Monthly Archives: July 2022

The BA.5 Covid-19 subvariant is now the most dominant strain in the country; the highly infectious variant has caused an uptick in cases and hospitalizations both in hotspots like New York City and the nation overall, but public health action and messaging is less aggressive than with previous outbreaks.

BA.5 typically causes familiar symptoms like fever, headache, muscle aches, cough, and sore throat but can still cause serious illness, especially in individuals with preexisting conditions. Its even entered the highest halls of power, with President Joe Bidens doctor saying in a letter Saturday that Biden is likely infected with BA.5. But theres been little focus on the national plan to keep the subvariant under control, which the Biden administration rolled out July 12.

Tracking BA.5s rise is complicated somewhat because of an increase in at-home rapid testing to confirm infection, rather than testing in a clinical setting, which would make its way to health authorities and paint a fuller picture of the data. While the number of cases is nowhere near the level of infections due to omicron last winter, the week-on-week total of hospital admissions overall has trended up steadily over the past month, according to data from the Centers for Disease Control and Prevention.

Furthermore, its likely that the full magnitude of the BA.5 outbreak isnt being captured by available data. In some places like San Diego that use wastewater monitoring, wastewater analysis showed a massive surge in copies of the virus shed into the communitys sewage 15.5 million copies per liter of wastewater on Wednesday of last week, versus 8 million copies per liter from the same location the previous week, according to the San Diego Union-Tribunes Paul Sisson. That trend directly contradicts data available from the San Diego County health department, which actually showed positive rates declining 8.3 percent over the same period. For comparison, Sisson reported, there were 47.6 million copies per liter in the same location on January 9, 2022, during the omicron wave.

BA.5s and its fellow omicron subvariant BA.4s advantage likely comes from a combination of increased transmissibility and mutations that enhance their ability to evade immunity people have from previous infection or vaccination, Natalie Dean, an associate professor of biostatistics and bioinformatics and of epidemiology at the Rollins School of Public Health of Emory University, told Reuters. You dont even need an increase in transmissibility to explain the advantage, she said.

Given data showing low rates of severe illness and death in many places and fatigue with Covid-19 restrictions, many health authorities arent tightening previously loosened restrictions.

Im like everyone else: I hate wearing that mask. But more than that, I hate the idea that I might accidentally transmit to somebody else, Barbara Ferrer, the Los Angeles County public health director, told the New York Times. Thats my biggest fear that were so anxious to be done with this virus that were getting complacent.

Throughout the pandemic, New York City has been a hot spot; crowded living conditions and public transit make it easy for the virus to spread through the air. While the citys BA.5 infection rate is nowhere near what it was with previous waves, its continuing to trend up and may even be much higher than available data shows.

As the Timess reporting points out, New York Citys test-and-trace program got phased out this April under Mayor Eric Adams who contracted Covid-19 that month. Restaurants no longer require proof of vaccination to enter, and the citys mask mandate ended in March, though masks are still required on public transit. Despite the citys uptick, and his own health departments recommendation that people mask indoors, Adams has repeatedly resisted bringing back the mask mandate.

We are always re-evaluating our response efforts to ensure we are providing New Yorkers with the best information possible and so that they can make the decisions that are right for them, Fabien Levy, Adamss press secretary, told Vox in an email. However, as City & State, an outlet covering the politics of New York City and Albany, noted earlier this month, the New York City Department of Health removed a color-coded alert system that included specific guidance about how to handle different levels of Covid-19 outbreak, including public health measures to enact. As the New York Times reported earlier this month, the system which Adams unveiled in March recommended that the mayor require face masks at indoor settings and crowded outdoor settings, and bring back the vaccine requirement to enter restaurants and bars.

As of Sunday, the website still states that the administration is re-evaluating the citys COVID Alert system, and advises users to check back here for updates in the coming weeks. It also recommends that New Yorkers wear a high-quality mask in all public indoor settings and around crowds outside, as there are currently high transmission levels of COVID-19 throughout the city.

Instead of bringing back such measures, Adamss office has promoted vaccination, at-home and community testing locations, and antivirals to address Covid-19.

New York is leading the nation in testing and treatment delivery, and, in the last six months alone, weve given out more than 35 million at-home tests to New Yorkers and delivered approximately 90,000 courses of Paxlovid, Levy said in his email to Vox. We review the numbers every day and will continue to follow the guidance of health experts to keep New Yorkers safe and healthy.

But New Yorkers are continuing to get sick, with reported Covid-19 cases up 22 percent over the past two weeks, hospitalizations up 25 percent, and deaths up 29 percent, according to the New York Times. Again, the numbers are still small in comparison; a daily average of 12 deaths is nothing like the daily averages in spring 2020. Vaccines and antivirals undoubtedly help prevent serious illness, hospitalizations, and deaths but they need to be supplemented with other mitigation and support measures like masking, as Ed Yong pointed out in his article for the Atlantic earlier this month.

Biden tested positive for Covid-19 on Thursday, and while hes reportedly still working and experiencing only mild symptoms, his age he is 79 years old puts him at increased risk for complications from the disease. He has twice been boosted, as Voxs Dylan Scott and Li Zhou wrote Thursday, and is being treated with paxlovid. In a short video address posted to Twitter, Biden assured the public that he was feeling fine and getting lots of work done.

Though he shared that he had been vaccinated and fully boosted, he didnt give any guidance for those watching no exhortations to get vaccinated or boosted, or to wear masks indoors. In the meantime, keep the faith, he said. Its going to be okay.

Thats not to say that the White House has made no effort of late to address the prevalence of BA.5; on July 12, the administration rolled out new guidance to manage the latest Covid-19 subvariant.

A press release announcing the strategy acknowledged that BA.5s apparent ability to evade at least some immunity has the potential to cause the numbers of infections to rise in the coming weeks, particularly where people are unvaccinated or where vaccine immunity is waning.

To address this, the White House proposal includes increasing access to antiviral treatments like the one Biden is taking, as well as continuing to encourage vaccine and booster uptake. Increasing availability of and access to free testing is also a key tenet of the strategy, as is better ventilation, increasing access to the preventive treatment Evusheld for immunocompromised people, and ensuring access to respirators and a clear indication of situations in which masking is advised.

That proposal at least presents a comprehensive if not aggressive approach to the new subvariant and the new normal of life with Covid-19. As experts have warned throughout the pandemic, relying on vaccines as a silver bullet, particularly when an omicron-specific vaccine booster is months away, wont stop Covid-19 and wont prevent new variants from forming. As Yong points out, we dont know what those variants will look like, and we have no way of predicting the seriousness of the resulting illness, or the ways theyll evade our immune responses in the future.

Everybodys hoping to get a degree of what they call endemicity living with the virus at a level that does not disrupt society, Anthony Fauci, the USs top infectious diseases expert, told Barrons in an interview Thursday. Thats where I think were going. I dont believe were going to eradicate this.

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The dominant BA.5 variant of Covid-19 signals were still not in the clear - Vox.com

MOREHEAD CITY The COVID-19 virus has been showing up in eastern North Carolinas wastewater during the past two weeks at levels not seen since the peak this past winter a troubling early warning sign for community spread and illness.

The latest wastewater sampling data on the states COVID-19 dashboard, which shows trends among people who use toilets connected to selected sewage treatment sites and is updated every Wednesday, indicate that the prevalence of the virus has significantly increased over the past 15 days and particularly in the coastal region. And the detection rate is at or above that of early 2022, when more than 200,000 new cases were being reported each week in North Carolina and more than 4,000 people were being admitted weekly to hospitals with confirmed cases.

Dr. Rachel Noble is a researcher at the University of North Carolina Institute of Marine Sciences in Morehead City. Her lab analyzes wastewater samples for pathogens and works with other academics, the state Department of Health and Human Services, wastewater utilities and public health departments to provide the data driving the dashboard. She told Coastal Review Friday that the trends mean we are still in the upswing of the pandemic.

The numbers that were seeing now are either equal to or similar to the very highest numbers that weve seen since we started monitoring, Noble said.

The wastewater samples are screened for the genetic material in the virus that causes COVID-19. Researchers can detect the viral RNA using a polymerase chain reaction, or PCR, test.

The dashboards latest 15-day rate of change shows detection increases of more than 100% in wastewater in Wilmington, New Hanover County, Beaufort and Roanoke Rapids. The latest percentile data show that most of the above sites are at or nearly at the peak levels seen in January, as indicated on the dashboard map by red or orange dots. But Noble said that because of recent heavy rains on the coast, the data may not fully reflect the extent of the virus spread in the communities where sampling is done. She said its likely a conservative estimate because of stormwater infiltration of sewer lines, a common problem with aging infrastructure.

One of the reasons why I would interpret those numbers a little bit cautiously is that we know that definitely in the eastern part of the state, if not in the majority of the state our wastewater in the summer months here has been diluted more by rainwater. And so those concentrations are still reading as being high, but if we were accounting for the dilution from rainwater, they would look even higher to us, she said.

Our sewer systems are not closed systems. They were actually engineered to be closed systems, but the sewage systems in North Carolina, they suffer from a lot of inflow that comes from rain.

Also flowing into coastal areas are throngs of tourists each week. The influx of summer vacationers means a lot more people are contributing to the wastewater systems here. And in coastal communities where there is wastewater monitoring, there are more and more viruses detected in the systems, Noble said.

We are getting this constant influx of new community members and a portion of those are infected. They might be asymptomatic. They might do what a lot of people are doing and say, Oh, I have just a little cold, and keep going through their vacation, but theyre still contributing viruses to the system, Noble said.

The more people who are exposed to the virus, the more opportunities the virus has to evolve and become more easily transmissible or cause more severe symptoms.

Viruses constantly mutate and these changes sometimes result in a new variant. According to information from the Centers for Disease Control and Prevention, the omicron virus spreads more easily than other variants but has generally less severe symptoms. And while omicron is still a variant of concern, it has evolved with numerous sublineages. These are still referred to as being in the omicron family, But weve gone all the way from BA.1 to BA.2 and now were at BA.4 and BA.5, Noble said.

When we do our analysis in the laboratory, were trying to basically figure out what the most dominant current lineage is or what the most dominant current variant is in any given location, and what were seeing in North Carolina right now is BA.4 and BA.5. Theyre still an omicron-type virus, but theyre not the original omicron that we saw in December and January, she said.

And while the BA.5 variant is highly contagious, the trade-off is that for most people, symptoms have been milder, especially those who have had a previous coronavirus infection or were vaccinated.

The CDC has labeled 41 of North Carolinas counties as high COVID-19 community levels because of BA.5. The number is up from 18 the previous week. These counties have a high risk of illnesses that could strain the healthcare system. Many of these counties are on the coast, especially in the northeastern part of the state. The BA.5 variant is causing repeat infections, including in people who have recent past infections from other variants or were vaccinated.

Meanwhile, many all of us are suffering from pandemic fatigue and some may be letting down their guard. Others may be resigned to the fact that everybody will at some point get the virus. Noble said she understands the mindset.

I think everybody is going to get it, she said. But, she added, theres still the problem that if people think, Well, everybodys going to get it, put away the masks, go to concerts, do what youre going to do normal life, the virus spreads and mutates even more.

We keep on giving the virus opportunity to mutate in a way that actually sends us right back to those really dangerous variants like delta and like alpha, which caused a lot of hospitalizations and a lot of deaths and a lot of very, very serious illness and long-term illness for people that were either obese or had diabetes or some in some cases, just genetic diseases, Noble said.

A premature return to pre-pandemic life comes with the risk that new variants will mean hospital beds are unavailable and elective surgeries must be postponed, she said.

I feel like were playing exactly into the virus hands by allowing that circulation, Noble said.

Officials say vaccines remain highly effective in preventing severe outcomes including hospitalization and death from COVID-19.

While Covid variants continue to infect people, we have the tools to protect ourselves from the most serious effects of this virus, Gov. Roy Cooper said last week. Get vaccinated and boosted, wear a mask indoors in crowds if you believe you need better protection and if you become infected, talk with a health professional quickly about effective treatments like Paxlovid. Cases are on the rise with this latest BA.5 variant so I encourage all North Carolinians to know their risk and take steps to protect themselves.

The CDC and FDA announced last week that the Novavax COVID-19 vaccine, a different type of coronavirus vaccine, may be used by adults ages 18 and older when it becomes available in the coming weeks.

Today, we have expanded the options available to adults in the U.S. by recommending another safe and effective COVID-19 vaccine. If you have been waiting for a COVID-19 vaccine built on a different technology than those previously available, now is the time to join the millions of Americans who have been vaccinated. With COVID-19 cases on the rise again across parts of the country, vaccination is critical to help protect against the complications of severe COVID-19 disease, CDC Director Dr. Rochelle Walensky said in a statement Tuesday.

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COVID-19 virus detection in wastewater samples on the rise | Coastal Review - Coastal Review Online

Few serious side effects have been reported from the administration of the various new vaccines that were developed during the coronavirus pandemic [1]. However, vaccine-induced thrombotic thrombocytopenia (VITT) is a very rare prothrombotic syndrome that has been reported in some patients after receiving coronavirus vaccination with the adenovirus vector-based vaccines: AstraZeneca (ChAdOx1 nCoV-19) and Johnson and Johnson (Ad26.COV2.S) [2].

VITT is a thrombotic syndrome that involves the development of immunoglobulin G (IgG) antibodies that bind to the Fc portion of the IgG receptor on platelet factor-4 (PF4). Platelet activation occurs upon binding, a phenomenon similar to heparin-induced thrombocytopenia (HIT). The immunopathology of VITT differs from HIT since the antibodies bind to a different epitope on PF4, and VITT is not dependent on exposure to heparin products. The mechanism in which VITT causes antibody formation is still unclear. Some theories suggest vaccine components may generate a neoantigen when bound to PF4 [2]. VITT is a very rare complication of the adenoviral-vector-based COVID-19 vaccines, with the CDC estimating an incidence of 1 in 533,333 [3].

In this report, we present a case of VITT in an adult female with no previous medical issues.

A 37-year-old female with no previous health conditions presented to the ED with an 11-day history of headachez following vaccination with the Johnson and Johnson COVID-19 adenovirus-based vaccine. The headache was localized to the bi-temporal region, was constant in nature, and had been progressively worsening since the time of vaccination. The patient had a past surgical history of cholecystectomy and Cesarean section. She had no known medical conditions and was a current cigarette smoker with a 10-pack-year history. The patient reported a positive history of blood clots in her sister and mother, with no known diagnoses of hereditary coagulopathies. Vital signs on arrival were within the normal limits: temperature of 98.1, heart rate of 72 beats per minute, blood pressure of 114/78 mmHg, and oxygen saturation of 96% on room air. Labs in the ED were significant for thrombocytopenia, with a platelet count of 22,000. Other pertinent lab values include an elevated C-reactive protein (CRP) of 3.19 mg/dL. -HCG was negative, and urinalysis showed no evidence of urinary tract infection. At the time of presentation, the patient had no signs of active internal bleeding, petechiae, purpura, or ecchymosis. Physical examination was unremarkable, although the patient appeared to be in significant distress because of the headache. A non-contrast CT scan of the head was ordered and showed no acute abnormalities. A chest X-ray was also performed and demonstrated no acute cardiopulmonary disease. The COVID-19 rapid antigen test was positive, and a polymerase chain reaction (PCR) test was ordered. A full respiratory serology panel was performed and was negative. The patient received a 500 mL bolus of sodium chloride, 30 mg of IV ketorolac, and 10 mg of IV dexamethasoneand was admitted to the general medical floor for observation and management of thrombocytopenia.

On day 1 of hospitalization, the patient woke up with sudden excruciating right lower extremity pain. At this time, she was diaphoretic, tachycardic, and flushed. The pain was associated with numbness, tingling, and decreased sensation around the right ankle with preserved motor function. The dorsal pedal, posterior tibial, and popliteal pulses were non-palpable and non-Dopplerable. Labs showed a high d-dimer level of 6.01 (normal 0.19-0.5), a low platelet count of 20,000, and an elevated immature platelet fraction of 14.3%. Fibrinogen was normal at 217, and coagulation studies, including prothrombin time (PT), partial thromboplastin time (PTT), and International Normalized Ratio (INR), were within the normal limits. CRP was elevated at 2.67, and procalcitonin was normal at 0.06 ng/mL. Venous duplex ultrasound of the right lower extremity showed no evidence of deep vein thrombosis. A computed tomography angiography (CTA) scan of the abdominal aorta with runoff was ordered and showed a right common femoral artery embolus extending into the origin of the superficial femoral and profunda artery, a left distal popliteal trifurcation embolism with segmental occlusion, a small pulmonary embolism in the right lower lobe, and a mural thrombus of soft plaque in the anterior wall of the infrarenal abdominal aorta (Figures 1-3). The patient was not a candidate for thrombolysis due to thrombocytopenia, so an open thrombectomy of the right common and superficial femoral arteries was done with an embolectomy catheter. Post-operatively, the patient received anticoagulation with argatroban.

Following the procedure, the patients platelet count had decreased to 12,000, the WBC was elevated at 12,400, hemoglobin (Hb) was low at 11.6, and PTT was increased to 39.9. She was admitted to the ICU and was started on 10 mg IV dexamethasone Q6H for four days. The COVID-19 PCR test came back negative, confirming a false-positive rapid antigen test. Pathology was consulted to examine a peripheral blood smear, which showed normal platelet morphology with a decrease in the number of platelets. The pathologist suggested that this may be secondary to peripheral consumption and SARS-CoV-2 vaccine-induced immune thrombotic thrombocytopenia. The patients serum was tested for heparin-platelet factor 4 (heparin-PF4) antibodies. Heparin-PF4 antibody enzyme-linked immunosorbent assay (ELISA) was positive with 100% heparin-PF4 antibody inhibition and an optical density of 2.265. Hematology was consulted and suggested that thrombosis is related to a HIT-like mechanism, even without known exposure to heparin products. This was concluded by cases in the literature that showed immune-induced thrombocytopenia with vascular thrombotic events after COVID-19 vaccination, mostly after receiving the AstraZeneca vaccine. It was recommended that low-weight molecular heparin and platelet transfusions should be avoided to prevent worsening thrombosis. Hematology requested that the patient be started on IV immunoglobulin (IVIG) for two days if there was worsening thrombocytopenia or any signs of bleeding.

On hospital day two, morning labs showed that the platelet count dropped to 8000. The patient received her first day of IVIG. WBC count at this time increased to 14,300. Immature platelet fraction had increased to 19.6%, and PTT increased to 41.4. At this time, hematology suggested that platelet transfusions should be withheld unless active bleeding is present. Venous duplex ultrasound of the unaffected left leg was taken and showed no evidence ofdeep vein thrombosis (DVT). Venous duplex ultrasounds of the bilateral upper extremities showed acute DVT in the left brachial vein. MRI of the brain showed no evidence of acute infarct, parenchymal hemorrhage, cerebral edema, or cerebellar tonsillar ectopia. Magnetic resonance angiogram (MRA) showed no significant stenosis of the major intracranial arteries and did not identify any medium or large-sized aneurysms. Magnetic resonance venography (MRV) showed no evidence of dural venous thrombosis. CT scan of the brain and head with contrast showed no evidence of dural venous sinus or cavernous sinus thrombosis and no acute intracranial hemorrhage or mass effect. Repeat afternoon labs showed some improvement in platelet count, rising to 14,000. WBC count at this time continued to trend upward to 16,200. Immature platelet fraction increased to 21.6%. Coagulation studies showed prolonged PT of 16.3 and PTT of 45. Other lab abnormalities include low fibrinogen of 135 and an elevated aspartate aminotransferase (AST) of 123.

On hospital day three, the platelet count continued to trend upwards to 20,000, WBC count remained stable at 14,500, Hb was low at 10.3, immature platelet fraction remained stable at 22.3%, PTT remained stable at 44.5, and AST was high but trending downwards to 105. The head CT scan showed no evidence of dural venous sinus or cavernous sinus thrombosis and no acute intracranial hemorrhage. The patient received day two of IVIG.

On hospital day four, the platelet count increased to 47,000. The WBC count trended downwards to 13,100. Hb remained low but stable at 10, PT remained elevated but stable at 24.3, PTT was high but stable at 50, and AST continued to trend down to 69.

On hospital day five, the platelet count improved to 101,000. WBCs trended down to 12,200, Hb was 10.4, PTT was 48.4, and AST was 42, trending towards normal. The patient was discontinued on argatroban and started on oral apixaban 10 mg two times a day (BID) every 12 hours (Q12H) for seven days. The dexamethasone changed from IV to 10 mg per os (PO) today, and she was transferred from the ICU to the medical floor. Pathology confirmed that the content analyzed from the femoral arteries was consistent with a thrombus.

On hospital day six, the platelet count improved to 143,000. WBC count was elevated at 17,500, Hb increased to 11.7, and AST trended down to 52. Dexamethasone was tapered to 10 mg BID, then discontinued upon discharge. The patient was told to decrease the apixaban dose to 5 mg BID after seven days.

Lab values recorded during the hospital stay are summarized in Table 1.

VITT is an uncommon but potentially life-threatening complication that has developed after vaccination with AstraZeneca and Johnson and Johnson COVID-19 adenoviral-based vaccines. This led to safety concerns as several individuals received these vaccinations during the COVID-19 pandemic. However, studies reveal that there is no association between the development of VITT and the BioNTech Pfizer vaccine [4]. One case report has also been published on fatal thrombotic events following vaccination with Moderna. However, it is unknown if this was a direct result of VITT or was related to a prior illness [5].

We reported a case of VITT following the Janssen (Johnson and Johnson) COVID-19 vaccination. A case report in the UK that included 220 cases of definite or probable VITT stated that the median time of diagnosis post-vaccination is 14 days, ranging from 5 to 48 days [6]. This study showed a female predominance among cases, with 55% of patients being female, making this a significant risk factor for VITT [6]. Over half of the patients studied had multiple thrombi present in different locations. The patient in our case report had similar demographics to this study as she presented to the hospital with symptoms 11 days post-vaccination, is female in gender, and had four different thrombotic sites. In systematic reviews, the headache was shown to be the most common presenting symptom in patients with VITT and cerebral venous sinus thrombosis (CVST) [7]. Despite our patients presentation of an unremitting headache, no signs of CVST or neurological abnormalities were found on imaging.

Sites of venous thrombosis in VITT can vary but are more commonly seen as deep vein thrombosis of the lower extremities and thromboembolism to the lungs [1,8]. Some rare but observed sites of thrombosis in VITT include the splenic, portal, mesenteric, adrenal, cerebral, and ophthalmic veins [1,8]. CVST is an uncommon but serious complication of VITT, where thrombosis of the cerebral sinuses occurs, leading to intracranial hypertension [9]. Thrombosis in the presence of VITT can be diagnosed through MRI with venography or CT venography. This was done after our patient developed thrombosis in the setting of thrombocytopenia, thus ruling out dural sinus thrombosis as a cause of the headache [1,9].

Arterial thrombosis caused by VITT has been displayed through reports of middle cerebral artery stroke and occlusion of peripheral arteries [10]. Our patients sites of thrombosis are consistent with these locations as they include the femoral arteries, popliteal artery, pulmonary vasculature, and abdominal aorta. The median platelet count for patients with VITT is 20,000-25,000 [2]. In this report, the patients platelet count dropped as low as 8000 but mostly remained within the 10,000-20,000 range.

VITT is diagnosed by using PF4 antibody tests [11]. A diagnosis is based on a positive PF4 antibody assay and the presence of thrombocytopenia or thrombosis. The test used on our patient was the ELISA, which is the recommended screening test [11]. Other screening tests include serotonin release assay, which can be used in patients with suspected VITT with a negative or equivocal ELISA [12]. Patients diagnosed with VITT from case reports in the UK had high optical densities on ELISA, ranging between a density of 2 and 3 [2]. The patient in our report had an optical density of 2.265.

Our patient was treated for two days with IVIG infusions, one of the mainstays of treatment in VITT, as it substantially improves the patients platelet count while stabilizing coagulative events [13]. IVIG interferes with the ability of PF4 to activate platelets by blocking FcRyIIA receptors, as seen in HIT [14]. Plasma exchange is another potential treatment that temporarily reduces the PF4 antibodies, thus decreasing coagulability [7]. It is important to note that platelet infusions should be avoided in the case of VITT to prevent further antibody formation and thrombosis [14]. The long-term complications of PF4 antibodies have not yet been established [13]. An observational study showed that VITT patients had a negative platelet functional assay within a median time of 15.5 weeks [15]. However, 7.5% of subjects showed persistently high levels of antibodies and optical densities, and two out of these five patients had a recurrent episode of thrombocytopenia [15]. Due to the new emergence of this condition, the prolonged implications of VITT and PF4 antibodies will be an essential topic for research in the coming years.

Our patient presented with a case of vaccine-induced thrombotic thrombocytopenia, a recent illness that arose with the development of vaccines produced in light of the COVID-19 pandemic. VITT can be life-threatening if not recognized quickly and treated adequately.

In this case, the patient was treated surgically and medically for multiple thrombotic events in the presence of thrombocytopenia, leading to a full recovery prior to discharge. VITT is a very rare complication of the adenoviral-vector-based COVID-19 vaccines, and although it can result in serious medical issues, the benefits of protection against COVID-19 heavily outweigh any associated risks.

Read more from the original source:

A Case of COVID-19 Vaccine-Induced Thrombotic Thrombocytopenia - Cureus

Judge tosses Arizona suit over limits on COVID-19 relief funds

PHOENIX (AP) - A judge has dismissed Arizona Gov. Doug Duceys lawsuit challenging the Biden administrations demands that the state stop sending millions in federal COVID-19 relief money to schools that dont have mask requirements or that close due to outbreaks.

The state filed the lawsuit earlier this year after the U.S. Treasury Department demanded that Ducey either restructure the $163 million program to eliminate restrictions it says undermine public health recommendations or face a repayment demand.

The Treasury Department also wanted changes to a $10 million program Ducey created that gives private school tuition money to parents if their childrens schools have mask mandates.

In a ruling earlier this week, U.S. District Judge Steven Logan concluded it was reasonable for the Biden administration to say that the money couldnt be spent on efforts that would undermine compliance with COVID-19 prevention guidelines. The judge said a program that requires noncompliance with guidelines may worsen the pandemic and create more negative effects, which goes against the purpose of the relief fund.

MORE: Controversy flares as Gov. Ducey denies grant money to districts with mask mandates

While Ducey claimed the American Rescue Plan Act wasnt clear in the conditions it imposed on using the relief money, the judge agreed with the Biden administrations argument that the permissible uses for the funds under the law and its authorization for the Treasury Department to issue appropriate regulations put the state on notice about the conditions associated with accepting the money.

Duceys lawyers have said in court records that the governor is appealing the ruling. Ducey spokesman C.J. Karamargin said on Saturday that the governors office was reviewing the decision.

The lawsuit said the Treasury Department created restrictions on spending the money Arizona receives under the American Rescue Plan Act on its own and without legal authority. It asked a court to declare that the Treasury Departments rules are illegal and permanently block enforcement and any demands that it pay back the money spent on the two programs.

The Treasury Department started demanding that Ducey change the programs in October. It was part of a concerted effort to force Arizona and some other Republican-led states that have opposed mask mandates or were using pandemic funding to advance their own agendas to end those practices.

Ducey rejected Treasurys request the following month, and the Biden administration followed up with a formal demand that it cease using the money for the disputed programs or face either repayment demands or withholding of additional money it is set to receive under Bidens COVID-19 relief bill.

MORE: Arizona is most guilty of COVID-19 'panic buying,' study says

At issue are two state programs the Republican governor created last summer meant to help schools and students.

Arizonas Education Plus-Up Grant Program provides $163 million in funding to schools in higher-income areas that received less than $1,800 per student in federal virus aid. Districts that require face coverings or that have closed due to virus outbreaks are ineligible.

Another called the COVID-19 Educational Recovery Benefit Program provides for up to $7,000 for parents if their childs school requires face coverings or quarantines after exposure. It lets parents use the money for private school tuition or other education costs and its design mirrors the states existing school voucher program.

MORE: Arizona governor's $10M Educational Recovery Fund in question by some parents still waiting for the money

Ducey created the programs in part to up the pressure on school districts that had mask mandates or other COVID-19 restrictions, saying they were hurting children and parents who had endured more than a year of school shutdowns, remote learning and other restrictions.

Link:

Judge tosses Arizona suit over limits on COVID-19 relief funds - FOX 10 News Phoenix

Steve Barnes| Special to the Times Record

Faucis resigning, I said, mistakenly; it wasn't even noonand already it had been a long day.

Not resigning, retiring.

And then corrected myself a second time: Not right away, but when Bidens term is up.

And then another tweak: Well, this term, the one thats up in two years. The ultimate length of the incumbent presidents tenure is unknowable.

To that news: Oh, she replied, the medical pro who is one of my two best frontline sources on COVID-19 in Arkansas, the other being my daughter-in-law. COVID-19, yes, and its variants and, now, its subvariants. Letters and numbers, punctuated with hyphens or decimal points.

The news broke a few minutes before the nurse and I spoke. Anthony Fauci, universally known as the nations leading infectious disease expert, told a Washington-based news site that he would almost certainly step down in 2025 from his post as director of the National Institute of Allergy and Infectious Diseases. Hes been with the agency since 1968 and has been its leader since 84. Since the winter of 2020, the first season of COVID, hes been under fire from both ends of the political spectrum. On occasion, the left accused Fauci of essentially kowtowing to President Donald Trump and thus failing to champion a more vigorous response to the pandemic. But far more oftenthe rounds were fired from the right, and so vitriolic and so threatening did they become, and as they sometimes still are, that Fauci may be the first government doctor to be assigned a security detail.

Fringe conservative figures on the national scene demanded Faucis head on a pike, and not a few Arkansas politicians zestfully joined in. While the latter pols were at it, they made clear they had no use for the Arkansas medical establishment, especially Dr. Jose Romero, then Gov. Asa Hutchinsons secretary of health.

I offered to email the nurse, a veteran registered nurse, some of the clips regarding Fauci that were starting to flood the Internet.

She laughed. Whos got time to read them?

Was her hospital among those in Arkansas dealing with the resurgence of COVID-19 cases?

Of course, she said immediately, almost snappishly.

She and her colleagues on the floorhad just begun to get a handle on their clinical situation, the staff shortages, which bled over into their personal lives, when up jumped the devil. She, they, had been expecting it. There was no way to avoid a significant uptick in the case count given Arkansascomparatively low vaccination rate.

All it took was another shapeshift of the virus, which every clinician knew was not only inevitable but imminent. So once there was COVID-19, then the delta variant, followed by the omicron variant, with BA.2 and BA.4 close behind, and now BA.5.

The pros say there quite certainly will be subsequent variants, new mutations; and no one who knows his or her stuff is proclaiming victory in sight, light at the end of the tunnel. Each turn of the virus seems more easily transmissible, hence the abrupt rise in the overall case numbers, and the accompanying increase in hospitalizations, and the consequent impact on Arkansaspublic and private treasuries.

I read aloud to my nurse source a quote from a Pennsylvania physician, a ranking virologist and pediatrician named Paul Offit of the Philadelphia Childrens Hospital. COVID-19 and its seemingly endless chain of variants will be here for my lifetime, my childrens lifetimes, and their childrens lifetimes,Offit told The Washington Post.

I waited for my nurse friend to react but she said nothing for a time, as if I was about to give her some additional happy news.

Well, okay, fine, she finally replied. Not so much sarcasm as weariness. In the background I could hear some of those noises that are common at a nurses station.

Hold on, she said, and spoke with someone on the floor,presumably a coworker.

After a few moments she returned to our conversation, but only to end it:I gotta run, okay?

Okay.

I reached out to my daughter-in-law to see if she had to run, too. Yes, she did, although on this day she was dealing with patients with problems other than COVID. But shes due for another rotation in the emergency room, so she expects to see a few more Arkansans stumble in, or be rolled in, blue from lack of oxygen, gasping for breath, confessing assuming they are able to speak that they had postponed vaccination, or didnt believe in it; or were certain their ailment was something else, anything elsethan that COVID stuff, which we all know is overblown.

In other words,she would be sayingwell, okay, fine before the week ends, before Faucis stewardship ends, before the plague ends.

Steve Barnes is the host of "Arkansas Week" on Arkansas PBS.

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The resurgence of COVID-19, the retirement of Fauci | Barnes - SWTImes

EAST GREENSBORO, N.C. (July 22, 2022) North Carolina Agricultural and Technical State University has been awarded third place and a $10,000 prize in the Four-Year STEM Undergraduate category of the National Science Foundation (NSF)s Taking Action: COVID-19 Diversity, Equity, and Inclusion Challenge.

N.C. A&Ts entry highlights The Student Hangar, a resource hub that connects students with counseling, food, housing, utilities, transportation, health care, social and protective services, and other resources geographically closest to them. The rollout of this new mobile app will help Aggies overcome barriers associated with the digital divide or health equity when working on campus or remotely from home.

A&T, the nations largest historically Black college or university, saw student engagement in classes decrease substantially when COVID-19 forced the transition to online instruction in March 2020. Not only did this put students at risk of dropping out, but when coupled with known psychosocial determinants of health it also raised their threat of exposure to COVID-19, exacerbating their anxieties and stress levels.

This prompted the university to assemble a multidisciplinary research team tasked with promoting the retention of future STEM professionals from racially minoritized communities.

The team consisted of Jeannette Wade, Ph.D., assistant professor of sociology, Stephanie Teixeira-Poit, Ph.D., associate professor of sociology, Anna Lee, Ph.D., John R. and Kathy R. Hairston College of Health and Human Sciences interim associate dean for faculty affairs and psychology professor; Smriti Shrestha, senior lecturer in the School of Nursing; Christopher Doss, Ph.D., associate professor of computer engineering; and Adrienne Aiken-Morgan, Ph.D., clinical assistant professor of geropsychology in the University of North Carolina at Chapel Hill School of Medicine.

With the support of the NSF under RAPID Award No. 2033926, the team conducted a survey and follow-up interviews with undergraduate students to explore psychosocial barriers such as housing insecurity, food insecurity and stress that were affecting their physical and mental health and academic persistence during the pandemic. The team then identified resources on campus and in the community that address these psychosocial barriers.

The newly developed mobile app aims to increase student awareness about available resources and help connect students to those that can help them overcome psychosocial barriers, subsequently promoting student well-being, retention, and graduation.

Our project is well-positioned to highlight the extent to which psychosocial risk factors, including poor access to technology resources related to the current extenuating circumstances, are having an impact on student learning outcomes, the A&T team wrote. This, in turn, allows future scholars and practitioners to take steps in mitigating barriers to our efforts to promote diversity, equity, and inclusion in STEM.

The NSF Taking Action: COVID-19 Diversity, Equity, and Inclusion Challenge aimed to encourage institutes of higher education to think deeply about the long-term, potentially negative impacts of the COVID-19 pandemic on diversity, equity, and inclusion in STEM and develop systemic solutions and actions to mitigate the impacts on STEM students, postdoctoral researchers, and faculty.

Through the challenge, the NSF distributed a total of $200,000 in cash prizes among the winners and hosted a virtual showcase for their projects. In addition, the NSF established an open access repository of winning entries and honorable mentions to highlight the importance of these efforts and allow other institutes of higher education to adapt them.

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N.C. A&T Earns Third Place in COVID-19 Diversity, Equity and Inclusion Challenge - North Carolina A&T

Clubs across Europe fear that UEFA, the sports governing body in the region, is set to renege on a proposed multi-billion pound recovery fund intended to stimulate transfer market growth following the economic hardship suffered during the COVID-19 pandemic.

In December 2021, UEFAs website announced the UEFA Executive Committee had heard a detailed update on plans for the European Club Football Recovery Plan.

Sports teams were impacted to varying degrees by COVID-19, through the loss of match-day and ticketing revenue, downgraded commercial partnerships and rebates paid to broadcasters when the sporting product was unable to continue or fundamentally altered in the case of matches played behind closed doors.

UEFAs Football Landscape Report, released in February 2022, revealed projected losses for European top-flight clubs in 2021 of 4billion (3.4billion, $4.09billion). It also demonstrated a growing polarisation between the English Premier League and its rival domestic leagues across the continent as the division was responsible for 34 per cent of global transfer spending.

The European Club Association, a lobbying organisation tasked with representing the interest of clubs that compete in European club competitions, was supportive of the recovery plan and sources indicated to The Athletic that clubs in France, Turkey, Greece, Cyprus, Poland, Croatia and Portugal have all expressed concerns about UEFAs failure thus far to deliver on the initiative.

Executives from leading clubs in Turkey, for example, say they are finding it extremely difficult to secure loans from Western lenders owing to the weak accounts of their major clubs and a calamitous financial situation for the local currency in Turkey.

The Athletic has spoken to multiple club executives in a cross-section of European leagues over the past week and several said they felt that UEFA were now unlikely to push through the rescue plan. The club executives wished not to be named owing to sensitive relations with UEFA but two said a failure to deliver the fund could push clubs towards riskier approaches to raising money. This could include selling a percentage of future broadcast revenue or commercial income to private equity funds, as Barcelona have done, or venturing further into the space of fan tokens and non-fungible tokens (NFTs).

UEFA acknowledged the fund has not yet materialised but attributed the delay to a completely new economic environment as a result of the Russian invasion of Ukraine, after which they say market conditions dramatically and unexpectedly changed. UEFAs finance committee, chaired by former Manchester United chief executive David Gill, has also expressed reservations about the plan.

A UEFA spokesperson told The Athletic: The unforeseen conflict between Russia and Ukraine triggered severe policy actions across economies. It continues to disrupt several industries and drives global financial market volatility to historically high levels. Notably, there has been a considerable widening in credit spread, starting from a few weeks after the invasion of Ukraine, signalling tighter financing conditions. These factors have driven a sharp rise in borrowing costs over the past few months and increased the risk profile of the initiative for the clubs.

The plan had been to use the competition revenues of UEFA club competitions as security in order to allow European clubs to gain access to greater liquidity, which in turn would drive investment and growth in the transfer market.

The hope was that the UEFA brand and competition revenue streams would provide sufficient credibility and allow clubs to borrow money at lower interest rates than would ordinarily be possible.

The relief fund was initially set to be made available to clubs who compete in European club competitions, such as the Champions League, Europa League and Conference League. The repayment of the borrowed money would be hooked to future payments owed to clubs by UEFA for their participation, which can be worth tens of millions each year.

UEFAs website said last December: Starting with an estimated initial amount of 2billion, the financing programme is expected to grow over time.

UEFA also said that Citigroup had been appointed as the sole global coordinator bank for the programme and added: If approved, it could be operational as early as Spring 2022.

The fund was further marketed to clubs at the General Assembly of the European Club Association in the Austrian capital of Vienna in March, leaving many hopeful of receiving funds ahead of this summers transfer window. Yet this did not materialise. In May, Bloomberg reported UEFA had paused plans for the rescue fund due to concerns about how money would be distributed to the clubs and how UEFA would balance its role as a competition organiser, a regulator and also a facilitator for lending (although UEFA itself would not have been the lender).

Now, however, UEFA is publicly attributing the delay to the war in Ukraine, which is one of the concerns outlined by UEFAs finance committee.

The committee is chaired by Gill, who is also UEFAs treasurer, and has three further members: the Hungarian banker Sandor Csanyi, the French Football Federations director general Florence Hardouin and the Finnish Football Association president Ari Lahti.

When asked to outline the finance committees concerns, the UEFA spokesperson said: The UEFA Finance Committee has been consulted on the initiative several times since its inception. Its members pointed out these new risks that have unexpectedly hit the broader world economy after more than 10 years of stable, low-interest-rate conditions.

UEFA, though, marketed the proposal to clubs at the ECA General Assembly in late March over a month after the Russian invasion of Ukraine began.

European footballs governing body is still to communicate a change to the plan in correspondence to clubs, while senior ECA sources also indicated they remain in the dark as to the reasons for the fund not going ahead. This is despite repeated attempts by senior ECA personnel, as well as Paris Saint-Germain president Nasser Al-Khelaifi who is also the ECA chairman and a member of the UEFA Executive Committee to raise the issue with UEFA officials in meetings.

A UEFA spokesperson said clubs would be updated on the status of the project at an ECA board meeting in late August and at the UEFA Executive Committee in September. The spokesperson added there was a need to carefully assess the ongoing volatile market situation and evaluate several alternatives before entering into its execution. UEFA added it is wary of triggering unintended consequences by executing the rescue plan.

Not all club executives spoken to by The Athletic felt the fund was as necessary as some suggest, with one executive arguing it could be used to benefit clubs who had been poorly managed even before the pandemic, while adding that European football had proved itself to be more resilient than first feared when the pandemic came along. There had been apocalyptic predictions that clubs would go under.

Many domestic leagues, however, have seen a vast reduction of transfer market spending, with the Premier League proving to be a notable exception. Clubs in Turkey, for example, had theorised that loans to leading European clubs such as Fenerbahce, Besiktas and Galatasaray would have a waterfall effect for middling and smaller clubs in the country as the larger clubs would invest the money received in the transfer market. Sceptics, however, would caution that a waterfall or trickle-down approach sometimes simply further entrenches the power and privileges of those at the very top of an industry.

There is, however, widespread agreement among many club executives that UEFA erred in announcing and marketing the fund before securing approval from its own finance committee, as some clubs had already started to budget their plans around the loans. Indeed, some argued UEFA, conscious of the ongoing threat posed by the proposed European Super League, had been keen to make bold pledges to safeguard European footballs finances to ensure the ongoing loyalty of clubs across Europe. UEFA rejects this suggestion.

A UEFA spokesperson insisted the organisation would finance any consultancy fees associated with the thus far unsuccessful project, rather than transfer the burden to clubs.

UEFA further countered: ItwasUEFAs duty to presentandexplain the programme in detailto the clubsinorder togaugetheir interestinthe initiativeand get theirpreliminaryapproval.In effect, clubs were presented with numerous updates on the plan, including a final update on the fund during ECAs General Assembly in Vienna. In every presentation made to ECA, it is explained that the programmes implementation remains subject to UEFAs Executive Committee approval, following Finance Committee decision.

Citibank did not respond to a request for comment.

(Top photo: OZAN KOSE/AFP via Getty Images)

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Exclusive: Clubs fear UEFA will withdraw 2bn COVID-19 relief fund - The Athletic