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Thursday, February 10, 2022

CDC still recommends universal masking in every county except these

 In most parts of the country, you are no longer required to wear a mask in public. Even more states and counties have announced plans to lift mask mandates in the next week. But even where you’re not required to wear a mask, should you?

The Centers for Disease Control and Prevention still recommends wearing a mask in public indoor settings in any county that has “high” or “substantial” COVID-19 spread. That covers 99.5% of U.S. counties.

Only 13 counties are shown as having “moderate” or “low” levels of community transmission on the CDC’s map as of Wednesday. In those counties, the CDC recommends unvaccinated people continue masking when out in public, but says vaccinated people can be less cautious.

The two counties with “moderate” COVID transmission, according to the CDC, are both in Texas:

  • Jeff Davis County
  • Concho County

There are 11 counties shown with “low” community transmission:

  • Arthur County, Nebraska
  • Blaine County, Nebraska
  • Harmon County, Oklahoma
  • Hayes County, Nebraska
  • Hooker County, Nebraska
  • Jones County, South Dakota
  • Loup County, Nebraska
  • Petroleum County, Montana
  • Rock County, Nebraska
  • Thomas County, Nebraska
  • Wheeler County, Oregon

In the other 3,200 or so U.S. counties, the CDC still recommends wearing a mask anytime you’re in public and indoors until the spread of the virus drops to safer levels.

CDC Director Rochelle Walensky told Reuters Tuesday that “now is not the moment” to drop mask mandates.

“We have and continue to recommend masking in areas of high and substantial transmission — that is essentially everywhere in the country in public indoor settings,” Walensky said.

To qualify for the agency’s “moderate” category, there need to be fewer than 50 new COVID cases a week per 100,000 residents and the test positivity rate has to be under 8%. (The test positivity rate is the percentage of people who get a COVID test and turn back a positive result.)

These CDC recommendations are just that: recommendations. They don’t have legal binding in this case, so counties and states are still allowed to set looser mask guidelines. The only places where the federal government has mandated masks are on public transit, airplanes, in transit hubs (like airports) and in federal buildings.

https://www.koin.com/news/cdc-still-recommends-universal-masking-in-every-county-except-these/

Most vulnerable still in jeopardy as COVID-19 precautions ease

 Two years into the pandemic Jackie Hansen still left home only for doctor visits, her immune system so wrecked by cancer and lupus that COVID-19 vaccinations couldn’t take hold.

Then Hansen got a reprieve — scarce doses of the first drug that promises six months of protection for people with no other way to fend off the virus.

“This is a shot of life,” Hansen said after getting injections of Evusheld at a University of Pittsburgh Medical Center clinic. She can’t wait to “hug my grandkids without fear.”

Up to 7 million immune-compromised Americans have been left behind in the nation’s wobbly efforts to get back to normal. A weak immune system simply can’t rev up to fight the virus after vaccination like a healthy one does. Not only do these fragile patients remain at high risk of severe illness and death from COVID-19, they can harbor lengthy infections that can help spark still more variants.

With more of the country now abandoning masks and other precautions as the omicron wave ebbs, how to keep this forgotten group protected is taking on new urgency.

This is “quickly transitioning into an epidemic of the vulnerable,” said Dr. Jacob Lemieux, an infectious disease specialist at Massachusetts General Hospital. While healthy vaccinated people may return to pre-pandemic activities with little worry about severe consequences, “the immunocompromised -- despite vaccination, despite taking all precautions -- cannot, and remain at risk.”

“We’re going to have to navigate this as a society, and it’s going to be a really difficult societal conversation,” he added.

Indeed, amid all the talk about omicron being less severe for many people, the most contagious variant so far laid bare how the immune-compromised need more defenses.

“The pandemic has not spared them yet,” said Dr. Ghady Haidar, an infectious disease specialist at UPMC, where people hospitalized with serious COVID-19 over the past month have been a mix of the immune-compromised and the unvaccinated.

Hansen, a retired nurse, has had to have tough conversations about why she can’t be around anyone who’s not vaccinated.

“Other people’s behaviors really affect and jeopardize the lives of people like myself,” said Hansen, who nearly died from the flu shortly before the pandemic began.

“We’re all tired of wearing a mask; everybody just wants to put it behind us,” Hansen said. But while for most people “‘it’s an annoyance to put a mask on to go to the grocery store,” she’s had to fight to get her cancer care scheduled during COVID-19 surges.

There aren’t many options for the immune-compromised as community-wide COVID-19 precautions wane. Health authorities are pushing a fourth vaccine dose for these vulnerable patients, since some get at least a little protection from repeat vaccinations. The immune-compromised are supposed to get three up-front doses of the Pfizer or Moderna vaccines followed by a booster, one more shot than the U.S. recommends for everyone else.

The Centers for Disease Control and Prevention also is considering if the immune-compromised need their booster a little sooner -- three months after their last shot rather than five months.

But many patients are anxiously awaiting AstraZeneca’s Evusheld, the first set of antibodies grown in a lab to prevent COVID-19 -- rather than treat it -- in people who can’t make their own virus-fighters. Evusheld contains two types of antibodies, given in two shots at the same appointment, that are expected to last for six months.

The problem: There’s not nearly enough to go around. A federal database shows nearly 500,000 of the 1.2 million doses the government has purchased have been distributed, and an AstraZeneca spokesperson says the rest should arrive before April.

Without enough for everyone deemed immune-compromised, many hospitals used a lottery system to dispense doses to their highest-risk patients -- and no one knows what will happen later in the year when those people need another dose.

A study found Evusheld cut by 77% the chances of a COVID-19 infection, although that was before omicron appeared.

While that’s not perfect protection, one organ transplant recipient credits his Evusheld dose with preventing him from becoming seriously ill.

Just getting to the Evusheld appointment at a University of Washington clinic in Seattle, over an hour from his home, made Ray Hoffman nervous. He takes strong immune-suppressing drugs after recent liver and kidney transplants and never ventures out without his mask — but wound up with a masked but coughing cab driver. The next day Hoffman developed cold-like symptoms that turned out to be mild COVID-19, and his worried doctors told him the protective antibody injections likely made the difference.

“I’m just really happy that, fortunately for me, it was just a couple of days of feeling pretty bad and then that was the worst of it,” he said.

As long as Evusheld helps weakened patients avoid a severe infection, “that is definitely a win,” said UPMC’s Haidar. “I’m cautiously optimistic.”

Hansen, the suburban Pittsburgh patient, knows she can’t completely let down her guard but says Evusheld has eased her crippling fear.

“Maybe I can go out for lunch, maybe my husband and I can go do something instead of just sitting here in the house,” she said. “This drug needs to be made more available. It’s a great victory for me, but until everybody else that’s compromised gets it, it’s hard for me to celebrate.”

https://www.azfamily.com/news/us_world_news/most-vulnerable-still-in-jeopardy-as-covid-19-precautions-ease/article_ec87f273-28cb-5b2a-ae06-1a8d4ae6245f.html

California To Begin ‘Endemic’ Approach To COVID-19 Pandemic

 California health officials next week will outline a new approach to dealing with the coronavirus that assumes it’s here to stay, Gov. Gavin Newsom said Wednesday, while condemning organized disinformation efforts that limit vaccinations critical to California entering the next stage.

A disease reaches the endemic stage when the virus still exists in a community but becomes manageable as immunity builds.

“We’re looking back at the last two years — what worked, what didn’t, what we’ve all learned on the journey we’ve been on together,” Newsom said. That includes reviewing the impact on people and businesses from California’s rules, regulations and requirements, he said.

The World Health Organization declared the COVID-19 outbreak a pandemic on March 11, 2020. While still considered a pandemic, health experts have been expecting the coronavirus to eventually become endemic.

Newsom imposed the nation’s first statewide stay-home order that largely shut down the most populous state’s economy in the early months of the pandemic, followed by occupancy, masking and vaccination requirements that California is only now beginning to ease.

The new approach, he said, “allows for the kind of flexibility of thinking that is incumbent upon all of us as it relates to dealing with any endemic, particularly one as stubborn … as COVID.”

It will still include quarantines, testing of those who don’t show symptoms and other precautions, but those safeguards will vary based on what he said are more than a dozen “guideposts and measurements” designed to spot new surges and virus variants.

It also will include a continued emphasis on vaccinations and booster shots that can prevent serious illness, hospitalization and death, he said. About 700,000 Californians got their shots in the last seven days, he said, which is “not insignificant, but it’s not where we want to be.”

“We still have a lot of work to do to convince people that they should still get vaccinated, let alone boosted,” he said.

Nearly 74% of Californians age 5 and up are fully vaccinated and another nearly 9% are partially vaccinated. About 55% have had booster shots.

Another part of the approach will confront not only misinformation about the virus and vaccinations, but what he called “overt disinformation that continues to be perpetuated … by individuals, organizations, networks in this country that continue to put people’s lives at risk.”

Newsom said California health officials will also outline their revised approach to school mask-wearing requirements no later than Monday, after negotiating with school officials and teacher unions. Governors in New Jersey and other states this week moved to ease those mandates.

“I feel like this is utterly the question of the day” as officials worldwide struggle for answers, she said: “What does endemic management look like?”Newsom spoke after signing a series of bills into law, including one that requires larger companies to give workers up to two weeks of paid time off if they get sick from the coronavirus. The requirement was coupled with billions of dollars in business tax cuts and other assistance approved by state lawmakers on Monday.

Encouraging people to stay home when they are sick through things like paid leave is one of the keys to limiting the spread of an endemic virus, said Dr. Monica Gandhi, a professor of infectious diseases at the University of California, San Francisco.

Health officials could track coronavirus cases by testing wastewater for evidence of disease, she said, with increased genomic analysis if they spot a spike to see if a new variant has surfaced.

State officials could continue recommending vaccinations and more effective masks, particularly for those who are vulnerable. But an endemic approach likely means no more masking or vaccination mandates for entering businesses, schools or entertainment venues, and an increased emphasis on antibody, antiviral and other treatment options for those who cannot or will not be vaccinated.

And Gandhi expects the pandemic will leave a permanent emphasis on improved ventilation systems in buildings and the importance of leaving windows open even in winter.

Coronavirus vaccines are likely to be just one more routine childhood shot, and it will be rare for a child to avoid exposure to COVID-19 by age 5, when symptoms generally are mild, said Dr. Jeffrey Klausner, an epidemiologist at the University of Southern California.

Health officials will mainly direct their emphasis to controlling outbreaks in congested areas, like schools, nursing homes and prisons.

“We’ll be moving to a place where we have vaccines, we have treatments and it will become more normalized into our medical system and will not cause this kind of public health response where people felt society had to be shut down and people had to be required to be distanced or wear masks,” Klausner said.

There will continue to be regional and county variations, as evidenced already in both the San Francisco Bay Area and Southern California. That will inevitably cause confusion and increase pressure on health officials like those in Los Angeles County who said they may keep masking requirements through April, he said.

“We’ll live with the availability of COVID tests. Where people get a flu test, now they’ll get a COVID test as well. We’ll live with the availability of COVID treatments. We’ll live with people who are at very high risk for severe disease — whether they be older or unvaccinated or immunocompromised — will have to continue to work to protect themselves,” Klausner said.

But I think that the general population, many things will recede into the rearview mirror in terms of the day-to-day,” he said.

https://sacramento.cbslocal.com/2022/02/09/california-to-begin-endemic-approach-to-covid-19-pandemic/

More countries reopen to travelers, signaling a big shift in pandemic thinking

 Another day — another border reopens.      

In the past two weeks, a slew of countries announced plans to reopen or relax border restrictions. These include places that have maintained some of the strictest pandemic-related border controls in the world. 

The announcements come on the heels of a record-setting period of global infections. According to the World Health Organization, Covid-19 cases hit a new peak worldwide in late January, with more than 4 million cases registered in a single day. 

However, many countries are signaling that they can’t economically afford — or are no longer willing — to stay closed.

The pervasiveness of the omicron variant, which started spreading in countries — both open and closed — late last year, led people to question the utility of locked border policies.

In addition, more than half (54%) of the world’s population is now vaccinated, according to Our World in Data. Medical treatments can successfully thwart and treat severe infections. And, many experts are now “cautiously optimistic” — as top American medical advisor Dr. Anthony Fauci has stated — that a new phase of the pandemic may be within reach.

Australia

Arguably the biggest announcement of the past week came Monday, when Australia declared plans to reopen to vaccinated travelers from Feb. 21.

The news signaled the end to “Fortress Australia,” a moniker applied to the country’s controversial closed border policy that locked out foreigners and citizens alike.

The economic toll of Australia’s insular border policy was highlighted in January, when soon after backpackers were granted permission to enter, Prime Minister Scott Morrison pledged to refund some $350 in visa fees to those who moved swiftly. As it turned out, the about-face toward “working holiday maker” visa holders was part of an effort to reduce severe labor shortages.

Darryl Newby, co-founder of the Melbourne-based travel company Welcome to Travel, said the pandemic “not only affected the travel sector but every single industry” in Australia.

Pressure mounted when Covid infections skyrocketed in December, leaving an open question as to the purpose of keeping vaccinated and tested travelers locked out.

“Negative sentiment,” which began showing up in market research, may have been another factor, according to The Sydney Morning Herald. The article quoted Tourism Australia Managing Director Phillipa Harrison as saying the country went from being “envied” to “ridiculed” over its border policies, with some fearing lasting damage to Australia’s touristic appeal.

The state of Western Australia, home to Perth, is not reopening to either foreigners or Australian tourists yet. It scrapped plans to reopen amid a rise in Covid cases in January.

Percent of peak*: 38%

 *Reuters’ rolling 7-day daily case average compared with the country’s all-time highest infection rate.

New Zealand

Another so-called “fortress” announced plans to welcome back vaccinated international visitors.

Unlike Australia, New Zealand last week outlined a five-step phased reopening plan that won’t allow international travelers to enter until July, at the earliest. Vaccinated travelers must also self-isolate for 10 days upon arrival.

With some exceptions, the plan first welcomes citizens and residents to enter later this month, if they are traveling from Australia. Citizens and residents coming from other places, plus eligible workers, can enter in mid-March, followed by some visa holders and students in mid-April.

Vaccinated travelers from Australia and those from countries who don’t need visas — including those from Canada, the United States, Mexico, the United Kingdom, France, Germany, Israel, Chile, Singapore and the United Arab Emirates — can enter from July. Others will be allowed to visit starting in October.

Percent of peak: At peak and rising

Philippines

After closing its borders in March 2020, the Philippines announced plans to reopen today to vaccinated travelers from more than 150 countries and territories.  

The country suspended its color-coded country classification program in favor of opening to vaccinated travelers who test negative via a PCR test. Facility-based quarantines were also replaced with a requirement to self-monitor for seven days.

Covid cases in the Philippines peaked last month, with more than 300,000 daily cases at one point. Cases dropped as quickly as they rose, with 3,543 confirmed cases in the past 24 hours as at Feb. 10, according to the WHO.

Despite the surge, the Philippines’ Department of Tourism indicated the decision to reopen was related to economic hardship and, possibly, to match the policies of other Southeast Asian countries.

“The Department sees this as a welcome development that will contribute significantly to job restoration … and in the reopening of businesses that have earlier shut down during the pandemic,″ said Tourism Secretary Berna Romulo-Puyat in an article on the department’s website. “We are confident that we will be able to keep pace with our ASEAN neighbors who have already made similar strides to reopen to foreign tourists.”

Percent of peak: 19% and falling

Bali 

Despite rising infections, Bali, Indonesia, opened to vaccinated international travelers last week.

“It is known that currently the positivity rate is already above the WHO standard of 5% … the number of people who are checked and tested on a daily basis has also increased significantly,” according to a news release published on Jan. 31 on the country’s Coordinating Ministry for Maritime and Investment Affairs office.

Yet the decision to reopen to international travelers — which has been postponed in the past — was made to “re-invigorate Bali’s economy,” according to the website. 

Travelers face a five-day quarantine requirement, though they can isolate in one of 66 hotels, which include many of the island’s well-known luxurious resorts, such as The Mulia Resort and Villa and The St. Regis Bali Resort.

Bali, however, isn’t reopening to foreign tourists for the first time. It opened last October to travelers from 19 countries. Yet few people turned up due, in part, to a lack of international flights and the island’s stringent entrance requirements.   

Percent of peak (Indonesia): 68% and rising

Malaysia

Malaysia’s National Recovery Council on Tuesday recommended that the country reopen to international travelers as early as March 1, according to Reuters.

Travelers are not expected to have to quarantine on arrival, similar to tourism policies enacted by Thailand and Singapore.

Nearly 98% of Malaysia’s adult population is vaccinated, according to the country’s Ministry of Health, with more than two-thirds using vaccines produced by Pfizer or AstraZeneca, and one-third on the Chinese-made Sinovac vaccine.

Malaysia may be on its way toward an omicron-induced case peak. A steep uptick in daily cases began two weeks ago and has yet to decline.

Percent of peak: 41% and rising

Relaxing travel restrictions

Countries that are already open to international travelers are moving to further relax entrance requirements.

Though Europe is the regional leader in new Covid cases according to the WHO, countries such as Greece, France, Portugal, Sweden and Norway have announced plans to drop incoming test requirements for vaccinated travelers — though some apply only to EU residents.

Last week, the islands of Puerto Rico and Aruba enacted similar measures.

Other places are moving in the opposite direction. After shuttering bars and banning some incoming flights in late January, Hong Kong this week imposed new restrictions, including limiting public gatherings to two people. The restrictions are causing citywide food shortages, inflated prices and a rising public anger.  

China also reinstituted strict measures ahead of the Winter Olympic Games, with lockdowns affecting some 20 million people in January, according to the Associated Press.   

Though both relaxed border restrictions, the Philippines and Bali also announced heightened local restrictions this year.

https://www.cnbc.com/2022/02/10/australia-new-zealand-bali-malaysia-philippines-reopen-for-travel.html

Antihistamines for Postacute Sequelae of SARS-CoV-2 Infection

 Melissa D.PintoNatalieLambertCharles A.DownsHeatherAbrahimThomas D.HughesAmir M.RahmaniCandace W.BurtonRanaChakraborty

DOI: https://doi.org/10.1016/j.nurpra.2021.12.016

PDF: https://www.sciencedirect.com/science/article/pii/S155541552100547X/pdfft?md5=617f76b6e4e2636438979b0a31ad655d&pid=1-s2.0-S155541552100547X-main.pdf

Highlights

Postacute sequelae of SARS-Co-V 2 infection (PASC) is a public health crisis.

Currently there are no treatments for PASC.

Two patients with PASC report rapid symptom resolution with antihistamine use.

Antihistamines may be a high accessible therapy for PASC.

Abstract

Postacute sequelae of SARS-CoV2 (PASC) infection is an emerging global health crisis, variably affecting millions worldwide. PASC has no established treatment. We describe 2 cases of PASC in response to opportune administration of over-the-counter antihistamines, with significant improvement in symptoms and ability to perform activities of daily living. Future studies are warranted to understand the potential role of histamine in the pathogenesis of PASC and explore the clinical benefits of antihistamines in the treatment of PASC.

https://www.sciencedirect.com/science/article/pii/S155541552100547X

Omicron Death Rate Higher Than During Delta Surge

 With the Omicron variant now accounting for almost 100% of COVID-19 cases in the United States, the seven-day average of daily COVID-related deaths hit 2,600 recently, the highest rate in about a year, The Washington Post reported.

That's higher than the approximately 2,000 daily deaths last autumn during the Delta surge, but less than the 3,000 daily deaths last January, when COVID vaccines were not widely available, The Post data analysis said.

The Omicron variant generally causes less severe disease than other strains of COVID, but because it is so transmissible, Omicron is infecting higher raw numbers of people that previous strains.

"Even if on a per-case basis fewer people develop severe illness and die, when you apply a small percentage to a very large number, you get a substantial number," Jennifer Nuzzo, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health, told The Post.

The unvaccinated, people over 75, and people with underlying medical conditions are the groups most endangered by Omicron, The Post said. About half of the deaths in January 2022 were among people over 75, compared to about a third in September during the Delta surge.

The age trend is seen in Florida, said Jason Salemi, an epidemiologist at the University of South Florida College of Public Health. He told The Post that seniors accounted for about 85% of deaths last winter, about 60% during the Delta surge, and about 80% now during the Omicron surge.

The uptick in senior deaths may have occurred because seniors who got vaccinated in early 2021 didn't get boosted ahead of the Omicron surge, he said.

"Omicron may be less severe for younger people, but it will still find vulnerable seniors in our community," Salemi said. "That vaccination back in February isn't as effective now if you aren't boosted."

CDC data show that 95% of people in the United States over 65 have gotten at least one dose of vaccine, 88.5% are fully vaccinated, but only 62.5% have gotten a booster dose.

The COVID death rate is highest in the Midwest. During the last two months, Chicago reported more than 1,000 COVID deaths, almost as much as the December 2020 peak, The Post said. Minorities have been hit hard. About third of the city's population is Black but about half the COVID victims are Black, The Post said.

"It's been challenging because it goes up against the national narrative that omicron is nothing dangerous," said Allison Arwady, commissioner of the Chicago Department of Public Health.

In a Wednesday news briefing at The White House, CDC Director Rochelle Walensky, MD, provided slightly different statistics on COVID-related deaths. She said that the seven-day average of daily deaths was about 2,400, up 3% from the previous week.

The seven-day daily average of cases is about 247,300 cases per day, down 44% from the previous week, she said. Hospital admissions are about 13,000 daily, down 25% from the previous week.

Walensky said the Omicron variant now accounts for almost 100% of COVID viruses circulating in the United States.

Sources

The Washington Post: "Covid deaths highest in a year as omicron targets the unvaccinated and elderly"

CDC: "COVID-19 Vaccinations in the United States"

The White House: "Press Briefing by White House COVID-⁠19 Response Team and Public Health Officials"

https://www.medscape.com/viewarticle/968283

Biden touts $T-priced Build Back Better to whip inflation

 U.S. President Joe Biden on Thursday touted his plan to bring down the cost of prescription drugs as an antidote to high inflation on a day when government data showed consumer prices posted their biggest annual gain in 40 years in January.

Speaking at an event in Virginia, Biden said that proposals in his Build Back Better legislation would help bring down prices for families. The roughly $1.7 billion bill, which includes social spending and climate change provisions, is stalled and Biden has said previously that chunks, rather than the full package, could pass.

U.S. stock indexes dropped on Thursday after hot consumer price data raised fears of a hefty interest rate hike by the Federal Reserve. Consumer prices in the 12 months through January rose 7.5%, the biggest jump since February 1982, according to the Labor Department.

Biden’s plan, contained within the Build Back Better legislation, would give the federal government’s Medicare program for seniors authorization to negotiate drug prices for the first time.

“The fact is that if we are able to do the things I’m talking about here, it’ll bring down the cost for average families,” Biden said.

Noting that Build Back Better had already passed the House of Representatives, Biden said, “Now we just have to get it through the United States Senate. And we’re close.

“We can do even more to lower out-of-pocket prescription costs,” he said. “Under my proposal, we will hold drug companies accountable for the absurd price increases.”

The Democrats hold a razor-thin majority in the Senate, providing little leeway given that Republicans have been opposed to allowing the government to negotiate prescription drug costs.

High inflation and fatigue over the ongoing pandemic have hurt Biden’s popularity with Americans, causing concern for his fellow Democrats, who risk losing control of both houses of Congress in the November midterm elections.

Biden was joined by Democratic Representative Abigail Spanberger of Virginia, who could face a tough re-election fight in November, and Xavier Becerra, his secretary of Health and Human Services, who has faced criticism for a low-profile role in the administration’s fight against COVID-19. Biden praised Becerra for “how much he’s helped us make so much progress in getting people vaccinated” and making healthcare affordable.

https://www.amny.com/politics/biden-touts-plan-to-bring-down-drug-prices-as-helping-to-tame-inflation/