Mass. to Change the Way It Reports COVID-19 Hospitalizations

 Beginning next week, Massachusetts hospitals will start to differentiate between patients they admit primarily for COVID-19 and those admitted to be treated for something else who end up testing positive for COVID-19.

COVID-19 hospitalizations have surged over the last month as the omicron variant has become dominant and the patient count (2,426 patients hospitalized as of Tuesday) is now on par with the peak of the December 2020/January 2021 surge. Meanwhile, hospitals are dealing with staffing shortages that are further stressing the system and limiting bed capacity.

The Department of Public Health said Thursday morning that hospitals will start reporting next week whether admissions are primary or incidental to COVID-19. The update could provide the public with a clearer sense of the severity of the omicron variant and how the record high numbers of new cases correlate to severe illness that requires hospitalization.

DPH's daily COVID-19 updates provide the number of "patients hospitalized for COVID-19," but the difference between patients with coronavirus infections serious enough to warrant hospital-level care and patients receiving non-COVID treatment who test positive as part of routine testing at hospitals has been on Gov. Charlie Baker's mind for more than a year.

"When you call the hospitals and you talk to them one at a time, or the systems, a significant number of the people who they -- who we -- count as COVID positive are not in the hospital because they have COVID. They're in the hospital for some other purpose and they got tested positive when they came in," the governor said on Oct. 1, 2020.

Rep. Jon Santiago, an emergency room doctor at Boston Medical Center, tweeted earlier this week that during a recent stretch of ER shifts a "significant number of my COVID patients fell into 2 buckets: mild symptoms & discharged OR were admitted for non-COVID reasons BUT tested positive for COVID (all admitted patients are tested)."

"Of course, that presents a different set of challenges but the fact that many patients weren't primarily admitted FOR COVID but rather for other medical issues should add nuance to the 'COVID hospitalization' numbers," Santiago wrote. "This shouldn't take away from the bed crunch we face, a serious issue already present pre-COVID..."

He said hospitals in Boston and elsewhere are challenged by the number of homeless patients who test positive with mild COVID-19 symptoms and need a place to isolate while they are contagious and by dialysis patients who cannot go to their usual dialysis centers.

"Where do they end up? To the ER they go! To wait for hours (or days!) in a hallway until a precious bed opens up when the VAST majority of these patients don't have to be in the ER or hospitalized for medical reasons," he tweeted. "Again, says more about our healthcare system than anything else."

Despite the stress and strain of the current situation, Santiago said it demonstrates that the COVID-19 vaccines are working as expected.

"Recall that the vaccine's primary goal was to prevent severe disease - not prevent transmission. Most of us are bound to get COVID but the majority of people will escape severe consequences. And in case you didn't already know, the unvaccinated folks continue to bear the brunt of severe disease," he said. "In fact, one can usually correctly guess a patient's vaccination status while observing their clinical status."

DPH reported that 93% of medical/surgical beds in Massachusetts were occupied as of Tuesday and that 86% of intensive care unit beds were occupied, though not all with COVID-19 patients.

Massachusetts hospitals are also contending with a staffing shortage, which has already led the Baker administration to order hospitals to scale back non-emergency procedures if they cannot maintain sufficient capacity. Its impact is clear in the number of total beds reported in DPH's hospital capacity reports.

One year ago, Massachusetts had 9,254 hospital beds and 1,458 total ICU beds that could be staffed within 24 hours. DPH's latest hospital capacity update showed a total of 8,775 hospital beds statewide and 1,256 ICU beds -- a difference of nearly 700 beds.

New York began this week reporting the breakdown between people hospitalized for COVID-19 and people hospitalized with COVID-19. Gov. Kathy Hochul said Monday that she was "going to start asking some questions" at a critical phase for the state's hospitals.

"How many people are being hospitalized because of COVID symptoms? How many people are happened to be testing positive just while they're in there for other treatments? I think that's important. I just want to always be honest with New Yorkers about how bad this is," Hochul said, according to a transcript from her office. "Yes, the sheer numbers of people infected are high, but I want to see whether or not the hospitalizations correlate with that. And I'm anticipating to see that at least a certain percentage overall are not related to being treated for COVID."

https://www.nbcboston.com/news/local/mass-to-change-the-way-it-reports-covid-19-hospitalizations/2606930/

B.1.640: 5 Canadian cases of little-known coronavirus variant

 A coronavirus variant that made headlines recently has been a "variant under monitoring" since November 2021, according to the World Health Organization (WHO), but is not currently circulating widely.

The B.1.640 variant was first detected in a number of countries in September 2021, according to the WHO, and has two sub-lineages, B.1.640.1 and B.1.640.2. B.1.640.2, dubbed the “IHU” following a study published at the end of December on the preprint server medRxiv.org by IHU Méditerranée Infection in Marseille, France, attracted attention due to the large number of mutations detected. Preprints are studies that have yet to be peer-reviewed and evaluated.

Five cases of the variant have been sequenced in Canada and shared on GISAID – four in Ontario and one in Quebec. GISAID allows scientists from around the world to quickly share COVID-19 data, including genetic sequencing. The Quebec sequence was collected on Oct. 2, 2021 in a 34-year-old individual. One Ontario sample was collected in a male on Dec. 10, 2021 and another on Jan. 4, according to GISAID data.

Variants under monitoring are those with genetic changes that are "suspected to affect virus characteristics with some indication that it may pose a future risk" but the evidence of its impact is currently unclear, according to the WHO. These variants fall below the "variants of concern" identified by the health agency, such as Omicron and Delta, and also below "variants of interest" which have genetic changes predicted or known to affect characteristics like transmissibility and disease severity, and has caused notable transmission or clusters in multiple countries or other epidemiological impacts that could pose a risk.

"Less than one per cent of the samples that were sequenced in France are of this particular variant," Dr. Maria Van Kerkhove, the COVID-19 technical lead with the World Health Emergencies Programme said during a WHO press conference.

"This means that it’s important that we track this, particularly because of the number of mutations that it has, but it isn’t circulating widely at the moment."

Globally, focus remains on the Omicron variant that has swept through at least 99 countries with unprecedented speed. Unlike the B.1.640 variant, Omicron, which also carries a large number of mutations, has pushed daily new infections to record-breaking levels in numerous countries.

“[B.1.640] is just something to keep an eye on. It looks like it’s being overcrowded by Omicron and it doesn’t look like this has taken off, but obviously you can’t sweep anything under the rug,” infectious diseases specialist Dr. Isaac Bogoch told CTV’s Your Morning earlier this week.

“This variant was discovered in September and it hasn’t exploded yet in France or elsewhere in the world. Again, you can’t ignore it, but it’s pretty clear that Omicron is the current and significant threat right now and we really have to take Omicron seriously.”

Van Kerkhove emphasized the continued importance of sharing sequencing on global platforms like GISAID to help track the variants. In December alone, an unprecedented one million genetic sequences were shared on the platform, she said.

"The reason why we classify it as a variant under monitoring is to raise awareness and for people to be on the lookout for that," she added.

Most of the B.1.640 sequences reported on GISAID have come from France, with 319, followed by Republic of the Congo, with 40.

The B.1.640.2 lineage has 46 mutations and 37 deletions resulting in 30 amino acid substitutions and 12 deletions, according to the IHU pre-print, with 14 amino acid substitutions and 9 deletions located in the spike protein. 

https://www.ctvnews.ca/health/coronavirus/b-1-640-5-canadian-cases-of-little-known-coronavirus-variant-1.5731402

Half of all people offered Moderna COVID-19 vaccine refuse it: Ontario pharmacists

 The association representing Ontario pharmacists says roughly half of all people who are offered the Moderna vaccine are refusing it.

"They may cancel their appointment. They may walk out," said Justin Bates, CEO of the Ontario Pharmacists Association. 

"That's creating a significant challenge," said Bates, as pharmacists also have to deal with combative patients who want to shop around for vaccines. 

Many people did the same thing last spring when they questioned the safety of Moderna or mixing vaccines during the rollout of second doses. 

Now, they have less choice in the matter because many public health units are reserving Pfizer for younger people because there's now a greater supply of Moderna. In Toronto, those 18 and up will only be offered Moderna at city-run clinics as of Jan. 6. The same goes for people aged 30 and up in Durham region. 

Last fall, the Ontario government recommended people between 18 and 24 receive the Pfizer vaccine due to a "mild risk" of the rare heart condition myocarditis "out of an abundance of caution." Pfizer is also only being offered to those aged 12 to 17. 

Jason Chomik and his daughter Liliana in their family home in Toronto. (Submitted by Jason Chomik)

Jason Chomik opted to get Moderna for his third shot on New Year's Day, even though he put off two appointments before getting Pfizer for his second dose. He says the surging Omicron variant finally prompted him to make the move.

"If the numbers hadn't been climbing as rapidly as they are now, I probably would have waited," he said. 

"I'm glad I got the booster but I'm still concerned around the long-term effects of mixing the vaccines."

'They only want Pfizer'

Despite public messaging that mixing vaccines is safe, as is Moderna, many are still reluctant to get it. Aside from pharmacies, health workers at other vaccine clinics are seeing this, too. 

"When they sit down in the chair, they immediately confirm [they're getting Pfizer] with me," said Allan Grill, who has been administering vaccines in York Region, north of Toronto, and is chief of family medicine at Markham Stouffville Hospital. 

"They only want Pfizer." 

Grill, along with many infectious disease experts, have long maintained the risk of getting infected with COVID-19 is far greater than any risk associated with getting any of the vaccines. 

"Omicron is spreading like crazy and people are getting sick," he said. 

Even Ontario's Chief Medical Officer of Health Dr. Kieran Moore made a plea during his briefing on Thursday. 

"I, too, got Moderna as my booster," he said. 

"The latest evidence demonstrates the protection provided by the Moderna vaccine, particularly for older individuals, is very robust."

More brand awareness

Bates said there's more brand awareness around Pfizer's vaccine, especially since many got it for their first or second dose. He also said the pandemic continues to change policy with time and new research.

Toronto's Medical Officer of Health Dr. Eileen de Villa is pictured here at a news conference on the city’s COVID-19 response on Jan. 4, 2022. (Evan Mitsui/CBC)

"People aren't used to seeing science evolve in real time," he said. "And changing public perception is the hardest thing to do."

Toronto's Medical Officer of Health Dr. Eileen de Villa said the city is "doing everything we can" to make sure people are aware vaccines are safe and effective. 

"In fact, there are some studies showing a particular benefit to those who receive the Moderna vaccine and its effectiveness against the Omicron variant." 

https://www.cbc.ca/news/canada/toronto/covid-19-moderna-vaccine-pfizer-booster-1.6306892

DeSantis to deploy 15,000 doses of Regeneron to Floridians

 Gov. Ron DeSantis announced Friday that his administration secured 15,000 doses of Regeneron, out of the 30,000 requested from the federal government, for Floridians. 

DeSantis continues to tout the effectiveness of the antibody therapy treatment on COVID-positive patients and says he will continue to push back against the Biden administration's hold on the supply of monoclonals for the state of Florida. In a release, the governor's office said the Florida Division of Emergency Management sent a letter to the U.S. Health and Human Services "offering logistical support to receive the additional doses as quickly as possible, including picking them up and driving them to Florida."

"Before the Biden Administration seized control of the monoclonal supply after Florida pioneered its widespread use and demonstrated its efficacy, approximately 30,000 doses per week were being administered to Floridians, saving countless lives," the statement said. "We will rapidly deploy the 15,000 doses that we have now secured, but the Biden Administration is still obstructing the state of Florida's ability to manage our own supply of monoclonal antibodies and I will continue to seek additional doses for Floridians."

Earlier this week, DeSantis announced plans to open more monoclonal treatment sites across the state as omicron continues to spread. 

DeSantis said the state will get treatment sites open immediately once the state receives treatments from the federal government. 

The governor also announced yesterday in West Palm Beach a plan to provide 1 million at-home COVID tests to seniors in Florida. The tests will be sent to nursing homes and long-term care facilities.

https://www.baynews9.com/fl/tampa/news/2022/01/07/gov--to-deploy-15-000-doses-of-regeneron-to-floridians

Walgreens Will Open 160 Village Medical Clinics By Year’s End

 Walgreens Boots Alliance will have more than 160 of its doctor-staffed Village Medical clinics open next to drugstores by the end of this year.

Executives at Walgreens, which last fall invested another $5.2 billion in VillageMD to escalate the expansion of doctor-staffed clinics across the U.S. under a new “Walgreens Health” business, told analysts on its quarterly earnings call Thursday that 80 of its “Village Medical at Walgreens” centers are now open and the company has targeted more than 160 to be open by the end of 2022.

The $5.2 billion investment gave Walgreens a 63% stake in VillageMD ahead of an initial public stock offering the Chicago-based primary care company plans this year. Walgreens previously had a 30% stake in VillageMD, a standalone company that landed a $1 billion investment from the drugstore giant in 2020.

Speaking at the Forbes Healthcare Summit last month, Walgreens chief executive officer Roz Brewer said Walgreens eventually will have 45% of the company’s 9,100 stores “that happen to be within five miles of 75% of the homes across the United States – where you can walk in and see a primary care physician that’s attached to a Walgreens drugstore.”

“And you come into this beautiful lobby and there are eight exam rooms with two physicians and a staff,” Brewer said at the Summit, a virtual event. “And they can do the testing that you need that day when they take a blood sample or urinalysis and you can manage that right in the building and then walk over and get your script done. That’s our goal.”

https://www.forbes.com/sites/brucejapsen/2022/01/07/walgreens-to-have-160-village-medical-clinics-open-this-year/?sh=21517a0c699f

FedEx warns of shipment delays as Omicron leads to staffing shortage

 FedEx Corp warned on Friday that rising cases of Omicron variant has caused staff shortage and delay in shipments transported on aircraft.

"The explosive surge of the COVID-19 Omicron variant has caused a temporary shortage of available crew members and operational staff," the company said https://www.fedex.com/en-us/service-alerts.html.

The delivery firm said severe winter storms around the country, including at its main air hub in Memphis, Tennessee, are posing challenges and it is implementing contingency plans and adjusting operations to minimize disruptions.

Rival United Parcel Service Inc said that call-outs due to Omicron are not impacting their services, adding that contingency plans are in place.

"Recent weather events in the Louisville, Kentucky and Philadelphia, Pennsylvania areas caused some delivery delays," a UPS spokesperson said.

Severe winter weather and the rapid spread of the highly transmissible Omicron variant have led to a sharp rise in infections, forcing several U.S. airlines to cancel flights as pilots and crew quarantine.

Inadequate staffing and other issues had on Thursday forced the U.S. Postal Service, one of the largest civilian U.S. employers, to seek for its 650,000 employees a temporary relief from the Biden administration's new vaccine or testing requirements covering large businesses.

U.S. coronavirus deaths have risen by at least 2,133 on Thursday to 836,901 total versus 834,768 the previous day, according to a Reuters tally.

https://www.marketscreener.com/quote/stock/FEDEX-CORPORATION-12585/news/FedEx-warns-of-shipment-delays-as-Omicron-leads-to-staffing-shortage-37493193/

Amazon shortens COVID isolation, paid leave for U.S. workers

 

Amazon.com Inc on Friday told workers they only have to isolate for a week after testing positive for COVID-19, instead of 10 days, following updated U.S. health guidance.

The Omicron variant of the coronavirus has prompted a spike in cases in the United States and worker shortages at schools, airlines and businesses. On Tuesday, the U.S. Centers for Disease Control and Prevention (CDC) backed recent guidance that people who contract the virus can end their isolation after five days.

In a message to staff, which Amazon shared with Reuters, the online retailer said its new week-long isolation policy took effect immediately. Workers with the virus can receive up to 40 hours paid leave, a decrease corresponding to the shorter isolation period.

"Do not come to work if you are sick," the message said. "Additional leave options are available for individuals who remain symptomatic beyond one week."

The Wall Street Journal earlier reported the news.

With hundreds of thousands of warehouse and logistics staff, Amazon is the second-largest U.S. private employer. Walmart Inc, the largest, this week told workers it was halving its COVID-19 paid leave in line with the updated CDC guidance.

https://www.marketscreener.com/quote/stock/AMAZON-COM-INC-12864605/news/Amazon-shortens-COVID-isolation-paid-leave-for-U-S-workers-37493209/