POST 248. April 27, 2022. CORONAVIRUS. “For at-risk Americans without access to a “test-to-treat” drugstore that has a qualifying provider available, this means some will have to make multiple trips to get the pills. You have to develop COVID symptoms, you have to subsequently get a test for COVID-19, get the result of that test, find and go to see a provider, get a prescription, and then fill that prescription. That’s six steps in five days,”…

“Although the cost of the pills is covered by the federal government, obtaining a prescription at the pharmacies that dominate the program can be expensive. Though CVS does not charge symptomatic uninsured people for on-site covid tests, MinuteClinics charge upwards of $100 for in-person or telehealth appointments to examine patients and prescribe an antiviral, if needed. People without insurance, whose health plans don’t cover visits to the clinics, or who have high-deductible plans must shoulder the full cost of the appointment…”

for links to POSTS 1-248 in chronological order highlight and click on

The federal “test-to-treat” program, announced in March, is meant to reduce covid hospitalizations and deaths by quickly getting antiviral pills to people who test positive. But even as cases rise again, many Americans don’t have access to the program.

Pfizer’s Paxlovid and Merck’s Lagevrio are both designed to be started within five days of someone’s first symptoms. They’re for people who are at high risk of developing severe illness but are not currently hospitalized because of covid-19. Millions of chronically ill, disabled, and older Americans are eligible for the treatments, and Dr. Anthony Fauci of the National Institutes of Health said April 11 that more people may qualify soon.

The program allows people with covid symptoms to get tested, be prescribed antiviral pills, and fill the prescription all in one visit. The federal government and many state and local health departments direct residents to an online national map where people can find test-to-treat sites and other pharmacies where they can fill prescriptions.

But large swaths of the country had no test-to-treat pharmacies or health centers listed as of April 14. And the website of the largest participant, CVS, has significant technical issues that make booking an appointment difficult…

Ninety-one percent of the sites listed on the national map are federal partners: pharmacy chains like CVS, federally qualified health centers, and military and Indian Health Service clinics. HHS has asked state and local health departments to identify other potential participants, like San Francisco General Hospital, so they can be added. Most states have none of those partners listed yet.

Nationally, CVS MinuteClinics make up more than half of all test-to-treat locations, according to the federal data. The roughly 1,200 clinics, in 35 states and Washington, D.C., are housed under the same roof as CVS pharmacies, where patients can pick up prescriptions for covid antivirals. Walgreens drugstores and Kroger grocery store affiliates run about 400 more sites.

The federal government has set aside nearly 400,000 courses of the antivirals for its federal pharmacy partners — about a quarter of the total supply since the program began in March.

Although the cost of the pills is covered by the federal government, obtaining a prescription at the pharmacies that dominate the program can be expensive. Though CVS does not charge symptomatic uninsured people for on-site covid tests, MinuteClinics charge upwards of $100 for in-person or telehealth appointments to examine patients and prescribe an antiviral, if needed. People without insurance, whose health plans don’t cover visits to the clinics, or who have high-deductible plans must shoulder the full cost of the appointment…

Another complication: The FDA requires doctors, advanced practice registered nurses, or physician assistants to write the prescriptions. A pharmacist can’t do it. Many of the nation’s leading pharmacy organizations have asked the Biden administration to remove the restriction, which would expand the program to scores of rural and underserved communities.

Because of this rule, the program requires clinics and pharmacies to be under the same roof — a setup that doesn’t exist in many regions, particularly in rural areas…

“If you’re just an average person trying to navigate this,” she said, “it’s actually completely impossible.” (A)

“Almost two months after President Biden promised to make lifesaving drugs against Covid widely available to Americans, the medications remain hard to get for many, despite supplies, leaving large numbers of Americans to face increased risks of avoidable death and serious illness.

That’s largely because, once again, a dysfunctional health care system that costs more and often delivers less than that of any other developed country has hindered our pandemic response.

As was the case with vaccines, the United States quickly snapped up these therapeutics and accumulated vastly more supply than any other country. These drugs do not replace vaccines but provide crucial extra protections for vulnerable people who number in the millions and who face increased risks as the few remaining public health protections are rolled back.

Paxlovid, an antiviral treatment developed by Pfizer, an American pharmaceutical company, is highly effective for reducing hospitalizations and deaths in high-risk patients, as long as it is started early. This is especially important for elderly or immunocompromised people, since their immune systems are not as robust as others’ against viruses, even when vaccinated. In his State of the Union address, Biden announced a “test to treat” initiative to provide such pills on the spot in pharmacies when someone tests positive.

The national map of participating pharmacies in test to treat shows large parts of the country with none. Even in areas where treatment is supposed to be available, it can be hard to get. A Kaiser Health News reporter spent three hours driving around Washington, D.C., before finding a pharmacy where testing was available and the drug was in stock — something we should not expect sick people to do. When trying to book appointments online in several states, the reporter was sometimes denied an in-person appointment after listing upper-respiratory symptoms and a positive coronavirus test, even though the point of the program is to treat people with respiratory illness so they don’t get sicker. Many places did not have any same-day appointments, a big obstacle for a drug that should be given as quickly as possible.

The greater difficulty is that the drug can be prescribed only by a medical doctor, advanced practice registered nurse or physician assistant, especially because it can interact harmfully with many other drugs. It cannot be prescribed by a pharmacist. Many pharmacies aren’t participating in the national program because they don’t have a clinic on site where a health practitioner can assess a person’s eligibility. Even if they have one, managing prescriptions for high-risk people is best done by a patient’s regular doctor, not in a one-off encounter at a pharmacy. Patients who successfully wangle an appointment are asked to bring a list of all their drugs and, I suppose, resolve all the complexities in one sitting.

As further congressional funding has not been approved, the funds used for reimbursement for coronavirus testing have begun to be depleted, so people without insurance or whose insurance doesn’t cover such clinics have to pay for the health appointment out of pocket.

So it’s not hard to predict that many people will be left behind…

Also, it’s not that easy to get a same-day appointment with one’s regular physician, even for those who have great insurance. This makes catching the early treatment window harder. In most places, emergency rooms are always open, but besides being overloaded and understaffed, they are the last places where infected people should congregate or where the elderly or those at high risk should spend hours merely to get access to a crucial drug…

Not having a regular relationship with a medical provider — too common in the United States — leaves these high-risk people open to confusion and misinformation, especially in the current political environment. People without insurance lagged in being vaccinated at all and will face more obstacles in getting antivirals.” (B)

“Last month, the owner of a small pharmacy here secured two dozen courses of Pfizer’s new medication for treating Covid-19, eager to quickly provide them to his high-risk customers who test positive for the virus.

More than a month later, the pharmacy, Demmy’s, has dispensed the antiviral pills to just seven people. The remaining stock is sitting in neatly packed rows on its shelves in the suburbs of Washington, D.C. And the owner, Adeolu Odewale, is scrambling to figure out how to get the medication, Paxlovid, to more people as cases have increased over 80 percent in Maryland in recent days.

“I didn’t expect that I was still going to be sitting on that many of them,” he said of the pills he still has on hand. “It’s just that people need to know how to get it.”…

State health officials say that many Americans who would be good candidates for Paxlovid do not seek it out because they are unaware they qualify for it, hesitant about taking a new medication, or confused by the fact that some providers interpret the eligibility guidelines more narrowly than others.

Since the medication has to be prescribed by a doctor, nurse practitioner or physician assistant, people have to navigate an often byzantine health care system in search of a prescription, then find a pharmacy that carries the treatment, all within five days of developing symptoms. The medication, prescribed as three pills taken twice a day for five days, is meant to be started early in the course of infection.

A new federal program that President Biden announced earlier this year, called “test to treat,” is supposed to let people visit hundreds of qualified pharmacy-based clinics, community health centers and long-term care facilities across the country to get tested for the coronavirus and, if positive, receive Paxlovid on the spot. But almost two months later, it is still limited in its reach and has not dramatically sped up access to the drug beyond what its sites were already equipped to do, experts said.

More than 630,000 courses of the drug — roughly a third of the supply distributed to date — are currently available, and the federal government has been sending 175,000 courses to states each week, according to federal data. Its use rapidly increased in recent weeks, federal officials said, but data on who has received the medication remains sparse.

The White House on Tuesday morning announced a series of new measures intended to shore up programs for getting the pill to eligible Americans, emphasizing the surplus and pushing doctors to stop thinking of the treatment as scarce. It said it would allow pharmacies to begin ordering the drug directly from the federal government, and that it would aim in coming weeks to double the number of pharmacies carrying Covid antiviral medication, to 40,000. The administration would also work with states to open new test-to-treat locations, the White House said.

Of the more than 2,000 test-to-treat sites, about half are CVS MinuteClinics with in-house nurse practitioners and physician assistants who can prescribe the drug. Many of the other sites are Walgreens, Kroger and other chain pharmacies, as well as federally funded health centers.

Public health experts and patients who have tried navigating the program say that appointments can still be difficult to find, and can require long drives. Much of rural America lacks easy access to the program.

“It’s a good idea, except for all of the barriers,” said Dr. Walid Gellad, a pharmaceutical and drug safety expert at the University of Pittsburgh.

One of those obstacles, he said, is differing interpretations of the eligibility guidelines. Some health departments and doctors might go by the C.D.C.’s definition of people at high risk for becoming severely ill or dying from Covid, which includes not only people 65 and older and those with chronic medical conditions but also people who are at increased risk based on “where they live or work, or because they can’t get health care.”..

Giving pharmacists prescribing power could dramatically expand the speed and ease with which people get the treatment, public health experts say. But regulators at the F.D.A. and other federal health officials believe there is reason to not allow pharmacists to prescribe Paxlovid themselves, even though some Canadian pharmacists can do so. The treatment can interfere with certain medications and should be prescribed at a lower dose for people with kidney impairment, which is measured with a blood test.

Pharmacists say that they are highly trained and well equipped to conduct such screening themselves. Michael Ganio, senior director of pharmacy practice and quality at the American Society of Health-System Pharmacists, said pharmacists could get Paxlovid to patients faster if they could prescribe it, “without having to call a physician’s office and wait for a call back, and hope it happens within five-day period.”

Noting that MinuteClinics tend to be located in affluent areas, he said of the test-to-treat program: “In terms of expanding access, it hasn’t done what it could do, particularly in medically underserved areas.” (C)

“Now that most US cities and states have dropped masking requirements and other precautions against Covid-19, you may be wondering about your chances of getting infected or, worse, being hospitalized or dying if you happen to get sick.

Researchers have been digging into that question, and in general, what they’ve found is that for people who are considered up to date on their Covid-19 vaccines — that means getting a booster when it’s recommended — protection against illness drops off over three or four months after your last dose, but protection against hospitalization and death remains high…

Data presented this week to the US Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices breaks this down.

Here’s how protection is holding up in real life against an infection by the Omicron coronavirus variant that causes symptoms. If you got:

Two doses of the Johnson & Johnson vaccine, they’re are 30% effective between two and four months after your shots.

One dose of Johnson & Johnson and one dose of an mRNA shot from Pfizer/BioNTech or Moderna, your vaccines are 55% effective between months 2 and 4.

Three doses of an mRNA shot, your vaccines are 63% effective between months 2 and 4.

After five months, boosters offer almost no protection against Omicron infection, according to data from the UK’s Health Security Agency.

Protection against hospitalization with low immune function

When it comes to emergency care or hospitalization, the protection you get from vaccines really depends on your immune function.

Sara Tartof, an epidemiologist for Kaiser Permanente in Southern California, has been studying how well a third dose of the Pfizer mRNA vaccine is doing at keeping adults in her health system out of the hospital.

Up to three months after a third dose, the vaccine’s effectiveness against hospitalization was 85%, but it fell to 55% after three months. After a closer look, though, she found that these results were largely driven by immune status.

“We saw no evidence of waning but in the immunocompromised,” Tartof said. “In the immunocompromised, vaccine effectiveness basically starts low and gets lower.”

But for people with regular immune function, vaccine effectiveness against hospitalization stayed high — about 86% — after three months.

Her initial study results are published in The Lancet Repiratory Medicine. Tartof says she plans to update them soon with results by immune status.

In general, researchers are finding that for adults 50 and older whose immune systems are working normally, protection starts high and remains high — about 84% — for up to six months after a booster dose, when it comes to the risk of being hospitalized with an infection caused by the Omicron variant.

For adults 50 and older who have reduced immune function, such as those who’ve had solid organ transplants or who are getting cancer treatment, protection from a booster is initially good but falls faster.

For example, up to two months after a booster dose of an mRNA vaccine, an immunocompromised adult can expect 81% protection from hospitalization if they get an infection caused by the Omicron variant, but that drops to about 49% after four months, according to new CDC data. This is one of the reasons this group has been prioritized for additional boosters.” (D)

“A fourth dose of the Pfizer-BioNTech coronavirus vaccine offers a short-term boost of protection against infection that starts waning after just four weeks, according to new research out of Israel.

The study, which was published in the New England Journal of Medicine on Tuesday, found that effectiveness against infection in the fourth week after the second booster shot was lower than protection mounted after the third vaccine dose. The protection drastically falls after eight weeks.

Researchers concluded that “these findings suggest that protection against confirmed infection wanes quickly.”

Protection against severe illness, however, didn’t wane during the six weeks after the fourth shot, according to the study. But researchers reported that “more follow-up is needed in order to evaluate the protection of the fourth dose against severe illness over longer periods.”

The study focused on adults ages 60 and older and examined 1.25 million vaccinated people in Israel from Jan. 10 to March 2, when the omicron variant was the dominant strain.

The research comes just about a week after the Food and Drug Administration authorized an additional coronavirus booster shot for Americans ages 50 and older at least four months after their third dose, citing waning protection from previous shots.

The agency cited data out of Israel showing “increases in neutralizing antibody levels against SARS-CoV-2 virus, including delta and omicron variants were reported two weeks after the second booster as compared to 5 months after the first booster dose” for its decision, which came without a meeting or endorsement from its vaccine advisory committee.

Leading infectious disease expert Anthony Fauci said during a press briefing on Tuesday that “booster shots protect against serious illness, hospitalizations and even death” – notably not mentioning infection.” (E)

“The Director for Infectious Disease Research and Policy at the University of Minnesota, Dr. Michael Osterholm, said there are really two parts to the question of the mask mandate for transit being thrown out by the judge in Florida.

“I think the legal aspect of whether CDC has authority to make such recommendations is really critical,” Osterholm said. “Not in the entire history of health in this country have we had a ruling that could limit significantly what a public health agency can recommend or do in the time of a public health emergency or crisis. That would be a really shortsighted mistake to do that. So I hope that from that standpoint, this decision is overturned.”

However, from a pure health standpoint, Osterholm does not believe the mandate as it has existed is effective.

“In terms of the actual mask mandate is the fact that if you’re using an N95 respirator and you actually wear it over your nose and don’t take it off to eat or drink, then the impact of that, both in terms of you transmitting the virus to someone else, if you’re infected or of you becoming infected from someone else, is remarkable, that would be outstanding,” Osterholm said.

That is not how the mandate was being enforced.

“The bottom line is the mask mandate doesn’t require that,” Osterholm said. “What it says is you’ve got to put some kind (of mask) in front of your face. And oh, by the way, if it’s all underneath your nose, so what? Which a quarter of the people do. Oh, by the way, if you’re eating or drinking, you don’t have to wear it. Like somehow the virus is going to take a vacation while you’re eating or drinking. So, from that standpoint, the mask mandate has never made public health sense to me because it’s really extracting a lot of political capital from public health.” (F)

“In the middle of last year, the World Health Organization began promoting an ambitious goal, one it said was essential for ending the pandemic: fully vaccinate 70 percent of the population in every country against Covid-19 by June 2022.

Now, it is clear that the world will fall far short of that target by the deadline. And there is a growing sense of resignation among public health experts that high Covid vaccination coverage may never be achieved in most lower-income countries, as badly needed funding from the United States dries up and both governments and donors turn to other priorities.

“The reality is that there is a loss of momentum,” said Dr. Isaac Adewole, a former health minister of Nigeria who now serves as a consultant for the Africa Centers for Disease Control and Prevention.

Only a few of the world’s 82 poorest countries — including Bangladesh, Bhutan, Cambodia and Nepal — have reached the 70 percent vaccination threshold. Many are under 20 percent, according to data compiled from government sources by the Our World in Data project at the University of Oxford.

By comparison, about two-thirds of the world’s richest countries have reached 70 percent. (The United States is at 66 percent.)

The consequences of giving up on achieving high vaccination coverage worldwide could prove severe. Public health experts say that abandoning the global effort could lead to the emergence of dangerous new variants that would threaten the world’s precarious efforts to live with the virus….

Some global health experts say the world missed a prime opportunity last year to provide vaccines to lower-income countries, when the public was more fearful of Covid and motivated to get vaccinated.

“There was a time people were very desperate to get vaccinated, but the vaccines were not there. And then they realized that without the vaccination, they didn’t die,” said Dr. Adewole, who wants to see countries continue to pursue the 70 percent target.

What momentum remains in the global vaccination campaign has been hindered by a shortfall in funding for the equipment, transportation and personnel needed to get shots into arms.

In the United States, a key funder of the vaccination effort, lawmakers stripped $5 billion meant for global pandemic aid from the coronavirus response package that is expected to come up for a vote in the next few weeks. Biden administration officials have said that without the funds, they will be unable to provide support for vaccine delivery to more than 20 under-vaccinated countries.”  (G)

“The Biden administration will renew its push with lawmakers to secure Covid-19 funding next week when Congress returns from recess, a White House official told CNN, following inaction from the Senate on a $10 billion funding package before the two-week Easter break…

The Biden administration has been sounding the alarm for weeks that additional funding is needed to continue the federal Covid-19 response, even as it seeks a return to “normal” with many pandemic-era restrictions lifting.

Concerns raised by officials include:

A possible lack of adequate resources to purchase enough booster shots for all Americans if additional booster shots are authorized

The possibility that monoclonal antibody treatments run out as soon as next month

A scaled-back purchase of AstraZeneca’s preventative treatment

Insufficient testing capacity and supply going forward

Impacts to research and development

Impasse over Covid aid

The Biden administration requested $22.5 billion in supplemental Covid-19 relief funding last month in a massive government funding package, but it was stripped from the bill. It included funding for testing, treatments, therapeutics and preventing future outbreaks. Negotiators were able to reach an agreement on a scaled-back $10 billion package, but Congress left Washington earlier this month without passing that bipartisan bill amid a disagreement over the Title 42 immigration policy — a pandemic-era rule that allowed migrants to be returned immediately to their home countries citing a public health emergency.

The impasse before the Easter break came as Republicans demanded a vote on an immigration amendment to restore Title 42. Democrats objected, criticizing Republicans for what they called an eleventh-hour ask in a negotiation they had thought was final…

The inaction before the break marked the second time a tentative deal on a Covid relief package had been scuttled in just over a month. In March, a $15.6 billion package that had been negotiated by House and Senate leaders collapsed when a group of House Democrats revolted against it because of how it was paid for.” (H)

“As COVID-19 cases rise across the country, the leader of the White House’s coronavirus response said officials are paying close attention to new variants but stressed that the U.S. should “get through this without disruption.”

Virus cases have jumped more than 50% in the past two weeks as the omicron BA.2 variant becomes the dominant strain in the country.

Hospitalizations, meanwhile, have not surged so far during this wave.

“We’re going to watch this carefully,” Ashish Jha, the White House’s COVID-19 response coordinator, said on CNN’s “State of the Union” on Sunday. “My expectation is that we’re going to see cases go up. We’re going to see cases go down. The key things: Make sure that hospitalizations and deaths are not rising in any substantial way, looking at variants, paying very close attention.

“Let’s see where the next few months go,” he added. “I’m concerned. I’m going to watch those numbers. But at this point, I remain confident that we’re going to get through this without disruption.”..

“Cases are still important. Infections are still important. We want to keep those infection numbers low. But, they mean something different now than they did a year ago,” Jha said. “They mean something different because people are vaccinated and boosted. They mean something different because we have a lot more therapeutics available.

“So we are going to have to change our behavior and respond in a different way as the pandemic evolves,” he added. “And I think, at this point, responding with care and caution, but not overreacting, is critical.”  (I)

“The White House is making a push Tuesday for more Covid patients to get treated with Pfizer’s Paxlovid as hundreds of people in the U.S. continue to die from the coronavirus every day.

Officials said that because the drug has been underused in the fight against the pandemic, the federal government will double the number of locations where Paxlovid is available. The locations will include 40,000 pharmacies, community health centers, hospitals, urgent care centers and Veterans Affairs clinics.

The White House said it expects that as many as 10,000 of the sites could start carrying the drug as soon as this week.

“It’s pretty clear from the uptake of Paxlovid and the rate of hospitalizations and deaths over the months Paxlovid has been available that there still are some folks who could have benefited from these medications,” a senior administration official told reporters. “We can save more lives by getting this medication to more people.”

Administration officials said the federal government will work with state and local governments to set up additional test-to-treat sites where patients can be seen by medical providers and get the drug in one location, rather than the two-step process of visiting their physicians and then picking up the prescriptions from pharmacies. There are currently 2,200 test-to-treat locations nationwide, the White House said.

Officials have been frustrated for weeks about the limited use of the drug, saying many doctors and patients probably don’t realize it is now widely available after months of being in scarce supply.” (J)

“Following concerns that the program was inaccessible to Americans living in many parts of the country, officials said the administration is planning to launch new “federally-supported Test-to-Treat sites” beyond the 2,200 locations currently in the program.

“I think we’re going to be working really closely with these new federally supported sites, work directly with state, territorial, and jurisdictional leadership to identify the places that need more support,” said an administration official.

Officials acknowledged that the new moves do not address some of the criticisms levied against the Biden administration’s treatment effort.

Despite objections from pharmacy trade groups, the FDA excludes most pharmacists from being able to prescribe Paxlovid or Lagevrio. For at-risk Americans without access to a “test-to-treat” drugstore that has a qualifying provider available, this means some will have to make multiple trips to get the pills.

“You have to develop COVID symptoms, you have to subsequently get a test for COVID-19, get the result of that test, find and go to see a provider, get a prescription, and then fill that prescription. That’s six steps in five days,” said an official.” (K)

“Florida’s respite from the pandemic may be ending. The state’s COVID-19 infection rate has doubled in the past two weeks and the positivity rates are up to 8 percent — the highest level seen since February. Even hospitalizations, which tend to lag behind infections, are ticking back up across the state.

A new strain of COVID-19 may be partially to blame. The variant, called BA.2.12.1 is part of the omicron family. It may be 23-to-27 percent more infectious than BA.2, according to the New York Department of Health, and is likely behind the recent spike in infections in that state. The Florida Department of Health would not comment on whether the new variant was a concern here…

20,860: Number of cases reported in Florida in the past week.

2,980: Average cases a day, a 34 percent increase compared to the previous week.

Positivity. 8 percent: Florida, compared to 6.2 percent the previous week.

Hospitalizations. 746: Florida hospitalizations, a 7 percent increase compared to the prior week.” (L)

“As SARS-CoV-2 continues to spread and mutate globally, facilitated by pandemic fatigue, recombinants of variants keep forming; the recently discovered XE subvariant is a hybrid of BA.1 and BA.2 that is starting to spread; XE cases are relatively rare but have grown high enough that the U.K. Health Security Agency estimates it’s about 10 percent more contagious than BA.2.

Meanwhile, a new BA.2 descendent called BA.2.12.1 is spreading even more rapidly, causing 20 percent of all cases in the U.S. within a month of its discovery in early March. Earlier estimates show that BA.2.12.1 spreads faster than earlier strains and could be better at dodging the immune system’s antibodies.

“There are actually many new versions of Omicron, not just two. And in some cases, they do appear to be outcompeting even BA.2,” says Harvard’s Barouch.

This all means the U.S. “needs to recharge its vaccination program” to avoid a likely surge in the fall and winter, says Saad Omer, an epidemiologist who directs the Yale Institute for Global Health in Connecticut.” (M)

“The Coronavirus Has Infected More Than Half of Americans, the C.D.C. Reports. But prior infection does not guarantee protection from the virus, officials said, and Americans should still get vaccinated and boosted.

Sixty percent of Americans, including 75 percent of children, had been infected with the coronavirus by February, federal health officials reported on Tuesday — another remarkable milestone in a pandemic that continues to confound expectations.

The highly contagious Omicron variant was responsible for much of the toll. In December 2021, as the variant began spreading, only half as many people had antibodies indicating prior infection, according to new research from the Centers for Disease Control and Prevention.

While the numbers came as a shock to many Americans, some scientists said they had expected the figures to be even higher, given the contagious variants that have marched through the nation over the past two years.

There may be good news in the data, some experts said. A gain in population-wide immunity may offer at least a partial bulwark against future waves. And the trend may explain why the surge that is now roaring through China and many countries in Europe has been muted in the United States.

A high percentage of previous infections may also mean that there are now fewer cases of life-threatening illness or death relative to infections. “We will see less and less severe disease, and more and more a shift toward clinically mild disease,” said Florian Krammer, an immunologist at the Icahn School of Medicine at Mount Sinai in New York.

“It will be more and more difficult for the virus to do serious damage,” he added.

Administration officials, too, believe that the data augur a new phase of the pandemic in which infections may be common at times but cause less harm.

At a news briefing on Tuesday, Dr. Ashish Jha, the White House’s new Covid coordinator, said that stopping infections was “not even a policy goal. The goal of our policy should be: obviously, minimize infections whenever possible, but to make sure people don’t get seriously ill.”

The average number of confirmed new cases a day in the United States — more than 49,000 as of Monday, according to a New York Times database — is comparable to levels last seen in late July, even as cases have risen by over 50 percent over the past two weeks, a trend infectious disease experts have attributed to new Omicron subvariants.

Dr. Jha and other officials warned against complacency, and urged Americans to continue receiving vaccinations and booster shots, saying that antibodies from prior infections did not guarantee protection from the virus.” (N)

(A) How the Test-to-Treat Pillar of the US Covid Strategy Is Failing Patients, By Hannah Recht,–hQMTtFxQRMwsq0xvqfCL1PKWp2TBvdCis2WcNZfuSRIK1GYvD6FQCswpCBzajMH6Iyrg0nSaXMScdpiKNUKbRGkJPOIwBGyzE5tMMKsR43ddSE_U&utm_content=210127631&utm_source=hs_email

(B) Covid Drugs Save Lives, but Americans Can’t Get Them, by ZEYNEP TUFEKCI,

(C) With Supply More Abundant, Pharmacies Struggle to Use Up Covid Pills, By Noah Weiland,

(D) How well is our immunity holding up against Covid-19?, By Brenda Goodman,

(E) Israeli Study Suggests Protection Against COVID-19 Infection from 4th Vaccine Dose Wanes Quickly, By Cecelia Smith-Schoenwalder,

(F) Osterholm says CDC needs to have the authority to decide mandates, by Ryan Janke,

(G) The Drive to Vaccinate the World Against Covid Is Losing Steam, By Rebecca Robbins and Stephanie Nolen,

(H) Biden administration to renew Covid-19 funding push when Congress returns next week, By Betsy Klein,

(I) Ashish Jha on the omicron BA.2 variant wave: ‘We’re going to get through this without disruption’, By RICK SOBEY,

(J) White House pushes to increase use of Pfizer’s Covid treatment Paxlovid, By Shannon Pettypiece,

(K) White House aims to boost use of COVID drugs like Paxlovid, citing plentiful supply, BY ALEXANDER TIN,

(L) Florida adds 20,860 COVID cases in past week as infections climb, By Ian Hodgson,

(M) Here’s what we know about the BA.2 Omicron subvariant driving a new COVID-19 wave, BY SANJAY MISHRA,

(N) The Coronavirus Has Infected More Than Half of Americans, the C.D.C. Reports, By Apoorva Mandavilli,


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    cleaning rules in the kitchen

    no doubt of the fact that in the food preparation companies, cleaning since cleanliness are critical factors. almost any united states make legislation when it comes to practices, that will reason to be totally then diners and hotels, disappointment which the results may very well be that this organization is de-activate or greatly penalized to get disregard. It isn’t supplying the staff via uniforms reminiscent of kitchen wear and simply hats, just much more now switches into some sort of neat and hygienic place healthy meant for making ready foodstuff.

    keep the your kitchen clean and hygienic seriously isn’t the responsibility of a few employee, nevertheless,having said that everyone ought to be kept accountable for it, From the gm on the store to the pinnacle cocinero to the dish washer. Even the particular breach in sanitation models results in a massive problem for the bosses, so because of this direct adherence to very high conditions over practices is essential.

    very own appearing One of the biggest the different parts of protecting against toxins of foods are rrn order that all company playing with for example food use stringent limits. towards all kinds of bacterium may be brought from a good individual present to the foodstuff may buy, really significant and personnel know the importance of keeping unique your hands keep clean. due to the fact, The software must provide cleaning soap or possibly a handwash in a few facets of the kitchen, as essential handwashing is actually elevated associated with the staff, just like before beginning labor, sooner than delivering a specialized challenge, afterwards closing a special piece of work, the second changing gas stations, should they have carressed any kind of themselves nicely any on the exterior covering as well as. soon after washing, cards have to dried using new large towel, Which is changed routine. excess hair could perhaps control bacterias this may contaminate food, and therefore decidedly water proof cook hatsshould be specified for manyof associates, and hence avoiding both sebaceous in addition,yet pelt totally from falling over in order to a meal.

    items many debris are utilized in cooking through the garments people will wear, which is in the form of bathroom representatives, commonplace uniforms are supplied so they can become as you are managing, And we’re not allowed to work carrying the widespread out of shirts. circumstances regarding mud, soil, virus, dog’s fur and so much more gets that come with outfit if they are right outside and can then be proceed inside the food they are planning to purchase. and so several employees should discover chef’s layers, trousers, help you make tee shirts, apron, in cook a terrific way to to become able prevent contaminants along with supper.

    a meal storage space space have to kept in a healthy process naturally in runs vases, And it must be given that most several types of fruit should be filed on your own. for example, raw various meats but also grilled shouldn’t placed be in conjunction, And the same goes for live dishes and home grown vegetables. team preferably should make sure you keep storage containers surely have air taught truck tops, feeling that all foods accumulated ought to have the night out chosen fully marked in it. edibles ought held because of single temperature made for each particular addition.

    de-frosting immediate heat improvements could potentially cause bacteria to build found on cuisine, so therefore if you are de-frosting things you eat, It ought to be done in cooled cupboards in order that the process is regarded as step by step.

    fold toxins it is recommended to have visibly labeled discrete products for acquiring cooking so as to prevent, like for example dicing message boards, cutlery therefore on. interesting this can be simply completed in by the pigment coding the device in the kitchen area, So that mindful which article will be used with kinds of food stuff.

    freeze them food it is very important that every conventional cooking consists of send chillers and as well be capable of veggies and fruitsrs which straight away making certain that merely acne bacteria produce built in, unique after preparing. The and even cool down method is used in the majority of decks from around the world.

    servicing food Once food is prepared it shouldn’t be touched from give ever since the food can aquire infected. the best products should be used to menu the food and providers and servers should learn to serve food minus touching it.

    cleaning the entire kitchen area site that will direct gadgets must be diligently laundered and disinfected (mainly cookware and consequently sinks) Both before embark on regarding day also avoid to make sure that day the most effective values habits. therefore, A weekly powerful purify of your kitchen have to be completed by workforce, which has a massive detox of your kitchen courtesy of – commercial products ought to be done at least one time each and every single six months.

    cleansing dinners ought to be done an ideal fashion in, in addition a required real expense to get industry your kitchen’s genuinely garbage disposal, microwave. Using the ideal liquids and as well,as well as the detailing cellular fluids is necessary to check practically no pass of a microorganisms through diet leftovers.

    talked about formerly, you’ll find it all [url=][/url] employee work to be sure of a clean and hygienic ambiance in food preparation if they want see achieving success during their business organisation, and hence good preparation ought given to all office managers to get conditions akin to practices and hygiene, in addition the cleaning hints and methods. just simply passing along staff members due to gourmet coatsand a terrific way to and different uniforms deficiency of is to make sure that a good run of the mill to personal hygiene, yet unfortunately other ingredient of it ought to be content very. precisely what helps make an excellent restaurants experiences can be.

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