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Sunday, May 2, 2021

New cuff-based tech monitors endothelial function for heart disease prevention, treatment

 Blood pressure monitors are a common at-home tool for monitoring heart health, but they don't look at the health of the endothelium, the lining of the blood vessels. And endothelial function is a powerful predictor of heart attack and stroke. It has also been linked to COVID-19 in a number of studies.

The trouble is, the current state-of-the-art method to monitor endothelial health, flow-mediated dilation (FMD), which measures the change in diameter in the brachial artery before and after shutting off , requires the use of an ultrasound scanner or expensive systems. The cost of these systems, and the technical skills needed to perform the measurement preclude frequent testing or continuous monitoring. And some FMD systems that are based on microvascular tone aren't always accurate, as they are sensitive to "sympathetic nervous activation," which can confound the results.

Berkeley Lab has developed a technology using cuffs, like those used for taking , to monitor both  and endothelium-independent vasodilation. Studies on  have verified that the cuff-based method is 37% more sensitive to arterial relaxation than  imaging. In addition, the apparatus costs one-fifteenth as much as an ultrasonic imager and eliminates the need for an ultrasound technician.

The lower cost and non-invasive method allows for routine detection and monitoring of endothelial health. That means earlier identification of cardiovascular disease and closer management of endothelial health.

"The cuffs are similar to the blood pressure devices many people already use," said bioscientist Jonathan Maltz, who developed the technology with fellow bioscientist Thomas Budinger. "With this technology, people can regularly monitor their endothelial health, in addition to their blood pressure, either at the doctor's office or in the comfort of their own homes."

Maltz also invented a way to calibrate the cuff-based measurements with those of ultrasound-based flow-mediated dilation. The calibrations allow health providers to monitor the effects of interventions such as exercise, smoking cessation, dietary modification, and cholesterol-lowering therapy, on patient health.


Explore further

Impaired blood vessel and kidney function underlie heart disease risk in people with HIV

More information: Joseph A. Vita et al. Endothelial Function, Circulation (2002). DOI: 10.1161/01.CIR.0000028581.07992.56

Eleni Gavriilaki et al. Endothelial Dysfunction in COVID-19: Lessons Learned from Coronaviruses, Current Hypertension Reports (2020). DOI: 10.1007/s11906-020-01078-6


https://medicalxpress.com/news/2021-04-cuff-based-technology-endothelial-function-aid.html

Sparse evidence on whether portable air filters reduce incidence of COVID-19

 There is an important absence of evidence regarding the effectiveness of a potentially cost-efficient intervention to prevent indoor transmission of respiratory infections, including COVID-19, warns a study by researchers at the University of Bristol.

Respiratory infections such as coughs, colds, and influenza, are common in all age groups, and can be either viral or bacterial. Bacteria and viruses can become airborne via talking, coughing or sneezing. The current global  (COVID-19) pandemic is also spread primarily by , and to date has led to over three million deaths worldwide.

Controlling how we acquire and transmit respiratory infections is of huge importance, particularly within indoor environments such as , households, schools/day care, office buildings and hospitals where people are in close contact. Several manufacturers of portable air filters have claimed their products remove potentially harmful bacteria and viruses from , including COVID-19 viral particles. However, there is often no detailed evidence provided on their websites to corroborate their claims for potential consumers to review before purchasing.

A team of UK researchers from the University of Bristol reviewed previous studies to investigate whether portable air filters used in any indoor setting can reduce incidence of respiratory infections and thus, whether there is any evidence to recommend their use in these settings to reduce the spread of COVID-19 and other respiratory infections. The team also explored whether portable air filters in indoor settings capture airborne bacteria and viruses within them, and if so, what specifically is captured.

The researchers found no studies investigating the effects of portable, commercially available air filters on the incidence of respiratory infections in any indoor community setting. Two studies reported removal or capture of airborne bacteria in indoor settings (an office and emergency room), demonstrating that the filters did capture airborne bacteria and reduced the amount of airborne  in the air. Neither tested for the presence of viruses in the filters, nor a reduction in viral particles in the air.

The study, funded by Professor Alastair Hay's National Institute for Health Research Senior Investigator Award and published in PLoS One, was a systematic review of studies published after 2000 reporting (i) effects of portable air filters on incidence of , or (ii) whether filters capture and/or remove aerosolised  and viruses from the air, including information of what is captured. Studies reporting non-portable air filters were excluded from this study.

Lead author, Dr. Ashley Hammond, an Infectious Disease Epidemiologist at the Centre for Academic Primary Care, University of Bristol, said: "Our study highlights the considerable gap in evidence related to the effectiveness of portable air filters in preventing respiratory infections, including COVID-19. Whilst we found some evidence suggesting use of air filters could theoretically contribute to reducing the spread of COVID-19 and other respiratory infections by capturing airborne particles, there is a complete absence of evidence as to whether they actually reduce the incidence of these infections."

Professor Alastair Hay, a GP and Professor of Primary Care at the Centre for Academic Primary Care, University of Bristol, and the research group lead, said: "Randomised controlled trials are urgently needed to demonstrate the effects of portable air filters on incidence of respiratory infections, including COVID-19. The main research questions should focus primarily on whether use of portable air filters in any indoor environment can reduce respiratory infections compared to those environments without portable air filters."


More information: Should homes and workplaces purchase portable air filters to reduce the transmission of SARS-CoV-2 and other respiratory infections? A systematic review by Ashley Hammond, Tanzeela Khalid, Hannah V Thornton, Claire A Woodall and Alastair D Hay. PLOS ONE, 29 April 2021.

https://medicalxpress.com/news/2021-04-considerable-gap-evidence-portable-air.html

Coronavirus spike protein plays additional key role in illness

 Scientists have known for a while that SARS-CoV-2's distinctive "spike" proteins help the virus infect its host by latching on to healthy cells. Now, a major new study shows that they also play a key role in the disease itself.

he paper, published on April 30, 2021, in Circulation Research, also shows conclusively that COVID-19 is a vascular disease, demonstrating exactly how the SARS-CoV-2 virus damages and attacks the vascular system on a cellular level. The findings help explain COVID-19's wide variety of seemingly unconnected complications, and could open the door for new research into more effective therapies.

"A lot of people think of it as a respiratory disease, but it's really a vascular disease," says Assistant Research Professor Uri Manor, who is co-senior author of the study. "That could explain why some people have strokes, and why some people have issues in other parts of the body. The commonality between them is that they all have vascular underpinnings."

Salk researchers collaborated with scientists at the University of California San Diego on the paper, including co-first author Jiao Zhang and co-senior author John Shyy, among others.

While the findings themselves aren't entirely a surprise, the paper provides clear confirmation and a detailed explanation of the mechanism through which the protein damages vascular  for the first time. There's been a growing consensus that SARS-CoV-2 affects the vascular system, but exactly how it did so was not understood. Similarly, scientists studying other coronaviruses have long suspected that the spike protein contributed to damaging vascular endothelial cells, but this is the first time the process has been documented.

The novel coronavirus' spike protein plays additional key role in illness
Representative images of vascular endothelial control cells (left) and cells treated with the SARS-CoV-2 Spike protein (right) show that the spike protein causes increased mitochondrial fragmentation in vascular cells. Credit: Salk Institute

In the new study, the researchers created a 'pseudovirus' that was surrounded by SARS-CoV-2 classic crown of spike proteins, but did not contain any actual virus. Exposure to this pseudovirus resulted in damage to the lungs and arteries of an animal model—proving that the spike protein alone was enough to cause disease. Tissue samples showed inflammation in endothelial cells lining the pulmonary artery walls.

The team then replicated this process in the lab, exposing healthy endothelial cells (which line arteries) to the spike protein. They showed that the spike protein damaged the cells by binding ACE2. This binding disrupted ACE2's molecular signaling to mitochondria (organelles that generate energy for cells), causing the mitochondria to become damaged and fragmented.

Previous studies have shown a similar effect when cells were exposed to the SARS-CoV-2 virus, but this is the first study to show that the damage occurs when cells are exposed to the spike protein on its own.

"If you remove the replicating capabilities of the , it still has a major damaging effect on the vascular cells, simply by virtue of its ability to bind to this ACE2 receptor, the S protein receptor, now famous thanks to COVID," Manor explains. "Further studies with mutant spike proteins will also provide new insight towards the infectivity and severity of mutant SARS CoV-2 viruses."

The researchers next hope to take a closer look at the mechanism by which the disrupted ACE2  damages mitochondria and causes them to change shape.

More information: Yuyang Lei et al, SARS-CoV-2 Spike Protein Impairs Endothelial Function via Downregulation of ACE 2, Circulation Research (2021). DOI: 10.1161/CIRCRESAHA.121.318902

https://medicalxpress.com/news/2021-04-coronavirus-spike-protein-additional-key.html

Shifting Coronary Procedures to Outpatient Centers: Safety First?

 Regulators are on board and the reimbursement is there, but should more complex percutaneous coronary intervention (PCI) procedures be shifted from a traditional hospital setting to an ambulatory surgical center (ASC)?

"Obviously we're not advocating that [PCI in a] high-risk patient with high-risk anatomy should be performed in an ASC setting at this point. Probably, those patients should stay in the hospital," said Georges Nseir, MD, of Premier Cardiovascular Center in Chandler, Arizona, at a panel discussion during the virtual meeting of the Society for Cardiovascular Angiography and Interventions (SCAI).

"Just because you can do it in the hospital doesn't automatically mean it will translate to the ASC or OBL [office-based lab] setting," cautioned Jeffrey Carr, MD, of Tyler Cardiac and Endovascular Center and CardiaStream in Tyler, Texas.

But when stars align for experienced operators and appropriate patients, the benefits of complex coronary procedures in outpatient settings can include improved efficiency of care, increased access to care, and better patient satisfaction.

Reduced costs -- especially with same-day discharge after elective PCI -- are also tempting: CMS anticipates a $20 million savings if just 5% of PCIs were moved to ambulatory surgical centers, said Deepali Tukaye, MD, PhD, of Northside Hospital Cardiovascular Institute in Cumming, Georgia, during the SCAI session.

Numbers from the National Cardiovascular Data Registry support PCI at ambulatory surgical centers, given the "fairly low" rates of major complications among elective patients, Tukaye noted.

In addition, Nseir cited research that patients with complex lesions -- as well as those with left main lesions, chronic total occlusions, and elderly patients -- have been shown to be safely discharged from the cath lab within 6 hours. Moreover, one group reported a less than one in 1,000 incidence of referral to emergency bypass surgery.

The key is that ASCs need to meet certain criteria for physicians, staff, equipment, and facilities, and choose the right PCI patients, Nseir said.

Yet "everyone has a plan until they get punched in the mouth," said Anbukarasi Maran, MD, of the Medical University of South Carolina in Charleston, quoting boxer Mike Tyson. She took the stance against ambulatory centers taking on complex PCIs during the discussion.

"Would you rather have a member of your family ... have their cardiac cath in a state-of-the-art cath lab, which has access to all kinds of atherectomy, all kinds of advanced mechanical circulatory support [MCS], vascular and CT surgery backup if you need it?" Maran asked.

Or, she posed, would an ASC, with the "bare minimum," that can only fix type A lesions, be preferred? "There is no access to advanced MCS apart from a balloon pump, no access to atherectomy, no CT surgery or vascular surgery, and [it takes] 60 minutes to one hospital either by ambulance or helicopter," she continued.

Maran emphasized that the <1% complication rate following PCI should not be viewed the same as the 1% also cited for dermatologists giving Botox injections.

"Complications in the cath lab can be cognitive errors. [It] can be, you are just putting your head in the sand, you're not seeing the first mistake, and you're making more and more mistakes," she said. "Those you can learn from, you can get better, you can improve."

"PCI, my dear friends, is not a Botox injection, and it cannot be, should not be recommended in an outpatient ambulatory surgical setting. Complications are rare, but can be devastating," Maran concluded.

Other discussants agreed that patient safety comes first, but did not believe in a blanket rejection of PCI in ASCs.

"I think of the analogy of a [road]. Some roads are safer to drive on than others. That [doesn't] mean you [can't] drive on them. But, you probably [shouldn't] take your [Porsche] at 120 mph down a country road," wrote Lyndon Box, MD, of West Valley Cardiology Services in Caldwell, Idaho, in the virtual chatroom for the session.

"People often ask the 'would you have you or your family member get a PCI in an ASC?' I can definitely say that I would rather have Jeff Carr do my PCI in his ASC than a lot of other people doing it in their large academic medical center," Box added.

Carr shared several tips for outpatient centers performing PCI and same-day cardiac interventions:

  • Having an array of devices to bail out when necessary (e.g., covered stents, thrombectomy catheters)
  • Considering staged procedures for sicker patients
  • Maintaining skill in different techniques, alternative access
  • Using ultrasound guidance
  • Participating in mentorship and remote case support for less experienced operators
  • Routine bailout drills to sharpen skills

Besides safety concerns, the potential drawbacks of shifting coronary procedures to outpatient centers also include a change in an affiliated hospital's finances and a rise in inappropriate PCIs, Tukaye said.

CMS reimbursement for coronary interventions in ASCs began in January 2020. In response, guidance for starting such a program was set forth by an SCAI group -- led by Box, with Carr and Tukaye as co-authors -- in July.

This January, CMS also started reimbursing for atherectomy at ASCs.


Primary Source

How Ike's 1950s America Beat The 'Asian Flu' With Science & Common Sense

 This essay is adapted from Mr. Ferguson’s new book, “Doom: The Politics of Catastrophe,” which will be published by Penguin Press on May 4. He is a senior fellow at the Hoover Institution at Stanford University.

In 1957, the U.S. rose to the challenge of the ‘Asian flu’ with stoicism and a high tolerance for risk, offering a stark contrast with today’s approach to Covid-19...

“Bliss was it in that dawn to be alive,/But to be young was very heaven!” Wordsworth was talking about France in 1789, but the line applies better to the America of 1957. That summer, Elvis Presley topped the charts with “(Let Me Be Your) Teddy Bear.” But we tend to forget that 1957 also saw the outbreak of one of the biggest pandemics of the modern era. Not coincidentally, another hit of that year was “Rockin’ Pneumonia and the Boogie Woogie Flu” by Huey “Piano” Smith & the Clowns.

When seeking historical analogies for Covid-19, commentators have referred more often to the catastrophic 1918-19 “Spanish influenza” than to the flu pandemic of 1957-58. Yet the later episode deserves to be much better known, not just because the public health threat was a closer match to our own but because American society at the time was better prepared—culturally, institutionally and politically—to deal with it.

The “Asian flu”—as it was then uncontroversial to call a contagious disease that originated in Asia—was a novel strain (H2N2) of influenza A. It was first reported in Hong Kong in April 1957, having originated in mainland China two months before, and—like Covid-19—it swiftly went global.

Like Covid-19, the Asian flu led to significant excess mortality. The most recent research concludes that between 700,000 and 1.5 million people worldwide died in the pandemic. A pre-Covid study of the 1957-58 pandemic concluded that if “a virus of similar severity” were to strike in our time, around 2.7 million deaths might be anticipated worldwide. The current Covid-19 death toll is 3 million, about the same percentage of world population as were killed in 1957–58 (0.04%, compared with 1.7% in 1918-19).

True, excess mortality in the U.S.—now around 550,000—has been significantly higher in relative terms in 2020-21 than in 1957-58 (at most 116,000). Unlike Covid-19, however, the Asian flu killed appreciable numbers of young people. In terms of excess mortality relative to baseline expected mortality rates, the age groups that suffered the heaviest losses globally were 15- to 24-year-olds (34% above average mortality rates) followed by 5- to 14-year-olds (27% above average). In total years of life lost in the U.S., adjusted for population, Covid has been roughly 40% worse than the Asian flu.

The Asian flu and Covid-19 are very different diseases, in other words. The Asian flu’s basic reproduction number—the average number of people that one person was likely to infect in a population without any immunity—was around 1.65. For Covid-19, it is likely higher, perhaps 2.5 or 3.0. Superspreader events probably played a bigger role in 2020 than in 1957: Covid has a lower dispersion factor—that is, a minority of carriers do most of the transmission. On the other hand, people had more reason to be afraid of a new strain of influenza in 1957 than of a novel coronavirus in 2020. The disastrous pandemic of 1918 was still within living memory, whereas neither SARS nor MERS had produced pandemics.

The first cases of Asian flu in the U.S. occurred early in June 1957, among the crews of ships berthed at Newport, R.I. Cases also appeared among the 53,000 boys attending the Boy Scout Jamboree at Valley Forge, Penn. As Scout troops traveled around the country in July and August, they spread the flu. In July there was a massive outbreak in Tangipahoa Parish, La. By the end of the summer, cases had also appeared in California, Ohio, Kentucky and Utah.

It was the start of the school year that made the Asian flu an epidemic. The Communicable Disease Center, as the CDC was then called, estimated that approximately 45 million people—about 25% of the population—became infected with the new virus in October and November 1957. Younger people experienced the highest infection rates, from school-age children up to adults age 35-40. Adults over 65 accounted for 60% of influenza deaths, an abnormally low share.

Why were young Americans disproportionately vulnerable to the Asian flu? Part of the explanation is that they had not been as exposed as older Americans to earlier strains of influenza. But the scale and incidence of any contagion are functions of both the properties of the pathogen itself and the structure of the social network that it attacks. The year 1957 was in many ways the dawn of the American teenager. The first baby boomers born after the end of World War II turned 13 the following year. Summer camps, school buses and unprecedented social mingling after school ensured that between September 1957 and March 1958 the proportion of teenagers infected with the virus rose from 5% to 75%.

The policy response of President Dwight Eisenhower could hardly have been more different from the response of 2020.

Eisenhower did not declare a state of emergency. There were no state lockdowns and, despite the first wave of teenage illness, no school closures. Sick students simply stayed at home, as they usually did. Work continued more or less uninterrupted.

With workplaces open, the Eisenhower administration saw no need to borrow to the hilt to fund transfers and loans to citizens and businesses. The president asked Congress for a mere $2.5 million ($23 million in today’s inflation-adjusted terms) to provide additional support to the Public Health Service. There was a recession that year, but it had little if anything to do with the pandemic. The Congressional Budget Office has described the Asian flu as an event that “might not be distinguishable from the normal variation in economic activity.”

President Eisenhower’s decision to keep the country open in 1957-58 was based on expert advice. When the Association of State and Territorial Health Officials (ASTHO) concluded in August 1957 that “there is no practical advantage in the closing of schools or the curtailment of public gatherings as it relates to the spread of this disease,” Eisenhower listened. As a CDC official later recalled:

“Measures were generally not taken to close schools, restrict travel, close borders or recommend wearing masks….ASTHO encouraged home care for uncomplicated influenza cases to reduce the hospital burden and recommended limitations on hospital admissions to the sickest patients….Most were advised simply to stay home, rest and drink plenty of water and fruit juices.”

This decision meant that the onus shifted entirely to pharmaceutical interventions. As in 2020, there was a race to find a vaccine. Unlike in 2020, however, the U.S. had no real competition, thanks to the acumen of one exceptionally talented and prescient scientist. From 1948 to 1957, Maurice Hilleman—born in Miles City, Mont., in 1919—was chief of the Department of Respiratory Diseases at the Army Medical Center (now the Walter Reed Army Institute of Research).

Early in his career, Hilleman had discovered the genetic changes that occur when the influenza virus mutates, known as “shift and drift.” It was this work that enabled him to recognize, when reading reports in the press of “glassy-eyed children” in Hong Kong, that the outbreak had the potential to become a disastrous pandemic. He and a colleague worked nine 14-hour days to confirm that this was a new and potentially deadly strain of flu.

Speed was of the essence, as in 2020. Hilleman was able to work directly with vaccine manufacturers, bypassing “the bureaucratic red tape,” as he put it. The Public Health Service released the first cultures of the Asian influenza virus to manufacturers even before Hilleman had finished his analysis. By the late summer, six companies were producing his vaccine.

It has become commonplace to describe the speed with which vaccines were devised for Covid-19 as unprecedented. But it was not. The first New York Times report of the outbreak in Hong Kong—three paragraphs on page 3—was on April 17, 1957. By July 26, little more than three months later, doctors at Fort Ord, Calif., began to inoculate recruits to the military.

Surgeon General Leroy Burney announced on August 15 that the vaccine was to be allocated to states according to population size but distributed by the manufacturers through their customary commercial networks. Approximately 4 million one-milliliter doses were released in August, 9 million in September and 17 million in October.

This amounted to enough vaccine for just 17% of the population, and vaccine efficacy was found to range from 53% to 60%. But the net result of Hilleman’s rapid response to the Asian flu was to limit the excess mortality suffered in the U.S.

A striking contrast between 1957 and the present is that Americans today appear to have a much lower tolerance for risk than their grandparents and great-grandparents. As one contemporary recalled,

“For those who grew up in the 1930s and 1940s, there was nothing unusual about finding yourself threatened by contagious disease. Mumps, measles, chicken pox and German measles swept through entire schools and towns; I had all four….We took the Asian flu in stride. We said our prayers and took our chances.

D.A. Henderson, who as a young doctor was responsible for establishing the CDC Influenza Surveillance Unit, recalled a similar sangfroid in the medical profession:

“From one watching the pandemic from very close range…it was a transiently disturbing event for the population, albeit stressful for schools and health clinics and disruptive to school football schedules.”

Compare these stoical attitudes with the strange political bifurcation of reactions we saw last year, with Democrats embracing drastic restrictions on social and economic activity, while many Republicans acted as if the virus was a hoax. Perhaps a society with a stronger fabric of family life, community life and church life was better equipped to withstand the anguish of untimely deaths than a society that has, in so many ways, come apart.

A further contrast between 1957 and 2020 is that the competence of government would appear to have diminished even as its size has expanded. The number of government employees in the U.S., including those in federal, state and local governments, numbered 7.8 million in November 1957 and reached around 22 million in 2020—a nearly threefold increase, compared with a doubling of the population. Federal net outlays were 16.2% of GDP in 1957 versus 20.8% in 2019.

The Department of Health, Education and Welfare was just four years old in 1957. The CDC had been established in 1946, with the eradication of malaria as its principal objective. These relatively young institutions appear to have done what little was required of them in 1957, namely to reassure the public that the disastrous pandemic of 1918-19 was not about to be repeated, while helping the private sector to test, manufacture and distribute the vaccine. The contrast with the events of 2020 is once again striking.

It was widely accepted last year that economic lockdowns—including shelter-in-place orders confining people to their homes—were warranted by the magnitude of the threat posed to healthcare systems. But the U.S. hospital system was not overwhelmed in 1957-58 for the simple reason that it had vastly more capacity than today. Hospital beds per thousand people were approaching their all-time high of 9.18 per 1,000 people in 1960, compared with 2.77 in 2016.

In addition, the U.S. working population simply did not have the option to work from home in 1957. In the absence of a telecommunications infrastructure more sophisticated than the telephone (and a quarter of U.S. households still did not have a landline in 1957), the choice was between working at one’s workplace or not working at all.

Last year, the combination of insufficient hospital capacity and abundant communications capacity made something both necessary and possible that would have been unthinkable two generations ago: a temporary shutdown of a substantial proportion of economic activity, offset by massive debt-financed government transfers to compensate for the loss of household income. That this approach will have a great many unintended adverse consequences already seems clear. We are fortunate indeed that the spirit of the vaccine king Maurice Hilleman has lived on at Moderna and Pfizer, because much else of the spirit of 1957 would appear to have vanished.

“To be young was very heaven” in 1957—even with a serious risk of infectious disease (and not just flu; there was also polio and much else). By contrast, to be young in 2020 was—for most American teenagers—rather hellish. Stuck indoors, struggling to concentrate on “distance learning” with irritable parents working from home in the next room, young people experienced at best frustration and at worst mental illness.

We have done a great deal over the past year (not all of it effective) to protect the groups most vulnerable to Covid-19, which has overwhelmingly meant the elderly: 80.4% of U.S. Covid deaths, according to the CDC, have been among people 65 and older, compared with 0.2% among those under 25.

But the economic and social costs, in terms of lost education and employment, have been disproportionately shouldered by the young.

The novel that captured the ebullience of the Beat Generation was Jack Kerouac’s “On the Road,” another hit of 1957. It begins, “I had just gotten over a serious illness that I won’t bother to talk about.” Stand by for “Off the Road,” the novel that will sum up the despondency of the Beaten Generation. As we dare to hope that we have gotten over our own pandemic, someone out there must be writing it.

https://www.zerohedge.com/covid-19/niall-ferguson-how-ikes-1950s-america-beat-asian-flu-science-common-sense

Saturday, May 1, 2021

Chinese health insurance platform Waterdrop sets terms for $330 million US IPO

 Waterdrop, which operates a health insurance distribution and crowd-funding platform in China, announced terms for its IPO on Friday.


The Beijing, China-based company plans to raise $330 million by offering 30 million ADSs at a price range of $10 to $12. New and existing shareholders have indicated on $210 million of the IPO, including Boyu Capital ($100mm), HOPU Investments ($80mm), and Kevin Sunny Holding ($30mm). At the midpoint of the proposed range, Waterdrop would command a fully diluted market value of $4.6 billion.

Waterdrop states that it is the largest independent third-party insurance platform in China by life and health insurance first year premiums distributed in 2020. As of December 31, 2020, the company collaborated with 62 insurance carriers to offer 200 health and life insurance products, and over 1.7 million patients received donations through the company's Waterdrop Medical Crowdfunding.

Waterdrop was founded in 2016 and booked $468 million in sales for the 12 months ended December 31, 2020. It plans to list on the NYSE under the symbol WDH. It had been on our Private Company Watchlist since August 2020. Goldman Sachs (Asia), Morgan Stanley, BofA Securities, ABC International Securities, China Merchants Securities, China Renaissance, CITIC CLSA and Haitong International are the joint bookrunners on the deal.

Powerful teachers union swayed CDC on school reopenings, emails show

 The American Federation of Teachers lobbied the Centers for Disease Control and Prevention on, and even suggested language for, the federal agency’s school-reopening guidance released in February.

The powerful teachers union’s full-court press preceded the federal agency putting the brakes on a full re-opening of in-person classrooms, emails between top CDC, AFT and White House officials show.

The emails were obtained through a Freedom of Information Act request by the conservative watchdog group Americans for Public Trust and provided to The Post.

The documents show a flurry of activity between CDC Director Dr. Rochelle Walensky, her top advisors and union officials — with Biden brass being looped in at the White House — in the days before the highly-anticipated Feb. 12 announcement on school-reopening guidelines.

“Thank you again for Friday’s rich discussion about forthcoming CDC guidance and for your openness to the suggestions made by our president, Randi Weingarten, and the AFT,” wrote AFT senior director for health issues Kelly Trautner in a Feb 1 email — which described the union as the CDC’s “thought partner.”

“We were able to review a copy of the draft guidance document over the weekend and were able to provide some initial feedback to several staff this morning about possible ways to strengthen the document,” Trautner continued. “… We believe our experiences on the ground can inform and enrich thinking around what is practicable and prudent in future guidance documents.”

Walensky wasn’t on the Feb 1 email, but it was forwarded to her by Carole Johnson, the White House coronavirus testing coordinator. Many emails included Will McIntee, an associate director of public engagement at The White House.

American Federation of Teachers senior director for health issues Kelly Trautner described the union as the CDC's "thought partner," emails show.
American Federation of Teachers senior director for health issues Kelly Trautner described the union as the CDC’s “thought partner,” emails show.
Getty Images for MoveOn.org

“We are immensely grateful for your genuine desire to earn our confidence and your committment to partnership,” Trautner said in another email to Walensky on Feb 3.

Emails show a call between Walensky and Weingarten — the former boss of New York City’s United Federation of Teachers — was arranged for Feb 7.

The lobbying paid off. In at least two instances, language “suggestions” offered by the union were adopted nearly verbatim into the final text of the CDC document.

With the CDC preparing to write that schools could provide in-person instruction regardless of community spread of the virus, Trautner argued for the inclusion of a line reading “In the event of high community-transmission results from a new variant of SARS-CoV-2, a new update of these guidelines may be necessary.” That language appeared on page 22 of the final CDC guidance.

The AFT also demanded special remote work concessions for teachers “who have documented high-risk conditions or who are at increased risk for … COVID-19,” and that similar arrangements should extend to “staff who have a household member” with similar risks. A lengthy provision for that made it into the text of the final guidance.

Then Senator Kamala Harris listens to American Federation of Teachers president Randi Weingarten (right) talk to the press in Detroit, Michigan on May 6, 2019.
Then Senator Kamala Harris listens to American Federation of Teachers president Randi Weingarten (right) talk to the press in Detroit, Michigan on May 6, 2019.
REUTERS/Rebecca Cook

The final CDC guidance won high praise from the AFT. “Today, the CDC met fear of the pandemic with facts and evidence,” the union said in a Feb 12 press release.

Many others, however, were puzzled and angered by what they saw as the CDC willfully ignoring the science and slow-walking a return to in-person learning even as mounting evidence showed schools were not a primary source of coronavirus infections as long as they followed mitigation strategies.

In a widely viewed CNN interview on Feb 14, anchor Jake Tapper grilled Walensky and demanded to know why the guidelines would allow schools in areas with high coronavirus community spread — know as “red zones” — to opt out of in-person reopening, noting that 99% of US kids fell within those areas, according to a CNN analysis.

“Can you point to any scientific reason for students in the United States not to return to in person classes tomorrow?” Tapper demanded several times.

“If you’re in middle school or high school we would advocate for virtual learning for that group … We really don’t want to bring community disease into the classroom,” Walensky replied, repeatedly refusing to offer a scientific explanation for the reopening avoidance. “We also know that mask breaching is among the reasons that we have transmission within schools when it happens. Somewhere around 60% of students are reliably masking. That has to be universal. So we have work to do.”

Dr. Monica Gandhi, a professor of medicine at the University of California, San Francisco who has written extensively on coronavirus, called the CDC-AFT emails “very, very troubling,”

“What seems strange to me here is there would be this very intimate back and forth including phone calls where this political group gets to help formulate scientific guidance for our major public health organization in the United State,” Gandhi told The Post. “This is not how science-based guidelines should work or be put together.”

The close communication between the union and the feds came despite repeated assurances from CDC and Biden officials that the medical guidelines would “follow the science” and be free of political interference.

“I can assure you that this is free from political meddling,” Walensky said when the guidance was released.

The AFT and its affiliates have long been one of the most reliable and deep pocketed donor constituencies of the Democratic party, dropping almost $20 million to elect party members during the 2020 election cycle, according to the Center for Responsive Politics.

The union defended its role in shaping federal COVID policy.

“The AFT represents 1.7 million educators, healthcare professionals and public employees who spent the last 14 months serving on the front lines of the COVID-19 pandemic. So naturally, we have been in regular touch with the agencies setting policy that affect their work and lives, including the CDC,” said AFT spokeswoman Oriana Korin, adding the union also worked closely with the Trump administration.

The CDC also insisted such conversations are routine.

“As part of long-standing best practices, CDC has traditionally engaged with organizations and groups that are impacted by guidance and recommendations issued by the agency. We do so to ensure our recommendations are feasible to implement and they adequately address the safety and wellbeing of individuals the guidance is aimed to protect. These informative and helpful interactions often result in beneficial feedback that we consider in our final revisions to ensure clarity and usability,” Jason McDonald, a spokesman for Dr. Walensky, told The Post.

McDonald said the agency had worked with a number of other non-governmental parties that would be affected by the guidance and provided them draft copies — including the National Education Association, National Association of School Nurses and National Association of State Boards of Education.

https://nypost.com/2021/05/01/teachers-union-collaborated-with-cdc-on-school-reopening-emails/