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Category Archives: Covid-19

Breakthrough: When the fully vaccinated get COVID-19 anyway – Monterey Herald

Posted: September 8, 2021 at 10:14 am

When summer began, delta was still just an airline. Coronavirus restrictions had vanished and fully vaccinated folks felt liberated hopping on planes to visit loved ones, munching popcorn in real movie theaters, peeling masks off with the giddy confidence that looser public health recommendations gave them.

It felt, for a blissful few weeks, that the COVID-19 shots were like armored shields, protecting them.

We were told these vaccines were like unicorn farts, said Andrew Noymer, an epidemiologist and demographer at UCI Irvine. The CDC missed another opportunity to be realistic in its messaging. Theyre not exactly magic.

Fully vaccinated Steve Edwards of Big Bear discovered that in July, when he developed what he thought was a head cold. As did fully vaccinated C.P. Smith of Lake Forest, whose general malaise devolved into a wave of fatigue unlike anything hed ever experienced. It was a summer epiphany for Kristen Howerton of Costa Mesa, whose two fully vaccinated sons tested positive in July and August without displaying a single symptom.

There was hope the vaccines might prove to be impenetrable shields, staving off all infection but experts say they werent designed to do that. They were designed to prevent severe disease and death, and theyre doing that spectacularly well, despite the much more contagious delta variant.

I got a little cold, almost like allergies, said Edwards, a manager at Stater Bros. in Big Bear. I probably wouldnt have even missed work because of it during normal times, but I knew it was going around at work, so I went and got tested.

The first test was inconclusive; the second was positive. I barely knew I had it, and I probably wouldnt have known if it wasnt going around the store, he said.

Fully vaccinated people are indeed getting breakthrough COVID-19 cases with increasing frequency, state data show.

As the delta variant surged this summer, more than 100,000 vaccinated Californians got hit with breakthrough COVID-19 cases over June, July and August with more than 10,000 cases reported in the last week of August alone.

With the caveat that hospitalization and death data for breakthrough cases are imprecise (the states figures include those who went to the hospital for something besides COVID a car accident, for example and tested positive upon arrival, and also fail to differentiate between those who died with COVID such as the car accident victim from those who diedfromCOVID), the increases were still striking:

Thats just 0.5% of Californias total COVID-19 deaths, which now total more than 66,000.

I feel very strongly the Moderna coursing through my system almost like an internal battle of good and evil, said Smith, a retired editor for the Orange County Register.

After jaunts to Catalina and Albuquerque, he woke up on a July morning with profound fatigue. His sense of smell had blinked off like a light. But within 36 hours, his sense of smell blinked back on Hey! he exclaimed as he entered his kitchen, I can smell peanut butter! and he felt much, much better.

I never had fever, never had chills, never lost any sense of taste, Smith said. I fit into the senior category, a crotchety old 67, but not once did I feel that any breath I took was in any way challenged. Except for that one day of fatigue and the smell blinking off and blinking on, I felt like myself, and I came out thinking, Science worked. I really feel thats what made me safe.

Dr. Julie Parsonnet, professor of medicine, epidemiology and population health at Stanford University, is sure of that as well. Its true that, as the number of unvaccinated people drops and the number of vaccinated people rises, well see more cases in the vaccinated thats just a function of statistics, she said.

Overall, the vaccines look great in terms of preventing severe illness, Parsonnet said. Theyre just incredible. People can be sick sometimes its not just a little runny nose, but more like a bad cold but then their symptoms go away a lot faster than if they were unvaccinated, and they dont progress.

The key thing is, these vaccines are miraculous, she said. Miraculous. Were tuned in to all the negative things, but the fact is, people are going to restaurants, to movies, doing other things maybe with masks but getting back to their regular lives. People should be very happy with the vaccines.

It may be cruel irony when a fully vaccinated doctor who specializes in infectious diseases gets COVID-19. But thats what happened to Dr. Paul Adamson, a physician at UCLA Health and a clinical instructor at the David Geffen School of Medicine at UCLA, about six weeks ago.

Adamson was readying for a trip to Northern California for a baby shower when he noticed that he had a runny nose. It felt like allergies. But it would be bad to expose people at a baby shower, so he took one of those rapid antigen tests. It came back positive, and was soon confirmed by the gold standard PCR test at UCLA.

He canceled the trip. The next morning, he awoke with deep muscle aches and deep exhaustion. He felt awful but by later that afternoon, he felt much better, and the next day, felt back to normal.

It was quite incredible, he said. I had aches and pains and a little bit of chills, but it was amazing how quickly I recovered. It lasted about 36 hours, and I felt bad for maybe 18 of them.

It wasnt completely over, though: When his wife made his favorite Indian dish, it tasted like a bowl of hot mush. He had lost his sense of taste. But that reappeared about 12 days later.

Howerton, psychotherapist and author of Rage Against the Minivan, never got a breakthrough infection herself, but her two fully vaccinated sons did. Kembe, 14, was exposed at church camp, where some 20 people most of them unvaccinated were infected.

It was real clear that the kids who had been vaccinated had no symptoms, and the kids who werent vaccinated, some of them got very sick, Howerton said. Its great that both of my boys had no symptoms, but it was an incredibly stressful time and they both missed big portions of their lives.

There was worry. What if they had exposed kids on the football team? What if they exposed their sister, who had been rehearsing a play for months?

Thats the part people may not understand, Howerton said. People who feel that vaccination is a personal decision its not. That decision has far-reaching consequences that can affect entire communities, including kids who have vulnerable family members.

The fallout could be teen disappointments, or days of missed work, or hospitalization, or even death. Get the vaccine, Howerton said.

Philip L. Felgner and his colleagues at UCIs Vaccine Research and Development Center are studying the strength of immunity over time in vaccinated health care workers at the UCI Medical Center.After six months, theyve found that the immune response appears durable, declining by only about 10% from the peak.

Based on our data, it looks like an annual boost similar to what we expect to get for the flu vaccine may be recommended, said Felgner, director of the center. Since this coronavirus is prone to variants, the annual boost may contain a different variant from year to year, similar to the flu shot.

COVID-19 continues to mutate, as all viruses do, in populations that are not well protected by vaccination, said Dr. Elizabeth Hudson, regional chief of infectious diseases for Kaiser Permanente.

Until we get to a time where the virus doesnt have large numbers of people it can infect, we can expect it to continue to change, Hudson said. Some of these changes could be helpful to the virus, and some of them will not be so. At this time, the vaccines we have do provide good protection against all the variants of concern, including delta and alpha, so theres no need for a different type of vaccine at this time.

If more changes come to the COVID virus, she said, newer vaccines with different types of protection may be needed. When and if that time comes, the mRNA vaccine technology will allow for a rapid scale-up of new COVID vaccines.

Noymer, the epidemiologist at UCI, is a bit less sanguine.

Breakthrough cases dont please me too much, he said. Obviously, a symptomatic breakthrough case that, in the absence of the vaccine, could have been a hospitalization or worse yeah, give me more of that. If its a vaccine that converts fatalities into people simply feeling sick, OK. Good. But we were hoping for fewer breakthrough cases at all.

Its not that we cant all survive a few days of feeling crappy. You could spread it to someone else in the period before you became symptomatic. Herd immunity is going to be very elusive if vaccinated people can spread it and get infected, so its just going to prolong this whole thing.

On July 1, Noymer was feeling liberated, finally venturing to restaurants and taking off his mask. By Aug. 1, he was canceling lunch plans and masking up again. And here we are on Sept. 1, he said. Im nervous, with school starting and breakthrough cases happening. COVID has capacity to surprise us. I know for sure well have at least one other wave before this is all over.

Adamson, the UCLA doctor who had a breakthrough infection, said Los Angeles hospitals are seeing many COVID patients again, and 99% of them are unvaccinated. For people who are unvaccinated, he said, its really quite a threat.

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‘So hard to watch’: Weekend spike brings Alaska’s COVID-19 hospitalization numbers to another record – Anchorage Daily News

Posted: at 10:14 am

At Mat-Su Regional Medical Center, nearly half the patients have tested positive for COVID-19. Photographed August 2021. (Loren Holmes / ADN)

Alaskas COVID-19 hospitalizations hit a dramatic new high this week as health care facilities struggle with a surge of mostly unvaccinated patients who providers say are stretching the system to its limits.

The state reported 186 people hospitalized with COVID-19 as of Monday as well as two deaths in people with the virus, according to the Alaska Department of Health and Social Services dashboard. The deaths were in a man in his 50s from the Fairbanks North Star Borough and a woman in her 60s from the Kusilvak Census Area in Western Alaska.

Statewide, COVID-positive patients accounted for 1 in 5 of all hospitalized people as of Monday. The states hospitals added about 20 new COVID-positive patients over the Labor Day weekend, putting more pressure on a hospital system providers say is already becoming overwhelmed.

Hospitalizations recently hit new records, superseding 151 people hospitalized at one time over the winter. There were at least 165 patients with COVID-19 in hospitals around the state by weeks end.

The hospital statistics dont include long-term COVID-19 patients who no longer test positive but continue to need care, hospital officials said this week. So they underestimate the true impact of the virus on capacity.

Cars wait in line at Alaska Airlines Center COVID-19 testing site in Anchorage on Tuesday, Sept. 7, 2021. (Emily Mesner / ADN)

Providers say COVID-19 patients now are younger and sicker than before, requiring time-intensive care, and needing hospitalization longer than traditional patients.

Mat-Su Regional Medical Center, in the states least vaccinated urban region, reported 39 COVID-19 patients as of Monday nearly half of the hospitals total patient count.

The hospital has stopped accepting transfers from other facilities and is postponing non-emergency procedures on a daily, case-by-case basis, according to Dr. Thomas Quimby, the hospitals emergency department director. That can mean delaying cardiac catheterization or the removal of cancerous tumors.

The hospitals COVID-positive patients stay for an average of three weeks longer than other patients.

Cases show no sign of abating in Mat-Su, which tends to lag several weeks behind Anchorage, Quimby said. Maybe Anchorage will level off soon and his hospital can send patients there.

If that doesnt happen, theres no place to shift patients, he said. Thats very concerning.

The states chief medical officer, Dr. Anne Zink, worked an emergency shift at the Mat-Su hospital on Saturday night and shared a photo on social media of a patient dashboard with 10 cases, eight of them showing symptoms of the virus.

So much COVID, Zink tweeted.

[Idaho hospitals, overloaded with COVID patients, begin rationing care]

The highly contagious delta variant is driving the surge in hospitalizations and new cases. The state reported 2,059 resident cases over a four-day period from Friday to Monday, including 850 reported for Friday, the second-highest one-day resident tally since the pandemic began in March 2020.

This situation continues to get worse and worse, said Jared Kosin, president and CEO of the Alaska State Hospital and Nursing Home Association. It is so hard to watch.

The new levels come as Anchorage mayor Dave Bronson and Alaska Gov. Mike Dunleavy continue to make it clear they plan no new mitigation measures like mask orders and shy away from specific vaccine messaging. And unlike during last winters peak, hospitals are already full with other patients being treated by health care workers reeling from pandemic burnout or leaving the profession for good, leading to shortages.

As of Tuesday, 61.3% of eligible Alaskans had received at least one dose of vaccine and 55.7% were fully vaccinated, according to state data. Alaska was ranked 33rd out of 50 states for per capita vaccination rates.

The states test positivity rate, the percent positive tests out of the total performed, was 8.07% over a seven-day period as of Monday. Health experts say anything over 5% means broader testing is needed.

Dunleavy last week rejected calls to enact a public health disaster declaration. The governor amended the upcoming special session, adding bills expanding telehealth offerings and streamlining background checks and nurse licensing. Hearings began Tuesday.

More than 90% of the patients he sees at Mat-Su Regional are unvaccinated, Quimby said.

He saw a patient on Sunday who was in his 50s without significant medical problems. His wife was vaccinated but he wasnt. Hed already been sick for 10 days before coming to the ER and was admitted with low oxygen levels.

The patient was scared.

He just was miserable and remorseful. Hes already been sick for 10 days, now hes going to be in the hospital, Quimby said. He asked me, Can I get the vaccination now? I wish I had gotten it.

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'So hard to watch': Weekend spike brings Alaska's COVID-19 hospitalization numbers to another record - Anchorage Daily News

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What’s the mu variant? And will we keep seeing more COVID-19 variants? – WANE

Posted: at 10:14 am

(NewsNation Now) The World Health Organization has identified another coronavirus variant of interest, calling it the mu variant, saying it may have the ability to evade vaccine protections.

Heres what you need to know:

The B.1.621 variant, also known as the mu variant, was first found in Colombia in January 2021 and has been found in about 39 countries so far, including the United States. The variants prevalence has consistently increased in Colombia and Ecuador, despite reports of sequenced cases dropping globally overall.

WHO said further studies are needed to determine the characteristics of the mu variant.

Mu has changes, called mutations, which means it might be able to evade some of the protection given from COVID vaccines.

One reassuring element is that, despite being around since January 2021, it doesnt seem to be outcompeting delta, the dominant variant across most of the world. Mu has been designated a variant of interest or VOI by WHO. If there are changes to the virus that means it looks like it has the potential to do more harm, then it is designated as a variant of interest.

WHOs variants of interesthave been determined to exhibit genetic changes that are predicted or known to affect virus characteristics including transmissibility, immune escape, disease severity or resistance to treatment. VOIs being monitored by WHO include eta, iota, kappa and lambda.

Mu has yet to be designated as a variant of concern, or VOC, by WHO. If theres evidence mu is more serious and beginning to overtake other variants such as delta, it might be upgraded to a VOC. Variants of concern worldwide include alpha, beta, gamma and delta.

The Centers for Disease Control and Prevention has also named alpha, beta, gamma and delta as all variants of concern in the United States.

If mu was truly as contiguous as the delta variant, we would have expected to have started to see indications of this, and we havent yet.

Some mutations will be detrimental to the virus, but some will be beneficial, allowing it to spread better, escape the protection offered by vaccines or even evade COVID tests.

The CDC advised that variants are expected as the pandemic evolves and that receiving COVID-19 shots is still the best way to protect against the virus.

Most COVID vaccines target the spike protein of the virus, which it uses to enter our cells. Our vaccines expose our bodies to a part of the virus, commonly the spike protein, so our immune system can learn to fight the virus off if it encounters it.

If a variant has significant changes in the spike protein, this may decrease the effectiveness of our vaccines.

The WHO said preliminary evidence suggests themu variantcould partially evade the antibodies we get from vaccination. But because this data is from lab studies, we cant be sure how the variant will actually play out in the population.

More research is needed to be certain about how it behaves in humans, and work on this is ongoing.

The good news is vaccines currently protect well against symptomatic infection and severe disease from all variants of the virus so far.

Theres a probability a new variant that will arise one day that can significantly escape the protection offered by our vaccines, which are based on the original strain of the virus. We would call this an escape variant.

However, the leading COVID vaccine manufacturers are well prepared if this eventuates. Some are already developing vaccines for new variants, such as delta.

The Associated Press, Reuters and Nexstar Media Wire contributed to this report.

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What's the mu variant? And will we keep seeing more COVID-19 variants? - WANE

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Inside Mississippi’s darkest month of the COVID-19 pandemic – Mississippi Today

Posted: at 10:14 am

In just one brutal months time, the delta variant of COVID-19 accounted for one-fifth of the state of Mississippis total cases since the pandemic began and killed nearly 1,000 Mississippians.

During the month of August, the virus decimated the states hospital system, demoralized already weary frontline workers, and disrupted school for nearly every student and parent in the state.

Mississippi, among the least vaccinated states in America, will remember August 2021 as one of the darkest months of the COVID-19 pandemic.

By mid-August, Mississippi was the COVID capital of the world. At one point later in the month, four Mississippi counties claimed spots in the national top 10 list for highest caseload per capita, including the top spot.

The virus spread through the state so completely and violently that several tent hospitals were erected in parking garages during the hottest month of the Mississippi summer. By mid-August, there were no ICU beds available in the entire state, and COVID patients were waiting in full emergency rooms for critical care. To help alleviate the hospital staffing shortage, the Mississippi State Department of Health issued an order to allow EMTs and paramedics to offer care to COVID patients while they waited for bed space.

The states healthcare system was so overwhelmed that experts warned the entire hospital network was within days of collapsing. To fend off that collapse, the state had to request that the federal government foot the $8 million-per-week bill for 1,100 contract healthcare workers.

READ MORE: Mississippis hospital system could fail within 5-10 days. Gov. Tate Reeves says to remain calm.

Hospital administrators across the state reported the virus killed numerous pregnant women. Multiple pregnant women on ventilators died of COVID-19 in a Jackson hospital, requiring ICU c-section deliveries to save their babies.

The seasoned OB-GYNs and critical care specialists said this never happens never, said Mark Horne, president of the Mississippi State Medical Association, on Sept. 3.

Multiple Mississippians were hospitalized because they chose to take horse dewormer instead of a safe and effective vaccine, leading the health department to issue dire public pleas for humans to stop taking the animal medicine.

Thirteen-year-old Mkayla Robinson, an eighth grader in Smith County, died a couple days after being diagnosed with COVID-19. That tragedy spurred pleas from the states largest medical and education groups for a statewide mask mandate in schools, similar to one issued by Gov. Tate Reeves last school year.

Reeves, however, rebuffed those pleas, ensuring Mississippians the days of statewide mandates to stem the spread of the virus were over.

Meanwhile, the swift and uncontrollable outbreaks of the virus inside schools caused nearly 15% of Mississippi schoolchildren to quarantine in August just days after they returned for the fall semester due to infection or direct exposure. This stirred fear inside classrooms among teachers and students alike.

There was little relief from Reeves, the states chief executive and top manager of the states pandemic response efforts. The governor remained steadfast in his refusal to say, without equivocation, that every eligible Mississippian should get a vaccine despite the fact that Republican governors in neighboring states offered clear and concise encouragement for their residents to get the shot.

Reeves was blistered by hospital executives and school leaders for his inconsistent COVID policies. He directly countered advice from the states top doctors, he placated those who refused to get the vaccine, and he uttered jaw-dropping comments about the pandemic.

Reeves countered the medical advice of Dr. Thomas Dobbs, the state health officer, saying that there was not much reason for people who are vaccinated to wear masks. He said that a reporter who wore a mask inside a governors press conference was virtue signaling, and he falsely claimed that the press had fabricated reports of his response to the pandemic.

At a Republican fundraiser in Memphis in mid-August, Reeves said that Mississippians arent as scared of COVID as other Americans because they believe theyll go to heaven when they die.

When you believe in eternal life, when you believe that living on this earth is but a blip on the screen, then you dont have to be so scared of things, Reeves said, neglecting to mention any of the Mississippians who had died from COVID in August 984 by months end or their families.

Now one week into September, there is reason for cautious optimism. Cases and hospitalizations are trending sharply downward.

Mississippis seven-day average of new COVID cases has dropped nearly one-third from Augusts peak. Hospitalizations have seen a more modest decrease just over 16% from their peak but these trends are naturally out of sync. It takes time for trends in caseloads to be reflected in hospitalizations and then deaths.

Another promising sign is Mississippis declining prominence among the most infectious counties in America. Just two weeks ago, Mississippi claimed four spots on the national top 10 list for highest caseload per capita, including the top spot. Now it only has one Wayne County sitting at No. 10. During that same period, Mississippi went from having the highest infection rate per capita of any state to the fourth-highest.

While the downward trend is welcomed, medical professionals are urging Mississippians to get the vaccine and remain vigilant.

We cant let our guard down, Dobbs said during a press conference last week. Weve got a lot more coronavirus to go through before we can get back to where we were previously.

Central to our mission at Mississippi Today is inspiring civic engagement. We think critically about how we can foster healthy dialogue between people who think differently about government and politics. We believe that conversation raw, earnest talking and listening to better understand each other is vital to the future of Mississippi. We encourage you to engage with us and each other on our social media accounts, email our reporters directly or leave a comment for our editor by clicking the button below.

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by Will Stribling, Mississippi Today September 7, 2021

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

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Inside Mississippi's darkest month of the COVID-19 pandemic - Mississippi Today

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Why experts are focused on reducing Covid-19 risk instead of ending the pandemic – Vox.com

Posted: at 10:14 am

More than a year and a half into the Covid-19 pandemic, America still doesnt agree on what its trying to accomplish.

Is the goal to completely eradicate Covid-19? Is it to prevent hospitals from getting overwhelmed? Is it hitting a certain vaccine threshold that mitigates the worst Covid-19 outcomes but doesnt prevent all infections? Or is it something else entirely?

At the root of this confusion is a big question the US, including policymakers, experts, and the general public, has never been able to answer: How many Covid-19 deaths are too many?

The lack of a clear end goal has hindered Americas anti-pandemic efforts from the start. At first, the goal of restrictions was to flatten the curve: to keep the number of cases low enough that hospitals could treat those that did arise. But that consensus crumbled against the reality of the coronavirus leaving the country with patchwork restrictions and no clear idea of what it meant to beat Covid-19, let alone a strategy to achieve a victory.

The vaccines were supposed to be a way out. But between breakthrough infections, the risks of long Covid, and new variants, its becoming clear the vaccines didnt get rid of the need to answer the underlying question of what the Covid-19 endgame is.

America is now stuck between those two extremes: The country wants to reduce the risk of Covid-19, but it also wants to limit the remnants of social distancing and other Covid-related restrictions on day-to-day life.

Were not trying to go for zero Covid, Ashish Jha, dean of the Brown University School of Public Health, told me. The question becomes: When do, in most communities, people feel comfortable going about their daily business and not worrying, excessively, about doing things that are important and meaningful to them?

Will Americans accept the deaths of tens of thousands of people, as they do with the flu, if it means life returning to normal? Can the public tolerate an even higher death toll akin to the drug overdose crisis, which killed an estimated 94,000 people in 2020 if thats what it takes to truly end social distancing and other precautions?

Does it make a difference if the vast majority of deaths are among those who are willingly unvaccinated, who, in effect, accepted a greater risk from the coronavirus? Are further reductions in deaths worth postponing a return to normal or changing what normal means if continued precautions are mild, like prolonged masking or widespread testing?

There are no easy answers here. Even among the experts Ive spoken to over the past few weeks, theres wide disagreement on how much risk is tolerable, when milder precautions like masking are warranted, and at what point harsher measures, like lockdowns and school closures, are needed. Theres not even agreement on what the endgame is; some say that, from a policy standpoint, the goal should be to keep caseloads manageable for hospitals, while others call for doing much more to drive down Covid-19.

One big problem identified by experts: I dont think were having those conversations enough, Saskia Popescu, an infectious disease epidemiologist at George Mason University, told me. Instead of the public and officials openly discussing how much risk is acceptable, the public dialogue often feels like two extremes the very risk-averse and those downplaying any risk of the coronavirus whatsoever talking past each other.

But the path to an endgame should begin with a frank discussion about just how much risk is tolerable as the coronavirus goes from pandemic to endemic.

If there is one point of agreement among most experts, its that Covid-19 is here to stay. Until very recently, I was hopeful that there was a possibility of getting to a point where we had no more Covid, Eleanor Murray, an epidemiologist at Boston University, told me. Now she believes that it is infeasible, in the short term, to aim for an eradication goal.

Particularly with the rise of the delta variant, a consensus has formed that the coronavirus likely cant be eliminated. Like the flu, a rapidly shapeshifting coronavirus will continue to stick around in some version for years to come, with new variants leading to new spikes in infections. Especially as it becomes unlikely that 100 percent of the population will get vaccinated, and as it becomes clear that the vaccines provide great but not perfect protection, the virus is probably always going to be with us in some form, both in America and abroad.

That doesnt mean the US has to accept hundreds of thousands of deaths annually in the coming years. While the vaccines have struggled at least somewhat in preventing any kind of infection (including asymptomatic infection), they have held up in preventing severe illness, hospitalization, and death reducing the risk of each by roughly 90 percent, compared to no vaccine. Research has also found stricter restrictions reduce Covid-19 spread and death, and that masks work.

But its also become clear most Americans arent willing to tolerate drastic deviations from the pre-pandemic normal lockdowns, staying at home, and broadly avoiding interactions with other people for long. While social distancing staved off the virus in the pre-vaccine pandemic days, it also wrought economic, educational, and social devastation around the world. Its the intervention that, above all, most people want to avoid going forward.

Thats the goal, in my mind: to eliminate or reduce social distancing, Jha said.

What policymakers can aim for is not a total end to Covid-19 but a balancing act. On one side of that scale is containing Covid-19 with restrictions and precautions. On the other is resuming normal, pre-pandemic life. Vaccines have changed the balance by giving us the ability to contain Covid-19s worst outcomes hospitalization and death with less weight on the side of restrictions. But vaccines alone cant drive hospitalizations and deaths to zero if all the weight on the restriction side is removed.

That suggests a choice: Either Americans accept some level of Covid-19 risk, including hospitalization and death, or they accept some level of restrictions and precautions in the long term.

Depending on how that choice is made, the US could be looking at very different futures. Americans could decide some milder precautions, like masking, are fine. Or they could conclude that even masking is too much to ask, even if that means a greater death toll. It hinges on how much weight on the restrictions side remains acceptable for the bulk of the population how high the threshold is for embracing continued deviations from what day-to-day life was like before.

Regardless, experts say the balance, as the coronavirus becomes endemic, will require accepting some level of Covid-19 risk both to individuals and to society. America already does that with the flu: In some years, a flu season kills as many as 60,000 people in the US, most of whom are elderly and/or people with preexisting health conditions, but also some kids and previously healthy individuals. As a cause of death, the flu can surpass gun violence or car crashes, but its a tolerated cost to continuing life as normal.

You want to get Covid to a place where its more comparable in terms of disease burden and in terms of economic impact to the flu, Cline Gounder, an epidemiologist at New York University, told me.

With about half the country vaccinated, the Covid-19 death rate is still much higher than that of the flu the more than 120,000 deaths over the past six months is still more than double the number of people even the worst flu seasons have recently killed. But as more people get vaccinated and others develop natural immunity after an infection, the death rate will likely come down.

A glimpse of what this could look like in the future came from a study in Provincetown, Massachusetts. The study was at first widely reported as evidence that the virus can still spread among the vaccinated because the outbreak happened in a highly vaccinated population, and three-fourths of those who were infected had gotten their shots.

But experts now argue for another interpretation of the study: Its what a post-pandemic world could look like. Yes, the coronavirus still circulated among vaccinated people. But in an outbreak that eventually infected more than 1,000, only seven hospitalizations and zero deaths have been recorded. If this was 2020, given overall hospitalization and death rates, the outbreak would have likely produced around 100 hospitalizations and 10 deaths.

We should cheer, Amesh Adalja, senior scholar at the Johns Hopkins Center for Health Security, told me. The Provincetown outbreak, contrary to what the press reported, was evidence not of the vaccines failure but of their smashing success.

That doesnt mean the vaccine is perfect. A 90 percent reduction in death, relative to the unvaccinated, is not 100 percent. But it is a much lower risk. If this holds up despite future variants and potentially waning vaccine efficacy, its great news.

But that isnt how the Provincetown study has been widely interpreted, especially after the Centers for Disease Control and Prevention cited it to reinstitute masking recommendations for the vaccinated in public indoor spaces in areas with substantial or high caseloads.

And the national Covid-19 disease burden may never resemble Provincetowns anyway, since the city resides in the second most vaccinated state. In that context, Americans may have to come to accept even higher levels of sickness and death if the goal is to return to normal and vaccination rates dont go up quickly enough.

That leaves the country with a blunt question: How many deaths are Americans willing to tolerate?

The problem is theres no agreement, including among experts, on Covid-19 risk. Some have accepted merely reducing the coronaviruss strain on hospitals as the major policy goal. Theres next to no confidence that anything like Covid zero can be achieved now, but other experts still prefer harsher restrictions if it means preventing more deaths. And many people fall in between.

Its this debate, between flatten the curve and Covid zero, thats long divided the USs Covid-19 response. Red states hewed at least for a while to flatten the curve, moving to lift Covid-related restrictions and reopen their economies as soon as hospitals stabilized. Blue states never truly pushed for Covid zero, but they were generally much less willing to tolerate high levels of cases and deaths and, as a result, shut down more quickly in response to even hints of major surges. (Although there were some outliers on both sides.)

Even with the vaccines, this division, among both policymakers and the public they serve, has kept America in limbo.

Part of the divide is on a philosophical question about the role of government. But its about individuals decisions, too: Are they willing to forgo social activities, government mandate or not, to reduce deaths? Are they willing to keep wearing masks? Submit to continued testing in all sorts of settings?

Are 30,000 to 40,000 deaths a year too many? Thats generally what the country sees with gun violence and car crashes and American policymakers, at least, havent been driven to major actions on these fronts.

Are as many as 60,000 deaths a year too many? Thats what Americans have tolerated for the flu.

Are 90,000 deaths a year too many? Thats the death toll of the ongoing drug overdose crisis and while policymakers have taken some steps to combat that, experts argue the actions so far have fallen short, and the issue doesnt draw that much national attention.

Is the current death toll of more than 1,500 a day, or equivalent to more than 500,000 deaths a year too much? Many people would say, of course, it is. But in the middle of a delta variant surge, Americans may be revealing their preferences as restaurant reservations are now around the pre-pandemic normal a sign the country is moving on. The loudest voices on social media and in public are way more cautious than the average American, Jha said.

Part of the calculus may be influenced by who is getting infected and dying. Once everyone (including children) is eligible for the vaccines, is a high death toll among those who remain unvaccinated simply part of the risk they decided to take by not getting the shot?

This is not something most experts I spoke to are comfortable saying, but its a sentiment Ive repeatedly heard from vaccinated people and even some who are unvaccinated a very dire version of actions have consequences.

Another consideration is whether some Covid-related precautions become permanent. Social distancing in any of its forms doesnt seem like a candidate. But what about masking in indoor spaces? More frequent testing? Vastly improving indoor ventilation? Doing more things outdoors? Depending on whether Americans embrace these other interventions, the level of Covid-19 risk people have to tolerate may end up being lower but what normal looks like would also be redefined to some degree.

Other countries are talking about these trade-offs more explicitly. Australian leaders, for example, have said that they will shift from a long-heralded Covid zero strategy once vaccination rates hit certain thresholds even though this means continued cases and deaths, particularly among the unvaccinated. In the US, the end goal has never been so clear.

Experts argue that these kinds of questions need to be out in the open, so Americans and their leaders can openly discuss them and decide on a plan forward.

Those conversations were important to have in the beginning, Murray said. But theyre even more important now, as we move into this control phase rather than a phase where elimination or eradication [of Covid-19] seems possible.

The country may just continue muddling along. Vaccination rates and natural immunity will slowly increase. Deaths and hospitalizations will similarly decline. Eventually, the virus will hit a level that most Americans find tolerable (if that hasnt happened already). Politicians and the media will talk less about the coronavirus. And, perhaps before we know it, the pandemic will be a thing of the past in the US.

Thats what was happening in June before the delta surge. But over the past 18 months, weve seen that, with no agreement on the endgame, its often impossible to say if the end is really near.

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Covid-19 continues to rapidly spread while calls to crisis lines increase in number and intensity – LouisvilleKy.gov

Posted: at 10:14 am

September 5- 11 is National Suicide Prevention Week

LOUISVILLE, Ky. (September 7, 2021) Today, Mayor Greg Fischer and Dr. Sarah Moyer, Chief Health Strategist for the city, were joined by Geneva Robinson, Director of the Crisis and Information Center at Seven Counties Services, to provide an update on the surge of COVID-19 in the community.

Besides people experiencing severe illness and death from COVID-19, another sad impact of the virus is the tragedies caused by the despair of the pandemic and the sense of instability practically everyone has experienced, said Mayor Fischer. This is Suicide Prevention Week, and we want to make sure everyone has the information they need to get through this difficult time and to help others as well.

Robinson shared that since the beginning of 2020 calls to Seven Counties free 24/7 crisis lines have increased in number and in severity. Before 2020, they received anywhere from 61,000 to 64,000 calls a year. In 2020, they answered 71,000 calls.

Robinson also noted that theres been an increase in calls from individuals who were at the point of self-harm 750 in 2020 vs. 500 in 2019. With calls like that, they can initiate active rescue to immediately initiate help to the individual.

We want people to know you dont have to be at a breaking point to call us, Robinson said. Reach out to us when youre having trouble coping, when feelings start to get out of hand, or you are having difficulty handling whatever is going on in your life. Our crisis counselors provide a safe place to talk and a safe place to help you get resources you may need.

Its OK to not be OK, Robinson added. We are in an unprecedented time for all of us. People are experiencing a multitude of challenges at once. Please call us. Your call is anonymous and confidential. We want to help you.

Mental Health and Suicide Prevention Crisis Lines:

Crisis Text Line

Text LOU to 741741

Seven Counties Services

24/7 Adult Crisis Line (502) 589-4313

24/7 Child Crisis Line (502) 589-8070

National Suicide Prevention Lifeline

(800) 273-8255

National Suicide Prevention Lifeline (Spanish)

(888) 628-9454

National Suicide Prevention Lifeline (Options for Deaf and Hard of Hearing)

(800) 799-4889

Veterans Crisis Line

(800) 273-8255 Press 1

Trevor Project: LGBTQ+ Community

866-488-7386

Trans Lifeline

(877) 565-8860

Louisville Still in High Alert Red Level

We are in a red high-alert level. COVID is everywhere, said Dr. Moyer. If you are unvaccinated, it is unsafe to be out in the community right now. Please stay home if you can. If youre vaccinated or unvaccinated, its still important to wear your mask and keep your space.

Moyer added, If you participated in any high-risk activities this weekend went to gatherings of any kind please get tested this week. The sooner those that are positive stay home, the faster we will get this surge under control. Remember, you are spreading the virus two days before you start having symptoms.

Here are the key COVID-19 data metrics for September 7, 2021:

Vaccines

We are at almost record-breaking numbers for people with such serious illness from COVID they require hospitalization, admittance to the ICU, and being put on a ventilator. Patients are younger, sicker and unvaccinated. If you dont have immunity whether from the vaccine or from having a previous moderate to severe diagnosis of COVID, you need to be staying home until youre fully vaccinated, Moyer said.

This pandemic has had a major effect on our lives.some more than others as many have lost family members or friends they loved; some are dealing with long haul symptoms for months after recovering, some have had to quit jobs to care for children or family members; some like our healthcare workers and your public health workers have faced what sometimes seems like an overwhelming load of responsibility and care. Weve got to take care of ourselves. But we must also take care of each other. Please get vaccinated today. And please reach out to the crisis line if youre struggling.

# # #

View this weeks COVID-19 briefing with public health officials here.

The citys COVID-19 data dashboard, a complete list of COVID-19 testing sites, vaccine information, prevention and contact tracing can be found atwww.louisville.gov/covid19. The LOU HEALTH COVID19 Helpline is also available: 502-912-8598.

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S.Korea planning to live ‘more normally’ with COVID-19 after October – Reuters

Posted: at 10:14 am

SEOUL, Sept 8 (Reuters) - South Korea is drawing up a plan on how to live more normally with COVID-19, expecting 80% of adults to be fully vaccinated by late October, health authorities said on Wednesday.

The country is in the middle of its worst wave of infections, but it has kept the number of severely ill cases under control through steadily rising vaccination rates.

"We'll review measures that will allow us to live more normally, but any such switch will be implemented only when we achieve high vaccination rates and overall (COVID-19) situations stabilise," Son Young-rae, a senior health ministry official, told a briefing.

The strategy will be implemented in phases to gradually ease restrictions, authorities said. Masks will still be required at least in the initial stage.

The government expects to implement the plan sometime after late October, when 80% of its adult population likely will have been vaccinated. As of Tuesday, South Korea had given at least one vaccine dose to 70.9% of its adult population, while 42.6% are fully vaccinated.

It reported 2,050 new COVID-19 cases for Tuesday, with 2,014 of those locally acquired.

South Korea extended national social distancing curbs to Oct. 3 this week as the country boosts its vaccination campaign ahead of a thanksgiving holiday that falls later this month.

Restrictions in place include limited operating hours for cafes and restaurants and on the number of people allowed at social gatherings.

South Korea has registered 265,423 infections since the pandemic started, with 2,334 deaths.

The country has not seen a significant increase in coronavirus deaths, with a mortality rate of 0.88%, largely due to high vaccination rates among the elderly and vulnerable.

Severe or critical cases stood at 387 as of Tuesday.

Reporting by Sangmi Cha; Editing by Miyoung Kim and Tom Hogue

Our Standards: The Thomson Reuters Trust Principles.

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Kentucky hits another record week of COVID-19 cases – Cincinnati.com

Posted: at 10:14 am

Kentucky had more than 30,000 new COVID-19 cases last week, the single largest week for cases in the commonwealth during thepandemic, Gov. Andy Beshear said Tuesday during his update.

Last week, 30,680 new coronavirus cases were reported in Kentucky. The previous week had also set a record with 29,456 cases, making it back-to-back weeks with the most cases.

We continue to see more cases than is safe by any means, Beshear said.

Over the Labor Day weekend through Tuesday, there were a combined 13,005 new coronavirus cases and 60 new deaths. Heres how the numbers break down:

Beshear said he expected to have higher numbers of cases and deaths over the next few days as the under-reporting of cases catches up.

On Saturday, Beshear signed a proclamation calling state lawmakers into a special session on Tuesday to extend the COVID-19 state of emergency in Kentucky.

Our situation is dire, Beshear saidSunday on NBCs Meet the Press news program. We are setting case records. We have a record number of Kentuckians in the hospital battling COVID,in the ICU battling for their lives.

A recent state Supreme Court ruling limitedthe governors executive powers.

If I had the ability to do it right now, we would have a masking order when you are in public and indoors, Beshear said. We know thats a proven way to slow the spread of the virus and ultimately help our health care capacity.

More: Kentucky lawmakers consider ending school mask mandate during special session

More: COVID-19 has shut down at least one-fifth of Kentucky school districts. Here's the latest

UPDATED LIST: More schools switch to universal mask policies as COVID-19 cases rise

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Avera Requires COVID-19 Vaccines for Employees to Protect Patients and Staff – Avera Health

Posted: at 10:14 am

SIOUX FALLS, S.D.- Avera Health announced today that it will require full vaccination for its physicians, employees and volunteers by Dec. 1, 2021.

This policy also applies to students rotating in Avera facilities, contracted workers and vendors. Avera Health will consider exemptions for employees with medical contraindications and sincerely held religious beliefs. Employees who receive an exemption will be required to wear appropriate personal protective equipment and comply with regular COVID-19 testing and other preventive measures.

As a health care ministry, Avera is called upon to provide a safe and protective environment for our patients, their families and our employees. This is consistent with our mission and values, said David Erickson, MD, Chief Medical and Innovation Officer at Avera Health. For decades, vaccination has been an important tool in public health. Avera has long been requiring vaccinations among its employees for influenza and other infectious diseases like measles.

The Pfizer vaccine was approved by the Food and Drug Administration (FDA) on Aug. 23.

Avera is an amazing, quality-driven organization. We want our employees to enjoy working in a safe and collaborative environment. Requiring a COVID-19 vaccine is consistent with our other Human Resources policies, said Kim Jensen, Chief Human Resources Officer at Avera Health. We already require annual vaccination against flu and we require a record of immunizations for new hires.

The majority of Avera employees are already vaccinated for COVID-19 and, in an all-employee survey, a majority of employees voiced support for requiring vaccination. The majority of our employees have already turned to vaccination to protect themselves, their families and their patients, Jensen added.

A recent Centers for Disease Control and Prevention (CDC) study shows that unvaccinated people are 29 times more likely to be hospitalized with COVID-19 than those who are vaccinated. The study also found that unvaccinated people are about five times more likely to be infected with COVID-19 than those who are not. When uncommon breakthrough infections do happen in vaccinated persons, most often the illness is mild.

COVID vaccines are doing what theyre supposed to do and thats reducing hospitalizations and deaths due to COVID-19. No vaccine can offer absolute protection. But the fact remains that the most effective thing people can do to prevent the spread of COVID is to get vaccinated, said Kevin Post, DO, Chief Medical Officer for Avera Medical Group.

Vaccines are safe and effective. Millions of people have safely received the vaccines. With over half of the U.S. population vaccinated plus millions across the world, COVID vaccines are among the most tested vaccines ever, Erickson said. Adverse reactions are extremely rare.

Hospitalizations of COVID patients across the United States are topping 100,000 including young adults and children. Those hospitalizations are due to the contagious nature of COVID-19, Erickson added.

Due to increased pediatric cases with the Delta variant, children ages 0-11 remain vulnerable because there is not an approved vaccine for that age group. Adults can help protect children by getting vaccinated, Post said.

Numerous medical organizations support the requirement of COVID-19 vaccination for health care workers including the American Hospital Association, American Medical Association, American Academy of Pediatrics, American Nurses Association, American College of Physicians, Catholic Health Association and more.

About Avera Health

The Avera Health system has over 19,000 employees and physicians, serving more than 300 locations and 100 communities in a five-state region. Our ministry, our people and our superior value distinguish Avera. We carry on the health care legacy of the Benedictine and Presentation Sisters, delivering care in an environment guided by our values of compassion, hospitality and stewardship. For more information about Avera, visit our website at Avera.org.

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COVID-19 boosters are coming but who will get them and when? – Associated Press

Posted: at 10:14 am

COVID-19 booster shots may be coming for at least some Americans but already the Biden administration is being forced to scale back expectations illustrating just how much important science still has to be worked out.

The initial plan was to offer Pfizer or Moderna boosters starting Sept. 20, contingent on authorization from U.S. regulators. But now administration officials acknowledge Moderna boosters probably wont be ready by then the Food and Drug Administration needs more evidence to judge them. Adding to the complexity, Moderna wants its booster to be half the dose of the original shots.

As for Pfizers booster, who really needs another dose right away isnt a simple decision either. Whats ultimately recommended for an 80-year-old vaccinated back in December may be different than for a 35-year-old immunized in the spring who likely would get a stronger immunity boost by waiting longer for another shot.

FDAs scientific advisers will publicly debate Pfizers evidence on Sept. 17, just three days before the administrations target. If the FDA approves another dose, then advisers to the Centers for Disease Control and Prevention will recommend who should get one.

Thats tricky because while real-world data shows the vaccines used in the U.S. remain strongly protective against severe disease and death, their ability to prevent milder infection is dropping. Its not clear how much of that is due to immunity waning or the extra-contagious delta variant or the fact that delta struck just as much of the country dropped masks and other precautions.

When to jump to boosters becomes a judgment, said Dr. Jesse Goodman of Georgetown University, a former FDA vaccine chief. And is that urgent or do we have time for the data to come in?

Already the CDC is considering recommending the first boosters just for nursing home residents and older adults whod be at highest risk of severe disease if their immunity wanes -- and to front-line health workers who cant come to work if they get even a mild infection.

Some other countries already have begun offering boosters amid an ethical debate about whether rich countries should get a third dose before most people in poor countries get their first round. Heres what we know about the biology behind booster decisions:

WHAT DO BOOSTER SHOTS DO?

Vaccines train the immune system to fight the coronavirus, including by producing antibodies that block the virus from getting inside cells. People harbor huge levels right after the shots. But just like with vaccines against other diseases, antibodies gradually drop until reaching a low maintenance level.

A booster dose revs those levels back up again.

Pfizer and Moderna have filed FDA applications for booster doses but the government will decide on extra Johnson & Johnson doses later, once that company shares its booster data with the agency.

HOW MUCH PROTECTION DOES THAT TRANSLATE INTO?

No one yet knows the magic line the antibody level known as the correlate of protection below which people are at risk for even mild infection, said immunologist Ali Ellebedy of Washington University at St. Louis.

But vaccines main purpose is to prevent severe disease. Its a very high bar to really go and say we can completely block infection, Ellebedy noted.

Plus, peoples responses to their initial vaccination vary. Younger people, for example, tend to produce more antibodies to begin with than older adults. That means months later when antibody levels have naturally declined, some people may still have enough to fend off infection while others dont.

That initial variation is behind the FDAs recent decision that people with severely weakened immune systems from organ transplants, cancer or other conditions need a third dose of the Pfizer or Moderna vaccine to have a chance at protection. In those people, its not a booster but an extra amount they need up-front.

WONT ANTIBODIES JUST WANE AGAIN AFTER A BOOSTER?

Eventually. We dont know the duration of protection following the boosters, cautioned Dr. William Moss of Johns Hopkins University.

But antibodies are only one defense. If an infection sneaks past, white blood cells called T cells help prevent serious illness by killing virus-infected cells. Another type called memory B cells jump into action to make lots of new antibodies.

Those back-up systems help explain why protection against severe COVID-19 is holding strong so far for most people. One hint of trouble: CDC has preliminary data that effectiveness against hospitalization in people 75 and older dropped slightly in July -- to 80% -- compared to 94% or higher for other adults.

Its much easier to protect against severe disease because all you need is immunologic memory. And I would imagine for a younger person that would last for a while, maybe years, said Dr. Paul Offit, a vaccine expert at the Childrens Hospital of Philadelphia.

WHATS THE BEST TIME TO GET A BOOSTER?

For many other types of vaccines, waiting six months for a booster is the recommended timing. The Biden administration has been planning on eight months for COVID-19 boosters.

The timing matters because the immune system gradually builds layers of protection over months. Give a booster too soon, before the immune response matures, and people can miss out on the optimal benefit, said Dr. Cameron Wolfe, an infectious disease specialist at Duke University.

Sometimes waiting a little bit extra time is in fact appropriate to gain the strongest response, he said.

Not everyones waiting on a final decision. For example, Colorados UCHealth has opened boosters to certain high-risk people first vaccinated back in December and January. San Francisco is giving some people who had a single-dose J&J vaccine a second shot from Pfizer or Moderna.

WILL BOOSTER SHOTS CONTAIN THE ORIGINAL VACCINE, OR ONE TAILORED TO DELTA?

The boosters will be an extra dose of the original vaccine. Manufacturers still are studying experimental doses tweaked to better match delta. Theres no public data yet that its time to make such a dramatic switch, which would take more time to roll out. And independent research, including studies from Ellebedys team, shows the original vaccine produces antibodies that can target delta.

Im very, very confident that this vaccine will work against delta with a single booster of the same vaccine, Pfizer CEO Albert Bourla told The Associated Press.

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AP Medical Writer Carla K. Johnson contributed to this report.

___

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institutes Department of Science Education. The AP is solely responsible for all content.

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