“Refusing a vaccine when one is available is known as “vaccine hesitancy.” In recent years, vaccine hesitancy has increased worldwide — so much so that the World Health Organization considered it a top 10 global health threat in 2019. Misinformation is a major cause of vaccine hesitancy, and there is much misinformation about both COVID-19 and its vaccine because they are new.
Vaccine hesitancy or distrust is a problem because it can make it harder to contain a disease. To improve disease control in a community, the community must reach “herd immunity.” Herd immunity means that the majority of people cannot get sick or spread the disease to others. In this way, the whole community is protected.
The percent of people that need to be immunized to achieve herd immunity is different for different diseases. For COVID-19, experts estimate that between 70% and 90% of a community would need to be immunized against the virus to achieve herd immunity, although the exact number is not known. People can become immunized either by having a COVID-19 infection or through taking a vaccine.
Since COVID-19 can be a very serious illness, if 70% to 90% of Americans became sick, a large number of people would need to be hospitalized and many could die. This is why having a vaccine that works is so important. With a vaccine, many more people could become immunized without getting sick. If not enough people take the vaccine, though, achieving herd immunity becomes much more difficult.
Why are some people hesitant to get the COVID-19 vaccine?
There are many reasons why people may hesitate to take the COVID-19 vaccine.
Distrust of vaccines: Some people will not accept any vaccines at all. For example, some people choose not to get the yearly flu vaccine because they think it does not work or they worry that it will make them sick. Others worry about links between vaccines and autism disorder, and although these links have been disproven, they choose to skip recommended childhood vaccines.
Vaccine timeline: Others may accept common vaccines, but may hesitate to take the COVID-19 vaccine because it is new and was created quickly. In the past, development and approval of most vaccines took years. For the COVID-19 vaccine, creation and approval took less than a year. This seems rushed to some, and may contribute to concerns about vaccine safety. However, development of the vaccine was not as rushed as it seems. Scientists have used the technology behind the COVID-19 vaccine for 20 years. This is why they were able to create the vaccine as fast as they did.
Effectiveness: While some people worry about safety, others worry about effectiveness. After development of the vaccine, scientists studied it in human volunteers. These early studies have shown that the vaccine is safe and effective, but there is still much that is unknown, including how long the vaccine is effective, if it works against new strains of the virus, and whether or not someone who is vaccinated can still spread the disease to others.
Side effects: Fear of unknown side effects and frustration about unknown long-term effects are other reasons that some people may not accept the vaccine.
Lack of concern about the virus: Finally, there are also some communities where people do not consider COVID-19 to be a serious risk. In these communities, people may not accept a COVID vaccine because to them the risks of the vaccine seem greater than the risks of the disease.” (A)
“The views of one-third of Americans may not always amount to a national crisis, but those views matter a lot when the country needs to do something that requires nearly everybody on board. That’s the case with the Covid-19 vaccination campaign, where 70 or 80 percent — or more — of the country will need to get vaccinated to reach herd immunity. So surveys that show as many as one-third of Americans are skeptical amount to a real public health crisis.
Compounding that is the reality that a Covid-19 vaccine still hasn’t been approved for children — and that might not happen until later this summer or even 2022. Given that kids make up 22 percent of the population, herd immunity probably can’t happen without them. But even if herd immunity only requires the lower estimate of 70 percent of Americans, that still will be impossible if more than 30 percent of adults refuse a vaccine.
Based on public surveys, particularly in-depth ones from the Kaiser Family Foundation, the skeptical report a variety of concerns regarding the Covid-19 vaccine.
A major one is concerns about side effects, particularly long-term health consequences. The Covid-19 vaccines do have side effects, but they’re almost entirely minor — temporary aches, fever, and cold-like symptoms — aside from rare allergic reactions, which require monitoring but are treatable. Still, people worry about the risks.
Some of the skeptics worry that the vaccine approval process, given its record speed, was rushed. But the Covid-19 vaccines still went through the three-phase clinical trial process required by the Food and Drug Administration, testing for safety and efficacy. The vaccines have also been out in the real world for months now, with still no reports of previously unknown and serious effects.
Some people of color also distrust the health care system, based on their experiences with a system that’s often discriminatory and a history of experimentation on Black bodies, such as the Tuskegee study. Surveys show that Latinos and Black people, in particular, are less likely to trust doctors and hospitals in general. That’s likely fed into distrust toward the vaccine, too.” (B)
“IHME forecasts that no more than 40 percent of U.S. residents will be immune to COVID-19 by July ’21
First, if the population is hesitant to get vaccinated, it could halve coverage: in the United States, surveys of adult Facebook users indicate that approximately 25 percent will refuse the vaccine and a further 25 percent are uncertain. Assuming that half of the uncertain people can be persuaded to be vaccinated, 62.5 percent of the adult population will be covered. (The vaccine is only currently approved for adults, so this would cover less than 50 percent of the total population)…
The second factor is the protective impact of the vaccines. If half the U.S. population were vaccinated, what share would be immune? The Moderna and Pfizer vaccines are highly effective at preventing severe disease but there is very limited evidence as to whether they prevent infection or infectiousness. The Astra Zeneca vaccine is less effective, and in a subset of trial participants appeared to block infection in around half of those vaccinated. Early data from Israel suggest that the fraction protected from infection may be between 30 and 60 percent. In our modeling at the Institute for Health Metrics and Evaluation, we estimate that vaccines are half as effective at blocking infection as they are at preventing severe disease. To further complicate this picture, a vaccine may fail to prevent infection yet still reduce patients’ infectiousness, but no data are currently available to assess this.
In the United States, if we assume that by vaccinating half of the population by the fall we render a quarter of the population immune, and combine that with those immune through previous infection, we get to levels of overall immunity of 40 to 50 percent. Most high-income countries will have similar experiences. This level of immunity may be enough for summer herd immunity, but is unlikely to prevent a third wave in the winter of 2021 — even if due to the high clinical efficacy of the vaccines in preventing severe disease, we would expect there to be far fewer deaths.
A third variable is the spread of new viral variants, such as B.1.1.7 (first identified in the United Kingdom) and B.1.351 (first identified in South Africa), whose higher transmissibility raises the threshold needed to reach herd immunity. Available evidence suggests these variants will become dominant within two to five months. Moderna reports that their vaccine produces 20 percent of the neutralizing antibodies for B.1.351 that it did for the original virus; this may render the vaccine less clinically effective, and less effective in preventing infection. Rapid spread of B.1.1.7 in Portugal in recent weeks indicates that other countries presages its arrival in other countries in the Northern Hemisphere. These variants can extend the current winter surge later into the spring, and also make it more difficult to achieve herd immunity in order to prevent a third wave. Randomized clinical trials or effectiveness studies to test vaccines’ actual clinical effectiveness against the variants will be critical for determining the path to herd immunity.”
Finally, if immunity from infection or vaccination wanes over time, a real possibility, the level of cumulative infection and vaccination required to achieve herd immunity will also be higher, increasing the likelihood that COVID-19 becomes a seasonal disease like flu. So far, we do not have data to model for this.” (C)
“All eyes are on the nation’s chaotic COVID-19 immunization rollout, as public health officials struggle to outpace the coronavirus and its variants by quickly inoculating those most likely to be hospitalized or die if infected.
But in the months ahead, as the vaccine supply chain unkinks, the demand for shots is expected to ebb, leaving public health agencies with a different and perhaps greater challenge—coaxing people who aren’t sure they want a shot to roll up their sleeves.
The goal is to reach herd immunity, a widely debated concept that most scientists say can be achieved by vaccinating roughly 80% of the adult population, leaving the coronavirus with so few hosts that it all but disappears.
“We’ve never done that before with any other adult vaccine,” said Dr. William Schaffner, professor of preventive medicine at the Vanderbilt University School of Medicine. It’s a worthy goal, he said, but it will take a monumental effort.
In some places, local health departments already are making inroads in minority and immigrant neighborhoods where people may mistrust the medical community and refuse vaccinations, he said.
But even within the priority groups designated in the federal Centers for Disease Control and Prevention’s guidelines—health care workers, long-term care residents and staff, and people 65 and older—a substantial number of people are holding back.
According to January survey data from the Kaiser Family Foundation, a San Francisco-based nonprofit that researches national health issues, roughly 3 in 10 health care workers express hesitancy about getting a COVID-19 vaccine. That proportion is higher for staff in long-term care facilities, where 6 in 10 health care workers did not get a shot during the first month of vaccine distribution, according to the CDC.
Vaccine hesitancy is lowest among people 65 and older of all races, with only 10% of older White people and 14% of older Black people saying they plan to wait and see whether the shots cause serious side effects before rolling up their sleeves, according to Kaiser.
“The more people we vaccinate, the harder we’ll have to work to get the next group in,” Schaffner said. “Once we vaccinate the eager early acceptors, we’re going to have to go out and find people in the general population who haven’t lined up yet.”
When that happens, public health experts warn that states, cities and counties will face an array of challenges. Among them: reaching large immigrant and Black, Hispanic and Native American populations who mistrust the government, and combatting the disinformation that well-organized anti-vaccine groups are spreading across social media. Public health workers also will need to create pop-up and mobile clinics to vaccinate residents in rural areas and urban neighborhoods with limited access to hospitals, doctors and pharmacies.
“Figuring out how to get vaccines to people who can’t get to the clinics is only part of the problem,” Schaffner said. “The other part is the persuasion, the reassurance, the comfort that inherently reluctant populations need to come forward and get vaccinated. You have to work on both of those at the same time. That takes people and people take salaries.”…(D)
“Nearly a third of the people who took part in a recent Kaiser Family Foundation survey fell into the “wait and see” category, and that’s enough to imperil the chances of reaching the goal of vaccinating 70 percent of the population to stunt the pandemic and allow American life to get back to normal, they said.
“We’re in a race now, if you will,” Dr. Marti Sharkey, who is the health officer in the city of Fayetteville, Arkansas, told NBC News. “It’s vaccines versus variants. The virus is constantly mutating, so we need to reach herd immunity as quickly as possible, and the way to do that is to vaccinate as quickly as possible. The vaccines are going to be more effective the faster we get them into arms.”
Summer Johnson McGee, who is dean of the University of New Haven’s School of Health Sciences, agreed.
“Every time there is a new Covid-19 infection, we are giving the virus a chance to mutate and develop more transmissible or deadly variants,” she said. “The sooner we reach herd immunity and stop chains of transmission, the less impact these variants are likely to have because it will be so much harder for Covid-19 to find an unvaccinated individual.”
The problem, however, is that the fence-sitters have built up their own immunity against that kind of messaging, the experts said. And the potentially dire consequences of not breaking through to them wound up being a big part of the discussion this week at a meeting of the Fayetteville Board of Health.
“My fear is that we plateau at less than 50 percent vaccination rate in the community and that would make it a difficult summer — not what it could be — which is why messaging is so critically important,” said Dr. Hershey Garner, a local physician who treats cancer patients…
The fence-sitters were also “a politically diverse group” with 42 percent identifying as Democrats or Democratic-leaning independents, 36 percent identifying at Republican or Republican-leaning independents, and 14 percent who claim to be independents “who don’t lean either way,” according to the researchers.
“The vaccine hesitancy we are seeing isn’t just about Covid vaccines,” McGee said. “It is a general reflection of Americans’ lack of trust in science, the pharmaceutical industry, and large health care institutions. We need a full court press on science and vaccine education right now to prevent more aggressive Covid-19 variants from developing and taking hold.” (E)
“Once you’re looking at around 200 million vaccines available for first injections, I think we’re going to run out of demand,” said former FDA Commissioner Scott Gottlieb in a CNBC interview on Monday. “I think we’re going to run out of demand sooner than we think.”
The number of Americans willing to get vaccinated rises as more of their friends and family do so. A January poll by the Kaiser Family Foundation found that while 47 percent would be willing to get vaccinated as soon as possible, 31 percent said they wanted to wait and see how the vaccine is working.” (F)
“But we have still some very important work to go,” McClellan said. “We could in theory have enough vaccines for all adult Americans who want them by early this summer, at the pace we’re on now. But that’s going to require a big gap to close between having the vaccines for everybody who wants them and having enough people who want them.”
McClellan also noted that the presence of the variants highlights the need to ramp up vaccinations to make sure the variants are not widely spread in the country.
“The very important thing now is: We need to get people vaccinated before those variants spread,” McClellan said. “Instead of aiming for getting to 70% herd immunity levels between vaccinations and immunity from people who have recovered by late summer, the numbers are there to potentially do it sooner by June.”
For this reason, the faster people are vaccinated, the fewer opportunities there will be for variant versions to spread and for more variants to emerge, McClellan explained. This will allow for life to begin to return to a greater level of normality soon.
“I think in a matter of months, Americans should be able to go back to doing a lot of the things that they did before. Maybe not the summer 100,000 person concerts, but more group activities, restaurants reopened, schools reopened, more businesses reopened, and more travel,” McClellan said.
This process is going to occur in steps as we reach higher levels of vaccinations throughout the country while simultaneously continuing to conduct COVID-19 testing, McClellan explained.
“If you have those things in place, the virus will still be out there and still be something to watch for mutation, but we won’t have anything like the consequences we’re having now. People won’t be going to the hospital, they won’t be losing loved ones, they won’t have to worry if they can go out and enjoy a dinner in a restaurant. So, it is going to take all of these steps to get there,” McClellan said.
However, McClellan noted that it remains important to recognize that the pandemic is a global issue, so it’s important to increase vaccination rates beyond just the United States in order to protect Americans in the long-term.
“As long as there are high rates of outbreaks in other parts of the world, there is going to be continued spread,” McClellan said. “So that’s a big job that is going to take more into next year, but I think we’re making progress, and hopefully we can keep accelerating that and have a much more normal life, not the same as pre-pandemic, but much more normal life not that far off.”” (G)
“Trying to convince someone to be vaccinated? Here are seven more key pieces of advice from these U-M experts:
Provide emotional support. Say “I know there is uncertainty, but this disease is scary. I got the vaccine (or am planning to) and I want it for my family and want you to get it too.”
Acknowledge uncertain risk. People react very strongly to any kind of new risk, or perceived risk from something they have no experience with. But it’s not the case that we go through life never facing risk: we face it every time we drive our car, or allow our kid to ride their bike down the street. The threat of COVID-19 is real and increasing, and while it is reasonable to wonder about the vaccine or seek more information from reliable sources before deciding to get vaccinated, getting vaccinated will reduce risk to yourself, your loved ones and society as a whole.
Talk about known risks. Let people know what to expect when getting the vaccines, from common side effects like muscle soreness and fever to the rare risk of allergic reactions. Talk about what’s being done to monitor and respond to those reactions.
Provide information for information-seekers. Share articles from reputable sources to combat misinformation about the vaccines and their safety and efficacy.
Partner with communities. Approach patients who are skeptical with transparency and respect. For example, with Black communities, acknowledge the problems that exist and partner with those with long-standing relationships in the communities to provide information.
Share your experience. Saying “go get the vaccine” is one thing; showing that you are willing to do it openly is another, and even more powerful.
Tap into people’s desire to protect. Use those pre-existing motivations to protect friends and family, and frame getting vaccinated as something you and everyone can do concretely for the people you love.” (H)
“Epidemiologists said they viewed the current moment in the pandemic as a sprint between vaccinations and newly confirmed cases of the virus, particularly infections that are spreading because of variants that can be more contagious. Dr. Anthony S. Fauci, the nation’s top infectious-disease expert, warned Friday “that it’s really quite risky to declare victory before you have the level of infection in the community to a much, much lower level than 53,000 cases per day.” (I)
PART 1. January 21, 2020. CORONAVIRUS. “The Centers for Disease Control and Prevention on Tuesday confirmed the first U.S. case of a deadly new coronavirus that has killed six people in China.”
PART 2. January 29, 2020. CORONAVIRUS. “If it’s not contained shortly, I think we are looking at a pandemic..”….. “With isolated cases of the dangerous new coronavirus cropping up in a number of states, public health officials say it is only a matter of time before the virus appears in New York City.”
PART3. February 3, 2020. “The Wuhan coronavirus spreading from China is now likely to become a pandemic that circles the globe…”..Trump appeared to downplay concerns about the flu-like virus …We’re gonna see what happens, but we did shut it down..” (D)
PART 4. February 9, 2020. Coronavirus. “A study published Friday in JAMA found that 41% of the first 138 patients diagnosed at one hospital in Wuhan, China, were presumed to be infected in that hospital.….
PART 5. February 12, 2020. CORONAVIRUS. “In short, shoe-leather public health and basic medical care—not miracle drugs—are generally what stop outbreaks of emerging infections..”
POST 6. February 18, 2020. Coronovirus. “Amid assurances that the (ocean liner) Westerdam was disease free, hundreds of people disembarked in Cambodia…” “ One was later found to be infected”…. “Over 1,000… passengers were in…transit home”…. “This could be a turning point””
PART 7. February 20, 2020. CORONAVIRUS. With SARS preparedness underway in NJ LibertyHealth/ Jersey City Medical Center, where I was President, proposed that our 100 bed community hospital with all single-bedded rooms, be immediately transformed into an EMERGENCY SARS ISOLATION Hospital.
PART 8. February 24, 2020. CORONAVIRUS. “…every country’s top priority should be to protect its health care workers. This is partly to ensure that hospitals themselves do not become sites where the coronavirus is spread more than it is contained.”
PART 9. February 27, 2020. CORONAVIRUS. Responding to a question about the likelihood of a U.S. outbreak, President Trump said, “I don’t think it’s inevitable…”It probably will. It possibly will,” he continued. “It could be at a very small level, or it could be at a larger level.”
Part 10. March 1, 2020. CORONAVIRUS. Stop Surprise Medical Bills for Coronavirus care. (&) Lessons Learned (or not) In California and Washington State from community acquired cases.
PART 11. March 5, 2020. CORONAVIRUS. “Gov. Andrew Cuomo… would require employers to pay workers and protect their jobs if they are quarantined because of the coronavirus.”
Part 12. March 10, 2020. CORONAVIRUS. “Tom Bossert, Donald Trump’s former homeland security advisor…(said) that due to the coronavirus outbreak, “We are 10 days from the hospitals getting creamed.”
Part 13.. March 14, 2020. CORONAVIRUS. “If I’m buying real estate in New York, I’ll listen to the President….If I’m asking about infectious diseases, I’m going to listen to Tony Fauci,”
PART 14. March 17, 2020. CORONAVIRUS. “ “Most physicians have never seen this level of angst and anxiety in their careers”…. One said “I am sort of a pariah in my family.”
PART 15. March 22, 2020. CORONAVIRUS. “…Crimson Contagion” and imagining an influenza pandemic, was simulated by the Trump administration….in a series of exercises that ran from last January to August.
PART 16. March 27, 2020. CORONAVIRUS. I am not a clinician or a medical ethicist but articles on Coronavirus patient triage started me Googling………to learn about FUTILE TREATMENT
PART 17. April 2, 2020. CORONAVIRUS. Florida allows churches to continue holding services. Gun stores deemed “essential.” “New York’s private and public hospitals unite to manage patient load and share resources.
PART 18. April 9, 2020. CORONAVIRUS. “The federal government’s emergency stockpile of personal protective equipment (PPE) is depleted, and states will not be receiving any more shipments, administration staff told a House panel.
PART 19. April 13, 2020 CORONOAVIRUS. “…overlooked in the United States’ halting mobilization against the novel coronavirus: the personal aides, hospice attendants, nurses and occupational or physical therapists who deliver medical or support services to patients in their homes.”
POST 22. April 29, 2020. CORONAVIRUS. ..the “ACS released a list of 10 issues that should be addressed before a healthcare organization resumes elective surgeries[JM1] ….”
POST 23. May 3, 2020. CORONAVIRUS. … what Dr. Fauci really wants,…”is just to go to a baseball game. That will have to wait. The level of testing for the virus is not adequate enough to allow for such mass gatherings.’ (K)
POST 24. May 7, 2020. CORONAVIRUS. Former New Jersey governor Chris Christie said: “there are going to be deaths no matter what”… but that people needed to get back to work.
POST 25. May 10, 2020, CORONAVIRUS. “It is scary to go to work,” said Kevin Hassett, a top economic adviser to the president. “I think that I’d be a lot safer if I was sitting at home than I would be going to the West Wing.”
POST 26. May 14, 2020. CORONAVIRUS, “Deep cleaning is not a scientific concept”….”there is no universal protocol for a “deep clean” to eradicate the coronavirus”
POST 27. May 19, 2020. CORONAVIRUS. “Hospital…executives…are taking pay cuts…to help offset the financial fallout from COVID-19.” As “front line” layoffs and furloughs accelerate…
POST 28. May 23, 2020. CORONAVIRUS. ““You’ve got to be kidding me,”..”How could the CDC make that mistake? This is a mess.” CDC conflates viral and antibody tests numbers.
PART 29. May 22, 2020. CORONAVIRUS. “The economy did not close down. It closed down for people who, frankly, had the luxury of staying home,” (Governor Cuomo). But not so for frontline workers!
POST 30. June 3,202. CORONAVIRUS. “The wave of mass protests across the United States will almost certainly set off new chains of infection for the novel coronavirus, experts say….
Post 32. June 16, 2020. CORONAVIRUS. Could the Trump administration be pursuing herd immunity by “inaction”? “ If Fauci didn’t exist, we’d have to invent him.”
POST 34. June 26, 2020. CORONAVIRUS. CDC Director Redfield… “the number of coronavirus infections…could be 10 times higher than the confirmed case count — a total of more than 20 million.” As Florida, Texas and Arizona become eipicenters!
POST 35. June 29, 2020. CORONAVIRUS. Pence: “We slowed the spread. We flattened the curve. We saved lives..” While Dr. Fauci “warned that outbreaks in the South and West could engulf the country…”
POST 36. July 2, 2020. CORONAVIRUS. “There’s just a handful of interventions proven to curb the spread of the coronavirus. One of them is contact tracing, and “it’s not going well,” (Dr. Anthony Fauci)..
POST 37. June 8, 2020. CORONAVIRUS. When “crews arrive at a hospital with a patient suspected of having COVID-19, the hospital may have a physical bed open for them, but not enough nurses or doctors to staff it.”
POST 38. July 15, 2020. CORONAVIRUS. Some Lessons Learned, or not. AdventHealth CEO Terry Shaw: I wouldn’t hesitate to go to Disney as a healthcare CEO — based on the fact that they’re working extremely hard to keep people safe,” (M)
POST 39. July, 23,2020. CORONAVIRUS. A Tale of Two Cities. Seattle becomes New York (rolls back reopening) while New York becomes Seattle (moves to partial phase 4 reopening)
POST 40. July 27, 2020. CORONAVIRUS.” One canon of medical practice is that you order a test only if you can act on the result. And with a turnaround time of a week or two, you cannot. What we have now is often not testing — it’s testing theater.”
POST 41. August 2, 2020. CORONAVIRUS. “Whenever a vaccine for the coronavirus becomes available, one thing is virtually certain: There won’t be enough to go around. That means there will be rationing.”
POST 44. September 1, 2020. CORONAVIRUS. “The CDC…modified its coronavirus testing guidelines…to exclude people who do not have symptoms of Covid-19.” (While Dr. Fauci was undergoing surgery.) A White House official said: “Everybody is going to catch this thing eventually..”
POST 45. September 9, 2020. CORONAVIRUS. Trump on Fauci. ‘You inherit a lot of people, and you have some you love, some you don’t. I like him. I don’t agree with him that often but I like him.’
POST 46. September 17, 2020. CORONAVIRUS. “Bill Gates used to think of the US Food and Drug Administration as the world’s premier public-health authority. Not anymore. And he doesn’t trust the Centers for Disease Control and Protection either….”
POST 47. September 24, 2020. CORONAVIRUS. “Perry N. Halkitis, dean of the School of Public Health at Rutgers University…called New York City’s 35 percent rate for eliciting contacts “very bad.” “For each person, you should be in touch with 75 percent of their contacts within a day,” he said”
POST 48. October 1, 2020. “…you can actually control the outbreak if you do the nonpharmaceutical interventions (social distancing and masks). In the United States we haven’t done them. We haven’t adhered to them; we’ve played with them.” (A)
POST 49. October 4, 2020. CORONAVIRUS. RAPID RESPONSE. “The possibility that the president and his White House entourage were traveling superspreaders is a nightmare scenario for officials in Minnesota, Ohio, New Jersey and Pennsylvania…”
POST 50. October 6, 2020. CORONAVIRUS. Monday October 5th will go down as one of the most fraught chapters in the history of American public Health (and national security).
POST 51. October 12, 2020. Rather than a hodge-podge of Emergency Use Authorizations, off-label “experimentation”, right-to-try arguments, and “politicized” compassionate use approvals maybe we need to designate REGIONAL EMERGING VIRUSES REFERRAL CENTERS (REVRCs).
POST 52. October 18, 2020. ZIKA/ EBOLA/ CANDIDA AURIS/ SEVERE FLU/ Tracking. “… if there was a severe flu pandemic, more than 33 million people could be killed across the world in 250 days… Boy, do we not have our act together.” —”- Bill Gates. July 1, 2018
POST 54. October 22, 2020. CORONAVIRUS. POST 54A. New Jersey’s Coronavirus response, led by Governor Murphy and Commissioner of Health Persichilli started with accelerated A+ traditional, evidence-based Public Health practices, developed over years of experience with seasonal flu, swine flu, Zika, and Ebola.
POST 55. October 26, 2020. CORONAVIRUS. The Testing Conundrum: “ It’s thus very possible to be antigen negative but P.C.R. positive, while still harboring the virus in the body..”
POST 57. November 3, 2020. CORONAVIRUS. Dr. Deborah Birx: the US is entering its “most deadly phase” yet, one that requires “much more aggressive action,”
POST 58. November 4, 2020. CORONAVIRUS. “…the president has largely shuttered the White House Coronavirus Task Force and doubled down on anti-science language…”
POST 59. November 5, 2020. Coronavirus. “The United States on Wednesday recorded over 100,000 new coronavirus cases in a single day for the first time since the pandemic began..
POST 61. November 7, 2020. CORONAVIRUS. “Joe Biden’s top priority entering the White House is fighting both the immediate coronavirus crisis and its complex long-term aftermath…” “Here are the key ways he plans to get US coronavirus cases under control.”
POST 62. November 8, 2020. CORONAVIRUS. “The United States reported its 10 millionth coronavirus case on Sunday, with the latest million added in just 10 days,…”
POST 63. November 9, 2020. CORONAVIRUS. “New York City-based Mount Sinai Health System has opened a center to help patients recovering from COVID-19 and to study the long-term impact of the disease….”
POST 64. November 10, 2020. CORONAVIRUS. “It works! Scientists have greeted with cautious optimism a press release declaring positive interim results from a coronavirus vaccine phase III trial — the first to report on the final round of human testing.”
POST 65. November 11, 2020. CORONAVIRUS, “The Centers for Disease Control and Prevention took a stronger stance in favor of masks on Tuesday, emphasizing that they protect the people wearing them, rather than just those around them…
POST 66. November.12, 2020. CORONAVIRUS.”… as the country enters what may be the most intense stage of the pandemic yet, the Trump administration remains largely disengaged.”… “President-elect Biden has formed a special transition team dedicated to coordinating the coronavirus response across the government…”
POST 67. November 13, 2020. CORONAVIRUS. “When all other options are exhausted, the CDC website says, workers who are suspected or confirmed to have COVID-19 (and “who are well enough to work”) can care for patients who are not severely immunocompromised — first for those who are also confirmed to have COVID-19, then those with suspected cases.”
POST 68. November 14, 2020. CORONAVIRUS. The CDC “now is hewing more closely to scientific evidence, often contradicting the positions of the Trump administration.”..” “A passenger aboard the first cruise ship to set sail in the Caribbean since the start of the pandemic has tested positive for coronavirus..”
POST 69. November 15, 2020. CORONAVIRUS. “Colorado Gov. Jared Polis will issue a new executive order outlining steps hospitals will need to take to ready themselves for a surge in COVID-19 hospitalizations and directing the hospitals to finalize plans for converting beds into ICU beds, adding staffing and scaling back on or eliminating elective procedures….
POST 70. November 16, 2020. CORONAVIRUS. “White House coronavirus task force member Dr. Atlas criticized Michigan’s new Covid-19 restrictions..urging people to “rise up” against the new public health measures.
POST 71. November 17, 2020. CORONAVIRUS. ”Hospitals overrun as U.S. reports 1 million new coronavirus cases in a week.” “But in Florida, where the number of coronavirus infections remains the third-highest in the nation, bars and schools remain open and restaurants continue to operate at full capacity.”
POST 72. November 18, 2020. CORONAVIRUS. “The Health and Human Services Department will not work with President-elect Joe Biden’s (PANDEMIC) team until the General Services Administration makes a determination that he won the election,….”
POST 73. November 19, 2020. CORONAVIRUS. “…officials at the CDC…urged Americans to avoid travel for Thanksgiving and to celebrate only with members of their immediate households…” When will I trust a vaccine? to the last question I always answer: When I see Tony Fauci take one….”
POST 74. November 20, 2020. CORONAVIRUS. Pfizer…submitted to the FDA for emergency use authorization for their coronavirus vaccine candidate. —FDA issued an EUA for the drug baricitinib, in combination with remdesivir, as WHO says remdesivir doesn’t do much of anything.
POST 75. November 21, 2020. CORONAVIRUS. “The president and CEO of one of the nation’s largest non-profit health systems says he won’t be wearing a mask at work because he’s recovered from COVID-19, and doing so would only be a “symbolic gesture” because he considers himself immune from the virus….
POST 76. November 23, 2020. CORONAVIRUS. “No battle plan survives contact with the enemy.” Ventilators..”just keep people alive while the people caring for them can figure out what’s wrong and fix the problem. And at the moment, we just don’t have enough of those people.”
POST 77. November 26, 2020. CORONAVIRUS. Pope Francis: “When I got really sick at the age of 21, I had my first experience of limit, of pain and loneliness.”.. “….Aug. 13, 1957. I got taken to a hospital…”….” I remember especially two nurses from this time.”…” They fought for me to the end, until my eventual recovery.”
POST 78. November 27, 2020. CORONAVIRUS. “Kelby Krabbenhoft is no longer president and CEO of Sioux Falls, S.D.-based Sanford Health.” “…for not wearing a face covering… “ because “He considered himself immune from the virus.”
POST 79. November 28, 2020. CORONAVIRUS. Mayo Clinic. “”Our surge plan expands into the garage…”..””Not where I’d want to put my grandfather or my grandmother,” … though it “may have to happen.”
POST 81. December 1, 2020. CORONAVIRUS. “Dr. Atlas, … who espoused controversial theories and rankled government scientists while advising President Trump on the coronavirus pandemic, resigned…”
POST 82. December 3, 2020. CORONAVIRIUS. The NBA jumped to the front of the line for Coronavirus testing….while front line nurses often are still waiting. Who will similarly “hijack” the vaccine?
POST 83. December 4, 2020. CORONAVIRUS. “California Gov. Gavin Newsom says he will impose a new, regional stay-at-home order for areas where capacity at intensive care units falls below 15%.”… East Tennessee –“This is the first time the health care capability benchmark has been in the red..”
POST 84. December 6, 2020. CPRONAVIRUS. “ More than 100,000 Americans are in the hospital with COVID-19…” “We’re seeing C.D.C. …awaken from (its) politics-induced coma…”…Dr. Fauci “to be a chief medical adviser in Biden’s incoming administration..”.. “Trump administration leaves states to grapple with how to distribute scarce vaccines..”
POST 85. December 7, 2020. CORONAVIRUS. “…Florida, Gov. DeSantis’ administration engaged in a pattern of spin and concealment that misled the public on the gravest health threat the state has ever faced..”.. “NY Gov. Cuomo said…the state will implement a barrage of new emergency actions..”… Rhode Island and Massachusetts open field hospitals… “Biden Names Health Team to Fight Pandemic”
POST 86. December 9, 2020. If this analysis seems a bit incomprehensible it is because “free Coronavirus test” is often an oxymoron! with charges ranging from as little as $23 to as much as $2,315… Laws (like for free Coronavirus tests) are Like Sausages. Better Not to See Them Being Made. (Please allow about 20 seconds for the text to download. Thanx!)
POST 87. December 10, 2020. CORONAVIRUS. “…Rudolph W. Giuliani, the latest member of President Trump’s inner circle to contract Covid-19, has acknowledged that he received at least two of the same drugs the president received. He even conceded that his “celebrity” status had given him access to care that others did not have.”
POST 88. December 11, 2020. CORONAVIRUS. “As COVID-19 cases surge, the federal government is releasing data about hospital capacity at facilities around the country….”The new data paints the picture of how a specific hospital is experiencing the pandemic,”…
PART 89. December 12, 2020. CORONAVIRUS. THE VACCINE!!! “Now this is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning.” Winston Churchill
POST 90. December 14, 2020. CORONAVIRUS. “…the first doses of a Covid-19 vaccine have been given to the American public..”…” Each person who receives a vaccine needs two doses, and it’s up to states to allocate their share of vaccines.”
POST 91. December 15, 2020. CORONAVIRUS. “UPMC will first give (vaccination) priority to those in critical jobs. That includes a range of people working in critical units, from workers cleaning the emergency room and registering patients to doctors and nurses.. “Finally, if needed, UPMC will use a lottery to select who will be scheduled first.”
POST 92. December 17, 2020. CORONAVIRUS. “..each state — and each hospital system — has come up with its own (vaccination) plan and priorities. The result has been a sometimes confusing constellation of rules and groupings that has left health care workers wondering where they stand.” (Trump appointee July 4th email “…we need to establish herd, and it only comes about allowing the non-high risk groups expose themselves to the virus. PERIOD,”)
POST 93. December 19, 2020. CORONAVIRUS. On NPR Congresswoman Shalala (D-Florida) said she wouldn’t jump the vaccination line in Miami; then added she would get vaccinated in Washington this week. This, even though Congress has failed to pass “essential” Coronavirus legislation. So who are our “essential” workers?
POST 94. December 21, 2020. CORONAVIRUS. “A doctor at an L.A. County public hospital said the number of COVID-19 patients is “increasing exponentially, without an end in sight.”.. “I haven’t done ICU medicine since I was a resident — you don’t want me adjusting your ventilator,” he said. “That’s the challenge, actually — it isn’t so much space, it’s staff…”
POST 96. December 26, 2020. CORONAVIRUS. “Achieving herd immunity against the coronavirus could require as much as 90 percent of the population to be vaccinated, Anthony Fauci…”…”..he hesitated to state a number as high as 90% weeks ago because many Americans still seemed skeptical about vaccine….”
POST 97. December 27, 2020. “A new variant of the coronavirus that has been spreading through the UK and other countries has not yet been detected in the United States..”.. . But if new-wave medicines like antivirals and antibody therapy contributed to the development of viral variants, it will be “a reminder for all the medical community that we need to use these treatment options carefully.”
POST 99. December 29, 2020. CORONAVIRUS. “ICUs are being overwhelmed across many parts of California. Statewide aggregate ICU availability has been at 0% since Christmas Eve…. a surge on top of a surge on top of a surge.”… “hospitals are getting close to the point where they would begin putting COVID-positive patients under the care of COVID-positive staff who are asymptomatic.”
POST 100. December 29, 2020. CORONAVIRUS. Front line hospital workers – in the ER, ICUs, EMS, acute medical care, behavioral health – are amongst the most courageous, heroic and dedicated colleagues you will ever meet.
POST 101. December 30, 2020.CORONAVIRUS. Is there a point where the increasing Coronavirus trajectory so far exceeds the slow growth of the vaccination rate that reaching herd immunity through vaccinations becomes less likely?
POST 102. January 2, 2020. CORONAVIRUS. “We’ve taken the people with the least amount of resources and capacity and asked them to do the hardest part of the vaccination — which is actually getting the vaccines administered into people’s arms,” said Dr. Ashish Jha, the dean of Brown University’s School of Public Health. “Ultimately, the buck seems to stop with no one,”…
POST 103. January 4, 2021. CORONAVIRUS. Dr. Fauci said “that the United States would not follow Britain’s lead in front-loading first vaccine injections, potentially delaying the administration of second doses…Dr. Moore – ”British officials “seem to have abandoned science completely now and are just trying to guess their way out of a mess.”
POST 104. January 6, 2021. CORONAVIRUS. “Paramedics in Southern California are being told to conserve oxygen and not to bring patients to the hospital who have little chance of survival…”
POST 105. January 8, 2021. CORONAVIRUS. POST 105. January 8, 2021. CORONAVIRUS. “Facing a shortage of vaccinators, the Association of Immunization Managers… recommends relaxing regulation or adjusting licensing requirements. At least two states, Massachusetts and New York, have changed their laws in recent weeks to expand those who are eligible to give shots.”
POST 106. January 9, 2021. CORONAVIRUS. The riots at the Capitol could have been a superspreader event. “From what I saw… you had a large congregation of individuals who were in close contact for an extended period of time and almost universally unmasked…. many coming and going on buses as well, also unmasked, and hanging out in hotel lobbies.”
POST 107. January 8, 2021. CORONAVIRUS. “Our job is to make sure the vaccine isn’t politicized the way masks were politicized,” Rep. Alexandria Ocasio-Cortez, D-N.Y., said after getting her vaccine. South Carolina Rep.-elect Nancy Mace, a Republican, wrote that “Congress shouldn’t be putting themselves first in line for the COVID-19 vaccination when the average American can’t get it.”
POST 108. January 9, 2021. CORONAVIRUS. (vaccination)”Line-cutters will be named and shamed. It’s inevitable, as will be the congressional hearings and front-page investigative stories ferreting out who saved their own skin at the expense of others.”
POST 109.January 9, 2021. CORONAVIRUS. “President-elect Joe Biden will aim to release nearly every available dose of the coronavirus vaccine when he takes office, a break with the Trump administration’s strategy of holding back half of US vaccine production to ensure second doses are available.
POST 110. January 13, 2021. CORONAVIRUS. ““The (federal) government is changing the way it allocates Covid vaccine doses, now basing it on how quickly states can administer shots and the size of their elderly population.”… “New York State sent a letter to hospitals saying if they don’t use their vaccine allocations by the end of this week, they won’t receive any further allocations.”
POST 111. January 14, 2021. CORONAVIRUS. “Visitors from Toronto to New York to Buenos Aires have long flocked to Florida for sun, surf and shopping. Now they are coming for the Covid-19 vaccine….
POST 112. January 14, 2021. CORONAVIRUS. CHINA – “Eleven million people are under lockdown in Hebei province after a new cluster of coronavirus infections.
PART 113. January 17, 2021. CORONAVIRUS. The Next President Actually Has a Covid Plan… New York City and other places in the state expect to exhaust their supply of doses as early as next week… Charles Barkley said during the “NBA on TNT” broadcast that pro athletes should get the first round of the vaccine…..
POST 114. January 18, 2021. CORONAVIRUS. “When government programs that have been unattended, underfunded and bogged down by red tape suddenly have to meet a huge demand in a crisis, they can’t cope and people suffer….”
POST 115. January 21, 2020. CORONAVIRUS. A year ago today an unnumbered POST was headlined “The Centers for Disease Control and Prevention on Tuesday confirmed the first U.S. case of a deadly new coronavirus that has killed six people in China.” The CORONAVIRUS CONTENT TRACKING PROJECT started with HISTORIOGRAPHY and over time moved to LESSONS LEARNED, RAPID RESPONSE, and THE VACCINATION PROGRAM. Now 115 POSTS later – the BIDEN CORONAVIRUS PLAN.
POST 116. January 22, 2021. President Biden – “We’re entering what may be the toughest and deadliest period of the virus. We must set aside politics and finally face this pandemic as one nation.”
POST 117. January 23, 2021. CORONAVIRUS. 1.Dr. Fauci:“The idea that you can get up here….”and.. let the science speak”… “It is somewhat of a liberating feeling.” 2.updated CDC guidance:”.. providers could give the second dose up to six weeks after the first dose..” 3.Dr. Fauci: people would be “taking a chance” if they follow the CDC’s updated guidance.
POST 118. January 24, 2021. CORONAVIRUS. “Unfortunately, we’ve let this virus spread extensively and are launching the vaccination campaign at the height of the threat,” Dr. Meyers said. “The more the virus spreads before the vaccine reaches people, the fewer deaths we can prevent with the vaccine.”
POST 119. January 27, 2010. CORONAVIRUS. Amazon is offering its help to President Joe Biden with the rollout of COVID-19 vaccines. Washington’s governor, Jay Inslee, included the help of companies like Starbucks, Costco and Microsoft in a plan to vaccinate 45,000 residents a day.
POST 120. January 28, 2021. CORONAVIRUS. “The fact that four vaccines backed by the federal government seem to be less effective against the (South African) B.1.351 variant has unsettled federal officials and vaccine experts alike. Facing this uncertainty, many researchers said it was imperative to get as many people vaccinated as possible — quickly. Lowering the rate of infection could thwart the contagious variants while they are still rare, and prevent other viruses from gaining new mutations that could cause more trouble.”
POST 121. January 30, 2021. CORONVIRUS. Will our communities become stratified by which vaccine is distributed? 95%ters v. 72%ters? Will the easier distribution of the J&J vaccine drive its inequitable distribution to” hard-hit, marginalized, and medically underserved communities.” (thanx! to XJ/LA)
POST 123. February 4, 2021. CORONAVIRUS. “Nursing homes across the country are facing the same struggle, as workers have been more reluctant than residents to be vaccinated…
POST 124. February 5, 2021. CORONAVIRUS. Dr. Osterholm ” …it may be time to..go with a ‘first-dose only’ approach, so more people over the age of 65 can have at least some protection right away. He said that would require delaying second doses until this summer.” Dr.Fauci “warned against this practice, and cautioned people about “the danger” that could come with focusing only on the first dose.”
POST 125. June 9, 2021. CORONAVIRUS. “States are rolling back Covid-19 restrictions as new cases trend down from record highs across the country. But experts warn it might be too much too soon as variants pose an increased risk and the pandemic… is far from over.”
POST 126. February 11, 2021. CORONAVIRUS. “There will be more coronavirus outbreaks in the future. Bats and other mammals are rife with strains and species of this abundant family of viruses. Some of these pathogens will inevitably spill over the species barrier and cause new pandemics. It’s only a matter of time.” (A)
POST 127. February 12, 2021. CORONAVIRUS. “… Trump only agreed to be hospitalized when aides told him that he could walk to Marine One or he could wait until his case progressed and he would be carried out.”
POST 128. February 14, 2021. CORONAVIRUS. “The Centers for Disease Control and Prevention released new research on Wednesday that found wearing a cloth mask over a surgical mask offers more protection against the coronavirus, as does tying knots on the ear loops of surgical masks…
POST 129. February 15, 2021, CORONAVIRUS. “ “The CDC released its much-anticipated, updated guidance to help school leaders decide how to safely bring students back into classrooms, or keep them there.”…” For politicians, parents and school leaders looking for a clear green light to reopen schools, this is not it.”
POST 130. February 16, 2021. CORONAVIRUS. “A second person who had contracted the Ebola virus died this week in the Democratic Republic of Congo, marking another outbreak just three months after the nation outlasted the virus’s second-worst outbreak in history…”
POST 131. February 17, 2021. CORONAVIRUS. “It really is right now – a race between how quickly new variants, particularly the U.K. variant, can spread in the United States and how quickly we can get people vaccinated”
POST 132. February 20, 2021. CORONAVIRUS. “In Texas, where over 2.5 million people are still without power, the state health department said this week’s vaccine shipments wouldn’t arrive until Wednesday at the earliest.”
POST 133. February 23, 2021. CORONAVIRUS. “Going off your meds is a surefire way to aggravate your doctor. What if a whole country did it?” The United Kingdom has veered into uncharted territory by changing tack and introducing a revised COVID-19 vaccination protocol, one that involves distributing the second dose at 12 weeks, rather than the prescribed 21 days.”
POST 134. February 24, 2021. CORONAVIRUS. The first tranche of the J&J (single dose) vaccine must go to K-12 teachers, so schools can open safely in the first 100 days of the Biden Administration. The federal government…”can set up its own vaccination centers in regions with eligible populations it’s trying to target.” We owe our front-line teachers nothing less!
POST 135. February 27, 2021. CORONAVIRUS. “As Chief Executive Officers of New York’s major health care systems, we would like to provide facts to clear up confusion in the public and the media regarding decisions to discharge patients to nursing homes during New York’s spring coronavirus surge.”
POST 136. March 2, 2021. CORONAVIRUS. ““The governors of Texas and Mississippi both announced on Tuesday they would be lifting their states’ mask mandates and rolling back many of their Covid-19 health mandates..”…while “The US could experience a “fourth surge” of coronavirus before the majority of the country is vaccinated.”
POST 137. March 4, 2021. CORONAVIRUS. “The clamor for hard-to-get Covid-19 vaccines has created armies of anxious Americans who have resorted to hunting for leftovers on the fringes of the country’s patchwork vaccination system. They haunt pharmacies at the end of the day in search of an extra, expiring dose. They drive from clinic to clinic hoping that someone was a no-show to their appointment. They cold-call pharmacies like eager telemarketers: Any extras today? Maybe tomorrow? Some pharmacists have even given them a nickname: vaccine lurkers.” (H)
POST 138. March 6, 2021. CORONAVIRUS. “New cases are decreasing in the third wave because we are past the holidays, not because of vaccinations. It is a common misconception that the decrease we are seeing in new cases, hospitalizations, and deaths in the U.S. is due to vaccinations. The two aren’t related; at least yet.”
POST 139. March 8, 2021. CORONAVIRUS. CDC Issues First Set of Guidelines on How Fully Vaccinated People Can Visit Safely with Others…” In practice, that means fully vaccinated grandparents may visit unvaccinated healthy adult children and healthy grandchildren of the same household without masks or physical distancing.” (C)
POST 140. March 9, 2021. CORONAVIRUS. “In West Virginia, they are bracing for the second wave….. Not coronavirus but opioid overdoses, with one scourge driving a resurgence of the other.
POST 141. March 11, 2021. CORONAVIRUS. Today is the first anniversary of the WHO declaration that the novel coronavirus was a Public Health Emergency of International Concern… “To truly prepare itself against the next pandemic, the U.S. has to reimagine what preparedness looks like.”
POST 142. March 15, 2021. CORONAVIRUS. “Candida auris is a superbug, a pathogen that can evade drugs made to kill it—and early signs suggest the COVID-19 pandemic may be propelling infections of the highly dangerous yeast. That’s because C. auris is particularly prominent in hospital settings, which have been flooded with people this year due to the coronavirus.”
POST 143. March 17, 2021. CORONAVIRUS. “The Trump administration sought to suppress Covid-19 testing in the United States last year by softening guidance from the Centers for Disease Control and Prevention on who needed to be tested, a House panel said Monday.”
POST 144. March 20, 2021. CORONAVIRUS. ““The vaccine hesitancy we are seeing isn’t just about Covid vaccines,”… “It is a general reflection of Americans’ lack of trust in science, the pharmaceutical industry, and large health care institutions. We need a full court press on science and vaccine education right now to prevent more aggressive Covid-19 variants from developing and taking hold.”
In August, the CDC revised its Covid-19 testing guidance to say that people who don’t have symptoms “do not necessarily need a test” even if they were exposed to an infected person. The move was widely criticized by public health specialists and politicians, who said testing asymptomatic people is an important part of identifying and cutting off chains of spread.
Assistant Secretary for Health Adm. Brett Giroir, who led the Trump administration’s testing effort, at the time firmly denied allegations the White House was pressuring health officials to change the guidance.
But the House Select Subcommittee on the Coronavirus Crisis on Monday released newly obtained emails from a political appointee within the Department of Health and Human Services that indicate he pushed for the new guidance.
In the emails, former HHS scientific advisor Paul Alexander defended the change in testing policy and downplayed the importance of testing people without symptoms, saying it “is not the point of testing.” Alexander was brought into HHS by Michael Caputo, a longtime Trump ally who led the department’s communications last year before departing abruptly after he accused CDC scientists of sedition.
“Testing asymptomatic people to seek asymptomatic cases is not the point of testing, for in the end, all this accomplishes is we end up quarantining asymptomatic, low risk people and preventing the workforce from working,” Alexander wrote one day after the change in CDC testing guidance was reported in an email to other HHS officials.
“In this light, it would be unreasonable based on the prevailing data to have widespread testing of schools and colleges/universities. This will not allow them to optimally re-open,” he added, defending the policy change.
In September, the CDC quietly reversed the guidance, saying that anyone, even those without symptoms, who has been in close contact with an infected person needs a Covid-19 test.” (A)
In August, the CDC revised its Covid-19 testing guidance to say that people who don’t have symptoms “do not necessarily need a test” even if they were exposed to an infected person. The move was widely criticized by public health specialists and politicians, who said testing asymptomatic people is an important part of identifying and cutting off chains of spread.
Assistant Secretary for Health Adm. Brett Giroir, who led the Trump administration’s testing effort, at the time firmly denied allegations the White House was pressuring health officials to change the guidance.
But the House Select Subcommittee on the Coronavirus Crisis on Monday released newly obtained emails from a political appointee within the Department of Health and Human Services that indicate he pushed for the new guidance.
In the emails, former HHS scientific advisor Paul Alexander defended the change in testing policy and downplayed the importance of testing people without symptoms, saying it “is not the point of testing.” Alexander was brought into HHS by Michael Caputo, a longtime Trump ally who led the department’s communications last year before departing abruptly after he accused CDC scientists of sedition.
“Testing asymptomatic people to seek asymptomatic cases is not the point of testing, for in the end, all this accomplishes is we end up quarantining asymptomatic, low risk people and preventing the workforce from working,” Alexander wrote one day after the change in CDC testing guidance was reported in an email to other HHS officials.
“In this light, it would be unreasonable based on the prevailing data to have widespread testing of schools and colleges/universities. This will not allow them to optimally re-open,” he added, defending the policy change.
In September, the CDC quietly reversed the guidance, saying that anyone, even those without symptoms, who has been in close contact with an infected person needs a Covid-19 test.” (A)
“Those altered reports are said to have produced a false sense of security pushed by the CDC that allowed businesses and some schools to open, made people feel secure in public places, and downplayed the importance of wearing a mask.
According to one of the documents released, the Trump administration changed the guidance for the “explicit purpose of reducing testing and allowing the virus to spread while quickly reopening the economy.”
On Sept. 11, 2020, for example, top Trump HHS adviser Paul Alexander emailed senior COVID Task Force adviser Scott Atlas about a forthcoming CDC report on deaths in young people, which Alexander claimed that, despite being true, was “very duplicitous to damage the administration.” He tried to engage Atlas to help “craft an op-ed .. disputing the reporting for on face value, it is meant to mislead,” according to the documents.
In the email, which is part of the cache of documents released Monday, Alexander warned, “The timing of this is meant to interfere with school re-opening and we need to get something out fast to preempt this in the next day or so and I can work with you on it.”
Alexander became the focus of public outrage in December when internal emails emerged showing he was pushing top Trump health officials to adopt a “herd immunity” strategy for the U.S. “There is no other way, we need to establish herd, and it only comes about allowing the non-high risk groups expose themselves to the virus. PERIOD,” his letter to Trump HHS public-affairs adviser Michael Caputo read. “Infants, kids, teens, young people, young adults, middle aged with no conditions etc. have zero to little risk…. so we use them to develop herd… we want them infected….”…
The documents show how Alexander pressured Food and Drug Administration officials to go so far as to quickly approve emergency use of convalescent plasma as treatment, even advising them to disregard concerns from National Institutes of Health (NIH) Director Francis Collins and Allergy and Infectious Diseases chief Anthony Fauci, instead accusing the NIH of “stepping out of their lane.”” (B)
“The United States has by far the highest number of confirmed infections and deaths from Covid-19 in the entire world. Recent harmful trends in the federal government — including distortions of science, attacks on government scientists and other experts, unqualified leadership and widespread vacancies in key posts, conflicts of interest, and other abuses of power — have prevented the federal government from responding effectively to the pandemic.
Communities of color have too often borne the brunt of these failures. Native, Black, and Latino Americans are suffering from Covid-19 at vastly disproportionate rates compared to white people in this country, a disparity resulting from decades of racist economic, healthcare, and housing policies. The Trump administration’s failure to effectively manage the crisis has made an already perilous situation worse. The racial injustice exposed by the pandemic underscores the urgent need for executive branch leaders to work for — and be accountable to — the American public.
Collected below are examples of norm violations and other abuses that have hampered the federal government’s response to this historic public health crisis.
Congress and the next president must take bold action to repair what has been broken. The Brennan Center has advocated for a number of reforms that, while not solving all of the problems exposed by the Covid-19 crisis and the many other crises and scandals of the Trump era, would go a long way to curtail abuses of power. For instance, the Brennan Center’s bipartisan National Task Force on Rule of Law and Democracy has published two reports that lay out a legislative agenda to prevent many abuses of executive power that have become commonplace during the Covid-19 crisis. The Task Force’s proposals include legislation to protect government science from political interference, strengthen federal ethics laws, and curb the practice of placing acting officials in key government positions.The Brennan Center has also put forward a series of actions the president can take to curb executive branch abuses.” (C)
PREQUELS
POST 53. October 20, 2020. CORONAVIRUS. “a…“herd-immunity strategy” is a contradiction in terms, in that herd immunity is the absence of a strategy.”
POST 58. November 4, 2020. CORONAVIRUS. “…the president has largely shuttered the White House Coronavirus Task Force and doubled down on anti-science language…”
POST 70. November 16, 2020. CORONAVIRUS. “White House coronavirus task force member Dr. Atlas criticized Michigan’s new Covid-19 restrictions..urging people to “rise up” against the new public health measures.
POST 81. December 1, 2020. CORONAVIRUS. “Dr. Atlas, … who espoused controversial theories and rankled government scientists while advising President Trump on the coronavirus pandemic, resigned…”
“Seeing the world as a one-pathogen world is really problematic,” said Dr. Susan S. Huang, an infectious disease specialist at the University of California at Irvine Medical School, noting that the nearly singular focus on the pandemic appears to have led to more spread of drug-resistant infection. “We have every reason to believe the problem has gotten worse.”…
“Patient care staffing, supplies, care sites and standard practices have all changed during this extraordinary time,” the letter stated…
Dr. Huang and other experts said they are not suggesting that the priority on fighting Covid-19 was misplaced. Rather, they say that renewed attention must be paid to drug-resistant germs. Earlier research has shown that as many as 65 percent of residents of nursing homes carry some form of drug-resistant infection…
But after the pandemic began, there was much less monitoring and even, at times, a wholesale breakdown of communications about the transfer of such patients, experts said. Plus, the sickest Covid-19 patients were put on ventilators, where drug-resistant infections can cling and then spread.
Another possible contributor has been the heavy and regular use of steroids to treat Covid-19. These drugs help alleviate the virus’s most dangerous symptoms but can leave the immune system compromised in a way that allows other germs to more easily infiltrate the body.
The combination of these factors “is perfect” for the fungus to “take hold,” said Dr. Tom Chiller, the head of the fungal division of the C.D.C….
The upshot is that the confirmed cases are “likely the tip of the iceberg,” Dr. Chiller said.” (G)
PREQUEL
POST 52. October 18, 2020. ZIKA/ EBOLA/ CANDIDA AURIS/ SEVERE FLU/ Tracking. “… if there was a severe flu pandemic, more than 33 million people could be killed across the world in 250 days… Boy, do we not have our act together.” —”- Bill Gates. July 1, 2018
POST 52. October 18, 2020. ZIKA/ EBOLA/ CANDIDA AURIS/ SEVERE FLU/ Tracking. “… if there was a severe flu pandemic, more than 33 million people could be killed across the world in 250 days… Boy, do we not have our act together.” —”- Bill Gates. July 1, 2018
Over Christmas break in 2015, Johanna Rhodes received a panicked email from a doctor working at the Royal Brompton Hospital, the largest heart and lung center in the United Kingdom. A horrid yeast was invading the skin of patients, spreading through the intensive care unit even though the hospital maintained extensive protocols for infection control.
“The doctor asked me to take a look … I thought, how bad can it be?” recalls Rhodes, an infectious disease expert at Imperial College London who studies antifungal resistance. Rhodes stepped in to help one of the world’s top cardiology hospitals identify the pathogen and clear it from the premises. The germ was Candida auris, little known at the time. What she saw stunned her: “You think COVID-19 is bad until you see Candida auris.”
Candida auris is a superbug, a pathogen that can evade drugs made to kill it—and early signs suggest the COVID-19 pandemic may be propelling infections of the highly dangerous yeast. That’s because C. auris is particularly prominent in hospital settings, which have been flooded with people this year due to the coronavirus.
The superbug sticks stubbornly to surfaces such as sheets, bed railings, doors, and medical devices—making it easier to colonize skin and pass from one person to another. Moreover patients who have tubes that go into their body, such as catheters or ones for breathing or feeding, are at the highest risk for C. auris infections, and these invasive procedures have become more common because of the respiratory failure associated with COVID-19…
The worry is that if C. auris becomes more common in hospitals or the general public, it could bolster the growing crisis of superbugs, which already infect millions worldwide. Last year, the CDC classified C. auris as one of the biggest drug resistance threats in America. Now, though it’s too early to confirm a direct knock-on effect, the U.S. has recorded 1,272 confirmed cases of C. auris in 2020, a 400 percent increase over the total recorded during all of 2018, the most recent year with available data.
The real number is likely to be much higher, though, as the COVID-19 pandemic has halted much of the disease surveillance for C. auris at hospitals and because the germ can often colonize a person’s skin without generating symptoms.
Such superbugs may also be contributing to the tens of thousands of excess deaths occurring during the COVID-19 era. Hence why doctors around the world are sounding the alarm.” (A)
“Health systems have had to adapt their operations to meet the urgent needs of the COVID-19 pandemic, but experts warn that pathogens like Candida auris are taking advantage of gaps in monitoring and containment efforts, and COVID-19 patients are at risk for fatal coinfection.
“Most health care facilities have been extremely stressed for resources and personnel during the pandemic, which may create ideal conditions for nosocomial outbreaks with pathogens such as C. auris,” said Melissa Johnson, PharmD, an associate professor of medicine, Division of Infectious Diseases and International Health, at Duke University Medical Center, in Durham, N.C.
At the CDC’s last count on Nov. 30, 2020, there were 1,595 confirmed clinical cases of C. auris reported in the United States—an increase of more than 400% over 2018, which is the most recent year with available data. Rising C. auris infection rates make coinfection with SARS-CoV-2 increasingly likely, recent data indicated.
According to a report this year in Morbidity and Mortality Weekly Report (2021;70[2];56-57), a Florida hospital reported three C. auris infections in four patients with SARS-CoV-2, who were hospitalized in the same COVID-19 unit in July 2020. The acute care hospital’s COVID-19 unit took up five wings on four floors, each with ICU rooms…
“The crowding in our ICUs and the need in some places to provide intensive care in hospital units not designed for this purpose, sometimes staffed by health care workers not completely prepared to provide this level of care, augurs a repeat of this Indian experience in the U.S.,” Stephen Baum, MD, a professor of medicine and of microbiology and immunology at Albert Einstein College of Medicine, in New York City, cautioned in an online commentary on the Indian study.
Indeed, the California Department of Public Health issued a health advisory based on sharp increases in C. auris cases in health care facilities in that state after the numbers nearly doubled.
“Personal protective equipment conservation strategies and other containment strategies (e.g., cohorting) on the basis of COVID-19 status alone might be contributing to this resurgence of C. auris,” the agency stated on its website.
Hospitals need to “continue with routine screening and infection control practices despite having the increased workload of dealing with COVID-19,” said Susan Poutanen, MD, MPH, a medical microbiologist and an infectious disease physician at the University Health Network and Sinai Health, and an associate professor, Departments of Laboratory Medicine and Pathobiology and Medicine at the University of Toronto.
The reports of “nosocomial C. auris transmission in patients with COVID-19 admitted to the ICU is an excellent reminder of the need for such efforts,” Poutanen said.
Despite their best intentions, some hospitals experienced interruptions in their C. auris screening programs during the pandemic, she noted.” (B)
“The yeast infection may have been caused due to the reuse of the personal protective equipment (PPE), as per a report by the Centers for Disease Control and Prevention (CDC)…
The recent outbreak began in July when a hospital, which the report did not name, notified the Florida Department of Health of an initial four cases of the fungus among patients being treated for the coronavirus.
The next month, the hospital carried out additional screening in its Covid-19 unit, which spanned four floors across five wings, and identified 35 more patients as being Candida Auris-positive.
Follow-up data was available for only 20 out of the 35 patients. Eight of these 20 people died, but it was not clear whether the fungus was the main factor or not.
The Florida Department of Health and CDC performed a joint investigation focused on infection prevention and control measures, finding numerous weaknesses.
“Mobile computers and medical equipment were not always disinfected between uses, medical supplies (e.g., oxygen tubing and gauze) were stored in open bins,” the CDC report said.
It added that hospital staff, possibly out of fear of the coronavirus, were wearing multiple layers of personal protective equipment (PPE), which is not recommended and in fact heightens the risk of microbe transmission.
There were also instances of extended PPE use and re-use.
After the hospital removed supplies from hallways, enhanced cleaning and disinfection practices, and improved practices around PPE use, no further Candida Auris was detected on subsequent surveys.
“Outbreaks such as that described in this report highlight the importance of adhering to recommended infection control and PPE practices and continuing surveillance for novel pathogens like Candida Auris,” the report concluded.
Candida Auris has now been documented in more than 30 countries, with some 1,500 US cases reported to the CDC as of October 31, 2020.
The CDC says the fungus can spread in healthcare settings “through contact with contaminated environmental surfaces or equipment, or from person to person.” (C)
“The recent outbreak of the fungal infection was reported in July 2020. the Florida Department of Health reported the initial four cases of the fungus, among patients being treated for COVID-19, the disease caused by the novel coronavirus.
The following month, they carried out additional screening and identified 35 more patients were already infected with the fungus.
Eight of 20 people, whose follow-up data were available, died. However, it was not certain if the fungus was the main factor or not.
The Florida Department of Health and CDC performed a joint investigation focused on infection prevention and control measures, finding numerous weaknesses.
“Mobile computers and medical equipment were not always disinfected between uses, medical supplies (e.g., oxygen tubing and gauze) were stored in open bins,” the CDC report said.
It added that hospital staff, possibly out of fear of the coronavirus, were wearing multiple layers of personal protective equipment (PPE), which is not recommended and in fact heightens the risk of microbe transmission.
There were also instances of extended PPE use and re-use, Wion News reported.
After the hospital removed supplies from hallways, enhanced cleaning and disinfection practices, and improved practices around PPE use, no further Candida Auris was detected on subsequent surveys.
“Outbreaks such as that described in this report highlight the importance of adhering to recommended infection control and PPE practices and continuing surveillance for novel pathogens like Candida Auris,” the report concluded.
Candida Auris has now been documented in more than 30 countries, with some 1,500 US cases reported to the CDC as of October 31, 2020.
The CDC says the fungus can spread in healthcare settings “through contact with contaminated environmental surfaces or equipment, or from person to person.” (D)
“The California Department of Public Health (CDPH) has released a Health Advisory alerting providers of the increasing number of Candida auris (C. auris) cases reported in Southern California in recent months.
CDPH notes that personal protective equipment conservation strategies and cohorting COVID-19 patients might be contributing to this resurgence of C. auris. As a result, CDPH recommends health care facilities:
Assess C. auris and other multidrug-resistant organism (MDRO) status for all patients and residents upon admission, by reviewing medical records and screening high-risk individuals.
When cohorting patients by COVID-19 status, consider C. auris and other MDRO status during room placement.
Do not reuse or extend use of gloves or gowns between patients with different or unknown C. auris or other MDRO, and COVID-19 status.
CDPH also advises health care facilities to report any cases of C. auris or unusual or highly-resistant organisms to their local health department and CDPH at [email protected].
CDPH also advises health care facilities to report any cases of C. auris or unusual or highly-resistant organisms to their local health department and CDPH at [email protected].” (E)
“Whenever a facility has a suspected or confirmed case of C. auris, rapid action is the name of the game. Nursing and infection prevention teams need to be notified swiftly, so that they in turn can immediately implement appropriate infection prevention protocols, stressed Teri Caughlin, RN, MHA, regional director of infection prevention for Southern California Kaiser Permanente in Pasadena. These protocols typically include contact precautions, personal protective equipment (PPE), and Environmental Protection Agency-approved surface cleaning products effective against C. auris. The latter matters because even products with fungicidal claims might not kill C. auris.
Establishing point prevalence and conducting contact tracing and admission screening also are essential elements for controlling the spread of C. auris, added Sudha Chaturvedi, PhD, director of the Mycology Laboratory at the New York State Department of Health’s Wadsworth Center in Albany. All of these strategies depend on the availability of swift and accurate testing, she stressed.
Although some hospitals in high prevalence areas might routinely test all patients for C. auris colonization, others might not do so until they have a positive case. This type of epidemiologic search is critical, said Procop: “The clinical isolate may be the tip of the proverbial iceberg.”
Some evidence suggests that the COVID-19 pandemic could exacerbate C. auris transmission in healthcare facilities. PPE shortages, or changes in infection control practices spurred by concerns about future shortages, could allow the fungus to spread. “This has been observed in long-term care facilities, as well as acute care hospitals, which typically had less C. auris transmission prior to the COVID-19 pandemic,” said Meghan Lyman, MD, epidemiologist at CDC.
Facilities also can’t take for granted that the same procedures that curb the spread of SARS-CoV-2 will work for C. auris. For example, “disinfectants recommended for use against COVID-19 in the United States are either ineffective against C. auris or have not yet been tested for effectiveness,” warned Berkow.
However, improved hand hygiene due to the COVID-19 pandemic has benefited patients by reducing the transmission of non-COVID pathogens, said Caughlin. And the COVID-19 pandemic might not have compromised the ability to detect C. auris in facilities like Van Horn’s with dedicated mycology labs, he suggested.
“We will have a clearer picture of what, if any, impact the COVID-19 pandemic has had on C. auris control later in the year,” added Chaturvedi.” (F)
“Seeing the world as a one-pathogen world is really problematic,” said Dr. Susan S. Huang, an infectious disease specialist at the University of California at Irvine Medical School, noting that the nearly singular focus on the pandemic appears to have led to more spread of drug-resistant infection. “We have every reason to believe the problem has gotten worse.”…
In an acknowledgment of the issue, three major medical societies sent a letter on Dec. 28 to the Centers for Medicare and Medicaid Services asking for a temporary suspension of rules that tie reimbursement rates to hospital-acquired infections. The three groups — the Society of Healthcare Epidemiology of America, the Society of Infectious Diseases Pharmacists, and the Association for Infection Control and Epidemiology — feared that the infection rates may have risen because of Covid-19.
“Patient care staffing, supplies, care sites and standard practices have all changed during this extraordinary time,” the letter stated.
Not all types of drug-resistant infections have risen. For instance, some research shows no particular change during the pandemic in the rate of hospital patients acquiring the bacterium Clostridioides difficile — a finding that suggests the overall long-term impact of the pandemic on these infections is not yet clear.
Dr. Huang and other experts said they are not suggesting that the priority on fighting Covid-19 was misplaced. Rather, they say that renewed attention must be paid to drug-resistant germs. Earlier research has shown that as many as 65 percent of residents of nursing homes carry some form of drug-resistant infection.
Over the years, critics have charged that hospitals and, in particular, nursing homes, have been lax in their efforts to confront these infections because it is expensive to disinfect equipment, train staff, isolate infected patients and screen for the germs.
In response to these and other concerns, a greater effort was beginning to be made before the pandemic to monitor patients for these infections, particularly as they cycled in and out of nursing homes and intensive care units. This revolving door is known to spread germs that are carried by infected patients.
But after the pandemic began, there was much less monitoring and even, at times, a wholesale breakdown of communications about the transfer of such patients, experts said. Plus, the sickest Covid-19 patients were put on ventilators, where drug-resistant infections can cling and then spread.
Another possible contributor has been the heavy and regular use of steroids to treat Covid-19. These drugs help alleviate the virus’s most dangerous symptoms but can leave the immune system compromised in a way that allows other germs to more easily infiltrate the body.
The combination of these factors “is perfect” for the fungus to “take hold,” said Dr. Tom Chiller, the head of the fungal division of the C.D.C….
The upshot is that the confirmed cases are “likely the tip of the iceberg,” Dr. Chiller said.” (G)
F.Institutions explore the best options for identifying and mitigating C. Auris, by Kristin Harper,https://www.aacc.org/cln/articles/2020/october/stopping-superbug
