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Saturday, July 24, 2021

Social media, using public health as an excuse, are eroding free speech

 There is a growing tendency toward censorship in the United States, made worse by the Covid-19 pandemic. It must be opposed vigorously, as it is a slippery slope indeed. Once people have the power (and it is an awesome one) to decide what is truth and what is not, they will never willingly give it up. As that great political scientist, James Madison, explained, “Men love power.”

Over the last few years, the phrase “the science is settled” has become a euphemism for “shut up.” This year, the various social media platforms have been deleting what they declare to be Covid “misinformation.” The truth, as far as Facebook, Twitter, and others are concerned, is now whatever the government’s line is at the moment. Disgracefully, the Biden administration has been encouraging social media platforms to increase this censorship.

If the Centers for Disease Control has made a pronouncement regarding the pandemic, not even a highly credentialed epidemiologist is allowed to disagree, at least until the CDC changes its mind. Last year, to suggest that Covid-19 originated in a Wuhan virology lab was “misinformation.” Today, it is the leading theory.

Obviously, the powers that be on social media have no idea how science operates. Science, almost by definition, is never settled. Scientists argue in order to find the truth (unlike lawyers, who argue in order to win the argument). Indeed, disagreement is the very engine that drives scientific advancement. That’s why scientific conferences are often contentious, even raucous affairs.

And scientists, like the rest of us, tend to become set in their ways as they age. That’s why fundamental breakthroughs in science—and in the arts, for that matter—tend to come from the young. Einstein was 26 when he published the theory of special relativity. Newton was elected a fellow of the Royal Society when he was 29. Lord Byron was 24 when he “awoke one morning to find myself famous.”

The scientists who issue pronouncements from on high, such as the CDC, tend to be well into middle age or even beyond (Anthony Fauci is 80). That’s why Facebook and Twitter should learn about the first of “Clarke’s laws,” developed by the great science writer Sir Arthur C. Clarke: “When a distinguished but elderly scientist states that something is possible, he is almost certainly right. When he states that something is impossible, he is very probably wrong.”

Three historic scientific breakthroughs show how science is never settled.

In 1912, Alfred Wegener, then 32, a German meteorologist and polar explorer, proposed that the continents drifted around the globe, sometimes coming together and sometimes splitting apart. That is why, for instance, South America and Africa seem to fit so closely together, with the bulge of Brazil tucking neatly into the Bight of Benin.

The idea was ridiculed by geologists for decades. Then in the 1950s came the discovery of paleomagnetism, which proved that sea floors indeed spread, pushing the continents around. Today, plate tectonics is the very foundation of the science of geology.

In the mid-twentieth century, gastroenterologists “knew” what caused stomach ulcers: stress, spicy foods, and excess stomach acid. But an Australian physician, Barry Marshall, 31, and his coworker Robin Warren had another idea. They thought peptic ulcers were the result of infection by the bacterium Helicobacter pylori. Experts ridiculed the idea, for it was thought that bacteria could not live in the highly acidic environment of the stomach.

Only when Barry Marshall drank a broth containing the bacteria and promptly developed severe gastritis did the idea gain credence. In 2008, the pair were awarded the Nobel Prize in Medicine.

Or consider the most settled science there has ever been, Newton’s law of universal gravitation. After all, as Newton’s contemporary, the poet Alexander Pope, explained,

Nature and Nature’s laws lay hid in night:

God said, “Let Newton be!” and all was light.

One of the triumphs of Newton’s law was the discovery of the planet Neptune in 1846. The planet Uranus was not orbiting the sun quite as Newton’s law said it should. The French mathematician Urbain Le Verrier thought that another, then-undiscovered planet was perturbing its orbit and calculated where in the sky it would be found. When the Prussian astronomer Johann Galle looked for it, he found it almost immediately, located only one degree from where Le Verrier had predicted.

When observers found a similar perturbation in the orbit of Mercury a few years later, Newton’s law didn’t help. It was again assumed that there must be a planet, inferior to Mercury’s orbit, and Le Verrier again calculated where it would be found. It was even given a name, Vulcan. But despite a small army of astronomers hoping for the glory of discovering a new planet (at considerable risk to their eyesight, as even a momentary glimpse of the sun’s disk through an unfiltered telescope can cause severe eye damage), nothing was found.

Newton’s description of gravitation was precise in some situations but not in others. It was Einstein who figured it out, describing gravity as the curvature of space-time and deriving new equations. Using these equations instead of Newton’s, Einstein was able to explain Mercury’s observed orbit without the need for hypothetical planets like Vulcan. It was one of the first confirmations of the theory of general relativity.

Thomas Jefferson (once a hero to the Left until it was suddenly discovered that he had owned slaves) had a low opinion of newspapers, the media of his day. But he realized that the only way for the truth to get out was to have a multiplicity of them, each with its own opinions on the subjects of the day. He was confident that disagreement among them would eventually produce the truth. Jefferson was, of course, no mean scientist himself.

In our own time, social media has become ever more dominant in the realm of public discourse, eclipsing newspapers and even television. For better or worse, it is the agora of our times. So banning certain ideas and people from social media is deeply pernicious.

The solution for politicians who advocate censorship is easy: vote them out of office. You can’t do that with the people who run social media sites, however. Some argue that, since they are private companies, the social media providers are free to censor to their heart’s content, for the First Amendment applies only to government. But railroads, airlines, and utilities such as power and telephone companies are private companies, too, and they can’t deny service to people whom they dislike or disagree with

. They are what is known as “common carriers,” subject to government regulation to make sure that they don’t discriminate.

A version of the common-carrier solution has been proposed for social media companies, analogous to the Fairness Doctrine that required television and radio stations to present both sides of an issue. That doctrine was dropped as no longer necessary in the Reagan years when the number of television networks began to expand dramatically. But social media platforms—which are, in fact, vast conversations—are what economists call “natural monopolies,” where competition is inescapably limited or nonexistent. Everyone wants to be on the biggest platform.

Conservatives are instinctively leery of government regulation, but the increasing plausibility of a social media fairness doctrine illustrates just how badly the situation has deteriorated. Whatever the solution may be, few would deny now that the growing prevalence of censorship is a major threat to the American future. It is tearing the heart out of the First Amendment and endangering our democracy.

US Won't Probe Govs Who Ordered Nursing Homes To Accept COVID-Positive Residents

 by Zachary Stieber via The Epoch Times,

The U.S. Department of Justice has opted against investigating any of the Democrat governors who last year ordered nursing homes to accept residents who tested positive for COVID-19 against the recommendations of health groups.

Federal officials reviewed information they received from New York, Pennsylvania, Michigan, and New Jersey last year regarding the orders.

Based on the review, they’re not opening Civil Rights of Institutionalized Persons Act (CRIPA) investigations in the first three states, Joe Gaeta, deputy assistant attorney general, told Rep. Steve Scalise (R-La.) in a letter on Friday.

The act enables the attorney general to launch a case in court against a state or local government, or its employees or agents, when officials suspect or find that people in institutions owned or run by such a government have had their rights denied.

The Department of Justice opened a CRIPA probe into conditions at two nursing facilities operated by the state of New Jersey in October 2020, but has given no indication that it is probing New Jersey Gov. Phil Murphy.

Scalise, the ranking member of the House Subcommittee on the Coronavirus Crisis, reacted strongly to the refusal to investigate Murphy or governors of the other states, all Democrats.

It is outrageous that the Department of Justice refuses to investigate the deadly ‘must admit’ orders issued by governors in New York, Pennsylvania, and Michigan that resulted in the deaths of thousands of senior citizens. Where is the justice for nursing home victims and their grieving families?” he said in a statement.

“These deadly orders contradicted the CDC’s guidance, and needlessly endangered the most vulnerable among us to the deadly COVID-19 virus,” he added, referring to guidance from the Centers for Disease Control and Prevention.

The CDC issued guidance in March 2020, before the orders were released, saying COVID-positive patients could be released from healthcare facilities to long-term care facilities but if that happened, the facilities should be equipped with “adequate personal protective equipment supplies and an ability to adhere to infection prevention and control recommendations for the care of COVID-19 patients.”

“Preferably, the patient would be placed at a facility that has already cared for COVID-19 cases, in a specific unit designated to care for COVID-19 residents,” the guidance stated.

The orders in question were imposed by Cuomo and the others early in the COVID-19 pandemic. They informed nursing home operators that they could not turn away residents solely on the basis of a confirmed or suspected diagnosis of COVID-19.

Health groups like The Society for Post-Acute and Long-Term Care Medicine warned against the orders, stating in a resolution in March 2020 that “admitting patients with suspected or documented COVID-19 infection represents a clear and present danger to all of the residents of a nursing home.”

Large percentages of deaths pinned to COVID-19 in the four states took place among nursing homes.

In Pennsylvania, 9,556 deaths have been among long-term care facility residents, according to state data. That’s approximately 34 percent of the state’s death toll.

Governors have insisted the orders did not lead to more COVID-19 deaths among nursing homes and other long-term care facilities, which house groups that are most vulnerable to COVID-19, the disease caused by the CCP (Chinese Communist Party) virus, even as nursing home deaths were up by 32 percent last year.

Cuomo, for instance, trumpeted a state report that claimed staff members and visitors were to blame for bringing the virus into nursing homes, though the report was quickly questioned by some.

The offices of Cuomo and Wolf did not respond to requests for comment. Spokespersons for Murphy declined to comment. Whitmer’s office confirmed the receipt of a letter from the DOJ informing her that the state would not be investigated.

Nursing home deaths were up by 32 percent last year

https://www.zerohedge.com/political/us-wont-investigate-governors-who-ordered-nursing-homes-accept-covid-positive-residents

Is Israel or the UK right when it comes to COVID-19 vaccine effectiveness?

 Is the Pfizer coronavirus vaccine 88% or only 40% effective against preventing symptomatic infection?

Two separate studies, one published by Israel’s Health Ministry and the other published in the New England Journal of Medicine late Thursday showed striking differences.
“This discrepancy is kind of unsettling and needs to be further investigated,” said Prof. Cyrille Cohen, a member of the advisory committee for clinical trials on SARS-COV2 vaccines at the Health Ministry.
Specifically, the ministry’s study found that the Pfizer coronavirus vaccine was only 40% effective against symptomatic cases of COVID-19 and 39% effective at stopping infection at all against the Delta variant.

It did, however, show that the vaccine remains 91% effective against developing serious cases of the disease and 88% effective against hospitalization.
The British study, in contrast, found that two doses of the Pfizer vaccine were 88% effective against stopping symptomatic infection against the Delta variant.
The study was authored by researchers from Public Health England, the National Institute of Health Research, Guy’s and St. Thomas’ Hospital NHS Trust and the University of Oxford.
The Delta variant is currently responsible for more than 90% of cases in the country and has been found to be significantly more contagious.
According to Cohen, there are several possible answers to the data gap.
First and critical is the difference in time between exposure to the Delta variant and vaccination.
England vaccinated at a much slower pace than Israel, meaning that the majority of its population was only fully vaccinated by mid-April 2021. This is in contrast to Israel, where around 90% of the country’s most vulnerable population were jabbed by the end of January.
It is beginning to become clear that vaccine immunity begins to wane after about six months. The Israeli study showed that for people vaccinated more than six months ago, the effectiveness of the vaccine at stopping coronavirus dropped to as low as 16%.
Among more than 1.8 million people who received two shots by January 31, some 5,770 contracted the virus – and 1,181 of them, or 20% of all new infections, were contracted during the week of July 11 to 17, the Health Ministry reported.
“If you take into account that they [the UK population] vaccinated later and were exposed to the Delta variant a month before us,” Cohen said, “it could make sense that at the point they checked, they had around 80% effectiveness. The question is what is going to happen in three months? Will they see the same efficacy that we are seeing?”
THE NEXT issue is age.
Both Israel and the UK were careful to first vaccinate healthcare workers and the elderly. In England, however, the older population was largely administered the AstraZeneca vaccine, whereas people under 40 were offered Pfizer or Moderna as an alternative, due to evidence linking AstraZeneca to rare blood clots. The same study showed that the AstraZeneca vaccine was only 67% effective against symptomatic disease after two doses.
In Israel, everyone received Pfizer. Breakthrough infections were most prominent among people aged 60 and older, a cohort that already has a greater tendency to be immunocompromised and prone to developing symptomatic if not severe cases of COVID-19.
A third explanation relates to the level of PCR testing carried out in the two countries. Israel uses a more sensitive or stringent PCR testing regime than the UK.
Genetic matter from the virus is amplified in cycles by PCR tests. The more cycles that are run, the more likely the lab is to detect the virus. Israel uses 37 amplifying cycles, which means that you are positive for the coronavirus even if the test process required up to 37 cycles to detect the virus.
“If the PCR testing is less sensitive, England may miss some cases – or Israel may catch more cases – and that could play a role in the numbers,” Cohen said.
 
FINALLY, a separate Oxford University study that was published over the weekend found that an eight-week gap between the first and second doses of the Pfizer vaccine is a “sweet spot” when it comes to generating neutralizing antibodies.
When England launched its vaccination campaign, it did not have enough doses to vaccinate the population according to Pfizer’s recommended regime of two doses three weeks apart. As such, it spread doses out to between four and 12 weeks to allow more people to get at least one jab.
Specifically, the new research showed that neutralizing antibody levels, the level of those antibodies responsible for defending cells from pathogens, were higher after the extended dosing interval (six to 14 weeks) compared to the conventional three-to-four-week regime.
In contrast, the T cell response was of a marginally lower magnitude after the longer dosing interval. T cells provide longer-term immunity and scientists believe that they could provide some immunity to COVID-19, even when antibodies become less effective at fighting the disease.
“The question is: Would you wait eight weeks when there is a pandemic?” Cohen asked, noting that separate studies have shown that one dose of the Pfizer vaccine is only around 30% effective against the Delta variant, which would leave the population vulnerable for two months. “It’s a tough question.”
Cohen’s solution is to provide a third shot to the most vulnerable people, which new research is starting to show does a good job in boosting antibody levels.
“We are still learning the best way to immunize people with these vaccines,” he said. “But we are still in the middle of the pandemic.”

More fatal fungus Candida auris’ threat looms large

 After mucormycosis or black fungus, another multi-drug resistant infection Candida auris is looming large amidst Covid-19 pandemic.

Health experts have sounded alarm that Covid-associated fungus Candida auris cases are worsening in India even as it has spread across the globe — from neonatal unit in Venezuela to a hospital in Spain and Brazil where cases of drug-resistant super fungus were reported on Wednesday, leaving the exhausted authorities a worried lot.

According to the researchers, death among candidemia patients infected by Candida auris can reach 60 per cent.

This can happen for some people because fungus enters the bloodstream and causes a systemic infection known as candidemia.

They warned that there was enough evidence that suggests that the ongoing Covid-19 crisis may provide ideal conditions for outbreaks of Candida auris in hospital ICUs, thus leading to adverse outcomes and additional strain on healthcare resources. The death rate is quite high, they said.

For instance, as reported by a study published in the Journal of Fungi, the Covid-19 conditions in Brazil have opened the door for the emergence and spread of a relatively new fungus that is quickly showing signs of becoming the drug-resistant “superfungus.” India had for long been hotbed for this deadly fungus.

In fact, much before the SARS-CoV-2 had spread its tentacles, Candida auris was already considered a major global health threat due to high rates of drug resistance and ease of transmission in hospital settings.

However, now in the backdrop of Covid-19 the threat has enhanced.

Candida auris has been reported from over 40 countries across six continents since its first description a decade ago from Japan, said a study.

Prof Arunaloke Chakrabarti, mycologist and head of the Department of Medical Microbiology at PGIMER (Post Graduate Institute of Medical Education and Research), Chandigarh, said that hospital environments may serve as venues for Candida auris transmission as it is a known environmental colonizer of ICUs.

“Candida auris patients shed viable yeast cells from their skin continuously and thereby contaminate hospital environments. Candida auris outbreaks occur in critically-ill hospitalized patients and can result in mortality rates ranging from 30 per cent to 72 per cent,” he said.

Experts say both Candida auris and SARS-CoV-2 have been found on hospital surfaces including on bed rails, IV poles, beds, air conditioner ducts, windows and hospital floors.

Therefore, the standard Covid-19 critical care of mechanical ventilation and protracted ventilator-assisted management makes these patients potentially susceptible to colonization and infections by Candida auris.

The matter does not rest here. The resistance of Candida auris to drugs like fluconazole is particularly worrisome, said yet another study titled, “New Clonal Strain of Candida auris, Delhi, India”. It was published way back in 2013 when Candida auris traces were reported from two hospitals by a team of researchers led by Dr Anuradha Chowdhary from Delhibased Vallabhbhai Patel Chest Institute.

As per the study, “Candida species has been identified among 25 per cent of Intensive Care Unit (ICU) patients with central line associated bloodstream infections and the prevalence of the fungus was estimated to be ranging from 5 to 30 per cent among Candidemia patients. The emergence of Candida auris raises several serious concerns for public health primarily due to its outbreak potential.”

Dr Chakrabarti added that hand hygiene should be followed strictly by staff and patient attendants before and after contact. Soap and water and alcohol hand sanitizers with or without chlorhexidine have been found equally effective in eradicating hand carriage of Candida auris, he said.

As per the Public Health England, key IPC practices include isolation of all infected or colonized patients; use of contact precautions in addition to rigorous hand hygiene; screening of close contacts; and a terminal cleaning once infected patients get discharged.

In their other study, Dr Anuradha Chowdhary and Dr A Singh from Vallabhbhai Patel Chest Institute of the University, B Tarai from Max Health Care Institute, and A Sharma from  International Centre for Genetic Engineering and Biotechnology, all Delh-based institutes,  found that candidemia affected 15 critically-ill coronavirus disease patients admitted to an intensive care unit during the said period. Candida auris accounted for two thirds of cases with 60 per cent case-fatality rate.

On further analysis, the findings highlighted the role of hospital-acquired fungus bloodstream infections, showing that the patients were probably infected while hospitalized.

“Candida auris can be transmitted in healthcare settings just like other multidrug-resistant organisms, such as carbapenem-resistant Enterobacteriaceae and methicillin-resistant Staphylococcus aureus,” said the study adding that “all patients in the ICU had indwelling invasive devices such as central venous and urinary catheters, which may be the source of fungus infections (i.e., candidemia and urinary tract infection).”

At least, 6 of the 10 patients died, possibly because of multiple underlying health conditions. However, 67 per cent of those who died had persistent candidemia, which may have contributed to their death, said the study.

https://www.dailypioneer.com/2021/page1/more-fatal-fungus-candida-auris----threat-looms-large.html

States scale back virus reporting just as cases surge

 Several states scaled back their reporting of COVID-19 statistics this month just as cases across the country started to skyrocket, depriving the public of real-time information on outbreaks, cases, hospitalizations and deaths in their communities.

The shift to weekly instead of daily reporting in Florida, Nebraska, Iowa and South Dakota marked a notable shift during a pandemic in which coronavirus dashboards have become a staple for Americans closely tracking case counts and trends to navigate a crisis that has killed more than 600,000 people in the U.S.

In Nebraska, the state actually stopped reporting on the virus altogether for two weeks after Gov. Pete Ricketts declared an end to the official virus emergency, forcing news reporters to file public records requests or turn to national websites that track state data to learn about COVID statistics. The state backtracked two weeks later and came up with a weekly site that provides some basic numbers.

Other governments have gone the other direction and released more information, with Washington, D.C., this week adding a dashboard on breakthrough cases to show the number of residents who contracted the virus after getting vaccines. Many states have recently gone to reporting virus numbers only on weekdays.

When Florida changed the frequency of its virus reporting earlier this month, officials said it made sense given the decreasing number of cases and the increasing number of people being vaccinated.

Cases started soaring soon after, and Florida earlier this week made up up one-fifth of the country’s new coronavirus infections. As a result, Florida’s weekly releases — typically done on Friday afternoons — have consequences for the country’s understanding of the current summer surge, with no statewide COVID stats coming out of the virus hotspot for six days a week.

In Florida’s last two weekly reports, the number of new cases shot up from 23,000 to 45,000 and then 73,000 on Friday, an average of more than 10,000 day. Hospitals are starting to run out of space in parts of the state.

With cases rising, Democrats and other critics have urged state officials and Gov. Ron DeSantis to resume daily outbreak updates.

“There was absolutely no reason to eliminate the daily updates beyond an effort to pretend like there are no updates,” said state Rep. Anna Eskamani, a Democrat from the Orlando area.

The trend of reducing data reporting has alarmed infectious disease specialists who believe that more information is better during a pandemic. People have come to rely on state virus dashboards to help make decisions about whether to attend large gatherings or wear masks in public, and understanding the level of risk in the community affects how people respond to virus restrictions and calls to get vaccinated.

“We know that showing the data to others actually is important because the actions that businesses take, the actions that schools take, the actions that civic leaders take, the actions that community leaders take, the actions that each of us individually take are all influenced by our perception of what the risk is out there,” said Dr. Kirsten Bibbins-Domingo, who leads the department of epidemiology and biostatistics at the University of California, San Francisco.

But reporting the numbers on a weekly basis still allows people to see the overall trends while smoothing out some of he day-to-day variations that come from the way cases are reported and not the actual number of new cases. And experts have long advised that it makes sense to pay more attention to the seven-day rolling average of new cases because the numbers can vary widely from one day to the next.

And Florida health officials say that they have not curtailed the sharing of data with the Centers for Disease Control and Prevention.

Maintaining daily updates on the virus does require significant resources for states. For instance, Kansas went to reporting virus numbers three times a week in May because the state health department said providing daily statistics consumed too much time for its already overwhelmed staff.

In Nebraska, officials decided that continuing to update the virus dashboard daily wasn’t the best use of state resources now partly because there had been a steady decline in the number of views of the website indicating less interest in the numbers, spokeswoman Olga Dack said. The state could return to providing daily updates if the governor’s office decided that was needed, she said.

“Now that Nebraska is back to normal, some of the staff that has been dedicated to the dashboard has been able to focus on some of the other important issues,” Dack said.

State health departments have a long history of providing the public regular updates on other diseases like flu and West Nile, but those viruses have none of the political baggage associated with COVID-19.

In Florida, a former health department employee was fired last year after publicly suggesting that managers wanted her to manipulate information on coronavirus statistics to paint a rosier picture. The employee, Rebekah Jones, did not allege any tampering with data, but her comments sowed doubts about the reliability of the metrics.

Infectious disease specialist Dr. David Brett-Major said that for many people, national websites such as the one run by the CDC can be a good source of data on the latest state trends and weekly updates could be OK. The World Health Organization often uses weekly updates, but he said they do that for practical data management reasons, not political ones.

He said the message Nebraska sent when it ended its dashboard that the state emergency was over and conditions were returning to normal was troubling.

“The main problem is that it reflects a disinterest in pandemic risk management,” said Brett-Major, with the University of Nebraska Medical Center in Omaha.

Janet Hamilton, executive director of the Council of State and Territorial Epidemiologists, said part of the problem is that public health officials generally don’t have sophisticated data systems so it is more labor intensive to produce the daily dashboards. Even though public health agencies have money for operations at a time when pandemic government spending is flush, they haven’t necessarily had the chance to upgrade.

“It would be great if daily reporting could be made widely available, but public health would have to be funded better to do that and right now that is just not the case,” said Hamilton.

And even in states where virus numbers aren’t being reported publicly every day health officials are still looking at the latest data, Hamilton said.

But at a time when the delta variant is, in the words of the CDC director, “spreading with incredible efficiency,” Bibbins-Domingo said it is important that everyone can see the latest trends and understand the risks.

“Even if we know that they are available to decisionmakers on a daily basis, there is considerable value to providing the data to the public,” she said.

https://apnews.com/article/health-coronavirus-pandemic-f9c58c50f565e707be9bedfa9a82319e

Postvaccination SARS-CoV-2 Infections Among Skilled Nursing Facilities

 Early studies suggest that COVID-19 vaccines protect against severe illness;[1] however, postvaccination SARS-CoV-2 infections (i.e., breakthrough infections) can occur because COVID-19 vaccines do not offer 100% protection.[2,3] Data evaluating the occurrence of breakthrough infections and impact of vaccination in decreasing transmission in congregate settings are limited. Skilled nursing facility (SNF) residents and staff members have been disproportionately affected by SARS-CoV-2, the virus that causes COVID-19,[4,5] and were prioritized for COVID-19 vaccination.[6,7] Starting December 28, 2020, all 78 Chicago-based SNFs began COVID-19 vaccination clinics over several weeks through the federal Pharmacy Partnership for Long-Term Care Program (PPP). In February 2021, through routine screening, the Chicago Department of Public Health (CDPH) identified a SARS-CoV-2 infection in a SNF resident >14 days after receipt of the second dose of a two-dose COVID-19 vaccination series. SARS-CoV-2 cases, vaccination status, and possible vaccine breakthrough infections were identified by matching facility reports with state case and vaccination registries. Among 627 persons with SARS-CoV-2 infection across 75 SNFs since vaccination clinics began, 22 SARS-CoV-2 infections were identified among 12 residents and 10 staff members across 15 facilities ≥14 days after receiving their second vaccine dose (i.e., breakthrough infections in fully vaccinated persons). Nearly two thirds (14 of 22; 64%) of persons with breakthrough infections were asymptomatic; two residents were hospitalized because of COVID-19, and one died. No facility-associated secondary transmission occurred. Although few SARS-CoV-2 infections in fully vaccinated persons were observed, these cases demonstrate the need for SNFs to follow recommended routine infection prevention and control practices and promote high vaccination coverage among SNF residents and staff members...

https://www.medscape.com/viewarticle/950314

Vaccine Breakthrough Cases Rising With Delta: What That Means

 At a recent town hall meeting in Cincinnati, Ohio, President Joe Biden was asked about COVID-19 cases, hospitalizations, and deaths rising in response to the Delta variant.

Touting the importance of vaccination, "We have a pandemic for those who haven't gotten a vaccination. It's that basic, that simple," Biden said at the event, which was broadcast live on CNN.

"If you're vaccinated, you're not going to be hospitalized, not going to the ICU unit, and not going to die," he said, adding "you're not going to get COVID if you have these vaccinations."

Unfortunately, it's not so simple. Fully vaccinated people continue to be well protected against severe disease and death, even with Delta, but so-called breakthrough cases, where a person gets infected despite being fully vaccinated, are on the rise. Because of that, many experts continue to advise caution, even if fully vaccinated.

"I was disappointed," Leana Wen, MD, MSc, an emergency physician and visiting professor of health policy and management at George Washington University's Milken School of Public Health in Washington, DC, told CNN in response to the president's statement.

"I actually thought he was answering questions as if it were a month ago. He's not really meeting the realities of what's happening on the ground," she said. "I think he may have led people astray."

Vaccines Still Work

Recent cases support Wen's claim. Fully vaccinated Olympic athleteswedding guestshealthcare workers, and even White House staff have recently tested positive. So what gives?

The vast majority of these illnesses are mild, and public health officials say they are to be expected. 

"The vaccines were designed to keep us out of the hospital and to keep us from dying. That was the whole purpose of the vaccine and they're even more successful than we anticipated," says William Schaffner, MD, an infectious disease expert at Vanderbilt University in Nashville, Tennessee.

As good as they are, these shots aren't perfect. Their protection differs from person to person depending on age and underlying health. People with immune function that's weakened because of age or a health condition can still become seriously ill, and, in very rare cases, die after vaccination.

When people are infected with Delta, they carry approximately 1000 times more virus compared with previous versions of the virus, according to a recent study. All that virus can overwhelm even the strong protection from the vaccines.

"Three months ago, breakthroughs didn't occur nearly at this rate because there was just so much less virus exposure in the community," said Michael Osterholm, PhD, director of the Center for Infectious Disease Research and Policy at the University of Minnesota in Minneapolis.

Breakthroughs by the Numbers

In Los Angeles County, where 69% of residents over age 12 have been fully vaccinated, COVID-19 cases are rising, and so, too, are cases that break through the protection of the vaccine.

In June, fully vaccinated people accounted for 20%, or 1 in 5, COVID cases in the county, which is the most populous in the United States. The increase mirrors Delta's rise. The proportion of breakthrough cases is up from 11% in May, 5% in April, and 2% in March, according to the Los Angeles County Department of Public Health. 

In the United Kingdom, which is collecting the best information on infections caused by variants, the estimated effectiveness of the vaccines to prevent an illness that causes symptoms dropped by about 10 points against Delta compared with Alpha (or B.1.1.7). 

After two doses, vaccines prevent symptomatic infection about 79% of the time against Delta, according to data compiled by Public Health England. They are still highly effective at preventing hospitalization, 96% after two doses.

Out of 229,218 COVID infections in the United Kingdom between February and July 19, 28,773 — or 12.5% — were in fully vaccinated people. Of those breakthrough infections, 1101, or 3.8%, required a visit to an emergency room, according to Public Health England. Just 474, or 2.9%, of fully vaccinated people required hospital admission, and 229, or less than 1%, died.

Unanswered Questions

One of the biggest questions about breakthrough cases is how often people who have it may pass the virus to others.

"We know the vaccine reduces the likelihood of carrying the virus and the amount of virus you would carry," Wen told CNN. But we don't yet know whether a vaccinated person with a breakthrough infection may still be contagious to others.

For that reason, the Centers for Disease Control and Prevention says that fully vaccinated people still need to be tested if they have symptoms and shouldn't be out in public for at least 10 days after a positive test.         

How should fully vaccinated people behave? That depends a lot on their underlying health and whether or not they have vulnerable people around them. 

If you're older or immunocompromised, Schaffner recommends what he calls the "belt-and-suspenders approach," in other words, do everything you can to stay safe.

"Get vaccinated for sure, but since we can't be absolutely certain that the vaccines are going to be optimally protective and you are particularly susceptible to serious disease, you would be well advised to adopt at least one and perhaps more of the other mitigation measures," he said.

These include wearing a mask, social distancing, making sure your spaces are well ventilated, and not spending prolonged periods of time indoors in crowded places.

Taking young children to visit vaccinated, elderly grandparents demands extra caution, again, with Delta circulating, particularly as they go back to school and start mixing with other kids.

Schaffner recommends explaining the ground rules before the visit: Hugs around the waist. No kissing. Wearing a mask while indoors with them.

Other important unanswered questions are whether breakthrough infections can lead to prolonged symptoms, or "long covid." Most experts think that's less likely in vaccinated people.

And Osterholm said it will be important to see whether there's anything unusual about the breakthrough cases happening in the community.

"I think some of us have been challenged by the number of clusters that we've seen," he said. "I think that really needs to be examined more."

https://www.medscape.com/viewarticle/955342