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Wednesday, January 26, 2022

Moderna begins trial for omicron-targeted booster shot

 Moderna has started testing an omicron-specific booster shot in adults, the company announced Wednesday.

The trial, which will include several hundred people at two dozen sites across the U.S., comes as companies and health officials grapple with a rise in cases linked to the omicron variant.

Omicron has become the dominant strain in the U.S. since it first appeared in the country late last year, with the highly transmissible virus driving up cases and hospitalizations, though early data suggests it causes less severe disease.

"Given the long-term threat demonstrated by Omicron's immune escape, we are advancing our Omicron-specific variant vaccine booster candidate," Stephane Bancel, the CEO of Moderna, said in a statement, adding he was "pleased" by the trial start.

"We are also evaluating whether to include this Omicron-specific candidate in our multivalent booster program. We will continue to share data with public health authorities to help them make evidence-based decisions on the best booster strategies against SARS-CoV-2."

The news follows Pfizer's announcement on Tuesday that it was starting a human trial for an omicron-targeted vaccine including about 1,400 participants. Pfizer expects that vaccine to be available in March.

Bancel previously hinted about starting a clinical trial for an omicron booster. The CEO said earlier this month he was discussing making such a booster available by the fall, citing the need to be "careful to try to stay ahead of a virus and not behind the virus."

In Moderna's phase two trial, candidates are grouped into two "cohorts" who will receive the omicron-specific booster shot.

The first cohort includes those who are fully vaccinated with the Moderna vaccine, with the last dose being six months ago. The second includes those who are fully vaccinated and boosted with the Moderna vaccine, and the last dose being three months ago.

Officials have been pushing booster shots to combat the spread of omicron. On Wednesday, Moderna said its booster remains durable against omicron, but six months after the third dose, protection had waned and was six times lower.

https://thehill.com/policy/healthcare/591548-moderna-begins-phase-2-trial-for-development-of-omicron-targeted-booster

Long covid: 4 factors that can predict how you get it

 Long COVID-19 has had an air of mystery around it for months. Doctors have struggled to explain or understand why some people who contract COVID-19 end up having lingering symptoms like fatigue, difficulty thinking clearly, or shortness of breath weeks or even months later.  

new study published in the journal Cell helps shed some light on the condition, for the first time identifying four factors that can help predict whether someone will develop long COVID-19.  

“Being able to identify the factors that can cause the disease, cause the chronic condition, is the first step towards defining that it actually is a condition that can be treatable,” Jim Heath, president of the Institute for Systems Biology in Seattle, and an author of the study, said in an interview. “And then some of these factors also are in fact the kind of things one can imagine developing treatments for.” 

The most important factor the study identified in predicting long COVID-19 is the presence of certain kinds of antibodies called autoantibodies, which mistakenly attack healthy parts of the body. Autoantibodies are associated with autoimmune diseases, like lupus, where your immune system attacks your own body.  

But someone does not have to have an autoimmune disease to have autoantibodies present and be at higher risk for long COVID-19, Heath said.  

“Most people that have autoantibodies don't really know it,” he said. “They're what you call subclinical ... maybe you have a risk of some autoimmune disease but it hasn't developed.” 

Still, he said one practical application of the study is that lupus treatments could be “worth exploring” as treatments for long COVID-19.  

The second factor that can lead to long COVID-19 is the reactivation of a different virus called Epstein-Barr Virus (EBV), which is extremely common, infecting up to 90 percent of people at some point, and often causes only mild symptoms. 

The virus usually becomes inactive in the body following the initial infection, but it can be reactivated when someone gets COVID-19, helping lead to long COVID-19 symptoms. 

Heath said EBV could become reactivated when the immune system is distracted by fighting COVID-19.  

“It could be that the large distraction that’s COVID-19 infection is taking that attention away,” he said.  

The third factor identified is how much of the virus that causes COVID-19, officially called SARS-Cov-2, is present in the blood, known as the “viral load.” 

This factor along with the role of EBV suggests that new antiviral drugs that fight the immediate effects of COVID-19 infection, like the Pfizer pill Paxlovid, might also be useful in treating long COVID-19.  

“Two of these predictive factors are virus levels that are in the blood,” Heath said. “So that suggests that these antivirals that are being used to treat acute disease probably have a role for long COVID as well.” 

The final of the four factors that can predict long COVID-19 is more easily identifiable: if a patient has Type 2 diabetes. 

While these four factors are a step forward in understanding what causes long COVID-19 and helping develop treatments, the mechanism for why they are associated with long COVID-19 is still not fully clear.  

“They have a flavor of mechanistic factors,” Heath said. “The actual mechanism is not clear.” 

The study followed 309 COVID-19 patients, taking blood and swab samples at different points in time.  

In addition, one way to likely cut the risk of long COVID-19 is vaccination. A separate study from the United Kingdom found that vaccinated people were 41 percent less likely to develop long COVID-19.

https://thehill.com/policy/healthcare/591528-long-covid-study-author-explains-four-factors-that-can-predict-how-you-get

NYC Announces Shorter Quarantines For K-12 Students

 The New York City Department of Education is shortening its quarantine requirements for most students.

Under new rules that go into effect Monday January 31st, the quarantine period for students who test positive is being reduced from 10 days to five with some conditions. Students, from kindergarten through 12th grade, who test positive can return on the sixth day after their first positive test, if they have been fever-free without medication for 24 hours. Students do not have to show a negative test to return, but must wear well-fitting masks.

The quarantine period for students in 3K and pre-K who test positive remains 10 days, but their classmates won’t have to quarantine for as long.

Education department officials said the policy change is based on Centers for Disease Control and Prevention and New York State Department of Health guidance, and it conforms with guidance released for staff weeks ago.

There are also changes for unvaccinated K-12 students who are exposed to the virus outside school: their quarantine period is also down from 10 to five days. If a student is exposed to the virus by someone inside their home, they must quarantine for five additional days after the isolation period for their other household member ends.

The moves come just weeks after another significant change to quarantine policies that went into effect in the new year. Now, when a student is exposed to a positive case in school, they are sent home with two rapid tests, to be taken on the first and fifth days after exposure. If the student tests negative, they can keep coming to school.

For students who are returning on Day Six following a positive test, the city is recommending KN95s and will supply adult KN95 masks for students who can use them or surgical masks.

The fate of New York state’s mask mandate was called into question Monday when a Nassau County Supreme Court judge ruled that it could not be enforced. By Tuesday, dozens of New York school districts, mainly on Long Island, told families masks had become optional. But the state quickly appealed, and an appellate judge placed a stay on the order Tuesday afternoon, leaving the mask mandate in effect.

Another hearing is scheduled for Friday, and the state education department announced New York students must continue to wear masks as the case makes its way through the courts. New York City officials also assert that their mask mandate for schools predated the state rule and will remain in place regardless.


https://gothamist.com/news/new-york-city-announces-shorter-quarantines-k-12-students

Tested positive for Covid and at high risk? How to get antiviral pills

 With at-home Covid-19 testing kits beginning to arrive in Americans’ mailboxes nationwide, people who test positive for Covid and at high risk for severe illness may want to seek out two newly authorized antiviral pills that have been shown to cut the risk of hospitalization or death.

Unlike all other FDA-authorized Covid treatments, which need to be given intravenously or by injection from a health care provider, the two antiviral pills — Pfizer's Paxlovid and Merck's molnupiravir — can be picked up at a pharmacy and taken at home.

The two easy-to-administer treatments add to the nation's Covid arsenal at a time when federal regulators have asked states to stop using certain antibody drugs because they don't work against the omicron variant, which now accounts for virtually all new cases in the United States. Pfizer and Merck have said their pills should work against the new strain.

To be sure, the process for obtaining the pills is more complex than for Covid vaccines and other treatments, and both drugs come with risk of side effects for certain groups of people.

Additionally, finding the pills won't be easy for everyone, health experts say, as they are currently in short supply in the U.S. The Department of Health and Human Services has already allocated hundreds of thousands of courses of the antivirals, but the distribution has varied by state and some state governments may have different eligibility requirements for who can receive the drugs. In some places, preference is given to the unvaccinated or those with weak immune systems who don't respond well to vaccination.

"There is very limited supply at this point and they are for very specific types of patients," said Kurt Proctor, senior vice president of strategic initiatives at the National Community Pharmacists Association. "It certainly isn't like every person who gets one of these [over-the-counter] tests and, if they test positive, should start trying to get one of these meds."

These are the steps experts say you should take to get the drugs.

A positive test

A positive Covid test is required before a health care provider can consider prescribing the pills.

The FDA has permitted a Covid diagnosis from both over-the-counter rapid antigen tests — like the ones being distributed by the federal government — and PCR, or polymerase chain reaction tests, often referred to as the "gold standard" because they are considered the most reliable.

People who suspect they have Covid should get tested as early as possible because both treatments must be started early to be effective — within five days of symptoms.

Get a test "as quickly as possible," especially if one already has symptoms, said Dr. William Schaffner, an infectious disease expert at Vanderbilt University Medical Center in Nashville, Tennessee. "In other words, don't put it off if you're becoming ill because you're wasting time."

He added that patients may prefer a rapid test, if available, since PCR tests require special lab equipment and the turnaround time can average several days.

Find out if you qualify for the pills

The pills are not available to everyone.

The FDA authorized Paxlovid for at-risk people as young as 12 with mild to moderate Covid to receive a five-day course of the medication. The agency authorized molnupiravir for at-risk adults with the illness. Molnupiravir is also limited to situations where other authorized treatments are inaccessible or not “clinically appropriate," according to the FDA.

Because of supply shortages, some states and local governments may have even narrower eligibility requirements and some people at high risk may be turned away. Additionally, unvaccinated patients may get priority when there is a limited supply under National Institutes of Health guidelines.

The guidelines have "rubbed some people the wrong way," said Dr. David Boulware, an infectious disease physician at the University of Minnesota Medical School. "But as far as if you want to maximize the absolute benefit, that's sort of the best way."

For example, in Clark County, Nevada, Paxlovid is initially being given first to patients who arrive at the county's public health department testing site who are:

  • Symptomatic
  • Have a positive Covid test
  • Over the age of 65.

New York state is prioritizing treatments to those who are:

  • Moderately to severely immunocompromised, regardless of vaccination status
  • Older and not fully vaccinated, with at least one risk factor for severe illness. 

If you're uncertain if you qualify, you can check your local health department website or ask your primary care physician.

"If you're overweight and you're over 50 and you've got some high blood pressure, like boom, boom, boom, you might be able to fall into a high-risk category pretty quickly," Boulware said.

Get a formal prescription

Reach out to your primary care physician, urgent care doctor or local health system to get a prescription. A pharmacist cannot prescribe these medications.

Both antivirals come with certain side effects, and so underlying health conditions may affect which drug people get, if any, Boulware said. Availability may also affect which drug a patient gets.

Pregnant women, for example, should not take the Merck pill because of risks to the fetus, according to the FDA. The agency has also recommended that patients use contraception while using that treatment and for four days after the last dose.

The FDA has noted that the Pfizer pill may also be unsuitable for some people, such as those with HIV or some organ transplant patients, because of the potential for interactions with other medications.

Though since both treatments are taken for only five days, a physician may be able to adjust or temporarily suspend medication for other ailments.

"Common things, like cholesterol medicines, you could probably skip for five days," Boulware said. "Those are not life-sustaining."

Find the pills, if you can

The pills are scarce: Merck said it has shipped 2 million treatment courses to the U.S. government so far, while Pfizer said it has shipped 250,000 courses.

The U.S. has agreed to purchase about 3.1 million courses of Merck’s drug, most of which could be available to states by the end of the month. The government has purchased 20 million courses of Pfizer's drug. Allocations are expected to ramp up over the next several months, officials say, with at least 10 million courses delivered by the end of June.

The federal government has a database where patients may be able to find the treatments. GoodRx, a digital health care platform, also created an interactive map where people can see which pharmacies near them have the pills in stock.

Doctors may look at the availability of the treatments in the area before prescribing the pills, but because the pills are so hard to find, some doctors are putting the burden on sick patients.

Roy Nwaisser, a Los Angeles resident who sought the Pfizer pill for his father who suffers from a heart condition, said a pharmacy he called didn’t even know about the pills.

"It was shocking to me that when I called the pharmacy that, in the middle of Covid and an omicron surge, that they don’t even know that there is a pill for Covid," he said.

Experts hope that will change as the supply of tests and pills become more readily available.

"I can envision a future in which you know you feel bad ... you go to the drugstore and you get a test. You’re positive. You call your doctor. They call in a prescription and you know, within a couple of hours, you can start therapy," said Dr. Carlos del Rio, an infectious disease physician at Emory University School of Medicine.

Pick the pills up

The antivirals, allocated through the federal government, should come at no cost to patients, said Katherine Yang, an infectious diseases pharmacist specialist at UCSF Health.

Once at the pharmacy, the pharmacist may call the provider to go over the patient's risk factors and the safety of the prescription, including the potential for drug-to-drug interactions, Yang said.

If the pharmacist feels the patient doesn't qualify or is outside the five-day window, they could refuse to dispense the drugs, she said.

"We do ask our providers to attest when they prescribe that the patient is within our guidance and it's within five days of symptoms," she said.

Pharmacists also stress that it's important to take the full course of the treatments as prescribed.

A full course of Pfizer’s treatment is a total of 30 pills, taken three pills twice daily for five days. The treatment includes a low dose of ritonavir, a commonly used HIV drug, along with an antiviral developed by Pfizer called nirmatrelvir.

A full course of Merck’s treatment is a total of 40 pills, taken as four 200-milligram pills, twice a day for five days.

https://www.nbcnews.com/health/health-news/covid-pills-get-antiviral-drugs-testing-positive-rcna13474

Next Covid variant will be more contagious than omicron, but question is if it will be more deadly: WHO

 The next Covid-19 variant that will rise to world attention will be more contagious than omicron, but the real question scientists need to answer is whether or not it will be more deadly, World Health Organization officials said Tuesday.

Roughly 21 million Covid cases were reported to the WHO over the last week, setting a new global record for weekly cases from the rapidly spreading omicron variant, Maria Van Kerkhove, WHO’s Covid-19 technical lead, said during a livestreamed Q&A across the group’s social media channels.

While omicron appears to be less virulent than previous strains of the virus, the sheer volume of cases is crushing hospital systems worldwide.

“The next variant of concern will be more fit, and what we mean by that is it will be more transmissible because it will have to overtake what is currently circulating,” Van Kerkhove said. “The big question is whether or not future variants will be more or less severe.”

She warned against buying into theories that the virus will continue to mutate into milder strains that make people less sick than earlier variants.

“There is no guarantee of that. We hope that that is the case, but there is no guarantee of that and we can’t bank on it,” she said, noting that people should heed public safety measures in the meantime. What’s more, the next iteration of Covid may also evade vaccine protections even more, making the existing vaccines even less effective.

Pfizer and BioNTech on Tuesday started testing a Covid vaccine that specifically targets the omicron variant, as concerns grow that the current shots aren’t holding up against infections and mild illness caused by the strain discovered just over two months ago.

The U.S. Centers for Disease Control and Prevention found in a study published last week that a booster dose of Pfizer’s vaccine was 90% effective at preventing hospitalization from omicron 14 days after the third shot was administered.

Booster doses are also up to 75% effective at preventing symptomatic infection from omicron two to four weeks after the third shot, according to data from the U.K. Health Security Agency published earlier this month. However, the study found that boosters weaken substantially after about 10 weeks, providing 45% to 50% protection against symptomatic infection.

While omicron appears to have peaked in some countries, it’s gaining ground in others, WHO officials said. “You won’t have to wear a mask forever and you won’t have to physically distance, but for now, we need to keep doing this,” Van Kerkhove said.

The virus will continue to evolve before it settles into a pattern, said Dr. Mike Ryan, WHO’s director of emergency programs. He said it will hopefully settle into a low level of transmission with potentially occasional epidemics. It could become more seasonal or may only affect vulnerable groups, he said.

The problem, he said, is that Covid is unpredictable.

“The virus has proven to give us some nasty surprises,” Ryan said. World health officials need to continue tracking Covid as it evolves, he said, and be ready “if there’s a nasty surprise that we can at least put in place measures again that will stop this new variant doing any more damage.”

https://www.cnbc.com/2022/01/25/the-next-covid-variant-will-be-more-contagious-than-omicron-who-says.html

'Just wear a mask and don’t tell anyone’: Workplaces filling up with sick employees

 Maria Bernal, an employee at a Jack in the Box in Folsom, Calif., couldn’t read the orders popping up on her screen. Her vision was blurry, her hands shook from chills and her head felt heavy.

A pharmacist told her she probably had COVID-19. When she told her boss, the manager told Bernal to keep working.

“Don’t worry, everyone has it, you can still work. Just wear a mask and don’t tell anyone,” the manager said, according to a Jan. 14 complaint Bernal filed with Sacramento County’s public health department.

As the Omicron variant knocked out swaths of the labor force, people in a variety of jobs — fast-food workers, grocery clerks, teachers — say they have been under immense pressure to report to work while feeling sick or having tested positive with the virus.

Recently changed guidance from the Centers for Disease Control and Prevention has ratcheted up the pressure, workers told The Times, with employers calling back ill employees or trying to keep them on the job while their COVID status is unclear. The CDC shortened its recommendation for isolation for people who are infected with the virus but don’t have symptoms, or who are on the mend, to five days from 10.

“A lot of workers feel pressure to come in — a supervisor is leaning on them, saying, ‘I really need you today,’” said Kristen Harknett, a professor of social behavioral sciences at UC San Francisco who has polled service sector workers during the pandemic.

Two-thirds of service workers surveyed in the months leading up to the Omicron surge said they did not stay home when they were feeling sick and went to work ill. The numbers highlight the precarious situation for workers without sick leave, Harknett said. They also show the pressure of chronic short staffing, threats from bosses and the possibility of losing pay that also causes people to keep going to work, she said.

Pressures have only built since then.

In California, officials took a further step to battle shortages of healthcare workers as intensive care units filled up with COVID-19 patients. A policy change allows healthcare workers who have tested positive for the coronavirus but don’t have any symptoms to return to work immediately. And at facilities with the most severe staffing shortages, symptomatic staff are allowed to work with COVID patients.

Officials have said that the move, criticized by some as reckless, was necessary to keep hospitals staffed and essential medical care going through another COVID surge, and that workers are outfitted with protective N95 masks and tested frequently.

In the private sector, that is not the case. Ill workers are serving meals, taking orders and talking to co-workers and customers through cloth or surgical masks that offer less protection and raise the risks for all.

In the absence of a national effort to provide testing at the onset of the Omicron surge, corporate giants such as Google and JPMorgan Chase offered employees — many of whom work from home — high-end testing for free. Sports leagues such as the National Basketball Assn. and the National Football League also provided frequent testing to players.

The Biden administration has moved to make rapid tests accessible to all households, with the first shipment of free tests due to go out by the end of the month. But many lower-wage workers struggle to access these tests on their own, and many employers are not helping.

“Leaving workers in limbo is the last thing you want to do as an organization,” said Hakan Ozcelik, a professor of management at the Sacramento State College of Business.

Employers should set clear rules on testing and return-to-work policies, explain why they work the way they do and continually update employees, he said. They should not be leaving workers to navigate public health guidance about testing, isolation periods, masks or vaccination on their own.

A recent run on over-the-counter rapid tests made it harder for people to make quicker, more informed decisions about going to work. And as return times for polymerase chain reaction, or PCR, lab test results have stretched, workers with limited time off or who can’t afford to be off the job are showing up to work as normal.

Bernal, the Jack in the Box employee, said she does not know what the chain’s protocols and sick-leave benefits are for workers who contract the virus, as no manager at the company has given her this information.

The complaint Bernal filed with Sacramento County’s public health department alongside three of her co-workers at the Folsom Jack in the Box alleges restaurant management dissuaded workers from quarantining, encouraged them to cover up or not disclose their symptoms to their co-workers and failed to take additional safety precautions.

The complaint says the restaurant has allowed several staff members with COVID-like symptoms to continue working without wearing masks, including the store manager. About a third of workers at the Folsom location have been working with COVID-like symptoms or were home sick with a confirmed COVID case in the first two weeks of January, the complaint says.

Jack in the Box did not respond to requests for comment.

Crystal Orozco, another Jack in the Box worker in Folsom, said in the complaint her manager asked to see a doctor’s note after Orozco texted the manager reporting she was sick with a fever and a cough, and was having trouble finding a COVID test.

Orozco doesn’t have health insurance and asked if the company could pay for her doctor’s visit. The manager never responded, according to Orozco’s statement submitted with the complaint.

New emergency rules by California’s worker health and safety agency that went into effect Jan. 14 require businesses to make COVID testing available at no cost, during paid time, to fully vaccinated employees who had a close contact at the workplace with a COVID case, even if the employees are asymptomatic.

The temporary rules also emphasize more stringent masking requirements in the workplace, recommending surgical and medical grade masks and banning cloth masks “that allow light to pass through them” as a suitable face covering in the workplace. (In Los Angeles County employers are required to provide well-fitting medical-grade masks, surgical masks or respirators, such as N95s or KN95s, to employees who work indoors in close contact with others, effective Jan. 17.)

It’s unclear how some of these rules will be enforced, and workplace attorneys said the burden is mainly on employers to comply.

With their severe staffing shortages, particularly in the food and retail sectors, and lapses in safety nets, such as mandated paid sick leave, the average workplace has become more dangerous during the Omicron wave, workers and labor advocates say.

On Tuesday, Gov. Gavin Newsom and state lawmakers reached an agreement to reinstate legislation requiring employers to give workers up to two weeks of supplemental paid sick leave to recover from COVID or care for a sick family member.

A similar law from 2021 expired Sept. 30, leaving many workers vulnerable.

“If they’re sick, they need to choose between showing up to work sick or forgoing pay or potentially getting written up,” said Harknett, the UC San Francisco researcher.

In her recent work, half of more than 6,000 workers surveyed in service sectors such as retail, fast food and grocery said they did not have access to any paid sick leave.

And workers often have to jump through additional hurdles to secure time off.

Ariella Alaia lives in a transitional housing facility where each time a resident is exposed to the virus, she is required to quarantine. When she called the Goodwill in L.A. County where she works on Dec. 27 to ask for time off, she said, the HR representative told her she had to come to work: The organization’s policy states that vaccinated individuals who have been exposed should still report to work.

Alaia said she went back and forth with HR as she tried to explain that her living situation mandated she stay home. She doesn’t believe she will be paid for the four days she took off from work to comply with the residence’s policy.

Liz Schwalbach, human resources chief of Goodwill Southern California, said COVID sick leave is reserved for people who test positive. The nonprofit has resources for employees to schedule COVID tests and vaccine appointments, and it is committed to supporting workers in transitional housing, she said.

After the CDC shortened its isolation guidance, Los Angeles City Councilmember Paul Koretz wrote letters to Amazon and Walmart, two companies that cut back the number of paid days off their employees can take for COVID quarantining, urging them to reconsider. Koretz reminded the companies that employees at their Los Angeles locations were still entitled to a full 80 hours of paid leave.

“Workers in Amazon facilities should not have to choose between caring for themselves, a sick family member or child and putting food on the table,” Koretz said in the letter, sent this month.

People in the city of L.A. employed by a company with 500 or more employees within the city limits, or 2,000 nationally, are guaranteed 80 hours of supplemental paid sick leave, per a June emergency order.

A CVS worker in L.A. who was out sick with COVID for nearly two weeks — her daughter was sick with the virus too — said she received pay for just five days off. Testing facilities are “super booked up,” said the worker, who wanted to stay anonymous in order to talk freely about her employer.

CVS isn’t providing PCR testing services at its Minute Clinics to employees, only home rapid-test kits, which aren’t as accurate, she said.

She’s worried other workers at the store are coming back to work still sick.

“There’s no way people can get a COVID test and result within five days,” she said. “Five days is not good enough.”

CVS confirmed it provides rapid tests to employees who have trouble getting one. CVS Health spokeswoman Monica Prinzing said in an email that the company is providing five days of paid leave for eligible workers, in line with the changes to CDC guidance, except where state or city paid leave laws provide for more.

In California, workers are eligible for up to 10 days of paid leave if they have a confirmed case of COVID-19, she said. She didn’t comment specifically on the case of the L.A. worker.

Calls for more proactive COVID policies, including paid sick leave and more uniform guidance on testing in the workplace, are growing nationally.

“I think testing is such a huge mitigation strategy. We could have had a better one,” said Autumn Laidler, a teacher in the Chicago Public Schools system.

Laidler and others in the teachers union prompted a sudden shutdown of the city’s schools in early January when they voted to refuse to return to in-person work because of surging COVID cases. The union wanted more robust testing, as well as rules requiring that schools transition to remote learning when the number of staff isolating due to COVID cases or exposures rises to a certain threshold.

A child-care provider at a facility in Las Vegas was told to come to work even after reporting to her boss she had been exposed to the virus and wasn’t feeling well, according to screenshots of text messages reviewed by The Times. The facility was short-staffed, and its director believed the worker, who is vaccinated, was well-protected.

The worker got a PCR test and went to work. After her shift, she was able to find a rapid test. The result was positive.

When she returned to work a few days later, the message from management was to not talk about what happened. “They said, ‘We didn’t let anyone know about your situation. You’re fine now, you can just work.’”

Of 215 complaints filed with Nevada’s OSHA workplace safety department in December, at least a dozen described scenarios in which employees were required to work while COVID-positive, or symptomatic and awaiting test results.

https://www.latimes.com/business/story/2022-01-26/covid-testing-rapid-tests-access-sick-leave-cdc-quarantine-workplace-risks

For 1st time in Michigan history, more people died than were born in 2020

 For the first time in Michigan's recorded history, deaths outpaced births in 2020 — a situation worsened by the wave of deaths from COVID-19, said Kurt Metzger, a demographer who founded Data Driven Detroit and studies Michigan population trends.

In the first year of the pandemic, 104,149 babies were born in Michigan but 117,087 people died in the state, Metzger said — a difference of 12,938. 

"Looking at those numbers, I just said, 'Whoa! Here we are,' " said Metzger, who used data from the state health department to make the analysis. "It's the first time we've ever seen more deaths than births, which is kind of frightening."

Among them were 11,362 Michigan residents who died from COVID-19, according to the state health department's 2020 mortality data, which counts only people for whom COVID-19 was listed as the underlying cause of death. 

When added to a declining birth rate, an aging population and a lack of immigrants, Metzger said, COVID-19 exacerbated an already downward population spiral that could have wide-reaching economic and political implications for the state. 

"It's not necessarily that growth is the answer to everything, but when you're not growing in population, people start to question decisions to move there or open businesses there or anything else," said Metzger, who also served for eight years as mayor of Pleasant Ridge.

"It is, overall, this aging population in Michigan and the inability to attract young, educated workers that has been a characteristic of the state for quite a while and doesn't seem to be changing at all."

Population losses also mean fewer federal dollars and other resources for the state, as well as less representation in Congress

"We lost a congressional seat again," he said of redistricting, which this year dropped the number of U.S. House districts in Michigan to 13. "We've lost one every 10 years since 1970. ... If we continue to lose as we've had, Michigan's role just becomes diminished.

"Population and other characteristics are vital to funding formulas and we know that Michigan will, as it keeps losing population, keep losing federal funds," he said, noting, however, that COVID-19 federal relief has helped to buoy state coffers at least temporarily. 

"If we ever got back to a normal state of things, our funding would continue to go down."

The birth rate in Michigan has been on a downward trend since the 1950s. By 2019, the most recent year for which data was available, the birth rate had dropped to 10.8 per 1,000 people — the lowest point since 1950, when it was more than double that — 25.1 per 1,000 people. 

Even though the U.S. overall also has a declining birth rate, Michigan's is lower than the national average of 11.4 per 1,000 population.

The pandemic has just piled on, Metzger said, because "people are delaying births even more because of COVID" even as more people are dying from the virus.

COVID-19 became the third-leading cause of death in Michigan in 2020, behind only heart disease and cancer. 

"We can blame a lot of deaths on COVID," Metzger said, "but the fact is the trend of increasing deaths and decreasing births is a problem for Michigan outside of COVID."

Exactly how many people died in Michigan from the virus in 2020 differs depending on how a COVID-19 death is defined. 

The state health department has published two charts that show three different death statistics from the virus in the first year of the pandemic. 

The 2020 mortality rate table shows 11,362 people Michigan residents for whom coronavirus was the underlying cause of death, regardless of what state they were in when they died. That number has been finalized, said Chelsea Wuth, a spokesperson for the state Department of Health and Human Services. 

"It includes only people whose underlying cause of death was COVID-19 per the death certificate," Wuth said. "It does not include people where COVID was a contributing factor, but wasn’t the underlying cause."

The state health department also published a chart detailing the number of COVID-19 deaths by age in 2020. It suggests there were 12,570 provisional COVID-19 deaths in Michigan that year.

That number may still be adjusted, Wuth said, and includes deaths from non-Michigan residents who died in the state as well as people for whom COVID-19 was listed as either the underlying or contributing cause of death. 

"The underlying cause of death is defined as the disease or condition that sets in motion the chain of morbid events resulting in death," Wuth said. "For COVID-19-related deaths, the medical certifier might indicate that COVID caused the death, or that it was only a contributing condition."

That chart also includes 13,002 COVID-19 "fitted deaths" in 2020. That number, Wuth said, is a statistically scaled estimate with data reported in the Michigan Disease Surveillance System, which tracks lab-confirmed cases of the virus and also documents COVID-related mortality reported by local health departments. 

"Because MDSS numbers are more timely than death certificate numbers, the statistical fitting allows us to track the relative agreement between the two systems," Wuth said. 

Regardless of how COVID-19 deaths are counted, Metzger said the data clearly show that some counties fared better than others when it came to population changes in 2020. 

The biggest population loss was seen in Macomb County, which shrunk by 2,045 residents in 2020. 

Wayne and Genesee counties lost 1,269 and 1,220 people, respectively, followed by a 723-person loss in the city of Detroit.

Saginaw, Bay, St. Clair and Oakland counties also were among the state's biggest losers in 2020, with population reductions ranging from 609-714 people each. 

While most Michigan counties saw falling population numbers, seven saw gains in 2020. They were:

  • Kent County, which grew by 2,465 people.
  • Ottawa County, which grew by 576 people.
  • Washtenaw County, which grew by 533 people.
  • Ingham County, which grew by 217 people.
  • Kalamazoo  County, which grew by 211 people.
  • Ionia County, which grew by 26 people.
  • Branch County, which grew by 19 people.

That growth was concentrated, Metzger said, on the west side of the state.

"That area has been the fastest-growing for a long time. But it just shows because of migration into that area of a younger population you're seeing the higher numbers of births," he said. "And then it's also three counties that have universities — Washtenaw, Ingham and Kalamazoo" that also have seen modest growth. 

"They're not large numbers, but because of the younger population, they continue to be able to to maintain that population."

The opposite is happening in metro Detroit. 

"All of those older, central metro counties are showing significant losses," he said. "Oakland had 609 more deaths than births."

That's true for the state overall, too. 

"I looked at the United Van Lines numbers, U-Haul numbers, and Michigan is toward the bottom in terms of move-ins and at the top of move-outs," Metzger said. "Everything is pointing to continued loss of population, and for me, that should be of some concern to the powers that be."

COVID-19, he said, will only intensify the problem in 2021, Metzger said.

"We know that more people died from COVID in 2021 than died in 2020," he said. "For a state that does not attract … migrants, combined with lower immigration numbers ... and then you get more deaths and births, you start to wonder, OK, what is the future in Michigan? How do you start to reverse those things?

"The number of deaths in Michigan are continuing to go up just because of our aging population. Birth rates, birth trends are indicating that those numbers will continue to go down.

"I think the answer is how does Michigan attract immigrants? How does Michigan attract young folks in their child-bearing ages to come to the state?

"It's just another indication that Michigan has a lot of work to do."

https://www.freep.com/story/news/health/2022/01/26/deaths-outpaced-births-michigan-1st-time-2020/6584958001/