SARS-CoV-2 and COVID-19 (23)

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SARS-CoV-2 and COVID-19 (23)

Editado: Jul 14, 12:56pm

Deaths and Hospitalizations Averted by Rapid U.S. Vaccination Rollout
The Commonwealth Fund
Issue Briefs
July 7, 2021

The U.S. COVID-19 vaccination campaign has significantly curbed the virus’s spread and national death toll, saving an estimated 279,000 lives and averting up to 1.25 million hospitalizations

The Delta variant’s spread among unvaccinated populations could lead to a surge in new COVID-19 cases and reverse the downward trend of infections and deaths across the U.S...

Jul 15, 3:09am

Vaccine shortages and surging cases: A COVID-19 Africa snapshot (The New Humanitarian)

‘The biggest problem now is unavailability of the vaccine.’

A “third wave” of COVID-19 cases is filling hospital beds, exhausting oxygen stocks, and testing already overloaded health staff in the hardest-hit African countries...

The continent’s vaccine rollout is crawling, slowed in part by a critical shortage of doses. Countries are reliant on bilateral deals and the UN-backed COVAX facility, which aims to distribute vaccines equitably. But vaccine deliveries have not come close to matching needs, and almost ground to a halt in May and early June, according to the WHO. As a result, less than two percent of Africans are fully vaccinated, and the 50 million jabs administered so far account for just 1.6 percent of the global total. “Vaccine nationalism” – the hoarding of stock by Western governments – is part of the problem. But there have also been failings in the vaccine strategy of individual African countries – despite their proven ability to respond to other health emergencies, including HIV...

Jul 15, 9:47am

Hopeful News on Delta
The Delta variant is more contagious. It does not appear to be more severe.
David Leonhardt | July 15, 2021

There are two basic questions to ask about any variant of the Covid-19 virus: Is it more contagious than earlier versions of the virus? And is it more severe?

...After the Alpha variant {B.1.1.7, first reported in UK} began spreading late last year, many people assumed that it was both more contagious and more severe. The data soon told a different story, though: Alpha seems to be only more contagious.

...Now the story may be repeating itself with Delta {B.1.617.2, first reported in India}. It is significantly more contagious than even Alpha by almost every measure. It does not appear to be more severe, based on the data available so far.

...For unvaccinated older adults, Covid does not need to be additionally severe to be a mortal threat. The increased contagiousness of Delta has led to Covid surges across much of the globe, putting those unvaccinated adults at greater risk of contracting it.

As a result, vaccination has become even more important than it already was...As has often been the case with Covid, the story is not a simple one. Delta is a menacing development in some places and may make little difference in others...

Jul 15, 10:18am

Interesting bar graph from NYT (Dec 15, 2020) in article below:
Vaccine developers' "Immunizations promised to countries by income level"

Curious what such a graph would look like if instead of income level, #cases and #deaths?
Surely US was neediest (and most likely to generate VOCs) using that metric in winter of 2020/2021?

Which isn't to say it's not time to come about...

Vaccine nationalism – and how it could affect us all
Harry Kretchmer | 06 Jan 2021

...As COVID-19 vaccines are developed and approved, national leaders face a dilemma: which to prioritize – country or planet?

Both, most people would answer. Nonetheless, ‘‘vaccine nationalism,” where countries prioritize their own vaccine needs, is forecast to handicap not just the global health recovery but the economic one, too, with one report estimating its impact at more than $1 trillion per year...

Jul 15, 11:56am

Indonesia overtakes India as Asia's new Covid-19 epicenter
Masrur Jamaluddin and Joshua Berlinger | July 15, 2021

Jakarta, Indonesia (CNN) Indonesia reported 54,517 new cases of Covid-19, authorities said Wednesday, a single-day national record and dire warning sign for the world's fourth-most populous country...home to about 270 million people

...If the spread continues unabated, experts say it could push Indonesia's health care system to the brink of disaster.

...situation may be worse than the numbers show, because not enough people are getting tested for the virus. A survey published Saturday found that nearly half of the 10.6 million residents of Jakarta may have contracted Covid-19...

Jul 15, 12:07pm

Moderna vaxx appears to "efficiently stimulate the SARS-CoV-2–specific B-cell memory that has been generated by a prime dose of (Astrazeneca) vaccine 9 to 12 weeks earlier and that it may provide better protection against the B.1.351 variant (Beta, first reported in S Africa) than (Astrazeneca) boost."

Johan Normark et al. 2021. Heterologous ChAdOx1 nCoV-19 and mRNA-1273 Vaccination (Letter). NEJM July 14, 2021 DOI: 10.1056/NEJMc2110716

...We conclude that the mRNA-1273 vaccine can efficiently stimulate the SARS-CoV-2–specific B-cell memory that has been generated by a prime dose of ChAdOx1 nCoV-19 vaccine 9 to 12 weeks earlier and that it may provide better protection against the B.1.351 variant than a ChAdOx1 nCoV-19 boost. These data also suggest that mRNA vaccines (here in the form of mRNA-1273) may be useful for vaccination strategies in which a third dose is to be administered to persons who have previously received two doses of ChAdOx1 nCoV-19.

Jul 16, 8:17am

Africa’s Covid Crisis Deepens, but Vaccines Are Still Far Off
Abdi Latif Dahir and Josh Holder | July 16, 2021

Africa’s grim vaccine prognosis
Logistical roadblocks to vaccine delivery
Hesitancy and misinformation

... What could speed up vaccinations
The W.H.O. and the Africa C.D.C. have said they are hopeful vaccine deliveries — both bilateral donations and those from Covax — would gather momentum in the coming weeks. Aurélia Nguyen, the managing director of Covax, said last week that it expected to deliver 520 million vaccines to Africa by the end of the year, and 850 million by the end of the first quarter of 2022.

In the meantime, wealthy nations with excess doses have started sharing vaccines. In coordination with the African Union, Covax will soon deliver more than 20 million Johnson & Johnson and Pfizer-BioNTech vaccines donated by the United States to 49 African countries. France and Denmark have cumulatively donated hundreds of thousands of doses, while donations from Norway and Sweden are set to arrive in the coming weeks, Dr. Moeti said. G7 nations also announced in June their intention to share at least 870 million doses with low-income nations, including those in Africa.

Some nations are also looking to manufacturing to boost vaccine availability. Only seven African countries have companies operating in the vaccine-manufacturing chain, a recent study shows. Kenya has announced plans to build a plant that would package Covid-19 vaccines and distribute them regionally. Moroccan and Egyptian companies aim to start producing China’s Sinopharm and Sinovac vaccines, respectively, while Rwanda signed a deal with the European Union to bolster its vaccine manufacturing capabilities. A joint American-European plan would invest more than $700 million for a South African plant to produce more than 500 million doses of the Johnson & Johnson vaccine by the end of 2022.

The availability of more vaccine varieties globally could help curb the virus in Africa, said Ms. Taylor of the Duke Global Health Innovation Center. Novavax, based in the United States, announced last month that its two-dose inoculation provides protection against the virus. There’s also Corbevax, from the Indian firm Biological E, which has enormous manufacturing capacity and promising provisional data, she said.

But even as more people get inoculated, the efficacy of the particular vaccines being delivered to African countries remains a concern. That is the case in Seychelles, which raced to vaccinate its population of just over 100,000 with China’s Sinopharm, only to face a surge in coronavirus infections. While the W.H.O. and the Africa C.D.C. have said they are studying the situation in Seychelles, both institutions have for now encouraged countries to continue using any of the Covid-19 vaccines listed for emergency use.

Jul 16, 11:19am

"Cardiovascular drugs are not associated with poor COVID-19 outcomes in adjusted analyses. Patients should continue taking these drugs as prescribed."

Innocent G. Asiimwe et al. 2021. Cardiovascular drugs and COVID-19 clinical outcomes: A living systematic review and meta-analysis. Britisj journal clinical Pharmacology. First published: 07 June 2021.

Of 52 735 screened records, 429 and 390 studies were included in the qualitative and quantitative syntheses, respectively. The most-reported drugs were angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs) with ACEI/ARB exposure having borderline association with confirmed COVID-19 infection (OR 1.14...). Among COVID-19 patients, unadjusted estimates showed that ACEI/ARB exposure was associated with hospitalization (OR 1.76...), disease severity (OR 1.40...) and all-cause mortality (OR 1.22...) but not hospitalization length (mean difference −0.27...). After adjustment,* ACEI/ARB exposure was not associated with confirmed COVID-19 infection (OR 0.92...), hospitalization (OR 0.93...), disease severity (OR 1.05...) or all-cause mortality (OR 0.84...). Similarly, subgroup analyses involving only hypertensive patients revealed that ACEI/ARB exposure was not associated with confirmed COVID-19 infection (OR 0.93...), hospitalization (OR 0.84...), hospitalization length (mean difference −0.14...), disease severity (OR 0.92...) while it decreased the odds of dying (OR 0.76, 95% CI 0.65–0.88). A similar trend was observed for other cardiovascular drugs. However, the validity of these findings is limited by a high level of heterogeneity and serious risk of bias.

Cardiovascular drugs are not associated with poor COVID-19 outcomes in adjusted analyses. Patients should continue taking these drugs as prescribed....

*...2.8 Publication bias
Where enough (10 or more) studies were available for a given exposure–outcome combination, publication bias was assessed using the linear regression test of funnel plot asymmetry (Egger's test, implemented using the metabias function in the R meta package). A P-value of less than .1 was considered to suggest the presence of publication bias. When asymmetry was suggested by a visual assessment, we performed exploratory analyses to investigate and adjust for it (trim and fill analysis) using the trimfill function (R metafor package)...

Jul 16, 12:23pm

"Patients with Long COVID report prolonged, multisystem involvement and significant disability. By seven months, many patients have not yet recovered (mainly from systemic and neurological/cognitive symptoms), have not returned to previous levels of work, and continue to experience significant symptom burden."

Identification of Over 200 Long COVID Symptoms Prompts Call for UK Screening Programme
University College London | 15-Jul-2021

...Symptom prevalence - summary

Top three symptoms: Fatigue 98.3%, post-exertional malaise (PEM) 89.0%, and brain fog and cognitive dysfunction in 85.1% (3,203) of respondents.

The top three most debilitating symptoms listed by patients were: fatigue (2,652 patients), breathing issues (2,242), and cognitive dysfunction (1,274).

Symptoms remaining at six months

A total of 2,454 (65.2%) respondents were experiencing symptoms for at least six months. Over 50% experienced the following symptoms: fatigue (80%) post-exertional malaise (73.3%), cognitive dysfunction (58.4%), sensorimotor symptoms (55.7%), headaches (53.6%), and memory issues (51%). In addition, between 30%-50% of respondents were experiencing the following symptoms after six months of symptoms: insomnia, heart palpitations, muscle aches, shortness of breath, dizziness and balance issues, sleep and language issues, joint pain, tachycardia, and other sleep issues.


Hannah E. Davis et al. 2021. Characterizing long COVID in an international cohort: 7 months of symptoms and their impact. EClinicalMedicine Published:July 15, 2021. DOI:

For the majority of respondents (>91%), the time to recovery exceeded 35 weeks. During their illness, participants experienced an average of 55.9+/- 25.5 (mean+/-STD) symptoms, across an average of 9.1 organ systems. The most frequent symptoms after month 6 were fatigue, post-exertional malaise, and cognitive dysfunction. Symptoms varied in their prevalence over time, and we identified three symptom clusters, each with a characteristic temporal profile. 85.9% of participants (95% CI, 84.8% to 87.0%) experienced relapses, primarily triggered by exercise, physical or mental activity, and stress. 86.7% (85.6% to 92.5%) of unrecovered respondents were experiencing fatigue at the time of survey, compared to 44.7% (38.5% to 50.5%) of recovered respondents. 1700 respondents (45.2%) required a reduced work schedule compared to pre-illness, and an additional 839 (22.3%) were not working at the time of survey due to illness. Cognitive dysfunction or memory issues were common across all age groups (~88%). Except for loss of smell and taste, the prevalence and trajectory of all symptoms were similar between groups with confirmed and suspected COVID-19.

Patients with Long COVID report prolonged, multisystem involvement and significant disability. By seven months, many patients have not yet recovered (mainly from systemic and neurological/cognitive symptoms), have not returned to previous levels of work, and continue to experience significant symptom burden.

Jul 16, 12:59pm

David Frum @davidfrum | 11:53 AM · Jul 16, 2021:
Many state governments are actively making things worse.

ALABAMA has forbidden private businesses to refuse service to unvaccinated people.
Alabama SB267 | 2021 | Regular Session
Bill Text (2021-05-17) Vaccine passports, prohibited, entities prohibited from requiring an individual to receive an immunization as a condition for receiving government benefits or services ...

ARKANSAS has - among many other coercive measures -
forbidden private insurers to charge higher premiums to those who refuse vaccination.

FLORIDA By executive order, has forbidden privately owned businesses to demand proof of vaccination from patrons or customers.

MONTANA forbids *HEALTH CARE PROVIDERS* from requiring COVID-19 vaccination$BSIV.ActionQuery?P_BILL_NO1=702&P_BLT...


Lorenzo @usa421 | 12:21 PM · Jul 16, 2021:
In Tennessee, health officials on Friday were ordered to halt outreach to adolescents for all vaccines —
not just the coronavirus shot — after pressure from Republican lawmakers, as The Tennessean first reported.
That prohibition extends to vaccines for flu, human papillomavirus

Michelle Fiscus, Tennessee’s former top vaccine official, said in a statement Monday that she had just been fired for promoting immunizations.

Jul 17, 6:58am

FDA grants priority review to Pfizer/BioNTech Covid-19 vaccine; agency official says approval decision expected within two months
Jamie Gumbrecht | July 16, 2021

...The companies are seeking approval for the two-dose series for people age 16 and older, and expects to apply for approval for people ages 12 to 15 when the data are available. Moderna has also begun submitting data for approval of its two-dose coronavirus vaccine, and Johnson & Johnson is expected to seek FDA approval.

While the FDA must make its decision by January, it's likely to come much sooner, acting FDA commissioner Dr. Janet Woodcock said. "...the review of this BLA has been ongoing, is among the highest priorities of the agency, and the agency intends to complete the review far in advance of the ... Goal Date"...

Jul 17, 7:31am

How Is The COVID-19 Vaccination Campaign Going In Your State?
Audrey Carlsen, Pien Huang, Zach Levitt, Daniel Wood | July 15, 2021

This page is updated on weekdays.

How have vaccination rates changed over time?
Looking ahead: Projected dates for vaccination coverage

Editado: Jul 18, 7:31am

Tucker (anti-vaxxer) Carlson, Murdoch's bought-and-paid-for mouthpiece, appears to be on a daily mission to kill off Trump voters!!! ~ unintended consequences???

Thank God modern-day GOPers, Fox News and the Internet were not around when the polio and measles outbreaks were afflicting the US.

Jul 19, 7:58am

"We're not out of the woods yet." (cartoon)
- Steve Breen @sdutBreen, Editorial cartoonist for the San Diego Union-Tribune.

Jul 19, 12:01pm

Pediatric group recommends masks for students over 2 when schools reopen
Justine Coleman | 07/19/21


News Release
American Academy of Pediatrics Updates Recommendations for Opening Schools in Fall 2021
July 19, 2021

In updated guidance for the 2021-22 school year, the American Academy of Pediatrics strongly recommends in-person learning and urges all who are eligible to be vaccinated to protect against COVID-19.

In addition to vaccinations, the AAP recommends a layered approach to make school safe for all students, teachers and staff in the guidance here. That includes a recommendation that everyone older than age 2 wear masks, regardless of vaccination status. The AAP also amplifies the Centers for Disease Control and Prevention’s recommendations for building ventilation, testing, quarantining, cleaning and disinfection in the updated guidance...

Jul 19, 12:10pm

Federal appeals court ruling will allow CDC to enforce Covid rules on cruise ships
Kay Jones and Chuck Johnston | July 18, 2021

A federal court has temporarily blocked a lower court's ruling and will allow the Centers for Disease Control and Prevention to continue to implement safety protocols on the cruise industry.

...Saturday's ruling by the Court of Appeals for the Atlanta-based Eleventh Circuit came down to a 2-1 vote. Opinions had not been filed as of Sunday morning explaining the decision.

The motion filed by the CDC in the appeal said that the state of Florida ignored "what the protocols actually require: conventional communicable-disease control measures for cruise ships engaged in international travel, which fall easily within the CDC's longstanding statutory and regulatory authority." It also said the state "disregards the threat to public health that would arise if cruise ship operators were at liberty to ignore the CDC guidance or to act without oversight from public-health authorities."...

Editado: Jul 19, 12:22pm
‘People Are Dying’ Because of Them: Mika Brzezinski Tears Into Trump, ‘Evil’ Media Allies for Creating a Pandemic Death Cult

My take ~ Voters in the Trump cult most likely lack health insurance coverage. They, therefore, don't have doctors they can visit. They rely on people like Tucker Carlson and his ilk for vaccine information, instead. TC and his ilk only care about viewer/listener numbers and moolah.

Jul 19, 12:40pm

Shingai Machingaidze & Charles Shey Wiysonge. 2021. Understanding COVID-19 vaccine hesitancy.
Nature Medicine (16 July 2021)

... ‘the 5C model of the drivers of vaccine hesitancy’, provides five main individual person–level determinants for vaccine hesitancy: confidence, complacency, convenience (or constraints), risk calculation, and collective responsibility...

Included in the analysis were seven studies in low-income countries (Burkina Faso, Mozambique, Rwanda, Sierra Leone and Uganda), five studies in lower-middle-income countries (India, Nepal, Nigeria and Pakistan) and one study in an upper-middle-income country (Colombia). The authors compare these findings with those from two countries at the forefront of vaccine research and development: Russia and the United States. Overall, they found that the average acceptance rate across the full set of studies in LMICs was 80.3%, with lowest acceptance in Burkina Faso (66.5%) and Pakistan (66.5%); moreover, the acceptance rate in every sample from LMICs was higher than that of samples from the United States (64.6%) and Russia (30.4%)5. The data show that vaccine acceptance is explained mainly by an interest in personal protection against COVID-19, whereas concerns about side effects are the most common reasons for hesitancy, and health workers are the most trusted sources of guidance about vaccines against COVID-19. It is, however, important to note that reported intentions may not always translate into vaccine uptake.

Another survey was conducted by the Africa Centres for Disease Control and Prevention...found that the majority of respondents in Africa (79%) would be vaccinated against COVID-19 if it were deemed safe and effective. Perhaps it may be that lived experience in LMICs, where many vaccine-preventable infectious diseases are still causing thousands of deaths annually, results in higher perceived need for or value of vaccines....

With the wide availability of smartphones, ... presents several challenges in the form of misinformation (including ‘anti-vaxx’ messaging) and incomplete information, as well as inconsistent and complicated scientific information that may be difficult to understand....

The reasons for COVID-19 vaccine acceptance and hesitancy remain complex. As new SARS-CoV-2 variants emerge, adding further complexity, and new vaccines come to the market, it will be important to maintain a delicate balance in communicating what is known and acknowledging the uncertainties that remain....

Although issues of vaccine-distribution equity remain a considerable challenge for LMICs that require urgent intervention, the lag in the rollout of vaccines against COVID-19 in these regions does present a window of opportunity for addressing issues of hesitancy...

Julio S. Solís Arce, Shana S. Warren, {…}Saad B. Omer. 2021. COVID-19 vaccine acceptance and hesitancy in low- and middle-income countries. Nature Medicine (2021)

Widespread acceptance of COVID-19 vaccines is crucial for achieving sufficient immunization coverage to end the global pandemic, yet few studies have investigated COVID-19 vaccination attitudes in lower-income countries, where large-scale vaccination is just beginning. We analyze COVID-19 vaccine acceptance across 15 survey samples covering 10 low- and middle-income countries (LMICs) in Asia, Africa and South America, Russia (an upper-middle-income country) and the United States, including a total of 44,260 individuals. We find considerably higher willingness to take a COVID-19 vaccine in our LMIC samples (mean 80.3%; median 78%; range 30.1 percentage points) compared with the United States (mean 64.6%) and Russia (mean 30.4%). Vaccine acceptance in LMICs is primarily explained by an interest in personal protection against COVID-19, while concern about side effects is the most common reason for hesitancy. Health workers are the most trusted sources of guidance about COVID-19 vaccines. Evidence from this sample of LMICs suggests that prioritizing vaccine distribution to the Global South should yield high returns in advancing global immunization coverage. Vaccination campaigns should focus on translating the high levels of stated acceptance into actual uptake. Messages highlighting vaccine efficacy and safety, delivered by healthcare workers, could be effective for addressing any remaining hesitancy in the analyzed LMICs.

Jul 19, 12:45pm

Antibodies to SARS-CoV-2, the virus that causes COVID-19, remain present in the body at least 9 months after the original infection.

Ilaria Dorigatti, Enrico Lavezzo, {…} Andrea Crisanti. 2021. SARS-CoV-2 antibody dynamics and transmission from community-wide serological testing in the Italian municipality of Vo’. Nature Communications volume 12, Article number: 4383 (19 July 2021)

In February and March 2020, two mass swab testing campaigns were conducted in Vo’, Italy. In May 2020, we tested 86% of the Vo’ population with three immuno-assays detecting antibodies against the spike and nucleocapsid antigens, a neutralisation assay and Polymerase Chain Reaction (PCR). Subjects testing positive to PCR in February/March or a serological assay in May were tested again in November. Here we report on the results of the analysis of the May and November surveys. We estimate a seroprevalence of 3.5% ... in May. In November, 98.8% ... of sera which tested positive in May still reacted against at least one antigen; 18.6% ... showed an increase of antibody or neutralisation reactivity from May. Analysis of the serostatus of the members of 1,118 households indicates a 26.0% ... Susceptible-Infectious Transmission Probability. Contact tracing had limited impact on epidemic suppression.

Jul 19, 12:50pm

Azithromycin — a broad-spectrum antibiotic that doctors worldwide prescribe for the treatment of COVID-19 outside of the hospital — is no more effective in treating the disease caused by SARS-CoV-2 than a placebo.

Catherine E. Oldenburg et al. 2021. Effect of Oral Azithromycin vs Placebo on COVID-19 Symptoms in Outpatients With SARS-CoV-2 InfectionA Randomized Clinical Trial. JAMA. Published online July 16, 2021. doi:10.1001/jama.2021.11517

Results Among 263 participants who were randomized ..., 76% completed the trial. The trial was terminated by the data and safety monitoring committee for futility after the interim analysis. At day 14, there was no significant difference in proportion of participants who were symptom free (azithromycin: 50%; placebo: 50%; prevalence difference, 0%...). Of 23 prespecified secondary clinical end points, 18 showed no significant difference. By day 21, 5 participants in the azithromycin group had been hospitalized compared with 0 in the placebo group (prevalence difference, 4% ....

Conclusions and Relevance Among outpatients with SARS-CoV-2 infection, treatment with a single dose of azithromycin compared with placebo did not result in greater likelihood of being symptom free at day 14. These findings do not support the routine use of azithromycin for outpatient SARS-CoV-2 infection.

Jul 20, 8:49am

"perturbations associated with COVID-19 overlap with those found in chronic brain disorders and reside in genetic variants associated with cognition, schizophrenia and depression."

Andrew C. Yang et al. 2021. Dysregulation of brain and choroid plexus cell types in severe COVID-19
Nature (21 June 2021)

Although SARS-CoV-2 primarily targets the respiratory system, patients with and survivors of COVID-19 can suffer neurological symptoms.... However, an unbiased understanding of the cellular and molecular processes that are affected in the brains of patients with COVID-19 is missing. Here we profile 65,309 single-nucleus transcriptomes from 30 frontal cortex and choroid plexus samples across 14 control individuals (including 1 patient with terminal influenza) and 8 patients with COVID-19. Although our systematic analysis yields no molecular traces of SARS-CoV-2 in the brain, we observe broad cellular perturbations indicating that barrier cells of the choroid plexus sense and relay peripheral inflammation into the brain and show that peripheral T cells infiltrate the parenchyma. We discover microglia and astrocyte subpopulations associated with COVID-19 that share features with pathological cell states that have previously been reported in human neurodegenerative disease... Synaptic signalling of upper-layer excitatory neurons—which are evolutionarily expanded in humans... and linked to cognitive function...—is preferentially affected in COVID-19. Across cell types, perturbations associated with COVID-19 overlap with those found in chronic brain disorders and reside in genetic variants associated with cognition, schizophrenia and depression. Our findings and public dataset provide a molecular framework to understand current observations of COVID-19-related neurological disease, and any such disease that may emerge at a later date.

Jul 20, 8:05pm

J.&J. Vaccine May Be Less Effective Against Delta, Study Suggests
Many who received the shot may need to consider boosters, the authors said. But federal health officials do not recommend second doses.
Apoorva Mandavilli | July 20, 2021

The coronavirus vaccine made by Johnson & Johnson is much less effective against the Delta and Lambda variants than against the original virus, according to a new study*...
posted online on Tuesday.

Although troubling, the findings result from experiments conducted with blood samples in a laboratory, and may not reflect the vaccine’s performance in the real world. But the conclusions add to evidence that the 13 million people inoculated with the J.&J. vaccine may need to receive a second dose — ideally of one of the mRNA vaccines made by Pfizer-BioNTech or Moderna, the authors said.

The conclusions are at odds with those from smaller studies published by Johnson & Johnson earlier this month suggesting that a single dose of the vaccine is effective against the variant even eight months after inoculation.

The new study has not yet been peer reviewed nor published in a scientific journal. But it is consistent with observations that a single dose of the AstraZeneca vaccine — which has a similar architecture to the J.&J. vaccine — shows only about 33 percent efficacy against symptomatic disease caused by the Delta variant...

Takuya Tada et al. 2021. Comparison of Neutralizing Antibody Titers Elicited by mRNA and Adenoviral Vector Vaccine against SARS-CoV-2 Variants. BioRxiv (July 19, 2021) doi:

This article is a preprint and has not been certified by peer review

The increasing prevalence of SARS-CoV-2 variants has raised concerns regarding possible decreases in vaccine efficacy. Here, neutralizing antibody titers elicited by mRNA-based and an adenoviral vector-based vaccine against variant pseudotyped viruses were compared. BNT162b2 and mRNA-1273-elicited antibodies showed modest neutralization resistance against Beta, Delta, Delta plus and Lambda variants whereas Ad26.COV2.S-elicited antibodies from a significant fraction of vaccinated individuals were of low neutralizing titer ... The data underscore the importance of surveillance for breakthrough infections that result in severe COVID-19 and suggest the benefit of a second immunization following Ad26.COV2.S to increase protection against the variants.

Editado: Jul 21, 8:50am
Rand Paul Tells Hannity He’s Sending Letter to DOJ ‘Asking for a Criminal Referral’ Into Fauci

My take ~ Trump has inadvertently done the country one grand favor over the last several years. He has made it possible for us to view the despicable, hidden sides of modern-day GOPers.

Jul 23, 7:59am

Florida, Texas and Missouri account for 40% of new US cases: Latest COVID-19 updates
Jeanine Santucci | July 23, 2021

As the number of COVID-19 cases across the country is rising, three states have contributed to over 40% of all recent positive cases, according to the White House on Thursday.

White House COVID-19 Response Coordinator Jeff Zients said Florida, Texas and Missouri were contributing the highest number of cases, with Florida accounting for one in five positive cases for the second week in a row.

Those states also have some of the lowest rates of vaccination, Zients said, adding that "within communities, these cases are primarily among unvaccinated people."

But in Florida and other states with high case numbers, he said, such as Arkansas, Louisiana, Missouri and Nevada, people are also becoming vaccinated at greater rates than the rest of the country, an encouraging trend...

Jul 23, 10:45am

Isaac Bogoch (MD Toronto) @BogochIsaac | 8:22 PM · Jul 22, 2021
Spacing Pfizer #COVID19 shots boosts neutralizing antibody levels.

"I think the 8 week is about the sweet spot."
-Prof. Susanna Dunachie, joint chief investigator of the study

Spacing Pfizer COVID shots boosts antibody levels after initial drop -study | July 22, 2021

..."For the longer dosing interval ... neutralising antibody levels against the Delta variant were poorly induced after a single dose, and not maintained during the interval before the second dose," the authors of the study, which is being led by the University of Oxford, said.

"Following two vaccine doses, neutralising antibody levels were twice as high after the longer dosing interval compared with the shorter dosing interval."...


Two doses of Pfizer, AstraZeneca shots effective against Delta variant: study
Reuters | July 22, 2021

...Two shots of AstraZeneca vaccine were 67% effective against the Delta variant, up from 60% originally reported, and 74.5% effective against the Alpha variant, compared to an original estimate of 66% effectiveness...The full study published on Wednesday found that one dose of Pfizer's shot was 36% effective, and one dose of AstraZeneca's vaccine was around 30% effective...

Jul 24, 7:31am

Eric Topol @EricTopol | 1:07 PM · Jul 23, 2021:
A new (preprint) study* in 61 people w/ kidney transplants and 3-doses of mRNA vaccines.
It's safe and it helps with both antibody response, T cells, and vs variants
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Eric Topol @EricTopol | 3:44 PM · Jul 23, 2021:
And in @JAMANetworkOpen today similar findings in 159 individuals**
with kidney transplants and 3rd dose mRNA
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*Filippo Massa et al. 2021. Safety and Cross-Variant Immunogenicity of a Three-Dose COVID-19 mRNA Vaccine Regimen in Kidney Transplant Recipients. Lancet preprint. 27 Pages. Posted: 22 Jul 2021.

...Interpretation: A third dose of the BNT162b2 vaccine increases both SARS-CoV-2-specific humoral and cellular responses in KT recipients with an acceptable tolerability profile. However, neutralizing antibody titres remain low after three doses, especially against variants of concern, and barrier measures and vaccination of the relatives remain essential.

** Ilies Benotmane etal. 2021. Antibody Response After a Third Dose of the mRNA-1273 SARS-CoV-2 Vaccine in Kidney Transplant Recipients With Minimal Serologic Response to 2 Doses (Research Letter). JAMA. Published online July 23, 2021. doi:10.1001/jama.2021.12339

This study found that a third dose of mRNA-1273 vaccine induced a serologic response in 49% of kidney transplant recipients who did not respond after 2 doses. The findings in this large group of kidney transplant recipients are in accordance with other studies of solid organ transplant recipients.... However, 51% of the patients did not develop anti–SARS-CoV-2 antibodies after the third dose, especially those receiving triple immunosuppression. The possibility that patients developed cellular immunity capable of conferring protection against severe disease was not assessed. However, the occurrence of severe COVID-19 in some vaccinated transplant recipients may suggest a lack of immunity...

In conclusion, the use of a third dose of vaccine may be considered in organ transplant recipients.

Editado: Jul 24, 10:33am

Wonder if breakthrough, but milder cases of COVID due to shift to T cell protection?
T cells target infected CELLS, not virus itself, so one needs to have infection going on for T cells to target?

Thread on Israeli data /need for boosters:

Eric Feigl-Ding (epidemiologist) @DrEricDing | 4:29 PM · Jul 23, 2021
...ANOTHER EFFICACY DROP—Not good—Israel Ministry of Health just released another vaccine efficacy update due to #DeltaVariant—
only 39% Pfizer VE for #COVID19 infection,
40.5% for symptomatic,
88% for hospitalization,
91% for ICU/low oxygen/ death.
More—waning efficacy too—Thread
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Vincent Rajkumar (Mayo MD) @VincentRK | 9:44 AM · Jul 24, 2021:
Real world data. It raises the question of what a year from now will look like if the trend continues.
People are still highly protected from severe disease. But data suggest we will likely need
boosters, starting with elderly and immunocompromised individuals.

Quote Tweet:
Eric Feigl-Ding @DrEricDing | 4:33 PM · Jul 23, 2021:
4) Let’s now look at breakthrough rates by when someone got their vaccination— you clearly clearly see than January vaccinated people currently have the most breakthrough per capita, followed by Feb… and so on. This is partly age (elderly vaxxed first) but possibly also waning.

Image-breakthrough rate Jan 2021-July 18, 2021

Jul 24, 10:38am

Biden Officials Now Expect Vulnerable Americans to Need Booster Shots
The growing consensus that at least some Americans will need a booster is partly tied to research suggesting that Pfizer’s vaccine is less effective after about six months.
Sharon LaFraniere | July 23, 2021

WASHINGTON — Biden administration health officials increasingly think that vulnerable populations will need booster shots even as research continues into how long the coronavirus vaccines remain effective.

Senior officials now say they expect that people who are 65 and older or who have compromised immune systems will most likely need a third shot from Pfizer-BioNTech or Moderna, two vaccines based on the same technology that have been used to inoculate the vast majority of Americans thus far. That is a sharp shift from just a few weeks ago, when the administration said it thought there was not enough evidence to back boosters yet.

On Thursday, a key official at the Centers for Disease Control and Prevention said the agency is exploring options to give patients with compromised immune systems third doses even before regulators broaden the emergency use authorization for coronavirus vaccines, a step that could come soon for the Pfizer vaccine...

...Pfizer’s continuing global study of its clinical trial participants shows that four to six months after the second dose, the vaccine’s effectiveness against symptomatic infection drops from a high of 95 percent to 84 percent, according to the company.

Data from the Israeli government, which has fully vaccinated more than half of its population with Pfizer doses since January, also points to a downward trend in effectiveness over time, although administration officials are viewing that data cautiously because of wide margins for error...

Jul 24, 12:59pm

Vincent Rajkumar (Mayo MD) @VincentRK | 10:44 AM · Jul 24, 2021:
The lack of FDA approval for mRNA COVID vaccines is preventing doctors like me from telling immunocompromised patients what we really think they should do with regards to a boosters.

I get asked every day.

Ditto with J&J single dose recipients. Especially elderly and immunocompromised living in high incidence areas.

With approval, doctors have liberty of recommending off label treatments. Under EUA we are all unsure what we can legally do and what we cannot.

At least a clarification on that question would help.

Jul 24, 4:02pm

Lisa M Brosseau (bio-aerosol scientist) @brosseau_lisa | 10:47 AM · Jul 24, 2021:
11 yrs ago I did a study with naive subjects donning N95 filtering facepiece respirators.
76-86% of subjects were able to get a fit factor of 10 (10% leakage),
which is better than any face covering or most surgical masks could achieve.
Image-T III ( )

Lisa M. Brosseau. 2010. Fit Testing Respirators for Public Health Medical Emergencies. Journal of Occupational and Environmental Hygiene Volume 7, 2010 - Issue 11 Pages 628-632 | Published online: 16 Sep 2010

Concerns about limiting pandemic infectious disease transmission when vaccines are not yet available prompted the Food and Drug Administration (FDA) to develop guidance for marketing respirators for use in public health medical emergencies. This project describes the results of filtering facepiece fit tests using 35 untrained, inexperienced subjects meeting the face size criteria of the National Institute for Occupational Safety and Health bivariate panel, in preparation for an FDA 510(k) application. Quantitative fit factors were measured for each subject on two replicates of each of two N95 filtering facepiece respirators (A and B) using the TSI Portacount Plus with N95 Companion. Subjects received no training or assistance with donning and had no prior experience with wearing respirators. The panel consisted of 20 females and 15 males; 80% were between 18 and 34 years of age. Almost all subjects properly placed the respirator on the face and formed the nose clip. Straps were improperly placed 25% of the time. Users reviewed the donning instructions 73% of the time and performed a seal check 80% of the time. Leaks were observed during 80% of the fit tests, most frequently at the chin during the head up and down exercise. For Respirator A, all but one subject had a 95% fit factor greater than 2 (the minimum required by FDA); one subject had a 95% fit factor of 1.5. All subjects had a 95% fit factor greater than 2.5 for Respirator B. Geometric mean fit factors ranged from 19–28 for these two respirators, and a majority of subjects were able to achieve a fit factor of 10 most of the time. However, fewer than 25% of subjects received the fit factor of 100 expected in workplace settings.

Jul 25, 8:50am

The problem with Delta variant: "So Delta not only spreads faster, but transmission is hidden almost two-thirds of the time. This is why we need to treat everyone as infected, and continue to distance and mask. It’s also why asymptomatic testing is an important layer if we truly want to crush this pandemic."

Ryan Imgrund (biostatistician) @imgrund | 7:42 PM · Jul 24, 2021:

Mathematically, I want to emphasize the problem with the Delta variant.
First, two terms you must know:
INCUBATION PERIOD - the time from infection to illness onset
GENERATION TIME - the time between infection of the primary case and secondary cases
Image-graph ( )

One reason we are “still in this thing” is because you’re infectious while in the incubation period (i.e. presymptomatic phase).
This can lead to presymptomatic transmission - which happens, with Delta, 65% of the time.
Image-graph ( )

Therefore, you can pass a COVID symptom screening checklist and still be in a position to transmit to others.
This is why masking and distancing are still so important.
Image-infographic ( )

When two people have COVID-19, it can be difficult to determine who gave it to who.
COVID-19 can have a negative SERIAL INTERVAL, where person A shows symptoms before person B, yet person B transmitted the infection to A.
Image 1 ( )
Image 2 ( )

The Delta variant adds a whole new twist.
I took the Generation Time of several Delta variant case pairs and fit it to a Gamma Distribution.
Image 1 ( )
Image 2 ( )

I also fit the Incubation Period for several Delta cases into a Log-Normal Distribution curve.
Image 1 ( )
Image 2 ( )

For your comparison, I placed these on two graphs with identical axes.
The mean incubation period and generation time of the original strain were 5.2 and 4.1.
For Delta, it’s 4.4 and 2.9.
Image 1- Generation Time ( )
Image 2- Incubation Period ( )

So while it’s a good thing people show symptoms 0.8 days faster (i.e. smaller incubation period), the secondary infectee now transmits 1.1 days quicker.

So Delta not only spreads faster, but transmission is hidden almost two-thirds of the time.
This is why we need to treat everyone as infected, and continue to distance and mask
It’s also why asymptomatic testing is an important layer if we truly want to crush this pandemic.

Jul 25, 11:22am

Eric Topol @EricTopol | 10:22 AM · Jul 25, 2021:
There isn't anything good about the Delta variant and its waves, except that
—It descends, sometimes sharply
(especially for marked reduction of hospitalizations and deaths)

Image--graph daily cases per million, by countries

Jul 26, 6:53am

Lots of suggestions in this thread for substitute for N95 masks that be socially acceptable for 13YO girl:

Stacey Reiman @mspanish | 8:14 PM · Jul 25, 2021:
My daughter (13) says wearing an n95 to school would make her an instant outcast.

While I doubt that, I'm trying to find anything else with ear loops that actually has a decent seal and filtration that would be acceptable.

Anybody know of anything? Links appreciated!

Jul 26, 7:24am

Intranasal vaccines:

Eric Topol @EricTopol | 11:42 PM · Jul 25, 2021:
I still cannot understand why intranasal vaccines have not been given top priority,
given their remarkable allure to block Covid transmission; an excellent explainer for why and status*

Image-diagram routes of vaxx,, nasal, musculature

Image-table, 7 intranasal vaxx in clinical trials, only Cuba beyond Phase 1

We've tried to advocate with no success to date**

* Frances E. Lund and Troy D. Randall. 2021. Scent of a vaccine (Perspective). Science 23 Jul 2021: Vol. 373, Issue 6553, pp. 397-399. DOI: 10.1126/science.abg9857

...Ultimately, the goal of vaccination is to elicit long-lived protective immunity. However, the duration of serum antibody responses varies considerably, depending on poorly understood attributes of the initiating antigen (14). Mucosal antibody responses are often considered short-lived, but their actual duration may depend on how antigen is encountered. Similarly, recirculating central-memory T cells are self-renewing and persist for long periods, whereas lung-resident memory T cells wane relatively rapidly—more so for CD8+ T cells than for CD4+ T cells. Thus, intranasal vaccines may have to balance the goal of local immunity in the respiratory tract with the longevity of systemic immunity. However, effective vaccination strategies need not be restricted to a single route. Indeed, memory cells primed by intramuscular vaccination can be “pulled” into mucosal sites by subsequent mucosal vaccination (15). Thus, the ideal vaccination strategy may use an intramuscular vaccine to elicit a long-lived systemic IgG response and a broad repertoire of central memory B and T cells, followed by an intranasal booster that recruits memory B and T cells to the nasal passages and further guides their differentiation toward mucosal protection, including IgA secretion and tissue-resident memory cells in the respiratory tract.


** Daniel P. Oran, Eric Topol. 2021. To Beat COVID, We May Need a Good Shot in the Nose: Intranasal vaccines might stop the spread of the coronavirus more effectively than needles in arms. Scientific American. March 1, 2021.

...Although injected vaccines do reduce symptomatic COVID cases, and prevent a lot of severe illness, they may still allow for asymptomatic infection. A person might feel fine, but actually harbor the virus and be able to pass it on to others. The reason is that the coronavirus can temporarily take up residence in the mucosa—the moist, mucus-secreting surfaces of the nose and throat that serve as our first line of defense against inhaled viruses. Research with laboratory animals suggests that a coronavirus infection can linger in the nose even after it has been vanquished in the lungs. That means it might be possible to spread the coronavirus after vaccination.

Enter the intranasal vaccine, which abandons the needle and syringe for a spray container that looks more like a nasal decongestant. With a quick spritz up the nose, intranasal vaccines are designed to bolster immune defenses in the mucosa, triggering production of an antibody known as immunoglobulin A, which can block infection. This overwhelming response, called sterilizing immunity, reduces the chance that people will pass on the virus.

...Intranasal vaccines have some practical advantages, too. Unlike an injection, a nasal spray is painless. The absence of a needle might allay the concerns of those who are now hesitant about vaccination. An intranasal vaccine can also be self-administered at home, with minimal instruction. And some of the intranasal vaccines now being tested require no refrigeration, making them easy to transport and store, especially in l0w-resource countries.

All of these factors will become even more important if periodic booster vaccinations are needed to protect us against emerging coronavirus variants. Simply mailing someone a nasal spray is far more convenient than arranging for an in-person injection.

...We will bring the COVID pandemic under control when we successfully reduce the spread of the coronavirus to extremely low levels. But the presence of vaccinated asymptomatic carriers could make this very difficult to do...

Jul 26, 8:44am

Florian Krammer (virologist) @florian_krammer | 7:37 AM · Jul 26, 2021
Early this year, due to an outbreak with B.1.351 (1st reported in S Africa),
a whole district in Austria (Schwaz in Tirol) (~70K) was mass vaccinated with Pfizer/BioNTech (March '21).
@JorgPaetzold and @hwin365 compared case numbers in that district to surrounding areas.
The effect is impressive. Vaccines work!


Jörg Paetzold et al. 2021. The effects of rapid mass vaccination against SARS-CoV-2 and its Variants-of-Concern: Evidence from an early VoCs hotspot. Research Square (July 24, 2021) DOI: 10.21203/


We studied the real-life effect of an unprecedented rapid mass vaccination campaign. Following a large outbreak of B.1.351 and B.1.1.7/E484K in the district of Schwaz/Austria, 100,000 BNT162b2 doses were procured to mass vaccinate the entire adult population (16+) of the district between the 11th and 16th of March 2021. This made the district the first widely inoculated region in Europe. We examined the effect of this unique campaign on the number of infections including VoCs, hospital and intensive care unit (ICU) admissions. We compared Schwaz with (i) a control group of highly similar districts, and (ii) with populations residing in municipalities along the border of Schwaz which were just excluded from the campaign. We find large and significant decreases for all outcomes after the campaign, including VoCs cases. The reduction relative to the control regions was largest for younger age cohorts, which were mostly non-vaccinated in the rest of the country due to the age-gradient in the national vaccination plan. Our results demonstrate that rapid population-wide mass vaccination can be an effective tool to curb overall infections as well as VoCs.

Editado: Jul 26, 8:49am

Mixed AstraZeneca-Pfizer shot boosts COVID antibody level - study
Sangmi Cha | July 26, 2021

A mixed vaccination of first AstraZeneca (AZN.L) and then a Pfizer (PFE.N) COVID-19 shot boosted neutralizing antibody levels by six times compared with two AstraZeneca doses, a study from South Korea showed.

The study involved 499 medical workers - 100 receiving mixed doses, 200 taking two doses of the Pfizer/BioNTech (22UAy.DE) shot and the remainder getting two AstraZeneca shots.

All showed neutralizing antibodies, which prevent the virus from entering cells and replicating, and the result of the mixed schedule of vaccines showed similar amounts of neutralizing antibodies found from the group that received two Pfizer shots.

A British study last month showed similar results - an AstraZeneca shot followed by Pfizer produced the best T-cell responses, and a higher antibody response than Pfizer followed by AstraZeneca...

Jul 26, 8:55am

Coronavirus digest: French parliament approves vaccine pass
DW | July 26, 2021

France's parliament on Monday approved a law to tackle a fourth wave of the coronavirus pandemic despite massive protests against the measures.

The new law makes vaccinations against COVID-19 mandatory for health workers, who risk suspension if they don't take the jab by September 15.

It also requires special health passes for people to enter various social venues, including restaurants and bars, from the beginning of August.

France had already denied visitors' entry to museums, cinemas or swimming pools without proof of vaccination against the virus or a recent negative test.

The measures contained in the bill — which still needs approval from the constitutional court — are due to expire November 15.

Around 161,000 people protested on Saturday against the COVID pass.

Editado: Jul 26, 10:55am
Sarah Huckabee Sanders Pens Op-Ed Encouraging Vaccines: ‘It’s Clear That the Trump Vaccine Works and Is Saving Lives’

CNN’s New Day Shows ‘Very Revealing’ Data Connecting Fox News Viewers to Vaccine Hesitancy

UPSHOT ~ Having hundreds of millions of vaccine vials scattered around the country doesn't do us any good if the on-air personalities on FOX News keep questioning its advocacy on a daily basis.

Jul 26, 1:58pm

New: Hospital Vaccine Mandate Tracker
Do the hospitals near you require staff vaccinations? Help us track hospitals’ decisions on vaccine mandates
Benjy Renton, Sameer Nair-Desai, and Ashish K. Jha

Jul 26, 2:06pm

Eric Topol @EricTopol | 11:45 AM · Jul 26, 2021:
For people who had an immediate allergic reaction to a 1st dose mRNA vaccine, a multicenter study shows the 2nd dose can be given safely...
Image--Research Letter, highlighted ( )

Jul 26, 2:10pm

Joint Statement in Support of COVID-19 Vaccine Mandates for
All Workers in Health and Long-Term Care
4 p

...We call for all health care and long-term care employers to require their
employees to be vaccinated against COVID-19....


(Listed Alphabetically)

Academy of Managed Care Pharmacy (AMCP)
American Academy of Ambulatory Care Nursing (AAACN)
American Academy of Child and Adolescent Psychiatry (AACAP)
American Academy of Family Physicians (AAFP)
American Academy of Nursing (AAN)
American Academy of Ophthalmology (AAO)
American Academy of PAs (AAPA)
American Academy of Pediatrics (AAP)
American Academy of Allergy, Asthma & Immunology (AAAAI)
American Association of Clinical Endocrinology (AACE)
American Association of Colleges of Pharmacy (AACP)
American Association of Neuroscience Nurses (AANN)
American College of Clinical Pharmacy (ACCP)
American College of Physicians (ACP)
American College of Preventive Medicine (ACPM)
American College of Surgeons (ACS)
American Epilepsy Society (AES)
American Medical Association (AMA)
American Nurses Association (ANA)
American Pharmacists Association (APhA)
American Psychiatric Association (APA)
American Public Health Association (APHA)
American Society for Clinical Pathology (ASCP)
American Society for Radiation Oncology (ASTRO)
American Society of Health-System Pharmacists (ASHP)
American Society of Hematology (ASH)
American Society of Nephrology (ASN)
American Thoracic Society (ATS)
Association for Clinical Oncology (ASCO)
Association for Professionals in Infection Control and Epidemiology (APIC)
Association of Academic Health Centers (AAHC)

Association of American Medical Colleges (AAMC)
Association of Rehabilitation Nurses (ARN)
Council of Medical Specialty Societies (CMSS)
HIV Medicine Association
Infectious Diseases Society of America (IDSA)
National Association of Indian Nurses of America (NAINA)
National Association of Pediatric Nurse Practitioners (NAPNAP)
National Council of State Boards of Nursing (NCSBN)
National Hispanic Medical Association (NHMA)
National League for Nursing (NLN)
National Medical Association (NMA)
National Pharmaceutical Association (NPhA)
Nurses Who Vaccinate (NWV)
Organization for Associate Degree Nursing (OADN)
Pediatric Infectious Diseases Society (PIDS)
Philippine Nurses Association of America, Inc (PNAA)
Society of Gynecologic Oncology (SGO)
Society for Healthcare Epidemiology of America (SHEA)
Society of Hospital Medicine (SHM)
Society of Infectious Diseases Pharmacists (SIDP)
Society of Interventional Radiology (SIR)
Texas Nurses Association (TNA)
The John A. Hartford Foundation
Transcultural Nursing Society (TCNS)
Virgin Islands State Nurses Association (VISNA)
Wound, Ostomy, and Continence Nurses Society (W

Editado: Jul 28, 4:41am

CDC urges vaccinated people in high-transmission areas to resume wearing masks indoors as delta variant spreads
The agency recommends vaccinated people in high-transmission areas wear masks indoors. It also calls for all teachers, staff and students in schools to wear masks.
Yasmeen Abutaleb, Joel Achenbach, Dan Diamond and Adam Taylor | 7/27/2021


Annie Karni (NYT) @anniekarni | 5:07 PM · Jul 27, 2021:
Guidance just went out to W.H. staff that they are to mask again at the W.H.

WHCA (WH Correspondents Association) follows suit:
"WHCA is reimposing its mask requirement for all indoor spaces at the White House."


Biden administration considering vaccine requirements for all federal workers
Brett Samuels - 07/27/21

N.Y.C. Union Leaders Say Mayor’s Covid Mandate Took Them by Surprise
Municipal union leaders bristled at Mayor Bill de Blasio’s announcement that workers must get vaccinated or tested weekly, while city workers had mixed reactions.
Emma G. Fitzsimmons and Ashley Wong | July 27, 2021

L.A. will require city employees to get vaccinated or regularly tested for COVID-19
Emily Alpert Reyes, Maura Dolan, Luke Money | July 27, 2021

Jul 27, 5:49pm

Kashif Pirzada (Emergency MD Toronto) KashPrime | 4:46 PM · Jul 27, 2021
Incredible study showing 45% reduction in infections with improved ventilation and HEPA filter use in a hospital in NYC. More proof that we need to get this right in our schools this fall:

Mark H.Ereth et al. Health care-associated infection impact with bioaerosol treatment and COVID-19 mitigation measures. Journal of Hospital Infection (22 July 2021)

In Press, Journal Pre-proof

...Findings and Conclusion
... the addition of a ubiquitous facility-wide engineering solution at limited expense and with no alteration in patient, visitor, or staff traffic or work flow patterns reduced infections by 45%. A similar impact was documented with the addition of comprehensive, restrictive, and labour and material intensive COVID-19 mitigation measures. We believe this is the first direct comparison between traditional infection control, an engineering solution, and COVID-19 mitigation measures.

Jul 28, 9:11am

Florida’s COVID-19 numbers aren’t ‘hype.’ Right now, they’re quite bad
Tom Kertscher | July 27, 2021

Over the previous week, Florida accounted for more than one-fifth of new COVID-19 cases in the U.S. and recorded more COVID-19 deaths than any other state.

The seven day-average positivity rate for testing rose from 0.83% on June 11 to 24.3% on July 25.

Suggesting conspiracy, a woman who says she is a registered nurse living in Tampa claims that, despite news reports, COVID-19 is not ravaging Florida...

Editado: Jul 28, 3:08pm

Efficacy of Pfizer/BioNTech Covid vaccine slips to 84% after six months, data show
Damian Garde and Matthew Herper | July 28, 2021

...In the ongoing study, which enrolled more than 44,000 volunteers, the vaccine’s efficacy in preventing any Covid-19 infection that causes even minor symptoms appeared to decline by an average of 6% every two months after administration. It peaked at more than 96% within two months of vaccination and slipped to 84% after six months...


Stephen J Thomas et al. 2021. Six Month Safety and Efficacy of the BNT162b2 mRNA COVID-19 Vaccine. MedRxiv (July 28, 2021) doi:

This article is a preprint and has not been certified by peer review

...Results: BNT162b2 continued to be safe and well tolerated. Few participants had adverse events leading to study withdrawal. VE (vaccine efficacy) against COVID-19 was 91%... through up to 6 months of follow-up, among evaluable participants and irrespective of previous SARS-CoV-2 infection. VE of 86%‒100% was seen across countries and in populations with diverse characteristics of age, sex, race/ethnicity, and COVID-19 risk factors in participants without evidence of previous SARS-CoV-2 infection. VE against severe disease was 97% %... In South Africa, where the SARS-CoV-2 variant of concern, B.1.351 (beta), was predominant, 100% ... VE was observed.

Conclusion: With up to 6 months of follow-up and despite a gradually declining trend in vaccine efficacy, BNT162b2 had a favorable safety profile and was highly efficacious in preventing COVID-19...

Jul 29, 7:25am

Eric Topol @EricTopol | 9:46 PM · Jul 28, 2021:
US Covid hospitalizations have shot up to >42 margd:,000 today, almost 3X in the month of July, due to Delta infections in nearly all, and the lack of shots, in some states, as high as 98% of admissions are among unvaccinated people.
A Déjà Vu that was so utterly preventable.

Image-graph US hospitalized April-July 2021 ( )

Jul 29, 1:56pm

To beat Covid, there’s a simple lesson – no one’s safe until everyone’s safe (Guardian) by WHO special envoys

The world is witnessing the emergence of more infectious variants of the Sars-CoV-2 virus, but a stuttering race to ensure equitable access to vaccines has seen a handful of countries streak ahead, immunising their own populations, leaving many of the world’s vulnerable people in their wake.

Communities are struggling with impatience and fatigue, which is understandable. However, easing basic public health measures such as wearing masks and social distancing risks fuelling transmission. In combination with more infectious variants and the “me first” attitude of some countries, people who are unvaccinated and those who have received only one dose are at increasing risk.

The world is at a perilous point and we, the special envoys of the World Health Organization’s director general, are calling for a renewed commitment to a comprehensive approach to defeating this pandemic. We have to accelerate along two tracks – one where governments and vaccine manufacturers support all WHO member states in their efforts to create vaccine manufacturing capacity and vaccinate their most vulnerable populations, and the other where individuals and communities maintain a steely focus on continuing essential public health measures to break transmission chains...

Editado: Jul 29, 2:11pm

>42 margd: Here in Denmark Delta rules, except that hospitalizations don't go up. Almost all vulnerable have been vaccinated and half the total population has gotten two shots. Since we started with the older persons we can now see the difference between cities with lot of young persons and areas with lot of old persons.
Covid-19 has gone from a major headache to a mild nuisance here. About a third of the daily cases have been on vacation outside Denmark and brought it back from there :-(
(And daily cases is somewhere between 750 and 1000, so Covid-19 is certainly still around).

So just get everybody vaccinated and things will clear up. (Easier said than done.)

Jul 29, 4:10pm

>48 bnielsen: No masks?

New study estimates odds of vaccinated person getting 'long COVID' from breakthrough infection
Eric Ting | July 29, 2021

Of...1,497 (vaccinated health care workers at Israel's Sheba Medical Center between January and April 2021), just 39 got infected, and of those 39, seven developed an infection where symptoms, including headaches, muscle pain, loss of taste and smell and fatigue, lasted longer than six weeks. None of the seven required hospitalization...


Moriah Bergwerk et al. 2021. Covid-19 Breakthrough Infections in Vaccinated Health Care Workers. NEJM July 28, 2021
DOI: 10.1056/NEJMoa2109072

Among 1497 fully vaccinated health care workers for whom RT-PCR data were available, 39 SARS-CoV-2 breakthrough infections were documented. Neutralizing antibody titers in case patients during the peri-infection period were lower than those in matched uninfected controls (case-to-control ratio, 0.361...). Higher peri-infection neutralizing antibody titers were associated with lower infectivity (higher Ct (cycle threshold) values). Most breakthrough cases were mild or asymptomatic, although 19% had persistent symptoms (more than 6 weeks). The B.1.1.7 (alpha) variant was found in 85% of samples tested. A total of 74% of case patients had a high viral load (Ct value, less than 30) at some point during their infection; however, of these patients, only 17 (59%) had a positive result on concurrent Ag-RDT (antigen-detecting rapid diagnostic testing ). No secondary infections were documented.

Among fully vaccinated health care workers, the occurrence of breakthrough infections with SARS-CoV-2 was correlated with neutralizing antibody titers during the peri-infection period. Most breakthrough infections were mild or asymptomatic, although persistent symptoms did occur.

Jul 30, 4:00am

>49 margd:
Except for a few places (entering and exiting public transportation) there is no mask requirement. Public places like museums require a corona passport. (Either a passed recent test or a completed vaccination + 14 days)

Mild precautions like distancing, use of hand sanitizer, isolation if you have symptoms, etc are still in place. A few still use masks whenever they are out in the public, but most are quite happy to quit masks, so I'd guess I see one in fifty wearing a mask these days.
There's also some rules for local shut-downs if the number of cases go up too much (relative to a number of things). And a few mild rules limiting restaurants. And nightclubs and discos are still closed.

The number of new cases in the local area is published on a daily basis, so it's possible to judge how risky the local area is.

Editado: Jul 30, 7:42am

>50 bnielsen: The 3-county area in Ontario where we have summer place appears to be down to 0 cases in last couple weeks. They've had outbreaks--nail salon, church, construction site, university, hospital wing--but public health did great job from the beginning tracing contacts, testing, isolating. The public has been cooperative in public health measures, and most recently in vaccinations (~70% adults?). They are under some provincial restrictions still, and one sees a lot of masks (100%) and voluntary social distancing ("'excuse me"). The Canadian Government is opening border to vaxxed and tested Americans Aug 9, and U students will return at end of month, so fingers crossed.

The county where we live in Michigan has a few more cases. There's a little more resistance to masks and vaxx, this being America. It, too, has U students returning in fall. More pressure now to vaxx from federal employers and by two of our three hospitals (U, RC, VA). Curious that the hospital not (yet?) requiring vaxx is the university hospital--the Catholic and the veterans' hospitals are requiring vaxx.

Both places have some Delta variant circulating.

Jul 30, 7:43am

Uh oh:

C.D.C. Internal Report Calls Delta Variant as Contagious as Chickenpox
Infections in vaccinated Americans also may be as transmissible as those in unvaccinated people, the document said, and lead more often to severe illness.
Apoorva Mandavilli | July 30, 2021

Dr. Rochelle P. Walensky, the director of the agency, acknowledged on Tuesday that vaccinated people with so-called breakthrough infections of the Delta variant carry just as much virus in the nose and throat as unvaccinated people, and may spread it just as readily, if less often.

But the internal document lays out a broader and even grimmer view of the variant.

The Delta variant is more transmissible than the viruses that cause MERS, SARS, Ebola, the common cold, the seasonal flu and smallpox, and it is as contagious as chickenpox, according to the document, a copy of which was obtained by The New York Times.

...Infection with the Delta variant produces virus amounts in the airways that are tenfold higher than what is seen in people infected with the Alpha variant, which is also highly contagious, the document noted.

...The amount of virus in a person infected with Delta is a thousandfold more than what is seen in people infected with the original version of the virus, according to one recent study.

...Detailed analysis of the spread of cases showed that people infected with Delta carry enormous amounts of virus in their nose and throat, regardless of vaccination status, according to the C.D.C. document.

...Infection with the Delta variant may be more likely to lead to severe illness, the document noted. Studies from Canada and Scotland found that people infected with the variant are more likely to be hospitalized, while research in Singapore indicated that they are more likely to require oxygen.

Still, the C.D.C.’s figures show that the vaccines are highly effective in preventing serious illness, hospitalization and death in vaccinated people, experts said...

Graph of fatality rate, transmissibility of Delta v other diseases:

‘The war has changed’: Internal CDC document urges new messaging, warns delta infections likely more severe
The internal presentation shows that the agency thinks it is struggling to communicate on vaccine efficacy amid increased breakthrough infections
Yasmeen Abutaleb, Carolyn Y. Johnson and Joel Achenbach | July 29, 2021

...The document* strikes an urgent note, revealing the agency knows it must revamp its public messaging to emphasize vaccination as the best defense against a variant so contagious that it acts almost like a different novel virus, leaping from target to target more swiftly than Ebola or the common cold...

Improving communications around vaccine breakthrough and vaccine effectiveness
CDC | July 29, 2021
25 p

Jul 30, 9:08am

"The relationship between temperature/humidity/virus survival is complex and not linear."

Rajeev Jayadevan (MD) @RajeevJayadevan | 7:53 AM · Jul 30, 2021:

Is Humidity the missing link in COVID-19 spread in certain parts of India?
This is a hypothesis, not an assertion.
Transmission depends on the survival of virus in the air, that is through droplets. Weather may affect this.
Complex physics is involved here. See the thread.
Image-map India, humidity ( )

The most efficient viral transmission occurs in wet, high RH (relative humidity) (RED) & dry low RH conditions.
The least efficient transmission occurs in the intermediate range of RH, see the U shaped curve.
See the whole thread for details.
L. Guo et al. 2021. Systematic review of the effects of environmental factors on virus inactivation: implications for coronavirus disease 2019. International Journal of Environmental Science and Technology (17 July 2021) ...Virus survival and transmission is highly efficient in a dry environment with low relative humidity, and also in a wet environment with high relative humidity, and it is minimal at intermediate relative humidity...

The virus cannot move on its own. It has to catch a vehicle to travel, which is a droplet of throat or nose secretion. This is spherical, has a large surface area. The droplet also contains mucus, water & salts.
Smaller droplets hang in the air for many hours.

Larger droplets drop immediately to the ground because they’re heavy. It is the intermediate & smaller size droplets that we are interested in here. The intermediate size droplets shrink rapidly in size with evaporation, becoming smaller and lighter. They can float for hours.

The smallest droplets hang in the air for a while. Fast evaporation can destroy them. The virus is present within this droplet and is easily damaged by changes in the solute (salt) concentration, shearing forces of surface tension, and temperature.

When these droplets are inhaled by another person who shares the same room/space, the virus gets to enters the body, attaches to the mucosal lining, and enters the cells. Thus, survival of the droplets (vehicle) in an intact form is important for transmission of this virus.

There has been much debate about the optimal (best) conditions for virus transmission. Multiple papers have been published, not all of which agree with each other.
However there is consensus that enveloped viruses follow a U-shaped curve of relative humidity.
Image-graph infectiousness, humidity, temp ( )

There is no direct relationship with temperature- although it is said that in low temperature dry conditions for example in a meat packaging factory or cold storage or fish market, transmission occurs faster and more efficiently because droplets hang around in the air longer.

Similarly, when the relative humidity is high and the conditions are wet for example during the monsoon, the evaporation rate of the smaller droplets decreases.
Thus the smaller droplets manage to stay in the air for a longer period of time.

When droplets stay longer in the air, more people can potentially get infected.
Remember that it is also important for the virus to stay alive or viable within these droplets. Factors such as change in solute concentration and surface tension can damage the virus.

Change in solute concentration occurs when the salt content of the droplet increases with evaporation - typically during medium relative humidity conditions. This kills the virus.
When relative humidity is high >70%, salt concentration is ideal for the virus to survive.

Along with this, the higher relative humidity lowers evaporation rate, which means the droplet remains intact for longer time, helping the virus.
This applies to smaller droplets. The relationship between temperature/humidity/virus survival is complex and not linear.

When relative humidity is very low less than 30, the salt crystallises out of the droplet, thus the virus may survive.
This U-shaped relationship specifically applies to enveloped viruses like SARS-CoV2 and influenza virus, which have a fragile lipid coat over the protein/RNA core.

The evaporation rate of the droplet depends on relative humidity, temperature and wind factor. It is impossible to predict the ideal living condition or transmission efficiency for a virus. That is also why there are conflicting opinions on this topic.

The attached chart shows the relative humidity (RED) in various parts of India at this time. It can be seen that the highest relative humidity is seen along coastal states along the west coast & in north-eastern states. These areas are also receiving substantial rainfall.
Image-map India humidity ( )

Colombo in Sri Lanka also has the same humidity as Trivandrum, and is going through a spike in cases, similar to what is seen in Kerala.
The red/orange (highest RH) areas also have the most spread of virus at this time.
This can be seen from the map.

In science, correlation is not always causation. Therefore these correlations must be cautiously interpreted.
The hypothesis here is that these parts of the country are providing an optimal climate for the virus to stay alive longer in the air, in droplets, mostly indoors.

Most of the virus transmission now is happening indoors in social settings e.g. when people visit friends and family. Masks are seldom used indoors in such settings. Conversation generates aerosols. The droplets hang in the air for hours and everyone gets a dose of virus.

To make matters worse, fully vaccinated and partially vaccinated people are regularly picking up virus in their noses and throats and passing around to other people.
Vaccinated and unvaccinated people are thus involved with the spread of this virus.

Vaccinated people tend to believe that they are immune to the virus, and therefore are more likely to disregard standard precautions.
The communication regarding vaccination has to change - to request vaccinated individuals to follow the same precautions as other people.

For those who are interested in physics: some basics. Relative humidity is defined as the amount of water vapour present in the air expressed as a ratio to the maximum water vapour it can possibly hold at that temperature.
The greater the water content, the higher the RH.

The greater the relative humidity, the lower the evaporation rate. The lower the evaporation rate, the slower the decrease in size of droplets that are floating in the air.
(There are other factors such as temperature and wind speed involved)


Jul 30, 10:34am

The situation in Louisiana is dire.
Hospitalizations are on a similar trajectory.
Image--graph LA cases, 03/2020 - 07/2021 ( )

- Eric Topol @EricTopol | 9:46 AM · Jul 30, 2021

Jul 30, 1:18pm

>53 margd: My wife also noticed that. Weather conditions seem to have a lot to say. And yes, Contagious as Chickenpox is bad news for those still not vaccinated.

Editado: Jul 30, 4:46pm

FDA, under (lawmakers and prominent health experts) pressure, plans ‘sprint’ to accelerate review of Pfizer’s Covid-19 vaccine for full approval
Nicholas Florko | July 30, 2021

WASHINGTON — Under heavy pressure, the Food and Drug Administration center that reviews vaccines is planning to deprioritize some of its existing work, like meetings with drug sponsors and plant inspections, in an effort to accelerate its review of Pfizer’s application for the formal approval of its Covid-19 vaccine, a senior agency official told STAT...


Ana Cabrera (CNN) @AnaCabrera | 3:42 PM · Jul 30, 2021:
JUST IN: FDA pulling in extra help from across the agency
to speed final approval of Pfizer/BioNtech’s coronavirus vaccine,
an agency spokeswoman tells CNN.

Jul 30, 4:44pm

Time for Covidnomics
Government has done what it can. Now we need to use the power of free markets to fight the pandemic.
David Frum | July 30, 2021

...Thanks to gerrymandering and the overrepresentation of rural areas in legislatures and Congress, unvaccinated America exerts disproportionate political power. Vaccinated America, however, has more market power. And it’s time for individual consumers to start using it.

...Over the early summer, conservative governors such as Florida’s Ron DeSantis struck first, deploying the power of state government to impose their values on recalcitrant businesses. Now it’s time for public-health-conscious consumers to strike back, just as they would if the state of Florida tried to junk its fire codes or abolish food-safety rules or forbid cruise ships at Florida ports from carrying lifeboats...

Jul 31, 4:46am

Kenya bans in-person meetings, public gatherings as COVID surges (Al Jazeera)

Kenya said it is extending a nighttime curfew and banning public gatherings and in-person meetings to slow the spread of the coronavirus, warning that hospitals are becoming overwhelmed. The East African country has in recent days witnessed a jump in cases from the Delta variant, with a positivity rate of 14 percent as of Friday compared with about seven percent last month...

“We continue to implore all Kenyans, including those who have received their COVID-19 vaccines, not to let their guard down,” {Health Minister} Kagwe said after a meeting of the National Emergency Response Committee on Coronavirus. “We are all responsible (for) bringing the cases down"...

Ago 1, 3:17am

From Morocco to Sudan, North Africa grapples with crippling new wave of COVID-19 (Arab News)

North African states are seeing varying degrees of success at containing the coronavirus amid a devastating third wave. Slow vaccine rollouts, lockdown fatigue and the spreading Delta variant stretch health systems and economies to the limit...

Editado: Ago 2, 1:45am

Minks, ferrets, apes, now deer...
7% deer tested in Illinois in 2020 had COVID-19 antibodies.
18% in NY.
34% in Pennsylvania.
60% in Michigan.

USDA says the deer appear asymptomatic, and they pose little risk to people.
Always a risk, though, that the virus will learn new tricks in a new species...

Not known how wild deer came to be infected, but my guess would be like apes and mink, via an infected caretaker of domestic animals.
USDA - Covid White Tailed Deer Study
Caleb Holloway

Mitchell V Palmer et al. 2021. Susceptibility of white-tailed deer ( Odocoileus virginianus) to SARS-CoV-2. J Virol. 2021 Mar 10;95(11):e00083-21. doi: 10.1128/JVI.00083-21.


The origin of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus causing the global coronavirus disease 19 (COVID-19) pandemic, remains a mystery. Current evidence suggests a likely spillover into humans from an animal reservoir. Understanding the host range and identifying animal species that are susceptible to SARS-CoV-2 infection may help to elucidate the origin of the virus and the mechanisms underlying cross-species transmission to humans. Here we demonstrated that white-tailed deer (Odocoileus virginianus), an animal species in which the angiotensin converting enzyme 2 (ACE2) - the SARS-CoV-2 receptor - shares a high degree of similarity to humans, are highly susceptible to infection. Intranasal inoculation of deer fawns with SARS-CoV-2 resulted in established subclinical viral infection and shedding of infectious virus in nasal secretions. Notably, infected animals transmitted the virus to non-inoculated contact deer. Viral RNA was detected in multiple tissues 21 days post-inoculation (pi). All inoculated and indirect contact animals seroconverted and developed neutralizing antibodies as early as day 7 pi. The work provides important insights into the animal host range of SARS-CoV-2 and identifies white-tailed deer as a susceptible wild animal species to the virus.

IMPORTANCEGiven the presumed zoonotic origin of SARS-CoV-2, the human-animal-environment interface of COVID-19 pandemic is an area of great scientific and public- and animal-health interest. Identification of animal species that are susceptible to infection by SARS-CoV-2 may help to elucidate the potential origin of the virus, identify potential reservoirs or intermediate hosts, and define the mechanisms underlying cross-species transmission to humans. Additionally, it may also provide information and help to prevent potential reverse zoonosis that could lead to the establishment of a new wildlife hosts. Our data show that upon intranasal inoculation, white-tailed deer became subclinically infected and shed infectious SARS-CoV-2 in nasal secretions and feces. Importantly, indirect contact animals were infected and shed infectious virus, indicating efficient SARS-CoV-2 transmission from inoculated animals. These findings support the inclusion of wild cervid species in investigations conducted to assess potential reservoirs or sources of SARS-CoV-2 of infection.

Ago 1, 7:15am

Este utilizador foi removido como sendo spam.

Ago 1, 7:44am

You’re going to be asked to prove your vaccination status. Here’s how to do it.
Your smartphone can help you safely carry your coronavirus vaccination record, from a simple photo snap to a secure app. Just don’t call it a ‘vaccine passport.’

...states including California, Louisiana and New York offer portals to download fully authenticated vaccination information, and more are on the way. And millions across the United States have access to digital records from Walmart, CVS and Walgreens...

Ago 1, 7:46am

Ago 1, 12:53pm

Pfizer and Moderna hike up COVID-19 vaccines prices in EU: report
Staff Reuters | August 1, 2021

...The new price for the Pfizer shot was 19.50 euros (USD 23.15) against 15.50 euros previously...The price of a Moderna vaccine was USD 25.50 a dose, the contracts show, up from about 19 euros in the first procurement deal but lower than the previously agreed USD 28.50 because the order had grown, the report said, citing one official close to the matter.

Ago 2, 7:49am

Delta variant challenges China's zero Covid strategy — and raises questions over its vaccine efficacy
Nectar Gan and Steve George | August 2, 2021

...(Delta variant) is causing China's worst outbreak in months.

China reported 328 local Covid-19 infections in July, close to the total from the previous five months, according to the National Health Commission. Although that's only a fraction of the cases reported in countries like the United States and the United Kingdom, it is perceived as a serious threat in China, where authorities attempt to keep local infections at zero.

The latest outbreak started two weeks ago in the eastern city of Nanjing, where nine airport cleaners were found to be infected during a routine test. Since then, the cluster has spread to at least 26 cities across China, including a tourist hot spot in the southern province of Hunan and the capital Beijing.

Chinese authorities responded swiftly with mass testing, targeted lockdowns, extensive contact tracing and quarantine of close contacts — a tried and tested formula that has helped it quickly tame local flare-ups since March 2020. ("zero tolerance")

...On July 22, two days after the Nanjing cluster was first detected, a health expert in the city said the "vast majority" of those infected there had been vaccinated, except for one person under 18 years old. Airport staff, along with medical workers and border control personnel, were among the first to be vaccinated in China.

...It remains to be seen if repeated lockdowns and mass testing drives can sustain public support in the long run. Tolerance for such measures could begin to wane if, as expected, the government maintains its hardline approach until after the Beijing Winter Olympics in February next year.

But some prominent Chinese public health experts have raised the prospect that like elsewhere in the world, China will eventually need to learn to coexist with the coronavirus...

Ago 2, 8:05am

Florida breaks record for COVID-19 hospitalizations
A day after it recorded the most new daily cases since the start of the pandemic, Florida on Sunday broke a previous record for current hospitalizations set more than a year ago before vaccines were available
MIKE SCHNEIDER | August 2, 2021

...10,207 people hospitalized with confirmed COVID-19 cases...leading the nation in per capita hospitalizations for COVID-19, as hospitals around the state report having to put emergency room visitors in beds in hallways and others document a noticeable drop in the age of patients...come as the new, more transmittable delta variant has spread throughout Florida, and residents have returned to pre-pandemic activities.

...There has been a startling rise in the number of children with the virus at hospitals in Miami, many of them requiring intensive care...


Florida's largest school district is worried about funding after governor bans mask mandates for schools
Rosa Flores and Hollie Silverman | August 2, 2021

...DeSantis' order, signed Friday, threatens to withhold state funding if schools implement a mask mandate.

The order comes as many states, municipalities and school districts re-evaluate their mask policies following the new CDC guidance...

Ago 3, 3:46am

One of the worst afflicted states, Missouri, is known as the "show me" state.

'People are waking up': US sees rise in COVID-19 vaccinations as delta variant spreads
Madeline Holcombe, CNN | Aug 2, 2021

Editado: Ago 3, 11:41am

Long COVID: Epstein-Barr virus may offer clues
James Kingsland | July 27, 2021

More than 95% of healthy adults have a “latent” or dormant infection of the Epstein-Barr virus (EBV), a type of herpes virus.

Illness and other stressors can reactivate the infection.

Two very small recent studies have suggested reasons to explore the relationship between reactivation of the infection and the severity of both long COVID and COVID-19.

If more extensive studies support the role of EBV reactivation in long COVID, antiviral drugs that work against herpes viruses may help prevent or treat the condition.

Long COVID and severe COVID-19 infections associated with Epstein-Barr virus reactivation
Bioengineer | July 21, 2021

Jeffrey E. Gold et al. 2021. Investigation of Long COVID Prevalence and Its Relationship to Epstein-Barr Virus Reactivation. Pathogens. 2021 Jun; 10(6): 763. Published online 2021 Jun 17. doi: 10.3390/pathogens10060763

Coronavirus disease 2019 (COVID-19) patients sometimes experience long-term symptoms following resolution of acute disease, including fatigue, brain fog, and rashes. Collectively these have become known as long COVID. Our aim was to first determine long COVID prevalence in 185 randomly surveyed COVID-19 patients and, subsequently, to determine if there was an association between occurrence of long COVID symptoms and reactivation of Epstein–Barr virus (EBV) in 68 COVID-19 patients recruited from those surveyed. We found the prevalence of long COVID symptoms to be 30.3% (56/185), which included 4 initially asymptomatic COVID-19 patients who later developed long COVID symptoms. Next, we found that 66.7% (20/30) of long COVID subjects versus 10% (2/20) of control subjects in our primary study group were positive for EBV reactivation based on positive titers for EBV early antigen-diffuse (EA-D) IgG or EBV viral capsid antigen (VCA) IgM. The difference was significant ... A similar ratio was observed in a secondary group of 18 subjects 21–90 days after testing positive for COVID-19, indicating reactivation may occur soon after or concurrently with COVID-19 infection. These findings suggest that many long COVID symptoms may not be a direct result of the SARS-CoV-2 virus but may be the result of COVID-19 inflammation-induced EBV reactivation.

Ting Chen et al. 2021. Positive Epstein–Barr virus detection in coronavirus disease 2019 (COVID-19) patients. Sci Rep. 2021; 11: 10902. Published online 2021 May 25. doi: 10.1038/s41598-021-90351-y

The objective of this study was to detect the Epstein–Barr virus (EBV) coinfection in coronavirus disease 2019 (COVID-19). In this retrospective single-center study, we included 67 COVID-19 patients with onset time within 2 weeks in Renmin Hospital of Wuhan University from January 9 to February 29, 2020. Patients were divided into EBV/SARS-CoV-2 coinfection group and SARS-CoV-2 infection alone group according to the serological results of EBV, and the characteristics differences between the two groups were compared. The median age was 37 years, with 35 (52.2%) females. Among these COVID-19 patients, thirty-seven (55.2%) patients were seropositive for EBV viral capsid antigen (VCA) IgM antibody. EBV/SARS-CoV-2 coinfection patients had a 3.09-fold risk of having a fever symptom than SARS-CoV-2 infection alone patients .... C-reactive protein (CRP) ... and the aspartate aminotransferase (AST) ... in EBV/SARS-CoV-2 coinfection patients were higher than that in SARS-CoV-2 infection alone patients. EBV/SARS-CoV-2 coinfection patients had a higher portion of corticosteroid use than the SARS-CoV-2 infection alone patients .... We find a high incidence of EBV coinfection in COVID-19 patients. EBV/SARS-CoV-2 coinfection was associated with fever and increased inflammation. EBV reactivation may associated with the severity of COVID-19.

Editado: Ago 3, 4:05pm
Despite record COVID-19 hospitalizations, Florida's governor says 'admissions have slowed'

'We're not shutting down,' Gov. Ron DeSantis declares

DeSantis and his ilk believe Americans are merely interchangeable cogs in the nation's economic engine.

Editado: Ago 4, 4:31am

F.D.A. Aims to Give Final Approval to Pfizer Vaccine by Early Next Month
The Food and Drug Administration’s move is expected to kick off more vaccination mandates for hospital workers, college students and federal troops.
Sharon LaFraniere and Noah Weiland | Aug. 3, 2021

...Recent polls by the Kaiser Family Foundation, which has been tracking public attitudes during the pandemic, have found that three of every 10 unvaccinated people said that they would be more likely to get a shot with a fully approved vaccine. But the pollsters warned that many respondents did not understand the regulatory process and might have been looking for a “proxy” justification not to get a shot.

Moderna, the second most widely used vaccine in the United States, filed for final approval of its vaccine on June 1. But the company is still submitting data and has not said when it will finish. Johnson & Johnson, the third vaccine authorized for emergency use, has not yet applied but plans to do so later this year...

Ago 4, 4:54am

Fully Vaccinated Still at Considerable Risk of Getting COVID, Giant UK Study Shows
AFP | 4 August 2021

Fully vaccinated people in England were one-third as likely to test positive for COVID-19, according to an ongoing survey of the population released on in 160 people infected with coronavirus, with a prevalence rate of 1.21 percent for unvaccinated respondents and 0.40 percent for those fully jabbed.

The study also found double-vaccinated people may be less likely to pass on the virus to others than those who have not received a vaccine...


Elliott, P et al. 4 Aug 2021. REACT-1 round 13 final report: exponential growth, high prevalence of SARS-CoV-2 and vaccine effectiveness associated with Delta variant in England during May to July 2021. (Imperial College London and market research company Ipsos MORI Working Paper)


...Discussion From end May to beginning July 2021 in England, where there has been a highly successful vaccination campaign with high vaccine uptake, infections were increasing exponentially driven by the Delta variant and high infection prevalence among younger, unvaccinated individuals despite double vaccination continuing to effectively reduce transmission. Although slower growth or declining prevalence may be observed during the summer in the northern hemisphere, increased mixing during the autumn in the presence of the Delta variant may lead to renewed growth, even at high levels of vaccination.

Ago 4, 4:56am

Greg Abbott (TX Gov) @GregAbbott_TX | 6:00 PM · Jun 7, 2021:

Texas is open 100%.
Texans should have the freedom to go where they want without any limits, restrictions, or requirements.
Today, I signed a law that prohibits any TX business or gov’t entity from requiring vaccine passports or any vaccine information.

0:57 ( )

Editado: Ago 4, 5:40am

>72 margd: Texans should have the freedom to go where they want without any limits, restrictions, or requirements.

Or to put it in different words, what he's saying is that Texans should NOT have the right to protect themselves, their employees, their customers, their families and the general public against a deadly disease being spread by irresponsible individuals who refuse to wear masks or get vaccinated.

Ago 4, 5:52am

>73 John5918: Just amazing. Businesses can deny services to gays, but not to the unvaxxed, who pose a real risk??

At some point this becomes a question of interstate commerce, so a federal issue?

Personal choice, also. Companies will want to stay the heck out of FL and TX. I know we're staying away from FL next winter.

Below is NYC's take. How can the union stand with FL & TX...and NYC?

New York City to Require Proof of Vaccination for Indoor Dining and Gyms
Mayor Bill de Blasio said the tough restrictions were necessary to encourage New Yorkers to get vaccinated and curtail a third wave of coronavirus cases.
Emma G. Fitzsimmons | Aug. 3, 2021

Ago 4, 6:10am

Eric Topol @EricTopol | 7:02 PM · Aug 3, 2021
New @LancetChildAdol is a very reassuring prospective study of >250,000 children, >1700 with + covid test, age 5-17, that shows the risk for chronic Covid symptoms is quite low; 4.4% beyond 4 weeks

Image-summary, highlighted ( )
Image=graph, symptoms # days, younger & older children ( )

Erika Molteni et al. 2021. Illness duration and symptom profile in symptomatic UK school-aged children tested for SARS-CoV-2. The Lancet Child and Adolescent Health. August 03, 2021 DOI:

Editado: Ago 4, 4:25pm

Temporary Protection from Eviction
CDC | Updated Aug. 3, 2021

CDC is issuing a new order temporarily halting evictions in counties with heightened levels of community transmission in order to respond to recent, unexpected developments in the trajectory of the COVID-19 pandemic, including the rise of the Delta variant. It is intended to target specific areas of the country where cases are rapidly increasing, which likely would be exacerbated by mass evictions.

ORDER: Temporary Halt in Residential Evictions in Communities with Substantial or High Levels of Community Transmission of COVID-19 to Prevent the Further Spread of COVID-19*
19 p

* 9 Counties experiencing substantial transmission levels are experiencing (1) 50.99-99.99 new cases in the county in
the past 7 days divided by the population in the county multiplied by 100,000; and (2) 8.00-9.99% positive nucleic
acid amplification tests in the past 7 days (number of positive tests in the county during the past 7 days divided by
the total number of tests performed in the county during the past 7 days)...

10 Id. (defining high transmission levels as (1) more than 100 new cases in the county in the past 7 days divided by the
population in the county multiplied by 100,000; and (2) more than 10.00% positive nucleic acid amplification tests in the past 7 days (number of positive tests in the county during the past 7 days divided by the total number of tests performed in the county during the past 7 days)).

Ago 4, 4:37pm

The W.H.O. calls for a moratorium on Covid vaccine boosters to help each country get more people vaccinated.
Isabella Kwai, Benjamin Mueller, Daniel E. Slotnik and Adeel Hassan | Aug. 4, 2021,

The World Health Organization called on Wednesday for a moratorium on coronavirus vaccine booster shots until the end of September, so that vaccine supplies can be focused on helping all countries vaccinate at least 10 percent of their populations. The agency made its appeal to the world’s wealthiest nations to address the wide disparities in vaccination rates around the world...

Ago 4, 7:37pm

>72 margd: Texans should have the freedom to go where they want without any limits, restrictions, or requirements. Today, I signed a law that prohibits any TX business or gov’t entity from requiring vaccine passports or any vaccine information.

Should Texans have that freedom? That's seems like a very unTexan freedom; there's a right to roam in parts of Europe, but that'll get you shot in Texas. That's part of what makes this so frustrating is that it's pure defiance, without the remotest impression of a coherent philosophy behind it.

Editado: Ago 5, 6:49am

White House to DeSantis, Abbott: Handle Delta spike or 'get out of the way and let people do the right thing'
Alexander Nazaryan | August 3, 2021

On Tuesday, White House press secretary Jen Psaki said the White House had offered help to both governors. She described the talks with Austin and Tallahassee as ongoing, suggesting that the offer from Washington had not yet been accepted. The standstill has plainly exasperated the White House, which wants to see the spike in the Delta variant subside. That will be impossible without curbing its spread across the Southeast.

“If you aren't going to help, if you aren't going to abide by public health guidance, then get out of the way and let people do the right thing,...That means don't ban, don't make it harder for people to put requirements on masks — or asking for vaccination status — into law.”

...Psaki...allud(ed) to the political ambitions of both governors, who are widely believed to harbor presidential aspirations. “Leaders are going to have to choose whether they’re going to follow public health guidelines or they’re going to follow politics” ...

Ana Cabrera (CNN) @AnaCabrera | 7:39 PM · Aug 4, 2021:
FL superintendent sends letter to Gov pleading for temporary mask mandate, writing:
“In the last ten days alone, before school has even opened, four school-aged children in Leon County have been admitted to local hospitals. Two of our Pre-K teachers are currently in the (ICU)”

Arkansas banned mask mandates. As schools get ready to reopen, the governor says he regrets signing the law.
Katie | 8/5/2021

Mere months after Gov. Asa Hutchinson signed a bill that banned local mask mandates across Arkansas, the state’s top Republican has asked lawmakers to reconsider the prohibition so school districts might require children to don face coverings when they return to classrooms this fall...

Extracurricular activities back, no masks outside in Ontario back-to-school plan
Canadian Press |Aug 03, 2021

Ontario students returning to schools next month will be able to play on sports teams, use instruments in music class, go on field trips and ditch masks outdoors, even if distance can’t be maintained.

...Schools with mechanical ventilation are expected to use the highest-grade filters possible and turn their systems on at least two hours before school starts, and schools without are expected to have standalone HEPA filter units in all classrooms...

The plan places an emphasis on outdoor activities, such as allowing kids to play during recess with friends from other classes — with distancing encouraged but not required. It also allows shared materials again, such as computers, gym equipment, and toys in kindergarten...

COVID-19:Health, safety and operational guidance for (Ontario) schools (2021-2022)
Version 1 (Released August 3, 2021)
29 p


Ontario’s education minister says more money for ventilation, HEPA filters coming by 1st day of school
Gabby Rodrigues | August 4, 2021

Ontario’s education minister has announced another $25 million will go towards improving ventilation in schools with additional standalone high-efficiency particulate air (HEPA) filters...The government has committed more than $600 million to date for ventilation improvements across Ontario schools, Lecce said...

Ago 5, 2:52am

LA Lawmakers Consider Requiring People To Be Vaccinated In Indoor Public Spaces
Vanessa Romo | August 4, 2021

...the new law would require anyone 16 and over who is eligible, to show proof of at least one inoculation shot before stepping into restaurants, bars, retail stores, gyms, spas, movie theaters, concert venues and sporting events.

...The Los Angeles proposal comes a day after New York City announced it would require aspiring customers and/or bon vivants to show their paper copy of the CDC vaccine card or provide electronic proof via the city's Excelsior app. The mandate goes into effect on Aug. 16....


Eric Feigl-Ding @DrEricDing
Best video on why vaccine passports are needed. The burden should fall on the unvaccinated.
Well said @IAmPoliticsGirl. #vaccinate #COVID19

1:04 ( )
From PoliticsGirl

Ago 5, 9:11am

Here’s what we know about the delta-plus variant
Jennifer Hassan and Lateshia Beachum | August 3, 2021

South Korea’s Disease Control and Prevention Agency said Tuesday that it had recorded at least two cases of the new coronavirus delta-plus variant, which some experts believe to be more transmissible than the original delta variant that was first detected in India and has since thwarted plans for returning to life before the pandemic.

...First identified in Europe in March, the variant is also known as B. 1.617.2.1 or AY.1.
It has been detected in several countries, including the United Kingdom, the United States and India.

Last month, experts in India labeled the variant one of concern and warned that it appeared to be more transmissible than most. Citing studies, the country’s health ministry said that the variant has the ability to bind more easily to lung cells and could be resistant to therapies used to treat the infection. ( )

...The virus has not appeared to have gained intense traction on British soil, said Colin Angus, a public health policy modeler and analyst in England.

The “plus” of the variant’s name refers to its K417N spike protein mutation, which was also found in some substrains of the alpha variant — the dominant strain in the country before the delta variant — but the substrains never got a foothold, he explained.

“To date, there is no clear evidence that it conveys enough of a benefit to the virus to allow it to dominate the original delta variant,” he said. “So although it is clearly here, there is no obvious sign that it has gained a foothold over existing variants of the virus.”

...Angus also noted that delta-plus cases have primarily been in younger people but that preliminary data has shown that antibodies from vaccinated people are still effective against the variant.

“This was in a very small sample,” he said of the data. “We need more evidence to get a clear picture about any possible advantage against vaccines that delta plus may have, but the fact that we haven’t seen it clearly outcompete delta despite having been found in several countries with high vaccination rates, suggests that any advantage can only be very small.”...

Ago 5, 1:04pm

Moderna booster...

Meg Tirrell (CNBC) @megtirrell | 7:29 AM · Aug 5, 2021:
Moderna says lab studies show a booster w half the dose of its #covid19 vaccine
increases antibody levels against delta by 42-fold
Image-graph ( )

Moderna reports top-line findings from phase 2 study of booster shot, noting neutralizing antibody titers had waned significantly by 6 months; safety profile of dose 3 was similar to that of dose 2
Image- Phase 2 results for prototype booster ( )
Image- key takeaways ( )
Eric Topol @EricTopol | 10:20 AM · Aug 5, 2021
The half-dose might have worked as well (as the full dose) for the 1st and 2nd doses,
based on a randomized trial that looked at immune response

Ago 6, 7:22am

Cross-reactivity between wild type, B.1.1.7, B.1.351 and P.1 in the mouse model:
"All proteins induced high neutralizing antibodies against the respective viruses but also induced high cross-neutralizing antibody responses."

Fatima Amanat...Florian Krammer. 2021. Vaccination with B.1.1.7, B.1.351 and P.1 variants protects mice from challenge with wild type SARS-CoV-2. BioRxiv (Aug 5 2021) doi:

This article is a preprint and has not been certified by peer review


Vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been highly efficient in protecting against coronavirus disease 2019 (COVID-19). However, the emergence of viral variants that are more transmissible and, in some cases, escape from neutralizing antibody responses has raised concerns. Here, we evaluated recombinant protein spike antigens derived from wild type SARS-CoV-2 and from variants B.1.1.7, B.1.351 and P.1 for their immunogenicity and protective effect in vivo against challenge with wild type SARS-CoV-2 in the mouse model. All proteins induced high neutralizing antibodies against the respective viruses but also induced high cross-neutralizing antibody responses. The decline in neutralizing titers between variants was moderate, with B.1.1.7 vaccinated animals having a maximum fold reduction of 4.8 against B.1.351 virus. P.1 induced the most cross-reactive antibody responses but was also the least immunogenic in terms of homologous neutralization titers. However, all antigens protected from challenge with wild type SARS-CoV-2 in a mouse model.

Ago 6, 8:11am

Israel: "we observe a significant increase of the risk of infection in individuals who received their last vaccine dose since at least 146 days ago, particularly among patients older than 60."

18-39 year olds: 1.67x
40-59 year olds: 2.22x
60 years & older: 2.76x


Eric Topol (Scripps MD scientist) @EricTopol | 1:08 AM · Aug 6, 2021

The Israeli data for increased mRNA-vaccination breakthrough infections and "waning immunity" is finally available
Overall 2X risk, no statistical significant difference between age groups, but trend of increase w/ age
Table of results ( )

2 additional points
—There is a major confounder with Delta infections (93% of samples assessed at time of breakthroughs), no linkage with neutralizing antibody data. Cannot conclude “waning immunity” from these data
—The low 2% rate in the midst of Delta is actually reassuring.


Ariel Israel et al. 2021. Elapsed time since BNT162b2 vaccine and risk of SARS-CoV-2 infection in a large cohort. MedRxiv (Aug 5 2021) doi:

This article is a preprint and has not been certified by peer review .


Importance: Israel was among the first countries to launch a large-scale COVID-19 vaccination campaign, and quickly vaccinated its population, achieving early control over the spread of the virus. However, the number of COVID-19 cases is now rapidly increasing, which may indicate that vaccine protection decreases over time.

Objective: To determine whether time elapsed since the second BNT162b2 messenger RNA (mRNA) vaccine (Pfizer-BioNTech) injection is significantly associated with the risk of post-vaccination COVID-19 infection.

Design: This is a retrospective cohort study performed in a large state-mandated health care organization in Israel.

Participants: All fully vaccinated adults who have received a RT-PCR test between May 15, 2021 and July 26, 2021, at least two weeks after their second vaccine injection were included. Patients with a history of past COVID-19 infection were excluded.

Main Outcome and Measure: Positive result for the RT-PCR test.

Results: The cohort included 33,993 fully vaccinated adults, 49% women, with a mean age of 47 years..., who received an RT-PCR test for SARS-CoV-2 during the study period. The median time between the second dose of the vaccine and the RT-PCR test was 146 days.... 608 (1.8%) patients had positive test results. There was a significantly higher rate of positive results among patients who received their second vaccine dose at least 146 days before the RT-PCR test compared to patients who have received their vaccine less than 146 days before: odds ratio for infection was 3.00 for patients aged over 60 ...; 2.29 for patients aged between 40 and 59...; and 1.74 for patients aged between 18 and 39 ...

Conclusions and Relevance: In this large population study of patients tested for SARS-CoV-2 by RT-PCR following two doses of mRNA BNT162b2 vaccine, we observe a significant increase of the risk of infection in individuals who received their last vaccine dose since at least 146 days ago, particularly among patients older than 60.

Ago 6, 9:07am

>79 margd: contd. Texas heads back to school...

Back to School: Here's what to know about vaccination requirements
Jake Harris | August 5, 2021

...The COVID vaccine is not required for your child, but others are

...Gov. Greg Abbott's latest executive order forbids any mask mandates in schools.

...The latest TEA guidance also states that schools now don't have to inform parents of positive COVID cases, but they do have to report that information to state and local health departments.

Schools also don't have to contact trace, but if they choose to do so, parents can still choose to send their kid to school if they are a "close contact" of a positive COVID case...

Public Health Guidance (2 p)
Texas Education Agency | Aug 5, 2021

Ago 6, 9:24am

This member has been suspended from the site.

Ago 6, 10:58am

Eric Topol @EricTopol | 10:23 AM · Aug 6, 2021
New data (via press briefing) on the 1-shot J&J vaccine in >477,000 health care workers support high level of protection, including during the South African Delta wave. Look forward to seeing the dataset but certainly encouraging

Image-text ( )

South African study shows high COVID protection from J&J shot
Reuters | Aug 6, 2021

Ago 6, 11:49am

Eric Topol @EricTopol | 11:39 AM · Aug 6, 2021:

New @PHE_uk (Public Health England) report today provides data to support the high viral load (low Ct) is
similar for Delta infections among unvaccinated (17.8) and vaccinated (18.0)

Image- graph Fig 12 ( )


SARS-CoV-2 variants of concern and variants under investigation in
England Technical briefing 20 (44 p)
Public Health England | 6 August 2021

This briefing provides an update on previous briefings up to 23 July 2021...

Ago 6, 11:55am

This member has been suspended from the site.

Ago 7, 8:02am

Eric Topol @EricTopol | 10:08 PM · Aug 6, 2021:
Brilliant. Let's combine a superspreader variant (Delta) with a superspreader event (Sturgis Motrcycle Rally) in the midst of a big surge with over 130,000 new cases today. Only in the USA

Perfect slogan, too. ("We're spreading our wings.")

This is what happened last year after the rally
The Dakotas had the highest case and death rates in the world; neighboring states affected as well.
Estimated more than 250,000 new cases
By most accounts, the worst superspreader event in the US pandemic

Image-graph, case rate after 2000 rally, SD and nearby states ( )

Sturgis Motorcycle Rally revs up, drawing thousands and heightening delta superspreader fears
Thousands flock to 2021 Sturgis Motorcycle Rally in South Dakota
Timothy Bella | Aug 6, 2021

...Although Sturgis’s coronavirus case numbers are relatively low, the CDC has designated Meade County, which includes the city (pop 7,000), as an area of “high community transmission,” advising residents or visitors to wear masks in public indoor spaces. About 37 percent of Meade County is fully vaccinated, according to the CDC, and more than 47 percent of South Dakota is fully inoculated as of Friday.

Christina Steele, a spokeswoman for the city of Sturgis...the city is offering coronavirus tests, masks and hand sanitizer stations for anyone in town, but no mask mandate is in place. The city has also signed off on a temporary open container ordinance in an effort to keep people outside instead of crowded together inside bars. Steele said those who are not vaccinated or who have certain underlying health conditions are putting themselves at risk, but the virus has not been a talking point among those who’ve flocked to the Black Hills.

...Local clinics are still offering vaccines, including Johnson & Johnson’s one-dose shot, to attendees who want to be vaccinated... It can take weeks for a vaccine to strengthen a person’s immune system...

...Despite the potential for a surge in coronavirus cases, South Dakota Gov. Kristi L. Noem (R) has given her blessing to the motorcycle rally. The governor is supporting the large crowds expected for a 10-day event that generates $800 million in sales for the local economy, according to South Dakota’s Department of Tourism.

...The Sturgis rally is the latest large outdoor event to take place during the fourth wave of the pandemic...the Milwaukee Bucks won their first NBA championship...Lollapalooza...

Ago 7, 8:44am

Aerosols..."Fine aerosols produced by talking and singing contain more SARS-CoV-2 copies than coarse aerosols and may play a significant role in SARS-CoV-2 transmission...Isolating viable SARS-CoV-2 from respiratory aerosol samples remains challenging..."

Kristen K. Coleman (Duke Med School) @drkristenkc | 8:22 PM · Aug 6, 2021:
Our peer-reviewed research is now published in Clinical Infectious Diseases!
No matter how you slice it, COVID-19 is an airborne disease.
Let's call it like it is and put the appropriate measures in place.

Kristen K Coleman et al. 2021. Viral Load of SARS-CoV-2 in Respiratory Aerosols Emitted by COVID-19 Patients while Breathing, Talking, and Singing. Clinical Infectious Diseases, ciab691, Published:
06 August 2021.

Multiple SARS-CoV-2 superspreading events suggest that aerosols play an important role in driving the COVID-19 pandemic. To better understand how airborne SARS-CoV-2 transmission occurs, we sought to determine viral loads within coarse (>5 margd:μm) and fine (≤5μm) respiratory aerosols produced when breathing, talking, and singing.

Using a G-II exhaled breath collector, we measured viral RNA in coarse and fine respiratory aerosols emitted by COVID-19 patients during 30 minutes of breathing, 15 minutes of talking, and 15 minutes of singing.

Thirteen participants (59%) emitted detectable levels of SARS-CoV-2 RNA in respiratory aerosols, including 3 asymptomatic and 1 presymptomatic patient. Viral loads ranged from 63–5,821 N gene copies per expiratory activity per participant, with high person-to-person variation. Patients earlier in illness were more likely to emit detectable RNA. Two participants, sampled on day 3 of illness, accounted for 52% of the total viral load. Overall, 94% of SARS-CoV-2 RNA copies were emitted by talking and singing. Interestingly, 7 participants emitted more virus from talking than singing. Overall, fine aerosols constituted 85% of the viral load detected in our study. Virus cultures were negative.

Fine aerosols produced by talking and singing contain more SARS-CoV-2 copies than coarse aerosols and may play a significant role in SARS-CoV-2 transmission. Exposure to fine aerosols, especially indoors, should be mitigated. Isolating viable SARS-CoV-2 from respiratory aerosol samples remains challenging, and whether this can be more easily accomplished for emerging SARS-CoV-2 variants is an urgent enquiry necessitating larger-scale studies.

Ago 7, 9:09am

This member has been suspended from the site.

Ago 7, 9:42am

>90 margd: contd. Provincetown, Mass. BBQ of the vaxxed

How Provincetown, Mass., stress-tested the coronavirus vaccine with summer partying and delta
Hannah Knowles and Randy Dotinga | August 5, 2021

...July festivities at the tip of Cape Cod stress-tested the vaccines against indoor crowds and the fast-spreading, game-changing delta variant of the coronavirus. Provincetown’s outbreak of overwhelmingly mild or no-symptom cases would grow to more than 1,000 people. About three-fourths of people in a subset of cases analyzed by the Centers for Disease Control and Prevention were vaccinated — a phenomenon that led experts to believe the immunized can in rare cases spread the coronavirus.

The findings helped spur new national masking guidance and left Provincetown’s leaders, locals and infected visitors grappling with the same questions facing the country: What should life look like under delta?

...leaders from Provincetown to the White House are stressing that July’s events should be a cautionary tale less for the vaccinated than for the millions of Americans in parts of the country far less prepared for delta — areas still struggling to meet national vaccination goals and potentially more hostile to rapid containment measures for an outbreak. Only seven people, with a mix of vaccination statuses, were hospitalized in the Provincetown cluster, officials say, and no one has died.

“If this happened in a community that was actually under-vaccinated or had a low vaccination rate,” said Alex Morse, the town manager, “this would have been a very dangerous situation.”...

Ago 7, 4:11pm

What does the Delta variant have in store for the United States? We asked coronavirus experts
Meredith Wadman | Aug. 4, 2021

How many cases and deaths can the United States expect in the Delta-driven surge?
... a lot of uncertainty...Many computer models predict case counts will peak sometime between mid-August and early September.

...assumptions that are moving targets—such as mask wearing and vaccination behavior—and accuracy quickly diminishes the further out the forecast.

...Hospitalizations and deaths will lag behind cases by several weeks and, given the number of people who are now vaccinated, deaths are expected to be lower than their peak of more than 3400 per day in January.

...The national case count obscures the record-breaking infection rates in U.S. states with low vaccination rates such as Florida and Louisiana.

Can other countries’ Delta surges offer hints about what will happen in the United States?
Can Delta infect fully vaccinated people?
What might happen in the fall and winter, when people move indoors and children are back in school?
What will make the Delta surge fade away?
What will make the Delta surge fade away?
Have COVID-19 scientists changed their own behavior since Delta emerged?

Ago 7, 4:37pm

Eric Topol @EricTopol | 2:44 PM · Aug 7, 2021
Is this Microbe a challenge?
The situation in Iceland, now vertical in case rise, yet one of the most fully vaccinated countries in the world.
No sequence data available, assuming this is d/t Delta
Image-# cases Iceland ( )
Image- vaxx rates Iceland ( )

Ago 7, 5:05pm

Gov. Ron DeSantis objects to vaccine mandates at Florida hospitals
Florida hospitals announce new vaccine requirements amid rising cases
Christine Sexton | Aug 5, 2021

...DeSantis said between 80 percent and 90 percent of physicians got vaccinated, he said the uptake among nurses wasn’t as great.

Those comments were underscored by an AARP report last month that showed just 42 percent of Florida’s nursing-home workers were vaccinated. That was the second-lowest vaccination rate in the nation during a four-week review period and was significantly less than the 56 percent who were vaccinated nationwide.

...Florida reported an additional 20,133 new COVID-19 infections on Wednesday, making the state responsible for about 22 percent of the new cases reported nationwide for the day...

The state also reported 84 COVID-19 deaths Wednesday, accounting for nearly 17 percent of the reported deaths nationwide that day.

Meanwhile the numbers of people in Florida hospitals with COVID-19 reached 12,888, according to data maintained by the U.S. Department of Health and Human Services.

COVID-19 patients are occupying 22 percent of the hospital beds in the state, the highest percentage in the nation, the data show. Florida also lags in vaccination rates, a factor that has contributed to the spike.

Ago 8, 10:33am

More than 400 universities are requiring Covid-19 vaccines. But the murky threat of fake vaccination cards worries some students and experts
Neelam Bohra and Justin Lear | August 8, 2021

...Benjamin Meier, a professor of global health policy at UNC-Chapel Hill, about their peers buying fake vaccine cards, he began to worry about the effectiveness of university policy. Classes at will begin on August 18. "(Students) explained to me that they can easily purchase fake vaccine cards...I asked, 'Do you know students who have submitted these to the university?' Every one of them did."

...The (CDC) cards can be easily forged but it's a federal crime, which is punishable by a fine and up to five years in prison for forging government seals found on the card. Forging a card could also violate university rules and students could face punishment from their schools as well.

...a form of protest

...College students have somewhat normalized the creation of fake IDs to buy alcohol, and the idea of fake vaccination cards isn't far from that, Meier said...

Ago 8, 10:58am

Explainer: Beyond Delta, scientists are watching new coronavirus variants
Julie Steenhuysen | Aug 8, 2021

The Delta variant first detected in India remains the most worrisome. It is striking unvaccinated populations in many countries and has proven capable of infecting a higher proportion of vaccinated people than its predecessors.

...India listed Delta Plus as a variant of concern in June, but neither the U.S. Centers For Disease Control and Prevention nor the WHO have done so yet. According to, an open-source COVID-19 database, Delta Plus has been detected in at least 32 countries. Experts say it is not yet clear whether it is more dangerous.


The Lambda variant has attracted attention as a potential new threat. But this version of the coronavirus, first identified in Peru in December, may be receding

...B.1.621 - ONE TO WATCH
The B.1.621 variant, which first arose in Colombia in January, where it caused a major outbreak, has yet to earn a Greek letter name.

The European Center for Disease Prevention and Control has listed it as a variant of interest, while Public Health England describes B.1.621 as a variant under investigation. It carries several key mutations, including E484K, N501Y and D614G, that have been linked with increased transmissibility and reduced immune protection. So far, there have been 37 likely and confirmed cases in the UK, according to a recent government report, and the variant has been identified in a number of patients in Florida.

...To defeat SARS-CoV-2, he said, will likely require a new generation of vaccines that also block (nasopharyngeal) transmission...

Ago 8, 1:33pm

Eric Topol @EricTopol | 12:27 PM · Aug 8, 2021:
A marked reduction in testing likely explainer for a ~2:1 ratio for US cases: hospitalizations
Peak 3rd wave: 250,000 cases/7d avg; 125,000 hospitalizations, > 2M tests/day
Current 4th wave: 110,000 cases/7d avg; 63,000 hospitalizations , ~1M tests/day

Editado: Ago 9, 1:29pm

Judge rules Florida can't ban Norwegian Cruise Line 'vaccine passport'
Mychael Schnell | 08/09/21

A judge ruled on Sunday that Norwegian Cruise Line is permitted to ask customers to show proof of vaccination before boarding a ship, dealing a blow to Florida Gov. Ron DeSantis’s (R) law that prevented "vaccine passports" from being utilized in the state.

The nearly 60-page preliminary ruling* from U.S. District Judge Kathleen Williams in the Southern District of Florida said that the state law barring the use of vaccine passports is likely unconstitutional under the First Amendment and jeopardizes public health.

The judge ruled that Florida Surgeon General Scott Rivkees, whom Norwegian filed a lawsuit against over the vaccine passport ban, cannot enforce the law with the cruise line, giving Norwegian the greenlight to carry out its safety measures starting Aug. 15, when the company plans to resume passenger cruises from the Sunshine State...


Editado: Ago 9, 7:19pm

The Pentagon Has Moved Toward Making Vaccines Mandatory For Service Members
James Doubek | August 9, 2021

..."To defend this Nation, we need a healthy and ready force," Defense Secretary Lloyd Austin said in a memo to employees Monday. "I strongly encourage all DoD military and civilian personnel — as well as contractor personnel — to get vaccinated now and for military Service members to not wait for the mandate."

The Pentagon cannot take the step unilaterally because the Food and Drug Administration has not yet approved the vaccine. The move would require a presidential waiver, which Austin plans to ask for by mid-September.

After that, individual services would draft plans for implementing a mandate within each military branch, Pentagon spokesperson John Kirby told reporters Monday.

Alternatively, if the FDA gives full approval to the Pfizer-BioNTech vaccine before then, Austin has the authority to implement a mandate himself...

Editado: Ago 10, 8:44am

Gov. Ron DeSantis is waging a war on school mask mandates, and is threatening to withhold the paychecks of school board members who defy his mask ban
Cheryl Teh | 8/10/2021

Florida Gov. Ron DeSantis is threatening to withhold the salaries of school board members who impose mask mandates.
The governor on July 31 signed an executive order to strip funding from schools that mandate masks.
School districts in Florida, however, have recommended students wear masks, directly defying DeSantis.

...Miami-Dade public schools superintendent Alberto Carvalho responded to DeSantis in a separate statement to CBS Miami that the schools in his district — the fourth-largest in the US — will follow a "process" in consultation with public health experts to decide whether or not students should wear masks.

"At no point shall I allow my decision to be influenced by a threat to my paycheck, a small price to pay considering the gravity of this issue and the potential impact to the health and well-being of our students and dedicated employees," Carvalho said to CBS Miami...

...Florida has seen an uptick in infection rates...Hospitals in Florida are also seeing an increase in the number of children being infected with the virus

Ago 10, 8:57am

Of course the CDC rates the US itself as Level 4...

CDC adds seven destinations to 'very high' Covid-19 travel risk list
Marnie Hunter, CNN • Updated 10th August 2021

...The seven destinations added to the Level 4 (Covid-19 very high) list on August 9 are:
• Aruba
• Eswatini (formerly Swaziland)
• France
• French Polynesia
• Iceland
• Israel
• Thailand...

COVID-19 Travel Recommendations by Destination
CDC | Aug. 9, 2021


Editado: Ago 11, 2:06pm

Eric Topol (Scripps) @EricTopol | 9:38 AM · Aug 10, 2021
Current Israel data for mRNA vaccination in people age more than 60, 1st to get vaccines more than 6 months ago, now confronting Delta infections
1. Vaccines work but their apparent effectiveness is diminished over time + Delta
2. Boosters showing some preliminary evidence of working

via @dvir_a
Image--graph, case rates for unvaxx'd, vaxx'd, booster

Ago 10, 1:06pm

What to know about multiple myeloma and COVID-19 vaccinations
Jenna Fletcher | August 4, 2021

..a person should work with their doctor to determine whether the vaccine is the best choice for them and when they should get it. They also strongly encourage people living with MM to get the vaccine...

Ago 11, 12:41pm

Eric Topol @EricTopol | 10:58 AM · Aug 11, 2021:
Delta breakthrough infections among 62 healthcare workers vaccinated in Vietnam
1. High viral loads. Many asymptomatic infections with similar viral loads
2. Low neutralizing antibodies
3. Transmission between vaccinated individuals

Image ( )
Image ( )
Image ( )

Nguyen Van, Vinh Chau et al. 2021. Transmission of SARS-CoV-2 Delta Variant Among Vaccinated Healthcare Workers, Vietnam. The Lancet PREPRINT (10 Aug, 2021) 31 pp


Findings: Between 11th–25th June 2021 (week 7–8 after dose 2), 69 healthcare workers
32 were tested positive for SARS-CoV-2. 62 participated in the clinical study. 49 were
33 (pre)symptomatic with one requiring oxygen supplementation. All recovered uneventfully.
34 23 complete-genome sequences were obtained. They all belonged to the Delta variant, and
35 were phylogenetically distinct from the contemporary Delta variant sequences obtained
36 from community transmission cases, suggestive of ongoing transmission between the
37 workers. Viral loads of breakthrough Delta variant infection cases were 251 times higher
38 than those of cases infected with old strains detected between March-April 2020. Time
39 from diagnosis to PCR negative was 8–33 days (median: 21). Neutralizing antibody levels
40 after vaccination and at diagnosis of the cases were lower than those in the matched
41 uninfected controls. There was no correlation between vaccine-induced neutralizing
42 antibody levels and viral loads or the development of symptoms.

43 Interpretation: Breakthrough Delta variant infections are associated with high viral loads,
44 prolonged PCR positivity, and low levels of vaccine-induced neutralizing antibodies,
45 explaining the transmission between the vaccinated people. Physical distancing measures
46 remain critical to reduce SARS-CoV-2 Delta variant transmission.

...(Hospital for Tropical Diseases) HTD staff members were amongst the first people in Vietnam to be offered the Oxford-AstraZeneca COVID-19 vaccine....

Ago 11, 12:53pm

Sputnik V COVID-19 vaccine around 83% effective against Delta variant
Updated on August 11, 2021, at 8:00 a.m. PDT

On Wednesday, Russian Health Minister Mikhail Murashko said that the Sputnik V COVID-19 vaccine has demonstrated approximately 83% efficacy against the Delta variant of coronavirus. Read more about the vaccine here:
Sputnik V COVID-19 vaccine: How much do we know about its side effects?
Minseo Jeong on May 10, 2021

Sputnik V, developed by the Gamaleya National Center of Epidemiology and Microbiology in Russia, was the first COVID-19 vaccine to be authorized. This Snapshot feature discusses some of the common side effects reported in clinical trials, as well as controversies around potential safety concerns of the vaccine...

Editado: Ago 11, 2:04pm

Eric Topol @EricTopol | 12:22 PM · Aug 11, 2021:
There needs to be truth-telling about the reduced protection of mRNA vaccines vs symptomatic Delta infections.
It was 95% pre-Delta.
Many are claiming it's still ~80%.
It isn't.
50-60% is best estimate from all sources (not US, since we don't have the data)

Image ( )

Why is this important?
Because we need to protect the protected, the fully vaccinated.
Sure we want to get more people vaccinated, but truth engenders trust. And truth helps guide people to be safe, use masks, distance, ventilation and all the other tools we have and know helps.

Look at Israel's Delta case surge, a model country for vaccination, more than 15 per cent points more of total population vaccinated than the US. That, in itself, tells us about the reduction of protection of mRNA vaccines vs cases/spread
Image ( )

Ago 11, 2:42pm

The C.D.C. endorses Covid vaccinations during pregnancy.
Roni Caryn Rabin | Aug. 11, 2021

Federal health officials on Wednesday bolstered their recommendation that pregnant people be vaccinated against Covid-19, pointing to new safety data that found no increased risk of miscarriage among those who were immunized during the first 20 weeks of gestation.

Earlier research found similarly reassuring data for those vaccinated later in pregnancy.

Until now, the Centers for Disease Control and Prevention has said the vaccine could be offered during pregnancy; the recent update in guidance strengthens the official advice, urging pregnant people to be immunized.

The new guidance brings the C.D.C. in line with recommendations made by the American College of Obstetricians and Gynecologists and other medical specialty groups, which strongly recommend vaccination...

...The risks of having Covid-19 during a pregnancy are well-established, she said, and include severe illness, admission to intensive care, needing mechanical ventilation, having a preterm birth and death.

So far, there is limited data on birth outcomes, she added, since the vaccine has only been available since December. But the small number of pregnancies followed to term have not identified any safety signals.

Pregnant women were not included in the clinical trials of the vaccines, and uptake of the shots has been low among pregnant women. The majority of pregnant women seem reluctant to be inoculated: Only 23 percent of pregnant women had received one or more doses of vaccine as of May...

Ago 13, 6:20am

These 8 states make up half of US Covid-19 hospitalizations. And the surge among the unvaccinated is overwhelming healthcare workers
Travis Caldwell | August 13, 2021

...Of all Covid-19 hospitalizations, these eight states (Alabama, Arkansas, Florida, Georgia, Louisiana, Mississippi, Nevada and Texas) combined totals make up approximately 51% of (US) patients, despite accounting for only around 24% of the nation's population...

The percentages of Covid-19 patients in ICUs are even worse, with Florida, Louisiana and Mississippi approaching half of ICU beds in use for such patients, according to HHS data Thursday. ...

Ago 13, 6:35am

The Good News From Lollapalooza About COVID
Shannon Palus | Aug 12, 2021 officials in Chicago are saying that Lollapalooza (outdoor music festival, July 29-August 1, 2021, Chicago) does not appear to have been a superspreader event, as some feared it would be.

Out of nearly 400,000 people who attended the festival, just 203 tested positive for the virus.... The vast majority of people at the event—at least 88 percent—were vaccinated. While the case numbers include breakthrough cases (127 of them), festivalgoers who were unvaccinated were four times as likely to be among those cases.

Though it may be better at making itself at home in the human body, and is certainly more spreadable, delta can be kept in check by the same control measures that public health officials honed in on for the original coronavirus—namely vaccines, socializing outdoors instead of indoors, and masks. (A mask mandate for indoor spaces at the festival went into effect on its third day, to reflect Centers for Disease Control and Prevention guidance.)...

Ago 13, 7:02am

New Data Shows Not Getting Vaccinated in Pregnancy Is the Riskier Choice
The CDC strongly recommends the vaccine for anyone who is pregnant or thinking about becoming pregnant.
Beth Skwarecki | Aug 13, 2021

COVID vaccines caused no increased risk of miscarriage
No concerns from pregnancy data monitoring
Vaccination may protect your baby even after birth
COVID is more of a risk than the shot

CDC news release

COVID-19 Vaccines While Pregnant or Breastfeeding
CDC | Updated Aug. 11, 2021

COVID-19 vaccination is recommended for all people aged 12 years and older, including people who are pregnant, breastfeeding, trying to get pregnant now, or might become pregnant in the future. Pregnant and recently pregnant people are more likely to get severely ill with COVID-19 compared with non-pregnant people. Getting a COVID-19 vaccine can protect you from severe illness from COVID-19....

Ago 13, 7:18am

A snort or a jab? Scientists debate potential benefits of intranasal Covid-19 vaccines
Helen Branswell | Aug. 10, 2021

...Vaccines that are injected into arm muscles aren’t likely to be able to protect our nasal passages from marauding SARS-CoV-2 viruses for very long, even if they are doing a terrific job protecting lungs from the virus. If we want vaccines that protect our upper respiratory tracts, we may need products that are administered in the nose — intranasal vaccines.

...Florian Krammer, a vaccinologist at the Icahn School of Medicine at Mount Sinai Hospital, thinks existing vaccines likely induce high enough levels of circulating antibodies early after vaccination that some of them end up in the mucus membranes of the nose and throat. But as antibody levels start to drop in the months after vaccination, that early nasal protection seems to wane with it — especially in the face of the onslaught of the Delta variant...

For disclosure purposes: Krammer’s colleague, veteran virologist Peter Palese, is developing an intranasal vaccine that recently completed a Phase 1 trial in Mexico. Krammer is involved in the project. But he sees potential in the broader effort to develop intranasal vaccines against Covid.

“There are some approaches that … look OK and I think they can be moved forward — if there’s funding,” he said. That’s a big “if,” he acknowledged, explaining that funding for next-generation Covid vaccines — innovations on the initial options — has dried up.

...Intranasal vaccines have multiple advantages. They don’t require syringes, cutting the expense of vaccination and the amount of medical waste an immunization program generates. A vaccine that can be puffed up a nostril probably doesn’t require a health care professional to administer it; the oral polio vaccine used in many developing countries is dripped into the mouths of children by trained volunteers.

...There are challenges to making vaccines that are administered this way.

...Many virologists believe that over time, as people’s immune systems develop experience with SARS-2 — either through vaccination or infection — the virus and humans will reach a détente with SARS-2, becoming like the four human coronaviruses, one of the causes of the common cold.

Krammer, though, thinks there’s a role for the vaccines now. The one Mount Sinai is developing is produced in eggs — a low-tech, inexpensive production approach that could easily be adopted in low- and middle-income countries that don’t have the capacity to produce the more high-tech mRNA vaccines...

Human trials for nasal spray coronavirus vaccine to begin in Thailand
Adam Barnes | Aug. 11, 2021

Two nasal spray coronavirus vaccines developed in Thailand are set to begin human trials by the end of 2021.

The vaccines based on the adenovirus and influenza are being developed by the National Center for Genetic Engineering and Biotechnology.

Roughly 6 percent of the country is fully vaccinated...

Editado: Ago 13, 7:43am

>108 margd: contd.

Daniel Griffin MD PhD @DanielGriffinMD | 11:23 PM · Aug 12, 2021:
This is the data we need and it is not reassuring for people thinking herd immunity will ever be reached.
It seems COVID is here to stay

(Quote from preprint abstract below)
“Infectious SARS-CoV-2 was isolated from 51 of 55 specimens (93%) with Ct less than 25 from both vaccinated and unvaccinated persons, indicating that most individuals with Ct values in this range ... shed infectious virus regardless of vaccine status.”

Kasen K Riemersma et al. 2021. Shedding of Infectious SARS-CoV-2 Despite Vaccination when the Delta Variant is Prevalent - Wisconsin, July 2021. MedRxiv (Aug 11, 2021) doi:

This article is a preprint and has not been certified by peer review


The SARS-CoV-2 Delta variant and its sublineages (B.1.617.2, AY.1, AY.2, AY.3; ...) can cause high viral loads, are highly transmissible, and contain mutations that confer partial immune escape ... Using data from a single large contract laboratory, we show that individuals in Wisconsin, USA had similar viral loads in nasal swabs, irrespective of vaccine status, during a time of high and increasing prevalence of the Delta variant. Infectious SARS-CoV-2 was isolated from 51 of 55 specimens (93%) with Ct* less than 25 from both vaccinated and unvaccinated persons, indicating that most individuals with Ct values in this range ... shed infectious virus regardless of vaccine status. Notably, 68% of individuals infected despite vaccination tested positive with Ct less than 25, including at least 8 who were asymptomatic at the time of testing. Our data substantiate the idea that vaccinated individuals who become infected with the Delta variant may have the potential to transmit SARS-CoV-2 to others. Vaccinated individuals should continue to wear face coverings in indoor and congregate settings, while also being tested for SARS-CoV-2 if they are exposed or experience COVID-like symptoms...

* PCR test is performed by repeatedly replicating target viral material in the sample to the point that it becomes detectable. The number of cycles before the virus is detectable is known as the cycle threshold (Ct)...A positive test with a high Ct value may indicate a test from someone who had a very small amount of detectable viral RNA on their initial swab, and may not be infectious or have ongoing active infection. However, there are other clinical scenarios that can result in a positive test with high Ct value in someone who may still be infectious or who may soon become infectious.

Ago 13, 8:39am

Justice Amy Barrett denies appeal from Indiana University students fighting COVID-19 vaccine mandate
Andrew Mark Miller | 8/12/2021

...Supreme Court Justice Amy Coney Barrett (who has jurisdiction over the appeals court involved in the case) denied an appeal from students at Indiana University to block the school’s vaccine mandate...without consulting other colleagues on the court and without hearing from the school.

...Indiana University told students and employees that they are required to be vaccinated by the start of the fall term on August 23. Students who don’t comply will have their registration canceled, and employees who don’t comply will lose their jobs.

A three-judge federal appeals court panel, including two judges appointed by former President Donald Trump, was one of two lower courts to side with Indiana University and allow it to require vaccinations...

In July, an Indiana district court judge sided with the university in declining to issue a preliminary injunction blocking the vaccine mandate. The U.S. Court of Appeals for the 7th Circuit voted 3-0 to uphold the decision earlier this week. Two of the three appellate judges were appointed by Trump and the third by former President Ronald Reagan.

The mandate was being challenged by eight students who argued in court papers filed Friday last week that they have "a constitutional right to bodily integrity, autonomy, and of medical treatment choice in the context of a vaccination mandate." The students asked for an injunction from the High Court barring the university from enforcing the mandate. Seven of the students qualify for a religious exemption.

The appeal’s denial represents the first time the high court has reacted to an emergency appeal specifically related to vaccine mandates, which could set a precedent for how those cases are treated in the future.

Ago 13, 9:08am

Israel kicks off third shot COVID vaccination campaign among 50+
Health Minister Nitzan Horowitz says beating coronavirus is “in the hands and ‘shoulders’ of every person.”

...Healthcare workers, people at high risk of developing serious COVID, prisoners and wardens also qualify for the shots, the Health Ministry said, adding that further discussions are taking place to formulate the final guidelines regarding various populations.

“Members of the team (Advisory Committee for the Corona Vaccines and Epidemic Control) worked diligently, professionally and thoroughly, and reached the conclusion that the third inoculation for people aged 50 and over, and for medical teams, is effective and correct,” Prime Minister Naftali Bennett said. “The campaign to vaccinate people aged 60 and over has been a great success. Over 750,000 people have been vaccinated up until now and we are continuing on to the next stage. This is an important step in the fight against the Delta pandemic.”...

FDA authorizes third dose of Pfizer, Moderna shots for immunocompromised
LAUREN GARDNER | 08/13/2021

Acting Commissioner Janet Woodcock emphasized that people whose immune systems are not compromised — the vast majority of Americans — do not need additional vaccine doses...

Ago 13, 9:45am

...The relationship between education and being vaccinated is clearly a positive one. There's no curvilinear relationship.
70% of folks with a PhD had gotten the vaccine compared to 41% of HS grads.

Image--graph % vaxxed by education ( )

- Ryan Burge (Baptist Minister) @ryanburge | 8:42 AM · Aug 13, 2021

Ago 13, 12:09pm

Eric Topol @EricTopol | 10:56 AM · Aug 13, 2021:
Why is this graph so concerning?
We (US) are double the Delta wave peak of UK and Israel in hospitalizations and show no sign of letting up.
We'll hit 80,000 today and if we don't get slowing we'll exceed the 3rd wave peak of 125,000.
Never thought this would be possible with (vaccines)

Image--# hospitalizations per million, US, UK, Israel

Ago 14, 12:43am

Three Florida educators die of Covid, says union (BBC)

Three educators in Florida's second-largest school district have died from Covid-19 within two days of each other, teachers' union officials say. The deaths come just days before Broward County schools are due to reopen on 18 August. Florida's Republican governor has threatened to withhold pay from school leaders who require masks for pupils...

Ago 14, 6:55am

Biden administration offers financial help to Florida school leaders defying DeSantis

TALLAHASSEE — The Biden Administration further inserted itself into Florida’s mask fight on Friday by offering to pay the salaries of Florida school board members who lose state funds by defying Gov. Ron DeSantis’ ban on local K-12 mask mandates.

In a letter* to DeSantis and his Education Commissioner Richard Corcoran, U.S. Education Secretary Miguel Cardona wrote that school districts stripped of state funding for passing local coronavirus safety measures can use federal relief dollars to replenish the cash. Cardona said he was “deeply concerned” by DeSantis’ efforts preventing schools from requiring students to wear masks amid a surge in Covid infections, and that his agency could reach the schools directly if need be...


Editado: Ago 14, 7:18am
Don Lemon Is Completely Done with Anti-Vaxxers and Anti-Maskers: ‘What Are We Doing?!’

My take ~ The selfishness anti-maskers around the country (and world) are exhibiting during this Covid crisis is not a good omen for the survival of the human race. We are all together on what is becoming a virus-filled planet. They don't appear to understand, or care, that Covid is an equal-opportunity killer.

Editado: Ago 15, 9:18am

Carlos del Rio (Emory U) @CarlosdelRio7 | 3:16 PM · Aug 14, 2021:
What do we know today about #DeltaVariant ?
Still excellent VE against severe disease and hospitalization but lower VE against infection compared with Alpha.
Preprint from @MayoClinic suggests lower VE from for @pfizer vs @moderna_tx...

(SLIDES--references at bottom of slides)

Ago 15, 3:42pm

Eric Topol (Scripps MD scientist) @EricTopol | 2:17 PM · Aug 15, 2021:
What vaccination strategies lead to the highest level of neutralizing Ab, immune response, in rank order?
1. Prior covid + mRNA 1-dose
2. Adenoviral-vector vaccine 1st dose, mRNA 2nd dose
3. 2 doses mRNA
4. 2 doses adenoviral vector (AZ data)

Links to support
(1) Hybrid (natural + vaccine) ...
Image ( )
Image ( )

(2,3,4) On the mix and match vaccine front, a 2nd new study shows a significantly better immune response for AZ then mRNA than either 2 AZ shots or 2 mRNA shots @TheLancetInfDis
Image ( )

Ago 15, 6:25pm

Iceland has been a vaccination success. Why is it seeing a coronavirus surge?
Reis Thebault | 8/15/2021

What happened to Iceland?

The island nation that has been praised for its coronavirus response and its world-leading vaccination rate is now seeing its highest levels of infection since the start of the pandemic.

Just one month after the government scrapped all covid-19 restrictions, masks, social distancing and capacity limits have returned. And U.S. authorities last week warned Americans to stay away.

Vaccine opponents have gleefully pointed to Iceland as proof that the shots are a “failure.” But contrary to online misinformation and conspiratorial social media posts, infectious-disease experts say Iceland’s outbreak actually illustrates how effective the vaccines are at preventing the virus’s most severe impacts.

Many of the country’s recent infections have occurred among vaccinated people, but they’ve been overwhelmingly mild. So even as new cases multiplied, Iceland’s rates of covid-19 hospitalizations and deaths have remained low. Of the 1,300 people currently infected, just 2 percent are in the hospital. The country hasn’t recorded a virus death since late May...

Ago 16, 7:29am

Out of Control: America’s losing battle against diabetes
How the pandemic laid bare America’s diabetes crisis

...After years of improvement, the outlook for diabetes patients began to worsen by several measures about 10 years ago

...From 2009 to 2015, CDC data show that among diabetes patients, rates of hospitalization for hyperglycemic crises soared by 73%, and deaths by 55%. From 2010 to 2015, a jump in the rate of lower-limb amputations – always a risk for diabetes patients – erased more than one-third of a 20-year decline. The sharpest increases in these numbers were among adults 44 and younger. A Reuters analysis of more recent state-level data found that the trend has persisted. By 2019, U.S. deaths attributed primarily to diabetes reached their highest rate in eight years.

So when the pandemic struck, Americans with diabetes were in poorer health than they had been in years, increasing their vulnerability just as the virus overwhelmed the U.S. healthcare system.

...More Americans are developing diabetes earlier, even in childhood, because of long-term societal shifts toward sedentary lifestyles and unhealthy diets...Younger patients often have a harder time managing their disease, develop complications faster, and tend to have less consistent access to medical care, doctors say. Some patients ration their medications and limit doctor visits to avoid the hefty out-of-pocket costs of increasingly common high-deductible insurance plans, backed for years by employers, insurers and policymakers. The focus in U.S. healthcare on treating crises over preventing them doesn’t help, downplaying the importance of lifestyle changes that could lessen the severity of the disease.

...As diabetes became more widespread, more patients struggled to access the health care and healthy foods needed to manage their disease, especially in the Southeast and Appalachia.

Within just 12 years, the proportion of people with diabetes had doubled, or even tripled, in nearly 200 counties nationwide...rates for death and hospitalizations were now trending upward, too.

...While the coronavirus battered diabetes patients around the world, the longer-term reversal of fortunes is a particularly American problem. The U.S. mortality rate for diabetes was 42% higher than the average among 10 other industrialized countries in 2017, according to the Organization for Economic Cooperation and Development. In the British medical journal Lancet, researchers in 2018 gave the United States a score of 62 out of 100 on the quality of diabetes care. Most Western European countries scored in the 90s. The United States trailed Libya, Iran and Vietnam.

...Each state manages its Medicaid program, dictating what services to cover and how much it will pay medical providers. Low reimbursements are a big reason only 68% of family doctors, who treat most type 2 patients, are willing to accept new Medicaid patients, according to a 2019 federal report. That compares with 90% or more who accept patients on private insurance and Medicare.

...Diabetes was an underlying condition in nearly 40% of U.S. COVID-19 deaths early in the pandemic...

Ago 16, 12:11pm

Before Delta...

Dong Y, Mo X, Hu Y, et al. 2020. Epidemiology of COVID-19 Among Children in China. Pediatrics. 2020;145(6):e20200702

...we found that the proportion of severe and critical cases was
10.6% for the age groups, 1,
7.3%, 1 to 5,
4.2%, 6 to 10,
4.1%, 11 to 15, and
3.0% , 15 years and older...

Ago 16, 1:43pm

>121 Molly3028: I dunno. You could look at anti-maskers and anti-vaxxers at taking a peculiarly hard-line and selfless view on the whole population issue, by volunteering themselves to be culled, thereby sparing the rest of us the greenhouse-gas emissions that they would create if they'd lived a full life.

I'm not sure their tactics make a lot of sense to me, there's much simpler and more effective ways to kill yourself, but the end could be seen as weirdly noble

Editado: Ago 17, 11:46am

Eric Topol @EricTopol | 11:01 AM · Aug 17, 2021:

Current top 5 cases/capita in the world for country/state population greater than 1M
1. Florida 138/100,000
2. Georgia (country) 121/100,000
3. Louisiana 116/100,000
4. Mississippi 115/100,000
5. Botswana 89/100,000

Antonio Caramia @Antonio_Caramia | 6:30 PM · Aug 12, 2021
Total deaths per million in the last 7 days
Fiji 64
Georgia 61
Eswatini 59
Tunisia 57
Botswana 54

World Map-
Bar Graph-

Ago 17, 12:56pm

"We propose that the principal mechanism of action of famotidine for relieving COVID-19 symptoms involves on-target histamine receptor H2 activity, and that development of clinical COVID-19 involves dysfunctional mast cell activation and histamine release."

Robert W. Malone et al. 2021. COVID-19: Famotidine, Histamine, Mast Cells, and Mechanisms. Front. Pharmacol., 23 March 2021 |

SARS-CoV-2 infection is required for COVID-19, but many signs and symptoms of COVID-19 differ from common acute viral diseases. SARS-CoV-2 infection is necessary but not sufficient for development of clinical COVID-19 disease. Currently, there are no approved pre- or post-exposure prophylactic COVID-19 medical countermeasures. Clinical data suggest that famotidine may mitigate COVID-19 disease, but both mechanism of action and rationale for dose selection remain obscure. We have investigated several plausible hypotheses for famotidine activity including antiviral and host-mediated mechanisms of action. We propose that the principal mechanism of action of famotidine for relieving COVID-19 symptoms involves on-target histamine receptor H2 activity, and that development of clinical COVID-19 involves dysfunctional mast cell activation and histamine release. Based on these findings and associated hypothesis, new COVID-19 multi-drug treatment strategies based on repurposing well-characterized drugs are being developed and clinically tested, and many of these drugs are available worldwide in inexpensive generic oral forms suitable for both outpatient and inpatient treatment of COVID-19 disease.

Editado: Ago 17, 1:13pm

Cheap, generic cholesterol drug, fenofibrate, reduces SARS-COV-2 infection in human cells by 70%, destablilzes spike protein, inhibiting inding to ACE2.

A readily available drug may help fight COVID-19
Katharine Lang on August 16, 2021

Laboratory studies indicate that a cheap generic drug reduces SARS-CoV-2 infection in human cells by up to 70%.

The drug, called fenofibrate, regulates cholesterol levels but also destabilizes the spike protein on SARS-CoV-2 and inhibits binding to human cells.

It was effective against all the SARS-CoV-2 variants that the scientists tested in vitro.

An international effort — involving scientists from Keele University and the University of Birmingham, both in the United Kingdom, and the San Raffaele Scientific Institute in Milan — has found that a drug that people formerly used to control cholesterol levels could be an effective treatment against COVID-19.

The results of the study will appear in the journal Frontiers in Pharmacology.

....Scientists developed fenofibrate in the 1980s, and doctors used it widely to control people’s cholesterol levels. It was popular until the discovery of statins, which have the added benefit of reducing the risk of heart disease.

Around 30 million people worldwide now take statins. However, some people who cannot tolerate statins still take fenofibrate.

In laboratory experiments, the researchers found that fenofibrate destabilized the spike protein and inhibited binding to the ACE2 membrane protein, through which the virus enters the cells.

Fighting SARS-CoV-2 variants
The drug is effective against the Alpha and Beta variants of SARS-CoV-2, and the team is now investigating its effectiveness against the Delta variant.

“Because the drug affects multiple targets, not just the spike protein, it will be harder for resistance to develop, so new variants should not be able to escape the effect.” — Dr. Alan Richardson

After experiments with the isolated protein, other researchers in the team repeated the experiments with the live virus and found that fenofibrate was equally effective against the live virus.

...The researchers then looked at how much virus infected cells released after treatment with fenofibrate in vitro. They found that there was a 60% reduction in viral release compared with untreated cells. Other drugs, such as statins, did not have a similar effect.

The viral reproduction and spread among cells are what causes the symptoms as the body tries to control the virus. A drug that reduces that viral release should prevent severe disease and hospitalization and reduce the risk of those with SARS-CoV-2 passing it on to others.

Because people can take the drug by mouth and because the molecule is very cheap, if scientists replicate the recent finding in clinical trials, fenofibrate could prove invaluable for low and middle income countries that have not been able to get ahead with vaccination...a course of treatment would be about £10–20 ($14–28)...

The study authors advise caution around their findings, as all results are from laboratory trials. They are now keen to start clinical trials to assess fenofibrate as a potential therapeutic agent for COVID-19....

Scott P. Davies et al. 2021. The Hyperlipidaemic Drug Fenofibrate Significantly Reduces Infection by SARS-CoV-2 in Cell Culture Models. Front. Pharmacol., 06 August 2021 |

The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic has caused a significant number of fatalities and worldwide disruption. To identify drugs to repurpose to treat SARS-CoV-2 infections, we established a screen to measure the dimerization of angiotensin-converting enzyme 2 (ACE2), the primary receptor for the virus. This screen identified fenofibric acid, the active metabolite of fenofibrate. Fenofibric acid also destabilized the receptor-binding domain (RBD) of the viral spike protein and inhibited RBD binding to ACE2 in enzyme-linked immunosorbent assay (ELISA) and whole cell-binding assays. Fenofibrate and fenofibric acid were tested by two independent laboratories measuring infection of cultured Vero cells using two different SARS-CoV-2 isolates. In both settings at drug concentrations, which are clinically achievable, fenofibrate and fenofibric acid reduced viral infection by up to 70%. Together with its extensive history of clinical use and its relatively good safety profile, this study identifies fenofibrate as a potential therapeutic agent requiring an urgent clinical evaluation to treat SARS-CoV-2 infection.

Ago 17, 1:32pm

Babies and Toddlers Spread Virus in Homes More Easily Than Teens, Study Finds
Emily Anthes | Aug. 16, 2021

Babies and toddlers are less likely to bring the coronavirus into their homes than teenagers are, but once they are infected, they are more likely to spread the virus to others in their households, according to a large new study by a Canadian public health agency.

The findings can be explained, at least in part, by behavioral factors, experts said, including the fact that very young children require lots of hands-on care and cannot be isolated when they are sick....

Lauren A. Paul, et al. 2021. Association of Age and Pediatric Household Transmission of SARS-CoV-2 Infection. JAMA Pediatr. Published online August 16, 2021. doi:10.1001/jamapediatrics.2021.2770

Key Points
...Findings In this cohort study of 6280 households with pediatric index cases, the adjusted odds of household transmission by children aged 0 to 3 years was 1.43 compared with children aged 14 to 17 years.

...Conclusions and Relevance This study suggests that younger children may be more likely to transmit SARS-CoV-2 infection compared with older children, and the highest odds of transmission was observed for children aged 0 to 3 years. Differential infectivity of pediatric age groups has implications for infection prevention within households, as well as schools/childcare, to minimize risk of household secondary transmission. Additional population-based studies are required to establish the risk of transmission by younger pediatric index cases.

Ago 17, 2:03pm

Caroline E. Wagner et al. 2021. Vaccine nationalism and the dynamics and control of SARS-CoV-2. Science 17 Aug 2021:e DOI: 10.1126/science.abj7364

Vaccines provide powerful tools to mitigate the enormous public health and economic costs that the ongoing SARS-CoV-2 pandemic continues to exert globally, yet vaccine distribution remains unequal among countries. To examine the potential epidemiological and evolutionary impacts of ‘vaccine nationalism’, we extend previous models to include simple scenarios of stockpiling between two regions. In general, when vaccines are widely available and the immunity they confer is robust, sharing doses minimizes total cases across regions. A number of subtleties arise when the populations and transmission rates in each region differ, depending on evolutionary assumptions and vaccine availability. When the waning of natural immunity contributes most to evolutionary potential, sustained transmission in low access regions results in an increased potential for antigenic evolution, which may result in the emergence of novel variants that affect epidemiological characteristics globally. Overall, our results stress the importance of rapid equitable vaccine distribution for global control of the pandemic.

Even as vaccine production increases, a number of countries are choosing to share little or no vaccines with countries that have very low vaccine availability. Vaccine nationalism, dosing regimes, and host immune responses have important interactive effects, and these will substantially shape epidemiological dynamics and evolutionary potential in the medium term. Additionally, unstable vaccine supply will also increase variability in the timing or availability of first and second doses.

Using extensions of our prior work..., we incorporated vaccine sharing scenarios in two countries whose infection dynamics are either otherwise independent or coupled through immigration of infectious individuals and evolution-driven increases in transmission rates. When country profiles are symmetric, we find that sharing vaccines with countries that have low availability decreases overall infections and may also mitigate potential antigenic evolution. Asymmetries in population size or transmission rates introduce additional complexities, which are particularly marked when natural and vaccinal immunity is weak. Nevertheless, our models indicate that the prompt redistribution of vaccine surpluses is likely advantageous in terms of epidemiological and evolutionary outcomes in both countries and, by extension, globally. Ethical arguments also support this policy.... Persistent elevated disease transmission in countries with low vaccine availability also substantially undermines attempts at infection control via stockpiling in the country with high vaccine availability, which is not accounted for when disease transmission in both countries is assumed to be decoupled. Overall, our work highlights the importance of continued efforts in quantifying the robustness of immunity following vaccination. Furthermore, reevaluation of stockpiling policies as vaccine supplies increase is imperative, and ramping up global vaccination efforts is crucial.

Ago 18, 10:05am

NIH hamster study evaluates airborne and fomite transmission of SARS-CoV-2
(US) NIH | August 17, 2021

...The scientists found that aerosol exposure directly deposited SARS-CoV-2 deep into the lungs, whereas fomite exposure resulted in initial virus replication in the nose. Regardless of exposure route, animals had SARS-CoV-2 replicating in the lungs, but lung damage was more severe in aerosol-exposed animals compared to the fomite group.

A second part of the study compared animal-to-animal transmission of the virus through the air and in contaminated cage environments (fomites). Airborne transmission was markedly more efficient compared to fomite transmission, suggesting that airborne droplets are a key SARS-CoV-2 transmission route. An additional experiment, using air flowing from infected to uninfected animals, supported the finding: Reversing the airflow from uninfected to infected animals greatly reduced transmission efficiency.

The findings support public health guidance focused on interventions to reduce indoor airborne transmission of SARS-CoV-2. These efforts include masking, increasing air filtration and social distancing, as well as handwashing and regular surface disinfection, particularly in clinical settings...

J Port et al. 2021. SARS-CoV-2 disease severity and transmission efficiency is increased for airborne compared to fomite exposure in Syrian hamsters. Nature Communications (Aug 17, 2021) DOI: 10.1038/s41467-021-25156-8

Ago 18, 10:28am

!Check out graph in Topol's tweet!

Eric Topol @EricTopol | 10:01 AM · Aug 18, 2021:
Why is Delta so much more contagious than prior #SARSCoV2 variants?
It achieves membrane fusion far more efficiently and faster

Image-graph relative fusion of variants over 200 minutes

(excerpted from)

Jun Zhang et al. 2021. Membrane fusion and immune evasion by the spike protein of SARS-CoV-2 Delta variant. BioRxiv
(Aug 17, 2021) doi:

This article is a preprint and has not been certified by peer review.

The Delta variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has outcompeted previously prevalent variants and become a dominant strain worldwide. We report here structure, function and antigenicity of its full-length spike (S) trimer in comparison with those of other variants, including Gamma, Kappa, and previously characterized Alpha and Beta. Delta S can fuse membranes more efficiently at low levels of cellular receptor ACE2 and its pseudotyped viruses infect target cells substantially faster than all other variants tested, possibly accounting for its heightened transmissibility. Mutations of each variant rearrange the antigenic surface of the N-terminal domain of the S protein in a unique way, but only cause local changes in the receptor-binding domain, consistent with greater resistance particular to neutralizing antibodies. These results advance our molecular understanding of distinct properties of these viruses and may guide intervention strategies.

Ago 18, 12:11pm

How can pharma companies ensure equitable vaccine distribution?
Robby Berman | August 17, 2021

Ezekiel J Emanuel et al. 2021. What are the obligations of pharmaceutical companies in a global health emergency? The Lancet (August 05, 2021) DOI:


Principles governing the response to COVID-19
1. Optimising vaccine production...
2. Fair distribution...
3. Sustainability...
4. Accountability...

Tiered pricing approach...
Global public goods...

A partly bilateral approach...
A fully multilateral approach...

From theory to practice...
Obligations under the partly bilateral approach...

Realising the four ethical principles requires urgent attention to further refine global institutional arrangements...

Ago 19, 4:26am

Eric Topol @EricTopol | 10:04 PM · Aug 18, 2021:
Now leading the world in covid cases/capita
(the US state with the lowest vaccination rate)

Image-graph, 7-day case rate, Mississippi


Ago 19, 5:15am

Pfizer vaccine effectiveness declines faster than AstraZeneca – study
But scientists said that the level of protection offered by both vaccines was similar after four to five months.
Nilima Marshall |8/18/2021

Two doses of the Pfizer BioNTech vaccine appears to have greater effectiveness initially against new Covid-19 infections associated with the Delta variant when compared to the Oxford AstraZeneca jab, but its efficacy also declines faster, preliminary research suggests.

Scientists from the University of Oxford have said that after four to five months, the level of protection offered by both vaccines is similar, with the AstraZeneca jab maintaining its effectiveness throughout the duration.

...The study, conducted in partnership with the Office of National Statistics (ONS) and the Department for Health and Social Care (DHSC), looked at data between December 2020 and August 2021 from the Covid-19 Infection Survey.

...for infections with a high viral load, protection a month after the second Pfizer dose was 90% greater than an unvaccinated individual, reducing to 85% after two months and 78% after three.

...For AstraZeneca, the equivalent protection was 67%, 65% and 61%...

Dr Koen Pouwels, senior researcher at the University of Oxford’s Nuffield Department of Population Health, said that the team “can be confident” that the numbers “really represent a decline” for the Pfizer vaccine, whereas for AstraZeneca “the differences are compatible with chance, that is there could be no change at all in the protection from AZ...Even with these slight declines in protection against all infections and infections with high viral burden, it’s important to note that overall effectiveness is still very high because we were starting at such a high level of protection...It is also worth highlighting that these data here do not tell us about protection levels against severe disease and hospitalisation, which are two very important factors when looking at how well the vaccines are working.”

...The scientists also found that a single dose of the Moderna vaccine had similar or greater effectiveness against the Delta variant as single doses of the other vaccines, but the researchers added that they did not yet have any data on second doses of the US-made jab.

The study also suggested that the time between doses did not affect effectiveness in preventing new infections, and that younger people (aged 18-34) had more protection from vaccination than older age groups (35 to 64-year-olds)...

Ago 19, 5:36am

Kashif Pirzada, MD(emergency, Toronto) @KashPrime | 3:23 PM · Aug 18, 2021:
Listening to this phenomenal seminar by @kprather88 (UC San Diego aerosol scientist)
and others on what's at stake on the return of kids back to school this month.

@denise_dewald (pediatrician) explains that the ICU system for kids i(s) fragile and not designed for big shocks

Image-Can the US pediatric hospital system absorb a Delta surge? (expected surge v. availability of pediatric and pediatric ICU beds in US v. surge)

3:12 to 7:45 in
Delta Concerns of U.S. School Reopenings and Reducing Airborne Transmission (2 hrs)

For more official details go to:

Ago 19, 10:23am


Alabama has no more I.C.U. beds available, the state authorities said.
Alyssa Lukpat | Aug. 19, 2021

I.C.U. beds are filling up across Southern states, and Alabama is one of the first to run out. The Alabama Hospital Association said on Wednesday night that there were “negative 29” I.C.U. beds available in the state, meaning there were more than two dozen people being forced to wait in emergency rooms for an open I.C.U. bed.

...Last week, at least two hospitals in Houston were so overwhelmed with virus patients that officials erected overflow tents outside. Elsewhere in Texas, in Austin, hospitals were nearly out of beds in their intensive care units. And in San Antonio, cases reached levels not seen in months, with children as young as 2 months old tethered to supplemental oxygen.

Arkansas hospitals were also close to capacity...

Ago 19, 10:41am

Eric Topol @EricTopol | 10:14 AM · Aug 19, 2021:
Emphasizing Delta's high risk of pre-symptomatic transmission

Image- title p of Nature news article (

Image- note graphs unvaccinated, vaccinated, prior to symptom onset and comparison w/ ancestral strain


People infected with the Delta variant generally do not have COVID-19 symptoms until two days after they start shedding the coronavirus.
Smriti Mallapaty | 19 August 2021

Min Kang et al. 2021.Transmission dynamics and epidemiological characteristics of Delta variant infections in ChinaMedRxiv Aug 13, 2021. doi:

This article is a preprint and has not been peer-reviewed.

... Results We identified 167 patients infected with the Delta variant in the Guangdong outbreak. The mean estimates of the latent period and the incubation period were 4.0 days and 5.8 days, respectively. A relatively higher viral load was observed in Delta cases than in wild-type infections. The secondary attack rate among close contacts of Delta cases was 1.4%, and 73.9% (95% confidence interval: 67.2%, 81.3%) of the transmissions occurred before onset. Index cases without vaccination (OR: 2.84, 95% confidence interval: 1.19, 8.45) or with one dose of vaccination (OR: 6.02, 95% confidence interval: 2.45, 18.16) were more likely to transmit infection to their contacts than those who had received 2 doses of vaccination.

Discussion Patients infected with the Delta variant had more rapid symptom onset. The shorter and time-varying serial interval should be accounted in estimation of reproductive numbers. The higher viral load and higher risk of pre-symptomatic transmission indicated the challenges in control of infections with the Delta variant.

Ago 19, 11:53am

Ibuprofen and COVID-19: Is it safe?
Aaron Kandola | August 17, 2021

...There were initial concerns about the safety of people with COVID-19 taking ibuprofen, but these claims originated from anecdotal and low-quality evidence. Major public health bodies around the world do not advise against using ibuprofen to ease COVID-19 symptoms or the side effects of the vaccine.

... 2021 study in The Lancet Rheumatology examined data from 72,179 people from 255 healthcare facilities across the United Kingdom. They found no evidence of an association between NSAID use and a higher risk of death or more severe illness in those with COVID-19...


Thomas M Drake et al. 2021. Non-steroidal anti-inflammatory drug use and outcomes of COVID-19 in the ISARIC Clinical Characterisation Protocol UK cohort: a matched, prospective cohort study. The Lancet Rheumatology. Volume 3, ISSUE 7, e498-e506, July 01, 2021. DOI:

Between Jan 17 and Aug 10, 2020, we enrolled 78 674 patients across 255 health-care facilities in England, Scotland, and Wales. 72 179 patients had death outcomes available for matching; 40 406 (56·2%) of 71 915 were men, 31 509 (43·8%) were women. In this cohort, 4211 (5·8%) patients were recorded as taking systemic NSAIDs before admission to hospital. Following propensity score matching, balanced groups of NSAIDs users and NSAIDs non-users were obtained (4205 patients in each group). At hospital admission, we observed no significant differences in severity between exposure groups. After adjusting for explanatory variables, NSAID use was not associated with worse in-hospital mortality (matched OR 0·95...), critical care admission (1·01...), requirement for invasive ventilation (0·96...), requirement for non-invasive ventilation (1·12...), requirement for oxygen (1·00...), or occurrence of acute kidney injury (1·08...).

NSAID use is not associated with higher mortality or increased severity of COVID-19. Policy makers should consider reviewing issued advice around NSAID prescribing and COVID-19 severity...

Ago 19, 12:05pm

COVID-19: Fewer deaths in US states with stronger controls
James Kingsland | August 18, 2021

A study has found a clear correlation between stronger state interventions to control the spread of COVID-19 and fewer deaths from the disease.

Being neighbors with a state that imposed weaker interventions, however, tended to cancel out the benefits of strong control measures.

Travel between jurisdictions with tough regulations and those with weaker regulations may partly explain the effect.

The scientists behind the study believe that a more uniform federal response to the pandemic would have saved more lives...


Annika J. Avery et al. 2021. Variations in Non-Pharmaceutical Interventions by State Correlate with COVID-19 Disease Outcomes. MedRxiv July 31, 2021. Doi:

This article is a preprint and has not been peer-reviewed.

The COVID-19 pandemic highlighted the lack of understanding around effective public health interventions to curtail the spread of an emerging respiratory virus. Here, we examined the public health approaches implemented by each state to limit the spread and burden of COVID-19. Our analysis revealed that stronger statewide interventions positively correlated with fewer COVID-19 deaths, but some neighboring states with distinct intervention strategies had similar SARS-CoV-2 case trajectories. Additionally, more than two weeks is needed to observe an impact on SARS-CoV-2 cases after an intervention is implemented. These data provide a critical framework to inform future interventions during emerging pandemics.

Heterogeneity in State NPI (non-pharmaceutical interventions) restrictions
SARS-CoV-2 case trajectories cluster by geographical region
Impact of NPI on case change occurs at greater than 2 weeks
COVID-19 disease outcome correlates with NPI score

...Taken together our results indicate that state implemented NPIs can lead to less COVID-19 cases and mortality. While it was previously thought that more NPIs led to a better outcome of disease burden (15), we found that even a moderate amount of restrictions can have a substantial impact on lowering COVID-19 transmission. In addition, we observed a clear geographical impact on SARS-CoV-2 trajectories, and it is likely that consideration of geographical neighbors should be considered when designing future pandemic NPI plans. Finally, additional analysis into the impact of interventions in each state is needed to account for the numerous confounders that limit this type of analysis. A more refined analysis examining the impact of interventions, when they were implemented, the state of the disease at time of implementation, the strength of interventions, and implementation of similar interventions in neighboring states, is needed.


Editado: Ago 19, 5:21pm

>137 margd:
Eric Topol @EricTopol | 9:22 AM · Aug 19, 2021
A summary table of the studies that have assessed mRNA vaccine effectiveness (VE) for Delta infections, updated with reports from yesterday, overall in line with estimate ~50-60%; *does not pertain* to high VE for hospitalizations or deaths

And a graphic summary FT
of some of these reports
"Public Health England’s real-world studies in May painted a rosier picture...But the new studies appear more in line with research in Israel"...

The early studies predominantly used 8-12 week dosing schedule for Pfizer (cf Israel, US, Qatar 3 weeks), and it was theorized that could explain the preserved effectiveness vs infections. But the new @UniofOxford study ( >137 margd: ) says dosing interval did not play a role. Needs replication.

Ago 19, 5:33pm

Those Anti-Covid Plastic Barriers Probably Don’t Help and May Make Things Worse
Tara Parker-Pope | Aug. 19, 2021

...Under normal conditions in stores, classrooms and offices, exhaled breath particles disperse, carried by air currents and, depending on the ventilation system, are replaced by fresh air roughly every 15 to 30 minutes. But erecting plastic barriers can change air flow in a room, disrupt normal ventilation and create “dead zones,” where viral aerosol particles can build up and become highly concentrated.

There are some situations in which the clear shields might be protective, but it depends on a number of variables. The barriers can stop big droplets ejected during coughs and sneezes from splattering on others, which is why buffets and salad bars often are equipped with transparent sneeze guards above the food.

But Covid-19 spreads largely through unseen aerosol particles. While there isn’t much real-world research on the impact of transparent barriers and the risk of disease, scientists in the United States and Britain have begun to study the issue, and the findings are not reassuring*...

...Most researchers say the screens most likely help in very specific situations. A bus driver, for instance, shielded from the public by a floor-to-ceiling barrier is probably protected from inhaling much of what passengers are exhaling. A bank cashier behind a wall of glass or a clerk checking in patients in a doctor’s office may be at least partly protected by a barrier**...



Ago 20, 9:48am

Eric Feigl-Ding @DrEricDing | 5:40 AM · Aug 20, 2021:
In faraway French Polynesia—psychiatrists are now doing hospital intubations because of insufficient hospital staff.
And hospitals simply don’t even start medical files on 80 year olds dying in hallways of the ER—
their ER triage just don’t have resources to treat 80 year olds.

Quote Tweet
StructuresMinimalistes @Minimaliste13 | · 11h:
À quoi ressemble la médecine en crise Covid, une histoire.

La femme d'un collègue est venue en mission en Polynésie française il y a quelques mois. Elle est psychiatre. Depuis quelques semaines, l'épidémie de #DeltaVariant y fait rage, avec une incidence à des niveaux inouïs.

Google translate: What Medicine In Covid Crisis Looks Like, A Story.

The wife of a colleague came on a mission to French Polynesia a few months ago. She's a psychiatrist. In recent weeks, the epidemic of #DeltaVariant is raging there, with an impact at unprecedented levels.

Eric Feigl-Ding @DrEricDing | 6:44 AM · Aug 20, 2021:
2) Even worse, hospitals in Guadeloupe and Martinique openly admit they don’t fully treat those over age 50….
“a sorting of patients is organized at the entrance of the hospital.. This sorting in resuscitation service would take place from the age of 50”

Épidémie de Covid hors de contrôle en Guadeloupe : les plus de 50 ans ne sont plus acceptés en...
De nouveaux renforts doivent atterrir ce vendredi 20 août en Guadeloupe pour soulager les hôpitaux antillais.

Ago 20, 1:21pm

>138 margd: kids & Delta contd. Still few hospitalizations in kids, but RATE is soaring. Concern is that COVID kid hospitalizations will outstrip pediatric and PICU beds, also relatively few compared to adults'. On up side, a higher ratio of kids than adults will survive intubation and mechanical ventilation.

Pediatric Covid-19 hospitalizations just soared past January.Why flattening the pediatric curve matters even more than for adults.
Jeremy Faust | Aug 16, 2021 after study has shown that children requiring intensive care for Covid-19—especially intubation and mechanical ventilation—have fared far better than adults have. In fact, unlike in adults, a towering majority of children requiring mechanical ventilation for Covid-19 do manage to survive. Among adults requiring mechanical ventilation last year, around two-thirds survived, and one-third died, though various improvements in how we manage Covid-19 have probably lowered the fatality rate to under 30%. Meanwhile, one study in the CDC’s journal Morbidity and Mortality Weekly Report found that among the 5% of children hospitalized specifically for Covid-19 who also required mechanical ventilation, all of them (10 intubated children out of the 203 hospitalized covered in the study) survived. An earlier and much larger study found that 89% of children placed on mechanical ventilators survived (though the final number may have been a bit worse because there were still a few children on ventilators at the time that study was published, and those outcomes were not reported)...

Ago 20, 3:06pm

Immunocompromised People Make Up Nearly Half Of COVID Breakthrough Hospitalizations.
An Extra Vaccine Dose May Help.
Jonathan Golob | August 20, 2021

Ago 20, 4:16pm


Dave Puglisi (Fox35orlando) @DavePuglisiTV | 2:22 PM · Aug 20, 2021:
Orlando Mayor Buddy Dyer and the Orlando Utilities Commission are addressing the media about a “unprecedented event” that they say needs immediate community assistance. More on the ask on @fox35orlando
Image ( )

The city of Orlando is asking residents to reduce water consumption IMMEDIATELY. Liquid oxygen used to treat water is being diverted to the hospitals to treat COVID patients. They believe if water consumption doesn’t change, water treatment could hit a critical point in a week.

This would mean a possible boil water notice could be put in place. More at 5 on @fox35orlando

Editado: Ago 22, 1:42pm

For vast majority, vaccines work best, but if you get infection and have co-morbidities...

Monoclonal antibodies are free and effective against covid-19, but few people are getting them
Lenny Bernstein and Laurie McGinley |

...Monoclonal antibodies are free to patients and there have been almost no side effects. They are accessible on an outpatient basis, via a single infusion (30 minutes infusion + 30 minutes observation) or four injections. Hospitals, urgent-care centers and even private doctors are authorized to dispense them.

But Regeneron Pharmaceuticals, maker of the only authorized, free monoclonal antibodies, said it is reaching fewer than 30 percent of eligible patients, up from fewer than 5 percent a month ago.

The White House COVID-19 Response Team reported last week that just more than 600,000 people have received the treatment since Regeneron and Eli Lilly received approval for separate versions in November. (Distribution of Lilly’s product has been paused nationwide because it is ineffective against some variants.)

...The antibodies mimic the body’s own immune response to the coronavirus, moving quickly into action while the natural response is gearing up. The Regeneron product is authorized for people 12 and over with mild to moderate covid-19 who are not hospitalized and don’t need supplemental oxygen.

The treatment is effective within 10 days after symptoms appear, according to the Food and Drug Administration, which is why it’s critical that people seek treatment as soon as they receive a positive test result. Some medical centers are reaching out to anyone who tests positive to inform them of the treatment’s availability.

Regeneron’s drug is a cocktail of two monoclonal antibodies, casirivimab and imdevimab. Research that has not yet been peer reviewed shows it reduced the chances of hospitalization and death by 70 percent and shortened the duration of symptoms by four days.

Last month, the FDA also approved it as a prophylactic medication for people who are unvaccinated or not fully vaccinated, have been exposed to the virus and are at higher risk for complications. That population includes millions of people, among them immunocompromised patients like Linda Burton, but also anyone older than 65 or with a body mass index of 25 or greater.

A study showed the medication reduced the risk of developing a symptomatic infection from an infected household contact by 81 percent.

The U.S. Department of Health and Human Services bought the first 300,000 doses of Regeneron’s product for $1,500 per dose in July 2020, then added an additional 1.25 million at $2,100 per dose. It provides the medication free, but medical centers can charge to cover their costs of administering it. Those costs are covered by Medicaid, Medicare and private insurance.

...Another single monoclonal anti­body, sotrovimab, made by GlaxoSmithKline and Vir Biotechnology, was given emergency use authorization in May. It is not free to patients, with a wholesale acquisition cost of $2,100 per dose, but the drug company said it would reimburse the cost of receiving the medication except for the amount covered by private insurance.

...“For the administration, mum’s the word on monoclonal antibodies, rapid home tests, high quality masks . . . anything except vaccines,” Eric Topol, founder and director of the Scripps Research Translational Institute, said in an email. “Which is wrong, since we need every tool in the kit to effectively take on delta; we’re not doing that well at all.”

An HHS spokeswoman said the agency has worked hard this year to expand access to the therapy, helping cities across the United States set up treatment centers. Weekly calls with state and territorial health officials include distribution of covid-19 therapies and a web site has been established to help consumers find the treatments, she said. The agency also has purchased ads and released information about the treatment on satellite radio, she said.

...Monoclonals “are logistically difficult to get to people,” said (Jason C. Gallagher, clinical professor of pharmacy practice and infectious diseases at Temple University School of Pharmacy). People with mild to moderate symptoms may not seek a coronavirus test for days, he said. After a positive test, they usually talk to their primary-care provider, who refers them to an infusion center or hospital. By the time they get to one, the window of effectiveness may be closing, he said.

At Intermountain Healthcare in Salt Lake City, few patients want an injection in each limb or four in their abdomen, said Brandon Webb, chair of the health system’s covid therapeutics committee. The subcutaneous injections have proved most useful in congregate settings such as nursing homes, where health-care workers offer the therapy to many people at once, he said.

The health center is also focusing on treatment rather than prophylaxis. For every seven patients offered the treatment, an average of one hospitalization is prevented, the hospital’s data shows. But giving the drug prophylactically prevents only one hospitalization in 100 patients, he said.


Vincent Rajkumar (Mayo Clinic) @VincentRK | 7:37 PM · Aug 17, 2021
Monoclonal antibodies are like the chemo we give after the cancer occurs.
Vaccines and masks are like stopping smoking so you reduce the risk of getting cancer.

Monoclonal antibodies don't help the poor, the uninsured, & don't prevent transmission.
Vaccines and masks do.

Ago 21, 9:43am

Check out FL's # cases by age group between 8/12 and 8/19:
I'd hesitate to open schools this fall, never mind insisting on masks!

William Ku, Ph.D. (data scientist) @wkdragon88 | 7:39 AM · Aug 21, 2021:
Evidence is emerging that reopening schools without protecting kids with strong mitigation measures
is endangering the future of America.
The table below shows that FL's wave #5 would have peaked last week were it not for kids getting more infected.

Image- # cases in FL by age group, week in Aug 2021

Ago 21, 9:54am

Hope the unvaxxed appreciate that the suggestion under discussion is infection AFTER vaxx,
not without vaxx...

Is catching Covid now better than more vaccine?
James Gallagher | 8/20/2021

The anatomy of immunity
Breadth: How much of the virus the immune system learns to attack
Strength: How well it stops infection or prevents severe disease
Duration: How long does protection last?
Location: Where in the body is the immunity?

Where does this leave the balance between more vaccine and virus?
There is clear evidence that adults who have not had any vaccine dose will have stronger immune defences if they do get vaccinated, even if they have caught Covid before.

But there are two big questions:
do vaccinated adults need to be boosted, or is exposure to the virus enough?
do children need vaccinating at all, or does a lifetime of encountering build a good immune defence?

The idea of regularly topping up immunity throughout life is not radical in other infections, such as RSV (respiratory syncytial virus) or the four other coronaviruses that infect people and cause common cold symptoms.

Each time you're exposed, the immune system gets a little bit stronger, and this continues until old age, when the immune system starts to fail and the infections become a problem again.

"This isn't proven, but it could be a lot cheaper and simpler to let that happen than spend the whole time immunising people," said Prof Finn, who warns we could end up "locked into a cycle of boosting" without seeing if it was necessary.

However, he said the argument in children had "already been won" as "40-50% have already been infected and most weren't ill or particularly ill".

There are counter-arguments. Prof Riley points to long-Covid in children, and Prof Openshaw to nervousness around the long-term effects of a virus that can affect many of the body's organs.

But Prof Riley said there was potential in using vaccines to "take the edge off" Covid, followed by infection, to broaden the immune response.

...Of course, with cases continuing to rumble on, there may not be much choice.

"I'm wondering whether it's inevitable," said Prof Klenerman, as if the virus continues to spread then "there will be this ongoing boosting effect".

Ago 29, 7:23am

>90 margd: Sturgis Motorcycle Rally (outcome, preliminary)

South Dakota Covid cases quintuple after Sturgis motorcycle rally
Meade County, home to Sturgis, has had a more than 1,500 percent increase in cases in the past 14 days.
Ben Kesslen and Joe Murphy | Aug. 25, 2021

...The state's rate of Covid-19 infections per capita in the past two weeks is in the bottom half of the country, but it's the sharp and sudden increase in case counts that sets it apart.

Meade County, home to Sturgis, has counted 330 new cases in the last two weeks, up from the 20 reported in the two weeks before the rally, according to Johns Hopkins University's case count. The 1,550 percent increase comes after the motorcycle rally, which usually draws around half a million people, possibly had its biggest year ever, according to County Sheriff Ron Merwin...

It’s too soon to know if the Sturgis rally, which began on Aug. 6 and ended Aug. 15, had a direct effect on the increase or can be classified as a “superspreader” event, but Meade County is now reporting a 36 percent positivity rate, with about 1 in every 3 Covid tests returning a positive result...

From the onset of the pandemic, South Dakota has seen a higher per capita rate of infections than all but two states, North Dakota and Tennessee...Gov. Kristi Noem, a Republican...Currently, 48.4 percent of South Dakota is fully vaccinated...
Este tópico foi continuado por SARS-CoV-2 and COVID-19 (24...).