We need one million more citizens to volunteer for the COVID-19 vaccine trials. Almost half a million Americans have signed up to be part of the clinical trials, but in order to complete the study, the COVID-19 Prevention Network—formed by the National Institute of Allergy and Infectious Diseases (NIAID) at the U.S. National Institutes of Health—will need more volunteers, and especially more volunteers from diverse backgrounds. The sooner the clinical trials finish accruing patients the sooner we will have results of the vaccine studies. I am a cancer doctor, but like many doctors and researchers have been called in to assist in any way we can to help the effort to fight COVID-19. We are all seeing too much suffering from this devastating virus. While there are many clinical trials across the country working on treatments for COVID-19 and prevention strategies, few are as important as our national vaccine effort. I teamed with David Ellison, a Hollywood producer, and his amazing team, as well as the incomparable Harrison Ford, to put together a public service announcement to encourage every citizen to consider enrolling in the vaccine trial effort. To aid in this effort, the COVID-19 Prevention Network sent an email out to those that had already volunteered, asking them why they did it. What they received back was overwhelming: an outpouring of inspirational and emotional videos, each giving a personal reason for becoming part of the trials. It’s inspiring that we have seen so many Americans come forward to help one another and be part of the solution to COVID-19. But, for the clinical trials to be completed, we need more volunteers. I am not a part of the COVID-19 Prevention Network, but am privileged to play my part to assist them fight this invisible enemy, and I so hope many others do the same. Please see PreventCOVID.org for more information and to register for the trial. from https://ift.tt/2HKsrlb Check out https://takiaisfobia.blogspot.com/
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Becton Dickinson and Co.’s COVID-19 test that returns results in 15 minutes has been cleared for use in countries that accept Europe’s CE marking, the diagnostics maker said Wednesday. The test is part of a new class of quicker screening tools named for the identifying proteins called antigens they detect on the surface of SARS-CoV-2. Becton Dickinson expects to begin selling the test, which runs on the company’s cellphone-sized BD Veritor Plus System, in European markets at the end of October. It will likely be used by emergency departments, general practitioners and pediatricians. “It is really a game-changing introduction here in Europe,” said Fernand Goldblat, BD’s head of diagnostics for Europe. Europe was really at the epicenter of the pandemic in April and May, “and unfortunately I think we’re headed back in that direction. So the need will be extremely high,” he said. Antigen tests have emerged as a valuable tool because they produce results much more quickly than gold-standard PCR diagnostic assays. However, they are generally less accurate. In the U.S., for instance, instructions for BD’s system recommend that negative results be confirmed by a molecular testing method. Becton Dickinson said its antigen assay is 93.5% sensitive, a measure of how often it correctly identifies infections, and 99.3% specific, the rate of correct negative tests. The data, which differ from the U.S. label’s 84% sensitivity and 100% specificity, come from a new clinical study that was recently submitted to the U.S. Food and Drug Administration, spokesman Troy Kirkpatrick said. European InroadsRapid antigen testing has been making inroads in Europe as well as the U.S. Roche Holding AG said this month it would launch its own 15-minute antigen test to European markets accepting the CE mark. Another test developer, LumiraDx, received CE marking for its antigen test late last month. It said it planned to manufacture 2 million tests in September and as many as 10 million in December. Becton Dickinson’s Veritor system has been used largely to screen for flu in Europe to date, but the new assay could help drive wider antigen testing adoption, including for influenza and other respiratory viruses, said Goldblat. The company is currently having conversations in multiple European countries, largely with governments and health authorities, about “where and how our solutions would fit,” he said. The test is already available in the U.S. Becton Dickinson said it is on track to produce about 8 million each month by October across its global markets, and 12 million monthly by March 2021. Goldblat declined to comment on how those tests would be allocated in Europe and the U.S., except that “a good portion” would be coming to Europe. Pricing will depend on commitments made and the reimbursement environment in a given country, among other factors, he said. In the U.S., where regulators cleared the assay in July, the Veritor Plus System has an average selling price of $250 to $300, and the tests themselves are about $20 each. from https://ift.tt/3cJKOSx Check out https://takiaisfobia.blogspot.com/ The Trump-Biden Debate Was a Missed Opportunity to Provide Americans With Clarity on COVID-199/29/2020 If Americans were hoping to get some reassurance, clarity, or even hope from this year’s presidential candidates about how the U.S. will make it through the coronavirus pandemic, then Tuesday night’s first debate fell woefully short. During the 15-minute segment dedicated to COVID-19—which is still killing hundreds of Americans each day, and stands to worsen once again—neither President Donald Trump nor Former Vice President Joe Biden provided any substantive plans for what health experts say will be a critical next few months, and possibly years, in the fight against the coronavirus. Instead of thoughtful plans for addressing the deadliest and most disruptive public health crisis the world has faced in a century, viewers got a mud-slinging brawl between two candidates who were mostly more interested in landing jabs than in providing any reassurance to an already edgy public reeling from lost loved ones, lost jobs and disrupted lives. “Get out of the bunker, get out of the sand trap and get to the Oval Office and fund what needs to be done now to save lives,” Biden told Trump. “He does not have a plan,” Biden added, characterizing the White House’s oft-criticized response to the pandemic. He noted that while the U.S. accounts for only 4% of the world’s population, it has weathered 200,000 deaths from COVID-19—about 20% of the global total. “He’s been totally irresponsible in the way in which he handled social distancing and people wearing masks; basically encouraging them not to,” Biden said. “He’s a fool on masks.” The Vice President went on to highlight revelations that Trump admitted to being aware of COVID-19’s danger in February, but downplayed the disease anyway—which the President said he did to avoid causing a panic. “He knew it was a deadly disease. What did he do? He’s on tape saying he didn’t want to panic the American people. You didn’t panic, he panicked,” Biden said. Trump maintained that his decision to close travel from China into the U.S. at the beginning of the year saved lives. “If we had listened to you and left the country wide open, millions would have died,” he told Biden. “You could never have done the job we did; you don’t have it in your blood.” The personal attacks and repeated interruptions from the candidates overshadowed any opportunity for voters to form a firm picture of how either Trump or Biden plan to navigate the remainder of this pandemic—not to mention the upcoming flu season, when the dangers of respiratory diseases like COVID-19 and flu circulate together. The next few months will also see critical results from the first potential coronavirus vaccines, but instead of explaining how we can ensure everyone who needs a shot receives one, Trump and Biden tussled over the Trump Administration’s constant conflict with scientists and public health experts and their differing views on how to safely reopen society. Trump also said he “disagreed” with his own experts who warn that any vaccine or vaccines won’t be widely available to the public until next year, and claimed that the vaccine makers can “go faster” but the process is “political.“ “Do you believe for a moment what he’s telling you in light of all the lies he’s told you on the whole issue relating to COVID?” Biden responded. It’s hard to say what to make of the sparring that often devolved into name calling and accusations during a discussion that instead could have provided some glimmer of hope for a public desperate to know how, and when, this pandemic will finally end. For now, the victory—if there is even one to declare—goes to the virus itself, which thrives on exactly the kind of confusion and conflict Tuesday’s debate provided in spades. from https://ift.tt/3jhfNb0 Check out https://takiaisfobia.blogspot.com/ This Falls College Reopenings Were a MessHeres How to Avoid COVID-19 Outbreaks Next Semester9/29/2020 Despite dire warnings this summer from public health experts, over a third of U.S. colleges and universities went full steam ahead with reopening, saying they had no choice due to financial or political pressures. The results, in some instances, have been catastrophic. From August 26 to September 10, 2020, there were at least 62,000 new positive test results at U.S. colleges and universities. A recent preprint study reports that colleges that reopened for in-person instruction this fall probably contributed more than 3,000 cases daily to their counties. About half of the counties with colleges around the country reported their worst week for cases in August. Given these mishaps, is there any way that colleges can successfully reopen in-person instruction during this pandemic? Protecting students from getting infected needs to remain a priority. It’s true that COVID-19 rarely kills young adults, but they can get sick and around 10% of infected people at any age can develop a long-term illness. Infected students can also infect older, vulnerable adults, including instructors and university maintenance and service staff. A recent CDC study showed that those between 20-29 years of age accounted for 20% of the new cases from June to August and in regions where infections among youth were seen, spikes in cases among seniors appeared about 9 days after spikes in the young. So, the young are contributing to community transmission and campus outbreaks can drive infection rates in the communities surrounding a university. Campuses, like nursing homes and jails, are congregate settings and it is really hard to avert outbreaks under these kinds of living situations. The best-laid plans for reopening can still go awry. Even universities that seemed to have robust plans (like the University of Colorado, Boulder, which called itself a “COVID-19 ready campus” before reopening) have had outbreaks. The truth is you can make a situation “safer” or “less safe” but there will be an unclear demarcating line between the two, its position driven by both human behavior and the arc of the pandemic. We need to quickly learn lessons from what went wrong with the first attempt at reopening. We should also learn from the colleges that, in the words of Erica Pandey, a business reporter at Axios, are “getting reopening right”—Middlebury College in Vermont, for example, had tested 6,735 students and staff by September 28 and has had only two infections. We wish that universities had taken the opportunity of reopening to formally conduct large-scale, forward-looking research that could guide our knowledge of safer reopening. In the absence of such research, however, we can still make some reasonable assertions based on case studies and on scientific modeling of different scenarios. Some common strategies are emerging from these experiences that may help colleges navigate the next semester more successfully. Unless you’re a tiny campus remote from town and you ban students from leaving, as Amherst did to create a “bubble,” you just can’t seal off your campus from its surroundings—so the first step in improving safety is waiting until levels of community transmission have been driven down before reopening. While this is no guarantee of success—Boston College had an outbreak in the week of September 7-13 (73 new cases) even though Massachusetts was doing relatively well in controlling the virus—it is a lot easier to keep campus rates low when there’s little virus in the surrounding community. Particularly if you are in an area of high transmission, it is completely reasonable to plan for an online-only spring semester, especially given that opening and then shutting down within a few weeks (as the University of North Carolina and North Carolina State University did) is hugely disruptive to education. Entry testing and then high frequency surveillance of all students (and potentially staff) is of utmost importance. One modeling study found that, assuming typical student behavior, testing all students every two to three days with a rapid, cheap, high specificity test (a test that’s very good at identifying people with the virus), is the best strategy to avert outbreaks. The CDC, whose leadership has repeatedly relented to pressure from the Trump Administration, unwittingly gave universities license to take risks when they came out in June against entry testing, a stance that was not based on evidence. An August survey led by the California Institute of Technology found that only one third of U.S. colleges that responded had done entry testing at the time, and only 20% planned on doing ongoing surveillance. All colleges and universities need robust quarantining and isolation facilities. Even if a campus is in a county or state with little community transmission, arriving students come from all over the country and overseas, so at the start of semester a 14-day quarantine on arrival can be valuable. During the semester, any student who tests positive must be isolated, and those exposed to an infected person need to be quarantined. Universities must not send infected or exposed students home across the country, as this risks seeding further outbreaks nationwide. Such quarantining is, of course, much harder for colleges with large number of commuting students. Students will socialize no matter what, so if your strategy to prevent outbreaks is just to “urge” students not to party or ask them to sign a “personal responsibility” compact, then you effectively have no strategy. Instead, universities need to offer safer alternatives to unmasked, indoor fraternity parties, such as outdoor and masked silent discos, movies, or yoga. As Julia Marcus, an infectious disease epidemiologist at Harvard says, “What might actually stand a chance of working is giving students an opportunity to stay socially connected and have fun that are lower risk—not necessarily zero risk—but lower risk than crowded indoor house parties.” Universities have quickly identified the tension between taking a punitive approach to students breaking social distancing rules and then depending on those same students to truthfully share information for contact tracing purposes. It also remains too early to know if on-campus contact tracing is successful strategy in general, given concerns with privacy. Universities must adopt the full range of so-called “non-pharmaceutical” measures to prevent the spread of the virus, including reducing campus density and enforcing universal masking, environmental cleansing, and distancing in common spaces such as dining halls. We now know the novel coronavirus can spread via aerosol transmission, which means that being inside around others in a poorly ventilated classroom is risky. This is why many universities are still leveraging digital learning, and pursuing a hybrid model even if they brought students on campus. If face-to-face teaching is absolutely essential, the risk of transmission can be reduced by adopting small class sizes, distancing, short class times, and fastidious attention to ventilation and air filtration. If colleges and universities are putting lives on the line by reopening, they need to be fully transparent and provide a daily dashboard showing the number of tests, infections, and hospitalizations among staff and students both on and off campus. This type of transparency may help buy some community trust, and it also helps everyone learn which campuses are doing well in outbreak prevention. A team of independent public health experts recently started a website that rates university dashboards for these reasons. Seventeen out of the 175 universities rated so far received an A, the highest rating, based on criteria such as whether they state how soon test results come back and whether they report on city/county data (which acknowledges “the potential effects on and from surrounding communities”). The challenge is that it looks as if you need to institute all of these strategies together to maximize chances of success. Focusing on just one or a few, rather than adopting a comprehensive integrated approach, has led to outbreaks. University of Colorado, Boulder, for example, had one of the best protocols in the country for ensuring classrooms were ventilated, and the University of Notre Dame conducted high frequency COVID-19 testing—but their plans were upended when off-campus parties became super-spreading events. Several large universities (such as Harvard, Boston and Tufts universities) in Massachusetts have adopted a fairly similar collection of interventions mentioned above including quarantine, arrival and surveillance testing and dashboard transparency with differing levels of in person learning. For now, these universities and others pursuing more comprehensive measures in areas of low prevalence appear to have the best chances of averting outbreaks as we enter the fall. The interventions we’ve described take resources and, as with K-12 schools, this pandemic is going to worsen inequality in learning at the college level, as private universities can leverage more resources and wealthier students have a much larger range of options. Public institutions of higher learning need government support, not just to stay afloat but to ensure that they can offer high-quality digital education to students of all income levels. We are already seeing economically disadvantaged minority and rural students dropping out of college at higher rates. Private universities should consider partnering with public universities in their cities during these difficult times to share resources such as testing (large university labs at private universities could run some extra batches of tests at little cost). And we urgently need more information on best practices and logistic hurdles in digital learning so schools that cannot open can at least adopt these practices. Data show that entering into this pandemic, most instructors in the U.S. did not have experience with digital resources. Universities will also face even bigger challenges ahead because the virus isn’t going away any time soon—in fact, cases are currently rising in many states. And with the onset of colder weather, which drives greater indoor gathering, and flu and respiratory virus season, the fall and winter are likely to herald nationwide increases in COVID-19 cases. Schools also probably need to start thinking of this as a multi-year challenge. Even in a best-case scenario, vaccine-generated herd immunity in the U.S. won’t be reached until after late 2021—when a candidate vaccine is hopefully expected to be widely available—so we have at least another “pandemic school year” ahead. It will take a serious investment of resources for American universities to reopen safely. But this is an investment worth making, as this pandemic will be with us at least until the end of 2021, and maybe longer. from https://ift.tt/2G1NMWU Check out https://takiaisfobia.blogspot.com/ On Sept. 28, the National Hockey League became the first of the so-called “Big Four” North American professional team sports leagues—the NHL, NBA, MLB, and NFL—to crown a champion in the COVID-19 era; the Tampa Bay Lightning lifted the Stanley Cup for the second time in franchise history, knocking off the Dallas Stars in Game 6 of the Cup finals, 2-0. After shutting down its season in March, the NHL returned to play in August, with 24 teams competing for the Stanley Cup in a postseason that took place in two “bubble” locations: Eastern Conference teams were stationed in Toronto, while Western Conference teams played in Edmonton (once the playoffs reached the Conference Finals round, the remaining four teams played their games in Edmonton). No NHL personnel tested positive in the bubble. Before Game 6, NHL commissioner Gary Bettman joined TIME for a phone conversation from Edmonton, to discuss the keys to managing COVID-19 in the bubble, lessons learned from the experience, what the 2020-2021 NHL season might look like, and more. Our conversation has been lightly edited for length and clarity. TIME: On Sept. 28th, news came out that the NHL has conducted 33,174 COVID-19 tests in its Toronto and Edmonton bubbles, with zero positives. What was the key to getting to that number? Bettman: We understood that we had a responsibility, in the face of COVID-19, to be as safe and as secure as possible. If you go back and you look at the phases we went through, there were four phases, the first one was self-isolation, phase two as we started up in training facilities, and there was some testing locally, phase three was training camp, and there was regular testing, and our belief was once we got to phase four, if we can get safely into the bubble without any COVID-19, if we’re testing everyday and we’re adhering to all the appropriate protocols, we should be O.K. There are some people who have said this might be the safest place in North America. At the end of the day, there were the protocols that were developed. Our cooperation with the Players’ Association, our medical people and the health authorities, and it was the players and other personnels’ willingness to adhere to those protocols, to take them seriously, that I believe got us to this point. Is there anything you’ve learned from this unprecedented season that you may apply to future seasons? We have no expectations that we can do this for an entire regular season. Because that wouldn’t be fair to the players. What we have learned is if you focus on the medical advice, and you follow the data, you can minimize the risk. We announced with the Players’ Association what the return to play format, what the protocols would be. There was some commentary that I should have, at the same time, decided where we were going. We made it a point not to do that. We only made the decision where to go when we absolutely had to, at the last minute, to effectuate the return to play plan. And the reason for that was I wanted to know exactly the state of COVID everywhere we were thinking of going. We had 10 different places we could go to. We had been gradually eliminating them. But at the time we had to make the decision, some of the places we were seriously considering were spiking. And we decided to go to two places that were the least COVID-intense of any of the cities and most of the places in North America. Was Florida a place you were considering? There were places all over. I think Florida had been—this has now been a while ago, you lose track of time—but there were places all over the United States that had asked us to consider them, including Nevada. Which at the time was spiking. So we wanted to go where we thought we could be safe, and we did that by following the data. Also, we had great cooperation by both Edmonton and the Oilers, by Toronto and the Maple Leafs, and by the health authorities, particularly at the provincial level. We needed the cooperation of the governments at all levels, including and especially the federal government. Obviously sports leagues like yours have resources—like daily testing, the ability to create bubbles—that other enterprises don’t. Still, is there anything the world at large can learn about managing COVID-19 from the NHL’s experience? I’m not one to lecture or give the world at large advice. But what we learned was, depending on the circumstances, you could do things to manage the risks. Which is what we were attempting to do. Other than when the players are playing and people are eating, when you walk around the bubble, you’re wearing a mask. And everybody is adhering to it. People are not trying to get out of the bubble. They understand the importance of staying in. They also understand that if they leave they are not coming back. There were a whole series of things that everybody here had to be willing to adhere to if it was going to work. And we did the best we could. We got the best advice we could. We collaborated and cooperated with the Players’ Association, which was essential. Because this undertaking, the number of moving parts, was a collaborative effort. Read more: Everything you’ve ever wanted to know about the Stanley Cup in two minutes Around the U.S., there have been testing shortages and backlogs in getting results. Some sports leagues have been criticized for doing so much testing while so many people struggle to get access to tests. Is that fair? Part of the decision was, we wouldn’t go to a place where we would interfere the slightest with the needs of the medical community for testing. We purchased all the testing that we used privately. We paid for it. And there was no shortage in any place where we are. So that there was no interference with our use of testing with what anybody else might have needed from a medical standpoint. We went to a place where COVID was most under control. When you’re the most under control, you have a lesser need for testing. In response to the Jacob Blake shooting, in late August the NHL took a two-day pause to protest, in solidarity with other professional athletes, racial injustices. What did you think of this action? Everything that was going on in sports had been initiated by the players. And my view was, if we were going to take a pause—which I believe was appropriate provided that this was what the players wanted—it wasn’t about making a PR statement, it was about having an authentic reaction to what was going on and trying to be supportive. And that was entirely up to the players. I’m proud of the way they reacted. A recent ESPN report revealed some dissatisfaction with the NHL bubble: players complained of feeling isolated and that some of the amenities fell short of what was promised. What’s your reaction to the article? Actually, the feedback that I’ve gotten on that article was twofold. One, I was told by a number of people, either from the players or people who work with the players, that it was terribly unfortunate that all of the sources were anonymous. And it seemed to be a very, very, very tiny minority of players who felt that way. I bump into players all the time in the bubble. You can always, I suppose, get a person or two who have a different view, provided they would identify themselves. But overwhelmingly, everybody was glad to have the opportunity to complete the season, to have an an opportunity to hoist the Stanley Cup. They felt extraordinary safe here. The Seattle Kraken will start playing in 2021-2022. Does the NHL have any more expansion plans? We’re not looking at any more expansion for the foreseeable future. Is there a market, or markets, where you feel the NHL should be? We’re not focusing on anything other than what we have and where we’re going, namely Seattle. Last week, an NHL promo video sent out on the league’s Twitter account that was criticized by some as glorifying violence was taken down. What’s your response to the criticism? Why was it taken down? It wasn’t supposed to glorify violence. What it was supposed to do, and maybe it was misconstrued, was focus on how intense and how hard it is to win the Stanley Cup. It can be a very intense, physically and mentally, gauntlet that has to be run. And it’s not the first time there was a video like that. Apparently, one of the sports networks in Canada was doing a piece on injuries and I guess the timing was unfortunate. But I’m not sure that we were in a position to be focusing on what a sports network was doing on its shoulder programming in the middle of the Stanley Cup final. But it was unfortunate, and if it was misconstrued we feel badly about that. Both Tampa Bay and Dallas held indoor watch parties for the Stanley Cup finals. Did this concern you at all? Two things about that. Obviously, everything we and our clubs do need to be in compliance with local regulations. And if Texas and Florida are more open than other places, then the buildings can be used, provided the appropriate protocols and social distancing were in place. And I’m told they were. But you know, the difference between indoor and outdoor, at least in our arenas which are multi-hundred-thousand foot facilities with state of the art air systems, I’m not sure is as accurate as it’s portrayed on a superficial level. Our buildings can be safe. And that’s something we’re going to be working with local authorities on. The NHL has previously named Dec. 1 as a target start date for the 2020-2021 NHL season. Are you still hoping to make that happen? December 1 was just a notional date. The likelihood is that we’ll be starting later than that, maybe late December, maybe early January. No timeframe yet has been established. Much like the discussion we had about this return to play, there’s a lot more we need to know about a number of things before we make that decision. Do you hope to at least be able to phase fans in? I mean, we certainly would love our buildings to be full. Our fans are an essential part of the energy of our game. Our fans are what make us, among other things, the best sport to attend in person. But tell me what COVID is going to be like. Tell me what the local regulations are going to be around all of our buildings. Tell me what the ease of access is going to be crossing the Canadian-U.S. border. These are all things that are going to have to be accounted for before we can make the decision. You’ve been a good sport about the booing you annually receive during the Stanley Cup presentation and during the draft. The Draft is coming up on October 6-7. Might some virtual booing be piped in? You’ll have to tune in to find out. from https://ift.tt/349aCUn Check out https://takiaisfobia.blogspot.com/ Americans Are Drinking More During the Pandemic Study FindsBut Perhaps Not As Much As Youd Think9/29/2020 Humans, like nature itself, abhor a vacuum—and there’s been no vacuum lately quite like the tedious months of COVID-19 quarantine. In nature, air rushes in to fill the empty space. In the time of pandemic, it’s been alcohol. That, at least, is the finding of a new survey of American adults conducted by the RAND Corporation and published Tuesday in JAMA Network Open. But the study bears close reading. From the very start of the pandemic, it was clear that alcohol was going to be the medication of choice for a lot of Americans, especially during the early days when panicky shoppers were hoarding toilet paper, hand sanitizer, bottled water, and groceries. During the week ending March 21, national alcohol sales increased 54% from the same week a year before and online sales leapt a staggering 262%. The question was, with more alcohol on hand—and plenty more available as soon as stores began to reopen but stay-at-home guidelines remained in place—would people actually consume more? The answer, according to the RAND researchers, who surveyed a sample group of 1,540 adults, was: And how. Overall, adults reported drinking 14% more than they did the year before. For adults in the 30 to 59 age group, the increase was even greater, at 19%. Women overall reported drinking 17% more, bringing them in above the all-adult total and below the 30-59 group. When it came to heavy drinking—which the researchers defined as four or more drinks within two hours for women and five or more for men—the figures for women were especially striking, or at least they seemed to be. The researchers found that while heavy drinking increased by just 7% among men, it rose a troubling 41% among women. So, that’s a serious cause for worry, right? Maybe not. Overall, men reported drinking heavily just .95 days per month in 2019; that increased by just .07 days per month this year. Women drank heavily on just 0.44 days per month in 2019; that increased by 0.18 day this year. So overall, men are still drinking heavily more than women are, and in both cases, the numbers factor out to just one bender per month. Clearly, no amount of heavy drinking is healthy, and the overall increase of 14% among adults is an undeniable cause for concern. But for the moment at least, it appears that even in time of pandemic, both men and women are holding the worst of their imbibing to a comparative minimum. from https://ift.tt/2EGVfd0 Check out https://takiaisfobia.blogspot.com/ 1 Million People Have Died of COVID-19. Its a Reminder That We Still Have So Much Work to Do9/28/2020 With an ever-climbing tally of COVID-19 infections, deaths, and calculations about how quickly the virus is spreading, the numbers can start to lose meaning. But one million is a resonant milestone. According to the Johns Hopkins Coronavirus Resource Center, the world has now lost one million lives to the new coronavirus. It’s easy to draw analogies--one million people dying of COVID-19 would be the equivalent of just over the entire population of a country like Djibouti, or just under the populace of Cyprus. Perhaps more sobering would be to think of that number less as an entity and more in terms of the precious individual lives it represents. It’s a chance to remind ourselves that each of those deaths is a mother, a father, a grandmother, a grandfather, a friend, a loved one. It’s also a warning to learn from these deaths so they haven’t occurred in vain. When the novel coronavirus burst into the world last winter, the best virus and public health experts were initially helpless to combat infections in a world where almost nobody had any immunity to fight it. As a result, the mortality rate, which hovered just under 3% around the world starting in late January, slowly began to creep upward, doubling in two months and hitting a peak of more than 7% at the end of April before inching downward again. While every death from COVID-19 is one too many, public health experts see some hope in the fact that while new cases continue to pile up around the world, deaths are starting to slow. That declining case fatality curve was and continues to be fueled by everything we have learned about SARS-CoV-2 (the COVID-19 virus) and everything that we have put into practice to fight it. That includes using experimental therapies like the antiviral drug remdesivir, as well as existing anti-inflammatory medicines that reduce the inflammation that can compromise and damage the lungs and respiratory tissues in the most severely ill patients. That falling case fatality is also due in part to wider adoption of prevention strategies such as frequent hand washing, mask wearing and social distancing. And to the fact that globally, we began testing more people so those who are infected can then self-isolate quickly. Read more: The Lives Lost to Coronavirus Still, another thing we have learned from the pandemic is that deaths often lag behind cases, sometimes by months. And the number of cases globally continues to increase, especially in new hot spots in South America and India, so the declining curve of the fatality rate hasn’t necessarily led to fewer overall deaths. Understanding how the geography and nature of COVID-19 deaths have shifted in recent months will be critical to maintaining any progress we’ve made, as nations and as a species, in suppressing COVID-19. In the U.S., for example, deaths early in the pandemic were centered in densely populated metropolitan areas, where infections spread quickly and hospitals became overwhelmed with severely ill people needing intensive care and ventilators to breathe. The virus had the advantage, and exploited the fact that there wasn’t much that science or medicine could do to fight it. The only strategy was to take ourselves out of the virus’s way. Lockdowns that prohibited gatherings, mandates for social distancing and requirements that people wear masks in public helped to slow transmission and gradually reduce mortality, as the most vulnerable were protected from infection. But nine months into the pandemic, deaths are beginning to rise in less populated parts of the country. Medium- and small-sized cities and rural areas accounted for around 30% of U.S. deaths at their peak in late April, but in September they have been responsible for about half of COVID-19 deaths in the country. The reason for that, public health experts suspect, has to do with the false sense of security that less populated communities felt and the assumption that the virus wouldn’t find them. Less stringent requirements and enforcement of social distancing and basic hygiene practices like hand washing and mask-wearing could have provided SARS-CoV-2 the entrée it needed to find new chances to infect people as those opportunities in more populated regions began to dwindle. Furthermore, health resources in rural areas aren’t as well distributed as they are in metropolitan regions, which makes preparing for an infectious disease more challenging. Globally, COVID-19 mortality also reflects the unequal distribution of health care around the world. While developed countries are able to rely on existing resources—including hospital systems equipped with the latest medical tools and well-trained nurses and doctors—those resources aren’t as robust in lower income countries where health care isn’t always a high national priority. That puts these countries at greater risk of higher fatality from COVID-19 as new infections climb. Without medical equipment and personnel to ramp up testing and isolate infected people, or to care for the sickest patients, deaths quickly follow new infections. That tragic reality is being borne out in recent case fatality trends. While the U.S. continues to lead the world in overall COVID-19 cases and deaths, the burden of deaths is shifting to countries such as Brazil and Mexico; Brazil has just over half the number of deaths of the U.S. Deaths in India are also likely to continue inching upward before they start to decline, as survival there under lockdown conditions is nearly impossible for families that have no income to buy food and pay rent. The pressure to reopen and re-emerge into densely populated cities will provide more fertile ground for COVID-19 to spread—and to claim more lives—before better treatments and vaccines can start to suppress the virus’ relentless blaze of despair. from https://ift.tt/2S7i3Wv Check out https://takiaisfobia.blogspot.com/ When the FDA approved mifepristone in late September 2000, advocates believed it was going to change abortion care in this country. Mifepristone causes an abortion when used with another long-approved drug, misoprostol. (In the United States, this regimen is used through ten or eleven weeks of pregnancy.) “Medication abortion,” as this new modality was called, raised the possibility of a dramatic expansion of abortion provision by bringing in new categories of providers. As a sociologist studying abortion, I was interested in documenting the dissemination of this new method. Shortly after the FDA approval, I tried to locate new providers who were going to start delivering medication abortion care, but initially I found very few. At this 20th anniversary, however, mifepristone is indeed finally leading to major changes—due to COVID-19. In the twelve long years between when the medication was first approved in France (1988) and in the United States, the anti-abortion movement had vociferously campaigned against mifepristone, spreading misinformation, and threatening boycotts against the medication’s then global manufacturer, Hoechst A.G., a German firm. (In response to the controversy, Hoechst eventually stopped production of the pill and gave up its patent rights.) At the same time, violence by abortion extremists was increasing. The first murder of a physician who performed abortion took place in 1993, followed a few years later by several more murders of people in the abortion-providing community. Weary both of this violence, and of the problems caused by a chronic shortage of abortion providers, the pro-choice movement fastened their hopes on medication abortion care as a solution to both these issues. This method carried the promise of increasing the number of providers because it did not require the specialized medical training of other forms of abortion care. If many primary care doctors, for example, incorporated medication abortion care into their practices, abortion care could move away from specialized clinics, and protestors would not know why someone was entering a particular facility. In retrospect, these hopes were inflated and naïve. Medically speaking, medication abortion care is quite straightforward. Socially, however, this method, as with abortion care generally, is quite complicated. Would-be new providers were taken aback to learn that incorporating medication abortion care into their primary practices meant that they would be subject to the restrictions governing abortion in their states, such as parental consent, waiting periods and other rules. Similarly, those who did start this provision soon realized that it was logistically impossible to alert patients of this new service but simultaneously keep it “secret” from protestors. This impossibility of confidentiality became clear when I interviewed a family medicine doctor in the rural Midwest who began providing medication abortion care to her patients. She was startled when a patient came into her office, and said, “Doctor, do you know that they are calling you a ‘daughter of Satan’ on Christian radio?” This doctor was not the only one I encountered whose decision to initiate medication abortion care became controversial, and led to unwanted attention from protestors, and in some cases, pushback from medical colleagues in their community. An additional hurdle for new providers: the FDA took the unusual step of placing mifepristone in a program that came to be known as Risk Evaluation and Mitigation Strategies (REMS). This program was established to regulate drugs known to be very dangerous, such as thalidomide, which causes severe birth defects. But ample evidence existed from trials in the United States and Europe of mifepristone’s safety. One can speculate that this step was taken in response to the medication’s controversy, not the science. The REMS classification imposed cumbersome restrictions. Mifepristone could not be dispensed in a pharmacy, but it had to be obtained at a clinic or doctor’s office. Doctors who offered mifepristone had to register with the distributor—no doubt causing apprehension among potential adopters about having one’s name on a list of known abortion providers. Gradually, however, the use of medication abortion has expanded. According to the most recent data, about 40% of all abortions in the United States are by this method. Some 17 states permit Advanced Practice Clinicians (nurse practitioners, midwives and physician assistants) to provide medication abortion, and this has particularly benefitted rural women. Simultaneously, however, from 2000 on, red state legislators have sought in numerous ways to restrict this method. Seventeen states, for example, prohibit the use of telehealth for medication abortion, though this has been very successful where allowed. But, as no one could have predicted, medication abortion care has really come into its own during the COVID-19 crisis. This method involves considerably less close provider-patient interaction than other abortion methods. I have found in recent interviews with providers that increasingly patients are opting for this regimen. Clinic staff are developing new protocols to minimize face-to-face interaction as much as possible, for example by doing preliminary counseling using telehealth, and by sending patients home with a pregnancy test, thereby eliminating the need for a follow-up visit to ascertain a successful abortion. But the REMS requirement still meant that patients had to travel to clinics to obtain the two pills of the regimen, thus risking exposure to COVID-19. Leading medical organizations, including the American College of Obstetricians and Gynecologists (ACOG), have long argued that the REMS were unnecessary. Abortion providers were therefore encouraged by the recent ruling, in a suit brought by ACOG, that temporarily overturned the REMS due to the pandemic. (The Trump administration has appealed to the Supreme Court to reinstate this restriction but the Court has not yet responded.) Currently, where state laws do not explicitly prohibit this, the relevant medications can be mailed to patients. Advocates hope that a paper trail of the safety of this measure will allow this policy to be continued even after COVID-19 is under control. When I started to document medication abortion care, I didn’t think this method’s promise would take this long to be realized. I wish it didn’t have to take a pandemic for the FDA to start loosening restrictions, but I’m thankful that progress is happening now. from https://ift.tt/36eViIA Check out https://takiaisfobia.blogspot.com/ There are few things as powerful as avoidance learning. Touch a hot stove once and you’re not likely to do it again. Cross against the light and almost get hit by a car and you’re going to be a lot more careful the next time. But when it comes to the U.S. response to COVID-19? Not so much. You’d have thought that the sight of overflow hospital tents and refrigerated trucks to hold victims’ bodies in New York would have been enough to scare us all straight in mid-March and early April, when infection rates peaked at 32,000 new cases a day, or nearly 10 cases per 100,000 residents—making social distancing, mask-wearing and hand-washing all universal practices. But shortly after that peak, the warm weather arrived and several states cautiously reopened some public spaces for Memorial Day. That, as we wrote at the time, quickly led to distressing signs of upticks in several states, pushing the national rate marginally north again. By the end of June, the rolling average of new cases per day had far exceeded the April peak, prompting some states to pull back their reopening plans. But the damage had been done. By mid-July, a second wave peaked at over twice the value of the first, exceeding 67,000 cases per day—more than 20 cases per capita. There was good news buried in that bad news, however: after the peak was reached, the decline was at least quicker and more precipitous than it was the first time. But now for the worse news: Heading into the fall and winter, there are clear signs of a third resurgence bearing a close resemblance to what we saw in early June. Since the most recent nadir on Sept. 9, when the national rate was at 34,300 cases a day—still a notch above the April peak—cases have risen to 45,300 a day, a 32% increase. The numbers paint an alarmingly familiar picture that spells trouble ahead—despite President Donald Trump’s repeated but false assertions that the country is “rounding the final turn” on the pandemic. “The latest information is that 90% of the country has not yet been exposed to the virus,” says Dr. Tom Inglesby, director of the Johns Hopkins Center for Health Security at the Bloomberg School of Public Health. “The virus hasn’t changed and has the capacity to spread rapidly if given a chance.” It’s now getting that chance. The politicization of mask-wearing; conflicting guidelines from the White House, the Centers for Disease Control and Prevention and the Food and Drug Administration; and state and local policies that contribute to viral transmission are helping to do the disease’s work for it. “A single and coordinated strategy might have brought us to a different place,” says Dr. Jon Samet, dean of the Colorado School of Public Health. “Even within some states, counties may proceed independently. There is wide variation in the credence given to misinformation, some sourced from the Administration and even the President.” Samet’s own state offers a vivid example of the rise of the third wave, with its graph since spring forming a stark, three-peaked mountain range, not unlike a view you might find while hiking in the Colorado Rockies: In some ways, however, Colorado is an outlier in the new wave—or at least lies at its very vanguard. The first wave hit hardest in the Northeast; the second in the South and the West. Now, even as cases balloon in the South again (driven in large part by Texas and Florida), the Midwest has surpassed the West in cases, with dramatic spikes from Wisconsin and Minnesota to the Dakotas and down to Utah and Wyoming: At a more granular level, the geographic trends become even clearer. There are more than 3,000 counties (or county-equivalents, like parishes) in the U.S., almost all of which report individual daily figures for new COVID-19 positive tests. Breaking them down into three categories—small, medium and large, each with about a third of the U.S. population—reveals that the 62 largest counties, which are home to 110 million people, were responsible for more cases than either of the other two categories through mid-August. Now the story has flipped, with the bloc of smallest counties—encompassing the same number of total people but distributed across a much larger, more rural geography—contributing the most new cases: “Given that these are rural areas, behaviors of individuals are likely to be a dominant driver: not adhering to distancing and not wearing masks,” says Samet. “Checking across mask orders in these states, there is a wide range. I suspect adherence to use of masks is lower in these rural counties than in urban areas, as in Colorado by anecdotal reports.” There has also been a shift in COVID-19 age demographics that in turn affect the regional situation. “In part of the Midwest, the rise is being driven by young adults who seem to have gotten the coronavirus in universities,” says Inglesby. It doesn’t help that college students—who are by nature less risk-averse than older people—are being enabled in their heedlessness by a lack of guidance from adults who ought to know better. It’s also worth noting that many young Americans hold jobs that increase exposure risk, like retail or restaurant work. Whatever the manifold causes of the third wave, there is reason to worry that it will prove worse than the first two. The arrival of colder weather in some states means more time spent indoors, where viruses are more easily transmitted by aerosols produced when people sneeze, cough or merely speak. With the pandemic still raging, many people will likely scrap seasonal travel and family get-togethers for Thanksgiving, Christmas and so on—but many are likely to press ahead regardless, meaning minimal social distancing in crowded planes and trains and around holiday dinner tables. “We are concerned that there could be a holiday spike with severity depending on where the epidemic curve is positioned before the start of the season in later November,” says Samet. Whether the third wave will be followed by a fourth is, paradoxically, both impossible to say and entirely within our control. Hopefully, greater policy coherence from Washington, uniform national rules around masking and distancing, and broad public acceptance of an eventual vaccine—once it is proven to be safe and effective—will all, at last, stuff the COVID-19 genie back into its bottle. Until then, the U.S., which represents only 4% of the world’s population yet has reported more than 20% of its COVID-9 cases and deaths, will continue to struggle. It is up to all of us, working together, to bring that suffering to an end. from https://ift.tt/33aLNbu Check out https://takiaisfobia.blogspot.com/ As the COVID-19 pandemic has stretched on, the American health care system has depended on the tireless efforts of nurses to care for the ill, tend to the dying, and stop the illness from seeping outside hospital doors. But despite all of these nurses’ dedication, they themselves have been let down—not only by state and local governments, but by the health care system as a whole, says Bonnie Castillo, a registered nurse and executive director of National Nurses United and the California Nurses Association. Castillo, who was recognized for her advocacy work as a member of the 2020 TIME100 list of the most influential people in the world, has been calling attention to shortages of personal protective equipment to protect health care workers for at least six months. But as she told Senior TIME Correspondent Alice Park in a TIME100 Talks discussion, the U.S. is still coming up short on essential items like N95 face masks, leaving nurses unable to protect themselves, the public or their patients. To make up for these shortfalls, Castillo feels that the U.S. must enact the Defense Production Act, which some critics feel the federal government has not employed aggressively enough to provide enough masks for health care workers. “It’s very frustrating because we know what we need,” says Castillo, noting that countries like South Korea have successfully produced their own personal protective equipment. “While we say the virus is novel, the science of infectious control and protection isn’t, and so we know that we could have done better, and we need to still do better.” Castillo says that nurses have been left to fend for themselves to get through the pandemic. She notes that nurses have had to bring their own personal protective equipment to work, and even rely on friends to borrow N95 asks. In turn, unions have also had to fight for nurses, to make sure that they get the personal protective equipment that they need. However, it hasn’t been enough to protect some nurses; 11 members of National Nurses United alone have died. “For us, it’s been a matter of life and death,” says Castillo. “If we had not been out there and collectively advocating and fighting, tooth and nail, for every single N95 and every single protection, we would have lost many more.” In Castillo’s opinion, Americans have suffered due to a lack of leadership in the fight against COVID-19. To begin to turn the country’s trajectory, she says, the United States must finally enact a coordinated national response. However, Castillo says, the country must also address one of the root problems that is making the COVID-19 pandemic so painful: a health care system that doesn’t put people before profit. In her opinion, that would be through a “Medicare For All” program. “We have seen this system function under a pandemic,” Castillo says. “And it has been an utter failure.” from https://ift.tt/3mPqKCV Check out https://takiaisfobia.blogspot.com/ |
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