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Sunday, August 1, 2021

Fauci says he expects no new U.S. lockdowns despite surging Delta

 President Joe Biden's chief medical adviser Dr. Anthony Fauci said on Sunday he does not expect the United States will return to lockdowns, despite the growing risks of COVID-19 infections posed by the Delta variant.

"I don't think we're going to see lockdowns," Fauci, who is also director of the National Institute of Allergy and Infectious Diseases, said on ABC's "This Week."

"I think we have enough of the percentage of people in the country - not enough to crush the outbreak - but I believe enough to not allow us to get into the situation we were in last winter."

Although Fauci does not think the United States will need to shut down again as it did last year, he warned on ABC that "things are going to get worse" as the Delta variant continues to spread.

"We have 100 million people in this country who are eligible to be vaccinated who are not getting vaccinated," he said.

The average number of new cases reported each day has nearly doubled in the past 10 days and the number of hospitalized patients in many states is surging, according to a Reuters analysis. https://tmsnrt.rs/2WTOZDR

At the same time, the number of Americans getting vaccinated has increased. (Graphic on global vaccinations) https://tmsnrt.rs/3tUM8ta

"The silver lining of this is that people are waking up to this and this may be a tipping point for those who have been hesitant," National Institutes of Health Director Francis Collins told CNN on Sunday. "That's what desperately needs to happen if we're going to get this Delta variant put back in its place, because right now it's having a pretty big party in the middle of the country."

https://news.trust.org/item/20210801135120-aoqql/

Over 100K vaccine breakthroughs identified in US: report

 There have been more than 100,000 breakthrough cases, or cases where fully vaccinated individuals contracted the coronavirus, identified in the U.S., according to a Bloomberg analysis.

Bloomberg has gathered data from 35 states since the Centers for Disease Control and Prevention (CDC) stopped tracking all breakthrough cases and found that more than 111,000 breakthrough cases have occurred in those states within the past two months. 

There are more than 164 million Americans fully vaccinated against the coronavirus. 

The CDC stopped tracking all breakthrough cases in May as the delta variant started spreading throughout the U.S.

The CDC only began tracking breakthrough cases that have resulted in a person's hospitalization or death, which is a small percentage compared to the number of breakthrough cases that have occurred.

The delta variant began picking up steam in June and has since caused an increase in cases across the country as it is considered to be the most contagious variant to date.

The CDC gave a statement to Bloomberg saying it has still tracked breakthrough coronavirus cases despite officially stopping the count of all cases in May.

“CDC is actively tracking breakthrough cases as part of what are called cohort studies, which often involve tens of thousands of people across the country,” spokesperson Kristen Nordlund told the outlet. “We will continue to publish additional results from these cohort studies as they are available.”

States have continued tracking breakthrough cases, making it possible to have an estimate of all the breakthrough cases that have occurred.

The fear of breakthrough cases and the ability of vaccinated people to spread the virus has caused the CDC to ask fully vaccinated individuals to wear masks in areas with high transmission rates of the virus.

https://thehill.com/policy/healthcare/565702-cdc-stopped-tracking-breakthrough-cases-as-delta-variant-spread

Hundreds of staffers at two San Francisco hospitals test Covid positive

 At least 233 staffers at a pair of San Francisco hospitals have tested positive for COVID-19, the majority of whom were fully vaccinated but became infected with the delta variant.

More than 50 cases were discovered among staff members at Zuckerberg San Francisco General Hospital, the hospital’s chief medical officer Dr. Lukejohn Day told The New York Times on Saturday. Of those who tested positive, roughly 75 to 80 percent were fully vaccinated.

At The University of California, San Francisco Medical Center, 183 staff members had tested positive as of Friday, 153 of whom were fully vaccinated, the Times reported.

Most of the infections were reportedly from the highly infectious delta variant, which has taken hold in the U.S. as the dominant COVID-19 strain.

Two of the infected staff members from U.C.S.F. Medical Center were hospitalized, according to the Times.

None of those who tested positive at San Francisco General required hospitalization, and most of the infections caused mild to moderate symptoms, Day told the newspaper. Asymptomatic cases were also detected through contact tracing.

The Hill reached out to both hospitals for comment.

Day told the Times that the cases would be far worse if staff members were not vaccinated.

“We’re concerned right now that we’re on the rise of a surge here in San Francisco and the Bay Area,” Day said. “But what we’re seeing is very much what the data from the vaccines showed us: You can still get COVID, potentially. But if you do get it, it’s not severe at all.”

The city of San Francisco mandated workers in high-risk workplaces, such as hospitals, to be vaccinated against COVID-19 by Sept. 15. In a statement revealing the infections, U.C.S.F. Medical Center said it was “doubling down on our efforts to protect our staff. This includes requiring all employees and trainees to comply with the new UC-systemwide Covid-19 vaccination mandate, with limited exceptions for medical or religious exemptions,” the newspaper reported.

The cluster of cases at the San Francisco hospitals come as concerns are rising regarding the delta variant, especially with the country’s vaccination rate plateauing.

Breakthrough cases, referred to infections detected in fully vaccinated individuals, are still rare throughout the U.S.

Of the more than 164.2 million people who have been fully inoculated, only 125,682 breakthrough cases have been reported in 38 states, according to data collected by NBC News.

That number translates to less than .08 percent, the network noted.

https://thehill.com/policy/healthcare/565814-hundreds-of-staffers-at-two-san-francisco-hospitals-test-positive

Biden hits resistance from unions on vaccine requirement

 Influential public sector unions are pushing back on a new vaccination requirement for federal workers in a rare split with the Biden administration.

President Biden’s latest vaccine push, announced Thursday, requires federal employees to attest that they have been vaccinated against COVID-19 or be subject to masking, social distancing and weekly testing.

While labor groups representing government employees have urged their members to get vaccinated, most of the leading public sector unions either oppose the vaccine requirement or say it must first be negotiated.

Groups representing educators, postal workers, law enforcement officers, Treasury Department personnel and other government employees expressed unease about the vaccine requirement this week. Only a few public sector unions outright endorsed the measure.

“We expect that the particulars of any changes to working conditions, including those related to COVID-19 vaccines and associated protocols, be properly negotiated with our bargaining units prior to implementation,” Everett Kelley, president of the American Federation of Government Employees, which represents nearly 700,000 workers, said in a statement.

Larry Cosme, president of the Federal Law Enforcement Officers Association, said requiring vaccinations “is not the American way and is a clear civil rights violation no matter how proponents may seek to justify it.”

National Treasury Employees Union President Tony Reardon said in a statement that the group has “a lot of questions about how this policy will be implemented and how employee rights and privacy will be protected.”

Most of the public sector unions that expressed concern over the new vaccine rule endorsed Biden’s election bid in 2020 and cheered his overall efforts to bolster a federal workforce that former President Trump often targeted with criticism and spending cuts.

But their support for Biden is not extending to his vaccine rule, which doesn’t apply to the much larger private sector.

“In order for everyone to feel safe and welcome in their workplaces, vaccinations must be negotiated between employers and workers, not coerced,” American Federation of Teachers President Randi Weingarten said in a statement earlier this week. The group represents educators and health care workers at various levels of government.

The American Postal Workers Union said “it is not the role of the federal government to mandate vaccinations for the employees we represent” and that any new rules for its workers must be discussed with union leaders.

Experts say the responses from unions aren’t entirely surprising.

“As a matter of principle, union leaders just don’t like anything called a ‘mandate’ that comes from management where they’re cut out of the bargain,” said Daniel DiSalvo, professor and chair of political science at the Colin Powell School at the City College of New York–CUNY.

The White House anticipated that unions would want a seat at the table on the new requirement. The administration’s own task force on workplace safety wrote in a memo Thursday that “agencies are reminded to satisfy applicable collective bargaining obligations” when implementing new vaccine rules.

Still, public sector unions’ demands could slow Biden’s federal vaccination campaign, and their resistance indicates that similar efforts by states and municipalities could face roadblocks as well.

New York City Mayor Bill de Blasio (D) announced earlier this week that municipal workers must get vaccinated or be tested weekly. He quickly encountered pushback from unions representing first responders, which said that about half of their members were vaccinated, lower than the city average.

“The internal structure of unions forces this kind of responsiveness to the membership,” DiSalvo said. “If you’re a union leader, you need to represent all employees.”

The American Federation of State, County and Municipal Employees, the nation’s largest public employee union, did not respond to a request for comment about its position on vaccine requirements.

A handful of national unions backed Biden’s order this week. The American Foreign Service Association, a union that represents foreign service officers, welcomed the measure, citing last month’s COVID-19 outbreak in the U.S. Embassy in Kabul, Afghanistan.

The International Federation of Professional and Technical Engineers, a union that represents 25,000 federal workers at NASA, the Justice Department, the Government Accountability Office and other agencies, also backed Biden’s order.

“We don’t think either our members or their mission should be placed at risk by those who have been hesitant to take a shot,” Paul Shearon, the group’s president, said in a statement.

AFL-CIO President Richard Trumka endorsed a mask mandate in an interview with C-SPAN on Tuesday, contradicting some of his member unions.

“If you come back in and you’re not vaccinated, everybody in that workplace is jeopardized,” he said. “If we don’t know whether you have been vaccinated or not, we can’t make the proper accommodations to make sure that you are protected and everyone else is protected.”

Biden’s order would affect millions of workers between federal employees and government contractors. Earlier this week, the Department of Veterans Affairs required its front-line health care workers to be vaccinated, and Biden has asked the Pentagon to examine “how and when” it will require service members to get the vaccine.

“With incentives and mandates, we can make a huge difference and save a lot of lives,” Biden said in a speech Thursday.

The urgency comes as the highly contagious delta variant spreads rapidly in areas of the U.S. with low vaccination rates.

Biden wants the private sector to follow his lead and encourage the remaining 31 percent of U.S. adults who have yet to receive at least one dose of the COVID-19 vaccine.

Several companies have announced vaccine mandates in recent weeks, including Google, Shake Shack, Netflix, Morgan Stanley and Delta Air Lines.

https://thehill.com/business-a-lobbying/565744-biden-hits-resistance-from-unions-on-vaccine-requirement

Saturday, July 31, 2021

Evaluation of silver nanoparticles to prevent SARS-CoV-2 infection: in vitro and in vivo

 

Horacio Almanza-ReyesSandra MorenoIsmael Plascencia-LópezMartha Alvarado-VeraLeslie Patrón-RomeroBelén BorregoAlberto Reyes-EscamillaDaniel Valencia-ManzoAlejandro BrunAlexey PestryakovNina Bogdanchikova

Safety Evaluation of 2nd Dose of mRNA COVID Vaccines in Patients With Immediate Reactions to 1st

 Matthew S. Krantz, MD1Jason H. Kwah, MD, MSCI2Cosby A. Stone Jr, MD, MPH1et al

doi:10.1001/jamainternmed.2021.3779

PDF: https://scholar.google.com/scholar_url?url=https://jamanetwork.com/journals/jamainternalmedicine/articlepdf/2782348/jamainternal_krantz_2021_ld_210043_1626713885.93287.pdf&hl=en&sa=T&oi=ucasa&ct=ufr&ei=uhsGYadkyqCZAYvjpoAD&scisig=AAGBfm1OhwAClDcB5-d4b1VOt864JV35SQ

Allergic reactions after messenger RNA (mRNA) COVID-19 vaccines have been reported to be as high as 2%, with anaphylaxis occurring in up to 2.5 per 10 000 individuals.1 There is uncertainty as to whether to administer a second dose of mRNA COVID-19 vaccine after a first-dose reaction.2,3 In this study, we examine the safety of the second dose of Pfizer-BioNTech or Moderna vaccine in those with a history of immediate and potentially allergic reactions to the first dose.

Methods

This multicenter, retrospective study conducted by Massachusetts General Hospital (Boston), Brigham and Women’s Hospital (Boston, Massachusetts), Vanderbilt University Medical Center (Nashville, Tennessee), Yale School of Medicine (New Haven, Connecticut), and University of Texas Southwestern Medical Center (Dallas) from January 1, 2021, to March 31, 2021, included patients with an immediate allergic reaction to the Pfizer-BioNTech or Moderna vaccine, which was defined as: (1) symptom onset within 4 hours of dose 1, (2) at least 1 allergic symptom, and (3) referral for an allergy/immunology consultation with in-clinic or telehealth assessment (eMethods in the Supplement). Anaphylaxis was scored using the Brighton and the National Institute of Allergy and Infectious Diseases/Food Allergy and Anaphylaxis Network criteria.4,5 Confirmed anaphylaxis required meeting at least 1 of these 2 criteria.

The primary outcome was second dose tolerance, which was defined as either: (1) no immediate symptoms after second dose administration or (2) symptoms that were mild, self-limited, and/or resolved with antihistamines alone. For any individuals who did not have their second dose observed by allergy/immunology departments, phone calls elicited clinical details. This study was approved by the Mass General Brigham human research committee with waiver of informed consent.

Results

There were 189 patients who participated in this study (mean [SD] age, 43 (14) years; 163 women [86%]) (Table). Of the mRNA COVID-19 vaccine first-dose reactions evaluated, 130 (69%) were to Moderna and 59 (31%) to Pfizer-BioNTech. The most frequently reported first-dose reactions were flushing or erythema (53 [28%]), dizziness or lightheadedness (49 [26%]), tingling (46 [24%]), throat tightness (41 [22%]), hives (39 [21%]), and wheezing or shortness of breath (39 [21%]). Thirty-two (17%) met anaphylaxis criteria.

A total of 159 patients (84%) received a second dose. Antihistamine premedication before the second dose was given in 47 patients (30%). All 159 patients, including 19 individuals with first-dose anaphylaxis, tolerated the second dose. Thirty-two (20%) reported immediate and potentially allergic symptoms that were associated with the second dose that were self-limited, mild, and/or resolved with antihistamines alone.

Discussion

This multisite US study supports the safety of Pfizer-BioNTech or Moderna vaccine second dose administration in patients who report immediate and potentially allergic reactions after the first dose. Although mild symptoms were reported in 20% of patients with second dose administration, all patients who received a second dose safely completed their vaccination series and could use mRNA COVID-19 vaccines in the future when indicated. Second dose tolerance following reactions to the first dose argues that either many of these initial reactions are not all truly allergic reactions, or supports an allergic, but non–immunoglobulin E–mediated mechanism in which symptoms can typically be abated with premedications.6

Because the Janssen vaccine received emergency use authorization, the US Centers for Disease Control and Prevention recommended that individuals with an immediate and potentially allergic reaction to the first dose of the Pfizer-BioNTech or Moderna mRNA COVID-19 vaccine could receive a Janssen single dose subsequently.2 However, our data suggest that most patients with immediate and potentially allergic reactions to mRNA COVID-19 vaccines tolerate a second dose. Therefore, it may not be necessary to consider this, to our knowledge, largely unstudied alternative mixed series approach. Although earlier work provided a shared framework for the clinical approach,3 our pooled study was limited by its retrospective study design, referral bias, and lack of a shared evaluation protocol among participating institutions.

https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2782348

COVID-19 Vaccine Safety in Adolescents 12–17 Years — US, Dec 14, 2020–July 16, 2021

 Anne M. Hause, PhD1; Julianne Gee, MPH1; James Baggs, PhD1; Winston E. Abara, MD1; Paige Marquez, MSPH1; Deborah Thompson, MD2; John R. Su, MD, PhD1; Charles Licata, PhD1; Hannah G. Rosenblum, MD1,3; Tanya R. Myers, PhD1; Tom T. Shimabukuro, MD1; David K. Shay, MD

DOI:

http://dx.doi.org/10.15585/mmwr.mm7031e1external icon

PDF: https://www.cdc.gov/mmwr/volumes/70/wr/pdfs/mm7031e1-H.pdf

Summary

What is already known about this topic?

In preauthorization trials of the Pfizer-BioNTech COVID-19 vaccine, adolescents aged 12–17 years reported local and systemic mild and moderate reactions. Myocarditis has been observed after vaccination with mRNA vaccines in postauthorization monitoring.

What is added by this report?

Local and systemic reactions after vaccination with Pfizer-BioNTech vaccine were commonly reported by adolescents aged 12–17 years to U.S. vaccine safety monitoring systems, especially after dose 2. A small proportion of these reactions are consistent with myocarditis.

What are the implications for public health practice?

Mild local and systemic reactions are common among adolescents following Pfizer-BioNTech vaccine, and serious adverse events are rare. The Advisory Committee on Immunization Practices conducted a risk-benefit assessment and continues to recommend the Pfizer-BioNTech COVID-19 vaccine for all persons aged ≥12 years.

https://www.cdc.gov/mmwr/volumes/70/wr/mm7031e1.htm