Cerebral Thrombosis After COVID Vax Deadlier Than Sporadic Form

 The cerebral venous thrombosis (CVT) that occurs as part of the rare adverse reaction to the adenovirus vector COVID-19 vaccines from Astra Zeneca and Johnson & Johnson is much more severe and associated with greater mortality and disability than sporadic CVT, new data show.

The UK study also provides more details of how the vaccine-associated CVT differs from the sporadic form in terms of presenting characteristics and responses to therapies, providing updated guidance for doctors on how to identify and treat the condition.

The two adenoviral vector COVID-19 vaccines have been associated with a condition characterized by severe venous thrombosis with thrombocytopenia, which has been named vaccine-induced thrombotic thrombocytopenia (VITT) and has been found to be linked to the generation of antiplatelet factor 4 (PF4) antibodies in response to the vaccine. CVT is a frequent and severe manifestation of VITT.

The new UK study was presented at the virtual European Stroke Organisation Conference on September 2 by lead investigator, Richard Perry, PhD, University College London, England. It was also recently published online in The Lancet.

"This is the first large study focusing on CVT associated with the COVID-19 vaccination and how it differs from sporadic CVT," Perry noted.

"Our data show that CVT associated with VITT is very different from sporadic CVT that we are used to seeing," he said, and was much more likely to result in death or severe disability than sporadic CVT. "It also has several particular characteristics that differ from sporadic CVT such as the frequent presence of venous thromboses in other parts of the body, a low platelet count, and much higher D-dimer levels," he noted.

"To our knowledge, our study provides the most detailed information reported to date on the clinical and radiological characteristics of VITT-associated CVT in a large number of patients. This can be used to update guidance on how to recognize and treat this condition."

Benefit of Vaccine Still Outweighs Risk

The researchers did not try to estimate the incidence of VITT in this study, but Perry emphasized that although this adverse effect is very serious with a high mortality rate, it is very rare.

"It is much more likely for an individual to get seriously ill or die from COVID-19 than it is to get VITT. We need to get our data out to doctors so they know how to identify and treat this condition, but we don't want to scare people away from having the vaccine," he said. "Our society has opened up because of these vaccines. The benefit to society is vastly greater than the risk."

Perry also pointed out that this VITT reaction occurs almost exclusively after the first dose of the Astra Zeneca vaccine. "In this study, all of the VITT cases occurred after a first dose of the vaccine. There have been a few cases of CVT reported after the second dose, but we do not know whether any of these were caused by VITT. Given this observation, it seems unlikely that it will occur after subsequent booster doses," he said.

Most Detailed Dataset Available

For the study, clinicians involved in the care of patients with CVT after COVID-19 vaccination were asked to submit all cases, regardless of the type of vaccine, interval between vaccine and onset of CVT or blood test results. Data on demographics, venous thrombosis risk factors, clinical features, laboratory results, radiological findings, and treatments given were recorded, as well as outcomes (death or dependency) at the end of hospital admission.

Patients were divided into two groups based on whether the CVT was believed to be caused by VITT or not as determined by data on platelet counts and D-dimer levels.

Results showed that of 95 confirmed cases of CVT after COVID vaccination reported in the study, 70 appeared to be related to VITT and 25 were not.

While the clinical features of CVT were similar in the VITT and non-VITT groups, there were many other differences. Patients with VITT-associated CVT had more intracranial veins thrombosed and more frequently had thrombosis in other parts of the body (44% vs 4%).

The primary outcome of death or dependency occurred more frequently in patients with VITT-associated CVT (47%) compared with the non-VITT control group (16%).

Death occurred in 29% of the VITT group vs 4% of the non-VITT group.

A good functional outcome (defined as a modified Rankin Scale score of 0-2) occurred in 53% of the VITT patients vs 84% of the non-VITT patients.

In terms of treatments given to the VITT group, the number of patients achieving a good functional outcome was similar (around 50%) whether they were given heparin or not, but better with non-heparin anticoagulants (64%) than those not receiving such treatment (25%).

Similarly, IV immunoglobulin (IVIG) was linked to a 60% chance of a good outcome vs 27% in those not receiving IVIG.

Platelet transfusions were linked to a worse outcome, with only 16% of patients given platelets achieving a good functional outcome vs 73% of those not given platelet transfusions.

New Recommendations

Perry told Medscape Medical News that observations from this dataset could improve the diagnosis and treatment of VITT-related CVT.

"Firstly, current guidelines tend to recommend D-dimer levels of more than 4000 μg/L for a VITT diagnosis, but we found a level of more than 2000 μg/L was more useful," he said.

"Current guidance also stipulates that platelet count has to be below 150 × 10⁹ per L but we described one patient whose platelet count never quite fell below this threshold, but who nonetheless had other strong evidence for a diagnosis of VITT and who was treated for this condition," he added.

"Current guidance tends to use hard cutoffs, but our data show that by using such simple criteria, some patients will be missed. I would say that of the three diagnostic criteria for VITT — raised D-dimer, low platelet count, and presence of anti-PF4 antibodies — if the patient has two of these then that would be strongly suggestive of VITT. They may not fulfill every criterion to the letter."

The finding of thrombus elsewhere in the body is very unusual for sporadic CVT, but is a particular feature of VITT, Perry noted.

"There is also a tight temporal relation. The vast majority of cases happen more than 3 days but less than 3 weeks after vaccination," he added.

"These patients can get seriously unwell very quickly, so prompt treatment is essential. Generalist and emergency doctors need to be aware of this condition and to do the right tests and give the right treatment straight away," he said.

Perry and colleagues are proposing that there should be two categories: (1) "definite VITT" when a patient has a platelet count below 150, a venous thrombosis, and has the presence of anti-PF4 antibodies; and (2) "probable VITT" which would include patients who don't quite satisfy all the criteria but should still be treated as though they have VITT.

"We don't want a situation where a patient does not get the correct treatment for VITT because they are presenting with a slightly different manifestation," he commented.

"Patients coming to the emergency department with a bad headache a few days/weeks after the AZ or J&J jab should be immediately given a platelet and D-dimer test and receive neuroimaging for venous thrombosis. PF4 antibodies are also desirable, but this test can take days to come back and we shouldn't wait for that to start treatment," Perry said.

"Our data suggest that patients in this situation who have cerebral venous thrombosis and evidence of raised D-dimer, low platelet count, or other blood clots elsewhere in the body should immediately be given IVIG and a non-heparin anticoagulant such as argatroban or fondaparinux."

He stressed that platelet transfusions are not recommended. "This would not be an unreasonable thing to do for a patient with a low platelet count but in this study patients who got platelets did much worse. Platelets are the cause of the clot in VITT — giving platelets is adding fuel to the fire."

This work was undertaken at UCL Hospitals/UCL, which receives a proportion of funding from the UK Department of Health NIHR Biomedical Research Centre funding scheme. Perry has disclosed no relevant financial relationships.

European Stroke Organisation Conference 2021. Presented September 1, 2021.

Lancet. Published online August 6, 2021. Full text

https://www.medscape.com/viewarticle/958186

Cancer Diagnoses Plunged in 1st Year of COVID-19 Pandemic: Quest Diagnostics

 New diagnoses of eight common types of cancer (prostate, breast, colorectal, lung, pancreatic, cervical, gastric and esophageal) significantly declined during most of the first 13 months of the pandemic (March 2020-March 2021), according to a Health Trends® study from Quest Diagnostics (NYSE: DGX) published today in JAMA Network Open. It is believed to be the largest and most comprehensive analysis of cancer diagnosis rates during the pandemic.

The study "Changes in Newly Identified Cancer Among U.S. Patients from Before COVID-19 Through the First Full Year of the Pandemic" is an analysis of Quest Diagnostics de-identified laboratory data from 799,496 patients with diagnoses of cancer during four-time periods defined to allow for comparison during different phases of the pandemic: pre-pandemic (January 2019 to February 2020), pandemic period 1 (March to May 2020), pandemic period 2 (June to October 2020), and pandemic period 3 (November 2020 to March 2021). It builds on research the Quest team published in August 2020 in JAMA Network Open that found a 46.4% decline in newly diagnosed cases of six cancers from March 1 to April 18, 2020. The new analysis, expanded to include two additional cancers, indicates that the double-digit declines in cancer diagnoses observed during the early weeks of the pandemic continued, although less dramatically, through much of 2020 and the first three months of 2021 as compared to before the pandemic was officially declared in March 2020.

The findings suggest that many individuals failed to receive preventive or other forms of medical care, such as routine screenings, that could have resulted in diagnosis of cancer during the first year of the pandemic, even though restrictions to travel and healthcare services generally lifted by Summer 2020. Cancer may not cause symptoms in early stages, and patients may be unaware that they have the disease without evaluation and testing. Delayed cancer diagnosis can lead to more advanced disease, more aggressive and costly treatment, and worse outcomes.

These three pandemic periods correlate with the winter and summer season months when COVID-19 cases were at their highest rates. Even when travel and healthcare service access resumed, many Americans continued to avoid in-person healthcare appointments due to fear of exposure.

"The significant decline in cancer diagnoses revealed by our Health Trends analysis raises the concern that more Americans are living with undiagnosed cancers because of the pandemic," said Yuri Fesko, M.D., Medical Director, Quest Diagnostics Oncology. "In the past years, we've made so many therapeutic advances in cancer care, but if a cancer is not diagnosed, we can't treat it. That's why it's important that patients engage in regular preventive care, including cancer tests and screenings, so that they have the best outcomes possible."

The investigators examined the mean monthly number of cancer diagnoses versus the pre-pandemic period to provide averages per period. They also evaluated ICD-10 medical diagnostic codes to establish if prior service (screening, diagnostic test or treatment) for cancer had occurred to identify if the diagnosis was new.  

Among the key findings:

• From March through May 2020, the monthly number of new diagnoses fell 29.8% for the 8 cancer types: breast, colorectal, lung, pancreatic, cervical, gastric, esophageal, and prostate. Declines were significant for all cancer types, ranging from breast (36.1%).to pancreatic (21.2%)
• From June through October 2020, the monthly number of new diagnoses fell 9.6%, statistically the same level as pre-pandemic for all cancers except prostate
• From November 2020 through March 2021, the number of new cancer diagnoses fell 19.1%

"Early screening, diagnosis and treatment for cancer is critical to achieving the most favorable outcomes. Due to gaps in care throughout the pandemic, we can expect a future wave of patients presenting with cancer at more advanced stages of disease," Harvey W. Kaufman, M.D., Senior Medical Director, Head of the Health Trends Research Program for Quest Diagnostics. "Many of these patients, unfortunately, can expect more aggressive therapy and care with less favorable outcomes. We hope our study highlights the critical need for Americans to get back to their doctors and seek preventive and other forms of medical care without delay, so that potential cancers and other medical concerns are detected and treated early, when the best outcomes are possible."

One possible limitation of the study is lack of demographic data on the patients, such as race/ethnicity or their access to care. However, Health Trends research published in January 2021 by Quest Diagnostics found that one in two White Americans (49%) surveyed in November 2020 were more likely to have seen a doctor for any form of preventive care during the pandemic, as compared to one in three Hispanic/Latinx (32%) and Black (33%) Americans.

https://newsroom.questdiagnostics.com/2021-08-31-Cancer-Diagnoses-Declined-Sharply-During-First-Year-of-COVID-19-Pandemic,-Finds-Quest-Diagnostics-Health-Trends-R-Study-Published-in-JAMA-Network-Open

'COVID-19 vaccination rate must rise above 85% to avoid fall lockdown, Ontario modelling shows'

 New modelling released Wednesday by Ontario's COVID-19 science advisory table says more than 85 per cent of the eligible population needs to be vaccinated to avoid a lockdown this fall due to the highly contagious delta variant.

The table said Ontarians also need to reduce contacts to about 70 per cent of pre-pandemic levels until vaccination levels are high enough to protect the population. To reduce contacts, the table recommends:

• Reducing indoor density, maintaining physical distancing, limiting large gatherings.
• Continuing indoor mask policies and working from home.
• Implementing policies that accelerate vaccination (e.g. certificates, mandates, outreach).

The table confirmed that Ontario is in the fourth wave of the pandemic and it said its modelling predicts the resulting spike in cases will be "substantial."

"Vaccination offers substantial protection against severe health outcomes. We do not expect to see the same proportion of severely ill cases in the vaccinated. Among the unvaccinated, we do expect to see a rapid increase in the number of seriously ill people needing hospital care as workplaces and education re-open in September," the table said.

"The fourth wave will affect all age groups with the potential to exceed ICU capacity."

The table said if Ontario cannot reduce transmission and accelerate vaccination, the number of people in intensive care units suffering from COVID-19 could exceed that of the third wave by October. You can read the full document for yourself at the bottom of this story. 

In its modelling, the table notes that public health measures, together with vaccination, can help to control the fourth wave. 

Vaccination will make the difference, it says.

"Unvaccinated people have a 6-fold higher risk of symptomatic COVID-19 disease, a 30-fold higher risk of being in the hospital and 48-fold higher risk of being in the ICU compared to the fully vaccinated," the table said.

The fourth wave means the province is facing "exponential growth" in cases, said Dr. Peter Juni, the table's scientific director and a professor of medicine and epidemiology at the University of Toronto. 

"What the modelling actually shows is that, if we continue on the general trajectory we were on in August and just believe that we can do all of this now with the current vaccine coverage, this won't work out," Juni said on Wednesday. 

"We will again be in a situation by October, or so, where our ICUs will start to be challenged more and more."

Juni said the province needs not only a vaccination rate of 85 per cent or higher, but also some public health restrictions.

"And that's where now the vaccine certificates that were announced today for Ontario will come in."

The above 85 per cent coverage is needed in all age groups and all areas of the province, he said.

More than 83 per cent of Ontario residents aged 12 and older had at least one dose of a COVID-19 vaccine as of Wednesday and more than 76 per cent had both doses.

Alexandra Hilkene, spokesperson for Ontario Health Minister Christine Elliott, said the pandemic continues to pose challenges for the provincial government.

"There's no question the months ahead will require continued vigilance as we confront the fourth wave," Hilkene said in a statement.

Hilkene said the government believes that Ontario is doing better than other jurisdictions because it has kept public health measures in place.

Those measures include indoor masking and capacity limits and its "last mile strategy" to bring vaccine doses to those not yet vaccinated or fully vaccinated.

Dr. Kieran Moore, Ontario's chief medical officer of health, advised the province to reopen cautiously and, as a result, Ontario has reported one of the lowest rates of active COVID-19 cases at 40 per 100,000, she said. Both B.C. and Alberta have higher active case rates, she added.

"We are confident that Ontario is currently trending between the projected medium- and best-case scenario," Hilkene said.

The province's new vaccine passport system, revealed earlier in the day, will "further improve" Ontario's situation, she said. 

According to the province, the table's modelling provides a range of forecasting, from a best- to worst-case scenarios.

"Due to Ontario's cautious approach and continued adherence to public health measures, we have never experienced the worst-case scenario," the government said.

Opposition criticizes timing

Liberal Leader Steven Del Duca says the province should have released the modelling earlier in the summer, not the week before schools are set to reopen.

"[Premier] Doug Ford's strategy of waiting until the very last moment to take action has jeopardized our province's re-opening," Del Duca said in a statement.

He said the Ontario Liberals called for mandatory vaccinations for health-care and education workers, vaccine certificates and 10 days of paid sick leave more than a month ago. 

NDP Leader Andrea Horwath also said the late release of the modelling is concerning.

"It's clear now that Doug Ford must use all of the resources of the provincial government to break down barriers and urgently vaccinate every eligible Ontarian," she said.

"Class sizes must be made smaller so we can reduce contacts to less than 70 per cent of pre-pandemic levels. Doug Ford needs to act now to accelerate vaccine certificate rollout and improve this policy to better protect the most vulnerable among us."

The modelling comes after Dr. David Fisman, a professor of epidemiology at the University of Toronto's Dalla Lana School of Public Health, resigned from the table because, he alleged, it delayed publication of its pandemic projections for the fall due to political interference. The table has denied the allegation.

https://www.cbc.ca/news/canada/toronto/ontario-covid-19-vaccination-rate-1.6161726

Ind. U Health suspends hundreds of unvaccinated workers, postpones all inpatient elective surgeries

 Hundreds of Indiana University Health did not meet Wednesday’s deadline to get vaccinated for COVID-19 and will be suspended immediately, the hospital system confirmed Thursday.

IU Health separately said it would temporarily suspend 100% of inpatient elective surgeries and procedures beginning Monday to relieve pressure on care teams and free up space for critically ill patients. The health system said last week it would suspend 50% of elective surgeries and procedures.

IU Health originally said Thursday that about 97% of the system’s approximately 36,000 employees have complied with the vaccination requirement, which was announced in June. But that means that more than 1,000 have not been vaccinated.

The health system later issued a correction, saying that the 97% compliance figure was an estimate from Wednesday, and the compliance figure is now higher, but it did not provide a new percentage.

“As of today, fewer than 300 team members have been suspended,” the hospital system said in the updated statement Thursday afternoon.

IU Health, the state’s largest hospital system, said unvaccinated workers will be placed on a two-week suspension and will be allowed to return to work if they attest to partial or full vaccination.

“Vaccinating team members is a safe and effective way to protect patients and help reduce the spread of COVID-19 in facilities and in the community,” spokesman Jeff Swiatek told IBJ in an email.

He did not have a figure for how many unvaccinated workers were directly involved in patient care.

IU Health operates the state’s largest hospital, Methodist Hospital, along with 15 others, including IU Health North in Carmel, IU Health Saxony in Fishers and University Hospital on the IUPUI campus.

Another hospital system, Franciscan Health, had also given employees a deadline this week to submit proof of vaccination status. But a hospital spokesman said he didn’t have a figure on the number of workers that were vaccinated by Tuesday’s deadline. The organization employs about 4,100 people in central Indiana, most of them at its largest hospital, Franciscan Health Indianapolis.

Three other hospital systems also have given employees a deadline to get vaccinated: Community Health Network by Sept. 15, Eskenazi Health by Sept. 20 and Ascension St. Vincent by Nov. 12.

Around the United States, more than 150 hospital systems have issued vaccination mandates to employees. Hospitals have borne the brunt of the surge in COVID-19 cases, and many have also reported a growing shortage of nurses and other patient-care workers who have resigned or taken administrative roles.

https://www.ibj.com/articles/iu-health-suspends-more-than-1000-unvaccinated-workers-suspends-all-inpatient-elective-surgeries

Pandemic's next stage may be endemic: what that would look like

 Will this pandemic ever end? How much harder does the delta variant make reaching herd immunity? Might the delta surge just peter out soon? Epidemiologist Catherine Troisi, with the University of Texas School of Public Health, spoke with us Wednesday.

Is this pandemic ever going to end?

It depends on what you mean by “end.” Is the virus going to disappear? Probably not.

Now, viruses surprise us. But if I were a betting person, I would bet a lot of money no.

What’s probably going to happen is, it’s going to become what we call “endemic” instead of “epidemic.” “Endemic” means that it’s around but at a lower level, sort of like the flu in a regular year.

If it’s endemic, we could still have another pandemic: That’s what happened H1N1, an influenza variant, in 2008. Most people didn’t have immunity, so it spread very quickly.

There are always going to be people who are susceptible to this virus. Newborn babies, for instance: If their mom has been vaccinated, they get antibodies for a little bit of time, but they lose those antibodies. And infants and children may be susceptible, depending on when we can vaccinate. There are certain people who can’t be vaccinated — not many, but some. And then there are people who don’t respond well to the vaccine, immunocompromised people and probably older folks.

And then of course, there are people who don’t get vaccinated. They will remain susceptible. Natural immunity does not seem to provide long-lasting immunity: Even if you get infected, there’s always the possibility of reinfections.

So the viruses is going to be here. How we as a society respond to this is pretty much up in the air. It looks as though we are simply going to decide “We’re done with the pandemic. We are tired of taking precautions, and we’re just going to go back to life as usual.”

People will get sick, hospitals will be crowded, and people will die from preventable infections. But we as a society seem to be headed that way.

You’ve been called to testify as an expert witness on epidemiology lately. Could you talk about that?

I testified recently in a couple of lawsuits about masks or face coverings in schools. The governor’s ban on mask mandates is really up in the air. Some school districts are ignoring it, and some courts have ruled that this exceeds the governor’s emergency powers.

I testified as to the need and effectiveness of face coverings in schools. We can’t vaccinate children under the age of 12 right now, but it’s very important kids get back to school. They lost a lot last year academically — never mind socially. So going back to school is good.

But we need to protect them. And the best way to protect them, since we don’t have a vaccine, is through face coverings.

How effective have masks been against the delta variant?

Well, they’re not perfect. We use the term “face coverings.” But that covers a wide range — everything from the N95, which is the gold standard, down to a single layer of cloth or a gaiter. The best is three layers — either two layers of cloth and a filter or three layers of cloth.

Effectiveness also depends on how the mask is fitted. If it’s gapping at your cheeks, air and potentially viruses getting in. I see people who are quote-unquote “wearing a mask,” but it’s underneath their nose. The virus enters and exits your body through your nose! It can come in through your mouth, but the main route is through your nose. So by wearing a mask only over your mouth or even worse, only over your chin, doesn’t do much. You have to wear that mask properly.

Masks, when worn properly, when thick enough to stop you from breathing in or exhaling virus, work very well. Many studies have shown this.

Absolutely no studies have shown that masks hurt children. Children adapt to the masks very quickly, and masks protect them from a disease that not only can put in the hospital, but can have long-term implications. We know that long COVID can happen in children. Why would you want to take that chance with a virus that can infect basically every organ in your body?

Could you give us an overview of what’s going on now with COVID in the Houston area?

We’re seeing a lot of infections. Our hospitals and our emergency departments are full. The husband of one of my students had acute appendicitis last week and spent the whole time before and after surgery in the emergency department because there weren’t any rooms for him.

You may have heard about someone from Bellville — a military veteran — who died because the hospital had no room for him.

That was because of a gallstone, right? Something that shouldn’t have killed him?

Right. It was very treatable and should not have killed him.

You don’t want to get COVID now, and you also don’t want to have a stroke or heart attack or be in an auto accident, because the hospitals are full and our medical staffs are overwhelmed. They have been at this for 18 months, and the burnout is incredible.

Now, in the last seven days, we have seen a plateau in new hospital admissions, which might be good. Seven days isn’t enough to really tell. But if it truly is plateauing, it’s plateauing at a very high level of cases.

And I think that we are going to see an increase in cases in the next couple of weeks because of kids going back to school. We’ve already seen a huge number of cases in children. Children may be less likely to spread it for various reasons, and that’s great. But if you have enough kids infected, some are going to bring it home to Mom and Dad, or worse, Grandma and Grandpa.

I think we’re in for a rough fall. I feel like a harbinger of doom.

You mentioned that medical workers are burned out. Epidemiologists have been at this for 18 months as well.

Yeah. Our public health practitioners and health departments have been working nonstop for 18 months — and besides COVID, they have to do their regular jobs as well. TB cases don’t go away. HIV doesn’t go away. Syphilis hasn’t gone away: We’ve seen an increase in syphilis. And never mind the work they do with chronic diseases.

Lately I’ve read hopeful stuff that points out that in some countries, such as England, for reasons for reasons not well understood, delta somehow just petered out after two months. What do you think of that? Is it likely to happen here?

I think it was John McCain who said that when he was a prisoner of war, the prisoners who didn’t do well were the ones who said, “Oh, I’m going to be out by Easter!” And Easter came and went.

Then they said, “I’m going to be out by Fourth of July!” And the Fourth of July came and went.

The prisoners who did well — the ones who were more resilient — were more realistic. They weren’t despondent. They had hope. But it was realistic hope.

Now, it would be wonderful if the virus disappears. But it hasn’t disappeared from England. They simply have made different choices. They have decided that they are going to act like nothing is happening, and they are willing to put up with a certain number of cases and deaths.

It also helps that Great Britain has the National Health Service, so everybody has access to medical care; we don’t have that here. We’ve seen throughout that the pandemic has a disproportionate effect on more vulnerable communities, such as people of color. Those are the people who are really going to suffer.

So back to your question: Do I think that in two months, the pandemic is going to disappear? I would be very surprised if that happened.

So here’s my ray of hope: More people are getting first vaccinations in Harris County. How good is our vaccination rate now? And where do we need it to be?

Right now around 60 percent of people in Harris County are vaccinated. That’s not high enough.

That’s 60 percent of people eligible for the vaccine? Not counting kids 12 and under, who aren’t eligible?

Yeah. And kids 12 and under are a significant proportion of the population in Texas. So it’s something over 50 percent of the total population.

Is that enough to stop transmission?

No, because first of all, there are pockets of unvaccinated people. So even if 90 percent were vaccinated, but that 10 percent all congregated together, there’s a possibility of spread.

With the original virus, we used to say that to get herd immunity, we would need maybe 70 percent or even 80 percent of people vaccinated. But the delta variant is much more infectious than the original virus.

So for delta, we’re estimating that we need 95 percent of people vaccinated to reach herd immunity. We can’t reach 95 percent if we can’t vaccinate children.

So yeah, 60 percent of eligible people vaccinated is better than it was before, but we’re not there yet.

At least the people who did get vaccines are now protected. They may get sick, but the odds that they’d be hospitalized or die are much reduced.

What else is on your mind these days?

I am part of the new Texas Public Health Institute, with the University of Texas and other partners. It was approved by the state legislature, and funding hopefully will be coming during this special session or the next one.

One of the things the institute is going to be looking at is detecting outbreaks before they become pandemics. Can we put better surveillance systems in place to have earlier detection of a potential pandemic in Texas?

One of the reasons this would be is important in Texas is, we’re on the border. With border states, there’s a possibility of an outbreak coming over the border.

Now, let me just say, to dispel misinformation out there, it is not asylum seekers who are bringing COVID into the United States. That is simply not true. But with a new infection, it’s possible.

We’re also a big agricultural state, and maybe 60 to 70 percent of new emerging infections come from animals to people. So it’s important not just to look at people who are getting sick, but also at animals that are getting sick, and to ask, could this be transmitted to humans?

What does that kind of surveillance look like? You’re not mounting some Big Brother camera over my doorbell?

Absolutely not. And I’m glad you brought that up. In public health, we use the term “surveillance,” and we know what it means. My husband the political scientist pointed out to me one time that maybe we shouldn’t be use the word “surveillance” because it makes people outside of our field think of the NSA tapping your phone. That is certainly not what we mean.

One of the things that is in place now, but could be improved on, is our hospital data. We don’t attach people’s identifying information. But we might know that we’re seeing more than the usual number of admits to an emergency department for, let’s say, a neurological condition. We’re not looking for specific diseases. We’re looking for syndromes — say, a gastrointestinal condition.

We also monitor drugstores. In the ’90s in Milwaukee, there was an outbreak of cryptosporidiosis. It’s a gastrointestinal illness that causes diarrhea, nausea and vomiting. They detected it because drugstores couldn’t keep Pepto Bismol on their shelves. So now we monitor drugstore sales.

Again, we’re not looking for personal information. We don’t know that Cathy Troisi went in there and bought Pepto Bismol. We simply know that usually, this CVS or Walgreens sells 10 bottles of Pepto Bismol a day, and all of a sudden they’re selling selling 50. Then epidemiologists will go in and ask, “What’s happening here?”

We’re also looking at putting community health workers on the ground. Community health workers are people who come from a community and have training in health. (Interestingly, Texas is one of the few states that requires community health workers to be certified.) Then they work in their community, with people who share their culture.

Since they work in those communities, and can be the eyes and ears of what’s happening — “Mr. Jones is sick with a GI illness, and Mrs. Smith is sick with the same thing.” — they notice patterns.

So the idea is that, even if we’re never really free of COVID, maybe we can prevent the next thing?

I’m not sure we can prevent it.

Give me some hope!

No, no, no. “Prevent” means it never happens. We can contain it.

So then I don’t end up stuck in my house for two years?

Exactly. Maybe we prevent the spread, and it stays a localized epidemic.

We’ve learned a lot from this pandemic. But of course, the next pandemic won’t look like this one. Probably we will be able to apply some of the lessons, but other things won’t work with a new pandemic.

What have we learned from this pandemic?

We need to improve funding for public health. Between 2008 and the onset of COVID, the U.S. lost 50,000 local public health workers.

In 2001, a lot of money was put into preparedness. That helped shore up public health laboratories and bought some public health workforce. Then the money went away.

This is what happens in public health. The issue with public health is that if we’re doing our job, you don’t see it. You don’t see the pandemic we prevented. You don’t see the people who didn’t get sick from contaminated water. So it’s easy to cut funding.

Who decides on funding? Politicians. Legislators. Legislators want to get re-elected. And in general — maybe not during the pandemic, but in general — the public cares more about the potholes that they see every day.

I mean, that’s the truth! I’ve done these community meetings.

Nobody there is asking about preventing an unexpected flu outbreak?

Exactly. Nobody asks about a disease unless people are already getting the disease.

Also, with public health — especially when you’re talking about chronic diseases like diabetes and heart disease — you’re not going to see results in six months. It’s a long-term thing, and it can be hard to measure. It’s hard to measure who didn’t get lung cancer.

Legislators are more apt to fund things that they can point to: “Look, I fixed these potholes!” rather than “I gave some money to the health department, and in 10 years, we’re going to see a decrease in lung cancer.”

So the funding for public health has been very cyclical. I hope we learn from the pandemic that it needs to be sustained at a higher level.

Does your husband the political scientist have any suggestions about changing that? I would love to hear your dinner conversations.

[Laughs.] My husband studies international relations — how war happens — so lately he’s been in the media, talking about Afghanistan. He jokes that he and I study two of the four horsemen of the Apocalypse.

But I actually don’t know what he thinks about public health funding. He leaves the public health stuff to me, and I leave international relations to… Well, actually, that’s not true. I have opinions on international relations. I’m an armchair international relations person.

But he knows better than to be an armchair epidemiologist?

Exactly.

https://www.houstonchronicle.com/news/houston-texas/health/article/covid-new-flu-pandemic-endemic-expert-lisa-gray-16430503.php

Kim Jong Un rejects Covid vaccine offer, urges N. Korea to fight pandemic 'our style'

 North Korean leader Kim Jong Un ordered officials to wage a tougher epidemic prevention campaign in “our style” after he turned down some foreign Covid-19 vaccines offered via the U.N.-backed immunization program.

During a Politburo meeting Thursday, Kim said officials must “bear in mind that tightening epidemic prevention is the task of paramount importance which must not be loosened even a moment,” the official Korean Central News Agency reported Friday.

While stressing the need for material and technical means of virus prevention and increasing health workers' qualifications, Kim also called for “further rounding off our style epidemic prevention system,” KCNA said.

Kim previously called for North Koreans to brace for prolonged Covid-19 restrictions, indicating the nation's borders would stay closed despite worsening economic and food conditions. Since the start of the pandemic, North Korea has used tough quarantines and border closures to prevent outbreaks, though its claim to be entirely virus-free is widely doubted.

On Tuesday, UNICEF, which procures and delivers vaccines on behalf of the COVAX distribution program, said North Korea proposed its allotment of about 3 million Sinovac shots be sent to severely affected countries instead. North Korea was also slated to receive AstraZeneca shots through COVAX, but their delivery has been delayed.

According to UNICEF, North Korea’s health ministry still said it would continue to communicate with COVAX over future vaccines.

Some experts believe North Korea may want other vaccines, while questioning the effectiveness of Sinovac and the rare blood clots seen in some recipients of the AstraZeneca vaccine.

The previously allocated 1.9 million AstraZeneca doses would be enough to vaccinate 950,000 people — only about 7.3 percent of the North’s 26 million people — meaning North Korea would still need much more quantities of vaccine to inoculate its population.

Leif-Eric Easley, a professor of international studies at Seoul’s Ewha Womans University, said North Korea is likely angling to receive more effective jabs from COVAX and then strategically allocate them domestically.

“Pyongyang appears to have issues with COVAX involving legal responsibility and distribution reporting requirements. So it might procure vaccines from China to deliver to border regions and soldiers while allocating COVAX shots to less sensitive populations,” Easley said.

“The Kim regime likely wants the most safe and effective vaccine for the elite, but administering Pfizer would require upgraded cold chain capability in Pyongyang and at least discreet discussions with the United States. The Johnson & Johnson option could also be useful to North Korea given that vaccine’s portability and one-shot regimen," he said.

In a recent U.N. report on the North’s human rights situation, U.N. Secretary-General Antonio Guterres asked North Korea to “take all necessary measures, including through international cooperation and assistance, to provide access to COVID-19 vaccines for all persons, without discrimination.”

He also asked North Korea to form a plan to enable diplomats and aid workers to return to the North and revive humanitarian aid distribution systems as soon as possible in conjunction with its COVID-19 vaccine rollout.

After their meeting in Seoul last month, Sung Kim, the top U.S. diplomat on North Korea affairs, and his South Korean counterpart Noh Kyu-duk told reporters that they discussed humanitarian cooperation with North Korea in providing anti-virus resources, sanitation and safe water.

https://www.nbcnews.com/news/world/kim-jong-un-rejects-covid-vaccine-offer-urges-north-korea-n1278445