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Saturday, January 23, 2021

Interesting heresay: 'Mink farms in China could be cradle of Covid-19'

 It seems increasingly plausible that Covid-19 originated in fur farms, especially mink, as our investigation shows. At the end of December 2020, Reporterre revealed that the strains responsible for the two epidemic waves that engulfed Europe emerged nearby to a number of large mink farms. Reporterre continued its investigation in China. On 8 January, Science published an article stressing the need to study the link between Covid and mink farms.


For the moment no-one knows for sure if the scientific delegation put together by the World Health Organisation (WHO) will be allowed in to China to investigate the origin of the pandemic. [1] The ten international experts still have not received the authorisations they need. Negotiations are underway, but no details have been released and it is impossible to predict the outcome.

It is staggering that a year after the start of the last century’s worst pandemic, no progress has been made in understanding how Sars-CoV-2 jumped from bats — its natural host — to humans. This uncertainty is not due to the limits of science, but to the attitude of the Chinese authorities, who for a year have adamantly opposed any independent inquiry — even inside the country — to find the answer. The question is what does China have to hide ?

It is a glaring absence that no inquiry has been made to confirm or deny a seldom mentioned but obvious hypothesis : that the pandemic originated in a fur farm. China is indeed the world’s leading market and leading producer of fur worldwide. The industry in China is worth more than $20 billion a year, and involves more than 50 million animals. Traditional livestock farming for beef, pork or poultry do not seem to be infected by the coronavirus. By contrast, animals bred for their fur, particularly the three main species — mink, fox, and the raccoon dog — are highly sensitive to it.

Specialists know that human epidemics originating from livestock farms are not exceptional. Farms are known breeding grounds for microbes : for example the last flu pandemic, in 2009, originated in American pig farms — hence its name swine flu.

« Coronavirologist » Christian Drosten, who co-discovered Sars-CoV-1 in 2003 and advises the German government, said in an interview with the Guardian in April 2020 « If somebody gave me a few hundred thousand bucks and free access to China to find the source of the virus, I would look in places where raccoon dogs are bred... »

Drosten’s hypothesis that raccoon dogs could be the missing link between bats (the original host of this coronavirus, according to scientific consensus) and humans is common sense. Raccoon dogs (Nyctereutes procyonoides) — often confused with the American raccoons that they resemble — are small carnivorous canids. A team led by Conrad Freuling, from the German Federal Institute of research on animal health in Riems, experimentally demonstrated in August 2020 that not only are these animals infected by the human coronavirus, but that they infect each other.

In China, the number of farmed raccoon dogs is estimated to be fourteen million in 2019.

« We have discovered that the virus remains in the nasal cavities of this animal, and does not reach its lungs », Freuling told Reporterre« The animals do not get sick when infected, and remain asymptomatic while they are contagious. Moreover, they probably excrete enough virus to infect a human ». This is similar to mink as we saw in Mink farms in Denmark and the Netherlands. Freuling added that transmission without making the host sick is typical of a well-adapted virus, which may confirm the hypothesis that this species could be the « missing link » between bats and humans.

Drosten’s reason for suspecting raccoon dogs dates back to the first SARS pandemic, which began in China in 2002, and spread all over the world in 2003. [2]. It has often been said that the animal spreading the first SARS was the masked civet (Paguma larvata), a member of the viverrid family… but in fact raccoon dogs were also infected and were equally likely to be responsible for the transmission to humans.

Studies carried out in 2003-2004 (notably focused on the markets of Shenzhen, in Guangdong province), show it is nearly impossible to determine which of the two species contaminated the other, or if a third contaminated both at the same time. An article published in Virus Research in April 2007, said the masked civet was the likely intermediate host. But one of the main findings supporting the argument was the contamination of three customers and a waitress in restaurants where live infected masked civets were kept in the dining room. Slim evidence, especially since civets were bred for decades for their fur before becoming a sought-after source of meat, and have seen their population shrink to about 40,000 for the entire country. This compares to a total of 5 million to 10 million raccoon dogs bred in farms during the same period.

In 2003, China seems to have twisted the facts to incriminate the civet, in an effort to divert attention from its fur industry

In winter 2003-2004, an extensive study financed by the Chinese Ministry of Science and Technology and the United States National Institutes of Health, sampled 1,107 civets from 23 farms across 12 provinces. It concluded that 91 civets were infected on the market of Xinyuan (Guangdong), while no infection was found in the farms where the civets came from. This suggests that the contamination could have occurred at the market or during the transport. Moreover, all the 15 raccoon dogs at the Xinyuan market at the same time were infected. Although several articles said the civets could have been contaminated by the raccoon dogs, no studies were undertaken to investigate the raccoon dogs any further. Many researchers, including Paul et Martin Chan, were surprised and regretted that the issue did not « raise more interest ». Shi Zhengli, China’s leading « coronavirologist » and research director at the Wuhan Institute of Virology said in the 2007 article of Virus Research, that it is not « always clear if the raccoon dogs infected the civets or if it is the opposite », before concluding : « Contrary to civets, very few studies have been made on raccoon dogs, wild or farmed. »

Freuling was also surprised. He told Reporterre that he ended up testing transmissibility in raccoon dogs in Germany because this had ever never been done in China, where the vast majority are found. The handful of farms in Europe are in Finland and Poland [3]

It should be noted that on the Xinyuan markets, foxes and other mustelidae were also infected. Strangely, the Chinese/American study ignored farms in Shandong, Liaoning, Jilin and Heilongjiang, the four most important provinces for mink farms. To have overlooked Shandong area is particularly surprising, because it is the uncontested capital of Chinese fur production, and the province is geographically closer to Guangdong than to Hebei — which was studied.

Fur farming regions in China

In 2003, it looks very much as though China manoeuvred to incriminate the civet, a species of marginal economic importance, in order to divert attention from and protect the fur industry. The same strategy seems to have been taken even further in 2020, in a different context, and with enormous stakes at play. This time, China has tried to take total control of both the scientific and public debate on the pandemic. After an initial period of confusion in January-February 2020, when journalists and scientists spoke out and published relatively freely, repression soon took over. A number of journalists were arrested or disappeared, and scientists were censored.

Information and news were evidently filtered and adapted to the needs of the Chinese government

A recent Associated Press (APreport documents how the Chinese government tried to regain control of scientific publications after a preprint by two researchers was posted online in February. The post, which has now disappeared from the internet [4], suggested that the virus had escaped from a laboratory in Wuhan. On 24 February, the Chinese Center for Disease Control (CDC) introduced a new approval procedure for publications.

On 3 March, the Ministry of Science issued a confidential note, which AP obtained and published online.

The note calls for « the coordination of scientific research publications on the Covid-19 across the country to be like a “game of chess” », under the control of a « group of scientific researchers from the State Council » and after having informed the Council’s “propaganda team.” The notification prohibits all publication not validated by this group — and states that offenders « would be held responsible ».

Thus when reading recent Chinese scientific publications, it should not be forgotten that despite the excellence of many researchers, the information provided is clearly filtered and modified to suit the Chinese authorities. The same applies to the press : for months there has been no mention of foxes, minks or raccoon dogs being sold on the Wuhan market before it closed on 31 December, 2019.

The Wuhan market sells a myriad of goods, including foxes, minks and raccoon dogs.

However, according to the latest WHO report, foxes were being sold on the « wet market » of Wuhan. And the Public Health Agency of Canada said in March that mink were sold there too. Photographs taken in the market by CNN in early December 2019 and published January 2020, showed that raccoon dogs were also present. Whatever the authorities say, it turns out that all three carnivore species were being sold on the Wuhan market.

Despite the Chinese media blackout on these species, the Chinese Minister of Agriculture and Rural Affairs has not forgotten them. Under pressure from world public opinion to prohibit the sale of wild animals on markets, because of the risk of the emergence and propagation of viruses, the authorities reclassified them as « domestic species » in order to prevent any obstacles to breeding them.

As for the pangolin fable, four Chinese scientific articles were published blaming these scaled animals for transmitting the virus to humans, even though the virus had still not been fully sequenced. The pangolin theory has since been abandoned, after it became clear that the pangolin virus was even further from Sars-CoV-2 than the bat virus. Just before these publications, the Chinese authorities had fed the press with the hypothesis that snakes were probably the intermediate host. There was even an attempt to blame turtles. With so many false leads, it is hard not to think that focusing on these three scaled species was an astute tactic to divert public attention from fur farms.

The most plausible intermediate host would be mink, recent research says

While the Agricultural department of Southern University in Louisiana in the United States said, without providing any proof, that the pangolin was responsible for the pandemic, a report taking the opposite view was virtually ignored. On 24 January, 2020, China’s English-language Global Times said that based on GISAID data and artificial intelligence software the most likely intermediate was... mink. It could even have been the original host. This study pointing to mink was set up by the Chinese Academy of Sciences, the Wuhan institute of Virology and the Chinese CDC. The team, led by Quian Guo, is highly respected, the study was well run, and the results were not contested. But its findings were ignored, except in Singapore and Australia. The pangolin, by stirring up passions and reinforcing prejudices, monopolized attention.

Another telling example of the Chinese scientific community’s tactics is the study carried out by the Shandong Medical University and published on 1 April, 2020 in the Medical Journal of Virology. The researchers analysed the structure of the receptor protein ACE2, to which the virus binds when it infects a host, in 85 species of mammals : humans, cats, dogs, pigs, horses, civets, pangolins, macaque monkeys, foxes, raccoon dogs, African elephants, meerkats, bulls, polecats, kangaroos, opossums, tortoises, lynx etc. But the team « forgot » mink, even though at least 15 million of them are bred in the Shandong region where the research originated.

The research concluded — apparently seriously — that a cetacean, « the Finless Porpoise of Yang Tsé, should be monitored because it can be found in the lakes close to Wuhan and could be infected by the Sars-CoV-2 or other closely related coronaviruses ». The study also concluded that small carnivores, including cats, have much less affinity with Sars-CoV-2 than cattle or sheep, whereas we know that the opposite is true.

Over 3,000 mink farms in China, some with over 100,000 animals

In fact, the focus should be on Chinese mink, especially those in Shandong. In recent months, we have learnt from scientists that mink can catch the virus from humans and infect them back, often adding some mutations in the process. But beyond that, a long history of disease in mink shows that in overcrowded intensive farming, this solitary species — like all farmed carnivores, unlike social herbivores —, is sensitive to many diseases and becomes a health nightmare. It is clear that the 3,000 mink farms in China, some of which have over 100,000 animals, could be the source of the current pandemic. It is therefore hard to understand why no viral research has been conducted on them.

Mink - here, a chinese one- can both contract the virus from humans and infect them in return, very often generating mutations in the process.

On example of the problem was in 2011, when a new virus was discovered in the feces of farmed minks in a farm in Hebei. It seemed to be a virulent combination of usually harmless strains from humans and pigs. All the mink were affected, and 5% died. A necrotizing encephalopathy in two children seemed to be closely related to this recombinant virus, and the study published by Emerging infectious diseases stressed the need to prepare for the emergence of even more virulent variants.

In 2014, Shandong mink farms suffered an outbreak of pseudo-rabies originating from pigs, which led to the death of 87% of the animals and to the spread of the disease to the rest of the province. The scientists trying to evaluate the extent of the outbreak in 14 locations confirmed in their publication that the virus was highly contagious in the region and that « it would be a challenge the fur producing industry ».

In 2015, a team including the Chinese virologist Shi Zhengli isolated and identified viruses from bats that were closely linked to human, pig and mink viruses. This suggests that interspecific transmission exists between bats and humans or other animals.

In October 2016, a team of veterinarians from the Qingdao Animal Science and Veterinary Medicine College discovered that the Shandong minks were contaminated by a very contagious avian flu H5N1.

In 2019, veterinarians from the same college detected in some mink farms in Shandong the emergence of a deadly co-infection virus of canine distemper and H1N1 swine flu, which became a new strain of H1N1 in the infected lungs of these mustelids.

Farmed minks are also possible intermediary hosts for type A Influenza which can lead directly or indirectly to the development of human pandemic strains. They sometimes host an epidemic form of type E Hepatitis virus but it is unclear whether it can affect humans. Minks are also monitored for BSE (Bovine Spongiform Encephalitis) because of the inclusion of animal protein in their diets.

In order to minimize damage, mink are vaccinated against the viruses which affect them most, such as the highly contagious parvovirus of the Aleutian disease, and canine distemper. Minks have fragile lungs. They spontaneously catch lung infections, which they spread easily by sneezing (as do ferrets, also of the mustelid family). Mink, like ferrets, carry specific coronaviruses. The ferret coronavirus is called « systemic », because it attacks all organs, while the mink’s virus is called mink CoV (MCoV).

Bats, attracted to fur farm buildings, frequently defecate on the caged animals

The fertile breeding ground for viruses that these farms represent is measured by the fact that Chinese mink are concentrated mainly in Shandong. This historic fur production region is home to thousands of farms, where different species are often raised together. The animal population totals, 15 million mink, 3 million raccoon dogs and 6 million foxes. Most of them are clustered in a relatively small area, which extends towards the south from the coastal town of Weifang. The animals live crowded together in sometimes appallingly unhygienic situations, are fed partially from fresh fish coming from the Yellow Sea, pig offal, poultry giblets, animal bone meal and carrion of their own species. Large amounts of animal protein are important for the quality of their pelts. Their captive existence is short : mink, for example, reproduce in March, give birth in April and the litters are killed between mid-November and mid-December. The only ones that survive are the males and females necessary to produce the next generation. These reproductive animals account for about 12% of the population of each farm, which is enough for pathogens to persist.

Sale of furs at the Sunning market in Hebei province.

Also important is the fact that Shandong is a mid-mountainous forested region, known partly for its caves that shelter many species of bats, some of which such as Rhinolophus ferrumequinumare coronavirus carriers. The bats are attracted to the farm warehouses, which provide them with easily accessible shelters. They urinate and defecate often over all that is beneath them, including the cages housing the animals.

So in Shandong, and in other areas of China, all the ingredients exist for powerful viral encounters, recombinations of all kinds, and the rapid emergence and spread of disease.

A little known fact is that in 2019 Shandong produced 6.5 million mink pelts, down from nearly 15 million in 2018. This means nearly 9 million mink disappeared from one year to the next, a 55% drop in production for just one province. Such a sharp decline suggests some form of disaster. Could it have been a health problem ? The production of hides from foxes (5,7 million) and racooon dogs (3 million) remained perfectly stable. The China Leather Industry Association, after several requests for information from Reporterre, explained in an email that « a stagnant market and overproduction » had led to « many companies leaving the industry ». This is hardly enough to explain such a dramatic drop in output.

All major mink fur production centres have been contaminated by Covid-19… except in China ?

It is surprising that officially not a single Chinese mink farm has been contaminated by Covid-19, whereas farms all over Europe—north, south, east and west —and in the United States and Canada have been affected. It would be abnormal for all the large producers in the world to be struck with the disease, except for the largest, despite many commercial links between industry professionals all over the world with the Chinese, especially North America, Northern Europe and Italy.

In short, mustelids, canids et viverrids — the mammals suspected to have an active intermediate role — are the same today as during the first Sars-CoV epidemic in 2003-2004. Except that masked civet are now a thousand times fewer in China than the foxes, raccoon dogs and mink bred for their fur. To establish the truth and avoid another pandemic, it is essential for the WHO to order a very close study of these fur farms in Shandong and elsewhere in China.

Sale of foxes and raccoon dogs at the Shangcun fur market (Hebei province).

From the WHO mission preparatory report, it seems this is the intention, despite careful diplomacy to avoid upsetting the Chinese authorities. It is for example stated that the commission plans to « chart the supply chains of all the animals sold on the market », wild and domestic, in order to identify « the interesting geographic zones in order to control the animal and human serology ». That is precisely what should have been done a year ago : studies to determine the presence of virus in the breeding farms.

Unfortunately, WHO, after many concessions to the Chinese government, abandoned the idea of carrying out the field work and instead signed a protocol delegating that part of the work to local researchers. The mission should not leave the territory of Wuhan, one team member recently told the magazine Science et Avenir, adding that one should not expect, « that the team would come back with a conclusive result ». But even after all these precautions, Beijing still seems to perceive the experts mission as a threat.

The wall erected by the Chinese government seems to be cracking, however. On 8 January, [an article signed by eminent Chinese researchers, Zhengli Shi et Peng Zou, acknowledged for the first time in Science that mink could be the host « of the virus which has become SARS-CoV-2 ». The researchers suggest carrying out « retrospective investigations of samples dating back to before the pandemic on the mink farms and other animals vulnerable to the virus ». Suspicious minds might ask why this suggestion comes so late in the day, when the vulnerability of mink to Covid has been known for six months ; they might also ask if such samples still exist. But others will no doubt say it is better late than never.

https://reporterre.net/Mounting-evidence-suggests-mink-farms-in-China-could-be-the-cradle-of-Covid-19-22020

Cal. Refuses To Disclose COVID-19 Data Used To Drive Lockdowns

 California Governor Gavin Newsom (D) promised months ago that the state's COVID-19 policy decisions would be driven by transparent data that would be shared with the public.

Now, his administration is refusing to disclose key information used to determine when lockdown orders are implemented or rescinded - and has denied a public records request filed with the California Health and Human Services (CHHS) Agency on May 28 by the Center for American Liberty (CAL) seeking both the data and science behind the state's lockdown decisions, according to Fox News.

State health officials now say they rely on a 'very complex set of measurements that would confuse and potentially mislead the public,' AP reports.

In short, California says you're too stupid to understand their rationale for mandating thousands of businesses into financial ruin through what appear to be arbitrary and unscientific decisions. To wit, at least two California judges have struck down the state's draconian mandates over lack of scientific evidence to support lockdowns and restaurant restrictions.

Not only that, according to SFGATE, there's growing speculation that California's ban on outdoor dining may have contributed to the state's COVID-19 surgeNot the best of optics as as a GOP effort to recall Newsom continues to gain momentum.

According to CAL executive director Mark Trammel, the Golden State won't answer why, for example, they won't answer why indoor religious services are strictly forbidden while other venues where people gather are just fine.

"If it’s safe enough to go to a marijuana dispensary or Macy’s or Costco that same standard should apply to parishioners in our congregation they should be able to sep in pews and wear a mask," Trammel told Fox News in a recent interview.

Dr. Lee Riley, chairman of UC Berkeley's School of Public Health infectious disease division thinks the state's lack of transparency is troubling.

"There is more uncertainty created by NOT releasing the data that only the state has access to," he told the Associated Press in an email.

More via AP:

Newsom, a Democrat, imposed the nation’s first statewide shutdown in March. His administration developed reopening plans that included benchmarks for virus data such as per capita infection rates that counties needed to meet to relax restrictions.

It released data models state officials use to project whether infections, hospitalizations and deaths are likely to rise or fall.

As cases surged after Thanksgiving, Newsom tore up his playbook. Rather than a county-by-county approach, he created five regions and established a single measurement — ICU capacity — as the determination for whether a region was placed under a stay-at-home order.

In short order, four regions — about 98% of the state’s population — were under the restrictions after their capacity fell below the 15% thresholdA map updated daily tracks each region’s capacity.

At the start of last week, no regions appeared likely to have the stay-at-home order lifted soon because their capacity was well below 15%But within a day, the state announced it was lifting the order for the 13-county Greater Sacramento area.

Suddenly, outdoor dining and worship services were OK again, hair and nail salons and other businesses could reopen, and retailers were allowed more shoppers inside.

Local officials and businesses were caught off guard. State officials did not describe their reasoning other than to say it was based on a projection for ICU capacity.

State health officials relied on a complex formula to project that while the Sacramento region’s intensive care capacity was below 10%, it would climb above 15% within four weeks. On Friday, it was 9%, roughly the same as when the order was lifted.

What happened to the 15%? What was that all about?” asked Dr. George Rutherford, an epidemiologist and infectious-diseases control expert at University of California, San Francisco. “I was surprised. I assume they know something I don’t know.

Trying to explain the quagmire, CA Health and Human Services Agency spokeswoman Kate Folmar said (with a straight face?) that officials are committed to transparency - and that projected ICU capacity is based on several variables - including available beds and staffing that can change regularly.

"These fluid, on-the-ground conditions cannot be boiled down to a single data point — and to do so would mislead and create greater uncertainty for Californians," she said.

According to First Amendment Coalition Executive Director David Snyder, the state's lack of disclosure is disturbing. 

"The state is wielding extraordinary power these days — power to close businesses, to directly impact people’s livelihoods and even lives — and so it owes it to Californians to disclose how and why it makes those decisions," he said, adding that secrecy "is exactly the wrong approach here and will only breed further mistrust, confusion and contempt for the crucial role of government in bringing us out of this crisis."

https://www.zerohedge.com/covid-19/california-refuses-disclose-covid-19-data-used-drive-lockdowns

UK quietly extends councils' lockdown powers until July 17

 The British government has quietly extended lockdown laws to give councils the power to close pubs, restaurants, shops and public spaces until July 17, the Telegraph reported on Saturday. https://bit.ly/3p8zwwC

Prime Minister Boris Johnson said on Friday the government could not consider easing lockdown restrictions with infection rates at their current high levels, and until it is confident that the vaccination programme is working

https://www.marketscreener.com/news/latest/UK-govt-quietly-extends-councils-lockdown-powers-until-July-17-Telegraph--32262711/

Trial Backs Metabolic Surgery as Long-Term Diabetes Cure

 For long-term diabetes remission, metabolic surgery is an effective option, 10-year data suggested.

In a randomized trial of 60 patients with type 2 diabetes and obesity, diabetes remission rates were significantly higher in the years following surgery versus conventional medical therapy, Geltrude Mingrone, MD, PhD, of King's College London in the U.K., and colleagues reported in The Lancet.

In previously reported 2-year outcomes, 75% of patients who underwent Roux-en-Y gastric bypass (RYGB) and 95% of patients who underwent biliopancreatic diversion (BPD) achieved diabetes remission, defined as an HbA1c under 6.5% and fasting glucose under 100 mg/dL (5.55 mmol/L) without ongoing pharmacological medication for at least 1 year.

In the newly reported 10-year outcomes of the same patients, 50% of those who underwent BPD were able to maintain their diabetes remission by year 10 (50%, 95% CI 29.9-70.1%), while a quarter of those who underwent RYGB maintained their remission 10 years after surgery (25%, 95% CI 11.2-46.9%, P=0.0082).

On the other hand, only 5.5% (95% CI 1.0-25.7%) of those who received nonsurgical medical therapy for their diabetes achieved and maintained long-term remission a decade later. Of note, this actually included only one participant who went into diabetes remission after crossing over to the surgery group.

"No patient was shown to be in diabetes remission after medical therapy," the researchers explained.

Overall, about 38% of all patients who underwent surgery maintained their diabetes remission throughout the decade-long follow-up. Also, no patient who didn't achieve remission within the initial 2 years achieved it later on.

"This factor might help us to intensify modern and potent glucose-lowering therapies like SGLT2 inhibitors and GLP-1 receptor agonists earlier after metabolic surgery," suggested the authors of an accompanying commentary, Alexander Miras, MRCP, PhD, of Imperial College London, and Carel le Roux, MBChB, MSc, PhD, of University College Dublin in Ireland.

"The combination of metabolic surgery and glucose-lowering agents could have a positive effect not only on glycemic outcomes but also on the prevention of the macrovascular and microvascular complications of type 2 diabetes," Miras and le Roux added.

Among the surgical patients who did achieve diabetes remission 2 years after surgery, a larger percentage of RYGB patients had a relapse into hyperglycemia versus BPD patients.

After 2-year remission, about 67% (95% CI 41.7-84.8%) of RYGB patients had a relapse vs 53% (95% CI 31.7-72.7%) of BPD patients. Importantly though, the team said, all these patients who had a relapse in diabetes 2 years later were able to maintain "adequate" glucose control by year 10, with an average HbA1c of 6.7%.

The median diabetes-free survival time was 9 years for the BPD patients and 5 years for the RYGB patients.

Not surprisingly, patients who underwent either type of metabolic surgery saw far fewer diabetes-related complications throughout the years, including macrovascular complications -- specifically myocardial infarctions -- and microvascular diabetic complications including retinopathy, nephropathy, and neuropathy.

Surgery patients also had significantly lower body weight, body mass index (BMI), waist circumference, Homeostatic Model Assessment for Insulin Resistance scores, plasma triglycerides, and higher quality-of-life scores; no differences were seen in blood pressure, however.

"Metabolic surgery is arguably the most effective available therapy for type 2 diabetes and can be a life-saving option for many patients. It should be appropriately prioritized in times of pandemic and beyond," said the study's senior author, Francesco Rubino, MD, of King's College London, in a statement.

The findings "provide the most robust scientific evidence yet that full-blown type 2 diabetes is a curable disease, not inevitably progressive and irreversible. In addition to represent[ing] a major advance in the treatment of diabetes, metabolic surgery is our best lead to the elusive cause of the disease," he added.

The open-label, single-center trial included 60 Italian patients -- 20 patients randomized to laparoscopic RYGB, BPD, or conventional medical therapy plus lifestyle interventions. The BPD was performed with an open-surgery approach with the Scopinaro procedure, which uses a horizontal gastrectomy and not a sleeve gastrectomy, the researchers explained. "The BPD used in this study leaves behind a larger gastric remnant and has a lesser effect on restriction of calorie intake than the duodenal switch variant."

Participants were ages 30 to 60, had a BMI of 35 or higher, had at least a 5-year history of type 2 diabetes, had an HbA1c of 7% or higher, and about half were female. After 10 years, the average HbA1c levels were 6.4% in the BPD group, 6.7% in the RYGB group, and 7.6% in the medical therapy group.

Miras and le Roux praised the study for not only its long follow-up, but also that it included patients with largely advanced type 2 diabetes as half of the participants were taking insulin at the time of surgery.

However, one limitation was that the sample size was small, meaning there was a lack of power to really quantify the benefits of surgery on type 2 diabetes complications. In addition, the team said, the BPD procedure is actually seldomly performed, whereas the sleeve gastrectomy procedure is currently the most popular metabolic surgery performed in the U.S. today.

"The 10-year data from STAMPEDE are now eagerly awaited to see how the sleeve gastrectomy performed over 10 years, but we hope also to gain more insight into the rates of hypoglycemia and long-term surgical and nutritional complications for all surgical procedures," the team noted.

Disclosures

The study was funded by Fondazione Policlinico Universitario Agostino Gemelli IRCCS.

Mingrone and co-authors reported relationships with Novo Nordisk, Fractyl, Johnson & Johnson, Ethicon, Medtronic, GI Dynamics, and Keyron.

Miras and le Roux reported relationships with Science Foundation Ireland, the Health Research Board, the Irish Research Council, Novo Nordisk, Herbalife, Boehringer Ingelheim, Johnson & Johnson, Keyron, AnaBio, and Sanofi.

US health officials: More data needed on UK COVID-19 variant warning

 The United States is closely watching the more infectious variant of COVID-19 after British officials warned that it may also be more deadly, two top U.S. health officials said on Saturday, cautioning more data is needed.

Officials are somewhat more worried about a separate variant from South Africa, although it has not yet been identified among U.S. cases of the novel coronavirus, National Institutes of Health (NIH) Director Francis Collins and Dr. Anthony Fauci, President Joe Biden’s top COVID-19 medical adviser, also said.

Collins noted the UK’s data was preliminary, and said it was unclear why those with the UK variant faced a higher risk of death, whether by changes in the virus itself or other external causes such as pressures on the healthcare system.

“Let’s take this as something to watch closely,” he told MSNBC in an interview.

Fauci separately told MSNBC that he needed to see the raw data from the UK before fully assessing the mortality risk and that U.S. officials were weighing how the two new strains could impact vaccine efficacy.

“These are serious situations that we are following very closely and, if necessary, we will adapt to it,” Fauci said, adding vaccines could be altered in coming months if needed.

Their comments come as Democratic President Joe Biden takes the reins of the nation’s COVID-19 response, seeking to re-energize the fight against the highly infectious disease and urging a war-like stance. In a flurry of actions since taking office Wednesday, Biden unveiled a new U.S. strategic plan to curtail the outbreak and signed numerous executive orders to boost vaccines and increase mask use, among other measures.

The United States is the nation hardest-hit by COVID-19, with 24.70 million cases and 413,775 deaths by midnight Friday. Over the past week, 3,089 Americans have died of the disease on average, while 20 U.S. states reported record deaths this month.

British Prime Minister Boris Johnson on Friday warned that the UK variant was associated with higher level of mortality.

The U.S. Centers for Disease Control and Prevention last week warned the UK variant, already circulating in at least 10 U.S. states, could become the dominant variant in the United States by March. The variant, known as B.1.1.7, is believed to be twice as contagious as the current one circulating nationwide.

“At the moment we are not alarmed about that,” Collins said, given that vaccines still appeared effective against it. “We are somewhat more concerned about a South African variant.”

Fauci, U.S. top infectious disease expert, echoed his concerns, calling data on the South Africa variant a bit more “ominous” even as current vaccines still appeared to protect against both variants.

Scientists on Wednesday said the South African variant may reduce the efficacy of current vaccines, which also raises the prospect of re-infection.

Britain has banned travelers from some African countries in an attempt to stop the spread of that strain in the United Kingdom and is weighing further restrictions.

Biden has moved to impose a mandatory quarantine for air passengers arriving in the United States, although details have not yet been released. He is also requiring U.S.-bound passengers to have a negative COVID-19 test starting on Tuesday.

Even without a greater mortality risk, more contagious variants increase the pressure on officials to vaccinate the population -- a campaign many state and local officials have said has been slow and chaotic and one Biden has pledged to improve.

“When you get more cases, you’re going to get more hospitalizations. And when you get more hospitalizations, you’re ultimately going to get more deaths,” Fauci told reporters at the White House on Thursday.

https://www.reuters.com/article/us-health-coronavirus-usa/u-s-health-officials-more-data-needed-on-uk-covid-19-variant-warning-idUSKBN29S0J9

What Was Amazon Waiting For?

 January 20 was Inauguration Day. It was also the day that a major American employer offered to help in the Covid-19 vaccination effort. In a letter from Amazon’s Worldwide Consumer CEO Dave Clark to newly inaugurated President Joe Biden, the company offered to vaccinate its more than 800,000 “essential” employees and “to leverage our operations, information technology, and communications capabilities and expertise to assist your administration’s vaccination efforts.”

Amazon made this offer, it said, because its “scale” could “make a meaningful impact immediately in the fight against COVID-19.” (emphasis added) Amazon surely knew that it had the capabilities, expertise, and scale to aid vaccination efforts before January 20, so the timing of its letter is curious, to say the least.

There is no question that Amazon can be helpful in vaccination efforts. It has the world’s most efficient logistics operation and has already contracted with a health-care provider to administer vaccinations on-site at its facilities. Efforts by Amazon and other private entities to vaccinate Americans would surely be more effective than the government over-regulation and micromanagement that has characterized current efforts, which have left more than half of the existing supply of vaccines in freezers rather than in peoples’ arms.

On December 16, Amazon’s Clark wrote to the CDC’s Advisory Committee on Immunization Practices, asking that the company’s 800,000 workers be considered essential workers and thus made a high priority for vaccination. The December letter mirrors the second paragraph of the January letter in this regard. But, unlike the new letter, the December letter didn’t offer Amazon’s resources to assist the nation’s vaccination efforts.

Amazon’s December letter came after the FDA’s December 11 authorization for emergency use of the Pfizer vaccine. One week later, the FDA authorized the Moderna vaccine. The media had been reporting on progress toward impending authorizations of these vaccines for months. It’s inconceivable that Amazon only began considering how to leverage its vast resources for the public good on January 20. Why did Amazon delay its offer to help? The company hadn’t gained any new capabilities in the weeks before January 20.

Could politics have played a role? Like most tech companies, Amazon is overtly liberal in outlook and action. Its policy prohibits customers using its AmazonSmile program from donating parts of their purchases to conservative nonprofits. More than three-quarters of Amazon employees’ political donations went to Democrats, and the far-left Bernie Sanders and Elizabeth Warren campaigns were the top two recipients during the primaries. Then there is the long-running, very public feud between former President Trump and Amazon founder and CEO Jeff Bezos.

It is hard to imagine that a major corporation like Amazon would risk public backlash by withholding aid to Trump’s administration on an issue of such public import, waiting instead for the Biden administration to commence. But given the political climate and the history of animosity between Trump and Bezos, the timing of Amazon’s offer will surely raise some eyebrows.

Amazon should be commended for offering its help in the vaccination effort, but it must also explain why it didn’t offer its capabilities sooner. If politics was the reason, Amazon has a lot of explaining to do.

https://www.city-journal.org/curious-timing-of-amazons-offer-to-assist-vaccine-distribution

Pfizer to ship fewer COVID vax vials to US as extra doses extracted

 Last month, pharmacists across the US found a pleasant surprise when they discovered that the vials of Pfizer's COVID-19 vaccine contained extra doses.

As a result, Pfizer will now ship fewer vials of vaccine to the US to account for that, according to a New York Times report. The pharmaceutical company has committed to providing 200 million vaccine doses to the US by the end of July. The extra doses found in the initial allocations will now count toward that number.

Pfizer charges by the dose and for weeks has reportedly pushed officials at the US Food and Drug Administration to formally acknowledge that the vials contain six (and sometimes seven) doses, instead of five.

Earlier this month, the FDA obliged, changing the wording of the vaccine's emergency use authorization, according to The Times. Pfizer officials argued the distinction was necessary, since the federal government's contract required payment by the dose.

But some pharmacists say they've had challenges actually extracting those extra doses, because that process requires a special syringe.

"Now there's more pressure to make sure that you get that sixth dose out," Michael Ganio, the senior director for pharmacy practice and quality at the American Society of Health-System Pharmacists said.

Pfizer's chief executive, Dr. Albert Bourla, said that the extra sixth dose allows the company to extend its vaccine supply further. Pfizer had originally estimated it could manufacture 1.3 billion doses in 2021, but the discovery of the extra doses reportedly played a role in the company's most recent estimate of two billion doses by the end of the year.

When pharmacists first discovered the extra doses, there was both excitement and confusion. Some even threw out the extra doses because they hadn't been given permission to use them, according to the newspaper. But the FDA soon offered both permission and instruction for using the extra doses.

At the time, the extra doses seemed to suggest that instead of the 100 million doses Pfizer had originally promised the US by the end of March, the country could wind up with as many as 120 million, some good news amid the chaotic vaccine rollout, but Pfizer demanded that the extra doses instead be counted as part of its existing contract.

"Pfizer will make a lot of money from these vaccines, and the US government assumed a lot of the upfront risk in this case, so I'm not sure why Pfizer didn't just continue to fill their supply as planned, even if it meant oversupplying a little," Dr. Aaron S. Kesselheim, a professor of medicine at the Brigham and Women's Hospital and Harvard Medical School said.

After weeks of reported language dispute between Pfizer and the FDA, the agency formally changed the vaccine's fact sheet to specify that six doses were included in each vial.

The number of Pfizer vaccines allocated to each state could be based on that new language starting as soon as next week.

https://news.yahoo.com/pfizer-now-ship-fewer-covid-015602891.html