Category: Corona Virus

The COVID pandemic is most certainly not over World Health Organization Director Tedros Adhanom Ghebreyesus said Sunday at the 75th World Health Assembly.

His warning comes as some countries are rescinding their COVID mandates, and cases are on the rise again.

Reported cases are increasing in almost 70 countries in all regions, Tedros said. This virus has surprised us at every turn a storm that has torn through communities again and again, and we still cant predict its path, or its intensity.

The WHO chief said that while more than 6 million global coronavirus deaths have been reported, the U.N. agency estimates that the worldwide tally is much higher at almost 15 million deaths.

Tedros called on countries to do all they can to eradicate COVID, including vaccinating 70% of their population, which would include 100% of people over 60 years old, 100% of health workers. and 100% of people with underlying conditions.

The pandemic will not magically disappear," warned the WHO leader, "but we can end it Science has given us the upper hand.

Meanwhile, Gallup, the global analytics firm, asks Americans every month What is the most important problem facing the United States?

The answer has been COVID since the beginning of the pandemic. That all changed this March, however, when concerns about COVID were replaced with worries about the U.S. economy.

Gallup Senior Editor Megan Brenan said in an interview on The Gallup Podcast with Mohamed Younis that apprehension about how the U.S. government is handling the economy and inflation, now tops the list of Americans worries.

The Johns Hopkins Coronavirus Resource Center reported early Monday more than 525 million global COVID infections and more than 6 million global coronavirus deaths.

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WHO Chief: The Pandemic Is Most Certainly Not Over - Voice of America - VOA News

Damage to the bodys organs including the lungs and kidneys is common in people who were admitted to hospital with Covid, with one in eight found to have heart inflammation, researchers have revealed.

As the pandemic evolved, it became clear that some people who had Covid were being left with ongoing symptoms a condition that has been called long Covid.

Previous studies have revealed that fewer than a third of patients who have ongoing Covid symptoms after being hospitalised with the disease feel fully recovered a year later, while some experts have warned long Covid could result in a generation affected by disability.

Now researchers tracking the progress of patients who were treated in hospital for Covid say they have found evidence the disease can take a toll on a range of organs.

Whats more, they say the severity of ongoing symptoms appears to be linked to the severity of the Covid infection itself.

Even fit, healthy individuals can suffer severe Covid-19 illness and to avoid this, members of the public should take up the offer of vaccination, said Prof Colin Berry, of the University of Glasgow, which led the CISCO-19 (Cardiac imaging in Sars coronavirus disease-19) study.

Our study provides objective evidence of abnormalities at one to two months post-Covid and these findings tie in with persisting symptoms at that time and the likelihood of ongoing health needs one year later, Berry added.

Writing in the journal Nature Medicine, the researchers describe how they tracked the outcomes of 159 people hospitalised with Covid between May 2020 and March 2021.

The team carried out a range of scans and blood tests at 28-60 days after the Covid patients were discharged, with patients also given questionnaires to complete. The results were compared with those from a control group of 29 people with a similar age, sex, ethnicity, and cardiovascular risk factors, who had not had Covid.

The authors write that, compared with controls, those who had been hospitalised with Covid showed several abnormalities, including in results from imaging of the heart, lungs and kidneys.

The team found about 13%, or one in eight, of those hospitalised for Covid were deemed by experts to be very likely to have myocarditis, or heart inflammation, compared with just one control participant. This led to a lower health-related quality of life, greater illness perception, higher levels of anxiety and depression [and] lower levels of physical activity, said Dr Andrew Morrow, also from the University of Glasgow.

The likelihood of myocarditis was higher among healthcare workers and those with acute kidney injury, as well as those with more severe disease requiring invasive ventilation.

These findings reinforce the importance of both the vaccine programme and novel treatments that have greatly reduced the number of severe cases of Covid-19, said Morrow.

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The results also reveal those who had been hospitalised with Covid were more likely to need outpatient secondary care or be referred for symptoms consistent with long Covid, with death and re-hospitalisations also much higher in this group.

Dr Betty Raman, a cardiologist and long Covid expert at the University of Oxford who was not involved in the work, said the study provided important insights into the prevalence of clinically adjudicated myocarditis and its association with prolonged symptoms in those hospitalised with Covid early in the pandemic.

However, Raman noted that presence of persistent heart inflammation was not assessed during later follow-up, few participants had received a Covid jab, and the Covid variants involved were unlikely to be the Omicron lineages that are prevalent today.

Current-day estimates of myocarditis following more novel Sars-CoV-2 variants in the post-vaccine era may differ from this study, given the lower risk of hospitalisation and severe disease attributable to differences in variants and vaccine effects, she said.

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Covid can cause ongoing damage to heart, lungs and kidneys, study finds - The Guardian

COVID does have an impact on the sexual health of of males. Research studies have confirmed an increased chance of new onset erectile dysfunction post-COVID-19 infection.

A recent research study published in the journal Sexual Medicine called for attention towards short- and long-term effects of coronavirus disease 2019 (COVID-19) on erectile function and penile vasculature as s the virus has been found to be present within the penile tissue. The study involved over 230,000 adult men who had COVID-19 and compared them with a similar number of men who were not infected.

Apart from the biological factors, there are several social factors that affected sexual activity during COVID.

As per a research study, COVID-19 related restrictions were correlated with higher rates of sexual dysfunction and reduced sexual activity. The study on 2454 women and 3765 men found that restrictions on peoples activities, reduced sports activities, economic issues, increased psychological stress, and reduced entertainment have, indeed, dramatically impacted sexual activity and functioning.

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Coronavirus infection: All you need to know about COVID and its impact on sexual health - Times of India

Vaccine effectiveness against COVID-19 breakthrough infections in patients with cancer (UKCCEP): a population-based test-negative case-control study  The Lancet

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Vaccine effectiveness against COVID-19 breakthrough infections in patients with cancer (UKCCEP): a population-based test-negative case-control study -...

The Korean Central News Agency (KCNA) said that between Friday and Saturday there had been 186,090 new cases, 299,180 recoveries and one death.

If true, that figure would be a marked drop -- the country has been reporting more than 200,000 of what it terms "fever cases" every day for the past week in an outbreak that has infected more than 2.5 million people and killed 67, according to official figures.

However, given the lack of independent reporting inside North Korea, it is difficult to verify the figures and there has long been widespread skepticism over the country's Covid reporting.

Before the current outbreak was announced earlier this month, North Korea claimed to be Covid-free. The country of 25 million reported what it said were its first cases earlier this month, referring to the outbreak as "explosive," raising fears about the ability of the country's dilapidated health care infrastructure to cope.

North Korea is not known to have imported any coronavirus vaccines and has previously snubbed offers such as one from China last year to provide nearly three million doses of its Sinovac shots.

On Monday, three North Korean cargo planes flew to China and back, according to a South Korean government official with knowledge of the matter. It is not known what the planes were carrying, but the rare trip came after China pledged to help North Korea with its Covid outbreak.

United States President Joe Biden, who is currently visiting South Korea as part of his first trip to Asia, said on Saturday the US had also offered to provide vaccines to North Korea but that Pyongyang has not responded.

A senior US administration official said on Sunday that Covid restrictions may be playing a role in Pyongyang's lack of response to offers of talks, Reuters reported.

"The fact that Kim Jong Un has decided to come out and publicly announce this health crisis is quite telling," Lina Yoon, a senior Korea researcher at Human Rights Watch told CNN. "(It) may have a political element, obviously."

North Korea's state media claims its outbreak peaked at over 390,000 new cases on Monday. After showing "rapid growth in the beginning" the outbreak is now in decline, it claims, "after being stably controlled and managed."

Among the actions KCNA credited were "intensive disinfection efforts" by nearly 200,000 medical and anti-epidemic workers at around 100,000 spots nationwide, including waste and sewage treatment plants.

It also said military medics had been deployed to 670 pharmacies in Pyongyang to supply medicine around the clock and "around 20 mobile temporary medicine service centers" had been created to distribute medicine "faster and more accurately."

North Korea's present problems are not limited to the outbreak. There have also been suggestions it is facing widespread food shortages, caused in part by strict border lockdowns that were meant to keep the virus out.

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North Korea claims 'positive trend' in Covid outbreak, but no reply to Biden's offer of help - CNN

People wear face masks during the outbreak of coronavirus disease (COVID-19) in Singapore, April 3, 2020. REUTERS/Edgar Su

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May 23 (Reuters) - The following is a summary of some recent studies on COVID-19. They include research that warrants further study to corroborate the findings and that has yet to be certified by peer review.

Omicron breakthrough infections may spare young hearts

The Omicron variant of the coronavirus does not have a negative affect on cardiovascular health in young adults who have been vaccinated, a small study suggests.

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Earlier variants have had a detrimental affect on patients' hearts and blood vessels, and researchers expected to see similar patterns when they compared 23 young adults with Omicron breakthrough infections diagnosed within the past six weeks to 13 vaccinated young adults who never had COVID-19. The average age of study participants was early- to mid-20s. As reported on Friday in the American Journal of Physiology - Heart and Circulatory Physiology, markers of cardiovascular health included blood vessel function and responsiveness to stimuli, stiffness of artery walls, heart rate variability, and the heart's responses to changes in blood pressure. "Contrary to our hypothesis," the researchers said, there were no differences in any of these parameters between healthy, vaccinated young adults who contracted COVID-19 during the Omicron wave and those who never had COVID.

The finding that "not all variants may be detrimental to cardiovascular health in young, otherwise healthy adults... is all very promising," they said. "However, there is some recent evidence that cardiovascular health may still be impacted in the long term... Therefore, follow-up studies will be needed to determine long-term cardiovascular health outcomes."

Delaying mammography after COVID vaccination unnecessary

Women should not delay routine mammograms after receiving a COVID-19 mRNA vaccine, experts now say.

In some women, the vaccines cause swollen lymph nodes around the armpits, which could be misread as a possible sign of breast cancer on a mammogram. Early after the vaccines became available, the Society for Breast Imaging advised women to wait four-to-six weeks after the second shot before having a screening mammogram because it was thought the abnormalities would resolve by then. New research shows that so-called axillary lymphadenopathy after vaccination can last longer than initially reported. In 111 women with this side effect after receiving an mRNA COVID vaccine, the swelling took an average of 12-13 weeks after the second shot to resolve completely, researchers reported in the American Journal of Roentgenology. Women should not delay their mammograms for extended periods, the Society for Breast Imaging now says.

In an updated guideline directed at asymptomatic, average risk women with no history of breast cancer or lymph node cancer, the group now advises that if screening mammograms show the kind of lymph node abnormalities associated with the vaccines, the exams should be repeated six months later.

mRNA vaccine response stronger after fourth dose vs third

A fourth dose of a COVID-19 mRNA vaccine can boost antibodies and other immune responses to levels higher than those seen after the third dose, according to UK trial data.

Researchers recruited 166 adults who had received a booster dose of the Pfizer (PFE.N)/BioNTech (22UAy.DE) mRNA vaccine after two doses of either AstraZeneca's (AZN.L) viral vector vaccine or initial inoculation with Pfizer/BioNTech's shots. They were randomly assigned to receive either another Pfizer/BionTech shot or Moderna's (MRNA.O) mRNA booster as a fourth dose. Half of the participants were older than 70, and the average interval since the third shot was seven months. Two weeks after the fourth dose, levels of antibodies targeting the spike on the coronavirus were up to twice as high as antibody levels seen four weeks after the third dose for both vaccines, regardless of initial vaccine schedule, the researchers reported in The Lancet Infectious Diseases. Responses of immune cells called T cells were significantly increased 14 days after the fourth dose compared with 28 days after the third dose, but only in participants who received three Pfizer shots followed by a Moderna booster.

Researchers cautioned that all of the increases "will probably wane rapidly, as has been observed after third doses." Participants with high levels of immune responses before the fourth dose had limited boosting from that shot, they said, which suggests there may be a "ceiling" to the booster effect and that people with high antibody levels "are unlikely to gain much boosting from additional doses."

Click for a Reuters graphic on vaccines in development.

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Reporting by Nancy Lapid; Editing by Bill Berkrot

Our Standards: The Thomson Reuters Trust Principles.

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Omicron breakthrough infections may spare young hearts; no need to delay mammogram after vaccination - Reuters

Editors Note: Adar Poonawalla is chief executive officer of vaccine manufacturer the Serum Institute of India. He is founder of Clean City Pune, an environmental institute aimed at making cities more liveable. The views expressed in this commentary are his own. Read more opinion on CNN.

CNN

Whether it was conducting groundbreaking research, completing clinical studies, manufacturing Covid-19 vaccines or distributing and administering billions of doses, scientists, public health officials, doctors and countless others have taken on the Herculean task of protecting people around the world from the novel coronavirus with vaccines, diagnostics and therapeutics.

While we the worlds largest manufacturer of vaccines by volume recognize the innovation and effort the global community undertook in the past two years, we also acknowledge that there is more to do. As world leaders come together at the World Economic Forum this week, I hope that they collectively work toward a healthy and safe future for the generations to come.

Developing vaccines or treatments that can actually prevent transmission of disease, not just hospitalizations and deaths, would help control the virus. And there needs to be multilateral cooperation from countries to provide equitable access to vaccines and therapeutics to all.

So, what are the lessons we learned? And how can we avoid a fragmented immunization effort in the event of another pandemic?

In 2021, around 11 billion doses of Covid-19 vaccines were produced, according to the World Economic Forum, however, the access to these vaccines was not equitable.

To ensure a fair global health system, there is no other option but to adopt a Global Pandemic Treaty aimed at building a common regulatory framework which would enable knowledge-sharing, provide resources and logistical support and maintain a transparent approval system of vaccine certificates.

Given the disruption and devastating loss of life weve seen in the past two years of Covid-19, it is of utmost importance that there are systems in place to prevent the next pandemic.

I am certainly not nave enough to think a global treaty would solve all our problems. Countries will still need to continue investing in their own health care systems and pharmaceutical manufacturing and create agile systems of detection for emerging diseases.

But beyond that, we still need political will and multilateral cooperation between countries to bring about a coordinated global response to any pathogen.

There would have to be at least four major cornerstones in such a treaty:

1.) A free flow of raw materials and vaccines to be exported and shared by major producing countries of essential drugs and medicines. Each country should agree to export at least 25% of what it can produce for itself, for example. Hopefully, more and more nations will build their own capabilities in the years to come.

2.) Sharing of intellectual property (IP) of breakthrough technologies, on a commercial basis that rewards the innovator to scale up the manufacturing in different parts of the world during a global pandemic. This could apply to diagnostics, treatments and vaccines. For instance, the partnerships between vaccine makers and manufacturers significantly cut down the time it took to get doses distributed and administered around the world, likely saving countless lives.

3.) Global agreement of regulatory standards: Clinical trials and manufacturing standards should be agreed to in advance, with oversight headed by a multilateral organization such as the World Health Organization. This will enable more manufacturers to be able to come forward and produce treatments and vaccines that adhere to good manufacturing practices and standards at a faster pace. This could also help fight misinformation about different treatments and vaccines, which fueled vaccine hesitancy and preferences for different vaccines over others.

4.) Universal travel vaccine certificates on a digital platform that is at the ready. This could eliminate any questions about authenticity and acceptance, especially for travelers in the event of future lockdowns.

These are just some elements that could help governments and international health regulatory bodies respond more quickly and effectively to future pandemics. A treaty like this could also provide a fair and predefined framework that would dial up the political will and help leaders deal with periods of crisis in their own countries.

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Opinion: We need a Global Pandemic Treaty -- before it's too late - CNN

With coronavirus cases on the rise, California finds itself in a familiar, if frustrating, position with the threat of another wave looming as summer fast approaches.

Coronavirus cases are increasing, in many areas at an accelerating pace. Authorities have not yet expressed alarm about the state of Californias hospitals or imposed far-reaching new rules to blunt the virus spread.

But officials say it is possible healthcare systems could once again come under strain unless the transmission rate is restrained underscoring how vital it is for residents and businesses to make use of the protective tools at their disposal.

Residents, workers and businesses need to not shy away from reinstating or adhering to safety practices that are known to reduce transmission, said Los Angeles County Public Health Director Barbara Ferrer. This includes indoor masking, testing when people are sick, exposed or gathering, and staying up to date on vaccinations.

L.A. County on Friday extended its order requiring mask use on public transit, including in rail and bus stations; in indoor areas of airports and seaports; and in ride-sharing vehicles. Vaccine clinics this week also began making available COVID-19 booster shots for children ages 5 to 11, following the U.S. Centers for Disease Control and Preventions recommendation Thursday that these youths should get one.

The Berkeley public school system announced Friday a new order to reinstate an indoor mask mandate for students and staff for the remainder of the school year, effective Monday, including indoor graduations. Berkeley schools are seeing an increase in clusters of coronavirus cases, and the surge has proved so disruptive that we have only been able to fill about 50% of our teacher absences with substitute teachers, the school district said in a statement.

This means that in schools across the district administrators are, once again, working in our classrooms as teachers while teachers are forgoing their planning periods to fill in for colleagues who are ill, the school system said.

Fourteen of Californias 58 counties are at the medium COVID-19 community level outlined by the CDC.

Counties in this category, the middle on the agencys three-tier scale, are experiencing elevated levels of coronavirus transmission. In those counties, residents should consider taking prevention measures based on their own risk, like avoiding crowds, wearing a mask, increasing their testing, especially before gathering with others indoors, according to CDC Director Dr. Rochelle Walensky.

Los Angeles moved into the medium category on Thursday, and is the only Southern California county at that level. Also in the medium category are eight of the nine counties in the San Francisco Bay Area (the lone exception is Napa County) and the coastal counties north of the Bay Area, as well as Santa Cruz County and Yolo County.

Reaching this category is concerning, since it could signal that the increases that were seeing in our COVID cases may soon put pressure on our healthcare resources, Ferrer said Thursday.

So far, no California counties are in the worst, or high, community level, which denotes a heightened level of coronavirus transmission and hospitals seeing significant impacts from COVID-19.

We need to do everything we can to stay out of high, Ferrer said. Nobody here wants to see us move to any categorization that could possibly cause stress on our healthcare system or result in more people getting sick or dying.

Being in the medium category does not trigger any new widespread rules or health guidance. However, L.A. County officials have said reaching high would prompt the return of a local universal public indoor mask mandate which hasnt been in place since early March.

Other counties in California have not outlined specific plans to reinstate a local mask order if cases or hospitalizations continue to worsen.

Masks are still required in healthcare settings, nursing homes, jails and homeless shelters and in certain other settings in some areas of the state. The San Francisco Bay Area Rapid Transit system has enacted a mask mandate. Oakland requires patrons attending indoor events with 2,500 or more people to wear a mask.

On Tuesday, a number of speakers at a health commission meeting urged San Francisco officials to reinstate a universal mask mandate.

But the citys health officer, Dr. Susan Philip, indicated she was not inclined to pursue that at this time, given the widespread availability of high-quality masks, vaccinations and boosters and anti-COVID drugs.

San Francisco has been at the medium COVID-19 community level for three weeks, sent into this tier because of its high case rate. But coronavirus-positive hospitalizations remain relatively low, Dr. Grant Colfax, the citys public health director, told health commissioners this week.

Our hospital capacity ... remains relatively robust, Colfax said.

Even though a face covering requirement hasnt been on the books for months, officials at the California Department of Public Health have consistently strongly recommended residents mask up indoors in public.

Ferrer has also urged residents to wear high-quality masks like KF94, KN95 and N95 respirators while indoors, get vaccinated and boosted, get tested when feeling sick or potentially exposed to the coronavirus, and prioritize gathering in well-ventilated areas or outdoors.

Despite the recent increases, Ferrer reiterated that she feels people can enjoy gatherings and activities, though she suggested taking prudent precautions.

While we are disheartened that the pandemic hasnt ended, I am reassured that with the tools at hand, we can continue to enjoy our time with each other and our participation in those activities we love, she said.

The situation elsewhere in the United States is more concerning.

Nationwide, 297 counties have a high COVID-19 community level including those that are home to New York City; Long Island, N.Y.; Detroit, Honolulu; and Milwaukee, Wis. Other areas in the high category include large swaths of upstate New York, New Jersey, Delaware and New England, including Boston; northern and eastern Pennsylvania; and all of Puerto Rico.

In these areas, which are home to 18% of the nations population, federal health officials recommend people wear masks indoors while in public.

While they havent ordered a new mask mandate, officials in New York City warned that pressure on the healthcare system is increasing and urged seniors and others at high risk of severe COVID-19 to avoid gatherings and wear a mask in crowded outdoor settings.

Officials have said the the dramatic rise in coronavirus cases and hospitalizations in New York City is being fueled by BA.2.12.1, one of a family of Omicron subvariants spawned in the wake of last winters surge.

By comparison, 483 U.S. counties home to 28% of U.S. residents are in medium., while the vast majority 2,444 counties, home to 54% of U.S. residents remain in low.

As were currently seeing a steady rise of cases in parts of the country, we encourage everyone to use the menu of tools we have today to prevent further infection and severe disease including wearing a mask, getting tested, accessing treatments early if infected, and getting vaccinated or boosted, especially if youre over 50 and if your last dose was more than five months ago, Walensky said during a briefing this week.

Statewide, officials have reported an average of roughly 12,900 new coronavirus cases a day over the last week a 63% jump from the previous weeks average, according to data compiled by The Times.

In L.A. County, officials have reported an average of about 3,200 cases per day over the last week. Thats a level not seen since mid-February, when the region was still on the downslope of last winters Omicron surge.

And officials say these numbers likely fail to capture a large amount of infections, as many people are using at-home tests the results of which are not reliably reported to health agencies.

Test positivity remains low, but has been creeping upward. Over the last week, that metric has risen from 2.6% to 3.7% in L.A. County.

The seven-day statewide test positivity rate was 6%, according to the California Department of Public Health data made available Friday. Thats up from 3.1% at the start of the month.

As of Thursday, the number of coronavirus-positive patients hospitalized statewide was 1,708. While still significantly lower than at many other points during the pandemic, the count has jumped 28% just in the last week.

The rate of week-over-week increases in hospitalizations is accelerating. The previous statewide week-over-week increase was 19%.

In L.A. County, the most recent coronavirus-positive patient count was 401, an increase of 35% from a week ago. The prior week-over-week increase was 20%.

Many of those patients arent necessarily hospitalized for COVID-19, though. On Tuesday, L.A. County Health Services Director Dr. Christina Ghaly said most of those who were are hospitalized with a positive coronavirus test within the countys public hospital system were there for some other reason such as a heart attack or stroke and happened to incidentally test positive upon admission.

However, an increase in hospitalizations, Ferrer said, is an important reminder that, for many, getting infected with COVID-19 does pose a serious risk.

COVID-19 deaths remain stable and low at an average of about 38 per day statewide, according to data compiled by The Times.

Deaths are a lagging indicator of coronavirus spread and often dont rise until weeks after a region starts recording an increase in infections. However, officials have expressed some optimism that the widespread administration of vaccines and availability of therapeutics might blunt and potential uptick in fatalities.

Our hope is that as more people take advantage of the protections that continue to be offered by vaccinations and boosters, the daily deaths will remain low, Ferrer said.

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Another bummer coronavirus summer for California? Cases keep rising along with concerns - Los Angeles Times

Project overview

This study was carried out from August2020 to January 2021, with focus groups conducted from November to December 2020. We used principles of community-based participatory research (CBPR), an approach that draws on the strengths of diverse partners, shares resources, and fosters shared decision making and knowledge creation [26]. Aligning with this approach, we convened a community advisory board of 10 members with representation from healthcare systems, healthcare providers, growers, community health workers, and medical and premedical students that met monthly to oversee the project, facilitate relationship building, and offer advice. The leadership team also met regularly with partnering public health officials and healthcare leaders to discuss COVID-19 testing service delivery (e.g., location of testing sites, hours of operation) and the engagement of more vulnerable communities in testing services.

The larger project included three aims: 1) support the delivery of COVID-19 testing services, 2) broadly disseminate COVID-19 public health information, and 3) conduct research on perceptions of the coronavirus and COVID-19 testing and vaccination among Latinx/Indigenous Mexicans in rural agricultural communities in Inland Southern California. As reported elsewhere, the larger project was successful in carrying out Aims 1 and 2 of the study [27]. The teams leadership established access to routine COVID-19 testing for rural, immigrant communities partnering with a federally qualified health center and county public health to conduct 26 testing clinics providing approximately 1470 tests. Additionally, community health workers orpromotores de salud disseminated COVID-19 related public health information via social media, at COVID-19 testing events, and in-person socially distanced community talks. These efforts resulted in 22 virtual COVID-19 community talks (Plticas de COVID-19) livestreamed on our Facebook page @Unidoporsalud and 10 in-person COVID-19 community talks (Plticas en el Pueblo).

For the purposes of this article, we focus on the findings from our third aim involving research on the coronavirus and COVID-19 perceptions. Prior to the start of data collection, we obtained ethical approval for the study from the University of California Riversides Institutional Review Board.

Our study focused on the effects of the coronavirus pandemic amongst Latinx and Indigenous Mexican immigrant communities in the rural desert region of Inland Southern California. Our research was carried out in Riverside County, an area of California in which racial-ethnic minority populations have been disproportionately impacted by the pandemic. At the time of the study, Riverside County had the second highest number of confirmed cases and deaths in the state [28, 29]. There are over 2 million Latinos in Riverside County, a majority minority population that outnumbers all other racial and ethnic groups in the region [30,31,32]. Most Latinos are of Mexican origin, with smaller numbers of Puerto Ricans, Salvadorans, and Guatemalans, and Indigenous Nations [33]. Latinos in this region suffer health disparities due to low income and education, limited English proficiency, and undocumented status [34,35,36]. Unsurprisingly, the pandemic has severely impacted this population in the region: At research inception in fall 2020, which aligned with wave two spread of the coronavirus in California, county level data indicated the Latinx population accounted for 57% of COVID-19 cases and 46% of deaths in Riverside County [28, 29, 37, 38].

Our study focused on engaging Latinx and Indigenous Mexicans in rural agricultural communities in the eastern part of the Coachella Valley in Riverside County. The Coachella Valley, a 45-mile-long valley encompassing nine cities and rural agricultural communities, is an area of particular racial-ethnic disparity. This area is home to several vulnerable communities including the unincorporated rural communities of the Eastern Coachella Valley (ECV): Mecca, North Shore, Oasis, and Thermal, home to many Latinx and Indigenous Mexican immigrants living below the poverty line and working in the nearby agricultural fields. This region is home to the Purpecha community, an Indigenous Mexican population from the state of Michoacn [34]. At the start of the pandemic this region was identified as a hotspot, with some reports indicating a COVID-19 infection rate in the ECV 5 times higher than other Coachella Valley communities [39].

During the time of our study, these unincorporated rural communities (Mecca, North Shore, Oasis, and Thermal) consistently reported the highest rates of COVID-19 cases per 1,000 residents in the Coachella Valley. For instance, in September 2020 Thermal reported>130 cases/1,000 residents, which increased to>250 cases/1,000 residents in January 2021. This is significantly higher than case rates in Palm Springs (also in the Coachella Valley), which reported>20 cases/1,000 residents in September 2020 and>50 cases/1,000 residents in January 2021 [40].

This pattern of increased total confirmed cases of COVID-19 in these ECV communities continued throughout the study period. In September 2020, Mecca had 455 cases increasing to 1079 cases in January 2021; North Shore had 136 cases increasing to 331 cases; Oasis had 333 cases increasing to 826 cases; and Thermal had 185 cases increasing to 440 cases [40]. An increase in deaths due to COVID-19 accompanied the increased cases. In September 2020, Mecca had 9 reported deaths increasing to 16 in January 2021; North Shore had 1 reported death and remained stable; Oasis had 5 reported deaths increasing slightly to 6; and Thermal had 0 reported deaths increasing to 4 deaths [40].

During community advisory board meetings, meetings with partners (e.g., public health, healthcare leaders), and attendance at meetings with growers we made ethnographic observations and jotted down key discussion topics [41]. Team members reflected on these observations and used this information to inform the focus group interview guide and analysis and interpretation of the data.

Promotores de salud recruited community members into the focus groups by distributing study flyers with eligibility criteria and study contact information to individuals and families in their social networks. Eligibility criteria were met if a community member: 1) was 18years of age or older, 2) lived in the ECV and/or farm-working community along the Salton Sea, 3) self-identified as Latino/Hispanic, Latinx and/or indigenous from Latin America, and 4) spoke Spanish and/or Purpecha. Monolingual English-speaking Latinos and monolingual speakers of an indigenous dialect other than Purpecha were excluded from participation.

A focus group is a group interview that allows qualitative researchers to gather collective data about a specific phenomenon of interest. This method of data collection allows participants to build on each others ideas [42], providing collective (rather than individual) knowledge about the structural andsocio-cultural factors shaping perceptions of the coronavirus and attitudes and behaviors around COVID-19 testing and vaccination. From November to December 2020, we conducted seven virtual focus groups (of six to ten people each) to elicit information on sharedstructural stressors and socio-cultural factors shaping attitudes and behaviors around COVID-19 testing and vaccination. For nonprobability samples, 80% of themes can be identified within two to three focus groups and 90% within three to six focus groups [43].

Promotores de salud facilitated the focus groups with assistance from medical and pre-medical students. All facilitators received training on qualitative data collection and data analysis. Facilitators used a semi-structured interview guide with open-ended questions to elicit information on shared beliefs and attitudes around the virus, its spread, and COVID-19 testing and future vaccination, as well as risk-reduction behaviors such as social distancing and use of face coverings. We prompted discussion about themes emerging from our ethnographic observations and conversations with community members during public health outreach and testing events, including trust in public health officials, the government, and providers/healthcare systems, as well as strategies and tools to support those with COVID-19 and increase risk-reduction behaviors and use of COVID-19 testing services. At the end of all focus groups, participants were asked to complete a socio-demographic survey, either by using a link to a Qualtrics (online) version of the survey, or by having a team member administer the survey to them via phone.

Focus groups were conducted via Zoom video conference, audio recorded, transcribed, and analyzed using template and matrix analysis, a rapid qualitative analytic technique [44,45,46]. This technique involved summarizing all focus group transcripts using a template organized by the key topics of the semi-structured interview guide (template analysis). Key domains included: coronavirus, its spread, and ways to reduce virus propagation; attitudes and beliefs about COVID-19 testing, barriers to testing, and resources for people testing positive; and thoughts about COVID-19 vaccines and barriers to vaccination. A matrix was then created to organize the responses from each summary template (as rows) by key domains (as columns). Promotores de saludand students participated in a 2-part training on template and matrix analysis and led data analysis with support from experts in this analytic approach. Team members read transcripts line-by-line and inserted data, including illustrative excerpts from the interviews, in the templates. Next, a matrix (focus groupdomain) was created, and data from each template were inserted into the matrix. The matrix facilitated the identification of cross-case themes/patterns across the seven focus groups conducted.

Through this iterative process of theme identification and constant comparison across cases, we developed a conceptual model (Fig.1) grounded in the data that reflects the relationships among themes and their connection with COVID-19 testing and vaccination. We used exemplar quotes to substantiate these patterns. Participant quotes were translated from Spanish to English by the first author, a native English speaker proficient in Spanish. Graduate and PhD-level bilingual (SpanishEnglish) team members then checked participants quotes for accuracy and validated them.

Structural and Social Determinants of Health in COVID-19 Risk

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Perceptions of the Coronavirus and COVID-19 testing and vaccination in Latinx and Indigenous Mexican immigrant communities in the Eastern Coachella...

PITTSFIELD Why, we asked three local experts, did Berkshire County find its way this weekto the top of a national list for highest rates of COVID-19 by population?

Well, its because, they said.

Because once its here, the more highly transmissible omicron variant now circulating, with the shorthand BA.2, is easy to spread.

Because once here and spreading, the virus is staying for a while, increasing the number of those who test positive. So much so, in fact, that Berkshire County led all other Massachusetts counties for new COVID-19 cases per 100,000 population in a recent seven-day period.

Thats the essence of the propagation of a surge, said Dr. James Lederer, chief medical officer and chief quality officer at Berkshire Health Systems. Once a surge has established itself in a region, the higher transmissibility of the variant means one sick person is likely to expose four more people to the virus. Thats why we see more.

Dr. James Lederer, chief medical and chief quality officer at Berkshire Health Systems.

Because the state of Massachusetts, on Feb. 15, updated its face covering advisory to say, a little obliquely, that people who are fully vaccinated dont need to wear masks inside public spaces unless they have other health risk factors.

Because people are taking fewer precautions in gatherings, including a relatively chilly Easter that may have encouraged indoor gatherings.

Laura Kittross, public health program manager with the Berkshire Regional Planning Commission, says the public health nurses she works with report many new cases within families, including children too young to be vaccinated. It takes a while to run through a group, she said. I start to get worried when the hospitalizations go up.

As of Friday, Berkshire Medical Center had 22 inpatients with COVID-19, up from 20 on Wednesday.

Amy Hardt, the lead public health nurse with the Southern Berkshire Public Health Collaborative, says the rise of the BA.2 variant, and whats known as its daughter sublineage, is proving adept at getting past the protection of vaccination and even boosters, in some cases.

Amy Hardt, center, organizes rapid COVID-19 antigen tests as they are sent out in January to waiting cars at a drive-thru testing clinic organized by the Southern Berkshire Public Health Collaborative in Lee.

It means people arent as well-protected as they expect to be, she said. Were just kind of having a ratcheting up. Its no longer as many older people. Instead, many cases are affecting school-age children and young adults.

Transmission is almost a given, with the BA.2 variant and the lack of precautions, Hardt said. Theyre not masking. Theyre doing their thing.

Or as the public health people put it: Less mitigation and more exposure. Of 10 recent cases of COVID-19 reinfection in South County, all were 25 or younger and showed no symptoms or mild symptoms.

This week's appearance by Berkshire County at the top of a list isn't the first of its firsts. In early 2020, Berkshire Medical Center cared for Rick Bua of Clarksburg, the first inpatient with COVID-19due to community spread.

And then there are the because maybe answers to why.

Because maybe Berkshire County residents are using PCR tests, to some degree, more than residents of other U.S. counties, elevating it on rankings of new cases by population.

This week, Berkshire County rose to the top of a list generated by data collected by The New York Times, behind only counties in Puerto Rico and the Virgin Islands. It fell back the next day behind Middlesex County in Connecticut as having the highest number of new daily cases of the coronavirus per 100,000 population.

Because maybe fewer people who received the initial one- or two-shot vaccine regime have gotten boosters. And use of boosters, a recent study by the Boston University School of Public Health found, is lower in Massachusetts in less affluent counties. However, boosters aren't foolproof in protecting oneself from infection, officials note.

Because maybe the new omicron variant took hold in the Berkshires during the recent public school vacation week.

It certainly hasnt gone down, Lederer, the Berkshire Medical Center doctor, said Friday. In a more troubling sense, its staying very stable.

What does the future hold? Is this a long, drawn-out plateau? Are we going to start to see some resolution?

Dr. James Lederer, Berkshire Health Systems

Lederer wasnt alone among local experts in thinking even just a few weeks ago that the case rise Hardt described in a Facebook post as a possible blip would fade.

Today, Lederer admits he isnt sure what lies ahead for case numbers. What does the future hold? Is this a long, drawn-out plateau? Are we going to start to see some resolution?

Hardt said that in the past week, cases are off 1 percent in the groups 10-town service area. If the data shes now seeing holds up, its possible the area may have reached a peak in new fifth-wave cases.

Tests for viral particles in Pittsfield wastewater were down about 10 percent from May 11 to May 18, a finding that points to a falling off in new cases.

Thats another good indicator, Hardt said.

Lederer recalled the initial COVID-19 cases that hit the hospital in March 2020. Four people from northern Berkshire County who had attended a basketball tournament in Springfield all came down with the illness, becoming the first COVID-19 inpatients in Massachusetts and staying for months of care in serious condition.

This is not the same kind of disease, Lederer said of the current cases, compared to the initial wave.

Half of the 22 now being cared for at BMC with COVID-19 are incidental, meaning they came into the hospital for another reason and were found, through routine testing, to be positive.

Since the pandemic began in 2020, 380 deaths in Berkshire County have been attributed at least in part to COVID-19. That's up one since Tuesday. This month, the U.S. passed one million deaths.

Lederer said that while current COVID-19 cases can be dangerous for those with other health issues, the omicron subvariant is more like the kind of coronaviruses that moved through the population before the 2020 arrival of the novel kind.

By that he means the virus strains present are not routinely overwhelming peoples immune responses with devastating lung and respiratory ailments.

For the most part, it's more of a mild, ambulatory disease, he said.

But not in all cases. While the clinical condition of those hospitalized with COVID-19 is generally better that earlier in the pandemic, with no one no in intensive care as of Friday morning, some patients are still needing supplemental oxygen.

Were starting to see an uptick in the number of people who have significant respiratory complaints, Lederer said.

Kittross, the planning commissions public health program manager, said people need to make their own judgments about masking and social distancing. It makes sense, she said, to be tested before visiting an elderly relative.

Though the states Stop the Spread program has ended, people can arrange PCR tests by calling 855-BMC-LINK, or 855-262-5465, daily from 8 a.m. to 4:30 p.m. Callers can ask the BMC hotline whether their insurance will cover the testing.

Public sentiment may resist a return to mask use, in Kittross' view. I dont think there is a ton of tolerance for that any more.

I would remind people that if you can, wear a mask for a week or two," she said. "And try not to be inside with a larger group. Hopefully, in a couple of weeks. well start to see the cases go down.

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The why of COVID-19's 'fifth wave' in the Berkshires - Berkshire Eagle