New Covid-19 variant of interest, Mu, seen as unlikely to overtake Delta

 The World Health Organisation upgraded the Mu mutation of the coronavirus to a variant of interest (VOI) on Monday (Aug 30).

But experts say it is unlikely to overtake the Delta variant of concern (VOC), which now accounts for more than 90 per cent of sequenced infections globally in the Covid-19 pandemic.

Dr Sebastian Maurer-Stroh, executive director of the Bioinformatics Institute of the Agency for Science, Technology and Research, said the Mu variant accounts for less than 1 per cent.

He added: "In order to cause larger outbreaks, any variant needs to be 'fit' and these variants are classified to be of interest because they contain features that are known to make viruses successful."

However he pointed out: "In South America, where both Lambda (declared VOI on June 14) and Mu had early appearances and outbreaks, numbers are now declining, and Delta has been taking over. In terms of total numbers and global distribution, Delta continues to be the dominant variant."

Delta was named a VOI on April 4 and a VOC on May 11. Although a relative new comer, Delta has superseded the other three VOCs - Alpha, Beta and Gamma - to become dominant globally.

Associate Professor David Allen, associate vice-president for health innovation and translation at the National University of Singapore, holds similar views.

Prof Allen, who helped Singapore set up training in infectious diseases three decades back, and was the founding head of infectious diseases at Tan Tock Seng Hospital, said: "I think we need to be aware of Mu and its potential to cause harm as we do for all variants, but I would not elevate Mu to a source of worry at this time."

He added: "It's Mu's potential to cause harm, more than its record for doing so, that has our attention."

In Colombia, where Mu emerged in January and had soared to account for more than 80 per cent of all sequenced genomes there, it is now rapidly losing ground to Delta, which reached the South American country a couple of months back.

Said Prof Allen: "Delta is rapidly overtaking Mu for the 'market share' and Mu's share has commensurately shrunk. If the trend continues, Delta will be the dominant variant in Colombia in the next couple of weeks."

Globally, Prof Allen said: "At this point in the pandemic, Delta has become the standard to which other variants are compared when thinking about transmission and variant dominance in a community.

"It is likely that the combination of Delta's more rapid rate of reproduction and more efficient transmission makes it a formidable competitor for the other variants."

Dr Maurer-Stroh added that current vaccines would probably work against these VOIs as well as they do against Delta, as the range of changes causing the mutations may be comparable.

As for the future, he said: "The virus is behaving as expected, which is a good thing as it becomes more predictable.

"We know that it will continue changing and the same changes that make it more successful in one variant seem to be recurring in different combinations in new variants."

https://www.straitstimes.com/singapore/health/new-variant-of-interest-mu-unlikely-to-make-covid-19-waves-say-experts

Israel virus czar calls to begin readying for eventual 4th vaccine dose

Israel’s national coronavirus czar on Saturday called for the country to begin making preparations to eventually administer fourth doses of the coronavirus vaccine.

“Given that that the virus is here and will continue to be here, we also need to prepare for a fourth injection,” Salman Zarka told Kan public radio.

He did not specify when fourth vaccine shots could eventually be administered.

Zarka also said that the next booster shot may be modified to better protect against new variants of the SARS-CoV-2 virus that causes COVID-19, such as the highly infectious Delta strain.

“This is our life from now on, in waves,” he said.

Zarka made similar comments in an interview with The Times of Israel last month.

“It seems that if we learn the lessons from the fourth wave, we must consider the [possibility of subsequent] waves with the new variants, such as the new one from South America,” he said at the time.

“And thinking about this and the waning of the vaccines and the antibodies, it seems every few months — it could be once a year or five or six months — we’ll need another shot.”

Zarka said that he expects that by late 2021 or early 2022, Israel will be giving shots that are especially adapted to cope better with variants.

Israel — the first country to officially offer a third dose — began its COVID booster campaign on August 1, rolling it out to all those over the age of 60. It then gradually dropped the eligibility age, expanding it last week to everyone age 12 and up who received the second shot at least five months ago.

As of Friday, over 2.5 million Israelis had received the third dose.

The Health Ministry last week also announced that the “Green Pass” system — a document that allows entry into certain gatherings and public places for those who are vaccinated or have recovered from the coronavirus — will expire six months after the holder received their second or third dose, hinting that a fourth dose may be administered in six-months time.

On Friday, the Health Ministry reported 11,269 new coronavirus infections the day before. Thursday’s figure was slightly below the daily record of 11,274 infections confirmed on Wednesday.

Despite surging infections, serious cases have begun falling since peaking at 753 on Sunday, with the Health Ministry reporting that 654 people were in serious condition from COVID-19 complications as of Friday afternoon.

The positive test rate on Thursday was 8.43 percent, the highest it has been during the current wave of morbidity.

The death toll stood at 7,129.

https://www.timesofisrael.com/virus-czar-calls-to-begin-readying-for-eventual-4th-vaccine-dose/

Los Angeles Officials Say First Cases Of Mu Covid Strain Have Arrived

 Dr. Anthony Fauci on Thursday said U.S. public health officials are “keeping a very close eye” on a new variant of Covid-19 that was first detected in Colombia.

Known as B.1.621 or the “Mu variant” according to the World Health Organization nomenclature, it has “a constellation of mutations that indicate potential properties of immune escape,” according to a WHO report released on Monday. “Preliminary data presented to the Virus Evolution Working Group show a reduction in neutralization capacity of convalescent and vaccine era similar to that seen for the Beta variant, but this needs to be confirmed by further studies.”

Today, the Los Angeles County Department of Public Health announced the Mu variant, for the first time, has been identified in the region. The numbers are still small; Only 167 Mu variants have been identified in L.A. County thus far. “These specimens were sequenced between June 19 and Augusts 21, with the majority of Mu specimens sequenced in July,” according to a statement from county public health officials.

There was no mention of those cases the day before from Public Health Director Barbara Ferrer briefed reporters on L.A. County’s Covid response. Mu, which is classified by WHO as “variant of interest,” did on the chart Ferrer presented Thursday, which graphed only “variants of concern.” Even if it had been, however, it would have barely registered next to Delta which, she said, is 99% of all variants identified.

LADPH

Speaking of Mu Fauci said, “This variant has a constellation of mutations that suggests that it would evade certain antibodies, not only monoclonal antibodies, but vaccine- and convalescent serum-induced antibodies…But there isn’t a lot of clinical data to suggest that. It is mostly laboratory in-vitro data.”

Mu was first detected in Colombia in January of this year. It has since been reported in 39 countries. According to the Washington Post, 2,000 Mu cases have been identified in the United States, including in California, Florida, Texas and New York. The California Department of Public Health told the Post on Thursday that 348 Mu cases had been identified so far.

Another new variant not on the L.A. list, which has not been seen in the county — or the country, for that matter — is C.1.2. The variant, which was first identified in South Africa in July. According to the L.A. Times C.1.2 has “made its way from Africa to Asia, Oceania and Europe. Scientists have spotted it in Botswana, Mauritius, China, New Zealand, Portugal, Switzerland and the United Kingdom.” It has worrisome mutations but, the strain is so new, it is not yet known if they indeed post a greater threat than those of other variants.

L.A. officials confirmed 2,673 new cases of and 37 new deaths due to Covid today. On Thursday, the 7-day average case rater per 100,000 was down 4%, from 26.2 last week. Ferrer said on Thursday that, “Hospitalizations may be plateauing, or even decreasing slightly.” There were 1,641 Covid patients hospitalized today and a rising number — 27% — were in the ICU. The test positivity rate was 3.3%.

https://deadline.com/2021/09/mu-variant-los-angeles-first-cases-new-covid-1234827340/

Vaccine passports to start in England this month

 Vaccine passports in nightclubs and other indoor venues in England will be required at the end of this month, the vaccines minister has confirmed.

Nadhim Zahawi said it was the right time to start the scheme for sites with large crowds as all over-18s will have been offered two jabs by then.

Asking people to show certificates with Covid vaccination proof has been criticised by venues and some MPs.

Mr Zahawi said it would ensure the economy could remain open.

"The best way we can keep those industries open in my view, in our view, is to work with the industry," he told the BBC's Andrew Marr Show.

The vaccines minister said: "One thing that we have learnt is that in large gatherings of people, especially indoors, the virus tends to spike and spread."

Mr Zahawi also indicated the government's plans to offer a Covid booster jab to most vulnerable people - including all over-50s - could get the go-ahead this month.

And he said extending the vaccine rollout to all 12-15 year-olds would "absolutely" be the right thing to do if the UK's chief medical officers recommended it.

Asked about vaccine passports, Mr Zahawi referred to Premier League football clubs asking some fans to show proof they have been jabbed, which allowed stadiums to reopen to capacity crowds last month.

However, only a small number of clubs have made Covid-19 checks a mandatory condition of entry.

Mr Zahawi added: "When the evidence that you are presented is so clear cut and that we want to make sure the industry doesn't have to go through [an]open-shut, open-shut sort of strategy, then the right thing to do is to introduce that by the end of September when all over 18 year-olds have had their two jabs."

The prime minister's official spokesman last week said the plans first unveiled in July remained in place, adding: "We set out broadly our intention to require vaccination for nightclubs and some other settings."

The Night Time Industries Association has said plans for vaccine passports could "cripple the industry" and see night clubs facing discrimination cases.

Opposition to the plans has also come from Tory MPs on the Covid Recovery Group as well as the Liberal Democrats, whose leader, Ed Davey, described them as "divisive, unworkable and expensive".

Meanwhile, Scottish Labour has refused to support plans to require vaccine passports for entry to nightclubs and many large events in Scotland from later this month.

Opposition is building to the Scottish government's proposal, which First Minister Nicola Sturgeon has said would be the least restrictive way to keep people safe.

Wales says it has no plans to introduce Covid passports for venues, while ministers in Northern Ireland have not yet announced a position on a scheme.

On the issue of offering Covid jabs to all 12 to 15-year-olds, Mr Zahawi said he did not want to "pre-determine" the decision of the UK's chief medical officers but would accept their advice.

The Joint Committee on Vaccination and Immunisation (JCVI) decided not to recommend the rollout be extended, saying the benefits to younger children on health grounds alone were "marginal". They have now asked the chief medical officers to consider the wider implications - including transmission rates and disruption to schools.

Prof Peter Openshaw, a member of the Nervtag group that advises the government on virus threats, said he was "a little surprised" at the JCVI's decision.

"We do know the virus is circulating very widely amongst this age group, and that, if we're going to be able to get the rates down and also prevent further surges of infection perhaps later in the winter, then this is the group that needs to become immune," he told BBC Breakfast.

Interim advice from the JCVI has also suggested giving a third dose of a Covid vaccine to more than 30 million people.

Mr Zahawi said: "It is very likely that we will begin boosting those groups as per the, I hope, interim advice becomes final advice by the end of this month."

On Sunday, 37,001 cases of coronavirus were reported in the UK and 68 deaths within 28 days of a positive test.

https://www.bbc.com/news/uk-58452953

As Medicare hospital fund run out of money, 5 ideas on how to help

 Medicare’s hospital fund is expected to run out of funds in only five years, but experts say a massive overhaul isn’t going to get passed by Congress anytime soon.

With that major caveat in mind, what is the solution?

A panel of experts convened by the Urban Institute think tank recently discussed several reforms that, taken together, can shore up the Medicare Hospital Insurance Trust Fund, which pays for inpatient hospital services under Medicare Part A.

The Medicare Trustees report, released Tuesday, said the fund will run out in 2026 if no action is taken.

Among the potential reforms are:

Shifting who pays for home health

Currently, Part A pays for about one-third of home health spending, but that spending could be shifted to Part B, saving nearly $6 billion a year that can go toward the trust fund.

However, several panelists noted the shift could lead to higher Part B premiums and add to the general fund revenue needed for Part B spending.

The recommendation comes as home health services have seen an explosion in use due to the COVID-19 pandemic.

Targeting Medicare Advantage profits

Medicare Advantage (MA) plans had a banner year in 2020 due to a massive drop in healthcare use caused by the COVID-19 pandemic. In late 2020, healthcare utilization returned largely to normal, but the decline earlier in the year reduced Part A trust fund spending by $8.4 billion, according to the institute.

“MA plans continued to receive the predetermined per-beneficiary amounts, so the reduced utilization constituted an unexpected windfall,” the report said.

Some of the experts on the panel called for remanding some of the profits, possibly through the MA medical loss ratio requirements that call for plans to pay at least 85% of every premium dollar on patient care.

Changing how MA payments are calculated 

The panel also pitched changing how the MA benchmark, which determines payment amounts for plans, is calculated. Currently, the benchmark is tied to spending on traditional Medicare in a geographic area. The panel called for tying benchmarks instead to the local MA plan bids.

“For example, the benchmark might be the second-lowest-cost bid among MA plans,” the report said. “This would induce greater price competition among MA plans.”

The Congressional Budget Office, the nonpartisan scorekeeper on how legislation will impact spending, has estimated such as move could save $44 billion over 10 years.

This isn’t the first time MA has been identified as a potential source to shore up the fund.

The Medicare Payment Advisory Commission, which advises Congress on Medicare issues, called for changes to how MA plans are calculated and cut payments by 2%, adding billions each year to the fund.

Changing provider reimbursements

Several experts floated reimbursement changes to providers as a way to find funding. Chief among the recommendations were cuts to payments to post-acute care providers such as home health, long-term care and nursing home facilities.

It refers to a prior recommendation from MedPAC, which projected such cuts could generate up to $80 billion over a decade.

“This policy was identified by panelists as one that could potentially reduce excessive spending without harming Medicare beneficiaries,” the institute’s report said.

Another area of funding could be expanding site-neutral payment policies that reduce payments to hospital off-campus outpatient facilities. While the federal government has implemented some site-neutral payments, many hospital-owned practices were grandfathered in and weren’t affected by the reforms.

The experts note that expanding site-neutral payments to grandfathered practices could add $40 billion over a decade.

Controlling high-cost drugs in hospitals 

Most of Medicare’s drug spending is centered in Part D and Part B, which covers drugs administered in a doctor’s office such as chemotherapy. However, controlling costs of drugs administered in a hospital and reimbursed under Part A could help generate savings.

Some of the drug pricing reforms considered by Congress would increase savings for Part D and can’t be used in the hospital fund due to how Medicare is structured. But there are some reforms, such as paying doctors a fixed amount for administering Part B drugs as opposed to the current approach of getting reimbursed a percentage of the average cost, that can reduce overall Medicare spending.

Congress should act now to adopt some of the reforms—especially any that reduce spending or call for new taxes—to give more time to implement them, said Bowen Garrett, senior fellow at the Urban Institute and a lead author of a study on the panel’s findings.

“If you will cut some payments by a longer amount then can do it on a longer schedule and do it gradually,” he told Fierce Healthcare in an interview.

https://www.fiercehealthcare.com/hospitals/medicare-s-hospital-fund-running-out-money-experts-have-five-ideas-how-to-help

Multi-Day Hospital Stays for Banged Up E-Scooter Riders

 E-scooter users broke bones from head to toe, and a third were so banged up, they were in-hospital for an average of 11 days, a researcher reported.

In a study that tracked and compared the growth of e-scooter injuries from August 2016 to February 2018 -- and from August 2018 to February 2020 after e-scooters became widespread -- the number of injuries grew from 23 to 197, and the cost of care skyrocketed from $1.8 million to $7.6 million, according to Nicole Look, MD, of Denver Health Medical Center.

In the second period, most injured patients were male (63%) and 73% of the 28% who were tested for alcohol/drugs were found to be intoxicated. About a third of patients (34%) were admitted to the hospital, while 40% required surgery, and 6% had open fractures, Look and colleagues stated in poster session at the American Academy of Orthopaedic Surgeons annual meeting.

"Injuries due to e-scooters are severe and expensive," Look told MedPage Today. "These are high-energy traumas with increased injury severity scores and increased likelihood of requiring operative intervention. Therefore, they should be treated similar to car or motorcycle accidents."

Look's group launched the study at their institution after noticing "all the crazy injuries" due to e-scooters -- "highly comminuted, intra-articular complex type fractures that what we would see in high-energy traumas rather than with ground-level falls." When they saw the trend, "we wanted to collect this concrete data to show the community that e-scooters can be quite dangerous when riding in a city [Denver]," she noted.

We also confirmed what we typically saw in the emergency department [ED] and operating room," Look said. "Many of these injuries involve the upper extremity as patients fall on their outstretched hands and the tibia as these patients attempt to brace themselves from a fall by placing their foot on the ground and sustaining a twisting injury. Additionally, head injuries and facial fractures are not uncommon during the fall."

About two-thirds (64%) of orthopedic injuries were to the upper extremities, most commonly distal radius (14%), proximal radius (12%), and metacarpal (7%) injuries. The most common lower extremity injuries were proximal tibia fractures (8%), ankle fractures (7%), and tibial shaft fractures (3%).

Other e-scooter-related orthopedic injuries were tooth injury (n=3), chest injury (n=12), double forearm fractures (n=5), patellar tendon rupture (n=2), Achilles tendon rupture (n=1), tarsal fractures (n=7), and spine fracture (n=3).

Look said that, in general, the injuries are similar to those in bicyclists. "It's important for the public to understand that riding an e-scooter must be done with caution and awareness," she stressed. "And improved enforcement of sobriety while using an e-scooter should be a high priority in cities."

She added that there's no sign that injuries are trending downward as users figure out how to safely use e-scooters, but "Many of the patients we see are visiting the city as tourists so I'm not quite sure they have gained experience from riding e-scooters."

The majority of e-scooter injuries in the study were due to falls and not collisions. A 2021 review in Injury Prevention examined 10 e-scooter studies with relevant data and found that "92.8% of riders were injured in single road user events, while 7.1% were injured in multiple road user events. Single user events included falls, collisions with objects, excessive speed and unfavorable road conditions, with falls (94.6%) being the most common," according to the Vancouver-based authors.

Those researchers also looked at 16 studies that had data about helmets in e-scooter injuries, and found that only 4.5% of electric scooter riders wore a helmet at the time of their injury, and "A protective effect of helmets on the incidence of head injuries was noted in the sole study where this association was examined."

ED physician Stephanie VandenBerg, MD, of Calgary Zone and the University of Calgary in Alberta, said the findings from the Denver study were consistent with patterns seen in her city. Her group found that e-scooter injuries made up 3.6% of all traumas that presented to EDs and a single urgent care center in Calgary from 2019 to 2020. In addition, an estimated one in each 1,200 e-scooter trips resulted in an injury requiring treatment, most commonly lower limb injuries. The average age of the injured patients was 34 and 52% were male.

VandenBerg, who was not involved in the Denver study, told MedPage Today that factors contributing to injuries include the challenges of using e-scooters on the road -- when they can be too slow for conditions -- and on the sidewalk, when they can be too fast. Inappropriate or missing equipment, like helmets, can also spell trouble, she said.

VandenBerg noted that there is a gap in the understanding of the full risk of e-scooter injuries and the ways to reduce it. "We are missing information from the [e-scooter] companies themselves on the [physical] location of the injuries as well as the frequency of injuries that do not present to emergency medical services or emergency departments," she stated. In 2019, Consumer Reports successfully fought several e-scooter manufacturers to obtain data on company-recorded user injuries.

https://www.medpagetoday.com/meetingcoverage/aaos/94369

56% think assertion China committed 'greatest cover-up in human history' is true: poll

 A majority of voters in a new poll said they think that the House Republican Committee’s probe asserting that the coronavirus originated in a lab in Wuhan, China, and the Chinese Communist Party (CCP) engaged in the "greatest cover-up in human history," is a true statement, a new Hill-HarrisX poll finds.

Fifty-six percent of registered voters in the Aug. 13-14 and Aug. 16-17 survey said the probe's conclusion is mostly or somewhat true.

By contrast, 20 percent of respondents said it is mostly or somewhat false and 25 percent said they are unsure.

 

Seventy-two percent of Republican voters said the House GOP probe's assertion is true while 8 percent said it is not true and 20 percent said unsure.

Pluralities of Democrats and independents said the probe's conclusion is mostly or somewhat true, at 44 percent and 49 percent, respectively. 

A June 7-9 Hill-HarrisX survey found roughly half of voters said they believe the COVID-19 virus was created in a lab in Wuhan, China.

Eighty-three percent of voters in a May 30-June 1 Hill-HarrisX survey said they support the U.S. government taking action towards China if new intelligence reveals that COVID-19 originated in a lab in the city of Wuhan, while 17 percent of respondents oppose any action. 

On Tuesday, President Biden received classified findings from an intelligence report on the origins of COVID-19 that could not conclude whether the virus was created naturally or accidentally leaked from a lab.

The most recent Hill-HarrisX poll was conducted online among 1,919 registered voters. It has a margin of error of 2.24 percentage points.

https://thehill.com/hilltv/what-americas-thinking/569378-poll-56-percent-of-voters-say-the-house-gop-committee-probes