Category: Corona Virus

Carlos del Rio does not mess around when it comes to the health of his 87-year-old mother. Even when he doesnt feel sick, a day before he plans to visit her, the professor of infectious disease at Emory University in Atlanta takes a home COVID-19 test. The next day, he tests again the moment he enters her house. I want to minimize the risk that Im infected as much as possible before I see her, del Rio says.

It doesnt take an infectious disease specialist to know that an 87-year-old is a high-risk person, but dual-testing the way del Rio does is not in any formal protocol for how to interact with a person of such advanced yearsits just a practice he developed on his own. In that way, the expert is a lot like the rest of usfollowing a testing rule book that hasnt really been written.

Earlier in the pandemic, home tests either didnt exist or, when they were authorized, were hard to get your hands on as demand soared and supply lagged. Now, there are plenty to be had: the federal government will ship several rapid tests to your home for free, and insurers are required to reimburse covered individuals for 8 tests per month, so people can stock up on them to use as needed. But exactly when are they needed? Should you test yourself before you travel? After? When youre visiting a home with young, unvaccinated children? Beforeor afteryou attend a dinner party? At this point, there is no general agreement on when to use them.

What, then, do the professionals dothe scientists who specialize in infectious diseases? To find out, TIME quizzed a few experts to determine how often they break out the tests in their own householdsand when they might ask other people to test before visiting or interacting with them.

If there is any situation in which a self-test is a must-do, its when you or a member of your household are experiencing symptoms consistent with COVID-19. But while taking the test is an important first step, the results might not tell you the whole story, warns Thomas Briese, associate professor of epidemiology at Columbia Universitys Mailman School of Public Health. Symptoms can appear before a persons viral load is high enough for a home test to detect it.

There is discussion about how sensitive those home tests are in comparison to a laboratory test, Briese says. After a negative test, I tend to re-test maybe a day or two later. As an alternative to a second home test, he says, a PCR test is also an option, and that is Brieses own preference, since PCR tests are more sensitive than home tests and likelier to produce a more accurate result. The downside, of course, is that a PCR test requires a visit to a clinic or testing center and results take longerusually 24 hours or more.

Whats more, those results arent perfect, warns Michael Mina, former assistant professor of epidemiology at Harvard T. H. Chan School of Public Health and now chief science officer at eMed, a home testing and treatment company. PCR tests, which look for genetic material from the coronavirus, can also produce a false negative if you have a low viral load at the time. If in doubt, isolating for at least five daysas the U.S. Centers for Disease Control and Prevention (CDC) recommendscan help prevent the spread of COVID-19. Mina would even extend that five-day period to eight days, just to play it safe.

Theres a wide variability in how quickly people clear the virus, he says. Some people will clear it by four or five days; some people will take 15 days.

Read More: A New Test Can Help Reveal If Youre Immune to COVID-19

With mask mandates now lifted for air and other means of travel, COVID-19 is potentially easier to transmit on planes, buses, and trains than it was when we all kept our faces covered. Testing before you travel is one way to look out for others and make sure youre not the viral vector in a confined space.

That may help protect your fellow travelers, of course, but it doesnt mean that everyone is so careful, and you could wind up being not the person who spreads the disease, but the person who contracts it. For that reason, del Rio brings tests with him when hes on the road. When Im traveling Ill test myself two or three days after I arrive at my destination, he says. Then Ill do the same after I arrive home.

Mina, who is the father of a baby girl who is currently unvaccinated, is rigorous about testing the family before travelingespecially if they are visiting other people in their homes. If were going to be in someones house, we just dont want to be the ones who are responsible for bringing COVID in, he says.

Pre-pandemic, no one thought much about the health implications of a dinner party, but now thats changed. Del Rio makes it a practice of testing himself before gathering with a large group of people, especially if the get-together is indoors. In the summer months, there are more opportunities to be outside, but SARS-CoV-2 can spread in the open airthough significantly less efficiently than it does indoors.

If youre the host of a social event, things can be a little more delicate, raising the question of whether or not to ask your guests to test as a sort of admission ticket to your home. Here, del Rio plays it safe. Lets suppose we were going to have 10 or 12 people in our house: we would probably do testing, he says. Id make testing available right before they came in.

Mina agrees. We allow people to come in and we dont make a big thing about it, he says. We just say keep your mask on and test right before you come in and then just let it sit for 10 minutes. We all feel a lot more comfortable knowing that everyone is negative.

Visiting the vulnerablethe immunocompromised, the elderly, or unvaccinated babies and small childrenis another area in which the experts are in agreement about testing protocols. Minas parents are in their 70s and, like del Rio with his 87-year-old mother, he tests before visiting them. Briese tests before visiting anyone with any medical condition, even if he doesnt know if the person is immunocompromised. And while vaccines are now available for babies as young as 6 months, uptake is likely to be slow, and testing before visiting any baby is a considerate precaution.

Read More: Dogs Can Sniff Out COVID-19 and Signs of Long COVID, Studies Suggest

When COVID-19 cases are on the rise, it pays to be particularly vigilant. During the last surge, Mina and his family tested on average once a week, even if no one was showing symptoms.

Briese sees children as a special area of concern here, since they spend their days in school around so many other kids and in general have extensive social contacts. Even if there is no known case of COVID-19 in a childs social circle, the risk of transmission existsespecially during a surge. It might make some sense to test children on a more regular basis, he says.

That said, if you have a limited number of tests, you shouldnt necessarily test immediately after a known or suspected exposure to someone who is infected. If youve just been exposed, dont even bother testing for two days, says Mina. Wait at least that long, but often you have to wait three daysif not fourpost-exposure [to get an accurate result] because the virus has to have a chance to become detectable.

Ultimately, the experts agree, testing is a personal decision, and people have to find their own comfort level and risk tolerance. For everyone though, the goals should remain the same: avoiding both contracting the virus and passing it on to others. Masking and staying up-to-date on vaccinations are key elements in that anti-COVID-19 tool box. Rapid testing should be one, too.

More Must-Read Stories From TIME

Write to Jeffrey Kluger at jeffrey.kluger@time.com.

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How to Use At-Home COVID-19 Tests, According to Experts - TIME

(CNN) Covid patients arent directly overwhelming hospitals right now, but ripple effects of the pandemic are keeping beds full and patients away from the care they need.

Mostnursing homes are limitingnew patients because of staffing shortages,driving the average hospital stay up to be longer than it was pre-pandemic.

In Washington, about 10% of patients currently in hospital beds no longer need hospital care, said Cassie Sauer, chief executive officer of the Washington State Hospital Association. Most are waiting for a spot at a nursing home or mental health facility.

Its a national phenomenon, said Sauer, who has experienced the effects first-hand. A family members hospital discharge was delayed after two nursing homes she was interestedin closed for Covid outbreaks.

Stephanie Schulz, a board-certified independent patient advocate, said that one hospital she works with recently had 45 patients who all needed to be discharged within the same time frame and they were struggling to find appropriate care for all of them.

Another patient and their family were considering options that were three hours away from home.

So many people dont want to think Covid is still one of the reasons, but it is, Schulz said.

More than 60% of nursing homes are limiting new admissions because of staffing shortages, according to a survey conducted by the American Health Care Association in May. Most say its gotten worse since January.

The pandemic has made a really difficult job even tougher, said Mark Parkinson, president and CEO of the American Health Care Association, as employees are faced with intense work to prevent the spread of Covid.

Data from the Bureau of Labor Statistics shows that hundreds of thousands of employees have left the nursing home industry since the start of the pandemic.

And now, hospitals just arent able to discharge people like they typically could, he said. Theyre calling around to the nursing homes, and the nursing homes are saying we just cant take the patient because we dont have enough employees to take any patients at this time.

In fact, patients heading from a hospital to a skilled nursing facility required an average of four referrals in 2019 but that jumped to an average of seven referrals in the first five months of 2022, according to data shared with CNN by WellSky, a health care technology company with products utilized by hospitals across the country.

Those patients would stay in the hospital for an average of nine days in 2019, but are now in the hospital for an average of 10.5 days, according to the WellSky data.

Generally speaking, we as a country have worked our tails off to discharge particularly elective surgeries or pregnancies much, much quicker, and the level of outpatient surgery has gone through the roof. And yet, here we are in 2022 seeing length of stay balloon up in ways that weve never seen, when in fact most of everything weve done is to work that number down, said Bill Miller, chief executive office of WellSky.

Youre seeing these ballooned rates and Covid is, I think, the primary culprit. Its still working its way through the system.

Overall in the US, just 4% of beds are in-use by Covid-19 patients as hospitalizations hover at one of the lowest points of the pandemic, according to data from the US Department of Health and Human Services.

But one in five people in the US still lives in a county that the US Centers for Disease Control and Prevention considers to have a high Covid-19 community level, where the health care system is at risk of being overwhelmed again.

We really need to have available capacity if there is another surge. Patients waiting in hospitals take up a lot of unnecessary space and staff time, Sauer said.

She estimates that hospital stays for Covid patients are about five days, on average. If someone waiting for a spot in a nursing home is in the hospital for more than 10 days, theyre occupying space that two Covid patients could have used and many stays are much longer than that.

While Covid admissions are low, the persistent strain on the broader health care system is leaving many hospital patients with tough decisions.

As the denials for discharge pile up, families are feeling like they really have no choice, Schulz says. They feel trapped in the hospital and like they have to take the first facility that accepts them.

Those hard decisions do have to sometimes be made to forego certain types of treatment just to get them out of the hospital, Schulz said even among patients with a terminal diagnosis.

Discharge delays have a compounding effect, too.

There can be such a gap between the start of discharge planning for a patient and when they find a spot that their care needs change and the process has to start all over again.

Having reassessments done on level of care includes all disciplines of the health care team. So youre bringing back in PT, OT, speech therapy, all the providers that are working with those patients, she said.

And potential exposure to Covid in the hospital requires patients to be held for at least a week, too.

Its quite a big domino effect. she said.

Sauer says the time to make adjustments is now.

I dont like that were waiting til things get really bad to respond like the notion that with hospitalizations, we reach a crisis point, then well ask people to take corrective action, she said.

Theres delayed care, thats a phenomenon across the country. And the people who cant get discharged from hospitals, thats a phenomenon across the country. And the lack of mental health care is also phenomenon across country. And short staffing. So we know hospitals are stressed, she said. I just dont want to wait til we get to the crisis to do something about it.

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COVID-19 is still keeping hospitals backed up, even as new admissions stay low - WISH TV Indianapolis, IN

In the last two years, COVID-19 has followed a predictable, if painful, pattern: When coronavirus transmission has rebounded, California has been flooded with new cases and hospitals have strained under a deluge of seriously ill patients, a distressing number of whom die.

But in a world awash in vaccines and treatments, and with healthcare providers armed with knowledge gleaned over the course of the pandemic, the latest wave isnt sticking to that script.

Despite wide circulation of the coronavirus the latest peak is the third-highest of the pandemic the impact on hospitals has been relatively minor. Even with the uptick in transmission, COVID-19 deaths have remained fairly low and stable.

And this has occurred even with officials largely eschewing new restrictions and mandates.

In some ways, thats what is supposed to happen: As health experts get better at identifying the coronavirus, vaccinating against it and treating the symptoms, new surges in cases shouldnt lead to excessive jumps in serious illnesses.

But todays environment is not necessarily tomorrows baseline. The coronavirus can mutate rapidly, potentially upending the public health landscape and meriting a different response.

The one thing that is predictable about COVID, in my mind, is that its unpredictable, said UCLA epidemiologist Dr. Robert Kim-Farley.

While its too soon to say for certain, there are signs the current wave is starting to recede. Over the weeklong period ending Thursday, California reported an average of just over 13,400 new cases per day down from the latest spikes high point of nearly 16,700 daily cases, according to data compiled by The Times.

By comparison, last summers Delta surge topped out at almost 14,400 new cases per day, on average.

And more than 8,300 coronavirus-positive patients were hospitalized statewide on some days at the height of Delta almost three times as many as during the most recent wave.

The difference in each surges impact on intensive care units has been even starker. During Delta, there were days with more than 2,000 coronavirus-positive patients in ICUs statewide. In the latest wave, however, that daily census has so far topped out at around 300.

That gap in hospitalizations illustrates how the pandemic has changed.

At the very beginning of the pandemic, we noted right away the game-changers were going to be vaccines, easy access to testing and therapeutics and now we have all those things, said Los Angeles County Public Health Director Barbara Ferrer.

It doesnt say the pandemics over. Thats not what weve accomplished, she stressed. What weve accomplished is weve reduced the risk, but we havent eliminated the risk.

And though hospitalizations have been lower, in the aggregate, during the latest wave, Ferrer noted that each infection still carries its own dangers not just severe illness, but the chance of long COVID, as well. Taking individual action to protect yourself, she said, carries the added benefit of helping safeguard those around you, including those at higher risk of serious symptoms or who work jobs that regularly bring them into contact with lots of people.

For me, it makes clear that layering in some protection is still the way to go while enjoying just about everything you want to enjoy, she said.

Californias most restrictive efforts to rein in the coronavirus ended almost exactly a year ago, when the state celebrated its economic reopening by scrapping virtually all restrictions that had long provided the backbone of its pandemic response.

Roughly a month later, with the then-novel Delta variant on the rampage, some parts of the state reinstituted mask mandates in hopes of blunting transmission.

Toward the end of the year, another new foe would arise: the Omicron variant. This highly transmissible strain brought unprecedented viral spread, sending case counts and hospitalizations soaring and prompting officials to reissue a statewide mask mandate for indoor public spaces.

The fury with which those two surges struck left some fearing, and others advocating for, the return of the stringent orders that restricted peoples movements and shut down broad swaths of the economy. However, both waves came and went without California officials resorting to that option.

And during this latest wave fueled by an alphanumeric soup of Omicron subvariants, including BA.2 and BA.2.12.1 such aggressive action seems off the table.

I think, deep in my heart, unless we see a new variant that evades our current vaccine protection, we are not going to need to go back to the more drastic tools we had to use early on the pandemic when we didnt have vaccines, when we didnt have access to testing, when we didnt have therapeutics, Ferrer said in an interview.

During both Delta and the initial Omicron surge, California carefully evaluated the unique characteristics of each variant to determine how to best handle the changes in the behavior of the virus, and used the lessons of the last two years to approach mitigation and adaptation measures through effective and timely strategies, according to the state Department of Public Health.

These lessons and experiences informed our approach to manage each surge and variant. In addition, there were more tools available for disease control during each subsequent surge, including the Delta and Omicron surges, the department wrote in response to an inquiry from The Times. So, rather than using the same mitigation strategies that had been used previously, CDPH focused on vaccines, masks, tests, quarantine, improving ventilation and new therapeutics.

The state has also eschewed its previous practice of setting specific thresholds to tighten or loosen restrictions in favor of what it calls the SMARTER plan which focuses on preparedness and applying lessons learned to better armor California against future surges or new variants.

Each surge and each variant brings with it unique characteristics relative to our neighborhoods and communities specific conditions, the Department of Public Health said in its statement to The Times.

Chief among those, the department added, are getting vaccinated and boosted when eligible and properly wearing high-quality face masks when warranted.

The U.S. Centers for Disease Control and Prevention recommends public indoor masking in counties that have a high COVID-19 community level, the worst on the agencys three-tier scale. That category indicates not only significant community transmission but also that hospital systems may grow strained by coronavirus-positive patients.

We certainly are not at a level at these numbers where you would say, OK, its now, quote, endemic, and we just go about business as usual, Kim-Farley said. I think, though, it is probably indicative of what we might see in the future going forward, that we will see low levels in the community, people can relax and let their guard down a bit. But there will then be other times when we might see surges coming in. ... Thats a time when we mask up again. So I think there may be some on and off a little bit, and hopefully these surges become fewer, more spread out and less intense as we go forward.

As of Thursday, 19 California counties were in the high community level Alameda, Butte, Contra Costa, Del Norte, El Dorado, Fresno, Kings, Lake, Madera, Marin, Monterey, Napa, Placer, Sacramento, San Benito, Santa Clara, Solano, Sonoma and Yolo. However, only Alameda County has reinstituted a public indoor mask mandate.

Ferrer has said Los Angeles County would do the same should it fall in the high COVID-19 community level for two consecutive weeks.

L.A. County, like the state as a whole, continues to strongly recommend residents wear masks indoors in public. But Ferrer acknowledged its a very tough needle to thread and said an unintended consequence of years of health orders might be that people dont grasp the urgency of a recommendation.

People are now assuming if we dont issue orders and require safety measures then its because its not essential, and thats not what we meant, she said. We have always benefited from having folks that are able to listen, ask questions and then, for the most part, align with the safety measures. And I think because its been such a long duration, because theres so much fatigue at this point and desperation in some senses to get back to customary practices, people are waiting for that order before they go ahead and take that sensible precaution.

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This new California coronavirus wave isn't sticking to the script: Big spread, less illness - Los Angeles Times

With recent UK data suggesting that the BA.4 and BA.5 Covid variants are kicking off a new wave of infections, experts answer the key questions about reinfection and prevention.

Though rare at the start of the pandemic, reinfections have become increasingly common as the months and years wear on particularly since the arrival of Omicron, which prompted a 15-fold increase in the rate of reinfections, data from the Office for National Statistics suggests.

In part, this is because of a decline in protective antibodies triggered by infection and/or vaccination over time, but the virus has also evolved to evade some of these immune defences, making reinfection more likely.

The original Omicron BA.1 variant was itself massively immune-evasive, causing a huge breakthrough caseload, even in the vaccinated, said Danny Altmann, a professor of immunology at Imperial College London. It is also poorly immunogenic, which means that catching it offers little extra protection against catching it again. On top of that, theres now further evidence of the very marginal ability of prior Omicron to prime any immune memory for BA.4 or 5, the sub-variants that seem to be driving the latest wave of infections.

The virus has also evolved to become more transmissible, meaning even fleeting exposure to an infected person means you may inhale enough viral particles to become infected yourself.

There are definitely a lot of people who got Covid at the start of the year who are getting it again, including some with BA.4/5 who had BA.1/2 just four months ago, who thought they would be protected, said Prof Tim Spector, who leads the Zoe Health Study (formerly known as the Zoe Covid Study).

We still dont have enough data to work out exactly when the susceptible periods [for reinfection] are, which is one reason why we need people to keep logging their symptoms. We do know its still quite rare within three months, and it used to also be rare within six months, but thats not the case any more.

According to unpublished data from Denmark, which looked at reinfections with the BA.2 Omicron sub-variant within 60 days of catching BA.1, such reinfections were most common among young, unvaccinated people with mild disease. Other studies have similarly suggested that Covid-19 vaccination provides a substantial added layer of protection against reinfection by boosting peoples immune responses.

However, Omicron infection in itself appears to be a poor booster of immunity, meaning that if you were infected during earlier pandemic waves, your immune response is unlikely to have been strengthened by catching it again earlier this year.

In general, infections should be less severe the second, third or fourth time around, because people should have some residual immunity particularly if theyve also been vaccinated, which would further raise their levels of immune protection. However, there are always exceptions to this. Anecdotally, some people are getting it for longer this time around than they did the last time, Spector said.

It is also too early to know about the risk of long Covid associated with BA.4/5, he added.

As the UK heads into a period dominated by BA.4 and 5, the potential for reinfection seems high. Were in quite a serious situation due to a convergence of factors: a country where a moderately successful third booster campaign is now long past, with immunity waned and successive large waves of Omicron through to the emerging dominance of BA.4/5, said Altmann.

The bottom line is that we should all consider ourselves essentially unprotected, except perhaps from intensive care unit admission and death, and then, as before, with the risks increasing with age.

Face masks and ventilation continue to provide important additional layers of protection especially in crowded settings. I still wear a mask, but not a cheap mask I wear a proper FFP2 or 3 mask, said Spector. These new variants are still very much airborne and you need an even smaller amount to get infected, so I think a mask is definitely a good idea when as many as one in 30 people have it again.

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Covid reinfections in the UK: how likely are you to catch coronavirus again? - The Guardian

Good evening. Im Karen Kaplan, and its Tuesday, June 21. Heres the latest on whats happening with the coronavirus in California and beyond.

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California has been averaging 13,768 new coronavirus cases per day over the last week. If health officials had reported a number like that back in the early months of the pandemic, wed have been seriously freaking out.

What makes me so sure? Its at least four times higher than any statewide case count reported during the pandemics first spring, according to data from the Centers for Disease Control and Prevention. In fact, California didnt see cases reach that level until late November 2020, when the devastating fall-and-winter surge was taking off. (We were definitely freaking out at that point.)

Now that were two-plus years into the outbreak, that case count barely registers with the public as a cause for concern.

Pretty much every public health leader from CDC Director Dr. Rochelle Walensky on down has lobbied hard for people to get their COVID-19 boosters, but only 47% of eligible Americans have done so. State and local health officials strongly recommend that people wear masks in indoor public settings, but most dont.

To some degree, this nonchalance is a sign of COVID-19 burnout. Were tired of letting the coronavirus dictate what we can and cannot do. We just want our lives to go back to normal.

At the same time, theres a reason that masks are strongly recommended but not required (at least, not yet): Although the Omicron variant is circulating widely and the current wave includes the third-highest peak of the pandemic, the number of people hospitalized with COVID-19 is still quite manageable, and deaths arent rising out of control.

Friends from Palisades Charter High School ride the MTA Expo Line in Los Angeles.

(Genaro Molina / Los Angeles Times)

Thats not to say the deaths are negligible California reported 74 deaths on Monday and was averaging 30 deaths each day over the prior week. (Plenty of those deaths were preventable; the risk of death for unvaccinated people is more than 10 times higher than for those who are vaccinated and boosted, state health officials report.)

But compared with earlier periods of the pandemic, we have a lot more tools at our disposal to stave off COVID-19s worst effects. And these tools are a lot more targeted than the stay-at-home orders, capacity restrictions and mandates weve had in the past.

The most important tools are vaccines: 72% of Californians are fully vaccinated, and 58% of those eligible have received at least one booster shot.

Adding to that is the natural immunity people have gained by surviving an infection. In December, the CDC estimated that nearly 95% of Americans had coronavirus antibodies due to vaccination, past infection or a combination of both.

There are also plentiful coronavirus test kits, antiviral pills such as Paxlovid and Lagevrio (also known as molnupiravir) and the IV medicine Veklury (remdesivir). (Monoclonal antibodies used to be on this list, but they arent very effective against Omicron and its subvariants.)

And lets not discount all the experience doctors, nurses, respiratory therapists and other healthcare professionals have acquired by caring for millions of COVID-19 patients.

This helps explain why the current wave, fueled by the Omicron subvariant known as BA.2.12.1, has seen far fewer hospitalizations than last years Delta surge despite causing more infections.

The current wave peaked with about 16,700 new daily cases in California, compared with almost 14,400 during the Delta days. But Delta sent 8,342 coronavirus-positive patients to the states hospitals on its worst day, while BA.2.12.1 hasnt surpassed 2,808.

ICU admissions diverged even more. With Delta, there were as many as 2,008 infected patients in intensive care units throughout the state at the same time. That number hasnt risen above 300 in the current wave.

At the very beginning of the pandemic, we noted right away the game-changers were going to be vaccines, easy access to testing and therapeutics and now we have all those things, Los Angeles County Public Health Director Barbara Ferrer told my colleague Luke Money.

That progress is something to appreciate, but it doesnt guarantee were out of the woods. If another variant comes along thats able to circumvent our vaccines and treatments, we could go back to seeing hospitalizations and deaths rising higher for a given increase in infections.

We certainly are not at a level at these numbers where you would say, OK, its now, quote, endemic, and we just go about business as usual, UCLA epidemiologist Dr. Robert Kim-Farley told Money.

I think, though, it is probably indicative of what we might see in the future, he added. Hopefully these surges become fewer, more spread out and less intense as we go forward.

California cases and deaths as of 4:40 p.m. on Tuesday:

Track Californias coronavirus spread and vaccination efforts including the latest numbers and how they break down with our graphics.

If youre having trouble swallowing the glass-half-full outlook outlined above, youre not alone. What looks like hard-won progress to some seems like complacency or even capitulation to others.

Dr. Elisabeth Rosenthal is most definitely in the latter camp. In an Op-Ed, the editor in chief of Kaiser Health News lays out the litany of ways in which America has simply surrendered the fight against the coronavirus.

The countrys vaccination rate has stalled out at around 67% (though itll probably rise a bit now that the shots have been made available to the nations 18.7 million children under 5). Boosters are even less popular than the initial doses.

President Biden requested $22.5 billion to continue funding the countrys COVID-19 response, including money to pay doctors who care for uninsured patients and cash to buy vaccines, tests and treatments. The Senate responded with a $10-billion package that doesnt include any funds to help squelch outbreaks overseas. Now even that compromise bill is being held up by the politics of immigration.

Dr. Ashish Jha, the White House COVID coordinator, has warned that we would see a lot of unnecessary loss of life if the money doesnt materialize. So far, that hasnt been enough of an incentive to break the impasse.

The lack of urgency is shared by state and local governments, in Rosenthals view. Theyve rescinded mask mandates even for high-risk settings, including places like bars and music venues where people crowd together indoors. Health officials arent acting with urgency to get more people boosted even though its become increasingly clear that a booster dose is essential to ward off Omicron.

When the government wont take preventive measures seriously, its hard to blame private employers for following suit. Few stores still require workers and customers to mask up; even if mask rules are still posted, theyre rarely enforced. (The latest example: Broadway theaters in New York City announced Tuesday that mask use during performances would become optional next week.)

In March, the Biden administration unveiled a plan to help Americans coexist with the coronavirus as safely as possible. The plans stated goal is to get back to our more normal routines. Who wouldnt get behind that?

Unfortunately, in response, our elected representatives and much of the country essentially sighed, preferring to move on and give up the fight, Rosenthal writes.

The problem isnt just that people are sick of caring about public health. The problem is that its inherently difficult to make people care about it.

Thats because if public health officials are respected, well-funded and allowed to do their job heres the result: Literally nothing happens, Rosenthal writes. Outbreaks dont lead to pandemics.

Maria Fernanda works on contact tracing in a half-empty office at the Florida Department of Health in Miami-Dade County in 2020.

(Lynne Sladky / Associated Press)

Health officials cant go around crowing about the bad stuff that didnt happen. But when people dont take their warnings seriously, theyre the ones who are blamed.

Theyre also the ones who get short shrift from politicians and the public. In the year before the pandemic, the CDCs budget was cut by 9%, according to the Trust for Americas Health. Money for programs like suicide prevention and HIV care was only slightly higher in 2020 than it was in 2008, after accounting for inflation.

At the state level, spending on public health didnt see significant growth between 2008 and 2018, except for programs aimed at preventing injuries, according to a 2021 study in the journal Health Affairs. State health departments weathered big cuts to cope with the Great Recession, and that funding hadnt been restored by the time COVID-19 came along, leaving them ill equipped to respond, the study authors wrote.

The cuts have resulted in the elimination of at least 38,000 state and local public health jobs, Rosenthal notes. Thats partly why states and cities have yet to spend much of the $2.25 billion allocated in March 2021 by the Biden administration to help reduce COVID disparities, she writes. There are now too few on-the-ground public health officials who know how to spend it.

Public health was front and center for awhile in the pre-vaccine era, when people were more afraid of the coronavirus and of having to use an iPad to say goodbye to a loved one hooked up to a ventilator in an ICU. Now our attention has shifted to mass shootings, inflation, the war in Ukraine and the abortion case before the U.S. Supreme Court.

A trio of anthropologists from George Washington University agree its important to keep COVID-19s victims at the top of our minds, especially when so much of the culture is determined to behave as if things are already back to normal. And they have some ideas for doing so.

Sarah E. Wagner, Roy R. Grinker and Joel C. Kuipers start by suggesting a national commission to take a hard look at how the country allowed the pandemics death toll to exceed 1 million. By documenting how we got here, the country would be holding itself accountable ultimately an act of healing for survivors, they write.

They also recommend a national day of remembrance for COVID-19 victims. Resolutions in both the House of Representatives and the Senate would turn the first Monday in March into COVID19 Victims and Survivors Memorial Day.

A designated national memorial day would make the pandemic visible for decades to come, they write.

See the latest on Californias vaccination progress with our tracker.

Its been a year and a half since the first COVID-19 vaccines received emergency use authorization from the U.S. Food and Drug Administration. During that time, the conversation around the vaccines has shifted from how to stop unscrupulous people from jumping the line to how to entice holdouts to roll up their sleeves.

So if you found yourself feeling ho-hum about the latest vaccine news that COVID-19 shots are now available for kids as young as 6 months try looking at it from McKenzie Packs perspective.

Pack has a 3-year-old son named Fletcher. Hes not old enough to remember a time before the pandemic. But once the vaccine builds up his coronavirus immunity, he can start doing things he would have otherwise taken for granted.

Hes never really played with another kid inside before, McKenzie Pack said. This will be a really big change for our family.

That change was made possible by the FDAs decision to grant emergency use authorization to two COVID-19 vaccines for infants, toddlers and preschoolers. Both are reformulated versions of the mRNA vaccines available to U.S. adults.

The one from Moderna is a two-shot series for kids ages 6 months to 5 years. Each injection contains one-quarter the dose used for adults. The two shots should be given four to eight weeks apart; young children with compromised immune systems should get a third dose as well.

The vaccine from Pfizer and BioNTech requires three doses for everyone. The first two shots are given three to eight weeks apart, and the third one follows at least eight weeks after the second dose. Its made for children ages 6 months to 4 years, and contains one-tenth the dose used in the adult vaccine.

The CDCs vaccine advisory panel spent two days debating the pros and cons of the vaccines before endorsing them on Saturday. Walensky accepted their advice and urged parents and caregivers to make a date with a needle, even for children whove already had COVID-19.

In clinical trials, the pediatric vaccines were less effective than the adult versions were when they began rolling out 18 months ago. Thats because new coronavirus variants especially versions of Omicron have become more adept at evading antibodies induced by the shots. The trial data suggested the new vaccines would probably reduce the risk of COVID-19 symptoms in young children by 30% to 60%.

We cannot let the perfect be the enemy of the good, said Dr. Oliver Brooks, chief healthcare officer of Watts Medical Corp. in Los Angeles and a member of the CDCs Advisory Committee on Immunization Practices. Thats the bottom line.

The advisors said they were persuaded by evidence that young childrens antibody response to the new vaccines was on par with the antibody response seen in older children and adults, two groups for which the vaccine has been shown to be protective. Clinical trials also established that the vaccine was safe among nearly 8,000 young children, there were no deaths and very few serious adverse events, such as high fever.

The Western States Scientific Safety Review Workgroup a coalition of public health experts from California, Nevada, Oregon and Washington conducted its own review over the weekend and announced its support for the new vaccines on Sunday.

California has ordered almost 400,000 doses, and it began allowing parents and caregivers to book appointments on the My Turn site on Tuesday. But many providers that showed up in search results didnt appear ready to accommodate the youngest children.

The website for the L.A. County Department of Public Health notified users that vaccines for children younger than 5 were on the way. It provided a list of sites that were expected to offer the vaccine as soon as it arrives. A spokesman for the department said most of those sites should have doses available by Wednesday.

Both the county health department and the state offered a heads-up that pharmacies couldnt vaccinate children under age 3. That means a visit to a pediatrician or health clinic is in order.

In other COVID-19 vaccine news, a study published last week in the New England Journal of Medicine found that two initial doses without a follow-up booster offered essentially no lasting protection against an infection with Omicron. Researchers also reported that an infection was about as good as a booster at preventing a new Omicron-fueled illness.

On the plus side, the study found that either type of immunity offered lasting protection against serious illness, hospitalization and death.

I think this is really the important part: The immunity against severe COVID-19 was really very much preserved, said study co-author Laith Jamal Abu-Raddad, an infectious disease epidemiologist at Weill Cornell Medicine-Qatar.

Moving on to treatments, Pfizer said Paxlovid didnt seem to help COVID-19 patients who were not at high risk of becoming severely ill. That became clear in a study testing its antiviral drug in a broader population of people who were relatively healthy and unvaccinated, or who were fully vaccinated but had a medical condition that made them more vulnerable to a serious case of COVID-19.

California is having trouble getting Paxlovid to patients who need it. In the month since the state began its test-to-treat system, fewer than 800 people received a prescription, even though thousands of Californians became infected each day.

The programs goal is to make antivirals available right away to high-risk patients who test positive for a coronavirus infection, since the drugs work best when taken shortly after symptoms begin. A total of 1,219 people had been screened for the drugs as of mid-June, and 768 got Paxlovid pills.

I think its a new concept that people are still getting used to, said Katharine Sullivan, who oversees a test-to-treat site in west Berkeley.

And finally, the World Health Organizations latest weekly report on COVID-19 said there were more than 8,700 deaths in the week that ended June 12. That number is notable because it represents a 4% increase over the prior week and the first increase since early May.

The Americas saw the largest increase in the COVID-19 death toll (21%), followed by the Western Pacific region (17%). Europe, Southeast Asia, the eastern Mediterranean and Africa all saw declines.

Todays question comes from readers who want to know: Whats the criteria for having a high COVID-19 community level?

This is important because if and when L.A. County crosses this threshold and stays there for two weeks, its indoor mask mandate will return.

To back up for a moment, COVID-19 community levels are a measure the CDC uses to gauge how the coronavirus and the disease it causes are affecting peoples health in a particular place, either directly (through illness) or indirectly (by placing undo strain on local healthcare resources, making them unavailable to others). They come in three flavors: low, medium and high.

Three factors determine a countys COVID-19 community level: the number of new infections diagnosed over the last week; the number of new COVID-19 patients admitted to local hospitals over the last week; and the percentage of hospital beds occupied by patients with COVID-19.

There are multiple combinations of these variables that would qualify a county (or state or territory) as having a high COVID-19 community level.

Start with the coronavirus case count. See whether your county has recorded at least 200 new cases per 100,000 people over the last week. L.A. County did: It saw 337 cases per 100,000 residents in the last week.

Since were over the 200 mark, were ineligible for the low level. But we can stay in the medium level if we have fewer than 10 new COVID-19 hospitalizations per 100,000 residents over the last week and fewer than 10% of hospital beds are filled by COVID-19 patients.

The latest CDC figures show that L.A. County hospitals are admitting 7.3 new COVID-19 patients per 100,000 residents per week, and that 3.5% of hospital beds are devoted to patients with COVID-19. That means our COVID-19 community level is still medium. But if either metric climbs too high, well be reclassified into the high category.

If our new case count were below 200 per 100,000 residents per week, we could still have a high COVID-19 community level if we had at least 20 new hospitalizations per 100,000 per week, or if at least 15% of hospital beds were filled with COVID-19 patients. However, those combinations are a lot less likely.

You can look up the COVID-19 community level for any U.S. state, territory or county on the CDC website.

We want to hear from you. Email us your coronavirus questions, and well do our best to answer them. Wondering if your questions already been answered? Check out our archive here.

(Shawn Thew / Associated Press)

He was the last person I expected to catch the coronavirus, but this pandemic is full of surprises.

The National Institutes of Health announced Wednesday that none other than Dr. Anthony Fauci had come down with a mild case of COVID-19. Fauci, 81, is fully vaccinated and double-boosted and still well enough to work from home, where he is isolating according to CDC guidelines.

Less than two months ago, the nations top infectious disease expert heralded the arrival of more of a controlled phase of the pandemic. But he was quick to add: By no means does that mean the pandemic is over.

In this case, Im sure he wishes hed been wrong about that.

Resources

Need a vaccine? Heres where to go: City of Los Angeles | Los Angeles County | Kern County | Orange County | Riverside County | San Bernardino County | San Diego County | San Luis Obispo County | Santa Barbara County | Ventura County

Practice social distancing using these tips, and wear a mask or two.

Watch for symptoms such as fever, cough, shortness of breath, chills, shaking with chills, muscle pain, headache, sore throat and loss of taste or smell. Heres what to look for and when.

Need to get a test? Testing in California is free, and you can find a site online or call (833) 422-4255.

Americans are hurting in various ways. We have advice for helping kids cope, as well as resources for people experiencing domestic abuse.

Weve answered hundreds of readers questions. Explore them in our archive here.

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Coronavirus Today: Flipping the script on COVID-19 - Los Angeles Times

A recent study published in Clinical Infectious Diseases assessed deaths due to fungal infections during the coronavirus disease 2019 (COVID-19) pandemic in the United States (US).

Study: Increased deaths from fungal infections during the COVID-19 pandemicNational Vital Statistics System, United States, January 2020December 2021. Image Credit: Kateryna Kon/Shutterstock

Yeasts, molds, dimorphic fungi, and yeast-like fungi are common fungal pathogens. Clinically, fungal infections result in superficial lesions as well as life-threatening conditions. Severe infections typically affect immunosuppressed individuals like cancer patients, recipients of solid organ or stem cell grafts, users of immunosuppressive medication, etc.

More than a million people have succumbed to COVID-19 in the US to date. Moreover, COVID-19 might elevate the risk for severe fungal infection due to COVID-19-associated immune dysfunction, lung damage, and therapies, impairing the host immune system against pathogenic fungi. Evidence suggests that severe fungal infection in COVID-19 patients could result in poor clinical outcomes.

The present study analyzed data from the US National Vital Statistics System (NVSS) to examine demographic information, fungal disease burden, and temporal trends. They used provisional mortality data for 2021 and final mortality data for 2018 2020 from NVSS. Deaths involving fungal infections were identified and coded according to the International Classification of Diseases, tenth revision (ICD-10) codes. Deaths involving COVID-19 were similarly coded.

The number, percentage, and age-adjusted rates of fungal deaths from January 2018 to December 2021 were analyzed by the fungal pathogen, year, and COVID-19 association (whether COVID-19 was a contributory factor). The monthly number of fungal deaths during the COVID-19 pandemic was examined by investigating whether COVID-19 contributed to mortality; concurrent monthly COVID-19 deaths were also analyzed.

Data on fungal deaths between January 2020 and December 2021 were stratified by the COVID-19 association; the age-adjusted death rates were examined by race/ethnicity, sex, fungal pathogens, and the US census division of residence.

Between 2018 and 2021, 22,700 deaths occurred due to fungal infections/pathogens. The number of fungal deaths per 100,000 people for 2018 and 2019 was similar, with 4746 and 4833 deaths, respectively, and the age-adjusted rate was 1.2 during both years. However, it increased to 5922 in 2020, with a mortality rate of 1.5. Likewise, about 7199 (fungal) deaths were observed in 2021, with a rate of 1.8.

COVID-19-associated deaths during 2020 and 2021 accounted for 21.9% of the 13,121 fungal deaths in that period. COVID-19 represented the most common underlying cause of death (90.5%) among the COVID-19-associated fungal deaths, accounting for 0.3% of COVID-19 deaths during 2020-21. Candida and Aspergillus were the common fungal pathogens constituting 24.4% and 16.4% of the total number of fungal deaths for 2020-21.

Nevertheless, the pathogen was unspecified for more than 35% of all fungal deaths in the same period. Notably, COVID-19-associated fungal deaths were predominantly due to Candida and Aspergillus infections relative to non-COVID-19-associated fungal deaths. On average, 399 fungal deaths were recorded per month during 2018-19, and 423 fungal deaths occurred during the peak of the first COVID-19 wave (April 2020). Nonetheless, it peaked in January 2021 and October 2021 with 690 and 718 fungal deaths coinciding with the COVID-19 mortality peak(s).

Most deaths from fungal infections in 2020-21 were recorded in males (59.7%) and people aged 65 or above. The age-adjusted rates for COVID-19-associated fungal deaths were higher for individuals who were non-Hispanic American Indian or Alaska Native (AI/AN) [1.3], Hispanic (0.7), and Black (0.6) than non-Hispanic White (0.2) and non-Hispanic Asian (0.3) populations.

Consistently, for non-COVID-19-associated deaths from fungal infections, the age-adjusted death rates were higher in AI/AN (3), Hispanic (1.9), and non-Hispanic native Hawaiian (NHPI) [2.4] and Black populations than White (1.1) or Asian (1.2) individuals. The crude fungal death rate was higher for people from non-metropolitan areas than metropolitan residents.

The age-adjusted fungal death rates were higher in the Mountain (2.1) and Pacific (2) US census divisions but lower in the New England (1.3) division. Mountain and West South-Central divisions showed higher rates (0.5) of non-COVID-19-associated deaths, while it was lower in New England division (0.2).

The researchers observed that more people died from fungal infections in 2020-21, an upward trend compared to preceding years. COVID-19-associated fungal deaths drove this increase, highlighting the critical significance of fungal infections in COVID-19 patients. Fungal deaths increased in tandem with COVID-19 peaks in January and October 2021 but not in April 2020.

In conclusion, the study demonstrated that fungal infections pose a substantial burden in the US. These results might help inform efforts to identify, treat, or prevent severe fungal infections in COVID-19 patients, particularly in some ethnic and racial groups and geographic regions.

Read more from the original source:

Deaths due to fungal infections during the COVID-19 pandemic in the US - News-Medical.Net

Introduction

In his State of the Union address earlier this year, President Joe Biden spoke of a new moment where the coronavirus will be more manageable and the need for masks less frequent. States have moved toward this transition as positive cases, hospitalization, and deaths began to drop. In the first week of March, governors inMississippi, Texas,Alabama, Arizona, West Virginia and Connecticut announced significant loosening of statewide pandemic restrictions like mask mandates and indoor capacity limits. These states joined several others in loosening statewide coronavirus restrictions much earlier in the year.

As we transition toward directly battling COVID-19 to the next phase in the process, we must note that living with the virus means something much different for those struggling with the symptoms of long COVID-19. Long COVID-19 is associated with chronic symptoms like fatigue, cognitive problems, and respiratory challenges that can linger for months after the initial coronavirus infection has passed. Long-haulers, or people who experience prolonged symptoms more than three or four weeks after infection could need several months to recover.

It is important to recognize that experiencing longer-term challenges with COVID is rather pervasive and affects not only those with severe cases, but those with relatively mild symptoms as well as Americans who are generally healthy, not just those with underlying conditions. In fact, our colleagues here at Brookings have estimated that 31 million working-age Americansmore than one in sevenmay have experienced, or be experiencing, lingering COVID-19 symptoms.

The persistence of these symptoms and their ability to limit major life activities creates new considerations for immediate and long-term policy solutions. The COVID-19 pandemic increases the need to protect vulnerable communities based on current knowledge and predictions of the extension of disparate health conditions.

Similar to all other health outcomes associated with the pandemic, there are significant racial inequalities associated with long COVID-19 as vast inequalities in underlying conditions make the severity of longer-term cases more pronounced for racial and ethnic minorities. This blog post summarizes a few considerations about the racial differences among COVID-19 patients with longer-term symptoms and identifies policy solutions to help address these challenges.

The glaring racial inequalities in COVID-19 outcomes have been well documented by Brookings and a wide range of other scholars and think tanks. It is clear that Native Americans, African Americans, and Latinos have all experienced higher rates of coronavirus infection, hospitalization and casualties throughout the pandemic.

However, our knowledge of how race impacts long-term challenges with COVID-19 is unfortunately pretty limited. A key report focused on the State of Black America and COVID-19 has identified that Black Americans have not been sufficiently included in long COVID-19 trials, treatment programs and registries. There is unfortunately limited research on other racial and ethnic minorities as well.

It has now become clear that access to a primary care physician and adequate health care coverage as well as appropriate disability coverage will be crucial to the ways in which Americans navigate long COVID-19.

First, primary care doctors will be key to patients with long COVID-19, as many patients require comprehensive assessment to exclude serious complications that might be associated with their symptoms. A primary care clinician who knows the patient and his or her life circumstances is in an optimal position to coordinate and personalize the recovery plan and understand the barriers the patient may face along the way. Ideally patients with difficult cases would have access to holistic clinical intervention and followup.

Unfortunately, there is a significant gap in access to a primary care physicians for Americans from diverse backgrounds. TheAfrican American Research Collaborative/Commonwealth Fund American COVID-19 Vaccine Pollis an extensive, diverse national survey with measures of access to primary care physician. According to the survey, 82% of white Americans reporting having a primary care doctor while only 74% of Black, 69% of Latino, and 72% of Native Americans have access to a doctor they see regularly for care.

Second, people with long COVID-19 will need adequate health coverage to manage both the financial and health components of care management. Unfortunately, racial inequalities in access to health insurance are vast, particularly for Latinos. This is a direct consequence of the several jobs held by people of color lacking sufficient healthcare benefits. Additionally, states in which Medicaid has not been expanded complicate the way in which people of color are able to manage long COVID-19.

It is important to note that long COVID-19, particularly in vulnerable groups, may be complicated by other longterm conditions, notably diabetes, hypertension, ischemic heart disease, and chronic mental health conditions.[1] Racial and ethnic minorities are more likely to experience all of these conditions which strongly suggests that we should anticipate more complex and challenging cases for all non-white groups.

One of the other health issues associated with long-haulers is insomnia, a condition that can last months and possibly longer among Americans with long-term challenges due to COVID-19. Like most chronic health conditions, challenges with insomnia are greater among racial and ethnic minorities already, particularly for those who have high levels of perceived discrimination. Given the correlation between lack of quality sleep and a wide range of other health conditions, this may generate even greater racial inequalities in health outcomes down the line. The challenges with sleeping are likely to be exasperated by a host of underlying forces that impact sleep, including sub-par housing conditions.

The long-term effects of COVID-19 have not been realized. Our health systems and structures and the policies that regulate them will need major overhauling to be flexible enough to manage the impending social and health implications of long COVID-19. In closing, while we all enjoy the ability to feel more comfortable with expanded social interaction, and the ability to not have to wear our masks as often when we leave our homes, we must recognize that those struggling with the symptoms of long COVID-19 are far from being able to return to normalcy.

Finally, people suffering from the persistence of symptoms are eligible for disability services according to the Department of Health and Human Services. The physical impairment due to long COVID-19 can affect walking, standing, speaking, breathing, and many other physical functions that may limit ones role in their ability to manage daily activities with their families, and in their current jobs. Because long COVID-19 can be experienced by youth and young adults, there is additional guidance on how primary, secondary, and post-secondary schools should evaluate, assess, and make academic adjustments for those in school and higher education settings.

In this post we identify the gaping racial inequalities not only associated with long COVID-19 cases, but in the resources needed to properly manage a lingering case. In future posts we will summarize the policy solutions needed to help address the challenges raised in this blog, as well as the economic consequences associated with long COVID-19 for communities of color who are already being squeezed by inflation and a slower recovery from the economic downturn.

[1] See for example: https://pubmed.ncbi.nlm.nih.gov/32419765/

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Living with COVID-19 will not be easy for many Americans suffering from long COVID-19, particularly those from diverse communities - Brookings...

WASHINGTON President Joe Biden on Wednesday will call on Congress to suspend federal gasoline and diesel taxes for three months a move meant to ease financial pressures at the pump that also reveals the political toxicity of high gas prices in an election year.

The Democratic president will also call on states to suspend their own gas taxes or provide similar relief, the White House said.

At issue is the 18.4 cents-a-gallon federal tax on gas and the 24.4 cents-a-gallon federal tax on diesel fuel. If the gas savings were fully passed along to consumers, people would save roughly 3.6% at the pump when prices are averaging about $5 a gallon nationwide.

But many economists and lawmakers from both parties view the idea of a gas tax holiday with skepticism.

Barack Obama, during the 2008 presidential campaign, called the idea a "gimmick" that allowed politicians to "say that they did something." He also warned that oil companies could offset the tax relief by increasing their prices.

High gas prices pose a fundamental threat to Biden's electoral and policy ambitions. They've caused confidence in the economy to slump to lows that bode poorly for defending Democratic control of the House and the Senate in November.

Biden's past efforts to cut gas prices including the release of oil from the U.S. strategic reserve and greater ethanol blending this summer have done little to produce savings at the pump, a risk that carries over to the idea of a gas tax holiday.

Biden has acknowledged how gas prices have been a drain on public enthusiasm when he is trying to convince people that the U.S. can still pivot to a clean-energy future. In an interview with The Associated Press last week, Biden described a country already nursing some psychological scars from the coronavirus pandemic that is now worried about how to afford gas, food and other essentials.

"If you notice, until gas prices started going up," Biden said, "things were much more, they were much more optimistic."

The president can do remarkably little to fix prices that are set by global markets, profit-driven companies, consumer demand and aftershocks from Russia's invasion of Ukraine and the embargoes that followed. The underlying problem is a shortage of oil and refineries that produce gas, a challenge a tax holiday cannot necessarily fix.

Mark Zandi, chief economist at Moody's Analytics, estimated that the majority of the 8.6% inflation seen over the past 12 months in the U.S. comes from higher commodity prices due to Russia's invasion and continued disruptions from the coronavirus.

"In the immediate near term, it is critical to stem the increase in oil prices," Zandi said last week, suggesting that Saudi Arabia, the United Arab Emirates and a nuclear deal with Iran could help to boost supplies and lower prices.

Republican lawmakers have tried to shift more blame to Biden, saying he created a hostile environment for domestic oil producers, causing their output to stay below pre-pandemic levels.

Senate Republican leader Mitch McConnell mocked the idea of a gas tax holiday in a February floor speech. "They've spent an entire year waging a holy war on affordable American energy, and now they want to use a pile of taxpayers' money to hide the consequences," he said.

Democratic House Speaker Nancy Pelosi has previously expressed doubts about the value of suspending the federal gas tax.

Administration officials said the $10 billion cost of the gas tax holiday would be paid for and the Highway Trust Fund kept whole, even though the gas taxes make up a substantial source of revenue for the fund. The officials did not specify any new revenue sources.

The president has also called on energy companies to accept lower profit margins to increase oil production and refining capacity for gasoline.

This has increased tensions with oil producers: Biden has judged the companies to be making "more money than God." That kicked off a chain of events in which the head of Chevron, Michael Wirth, sent a letter to the White House saying that the administration "has largely sought to criticize, and at times vilify, our industry."

Asked about the letter, Biden said of Wirth: "He's mildly sensitive. I didn't know they'd get their feelings hurt that quickly."

Energy companies are scheduled to meet Thursday with Energy Secretary Jennifer Granholm to discuss ways to increase supply.

Read more here:

Biden to call for 3-month suspension of gas and diesel taxes - Star Tribune

COVID-19 surveillance program in Pune, India

Pune city-located in western India around 150km east of Mumbai (Fig.1a)launched a COVID-19 surveillance program during the early stages of the pandemic (January 2020). Pune Municipal Corporation (PMC) collaborated with multiple public and private health facilities to establish SARS-CoV-2 diagnostics, quarantine facilities for asymptomatic persons, and hospital/critical care beds for moderate to severely ill patients diagnosed with COVID-19. In addition, community-based workers were mobilized to conduct contact tracing activities. A publicly accessible dashboard was established to report the cumulative COVID-19 caseload in the PMCs 41 Prabhags (also known as electoral wards). The number tested and individual-level data, such as age, sex, residential address, COVID-19 test results, and COVID-19 outcomes, were centrally compiled on a regular (almost daily) basis22.

(a) Location of Pune City, India. (b) Geographic boundaries of ward offices located within Pune Municipal Corporation (PMC). Fill color indicates the quartile of population density (persons per square kilometer) and the proportion of slum population in each ward. Numbers inside the olive boxes indicate the official ward office number (see Supplemental Table S1 for the name corresponding to each ward office number). (c) the number of COVID-19 patients in each PMC ward office at beginning of the pandemic (left panel), at the end of the nationwide lockdown (middle panel), and at the end of the study period (right panel). The date is located at the top of each panel. Dark gray indicates<50 patients, white indicates no patients, and the transition between blues and reds seen in the middle panel denotes approximately 600 patients.

Indias initial response to the pandemic comprised travel advisories on international travel and suspension of visas from mid-January through mid-March. During this period, COVID-19 testing was administered to travelers who were returning from China and other foreign countries and had fever, cough or other viral respiratory symptoms20. Those testing positive were hospitalized for quarantine, and their close contacts were traced and underwent COVID-19 testing. The first nationwide lockdown was implemented from March 25th to April 14th, 2020 (Lockdown 1). Nearly all services and factories were suspended with reports of arrests for lockdown violations. During this time, Pune city expanded COVID-19 testing capacity, making testing available to persons with viral symptoms or within 14days of COVID-19 exposure. The nationwide lockdown was extended from April 15th to May 3rd (Lockdown 2). Agricultural activities and essential services were allowed to function from April 20th, and Pune city areas were classified into red, orange, and green zones based on infection clusters. Red zones were defined by the central government based on case counts, doubling rate, and testing/surveillance findings. Initially, the central government defined the red zone as a particular area/district with more than 15 active cases. The area with<15 cases with no recent surge were defined as the orange zone. The area with zero COVID cases were green zones. However later as the cases surged in the country, the central government allowed the states to categorize the zones. Notably, interstate transport was allowed for stranded individuals, and during the month of May alone, approximately one million migrants traveled via roads or trains to their home states, mostly from Maharashtra state. The lockdown was extended again from May 4th to May 17th (Lockdown 3), but with more relaxations in green zones where lower infection rates were reported. The final extension spanned May 18th to May 31st (Lockdown 4). States were given more authority to demarcate infection zones, and red zones were further divided into containment zones, which maintained stricter enforcement of lockdown norms than other zones.

The unlocking (resumption) of economic activities began in June 2020. During the first phase (Unlock 1, June 1st to June 30th), interstate travel was allowed with few state-specific restrictions while containment zones continued to follow lockdown norms. Phased unlocking continued in July (Unlock 2) when the authority to impose lockdowns was further decentralized to local governments. Pune city and the adjoining areas implemented a regional lockdown from July 14th to July 23rd in response to a sharp rise in COVID-19 patients. City and state authorities enforced a strict lockdown during the first weeka complete shutdown of all essential services, except emergency healthcare. This resulted in minimal movement in Punes public spaces. Slight relaxations in the supply of essential goods and services followed during the second week and Unlock 2 resumed in Pune on July 24th. August 1st to August 31st (Unlock 3) witnessed further relaxations in interstate travel and an end to nationwide curfews. Pune shopping malls and market complexes could remain open until evening, and cab services could operate with a restricted passenger load. However, lockdown restrictions continued in containment zones. During September (Unlock 4), gatherings of up to 50 persons were permitted while containment zones continued to follow lockdown norms. Early in September, Pune experienced a sharp rise in COVID-19 patients and became a top national COVID-19 hotspot (The lockdown events are summarized in the supplemental Fig.1).

The area within PMC limits is divided into 15 administrative units, called ward offices (Fig.1b), which are further divided into 41 electoral wards with similar populations, called prabhags. Individual-level data were included for the time period spanning February 1st to September 15th, 2020. According to daily press reports released by PMC, a total of 542,946 samples were collected for COVID-19 testing during the study period, and of these, 313,373 records were available. These data were curated to remove records with missing data. The remaining records were assigned to a prabhag using a machine learning based geocoder that was developed in house. The geocoding methodology is described in the supplementary material 1. Records with a confidence score below 0.5 out of 1.0 (provided by the ML geocoder) and records for persons residing outside PMC limits were removed. The final dataset used for this analysis comprises 241,629 records.

This analysis was done retrospectively on programmatic data without personal identifiers, hence individual patient consent was not obtained as infeasible. The Ethics Committee of Indian Institute of Science Education and Research, Pune, India approved the analysis of COVID-19 programmatic data and has waived the need for obtaining the consent. The analysis and reporting were performed in accordance with the relevant guidelines and regulations.

The primary endpoint was weekly change in incident COVID-19 patients. The secondary endpoint was weekly infection rate; infection rate was calculated as the number of positive SARS-CoV-2 results divided by the total number of tests per 1000 population. Other endpoints included risk of COVID-19, defined as an incident COVID-19 case. Primary and secondary endpoints were assessed pre-lockdown, during lockdown and post-lockdown in the overall dataset and by population characteristics, namely sex, age group, and ward office-specific subcategories (population density and proportion residing in slum areas). Population density was calculated as number of people per 1 square kilometer and has been reported for all 15 PMC ward offices. For this analysis, population density was binarized as high (above the 3rd quartile of PMC ward office density, n=6) or low-average (below the 3rd quartile of PMC ward office density, n=9) (Fig.1b). Since differences in infection rates existed among ward offices, the effect of lockdown on the primary endpoint was assessed using a multilevel Poisson regression model with random effects for ward office and test week. Change in the weekly infection rate over the study period was estimated using quasi-Poisson regression analysis. Logistic regression was used to assess the effect of risk factors on mortality. Epidemic curves for trends of incident patients over time were plotted using nonparametric locally weighted regression for the overall population and by sex, age group, and ward-specific subcategories.

We modelled the trajectory of the natural epidemic to estimate the delay of the peak of the pandemic. For this, we used a 9-compartmental model INDSCI-SIM that enables robust predictions taking into account the effects of various non-pharmaceutical measures (Supplementary appendix)23,24. There are a wide range of estimates for the value of R0; for example, Hilton and Keeling estimated R0 between 2 and 325 while India specific study by Sinha found out the value to be around 1.8. In order to avoid overestimation of total patients, we also considered R0 =1.826. Although there is no unique way to estimate actual number of patients, we assume infection on the first day (taken to be 1st April 2020) of the simulation to be three times reported patients. We note here that the choice of R0 and initial values may affect the final outcome, but our choices are conservative and more accurate estimation may make the results worse than reported here. We assessed the geospatial spread of COVID-19 patients over time and the visualizations were generated using the Python library geopandas (version 0.7.0, https://pypi.org/project/geopandas/0.7.0/). (Supplementary appendix). Data were analyzed in Stata Version 142.

Continued here:

Association of national and regional lockdowns with COVID-19 infection rates in Pune, India | Scientific Reports - Nature.com

In a recent study published in Nature Biotechnology, researchers assessed the role of smartphone apps during the coronavirus disease 2019 (COVID-19) pandemic.

Smartphone apps were widely used for tracing, tracking, and educating the general public about COVID-19. While there are major concerns related to data privacy and data security, evidence suggests the usefulness of apps in understanding the infection outbreaks, individual screening as well as contact tracing.

In the present study, researchers reviewed and assessed major digital app projects according to outbreak epidemiology, individual screening, and contact tracing.

The team divided the COVID-19 epidemiology into (1) surveillance of active user participants, (2) population-level tracking of passive users, (3) individual risk assessment, and (4) forecasting viral illness. Participatory surveillance was performed using phone and text-based surveys to obtain syndromic surveillance data in places where web-based applications were unavailable.

Various syndromic reporting platforms, including Flu Near You used in the US, InfluenzaNet in Europe, and Reporta in Mexico, allowed citizen scientists to report influenza-like symptoms into a reporting platform based on either the web or an app. Such reporting has shown great promise in correlating the timing and extent of viral illness activity.

Since there was a significant overlap between COVID-19 and influenza symptoms, several of the aforementioned apps also tracked COVID-19. Another app-based platform from Brazil obtained syndromic data from a total of 861 participants and found that the data collected matched the temporal as well as spatial trends observed in the traditional surveillance methods used for COVID-19. This platform also identified communities that should be prioritized for testing and improved the surveillance conducted in regions lacking healthcare facilities.

Passive crowdsourcing of outbreak data from social media, web queries, and lay media-generated large-scale data could provide warning signals earlier than those provided by traditional means of surveillance. Healthmaps Outbreaks Near Me platform monitored, organized, and visualized the location as well as the time when the infectious disease outbreak was reported globally via electronic media. This enabled near-real-time visualization as well as identification of clusters of infection cases reported by the media in a region which helps public health responders recognize new outbreaks faster than traditional measures.

Several apps, including the Safer-Covid app, provided users with information related to individual risk taking into account the age, type of activity, and location. The Health Code surveillance app from China categorized individuals into three classifications according to their level of risk based on mining location, contact data, and payment platform. Individuals belonging to the high-risk categories were barred entry into specific public places, transit systems, and buildings. Such individual risk assessments also could enhance the usage of non-pharmaceutical interventions (NPIs), including mask-wearing, increased testing, social distancing, or stay-at-home measures.

The symptom-checker apps were divided into active or passive according to their need for user engagement.

These apps required frequent active interaction with the app as the participant reported symptoms on a regular basis. Continuous reliance on user reporting led to survey fatigue resulting in smaller-than-expected sample sizes, waning user retention as well as participant bias. These factors limited the apps ability to form meaningful inferences about the local trends with respect to COVID-19 infections.

Passive screening obtained data from wearables used by the participants to detect COVID-19 or any other viral illnesses. Such screening required minimal participation on the users behalf. Initial studies evidenced the potential of these apps in understanding ambulatory physiology and identifying subclinical forms of the viral disease. A study app called the digital engagement and tracking for early control and treatment (DETECT) employed a hybrid active and passive approach using data collected from Fitbit or any other wrist sensor connected to either data obtained from Google Fit or Apple HealthKit, along with symptom questionnaires.

The team noted that the analysis of resting heart rate (RHR) among symptomatic COVID-19 patients in the DETECT cohort revealed an average initial increase in RHR followed by transient bradycardia. This was further followed by prolonged relative tachycardia, which was resolved almost three months after the onset of symptoms.

An Oxford University study showed that contact tracing could potentially mitigate the COVID-19 outbreaks. Smartphones enabled contact tracing due to their ability to detect proximity between persons using technologies such as bluetooth low-energy systems. Moreover, global position systems, internet protocol addresses, proximity to cell towers, and international mobile equipment identity numbers could enable the geolocation of certain persons.

According to the authors, further research is essential to investigate the efficacy of COVID-19 apps.

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The role of smartphone apps during the COVID-19 pandemic - News-Medical.Net