Category Archives: Corona Virus

Arthur Allen| Kaiser Health News

In March 2020, Dr. Joseph Vinetz left the contemplative world of his Yale University infectious-disease laboratory and plunged into the COVID ward at Yale New Haven Hospital, joining an army of health care workers who struggled to treat the deadly viral disease.

There were no drugs against COVID-19, and no way to predict which infected patients would develop pneumonia or fall into an inflammatory tailspin leading to severe illness or death. In desperation, Vinetz and countless other doctor-scientists trawled the literature for existing medicines that might help.

We were in the hospital. We had nothing, Vinetz said. I was one of tens of thousands of doctors around the world who said, We gotta figure out what to do.

On April 16, 2020, Vinetz saw an article in the journal Cell about a drug called camostat, licensed in Japan in 1985 to treat inflammation of the pancreas. Research during the first SARS epidemic, in 2004, had shown the drug had a plausible biochemical mechanism for slowing coronavirus infections, so Vinetz and his colleagues quickly organized a small clinical trial on outpatients with mild to moderate symptoms.

In those days, before COVID vaccines and COVID-specific treatments appeared on the market, Vinetzs experiment was one of thousands conducted by doctors who hoped older vaccines and drugs, usually cheap and off-patent, might provide them with options.

Mostly, the drugs were too toxic or had no clear effect. Of the more than 1,500 trials for potential COVID drugs listed on the website of the National Institutes of Health including antivirals, anti-inflammatories, and drugs used for cancer, asthma, heart disease, and dozens of other conditions few have produced helpful medicines.

In fact, only one older drug is routinely used to fight COVID. Thats the steroid dexamethasone, proven by British scientists to help keep hospitalized patients from requiring supplemental oxygen or intubation.

Drugs like hydroxychloroquine and ivermectin showed hints of value initially but failed in clinical trials only to remain in circulation, at least partly because their use symbolized affinity in the culture war for some of President Donald Trumps followers.

A few old drugs still show promise, but theyve had trouble getting traction. The ivermectin and hydroxychloroquine fiascoes soured doctors on repurposed medications, and the pharmaceutical industry has shown little interest in testing them, especially when it can earn billions from even mediocre new ones, scientists tracking the field say.

American and European scientists have confirmed the theoretical basis for camostats impact on COVID. But evidence for its effects is weak; last year the drug was dropped from a big NIH trial comparing various treatments.

A more promising story emerged with fluvoxamine, licensed under the brand name Luvox in 1994 to treat obsessive-compulsive disorder. The drug is in the same class as common antidepressants such as Prozac, Lexapro, and Zoloft.

A child psychiatrist noticed fluvoxamine might be good for COVID. In March 2020, while recovering from a bout of COVID, Dr. Angela Reiersen of Washington University in St. Louis saw a 2019 study in mice that showed how fluvoxamine could activate a protein similar to one missing in patients with Wolfram syndrome, a genetic disease that causes diabetes, neurological issues, and, eventually, death.

Reiersen and her colleague Dr. Eric Lenze, a geriatric psychiatrist, began a clinical trial of the drug in people with symptoms of COVID. Of the 80 in the fluvoxamine group, none suffered a serious decline, while six of 72 patients given sugar pills got pneumonia, and four were hospitalized.

In a follow-up 1,500-patient trial in Brazil, people who took at least 80% of their fluvoxamine pills were 66% less likely to require emergency care or hospitalization than those who got sugar pills. Only one died, compared with 11 in the placebo group.

Since October, when the Brazilian study was published, fluvoxamines future has dimmed. Neither the NIH nor the Infectious Diseases Society of America recommends fluvoxamine to prevent respiratory distress. The NIH panelists noted that the better outcomes in the Brazilian trial were only statistically significant among those who remained in the trial. (Because of nausea and other side effects, only 74% of trial participants in the fluvoxamine wing took all their pills, compared with 82% in the placebo wing.)

The NIH panel also was put off by the fact that the Brazilian trial counted hospitalizations as well as people put under a doctors care for six hours or more not a standard measure. Trial organizers said that was necessary because Brazilian hospitals were so packed with COVID patients that many people got their care in makeshift outdoor shelters.

Regulators and experts are awaiting results from two other big trials, one organized by a consortium of universities and hospitals, the other by the NIH. But both studies are using doses of 100 milligrams of fluvoxamine a day, compared with 200 or 300 milligrams in the successful trials.

I have concerns that they are not using a high-enough dose, Reiersen said, given that fluvoxamine operates on a different biochemical pathway to fight COVID than the one involved in psychiatric treatment.

The concern is shared by Craig Rayner, a former drug company scientist who worked on the Brazilian trial and other big tests of repurposed drugs. You can do the largest, most well-funded study in the world, he said, but if you choose the wrong dose, its rubbish in, rubbish out.

The team overseeing NIHs trial opted for a lower dose because higher doses had already been used in the earlier trials and often caused side effects, said Sarah Dunsmore, a program director at NIHs National Center for Advancing Translational Sciences.

On Dec. 21, David Boulware, a University of Minnesota infectious-disease expert, petitioned the FDA to approve a change in fluvoxamines label stating it can be used to prevent respiratory distress in at-risk patients with mild to moderate COVID. He hasnt received a response yet.

Its a different story for big drug companies. Two days after Boulwares submission, FDA authorized Merck to market its drug molnupiravir, which in its clinical trial showed about as much effectiveness as fluvoxamine, and also had side effects like nausea and dizziness. Fluvoxamine also can cause insomnia and anxiety; molnupiravir is not recommended for pregnant women or anyone, male or female, having unprotected sex, because it caused genetic and fetal damage in test animals.

Still, federal guidelines recommend molnupiravir in certain settings, and the government has bought more than 3 million doses for about $2.2 billion, or $733 per dose. Fluvoxamine, a generic, goes for less than $5 a pill.

You hate to say that Big Pharma has a lot of influence, but clearly they do, Boulware said. The molnupiravir data was not that great, but were spending billions on the drug and it got fast-track emergency use authorization while fluvoxamine remains in a gray area.

With the arrival of effective vaccines and the trickle of antiviral treatments, the urgency of rehabilitating old drugs for U.S. patients has ebbed. But the need remains high in lower- and middle-income countries where vaccines and new COVID treatments remain unavailable.

Its not rare for a pharmaceutical company to synthesize or study a drug for one purpose, only to discover it works better for something else. The classic instance is sildenafil, or Viagra, which was being developed as a drug for hypertension when scientists noticed a remarkable side effect. Remdesivir, now a front-line drug against COVID, was aimed at treating Ebola.

Its less common for a drug marketed for one use to acquire an entirely different purpose, but the pandemic drove scientists to try. They tested thousands of compounds in petri dishes for their virus-killing power, but the journey from test tube to human remedy is long, said Rayner, who is also a professor of pharmaceutical sciences at Monash University in Melbourne, Australia.

If fluvoxamine were a new drug, the company sponsoring it would have spent the money needed to get the drug approved and to show the FDA it has the means to monitor the drugs safety and efficacy. Since its an old drug, it will be up to independent scientists, or perhaps a reluctant generics manufacturer, to sponsor safety monitoring should the FDA provide an emergency use authorization, Rayner said.

An EUA or approval comes with strings. You have to continue to monitor the safety, to make sure no signals pop up when you move it from thousands to millions of patients, he said. Thats very expensive.

U.S. physicians can prescribe drugs off label, but most are leery of doing so until a drug has won approval for the new use. Thats especially true now.

Definitive answers on some repurposed drugs were slow in coming because there were too many small, poorly designed studies by every man and his dog, Rayner said. He calculates up to $5.6 billion has been wasted on hydroxychloroquine clinical trials alone.

A recent World Health Organization resolution called for better coordination and information-sharing among those organizing trials so that definitive answers can be obtained quickly with big pots of data.

As for camostat, Vinetz said those who took the drug felt better than those who got a placebo. It basically prevented loss of smell and taste, which people really bitterly care about, he said. That means theres a real biological effect. That merits further exploration.

But will that happen? Vinetzs team has sought publication of their research for five months with no success. Hed like to see whether camostat can prevent long COVID, but such investigations cost millions. Camostats Japanese manufacturer apparently lost interest in it as a COVID drug after its own small, unsuccessful trial.

When theres no profit motive, its tough, Vinetz said. Meanwhile, hes resumed his research into controlling a neglected tropical disease: leptospirosis.

KHN (Kaiser Health News) is a nonprofit news service covering health issues. It is an editorially independent program of KFF (Kaiser Family Foundation) that is not affiliated with Kaiser Permanente.

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Why cheap, older drugs that might treat COVID never get out of the lab - Great Falls Tribune

Confirmed cases of COVID-19 have passed 505 million globally, according to Johns Hopkins University. The number of confirmed deaths has now passed 6.19 million. More than 11.47 billion vaccination doses have been administered globally, according to Our World in Data.

Pfizer and BioNTech have said that a third dose of their COVID-19 vaccine produced significant protection against the Omicron variant in healthy children aged 5-11 in a trial.

The Moderna COVID-19 vaccine has been approved for use in children between six and 11 by Britain's medicines regulator.

Life expectancy in the United States fell by nearly two years in 2020 to about 77 years amid the COVID-19 pandemic. It was the sharpest drop among 21 other high-income countries, according to a global study.

It comes as the US extends its COVID-19 public health emergency for at least three more months. A mandate requiring travellers to wear masks on airplanes, trains and in transit hubs has also been extended by 15 days to 3 May.

Hong Kong, SAR, has confirmed it will ease some COVID-19 restrictions from 21 April.

South Korea is set to offer a second COVID-19 vaccine booster shot to people aged over 60. "The government plans to expand the fourth round of vaccination to those aged 60 and older," Health Minister Kwon Deok-cheol told a meeting, adding the infection rate in the age group has continued to rise to stand above 20%.

Almost all residents of Indonesia's most populous island of Java have antibodies against COVID-19, owing to a combination of prior infection and vaccination against the virus, a government-commissioned survey showed.

A Japanese Health Ministry committee said on April 17 it had approved Novavax's COVID-19 vaccine.

Shanghai reported a record number of symptomatic COVID-19 cases on Saturday and other areas across China tightened controls as the country kept up its "dynamic clearance" approach that aims to stamp out the highly transmissible Omicron variant.

Daily new confirmed COVID-19 cases per million people in selected countries.

Image: Our World in Data

The COVID Response Alliance to Social Entrepreneurs - soon to continue its work as the Global Alliance for Social Entrepreneurship - was launched in April 2020 in response to the devastating effects of the pandemic. Co-founded by the Schwab Foundation for Social Entrepreneurship together with Ashoka, Echoing Green, GHR Foundation, Skoll Foundation, and Yunus Social Business.

The Alliance provides a trusted community for the worlds leading corporations, investors, governments, intermediaries, academics, and media who share a commitment to social entrepreneurship and innovation.

Since its inception, it has since grown to become the largest multi-stakeholder coalition in the social enterprise sector: its 90+ members collectively support over 100,000 social entrepreneurs across the world. These entrepreneurs, in turn, have a direct or indirect impact on the lives of an estimated 2 billion people.

Together, they work to (i) mobilize support for social entrepreneurs and their agendas; (ii) take action on urgent global agendas using the power of social entrepreneurship, and (iii) share insights from the sector so that social entrepreneurs can flourish and lead the way in shaping an inclusive, just and sustainable world.

The Alliance works closely together with member organizations Echoing Green and GHR Foundation, as well as the Centre for the New Economy and Society on the roll out of its 2022 roadmap (soon to be announced).

Global confirmed COVID-19 cases since the start of the pandemic have passed 500 million. It comes as the highly contagious BA.2 sub-variant of Omicron continues to drive cases across Europe and Asia.

The BA.2 variant now makes up about 86% of all sequenced cases globally, according to the World Health Organization. It is known to be more transmissible than the BA.1 and BA.1.1 Omicron sub-variants. Evidence so far, though, suggests BA.2 is no more likely to cause severe disease.

Scientists continue to emphasize vaccines are critical for avoiding the devastation the virus can cause.

More than 6 million people around the world are confirmed to have died of COVID-19.

India's tally of daily confirmed COVID-19 cases almost doubled on April 18 from the previous day, hitting 2,000 for the first time in a month. The southern state of Kerala also reported a big jump in deaths.

India was at the centre of the global COVID crisis this time last year but the situation has improved since then and most precautions including the wearing of masks have recently been dropped.

But COVID-19 cases have been creeping up in the country of 1.35 billion people in the past few days.

Delhi last week tightened COVID precautions for schools and neighbouring Uttar Pradesh, India's most populous state, again made masks compulsory in public places in some districts.

Authorities reported 2,183 new infections on April 18, taking the running total to more than 43 million, according to health ministry data.

Written by

Joe Myers, Writer, Formative Content

The views expressed in this article are those of the author alone and not the World Economic Forum.

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COVID-19: What you need to know about the coronavirus pandemic - World Economic Forum

In the first year of the pandemic, at least four people in Michigan were infected with a version of the coronavirus observed mostly in mink, the Centers for Disease Control and Prevention confirmed on Monday.

The cluster, which previously included just three cases, represents the first known instance of possible animal-to-human transmission of the virus in the United States.

Two of the infected were employees of a Michigan mink farm that experienced a coronavirus outbreak in October 2020. The other two had no known links to the farm, suggesting that the mink variant may have been circulating more widely among area residents at the time.

Samples of the virus collected from all four people contained two mutations that scientists have hypothesized may be signs of adaptation to mink, Dr. Casey Barton Behravesh, who directs the C.D.C.s One Health Office, said in an email on Monday.

The mutations have previously been documented in farmed mink in Europe, as well as in people with connections to those farms.

This, in addition to the mink farm workers testing positive for Covid-19 after the mink herd had begun experiencing illness and increased mortality, suggests that the most likely hypothesis is that the workers were infected after contact with mink on the farm, Dr. Barton Behravesh said.

But that cannot be conclusively proved, she noted.

Because there are few genetic sequences available from the communities around the farm, it is impossible to know for sure whether the mutations came from mink on the farm or were already circulating in the community, she said.

National Geographic first reported the fourth human case, after obtaining government documents about the mink farm outbreak under the Freedom of Information Act.

Last year, The Detroit Free Press and the Documenting Covid-19 project reported on the first three cases, which included the two farm workers and a taxidermist who had no known connection to the mink farm, according to emails obtained by the two organizations.

On Monday, they reported that the fourth case had been the taxidermists wife.

In early October 2020, Michigan officials announced that the virus had been detected in mink on a local farm and that several of the animals had died. Upon the states request, the C.D.C. deployed a team to help investigate the outbreak.

The investigators collected samples from animals and human workers on the farm, as well as people in the surrounding community, Dr. Barton Behravesh said. In March 2021, the C.D.C. updated its website to note that a small number of people had contracted a version of the virus that contained unique mink-related mutations.

This suggests mink-to-human spread might have occurred, the agency said, noting that all of the human patients had recovered.

But the first human cases, in two workers on the affected mink farm, were identified as early as Nov. 4, months before the agency updated its website, National Geographic reported.

C.D.C. became aware of genetic sequencing data indicating possible mink-to-human transmission in late 2020, Dr. Barton Behravesh said.

The agency then worked with other federal and state officials to analyze that data, she added: Information was published on the C.D.C. website as soon as it became clear there was possible mink to human spread.

Mink-to-human transmission has also been reported in Denmark, the Netherlands and elsewhere.

Overall, transmission of the virus from animals to humans is believed to be rare. Humans are far more likely to spread the virus to one another, or to other species, than they are to catch it from animals, experts say.

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Four Americans Were Infected With a Virus Variant Seen in Mink - The New York Times

We regularly answer frequently asked questions about life during the coronavirus crisis. If you have a question you'd like us to consider for a future post, email us at goatsandsoda@npr.org with the subject line: "Weekly Coronavirus Questions." See an archive of our FAQs here.

Many of us are returning from spring break travel and holiday celebrations with loved ones just as cases in parts of the United States and in some other countries are starting to tick back up.

Testing for COVID is as critical now as it was in earlier stages of the pandemic in order to understand where cases are rising and so that you can seek treatment.

So you may be wondering: When do I need to test now? And can I trust a first test result?

First off: If you develop COVID-like symptoms, test as soon as possible.

And let's assume you're going to self-test because you don't have easy access to a facility that offers PCR tests and/or your insurance doesn't cover it and/or you don't want to wait extra time for results rather than an instant read off a do-it-yourself antigen test.

So you take that home test... and it's negative. Are you in the clear? Maybe, but not definitively. Our experts suggest testing again after a couple of days.

Your body's response to SARS-CoV-2 infection depends on your level of immunity from previous encounters with the virus and from vaccines and boosters.

So it's possible that the negative result is correct and you simply didn't get infected.

Or you might not have enough "viral load" in the early stages of being infected to test positive. That can happen if you have some degree of immunity from a prior case or a vaccination but you get infected anyway (see: Nancy Pelosi).

That's why experts recommend testing at least twice. Test number one would come when you first have concerns that you are infected based on symptoms.

And if you've been exposed to someone with COVID or were in a higher-risk situation (traveling, karaoke party, Gridiron dinner) and then plan to be around an older relative or a child too young to be vaccinated or someone who's immune-compromised?

"If you are going to be around the vulnerable population that can't be protected from the disease and, unfortunately, we have a lot of people that fall into that category then you should do everything in your power to try and make sure you don't have the virus," said Omai Garner, director of clinical microbiology in the UCLA Health System.

You might be tempted to test right away to ease your anxiety. But the recommendation from the U.S. Centers for Disease Control and Prevention is to wait five days after a possible exposure.

It takes a little while for the virus to build up in your body. Testing too soon might give you a false negative.

"You can't take a pregnancy test the day after intercourse to see if you're pregnant, right?" Bergstrom said. The rapid test for COVID is "an excellent test it just has to be used properly and at the right time."

And there's a reason tests come in pairs of two, Garner said. "You need to use them in the pair that they come in, and have multiple days in between, in order to be sure."

And for that second test, waiting a few hours doesn't count because your viral load still might not be high enough to detect. Testing experts suggest an interval of 48 hours before a second test.

Now if you do go for a PCR test, you won't have quite the same concerns. That's because for rapid home tests to turn positive, you need a higher viral load: Those antigen tests don't amplify the sample as PCR tests do.

For those with prior immunity to the virus, "most people feel that a PCR is positive 24 hours sooner than the rapid," says Ida Bergstrom, an internal medicine physician at a medical and travel clinic that conducts testing in Washington, D.C.t.

If you've developed symptoms after close, significant contact, you might consider getting a PCR even after negative rapid tests.

"If your husband is positive, and you develop symptoms, and you have a negative rapid and then the subsequent day you have a negative rapid I would still personally do a PCR before I called myself in the clear," Bergstrom says.

And should I contact my doctor if I have a positive test?

YES. There are a few reasons why.

If you are at risk of severe outcomes because of your age or preexisting conditions, you should try to get highly effective antivirals or monoclonal antibodies as soon as you test positive. The faster you can get the treatments, the better they work but they can only be prescribed after a positive test.

Even if you're not at high risk, you should let your doctor know of your positive test so that they can help you monitor your symptoms and have a more complete record of your health history.

This is a really important step, because you could go on to develop long COVID even after a mild illness, even if you were previously healthy. Between 10 to 50% of people who recover from COVID have long-term symptoms.

"If your symptoms linger or if there's any question with disability or anything in the future, it's nice that there's a trail," Bergstrom said.

Insurance companies may not cover treatments for long COVID if you don't have documented evidence of a positive test, and you may not be able to apply for disability without it.

It's also a great idea to report your home test results to your local health department, if that's an option, so that they can track local cases. Some states and cities also offer services like deferred rent or mortgage assistance for those who test positive.

Melody Schreiber (@m_scribe) is a journalist and the editor of What We Didn't Expect: Personal Stories About Premature Birth.

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COVID home tests are still critical but there's confusion about test protocols : Goats and Soda - NPR

(CNN) Although a federal judgestruck downthe Biden administrations mask mandate forpublic transportationMonday, some experts say you dont want to throw out your mask just yet. No matter the form of public transportation planes, trains, trams, subways, buses or even rideshares good ventilation can help reducethe spread of Covid-19, but masks work best.

You cant engineer your way out of a problem like this, saidKrystal Pollitt, an assistant professor of epidemiology and assistant professor in chemical and environmental engineering at the Yale Institute for Global Health.

Someone infected with Covid-19 releases aerosols that contain the coronavirus when they talk, laugh or simply exhale. If the person isnt wearing a mask to block those aerosols, they can hang in the air and be inhaled by other people nearby.

Outdoors, viral particles may disperse with even a light wind. But indoors, where there is no wind, particles tend to concentrate and hang around. Good ventilation can help break up the concentration of viral particles, but it cant do everything.

Ventilation is great, but we know if we are outside, the risks are lower. Being able to re-create the same amount of airflow that you would have with just your natural wind patterns in a confined indoor space thats heavily occupied is incredibly hard to do, Pollitt said. Outside of putting yourself into, say, a wind tunnel, which obviously wouldnt be comfortable for many reasons or energy-wise, we have to think about whats realistic.

On public transportation of any kind, a heating, ventilation and air-conditioning system sucks in air from outside, treats it and pushes it into the cabin or car. Its a closed-loop system that can pull a little bit of fresh air.

A bus or subway car can have 10 to 18 air exchanges per hour on the low side, according to Jim Alosi, a former Massachusetts secretary of transportation who is now a lecturer on transportation policy planning at MITs Department of Urban Studies and Planning; on the high side, it might have 40 to 50.

Everything depends on the age of the equipment, Alosi said. Older systems are not as efficient as newer ones.

Ventilated air that iswell-mixedhas good circulation and is relatively safe, saidVarghese Mathai, an assistant professor in the Department of Physics at the University of Massachusetts-Amherst who has done studies on how the coronavirus spreads in an environment.

But when ventilation is not as good, the air is not so well-mixed, and there can be zones inside a room with a higher concentration of particles.

One cant really predict where these zones are not well-mixed in a room. Really, its a multidimensional problem, and its not easy to predict in a not-so-well-mixed room how safe it is to stay for an extended duration of time, Mathai said.

And if the transportation system wants maximum efficiency to cool or heat the air in a cabin, it can shut off the air intake and use whats already inside,explained Aly Tawfik, director of the Fresno State Transportation Institute and an assistant professor in the Department of Civil and Geomatics Engineering at California State University, Fresno.

Buses have filters, just like the ones inside our vehicles, Tawfik said. But they are not designed for viruses like the coronavirus or the flu virus.

In May 2020, Tawfik and his team didan experimentto see how a virus could spread through buses with a typical ventilation system.

Using nontoxic colored candles and steam, they simulated how air flowed in a variety of buses. They found thatHVAC systems are extremely efficient and hold cool or the warm air inside a bus a lot longer than some may expect.

When the team introduced smoke, they saw that it spread in seconds and filled the whole cabin. Even when they opened the doors and introduced fresh air into the HVAC systems, the smoke lingered for minutes. The researchers think the virus behaves like the smoke did and could linger even after an infected person has left a bus.

These were unpleasant findings, because it means that opening the doors and windows doesnt help much, Tawfik said. The systems were designed to treat air fast and keep it inside the cabin for a long period of time.

With another experiment, the team tried to see if they could treat the air to make it safer. They tested the buses with three viruses that were similar to the coronavirus.

Cooling the air mitigated an average of about 80% of the viruses, and heating was at about 90%.

That does not necessarily mean that its safe, because this 10% is still millions of viruses, Tawfik said. For one thing, its not clear how much of the virus virus it takes to infect someone.

HEPA filters mitigated about 94% of the viruses. Ionizers were a little less efficient, but photocatalytic oxidation and UV lights were better. UV lights in the HVAC system removed about 99% of the viruses.

Northern Californias BART system and New Yorks Metro system are among those that have introduced some of these technologies during the pandemic.

People can catch Covid-19 on planes, especially when an infected person isnt wearing a mask,studies have shown,but a planes air system is much stronger than one on a bus or train.

Airplanes use HEPA filters that can capture about 99% of particles in the air. They also have better air circulation when flying. Air is typically fed in through the top of the cabin, extracted by floor vents, fed through those filters and eventually sent back into the cabin.

Planesbring in air in a top-to-bottom direction about 20 to 30 times per hour, creating a 50-50 mix of outside and recirculated air and reducing the potential spread of the virus. So the risk of getting sick is low, the experts say.

However, people are usually on planes a lot longer than they may be on a subway or on a bus, and more time in a crowded plane can increase someones exposure.

When a plane is parked, it does not have that superior circulation.

Airplane systems are a little similar to bus systems when they are on the ground, Tawfik said. Thats why youll notice the temperature isnt as well-regulated then, and its also when there isnt the same amount of fresh air circulating. Its then dealing with the same challenges.

Uber and Lyft have dropped their mask mandates, and many taxi companies have stopped requiring masks.

Infection in a car is certainly possible,studies show.

You can always wear a mask, and some experts suggest opening car windows and keeping talk to a minimum. Keep in mind that shorter rides are also better than longer ones.

Alosi said there are things that transportation systems could do to mitigate some of the risk. Trains and buses could run more often so there arent as many people on board, for instance.

He says it could help to require people to show proof of vaccination if they want to get on a train or plane. That probably wouldnt work with subways or buses, though, nor would it fly politically.

Alosi thinks public transportation has been unfairly stigmatized. If youre not up in arms about people being unmasked in the grocery store, you should chill out about public transit, he said.

Even before masks were mandatory on public transportation,studies have found, mass transit systems dont seem to be major drivers of viral spread.

And although its not mandatory, the US Centers for Disease Control and Prevention still recommends that people wear masks in indoor public transportation settings.

When you spend significant duration indoors, you obviously inhale, and if you have co-occupants who are potentially infected, you can inhale these tiny droplets that can get you sick, Mathai said.

Ventilation absolutely helps, he said, but protecting yourself can take multiple tools of mitigation. Masks really reduce the momentum of these released aerosol droplets.

A maskcan even protect youwhen others arent wearing them.

Just wearing a mask is a such a simple solution to increasing the level of safety, Pollitt said. Putting one on, its an easy thing to do.

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Ventilation helps make public transit safer from spread of Covid-19, experts say, but masks are better - WISH TV Indianapolis, IN

After getting a first dose of the Pfizer-BioNTech vaccine in San Francisco last year.Credit...Mike Kai Chen for The New York Times

A corporate announcement on Thursday that a small clinical trial showed a booster shot of the Pfizer-BioNTech coronavirus vaccine strengthened the immune response of 140 children aged 5 to 11 comes as new U.S. virus cases are again ticking up.

The upswing has been particularly noticeable in the Northeast, where the Omicron subvariant known as BA.2, now the dominant version of the virus in the United States, first took hold.

Dr. Anthony S. Fauci, President Bidens chief medical adviser, warned in recent days that the United States could see a significant increase in infections over the next several weeks. But he has said the rates of hospitalizations are unlikely to rise in tandem because so many Americans have a degree of immunity, either from vaccines or prior infections.

Several hundred children age 5 to 11 have died of Covid since the pandemic began, according to the Centers for Disease Control and Prevention, but pediatric shots have been a hard sell for many parents. Only about 28 percent of children in that age group have received two doses and would be eligible for a booster. Roughly 7 percent have received just one dose, according to agency data.

There was an initial rush for shots after they were first offered for that age group in November, but the increase in the vaccination rate then slowed to a crawl. In the past month, for example, it rose by a single percentage point.

Dr. Kathryn M. Edwards, a pediatric vaccine expert at Vanderbilt University School of Medicine, said some parents feel that the chances are low that their children will get seriously ill, while the shots are an unknown. She said some research indicates that 45 percent of children who get infected have no symptoms.

The problem is that we cant predict who is going to get sick and who is not, she said. And among those who do, she said, there will be kids that are going to be hospitalized, and there will be a few deaths.

Dr. Sally Goza, a Fayetteville, Ga., pediatrician and former president of the American Academy of Pediatrics, said some parents see no reason to act because they view the pandemic as quelled. Ive had parents come into my office and say, Covids over. I dont need to worry about that, she said.

To some extent, she said, parents have also been numbed by surge after surge of infection. People are tired of dealing with it. They are just like, We are just going to take our chances, she said.

The share of children age 5 to 11 with at least one dose varies starkly by region, according to a Kaiser Family Foundation study. Five of the top 10 states with the highest rates were in New England, while eight out of the 10 states with the lowest rates were in the South.

Even though more than 250 million Americans have been safely vaccinated since the pandemic began, pediatric experts say many parents fear unknown consequences for their children. Compared with shots to protect against measles, mumps and other diseases, which have been around for decades, the Covid vaccines are brand-new.

A study done by New York researchers, posted online in late February, found that for children age 5 to 11, the Pfizer vaccines effectiveness against infection fell to 12 percent from 68 percent within 28 to 34 days after the second dose.

That was a steeper decline than for older adolescents and teens who received a much stronger dose. Some experts suggested that the difference in dosage explained the gap in protection, while others blamed the Omicron variant that was prevalent during the study.

Another C.D.C. study stated that two Pfizer doses reduced the risk of Omicron infection by 31 percent among those ages 5 to 11, compared with a 59 percent reduction in risk among those ages 12 to 15.

Pfizers vaccine is so far the only one authorized for those younger than 18.

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Covid News: South Korea to End Virtually All Restrictions - The New York Times

STATEN ISLAND, N.Y. New confirmed coronavirus (COVID-19) cases in the borough jumped by more than 50% over the past seven days compared to the preceding week, city Health Department data shows.

At the same time, the death rate on Staten Island attributed to the disease has remained constant, increasing by four in each of the past two weeks.

Meanwhile, coronavirus hospitalizations, which had soared above 300 early in the year, have fluctuated in the low-to-mid-20s since the beginning of the month.

With respect to new COVID cases, ZIP code data on the Health Departments web site depict a surge in certain parts of the city, especially sections of Manhattan and Brooklyn, including Williamsburg and Greenpoint.

On Staten Island, the ZIP codes with the highest positivity rate were 10307 at 8.16% and 10312 at 7.33% for the period of April 6 through 12, according to the most recent data available on the Health Departments web site.

ZIP code 10307 covers Tottenville, while ZIP code 10312 includes Annadale, Arden Heights, Eltingville, Greenridge and Huguenot.

As of Friday afternoon, 144,404 confirmed coronavirus cases have been recorded on Staten Island since the pandemic struck over two years ago, per city Health Department data.

There had been 144,283 cases on Thursday, for a one-day increase of 121.

On Friday, April 8, there were 143,622 confirmed cases, meaning that number rose by 782 over the past week.

That averages to about 112 cases a day, a boost of 53.4% from the 73 new daily cases the borough had averaged between April 1 and April 8.

As recently as the week between Feb. 25 and March 4, Staten Island had averaged just over 38 new COVID cases per day.

All data is preliminary, subject to change and can reflect lags in collection, the Health Department said.

HOSPITALIZATIONS

Despite the spike in new cases, the number of patients with coronavirus in Staten Island hospitals has remained fairly constant over past two weeks, and, in fact, has dropped considerably since the beginning of March.

As of Friday afternoon, 25 in-patients with coronavirus were being treated in Staten Islands two hospital systems. There had been the same number of patients a week earlier.

Staten Island University Hospital (SIUH) had 22 patients, up three from April 8, said Jillian OHara, a spokeswoman.

Richmond University Medical Center in West Brighton was caring for three patients, a drop from three from April 8, Alex Lutz, a spokesman, said.

Previously, on both Monday and Tuesday, COVID-19 hospitalizations in the borough had dipped to 20 before rising.

Looking back to the beginning of the month, 23 patients with coronavirus had been hospitalized on Staten Island on April 1.

Still, Fridays overall tally is 31 less than the 56 hospitalizations recorded on March 4. That marks a decline of more than 55% over the past six weeks.

COVID-19 hospitalizations in the borough have plummeted after hitting this years peak of 378 on Jan. 11.

Since that time, patient numbers have fallen by 353, or over 93%.

Hospitals must now report the number of patients being treated for coronavirus complications compared to those who test positive for the disease after being admitted for other reasons.

At Richmond University, none of Fridays three in-patients with coronavirus was admitted due to the disease or complications of it, said Lutz. While those patients were COVID-19 positive, the coronavirus was not included as one of the reasons for their admission, he said.

Those patients were hospitalized for various issues, such as emergency care, childbirth, behavioral health, and heart issues and were found to have the coronavirus.

An SIUH spokesman said in-patients there with COVID-19 are being treated primarily for the disease.

DEATHS

Also on Friday, 2,318 Staten Islanders are believed to have died from complications related to the coronavirus, per city Health Department statistics.

The death total had been the same on Thursday and was 2,314 on April 8.

Previously, Staten Island had also recorded four deaths during the one-week period of April 1 through April 8.

The fatalities include borough residents with confirmed coronavirus cases, as well as those whose deaths were considered as the probable result of the disease.

The Health Departments web site does not have a breakdown.

A death is classified as probable if the decedent was a city resident who had no known positive laboratory test for the coronavirus, but the death certificate lists COVID-19 or an equivalent as a cause of death.

The vast majority of confirmed coronavirus deaths in the five boroughs since the outbreak have occurred in individuals with underlying medical issues, which include lung disease, asthma, heart disease, a weakened immune system, obesity, diabetes, kidney disease, liver disease and cancer.

Citywide, 1,987,692 confirmed coronavirus cases have been reported as of Friday afternoon.

As for suspected coronavirus deaths across the five boroughs, that total has reached 40,133.

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Staten Island is seeing a rise in coronavirus cases. Here are the neighborhoods with the highest rates. - SILive.com

Attorney General Merrick B. Garland and Commerce Secretary Gina Raimondo said Wednesday that they had tested positive for the coronavirus, the latest in a series of prominent Democrats, lawmakers and Biden administration officials to say they had been infected.

Also Wednesday, Representative Katherine Clark of Massachusetts, the assistant House speaker, and Representative Scott Peters of California announced their own positive tests.

The Justice Department said in a statement that Mr. Garland, 69, asked to be tested after learning that he may have been exposed. Mr. Garland, who is vaccinated and boosted, was not experiencing symptoms and planned to work from home for at least five days, the department said. He will not return to the office before he tests negative at the end of that period.

The announcement about Mr. Garland came just hours after he delivered a news briefing at the Justice Department at 10 a.m., where he stood unmasked next to several other officials, including Christopher A. Wray, the director of the F.B.I. The Justice Departments statement announcing the test result followed several hours later.

Mr. Garland addressed reporters for more than half an hour, often trading places with others at the briefing room podium.

A White House official said President Biden, who has not tested positive for the coronavirus, was not considered a close contact. The official was not authorized to speak publicly and asked for anonymity.

In a news briefing Wednesday afternoon, Jen Psaki, the White House press secretary, said that although cases are increasing among Congress, the press corps and the White House, the administration is not planning on toughening protocols and plans to continue its return to work plan.

But Ms. Psaki, who recently tested positive herself for a second time, added that the president has remained protected from the virus by taking measures that go beyond what the C.D.C. protocols are, like ensuring everyone who sees Mr. Biden is tested in advance and socially distancing in meetings with the president including in the Oval Office.

The president was last tested on Monday and received a negative result, according to the White House.

Ms. Raimondo, 50, tested positive after taking an at-home antigen test, the Commerce Department said in a statement on Wednesday. The secretary, who is fully vaccinated and boosted, was experiencing mild symptoms and would isolate and work at home for five days before taking another test, in accordance with guidelines from the Centers for Disease Control and Prevention, the department said.

Her office said it was conducting contact tracing and was in the process of notifying people with whom she may have been in close contact.

Ms. Clark, 58, said on Twitter on Wednesday morning that she had tested positive for the virus and was experiencing mild symptoms. She said she had been vaccinated and boosted.

I am grateful to our health care professionals and researchers who have given us the tools to manage this deadly virus, she said.

Mr. Peters tweeted that he is feeling fine thanks to being vaccinated and boosted, and will isolate at home while his office remains fully operational.

Jamal Simmons, the vice presidents communications director, also tested positive for the virus on Wednesday, according to a White House statement. He will be isolating and working from home, but Mr. Simmons was in close contact to Vice President Kamala Harris. She will follow consult with her physician and plans to continue with her public schedule.

The officials who announced their test results on Wednesday came the day after three other House Democrats Representatives Joaquin Castro of Texas, Adam Schiff of California and Debbie Wasserman Schultz of Florida said they had tested positive.

The positive tests are a reminder that, even as top officials seek to pivot away from strict restrictions and encourage Americans to learn to live with the coronavirus, the pandemic continues, driven by the emergence of a new, highly contagious subvariant whose spread is alarming experts.

In March, at least nine House Democrats announced positive tests in a span of five days, with more than half of those cases emerging after lawmakers attended a party retreat in Philadelphia. Two other lawmakers who did not attend the retreat also tested positive during the same time.

Hillary Clinton and Doug Emhoff, the husband of Vice President Kamala Harris, also tested positive for the virus in March, as did Ms. Psaki, who tested positive for the second time in five months, one day before she was scheduled to join Mr. Biden on a diplomatic trip to Europe.

Katie Rogers contributed reporting.

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Attorney General Merrick B. Garland Tests Positive for the Coronavirus - The New York Times

The Department of Defense recently released the Consolidated Department of Defense Coronavirus Disease 2019 Force Health Protection (FHP) Guidance to serve as a uniform and consolidated policy for DOD's continued response to COVID- 19, and serve as the DOD COVID-19 Workplace Safety Plan required by Executive Order 13991, "Protecting the Federal Workforce and Requiring Mask-Wearing," January 20, 2021.

This memorandum consolidates and replaces the listed FHP memoranda, complies with applicable court orders, and is consistent with relevant Presidential directives and Office of Management and Budget and Safer Federal Workforce Task Force guidance.

Specifically, the guidance consolidates, incorporates, and rescinds the following policy and guidance:

As Federal COVID-19 guidance and requirements evolve, the Under Secretary of Defense for Personnel and Readiness will revise the affected portions of the document to rapidly update and disseminate targeted FHP guidance to all DOD Components. These updates will be in a form that can replace the pages of the consolidated guidance that the updates supersede. DOD Components may, in tum, issue any necessary supplemental guidance and, most importantly, will rapidly execute actions required to protect the health of the Force and preserve mission readiness.

The Consolidated Department of Defense Coronavirus Disease 2019 Force Health Protection Guidance can be found here.

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Consolidated Department of Defense Coronavirus Disease 2019 Force Health Protection Guidan - Department of Defense

Catching Covid is associated with a fivefold increase in the risk of deep vein thrombosis (DVT) and a 33-fold increase in risk of a potentially fatal blood clot on the lung in the 30 days after becoming infected, data suggests.

The findings, published in the British Medical Journal on Thursday, could help explain a doubling in the incidence of, and deaths from, blood clots in England since the start of the pandemic compared with the same periods in 2018 and 2019.

They also help to put the very small increased risk of blood clots associated with Covid-19 vaccination into context. The degree of complications associated with Covid-19 is much stronger and lasts for much longer than what we might be getting after vaccination, said Dr Frederick Ho, a lecturer in public health at the University of Glasgow, who was not involved in the research.

Even those people with mild symptoms who do not need to be hospitalised might have a small increase in the risk of [blood clots].

Although previous research had suggested that catching Covid was associated with an increased risk of blood clots, it was unclear for how long this risk remained, and whether mild infections also increased peoples risk.

To address these uncertainties, Anne-Marie Fors Connolly at Ume University in Sweden and her colleagues measured the risk of DVT, pulmonary embolism a blood clot on the lung and various types of bleeding, such as gastrointestinal bleeding or a burst blood vessel in the brain, in more than 1 million people with confirmed Covid infections and more than 4 million uninfected individuals.

Overall, they identified a 33-fold increase in the risk of pulmonary embolism, a fivefold increase in the risk of DVT and an almost twofold increase in the risk of bleeding in the 30 days after infection. People remained at increased risk of pulmonary embolism for six months after becoming infected, and for two and three months for bleeding and DVT.

Although the risks were highest in patients with more severe illness, even those with mild Covid had a threefold increased risk of DVT and a sevenfold increased risk of pulmonary embolism. No increased risk of bleeding was found in those who experienced mild infections.

Pulmonary embolism can be fatal, so it is important to be aware [of this risk], said Connolly. If you suddenly find yourself short of breath, and it doesnt pass, [and] youve been infected with the coronavirus, then it might be an idea to seek help, because we find this increased risk for up to six months.

Ho said the results remained relevant even in the Omicron era, since current vaccines were highly effective against severe Covid but breakthrough infections were common, even after a third dose of a vaccine.

Despite the potential for new variants of concern, most governments are removing restrictions and shifting their focus to determining how best to live with Covid. This study reminds us of the need to remain vigilant to the complications associated with even mild Sars-CoV-2 infection, including [blood clots].

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Covid linked to 33-fold increase in risk of pulmonary embolism - The Guardian