A few Saturdays ago, a charming teacher asked Katherine Palmer, 64, on a date at a local tavern. After a year of staying six feet apart from others, meeting up outside and wearing face masks, spending time with someone in person made her nervous at first. However, as she she started to relax into the date, she began to realize something else: they were hitting it off. Now that she’s fully vaccinated, she says, she’s ready to put her worries aside and put herself out there. Palmer says the pandemic made her recognize that, when it comes to finding love again, there’s no time to waste. “When your husband dies, you realize life is short,” she says. “That part was definitely missing: to have somebody by your side during a pandemic that you could talk to and, you know, tell them, ‘I’m afraid about what happened today,’ and they would console you. I missed all that with my husband not being here…So maybe I want another one.” Pandemic-era dating has been hard for pretty much everyone, but it’s been a particular challenge for older people, who are at higher risk of severe COVID-19. Many older people have changed their lifestyles accordingly over the past year—people over 60 were the most likely to practice measures that limit the spread of the virus, including physical distancing, avoiding crowds and canceling social activities, according to an Oct. 2020 survey from the U.S. Centers for Disease Control and Prevention. When vaccines became available in the U.S. starting late last year, older residents were among the first allowed to join the line, and, broadly speaking, they jumped at the opportunity. They’re now more likely than younger people to have at least partial protection; as of April 26, more than 80% of U.S. residents over 65 were at least partially vaccinated, compared to just 32.5% of people between 18 to 29. And vaccination has enabled many older people who have spent the year in relative isolation for fear of contracting the virus to throw themselves back into a fulfilling social life—including dating. Palmer, who received her second vaccine in early April, says her social calendar is already full again. However, she may not be playing the field for as long as she expected: the teacher impressed her with his bluntness, fun-loving spirit, and respect for her caution towards COVID-19. As their first date was going well, he turned to her and said, “Full disclosure: I had COVID in July.” “Oh, really?” she responded. “And I was vaccinated. And you are vaccinated,” he continued. “So, can I kiss you tonight?” “Okay, I see where this is going now. Yes, you can,” she said. (They did). Even then, she admits, it all felt strange. During the pandemic, she says, “you don’t kiss people, you don’t touch people. You know, it’s just so weird to have the shot and now have that freedom.” For some older singles, like Marianne Mohr, who’s in her 60s, the pandemic has become a useful way to gauge whether a prospective date is a good match. If someone she connects with online suggests they haven’t taken COVID-19 seriously, Mohr doesn’t bother meeting up with them regardless of their vaccination status, because it’s a sign that they don’t share her values. The pandemic “made me be more discerning,” says Mohr. Todd Omohundro, 60, says that as a very outgoing person, things in life used to “fall into [his] lap.” During the pandemic, however—and after a difficult shoulder surgery in November—he found himself getting increasingly lonely and depressed. As he recovered, he decided to take dating more seriously, even hiring a matchmaker. He says that he’s found even more confidence now that he’s vaccinated. “Honestly, it was part loneliness, part desperation,” says Omohundro. “We’ve all heard those amazing stories of people passing on all over the world, isolated from any loved ones at all. And wow, you know, that iconic image we have of being at the very end of our life and being surrounded by loved ones, and you know, the family dog. I don’t want to die from COVID by myself.” Ann Maas, 63, says that since mass vaccination began, she’s seen a growing interest in dating through her business taking people’s photos for their online dating profiles. It’s nice, she says, to see people get themselves cleaned up to get back out there. “The COVID beard and COVID extra weight does not help these men,” says Maas. “And so many women have these huge chunks of gray and colored hair. And so so many people need to get fixed up and be able to go back to their hairdressers before they go dating again. You know, so it’s not just the dating, it’s the prep for dating.” Many older single people, including 82-year-old Jim Byrne of Connecticut, are optimistic that it will be easier to meet people now that people are getting vaccinated and the gloom of the pandemic is starting to lift. Byrne says he’s happy to see that people are going out more, and as an actor, he’s looking forward to meeting new people once the local community theater scene gets going again. He says he’d love to meet a woman who likes to have fun—and maybe take a ride with him around Connecticut on his scooter. “At my age, et cetera, I’m not looking for anything serious-serious, you know, like proposing to a woman and getting married. I’m not interested in that at all. Most people my age are not looking for a long-term mate. They’re just hoping to stay alive long enough to have a little enjoyment,” says Byrne. “But you know, a good friend that you can go out and enjoy life with and have fun and, you know, be a little romantic. I’m a sentimental slob.” from https://ift.tt/3nBlyn4 Check out https://takiaisfobia.blogspot.com/
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Now that every American adult is eligible to get vaccinated, vaccine makers are shifting their priorities to meet the changing needs of people will need to be vaccinated in coming months. On April 29, Pfizer-BioNTech announced that it will begin shipping smaller packages of its COVID-19 by the end of May. Currently, the companies’ vaccine comes in packs of 195 vials, each of which contains about six doses of vaccine, for a total of around 1,100 doses. That size is useful for the mass vaccination centers that have been the focus of the U.S. vaccination program so far, with their goal of immunizing hundreds or even thousands of people a day. But it’s actually prohibitive for smaller doctors’ offices and pharmacies, which might be able to only vaccinate a few dozen people a week, no matter how many doses they have on hand. The company’s new packs will contain three containers of 25 vials each, for a total of 450 doses. The outer shipping container, which can serve as a temporary ultra-cold freezer at temperatures of around -70°C for the vaccine as long as it is replenished with dry ice for up to 30 days, will remain the same. “We’re hoping this solution will enable channels like doctor’s offices where 1,100 doses may be too much quantity, to have something they can use,” says Tanya Alcorn, vice president of the biopharma global supply chain at Pfizer. The companies are working on other approached to making their vaccine more easily distributable. For example, they are hope that by the end of this year, they will have a version that won’t require mixing at the vaccination site. Currently, technicians have to mix the doses in the vials with a dilutant; a ready-to-use version of the vaccine could further expand the vaccine’s utility globally in places where such expertise isn’t available. And like Moderna, which just recently reported it has begun testing a version of its vaccine that doesn’t need to be frozen (and could be stable at refrigerated temperatures for up to three months), Pfizer-BioNTech scientists are developing a version of their vaccine that can be shipped and stored at refrigerated temperatures. Alcorn says those studies are ongoing and if all goes well, the companies may have a vaccine by early next year for the U.S. Food and Drug Administration to review. from https://ift.tt/331FRR3 Check out https://takiaisfobia.blogspot.com/ Moderna Is Testing a New Version of Its COVID-19 Vaccine That Wouldnt Require Ultra-Cold Storage4/29/2021 As safety concerns over COVID-19 vaccines from AstraZeneca and Johnson&Johnson–Janssen have led to disruptions in the inoculation efforts of numerous countries relying on those shots, companies like Moderna are attempting to fill the resulting gaps. The Massachusetts-based biotech company announced on April 29 that it is investing billions to boost manufacturing facilities in Switzerland, Spain and the U.S., building enough capacity to produce up to 3 billion doses of its mRNA-based vaccine through 2022. The company’s vaccine technology differs from that of AstraZeneca and J&J, which both use an adenovirus to deliver COVID-19 virus genes to the immune system—and which both have been have been associated with serious, life-threatening—albeit very rare--blood clots. Stephane Bancel, CEO of Moderna, says that some of the wealthier, developed countries are eager to up their orders of the mRNA vaccines (which include both the Moderna shot and one produced by Pfizer/BioNTech). “In the last month or so, in the discussions we have had with heads of state, prime ministers, presidents of countries and health ministers, when governments look at efficacy, safety, manufacturing scalability, and the speed to the next generation of vaccines, what we are hearing loud and clear is that mRNA is the best for the problem at hand,” says Bancel. “And governments around the world want more and more mRNA product.” To meet that need, and the needs of facilities in less-resourced countries that don’t have the freezer capabilities required to store the company’s vaccine currently, Bancel says that his scientists are studying a new version of the Moderna vaccine that won’t need to be frozen, and instead would simply need to be kept under refrigerated conditions for up to three months. Right now, it can only be stored at those temperatures for one month after the doses are thawed from their frozen storage temperature of about -20°C (14°F)—which requires special equipment that is not widely available. If the studies show the new vaccine could be stable and efficacious at refrigerated temperatures, that could increase the number of places that could vaccinate with Moderna’s shot. “We played with a couple of key technological decisions and it is indeed a very different product,” says Bancel about the refrigerated version, which the company has just started testing in people. That means efficacy data won’t be available until the end of summer at the earliest; the company is working with the FDA to figure out what the authorization process would look like for that vaccine. Meanwhile, the company is also studying three new versions of its COVID-19 vaccine to address viral mutations. One is specifically designed to protect against a more infectious variant of the virus, B.1.351, first identified in South Africa. The current Moderna vaccine has been shown in studies to bestow sufficient protection against this variant, but that protection is slightly lower than that provided against the original viral strain, and Moderna researchers are testing if the new shot activates a stronger immune response against the B.1.351 variant. Studies in animals are promising and human studies have just begun, so by early fall, says Bancel, “we expect the data [for the new vaccine] in humans to be as strong as what we saw last year with the current vaccine.” The Moderna team is also testing whether a third shot of its currently authorized vaccine—at a lower dose than the first and second shots—could be effective as a booster, to increase protection against variant strains. And finally, the company is also testing a vaccine that combines the original vaccine with the new one against the South African variant. Looking ahead, some public health experts believe controlling COVID-19 may require regular vaccinations, similar to flu shots, to maintain immune protection. Anticipating that, Moderna scientists are also working on a combined flu and COVID-19 shot that would protect people against both respiratory diseases. from https://ift.tt/3t33uU6 Check out https://takiaisfobia.blogspot.com/ How the Closure of In-School Learning Damaged U.S. Childrens Mental Health During the Pandemic4/29/2021 Nobody ever believed the pandemic would go easy on children. The virus might target them less directly than it targets older people, but other challenges—the loss of school, the loss of play, the loss of time with friends—would exact their own emotional toll. A study published April 29 in JAMA Network Open sheds light on how serious that harm has been. The work, led by psychologist Tali Raviv at Northwestern University, involved a survey of more than 32,000 caregivers looking after children from kindergarten to grade 12 in the Chicago public school system. The definition of “caregiver” was broad, including parents and grandparents as well as anyone 18 or older with principal responsibility of caring for children in a household. The sample group of the families was ethnically and racially diverse—39.3% white, 30.2% Latinx; 22.4% Black; and 8.1% mixed. The pivot point of the research was March 21, 2020: the day that in-person instruction ended in Chicago public schools and home-schooling began. Raviv and her colleagues asked each caregiver to rate the children they were looking after on how they exhibited 12 different traits in the time before the end-of-school date, and in the time after (the surveys themselves were filled out between June 24 and July 15): The results were striking. On every one of the negative traits the overall scores went up, and on every one of the positive ones, there was a decline. Some were comparatively small shifts: Talking about plans for the future fell from 44.3% to 30.9% (a change of 13.4 percentage points); positive peer relationships declined from 60.4% to 46.8% (a 13.6 percentage-point drop). But in other cases the change was more dramatic. Just 3.6% of kids overall were reported to exhibit signs of being lonely before the schools were shuttered and 31.9% were that way after, a massive shift of 28.3 percentage points. Only 4.2% of children were labeled agitated or angry before the closures, compared to 23.9% after, a jump of 19.7 points. A small number of the children studied, Raviv says, improved over the before-and-after period. “About 7% actually benefited” from the shift to in-person learning, she says. Self-harm and suicidal ideation, for example, declined from 0.5% to 0.4% among Black children, and from 0.4% to 0.3% among Latinx kids. “Maybe school was a stressful place and remote learning was good for them.” But that’s not at all the case for most kids and, as with so many things, race, ethnicity and income play a role, though in this case it was Black and Latinx children generally faring better than whites, instead of the other way around. Overall, the figure for the “loneliness” characteristic was 31.9% post-school closures, but it broke down to 22.9% among Black kids and 17.9% among Latinx, compared to 48.4% among whites. Since all three groups clocked in at just over 3% before in-class learning ended, the resulting increase in loneliness was much higher among whites. On the “hopeful or positive” metric, 36.4% Black kids exhibited the traits, compared to 30.7% in Latinx households and just 24.6% among whites—a decline in all three cases, but a more precipitous one among whites who were down from 55.7%, compared to 40.2% for Latinx kids and 49.8% for Blacks. The explanation, Raviv suspects, could be that the greater level of privilege whites generally experience left them less prepared to deal with the hardships of the lockdowns when they came around.”It may have been more unusual for white families to have to cut back,” she says. “For some lower-income people it might not have been that much of a change.” But Black and Latinx families suffered in other ways. Across the board, they were more likely to have a family member who contracted COVID-19; to have lost a job, lost a home, lost health insurance; to have difficulty getting medicine, health care, food, and PPE. Even if the Black and Latinx children’s change in overall mental health as tabulated in the study was less severe than that of white kids’, they experienced hardship all the same. “They were more likely to see these additional stressors,” says Raviv. Going forward, Raviv and her colleagues write that the pandemic can be something of a teachable moment for educators, clinicians, and policymakers. The research, they say, points to the need for a renewed commitment to better mental health care—especially access to telehealth; improved access to school- and community-based mental health services; improved funding for communities in need; and a better effort to eliminate structural inequality. The pandemic, eventually, will end. The emotional pain kids in every ethnic group have sustained could stay with them for a long time to come. from https://ift.tt/32X77Qz Check out https://takiaisfobia.blogspot.com/ It’s easy to forget that the U.S. Food and Drug Administration (FDA) only gained the ability to regulate tobacco products in 2009, given how much it has done in the following decade-plus. In recent years, the FDA has enacted a series of regulations that have significantly shaped the ways in which Americans buy and consume nicotine. In the last two years alone, the FDA has banned the sale of many flavored e-cigarette products and, following legislation issued by the Trump Administration in late 2019, began enforcing a new federal minimum age for tobacco sales, up to 21 from 18. A policy originally proposed in 2017 by then-FDA Commissioner Dr. Scott Gottlieb—a cap on the amount of nicotine in cigarettes, meant to make them less addictive—is now once again under discussion. And, as FDA officials announced on April 29, the agency will soon ban all favored cigars and all menthol cigarettes, the only flavored combustible cigarette products still available for sale in the U.S. The FDA ban must still go through a rule-making process and so may not take effect for years. Even still, the policy fits into a new era of U.S. tobacco regulation—one that has already and will continue to clear the market of many tobacco products, from flavored e-cigarettes to menthol cigarettes [and cigars, if this happens too CKCK] and, maybe someday, cigarettes with enough nicotine to be addictive. Many public-health groups say that approach is appropriately aggressive, given the nearly 500,000 Americans who die each year from smoking-related disease. The FDA’s policies have, however, earned it plenty of critics. Some lawmakers, as well as nicotine industry supporters and harm reduction advocates, consider the recent federal approach prohibitionist and draconian. And some unexpected adversaries, including civil rights groups, fear the FDA may be setting the stage for discriminatory policing practices with a new list of banned products. The FDA’s menthol ban comes eight years after a citizen petition calling for such a move. Many public-health groups have for years vocally opposed the sale of menthol cigarettes, arguing that menthol’s cool mouthfeel and minty flavor makes cigarettes more palatable and appealing, particularly to young people. Cutting off access to menthol products, they contend, could dissuade some people from smoking, further lowering rates of addiction and tobacco-related disease. Some civil rights groups have also called for a menthol ban, given cigarette companies’ long history of targeting menthol cigarette advertising toward Black communities. Today, according to U.S. Centers for Disease Control and Prevention data, Black adults are more likely than non-Black adults to smoke menthols, and roughly 70% of Black youth who smoke combustible cigarettes choose menthols. “The predatory marketing of menthol cigarettes and other flavored tobacco products must be stopped and we should all recognize this as a social justice issue, and one that disproportionately impacts youth and communities of color,” a group of 10 civil rights and health organizations reportedly wrote in a recent letter to Xavier Becerra, Secretary of the U.S. Department of Health and Human Services. Opponents of such a ban argue that it could create an underground market and become a new criminal justice issue: “Such a ban will trigger criminal penalties, which will disproportionately affect people of color, as well as prioritize criminalization over public health and harm reduction,” representatives from numerous civil rights and drug policy groups wrote in their own letter to Becerra. Proponents of the ban argue that criminal penalties would fall primarily on manufacturers and retailers, not individuals. Even before the menthol ban, there was fierce outcry from the tobacco and harm-reduction worlds over the FDA’s increasingly aggressive nicotine regulations. Recently, that conversation has largely centered around e-cigarettes. The FDA was initially slow to act on e-cigarettes, taking years to draw up rules for their regulation in the U.S. The products were meant to give smokers a less dangerous alternative to combustible cigarettes. And indeed, most health experts agree that they are less harmful than cigarettes—though there are still not enough data to say for certain how effective they are at helping smokers stay away from cigarettes and improve their health. E-cigarettes have been a subject of intense legal and regulatory scrutiny over the past few years, due largely to what federal health officials have called an “epidemic” of teen vaping. In an effort to curb youth vaping, the FDA in the fall of 2018 put forth new restrictions, forbidding the sale of products in all flavors except mint, menthol, and tobacco in stores where minors can shop. In early 2020, it all-out banned the sale of potentially youth-friendly flavored products—notably and controversially excluding menthol—used in pod-based systems, like market leader Juul. Those policies have drawn praise (from anti-tobacco groups) and criticism (from pro-vaping and harm reduction groups) in almost equal measure. The Biden Administration’s efforts to add menthol to the federal ban list will surely fuel these debates. And the biggest regulatory battles are still yet to come: the FDA is expected to make a call later this year on whether to grant e-cigarette products the approval they need to stay on the market in the U.S. The agency is also reportedly considering new limits on the amount of nicotine in combustible cigarettes. Changes are coming to the U.S. nicotine market, no matter what; the question is, how dramatic they will be. from https://ift.tt/3gPoZoD Check out https://takiaisfobia.blogspot.com/ For the first time in over a year, we are starting to see a light at the end of the tunnel from the devastation caused by COVID-19. While much work remains to end and avoid a resurgence of the pandemic, public and private investments in scientific research will get us to a new normal. The speed to develop, test and manufacture COVID-19 vaccines has shown how science and technology, supported by leadership from governments and the private sector, have the ability to save lives. For example, the CDC’s V-safe program, which recorded side effects, led to the collection of data from tens of millions of people after vaccination, creating a new paradigm for data collection after drug approval. These successes show just how much can be done when we invest in science and the systems to deploy it effectively. That is why we believe President Biden has the opportunity to lead on another major investment in scientific leadership: the battle to end suffering from cancer. Despite recent advancements in medicine, cancer still kills more Americans each year than the COVID-19 pandemic has to date. Significant disparities exist, with African-American men having the highest death rates from cancer of any group in the country. Now in its fifth of seven years, the Cancer Moonshot program, launched under the leadership of then Vice President Biden, has made significant progress. But with challenges remaining, there is a need to renew commitment, refresh priorities and increase funding for Cancer Moonshot 2.0. These efforts will complement and accelerate the National Cancer Institute’s (NCI) existing work. We see several interrelated priorities for a second Cancer Moonshot, which can unlock new and needed progress in the war on cancer. To begin: standardizing and collecting cancer-patient data (using the same vocabulary to describe medical events and collecting patient data in the same way so they can be compared), especially on outcomes that matter to patients. Patients want to be part of the solution and participate, through use of their privacy-protected data. For too long, electronic health records have been health system–centric, making it difficult for patients, doctors and researchers to track an individual patient’s data over time and across systems. With standardized, patient-centric data, artificial intelligence (AI) can help identify measures for intercepting cancer early, reducing disparities in outcomes and using precision medicine to get treatments to patients who will most benefit from them. With standardized data, we can also create a national cancer data (NatCanDa) repository that researchers can use to inform treatment development, and better pool and share our data with the world. Data holds the clues to better treating cancer. In addition, we have to modernize systems at the NCI, the FDA, Centers for Medicare and Medicaid Services and other government agencies that collect cancer-related data. Modernized systems, including outcomes, clinical-trial and claims data, will allow us to use real-world evidence to determine which treatments work best for which types of patients and under which models of care, and the most cost-effective ways of delivering those treatments. This will also serve as the foundation of a coordinated cancer clinical trial infrastructure to support faster and more effective drug development. Together, these initiatives can set up a national “learning health system” for cancer treatment and prevention, where research informs clinical care, and clinical care informs research. Better data sharing and use of real-world evidence can lay the foundation for similar progress on other diseases, especially complex chronic conditions like heart disease and diabetes. The ability of science to respond to the COVID-19 pandemic shows that, with the right government, scientific, health care, technology and community leadership, we can come together to save lives. from https://ift.tt/3gL9RZt Check out https://takiaisfobia.blogspot.com/ Dusk is falling in the Indian capital, and the acrid smell of burning bodies fills the air. It’s the evening of April 26, and at a tiny crematorium in a Delhi suburb, seven funeral pyres are still burning. “I have lived here all my life and pass through this area twice a day,” says local resident Gaurav Singh. “I have never seen so many bodies burning together.” Scenes of mass death are now unavoidable in what’s often called the world’s largest democracy. Social media is filled with images of body bags and urgent requests for medical aid. Indians gasping for breath are being turned away from overwhelmed hospitals, sometimes simply because they don’t have lab reports confirming COVID-19 infection. Health workers plead for basic supplies. “We feel so angry,” says Kanchan Pandey, a community health worker in Azamgarh, Uttar Pradesh. “At least give us some masks and gloves. Is there no value to our lives?” Such devastation would have been hard to imagine just a few months ago. Children were back in school, politicians were on the campaign trail, and people were dancing at weddings. “Soon the winter of our discontent will be made glorious summer,” India’s usually staid central bank said in a Jan. 21 bulletin. The next day, Prime Minister Narendra Modi heralded the spirit of atmanirbhar Bharat (self-reliant India) that had helped India secure victories in two major battles: on the cricket field against Australia and in the pandemic. “A positive mindset always leads to positive results,” he declared. That ebullience did not fade even as epidemiologists noted that cases were starting to rise in a few key states. On Feb. 21, Modi’s ruling Bharatiya Janata Party passed a resolution unequivocally hailing the “visionary leadership of Prime Minister Modi” in turning India into a “victorious nation in the fight against COVID.” Two months later, India’s crisis has blown well past the scale of anything seen elsewhere during the pandemic. For six of the seven days beginning April 21, India set new global records for daily COVID-19 infections, repeatedly surpassing the 300,000 tally previously set by the U.S. Its total confirmed cases—more than 18 million—are second only to that of the U.S. By official counts, more than 200,000 have now died, and some 3,000 are dying per day. The true daily death toll is at least two times higher, says Bhramar Mukherjee, an epidemiologist at the University of Michigan, from a caseload likely at least 10 times higher, based on modeling of data from the first wave. India’s health system is on the brink of collapse. Hospitals across the country are running out of oxygen supplies, ventilators and beds. Indians are rushing to buy drugs like remdesivir, causing prices to surge, while labs struggle to process growing backlogs of COVID-19 tests. Its humanitarian crisis will not just be devastating for the country’s nearly 1.4 billion citizens. In the words of the director general of the World Health Organization, the pandemic is a global inferno: “If you hose only one part of it, the rest will keep burning.” In India, where crematoriums have been burning so long that their metal structures have started to melt, the hose isn’t even turned on yet. When the pandemic swept the world last year, India braced itself. Modi announced a sudden national lockdown in March, sparking an exodus of migrant workers, hundreds of whom died en route from cities to their hometowns. India’s economy was one of the hardest-hit in the pandemic, and lockdown was eased in June to allow businesses to reopen. Cases peaked around 93,000 per day in September—less than a third of the daily tallies India is reporting this April—and then the curve began to flatten. A narrative emerged that India may have quietly achieved herd immunity, thanks to its comparatively young population—the median age is 27, and just 6.4% of Indians are over 65—and the fact that 66% of its population live in rural areas, spending most of their time outdoors. That optimistic account has since been complicated by two facts: cases are now hitting the young, and also surging in poor, rural states like Bihar and Uttar Pradesh. Read More: How the Pandemic Is Reshaping India The scale of the current crisis may have been driven by more-transmissible variants, though data are limited because of a lack of widespread genomic sequencing, says Dr. Ashish Jha, dean at Brown University School of Public Health. Other factors are contributing to the surge. The virus moves quickly through the multigenerational households that account for 4 in 10 Indian homes. Chronic underfunding of the health system over decades has also left hospitals ill-equipped to deal with the surge. India’s total health care spending is a mere 3.5% of GDP, far lower than in countries ranging from the world’s wealthiest like France (11.3%) and the U.K. (10%) to other emerging economies like Brazil (9.5%) and South Africa (8.3%). And only a third of India’s health care spending comes from the government, with the rest mostly coming out of citizens’ pockets. “It essentially means that those who can afford to purchase health can have it,” says Dr. Gagandeep Kang, a virologist and public-policy researcher at Christian Medical College, Vellore. For all those vulnerabilities, experts say the current crisis could have been avoided if the government had acted earlier. “It is the virus, but it’s way more than the virus,” says Sumit Chanda, an infectious-disease expert at Sanford Burnham Prebys Medical Discovery Institute in California. “It’s equal parts complacency and incompetence.” Many Indians who took strict precautions last year abandoned their masks and gathered indoors when the broader public messaging implied that India had conquered the virus. They were “pristine prey,” as Mukherjee puts it, when the virus resurged this spring. Crucially, this complacency was encouraged by the government’s “mission-accomplished mentality,” Chanda says. India’s leaders ignored warning signs in the data and the news of variants circulating in other countries. “By early March, it was really starting to be clear, and by late March, we had flashing red lights,” Brown’s Jha says. “Even then, the government was largely acting like there wasn’t anything serious going on.” Read More: ‘This Is Hell.’ Prime Minister Modi’s Failure to Lead Is Deepening India’s COVID-19 Crisis Rather than intensifying public-health messaging and ramping up interventions like banning mass gatherings and encouraging mask wearing, Modi and his officials did the opposite. They held mass rallies ahead of elections and promoted the Kumbh Mela, a Hindu pilgrimage that drew millions of worshippers to a single town—an event Jha predicts will end up “one of the biggest superspreader events in the history of humanity.” On April 17, after India had overtaken Brazil to become the second worst-hit country in the world, Modi told a rally in West Bengal that he was “elated” to see such a large crowd. Modi’s insistence on atmanirbhar Bharat, the principle of self-reliance, also made India slow to approve and purchase foreign vaccines, including Pfizer-BioNTech’s, in favor of its own Covaxin. In the meantime, the government was keen to wield its heft as the “pharmacy of the world,” exporting doses even as it vaccinated only 0.2% of its population per day. “The complete policy complacency created a scenario where we allowed COVID-19 to get the better of us,” says Yamini Aiyar, president of the Centre for Policy Research in New Delhi. “We couldn’t have predicted the scale, but the complete lack of preparedness and crowding in pursuit of power is really unforgivable.” Though Modi has been reluctant to admit failures handling the pandemic, his tone has become more somber as India has started airlifting oxygen generators and other supplies from abroad, with countries including Australia, the U.K. and even India’s rival Pakistan offering support. The White House is sending ventilators, test kits, PPE and oxygen concentrators to Delhi, and has overturned a ban on the export of raw materials India needs to ramp up vaccine production. In the short term, this emergency disaster relief—along with lockdowns in hot spots and a national mask mandate—is key to curbing the second wave. In the longer term, vaccinations are desperately needed to prevent a third wave. Only 9% of Indians have had at least one vaccine dose (some, like Covaxin, require two doses), and the current pace of inoculation is too slow. It’s also not realistic, says Dr. Prabhat Jha, an epidemiologist at St. Michael’s Hospital, University of Toronto, for India to try to rapidly vaccinate 1 billion people. With limited vaccine supply, the most effective way to reduce transmission may be to target hot-spot areas and higher-risk people—which means India needs better data, fast. How India handles its internal crisis is already having spillover effects. Modi has suspended India’s vaccine exports and is looking to import doses from other countries. This will have critical repercussions for millions in Africa and Latin America, who depend heavily on India’s vaccine production. Serum Institute, the Indian vaccine manufacturer, was already running behind. Expected to deliver 100 million doses for other countries by May, it so far has delivered only 20 million. Read More: How Countries Around the World Are Helping India Fight COVID-19—and How You Can Too India may be far less wealthy than the Western countries now lending support, but it also has the tools to emerge from this crisis. It has a history of successful, large-scale immunization programs for diseases like polio and tetanus, first-rate scientists, highly trained doctors and powerful networks of community health workers. What has been lacking, experts say, is the political will to get ahead of the crisis—and to use data and science to its advantage. “Without data—on who is testing positive, where the hot spots of cases and deaths are, who is really vulnerable—there’s no easy way for India to walk out of the pandemic,” Prabhat Jha says. Many say the government has lost sight of its priorities. As cases soared to record highs in April, the government ordered Twitter and Facebook to remove posts critical of the authorities. Independent journalists have scrambled to identify massive discrepancies between official figures and deaths. “Those who died will never come back,” the Chief Minister of Haryana said in response to questions on April 26 about whether COVID-19 deaths were higher than official figures. “There is no point debating if the number of deaths is actually more or less.” Modi entered the pandemic with sky-high approval ratings of nearly 80%, and polls from as recently as January suggest those numbers have barely dipped. Now, anger is rising among those spending their days trying to find beds for relatives or caring for their communities. But for most Indians, whether Modi can survive this crisis is now less urgent than whether they can. “The cries for help are growing—but not our capacities,” says Usha Thakur, a community health worker in Najafgarh, Delhi. “The governments are fighting amongst each other. They don’t care about the people but it’s the people who are losing their loved ones.” --With reporting by Nilanjana Bhowmick/New Delhi, Alice Park/New York and Billy Perrigo/London
from https://ift.tt/2R5y2au Check out https://takiaisfobia.blogspot.com/ As the numbers of COVID-19 cases and deaths in India continue to mount, public health officials are carefully watching yet another looming threat: the appearance of mutations that could be making the virus circulating there more infectious or more capable of causing severe disease. Scientists believe that the variants of SARS-CoV-2 responsible for this second wave of cases in India already include at least two mutations that make them more dangerous. These mutations are already familiar to COVID-19 experts. One is found in a variant first identified in South Africa, while the other is part of a variant believed to have emerged from California. Researchers believe that these two mutations may, respectively, make it easier for the virus to infect human cells, and to evade the protection provided by immune cells like antibodies. According to the latest data from the public genome database GISAID, 38% of genetically sequenced samples from India collected in March contain the two mutations—scientists have labelled this the B.1.617 variant. “It’s taken us by surprise,” says Dr. Ravindra Gupta, professor of clinical microbiology at the University of Cambridge who has studied the SARS-CoV-2 virus and its variants, including the one emerging from the UK, B.1.1.7. that appears to spread more easily among people, and is now the dominant strain of virus causing new infections in the U.K. and the U.S. “The steep, rapid increase in cases is really quite startling. It’s probably the result of relaxed social distancing, a lot of social gatherings including religious gatherings, also combined with new variants.” Sumit Chanda, director of the immunity and pathogens program at Sanford Burnham Prebys Medical Discovery Institute in San Diego, Calif., describes the situation in India as a sort of perfect storm. “People became complacent, and politicians were declaring victory over the virus—a mission accomplished mentality,” he says. “They decided to have one of the biggest religious ceremonies and mass gatherings of humans in the world—I saw pictures and no one was masked, and it was happening in highly dense population centers. Then you have the emergence of a variant and that’s what is really driving what is happening over there.” Chanda says it’s likely that the mutations evolved from the excessive replication that’s occurring among the burgeoning infections in India. With every new person the virus infects, it has a new opportunity to frantically copy its genome. And in its rush to duplicate its genome, the virus makes mistakes—repeatedly—and those mistakes sometimes end up making the virus fitter and stronger. Those “mistake” versions become variants that start to outcompete and dominate other, less fit viruses. For the people the virus infects, that could also mean a viral variant that causes more severe, and even deadly disease. Following India’s first wave of COVID-19 in the spring of 2020, health officials locked down the country, but it turned out that people who were infected didn’t get that sick; in fact, the case fatality rate was low. That led to a proportion of the population developing some level of natural immunity to the virus. But that proportion wasn’t enough to provide anything close to herd immunity, so when social restrictions were lifted in May 2020 and people began congregating again, it created the perfect conditions for the virus to mutate. “Once you let your guard down, these variants basically have more field to play on,” says Chanda. “When you have unmitigated spread, then that’s more fuel you give to the virus to make these mistakes, and the stronger viruses will pop out.” Chanda, Gupta and others are also investigating whether another phenomenon might be at work driving the severe disease in India. It’s possible that people previously infected with SARS-CoV-2, but who did not have a severe case of COVID-19, might get even sicker if they are reinfected—a dynamic seen with some other disease-causing viruses, like dengue. Researchers refer to this phenomenon—in which people are infected and only partially successful in fighting the virus so they continue to harbor the infection for months rather than days—as “suboptimal protection.” In one such patient, who was infected for about four months, Gupta documented the steady changes the virus made as it mutated to become better and better at evading any immune responses directed against it. “Some people can’t clear the virus—they get infected and they can’t get rid of it—so they have some immunity to the virus but the virus learns to live with their immune system, and makes mutations to adapt. And those same mutations adapt again when they infect someone else.” It’s not clear if this is happening in India, but it could explain why so many people are getting sick so quickly. In any case, from a public health perspective, it makes sense to assume this is what’s going on—the response should be to urge people to take preventive actions like wearing masks and social distancing even if they have been infected in the past, which would be beneficial during an epidemic whether or not the virus is spreading among the previously infected. “We should be planning for the worst case scenario and assume people are being reinfected. There’s not much lost by over-calling it, since the rate of infection is already so high,” says Gupta. As countries including the U.K. and U.S. start to send supplies and aid, India’s experience should serve as a warning for the world. The Indian variant has already been reported in the U.K. and Japan, and samples from the U.S. also appear to contain the variant’s genetic fingerprint, so building up immunity quickly through mass vaccination is more critical than ever. “India is a cautionary tale that if we open up bars willy nilly, this could happen to us,” says Chanda. “We are at the point now [in the U.S.] where we have suboptimal immunity because people are still being vaccinated.” That is, this is exactly the time that the virus has enough room to maneuver, and genetically adapt to evade vaccines. The key to preventing that from happening? Get more people vaccinated. from https://ift.tt/2Ra7g0k Check out https://takiaisfobia.blogspot.com/ (NEW YORK) — The Centers for Disease Control and Prevention eased its guidelines Tuesday on the wearing of masks outdoors, saying fully vaccinated Americans don’t need to cover their faces anymore unless they are in a big crowd of strangers. And those who are unvaccinated can go outside without masks in some situations, too. The new guidance represents another carefully calibrated step on the road back to normal from the coronavirus outbreak that has killed over 570,000 people in U.S. For most of the past year, the CDC had been advising Americans to wear masks outdoors if they are within 6 feet of one another. “Today, I hope, is a day when we can take another step back to the normalcy of before,” CDC Director Dr. Rochelle Walensky said. “Over the past year, we have spent a lot of time telling Americans what you can’t do. Today, I am going to tell you some of the things you can do, if you are fully vaccinated.” The change comes as more than half of U.S. adults — or about 140 million people — have received at least one dose of vaccine, and more than a third have been fully vaccinated. Walensky said the decision was driven by rising vaccination numbers; declines in COVID-19 cases, hospitalizations and deaths; and research showing that less than 10% of documented instances of transmission of the virus happened outdoors. Dr. Mike Saag, an infectious disease expert at the University of Alabama at Birmingham, welcomed the change. “It’s the return of freedom,” Saag said. “It’s the return of us being able to do normal activities again. We’re not there yet, but we’re on the exit ramp. And that’s a beautiful thing.” Some experts portrayed the relaxed guidance as a reward and a motivator for more people to get vaccinated — a message President Joe Biden sounded, too. “The bottom line is clear: If you’re vaccinated, you can do more things, more safely, both outdoors as well as indoors,” Biden said. “So for those who haven’t gotten their vaccinations yet, especially if you’re younger or thinking you don’t need it, this is another great reason to go get vaccinated now.” The CDC, which has been cautious in its guidance during the crisis, essentially endorsed what many Americans have already been doing over the past several weeks. The CDC says that whether they are fully vaccinated or not, people do not have to wear masks outdoors when they walk, bike or run alone or with members of their household. They can also go maskless in small outdoor gatherings with fully vaccinated people. But unvaccinated people — defined as those who have yet to receive both doses of the Pfizer or Moderna vaccine or the one-shot Johnson & Johnson formula — should wear masks at small outdoor gatherings that include other unvaccinated people, the CDC says. They also should keep their faces covered when dining at outdoor restaurants with friends from multiple households. And everyone, fully vaccinated or not, should keep wearing masks at crowded outdoor events such as concerts or sporting events, the CDC says. The agency continues to recommend masks at indoor public places, such as hair salons, restaurants, shopping centers, gyms, museums and movie theaters, saying that is still the safer course even for vaccinated people. “Right now it’s very hard to tease apart who is vaccinated,” Walensky explained. She said the CDC guidance should be a model for states in setting their mask-wearing requirements. The advice to the unvaccinated applies to adults and children alike, according to the CDC. None of the COVID-19 vaccines in use in the U.S. is authorized for children under 16. “The biggest thing that it helps us is our mental health,” said Tim Stephens, a 52-year-old software salesman in Birmingham, Alabama, who suffered a bout of COVID-19 and has since gotten vaccinated. “To be able to feel like we’re turning the corner and can confidently go out and experience life and do a lot of the things that we did before COVID became an acronym in our world. It’s one more step in the process of moving beyond this.” In Oxford, Nebraska, population 800, hardly anyone wears a mask, and the school district dropped its mask mandate last month. Superintendent Bryce Jorgensen said maybe 10 of the 370 students are still covering their faces. “What goes on in other states is what goes on in other states,” Jorgensen said. “You just can’t compare Chicago to Oxford, Nebraska. Things are just different.” Dr. Babak Javid, a physician-scientist at the University of California, San Francisco, said the new CDC guidance is sensible. “In the vast majority of outdoor scenarios, transmission risk is low,” Javid said. Javid has favored outdoor mask-wearing requirements because he believes they increase indoor mask-wearing, but he said Americans can understand the relative risks and make good decisions. He added: “I’m looking forward to mask-free existence.” “The timing is right because we now have a fair amount of data about the scenarios where transmission occurs,” said Mercedes Carnethon, a professor and vice chair of preventive medicine at Northwestern University’s Feinberg School of Medicine in Chicago. What’s more, she said, “the additional freedoms may serve as a motivator” for people to get vaccinated. ___ AP medical writer Carla K. Johnson in Washington state contributed to this report. from https://ift.tt/3gKZB3m Check out https://takiaisfobia.blogspot.com/ When history looks back on the COVID-19 pandemic, 2020 will likely emerge as the year of testing, while 2021 (and likely 2022) will be the year of vaccinations. But that doesn’t mean testing no longer matters. In fact, testing will become more critical than ever as schools, gyms, workplaces, restaurants and shops reopen, and sports events and concerts rev up again. Given that reality, the recent availability of at-home, DIY tests is welcome news. As of last week, Abbott’s BinaxNOW COVID-19 test—which doctors and hospitals have already been using to screen people—started to become available at retail stores without a prescription. That’s just in time for the exodus from lockdown and social isolation expected this summer. As people start mingling again, they will need access to more convenient, rapid testing that can provide immediate answers—did my child get infected after playing in the soccer game? Is it safe to have a family dinner with relatives who don’t live with you? Did I get infected after going back to work? The gold standard testing for SARS-CoV-2, called molecular, or PCR, testing, requires people to go to a health care professional, who swabs a sample from deep in the back of the nose and throat, and then sends the sample to a lab that performs the test. Results take at least a day. But such testing isn’t always necessary. In the coming months, being able to test yourself not once, but as often as you need to, to ensure you haven’t been infected from your activities, will become the priority. The reason for that has to do with the changing landscape of the pandemic. Last year, when infections were spreading like a fire blazing out of control, testing was essential for identifying people who were positive so they could isolate and get the proper care. In most cases, doctors focused testing on people who had symptoms of COVID-19 like coughs, fever, chills and difficulty breathing. If you weren’t feeling sick, there wasn’t a reason to get tested, especially at the beginning of the pandemic when the tests were scarce and took a week or more to produce results, As more people get vaccinated, however, theoretically, fewer people will be infected and even fewer will have symptoms. Instead of an inferno, the infections will be more like embers, scattered in communities here and there, and harder to find. That’s where home, or DIY testing like Abbott’s kit, come in. These are tests that people can buy at their local pharmacy without a prescription, perform on their own without any medical help, and get results in about 15 minutes. The U.S. Food and Drug Administration (FDA) has now authorized four such at-home over-the-counter COVID-19 tests: two from Abbott (the BinaxNow, as well as the BinaxNow Ag Card, which allows people to collect the sample and perform the test while connected to a telehealth provider (an option for those who want the guidance of a professional), and one each from Quidel and Ellume. People swab their noses—not the back of the nose and throat that the other test requires—and place the sample in a specially treated card or tube that provides results, similar to the results of a pregnancy test, in 15 minutes. They are all antigen-based tests, which means that they pick up proteins made by the SARS-CoV-2 virus, and not the virus itself. But the level of viral proteins is a proxy for how active, and therefore infectious, the virus is. SARS-CoV-2 is busiest in the first week or so after infecting a new host, pumping out more and more copies of itself. That’s when people are most at danger of passing the virus on to others, through coughs, sneezes or other close contact, even if they don’t feel any symptoms. And those are the exact people these antigen tests are designed to find. How at-home antigen tests can slow the pandemic“These tests aren’t just to tell you if you are sick,” says Dr. Michael Mina, assistant professor of epidemiology at Harvard T. H. Chan School of Public Health. “These tests are society’s way of being able to see the enemy around us, and in this case the enemy happens to be a virus. If you can’t see it, then you don’t know what precautions to take.” Because they don’t require a prescription, and anyone can take the tests, Mina says their availability should vastly increase access to testing which should in turn help limit the spread of the virus. Parents worried about whether their child’s cough and fever is due to a cold or COVID-19 can use the test at home, for example, and if it’s positive, get in touch with a pediatrician—all without having to bring their sick child into the doctor’s office and potentially infect more people. People attending small gatherings, or taking a trip, can test themselves beforehand and afterward, so they can be reassured that they haven’t been infected. And schools can rely on the tests to screen for and isolate any positive students or staff, and trace any potentially exposed contacts as quickly as possible. Ideally, such democratized testing should have been the foundation for the COVID-19 response from the start, says Mina. Instead, since the first test for SARS-CoV-2, from the U.S. Centers for Disease Control (CDC), was slow to roll out after problems arose with its accuracy, and regulatory agencies like the FDA were initially hesitant to allow commercial and academic tests on the market, health officials have been blindfolded in trying to fight the virus. “In lieu of testing extensively, the whole pandemic, we treated everyone like they were positive,” says Mina, “and we had to shut the whole of society down because we’ve been blind.” The at-home tests could finally give us the eyes that we’ve needed into the virus’ comings and goings—and help to avoid another blanket shutdown. In Maryland, the health department is piloting programs to use at-home rapid testing to identify cases among high-risk populations such as home care health workers and people with disabilities. “We’re trying to target folks who can’t afford to get tested but can benefit from having them,” says Jonathan Weinstein, director of COVID-19 testing passports for the department. Weinstein also sees the self-tests as a way to expand the reach of testing by making them available at places like schools, festivals and baseball stadiums. How public health officials can make at-home testing even more usefulOne barrier to widespread use of the self tests, however, is concern about their accuracy, since health professionals won’t be involved in collecting the samples or interpreting the results. That’s the reason that some experts don’t see them as powerful public health tools, although they might be useful for individual people making personal decisions. “There are lots of conundrums for public health that we are trying to work through,” says Kris Ehresmann, director of infectious disease epidemiology, prevention and control at the Minnesota department of health. “I don’t want to suggest that they have no utility. Just that from a public health system and data collection perspective, and how we do our broader recommendations, I think there are enough gaps in validation and quality of the results that we have to really be careful.” She notes that self-tests are a good starting point to identify possible new cases, but that using them to take broader action is still problematic. If, for example, a student on a school soccer team tests positive using an at-home self-test, is that enough to quarantine the rest of the team, who might have been exposed to that player, and pull the entire team from upcoming games? To make those kinds of decisions, she says, “You want to make sure you are feeling really confident about the sensitivity and specificity of the test. I think there will be a lot of learning in the next months and years until we ultimately get to a place where we can speak more confidently about the role and place these tests will have.” Those decisions will also depend on the balance between the test’s sensitivity in detecting infections, and its convenience and accessibility. A CDC study of Abbott’s tests (both use the same chemistry) conducted at community health centers in November and December of 2020, and compared it to the results of PCR tests. They found that the Abbott test picked up 64% of cases among people with symptoms, but only 35% among those who did not. Because symptoms usually occur within days of infection, however, Abbott says its test is useful for identifying people who are most infectious, and therefore could be helpful in identifying infected people early and ultimately controlling spread of disease. Mina points out that the use case for at-home testing is different than that of molecular, or PCR testing. At-home testing, he says, is better suited to screening a population for infections, where the more involved PCR test isn’t always necessary or practical. And for much of the beginning of the pandemic, the FDA only allowed PCR testing even if it meant people waited as long as 10 days for the results. That strategy slowed the availability of at home testing in the U.S.; they are only now becoming widely available just over a year after the first case was confirmed, when they could have been useful all along in giving public health officials a better sense of where cases were before they became clusters. “We want everything to be totally controlled and totally perfect even if it is at the expense of testing failing,” he says. “We would rather not have any test than an imperfect test, which doesn’t make sense.” The goal of testing is also changing, from one that is entirely focused on public health needs to one that is increasingly personal and individual. “If you are asking if you can go see grandma right now, you’re asking if you are infectious right now. And that’s what the quick at-home tests allow,” says Mina. “What the super-high-sensitivity PCR tests are doing is effectively finding if someone was infectious two or three weeks ago, and that’s not the information you really want about whether it’s safe to visit your grandma right now.” “Public health is all about dealing with messy data,” he adds, about the potential that some results may not be as accurate as PCR testing. “We can look for signals in the noise.” One way to do that is to repeat the antigen at-home tests to have more confidence in the result. Indeed, Abbott’s BinaxNOW kit comes with two tests so users can do just that. Mina does acknowledge, however, that the at-home tests could become more useful for public health purposes if they include a way for people to easily report the results to their local health authorities so the data can be collected in a more systematic way. “We should be linking the tests to simple one-click reporting that should be anonymous and only geolocates by your zip code,” he says. “If we have more testing, then even if a small fraction of people are reporting, then ultimately that would provide more public health data, not less. Not having that reporting option is a big mistake.” Given that the FDA appears to be leaning toward encouraging at-home testing, that could become a huge missed opportunity. The agency has also authorized two at-home, over-the-counter PCR tests, from Lucira and Cue, which are more than 90% accurate in replicating results from lab-based PCR tests—and ready in 20- to 30 minutes, rather than a day or so. Eventually, people may use the cheaper antigen tests, which run $20 to $30, on a more regular basis, and if they test positive, spring for the $50-plus at-home PCR tests to confirm the result. As more people take advantage of self-testing, it’s now up to the CDC to take advantage of new funding for COVID-19 surveillance to find ways to tap into and exploit that data as more people engage in social activities and want to reassure themselves that they’re doing so safely. Mina says most of the tests are still not cheap enough to truly reach everyone who would want to use them—but it’s a start. “Self tests are a really, really powerful tool at your disposal if and when we need it,” he says. from https://ift.tt/3sZ7a98 Check out https://takiaisfobia.blogspot.com/ |
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