Category: Covid-19

OSHA's emergency temporary standard (ETS) requiring healthcare employers to adhere to numerous regulatory requirements addressing COVID-19 was largely withdrawn in December 2021. On June 21, 2022, the U.S. Department of Labor (DOL) published its regulatory agenda forecasting that employers in healthcare settings can anticipate that the Occupational Safety and Health Administration (OSHA) will roll out permanent COVID-19 regulations in September 2022.1 It is expected that many, perhaps most, of the requirements in the ETS will be resurrected in the new final rule. Healthcare employers will be well-served to prepare now to ensure compliance later this year if OSHA, in fact, publishes its new final rule.

One year ago, OSHA issued the 900-page healthcare ETS, which will serve as a starting point for its forthcoming permanent COVID-19 healthcare regulations. The healthcare ETS required employers to develop and implement COVID-19 plans that included paid time off for vaccination, social distancing, personal protective gear, physical barriers, ventilation, patient and employee screening, employee training, recordkeeping and reporting. Although the ETS immediately went into effect, the bulk of the emergency regulation was withdrawn in December 2021 when OSHA was unable to meet the six-month deadline to complete a final standard.2

Nevertheless, OSHA strongly recommended employers continue to adhere to all of the terms of the healthcare ETS and has asserted that doing so will offer protection against citations under the General Duty clause, respiratory standard, and PPE standards as they relate to COVID-19. However, the only healthcare ETS regulations that actually remain in effect are the healthcare ETS's log and reporting requirements, found at 29 CFR 1910.502(q)(2)(ii), (q)(3)(ii)-(iv), and (r).

OSHA opened (and has completed) two comment periods on its proposed final rule and held public hearings on a broad range of topics, including the necessity of permanent standards, compliance with CDC recommendations, and the scope of healthcare workers to be covered. Although it is anticipated that the new permanent regulations will be based upon and have similarities to the healthcare ETS, there are also potential differences. By definition, OSHA can only authorize an ETS in limited circumstances in which workers are in "grave danger." Given that a permanent standard will not have such restrictions, it is possible that the new rule will be applicable (or more clearly applicable) to a broader scope of workers in nonemergency situations, such as home healthcare settings and embedded clinics at non-healthcare workplaces (e.g., a clinic at a manufacturing or processing plant). Additionally, OSHA's requested comments and public hearings suggest that the new, permanent healthcare regulations will not include a mandatory vaccination requirement for employees. OSHA also appears to be contemplating allowing more flexibility in implementing required policies in areas where healthcare employees do not encounter people with COVID-19.

Assuming the new regulations are issued in September, it is likely that legal challenges will ensue targeting specific provisions or the new regulations altogether. DWT will continue to monitor OSHA's progress on these regulations and any potential lawsuits, and provide updates as they occur.

The DOL's regulatory agenda also includes a potential infectious disease regulation for healthcare and other high-risk environments that was initially considered in 2010 and is now scheduled for proposed rulemaking in May 2023. OSHA indicates the prospective rule will address safety standards for COVID-19, among other infectious diseases, in workplace settings that include healthcare, emergency response, correctional facilities, homeless shelters, and drug treatment programs. OSHA would first publish a proposed rule, then allow a period for comments. More will be revealed over the next year.

OSHA's forthcoming healthcare regulations will apply immediately to states in which federal OSHA directly enforces the federal Occupational Safety and Health (OSH) Act and its regulations. But approximately half of U.S. jurisdictions, including California, Washington, Oregon, Alaska, and Virginia have state plans that OSHA has approved and, as such, are administered by local state agencies. Any new OSHA regulations will not immediately be enforceable in these "state plan" states. Subject to OSHA oversight and approval, these state plans must adopt rules within six months of the federal regulation's adoption that are either identical to or more protective of employee safety and health than any new federal regulation. Thus, although any new federal OSHA COVID-19 or infectious disease regulations may not immediately apply to healthcare employers in these state-plan jurisdictions, they or something similar to them (and possibly even more restrictive) may apply in short order.

1 In the ETS, OSHA broadly defined "healthcare setting" to include places where practitioners (e.g., doctors, nurses, and dentists) provided healthcare services and where individuals provided healthcare support services, such as patient intake/admission, patient food services, housekeeping, and medical equipment cleaning. However, the ETS included several exceptions, which limited the application to more traditional healthcare settings (e.g., hospitals). As discussed below, OSHA will have a greater ability to define healthcare setting broadly with a non-emergency regulation than it did with the ETS.2 The OSHA healthcare COVID-19 ETS is not to be confused with OSHA's general industry COVID-19 ETS. The U.S. Supreme Court blocked the enforcement of OSHA's general industry ETS on January 13, 2022, which ruling effectively killed the general industry ETS.

The facts, laws, and regulations regarding COVID-19 are developing rapidly. Since the date of publication, there may be new or additional information not referenced in this advisory. Please consult with your legal counsel for guidance.

DWT will continue to provide up-to-date insights and virtual events regarding COVID-19 concerns. Our most recent insights, as well as information about recorded and upcoming virtual events, are available at http://www.dwt.com/COVID-19.

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Final COVID-19 OSHA Regulation Covering Healthcare Employers Is on OSHA's Agenda for Issuance in September 2022 - JD Supra

More-viscous blood, which increases the propensity for clotting, is a sign that patients hospitalized for COVID-19 are more likely to do worse over the short term, according to data from a New York City health system.

The risk of in-hospital all-cause mortality increased along with rising estimates of blood viscosity, with patients with the highest estimates of high-shear and low-shear blood viscosity having 53% and 36% greater relative risks, respectively, compared with their counterparts with the least-viscous blood.

If you have elevated blood viscosity, high shear or low shear, those individuals are in an accelerated pathway for death, senior author Robert Rosenson, MD (Icahn School of Medicine at Mount Sinai, New York, NY), told TCTMD, noting that the relationship held true even after adjustment for many of the biomarkers that have been used to stratify risk in the setting of COVID-19.

Those individuals should be appropriately hydrated to decrease the plasma viscosity, they should receive high-intensity glucocorticoids to decrease the inflammatory response, and they should be monitored much more closely because of the prognostic significance of an elevated blood viscosity, he advised.

Ongoing studies are exploring whether additional interventions can improve the prognosis of patients with COVID-19 and high blood viscosity. In the meantime, Rosenson said that based on the results of a multiplatform trial published last yearfrom the REMAP-CAP, ACTIV-4a, and ATTACC investigatorstherapeutic-dose heparin, which provided a benefit in noncritically ill patients, can be recommended.

The findings of the current study were published online today ahead of the July 26, 2022, issue of the Journal of the American College of Cardiology, with lead authors Daein Choi, MD, and Ori Waksman, MD (both Icahn School of Medicine at Mount Sinai).

Integrating Inflammatory and Thrombotic Markers

COVID-19 is characterized by the presence of diffuse microthrombi, which can lead to organ dysfunction, long-term disability, and death, but what the infection is doing to increase clotting is not clear, Rosenson explained. Prior research has examined markers like D-dimer and fibrinogen to try to understand which patients are most at risk for thrombotic events, he noted.

Theres been a lot of disappointment regarding these biomarkers, and thats because the inflammatory process also results in upregulation of the genes and the pathways that manufacture these acute-phase proteins like fibrinogen, he said.

Blood viscosity is an integrative measure of all of these influences, and a prior study showed that directly assessed viscosity (using centipoise as the unit of measure) was higher in patients hospitalized for COVID-19 than in people without the infection and remained so for 2 months after discharge, Rosenson said. Direct measurement of viscosity can be challenging, however, and a method for estimating itthe Walburn-Schneck model, which incorporates routinely measured lab values like blood count, hematocrit, and globulin levelshas been developed.

Estimates using that method are what was done in the current study, which included 5,621 patients hospitalized for COVID-19 within the Mount Sinai Health System between February 27, 2020, and November 27, 2021.

This is definitely the first time that anyone has shown a prognostic role of estimated blood viscosity in COVID patients. Cheryl Maier

The researchers differentiated between high-shear and low-shear blood viscosity: the former applies to high-flow situations in medium and large arteries and has been associated with endothelial damage, whereas the latter applies to low-flow situations and is associated with the propensity for clotting. Every one-centipoise increase in high-shear and low-shear estimated blood viscosity was associated with a 36.0% and 7.0% increase, respectively, in in-hospital mortality (P < 0.001 for both).

Compared with patients in the lowest quartile of high-shear estimated blood viscosity, those in the highest had an elevated in-hospital mortality risk after adjustment for confounders (adjusted HR 1.53; 95% CI 1.27-1.84). The relationship tended to be stronger in Hispanics, patients with diabetes, and those without any comorbidities.

Similarly, patients with the highest estimated values for low-shear blood viscosity had a greater risk of in-hospital mortality compared with those with the lowest values (adjusted HR 1.36; 95% CI 1.14-1.64).

Other factors associated with a greater risk of mortality were levels of C-reactive protein and interleukin-6, although the relationship between high-shear blood viscosity and death remained significant even after accounting for these inflammatory markers.

As new emerging antiviral agents suggest benefits in patients at high risk of progressing to severe illness, identifying high-risk populations in the earlier stage of the disease becomes crucial, the investigators write. From a translational perspective, the variables to calculate estimated blood viscosity (hematocrit, albumin, and total protein) are readily available to practitioners and are easily obtained from most admission labs, suggesting a possible use of estimated blood viscosity as an efficient and simple risk assessment of patients with COVID-19 to offer proper preventive therapy.

Moreover, they write, further studies investigating the impact of targeted reduction of whole blood viscosity are merited given the association between estimated blood viscosity and mortality.

Potentially Major Implications for Patient Management

Commenting for TCTMD, Cheryl Maier, MD, PhD (Emory University School of Medicine, Atlanta, GA), said this is definitely the first time that anyone has shown a prognostic role of estimated blood viscosity in COVID patients. And its also really helpful to the field that they were able to do this from a calculated measurement, because one of the major limitations in doing [a direct] assessment of viscosity is that most healthcare settings just dont have the ability to do it.

A key question is around the mechanism that links more-viscous blood with mortality in the setting of COVID-19, Maier said. A feature that is unique to COVID-19 is just how high fibrinogen levels rise in response to the acute infection, and this would directly increase blood viscosity, she noted. But the explanation for how that might ultimately lead to the multiorgan microvascular damage seen with COVID-19 is still missing.

The answer to that question, and whether blood viscosity is a marker of disease or is directly mediating the disease course, will influence the clinical implications of these findings, Maier indicated. If its mediating the disease, it absolutely could have impact patient management, because we should have targeted therapies that decrease the viscosity rather than just some of these more-standard approaches that weve already been trying.

A lot of these patients are given anticoagulants, but some still develop thrombotic events, Maier pointed out. If we knew that the viscosity was directly causing those clots . . . then we could target the viscosity itself rather than just using typical anticoagulation. She noted that despite the fact that anticoagulants are commonly called blood thinners, they dont necessarily thin the blood and instead work by stopping the clotting cascade.

Maiers group has conducted a small trial evaluating plasma exchange as a way to lower blood viscosity in the setting of COVID-19, though she said further research would be needed to establish that reducing viscosity will improve patient outcomes before implementing changes to practice.

In an accompanying editorial, Aldo Bonaventura, MD, PhD (Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi, Varese, Italy), and Nicola Potere, MD (G. dAnnunzio University of Chieti-Pescara, Chieti, Italy), also say that additional studies are needed.

While still requiring adequateboth external and prospectivevalidation, estimated blood viscosity is likely to represent an attractive biomarker, as it was shown to be an early and robust predictor of mortality, and it is widely available and relatively inexpensive, they write. In light of the translational potential associated with [it], further investigation is eagerly warranted to confirm and expand the present findings, in order to advance estimated blood viscosity into the clinical scenario.

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Increased Blood Viscosity Tied to Mortality in Hospitalized COVID-19 Patients - TCTMD

Surveillance is a core tool of public health, fundamental to capturing the course of disease and the consequences of interventions. Alexander Langmuir, who founded the CDCs renowned Epidemic Intelligence Service (EIS), offered the still widely used definition of surveillance in a 1963 New England Journal of Medicine article: The continued watchfulness over the distribution and trends of incidence [of a disease] through the systematic collection, consolidation, and evaluation of morbidity and mortality reports and other relevant data.

Since its start, we have tracked the COVID-19 pandemic with indicators of infection, disease, and death. Case reports and outbreaks, like that on the Diamond Princess cruise ship, signaled the pandemics start. Surveillance mechanisms were quickly implemented, following the established paradigm of monitoring positive tests, cases and outbreaks, hospitalizations, and deaths. With this pandemic, advances in data sciences supported the successful implementation of valuable, encompassing national and global databases, such as the Johns Hopkins Coronavirus Resource Center. The tracking of virus concentration in wastewater has proved to be an informative addition to the surveillance toolbox.

An article in Fridays Denver Post addressed the decision by the Colorado Department of Public Health and Environment (CDPHE) to stop publicly reporting outbreaks in schools. The article quotes school officials who were surprised by the announcement and concerns about the implications of the change. CDPHE made the change to bring reporting of COVID-19 into alignment with how reporting for other respiratory pathogens is handled, part of the states plan for a return to normalcy. A change was made earlier to no longer post daily hospitalization count.

Langmuirs definition did not directly acknowledge that the relationships of indicators with the underlying public health problem may change over time. For COVID-19, that is certainly the case, complicating interpretation of trends over longer periods of time. The Los Angeles Times commented on this topic on Saturday. The case-fatality rate fell as clinical care improved over the pandemics first months; vaccination reduced the risk of severe disease and death as did the arrival of therapeutic agents, e.g., paxlovid; and the availability of home testing has undoubtedly affected reported case numbers and test positivity, as ascertained by public health agencies. The Colorado Modeling Group has used hospitalization count in its model to describe the pandemics course in Colorado and project where the epidemic curve is heading. Beginning around March of this year, the states hospitals stopped routine testing of all persons admitted. The hospitalization count had included persons admitted because of COVID-19 and persons incidentally found positive because of testing on admission. The modeling team now makes an adjustment for this change.

Surveillance remains critical for tracking the pandemic and trends in the established indicators in the shorter-term. The response to the change in reporting described by the Denver Post is reflective of how intertwined the pandemic has become in our lives. I still track CDPHEs dashboard, but no longer on a daily basis. And what does surveillance show for Colorado? Remarkably, the plateau at 300+ hospitalized Coloradans continues into its fifth week.

During the Lance Armstrong era, my wife and I became avid watchers of the Tour de France, which is in progress through this month. COVID-19 is affecting the race, sending some important riders home. So far, eight test-positive riders have left the tour, but two have been allowed to remain. Fellow tour afficionados are aware that the prospects of 2021 winner, Tadej Pogaar, have likely been harmed by the departure of two key team members.

What is the most sensitive way to track COVID-19 among riders and their support crews at the Tour? Testing protocols come from the Union Cycliste Internationale or UCI. They require pre-race testing and testing on rest days, and teams may do additional testing. A rule has been dropped that required any team with two or more riders testing positive by PCR in seven days to abandon the tour. The handling of riders (or other personnel) offers the possibility of keeping riders testing positive in the tour, as with two riders judged to have viral titers low enough to make them non-infectious and were allowed to remain in the race. This decision is left to the team physician, the tour COVID physician, and the UCI Medical Director. I am unaware of criteria for making such a decision, but I know that the race must go on.

Jonathan Samet, MD, MSDean, Colorado School of Public Health

Categories: Colorado School of Public Health | Tags: ColoradoSPH COVID-19 Dean's Notes ColoradoSPH Dean's Notes

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The COVID-19 Pandemic and More: Surveillance challenges, and the Tour de France and COVID-19 - Colorado School of Public Health

A Bay Area man says he tested positive for COVID-19 and was diagnosed with monkeypox at the same time.

Mitcho Thompson of Sebastopol said shortly after he tested positive for COVID-19 at the end of June and was feeling wiped out, he noticed red lesions on his back, legs, arms and neck.

"The doctor was very certain that I have monkeypox and that I had both," Thompson said. "That was the question. Could I get them at the same time? And he said, 'Yes, yes, yes.'"

Thompson said the one-two punch of viruses led to weeks of misery. He said he felt like he had a horrible flu.

"Really sick," he said. "And the worst of it was honestly where I just could barely get out of bed and you could barely even get a drink of water."

Dr. Dean Winslow, professor of medicine and infectious disease specialist at Stanford, said while it is rare, it is possible for someone to get both monkeypox and COVID-19 at the same time.

"It's certainly not impossible for that to occur," he said. "It's just incredibly bad luck. They are very different viruses."

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Bay Area Man Infected With COVID-19, Monkeypox at the Same Time - NBC Bay Area

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Bacterial and fungal isolation from face masks under the COVID-19 pandemic | Scientific Reports - Nature.com

Fourth of July gatherings and travel are associated with a rise in COVID-19 numbers in Hidalgo County, according to Health Authority Dr. Ivan Melendez.

Dr. Melendez believes most of the cases are caused by mutations of the omicron variant known as B.A.4 and B.A.5.

The reason that we believe that its this particular variant is because of the pattern of which it follows, Dr. Melendez said. So, it follows the pattern of easy infectability, not as many people in the hospital as before.

Melendez explains that mutations of the B.A.4 and B.A.5 variants cause the virus to spread rapidly.

The variants have one, the ability to penetrate the host cell much better because they're easier to attach to it, Dr. Melendez said. Two, theyre able to hide from the immune system because theyve changed so much that the immune system doesnt recognize it.

Health experts say while it spreads easier, it doesn't appear to cause serious illness. Dr. Melendez says most of the people whove been hospitalized have either never been vaccinated or are not up-to-date on their vaccinations.

So, if youve not been updated in six months and you have risk factors, absolutely, that's what we're seeing in the hospitals."

Dr. Melendez says this wont be the last time the county sees an increase.

We expect a continued increase as we get closer to the winter months, so the only thing that you can do to keep you out of the hospital and to keep you from dying is pay attention and be vaccinated, Dr. Melendez said.

Dr. Melendez said a lot of hospitalized COVID-19 patients aren't coming in because of the virus. Rather, they're coming in for underlying issues and are not getting better because they have COVID-19.

The county's next COVID-19 report is expected to be released on Tuesday.

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COVID-19 hospitalizations up after 4th of July in Hidalgo County - KRGV

Nearly 9 in 10 Californians now live in counties with a high COVID-19 community level, in which the U.S. Centers for Disease Control and Prevention recommends universal masking in indoor public spaces.

The new developments underscore the increasing concerns about super-infectious subvariants of Omicron that have fueled a summer coronavirus wave.

With the coronavirus resurgent and cases and hospitalizations on the rise, Los Angeles is poised to become the first Southern California county to reinstate mandatory public indoor masking.

L.A. County officially entered the high community level Thursday. Should it remain there for the next two weeks, the county will reissue an indoor mask mandate with an effective date of July 29.

No other California county has publicly tied its placement on the CDCs community level scale to a renewal of masking orders. Along with L.A., 41 other counties are in the high level as of this week.

Most places recommend, but do not require, masking indoors while in public.

Besides Los Angeles County, the other counties that on Thursday entered the high COVID-19 community level category for the first time since mid-March are San Diego, Orange, Santa Barbara, Imperial and Tehama.

A total of 42 of Californias 58 counties are now in the high COVID-19 community level, in which 87% of Californias residents live. Just a week earlier, 41% of Californians lived in the 34 counties with a high COVID-19 community level.

Ventura County was the first Southern California county to enter the high COVID-19 community level, which it did on June 30.

With case rates high, counties are generally entering the high COVID-19 community level when hospitalizations are exceeding a threshold of 10 new weekly coronavirus-positive hospitalizations for every 100,000 residents.

(There is also another threshold to enter the high COVID-19 community level based on the percentage of staffed hospital inpatient beds occupied by COVID-19 patients but counties are generally hitting the other threshold first.)

The U.S. Centers for Disease Control and Prevention in February said it chose these measures as a threshold to enter the high COVID-19 community level because it provided a good predictor of deaths, new hospital admissions and use of intensive care units.

The system was set up as a way to help inform people when it was relatively more important to mask up in indoor public settings. Layered prevention strategies like staying up to date on vaccines and wearing masks can help prevent severe disease and reduce strain on the healthcare system, the CDC said in February.

The California Department of Public Health has strongly recommended universal masking in indoor public spaces for those age 2 and above ever since the state lifted a two-month-old mask order in February.

Coronavirus case rates in Los Angeles County are continuing to rise at a fast pace.

L.A. County is now averaging about 6,800 new coronavirus cases a day, representing a 35% week-over-week increase. Thats the highest week-over-week increase seen since the days leading up to the Memorial Day weekend.

The latest rate is higher than the peak seen in last summers Delta wave, which rose to 3,500 cases a day. Last winters Omicron wave peaked at 42,000 cases a day.

On a per capita basis, L.A. County as of Friday was reporting 469 coronavirus cases a week for every 100,000 residents; a rate of 100 or more is considered high. The coronavirus case rate hasnt been this high since early February.

A renewed mandate for Los Angeles County would apply indoors for those 2 and older at a familiar host of establishments and venues including shared office space, manufacturing and retail settings, event spaces, restaurants and bars, gyms and yoga studios, educational settings and childrens programs.

Importantly, though, masks would not be required for those using outdoor spaces, as the risk of transmission in those settings is significantly lower than it is indoors.

Patrons also would be able to take off their masks indoors when actively eating or drinking.

We are not closing anything down. We are not asking people not to gather with the people they love. We are not asking you to forgo activities you love, Los Angeles County Public Health Director Barbara Ferrer said last week. Were asking you to take a sensible step when theres this much transmission, with a highly transmissible variant, to go ahead and put back on a well-fitting, high-filtration mask when youre indoors around others. And I think thats the prudent thing to do.

The new wave has been fueled by BA.5, a super-infectious subvariant that has shown the ability to reinfect even those who recently contracted an earlier Omicron subvariant.

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9 in 10 Californians live in areas with high COVID-19 levels - Los Angeles Times

LITTLE ROCK, Ark. According to data from the Arkansas Department of Health, the Natural State currently has 1,172 new cases of COVID-19 as of Saturday.

The data from the ADH shows that there are currently 885,987 total cases of COVID-19 in Arkansas and 16,483 active cases, which is up 286 from Fridays data.

There have been four deaths added to the states total since the beginning of the pandemic, which brings the number to 11,633.

Currently 402 Arkansans are hospitalized with COVID-19 which is up one from Friday. In addition, there are 69 Arkansans in the intensive care unit and 16 on ventilators.

The current number of vaccine doses given out to Arkansans is currently 4,247,516 since the start of the pandemic.

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Active cases of COVID-19 continue to rise in the Natural State - KARK

A 360 Clinic health care worker conducts testing at the drive-through COVID-19 testing super site on Nov. 12, 2020, in Costa Mesa, California. Many official government testing sites have now shut down as more testing is being done at home across the country. (Allen J. Schaben/Los Angeles Times/TNS)

LOS ANGELES In Sherman Oaks, Julia Irzyk tries to gauge how rampant the coronavirus is in her community, turning to a constellation of data points to guide her.

I have very little confidence that I would survive COVID, said Irzyk, who is more vulnerable to the coronavirus because she has lupus and other health conditions.

So Irzyk keeps track of hospitalizations and deaths. She checks data from wastewater monitoring that predicts spikes in the coronavirus. Recently, troubled by what she was seeing in the numbers, she told employees at her talent agency to stop coming to work in the office.

But she puts little stock in one of the simplest numbers regularly shared by health officials: how many COVID-19 cases are being reported.

Those official figures are relatively worthless at this point, said Irzyk, who authored a book on disability and the law. Positive tests are being discovered through home testing and theyre not reported to anyone.

The boom in home testing for the coronavirus has meant that health officials never hear about many COVID cases, deflating official counts.

Federal funding to test uninsured patients also dried up this spring, pinching the availability of free testing for some Americans. California has sought to continue providing testing for uninsured people through its own programs.

But official testing has nonetheless fallen off as states reckon with the rapid spread of the BA.5 subvariant.

At the University of Washington, researchers who test blood to assess the true level of infections have estimated that only 14% of cases are being reported across the United States. Testing has never captured the full spread of the coronavirus, but the figure is much lower than in some earlier points in the pandemic, when more than 40% of cases were once estimated to be detected.

Even the cases that are being detected are not being reported as frequently as they used to be, said Ali H. Mokdad, professor of health metrics sciences at the universitys Institute for Health Metrics and Evaluation. In many states, many counties, its only once a week.

Between the rise in home testing that goes unreported, budgetary reductions in testing services, and mild or asymptomatic infections going unnoticed, we dont really know how many cases we have, said Dr. David Dowdy, an infectious-diseases epidemiologist at the Johns Hopkins Bloomberg School of Public Health.

Public health officials can still piece together what is happening with other data, but the challenge is that you want your public health systems to develop responses that are based on these sorts of metrics, Dowdy said. As these metrics become less reliable ... youre left with going back to what it was before, which is just kind of a general sense of where things are headed.

As the pandemic has persisted, experts have turned to a range of metrics to assess how the virus is spreading and what toll it is taking. During the Omicron wave this past winter, some health officials argued that the sheer number of cases was less important than how many of them led to severe illness, as reflected in hospitalizations and deaths.

But infections remain an important metric for anyone trying to avoid them. If government officials are trying to prevent hospitals from being overwhelmed, it makes sense to focus on hospitalizations, Dowdy said.

Gauging personal risk, however, can be very different. Even if hospitalizations are not especially high, for those people who are at risk, those who are older, those who have compromised immune systems, the risk now is very high because of the high level of transmission thats out there, Dowdy said.

When COVID cases go uncounted, people think that it is safer to do activities that are not as safe to do, for people who are still trying to avoid infection, said Dr. Abraar Karan, a fellow in the Division of Infectious Diseases and Geographic Medicine at Stanford University.

As they try to calculate the costs and benefits of different activities, when people dont realize how much spread there is, they dont know what the true potential cost is, Karan said. People now may be doing things that they dont realize are going to put them at high risk of getting infected and infecting others.

Another concern is the risk of long COVID, in which symptoms can persist for months or years even after an initial illness that was relatively mild. Scientists have differing estimates of how common the condition is, but if massive numbers of people are infected, even estimates in the lower range would result in high numbers of patients with enduring symptoms.

Despite concerns about many COVID cases not being reported, L.A. County Public Health Director Barbara Ferrer said that because we triangulate data from wastewater, emergency departments and reported test results, we feel confident that we have a decent grasp on the level of spread across the county.

Ferrer has said that if current trends of rising hospitalizations continue, the county could reinstate a mask mandate for indoor spaces by the end of July.

We dont have to count every case to understand whats happening in our communities, said Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. Whats important is to understand the general trend of how cases are changing.

You have to assume right now that COVID particularly BA.5 is widespread in our communities everywhere. The bottom line is, extensive transmission is going on right now. Osterholm likened it to assessing the speed of a car as it passes. I couldnt tell you the difference between 80 and 120 miles per hour I just know its going really fast.

The virus is spreading rapidly as U.S. residents have expressed decreasing concern about getting seriously ill or infecting others: As of May, the percentage of Americans who said they were concerned about being hospitalized for COVID had fallen to its lowest level since the Pew Research Center began asking the question early in the pandemic. So had the share of people worried about unknowingly infecting someone else.

The fact that we dont have mask mandates also makes people think, Well, its not that serious, because otherwise we would have mask mandates the danger must be less, said Dr. Sherrill Brown, medical director of infection prevention at AltaMed Health Services.

L.A. County public health officials have continued to strongly recommend wearing masks, especially well-fitting respirators such as N95s and KN95s, in indoor settings. But when we made it a strong recommendation, virtually nobody did it, County Supervisor Sheila Kuehl said at a meeting this week.

Irzyk said that right now, its not like I could be a lot more cautious than Im being. The 44-year-old is not eating in restaurants or gathering in groups. Her husband gets their groceries by curbside pickup. She hasnt been on an airplane since before the pandemic and cant imagine doing so anytime soon.

Because few other people are wearing masks in her office building, she gets anxious about taking the elevator up to her office, where she still goes twice a week to issue paychecks to her employees. Even a neighbor in the office building who was made aware of her medical condition has stopped bothering to wear a mask around her, she said.

Brilliant people, experts in their fields, are emailing me asking what my dad says they should do on COVID, because they dont trust anybody else, said Irzyk, whose father, Mark Rothstein, is a public health and bioethics expert. We are just doing a terrible job at messaging.

Rothstein, who in the past served as public health ethics editor for the American Journal of Public Health, argued that unless the rate of new infections is slowed, were always going to be on this treadmill of new variants.

And as more cases have gone unreported, its harder for public health officials to make decisions about masking and other protective measures that can be justified with such data, where you can say, Look, weve gone from Point A to Point B and weve crossed a line that is very important, Rothstein said.

Osterholm, in turn, contended that the number of unreported cases has little consequence for whether such government actions are embraced by the public, because the public has come to the conclusion that theyre done with the pandemic, even if the virus isnt done with them.

Karan said that with a constantly evolving pandemic, its hard even for experts to synthesize the many factors that have shifted in assessing the reach and risk of the coronavirus over time, including the emergence of new variants and subvariants. I dont think that people in the general public are going to have any idea how to analyze a lot of this, he said.

Telling people to make these risk assessments is not going to work for many reasons, Karan said, including that theres too much data thats coming out all the time.

Instead, Karan argued that health officials need to be pursuing community mitigation measures such as upgrading ventilation and air filtration in public spaces to reduce the spread of the virus. Individual efforts will only get you so far, he said, when you have something thats spreading this fast.

Here is the original post:

Just how big is this COVID-19 surge? As reported tests fall off, it's harder to say - Anchorage Daily News

A crew member on theJewel of the Seas informs me that the Royal Caribbean cruise ship has a total of seventy-three (73) COVID-19 cases on the ship. There are fifty-seven (57) guests who tested positive for the virus and sixteen (16) crew members. The hotel director is also positive for COVID-19.

TheJewel left port in Amsterdam on Thursday July 14, 2022, on a twelve day cruise to ports in Scotland, Ireland, England, Wales, and Guernsey Island. She is scheduled to return to Amsterdam on July 26, 2022.

We last reported on COVID-19 cases on the Jewel of the Seas on July 2, 2022 when the ship was leaving on her last cruise and had seventy-nine COVID-19 cases amongst guests (61) and crew members (18).

Seventy-Nine (79) COVID-19 Cases on the Jewel of the Seas

Despite the efforts of the cruise lines and travel agents to convince the public that its safe to go on a cruise ship, the truth is that the vaccine-resistant BA.4 and BA.5 variants of COVID-19 are spreading around the world, including not only the U.S. but in Europe. In the U.S., according to the COVID-19 Disease Cruise Ship Dashboard, the Centers for Disease Control (CDC) indicates that of the 95 cruise ships monitored, 100% are orange. Zero are green.

In US, according to @CDCgov COVID19 Cruise Ship Dashboard, of the 95 cruise ships monitored, 100% are orange. Zero are green. This is first time CDC has concluded that all #cruise ships sailing from US ports have 0.3% or more of total passengers and/or crew positive for COVID. pic.twitter.com/1wsfcCUSIo

James (Jim) Walker (@CruiseLaw) July 16, 2022

To our knowledge, this is the first time that the CDC has concluded that all cruise ships sailing from U.S. ports have 0.3% or more of total passengers and/or crew positive for COVID.

Unfortunately, neither the CDC not the cruise lines will make the number of infected passengers and/or crew members public knowledge. This is a public disservice.

From information that we receive regarding the Jewel of the Seas from crew members and other sources, it reasonably appears that all cruise ships probably have an average of 75-150 infected guests and crew at any given time.

If you are aware of a COVID-19 outbreak on a cruise ship, please alert us and we will get the word out.

Have a comment or question? Please leave one below or join the discussion on our Facebook page.

Image credit: Jewel of the Seas Dave souza CC BY-SA 2.5.

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Jewel of the Seas - 73 COVID-19 Cases / For the First Time, 100% of Cruise Ships From U.S. Ports are Orange on the CDC's COVID-19 Dashboard - Cruise...