of the pandemic with long-term goals in mind.

“What’s the end game? With the variants, we are never sure what the end game is going to be,” Osterholm said in the interview. “This is not a critique of the current administration, as much as an opportunity to plan.”

In the same article, experts tout the important of accurate, free, and reliable at-home testing. Widespread access to N95 or KN95 respirators is also argued for, as is better air filtration systems in schools and congregate buildings.” (N)


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