Coronavirus / COVID-19 Information

Sonya · Jan 13, 2021 at 3:22 PM

I am currently without any power at home due to windstorms in the Seattle area last night. Outlook not great for me getting it back tonight.

I won't be able to do an update today.

Here is the link for today's numbers at NVIndy: https://thenevadaindependent.com/coronavirus-data-nevada

Hopefully I'll be back tomorrow with updates. *fingers crossed*

Sonya · Jan 14, 2021 at 5:59 PM

We have power!! And we even got running water around lunchtime today after a couple of days without. Fun times. One of the joys of semi-rural living in the Seattle area.

So, where were we?

Nevada COVID-19 updates for 1/14:

Test positivity remains high: 7-day avg is 37.5% or 21.6% using test encounters
Hospitalizations are down: 1,746 (-38)
Cases are down: 2,500 new cases/day on avg (-151)
31 days left in the again extended "statewide pause"

Nevada continues to set records for the new numbers of deaths reported on average each day. Today has set a new record, at a seven-day average of 44.1. (Again, this is expected given the case data we've seen over the past many weeks.)

https://thenevadaindependent.com/coronavirus-data-nevada

Las Vegas Hospital Issues "Disaster Alert"
https://www.reviewjournal.com/local/local-las-vegas/covid-19-wave-prompts-las-vegas-hospital-to-issue-disaster-alert-2251426/

With COVID-19 patients pushing hospitals across Southern Nevada to near capacity, one Las Vegas hospital issued a disaster declaration over the weekend.

St. Rose Dominican Hospital, San Martin campus, issued the declaration Saturday, when a surge in patients increased occupancy in its intensive care unit to 137 percent, according to an email obtained by the Review-Journal that was sent by the administration to hospital physicians.

The 147-bed hospital had a general occupancy of 121 percent as it treated 73 patients with COVID-19.

“As we experience a sustained increase in critically ill COVID-19 patients, key resources are in limited supply: hospital beds, ICU and health care staff,” hospital spokesman Gordon Absher said in response to questions about the declaration.

The disaster declaration comes as Las Vegas Valley hospitals brace for the full impact of the Christmas and New Year’s Eve holidays on hospitalization numbers.

The miles-long line of cars returning to coronavirus hot spot Southern California after New Year’s Eve made one hospital administrator consider how many Las Vegas hospitality and service industry workers might have been exposed to the virus over the holiday.

“The 200,000 guests that are estimated to have come to Las Vegas for the holiday period, what did they leave behind?” said Dr. Joe Corcoran.

He is the chief medical officer overseeing HCA Healthcare hospitals in Nevada and California, including the four Sunrise Health System hospitals in Las Vegas.

Disaster declaration

The disaster declaration at St. Rose Dominican, San Martin means that the “number of patients exceeds current resources and alternate care sites need to be made available,” Absher said in an email.

The hospital is taking steps to manage the situation, he said, “by suspending elective surgical procedures to preserve inpatient beds for our COVID patients.”

Post-operative recovery beds have been converted to ICU beds, and post-partum and surgery beds have been converted to inpatient beds.

“These efforts sometimes push us out of our standard nurse ratios, but we work to limit those as best we can with the resources available,” Absher said. “These guidelines will remain in place until patient volume no longer exceeds available resources.”

The other two area St. Rose hospitals have not issued disaster declarations but have similar patient volumes, he said.

“Under normal circumstances patients might be transferred to other facilities but in this unprecedented surge of COVID-19 patients, most other hospitals are experiencing very similar circumstances,” Absher said.

The Nevada Hospital Association said on its website Tuesday that the number of hospitalizations across the state is plateauing but that some hospitals continue to feel “significant strain.”

These hospitals are primarily in Southern Nevada, which has been experiencing its highest levels of hospitalizations since the beginning of the pandemic.

The association cautioned that the “full effects of the holiday season and other gatherings may not be fully realized for another several weeks.”

Across Southern Nevada, 92 percent of licensed beds, 83 percent of staffed beds and 80 percent of adult ICU beds are occupied, according to the association.

Hospital association data obtained from the governor’s office through a public records request shows that 13 of the county’s 17 acute-care hospitals reported reaching or exceeding the maximum capacity in their adult intensive care units for at least one day during the first half half of December.

A records request completed Monday indicates that Gov. Steve Sisolak’s staff had not received hospital-specific data after mid-December. The governor’s deputy general counsel, Jessica Diss, did not respond to a request for comment.

Will Nevada follow California?

Corcoran acknowledged that he is worried that Southern California, with its overwhelmed hospital system, could be a bellwether for Southern Nevada.

“In Southern California, there are hospitals that have gone through the exercise of preparing for ‘crisis of care’ standards, if they’re not there already,” Corcoran said.

Crisis of care, he explained, is a “very fancy way of saying rationing care.”

Southern Nevada has not had the sharp increase in hospitalizations that Southern California has experienced, Corcoran said, noting that “ours has been more gradual.”

Like counterparts across the county, hospitals in the Sunrise system have been full on some days, prompting the system to not only significantly curtail elective procedures but also to delay certain heart procedures and cancer treatments when possible.

“We’ve taken those beds and freed them up for for patients that need acute hospitalization,” Corcoran said.

Despite the plateau of the past few days, he remains concerned.

“I’m very, very anxious about what the next two weeks might look like,” Corcoran said. “And I hope that it doesn’t mirror the almost meteoric growth that they’re experiencing in Southern California right now.”
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This article is about the lockdown at the US Capitol Building last week, where some members exposed others to COVID by not wearing a mask indoors, but the article has some good reminders from Dr Fauci and other health professionals. I won't include the politics here, but just quote the important COVID parts.

https://www.thedailybeast.com/fauci-says-lawmakers-lockdown-amid-capitol-riot-looked-like-a-subway-car-during-rush-hour

“Of course, when you have people in close indoor settings without social distancing or masks, there are likely going to be some infections,” Fauci said.

“I’m just gonna stick by what I have said maybe 5,000 times in the last several months—the recommendation is that you wear masks uniformly, you keep physical distance, you avoid congregate settings, particularly indoors, and you wash your hands as often as you possibly can. Any deviation of that by anybody is creating a risk for acquisition and or spread of infection. Doesn't matter who you are.”
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The new cases at the Capitol come after the House attending physician warned that all members who were sheltered in the room together during the lockdown should get rapid COVID-19 tests. The refusal by some lawmakers to wear masks is indicative of a larger problem the country faces in trying to control the spread of the virus and related deaths following the holidays, Fauci said.

“We’re in a very, very difficult situation. Take a look at the number of infections each day. We’ve gone up as high as 300,000 infections in a day. We've now hit something like 375,000 deaths. Last week there were 4,111 deaths in one day. That's horrible. That’s terrible,” Fauci said.

“We’re having a big surge of infections in various parts of the country. At least 30 of the states are in red, namely, more than 10 percent positivity. And it was likely exacerbated by the fact that we’re in the winter season, people are doing indoors more than outdoors, and we've just had a prolonged holiday season.”
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“We know now that recent studies show that 50 percent of the infections are spread by someone who either never got any symptoms or didn’t and transmitted in a pre-symptomatic way. So people are going around thinking that they’re fine and they're inadvertently infecting other people,” Fauci added.

Fauci’s warnings are now almost a year old and still, he says, people throughout the country are choosing not to adhere to public health guidelines. If portions of the population continue to rebuff social distancing and mask-wearing guidelines and do not sign up for the COVID-19 vaccine, the country could experience a prolonged period of community spread with potentially disastrous ramifications for hospitals who are already overrun in certain regions of the U.S, experts warn.

Fauci said the timeline he laid out previously with The Daily Beast—that the country could reach herd immunity through vaccination by the fall—is still an estimation he feels comfortable with, despite the sluggish rollout of the vaccine.

“But that is totally dependent on the number of people that are willing to get vaccinated,” Fauci said. “If half the country doesn’t want to get vaccinated, we are not going to reach herd immunity with a vaccine. I'm spending maybe 50 percent of my day, on Instagrams, podcasts, Facebook lives—all kinds of things—talking to people about the importance of getting vaccinated. Literally, I’m spending about half of my time doing that.”

The federal government is still discussing how best to increase the vaccine rate in the country, Fauci said, adding that members of the White House Coronavirus Task Force and Operation Warp Speed spoke about the announcement of new federal guidelines on vaccine distribution. The guidelines recommend opening up vaccines to everyone in America older than 65, as well as anyone younger who has a pre-existing condition that could make them more vulnerable.

On top of widening access, the government will no longer hold back doses for the second shot of the vaccine and instead try to administer all available doses as quickly as possible.

“I think that there is now a greater enthusiasm for being less restrictive about who you give the vaccine to,” Fauci said. “Even though you’d like to get the people in the [first] priority group done, that doesn't mean that you shouldn't move on to the next group if you have vaccine available. You don't want vaccine lying around—give it to the elderly, give it to the people who are young but who have underlying conditions. Give it to the people who benefit from it. We shouldn’t be holding on to vaccine because you haven't graduated into the next group of priority people.”
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Meanwhile, as Operation Warp Speed works to scale distribution, Fauci said he and his colleagues at the National Institute of Health are busy studying the new COVID-19 variants reported across the globe, particularly the ones in the United Kingdom and South Africa.

News of the highly contagious variants has alarmed top health officials and scientists and has set off a wave of conversations about ramping up studies of the mutations, their impacts, and interactions with a vaccine. The CDC has said there is no indication yet that there is a homegrown U.S. mutation but that officials need to study the matter further.

“What we’re going to do is look at it really carefully. Thus far, there’s no data to indicate that the U.K. variant that is in our country now is one that evades the vaccine, but we need to study it more thoroughly,” Fauci said. “Before I can say that I feel comfortable that it doesn’t have any effect on the vaccine-induced antibody, I would like to see the data that we ourselves carefully perform. I’m not making any form of conclusions.”

“What I hear from my colleagues who are beginning to study the vaccine in South Africa is inklings that the [mutations] in South Africa might be a little bit more ominous,” Fauci added. “We're hearing that the series of mutations that are being identified… are mutations that might be a problem for some of the monoclonal antibodies. We don’t know whether it would be a problem for the vaccine. That is being intensively studied.”
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I have decided not to cover the vaccine distribution in Nevada in this thread, because I'm not sure we have enough locals for there to be a need here. However, if you're interested, the Nevada Independent's Megan Messerly, who gives us our daily COVID Numbers, has a great Q&A that she is regularly updating with all kinds of information about when, where and how. If you're interested, here's the link:

https://thenevadaindependent.com/article/indy-qa-when-can-i-expect-to-receive-the-covid-19-vaccine-who-is-getting-vaccinated-now-is-it-safe

Canadian Personal Trainer Shares Cautionary Tale After Catching COVID-19 Abroad:
https://globalnews.ca/news/7558519/london-trainer-cautionary-tale-covid-19-abroad/

A personal trainer from London, Ont., is sharing a cautionary tale about doubting the seriousness of COVID-19 after contracting the virus while vacationing abroad.

Jonathon O’Hagan recently travelled to the Dominican Republic over the winter holidays, seeking a break from nearly a year of having followed various health restrictions as a result of the COVID-19 pandemic.

“It’s really hard after one year to maintain your faith in something that you can’t see, smell or touch,” O’Hagan said.

As a personal trainer, his job was heavily affected due to multiple closures impacting his gym, including an ongoing provincewide lockdown in Ontario, and he recalls feeling depressed over the state of the world.

“I put some money together that I had to take my girlfriend away and another couple that we work with,” O’Hagan said.

“I probably shouldn’t have, but a year’s a long time.”

The trip soon took a turn for the worse when he began feeling a minor pressure behind his eyes, which he initially thought was due to allergies or his body acclimatizing to a new country.

Within days, he began feeling flu-like symptoms before his lungs collapsed.

“When I started not being able to breathe and gasping for air is when it really hit me the seriousness of the virus and how much we underestimate it,” O’Hagan said in a phone interview from his hospital bed in Punta Cana.

“I thought I was going to die, I thought of my family, I thought of my girlfriend… I was really scared.

While he’s lost about 20 pounds and is still unaware of what the long-term effects may be, O’Hagan’s condition has improved.

“I’m starting to show good vitals and I’m able to eat and function on my own now,” O’Hagan said.

With hope on the horizon for a recovery, O’Hagan has now turned his attention to changing the minds of those who doubt COVID-19.

“I felt it was really important for me to share my experience because of… how many people probably felt the same as me.”

“I’m overall a pretty healthy guy, I train jiu-jitsu, I box, I’m strength training about six days a week,” O’Hagan said, adding that he thought the virus would only affect those who are sick, elderly or have health complications.

“That’s not the case — this virus showed me no mercy. It took me to my knees and it crushed me.”

As of Wednesday, O’Hagan remains inside a Punta Cana medical centre. He was supposed to come home on Jan. 3 but is now unsure of when he’ll be released or when he’ll get home.

“I’m a firm believer if you make your bed you lie in it and I’m definitely lying in mine, so it’s something I’ll have to figure out.”

O’Hagan hopes his story will spur those listening to follow COVID-19 measures and take the virus seriously.

“I’m a trainer, people pay me to get them healthy… and I’m here struggling and fighting for my life, so that should say something if you think that you’re superior or that your immune system is stronger than everyone else’s,” O’Hagan said.

“Take my mistake and learn from it.”
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Data Fuel Debate over Whether Johnson & Johnson Vaccine Will Measure Up
https://www.statnews.com/2021/01/13/data-fuel-debate-over-whether-jjs-one-dose-covid-vaccine-will-measure-up/

Johnson & Johnson published updated early data on its Covid-19 vaccine Wednesday, showing that it provided participants in a clinical trial with at least some immunity after one dose.

The data, published in the New England Journal of Medicine, offer only hints to a tantalizing question: Could the vaccine, given as a single shot, perform as well as the vaccines that U.S. regulators have already authorized, which are given as two?

In the study, participants had neutralizing antibodies, measured in a unit called a geometric mean titer, of 224 to 354, on day 29 after their first vaccine dose; those levels reached 288 to 488 by day 57. These levels could be enough to produce immunity. But there was a big benefit to giving the participants a booster dose. It doubled or tripled their levels of neutralizing antibodies. The question is whether the antibody levels induced by the first dose are indeed enough, or if there are other types of immunity spurred by the vaccine that lead to protection.

“Just because it’s higher in neutralizing response doesn’t necessarily mean it’s more efficacious,” said Paul Offit, director of the Vaccine Education Center at the Children’s Hospital of Philadelphia. “It may be that the immune response induced by the first dose is enough and that more is not necessarily better.”

The answer to the question, of course, will come from Phase 3 clinical trial results. Said Carlos del Rio, a distinguished professor of medicine at the Emory University School of Medicine: “The proof is in the pudding.”

A third authorized vaccine — and one that could be given in a single dose — could help reshape the fight against the Covid-19 pandemic, even if supplies are expected to be limited for some time.

“Part of the complication we have is this two-dose deal,” del Rio said. “If we can have a vaccine that is a single dose, the J&J vaccine would become, without doubt, the vaccine of choice for the world.”

There are two Phase 3 studies running. A 40,000-volunteer study of the one-dose vaccine, conducted in the U.S., is set to read out in the next two weeks. A second, equally big study is being conducted using the same vaccine given as two doses, each administered 57 days apart, in case the vaccine does not prove effective in a one-dose regimen or there are other advantages, such as the durability of the vaccine, to giving a second dose.

A previous version of the paper published in NEJM was released in September on a preprint server, meaning it had not been peer-reviewed. But there are new data on the safety and durability of the vaccine in the current paper, which includes information on the safety of the shot, the duration of immune responses, and the effect of adding a second dose to the first.

Del Rio is optimistic. He points out that after one dose of the current vaccines — one made by Pfizer and its partner, BioNTech, and another made by Moderna — only 60% of participants appeared to have neutralizing antibody levels against SARS-CoV-2, the virus that causes Covid-19. With J&J vaccine data in NEJM, he said, that figure appears to be 90%. Del Rio was an investigator in the Moderna trial.

But Anna Durbin, a professor at the Johns Hopkins Bloomberg School of Public Health, was less confident about the levels of protection. In particular, she was skeptical a one-dose vaccine would be enough for older adults, who don’t always mount as strong an immune response as younger people.

“I think it was a bit of a gamble to go with the single dose, and I think it was very responsible of the company to look at a two-dose regimen and a one-dose regimen,” said Durbin, an investigator in trials of the Pfizer vaccine and another testing a vaccine made by AstraZeneca.

Johan Van Hoof, the global head of J&J’s vaccine division, said that both animal data, which had shown strong protection based on a single dose, and data made available on Wednesday, had given J&J confidence to attempt a one-dose trial. But part of the reason, he said, was the need for a one-dose vaccine in a pandemic.

The World Health Organization, Van Hoof said, points out that the ideal profile of a pandemic vaccine is different from one during normal times.

“The difference there is that for use in an epidemic setting, where you go for the [largest] vaccination campaign, there are huge advantages in going with a single dose, even if there will eventually be some trade-off eventually in terms of durability or protection,” Van Hoof said.

If the trial result, expected in the next few weeks, is positive, the data will be submitted to the Food and Drug Administration, setting up a possible emergency use authorization in February. But then there will be the question of how fast the vaccine can be manufactured. On Tuesday, on a call with reporters, Moncef Slaoui, the outgoing head of the government’s Operation Warp Speed program, said the ramp-up could take time.

He said there would be “single digit million” doses available in the second half of February, and that efforts were being made to make that number higher. There would more in March, and much more in April, Slaoui predicted.

Johnson & Johnson said that, without regulatory approval, it was too soon to offer month-by-month estimates on the number of doses available.

“We have begun production of our vaccine candidate and are confident in our ability to meet our 2021 supply commitments signed with governments, and we expect to share more detail after some of these steps are achieved,” the company said in a statement.
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COVID Deaths are Higher Than Ever and The More Infectious Variants Could Make Things Much Worse:
https://www.statnews.com/2021/01/14/more-infectious-variants-could-make-things-much-worse/

This is an important issue that people should be paying attention to. Don't get blind to the increasing numbers. Every percent of positivity over 5% is making this virus worse. Everyone needs to do their part to slow the spread while we can.

As horrific as the U.S. Covid-19 outbreak looks right now, it is almost certainly about to get worse.

They’ve raced through South Africa, the United Kingdom, and, increasingly, elsewhere, and now, new, more infectious variants of the coronavirus have gained toeholds in the United States. If they take off here — which, with their transmission advantages, they will, unless Americans rapidly put a brake on their spread — it will detonate something of a bomb in the already deep, deep hole the country must dig out of to end the crisis.

In other countries, scientists fear the variants will reignite outbreaks in places where the virus has already been tamped down. But in the U.S. — which averaged more than 250,000 new infections every day in the last week and where more than 4,000 people are dying some days from Covid-19 — the variants could accelerate what’s already exponential spread in certain areas, and make reining in the U.S. epidemic all the more difficult.

“I’m very, very concerned that we’ve now gone from a virus that we could control to a virus that we really can’t, unless we do something very dramatic,” said Kristian Andersen, an infectious diseases expert at Scripps Research Institute.

A spike in infections — on top of the existing caseloads — could force hospital leaders to consider how to surge capacity, staff, and resources — and weigh what happens if they have too many patients to care for. It could force schools to close again or delay plans to reopen. The variants are also ramping up the pressure on the country’s sputtering vaccine rollout, to try to protect more people and snuff out transmission before the variants become dominant.

Epidemiologists stress the country still has a chance to contain the variants before they become widespread, but only if public health authorities can keep ahead of them. It would require an expansion of testing and genomic sequencing to identify where the variants are starting to spread, and prioritizing contact tracing and quarantining programs to sever chains of transmission. Americans would need to redouble their efforts to wear masks, physical distance, and avoid gatherings. It would be no small feat: The variants loom at a time when health departments are exhausted and stretched thin, and many people are weary of Covid-19 precautions.

Just as the arrival of vaccines was providing a light at the end of a tunnel, “this is like a last-minute twist that creates more problems,” said Northeastern University’s Alessandro Vespignani, who models how emerging diseases spread.

SARS-CoV-2, the coronavirus that causes Covid-19, has been mutating throughout the pandemic, just like any virus. But at least two variants have set off global alarms in recent weeks because of a building body of evidence that they are more contagious than earlier forms of the virus. One, called 501Y.V2 or B.1.351, was first identified in South Africa and has since been found in a dozen or so other countries. The other, B.1.1.7, was first seen in the U.K. and is in more than 30 other countries. The latter is drawing more attention in the U.S. now as more states confirm cases — Indiana, Maryland, and Connecticut among them in this last week — but experts caution B.1.351 could very likely be here as well and could pose just as much of a threat, as could some other emerging variant.

The chart shows the dramatic increase in new Covid-19 cases in the U.K. and in Ireland, where the B.1.1.7 variant has taken off.SCREENSHOT VIA OUR WORLD IN DATA
The variants at this point do not seem to cause more or less severe cases of Covid-19. But that belies how dangerous a more transmissible variant is, said Maia Majumder, a computational epidemiologist at Boston Children’s Hospital.

“Even if B.1.1.7 (or some other more transmissible variant) isn’t any more likely to cause severe disease or death, we may see a larger volume of deaths in its presence simply because there will likely be more infections than there would be without it,” she wrote in an email.

Ayan Sen, the chair of critical care medicine at the Mayo Clinic in Arizona — which has already had to surge care to handle its current Covid-19 patient load — said it was hard to predict what impact the variants could have on hospitals. But if they led to another increase in patients above where the health system was now, it would require building out more ICU space, and “it would certainly affect patients who need care for reasons other than Covid — surgery, or cancer. It has a domino effect.”

It could also precipitate further considerations about triaging care. “We’re hoping for the best so we don’t have to make decisions about the scarce allocation of resources,” Sen said. “It’s really challenging for us as clinicians who want to do their best for all their patients, when they have to make decisions like that.”

If there was already an urgency to vaccinate people as widely and quickly as possible, the arrival of the variants adds accelerant. In order to bring the U.S. epidemic to a close, the population needs to develop what’s known as herd immunity — and based on transmission dynamics, getting to that point with a faster-spreading virus will require even more people to be vaccinated.

Epidemiologists hope that enhanced mitigation efforts — whether targeted at coronavirus transmission generally or the variants more specifically — could buy the country time to expand its vaccine campaigns before the variants gain too much territory.

“We’re basically in this race, because if we reach herd immunity before B.1.1.7 becomes responsible for a majority of cases, then B.1.1.7 might never become responsible for a majority of cases,” said Brooks Miner, an evolutionary ecologist at Ithaca College.

The U.S. has a notoriously spotty genomic surveillance network for different viral variants, and already, it feels like wherever researchers look for at least B.1.1.7, they’re finding it. Still, experts say that for now, based on available sequencing data, it is still causing just a fraction of new cases. They want to make sure it stays that way.

When more transmissible variants get imported into a country, they don’t immediately take over. It can take weeks or months for them to build up to levels where the impact of their infectiousness starts to be felt, and for them to box out other forms of the virus by spreading faster.

Scientists in the U.K., for example, identified the country had a fast-spreading variant in December, but looked back and noticed B.1.1.7 first appeared in their sequencing data in September. In Ireland, where transmission is among the highest in the world now, B.1.1.7 accounted for 8.6% of sequenced cases one week, then 12.8% the following week, then 24.9%. Now it’s making up roughly half of cases.

Such data suggest that if countries respond quickly, they can hem in the variants before they take off. But there are at least two challenges for the U.S. Because the coronavirus is spreading so easily here in general, more transmissible variants that arrive will “find fertile ground to transmit and generate a lot of cases and eventually replace” older variants, Vespignani said.

Plus, because of the lack of surveillance, it’s not totally clear where in the building-up process the variants are in this country.

“We don’t know what our current position is,” said infectious diseases epidemiologist Caitlin Rivers of the Johns Hopkins Center for Health Security. “Are we on Week 1, or are we on Week 6 and we just haven’t noticed?”

Just how infectious the variants are isn’t totally clear; it can be difficult to disentangle what factors — viral evolution, easing of mitigation policies, people gathering — are contributing to new cases. But some estimates have pegged B.1.1.7 to be 30% to 50% more transmissible than other forms of SARS-2.

The virus still transmits the same way — with people “shedding” it as they breathe or talk or laugh or sing, and others inhaling it into their noses or throats — so at the individual level, the precautions people should take are what UCSF epidemiologist Kirsten Bibbins-Domingo called “all the unglamorous things we have to do, like mask and separate.” It’s not certain whether quick, essential errands pose a greater risk to people because of the variants, and if so, to what extent, but some experts have started calling for the public to wear more masks that are more protective than cloth coverings.

It’s at the population level that the higher transmissibility rate becomes clear. If, say, 60% of people wearing masks could keep a brake on transmission of earlier forms of the virus, then perhaps 80% of people now need to wear masks to have the same benefit. Data from the U.K. show that 15% of contacts of people who had B.1.1.7 contracted the virus, versus 10% of contacts of people with other forms of the virus.

“The rates of transmission are going to be significantly more challenging to contain if we see more widespread proliferation of B.1.1.7,” said Mark Ghaly, the health secretary in California, which has already ordered people in some regions to largely stay at home because local outbreaks have threatened hospital capacity.

In the U.K., B.1.1.7 continued to spread while much of the country was under restrictive policies, with nonessential shops closed and people told to avoid mixing with other households. It resulted in case numbers that threatened hospital capacity, so the country instituted an even stricter lockdown this month. While it remains early, some data show cases in the country are starting to trickle down.

But what that signals is it may take the most extreme policies to rein in the variants if they’re given a chance to run rampant, at a time when U.S. politicians and the public seem done with new restrictions.

As scientists watch the variants build up in other countries, they see it as a preview of what could happen in this country without further action. In a way, it’s reminiscent of how the U.S. dawdled as the initial wave of Covid-19 cases surged into the country last year, not absorbing that a virus that tore through China and then Italy was on its way to doing the same in the U.S.

“I do see some parallels with this point last year,” Rivers said. “We knew there was a concerning situation abroad, and it was fairly easy to imagine it would be relevant to us, and we didn’t lean in at that point.” Seeing the variants drive up cases in other countries, Rivers said, “I worry we can expect the same challenges here.”
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How and Why Coronavirus Mutates:
https://www.statnews.com/2021/01/14/how-coronavirus-mutates/

At this link, you'll find a 1.5 minute video explainer of how the virus mutates.

Like all viruses, SARS-CoV-2, the virus that causes Covid-19, is mutating all the time. Recently some concerning mutations have emerged: the B.1.1.7 variant first discovered in the United Kingdom, which is thought to be approximately 50% more contagious, and the B.1.351 variant first seen in South Africa, which may also have potential to decrease the efficacy of vaccines. These variants are not believed to lead to more serious disease, but a more transmissible virus can put even more stress on an already overloaded health care system, and ultimately lead to more deaths.

Most of the time when a virus mutates, the resulting variants are benign or even weakened versions of the pathogen. But the coronavirus is spreading practically uncontrolled all over the world, which means it is more likely to evolve into a more efficient version. Over time, it is possible that future mutations could result in a virus that is even more contagious, more deadly, or harder to vaccinate against.
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Sonya · Jan 15, 2021 at 4:07 PM

Nevada COVID-19 updates for 1/15:

Test positivity remains high: 7-day avg is 36.7% or 21.6% using test encounters
Hospitalizations are down: 1,676 (-70)
Cases are down: 2,184 new cases/day on avg (-165)
30 days left in the again extended "statewide pause"

https://thenevadaindependent.com/coronavirus-data-nevada

And since today is Friday, we have Megan Messerly's Coronavirus Contextualized:
https://thenevadaindependent.com/article/coronavirus-contextualized-36th-edition-cases-remain-high-as-officials-anticipate-more-growth-from-holiday-gatherings

Cases and test positivity

COVID-19 cases in Nevada remain high, though the last two days have seen some decreases, attributable at least in part to an unusually low number of cases reported in Clark County on Wednesday, which Southern Nevada Health District officials attributed to “delayed laboratory reporting.”

As of Thursday, an average of 2,182 cases had been reported each day over the last seven days, slightly down from both the recent peak of 2,500 on Tuesday and last week’s average, 2,285. The record seven-day average, 2,736, was set on Dec. 10. The previous record from the summer surge was 1,176 on July 20.

Cases statewide have remained high since mid-September, when a low of 267 cases on average were reported each day.

The situation continues to be worse in Clark County than it is in Washoe County, which was hit hard by COVID-19 late last year.

Clark County set a new record seven-day case average of 2,092 on Tuesday, with cases generally continuing to climb since a dip around the holidays. (It’s important to note that reported cases dipped statewide around both the Thanksgiving and December holidays, likely the result of slowdowns in testing and lab reporting.) Clark’s average was down to 1,812 on Thursday, dragged down by the unusually low number of cases reported on Wednesday.

Washoe County, meanwhile, remains significantly below a record average of 532 it hit on Nov. 27. As of Thursday, its seven-day average was only 220. The county has seen a slight bump in cases since a recent low point of 218 on Dec. 29 — hitting 248 twice in the span of a few days — but is nowhere near breaking its November record.

State officials have said that Nevada will likely not see the full impact of December holiday gatherings in the state’s COVID-19 case numbers until the end of the month.

Since the beginning of the pandemic in March, there have been 256,496 COVID-19 cases reported statewide. More than a quarter of those cases, 66,686, have been diagnosed in the last month, and 6 percent, or 15,277 cases, have been reported in the last week.

One in 12 Nevadans has tested positive for the virus since the beginning of the pandemic. Nevada ranks 17th in the nation for COVID-19 cases per capita, up from 19th last week.

At the same time, Nevada’s test positivity rate — which looks at the percentage of tests or people coming back positive out of the total tested — remains high. As usual, we’ll look at two different methods of calculating test positivity below, using both individual people and a metric known as testing encounters.

Starting with the number of new reported people who tested positive for COVID-19 out of the total number of new reported people tested each day, the state’s seven-day average test positivity rate was about 37.5 percent as of Thursday, down from a recent high of 45.9 percent on Dec. 13 but still significantly higher than the recent low point before the surge this fall, 9.2 percent on Sept. 17.

One of the drawbacks, however, of looking at test positivity using individual people is that some people are tested repeatedly. Someone who tested negative four times but tested positive on their fifth time would be counted as a new positive person but not a new person tested. (In other words, they would be counted in the numerator but not the denominator.) That’s why the test positivity rates calculated this way look so high.

Another way of looking at test positivity, as we have noted each week, is to examine test encounters, or the number of individual people tested each day. This method of looking at test positivity excludes duplicate samples collected the same day but accounts for people who are tested repeatedly on different days.

It is not possible to independently calculate the test positivity rate based on test encounters because the state only reports the number of positive cases, not the number of positive test encounters. However, the state does provide this number, calculated as an average over a 14-day period with a seven-day lag. As of Wednesday, that number was 21.6 percent, up from a recent dip to 19.5 on Dec. 30 and nearly back to the record 21.7 percent positivity rate on Dec. 15. In September, before cases started to increase, the test positivity rate was 6.2 percent.

Whichever calculation you use to look at test positivity, the trends are generally the same. Test positivity had been increasing steadily since September, dipped a little bit in the last few weeks, and is once again going up.

Since the beginning of the pandemic, about 1.3 million people — about one in 2.4 Nevadans — have been tested for COVID-19, and there have been almost 2.3 million individual testing encounters.
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Vaccinations

Since vaccinations started in December, 76,844 people in Nevada have received their first dose of the COVID-19 vaccine — up 37,083 from last week, nearly double last week’s total — according to the Centers for Disease Control and Prevention. In total, Nevada has been distributed 210,075 doses of the vaccine.

At least 28,978 doses of the vaccine have been administered in Clark County, while the Washoe County Health District has individually administered 9,302 vaccines.

State officials have attributed the small numbers of vaccinations to lags associated with reporting into the state’s vaccination database, known as WebIZ. However, Clark County has experienced delays in getting the vaccine out to residents and is still administering vaccines to health care and public safety workers, even as other counties have started administering vaccines to K-12 employees.

A survey by UNR’s School of Medicine released this week that sampled 5,349 Nevadans between Nov. 25 and Dec. 31 found that 65 percent of people were likely to get the vaccine and 35 percent were unlikely. Among the various age groups, those 18-24 and 55 and older were most likely to say they would receive the vaccine.

White, Asian and non-Hispanic participants were most likely to say they would receive the vaccine (65 percent, 75 percent and 65 percent, respectively, were either “somewhat” or “very likely” to get it), while those who identify as American Indian, Hawaiian, African American or Black and Hispanic were generally less likely (58 percent, 60 percent, 42 percent and 58 percent, respectively). Those with chronic diseases were more likely to say they would receive the vaccine than those without chronic diseases.

The survey also found that each increased level of education correlates with at least a 5 percent increased likelihood of receiving the vaccine. Participants from urban counties were more likely to want to receive the vaccine than those from rural counties.

For more on the vaccination process in the state, read our vaccine Q&A here.
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Deaths

Nevada continues to set new records day over day for the number of new deaths on average being reported. As of Thursday, 45 deaths were being reported on average each day over the last seven days, a new high, up from 30.1 last week. The previous record over the summer was 20.7.

The high numbers of new deaths being reported are not, however, unexpected given that trends in deaths tend to lag trends in cases by a few weeks.

Over the last seven days, 315 new COVID-19 deaths have been reported across the state, including:

238 in Clark County

38 in Washoe County

13 in Carson City

7 in Nye County

6 in Pershing County

5 in Churchill County

4 in Douglas County

2 in Lyon County

1 each in Elko and White Pine counties

In the last month, 1,105 deaths from COVID-19 have been reported statewide, nearly a third of the 3,664 total COVID-19 deaths reported statewide since the beginning of the pandemic.

Churchill County continues to have the highest number of deaths per capita in Nevada, with 17.7 deaths per 100,000 residents, followed by Carson City at 15.6, Lander County at 14.5, and Clark County at 12.2.

Nevada ranks 21st in the nation for deaths per capita, the same as last week.
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Hospitalizations

Nevada continues to see high levels of COVID-19 hospitalizations statewide though the numbers have been trending down in recent days.

There were 1,746 people hospitalized with COVID-19 as of Wednesday, the last day for which data is available, down from 1,918 last week. Hospitalizations peaked at 2,025 on Dec. 13, dwarfing the record set over the summer, 1,165.

State officials, however, note that hospitalizations are likely to increase with cases again on the rise.

“It's important to understand that we have not seen the full impact of holiday transmission on our hospitalizations yet,” state biostatistician Kyra Morgan told members of the COVID-19 Mitigation and Management Task Force on Thursday. “We're actually anticipating that closer to the end of this month and the beginning of February is when we'll see the full impact related to holiday transmission and our hospitalization data.”

Individually, though, hospitals are being hit hard by the virus. Nevada hospital data from early January obtained by The Nevada Independent showed that 100 percent or more of inpatient beds were full in eight hospitals, including at Henderson Hospital, Valley Hospital, Renown Regional Medical Center and St. Rose Dominican Hospital, Siena Campus.

ICU beds were 100 percent full at seven hospitals, including Henderson Hospital, Valley Hospital, Sunrise Hospital, North Vista Hospital, Southern Hills Hospital and Spring Valley Hospital in Clark County and Humboldt General Hospital in Humboldt County. ICUs at another six hospitals were between 90 percent and 100 percent full.

While hospitals can transfer patients out to sister hospitals within their health system and facilities work together on a regional basis to balance out demand, the numbers show just how hard some Nevada hospitals have been hit by COVID this winter.

At eight hospitals, 50 percent or more of their inpatient beds were being taken up by COVID patients. Sixteen hospitals reported facing a critical staffing shortage.

The Nevada Hospital Association, in its report from Tuesday, noted only generally that “the southern region has multiple hospitals with elevated occupancy rates both within the wards and ICUs” and that “staffing remains a challenge at several hospitals.”

Nevada now has the third highest number of people hospitalized with COVID-19 per capita at 57.9 per 100,000, behind Arizona at 69.4 and Alabama at 60.7.

Nevada hospitals are currently staffing 6,954 beds, more than the 6,660 they are normally licensed to operate, to keep up with the demand. As of Wednesday, 81 percent of staffed hospital beds and 72 percent of ICU beds were occupied.
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County by county

Fifteen of the state’s 17 counties continue to meet the state’s criteria to be flagged as at risk of elevated spread of COVID-19. White Pine County joined Storey County this week on the list of counties not at risk.

Counties are considered at risk for elevated spread of COVID-19 if they meet two of the following three metrics:

The average number of tests per day per 100,000, calculated over a 14-day period. If this number is less than 100, a county could be considered at risk.

The case rate per 100,000, calculated by taking the number of cases diagnosed and reported over a 30-day period. If this number is greater than 200, a county could be considered at risk.

The case rate per 100,000 and the test positivity rate, calculated over a 14-day period with a seven-day lag. If the case rate is greater than 50 and the test positivity rate is greater than 8.0 percent, a county could be considered at risk.

Pershing County continues to have the highest case rate in the state at 7,685 cases per 100,000 residents over the last 30 days (driven in large part by an outbreak at Lovelock Correctional Center), followed by Clark County at 2,064 and White Pine County at 1,700. (Still, White Pine is not considered at risk because it wasn’t flagged under the test and test positivity metrics.)
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TL;DR

Clark County set a new record seven-day case average of 2,092 on Tuesday, with cases generally continuing to climb since a dip around the holidays.

State officials have said that Nevada will likely not see the full impact of December holiday gatherings in the state’s COVID-19 case numbers until the end of the month.

One in 12 Nevadans has tested positive for the virus since the beginning of the pandemic. Nevada ranks 17th in the nation for COVID-19 cases per capita, up from 19th last week.

As of Thursday, 45 deaths were being reported on average each day over the last seven days, a new high, up from 30.1 last week.

In the last month, 1,105 deaths from COVID-19 have been reported statewide, nearly a third of the 3,664 total COVID-19 deaths reported statewide since the beginning of the pandemic.

ICU beds were 100 percent full at seven hospitals, including Henderson Hospital, Valley Hospital, Sunrise Hospital, North Vista Hospital, Southern Hills Hospital and Spring Valley Hospital in Clark County and Humboldt General Hospital in Humboldt County. ICUs at another six hospitals were between 90 percent and 100 percent full.

Reno ICU Doctor Who Was Retweeted with False Claim, Talks About Caring for Critically Ill COVID Patients
https://thenevadaindependent.com/article/indy-qa-reno-icu-doctor-retweeted-with-false-claim-by-trump-shares-experience-treating-critically-ill-covid-19-patients

For the last 10 months, Dr. Jacob Keeperman has been on the frontlines of the coronavirus pandemic.

As a critical care doctor, he’s accustomed to life in the ICU, the sedated patients, the constant beeping, the suction and air delivery sounds. What he isn’t used to is seeing so few of his patients making it out of the ICU alive.

“We are often able to save our patients. We see them get better, and we see them wake up and able to walk out of there,” said Keeperman, who is the medical director for Renown’s Transfer and Operations Center. “Right now is such a difficult time because so many of our patients are not making it.”

On one of those difficult days, Keeperman took a selfie inside the alternate care site set up in Renown’s parking garage, captioned it with, “Everyone is struggling to keep their head-up. Stay strong,” and tweeted it out. His tweet was then quote tweeted by an account that falsely accused the parking garage site of being a “scam,” which then went viral when it was retweeted by President Donald Trump.

“When I had that retweeted, I was really in disbelief,” Keeperman said. “How could anyone think that this is fake, think that this is unreal? Who would ever want to turn a parking garage into a hospital?”

Keeperman sat down for an interview with the IndyMatters podcast this week to talk about all of that and more. The written adaptation of the interview has been edited for length and clarity.

I’m sure there has been no regular day for you in the last nine months, but can you start off by walking us through what a typical day looks like?

I arrive at the hospital around 6 a.m. I do a quick walkthrough of the ICU to look at each patient to see how they might have progressed, talk to the nurses who were working overnight with those patients, do a quick check-in on them, then spend a significant amount of time reviewing laboratory data, vital signs, etc., going and really doing a thorough exam on each patient, talking with them, visiting with them.

Our patients are in an unprecedented time where they are not having visitors that they typically have — and visitors are so important for patients — but due to the mitigation aspects of this disease where we don't want to expose people, we are not having visitors at this time. So I really try to spend some extra personal time with each and every person.

Then it is doing multidisciplinary rounds — we're very much a multidisciplinary collaborative group, nurses, pharmacists, physical therapists, dieticians — where we really work hand in hand with one another, because we all have really valuable perspectives to share on each patient and to help guide their path.

Then the day is spent, unfortunately, admitting many patients, having many, many very difficult family conversations, updating them on everything that's been happening and, unfortunately, informing them often of worsening status with their loved one. Unfortunately, with COVID, we're seeing people developing multi-system organ failure where not only are their lungs affected, but it goes on to affect their heart, their kidneys, their liver.

It's really explaining that to people and trying to help families to realize that we need to make sure that everything we're doing is for the patient, not just to the patient. There are many things that we can do. I can give more medications, I can perform more procedures, but if it's not going to benefit the patient, it really isn't fair to them for us to do that. I try to learn about the patient, learn what their goals of life are, what they would consider quality of life, and then help the families understand if we're going to be able to get their loved one to that stage.

What does treatment look like for someone, from the point they come into the hospital with COVID-19 to the point where they end up in the ICU?

Patients are having a variety of presentations, but often patients who initially arrive at the hospital require a few liters of supplemental oxygen. They may not be ready to go home yet, although we have developed a very robust system where we can send people home directly from the emergency department on oxygen with remote monitoring because of our hospitals being so overwhelmed.

But, often, patients are admitted. We are constantly monitoring their oxygen levels. We are having them turn themselves onto their belly so they are face down, or what we call proning, which helps distribute oxygen to other parts of the lungs and can really help improve patient status. The number of medications we can give is quite limited with COVID. We are giving steroids to people, most commonly dexamethasone. There are some different treatments that you hear about, one is called remdesivir. We have been giving that to patients that are requiring persistent oxygen therapy or high levels of oxygen. The data on it is a little bit mixed. There is no clear evidence of harm, but also not significant evidence of improvement for most patients, although it does decrease some of the patients that need to go onto a ventilator.

Throughout this time, we are often having to increase the amount of oxygen these patients are on. For those who pretty quickly stabilize on the oxygen or are able to go down on the oxygen, they are quickly discharged. It can often happen within 24 to 48 hours. But then for some people, they're requiring more and more oxygen.

Eventually, after high flow oxygen and still having increased work of breathing, we are admitting them to the intensive care unit where we often place them on a mechanical ventilator where we're putting in a breathing tube in, we are giving them sedating medications to make it so that they can tolerate the ventilator. Unfortunately, it's this population that is having an extremely poor outcome for them. Particularly the older population, really for those 70 or older, we're talking about less than 5 percent survival rate if they're requiring a ventilator.

Mostly the care we're providing is supportive for these patients because, again, there are not specific treatments for coronavirus. At one time we were using what's called convalescent plasma, or blood products, that we take from a patient who has already had COVID and recovered. Unfortunately, that has not panned out to be helpful for patients, so we have stopped that practice. It's been a really remarkable last year where we went from having zero data on this disease process to trying to apply knowledge that we would use for other diseases in the past to learning what did and didn't work and to now refining our processes, and we continue to talk to clinicians throughout the country and throughout the world on what best practices we're coming up with and how we can best serve our patient population.

What makes a patient one of the few who is able to come off of a ventilator? What are you looking for?

Often we do see that their body has kicked in and fought. Unfortunately, the majority of the people that are getting critically ill with this are developing multi-system organ failure, where their kidneys fail, then their liver fails. At least from that population, virtually no one is coming back. Really what we are working so hard to do is trying to prevent the multi-system organ failure for those. We can often continue to support the patient's lungs, but it's when so many different systems fail that it becomes a very large challenge.

Every day, we try to decrease the amount of support the ventilator is giving and see how somebody does with that. Once we are able to be successful with what we call “weaning trials” off the ventilator, we slowly ensure that the patient is becoming stronger and stronger and are able to remove the ventilator so that they can get back to functioning and having somewhat of a normal life.

Unfortunately, we're still learning about some of the long-term effects of COVID. People are having sometimes persistent fatigue, headaches, and other symptoms that we really don't understand why or how to treat, and, again, things that we just continue to learn and that we will keep trying our best to work through.

What is it like being in the ICU right now? What does it sound and look like?

ICUs are very foreign places to most people. As health care providers, in particular critical care health care providers, we take it for granted. I don't even think about how foreign it looks. Essentially you have patients, the majority of whom are on sedating medications, hooked up to machines. There's constant beeping, suction sounds, air delivery sounds. It is almost this very surreal environment where there is very little living going on.

In the best of times, we have moderate meaningful interaction with the patients because, again, they're often sedated, but we try to keep families at the bedside. Luckily, we are often able to save our patients. We see them get better, and we see them wake up and able to walk out of there.

Right now is such a different time because so many of our patients are not making it and we are not having the families that are able to tell us about the patient so that we can really see them as a person. We are having the same beeping and incessant machine noises that we've had in the past, we just don't have the more uplifting times that we had often had and that has been the most challenging.

As health care providers, we spend lots of time encouraging one another, interacting and trying to let off a little steam by joking around, playing around. With the social distancing and the lack of us being able to interact with one another in the ways that we're used to, it's been a huge challenge and often really demoralizing and sad. You see people now in the corner crying by themselves, where in the past you would go up to one of your teammates and talk and you would maybe see them a little bit sad, you'd give them a hug, and now you can't do that and it's awful.

The rare times when a family comes in is when a patient is dying and it's their last few minutes. I talk to the family about taking the risk of them being exposed so that they can hold their loved one's hand for the last few minutes of their lives. It's just a sad, rough time and while it's really sad and rough for the health care providers, it's worse for the patients. These patients have tubes and lines coming out of them. Many of them unfortunately have wasted away in bed as they've been sitting there for weeks or months on end as we've been doing everything we can to help them, but their bodies just can't overcome this terrible disease process.

What is the longest you’ve seen someone fight for their life with COVID in the hospital?

Seven months is the longest that I've seen. In the past, maybe once every five years, I would see someone in that long — someone maybe in the hospital waiting for a heart transplant or something very chronic where they just couldn't go home. This has just been staggering and, unfortunately, even that patient that was there seven months still didn't make it.

How often is it that families have to make the difficult decision to stop fighting and let their loved one go versus continuing to fight?

When the patients develop multi-system organ failure, those discussions really become more robust with the families, explaining what the death process looks like and trying to let them know why it's important to let their loved one die with dignity and to have a death of compassion versus a death that involves multiple people performing chest compressions, breaking their ribs. While CPR can be incredibly beneficial for certain conditions, it can't fix COVID. It can't fix an underlying multi-system organ failure. When we get to that point, chest compressions are frankly not going to be beneficial because it just can't change what is going on underneath.

Case numbers in Washoe County have improved since the fall, but does it feel like the situation has improved in the hospital? Does it still feel dire?

In the last week, week and a half, our numbers have certainly gone down significantly in the hospital. Yesterday, when I was walking through the halls and seeing many empty beds in the ICU, it was this feeling of impending doom, this kind of creepy feeling that I was feeling and that I overheard many of the staff talking about.

We know that we are just starting to see the significant ICU patient population from Christmas now, and soon, over the next week, week and a half, we'll start to see the effects of New Year’s. Even the small family gatherings that people thought were pretty innocuous, unfortunately with so many asymptomatic spreaders, people still get exposed during those times. We are expecting a significant surge in the coming few weeks. I'm also quite concerned as people start returning to schools how that's going to spread among the teachers, the students, and then to their families when they go back home.

We are still in for a bumpy road. Certainly, things look better than they did a month ago, but I am also routinely getting phone calls to transfer patients from hospitals in Las Vegas, hospitals in Bakersfield, throughout the San Joaquin Valley, Southern Nevada, because they don't have capacity and the closest available bed is up here in Reno.

You gained some national attention this fall after one of your tweets, with a selfie of you in the alternate care site set up in Renown’s parking garage, was quote tweeted by an account that falsely said the parking garage site was “fake and a “scam,” which was then retweeted by President Donald Trump. Where were you when you found out about the tweet, and what was going through your head?

I was at home when I found out I had been retweeted by the president. I had finished a long week in the ICU and was trying to really recognize my colleagues who had been working so hard and are often under-recognized. The amount of despair among the staff at that time was so palpable. People were daily walking to their cars with their head down. Nothing could really cheer us up because all we were thinking about was our patients dying and the fear that we were going to get sick or we were going to get our family members sick if we brought this home.

When I had that retweeted, I was really in disbelief. I didn't believe it at first. I thought, “This must be a joke.” Then I started getting more and more calls from friends and colleagues throughout the world, informing me of this, and I thought, “Well, they can't all be working together to trick me on this one,” and found it and I started reading stuff. It was just utter disbelief. How could anyone think that this is fake, think that this is unreal? Who would ever want to turn a parking garage into a hospital? That is never something somebody would elect to do. That is something that was forced out of necessity.

I really decided to try to develop a message and to send a sign that health care is not political — health care is a right, not a privilege — and that we really need to address this crisis that is facing the world so that we can go on with our lives. We need to move past the us versus them mentality and move towards the, how can all of our lives be better? I want to offer my help and support as a frontline caregiver, helping politicians on any side of the aisle develop policy that will make it so we can provide the very best care to all of our population.

A lot of it has to be done on the federal level, but with the Legislature meeting here in a couple of weeks, what policy would help you in your role right now?

No doubt there is more funding needed for public health. That is not an issue unique to Nevada, but throughout our country. Public health funding has been decreasing over the last many decades, which is somewhat of a testament to what an incredible job our public health officials have done and the success of so many different vaccination programs and disease mitigation programs they have put into place, but certainly we have a ton of work left to do.

There's an incredible need for further funding and resources going towards emergency management, towards care coordination, and resource coordination. Like I said, I am accepting patients from the Las Vegas area into a hospital bed in Reno. There's likely resources in between or resources that could be bolstered in between that could provide better care for these patients and better coordination of the actual resources available in the state and, frankly, in the surrounding states. It's not unique to Nevada. They need to be working with the emergency management departments of all of our surrounding states so that we can truly address this pandemic and, frankly, any future pandemic in a collaborative and efficient way.

We're also going to need to use those resources to get the vaccination out to our population. There's a few things that I think are super-important. One, we need to really have a more robust education campaign that goes out via all channels to people representing all walks of life — doesn't matter political party, economic level — we have to reach everyone and we need to get to a critical mass of people being vaccinated. Education is the first part of that. Two is actually getting the vaccines to those people that are willing to get it. I've been really fortunate here in Washoe County where the public health department and the hospitals have really worked incredibly well together to deliver the vaccines. But it's mostly been done through drive-thru venues, which are super convenient, provide a lot of social distancing, but we can't forget our population that don't have vehicles, people that rely on the Indian Health Service, making sure that we are having vaccines go to them, and that we are really providing this to rural Nevadans.

We must keep funding remote patient monitoring and hospital-at-home concepts that allow patients to stay closer to home. We are working on developing that program here in Reno through Renown, which we want to offer throughout the state, but really trying to be innovative in how we can provide health care to our population, no matter where they live or how far they may be from a facility.

You tweeted recently that you received your second dose of the vaccine. What was your experience getting vaccinated? Did you experience any side effects?

I have received both doses of the vaccine. I received the Pfizer vaccine. After I received my first dose, I had a sore arm for approximately 18 hours. That was it. I felt great. Other than that, I waited in anticipation greatly for the three weeks to come before I was able to receive my second vaccine, which I received on Friday. Again, I had a sore arm. This time it lasted for closer to 36 hours. Again, the only side effect that I had. I was very fortunate. Some people are having some fevers, some people get some muscle aches. Those are normal. It is normal to get that after virtually any vaccination — that actually indicates that your body is having an immune response — so those are positive signs. The symptoms can fairly easily be treated with over-the-counter medications like ibuprofen or acetaminophen.

I highly recommend everyone get the vaccine. Like I said, I was first in line for the first dose and the second dose. Everyone in my family will be getting the vaccine as soon as their name is called and their tier comes up. We need to get the vaccine. Until we get a significant number of our population vaccinated and our community vaccinated, we need to continue to wear masks, we need to continue to wash our hands and avoid gatherings, because what we don't want to do is get COVID during that time or spread it to other people.

We are not done yet, but there is certainly light at the end of this extremely long and very dark tunnel, and we can get there together, but we need to stay strong for a bit longer. We need to continue to work together. We need to make sure that our public health officials, county health departments, have the resources they need to get the vaccines out to the population, and we need to make sure that we continue providing education and support to those so that they can get the vaccine, understand that people might get some symptoms, and might have to miss a day or two of work, and make sure that our employers understand that and that our population isn't afraid of the financial ramifications of that, and that that doesn't prevent them from getting vaccinated.

Thinking about that light at the end of the tunnel, looking forward to the summer or the end of the year, what is your hope for what life will look like, both inside the hospital and outside it?

I can't wait to go to Northern California, where my family is, and hug my mom and dad and see my nieces and nephews. I moved from the Midwest out to Reno at the beginning of November, and I haven't been able to see my family yet, even though I am thousands of miles closer. That's my very first goal and hope and the very first thing I will do. But really what I'm looking forward to is us getting back to a day-to-day routine where we can interact with one another, where we can show affection where needed, where we can go about our day-to-day lives without being in constant fear.

I think we've probably learned some extremely valuable lessons from this COVID pandemic. We all could wash our hands more, and I hope that we continue to do that into the future. We all need to be much more cognizant about staying home and avoiding people when we are sick. That will help with our yearly flu season, with all viral transmissions. But I think we can get back to a place that is "more normal."

In the ICU, and in hospital settings in general, times have changed, and I think we are going to be wearing some sort of masks or face shield for a long time to come. In a health care setting, I'm not sure when, or if, that will end. Maybe someday, but it might not. I think we'll start to have visitors back in hospitals. We're going to start having more and more celebrations.

It was really interesting over the past week when I was working in the ICU how many times I heard the jingle on our overhead speakers when a baby was born. If you think about the timing, it's about nine months from when we started our initial lockdowns.

In the future, I hope we are able to love one another more. I hope that families become closer, friends become closer. I hope that those of us with differences of opinions are able to talk and have dialogue. I hope that health care becomes a non-political issue but is addressed as the humanitarian issue that it is, and I just look forward to getting back to normal.
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Do you all remember that video of a super crowded Cosmopolitan shortly after Vegas reopened? The guy who tweeted it out had another video yesterday of Park MGM. The video is on twitter. It's 2:20 and shows a VERY empty Park MGM.

https://twitter.com/ArashMarkazi/status/1349848073464238080

COVID Risk in Restaurants:
https://www.reviewjournal.com/life/health/expert-restaurant-covid-19-risk-comes-from-your-own-table-2253827/

For all those who think dining in restaurants is no more likely to spread COVID-19 than spending time in a busy supermarket or crowded airplane, Brian Labus has a simple message: It’s just not true.

Labus, an assistant professor in the Department of Epidemiology and Biostatistics, School of Public Health at UNLV said the Centers for Disease Control and Prevention researched various environments and found that there was greater risk associated with restaurants and bars.

”Retail settings did not have elevated risk,” he said, “and this makes sense, as people are not in close contact for extended periods of time while shopping, and all of them are required to wear a mask.”

Patrons are required to wear masks in restaurants and bars, too, but can remove them to eat and drink. And whether they are doing that indoors or outdoors, the social nature of these businesses also is a factor in the risk.

“You’re talking about people that are sitting around the same table,” he said. “Whether it’s indoors or outdoors, it’s not necessarily table to table. Your own table, that’s going to be your biggest risk.”

Relationships

Remember all those warnings about not welcoming extended family and friends into your home? The same principle applies to restaurants. Dining with those who live in your household is not the problem.

“That’s not necessarily going to be a risk,” Labus said. “We do often go out to meet other people. Restaurants have no way to control” whether the party is from one household or more. “That’s not something they can verify.”

And while some in the hospitality industry have complained that the state has made their employees a relatively low priority for vaccinations, Labus said that’s a separate issue.

“Even if the entire staff of the restaurant is vaccinated, there are going to still be restrictions,” he said. “It’s not employee-to-patron transmission; it’s really patrons’ transmissions among themselves.”

As for whether air-filtration systems are effective, Labus said it depends on the system and the layout of the establishment.

“There are different systems that can reduce the risk,” he said, “but it can never eliminate the risk. It comes down to the exact air flow in the restaurant.” Labus said national recommendations exist for monitoring and improving air flow in restaurants and other types of businesses.

Similarly, he said household room-sized filtration systems can help reduce risk as part of an overall plan, but personal, wearable devices may not.

Any mask better than none

“If somebody coughs or sneezes in your face, that’s not going to protect you,” Labus said, which brings us back to masks. Early recommendations were to wear two layers of closely woven fabric, but clear shields and knitted gaiters have proliferated. Labus said levels of protectiveness can vary, though no mask can provide 100 percent protection against transmission. Still, they’re important.

“Any mask is better than no mask,” he said.

And one more thing: Has Labus gone out to eat lately? No, not since before the pandemic started.

“It’s not something I’ve gone out and done,” he said. “I’ve picked up plenty of food and brought it home, but just the idea of sitting in close contact with other people is too much risk for me.”

When will he consider it safe?

“It depends where your numbers go in the community,” he said. “If you haven’t done it, now’s not the time to start doing it.

“When I’m fully vaccinated, I’m going to look at things differently, because the risk to me would be lower.”
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Plan to Expand Vaccination Likely Sets up New Debacles
https://www.statnews.com/2021/01/12/u-s-plan-to-expand-access-to-covid-19-vaccine-likely-sets-up-new-debacles/

As health authorities across the country struggle to get Covid-19 vaccination programs up and running, outgoing Health and Human Services Secretary Alex Azar threw a new wrench into the works on Tuesday, telling states to expand priority access to tens of millions of additional people immediately.

But it will be several months before there is enough vaccine available to meet that kind of demand. The move all but ensures the current narrative around the vaccine rollout — it’s too slow — will shift, but not in a positive direction: The incoming Biden administration will likely face a groundswell of complaints about long lines, failed efforts to find vaccine supplies, and an inequitable distribution system as it tries to live up to its promise of seeing 100 million vaccine doses administered in the new president’s first 100 days in office.

Azar’s new instructions put 152 million people — about half of the adult population of the country — at the front of the vaccine line. But Operation Warp Speed, the U.S. effort to fast-track the development and distribution of vaccine, currently estimates it will take until the end of March before it has 200 million doses to distribute. Even if those doses can be manufactured and shipped seamlessly, that’s only enough for 100 million people, given that the currently authorized vaccines require two doses each.

Azar reported Tuesday that 38 million doses of vaccine have been made available to the states so far.

The new prioritization scheme pushes everyone 65 and older, as well as people 16 and older with one high-risk medical condition, to the front of the vaccine line, where they join health workers and nursing home residents and staff. (The Centers for Disease Control and Prevention’s list of health conditions that put people at high risk of severe Covid infection is here.)

If states follow Azar’s instructions, a 24-year-old smoker who works from home would have the same vaccine priority status as a frail 85-year-old — and would be ahead of non-smoking teachers, municipal bus drivers, meat packing plant employees, and other frontline essential workers whom the CDC had previously recommended should be vaccinated in Phase 1b.

States, lacking sufficient federal funding and coping with limited supplies, have struggled to complete the vaccination of people in Phase 1a, which includes health workers plus the residents and staff of long-term care facilities — a population of about 24 million people. Federal officials believe the efforts will get easier as more supply becomes available, but to date only about 9.3 million people have received their first dose of vaccine, according to the CDC.

The initial prioritization schedule was drawn up by the Advisory Committee on Immunization Practices, an expert panel that provided recommendations to the CDC. ACIP envisioned frontline essential workers and adults 75 and older being included in the second phase of the vaccine rollout. There are an estimated 49 million people in those two groups, a more manageable figure in a time of vaccine scarcity.

In upending the prioritization schedule, Azar has pushed to the front of the line people he wanted to see there in the first place. When the ACIP recommended health workers and nursing home residents for Phase 1a, he pressed for changing the first group to people 65 and older, STAT reported in November. But CDC Director Robert Redfield had already signed off on the recommendation.

The ACIP plan had its critics, too, with some experts questioning how workable it would be to require pharmacists or people working in a vaccine clinic to determine who qualified as a frontline essential worker.

“Who’s supposed to be the gatekeeper for that? I mean, you can’t go to Rite Aid and Walgreens and ask the pharmacist to be the gatekeeper, which is essentially what you’d have to do,” Peter Hotez, co-director of the Texas Children’s Center for Vaccine Development, said in an interview.

Hotez, who published an opinion piece in the Washington Post on Monday urging changes to the vaccination rollout, said the stages outlined by the ACIP were too complex and were slowing down the program. “So my view is to toss ’em at this point.”

Beth Bell, a global health professor at the University of Washington who chaired a working group that devised the ACIP’s recommendations, expressed dismay at Azar’s instruction to the states.

“We all want the most effective and efficient vaccination program. But I’m quite concerned this approach … is not the best way to get us there,” Bell said.

The outgoing HHS secretary blamed states for the slow pace of the rollout, saying some are hewing so closely to prioritization schedules that they are not using the doses they have been allotted. “Some states’ heavy-handed, micromanagement of this process has stood in the way of vaccines reaching a broader swath of the vulnerable population more quickly,” Azar said.

He also put states on warning that those that don’t rapidly use their doses will see their supplies diminished in the future. Vaccination allocation so far has been based strictly on a population basis; beginning in two weeks, states that rapidly use their doses will get a larger allocation.

But in two weeks’ time, Azar will not be the HHS secretary, meaning it’s unclear if the plan will hold.

If states follow Azar’s instructions, efforts to protect frontline essential workers — people who cannot work from home and whose work puts them at greater risk of contracting Covid — will tumble further back in the prioritization scheme.

“By opening things up … there would be some gains in efficiency, but there would be significant losses as it relates to equity, racial justice, and the ability to … prevent morbidity and mortality in a high-risk group,” said Kristen Ehresmann, director of infectious disease epidemiology, prevention, and control for the Minnesota Department of Health.

“You gain something and you lose some things,” she said. “And I think many of the things you lose are really important things.”

Saad Omer, director of Yale University’s Institute of Global Health, supported prioritizing adults over the age of 65. But Omer, who was on a National Academy of Medicine panel that recommended vaccine priority groups and who worked on a priority schedule for the World Health Organization, said changing the advice at this point will come at a cost. State and local public health authorities will have to junk some plans and draft others.

“There’s been whiplash at the state level,” said Omer, who noted these decisions should have been made months ago. “And all the community-based partners are thoroughly confused.”

Azar on Tuesday also announced that Operation Warp Speed will no longer hold back half of vaccine supplies, a move it took to ensure that when people need to get their booster dose, there was enough available to give them a second, matching vaccine in the timeframe required — 21 days for the vaccine developed by Pfizer and BioNTech, and 28 days for the one developed by Moderna. The incoming Biden administration previously said it planned to rescind the policy.

Tom Frieden, former director of the CDC, was among the people who criticized the original decision to hold back the second dose. “You need to flood the zone with the vaccine that’s available, anticipating that the manufacturers will not fail,” said Frieden, who is now president and CEO of the global health initiative Resolve to Save Lives.
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The Coronavirus Is Evolving Before Our Eyes:
https://www.theatlantic.com/health/archive/2021/01/coronavirus-mutations-variants/617694/

In the final, darkest days of the deadliest year in U.S. history, the world received ominous news of a mutation in the SARS-CoV-2 coronavirus. Scientists in the U.K. had identified a form of the virus that was spreading rapidly throughout the nation. Then, on January 4, Prime Minister Boris Johnson announced a lockdown that began almost immediately and will last until at least the middle of February. “It’s been both frustrating and alarming to see the speed with which the new variant is spreading,” he said in an address, noting that “our scientists have confirmed this new variant is between 50 and 70 percent more transmissible” than previous strains.

Those figures, based on an early estimate by British government scientists in late December, made for terrifying push alerts and headlines. Though this strain of the virus (officially called “B.1.1.7”) quickly became known as “the U.K. variant,” it has already been found in 45 countries, suggesting that the opportunity to contain it with travel restrictions has passed. On January 8, Australia locked down Brisbane, a city of 2.3 million people, after discovering a single case.

Each day, B.1.1.7 is being found in more people in more places, including all around the United States. Experts have raised dire warnings that a 70 percent more transmissible form of the virus would overwhelm already severely stretched medical systems. Daily deaths have already tripled in recent months, and the virus is killing more than 3,000 Americans every day. From a purely mathematical perspective, considering exponential growth, a significantly more transmissible strain could theoretically lead to tens of thousands of daily deaths, with hospital beds lining sidewalks and filling parking lots.

To make matters worse, the warnings from Britain were followed by headlines about yet another variant, B.1.351, in South Africa. Then another concerning variant was identified in Brazil. News reports speculated that these strains may resist vaccines. Some experts cautioned that the mutations could render current treatments less effective. Scott Gottlieb, the former director of the FDA, said last week: “The South Africa variant is very concerning right now because it does appear that it may obviate some of our medical countermeasures, particularly the antibody drugs.” On Tuesday, Anthony Fauci echoed that concern, calling the variant “disturbing.”

These new variants demand to be taken seriously. Skyrocketing case counts in the U.K. suggest a potential to do enormous damage, and the identification of B.1.1.7 in so many countries is noteworthy. Still, we don’t yet know whether either variant will become as dominant worldwide as they have in their respective countries. They might spread widely and cause tremendous harm. They might also do neither.

The sheer scale and capacity of this virus are challenging many things we thought we knew, but the basic laws governing its evolution are not among them. All viruses are constantly evolving and changing, just as human populations are. When a virus is spreading as widely and rapidly as SARS-CoV-2, spinning through trillions of generations each minute, adaptation is inevitable. The transmissibility of the virus will change. The severity of the disease it causes will change. Its ability to evade our immune system will change. It very well may evolve to circumvent our current vaccines.

Thanks to genetic-sequencing technology, we can watch this evolution in real time. We can see the changes in a virus’s genes before we even know what they mean for the spread of disease. Charting the course of this evolution, and assessing its significance, has quickly become a foremost challenge of the pandemic. The peril is not that the virus will suddenly change in an extraordinary way that transforms the pandemic, but that it is changing in small, ordinary ways that are playing out on a vast scale, and whose significance we may not appreciate until it’s too late.

Almost exactly a year ago, in January of 2020, a flight attendant warned the renowned Chinese virologist Zhang Yongzhen: It was time to turn off all portable electronic devices. He was sitting with his phone to his ear. On the other end of the line, his Australian collaborator Eddie Holmes was pleading with him to publish the genetic code of the novel coronavirus.

The Chinese government had forbidden this. Yongzhen was torn. The world did not yet know the cause of the rapidly spreading respiratory infection, and he seemed to have uncovered it in a sample of sputum from a severely ill person in Wuhan. Using genomic sequencing to unravel the code of the virus, he had found what appeared to be the blueprint of a new coronavirus.

He told Holmes to publish the code. When Holmes did so on Twitter, the international scientific community pounced. Within days, researchers in Thailand were able to verify that the same virus had infected patients there. Scientists at the U.S. National Institutes of Health began to work on a vaccine. The code became the backbone of the Pfizer/BioNTech and Moderna vaccines, which owe their development to the speedy identification and sharing of the genome.

The exact sequence that Holmes tweeted is now a relic. The virus it represented is gone, replaced by many, many, many subsequent generations. New lineages have arisen in different parts of the world, and hundreds of thousands of slightly different sequences have been added to an international database. There are now thousands of unique SARS-CoV-2 genomes, each the result of myriad permutations of mutations in the code. There is no single, standard genetic code for this coronavirus, any more than there is a standard human genome.

“The term variant is misleading, in that it creates the idea that all the other viruses are the same,” explains Ramon Lorenzo Redondo, a genomic analyst at Northwestern University’s Feinberg School of Medicine. Technically, every version of the virus is a variant. Even within a single person, the virus changes and evolves many times. If you were to have your bodily fluids sequenced on different days, the viral strains would show new mutations. “Viruses operate as a cloud of mutants—a swarm of mutants,” Redondo told me.

This is not a flaw in the system, but rather the way viruses work. When it comes to reproduction, viruses are sloppy. The speed and scale of their replication come at the cost of accuracy; they operate like a spam email marketing scheme, favoring inundation over meticulous grammar. Insofar as a virus can be said to have a “goal,” the goal is to ensure as many future generations as possible. To that end, it fires off shotgun blasts of imperfect clones, gambling that a few will make their way to other cells and penetrate them.

Almost all of these accidental mutations are inconsequential: The virus still looks and functions just as its parent before it did. Over time, though, sets of mutations can layer on top of one another and accumulate, and the virus begins to function differently. Some of these differences confer an advantage of one sort or another—for example, increased transmissibility.

“What we’re observing is very expected,” Paul Turner, a professor of ecology and evolutionary biology at Yale, told me. “If a population can improve in its environment, evolution lets that happen. The virus population size is expanding, and mutations spontaneously occur.”

Although it’s not news that the virus has mutated, it’s extremely important to keep an eye on the general direction of the changes—and what they mean for the humans whose cells are being hijacked. “If you see a mutation that could allow the virus to escape detection by the immune system, or escape vaccine coverage, that’s very worrisome,” Turner said. “We don’t have evidence of that yet.”

The likelihood of these scenarios depends on a few factors. Some viruses mutate more readily than others: Influenza mutates so quickly that new strains spread around the world each year, requiring the creation of new vaccines. Measles, by contrast, mutates slowly, so people who were vaccinated decades ago are very likely still protected. “Coronaviruses typically don’t mutate very quickly,” Turner said. “I don’t see any evidence that this coronavirus is going to suddenly become like influenza. But right now there are so many people infected, and the virus is in a new environment [humans instead of bats], so I’m not surprised that evolution is pushing it to improve.”

In the long run, he believes, the spread of this coronavirus will more closely resemble measles than flu. Although we may need to update our vaccines occasionally, we won’t need to do so every year. But as long as rates of infection remain high, the coronavirus is likely to acquire, over months or years, the ability to at least partially bypass our immune responses. Second-time infections may be less severe, but their severity also depends on how the virus evolves. And we may develop immunity to one variant but not to another.

In anticipation of such complexities, Redondo and others have been creating and updating phylogenetic maps—essentially, family trees—for this coronavirus. Groups with a common ancestor are referred to as a “lineage.” A lineage is something like a human family: different individuals sharing a common ancestor. (B.1.1.7 and B.1.351 are separate lineages that evolved similar changes in their spike protein independently.)

Genetic commonalities can also define broader groups called “clades.” Last spring, a clade known as D614G came to dominate the world. This was attributed to a mutation in the spike protein that made this group more transmissible than previous strains. And this was just one part of a family tree that’s now more like a forest. “The two first clades that were defined have disappeared,” Redondo said. Right now five major clades are jockeying for dominance, he said, but the picture is constantly shifting.

The emergence of a new clade can be as difficult to predict as any rise to global domination. Obsolescence and dominance are determined by the qualities of the lineages, the characteristics of the host populations, and the legacies of previous microbial invaders. The fact that a lineage or clade is dominant in one place, within one group of humans, does not mean it will be in others. So far, the U.K. and South African variants are dominating local surges, but they are not expansive enough to be considered clades. The South African variant, for example, accounts for about 90 percent of the genetic sequences analyzed in the country, but remains a minor player elsewhere.

Similarly, the B.1.1.7 variant was identified in the U.K. in September, yet so far dominates only one geographic region. Although genomic testing in the U.S. is relatively sparse, “we’re doing enough sequencing that we know it’s not that common in the U.S.,” says Nathan Grubaugh, a microbial epidemiologist at the Yale School of Public Health. “This variant doesn’t seem to be more than 1 or 2 percent of cases at the moment. It’s here, and it’s very widespread, but it’s low in frequency. I think, for the most part, this is true globally.”

For now, these variants may be thought of like weeds in a garden. They have shown that they have the capacity to take over in some areas. There is a plausible mechanism that could allow them to do so elsewhere: Both the U.K. and South African variants share a mutation that manifests as a subtle change in a key site where the virus binds to human cells. But weeds take over for many reasons, and sometimes they have more to do with the garden than the weed. Human populations vary in so many ways—behaviorally, genetically, immunologically, geographically, environmentally—that the degree to which a regional surge in cases is due to a change in the virus itself is extremely difficult to discern. And that leads to some uncertainty. “We may have it wrong in the end, [and] it’s not actually more transmissible,” Grubaugh told me. “It seems to be, but we may have been fooled.”

Even if these variants are indeed as transmissible as the rising case numbers suggest, transmissibility is only one determinant of a virus’s overall potential to do harm. Sometimes viruses become more transmissible but ultimately less dangerous. And of course, each new variant is but an intermediate step toward some other form of the virus. The real challenge is understanding how any given change fits into all of these larger patterns, and what that means for us.

The plot of Michael Crichton’s 1969 novel, The Andromeda Strain, hinges on an extraterrestrial microorganism that “mutates” its way out of containment. A similar narrative device drives the film Outbreak, in which a bleed-from-the-eyes virus suddenly becomes airborne. What amounts to a lazy screenwriting cliché has loaded the word mutation with such horrifying subtext that it’s almost unusable. The process of viral evolution is much subtler, and requires a careful eye to detect. That subtlety is what makes it dangerous.

There are two basic ways that a coronavirus can become more transmissible. One is by binding more effectively to human cells. When this happens, a person who inhales viral particles becomes slightly more likely to develop an infection. The other is by replicating more efficiently, creating higher numbers of viral particles (higher “viral load”) in an infected person, so that they exhale more particles with each breath (making it statistically more likely that one of the particles will infect someone else). If a breath contains 10 percent more viral particles, it is that much more likely that one will land in someone else’s nose.

It’s unclear whether one or both of these mechanisms are at play in the U.K. and South African lineages, but we know their effects can be complex. If a person is carrying a much higher viral load, for example, they may get sick more quickly. That sounds bad—and it certainly is for that person. But a shorter asymptomatic period could ultimately make the virus easier to contain. This was the case with the first SARS coronavirus, in 2003 (SARS-CoV-1), which caused a more severe disease than SARS-CoV-2 does, but killed far fewer people in total because each case was identifiable.

By the same token, this coronavirus could evolve to cause a somewhat less severe illness—something slightly closer to that caused by the other four endemic coronaviruses. The common cold is extremely transmissible, yet rarely fatal. This makes sense from an evolutionary perspective: Viruses that kill their hosts are less likely to become dominant than those that don’t. “It could be that transmissibility correlates with being ‘kinder’ to your host,” Turner said. “We’ve observed that in other realms of virus evolution.” Natural selection would, hypothetically, favor the versions that leave people feeling well enough to be out and about, spreading the virus to other hosts.

Major changes in the severity of the disease—in either direction—are unlikely, but the scale at which this virus is operating means that small differences in things like transmissibility are amplified, and can manifest as significant changes in how many people get sick. Experts widely agree that playing it safe in the coming weeks is prudent. Oliver Pybus, a professor of evolution and infectious diseases at the University of Oxford, emphasizes that understanding why B.1.1.7 took over the U.K. “is extremely scientifically difficult.” He has been at the forefront of identifying and tracking the variant, but says huge questions remain unanswered. “There’s still considerable uncertainty as to the long-term consequences” of B.1.1.7, Pybus told me. “We don’t even know whether this lineage truly originated in the U.K., with so many countries not doing this surveillance.”

Though much of the world is now on alert for this particular variant, Pybus said that very few places are sequencing genomes as comprehensively as the U.K. is. In some places, institutions are sampling but not sharing findings in the public domain. Both elements are crucial. Testing with PCR or antigen tests alone is no longer sufficient. Positive tests must be followed by analyses of the genomes of the virus. The more genomes we have, the more effectively we can identify anomalous patterns, both to raise alarms early and to avoid raising false ones.

The U.S. is especially far behind the U.K. in this regard. Without a baseline level of genomic surveillance, Yale’s Grubaugh told me, we do not know if a city like New York would be as devastated by B.1.1.7 as London has been. The forecast for any given variant depends on context that we lack. “I don’t think any one state is doing enough sequencing yet,” Grubaugh said. “Sequencing is the most important thing. We don’t have a big organized project like in the U.K. What we have is a bunch of individual labs, mostly at academic medical centers.” Sporadic sequencing is arguably as bad as none at all, in that it can fail to represent how and why variants are spreading. And focusing too narrowly on hunting one particular variant can mean failing to notice other, possibly more consequential warning signs.

The hunt for any one variant also introduces selection bias, making it hard to know if the variant is truly spreading more readily than others, or if we are just looking harder for it. After finding a person carrying B.1.1.7 in New York last week, for example, state health officials sequenced the genomes of nearby cases—an approach that is likely to find a disproportionate number of B.1.1.7 cases. Without constant, widespread surveillance testing, Pybus said, it’s difficult to discern an accurate overall picture.

“The field of genomic epidemiology is going through its adolescence in public, developing in full view of the most extraordinary event of the century,” Pybus told me. The ability to identify new viral lineages before we even understand how they will affect people may allow epidemiologists to warn of consequential variants—but may undermine their credibility when strains don’t prove as dangerous as headlines predict.

Even if we cannot contain this particular variant, we’re learning from its spread. Preventing more virulent strains from becoming dominant—when they inevitably do arise—may be possible if we can track genomic patterns more widely, so that we have the context needed to determine whether a strain is indeed uniquely dangerous. If we can take steps to contain a new threat early enough, it may never become widespread. If we miss these opportunities, we risk repeating the kind of mistake that allowed the original SARS-CoV-2 strain to escape China in the first place.

Last week, Eddie Holmes reflected on the fateful moment when he tweeted the virus’s original genetic code. It was a moment of triumph for collaborative science, but the work was just beginning. The triumph must be repeated daily. “What worries me most of all is if politics gets in the way of data sharing and science,” he told Medscape. “Step one has to be immediate, rapid, open data sharing. Speed is of the essence in a pandemic. Any barrier to working together makes this a much less safe world. That should be the lesson of this outbreak.”

The changing genetic code of the coronavirus will not nullify our fundamental strategies for ending the pandemic. With better data, we can keep our vaccines and antibody treatments up to date and our shutdown measures as minimal as possible, and we can sever any ominous new chains of transmission. The spread of new variants is a stark reminder that we all have an immediate part to play in this. If you carry the virus, it will mutate within you. You could be the person in whom a new, even more threatening variant emerges. You could seed the entire world with it. But no matter how the virus mutates, the same basic preventive measures—the unglamorous ones we’ve been lectured about for nearly a year—will still have the power to ensure that you don’t.
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CDC Warns: Coronavirus Variant Could Become Dominant Strain in March
https://www.statnews.com/2021/01/15/covid19-b117-variant-cdc/

Anew, more transmissible variant of the virus that causes Covid-19 could sweep the United States in coming weeks and become the dominant strain as soon as March, leading to a new surge of cases through the spring, the Centers for Disease Control and Prevention warned Friday.

The CDC believes the variant, known as B117, is still circulating at low levels in the U.S. Only 76 infections caused by the new variant have been detected, in 12 states, though testing for it has not been routinely conducted. CDC officials acknowledge the variant is likely more widespread here than is currently recognized.

Modeling work done by CDC scientists suggests that unless the pace of vaccination of the population increases dramatically and people adhere stringently to Covid-19 control measures, the new variant will spread rapidly. The work was reported Friday in the CDC’s online journal Morbidity and Mortality Weekly Report.

“We’re concerned,” Jay Butler, CDC’s deputy director for infectious diseases, told STAT. “We want to sound the alarm and urge people to continue to do the things that we know work.”

The B117 variant, first reported in the United Kingdom, transmits more easily from person to person; it is thought that people infected with it develop higher levels of virus in their upper respiratory tracts. Some studies suggest the variant is about 50% more transmissible than existing iterations of the SARS-CoV-2 virus.

To date, there isn’t evidence to show the variant triggers more severe disease, but that’s of little reassurance, given the speed at which it spreads. Hospitals in many parts of the country are already at or near capacity. A tsunami of new cases could lead to a sharp decline in the quality of care for all. And even if the death rate stays stable, an increase in cases will fuel the already enormous death toll in this country.

As of Friday, roughly 390,000 people have died from Covid-19 in the country. That death toll has risen dramatically in recent weeks, with 45,000 deaths occurring since the beginning of January.

Butler said there is no evidence the current surge of cases in many parts of the country is due to the new variant.

The modeling effort estimated that without the new variant and with an effective rollout of vaccine, the rate of new cases in the country should have started to decline in February and March. But the vaccine rollout is not going smoothly, vaccine supplies are limited and will remain so for weeks, and now, there is a new variant to contend with.

“Efforts to prepare the health care system for further surges in cases are warranted,” the authors of the article cautioned.

Additional variants that appear to be more transmissible have been reported from South Africa and from Brazil. To date, there is no evidence they are spreading in the United States yet, the article noted.
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Biden to Deploy FEMA, National Guard to Deliver Vaccines:

President-elect Joe Biden plans to use FEMA and the National Guard to build coronavirus vaccine clinics across the United States, according to new details of his Covid-19 vaccination plan released by his transition team on Friday.

The Biden administration will also “quickly jumpstart” efforts to make the vaccines available at local pharmacies across the U.S., which should ensure that Americans have access to doses at facilities only miles from their home, according to the plan.

“Here’s the deal: The more people we vaccinate, the faster we do it, the sooner we can save lives and put this pandemic behind us and get back to our lives and loved ones,” Biden said at a speech in Wilmington, Delaware, Thursday night. “We won’t get out of it overnight and we can’t do it as a separated nation.”

Drug store chains and pharmacies were supposed to take on a larger role in distributing the vaccine once the government expanded access to more people. But the slower-than-expected rollout has frustrated pharmacy chains. The National Association of Chain Drug Stores called on the federal government earlier this week to allow states to send more doses directly to pharmacies as they do with hospitals and health departments.

The group estimated that the country’s retail pharmacies could administer at least 100 million doses of vaccines each month, which would exceed the incoming administration’s promise of 100 million shots in 100 days.

The Biden administration has said current vaccination efforts are not sufficient to quickly and equitably vaccinate the vast majority of the U.S. population, adding, “We must ensure that those on the ground have what they need to get vaccinations into people’s arms.”

The pace of vaccinations in the U.S. is going much slower than officials had hoped. As of Friday at 6 a.m. ET, more than 31.1 million doses of vaccine had been distributed across the U.S., but just over 12.2 million shots have been administered, according to data compiled by the Centers for Disease Control and Prevention.

Meanwhile, cases are rapidly growing, with the U.S. recording at least 238,800 new Covid-19 cases and at least 3,310 virus-related deaths each day, based on a seven-day average calculated by CNBC using Johns Hopkins University data.

“We remain in a very dark winter,” Biden said during a speech on Friday. “Almost a year later we’re still far from back to normal. The honest truth is this: Things will get worse before they get better,” he said. He called the vaccine rollout in the U.S. a “failure.”

According to the plan, Biden will also invoke the Defense Production Act to “maximize the manufacture of vaccine and vaccine supplies for the country.”

The incoming president’s advisors had previously hinted that he would invoke the wartime production law, which allows the president to compel companies to prioritize manufacturing for national security, to bolster vaccine production.

“The policy changes that we’re going to be making are going to take time to show up in the Covid statistics. It’s not just statistics, it’s people’s lives,” Biden said Friday.

The plan says the act will increase the supply of necessary equipment that could otherwise cause bottlenecks in the vaccine’s rollout if they were in shortage, including glass vials, syringes, stoppers and needles. It will also increase the capacity to package the vaccines into vials.

By the end of the first month in office, the administration plans to have 100 federally-supported centers across the nation that will ultimately vaccinate millions of people. “And as governors of both parties have asked, our administration will reimburse states 100 percent when “heir National Guard is deployed in the fight against COVID-19,” the transition team wrote.

Biden’s plan will also encourage states to open up eligibility beyond health-care workers and long-term care facility residents and staff, and include frontline essential workers like teachers, first responders, grocery store employees and anyone who is 65 and older.

The CDC on Tuesday issued new guidelines that expanded coronavirus vaccine eligibility to everyone age 65 and older as well as to those with comorbid conditions, like diabetes. Some 53 million Americans who are 65 and older and 110 million people between 16 and 64 with comorbid conditions are now eligible to receive the vaccine if every state adopts the guidelines, according to the CDC.

“It won’t mean that everyone in these groups will get vaccinated immediately, as supply is not where it needs to be,” the transition team wrote. “But it will mean that as vaccines become available, they will reach more people who need them.”

Biden said the administration also plans to launch a public information campaign to “rebuild that trust” as some polls suggest Americans are skeptical about getting a Covid-19 vaccine.

“We’ll help people understand what science tell us. That the vaccines help reduce the risk of Covid infections and can better safeguard our health and the health of our families and our communities,” the president-elect said.

“Our plan is as clear as it is bold,′ he added. Get more people vaccinated for free, create more places for them to get vaccinated, mobilize more medical teams to get the shots in people’s arms, increase supply and get it out the door as soon as possible. This will be one of the most challenging operation efforts ever undertaken by our country, but you have my word. We will manage the hell out of this operation.”
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That's it for me this week. I'm hoping to take a little time away from the computer this weekend. It's been a stressful couple of weeks of news and increasing COVID cases. We have crossed 23 million total cases and are very close to 390,000 deaths. We will be well over 400,000 by the end of next week. We are seeing days with over 4000 deaths. Please be safe this weekend. Take some time to do something that relaxes you or brings you joy. Tell someone that matters to you that you love them. Do what you can to spread a little kindness to someone who needs it. (Spoiler: We all need it.)

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Sonya Queen of VMB

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Sonya Queen of VMB

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