Ida Toll Rises With More Nursing Home Deaths in Louisiana

 Hurricane Ida's death toll rose on Saturday, nearly a week after making landfall in Louisiana, with two more evacuated nursing home residents among the confirmed dead, authorities said.

Northeastern states started the Labor Day holiday weekend digging through debris left by the deadly deluge that killed more than 44 people https://www.reuters.com/world/us/new-york-city-mayor-declares-state-emergency-after-record-breaking-rain-2021-09-02 and caused public transportation in New York City to grind to a halt, with operators promising to restore some lines before the start of the workweek on Tuesday.

The loss of life in the Northeast dwarfed the confirmed storm-related death toll of nine in Louisiana.

Southern tempers flared as power outages https://www.reuters.com/business/environment/why-hurricane-ida-crippled-new-orleans-power-grid-2021-09-04 that left more than 1 million people without electricity forced many into long lines at gas stations, scrambling to find fuel for generators.

The new deaths in Louisiana were among evacuated nursing home residents at a Tangipahoa Parish warehouse now under state investigation after reports of squalid conditions.

"Sadly, we also can now confirm 2 additional deaths among nursing home residents who had been evacuated to the Tangipahoa facility," the Louisiana Department of Health tweeted on Saturday.

"This brings the death toll of nursing home residents evacuated to this facility to 6," the health department tweeted.

Louisiana authorities on Saturday were seeking a suspect after gunfire left one man dead during a dispute on Friday at a gas station in Metairie, Jefferson Parish Sheriff Joseph Lopinto said.

"For somebody to lose their life over getting gas is absolutely ridiculous," the sheriff told reporters.

Hot weather continues in the area nearly a week after Ida made landfall in Louisiana on Sunday as a Category 4 hurricane, downing trees, power lines and debris with wind gusts that reached 172 miles per hour (276 kph).

Amid the cleanup https://www.reuters.com/business/environment/idas-deluge-stuns-new-yorkers-its-sheer-intensity-2021-09-02 in the Northeast, commuters using public transportation to venture into their offices amid the COVID-19 pandemic may not be completely in the clear with Hurricane Larry https://www.reuters.com/world/us/larry-strengthens-into-category-2-hurricane-us-nhc-2021-09-03 intensifying as it churns about 1,055 miles (1,700 km) east of the Leeward Islands.

"Higher swells could approach the Northeast coast by the end of the week, with Larry staying off shore," meteorologist Bob Oravec of the National Weather Prediction Center in College Park, Maryland, told Reuters.

https://www.usnews.com/news/top-news/articles/2021-09-04/hurricane-ida-toll-rises-with-more-nursing-home-deaths-in-louisiana

France first big EU nation to start widespread booster jabs

 France on Wednesday started administering booster shots of COVID-19 vaccine to people over 65 and those with underlying health conditions as the delta variant spreads in the country.

France is the first big EU country to introduce widespread booster shots, and several other European countries are expected to follow suit.

Many countries are still struggling to administer first doses of COVID-19 vaccines and the World Health Organization had called for a moratorium on boosters and also urged governments to donate vaccines to needy countries.

People in France can get the shot on condition a minimum six-month period has passed since they got fully vaccinated with the Pfizer or Moderna vaccine. Those who received the single-dose Johnson & Johnson jab can get a booster shot of Pfizer or Moderna at least four weeks after they first got vaccinated.

In nursing homes, a nationwide booster campaign starts on Sept. 12. About 18 million people are estimated to be eligible for the booster shot, according to the Health Ministry.

Lucien Slama, a 90-year-old retired researcher, told The Associated Press he was "absolutely not" afraid to get the shot on Wednesday at a pharmacy in Paris.

"It's my third injection and I remember the other two that caused me no issues at all," he said. "When you see hospitalizations and the damages it (COVID-19) does, in the short and in the long run, what's a jab every year or every six months? What does it matter?"

The French government followed the recommendations of the country's health authority, the HAS, which said last month that "recent studies suggest a fall in the vaccine's effectiveness, especially with the delta variant." Older people and those with underlying health conditions are the most affected by the drop over time, the HAS said.

Bernard Weill, 68, head of the French fashion house Weill, also received the booster shot on Wednesday.

"When you're in good health and people around you are in good health, that's what matters and those (the injections) are only very small details. So nothing to worry about and nothing to care about," he said.

The booster shot was already available in France for some particularly vulnerable people, like transplant recipients and others with weakened immune systems.

The French government so far has made no decision regarding the potential extension of the campaign to the whole population.

France has been facing high numbers of confirmed infections since July, with a slight decrease in recent weeks—from over 23,000 per day around mid-August to 17,000 now. But many fear a reverse of the trend as children will go back to school after summer holidays on Thursday.

French government spokesperson Gabriel Attal warned Wednesday that "almost half of ICU beds are occupied by COVID-19 patients, which is still substantial and preoccupying. So it is imperative that we maintain our efforts ... the upcoming weeks are not without risks."

Almost 44 million people, or 65.6% of the French population, are fully vaccinated.

France's decision to launch its campaign comes as the European Medicines Agency said it is reviewing data to see if booster shots are needed.

In Germany, authorities in Berlin, the capital, started offering booster shots Wednesday to residents of care homes. Several other German states have already begun offering boosters to vulnerable people. The country's independent vaccine advisory panel is planning to make recommendations soon about booster shots for older people and those who are immunocompromised, German news agency dpa reported Wednesday.

Israel has expanded this week its coronavirus booster shot program to include anyone over 12—the latest phase of a booster program that began in July with Israelis over 60.

U.S. health officials announced last month plans to dispense booster shots to all Americans. The campaign is expected to start by the end of September.

The head of WHO's European branch, Dr. Hans Kluge, said this week he agrees with the top U.S. infectious diseases expert that a third dose of coronavirus vaccines can help protect the people most vulnerable, and it shouldn't be seen as a "luxury booster."

https://medicalxpress.com/news/2021-09-france-big-eu-nation-widespread.html

Survey shows healthcare workers more likely to get COVID-19 at home

 A team of researchers affiliated with several institutions in Israel has found evidence that suggests healthcare workers are more likely to become infected with COVID-19 at home than on the job. They have published a paper on the open-access JAMA Network Open describing the results of surveys they conducted at Hadassah Medical Center.

As the global pandemic has continued, the general public has become aware of the sacrifices that healthcare workers have made to treat people with COVID-19 and to save lives. Over time, risks have been reduced by vaccines and protective gear. In this new effort, the researchers have found that as a result, healthcare workers are now more likely to become infected at home than at work, when they are not wearing their protective gear.

The work involved surveying all of the employees at Hadassah Medical Center back in March, before the delta variant arrived on the scene. At that time 5,312 medical center employees had received both doses of the Pfizer vaccine, while 690 had not.

The researchers found that 15 of the vaccinated employees had been infected after exposure to an infected person in their home, while 12 had become infected at work. They found also that eight of the infected vaccinated employees worked in a department where patients were being treated for COVID-19, though only two of those infections could be tied to their workplace. The researchers also found that 69 of the unvaccinated workers were infected.

The researchers suggest that the reason healthcare workers are more likely to be infected at home is because they do not wear protective gear there, and because the chances of becoming infected by someone nearby is greater in the home because it is such a closed environment where people are in close proximity. They suggest healthcare workers exposed to COVID-positive people at home be quarantined immediately. They also note that only one vaccinated infected worker needed to be hospitalized and no workers had died whether they had been vaccinated or not.

More information: Yonatan Oster et al, Association Between Exposure Characteristics and the Risk for COVID-19 Infection Among Health Care Workers With and Without BNT162b2 Vaccination, JAMA Network Open (2021). DOI: 10.1001/jamanetworkopen.2021.25394

https://medicalxpress.com/news/2021-09-survey-healthcare-workers-covid-home.html

Study suggests Delta does not cause more severe childhood COVID

 US pediatric COVID hospitalizations have surged since Delta became predominant, but a new study that offers a first look at the relevant data suggests that fears the variant causes more severe disease are unfounded.

The paper by the Centers for Disease Control and Prevention also found that between June 20 and July 31, 2021, unvaccinated adolescents were more than 10 times more likely to be hospitalized than those who were vaccinated.

The health agency analyzed hospital records from across an area covering around 10 percent of the US population, between March 1, 2020 and August 14, 2021.

This covered the period before the emergence of Delta, the most contagious strain to date, and after it became dominant, from June 20 onwards.

Weekly hospitalizations of children aged 0-17 were at their lowest between June 12 and July 3, at 0.3 per 100,000, before rising to 1.4 per 100,000 in the week ending August 14—a 4.7-fold increase.

Pediatric hospitalizations reached their all-time peak of 1.5 per 100,000 in the week leading up to January 9, when the US experienced its winter wave that was driven by the Alpha variant.

Consistent with prior research, children aged 12-17 and 0-4 are at higher risk of COVID hospitalization than those aged 5-11.

After examining 3,116 hospital records from the period before Delta, and comparing them to 164 records during the Delta period, the percentage of children with severe indicators was found to not differ greatly.

Specifically, the percent of hospitalized patients admitted to intensive care was 26.5 pre-Delta and 23.2 post; the percent placed on ventilators was 6.1 pre-Delta and 9.8 post; and the percent who died was 0.7 pre-Delta and 1.8 post.

These differences did not rise to the level of statistical significance.

The finding comes with the important caveat that because the number of hospitalizations in the post-Delta period is small, more data will need to accrue for scientists to gain greater confidence about the conclusion.

The study also underscored vaccine effectiveness against pediatric COVID hospitalization during Delta.

Between June 20 and July 31, among 68 adolescents hospitalized with COVID-19 whose vaccination status was known, 59 were unvaccinated, five were partly vaccinated, and four were fully vaccinated.

This meant the unvaccinated were 10.1 times more likely to be hospitalized compared to vaccinated.

Children shielded by community vaccinations

A second study by the CDC examined childhood COVID cases, hospitalizations, and emergency department visits from June to August 2021, and compared them to the levels of community vaccination at the time.

COVID-related pediatric (ages 0-17) emergency department visits and hospitalizations were 3.4 times higher and 3.7 times higher respectively in states that fell in the bottom quartile of overall vaccinated per capita, compared to states in the highest quartile.

The takeaway message is that, while clinical trials for vaccines among those under the age of 12 and subsequent authorizations are awaited, high community rates of vaccination squelch COVID transmission and protect children.

https://medicalxpress.com/news/2021-09-delta-severe-childhood-covid.html

White House wants $65B for ‘Apollo’-style pandemic preparedness program

 The Biden administration on Friday unveiled a sweeping new biosecurity plan, outlining a $65 billion proposal to remake the nation’s pandemic preparedness infrastructure in the wake of Covid-19.

The new spending would represent one of the largest investments in public health in American history: During a press briefing, Eric Lander, the White House science adviser, likened the proposal to the Apollo program of the late 1960s.

The immense funding boost would target programs aimed at developing and manufacturing vaccines, treatments, and tests more quickly. It would also provide new money for laboratory capacity, viral detection mechanisms, and early warning systems.

“For the first time in the nation’s history, due to these types of advancements in scientific technology, we have the opportunity not just to refill stockpiles but to transform our capabilities,” Lander said. “But we really need to start preparing now.”

Indeed, the White House funding request comes with a near-term deadline. While the spending would be spread over the coming seven to 10 years, it also includes an ask for at least $15 billion to be included within a forthcoming, $3.5 trillion budget plan still pending on Capitol Hill. The White House is still in discussions with Congress, Lander said, but he was “very optimistic” that lawmakers would agree to the request.

The new spending would target a wide array of new pandemic preparedness capabilities. It would include over $24 billion for vaccine infrastructure, with a goal of beginning to manufacture vaccine doses meant to protect against any virus family within 100 days of a pandemic threat first emerging.

The plan would include nearly $12 billion to develop — and have on hand — a range of treatments available for any known virus family even before a particular pathogen emerged as a pandemic threat.

It would also provide $5 billion for diagnostics that the government would aim to make available within weeks of identifying a new biosecurity threat.

“What this plan is about is ensuring the United States has the capabilities it needs to operationalize [its response] when we see the first signs of an emerging outbreak that could have epidemic or pandemic potential,” Beth Cameron, the top biosecurity expert on the National Security Council, said during the briefing.

It’s not yet clear how Congress will respond to the Biden administration’s sweeping proposal, which expands on a previous request to spend $30 billion over four years on improving future pandemic prevention and preparedness. In a subsequent version of Democrats’ budget bill, however, lawmakers included just $5 billion, drawing criticism from many public health experts who said the government was repeating the same mistakes that led to the country’s chaotic response to Covid-19.

The $65 billion proposal doesn’t stop at treatments, tests, and vaccines.

It would include $3.1 billion aimed at establishing an early-warning system for new disease outbreaks, including systems to sequence pathogens found in wastewater and a “reliable clinical surveillance system.” Biden also calls for spending to help reduce health inequity, fund lab capacity, and improve public health communication. He also wants to put money toward developing better protective equipment for health workers and creating better systems for “pathogen protection,” like better ventilation systems and surface cleaners.

The plan also includes measures to ensure that research and development “involving potentially dangerous biological agents is conducted safely and securely, by fostering a global research environment that adopts and enforces high standards.” The lab-safety provisions are a potential nod to the unproven theory that Covid-19 originated from “gain-of-function” research performed in a Chinese laboratory, a long-running controversy in U.S. and global politics.

https://www.statnews.com/2021/09/03/biden-wants-65-billion-for-apollo-style-pandemic-preparedness-program/

Rogue antibodies involved in almost one-fifth of COVID deaths

 Antibodies that turn against elements of our own immune defences are a key driver of severe illness and death following SARS-CoV-2 infection in some people, according to a large international study. These rogue antibodies, known as autoantibodies, are also present in a small proportion of healthy, uninfected individuals — and their prevalence increases with age, which may help to explain why elderly people are at higher risk of severe COVID-19.

The findings, published on 19 August in Science Immunology1, provide robust evidence to support an observation made by the same research team last October. Led by immunologist Jean-Laurent Casanova at the Rockefeller University in New York City, the researchers found that around 10% of people with severe COVID-19 had autoantibodies that attack and block type 1 interferons, protein molecules in the blood that have a critical role in fighting off viral infections2.

“The initial report from last year was probably one of the most important papers in the pandemic,” says Aaron Ring, an immunologist at the Yale School of Medicine in New Haven, Connecticut, who was not involved in this work. “What they’ve done in this new study is really dig down to see just how common these antibodies are across the general population — and it turns out they’re astonishingly prevalent.”

The international research team focused on detecting autoantibodies that could neutralize lower, more physiologically relevant concentrations of interferons. They studied 3,595 patients from 38 countries with critical COVID-19, meaning that the individuals were ill enough to be admitted to an intensive-care unit. Overall, 13.6% of these patients possessed autoantibodies, with the proportion ranging from 9.6% of those below the age of 40, up to 21% of those over 80. Autoantibodies were also present in 18% of people who had died of the disease.

Casanova and his colleagues suspected that these devious antibodies were a cause, rather than a consequence, of critical COVID-19. There were hints that this might be the case — the group had previously found that autoantibodies were present in around 4 in 1,000 healthy people whose samples had been collected before the pandemic2. The team also found that individuals with genetic mutations that disrupt the activity of type 1 interferons are at higher risk of life-threatening disease3,4.

To examine this link further, the researchers hunted for autoantibodies in a massive collection of blood samples taken from almost 35,000 healthy people before the pandemic. They found that 0.18% of those between 18 and 69 had existing autoantibodies against type 1 interferon, and that this proportion increased with age: autoantibodies were present in around 1.1% of 70- to 79-year-olds, and 3.4% of those over the age of 80.

“There is a massive increase in prevalence” with age, Casanova says. “This largely explains the high risk of severe COVID in people in the elderly population.” He adds that these findings have clear clinical implications, and suggests that hospitals should be checking patients for these autoantibodies, as well as mutations implicated in blocking type 1 interferons. This could identify people who are more likely to become critically ill from COVID-19, helping physicians to tailor their treatment appropriately.

A sample of more than 30,000 people is “too big to ignore”, according to Ring. “It just shows that this is something that we need to think about.” He adds that researchers should now consider whether autoantibodies play a part in driving other infectious diseases. Ring’s team has already found evidence5 of autoantibodies against various immune-system components in people with COVID-19, and he and his colleagues are now investigating further. “I suspect that we’ve just started scratching the surface,” Ring says.

doi: https://doi.org/10.1038/d41586-021-02337-5

https://www.nature.com/articles/d41586-021-02337-5

At-Home COVID Tests Are in Short Supply Amid Delta Surge

 Home coronavirus test kits made their way to store shelves this spring, and ever since, they’ve been relatively easy to find and purchase — that is until recently.

A surge in demand for the nasal swab kits that can tell you whether you have COVID-19 in a matter of minutes is wiping out online retailers and prompting stores like CVS to limit the number of tests consumers can purchase at once.

Experts have a few explanations for the renewed interest in these rapid home test kits, which usually cost between $25 and $40, and most of the blame falls on the delta variant.

Delta’s rise leads to scarcity of home tests

The highly contagious variant is driving up COVID-19 cases and hospitalizations across the country, especially in communities where vaccination rates remain low. And this swell of infections is happening at a time when kids are headed back to the classroom and many adults are returning to the office.

Plus, new research shows delta “seems to replicate in the nasal pharynx more vigorously” than pervious virus variants, even in people who are vaccinated, explains Sten Vermund, M.D., an infectious disease epidemiologist and dean of the Yale School of Public Health. This suggests that vaccinated people, while highly protected from getting really sick with COVID-19, can spread the virus to others, including unvaccinated or immunocompromised individuals, “and in that sense do some damage,” Vermund says.

Then there’s the “convenience and interest in having the answer right away,” adds Matthew Binnicker, director of the Clinical Virology Laboratory at Mayo Clinic — especially after a year-plus of dealing with testing backlogs and delays. You don’t need a doctor’s note to buy the latest home test kits, and most bypass the days-long wait for laboratory processing. (There is at least one over-the-counter COVID test that does not produce immediate results. It uses a different testing technology from the rapid tests, called PCR, or polymerase chain reaction, and relies on a lab to analyze the specimen.)

Manufacturers are aware of the sudden clamor for their rapid home tests and are working to fix it. Abbott, the maker of the BinaxNOW COVID-19 Antigen Self Test, tells AARP that it started “scaling up manufacturing” when the company saw demand rise with delta’s dominance.

“We’re hiring people and turning on parts of our manufacturing network that were idled or slowed when [testing] guidance changed and demand plunged,” an Abbott spokesperson told AARP. “While there will be some supply constraints over the coming weeks as we ramp back up, we are [pulling] resources from all over the company to help meet this unprecedented demand.”

Ellume, whose COVID-19 home test delivers results digitally, told Bloomberg that it is also scaling-up production. And CVS wrote in an email to AARP that it is continuing to work with its suppliers to meet customer demand.

Testing still key to helping slow COVID’s spread

With so much of the attention on vaccines these days, coronavirus testing can feel so 2020. But experts say that along with other preventive measures it’s still important when it comes to slowing the spread of disease, particularly when nearly half of the U.S. population remains unvaccinated. And home testing can play “a valuable role” in this strategy, Vermund says.

With cold and flu season on the horizon, “there’s going to be more situations where people are experiencing some symptoms that might be concerning for COVID-19 or influenza,” Binnicker says. “And so being able to quickly and easily perform a test at home is desirable and will become more of interest as we move into the next two, three, four months.”

In addition to cluing you in on whether your sniffles could be cold- or COVID-related, quick at-home tests can also be used as a way to navigate risk in certain situations — even for people who are fully vaccinated — like visiting a friend who is immunocompromised.

The rapid home-based tests, known as antigen tests, are considered less sensitive than PCR tests, and they can miss a positive case if the person infected has low levels of virus in the nose. “But it will catch the most infectious individuals. And they’re the ones who are the most important to catch anyway,” Vermund says.

So testing negative on one of these tests before visiting someone who is immunocompromised, for example, “would at least tell that individual at that point in time [they are] not shedding really high amounts of the virus” and their chances of transmitting the virus to the person they’re visiting is “going to be lower versus if [the test is] positive,” Binnicker says. You’ll want to reschedule your visit if you get a positive result.

And let’s not forget about group events: “There’s an increasing trend” for organizers of large gatherings — weddings, concerts, conferences and reunions — to ask everyone, including vaccinated people, to test themselves ahead of time to “be on the safe side,” Vermund says.

That said, it’s crucial to know that a negative test result, home-based or otherwise, isn’t a “free pass” to abandon other precautionary measures, Binnicker warns. It’s “really just one kind of mitigation step in our toolbox of helping to reduce risk of spreading COVID-19,” he adds.

Taking an at-home test

Before you purchase a home test, make sure it has been authorized by the U.S. Food and Drug Administration (FDA). Check the label on the package, or consult the FDA’s database of antigen tests that have received emergency use authorization.

When it comes to ensuring accurate results, timing is key. If you don’t have symptoms of COVID-19 but think you may have been exposed, wait three to five days after exposure before you swab your nose, the Centers for Disease Control and Prevention (CDC) says. If you do have symptoms and those symptoms are a result of a coronavirus infection, you’ll likely have enough virus in your respiratory tract for a rapid home test to pick up on.

Be sure to read the manufacturers’ instructions before setting up the test and swabbing your nose and be sure to follow the instructions in the order that they are listed. If you’re looking for some extra tips, the CDC has pointers on how to collect a sample.

If you test positive using a home test, Binnicker recommends contacting your health care provider and scheduling a confirmatory test. This will ensure your results get reported to health departments tracking the spread of the virus. It’s also important for your doctor to keep an eye on any concerning symptoms that may require additional care or treatment and for you to isolate yourself from others.

Some at-home tests are designed for serial testing, meaning a second test should be done a few days after the first. So if you test negative on the first one and two tests are included in the kit, be sure to follow up in a few days with a second swab for best results. The amount of virus in your respiratory tract may have changed since the last test. A second swab also helps account for any human error that occurred when administering the test the first time around.

If symptoms continue even with a negative test, you should still see a health care provider, Binnicker says. It could be the flu, which can be treated with antiviral medication. Cases of another respiratory virus known as RSV (respiratory syncytial virus) are also on the rise, and infections in older adults and young children can be dangerous.

And remember: A negative test doesn’t mean you can “just take the mask off, go wherever you want without a mask on and interact with unvaccinated people,” Binnicker says. Testing alone is “not a foolproof approach.”

Tips for Taking a COVID Test at Home

• Store all test components according to the manufacturer’s instructions until ready for use.
  
• Check the expiration date. Don’t use expired tests or test components that are damaged or appear discolored based on the manufacturer’s instructions.
• Clean the countertop, table or other surfaces where you will do the test.
• Don’t open test devices or other test components until you are ready to start the testing process.
• Read and record test results only within the amount of time specified in the manufacturer’s instructions. A result read before or after the specified time frame may be incorrect.
• Don’t reuse test devices or other components.
• After you have the results, discard the specimen collection swab and test kit in the trash, clean all surfaces that the specimen may have touched and wash your hands.

Source: CDC

https://www.aarp.org/health/conditions-treatments/info-2021/at-home-covid-test-shortage.html