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Sunday, January 31, 2021

China's New Covid-19 Outbreaks Trip Up Economic Momentum

 China's economy started the new year on a weaker footing as new coronavirus outbreaks and pandemic-containment measures sapped factory production and weighed on the country's services recovery, official data showed Sunday.

Official gauges of industrial and services activities eased more than expected in January, with demand taking a particular hit as authorities discouraged travel ahead of February's Lunar New Year festival, according to data from Beijing's National Bureau of Statistics.

China's official manufacturing purchasing managers index softened to 51.3 in January, lower than December's 51.9 reading and the 51.5 median forecast among economists polled by The Wall Street Journal.

The nonmanufacturing PMI, which includes services and construction activity, weakened even more to 52.4, from 55.7 in December, according to the statistics bureau.

Though both indexes showed activity remaining above the 50 mark that separates expansion from contraction, the new-orders subindex for the nonmanufacturing sector, a key measure of demand, dropped below the 50 line--to 48.7 from 51.9 the previous month--marking the lowest level since February last year, when the Chinese economy was absorbing the very worst of the coronavirus shock.

Sunday's PMI readings provided the first look at the economic damage wrought by fresh outbreaks of the coronavirus in northern China--the worst since the initial outbreak that began in Wuhan about a year ago. The latest wave has sickened hundreds and put restrictions on the movements of millions of people.

To keep the number of cases from rising further, government authorities nationwide are dissuading residents from traveling during the most important holiday of the year, Lunar New Year, which runs for a week beginning February 12.

The stricter quarantine and testing requirements imposed during this frantic season--when hundreds of millions of people typically travel to see family and splash out on gifts and dining--are likely to restrain economic activity.

Services requiring close human contact have borne the biggest brunt. Subindexes tracking business activity in catering, accommodations, logistics, transportation and entertainment fell sharply into contractionary territory in January, official data showed.

Hunter Chan, an economist at Standard Chartered Bank, expects the damage to persist through the end of the festival in late February, though he is optimistic that the economy will rebound.

"The economy will normalize quickly as effective control measures limit the prolonged impact," he said.

As coronavirus restrictions threaten a second straight year of Lunar New Year festivities, local governments have in recent weeks rolled out shopping vouchers in hopes of enticing people to stay in place over the holiday and to keep spending.

China's services and consumption sectors have lagged behind its broader economic recovery over the past year amid lingering concerns over infections and worker incomes that have been squeezed by the pandemic.

China's 2.3% expansion in gross domestic product in 2020, which made it the only major economy to post growth last year, was powered largely by industrial production, exports and government-backed investment. Retail sales, by contrast, was one of the few closely watched economic indicators to finish 2020 lower than the prior year.

In addition to the weakness in the services sector, Sunday's PMI reading also showed emerging signs of slowing momentum in the industrial sector, with both demand and production easing.

The subindex measuring manufacturing production fell to 53.5 in January, from 54.2 in December, while total new orders dropped to 52.3 from December's 53.6 reading. The subindex tracking new export orders also eased to 50.2 from 51.3 in December, but remained above the 50 mark for a fifth straight month.

China's statistics bureau said some workers had returned to their hometowns in anticipation of the tightening control measures, leading to a labor shortage at some factories.

https://www.marketscreener.com/quote/stock/STANDARD-CHARTERED-PLC-4003394/news/China-s-New-Covid-19-Outbreaks-Trip-Up-Economic-Momentum-32315268/

How Not to Waste COVID Vaccines

 

What do you do when your COVID-19 vaccine clinic is 20 minutes from closing, only six people showed up for the day's last appointment, and you just opened a 10-dose Moderna vial?

Reports suggest that many clinics dump their leftover doses in the trash.

But some facilities have found solutions to minimize vaccine waste. Relying on constant communication, flexible planning, and a focused workforce including diligent volunteers, they said they have found takers for nearly all the thousands of doses they have prepared since vaccinations began last month.

"So far this has been not a hard problem to solve," said Dora Anne Mills, MD, who is coordinating the 11-hospital MaineHealth system's vaccination sites. "It's really about planning and keeping an eye on things."

Once a vial's seal is punctured, workers have only a few hours to administer them. Some fortunate bystanders have gotten vaccinated merely by being at the right grocery store at the right time. But that can be chancy, and can also draw criticism for giving precious doses to people not on the current priority list.

"There are vaccines that are being wasted and that is a travesty," Terry Fulmer, president of the John A. Hartford Foundation, told ABC News. "Even one dose wasted is too many."

Some facilities told MedPage Today they establish plans every morning and then adjust throughout the day. At Northern Light in Maine, for example, staff remove enough vaccine to cover the first three hours' worth of booked patients; then they prepare smaller batches every hour to ensure they do not take too much out, said James Jarvis, MD, a family medicine and obstetrics specialist who oversees the 11-site system's COVID response.

Ascension St Vincent's four sites in the Indianapolis area keep the vials they think they will need for the day in a fridge -- usually enough for 1,000-1,500 doses of the Moderna and Pfizer vaccines, said Cindy Adams, PhD, the system's chief nursing officer and COVID vaccine coordinator.

In New Jersey, Rowan School of Osteopathic Medicine staff assemble 100 doses to cover the first couple hours, then draw about 50, then 20. To cover the last two hours before the site shuts to the public at 4 p.m., they bring out one vial at a time as needed. Sometimes they don't know if the last 10 patients will all show up, said site coordinator Joshua Coren, DO, but they know they at least will not waste all 10 shots. "You're never going to be exactly right, but I'd rather open up only one vial as we need it," said Coren, chair of the family medicine program. The site gives 300-500 Moderna doses daily.

These sites also maintain lists of healthcare workers, first responders, and others currently prioritized by their states. When they find they have doses unaccounted for, they methodically call these people, working their way down the list until enough of them agree to come in. Sometimes they settle on whoever is willing and available -- including nonclinical staff and volunteer workers, even when they don't qualify under the current priority scheme.

MaineHealth's Mills said the system has vaccinated unbooked spouses who come with patients to appointments when extra doses are available.

"We always have somebody waiting in the wings," said Jarvis at Northern Light, where staff at one location with leftover doses called a nearby dental office to offer them.

Rowan assembles a list late in the day of who is around and unvaccinated, then offers them leftover doses.

"The vaccines are going to go bad anyway. You might as well give [such] individuals the vaccine," Erik Hefti, executive director and assistant professor of pharmaceutical sciences at Harrisburg University of Science and Technology in Pennsylvania, told a local TV station.

"We don't want any vaccine wasted, so if they're going to vaccinate someone in [group] 1B as opposed to wasting it that's absolutely fine," Pennsylvania Secretary of Health Rachel Levine said earlier this month when dosing was nominally restricted to group 1A.

Ascension St. Vincent's pharmacists have drawn on the first few weeks of vaccination to predict no-shows and expected patient flow, Adams said.

That is no cinch: "It is very hard to predict exactly how many vaccines you're going to use in a day," Julie Willems Van Dijk, acting secretary of Wisconsin's Department of Health Services, told the Racine Journal Times newspaper.

https://www.medpagetoday.com/special-reports/exclusives/90935

80% of COVID-19 Patients May Have Lingering Symptoms, Signs

 Eight of 10 COVID-19 patients had lingering symptoms or signs 14 or more days after acute infection, a systematic review and meta-analysis showed.

More than 50 symptoms tied to SARS-CoV-2 infection persisted, most commonly fatigue (58%), headache (44%), attention disorder (27%), hair loss (25%), dyspnea (24%), and anosmia (24%) were identified, according to Sonia Villapol, PhD, of Houston Methodist Research Institute in Texas, and colleagues. The findings were reported in a medRxiv preprint and have not undergone peer review.

"We estimated that a total 80% of the patients infected with SARS-CoV-2 developed one or more long-term symptoms," Villapol said. "Preventive measures, rehabilitation techniques, and clinical management strategies designed to address prevalent long-term effects of COVID-19 are urgently needed," she told MedPage Today.

To date, there's no established diagnosis for the slow, persistent condition that people with lasting effects of COVID-19 experience; terms like "long COVID," "long haulers," and "post-acute COVID-19" have been used, Villapol and colleagues noted. In their review, they referred to lingering symptoms and signs as "long-term effects of COVID-19."

Last year, a widely-cited CDC survey showed 35% of COVID-19 patients had not returned to usual health 2 to 3 weeks after testing positive, but those were mild, outpatient cases. Early in 2021, a study in the Lancet showed that 6 months after illness onset, 76% of hospitalized COVID-19 patients in Wuhan, China, reported at least one symptom that persisted, mostly fatigue or muscle weakness.

In their meta-analysis, Villapol and colleagues included 47,910 people with a confirmed COVID-19 diagnosis in 15 studies that had evaluated symptoms, signs, or laboratory parameters 2 weeks or more week post-viral infection. Each study had a minimum of 100 patients. Nine studies were from Great Britain or Europe, three were from the U.S.

Six studies focused only people hospitalized for COVID-19; the others included mild, moderate, and severe cases. Patients ranged from ages 17 to 87 years, and follow-up time ranged from 14 to 110 days.

Fatigue was the most common symptom of both long and acute COVID-19, Villapol and colleagues noted: "It is present even after 100 days of the first symptom of acute COVID-19."

During follow-up, 34% of patients had an abnormal chest x-ray or CT. Elevated markers also were seen, including D-dimer (20%), NT-proBNP (11%), C-reactive protein (8%), serum ferritin (8%), procalcitonin (4%), and IL-6 (3%).

Other lingering symptoms were pulmonary (cough, chest discomfort, reduced pulmonary diffusing capacity, sleep apnea, pulmonary fibrosis), cardiovascular (arrhythmias, myocarditis), or neurologic or psychiatric (memory loss, depression, anxiety, sleep disorders).

All meta-analyses showed medium to high heterogeneity. "Future studies need to stratify by sex, age, previous comorbidities, severity of COVID-19 (ranging from asymptomatic to severe), and duration of each symptom," the researchers wrote. From the clinical perspective, multi-disciplinary teams with whole-patient perspectives are needed to address long COVID-19 care, they added.

Limitations include possible selection or reporting bias, small sample sizes for some outcomes, and variation in how outcomes and markers were defined. "Another limitation is that, given that COVID-19 is a new disease, it is not possible to determine how long these effects will last," Villapol and colleagues said.

"To determine whether these long-term effects either complicate previous diseases or are a continuation of COVID-19, there is a need for prospective cohort studies." they added. Measures like blood markers of genetic, inflammatory, immune, and metabolic function need to be standardized to compare studies, and open questions should be included.

Disclosures

The research was supported by the National Institute for Neurological Disorders and Stroke and the Houston Methodist Research Institute.

Villapol disclosed no relevant relationships with industry. A co-author is an employee of Novartis.

Will Recovering COVID-19 Patients Soon Be Walking Around on ECMO?

 A compact extracorporeal membrane oxygenation (ECMO) system built for mobility was greeted with enthusiasm at the Society of Thoracic Surgeons (STS) virtual meeting.

The Breethe Oxy-1 machine was designed for prolonged use in critically ill patients, providing veno-venous or veno-arterial support in either bedside or portable modes. Another notable feature of Breethe is the divided gas path design that separates oxygenation from carbon dioxide removal, according to Bartley Griffith, MD, of University of Maryland School of Medicine in Baltimore.

At the STS meeting, the ambulatory ECMO system informally won the "Shark Tank" session with 42% of audience votes.

Abiomed had acquired the device in May 2020. In October, the company received FDA 510(k) clearance for the Breethe to be used for ECMO in cardiogenic shock or respiratory failure for a maximum of 6 hours at a time.

Throughout the pandemic, critical care specialists have stressed the potential benefit of ECMO in COVID-19 patients with severe respiratory failure. Not all patients who receive ECMO survive, however, and there are not nearly enough machines for potential candidates.

Griffith described the young woman who was the first person to use the Breethe device in December 2020. She was able to walk down the hallway after having been on traditional ECMO in the ICU, he said.

Ultimately, Breethe was designed for someone like her "to run into the cafeteria when she's hungry," he told the audience.

Other competitors at STS "Shark Tank" included:

  • An aortic cross-clamp with a detachable head that applies force evenly for a less traumatic clamp.
  • A smartphone app that aids communication during organ procurement and transplantation for improved personnel productivity, shorter case times, and fewer organs wasted.
  • The StrokeShield left atrial appendage occluder that leaves no peri-device flow or residual space.
  • An augmented reality system that adds vitals, imaging data, and more to a surgeon's view; additionally, those wearing the headset can have the camera recording live and take annotations in real time.
  • A novel specimen extraction sleeve that can fit large tissue samples through small incisions during minimally invasive surgery.

"It's encouraging to see heart surgery is still alive and thriving with very innovative ideas," said session co-moderator William Cohn, MD, of Johnson & Johnson and the Center for Device Innovation at the Texas Medical Center in Houston.

https://www.medpagetoday.com/meetingcoverage/sts/90968

AZ has ‘constructive talks’ with EU leaders after vaccine row

 AstraZeneca has said it has had “constructive talks” with European leaders in a bid to cool the row over vaccine supplies to the EU.

The vaccine is expected to be approved by European regulators tomorrow, but this has been overshadowed by an announcement that the company will not be able to produce the 300 million doses the EU ordered by the end of March.

Low yields at AZ’s European sites led to a political row and yesterday escalated further with European Commissioner for Health Stella Kyriakides calling for shots manufactured in the UK to be diverted to the continent.

Following a meeting with the company last night Kyriakides said there was still a “lack of clarity on the delivery schedule” of the jabs.

She requested a “clear plan from AstraZeneca for the fast delivery of the quantity of vaccines that we reserved for Q1”.

A more upbeat spokesperson for AstraZeneca said in a statement: “Our CEO Pascal Soriot was pleased to participate in a meeting with the EU’s Vaccine Steering Board.

“We had a constructive and open conversation about the complexities of scaling up production of our vaccine, and the challenges we have encountered.

“We have committed to even closer coordination to jointly chart a path for the delivery of our vaccine over the coming months as we continue our efforts to bring this vaccine to millions of Europeans at no profit during the pandemic.”

Her comments followed a lengthy interview with Italy’s la Repubblica newspaper, where Soriot outlined some of the issues that have caused the shortfall in the vaccines.

According to Soriot production from the company’s European supply chain is around two months behind the UK.

He pointed out that the UK signed its contract three months before the EU and as a result production in Europe is significantly behind as the system is not yet fully up and running.

Lower than expected yields have also been an issue, although Soriot said things will begin to improve as the process is fine-tuned.

From February onwards the plant will be able to make 100 doses per month and Soriot noted that most vaccine operations will produce around 100 million doses per year.

Soriot also said that the contract stipulates a “best effort” to get the doses to the EU by that deadline, something that the EU disputes.

However with the contract covered by a confidentiality clause there is a lack of publication to verify claims by either party.

https://pharmaphorum.com/news/az-has-constructive-talks-with-eu-leaders-after-vaccine-row/

Video Games Score Big With Older Adults

 Growing older doesn't have to mean “game over,” at least according to a new survey from AARP that finds video games are booming among people age 50 and older. The research also found that video games are more popular among older women than older men.

In just three years, the number of older adults who play video games frequently has grown from 40.2 million gamers in 2016 to 50.6 million gamers in 2019, the study found.

"Video games have gone mainstream as [older] gamers find pleasure and functional utility in gaming,” the study says. “Over one-third constantly try new games. With increased access and use, older adults are using gaming to connect socially, stay mentally sharp, reduce stress and just to have fun."

For the report, AARP conducted an online survey in June of 3,737 people age 50 and older. The survey defined a video game as any interactive digital entertainment played via a computer, a game console (like the Xbox or PlayStation), or a phone or tablet.

Forty-seven percent of the respondents who said they play video games also said they played them daily, an increase of 7 percentage points since the 2016 survey. The average amount of time older adults spent playing a game was 5 hours per week, the research found.

The biggest spike in game play among older adults was among those age 50-59, the same generation that grew up playing Atari and Ms. Pac-Man decades ago. Game play for that group was 49 percent in the 2019 survey, up from 40 percent three years ago. For adults age 60-69, game play grew three percentage points, from 41 percent in 2016 to 44 percent in 2019. Among those age 70 and older, there was a two-percentage point increase in game play, from 37 percent to 39 percent.

While they are playing for fun, these adults also are adding up to big business. The survey offers a snapshot of an audience that is likely to have a growing effect on the video game industry at large, using their spending power to shape which types of games are made and become successful. According to the report, gamers 50 and older spent an estimated $3.5 billion on gaming within the six-month timeframe from January to June 2019, up from $523 million in 2016.

"Continued growth in the number of older gamers means increased spending power, particularly on content,” the report says.

The study also found a big difference in game play by gender. The survey found that 49 percent of women age 50 and older were gamers, while just 40 percent of men were. Women are playing video games more often, too, with 53 percent of them say they play video games every day, while just 39 percent on men said the same in the 2019 survey.

Most people age 50 and older who play video games do so on their phones or other mobile devices (73 percent, up from 57 percent in 2016). Puzzle and logic games were the most popular type of game (49 percent of respondents), followed closely by card and tile games — minus the gambling — with 47 percent.

https://www.aarp.org/home-family/personal-technology/info-2019/report-video-games.html

10 Republican Senators propose compromise on COVID-19 relief bill

 A group of 10 U.S. Senate Republicans plan to unveil a proposed compromise on COVID-19 relief legislation on Monday, saying they believe their proposal can win bipartisan support.

In a letter to President Joe Biden released on Sunday, the 10 lawmakers asked for a meeting with the White House, saying they wished to “work in good faith” with the new administration.

https://www.reuters.com/article/us-health-coronavirus-usa-congress/group-of-10-republican-senators-propose-compromise-on-covid-19-relief-bill-idUSKBN2A00H8