(WASHINGTON) — Deaths among Medicare patients in nursing homes soared by 32% last year, with two devastating spikes eight months apart, a government watchdog reported Tuesday in the most comprehensive look yet at the ravages of COVID-19 among its most vulnerable victims. —“We knew this was going to be bad, but I don’t think even those of us who work in this area thought it was going to be this bad,” said Harvard health policy professor David Grabowski, a nationally recognized expert on long-term care, who reviewed the report for The Associated Press. “This was not individuals who were going to die anyway,” Grabowski added. “We are talking about a really big number of excess deaths.” Investigators used a generally accepted method of estimating “excess” deaths in a group of people after a calamitous event. It did not involve examining individual death certificates of Medicare patients, but comparing overall deaths among those in nursing homes to levels recorded the previous year. The technique was used to estimate deaths in Puerto Rico after Hurricane Maria in 2017 and in New York City after the first coronavirus surge last spring. It does not attribute a cause of death, but is seen as a barometer of impact. Death rates were higher in every month last year when compared to 2019. The report documented two spikes with particular implications for government policy and for protecting the most vulnerable in future outbreaks of life-threatening illnesses. In April of last year, a total of 81,484 Medicare patients in nursing homes died. Then eight months later, after lockdowns and frantic efforts to expand testing — but before vaccines became widely available — nursing home patients accounted for a staggering 74,299 deaths in December. “This is happening long after it was clear that nursing homes were particularly vulnerable,” said Nancy Harrison, a deputy regional inspector general who worked on the report. “We really have to look at that. Why did they remain so vulnerable?” Federal investigators are still drilling down to try to document the chain of causes and effects. Tuesday’s report was the most comprehensive yet from the government because it included statistics for the early part of last year, during the initial coronavirus surge. Medicare did not require nursing homes to report COVID-19 cases and deaths occurring before May 8, more than four months into the pandemic year. In another new finding, the report showed that cases and deaths among Asian American patients tracked with the more severe impacts seen among Blacks and Latinos. Indeed, Asian Medicare enrollees in nursing homes saw the highest increase in death rates, with 27% dying in 2020 compared to 17% the previous year. For whites, the death rate grew to 24% in 2020 from 18% in 2019, a significant increase but not as pronounced. Death rates for Hispanic and Black patients were 23% last year, up from 15% in 2019. The inspector general’s office based its analysis on Medicare billing data, also including patients in Medicare Advantage plans sold by private insurers. Medicare covers the vast majority of nursing home patients, and the report included long-term residents as well as those temporarily at a facility for rehab care. Health economist Tamara Konetzka of the University of Chicago, who also reviewed the report for AP, said building an estimate from individual death certificates would have faced another set of challenges. Especially in the first wave of the pandemic, many who died would not necessarily have been tested for COVID-19, for example. “By looking at excess deaths you can get away from some of the measurement issues and say how much worse things were in 2020 than in 2019,” explained Konetzka, who has testified before Congress on the impact of COVID-19 in nursing homes. The inspector general’s findings about Asians highlight a riddle for researchers, said Konetzka. The reasons for higher cases and deaths among Blacks, Hispanics and Asians may not necessarily be tied to race and ethnicity. Instead, minority patients may be clustered in homes located in communities with more severe outbreaks. The report also found that low-income nursing home patients covered by Medicare and Medicaid together were much more likely to have gotten COVID-19. The infection rate for that group reached 56%, and 26% died. Some states suffered worse impacts. By the end of December more than half of the Medicare patients in nursing homes in Connecticut, Illinois, Louisiana and New Jersey had or likely had COVID-19. Across the U.S., the coronavirus found ideal conditions to spread among frail nursing home patients living in close quarters. Many researchers believe it’s likely staffers unwittingly brought the virus in from surrounding communities. Although facilities locked down in March of last year, government efforts to help were haphazard. The industry complained of chronic shortages of protective gear, including basics like masks and gowns. The Trump administration initially delegated responsibility for testing to states before belatedly marshaling more federal resources. HHS later laid the groundwork for vaccinations under the Trump administration, and the Biden administration followed through. As vaccination rates rose, nursing home cases plummeted, allowing facilities to again permit family visits. The country can’t move on yet, said deputy inspector general Harrison. “Hopefully, COVID will go away,” she said. “But once that happens, there will always be infectious diseases, and we all need to ask ourselves what we can do to protect vulnerable nursing home residents going forward.” from https://ift.tt/3gTKMKr Check out https://takiaisfobia.blogspot.com/
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(JOHANNESBURG) — The World Health Organization is in talks to create the first-ever technology transfer hub for coronavirus vaccines in South Africa, a move to boost supply to the continent that’s desperately in need of COVID-19 shots, the head of the U.N. agency announced. The new consortium will include drug makers Biovac and Afrigen Biologics and Vaccines, a network of universities and the Africa Centres for Disease Control and Prevention. They will develop training facilities for other vaccine makers to make shots that use a genetic code of the spike protein, known as mRNA vaccines. “We are now in discussions with several companies that have indicated interest in providing their mRNA technology,” said WHO director-general Tedros Adhanom Ghebreysus at a virtual press briefing on Monday. That technology is used in the Pfizer-BioNTech and Moderna vaccines. Africa will soon be able to “take responsibility for the health of our people,” as a result of the new WHO-backed technology transfer hub, South African President Cyril Ramaphosa said in the press briefing. It is “just not equitable and not fair” that some people are denied access to COVID-19 vaccines because of where they live, Ramaphosa said. Poor countries in Africa and elsewhere are facing dire shortages of COVID-19 jabs despite some countries having the ability to produce vaccines, lamented Lara Dovifat, a campaign and advocacy adviser for Doctors Without Borders. “The faster companies share the know-how, the faster we can put an end to this pandemic,” she said in a statement. Numerous factories in Canada, Bangladesh, Denmark and elsewhere have previously called for companies to immediately share their technology, saying their idle production lines could be churning out millions of doses if they weren’t hampered by intellectual property and other restrictions. More than 1 billion coronavirus vaccines have been administered globally, but fewer than 1% have been in poor countries. South Africa accounts for nearly 40% of Africa’s total recorded COVID-19 infections and is currently suffering a rapid surge, but vaccine rollout has been slow, marked by delayed deliveries among other factors. South Africa currently does not manufacture any COVID-19 vaccines from scratch, but its Aspen Pharmacare assembles the Johnson & Johnson shot by blending large batches of the ingredients sent by J&J and then putting the product in vials and packaging them, a process known as fill and finish. Earlier this month the company had to discard 2 million doses because they had ingredients produced in the U.S. in a factory under suspect conditions. South Africa’s current wave of infections threatens to overwhelm the country’s hospitals. “The climb in new cases has been extraordinarily rapid and steep over the past few weeks,” Ramaphosa said Monday in his weekly letter to the nation. “The number of daily new cases jumped from below 800 in early April to more than 13,000 in the past week. In other words, it increased more than 15-fold from the last low point.” Gauteng province, the country’s most populous with the cities of Johannesburg and Pretoria, is the worst-affected by the current surge with 60% of the new cases. All public and private hospitals are full, yet the numbers of new confirmed cases continue to rise, the province’s deputy premier, David Makhura, said Monday. “I don’t want to send a message saying everything is okay,” said Makhura. “I want to say to the people of the province: The house is on fire.” WHO officials said that while their new vaccine transfer technology will hopefully increase future supplies, it won’t address the immediate crisis, since it will take months for any new factories to start producing shots. With dozens of countries desperately waiting for more doses after the COVAX initiative, a U.N.-backed plan to distribute vaccines to poor countries faltered in recent months, the WHO has been trying to persuade rich countries to donate vaccines once their most vulnerable populations are immunized. But Dr. Michael Ryan, the WHO’s emergencies chief, acknowledged that countries have mostly declined to share vaccines immediately. “When you ask countries (to donate), they say, ‘Well, we’re going to vaccinate according to our priorities and our priorities are our own citizens,’” Ryan said. He added that while transferring vaccine technology will help in the medium to long term, it won’t help stem the current spike in infections. “We have not used the vaccines available globally to provide protection to the most vulnerable,” he said. ”And the fact that we haven’t … is a catastrophic moral failure.” from https://ift.tt/2SKi1be Check out https://takiaisfobia.blogspot.com/ If you’re a student or a faculty member who spends any time on the University of California, San Diego campus, you may know a lot more about what’s in your pee and poop—and that of your colleagues—than you might care to admit. Members of the UCSD community can download an app that tells them the COVID-19 status of the wastewater generated in the buildings where they spend the most time. In fact, it offers quite a bit of additional detail too, telling users whether any disease-causing microbes are flourishing in that sewage. If the COVID-19 virus is detected, campus regulars get a notification that they might be either infected or exposed, and they are urged to get tested. The system has already helped to reduce COVID-19 cases dramatically on campus, from 80-90% of wastewater samples testing positive for the virus between Thanksgiving and January, to only 5% in recent months. The sampling “really gives us an unprecedented ability to track the pandemic day by day as the waves of cases go up and down on campus,” says Rob Knight, professor of pediatrics, computer and engineering and director of the center for microbiome innovation at UCSD. Not only that, but Knight and his students were also able to use wastewater samples to zero in on people who were likely infected with the virus, but asymptomatic. They placed robots to sample wastewater from individual buildings in sewage pipes before they joined a common effluent, and by last September, they were able to note when samples from a specific building went from negative to positive, and then test everyone frequenting that building to identify the positive case, remove that person from the building, and then keep testing samples to ensure they turned negative again. “Being able to take a whole building, determine which person has COVID-19, remove that person from the building, and see the signal drop back down to zero—that exceeded our wildest dreams,” Knight says. He’s since conducted similarly successful analyses of wastewater in San Diego County to predict upcoming surges of COVID-19 infections. Waste—or more specifically, wastewater—could be the sleeping giant in the universe of disease detection. Because viruses like SARS-CoV-2, which is responsible for COVID-19, are generally shed in human waste, wastewater is proving to be a harbinger of future clusters—if not exactly as pleasant to manage as the proverbial canary in the coal mine, at least a practical warning of cases to come. Making the case for wastewaterThe U.S. Centers for Disease Control and Prevention (CDC), for example, has turned to wastewater surveillance to help monitor SARS-CoV-2 infections, and specifically new variants that might be gaining ground in certain communities. Not only can the virus be detected in waste, but once found, researchers can genetically sequence the culprit to figure out how much it has mutated. Knight’s team is among many that have documented evidence that SARS-CoV-2 can be detected in sewage several days before cases are reported by testing in humans. Early on in the pandemic, researchers sampling wastewater in northern Italian towns found SARS-CoV-2 in sewage weeks before the first cases started flooding hospitals. Last spring, in the college town of LaCrosse, Wis., Paraic Kenny, director of the Kabara Cancer Research Institute of the Gundersen Health System sequenced the virus he picked up from samples from the nearby municipal waste-treatment plant and compared them to positive samples from people frequenting bars and restaurants in the area last summer, when there was a known surge of the virus. They found that the samples genetically matched, meaning that the virus was picked up in the wastewater from infected people who had been spreading the virus for weeks before the first cases were confirmed through testing. And last spring, the Massachusetts Institute of Technology startup BioBot, the first commercial company to provide wastewater analysis for public health applications, began offering COVID-19-related services for communities. The demand for the company’s services is growing quickly; BioBot now samples and analyzes sewage for 100 communities across the U.S. “In principle, an approach like this can be used to not just ascertain how much virus is in the community, but maybe give hospitals and public health departments a warning of when to anticipate a surge in cases,” Kenny says. That idea is gaining ground especially in relatively contained communities like schools, college campuses or small cities where getting a heads up that the COVID-19 virus is in the area could lead to better mitigation and control measures to shut the pathogen down. “Over the course of this pandemic, the entire world has seen how valuable wastewater epidemiology is as a tool,” says Newsha Ghaeli, president and co-founder of Biobot. “Our long-term vision is that wastewater epidemiology becomes a permanent part of the infrastructure embedded on top of sewage systems across the country and around the world.” Before COVID-19, Biobot focused on trolling municipal sewage treatment plants for traces of opioids to help local public health officials concentrate resources and treatment programs where they would have the most impact. But convincing people that analyzing pee and poop would be a worthwhile investment was an uphill battle, Ghaeli says. “Our vision was to create a tool to enable public health to be more proactive, more data-driven, and more equitable, and there wasn’t as much buy-in into that vision as we see today.” Two primary changes led to this shift. First, Biobot conducted a pro bono demonstration in March 2020 for 400 communities that proved, with real data, the power of wastewater analysis for protecting public health. Second, COVID-19 hit. In some ways, the pandemic gave wastewater epidemiology the opportunity the fledgling surveillance strategy needed to legitimize itself. In February 2020, scientists documented for the first time that SARS-CoV-2 could be detected in the stool of infected people. Within weeks, Ghaeli and her partners at MIT and the Harvard School of Public Health, developed a way to pick up the virus in sewage and became the first to detect SARS-CoV-2 in wastewater. Because sewage is an amalgam of all types of human waste, the challenge for any scientist keen on analyzing it is to develop the right probe for snatching out just what they are looking for. It’s a matter of developing the right filters to progressively weed out the true waste from the virus they’re looking for. At UCSD, Knight’s team has refined and streamlined the process with the help of magnetized tracers that they use as probes to attach to SARS-CoV-2 in the samples to pull out the virus. The innovation means that the process of filtering out any SARS-CoV-2 that might be present in a sample of sewage is cut down from 10-12 hours (or overnight) to half an hour. Biobot works mostly with sewage treatment plants that serve large populations, and takes advantage of existing sampling systems in such facilities. The company sends treatment plants a sampling kit similar to those used by genetic-testing companies like 23andMe—except in this case, the kits are for 150 ml of sewage, rather than a bunch of saliva. The sample is overnighted to the company’s labs in Cambridge, Mass., where technicians run genetic sequencing to search for specific, short sequences of the virus’ genome they know are unique to SARS-CoV-2. “If there is one infected person in a population of about 6,500, we can detect it,” says Ghaeli. The company then provides a detailed report of the amount of SARS-CoV-2 in the wastewater, including comparisons to nearby communities if that information is available. From local to nationwideDepending on how extensive and quick COVID-19 testing is in the area, the wastewater analysis can also reveal the presence of COVID-19 days before the cases are confirmed by human-sample testing. That’s especially powerful since studies show that people infected with the SARS-CoV-2 tend to shed more virus at the beginning of their infection than they do later on. If these infected people were not identified until they developed symptoms and then went to get tested in the typical ways, they could be spreading the virus to others during that critical early period, meaning it’s possible the virus is well entrenched in a community before it’s detected. “We don’t feel wastewater epidemiology should ever replace or be seen as an alternative to clinical testing,” says Ghaeli. “But rather it’s used best to make clinical testing more effective and efficient and better target testing.” Rather than doing blanket testing of, for example, all of an office building’s employees or everyone on a college campus on a regular basis, the signals provided wastewater could identify early on where cases are more likely to be, and direct officials towards the places where they should be doing more extensive testing. Wastewater analysis could also be crucial to detecting the presence and growth of new variants of the virus, which in turn could signal the need to ramp up prevention measures or consider changes in treatments or vaccines. At least, that’s what the CDC is counting on when it launched a nationwide wastewater surveillance program for public health departments, last September. Currently, 33 states, four cities, one county and three U.S. territories can upload their wastewater surveillance data and get support from data analytics teams at the CDC to interpret them and figure out, for example, the speed at which the virus is spreading through a community—potentially forestalling an outbreak—or whether new variants are emerging. Such programs are a new way of tracking disease that’s still getting established. “The National Wastewater Surveillance Program did not exist prior to COVID-19,” says Amy Kirby, the program lead at the CDC. Kirby says that when scientists confirmed that SARS-CoV-2 was shed in urine and fecal matter, and when studies showed wastewater could detect the virus anywhere from four to six days before cases were confirmed by COVID-19 testing, the agency decided to exploit the field as an early warning system. “The four- to six-day lead time is really valuable,” says Kirby. “It’s enough time to really make a difference.” Kirby also notes that the wastewater approach brings a universality to pathogen surveillance. “Whether or not you go to the doctor and get tested, or whether testing is even available in your community, none of that matters for wastewater surveillance,” says Kirby. “As long as most people go to the bathroom—and 74% of U.S. households are connected to the sewer system—those communities can get good data.”” Throughout the surge of cases last spring and summer, the CDC was collecting and analyzing wastewater data in pilot programs with a handful of health departments around the country. In one example, as the number of cases began to rise last spring, some health officials weren’t sure whether the increase was due to an actual rise in new infections, or whether enhanced testing, and hence potential false positives, was simply logging more cases. Wastewater data confirmed that indeed the levels of virus in the communities in question were also rising. “We were able to say, no, this isn’t a factor of increased testing in the area, but more likely a true increase in cases,” says Kirby. Australia, as well as European countries like the Netherlands, U.K., France, Spain and Switzerland also have national surveillance systems in place to scan wastewater for signs of the virus. Even countries with less consistent municipal sewage infrastructure such as Thailand and are turning to the system in rural areas as a way to get ahead of the virus if testing isn’t as available or widespread. The hurdle to relying more heavily on wastewater surveillance isn’t so much the sequencing and detecting of the virus, but setting up the infrastructure needed to collect samples, process them and interpret the results. “Our health departments aren’t used to using this type of surveillance data,” says Kirby of the early U.S. efforts. “So the challenge was developing the infrastructure to develop a data repository to receive the data and provide the robust analysis for reporting back to the health departments in a way they can use.” As part of the national surveillance network, the CDC created the Data Collation and Integration for Public Health Response Platform, (DCIPHER), a standardized database for dumping the genetic analysis from wastewater and turning it into actionable policies. For example, some communities are using the DCIPHER data from their sewage to predict where they might need to concentrate testing efforts in regions where more virus is showing up in waste, or when they might expect mini surges in demand for hospital care so health care systems can redistribute personnel and resources. For the CDC, the next step is ensuring the current national network survives beyond COVID-19 so public health experts can use it to keep tabs on potential future pathogens. One potential challenge on that front is that, currently, the sequencing of the wastewater samples is primarily being churned out by academic and commercial labs that the CDC has partnered with—but there’s no guarantee that the government will be able to retain these partnerships. “That’s not a sustainable model for the long term,” says Kirby. “We want to bring this wastewater testing capacity into public health labs which are built for surveillance testing.” If that happens, sewage surveillance could alert public health officials to new variants of viruses like SARS-CoV-2 before they start causing disease. As more scientists become familiar with analyzing wastewater, the more information it will likely yield and the more powerful it will become as a tool for fighting infectious diseases in the future. The CDC fully anticipates that the NWSS will serve as a foundation for a public health disease-detection network that would raise an alarm when it identifies not just COVID-19 and any new viral variants behind it, but other public health threats as well. Given how valuable wastewater surveillance is proving to communities around the country, Kirby and her team at the CDC are optimistic that the agency will continue to invest in the strategy, so the next coronavirus, or other pathogen that threatens human health, can be picked up and managed more quickly—thanks to something as mundane as our pee and poo. from https://ift.tt/2S8AnSR Check out https://takiaisfobia.blogspot.com/ We’re not going to vaccinate our way completely out of this pandemic. With epidemiologists around the world increasingly accepting the reality that SARS-CoV-2 and its variants will become endemic viruses—like the seasonal flu—the push is on to develop antiviral medications that can be taken at home to prevent infections from leading to hospitalization and death. Today, the Department of Health and Human Services announced that the Biden Administration has authorized $3.2 billion to accelerate the development of antivirals already in the R&D pipeline, with the hope that at least one will be ready for release before the end of the year. “The remarkable and rapid development of vaccines and testing technology has shown how agile scientific discovery can be,” said Dr. Francis S. Collins, director of the National Institutes of Health (NIH), in an HHS statement. “We will leverage these same strengths as we construct a platform for the discovery and development of effective antivirals.” The plan will focus on 19 drugs currently being investigated for their antiviral potential, with a goal of accelerating their development to Phase 2 clinical trials. Last week, the Administration already placed a major bet on one of the 19, announcing that it will purchase up to 1.7 million doses of an antiviral being produced by Merck, pending emergency use authorization or full approval by the U.S. Food and Drug Administration. Of the $3.2 billion being allocated, $1.2 billion is going to fund the creation of what the HHS calls “collaborative drug discovery groups,” hoping that the push to create a COVID-19 treatment will also create a developmental infrastructure for other antivirals to treat other diseases. The new drugs could not only fill the breach left by the vaccine-hesitant who are slowing the push in the U.S. and around the world to reach herd immunity, they could also serve as a backstop against breakthrough infections—cases of COVID-19 that occur even among the vaccinated. Late last month, for example, the CDC reported more than 10,000 breakthrough vaccinations in 46 states as of the end of April, at a time when just over 100 million vaccines had been administered in the U.S. In Massachusetts alone, there have currently been a total of 4,000 breakthrough infections recorded, reported the Boston Herald today. That’s still a relatively small number—representing just 0.1% of vaccinated people—but does make the new drugs attractive. “New antivirals that prevent serious COVID-19 illness and death, especially oral drugs that could be taken at home early in the course of disease, would be powerful tools for battling the pandemic and saving lives,” said Dr. Anthony Fauci, head of the National Institute for Allergy and Infectious Diseases, in the HHS announcement. from https://ift.tt/3cM6hLN Check out https://takiaisfobia.blogspot.com/ Forty years ago this month, the U.S. Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report noted a rare lung infection among five otherwise healthy gay men in Los Angeles, Calif. Though they didn’t know it at the time, the scientists had written about what would turn out to be one of the historical moments that launched the Acquired Immunodeficiency Syndrome (AIDS) epidemic. Since then, HIV/AIDS has killed an estimated 35 million people, including 534,000 people in the U.S. from 1990 to 2018 alone, according to UNAIDS, making it one of the deadliest epidemics in modern history. Over the last year-plus, another outbreak—the COVID-19 pandemic—has also extracted a terrible toll, killing more than 600,000 in the U.S. and more than 3.7 million globally. For some of those who survived or otherwise had their lives irrevocably changed by HIV/AIDS, COVID-19 has been particularly challenging—those with HIV/AIDS may be at greater risk for severe conditions connected to infection with the coronavirus; and people with weakened immune systems may not get the same level of protection from vaccination as others. Over the last two months, TIME has been speaking with HIV/AIDS survivors about their experiences both with that epidemic and with COVID-19, and about the historical parallels between the two outbreaks. Their stories have been lightly edited for length and clarity. Gina BrownBrown, 55, lives in New Orleans and is the Community Engagement Manager for the Southern AIDS Coalition, which promotes access and care. She tested positive for HIV on April 4, 1994 while she was pregnant with her daughter. In the beginning of HIV, what little was said about it was misinformation. I thought I was the first woman in the world with HIV. I didn’t know any other woman who was living with HIV at that time. Everything was geared towards gay men or focused on IV drug use, promiscuity, sex work, certain behaviors. People didn’t talk about contracting HIV in a monogamous relationship. The same with COVID, and it came from the top. With COVID, we heard misinformation from President Trump. “If you’re not sick, you don’t have to wear a mask.” Well, everyone should be wearing a mask! With HIV, misinformation came from legislators, and the President [Reagan] was just silent. The isolation of COVID-19 reminded me of HIV, although the isolation from HIV was self-imposed. Both illnesses cause you to look at your fellow man as if they are a disease. My cousin, who was in his 20s, died from HIV in the 1980s. Normally in our family, if somebody is dying, you go and you kiss them, you tell them goodbye. Nobody did that. I thought I would die the first year of my diagnosis. I only told my mom, my two sisters, and my children’s father. I started really isolating myself, not hanging out with my friends; I felt paralyzed when the word “HIV” was said, that they’d look at me and see that I had HIV. In 1994, when I had my daughter, no one ever came to my room in the hospital. They put my food outside my door, and I had to bring the tray in myself. What also reminds me of COVID, is that marginalized people always bear the brunt—and they become the culprit. When people would talk about HIV, they would talk about Black gay men, and Black trans women, and Black women in a really negative light. And with COVID, people would say Black people die because they’re fat and they have diabetes. That wasn’t the story for everybody. People I know who died from COVID were essential workers—working at grocery stores, fast food places, at an HIV service organization. With both HIV and with COVID, we weren’t seeing the humanity in each other. Arthur FittingFitting, 67, is a registered nurse who has worked for the non-profit home care agency Visiting Nurse Service of New York (VNSNY) for decades. He currently manages the organization’s LGBT program. I was working in home health care in the West Village and Chelsea in Manhattan, which were areas where AIDS really started—and were hit the hardest. All of a sudden, patients were developing this mysterious illness, and I started to realize it was mostly gay men. There was nothing being said about how to treat these new patients. And especially as a gay man, I was really concerned about not knowing how it spread. You’re going into somebody’s home, and seeing so many of these patients; you didn’t know what was going to happen. Hospitals were not prepared; people were dying in cabs, in ambulances. Some emergency rooms weren’t even accepting AIDS patients. And when they came in, they were just dying in the ER. Once the public knew it was a gay-related disease, the homophobia started up even more. You had to be careful—people thought at that time that this came from gay people, so gay people should be punished. One time, I got punched in the face in the West Village at random. When we realized [in 1985] my partner had AIDS, I was in such shock. I walked about 60 blocks in a fog, thinking and thinking. My partner became ill quite rapidly. With older people, you might have a little preparation, but my partner was in his 20s. I took care of him for about 18 months until he had to be hospitalized. After he died [in 1987 at the age of 31], there was stigma because I’d been with somebody with AIDS, and it took a long time before I even wanted to have another relationship. In March 2020, I found out that my husband, who works in a hospital as a radiology technologist, had developed COVID. Again, there was no standardized treatment; we were just treating the symptoms for COVID. I’d broken down all my walls to be able to share my life with another person again. I felt so vulnerable, thinking, “how could this be happening again?” I was checking on him and watching all through the night. The possibility that I couldn’t be with him in the hospital was very difficult. When my partner died from AIDS, being at his bedside at least made me feel that I’d done all that I could to support him. After my husband got better, I took a very different approach to my work with VNSNY; its mission is to serve marginalized communities and the underserved. I started working with community-based organizations to assess what health care is like in their local community, and I realized the same conditions were present in marginalized communities last year as during the AIDS crisis. People couldn’t get care, again. How could we have spent so much money as a country after the AIDS outbreak, and not have been better prepared for another pandemic? COVID has just reawakened my determination; I’m not going to back down now from really fighting for health equity. Cecilia ChungChung, 55, lives in San Francisco and is the senior director of the Transgender Law Center, a non-profit trans advocacy organization. She immigrated to the U.S. from Hong Kong in 1984 and was diagnosed with HIV in 1993. With both outbreaks, there’s a lot of scapegoating—for HIV, gay men were scapegoated; HIV was called “the gay disease.” And for COVID, people of Asian descent are scapegoated. Even in San Francisco, we’ve had some anti-Asian violence. That’s why I go to the bank for my 78-year-old mom—so she doesn’t need to put herself in a dangerous situation. I also wanted to make sure that she was not exposed to COVID. There were a couple residents in her retirement community who passed away from COVID, so the entire building was in a lockdown. It was a relief for me when she got her shots. With HIV, I felt more discrimination because I was trans, rather than because I was Asian. After I became homeless, I started to engage in a lot of survival street work, such as sex work, to survive; that led to my arrest [in 1993]. It was very intimidating and scary to be in jail [for a few days] with men. I was coerced into having sex with one of my cellmates; later on that year, I tested HIV positive. However, a women’s clinic denied me medical services, since they didn’t see trans women patients. It was a lot harder to find the right services, and it can get quite discouraging after a while. You still see that happen today—”we’re not funded to see people like you.” Asians were invisible in the early days of HIV; I don’t remember seeing any images of an Asian living with HIV and dying of HIV. We began to believe that we must not be as impacted as much as other communities. The materials were not translated into too many languages, so it became a challenge to find additional information. It’s also not in our culture to talk about sexual risk. We don’t even talk about it with our family, let alone to strangers about our sexual practice. I think the severity of COVID escalated because the government failed to respond in a timely fashion, as it did with HIV. It took 30 years for this country to create a national HIV response. I don’t think we learned a lot from that, looking at COVID; it’s cost a lot more deaths than I think were necessary. I’m pessimistic; I think that these things are very cyclical. This is not the first time that there has been an outbreak of an epidemic disease, and I’m pretty sure that this won’t be the last. Ciarra (“Ci Ci”) CovinCovin, 33, lives in Philadelphia and is the Program Coordinator for The Well Project. She was diagnosed with HIV/AIDS in 2008. She is currently pregnant with her second child. I was diagnosed with HIV when I was 20 years old, living in rural Georgia. The life expectancy I found after researching HIV online is how I made some decisions early on. I got married around age 23 and got pregnant with my now 10-year-old son almost immediately, because I was doing math in my head. I said to myself, “If I get pregnant now, I’ll be around 40 when he graduates from high school. I can make it to 40.” Since then, I have made it a mission of mine to educate those around me. I wish that someone like me had reached out to me when I was younger. The HIV and AIDS community could benefit from the same compassion as those with COVID-19. After I was diagnosed with HIV, I received a lot of discrimination from the people down South. I was kind of under the impression that I was being punished for doing something that I shouldn’t have been doing. A woman told her daughter that I could not come to her house and sit on their furniture, as if they could get HIV from me that way. I think ignorance is everywhere. I’m as scared as hell of COVID. I became my son’s primary teacher, and I’m a single mom. And not only have we been locked inside, but my city was up in flames [during last summer’s Black Lives Matter protests]—to drive around and see stores getting looted and the racial tension, it just made me so nervous. After Sandra Bland’s death, that’s when I realized that the world really didn’t care about people that look like me. Then in the middle of all it is COVID, more death and more killings, and the trauma that comes. [On May 5], about five days after my grandfather was admitted to the hospital for a stroke, they called us to let us know he had COVID. He died in that hospital on [May 28]. He was alone, probably really uncomfortable. I hate that. How could he have gotten it there? I’m five months pregnant. Now we’re going to be in the hospital with COVID and HIV at the same time. I’m so nervous. How are you gonna protect me from getting COVID—or my baby? So many Black women die and have complications during birth. Jeff WachaWacha, 61, lives in Los Angeles County. His husband, Garry Bowie, was head of the nonprofit Being Alive, an L.A.-based HIV/AIDS social services organization, until he passed away from COVID-19 complications in April 2020. In February 2020, when word started getting around аbout COVID, Garry got his staff together, and they put together a mitigation plan. It just kills me that, as diligent as Garry was and prepared as he was, he was one of the first ones to succumb to it. It’s just not right. I didn’t mind taking care of Garry [when he got sick with COVID-19], but I finally had to call the ambulance when his breathing got bad. The EMTs at that time wouldn’t even come in the house. I had to get Garry dressed myself and get him out on the front steps before they would take over. The feeling of being a pariah because you have it reminded me of the feeling when I first found out I had HIV. The fear of being around people who have it, the “am I going to get it?” There’s also the survivor’s guilt. And the panic sets in: “Am I next?” Because that was usually the way it was with HIV. I did not deal with being diagnosed with HIV as well as Garry did. I went out and ran up all my credit cards as high as I could, thinking that I’d be dead before they came due. He was diagnosed in ’83. He went through the usual depression people go through; back then it was pretty much a death sentence. He quickly pulled himself out of it. When AZT [azidothymidine, an antiretroviral medication used to treat HIV/AIDS approved in the U.S. in 1987] came out, he and his mother would drive down to Mexico and buy all the AZT they could and bring it back, both terrified that they’d end up in jail. His time at the AIDS Foundation, and at Being Alive, it’s always been about advocacy, it’s been trying to help underserved people. He would spend hours upon hours on the internet doing research. And he would come up with these ideas, saying “Well, what if we tried this?” and he actually would put them into effect. He worked a lot with the homeless population; he was very proud of the fact that it was his idea to get people in and get them the services they need, whether it’s housing, food, medical care, get their viral load back down to zero, and try to give them a normal life. His primary goal was to stop new infections. Garry firmly believed that through education and practice that, even without new medications, we could eventually eradicate HIV. The entire time he spent in bed with COVID, he was on his computer, checking facts with the CDC and putting it out on social media. The man was sicker than he’s ever been in his entire life. And what’s he doing with his time? He’s finding ways to help other people. His biggest concern was making sure that I was okay. When he did get out of bed, he wouldn’t touch anything unless he got a Clorox wipe out. He’s probably the most compassionate person I’ve ever met. from https://ift.tt/3q62K0E Check out https://takiaisfobia.blogspot.com/ (WASHINGTON) — The Supreme Court dismissed a major challenge to the Obama era health care law on Thursday, turning aside an effort by Republican-led states to throw out the law that provides insurance coverage for millions of Americans. The justices, by a 7-2 vote, left the entire law intact in ruling that Texas, other GOP-led states and two individuals had no right to bring their lawsuit in federal court. The Biden administration says 31 million people have health insurance because of the law popularly known as “Obamacare.” The law’s major provisions include protections for people with pre-existing health conditions, a range of no-cost preventive services and the expansion of the Medicaid program that insures lower-income people, including those who work in jobs that don’t pay much or provide health insurance. Also left in place is the law’s now-toothless requirement that people have health insurance or pay a penalty. Congress rendered that provision irrelevant in 2017 when it reduced the penalty to zero. The elimination of the penalty had become the hook that Texas and other Republican-led states, as well as the Trump administration, used to attack the entire law. They argued that without the mandate, a pillar of the law when it was passed in 2010, the rest of the law should fall, too. And with a more conservative Supreme Court that includes three Trump appointees, opponents of Obamacare hoped a majority of the justices would finally kill off the law they have been fighting against for more than a decade. But the third major attack on the law at the Supreme Court ended the way the first two did, with a majority of the court rebuffing efforts to gut the law or get rid of it altogether. Trump’s three appointees to the Supreme Court — Justices Amy Coney Barrett, Neil Gorsuch and Brett Kavanaugh — split their votes. Kavanaugh and Barrett joined the majority. Gorsuch was in dissent, signing on to an opinion from Justice Samuel Alito. Justice Stephen Breyer wrote for the court that the states and people who filed a federal lawsuit “have failed to show that they have standing to attack as unconstitutional the Act’s minimum essential coverage provision.” In dissent, Alito wrote, “Today’s decision is the third installment in our epic Affordable Care Act trilogy, and it follows the same pattern as installments one and two. In all three episodes, with the Affordable Care Act facing a serious threat, the Court has pulled off an improbable rescue.” Alito was a dissenter in the two earlier cases, as well. Because it dismissed the case for the plaintiff’s lack of legal standing — the ability to sue — the court didn’t actually rule on whether the individual mandate is unconstitutional now that there is no penalty for forgoing insurance. Lower courts had struck down the mandate, in rulings that were wiped away by the Supreme Court decision. With the latest ruling, the ACA is “here to stay for the foreseeable future,” said Larry Levitt, an executive vice president for the non-profit Kaiser Family Foundation, which studies health care. “Democrats are in charge and they have made reinvigorating and building on the ACA a key priority,” Levitt said. “Republicans don’t seem to have much enthusiasm for continuing to try to overturn the law.” Republicans pressed their argument to invalidate the whole law even though congressional efforts to rip out the entire law “root and branch,” in Senate GOP Leader Mitch McConnell’s words, have failed. The closest they came was in July 2017 when Arizona Sen. John McCain, who died the following year, delivered a dramatic thumbs-down vote to a repeal effort by fellow Republicans. Chief Justice John Roberts said during arguments in November that it seemed the law’s foes were asking the court to do work best left to the political branches of government. The court’s decision preserves benefits that became part of the fabric of the nation’s health care system. Polls show that the 2010 health care law grew in popularity as it endured the heaviest assault. In December 2016, just before Obama left office and Trump swept in calling the ACA a “disaster,” 46% of Americans had an unfavorable view of the law, while 43% approved, according to the Kaiser Family Foundation tracking poll. Those ratings flipped and by February of this year 54% had a favorable view, while disapproval had fallen to 39% in the same ongoing poll. The health law is now undergoing an expansion under President Joe Biden, who sees it as the foundation for moving the U.S. to coverage for all. His giant COVID-19 relief bill significantly increased subsidies for private health plans offered through the ACA’s insurance markets, while also dangling higher federal payments before the dozen states that have declined the law’s Medicaid expansion. About 1 million people have signed up with HealthCare.gov since Biden reopened enrollment amid high levels of COVID cases earlier this year. Most of the people with insurance because of the law have it through Medicaid expansion or the health insurance markets that offer subsidized private plans. But its most popular benefit is protection for people with pre-existing medical conditions. They cannot be turned down for coverage on account of health problems, or charged a higher premium. While those covered under employer plans already had such protections, “Obamacare” guaranteed them for people buying individual policies. Another hugely popular benefit allowed young adults to remain on their parents’ health insurance until they turn 26. Before the law, going without medical coverage was akin to a rite of passage for people in their 20s getting a start in the world. Because of the ACA, most privately insured women receive birth control free of charge. It’s considered a preventive benefit covered at no additional cost to the patient. So are routine screenings for cancer and other conditions. For Medicare recipients, “Obamacare” also improved preventive care, and more importantly, closed a prescription drug coverage gap of several thousand dollars that was known as the “doughnut hole.” ___ Associated Press writer Ricardo Alonso-Zaldivar contributed to this report. from https://ift.tt/3gzb1GZ Check out https://takiaisfobia.blogspot.com/ A version of this story first appeared in the Climate is Everything newsletter. If you’d like sign up to receive this free once-a-week email, click here. For years, climate policy experts have watched as the issue has been pushed off the stage at global summits to make way for the geopolitical conflict dujour. That trend has long frustrated climate advocates who sought to make leaders understand that the scientific reality of climate change is just as urgent—if not more so—than other flavor-of-the-month topics. With this in mind, it was notable when many of these same climate advocates sharply criticized last week’s G7 leaders summit hosted by the United Kingdom for failing to adequately address another issue: the COVID-19 pandemic. In statement after statement, climate watchers homed in on what they often characterized as inadequate support from the world’s wealthy nations to address the pandemic in their poorer counterparts. Tasneem Essop, executive director of Climate Action Network, described the pandemic and climate change as “twin crises” and said the summit did “not measure up” to them. Nick Mabey, head of the E3G climate group, called out the G7 for failing to offer “enough financial firepower to tackle the global COVID, economic and climate crises.” And Jennifer Morgan, executive director of Greenpeace International, called for a vaccine patent waiver. It’s a remarkable turnaround. When COVID-19 first emerged, many in the climate world feared efforts to address the pandemic would distract from efforts to address climate change. Today, climate advocates are arguing that the two need to be addressed hand in hand. This change is in part practical: leaders in many developing countries will understandably remain focused on the pandemic rather than climate change if their on-the-ground situation doesn’t improve. And, with the November UN climate summit in Glasgow fast approaching, the situation on the ground may need to change quickly to give officials adequate time to prepare. But, in some sense, the rhetorical shift among climate activists may be just as symbolic as it is practical: climate advocates fear that failure to muster a strong response to COVID-19 will send a signal to developing countries that wealthy nations will leave them high and dry as the impacts of climate change start to mount. That, many believe, would hamper the motivation to take on mitigation efforts in the developing world—just as the needs grow more urgent. “In some ways, the vaccine issue is a metaphor for the larger climate issue,” says Alden Meyer, a longtime international climate policy expert who serves as senior associate at E3G. When you look closely, there are a number of issues related to fighting COVID-19 that map directly onto fighting climate change. Patent waivers have become a point of contention, as some argue that freeing the intellectual property surrounding vaccines would enable poorer countries to manufacture vaccines locally. In the climate fight, developing countries have for years called for their wealthier counterparts to share the technological know-how to allow them to reduce emissions—even if that meant companies losing out on potential revenue. Ponying up the money has also been a key point of contention in both COVID-19 and climate conversations. Ahead of the Paris Agreement, a group of rich countries committed to sending some $100 billion annually to the developing world to help finance climate efforts. Wealthy countries have repeatedly reaffirmed that promise—including at the G7 last week—but the money has yet to materialize at that scale. (You can read my colleague Ciara Nugent’s piece on climate finance and the G7 here). The fact that many poor countries facing pandemic-related budget crunches haven’t gotten much assistance from their wealthier counterparts doesn’t inspire much confidence in how things will play out when it comes to climate change. Events like the upcoming UN climate conference in Glasgow typically draw tens of thousands of participants from all across the globe. And, unlike many geopolitical settings, delegates from poorer countries, particularly those most vulnerable to the effects of climate change, often hold significant sway. What happens if those countries don’t have adequate access to vaccines by then? The U.K. has promised vaccines to “accredited delegations who would be unable to get them otherwise,” but the optics aren’t great. Will climate negotiators from developing countries get vaccinated while the elderly at vulnerable at home remain at risk? Even if they do show up, will those government leaders fear making aggressive climate commitments as their people suffer from a pandemic? Time will tell. Ultimately, though, there is one inescapable conclusion: tackling the pandemic will help the world tackle climate change. from https://ift.tt/3cQL7wb Check out https://takiaisfobia.blogspot.com/ At my animal hospital in upstate New York, an epicenter of the U.S. tick epidemic, my dog Fawn lets out a whimper as the veterinarian injects her with her annual Lyme disease shot. I roll my eyes. She doesn’t know how good she has it. The injection means that if a tick bites her (and in rural New York, a tick always does), the creepy crawly will feast on dog blood that’s been supercharged with a Lyme bacteria-killing substance, and Lyme disease won’t be transmitted to Fawn. I wish I could be shot up with that superpower. Currently, there is no human vaccine for Lyme disease—even though more than two decades ago, people could get a safe and effective preventative shot similar to Fawn’s. Now, thanks to potent anti-vaccine pushback, all we can do is try to avoid getting bitten by the tiny, vampiric nightmares. A tick can’t fly or jump; instead, it “quests,” or waits on a blade of grass or on the leaf of a bush for you, your dog or any other furry host to brush by. It then crawls up your body, finds a good place to feed, cuts your skin open with tiny incisors and sticks in a feeding tube, through which it slowly takes a blood meal. You don’t feel any of this, thanks to a numbing substance in tick saliva that lets it feed in secret (so good luck trying to swat a tick away). And that’s the benign part. Once a tick starts sucking your blood, its saliva—which can carry all sorts of pathogens—enters your bloodstream. That’s how people contract Lyme disease, by far the most common vector-borne illness in the U.S., according to the U.S. Centers for Disease Control and Prevention. A bullseye-shaped rash shows up at the bite site in about 70-80% of people who ultimately are determined to have Lyme. In those cases, it’s relatively straightforward to diagnose and treat with several weeks of antibiotics, which work best when given early on in the infection. But if you don’t get that rash, you might not even know you’ve been bitten, and fever, headache, fatigue, chills and joint pain can come on with no warning. Later signs of Lyme can include nerve pain, neck stiffness, sudden weakness in facial muscles, arthritis, heart palpitations, cognitive problems and brain and spinal cord inflammation. Some cases become chronic—what the CDC calls “post-treatment Lyme disease syndrome”—with mysterious symptoms lasting more than six months after treatment. Lyme disease is rarely fatal, but it can make life extremely unpleasant. Not every case responds well enough to antibiotics, and prolonged illness is more common and serious than once thought, shows research from the Johns Hopkins Bloomberg School of Public Health published in 2015 in the journal PLOS One. Lyme disease costs the U.S. health care system between $712 million and $1.3 billion every year—an average of about $3,000 per patient—in testing costs and repeat doctor visits. In the analysis, people with Lyme disease had 87% more doctors’ visits and 71% more visits to the emergency room in the year after their diagnosis compared to demographically similar people who didn’t have Lyme. Lyme disease, discovered in Lyme, Conn., in 1975, is caused by a tick-transmitted bacterium called Borrelia burgdorferi. Though it is often associated with the northeastern United States, the illness is found in many parts of North America and in Asia and Europe, and several different strains of the B. burgdorferi bacteria can cause it depending on the region. Tick-borne diseases are on the rise across the U.S. and around the world, with reported cases in the U.S. reaching record highs in recent years. The number of reported Lyme disease cases in the U.S. has at least tripled since the late 1990s, the latest CDC data suggest. Each year, about 476,000 Americans are diagnosed and treated for Lyme disease. A warming climate is one reason for the explosion in human exposure to ticks; another is increased land development on previously forested areas, putting people in closer contact with deer, mice, chipmunks and other tick hosts. U.S. cases of Lyme outnumber any other mosquito- or tick-borne disease by many thousands per year, but scientists have identified at least a dozen other such illnesses in the U.S., plus more abroad. Some are caused by bacteria transmitted by ticks, others by viruses. And some have truly weird effects in humans, like alpha-gal syndrome, in which a bite from an infected tick can trigger a red-meat allergy. Others, like the recently discovered Powassan virus, can be deadly and have no known treatment. The best way to protect against the growing threat of tick-borne diseases is through vaccines, as Dr. Anthony Fauci and his colleagues at the National Institute of Allergy and Infectious Diseases argued in a 2018 paper published in the New England Journal of Medicine. No human vaccines for Lyme exist. But that wasn’t always the case. Before Lyme disease shots went to the dogs, people had a safe and effective vaccine, approved by the U.S. Food and Drug Administration (FDA) in 1998. But anti-vaccine forces claimed it was dangerous, tanked its popularity and sued it out of existence after just a few years on the market. However, there are now several new options in the pipeline, and scientists are crossing their fingers that these don’t meet the same fate. The only Lyme disease vaccine ever approved by the FDA was developed in the 1990s. Called LYMErix and manufactured by GlaxoSmithKline (then SmithKline Beecham, or SKB), it worked in a unique way. Unlike most vaccines, which stimulate a person’s immune system to make antibodies that fight off a germ once it enters the person, LYMErix instead “immunized” the tick against its own dangerous bacteria. If a tick were to take a sip of a vaccinated person’s blood—now full of bacteria-neutralizing antibodies—the pathogens in the tick’s gut would be killed before they could be transferred to the human. “It had a very sexy, interesting mechanism of action,” says Dr. Robert Aronowitz, a physician and medical historian who wrote a detailed account of the history of Lyme disease vaccines for a 2012 issue of the health journal The Milbank Quarterly. LYMErix, which was given in a series of three shots, proved to be safe and about 75% effective in reducing the risk for infection in clinical trials. The FDA approved LYMErix in 1998, but with a great deal of ambivalence. Even after the vaccine’s approval, members of a CDC advisory committee disparagingly called it a “yuppie vaccine” for affluent suburbanites who “will pay a lot of money for their Nikes and their Esprit and shop at L.L. Bean’s (sic) [and] will have no consideration for cost-effectiveness when they want a vaccine because they’re going to travel to Cape Cod.” In other words, Lyme was seen as a champagne problem: a mild, treatable disease that affected a small number of people only in certain—wealthy—regions. Federal regulators and advisory boards were also concerned about LYMErix for other reasons, Aronowitz points out. Booster shots to the three-dose regimen were thought to be needed at some point. The trials hadn’t yet included children. Most of all, regulators were worried that LYMErix might cause some unknown side effects down the line. The fear was that the vaccine might, hypothetically, trigger an autoimmune reaction in some people that would cause the very same long-lingering symptoms of Lyme disease cases that don’t always respond to antibiotics, like arthritis and chronic fatigue. Scientists took the speculation seriously, but it was later disproven in long-term follow-up studies. Still, the very notion had been enough to turn the public against the vaccine. Lyme advocacy groups “latched onto the vaccine as being a horrendous thing, a cause of chronic fatigue and other persistent Lyme [symptoms],” says Dr. Neal Halsey, founder and former director of the Institute for Vaccine Safety at the Johns Hopkins Bloomberg School of Public Health, who chaired SKB’s data and safety monitoring committee for the LYMErix Phase 3 trial. “They quickly became anti-vaccine, even though you would think they would be pro-vaccine.” In 1999, more than 100 people who had taken LYMErix filed a class-action lawsuit against SKB for the perceived negative side effects they experienced. The CDC and FDA continued to monitor adverse events in the years following the vaccine’s approval but found no higher incidence of arthritis or any other serious side effect in vaccinated people. Neither did post-licensure safety trials conducted by SKB. Yet the negative attention pummeled vaccine sales. LYMErix sales dropped from about 1.5 million doses in 1999 to about 10,000 in 2002, and that year, SKB (by then GlaxoSmithKline) voluntarily pulled it from the market. A year later, the company settled the class-action lawsuit, while continuing to deny that the vaccine had caused harm. Lyme vaccine scientists felt burned after more than a decade of work. “I was surprised and annoyed and even a bit angry,” Halsey says. “I really thought settling the class-action lawsuit and taking it off the market was a mistake. I still believe that.” Most scientists moved on to different pursuits, and some find it hard to discuss those painful years even now. “Lyme disease is the only infectious disease that I know of for which we have a vaccine that’s been shown in Phase 3 trials to be safe and effective, but that is not available to the public,” says Dr. Allen Steere, professor of medicine at Harvard Medical School and director of translational research in rheumatology at Massachusetts General Hospital. Steere is credited with discovering Lyme disease and was the principal investigator of the Phase 3 LYMErix vaccine trial. “When is the scale finally going to tip? When are there going to be enough cases and enough people affected that [Lyme vaccination] really becomes a potent, societal force?” That time may be now. In 2020 and 2021, the U.S. National Institutes of Health funded more than $6 million in tick disease-prevention projects—many of them for vaccine development. Several new vaccines for Lyme disease are on the horizon, and in exciting but early work, researchers are even trying to develop vaccines that target ticks themselves, potentially protecting against a wide range of illnesses the tiny arachnids carry. The furthest along is a vaccine candidate co-developed by Pfizer, the U.S.-based pharmaceutical giant, and Valneva SE, a French biotech company. In March, the companies kicked off a Phase 2 trial in 600 people ages 5-65. The vaccine, which would be given in two to three doses, is very similar to LYMErix, but it targets six strains of Lyme bacteria—not just those common in North America, but in Europe as well—instead of the single strain that LYMErix targeted. Finding volunteers to take it has been easy, aside from a lull during COVID-19 lockdowns, says Thomas Lingelbach, president and CEO of Valneva. “The tick issue has reached a completely different scale,” he says. “Ticks are everywhere. Fortunately, there is a high and increasing level of awareness.” The same may be true for vaccination in general, which could help any new Lyme disease vaccine avoid the same fate as LYMErix. “I do believe that post-pandemic, the world is going to have a higher awareness of vaccination, and hopefully this will positively contribute to acceptability of vaccination globally,” Lingelbach says. Pfizer and Valneva hope that the Lyme vaccine, if proven effective, will be in use by 2025. Scientists at MassBiologics, a nonprofit vaccine and biologics manufacturer overseen by the University of Massachusetts Medical School, are taking a different approach with a preventative shot called Lyme PrEP. It’s not a vaccine but a monoclonal antibody: an injected antibody that shows up immediately in a person’s blood (unlike the LYMErix vaccine, which triggered the production of many different types of antibodies over time). This one antibody appears to protect against multiple species of Lyme disease-causing bacteria and “makes you immune to Lyme disease the day you receive the injection,” says Dr. Mark Klempner, executive vice chancellor for MassBiologics and professor of medicine. Like LYMErix, it works by neutralizing Lyme-causing bacteria in the tick’s gut before it can be transmitted to you. But one downside of LYMErix was that you had to get all three shots months ahead of tick season in order to allow an antibody response to build up in your blood. With Lyme PrEP, “there’s no waiting to develop immunity, and there are no other antibodies that might cause side effects.” Better still, Klempner believes the shot would only have to be given once a year. A Phase 1 trial of about 65 people began in February, and if all goes well, MassBiologics hopes that FDA approval could come in 2024. The holy grail would be an anti-tick vaccine that would make you immune to tick bites, full stop, protecting you from all types of tick-borne pathogens. There’s some experimental evidence that certain animals, like guinea pigs, build tick immunity after being bitten enough times; when a tick bites such an animal that has been bitten a number of times in the past, and then tries to feed again, the tick falls off and dies, or the bite results in enough surface irritation to alert the animal, which then scratches the tick off before bacteria has time to transmit. Anecdotal evidence suggests this may happen in people, too. “If you talk to entomologists who work in the field who are older, many of them would tell you they don’t worry about tick bites as much as they used to because ticks don’t seem to like them anymore,” says Dr. Erol Fikrig, who runs an infectious disease lab at Yale School of Medicine (and helped develop LYMErix). “That’s not proof, but it’s a suggestion that tick immunity does occur in humans.” Fikrig himself is a good example; when they bite him now while gardening or hiking, the bite site gets red “and I notice them very early, when they haven’t fed yet. Anecdotally, I think I am becoming tick-immune.” The hope is to one day develop a vaccine based on this phenomenon. “We’re cloning different proteins in tick saliva and testing the capacity of those proteins, individually and in combination, to cause rejection in our model system,” Fikrig says. Once the right protein is discovered, “you can make it very easily at large quantities in a pure form, and you can immunize people with it so that they can then have some form of tick resistance.” Another way Fikrig is trying to do this is by using mRNA vaccination—the technology behind two of the leading COVID-19 vaccines, from Pfizer-BioNTech and Moderna—to teach the body to make these tick-salivary proteins in order to generate an immune response. A universal tick vaccine is still a long way off. In the meanwhile, many people would settle for a Lyme disease vaccine akin to what we once had—but even that is 3-5 years away. Dogs now have four safe and effective Lyme disease vaccines. They’re similar to LYMErix, and, well, the canines aren’t complaining. The market for dogs like Fawn has proven remarkably successful—so much so that the makers of one canine Lyme vaccine, VANGUARD crLyme, are trying to take a version into humans. Now that ticks are creeping ever closer to all of us, maybe more people will finally be ready to take a shot when they can. from https://ift.tt/3vyB6ua Check out https://takiaisfobia.blogspot.com/ A version of this article also appeared in the It’s Not Just You newsletter.Sign up here to receive a new edition every Sunday. I’m a tech believer. My first job with TIME was to set up new communications systems and convince cranky foreign correspondents to trust them. Alexa and Google Home have colonized my apartment. And not only did I give my DNA to 23andMe, but I even answer their follow-up questions about whether I like olives or get carsick so they can map those genes. (Naturally, I also want to donate my body to research after I’m done with it–and if there were a way to send me a report in the afterlife about what they find, I’d request it.) So you can imagine how very excited I was when Fitbit and other wearable health trackers, including Amazon’s Halo and the Apple Watch, started coming up with ways to show us data on our stress levels. There’s a bevy of new devices that monitor not just our heart rate, daily steps, and the quantity of our sleep, but the quality of our sleep by hour, skin temperature, and fluctuations in our blood oxygen saturation. Many of these biomarkers relate to our mental wellness and physical health, and there’s new wearable technology that picks up on our emotions. But even data geeks like me realize there are crucial questions about whether technology is a solution or part of the problem when it comes to stress management. It’s fair to ask whether the very act of constantly checking personal health stats on our phones is antithetical to the kind of mindfulness and meditation practices that alleviate stress. And then there are all the sticky issues around data privacy. So as annual global spending on wearable tech rises to more than $80 billion a year and rates of stress and anxiety skyrocket simultaneously, we wonder: Is a quantified self a happier self? I spoke to mindfulness expert Deepak Chopra, M.D., and Fitbit CEO James Park about some of these questions. They’ve recently partnered on a series called “Mindful Method,” an expansion of Fitbit Premium‘s health tracking and content offerings. It includes short video meditations led by Dr. Chopra on cultivating the mind-body connection, getting better sleep, mental wellness, and my favorite, “resetting your bad mood.” This collection is paired with new Fitbit technology that detects electrodermal activity (EDA) responses–tiny electrical changes on your skin that can indicate a stress response. Both Park and Chopra will tell you they see tech as a neutral actor, one that can be used to better lives or exploit societal weaknesses. Park uses the example of controversial algorithms that favored the sharing of extreme content on Facebook and other social platforms, which can lead to negative behavior. But Park sees positive opportunities in applications that provide ever-more customized health offerings: “What’s fascinating to me is that you can use these same tools to look at populations and try to nudge them in ways that actually result in really positive behavior.” Did someone forward you this newsletter? Subscribe here to get a fresh edition every Sunday And on the fundamental question of whether health tracking devices are an impediment to mindfulness or an facilitator, Chopra is unequivocally in the latter camp. <strong>I think of technology as the evolution of human consciousness. Who created technology? We created technology, right? And technology is unstoppable. So how do we use it to our benefit?</strong> says Chopra. To that end, more wearable health trackers like Fitbit are adding mental wellness features and content. For example, these devices can help you become more aware of your emotional fluctuations by asking you to log your moods and showing you data about related wellbeing biometrics (like the quality of your sleep, your physical activity, heart rate, or some of the newer wearable capabilities that can recognize stress reactions in your voice or skin). There isn’t much independent research on whether digitally logging your moods is effective in managing your mental health. Still, the concept is similar to longstanding suggestions that it can be beneficial to keep a mood journal manually to identify your emotional patterns and triggers. However, according to some studies, monitoring one’s biometrics can leave some users feeling both empowered and anxious. You could say our smartwatch relationships are complicated. Not only do we share intimate information with them, our weight, what we eat, how we feel, but they now give us biometrics that only elite athletes once had. These are things we didn’t know we had to worry about like whether we’ve enough REM sleep or our heart rate variability. That amount of information can be overwhelming, and dispiriting if you’re not meeting your goals. And on the flip side, some people become anxious when they don’t have access to their health trackers. In a lot of ways, our gamified brains are primed to respond to trackers’ immediate feedback. Follow a guided breathing exercise and see your heart rate drop–it’s satisfying. “Today, we are not even talking about bio-feedback; we’re talking about bio-regulation, which means real-time data, real-time feedback, and real-time intervention,” says Chopra. “But,” he adds, “it’s a mistake to think that the quantified self is not the qualitative self as well. The quantitative self is data that makes you feel better about yourself without feeling guilty.” If you’re like me, this kind of data revolution isn’t so alarming, but there are obvious sensitivities about all the personal health information in the hands of private companies. This issue particularly current for Fitbit, which was acquired by Google earlier this year. Park assures us that Fitbit’s data will not be used by Google for ad targeting, explaining the terms of the deal this way: “The regulators have said, ‘Hey look, you can’t just make a verbal commitment, it actually has to be enshrined and encoded in the technology itself, and in the systems that enforce the separation.'” How data is gathered and used is undoubtedly one of the most vexing questions of our time. But Chopra believes it is medicine’s most valuable tool in managing chronic health conditions. He is working on a separate project for which a thousand people have agreed to share their biometric and other personal data from cradle to grave. “Data can give you instant knowledge of how to manage somebody’s concerns, whether they’re mental, emotional, physical, or even spiritual,” he says. Read more: My Fitbit Is More Interested In Me Than I Am Even those who have avoided the quantified-self movement would likely agree that we need more and better mental wellness interventions. There’s evidence the pandemic worsened what was already a stress epidemic. The American Psychological Association recently reported that 84% of U.S. adults reported feeling at least one emotion associated with prolonged stress in the prior two weeks. And, as Chopra and other health experts point out, long-term stress has all kinds of cascading physical health consequences, which can include high blood pressure, obesity, depression, and more. At the very least, the debate over whether tech helps with mental wellness is bringing more awareness of the tremendous toll of rampant stress and burnout. And this conversation goes beyond changing our individual lifestyles and behaviors. It’s also about transforming institutions and workplace culture to get at some of the systemic causes of stress. And in that fight, data is an ally.
Did someone forward you this newsletter? Subscribe here to get a fresh edition every Sunday. As always, you can send comments to me at: [email protected]. from https://ift.tt/3pY2LUc Check out https://takiaisfobia.blogspot.com/ My Home Country Has an Excellent Vaccination Track Record. What It Doesnt Have Is Vaccines6/16/2021 Every morning I sit at the breakfast table with my mother. She moved to New York about five years ago and having had her so close to me makes New York feel even more like home. Our morning meal, whipped up by my mom, is served up alongside a cup of Nepali chiya—a traditional black tea with milk, boiled with cardamom, cinnamon, and cloves. As we sit across the table sipping chiya from our hand-carved Nepali copper teacups, we catch up on life and current events, and share lighthearted laughter. For years, it’s been an uplifting start to my day. Unfortunately, our recent breakfasts have been much more somber. Over the past few months, a torrent of anti-Asian hate crimes has swept the country, partly incited by the racist portrayal of the COVID-19 virus as the “China virus.” Instead of being afraid and falling back to the margins (as the perpetrators of these hate crimes would have wanted), this has instead caused many Asian Americans to unite with greater force than ever before. Finally, our community has been able to move from a constant state of invisibility into a bit of deserved spotlight. Asian American communities all over the U.S. are finding solidarity in the fight for visibility in the media, pop culture, and everyday lives. On the other side of the globe, however, our families in east Asia are fighting a different type of battle. They’re not just fighting to be seen—they’re fighting to stay alive. My home country, Nepal, has been struggling through one of the worst public health catastrophes it has ever faced. Nestled between India and China, Nepal’s worsening COVID-19 pandemic has been overshadowed by the crisis in its southern neighbor. A fraction of the size of India, and even weaker diplomatically, its suffering has not received the kind of media coverage and visibility that is urgently needed to garner equitable help from the rest of the world. In May, COVID-19 infection rates in Nepal grew to almost 32 new cases a day per 100,000 people—one of the highest such rates in the world during that time frame. Nepal’s health care infrastructure is not suited to handle such pressure. The country is completely out of ICU beds, critical patients are being turned away, and oxygen tanks are being rationed. Experts estimate that within the coming weeks, ten patients will be vying for each ICU bed available. Nepal is in such dire need for oxygen tanks that the government has requested that mountaineers climbing Mount Everest bring back their oxygen cylinders. Unfortunately, these mountaineers, mostly white and Westerners, have received more global attention than ordinary Nepalis dying from lack of oxygen. It doesn’t have to be this way. In spite of many structural barriers, Nepal has developed an exemplary vaccination track record. For example, Nepal doubled immunization coverage for most vaccines from 43% in 1990 to 90% by 2012. Among other things, Nepal has a well-trained contingent of 55,000-plus Female Community Health Volunteers who use community-engaged and culturally sensitive strategies to deliver vaccines and other critical health care to the most remote parts of the country. Knowledge about the importance of vaccines is very high in Nepal. The country has good cold-chain storage capacity and other infrastructure to implement the COVID-19 vaccines in a smooth and speedy manner. The only thing missing is the supply of vaccines. Nepal has administered about 3 million doses of COVID-19 vaccinations so far among its population of 30 million. Unfortunately, many individuals that received the first dose have been unable to get their second dose to finish the treatment. Therefore, only about 2% of the overall population is fully vaccinated. At the current rate, experts estimate it will take 481 days to get to 10%. That’s still very far away from the 60%-80% most experts believe is required for herd immunity. When, on May 12, the U.S. Senate Committee on Foreign Relations discussed the international response to COVID-19, Chris Murphy, a Democratic from Connecticut, raised the question “What else can we be doing to make sure that Nepal is not overwhelmed in the way that India is today?” Jeremy Konyndyk, executive director of the USAID’s COVID-19 task force, responded by explaining that the U.S. had already given Nepal over $20 million for medical equipment and testing. Since then, USAID has also sent the first of three planned shipments of medical supplies to Kathmandu. While medical supplies are necessary and extremely appreciated, they only slow down the rate of spread but don’t extinguish it. Instead, the ideal solution would be proactive instead of reactive: vaccines. The U.S. is currently the largest donor to the COVAX program, from which Nepal has received 348,000 vaccines thus far. The Biden Administration announced on June 3 that the U.S. is looking to share at least 80 million surplus vaccine doses to countries around the world by the end of the month. On June 10, the administration made a further commitment to purchase 500 million Pfizer vaccines at the “not for profit” price and donate them to the world’s lowest-income countries by June of 2022, with 200 million delivered by the end of 2021. In the recent G7 meeting in Cornwall, other countries followed suit, raising the additional vaccine dose sharing commitment from G7 countries to 870 million. This upswing in recent funding commitments from wealthy countries is good news indeed. It comes as a big relief for the hundreds of Nepali activists, and advocates around the world, who have been working tirelessly for vaccine equity. However, we need to further amplify our pressure to ensure that the funding and vaccine sharing from wealthy countries do not slow down or stop. To date, over 75% of the world’s COVID-19 vaccines have been administered in just 10 of the richest countries. Such acute levels of vaccine inequity put the whole world at risk—even those countries with high vaccination rates. We know that the COVID-19 virus moves very fast and is more likely to mutate into fatal variants when more people in a population, especially vulnerable immunocompromised people, are infected. We need to move much, much faster than the virus. There is no time for sporadic, siloed, and nationalistic approaches. In early June, the leaders of World Health Organization, International Monetary Fund, World Bank, and World Trade Organization issued a joint statement calling wealthy countries to urgently scale up their vaccine donations and financial contributions to help meet the $50 billion investment needed to “end the pandemic and secure a global recovery” The statement also calls on the world to join forces to vaccinate 40% of the population. As much as USAID has stated that the COVID-19 crisis in Nepal is its “highest priority,” we still need your help. The most effective way is through reaching out to both your state senators, as well as senators on the South Asia subcommittee. We need to keep the pressure on elected officials to keep their promises, to act fast and to keep doing more. I know from talking to my family and friends in Nepal that Nepalis are ready and eager to beat the pandemic. They just need the vaccines, testing kits, oxygen tanks, and other critical supplies. In my daily calls with my sister, extended family, and friends living in Nepal, they have explained over and over again that the state of the country feels almost apocalyptic. Things are happening so quickly that it feels like family members here one day, and within the blink of an eye, they’re no longer with us. For so many Nepali citizens, seeing deaths in such masses has been so hard to wrap their heads around; after the catastrophic 2015 earthquake, no one in Nepal expected to have to deal with another devastating massive loss of lives within a mere decade. I’m so very lucky to have my mother near me who makes New York my new home. However, our identity will always be deep-rooted in Nepal. The place, the people, and the culture are what have shaped me into who I am today, and to see so much of the country and so much of my family lost in this battle, has made me more heavy-hearted than ever. So, while people in Nepal are fighting so hard to stay alive and fight this virus, we must do our part and fight for their visibility—so that Nepali and Asian voices are not rendered invisible again. from https://ift.tt/3xmA9Xd Check out https://takiaisfobia.blogspot.com/ |
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