SARS-CoV-2 and COVID-19 (16)

Això és la continuació del tema SARS-CoV-2 and COVID-19 (15).

En/na SARS-CoV-2 and COVID-19 (17) ha continuat aquest tema.

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SARS-CoV-2 and COVID-19 (16)

nov. 24, 2020, 7:27am

COVID-19 and Zinc (22:20)
Dr. John Campbell • Oct 15, 2020

nov. 24, 2020, 8:45am

Second Vitamin D clinical trial, positive results (21:14)
Dr. John Campbell•Nov 23, 2020

Short term, high-dose vitamin D supplementation for COVID-19 disease: a randomised, placebo-controlled, study (SHADE study)


Rastogi A, Bhansali A, Khare N, et al. 2020. Short term, high-dose vitamin D supplementation for COVID-19 disease: a randomised, placebo-controlled, study (SHADE study). Postgraduate Medical Journal Published Online First: 12 November 2020. doi: 10.1136/postgradmedj-2020-139065 .

Vitamin D has an immunomodulatory role but the effect of therapeutic vitamin D supplementation in SARS-CoV-2 infection is not known.

Effect of high dose, oral cholecalciferol supplementation on SARS-CoV-2 viral clearance.

Randomised, placebo-controlled.

Asymptomatic or mildly symptomatic SARS-CoV-2 RNA positive vitamin D deficient (25(OH)D50 ng/ml (intervention group) or placebo (control group). Patients requiring invasive ventilation or with significant comorbidities were excluded. 25(OH)D levels were assessed at day 7, and cholecalciferol supplementation was continued for those with 25(OH)D

nov. 24, 2020, 11:33am

Among the 5374 children with positive #COVID19, 7% were hospitalized.
Of these, 28% required ICU, 9% required mechanical ventilation.
Case fatality rate in kids was 0.2% (8 of 5374)...
- Eric Feigl-Ding @DrEricDing | 3:40 AM · Nov 24, 2020:


L. Charles Bailey et al. 2020. Assessment of 135,794 Pediatric Patients Tested for Severe Acute Respiratory Syndrome Coronavirus 2 Across the United States. JAMA Pediatr. Published online November 23, 2020. doi:10.1001/jamapediatrics.2020.5052

Figure 1. Standardized Ratios for Chronic Conditions Among Pediatric Patients With Severe Coronavirus Disease 2019 Illness
( )

Key Points
What is the epidemiology across the United States of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among pediatric patients undergoing diagnostic testing for the virus?

In this cohort study using electronic health records for 135,794 US pediatric patients in 7 children’s health systems, 96% of patients tested had negative results, and rates of severe cardiorespiratory presentation of coronavirus disease 2019 (COVID-19) illness were low. Minority race/ethnicity, chronic illness, and increasing age were associated with SARS-CoV-2 infection.

This study suggests that for most pediatric patients, the risk of SARS-CoV-2 infection appears low, but higher concern may be warranted for patients with medically complex conditions or those of minority race/ethnicity.

...Conclusions and Relevance
In this large cohort study of US pediatric patients, SARS-CoV-2 infection rates were low, and clinical manifestations were typically mild. Black, Hispanic, and Asian race/ethnicity; adolescence and young adulthood; and nonrespiratory chronic medical conditions were associated with identified infection. Kawasaki disease diagnosis is not an effective proxy for multisystem inflammatory syndrome of childhood....

nov. 24, 2020, 12:12pm

>3 margd: contd. 11/12-19/2020

Children and COVID-19: State-Level Data Report
Critical Updates on COVID-19 / Children and COVID-19: State-Level Data Report
American Academy of Pediatrics | 11/19/2020

...The number of new child COVID-19 cases reported this week (the past week from 11/12-11/19), over 144,000, is by far the highest weekly increase since the pandemic began. At this time, it appears that severe illness due to COVID-19 is rare among children. However, there is an urgent need to collect more data on longer-term impacts of the pandemic on children, including ways the virus may harm the long-term physical health of infected children, as well as its emotional and mental health effects... full report...

nov. 24, 2020, 1:06pm

Can't say we weren't warned... :(

Flightradar24 @flightradar24 | 12:18 PM · Nov 24, 2020
The skies above North America at Noon ET on the Tuesday before Thanksgiving.

Satellite antenna,-90.21/5

North America, focused on the United States at Noon eastern time on the Tuesday before Thanksgiving, 2018
6,815 active flights
( )

North America, focused on the United States at Noon eastern time on the Tuesday before Thanksgiving, 2019
7,630 active flights
( )

North America, focused on the United States at Noon eastern time on the Tuesday before Thanksgiving, 2020
6,972 active flights
( )

__________________________________________________​ @globalnews | 6:33 PM · Nov 23, 2020:
WATCH: FlightRadar24 reported heavy U.S. air travel ahead of the Thanksgiving holiday.
0:32 ( )

FlightRadar24 reports heavy U.S. air travel ahead of Thanksgiving
More than 2 million Americans are projected to fly to a destination for Thanksgiving, a decrease of roughly 48 per cent from last year

nov. 25, 2020, 4:17am

What explains Africa’s successful response to the COVID-19 pandemic?
Agnes Binagwaho, M.D., MPEd, Ph.D. and Kedest Mathewos | November 20, 2020

In 2019, the Global Health Security Index ranked countries according to their preparedness for pandemics. The United States was identified as the most prepared country, while most African countries were deemed to be least capable of dealing with any new health threat.

Further entrenching this perspective of Africa’s lack of preparedness, Africa as a continent was predicted to have 10 million COVID-19-related deaths.

However, this prediction could not have been more wrong, with African countries contributing to only 3.6% of cases and 3.6% of COVID-19 deaths worldwide as of November 13...

Swift response at the continental level

Collaboration at the regional level

Fast implementation of lockdown measures

Quick adoption of public health measures

Accounting for the socioeconomic impact
Using innovative technologies

Denouncing white supremacist narratives
...Of course, we are not denying that there might be other factors, such as demographic makeup, geographical factors, preexisting antibodies, and others, that could contribute to this low number of cases and deaths. In fact, it is in the interest of all to study them...

nov. 25, 2020, 4:30am

Good news: availability of a 2nd antibody treatment for mild-moderate Covid-19 cases.
Capacity concern: overburdened hospitals must infuse mild-moderate patients not before presenting themselves for medical attention.
Affordability: not cheap? Hope subsidized?

U.S. to begin distributing Regeneron's COVID-19 antibody therapy Tuesday
Manojna Maddipatla, Carl O’Donnell | November 23, 2020

The U.S. government will start distributing Regeneron Pharmaceuticals Inc’s newly authorized COVID-19 antibody combination on Tuesday (11/24/2020), beginning with over 30,000 treatment courses...

...doses will be allocated based on which states have the highest numbers of confirmed cases and hospitalizations

...emergency use authorization for the treatment called REGN-COV2, which combines two monoclonal antibodies, to be used for mild-to-moderate COVID-19 in adults and children who are at high risk of progressing to severe COVID-19.

Regeneron...expects to have enough REGEN-COV2 for about 80,000 patients by the end of this month. It expects to have enough doses to treat about 200,000 patients by the first week of January, rising to some 300,000 patients in total by the end of January.

...U.S. regulators earlier this month authorized another antibody treatment for COVID-19 from Eli Lilly and Co. Officials on Monday said the department of Health and Human Services has already helped distribute 120,000 doses of Lilly’s antibody to patients around the country...

nov. 26, 2020, 7:05am

Darn! (AstraZeneca mistakenly giving 1/2 dose to some subjects, etc.)

After Admitting Mistake, AstraZeneca Faces Difficult Questions About Its Vaccine
Rebecca Robbins and Benjamin Mueller | Nov. 25, 2020

The announcement this week that a cheap, easy-to-make coronavirus vaccine appeared to be up to 90 percent effective was greeted with jubilation...

But since unveiling the preliminary results, AstraZeneca has acknowledged a key mistake in the vaccine dosage received by some study participants, adding to questions about whether the vaccine’s apparently spectacular efficacy will hold up under additional testing.

Scientists and industry experts said the error and a series of other irregularities and omissions in the way AstraZeneca initially disclosed the data have eroded their confidence in the reliability of the results.

Officials in the United States have noted that the results were not clear. It was the head of the flagship federal vaccine initiative — not the company — who first disclosed that the vaccine’s most promising results did not reflect data from older people.

The upshot, the experts said, is that the odds of regulators in the United States and elsewhere quickly authorizing the emergency use of the AstraZeneca vaccine are declining, an unexpected setback in the global campaign to corral the devastating pandemic...

nov. 27, 2020, 7:49pm

Their own evaluations indicate two widely divergent responses, so a dosage error was pretty easy to figure out. Even so, in their poorer performing study group, efficacy far exceeded the minimum std. that the CDC wanted to see at 50%. Astrazenca's worse performers still achieved 62% effectiveness, which problem any drug company would be pleased to have with brand new drug's first trials.

Such results may even suggest that a lower dose can be administered and further ameliorate the side effects and perhaps other adverse responses to thier drug. I don't believe the dose can be reduced to a single injection since the desire is to provoke a long chain antibody response, which requires about 10-14 days for production. The second dose appears to be a challenge dose to test that production and provide additional stimulation to raise the concentration of IgG antibody levels to assure a vigorous response if exposed to actual Coronavirus.

If that's the true nature of the error, I'm heartened by it.

nov. 28, 2020, 7:57am

‘Essential workers’ likely to get earlier access to Covid-19 vaccine
Helen Branswell @HelenBranswell | November 23, 2020

...There was no formal vote by the members of the Advisory Committee on Immunization Practices, a group of outside experts that makes recommendations to the CDC on use of vaccines. But when asked how they felt about moving essential workers closer to the front of the line, there was clear support for the proposal.

“These essential workers are out there putting themselves at risk to allow the rest of us to socially distance. And they come from disadvantaged situations, they come from disadvantaged communities,” said Beth Bell, a global health expert from the University of Washington who is on ACIP and chairs its Covid-19 work group studying the vaccines.

Bell acknowledged people of color may not wish to be vaccinated early or even ever; polling suggests these communities distrust Covid vaccines even more than the American population in general. But principles of equity require addressing the risks people deemed essential workers are facing in the pandemic.

“We need to provide them with the opportunity early on in the process,” she said. “This is an important message to be sending.”

Essential workers include people who work in meat packing plants and other food processing facilities, in municipal wastewater management operations, and in transport. It also includes police and firefighters and, in the current iteration of the ACIP’s plan, teachers. The CDC estimates there are roughly 87 million people in jobs designated as essential services.

An agency within the Department of Homeland Security known as the Cybersecurity and Infrastructure Security Agency, or CISA, is responsible for designating which jobs are essential services. At the end of the day, however, state, territorial, and tribal authorities will interpret the recommendations and have leeway in who they deem to be essential...

nov. 28, 2020, 8:34am

Eric Feigl-Ding @DrEricDing
WOW. Amazing tool* to calculate #SARSCoV2 risk indoors w/ airborne aerosols:

If so, what type of mask?
How much ventilation?
How many people?
Speaking time?
Speaking volume?
Size of room?
Ceiling height?
Duration in room?

Why Is the Risk of Coronavirus Transmission so High Indoors? (article)
Whenever people gather in closed spaces, the infection risk climbs.
Our interactive tool shows how the coronavirus spreads.
Find out how safe your environment is.


* margd: Couldn't find the ineractive tool. Perhaps someone who reads (German?) could direct us?
Might be some questions in German to establish that one is not a robot?

nov. 28, 2020, 9:11am

PREGNANCY AVOIDANCE: "...given the ethical concerns raised by public health recommendations regarding pregnancy avoidance, strong justification for any such advice is needed. The criteria outlined above might be fulfilled during certain public health emergencies (e.g., a radiation emergency with continuing exposure), but we don’t believe that the risks associated with Covid-19 meet the bar. The pandemic further emphasizes the need to provide information and support to women related to their decisions to pursue or delay pregnancy."

Sonja A. Rasmussen et al. 2020. Delaying Pregnancy during a Public Health Crisis — Examining Public Health Recommendations for Covid-19 and Beyond (Perspective). N Engl J Med (Sept 30, 2020); 383:2097-2099 DOI: 10.1056/NEJMp2027940

Audio Interview Interview with Dr. Sonja Rasmussen on guidance related to pursuing or delaying pregnancy during a public health emergency. (10:11)

...The subject of delaying conception has once again arisen during the Covid-19 pandemic. Although data on Covid-19–related risks to pregnant women and newborns are limited, a recent study found that pregnant women with Covid-19 have 1.5 times the risk of being admitted to an intensive care unit (ICU) and 1.7 times the risk of requiring mechanical ventilation faced by nonpregnant women of childbearing age with Covid-19 but that pregnant women aren’t at increased risk for death... Information on adverse pregnancy outcomes associated with Covid-19 is also limited. Intrauterine transmission of SARS-CoV-2 appears to occur rarely,... and no evidence has suggested an association between Covid-19 and birth defects; however, data suggest that preterm birth and admission to a neonatal ICU are common among infants born to SARS-CoV-2–infected women...

In clinical contexts, advice regarding pregnancy avoidance has tended to rely on a doctrine of nondirective counseling, in which a clinician offers information about risks and approaches to minimizing them and supports patients in making informed decisions. ..

The exercise of public authority in an area as deeply personal and private as the decision about whether and when to have a child requires strong justification, given the many ethical issues it raises. There are several potential areas of concern. The first relates to reproductive autonomy. Respect for autonomy is a guiding principle in medicine; reproductive autonomy has been given particular priority because of the importance that decisions about childbearing may have for a person’s self-determination, personal security, and life course. Past efforts to coerce people to avoid pregnancy (e.g., compulsory-sterilization policies) are widely considered to represent egregious ethics violations. Another concern is the potential for discrimination. Even objectively neutral policies can translate into differential experiences according to race, ethnic group, or social class. Public advice discouraging pregnancy may also inappropriately shift responsibility for pregnancy outcomes to parents and away from institutions that are ultimately responsible for mitigating harm and have the power to do so. A final concern pertains to the interests of people with disabilities. As the disability-rights community has argued, advice about avoidance of pregnancies that might result in offspring with disabilities can send a harmful message about what or who is valued. There is a morally important difference between preventing disease and preventing the birth of a child with a disability.

We believe that before public health agencies make a recommendation to avoid pregnancy during a public health emergency, several criteria should be met. First, the pregnancy-related risks associated with the emergency should be well understood. ...

Second, pregnancy-related risk should be high and well above the risk associated with other conditions or exposures that are fairly common among pregnant women...

A third criterion should be that pregnancy-related risks cannot be reasonably minimized or mitigated...

Fourth, effective contraception should be readily available...

Ultimately, given the ethical concerns raised by public health recommendations regarding pregnancy avoidance, strong justification for any such advice is needed. The criteria outlined above might be fulfilled during certain public health emergencies (e.g., a radiation emergency with continuing exposure), but we don’t believe that the risks associated with Covid-19 meet the bar. The pandemic further emphasizes the need to provide information and support to women related to their decisions to pursue or delay pregnancy.

nov. 28, 2020, 9:26am

If I understand correctly the lower first-dose of the Oxford-Astrazeneca vaccine was given in error. On upside, lower-first-dose error may indicate strategy to avoid vector immunity that could reduce vaccine's effectiveness. OTOH, apparent dosing error in trial may undercut public confidence. Hopefully confusion will be allayed by immient publication of data in Lancet.

Anti-vaxxers exploit confusion over Oxford University data
Ben Spencer | 11/28/2020

Anti-vaccine campaigners are exploiting confusion over Oxford researchers’ data to cast doubts on their jab’s safety.

Experts fear substantial numbers will refuse the vaccine.

One study predicted only around half of British adults will agree to be vaccinated, severely hitting the ability of the programme to generate herd immunity.

These fears have grown as anti-vaccination campaigners have jumped on criticism of the way the preliminary data from Oxford’s trials has been handled.

...full publication of the data is expected in the Lancet medical journal soon.

The (UK) Government has asked the Medicines and Healthcare products Regulatory Agency (MHRA) to assess Oxford’s data, with a view to a rollout early next month.

Sir John Bell, professor of medicine at Oxford and the Government’s life sciences adviser, dismissed the criticism, saying: ‘We weren’t cooking this up as we went along.’ But so-called ‘anti-vaxxers’ have leapt on the confusion to spread fear online.

US campaigner Del Bigtree, producer of the notorious film Vaxxed, described it as a ‘trial disaster’ and sceptics on social media have cast doubts on the vaccine’s safety.

Professor Eleanor Riley, of the University of Edinburgh, said the matter needs to be cleared up rapidly to ensure trust is not lost.

Editat: nov. 28, 2020, 11:04am

Hannah Davis @ahandvanish | 6:37 PM · Nov 27, 2020:

A really important paper for #LongCovid for 2 reasons:

1) 4 patients tested negative for COVID via PCR tests, but all 4 tested positive in the olfactory mucosa. Again, we can't rely on PCR tests alone for COVID status.

2) They were tested at *100-196* days post-onset...and of the 4 patients, 3 had a high viral load in the olfactory mucosa, suggesting viral persistence - which could be one mechanism for #LongCovid.


"...We conducted a virologic, molecular, and cellular study of the olfactory system from COVID-19 patients presenting acute loss of smell, and report evidence that the olfactory epithelium represents a highly significant infection site where multiple cell types, including olfactory sensory neurons, support cells and immune cells, are infected...Viral persistence in the olfactory epithelium...provides a potential mechanism for prolonged or relapsing symptoms of COVID-19, such as loss of smell..."

Guilherme Dias De Melo et al. 2020. COVID-19-associated olfactory dysfunction reveals SARS-CoV-2 neuroinvasion and persistence in the olfactory system. BioRxiv (Nov 18, 2020) doi:

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

While recent investigations have revealed viral, inflammatory and vascular factors involved in SARS-CoV-2 lung pathogenesis, the pathophysiology of neurological disorders in COVID-19 remains poorly understood. Yet, olfactory and taste dysfunction are rather common in COVID-19, especially in pauci-symptomatic patients which constitutes the most frequent clinical manifestation of the infection. We conducted a virologic, molecular, and cellular study of the olfactory system from COVID-19 patients presenting acute loss of smell, and report evidence that the olfactory epithelium represents a highly significant infection site where multiple cell types, including olfactory sensory neurons, support cells and immune cells, are infected. Viral replication in the olfactory epithelium is associated with local inflammation. Furthermore, we show that SARS-CoV-2 induces acute anosmia and ageusia in golden Syrian hamsters, both lasting as long as the virus remains in the olfactory epithelium and the olfactory bulb. Finally, olfactory mucosa sampling in COVID-19 patients presenting with persistent loss of smell reveals the presence of virus transcripts and of SARS-CoV-2-infected cells, together with protracted inflammation. Viral persistence in the olfactory epithelium therefore provides a potential mechanism for prolonged or relapsing symptoms of COVID-19, such as loss of smell, which should be considered for optimal medical management and future therapeutic strategies.

nov. 28, 2020, 5:30pm

Sagar et al. 2020. Recent endemic coronavirus infection (with common cold coronaviruses) is associated with less severe COVID-19.

Perez-Pottiet al. 2020. Deciphering the ins and outs of SARS-CoV-2-specific T cells.

Eric Topol @EricTopol | 11:54 AM · Nov 28, 2020:
...the common cold coronaviruses cross-reactive immune response do appear to provide important protection vs severe #COVID19 illness

Manish Sagar et al. 2020. Recent endemic coronavirus infection is associated with less severe COVID-19. The Journal of Clinical Investigation (September 30, 2020) 10.1172/JCI143380

Four different endemic coronaviruses (eCoVs) are etiologic agents for the seasonal “common cold,” and these eCoVs share extensive sequence homology with human severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Here, we show that individuals with as compared to without a relatively recent documented eCoV were tested at greater frequency for respiratory infections but had similar rate of SARS-CoV-2 acquisition. Importantly, the patients with a previously detected eCoV had less severe coronavirus disease-2019 (COVID-19) illness. Our observations suggest that pre-existing immune responses against endemic human coronaviruses can mitigate disease manifestations from SARS-CoV-2 infection.


Eric Topol @EricTopol | 11:54 AM · Nov 28, 2020:
On the T cells from covid infections and common cold coronaviruses that cross-react...
It's not so simple: different specific epitopes and our HLA allotype
~10% of people w/o IgG antibody to #SARSCoV2 often have reactive T cells...

André Perez-Potti, Joshua Lange & Marcus Buggert. 2020. Deciphering the ins and outs of SARS-CoV-2-specific T cells. Nature Immunology (26 Nov 2020) News & Views.

Comprehensive analysis of specific and cross-reactive SARS-CoV-2 epitopes reveals functional T cell responses against specific viral regions in essentially all convalescent individuals and a majority of unexposed donors, demonstrating that cross-reactive responses to COVID-19 are widespread....


Editat: nov. 29, 2020, 5:39am

My experience with private fish farmers in matters of disease & invasive species management does not inspire confidence that mink farmers and their regulators will necessarily do the right thing for human (and wild mink) health... Sure hope CDC is on top of this!

An Oregon mink farm has reported a Covid-19 outbreak
Alaa Elassart | November 28, 2020

...This year, the virus was detected in mink in seven countries, including the Netherlands, Denmark, Italy, Sweden, and Spain, and three US states, Utah, Michigan, and Wisconsin, according to ODA (Oregon Dept of Agriculture*).

Thousands of mink have died at fur farms in Utah and Wisconsin after a series of coronavirus outbreaks. In Utah, ranchers have lost at least 8,000 mink to Covid-19.

There is currently no evidence that animals, including mink, play a significant role in transmitting the virus to humans, according to the CDC and the US Department of Agriculture. The risk of animals spreading Covid-19 to humans is considered low...

* OR Dept of Ag news release:

US Dept of Agriculture
Cases of SARS-CoV-2 in Animals in the United States
Last Modified: Nov 19, 2020

nov. 29, 2020, 7:28am

The amazingly speedy development of Moderna and Pfizer's mRNA vaccines is celebrated below.

Oxford Astrazeneca's, Chinese, and other vaccine efforts should be likewise celebrated. Latecomers may energe as better choice(s) as years pass.

Donaldo took a bow, but credit belongs to scientists. We should never forget our debt to:

(1) Katalin Karikó, the Hungarian pioneer of mRNA vaccine technology

(2) "consortium led by Yong-Zhen Zhang of the Shanghai Public Health Clinical Center & School of Public Health that posted the (SARS-CoV-19 genome) sequence on an open-access site, The consortium said it had also deposited the sequence in GenBank. In a brief note, the group said researchers were free to analyze and share the data, but asked that groups “communicate with us if you wish to publish results that use these data in a journal.”"

(3) FDA Peter Marks, who conceived Operation Warp Speed.

Eric Topol @EricTopol | 2:39 PM · Nov 28, 2020:
4:00 PM · Nov 28, 2020

This will go down in history as one of science and medical research's greatest achievements. Perhaps the most impressive.
I put together a preliminary timeline of some key milestones to show how several years of work were compressed into months.
Image ( )

There are several points noteworthy related to this timeline:
1. Moderna had a head-start, so why didn't their Phase 3 trial finish first?
Part of #OperationWarpSpeed (OWS), they were requested to slow down enrollment to get better minority representation

2. 3 scientists led the way
Katalin Karikó,* worked on a mRNA vaccine for ~30 years, was demoted from @PennMedicine
d/t losing her grants, went to @moderna_tx and the husband and wife team @BioNTech_Group

3. The 5 days from sequencing the virus to design of an mRNA vaccine, relayed by Tony Fauci in our conversation

4. Whose idea was OWS (Operation Warp Speed) and when did it kick in?
Peter Marks @US_FDA @SharonLNYT

It was announced May 15th


* Dan Komaromi @DanKomaromi | 4:00 PM · Nov 28, 2020:
The Nobel Prize for Medicine should go to Katalin Karikó, the Hungarian pioneer of the mRNA vaccine. “For more than four decades .. Despite demotions, countless grant rejections and, at points, deep scepticism from fellow scientists, she ploughed on.”

nov. 29, 2020, 8:12pm

>13 margd: AstraZeneca error aside, even in the group that received the less effective two full doses, there were no severe cases requiring hospitalization, even though there were more who had mild illness than in the half-initial-dose group. So in terms of avoiding dying, something we care a great deal about, the AstraZeneca vaccine looks like it is effective.

Editat: nov. 30, 2020, 7:12am

Dr Fauci is echoing Michael Mina (Harvard) call for home COVID tests, which can cheaply, easily allow people to test often and to quarantine as needed. While each home test is less accurate, used repeatedly, they are better suited for public health purposes. PCR lab tests are still needed for medical purposes (diagnostics, etc.) Preprint below quantifies sensitivity of point of care antigen rapid tests, as well as saliva v. nasopharyngeal sampling for lab diagnostic test, PCR.

"The high performance of RDTs (Rapid Diagnostic Tests) allows rapid identification of COVID cases with immediate isolation of the vast majority of contagious individuals. RDT could be a game changer in primary care practices, and even more so in resource-constrained settings. PCR (polymerase chain reaction) on saliva can replace NP (nasopharyngeal) PCR."

Jeff Huber (GRAIL) jhuber | 2:53 PM · Nov 29, 2020:
Sensitivity of evaluated rapid antigen tests was (very) good for detecting active infection & contagiousness.
Don’t let ‘perfect’ be the enemy of good.
Rapid tests can detect occurrences before they become outbreaks, and stop transmission chains.

Dan Larremore (U Colorado)@DanLarremore | 1:01 AM · Nov 29, 2020
In this study,* 928 patients were tested for SARS-CoV-2 infection with PCR and 3 diff't antigen tests.
Sensitivities of rapid Ag tests were 93%, 86%, 84% over all patients,
but rose to 97%, 98%, 95% among those w/ viral load over 1E6 cp/ml. 1/2

But the authors also evaluated specificity and found that there were zero false positive rapid antigen results among 385 confirmed negatives.
Interestingly, there were also 2 RDT positives when NP-swab PCRs were negative—but in these cases the *saliva* PCRs *were* positive! 2/2

Jean Marc Schwob et al. 2020. Antigen rapid tests, nasopharyngeal PCR and saliva PCR to detect SARS-CoV-2: a prospective comparative clinical trial. MedRxiv (Nov 24, 2020) doi:

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

Nasopharyngeal antigen Rapid Diagnostic Tests (RDTs) and saliva RT-PCR have shown variable performance to detect SARS-CoV-2.

In October 2020, we conducted a prospective trial involving patients presenting at testing centers with symptoms of COVID-19. We compared detection rates and performance of RDT, saliva PCR and nasopharyngeal (NP) PCR.

Out of 949 patients enrolled, 928 patients had all three tests. Detection rates were RDT, saliva PCR, NP PCR, and any test. For those with viral loads (VL) 106 copies/ml or greater, detection rates were 30.3%..., 31.4%..., 31.5%..., and 31.6%...respectively.

Sensitivity of RDT compared to NP PCR was 87.4%...for all positive patients and 96.5%...for those with VL 106 or greater. Sensitivity of STANDARD-Q®, Panbio™ and COVID-VIRO® Ag tests were 92.9% ..., 86.1%... and 84.1%..., respectively. For those with VL 106 or greater, sensitivities were 96.6%..., 97.8%... and 95.3%... respectively. Specificity of RDT was 100%... compared to any PCR. RDT sensitivity was similar less than 4 days (87.8%) and 4 days or longer (85.7%) after symptoms onset.... Sensitivities of saliva and NP PCR were 95.7%... and 96.5%... , respectively, compared to the other PCR.

The high performance of RDTs allows rapid identification of COVID cases with immediate isolation of the vast majority of contagious individuals. RDT could be a game changer in primary care practices, and even more so in resource-constrained settings. PCR on saliva can replace NP PCR.

Introduction (worth a read)...

Editat: des. 1, 2020, 8:34am

Moderna and Pfizer/BioNTech efficacy and safety results for their mRNA vaccines are roughly similar. Pfizer was a few days ahead in applying for EUA, and is already shipping vaccine. As I recall, Moderna's temperature requirements are a little more forgiving than Pfizer's, so perhaps more appropriate for rural areas? (A Detroit hospital at least has purchased a number of the very cold freezers.)

Moderna to submit Covid-19 vaccine to FDA as full results show 94% efficacy
Matthew Herper @matthewherper and Damian Garde @damiangarde | November 30, 2020

...Moderna said it would make its request to the FDA on Monday, and would also apply for a conditional marketing authorization from the European Medicines Agency. Rolling applications with the EMA, Health Canada, Switzerland, the United Kingdom, Israel, and Singapore are ongoing, Moderna said.

...The two-dose vaccine was 94.1% effective based on a total of 196 cases of symptomatic Covid-19 occurring in the company’s 30,000-volunteer study. That means that 185 cases of Covid-19 occurred in those who received a placebo injection, which was given to half the volunteers. Just 11 cases occurred in those volunteers who received the vaccine. data is being reviewed continuously, but that there are no new serious safety concerns. The most common adverse events included site pain, fatigue, muscle or bone pain, headaches, and redness at the injection site. The reactions were more serious in the vaccine group after patients received a second dose.

...The FDA is expected to authorize both vaccines, which require two doses a few weeks apart. But the supply of each will be constrained well into next year. Pfizer has said it will be able to provide the U.S. government 25 million doses in December — enough to vaccinate 12.5 million people. Moderna expects to hand over 15 million doses this year, which would cover 7.5 million vaccinations.

...Pfizer and BioNTech hope to manufacture up to 1.3 billion doses in 2021 to serve the entire world. Moderna said it is on track to produce 500 million to 1 billion doses of its vaccine globally in 2021.

...Moderna said that its vaccine’s efficacy was consistent regardless of age, race, or ethnicity.

...AstraZeneca’s CEO...expects it will need to conduct another study.

NovaVax, which has two large studies of its Covid-19 vaccine ongoing in the U.K. and South Africa, said Monday that its Phase 3 study in the U.S. and Mexico...will begin in the coming weeks.
‘Absolutely remarkable’: No one who got Moderna’s vaccine in trial developed severe COVID-19
Jon Cohen | Nov. 30, 2020 , 7:00 AM

...Only 11 people who received two doses of the vaccine developed COVID-19 symptoms after being infected with the pandemic coronavirus, versus 185 symptomatic cases in a placebo group. That is an efficacy of 94.1%, the company says, far above what many vaccine scientists were expecting just a few weeks ago.

More impressive still, Moderna’s candidate had 100% efficacy against severe disease. There were zero such COVID-19 cases among those vaccinated, but 30 in the placebo group...

nov. 30, 2020, 11:00am

Divisions emerge among U.S. officials over when first Covid-19 vaccine doses will be available — and for whom
Helen Branswell @HelenBranswell | November 30, 2020

...Robert Redfield, the director of the Centers for Disease Prevention and Control, ...suggested vaccination of Americans could begin by the end of next week...(Peter Marks, HHS Center for Biologics Evaluation and Research) responsible for...authorization said...that it may take several days or even “a few weeks” after the advisory committee meeting before his office gives the vaccine a green light.

...(HHS Secretary Alex Azar and White House coronavirus task force coordinator Deborah Birx) are pressing for adults 65 years old and older to be given first access to the vaccine...committee that advises the Centers for Disease Control and Prevention on vaccine policy, the Advisory Committee on Immunization Practices (ACIP), has signaled for months that it will recommend health care providers be at the front of the vaccination line.

...It’s not yet clear how the ACIP will vote on including long-term care residents in the first phase of vaccination...there aren’t yet data to indicate how well the first vaccines work in elderly people who are frail. (margd: at least vaccinate their staff and caretakers??)

...recently, (CDC Director) Redfield ...(said) nursing home residents would be first, followed by “some combination of health care providers and individuals at high risk for a poor outcome.”

...“Secretary Azar has insisted that science and data drive the process for vaccines and therapeutic development, and will do so for vaccine allocation and distribution,” an HHS spokesman said. “This means the doctors will make their recommendations, and ultimately the governors will make a determination of what works best for their communities based on input they receive and the circumstances on the ground.”

...Once the committee (ACIP) votes, the recommendation will go to Redfield, the CDC director. In the history of this committee, the CDC director has only once overruled a recommendation from the ACIP, related to a program to vaccinate health workers against anthrax after the 2001 anthrax attacks.

Editat: nov. 30, 2020, 11:31am

Craig Spencer (NYC) MD MPH @Craig_A_Spencer | 12:55 PM · Nov 29, 2020:

As COVID19 surges across the US, it’s hard to describe the situation inside hospitals for healthcare providers & patients.
We made this video depicting 1 day in the ER to show the painful reality & to remind us why we must remain vigilant. Please watch.

5:45 ( )
From AJ+


A version in French:

A version with Spanish subtitles:

Editat: des. 1, 2020, 10:49am

These dates will no doubt be pushed pack, and other reports of early COVID will emerge, but the "China virus" first found in
Italy: Sept 2019
China: Nov 2019
US: Dec 2019

Coronavirus came to Italy almost 6 months before the first official case, new study shows
Giselda Vagnoni /Reuters | 16 Nov 2020

COVID-19 was circulating in Italy from September 2019, according to a study by the Italian National Cancer Institute.

Italy’s first official COVID-19 case was detected on February 21st.

The new study which re-examined samples from a lung cancer screening trial between September 2019 and March 2020, suggests otherwise.

It showed that of the 959 healthy volunteers enrolled in the trial, 11% had developed coronavirus antibodies well before February.

A study by the University of Siena also supports this theory...

1st known case of coronavirus traced back to November in China
Jeanna Bryner - Live Science Editor-in-Chief March 14, 2020

Covid-19 Likely in U.S. in Mid-December 2019, CDC Scientists Report
New analysis of blood donations finds virus was present on West Coast earlier than previously believed
Jacob Reynolds/WSJ | Nov. 30, 2020

The new coronavirus infected people in the U.S. in mid-December 2019, a few weeks before it was officially identified in China and about a month earlier than public health authorities found the first U.S. case, according to a government study published Monday.

Sridhar V Basavaraju et al. 2020. Serologic testing of U.S. blood donations to identify SARS-CoV-2-reactive antibodies: December 2019-January 2020. (Accepted manuscript) Clinical Infectious Diseases, ciaa1785 (30 November 2020 ),

...To determine if SARS-CoV-2 reactive antibodies were present in sera prior to the first identified case in the U.S. on January 19, 2020, residual archived samples from 7,389 routine blood donations collected by the American Red Cross from December 13, 2019 to January 17, 2020, from donors resident in nine states (California, Connecticut, Iowa, Massachusetts, Michigan, Oregon, Rhode Island, Washington, and Wisconsin) were tested at CDC for anti-SARS-CoV-2 antibodies....

Of the 7,389 samples, 106 were reactive by pan Ig. Of these 106 specimens, 90 were available for further testing. Eighty four of 90 had neutralizing activity, 1 had S1 binding activity, and 1 had receptor binding domain / Ace2 blocking activity >50%, suggesting the presence of anti-SARS-CoV-2-reactive antibodies. Donations with reactivity occurred in all nine states.

These findings suggest that SARS-CoV-2 may have been introduced into the United States prior to January 19, 2020.
cross-reactivity limitations to study:

des. 1, 2020, 11:31am

A second generation COVID vaccine built on existing yellow fever vaccine may quickly endow immunity with a single dose. the yellow-fever vaccine is live-attenuated like the BCG vaccine. Tested thus far on hamsters, mice, and macaques.

Lorena Sanchez-Felipe et al. 2020. A single-dose live-attenuated YF17D-vectored SARS-CoV-2 vaccine candidate. Nature (1Dec 2020)

This is an unedited manuscript that has been accepted for publication.

The explosively expanding COVID-19 pandemic urges the development of safe, efficacious and fast-acting vaccines. Several vaccine platforms are leveraged for a rapid emergency response.... We describe the discovery of a live virus-vectored SARS-CoV-2 vaccine candidate using the yellow fever 17D (YF17D) vaccine as vector to express a non-cleavable prefusion form of the SARS-CoV-2 Spike antigen. We assess vaccine safety, immunogenicity and efficacy in several animal models. Vaccine candidate YF-S0 has an outstanding safety profile and induces high levels of SARS-CoV-2 neutralizing antibodies in hamsters, mice and cynomolgus macaques and concomitantly a protective immunity against YFV. Humoral immunity is complemented by a favourable Th1 cell-mediated immune response as profiled in mice. In a stringent hamster model2 as well as in non-human primates, YF-S0 prevents infection with SARS-CoV-2. Moreover, in hamsters, a single dose confers protection from lung disease in most vaccinated animals within 10 days. Taken together, the quality of immune responses triggered and the rapid kinetics by which protective immunity can be mounted already after a single dose warrant further development this potent SARS-CoV-2 vaccine candidate.

des. 2, 2020, 5:52am

A little inulin (soluble fiber) in one's morning coffee?

Study reveals connection between gut bacteria and vitamin D levels
Heather Buschman | November 30, 2020

...Multiple studies have suggested that people with low vitamin D levels are at higher risk for cancer, heart disease, worse COVID-19 infections and other diseases. Yet the largest randomized clinical trial to date, with more than 25,000 adults, concluded that taking vitamin D supplements has no effect on health outcomes, including heart disease, cancer or even bone health.

"Our study suggests that might be because these studies measured only the precursor form of vitamin D, rather than active hormone," said (senior author Deborah Kado, MD, director of the Osteoporosis Clinic at UC San Diego Health), who is also professor at UC San Diego School of Medicine and Herbert Wertheim School of Public Health. "Measures of vitamin D formation and breakdown may be better indicators of underlying health issues, and who might best respond to vitamin D supplementation."

The team analyzed stool and blood samples contributed by 567 men participating in MrOS. The participants live in six cities around the United States, their mean age was 84 and most reported being in good or excellent health...

In addition to discovering a link between active vitamin D and overall microbiome diversity, the researchers also noted that 12 particular types of bacteria appeared more often in the gut microbiomes of men with lots of active vitamin D. Most of those 12 bacteria produce butyrate, a beneficial fatty acid that helps maintain gut lining health.

...Because they live in different regions of the U.S., the men in the study are exposed to differing amounts of sunlight, a source of vitamin D. As expected, men who lived in San Diego, California got the most sun, and they also had the most precursor form of vitamin D.

But the team unexpectedly found no correlations between where men lived and their levels of active vitamin D hormone.

"It seems like it doesn't matter how much vitamin D you get through sunlight or supplementation, nor how much your body can store," Kado said. "It matters how well your body is able to metabolize that into active vitamin D, and maybe that's what clinical trials need to measure in order to get a more accurate picture of the vitamin's role in health."...

Robert L. Thomas et al. Vitamin D metabolites and the gut microbiome in older men, Nature Communications (26 Nov 2020). DOI: 10.1038/s41467-020-19793-8

...In summary, we provide strong evidence of important interactions between host vitamin D signaling and the health of the gut microbiome in older men. Co-localized expression of the CYP27B1- and CYP24A1-24-hydroxylases in the gut may be potentiated or inhibited by the types of microbiota present. The consistency and robustness of results in finding active vitamin D metabolites associated with more favorable gut microbial diversity, including specific microbiota that are known butyrate producers, provide potential targets for intervention, whether through dietary modification and/or vitamin D supplementation in clinically appropriate populations.

Editat: des. 2, 2020, 7:20am

U.K. Approves Pfizer Coronavirus Vaccine, a First in the West
Benjamin Mueller | Dec. 2, 2020

LONDON — Britain gave emergency authorization on Wednesday to Pfizer’s coronavirus vaccine, leaping ahead of the United States to become the first Western country to allow mass inoculations against a disease that has killed more than 1.4 million people worldwide.

Britain beating the United States to authorization — on a vaccine co-developed by the American pharmaceutical giant Pfizer, no less* — may intensify pressure on U.S. regulators, who are already under fire from the White House for not moving faster to get doses to people. And it has stirred up a global debate about how to weigh the desperate need for a vaccine with the imperative of assuring people that it is safe.

No country until Wednesday had authorized a fully tested coronavirus vaccine; Russia and China approved vaccines without waiting for large-scale efficacy tests...
Success has many fathers, but failure is an orphan...

Alok Sharma (British MP) @AlokSharma_RDG | 2:06 AM · Dec 2, 2020:
The UK was the first country to sign a deal with Pfizer/BioNTech - now we will be the first to deploy their vaccine
To everyone involved in this breakthrough: thank you
In years to come, we will remember this moment as the day the UK led humanity’s charge against this disease

Emma Graham-Harrison (Guardian, Observer) @_EmmaGH | 6:04 AM · Dec 2, 2020
Vaccine was developed in Germany, at company founded and led by scientists of Turkish heritage.
It was tested around the world.
And it’s being manufactured in Belgium.
But our (UK's) government’s take? “UK led the charge”....

Eric Feigl-Ding @DrEricDing | 6:13 AM · Dec 2, 2020
DEAR REPORTERS—When Donald Trump inevitably brags about the Pfizer #COVID19 vaccine again,
remind him it was developed first in Germany by scientists of Turkish ethnic descent.
And then ask Trump about his damn Muslim ban.

margd: AND vaccine is based on Chinese scientists' description of virus genome, freely shared in early January 2020!
AND Hungarian Katalin Karikó--a woman--pioneered mRNA vaccine technology with decades of thankless toil.

des. 2, 2020, 9:36am

Malaria gains at risk from COVID-19 pandemic: WHO (Al Jazeera)

Funding shortfalls and disruptions to treatment in sub-Saharan Africa as a result of the COVID-19 pandemic risk tens of thousands more lives being lost to malaria, the World Health Organization (WHO) warned in its annual report on the mosquito-borne disease on Monday. The UN’s health agency said it was concerned that even moderate disruptions in access to treatment could lead to a “considerable loss of life”...

des. 2, 2020, 10:26am

(Virologist) Florian Krammer @florian_krammer | 9:43 AM · Dec 2, 2020
I think it will be very important to communicate to the population that (mRNA) vaccines have more reactogenicity (injection site pain, transient fatigue, headache, elev temp) than most other licensed vaccines. Not dangerous but unpleasant. People need to know what to expect.

This Got Me Thinking @Speaking_Plain
Where is it on the Shingrix scale? Cause that stuff causes some major 'reactogenicity'.

I haven't had Shingrix, but I have been told that it is pretty bad. Certainly in that ballpark.....

This Got Me Thinking @Speaking_Plain·
Ah. Good to know. Thanks. I had almost two weeks of misery after the Shingrix booster but it was worth every second to know that I am safe from shingles.

2mLynn Blais@LynnBlais·
I’ve had Shingrix and was in the Pfizer trial. With Shingrix my reaction was acute pain and swelling at the site that lasted about a week. Very painful. With the vaccine I had a bad headache and serious fatigue for one day. (Not sure I got the vaccine, could have been a placebo)

feeds the birdsChris d. @TsimLirpa·
I had Shingrix vaccine a week ago and I had 101.2 fever, fatigue and body aches, for one day. Helpful to understand it is not the vaccine making you sick, it is your own immune response kicking in to heat up the body and make you rest. You win quickly against inactive virus.

I found it less bad than Shingrix. But I only had site pain. No real other symptoms from either.

Editat: des. 3, 2020, 5:06am

Too deep a dive for most of us, but if interest and will:
Cytokine Storm--review.
(A cytokine storm is an an immune response, where the body starts to attack its own cells and tissues rather than just fighting off the virus.)

David C. Fajgenbaum and Carl H. 2020. Cytokine Storm (review). N Engl J Med (Dec 3, 2020); 383:2255-2273
DOI: 10.1056/NEJMra2026131

.... In this review, we propose a unifying definition of cytokine storm; discuss the pathophysiological features, clinical presentation, and management of the syndrome; and provide an overview of iatrogenic, pathogen-induced, neoplasia-induced, and monogenic causes. Our goal is to provide physicians with a conceptual framework, a unifying definition, and essential staging, assessment, and therapeutic tools to manage cytokine storm...

Tables & figures tweeted by Eric Topol

Highlighted text tweeted by Eric Topol

Table 1 Soluble Mediators in a Cytokine Storm

des. 3, 2020, 8:31am


RELEASED: Pfizer - BioNTech Vaccine Package Leaflets
More data on possible side effects, efficacy, administration...

Recipient Leaflet:

Healthcare Professional Information:

- Alvin @alvie_barr | 8:11 PM · Dec 2, 2020

des. 3, 2020, 4:11pm

Meredith Wadman. 2020. Public needs to prep for vaccine side effects. Science 27 Nov 2020: Vol. 370, Issue 6520, pp. 1022
DOI: 10.1126/science.370.6520.1022

...transient reactions should not dissuade people from getting vaccinated in the face of a pandemic virus that kills at least one in 200 of those it infects, says Florian Krammer, a vaccinologist at the Icahn School of Medicine at Mount Sinai, who participated in Pfizer's trial. Sore arms, fevers, and fatigue are “unpleasant but not dangerous,” he says. I'm not concerned about reactogenicity at all.”

Most people will escape “severe” side effects, defined as those that prevent daily activity. Fewer than 2% of recipients of the Pfizer and Moderna vaccines developed severe fevers of 39°C to 40°C. But if the companies win regulatory approvals, they're aiming to supply vaccine to 35 million people worldwide by the end of December. If 2% experienced severe fever, that would be 700,000 people.

Other transient side effects would likely affect even more people. The independent board that conducted the interim analysis of Moderna's huge trial found that severe side effects included fatigue in 9.7% of participants, muscle pain in 8.9%, joint pain in 5.2%, and headache in 4.5%. In the Pfizer/BioNTech vaccine trial, the numbers were lower: Severe side effects included fatigue (3.8%) and headache (2%).

But that's a higher rate of severe reactions than people may be accustomed to. “This is higher reactogenicity than is ordinarily seen with most flu vaccines, even the high-dose ones,” says Arnold Monto, an epidemiologist at the University of Michigan School of Public Health.

...Drew Weissman, an immunologist at the University of Pennsylvania whose research contributed to both vaccines: “The companies just have to warn people: ‘This is what you need to expect. Take Tylenol and suck it up for a day.’”

(Bernice Hausman, an expert on vaccine controversy at the Pennsylvania State University College of Medicine) also sees a need to support people who have serious reactions...

Reactogenicity is typically higher after a second dose, Weissman says. The side effects “mean the vaccine is working well. … It means you had such a good immune response to the first dose and now you are seeing the effects of that,” he says.

“We suspect the lipid nanoparticle causes the reactogenicity, because lipid nanoparticles without mRNA in them do the same thing in animals,” Weissman says. “We see production, in the muscle, of inflammatory mediators that cause pain, redness, swelling, fever, flulike symptoms, etc.”

Hutchison hopes better vaccines are on the way. Still, he says, “Given that COVID can kill or incapacitate people, everybody should bite the bullet and expect a rough night. … Get lots of naproxen.”

des. 3, 2020, 11:38pm

>31 margd: When it comes to the side effects, other than fever, unless it was really bad, I wouldn't even be able to tell if it was from the shot or the normal aches and pains I get from my job.

Editat: des. 4, 2020, 10:03am

>32 rastaphrog: For most of us, the greatest generation, we are not... I worry that folks won't return for second shot, or doing so, will feed the anti-vaxxers with their complaints.

Hopefully, other kinds of vaccines will become available for children--mRNA vaccines may not be cleared for kids before Sept 2021, I understand--for even the most stoic among us wouldn't like to see our kids feeling these side effects.

ETA: :)
Adi @IDdocAdi | 5:35 PM · Dec 3, 2020
This is the guy that needs to be vaccinating everyone #VaccinesWork #stewardmeme
0:32 ( )
From Buitengebieden

des. 4, 2020, 9:53am

Why preventing hot spots of transmission is key to stopping the COVID-19 pandemic
Martin Enserink, Kai Kupferschmidt, and Nirja Desai | 30 October 2020

...superspreading appears to be particularly important in COVID-19. A study published in April estimated that 10% of patients are responsible for 80% of the spread.

...A study from India published in Science (September) concluded that 8% of infected people caused 60% of the secondary cases; 70% of people did not pass the virus on to anyone else.

...A March wedding in Jordan was another tragic example of the dangers of superspreading. The father of the bride was infected; he passed the virus on to at least 76 of about 360 guests, a study says. One woman died.

...Researchers have identified several factors that make superspreading events more likely, known in Japan as the three Cs: closed spaces with poor ventilation, crowds, and close contact settings. Shouting, singing, and heavy breathing also seem to increase the risk of superspreading.

...there is a high likelihood that person became infected at a superspreading event.That’s why contact tracers in some countries now spend more time understanding where someone was infected and finding other people from the same cluster.

This is called backward contact tracing. It can help find more chains of transmission...

Editat: des. 4, 2020, 11:47am

WaPo Editorial: Confronting the Virus
(As highlighted by Eric Topol, MD)


Ana Cabrera @AnaCabrera | 8:35 AM · Dec 4, 2020:
OMG. Coronavirus is the #1 cause of death in the US this week,
surpassing heart disease, @drsanjaygupta says

Editat: des. 5, 2020, 4:24am

Republican = co-morbidity?

Republicans are hit the hardest as coronavirus spreads among elected leaders
A persistent refusal to adhere to COVID-19 safety measures has put many Republican leaders and the public at risk, experts say.
Dinah Voyles Pulver, Carlie Procell, and Javier Zarracina | Dec. 4, 2020

Taking their cues from President Donald Trump, Republicans at every level of government have flouted public health guidelines to reduce the risk of catching and spreading the coronavirus. They eschewed masks, attended large gatherings and failed to socially distance.

Now, as the pandemic infiltrates the White House, Congress and statehouses across the nation, Republicans bear the brunt of those infections, a USA TODAY analysis shows. At least 81 elected officials in state and federal government roles have tested positive for the coronavirus since Sept. 1, just as the nation's case counts were about to rebound. Nearly three out of four are Republican...

des. 5, 2020, 7:37am

Nutrients such as vitamin D don't work in a vacuum, so difficult to study effects esp if D is the ONLY pro-health intervention, e.g., >25 margd: Thomas et al. 2020, "Vitamin D metabolites and the gut microbiome in older men", published in Nature.

Dozens of clinical trials ongoing to investigate whether vitamin D prevents COVID-19; no firm evidence yet
Iria Carballo-Carbajal

“Vitamin D insufficiency ... may account for the majority of COVID-19 deaths”


SOURCE: Facebook users, Facebook, Instagram, 30 Nov. 2020

Overstates scientific confidence: Although several studies found correlations between low vitamin D levels and COVID-19 infection or severity, they do not provide direct evidence to establish a cause-effect between both. Furthermore, different studies show mixed results that do not allow to extract robust conclusions about the role of vitamin D in COVID-19.

Several studies reported lower levels of vitamin D in COVID-19 patients. However, it remains unclear whether low vitamin D levels increase the risk of infection and severe outcomes, is a consequence of the disease, or is simply more common in patients who are already in ill health. Several of the studies that found an association between vitamin D levels and COVID-19 infection or severity did not account for confounding factors such as ethnicity, body mass index, or underlying health condition, which are known risk factors for the disease. Further research is needed to determine whether vitamin D might play a role in the prevention of and treatment of COVID-19.

FULL CLAIM: “Vitamin D insufficiency ... may account for the majority of COVID-19 deaths”; “There are cheap alternatives to prevent hospitalization and death. Why keep pushing for untested expensive drugs /vaccines?”


des. 6, 2020, 4:12am

Bas B. Oude Munnink et al. 2020. Transmission of SARS-CoV-2 on mink farms between humans and mink and back to humans. Science 10 Nov 2020: eabe5901. DOI: 10.1126/science.abe5901

Animal experiments have shown that non-human primates, cats, ferrets, hamsters, rabbits and bats can be infected by SARS-CoV-2. In addition, SARS-CoV-2 RNA has been detected in felids, mink and dogs in the field. Here, we describe an in-depth investigation using whole genome sequencing of outbreaks on 16 mink farms and the humans living or working on these farms. We conclude that the virus was initially introduced from humans and has since evolved, most likely reflecting widespread circulation among mink in the beginning of the infection period several weeks prior to detection. Despite enhanced biosecurity, early warning surveillance and immediate culling of infected farms, transmission occurred between mink farms in three big transmission clusters with unknown modes of transmission. Sixty-eight percent (68%) of the tested mink farm residents, employees and/or contacts had evidence of SARS-CoV-2 infection. Where whole genomes were available, these persons were infected with strains with an animal sequence signature, providing evidence of animal to human transmission of SARS-CoV-2 within mink farms.

...It is imperative that fur production and trading sector should not become a reservoir for future spillover of SARS-CoV-2 to humans.

des. 6, 2020, 7:51am

Already had the coronavirus? You could get it again.
Reinfection reports are still rare but steadily growing around the world, and they’re likely underreported.
Sarah Elizabeth Richards and Nsikan Akpan | December 1, 2020

People can catch COVID-19 twice. That’s the emerging consensus among health experts who are learning more about the possibility that those who’ve recovered from the coronavirus can get it again. So far, the phenomenon doesn't appear to be widespread—with a few hundred reinfection cases reported worldwide—yet those numbers are likely to expand as the pandemic continues. takes time to prove if immunity to any disease is durable. For early clues to how COVID-19 might behave, health experts tried to divine the risk of reinfection by looking at other human coronaviruses. For example, one study of four seasonal coronaviruses published in September in Nature Medicine found that reinfections could occur as soon as six or nine months later, but were more likely to be observed at 12 months. But a body’s response to SARS-CoV-2 is unlike that of seasonal viruses because humans and those latter germs have had time to adapt to each other.

...fading antibodies may be a sign of a normal and healthy immune response. In November, a British study published as a preprint (meaning that it was not peer reviewed) reported that an initial flood of antibodies soon after infection corresponded with protection for six months—even if the antibody levels faded over time. The study documented only three asymptomatic reinfections among 1,246 health-care workers who had detectable antibodies early on.

...When SARS-CoV-2 invades, the body’s opening movement is frantic. Some B cells rev up swiftly, producing that first burst of antibodies within a week or two. Simultaneously, a group of T cells—known as killers—hunts down any other cell infected by the coronavirus and gets it to self-destruct. A separate type of T cell—known as helpers—guides both of these crisis responses. If any part loses the harmony, it can throw off the entire production and actually cause more damage rather than less.

While all of this is happening, the immune system is also learning. A fraction of these B cells and T cells get stored away as so-called memory cells. After recovery, the memory cells continue to work behind the scenes to prevent reinfections.

...scientists were excited in July when a research paper showed that memory T cells were still detectable years after people recovered from the 2002-2003 SARS coronavirus, a close cousin of this year’s plague.

Now, the latest evidence suggests that both B cells and T cells generated from COVID-19 infections are also likely to stick around for the long run. One preprint, published November 16, began to sketch out the lifespans for these critical components of the immune system among 185 coronavirus patients. It showed that memory B cells remained widely abundant after six months, while memory T cells had been reduced, but only by half. Another study from November found that a hundred health-care workers who contracted the coronavirus in the spring and showed mild or few symptoms—and didn’t produce many antibodies to begin with—still had robust T cells six months later.

What’s unknown is how these B cells and T cells will act if the body is re-exposed to the coronavirus. Will they produce an inflammatory response that somehow leads to a worse case later with more severe symptoms? Or will they blunt the outcome and yield the mild reinfections witnessed in some early reports?

If the trajectories of cold-causing coronaviruses are any reassurance, getting COVID-19 again won’t be nearly as miserable the second time for most people...

For now, there isn’t enough long-term research to know if B cells and T cells activated by the cutting-edge mRNA vaccines on the verge of approval will offer lasting protection, though a recent, two-month study in mice suggests that the answer could be “yes.”

In the meantime, even if recovered COVID-19 patients are counting on a less painful second episode, they shouldn’t toss aside their masks. They could still catch the virus and pass it to others, who might then become sick...

des. 6, 2020, 8:57am

Amazing that fact check below didn't address irregularities in FL case reporting.
DeSantis has referred to FL as God's waiting room...A Trumpy friend, a cancer patient, just headed south to her FL place. :(

Ron DeSantis stated on November 30, 2020 in a press conference:
“The states that are locked down are increasing at twice the rate we are” in Florida
Louis Jacobson and Amy Sherman |

Is Florida doing better on COVID-19 than “locked down” states?
Half True

• Currently, Florida has relatively low rates of coronavirus cases, deaths and hospitalizations. However, the connection between this and Florida’s light regulation of businesses’ and residents’ behavior is less clear-cut than DeSantis suggests.

• Only about half of the 10 most stringently regulated states saw rates of cases, deaths and hospitalizations that were twice as high as Florida’s, which was DeSantis’ benchmark.

• Numerous other states that followed similarly low-regulation policies are seeing coronavirus statistics far worse than Florida’s. This means Florida’s lower infection numbers could be related to factors other than behavioral regulations, such as its warmer weather...

des. 6, 2020, 10:53pm

>40 margd: I'm frequently disappointed by what PolitiFact leaves out. I doubt they have enough writers following political news to keep up with the disinformation.

Editat: des. 7, 2020, 7:59am

COVID complications have been linked to NO2 pollution (2nd article). NO2 is produced by gas stoves and heaters, a particular problem in small, unvented spaces where pollution can exceed EPA's actionable levels for the outdoors.

Why experts are sounding the alarm about the hidden dangers of gas stoves
Jonathan Mingle | December 4, 2020

...the natural gas-burning stoves and furnaces found in millions of US kitchens and basements can produce a range of health-damaging pollutants, including particulate matter (PM), nitrogen dioxide (NO2), carbon monoxide (CO), and formaldehyde. Over the past four decades, researchers have amassed a large body of scientific evidence linking the use of gas appliances, especially for cooking, with a higher risk of a range of respiratory problems and illnesses.

...Meanwhile, troubling new findings suggest that exposure to NO2—the primary pollutant of concern from gas appliances—could compound the dangers of the novel coronavirus in communities that are already at higher risk of infection and of dying from the disease. A recent peer-reviewed study led by researchers at Emory University examined Covid-19 mortality data in more than 3,000 US counties, and found that long-term exposure to elevated NO2 was correlated with a higher risk of death from Covid-19—and that NO2 appeared to be more dangerous than particulate matter or ozone.

...EPA’s own analysis has found that American homes with gas stoves have much higher concentrations of NO2 than those using electric stoves—levels that would violate legal limits if measured outdoors.

...more than a third of all US households rely primarily on gas for cooking, the extent of the damage to people’s health, the RMI report concluded, could be quite large...Californians’ gas consumption is much higher than the national average.

Unvented gas-burning space heaters are illegal in California, but ... plenty of people still use them because they can’t afford alternatives or live in sub-standard rental housing.

...some people, especially renters, even use their gas ovens as supplemental heating sources in the winter, or as a primary one if their electricity gets shut off.

...Yifang Zhu, a professor of environmental health sciences at UCLA’s Fielding School of Public Health,...examin(ed) the impact of natural gas appliances—including furnaces and water heaters—on health and air quality in California. One of the most striking findings from their modeling: In nearly all small apartments, cooking for just one hour on a gas stove results in NO2 concentrations that would far exceed ambient air quality limits set by the EPA and CARB.

Many of the houses and apartments...don’t have functioning range hoods...only about a third of Californians who do have exhaust hoods use them regularly.

Zhu’s team..estimated that the health benefits of going all-electric—in the form of avoided deaths and chronic illness—would amount to $3.5 billion per year...if the impacts of breathing indoor particulate matter, carbon monoxide, and nitrogen oxides from gas combustion were tallied up, the health benefits of avoiding that exposure would almost certainly be far larger.

...Compared to the wood and coal it replaced in US households, gas was, and is, undoubtedly far better for air quality and health. That’s still true for the billions of people in the developing world who rely on solid fuels for cooking and heating, and are exposed to dangerous smoke every day as a result.

...Compared to electric-powered appliances, gas burners are unquestionably more polluting. Induction cooktops—which use magnetic fields to heat pots quickly, rather than burning gas or using the resistance heating coils of conventional electric ranges—have been widely used in Europe for many years, and are now becoming more available in the US.

“Induction is both cleaner with fewer pollutant emissions and also the most efficient and least dangerous in terms of burns and fires,” said Brett Singer, “but cooking on induction still can produce pollutants that need to be vented.” Using a ventilation hood is essential with any cooking system, he emphasized...Electric-powered induction cooktops may save energy and help homeowners breathe easier, but they are more expensive than conventional gas stoves...If policymakers took those health costs into account...the dollar value of all those avoided emergency room visits for asthma attacks and lost school and workdays could make wide-scale programs incentivizing adoption of induction cookers look like a bargain.

...without targeted incentives, most homeowners and renters won’t be able to afford new heat pumps and induction cookers, and will be stuck paying for increasingly costly gas hookups.

...women who cooked primarily with gas stoves had a significantly higher risk of asthma-like symptoms and reduced lung functions in tests than those who didn’t. (Intriguingly, they found no significant association among men, perhaps explained by the fact that women spent more time in the kitchen cooking, and in the home generally.)...

Donghai Liang et al. 2020. Urban Air Pollution May Enhance COVID-19 Case-Fatality and Mortality Rates in the United States. Cell. The Innovation. Volume 1, ISSUE 3, 100047, November 25, 2020. DOI:

Public Summary

• One of the first US studies on air pollution exposures and COVID-19 death outcomes
• Urban air pollutants, especially NO2, may enhance population susceptibility to death fromCOVID-19
• Reduction in air pollution would have avoided over 14,000 COVID-19 deaths in the US as of July 17, 2020
• Public health actions needed to protect populations from COVID-19 in areas with historically high NO2 exposure
• Expansion of efforts to lower air pollution may reduce population-level risk of COVID-19

...County-level average NO2 concentrations were positively associated with both COVID-19 case-fatality rate and mortality rate in single-, bi-, and tri-pollutant models. When adjusted for co-pollutants, per interquartile-range (IQR) increase in NO2 (4.6 ppb), COVID-19 case-fatality rate and mortality rate were associated with an increase of 11.3% ... and 16.2% ..., respectively. ...

Long-term exposure to NO2, which largely arises from urban combustion sources such as traffic, may enhance susceptibility to severe COVID-19 outcomes, independent of long-term PM2.5 and O3 exposure. The results support targeted public health actions to protect residents from COVID-19 in heavily polluted regions with historically high NO2 levels. Continuation of current efforts to lower traffic emissions and ambient air pollution may be an important component of reducing population-level risk of COVID-19 case fatality and mortality...

des. 7, 2020, 9:13am

When driving a COVID patient for testing or to hospital:

How Airflow Inside a Car May Affect COVID-19 Transmission Risk – What Works Best for Windows and Ventilation
Brown University December 5, 2020

...The study, by a team of Brown University researchers, used computer models to simulate the airflow inside a compact car with various combinations of windows open or closed. The simulations showed that opening windows — the more windows the better — created airflow patterns that dramatically reduced the concentration of airborne particles exchanged between a driver and a single passenger. Blasting the car’s ventilation system didn’t circulate air nearly as well as a few open windows, the researchers found.

“Driving around with the windows up and the air conditioning or heat on is definitely the worst scenario, according to our computer simulations,” said Asimanshu Das, a graduate student in Brown’s School of Engineering and co-lead author of the research. “The best scenario we found was having all four windows open, but even having one or two open was far better than having them all closed.”

...there’s no way to eliminate risk completely...

The computer models used in the study simulated a car, loosely based on a Toyota Prius, with two people inside — a driver and a passenger sitting in the back seat on the opposite side from the driver. The researchers chose that seating arrangement because it maximizes the physical distance between the two people (though still less than the 6 feet recommended by the CDC). The models simulated airflow around and inside a car moving at 50 miles per hour, as well as the movement and concentration of aerosols coming from both driver and passenger. Aerosols are tiny particles that can linger in the air for extended periods of time. They are thought to be one way in which the SARS-CoV-2 virus is transmitted, particularly in enclosed spaces.

Part of the reason that opening windows is better in terms of aerosol transmission is because it increases the number of air changes per hour (ACH) inside the car, which helps to reduce the overall concentration of aerosols. But ACH was only part of the story, the researchers say. The study showed that different combinations of open windows created different air currents inside the car that could either increase or decrease exposure to remaining aerosols.

Because of the way air flows across the outside of the car, air pressure near the rear windows tends to be higher than pressure at the front windows. As a result, air tends to enter the car through the back windows and exit through the front windows. With all the windows open, this tendency creates two more-or-less independent flows on either side of the cabin. Since the occupants in the simulations were sitting on opposite sides of the cabin, very few particles end up being transferred between the two. The driver in this scenario is at slightly higher risk than the passenger because the average airflow in the car goes from back to front, but both occupants experience a dramatically lower transfer of particles compared to any other scenario.

The simulations for scenarios in which some but not all windows are down yielded some possibly counterintuitive results. For example, one might expect that opening windows directly beside each occupant might be the simplest way to reduce exposure. The simulations found that while this configuration is better than no windows down at all, it carries a higher exposure risk compared to putting down the window opposite each occupant.

airflow adjustments are no substitute for mask-wearing by both occupants when inside a car....findings are limited to potential exposure to lingering aerosols that may contain pathogens. The study did not model larger respiratory droplets or the risk of actually becoming infected by the virus...

Varghese Mathai et al. 2020. Airflows inside passenger cars and implications for airborne disease transmission. Science Advances 04 Dec 2020: eabe0166 DOI: 10.1126/sciadv.abe0166

Transmission of highly infectious respiratory diseases, including SARS-CoV-2, is facilitated by the transport of exhaled droplets and aerosols that can remain suspended in air for extended periods of time. A passenger car cabin represents one such situation with an elevated risk of pathogen transmission. Here we present results from numerical simulations to assess how the in-cabin microclimate of a car can potentially spread pathogenic species between occupants, for a variety of open and closed window configurations. We estimate relative concentrations and residence times of a non-interacting, passive scalar–a proxy for infectious particles–being advected and diffused by turbulent air flows inside the cabin. An air flow pattern that travels across the cabin, farthest from the occupants can potentially reduce the transmission risk. Our findings reveal the complex fluid dynamics during everyday commutes, and non-intuitive ways in which open windows can either increase or suppress airborne transmission.

des. 8, 2020, 8:11am

Vaccines... PPE, testing deja vu?

Pfizer offered to sell the U.S. government additional doses of its vaccine late this summer (2020), which US declined. The company said it might not be able to provide more doses until June 2021.

Hopefully other brands, which US did buy, will have vaccines by then.

From charitable point of view, Govt probably didn't want to put all its eggs in one basket, but doesn't look good that Pfizer, which wasn't a beneficiary of Warp Speed also wasn't part of Vaccine Czar Moncef Slaoui's personal stock portfolio. He owns $10 million in Moderna stock.

Vaccine summit plus executive order should smooth it over, hey what?

Trump to sign coronavirus vaccine executive order prioritizing Americans over foreign nations
Brooke Singman | Dec 7, 2020

EXCLUSIVE: President Trump is expected to sign an executive order Tuesday that will ensure all Americans have access to the coronavirus vaccine before the U.S. government begins aiding nations around the world, Fox News has learned.

Senior administration officials told Fox News Monday that the president will reemphasize to the American people that the “priority has been an America First approach,” during a vaccine summit at the White House Tuesday...

BTW, Canada leads the world in vaccine orders on the books. 383% of its population size! Canada should start vaccinating this month. If I understand correctly, PM Trudeau says plan is to share extra with other countries. (It's signatory to WHO plan):

World map of vaccine purchases relative to population ( )


Here's infographic of countries' unweighted purchases of the various vaccines

("Janssen's" vaccine in legend s typo? Should be "Johnson & Johnson's"?)

Editat: des. 8, 2020, 11:29am

US FDA's Vaccines and Related Biological Products Advisory Committee
December 10, 2020 Meeting
Links for agenda and meeting materials (below).

Eric Topol (cardiologist, author) @EricTopol | 9:39 AM · Dec 8, 2020:
The @US_FDA's briefing document for Thursday's external (VRBPAC) review of @Pfizer/@BioNTech's vaccine exemplifies the thorough review of the data and transparency that we need and expect

Image--Table 4 ( )
Image--Figure 2 ( )
Six documents:
1. agenda,
2. members of advisory committee,
3. James Hildreth acknowledgment of financial interest,
6. waiver for Janes Hildreth participation.
Eric Topol @EricTopol
Efficacy looks consistent and very high across all subgroups, including age, ancestry, gender. And surprisingly high efficacy (>50%) even after the 1st dose. Also the protection against severe infection-illness events noted.
Table 13 ( )

des. 8, 2020, 12:05pm

Iran’s top banker says US blocking COVID-19 vaccine purchase
Maziar Motamedi | 7 Dec 2020

...Abdolnasser Hemmati on Monday said it must be “recorded in historical memory” that Iranian efforts to buy a vaccine through COVAX have been hampered due to money transfer issues arising due to the sanctions imposed by the US against Iran.

“So far, any methods to make payment and transfer the required currency have faced obstacles due to the inhumane sanctions of the US government and the need to obtain permits from OFAC,” Hemmati wrote in an Instagram post, referring to the Office of Foreign Assets Control of the US Treasury...

Iran, which is dealing with the largest and deadliest COVID-19 pandemic in the Middle East, announced months ago that it had become a member of COVAX in order to secure vaccines.

The WHO touts COVAX as “the world’s best hope” for tackling the pandemic in a coordinated and timely manner, and says the international initiative’s aim is to “guarantee rapid, fair and equitable access to vaccines for people in all countries”...

des. 9, 2020, 6:54am

Where Hospitals Are Filling Up (interactive US map)

New Data Reveal Which Hospitals Are Dangerously Full. Is Yours?
Sean McMinn and Audrey Carlsen | December 9, 20205:00 AM ET

The federal government on Monday released detailed hospital-level data showing the toll COVID-19 is taking on health care facilities, including how many inpatient and ICU beds are available on a weekly basis.

Using an analysis from the University of Minnesota's COVID-19 Hospitalization Tracking Project, NPR has created a tool that allows you to see how your local hospital and your county overall are faring. ( )

It focuses on one important metric — how many beds are filled with COVID-19 patients — and shows this for each hospital and on average for each county.'s concerning when that rate rises above 10%, hospital capacity experts told NPR.

Anything above 20% represents "extreme stress" for the hospital...

If that figure gets to near 50% or above, the stress on staff is immense. "It means the hospital is overloaded. It means other services in that hospital are being delayed. The hospital becomes a nightmare," IHME's Ali Mokdad told NPR...

des. 9, 2020, 7:33am

UAE registers Beijing Institute of Biological Product’s inactivated COVID-19 vaccine in a major step towards combating the global pandemic. The registration of this vaccine is a decision in response to the application from Sinopharm CNBG.

Florian Krammer @florian_krammer | 6:26 AM · Dec 9, 2020:
1) Now the first inactivated vaccine has interim results too. Respectable 86% and a very nice tolerability profile (judging from early phase clinical data). More information (# of cases, study protocol etc.) would be good. But still, this is great news!

2) This vaccine is unlikely to be licensed in the US or Europe. However, there is large scale production capacity for it in China and in India and it can be stored at 4C. I think this vaccine (and two very similar ones that are also in PhIII) will be big global players.

Jakob Simmank @JaSimmank: Great, was looking for those results already. May I ask what makes you think it will not be licensed in EU/US/GB?

Florian Krammer @florian_krammer: Regulatory barriers. It could be done. But it would take time and a lot of effort.

UAE Ministry of Health and Prevention announces official registration of inactivated COVID-19 vaccine used in #4Humanity Trials
WAM/Binsal AbdulKader | Wed 09-12-2020 09:09 AM

ABU DHABI, 9th December, 2020 (WAM) -- The UAE’s Ministry of Health and Prevention, MOHAP, has announced the official registration of Beijing Institute of Biological Product’s inactivated COVID-19 vaccine in a major step towards combating the global pandemic. The registration of this vaccine is a decision in response to the application from Sinopharm CNBG. The announcement is a significant vote of confidence by the UAE’s health authorities in the safety and efficacy of this vaccine.

MOHAP, in collaboration with Department of Health Abu Dhabi, DOH, has reviewed Sinopharm CNBG’s interim analysis of the phase III trials, which shows Beijing Institute of Biological Product’s inactivated vaccine to have 86 percent efficacy against COVID-19 infection. The analysis also shows the vaccine to have 99 percent seroconversion rate of neutralising antibody and 100 percent effectiveness in preventing moderate and severe cases of the disease. Furthermore, the analysis shows no serious safety concerns.

This vaccine was granted Emergency Use Authorisation, EUA, since September by MOHAP to protect frontline workers most at risk of COVID-19. The UAE is conducting Post Authorisation Safety Study, PASS, and Post Authorisation Efficacy Study, PAES, of its EUA programme. These ongoing studies show similar safety and efficacy profiles as the interim analysis.

The #4Humanity phase III trials have included 31,000 volunteers across 125 nationalities in the UAE alone. The EUA vaccination programme has effectively safeguarded the UAE frontline workers. MOHAP's official registration of Beijing Institute of Biological Product’s inactivated COVID-19 vaccine leads the way to comprehensively protecting the population and responsibly opening the economy.

Editat: des. 9, 2020, 7:55am

People with a history of ‘significant’ allergic reactions shouldn’t have Pfizer shot, UK regulator warns
Holly Ellyatt | Dec 9 2020

...The U.K’s Medicines and Healthcare products Regulatory Agency updated its guidance to British health service trusts on who should receive the vaccine, cautioning that “any person with a history of a significant allergic reaction to a vaccine, medicine or food (such as previous history of anaphylactoid reaction or those who have been advised to carry an adrenaline autoinjector) should not receive the Pfizer BioNtech vaccine.”

The precautionary advice came after two members of Britain’s National Health Service, who received the vaccine on Tuesday, experienced allergic reactions to the shot. Both are recovering well, according to the national medical director for the NHS.

“As is common with new vaccines, the MHRA have advised on a precautionary basis that people with a significant history of allergic reactions do not receive this vaccination,” Professor Stephen Powis, national medical director for the NHS, said in a statement from NHS England Wednesday...

des. 9, 2020, 9:59am

>49 margd: contd.

Two NHS staff 'recovering well' after allergic reaction to Covid vaccine
BBC | 9 December 2020

...both the staff members had a significant history of allergic reactions - to the extent where they need to carry an adrenaline auto injector with them.

They developed symptoms of "anaphylactoid reaction" shortly after receiving the vaccine and both have recovered after the appropriate treatment.

Following the incident, regulators issued a warning that people who have a history of "significant" allergic reactions should not currently receive the jab following the incident...

Professor Stephen Powis, national medical director for the NHS in England, said: "As is common with new vaccines the MHRA have advised on a precautionary basis that people with a significant history of allergic reactions do not receive this vaccination after two people with a history of significant allergic reactions responded adversely yesterday. Both are recovering well."

The Medicines and Healthcare products Regulatory Agency (MHRA) has given precautionary advice to NHS trusts that anyone who has a history of "significant" allergic reactions to medicines, food or vaccines should not receive the vaccine.

des. 9, 2020, 12:36pm
Giuliani’s Viral Election Witness Insists She Wasn’t Drunk and Also That the Obamas Funded Wuhan Lab to Create Covid

My take ~ These are the kinds of people who get
hooked in to the "plays" of life-long con men and cult
personalities. They are getting their 15 minutes in the
spotlight, and they are making America the laughing
stock of the civilized world.

Editat: des. 10, 2020, 6:52am

>50 margd: contd. Might be polyethylene glycol is responsible for allergic reactions associated with Pfizer vax. PEG is commonly added to food, cosmetics, and pharamaceuticals, e.g., MiraLAX's active ingredient.

UK issues anaphylaxis warning on Pfizer vaccine after adverse reactions
Alistair Smout | December 9, 2020

...The Medicines and Healthcare Products Regulatory Agency (MHRA) said there had been two reports of anaphylaxis and one report of a possible allergic reaction since rollout began.

...“Any person with a history of anaphylaxis to a vaccine, medicine or food should not receive the Pfizer BioNTech vaccine,” MHRA Chief Executive June Raine said in a statement.

“Most people will not get anaphylaxis and the benefits in protecting people against COVID-19 outweigh the risks... You can be completely confident that this vaccine has met the MHRA’s robust standards of safety, quality and effectiveness.”

...The fuller guidance, clarifying that the main risk was from anaphylaxis specifically, was issued after consulting experts on allergies. The MHRA had initially advised anyone with a history of a “significant allergic reaction” not to take the shot.

...A top U.S. official said on Wednesday that Americans with known severe allergic reactions may not be candidates for Pfizer’s COVID-19 vaccine until more was understood about what had happened.

Canada’s health ministry said it would look at the reported adverse reactions in Britain, but said adverse events were to be expected and would not necessarily change the risk/benefit of the shot, after the country approved the vaccine.

...Pfizer has said people with a history of severe adverse allergic reactions to vaccines or the candidate’s ingredients were excluded from their late stage trials, which is reflected in the MHRA’s emergency approval protocol.

However, the allergic reactions may have been caused by a component of Pfizer’s vaccine called polyethylene glycol, or PEG,* which helps stabilise the shot and is not in other types of vaccines.

...Imperial College London’s Paul Turner, an expert in allergy and immunology, who has been advising the MHRA on their revised guidance...: “As we’ve had more information through, the initial concern that maybe it affects everyone with allergies is not true...The ingredients like PEG which we think might be responsible for the reactions are not related to things which can cause food allergy. Likewise, people with a known allergy to just one medicine should not be at risk”...


* Katharina Wylon et al. 2016. Polyethylene glycol as a cause of anaphylaxis. Allergy, Asthma & Clinical Immunology volume 12, Article number: 67 (2016)

Polyethylene glycols (PEGs) or macrogols are polyether compounds and are widely used as additives in pharmaceuticals, cosmetics, and food.

Case report...

Potential life-threatening hypersensitivity reactions to hidden molecules like macrogol may be underdiagnosed. Cases of immediate-type PEG hypersensitivity were reported with increasing frequency. The awareness regarding the allergenic potential of PEG should be raised and a proper product labelling is crucial to prevent PEG mediated hypersensitivity.

Polyethylene glycol (PEG) or macrogol is a polyether compound. It is widely used as an additive in pharmaceuticals, cosmetics and food...Anaphylactic reactions to macrogol are rarely reported. However, in recent years more reports appeared in the literature with macrogol induced hypersensitivities due to drugs, personal hygiene products, dental products, lozenges and lubricants...

des. 11, 2020, 2:29am

U.S. death tolls will exceed 9/11 every day for two to three months, Redfield says
Katie Shepherd | Dec. 11, 2020

The novel coronavirus will kill more people in the United States every day for the next two to three months than died in the attacks on 9/11 and Pearl Harbor, Centers for Disease Control and Prevention director Robert Redfield said Thursday.

The stark warning came as the United States set a new record for fatalities in a single day for the second day in a row, surpassing 3,300 deaths Thursday and bringing the nation’s total covid-19 death toll to more than 291,800...

Editat: des. 11, 2020, 3:07am

Sanofi suffers major setback in development of a Covid-19 vaccine
Helen Branswell | December 11, 2020

...Sanofi and its development partner, GlaxoSmithKline...

Sanofi had hoped to start a Phase 3 trial of the vaccine this month and had projected it could produce 100 million doses of vaccine in 2020, and 1 billion doses in 2021.

The problem relates to inadequate results in older adults in Sanofi’s Phase 1/2 trial, which the company traced back to an inadequate formulation of their vaccine...

In effect, participants in the trial received too little vaccine. While the too-small dose generated adequate levels of neutralizing antibodies in adults aged 18 to 49 in the trial, adults 60 and older generated lower levels of neutralizing antibodies than are seen in the blood of people who have recovered from Covid-19 infection...

Perplexed by the findings, the company set out to figure out why the vaccine underperformed. It discovered two commercial reagents used to measure how much antigen — active vaccine — was included in each dose were giving false readings. In fact, Ng said, the concentration of the antigen “was insufficient.”

A revised formulation, tested recently in non-human primates, showed the vaccine prevented damage in the lungs, which is what triggers severe Covid disease in people, and led to rapid clearance of the virus.

The vaccine’s path will be more challenging because of this delay; the Covid vaccine landscape is changing daily and placebo-controlled trials may not be feasible for much longer, with the first vaccines soon to be deployed. If people know they may soon have access to an authorized vaccine, there is less motivation to enroll in a trial where they might get a placebo.

Sanofi knows this and is proposing to the Food and Drug Administration that its Phase 2b trial compare its vaccine to one that is already authorized, not a placebo...That would set a very high bar for the Sanofi vaccine. Pfizer and Moderna, the front-runners in the vaccine race, have reported vaccine efficacy of about 95% in their Phase 3 trials.

...The Sanofi vaccine would have one advantage compared to the Pfizer and Moderna vaccines: It wouldn’t require ultracold storage and could instead be kept in standard refrigerators, making it easier to distribute...


Florian Krammer (Icahn virologist) @florian_krammer | 1:14 AM · Dec 11, 2020
Disappointing, but I hope they keep going.

des. 11, 2020, 3:16am

Devastated UQ scientists tried for weeks to fix problem with COVID-19 vaccine
Stuart Layt
By Stuart Layt
December 11, 2020 — 2.04pm

View all comments

The University of Queensland team behind a COVID-19 vaccine candidate had known for weeks that it generated false positive HIV test results and was trying to find ways to work around the problem.

The Morrison government, following medical advice, terminated a billion-dollar arrangement to buy millions of doses of the potential vaccine after it was informed of the results on Monday.
Current Time 0:25
Duration 2:03

Coronavirus: University of Queensland vaccine terminated

Coronavirus: University of Queensland vaccine terminated

New tool to detect bowel cancer

Coronavirus: University of Queensland vaccine terminated

The Australian coronavirus vaccine has been terminated due to trial participants returning HIV ‘false positives’ at the University of Queensland.
Stuart Layt |12/11/2020

The Morrison government, following medical advice, terminated a billion-dollar arrangement to buy millions of doses of the potential vaccine...

...Every trial participant who was given the live vaccine and not a placebo generated a small immune response to HIV because the molecular clamp that held the viral protein together was derived from a fragment of HIV, a protein called Gp41.

The clamp does not affect how well the vaccine works and people are not contracting HIV, but because the fragment is recognised by the body’s immune system, it generates some antibodies.

These antibodies are looked for in many HIV screening programs now in place, and no good workaround could be found.

Professor (Trent) Munro, who had been overseeing the transition of the vaccine from laboratory to manufacturing, said they first became aware of the issue “some weeks ago” and had been trying to find a way around it.

....everyone who participated in the trial had been contacted and informed about what was going on. Some had already stopped registering an HIV response, with all of them seeing declining figures over time.

Professor Chappell, who developed the molecular clamp technology, said in hindsight they might not have used the HIV fragment but they needed to move forward quickly with development. “HIV is a well-studied virus. The structure of this protein has been known for some time … it’s a well-known structure...If we could go back in time, we’d make changes.”...


Florian Krammer @florian_krammer | 1:15 AM · Dec 11, 2020
That sucks. Nothing wrong with the vaccine but a technical issue that unfortunately derails the development.

Editat: des. 11, 2020, 3:50am

Harvard epidemiologist Mina an UNC prof Tufekci are suggesting that better use might be made of Pfizer vaccine by giving single dose to under-65s (and double to over 65s), etc. Study needed.

zeynep tufekci (UNC) zeynep | 9:53 AM · Dec 10, 2020
The BioNTech/Pfizer data is out—NEJM & FDA report. I understand this wasn't in the design & the long-term protection from single dose is open question. But given this sharp drop after 14 days after one dose, can someone explain why single dose isn't very very high on the agenda?
Show this thread :
Image--graphical depiction of his argument ( )

Michael Mina @michaelmina_lab | 3:02 AM · Dec 11, 2020
Pfizer vaccine shows 52% and 95% efficacy after 1 or 2 doses, respectively.
However dose 2 is at day 21 and vacc effects only ever kick in at ~14 days
By not censoring out first 14days, single dose evaluation was destined to appear (falsely) horrible *

Do additional studies need to be performed to see if a single dose can provide durable effective response? Yes.

But is it accurate to say a single dose vaccine would be only 52%? No. Absolutely not even close. Clearly the curves diverge sharply even just between d14-21

* Pfizer mRNA vaccine--Phase 3 clinical trial peer-reviewed publication:

Fernando P. Polack et al. for the C4591001 Clinical Trial Group. 2020. Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine. NEJM (December 10, 2020). DOI: 10.1056/NEJMoa2034577 .


A total of 43,548 participants underwent randomization, of whom 43,448 received injections: 21,720 with BNT162b2 and 21,728 with placebo. There were 8 cases of Covid-19 with onset at least 7 days after the second dose among participants assigned to receive BNT162b2 and 162 cases among those assigned to placebo; BNT162b2 was 95% effective in preventing Covid-19 (95% credible interval, 90.3 to 97.6). Similar vaccine efficacy (generally 90 to 100%) was observed across subgroups defined by age, sex, race, ethnicity, baseline body-mass index, and the presence of coexisting conditions. Among 10 cases of severe Covid-19 with onset after the first dose, 9 occurred in placebo recipients and 1 in a BNT162b2 recipient. The safety profile of BNT162b2 was characterized by short-term, mild-to-moderate pain at the injection site, fatigue, and headache. The incidence of serious adverse events was low and was similar in the vaccine and placebo groups.

A two-dose regimen of BNT162b2 conferred 95% protection against Covid-19 in persons 16 years of age or older. Safety over a median of 2 months was similar to that of other viral vaccines.

des. 11, 2020, 3:55am

>56 margd: NEJM's editorial on Lochart t al 2020 (Pfizer mRNA vaccine--Phase 3 clinical trial peer-reviewed publication)

Eric J. Rubin and Dan L. Longo. 2020. SARS-CoV-2 Vaccination — An Ounce (Actually, Much Less) of Prevention (editorial). NEJM (December 10, 2020) DOI: 10.1056/NEJMe2034717

...The results were impressive.

...There are nonetheless minor issues.

...Nevertheless, the trial results are impressive enough to hold up in any conceivable analysis. This is a triumph.

...Important questions of course remain.

...The logistic challenges of manufacturing and delivering a vaccine remain daunting....

des. 12, 2020, 2:32am

F.D.A. Clears Pfizer Vaccine, and Millions of Doses Will Be Shipped Right Away
Katie Thomas, Sharon LaFraniere, Noah Weiland, Abby Goodnough and Maggie Haberman | Dec. 11, 2020

An initial shipment of about 2.9 million doses of the vaccine will be sent around the United States over the next week.

..state health officials remain deeply concerned about what they describe as insufficient funding for the biggest immunization campaign the country has ever embarked on. State health officials have asked Congress for at least $8.4 billion to do the job well. But so far, they have received only about $350 million from the Centers for Disease Control and Prevention for vaccine distribution and administration tasks. Those tasks include expanding online systems to track and share information about who has been vaccinated; recruiting and training doctors, nurses and pharmacists to administer the shots; and convincing the public of the importance of getting immunized.

Supplying enough of the vaccine has also proven to be a challenge without a clear resolution. Pfizer had to scale back earlier estimates because of manufacturing setbacks, and has said it will be able to supply up to 25 million doses before the end of the year, and 100 million total vaccines by March.

This week, federal officials said that rather than using all 6.4 million doses that the government initially ordered from Pfizer to vaccinate people, it is holding back half of the supply for a booster shot to recipients three weeks after their first vaccination. But even though only about three million people will receive a vaccine in the first week, officials have held firm on their estimate that, between the Pfizer and Moderna vaccines, which each require two shots, they hope to give at least 20 million people their first dose of a vaccine by the end of the year.

Questions also persist about how quickly a vaccine will be available to anyone that wants one. Federal officials have said they expect to be able to vaccinate the bulk of the U.S. population by the middle of next year, but recent setbacks have challenged those estimates. Pfizer has told the federal government that it may not be able to provide an additional 100 million doses to the United States before the middle of next year because of agreements it has with other countries. And three other experimental vaccines, developed by Novavax, Sanofi and AstraZeneca, have faced delays in their clinical trials.

Editat: des. 12, 2020, 7:17am

AstraZeneca to use Russia’s Sputnik V in COVID-19 vaccine trials
Oriana Gonzalez | Dec 12, 2020

AstraZeneca will begin trials to test whether its experimental coronavirus vaccine can be successfully combined with Russia’s Sputnik V shot...

Why it matters: Both AstraZeneca's and Russia's vaccines have raised questions among experts around their separate trials. Russia has not completed advanced studies on the vaccine to ensure whether it is safe and adheres to scientific protocols. AstraZeneca's vaccine is reported to be about 62% effective, but some patients accidentally (>8 margd:) received a modified dosing regimen during trials.

The big picture: The announcement comes days after the developers of the Sputnik V vaccine proposed on Twitter that AstraZeneca combine its shot with Russia's.

Details: The Russian Direct Investment Fund, Russia’s sovereign wealth fund which has funded the development of Sputnik V, said clinical trials with AstraZeneca’s would begin by the end of the month...

Worth noting: Last week, Russia began distributing its vaccine — which they report to be 90% effective — in Moscow, announcing that 5,000 people had signed up to be inoculated in the city.*


* Russia expected a surge for its Sputnik V vaccine. But many skeptics still stayed away.
Robyn Dixon | Dec. 11, 2020

...there seemed to be more vaccine skeptics than (teacher, healthcare worker) takers in the first week across Russia, struggling with the fourth-highest number of cases at more than 2.5 million.

The reasons tap into both Russia’s history of wariness about authority, and Internet-driven conspiracy theories and pandemic deniers — reflecting similar anti-vaccine rallying cries in the United States, Germany and elsewhere.

Russian authorities also did not help their cause by issuing muddled messages about whether vaccine-takers need to avoid alcohol for weeks.

...Russia rushed to register its vaccine in the summer before it was fully evaluated in trials, which may have fueled public doubts. But deep-rooted skepticism of official promises goes back to Soviet times. Many Russians simply don’t buy the rosy picture of the vaccine painted by health authorities....

des. 12, 2020, 8:03am

'Hold Their Feet To the Fire': Getting A COVID-19 Vaccine To Hard-Hit Indian Country
Kirk Siegler | December 11, 2020
Heard on All Things Considered

...Tribes had the option of getting the vaccine shipments from their state or the Indian Health Service. More than half of the 574 federally recognized tribes are doing what the Nez Perce are, and opting for the IHS...

The federal government has designated an allocation of the first coronavirus vaccines to hard-hit Indian Country. Native Americans have long endured health care inequities, and they're four times as likely to be hospitalized by COVID-19.

Still, reaching everyone who needs it will be a monumental challenge, and there is plenty of skepticism about the federal government's ability to deliver, after a century's worth of broken treaties and failures to meet government to government obligations with sovereign tribes...

des. 13, 2020, 8:43am

Trump, the life-long con man, has performed one great
deed for the country. He has inadvertently exposed the
putrid hearts, minds and souls of GOPers. Their Covid
and post-election actions and statements have been
recorded on video, audio and in tweets for the whole
world to see for generations to come. To GOPers,
Americans are merely interchangeable cogs in the
country's economic engine ~ our deaths don't matter
and our votes are disposable.

des. 14, 2020, 10:13am

Wall Street, White House, professional sports, thieves all reported to be angling for vaccination / vaccines...
Et tu, distribution companies? (Federal Express? UPS?) PPE & test déjà vu...

Andy Slavitt (2015-207 Acting Admin Medicare % Medicaid) | 12:01 AM · Dec 14, 2020 :
Trump’s White House taking the vaccine tomorrow is a symbol of a larger problem.
I’m beginning to hear of privileged people who are like(wise) jumping (the queue).

Hearing that companies involved in distribution are carving out small caches for their executives.
Not people who are CDC recommended. But people with bank.

This is deeply immoral and fitting with some of the worst traits of our country.

I’m going to put this out there.
-People are dying
-People are risking their lives to try to save others
-People have to work every day & face the public are dying fastest

Privileged people already have a vaccine: it’s called their house & the Internet & masks.

What to do:
—journalists...need to be asking executives in the supply chain who is taking the vaccine & writing about it
—political leaders...publicly say you will take it if you like— when it’s your turn
—Congress...provide oversight and monitor

—community leaders— be vocal & visible if you’re community is getting left behind
—states & pharmacies must hold to the letter of the law
—we are talking months for production to ramp, not years. Let’s hang on

P.S. from here, if anyone asks me if I know a way they might be able to get the vaccine early, I might post it on Twitter.

Editat: des. 14, 2020, 12:04pm

Study hints that supplements may reduce COVID-19 risk in females (per PCR tests, but also males for self-reported anosmia)
James Kingsland | December 10, 2020

The research found small but significant decreases in the risk of SARS-CoV-2 infection among females — but not males — who took multivitamins, vitamin D, omega-3 fatty acids, or probiotics.

...females have more robust immune systems, which may mean that their immune defenses get more of a boost from supplements.

...females may be more likely to wear masks or wash their hands than males, which could increase the apparent protective effects of taking supplements.

...researchers had not accounted for factors such as income and educational attainment in their analysis.

The results in detail

Out of 327,720 users of the app in the U.K. who had each had a polymerase chain reaction or serology test for SARS-CoV-2, 175,652 reported having used supplements regularly since the beginning of the pandemic.

...After the researchers had adjusted for other factors that could contribute to COVID-19 risk, they found...
Taking probiotics, multivitamins, omega-3 fatty acids, or vitamin D was associated with a 14%, 13%, 12%, and 9% lower risk of COVID-19.

Taking vitamin C, zinc, or garlic supplements was not associated with any reduced risk.

When the researchers broke down the numbers by sex, they found reduced risk associated with probiotics, multivitamins, omega-3 fatty acids, and vitamin D in females only.

...(HOWEVER) Among the 993,365 regular users of the app worldwide who had not undergone testing, 126,556 had reported a loss of smell or taste. This suggests that they likely had COVID-19.

When the researchers analyzed data from these individuals, they found a small but significant reduction in risk among both males and females who regularly took omega-3 fatty acids, multivitamins, vitamin D, or probiotics.

...The authors emphasize that “Large randomized controlled trials of selected supplements testing their protective effects and also possible adverse effects on disease severity are required before any evidence-based recommendations can be made. We eagerly await the result of ongoing trials, including those investigating vitamin D and COVID risk.”


Panayiotis Louca...Cristina Menni et al. 2020. Dietary supplements during the COVID-19 pandemic: insights from 1.4M users of the COVID Symptom Study app - a longitudinal app-based community survey. MedRxiv (Nov 30, 2020).

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

Main Exposure
Main Outcome

In an analysis including 327,720 UK participants, the use of probiotics, omega-3 fatty acids, multivitamins or vitamin D was associated with a lower risk of SARS-CoV-2 infection by 14%..., 12%..., 13%..., and 9%..., respectively, after adjusting for potential confounders. No effect was observed for vitamin C, zinc or garlic supplements. When analyses were stratified by sex, age and body mass index (BMI), the protective associations for probiotics, omega-3 fatty acids, multivitamins and vitamin D were observed in females across all ages and BMI groups, but were not seen in men. The same overall pattern of association was observed in both the US and Swedish cohorts. Results were further confirmed in a sub-analysis of 993,365 regular app users who were not tested for SARS-CoV-2 with cases...defined as those with new onset anosmia (the strongest COVID-19 predictor).

We observed a modest but significant association between use of probiotics, omega-3 fatty acid, multivitamin or vitamin D supplements and lower risk of testing positive for SARS-CoV-2 in women. No clear benefits for men were observed nor any effect of vitamin C, garlic or zinc for men or women. Randomised controlled trials of selected supplements would be required to confirm these observational findings before any therapeutic recommendations can be made.


Trial of Vitamin D to Reduce Risk and Severity of COVID-19 and Other Acute Respiratory Infections (CORONAVIT) Identifier: NCT04579640
Last Update Posted : December 1, 2020
Sponsor: Queen Mary University of London

COvid-19 and Vitamin D Supplementation: a Multicenter Randomized Controlled Trial of High Dose Versus Standard Dose Vitamin D3 in High-risk COVID-19 Patients (CoVitTrial) Identifier: NCT04344041
Last Update Posted : October 5, 2020
Sponsor: University Hospital, Angers

Editat: des. 14, 2020, 3:39pm

U.S. crosses 300,000 COVID-19 deaths (Monday) as vaccine rollout begins
Anurag Maan | December 14, 2020

Florian Krammer @florian_krammer | 3:23 PM · Dec 14, 2020:
That's a 100 9/11s.....

des. 15, 2020, 9:44am

"Our results identify robust genetic signals relating to key host antiviral defence mechanisms, and mediators of inflammatory organ damage in Covid-19. Both mechanisms may be amenable to targeted treatment with existing drugs. Large-scale randomised clinical trials will be essential before any change to clinical practice."

Erola Pairo-Castineira, Sara Clohisey, …J. Kenneth Baillie. 2020. Genetic mechanisms of critical illness in Covid-19. Nature (11 Dec 2020)

This is an unedited manuscript that has been accepted for publication.

Host-mediated lung inflammation is present,... and drives mortality,... in critical illness caused by Covid-19. Host genetic variants associated with critical illness may identify mechanistic targets for therapeutic development...Here we report the results of the GenOMICC (Genetics Of Mortality In Critical Care) genome-wide association study(GWAS) in 2244 critically ill Covid-19 patients from 208 UK intensive care units (ICUs). We identify and replicate novel genome-wide significant associations, on a gene cluster encoding antiviral restriction enzyme activators (OAS1, OAS2, OAS3), on chr19p13.2...near the gene encoding tyrosine kinase 2 (TYK2), on chr19p13.3...within the gene encoding dipeptidyl peptidase 9 (DPP9), and on the interferon receptor gene IFNAR2. We identify potential targets for repurposing of licensed medications: using Mendelian randomisation we found evidence in support of a causal link from low expression of IFNAR2, and high expression of TYK2, to life-threatening disease; transcriptome-wide association in lung tissue revealed that high expression of the monocyte/macrophage chemotactic receptor CCR2 is associated with severe Covid-19. Our results identify robust genetic signals relating to key host antiviral defence mechanisms, and mediators of inflammatory organ damage in Covid-19. Both mechanisms may be amenable to targeted treatment with existing drugs. Large-scale randomised clinical trials will be essential before any change to clinical practice.

Editat: des. 15, 2020, 10:20am

FDA Analysis Of Moderna COVID-19 Vaccine Finds It Effective And Safe
Scott Hensley | December 15, 2020

The Food and Drug Administration released a detailed analysis Tuesday morning of the COVID-19 vaccine from drugmaker Moderna that supports the authorization of the company's vaccine for emergency use.*

The FDA's briefing document along with one from Moderna were posted two days before a group of experts will convene to advise the agency on whether to grant the vaccine emergency authorization for use, or EUA, during the pandemic.

The agency's analysis finds the vaccine has a "favorable safety profile" and that there are "no specific safety concerns identified that would preclude issuance of an EUA." Serious reactions were rare. Side effects are common, however, with a majority of study volunteers experiencing pain at the site of injection, fatigue and headaches.

...the 94% (effective) overall, assessed at least two weeks after the second dose of vaccine, in the final analysis.

...For people ages 18 to less than 65, the effectiveness is 96%, compared with 86% for people 65 and older.

...On Thursday, the Vaccines and Related Biological Products Advisory Committee, an advisory group, will discuss the vaccine in an open public meeting...


Vaccines and Related Biological Products Advisory Committee Meeting
December 17, 2020
FDA Briefing Document
Moderna COVID-19 Vaccine
54 p

Editat: des. 15, 2020, 5:02pm

Pfizer Covid-19 Vaccine Side Effects (Prevalence is slightly less in over 55s.)

The coronavirus vaccine comes with more side effects than a flu shot. Experts urge people to get it anyway
Catherine Ho | Dec. 12, 2020

des. 15, 2020, 10:46am

Nicola Jones. 2020. How COVID-19 is changing the cold and flu season. Measures meant to tame the coronavirus pandemic are quashing influenza and most other respiratory diseases, which could have wide-ranging implications. Nature 588, 388-390 (Dec 15, 2020) doi:

By mid-December, the Northern Hemisphere is usually well into the start of its annual cold and flu season — but so far this year, even as the COVID-19 pandemic surges in dozens of countries, the levels of many common seasonal infections remain extremely low.

The pandemic caused by the SARS-CoV-2 coronavirus has infected at least 67 million people and killed 1.5 million worldwide. The patchwork of responses intended to fight the pandemic — from temporary lockdowns to mask wearing, social distancing, enhanced personal hygiene and reduced travel — has had a huge impact on other common respiratory illnesses, too.

In the Southern Hemisphere — now past its winter — seasonal influenza hardly struck at all. That looks as though it might happen in the north, too. Conversely, some common-cold viruses have thrived, and tantalizing evidence suggests that they might, in some cases, protect against COVID-19.

...Most experts are cautiously betting on a very mild flu season for the Northern Hemisphere this year. That would be good news on many fronts — in particular, it would help to alleviate the potential burden on the health system, from hospitals to testing centres, caused by simultaneous waves of flu and COVID-19. But surprises could be in store.

...If this year’s flu season does fizzle out in the Northern Hemisphere, that could make it harder to predict the right strains to put in 2021’s flu vaccine. It could also have intriguing, longer-term consequences. (Virologist Richard Webby at St Jude’s hospital in Memphis, Tennessee) speculates that a low-flu season might kill off less-common variants of influenza. “A lot of different flus have been circulating in recent years. Are they all going to make it out of this or not?” he asks. “It’s possible that what this season will do is actually make the virological picture a lot simpler. That may be permanent, potentially.”

At the same time, Webby adds, the lack of viral competition in human hosts could conceivably open a door for new swine-flu variants in the future. “We get a handful of those every year, in the agricultural-fair season,” Webby says. “One of the things holding those viruses back a lot is natural immunity. If flu is low for a few seasons, that might leave a gap for swine viruses to have more impact.”..

Editat: des. 15, 2020, 4:44pm

Eric Topol @EricTopol | 11:52 AM · Dec 15, 2020
Why happens to respiratory viral droplets when we walk?
The importance of space size (like narrow hallways) and exposure to kids walking behind infectious adults via manikin simulation experiments

Image ( )
Zhaobin Li et al. 2020.Effects of space sizes on the dispersion of cough-generated droplets from a walking person featured
Physics of Fluids 32, 121705 (2020);

des. 15, 2020, 4:48pm

12/15/2020 10:18 GMT — New SARS-CoV-2 variant identified in England

Yesterday, the United Kingdom’s health secretary, Matt Hancock, announced that scientists had identified a new variant of SARS-CoV-2 in England. He explained that it was particularly prevalent in the South, which had recently experienced a sharp rise in cases.

Local authorities have recorded at least 60 COVID-19 cases that involve the new variant, Hancock reported, adding that there was “nothing to suggest” that the variant caused more severe disease or could limit the effects of vaccines.

During a press conference, Chief Medical Officer for England Chris Whitty explained: “There are many variants. It just happens that this one has quite a few more mutations than some of the other variants, so that’s the reason why we’ve taken it particularly seriously.”

He continued, “But there’s nothing to suggest that the symptoms are different, that the testing is different, or that the clinical outcome is different for this variant.”

In an interview with the BBC, Prof. Alan McNally, an expert in microbial genomics at the University of Birmingham, said:

“Let’s not be hysterical. It doesn’t mean it’s more transmissible or more infectious or dangerous. It is something to keep an eye on. Huge efforts are ongoing at characterizing the variant and understanding its emergence. It is important to keep a calm and rational perspective on the strain, as this is normal virus evolution and we expect new variants to come and go and emerge over time.”

des. 15, 2020, 4:58pm

Long COVID and periods: The unspoken impact on female well-being
Maria Cohut | December 15, 2020

...Most of the people we spoke to told us that ever since they contracted COVID-19, they have been experiencing irregular periods, unusual clotting of their period blood, or worsened premenstrual syndrome (PMS).

However, while everyone we spoke to had experienced some changes to their menstrual cycle, the form of these disruptions varied...

How this has affected quality of life...

Lack of medical support an issue

All of the contributors who responded to MNT‘s queries said they had received little to no support from doctors when they sought help for long COVID symptoms, including disrupted periods...

A stringent need for resources

Almost none of the contributors who were in touch with MNT had access to any specialized resources through their healthcare providers.

They confessed to navigating long COVID on their own, with informal support from dedicated online groups set up by people in similar situations, such as the Body Politic support group.

Some of them have been researching treatments and coping strategies online, turning to Reddit forums and YouTube videos discussing potentially helpful medication for people with long COVID...

Doctors’ perspectives

It remains unclear why menstrual cycles might be affected during and after COVID-19.

...According to one study published in Reproductive BioMedicine Online in September, of 177 individuals with COVID-19 with menstrual records, 45 (25%) reported changes in the volume of menstrual blood, and 50 (28%) saw various changes to their menstrual cycles, such as lighter bleeding or longer-lasting periods.

The study participants were part of a cohort of people with COVID-19 who had received care at Tongji Hospital in Shanghai, China.

...Those who are navigating the effects of long COVID and its impact on periods without help from medical experts are calling for more insights into the possible consequences of this disease on the body and better overall care and specialist support...

des. 16, 2020, 3:40am

A mysterious gap in COVID-19 deaths appeared in Florida before the presidential election
Cindy Krischer Goodman and David Fleshler | December 15, 2020, 9:47 PM EST

FORT LAUDERDALE, Fla. — An astonishing pattern has emerged in Florida’s COVID-19 death tally — one that suggests the state manipulated a backlog of unrecorded fatalities, presenting more favorable death counts in the days leading up to the 2020 presidential election.

At issue is the state’s handling of the lag between the date someone dies and the date Florida reports that death in the public count. With minor exceptions, Florida quit including long-backlogged deaths in its daily counts on Oct. 24, 10 days before the Nov. 3 election, and resumed consistently including them on Nov. 17, two weeks after the election.

The result: The daily death numbers Floridians saw during that time were significantly lower than they otherwise would have been...

des. 17, 2020, 3:03am

First U.S. adverse COVID-19 vaccine reaction reported in Alaska healthcare worker
Kate Winkle | Dec 16, 2020

...Alaska’s Chief Medical Officer...Dr. Anne Zink said the woman felt flush, was short of breath, had an elevated heart rate and a rash. She was taken to the emergency room and was kept overnight Wednesday but is now considered healthy. A total of 84 people, including the woman, were vaccinated at the hospital Tuesday. The hospital’s protocol is to observe everyone who gets the vaccine for 30 minutes after they’ve been given a dose.

The woman did not have a history of allergies, Zink told KTUU. She said, however, that health officials were aware a side effect like this could happen because of reports previously of two people in England with a similar reaction. The United Kingdom in early December reported it was investigating two adverse reactions to the Pfizer-BioNTech vaccine in people who had a “significant history” of allergic reactions.

Guidelines from the Centers for Disease Control say those administering vaccines should observe them after they receive the shot, and that “Appropriate medical treatment used to manage immediate allergic reactions must be immediately available in the event that an acute anaphylactic reaction occurs following administration of Pfizer-BioNTech COVID-19 vaccine.”...

Editat: des. 17, 2020, 10:58am

Wow, Rs unwillingness to stay at home and reduce social mobility, quantified:

Science Magazine @ScienceMagazine | 2:00 AM · Dec 17, 2020:
In the U.S., political partisanship has had ~27x more influence than
local #COVID19 incidence on individual social mobility decisions during the pandemic,
says a new study*in @ScienceAdvances based on >1mil surveys collected over 5 mos...

Graph ( )


*J. Clinton et al. 2020. Partisan pandemic: How partisanship and public health concerns affect individuals’ social mobility during COVID-19. Science Advances 11 Dec 2020:eabd7204 DOI: 10.1126/sciadv.abd7204

Rampant partisanship in the United States may be the largest obstacle to the reduced social mobility most experts see as critical to limiting the spread of the COVID-19 pandemic. Analyzing a total of just over 1.1 million responses collected daily between April 4th and September 10th reveals not only that partisanship is more important than public health concerns for explaining individuals’ willingness to stay-at-home and reduce social mobility, but also that the effect of partisanship has grown over time – especially among Republicans. All else equal, the relative importance of partisanship for the increasing (un)willingness of Republicans to stay-at-home highlights the challenge that politics poses for public health.


ETA Guidelines, prospects...

Protesters burn masks outside Florida Department of Health over COVID vaccine
Jessica Schladebeck | Dec 16, 2020

Protesters enraged over the prospect of a mandatory coronavirus vaccine torched face masks and waved signs denouncing government-mandated shutdowns outside the Florida Department of Health.

Members of two different groups, “Reopen South Florida” and “Florida Freedom Keepers,” gathered in front of the Fort Lauderdale building to protest guidelines and changes brought on by the pandemic, which has infected more than 1.1 million residents across the Sunshine State...


Governor Christie @GovChristie | 5:41 PM · Dec 16, 2020:
I am very happy today for this ad to start to run on TV across America.
I urge all Americans to learn from my experience and to, please, wear a mask and stay safe.

0:30 ( )

des. 17, 2020, 8:32pm

The single day death from Covid-19 surpassed the daily death totals (each) in USA from heart disease and from cancer.

Editat: des. 18, 2020, 12:18pm

Testing, PPE, now vaccines...
NO END to Trumpian incompetence (and corruption?), apparently.

Pfizer COVID-19 Vaccine Production and Distribution Working Well

New York, NY, December 17, 2020 –Pfizer Inc. (NYSE: PFE) today released the following statement to address public comments that allege there are issues in the production and distribution of the company’s COVID-19 vaccine:

“Pfizer is not having any production issues with our COVID-19 vaccine, and no shipments containing the vaccine are on hold or delayed. This week, we successfully shipped all 2.9 million doses that we were asked to ship by the U.S. Government to the locations specified by them. We have millions more doses sitting in our warehouse but, as of now, we have not received any shipment instructions for additional doses...

ETA: No written plan shared with Biden team = no written plan?

Biden on Trump administration distributing vaccine: 'There is no detailed plan'
Kate Sullivan | December 4, 2020


Walter Shaub @waltshaub | 8:27 AM · Dec 18, 2020:
Corruption and incompetence in government are deadly. They kill people all over the world. In other news, the Trump administration has stopped coordinating with Pfizer on the delivery of vaccine doses that have to be stored at 94 degrees Fahrenheit below zero.

Quote Tweet
Eric Feigl-Ding @DrEricDing · 6h
Whoa—Pfizer says Trump admin has stopped giving destinations for “millions more doses sitting in our warehouses”. Trump HHS is allowing #COVID19 vaccines to *just sit there* unused. Is this—

1) Incompetence/negligence?
2) Throttling for 2nd dose?
3) Hoarding for other reason?

Image--Pfizer statement ( )

2) Multiple states are reporting cuts to their promised vaccine allotments. Still unclear why. Florida says it’s production delays but no other states are citing that reasons for their huge cuts

COVID vaccine shipments being reduced by feds to some states
The federal government has told Illinois and Michigan their coronavirus vaccine shipments are being significantly reduced.

3) the cuts are pretty severe - from 30-50% reductions to promised vaccine deliveries. Weird.
Image-text on delays and cutbacks by states ( )


Molly Jong-Fast (The Daily Beast) @MollyJongFast | 12:01 PM · Dec 18, 2020:
Rupert Murdoch got the Covid vaccine
the day after Tucker Carlson spent his entire show sowing doubt about the Covid vaccine.

Editat: des. 18, 2020, 1:15pm

Bell's palsy was reported in vaccine groups (7 cases) and control groups (1 case) of the two mRNA vaccine clinical trials. (~70,000 people in all). Not enough info to establish cause, so I'm sure FDA will be following closely. Per Mayo Clinic: "...The exact cause is unknown. It's believed to be the result of swelling and inflammation of the nerve that controls the muscles on one side of your face. Or it might be a reaction that occurs after a viral infection. For most people, Bell's palsy is temporary..." To keep in perspective, 1 in 1,000 (and counting) Americans have now died of COVID-19, not to mention those significantly and permanently harmed...

COVID-19 vaccine: American experts meet ahead of expected approval for Moderna's candidate
AFP | Dec 17, 2020

...To date, there have been three reports of Bell's palsy -- a facial paralysis condition, most often temporary -- in the vaccine group and one in the placebo group.

The Pfizer trial saw four people get Bell's palsy in the vaccine group, and none in the placebo group.

The FDA said there was insufficient information to determine that either vaccine was the cause...

des. 18, 2020, 1:30pm

Few guardrails to keep people from cutting in line for Covid shots

As soon as more doses become available to wider categories of people, much of the immunization program will rely on the honor system.

...While rich and famous individuals may not have an obvious advantage, rich and powerful corporations certainly will. As officials continue to hammer out their vaccine distribution plans for essential workers, lobbyists from a swath of industries are pressuring federal and state entities to give groups from pesticide manufacturers to zookeepers priority.

“It’s ultimately about who and what as a society do we value,” said former CDC Director Tom Frieden. “The key is to be completely transparent about the decision-making progress, because you aren’t going to maintain the public’s trust if it looks like people are jumping the line. When you’re in a situation of shortage like we’re in right now, you want to make sure that you don’t create even the appearance of impropriety.”..

des. 18, 2020, 1:52pm

Eric Topol (cardiologist, author) @EricTopol | Eric Topol | 1:20 PM · Dec 18, 2020

1. There are limited data about the vaccines for people who have had covid. But we can learn from the @Pfizer
@BioNTech and @moderna trials which had 3% and 2.2% participants respectively confirmed at baseline (via FDA briefing docs)

2. In the Pfizer trial there were 9 reinfections among 670 participants (1.3%) who received placebo which was the same rate as those without prior infection (259 of 19,818 participants, 1.3%).
Only 1 reinfection in the vaccine group (after ≥ 7 days) for those w/ prior infection

3. We need to learn more about this with so many people with prior infections getting vaccinated. But this finding suggests vaccine-induced immune response may add protection to the natural response and adds another layer to the superhuman concept:

Dennis R. Burton & Eric J. Topol. 2020. Toward superhuman SARS-CoV-2 immunity?(essay) Nature Medicine (Nov 30, 2020)

des. 18, 2020, 9:17pm

Third record-setting day in a row for US Covid-19 cases, hospitalizations, and deaths.

S. Cal. hospitals have 0% available ICU beds.

With runoff elections underway GA stands at over 500,000 Covid cases. Anticipate more since record turnout and reduced early voting sights lead to overcrowded voting lines across the state.

20% of US prisoners with Covid-19 have died. Two Federal death row prisoners awaiting execution test positive.

Anticipating Christmas travel to go ahead, damn the precautions and guidelines telling Americans to stay home, Dr. Fauci predicts Coronavirus wave upon wave. January will be hellish in terms of cases, strain on medical system, and numbers of fatalities.

Remember: Immunization from vaccine is not assured until AFTER the second dose of MRNA vaccine -- 3 weeks for Pfizer, 4 weeks for Moderna. WEAR a DAMN MASK after you are vaccinated.

des. 19, 2020, 6:19am

Geographical locations of allergic reactions to Pizevaccine made me wonder if vitamin D deficiency was linked to risk of anaplalaxis. A quick google turned up some suggestions that it may, e.g., , .

Vaccination program might be opportunity to determine whether D deficiency is linked to the allergic reactions--and hopefully to minimize or eliminate them.

Five allergic reactions to Pfizer vaccine in US, including Alaska's three:

Two people in the UK:

des. 19, 2020, 7:22am

Taking two different kinds of vaccine may help, or not, or even hurt. It may be warranted in some instances, e.g., if one has developed immunity to the vaccine, e.g., adenovirus platform, and it may happen accidentally, but it certainly is not ethical strategy before vaccines are widely available.

Should people take more than one type of COVID-19 vaccine?
Sarah Elizabeth Richards | December 18, 2020

...More than 200 COVID-19 vaccines are in development worldwide that involve eight different technology platforms, from innovative ones made of genetic material, such as DNA or messenger RNA, to classic varieties built from inactivated versions of the coronavirus. The question is whether taking more than one type will improve your immunity and offer longer-lasting protection.

...What’s unknown is whether you’d induce an even stronger response with a different form of the coronavirus vaccine. In immunology, the concept is called a “heterologous prime-boost,” and some studies suggest that it might be a more effective way to design vaccine regimens, especially for challenging diseases such as malaria, tuberculosis, and HIV.

The idea is that you might benefit from the best of two vaccine platforms by eliciting different subsets of T cells, immune system agents that come in “killer” and “helper” forms and play a critical role in attacking an unwanted virus. Those divergent responses would then work in harmony to deliver rock-solid immunity.

...Here’s a potential reason to take multiple kinds: Some researchers are concerned about viral-vector platforms due to the possibility that a body might develop immunity to the adenovirus itself. For example, the vector used by AstraZeneca and Oxford is an adenovirus that infects chimpanzees...Russia, Johnson and Johnson, and Chinese biotech CanSino Biologics are developing vaccines using human adenoviruses, which often cause common might be wise to follow up with a second vaccine, like the one developed by Maryland biotechnology company Novavax that delivers bioengineered spike proteins via nanoparticles...(Florian Krammer, professor of vaccinology at Icahn School of Medicine at Mount Sinai in New York City) says.

But the safety of any combination hasn’t been determined, and the U.S. Centers for Disease Control and Prevention recently warned against mixing the Pfizer-BioNTech vaccine with “other COVID-19 vaccine products.”

...A mix-up wouldn’t necessarily be dangerous, given that our bodies often encounter the same virus multiple times throughout our lifetimes. However, (Brianne Barker, an associate professor of biology who studies immunity and viruses at Drew University in Madison, New Jersey) cautions that people shouldn’t miss the second shot of their original vaccine series. “If you had two different vaccines that used different parts of the virus, you would make two different immune responses instead of getting a boost to the first one,” she says...“It might further boost your immune response, but whether that boost matters is not clear...More doesn’t necessarily last longer in your body. At some point, you get enough of a response, so more doesn’t add anything.”

How long any of these COVID-19 vaccines last is a critical missing piece of the vaccine puzzle... People who are participating in vaccine clinical trials are having their antibody levels tracked over time. Otherwise, you can get a commercial antibody test to detect when such proteins are generated in response to a vaccine or infection...Other research suggests that the lingering presence of B cells, which make antibodies, and T cells also plays an essential role.

...“I don’t think we have nearly enough information that people should start mixing and matching COVID-19 vaccines,” says (Angela Rasmussen, Georgetown University). “It’s a novel virus with a novel vaccine. We shouldn’t rush into it.”

Editat: des. 19, 2020, 7:54am

Europe is paying less than U.S. for many coronavirus vaccines
Michael Birnbaum, Christopher Rowland and Quentin Ariès | Dec. 18, 2020 at 7:57 p.m. EST appears that the 27-nation union has a 24 percent discount on the Pfizer vaccine, paying $14.76 per dose relative to $19.50 in the United States. Some of the difference may reflect that the E.U. subsidized that vaccine’s development and the cost of shipping the European-made shots across the Atlantic. (margd: at least some manufactured in Michigan)

..(EU) will pay 45 percent less than the United States for the AstraZeneca-Oxford vaccine currently under development. But it will pay 20 percent more than the United States for the Moderna vaccine, which on Friday was authorized for emergency U.S. use. Both of those vaccines were funded partly by the U.S. government as part of Operation Warp Speed, an effort to expedite their development. The AstraZeneca-Oxford team received $1.2 billion, and Moderna got $4.1 billion.

...Pfizer noted that the E.U. coronavirus vaccine purchase, 200 million doses, was double that of the United States.

...“AstraZeneca is providing the vaccine at no profit during the pandemic and the price per dose varies depending on the supply chain. We are unable to comment on specific agreements,” the company said in a statement. The company has previously said it expected its vaccine to cost between $3 and $5 a dose, based on the cost of production. It was not clear why the E.U. figure was so much lower.

...“Based on the significantly varying levels of developmental funding, distribution costs, and other contract terms, we are confident we negotiated the best possible price for the American taxpayer,”' (Operation Warp Speed ) said in a statement. It noted that the price of Pfizer’s vaccine included distribution across the United States and territories, including charter flights from manufacturing sites in Europe.

The two vaccines that are first in line for approval — Pfizer-BioNTech and Moderna — are more expensive than others partly because they cost more to make, the result of a never-before-used approach that primes the immune system to defeat the

...The E.U.’s finance arm offered a $122 million loan to BioNTech in June to help develop the vaccine, followed by an additional $458 million from the German government in September. (Warp Speed did not finance the Pfizer-BioNTech vaccine.)

The other vaccine prices noted on the E.U. list were $9.30 for the one under development by Sanofi and GlaxoSmithKline, an 11 percent discount on the U.S. cost, and $12.30 for the one under development by CureVac, for which the United States has not signed contracts.

...confidentiality clauses presumably benefit the manufacturers, since they make it easier to vary prices from country to country.

Drug pricing is linked to a number of factors, including volume discounts and other specific promises made by governments when they sign the contracts. Some governments have agreed to limit the liability drug manufacturers will face if side effects arise from the vaccines, for instance. In February, the Trump administration offered vaccine manufacturers protection from lawsuits until 2024.

Europe has spread its bets relatively evenly among six vaccines, reserving 200 million to 300 million doses of all of them except the one produced by Moderna, of which it purchased 80 million...

des. 19, 2020, 1:30pm

>76 margd:

States were left scrambling after finding out they'd get 20-40% less vaccine than promised. We now know why.
Elizabeth Weise | Dec 19, 2020

In the first major hiccup of the rollout of the coronavirus vaccine, states this week found themselves scrambling to adjust as they received word they would get between 20% and 40% less vaccine next week than they had been told as late as Dec. 9.

States were given estimates that turned out to be based on vaccine doses produced, not those that had completed quality control and were releasable.Only on Wednesday and later were states informed of the actual numbers.

...After three days of confusion, the source of the problem was finally clarified Friday night by Gov. Jay Inslee of Washington state. He tweeted he'd had a "very productive" conversation with Gen. Gustave Perna, chief operating officer for Operation Warp Speed, the administration's COVID-19 treatment and vaccine program. "That discrepancy was the source of the change in allocations....It appears this is not indicative of long-term challenges with vaccine production."

..."At the end of the day, I accept responsibility for the miscommunication," (Perna) said. "Where I failed – I failed, nobody else failed – is to have a clear understanding of that cadence. But when I applied it into our forecast methodology and our planning with the states, I realized that there was a delta to the numbers that I personally thought were available and ready for distribution and what was releasable," he said.

The sudden shift and lack of clarity for several days represent a huge headache for states as they scramble to adjust their vaccination programs.

...The discrepancy represents a major breakdown in communicating the most essential information states rely on for vaccine rollout, said Dr. Kelly Moore, associate director of immunization education with the Immunization Action Coalition.

"The number one question you have if you're a state vaccination program is: 'How many doses do I have?' Everything you do flows from the answer to that one question," she said.

A last-second change of this magnitude in states' vaccine projections represents "an unforced error," she said, referring to a missed point in tennis due to a player's own blunder and not their opponent's skill.

"The states are real people making real plans based on the numbers. They deserve the truth, whatever it is," she said. "They can handle it. What they can't handle is a 40% drop with less than a week's notice."

Editat: des. 20, 2020, 5:44am

Britain tightens lockdowns over virus mutation with ‘significantly faster’ transmission rates
Boris Johnson imposes new coronavirus restrictions for Christmas in Britain
William Booth | Dec. 19, 2020

LONDON — Faced with a newly emerging and highly transmissible mutation of the coronavirus with "significantly faster" spread rate, British Prime Minister Boris Johnson on Sunday tightened pandemic restrictions, returning London and parts of England to virtual lockdown and breaking earlier promises for relaxed rules over the holidays.

The new mutation, or variant, of the virus was first detected in southeast England in September and is quickly becoming the dominant strain in London and other parts of the country.

At an evening news conference from 10 Downing Street, Johnson said new variant was “up to 70 percent more transmissible.” He added, “this is spreading very fast.”

England’s chief medical officer, Chris Whitty, said there is no evidence at this time to suggest the new strain causes more serious illness, is more deadly or is able to elude the vaccines designed to defeat it. But he said 62 percent of new cases in London are now driven by the variant...

des. 19, 2020, 5:43pm

Ann Gibbons. 2020. Neanderthal gene found in many people may open cells to coronavirus and increase COVID-19 severity. Science (Dec. 18, 2020)

...A small but significant number of people have an ancient gene variant from the extinct hominin that may double, or even quadruple, their risk of serious complications from COVID-19.

The finding, posted last week as a preprint on bioRxiv, shines a light on an enzyme called dipeptidyl peptidase-4 (DPP4). Scientists already know the protein allows another coronavirus, which causes Middle Eastern respiratory syndrome (MERS), to bind to and enter human cells. The new analysis, of DPP4 gene variants among COVID-19 patients, suggests the enzyme also provides SARS-CoV-2 with a second door into our cells, along with its usual infection route via the angiotensin-converting enzyme 2 (ACE-2) receptor on cell surfaces.

The conclusion remains tentative...


Hugo Zeberg and Svante Pääbo. 2020. The MERS-CoV receptor gene is among COVID-19 risk factors inherited from Neandertals
BioRxiv (Dec 12, 2020) doi:

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


In the current SARS-CoV-2 pandemic, two genetic regions derived from Neandertals have been shown to increase and decrease, respectively, the risk of falling severely ill upon infection. Here, we show that 2-8% of people in Eurasia carry a variant promoter region of the DPP4 gene inherited from Neandertals. This gene encodes an enzyme that serves as a receptor for the coronavirus MERS-CoV and is currently not believed to be a receptor for SARS-CoV-2. However, the Neandertal DPP4 variant doubles the risk to become critically ill in COVID-19.

Editat: des. 20, 2020, 4:21am

>68 margd: diminished flu season, contd. (fact check)

No, Harvey Staub the ‘Pharmacist’ Is Not Right About COVID
Alex Kasprak | 18 December 2020

Tweets claiming to be authored by a pharmacist assert that a decline in Tamiflu sales proves COVID-19 is not as dangerous as claimed. It's a great case study in how not to use data.

des. 20, 2020, 4:23am

No, COVID-19 is not a simulation (fact check)
Ciara O'Rourke | December 17, 2020

stated on December 11, 2020 in a Facebook post: “This whole COVID thing? It’s a SIMULATION.”

The COVID-19 pandemic is not a simulation. The virus has infected more than 74 million people around the world and caused more than 1.65 million deaths....

des. 20, 2020, 4:27am

Instagram Post Distorts Facts on COVID-19 Death Reporting (fact check)
Angelo Fichera | December 16, 2020

(Robert F. Kennedy Jr.) Instagram post falsely claims that the Centers for Disease Control and Prevention is reporting all pneumonia and influenza deaths as caused by COVID-19. That’s wrong and is based on a misreading of one type of monitoring the agency conducts...

Editat: des. 20, 2020, 5:13am

COVID-19 Vaccines and Severe Allergic Reactions
Updated Dec. 19, 2020

What CDC Recommends
Safeguards Are in Place
CDC Is Monitoring Reports of Severe Allergic Reactions

CDC issues new guidance addressing allergic reactions to coronavirus vaccine
Jordan Williams - 12/19/20

...The guidelines come after the Food and Drug Administration (FDA) said it was looking into five severe reactions to Pfizer’s vaccine reported this week. Two reactions were reported in Alaska, and the others have been reported in other states.

...Peter Marks, who leads the agency’s Center for Biologics Evaluation and Research, told reporters that the agency wasn’t sure what caused the reaction, but said a chemical called polyethylene glycol, which is present in Pfizer and Moderna’s coronavirus vaccine*, “could be the culprit.”...

* also in many foods, cosmetics, meds, eg., the laxative Miralax.

des. 20, 2020, 5:29am

Find Your Place in the (US) Vaccine Line (interactive tool)
Stuart A. Thompson. Illustrations by Jorge Colombo | Dec 3, 2020

...logistical challenges...

Editat: des. 20, 2020, 8:01am

>85 margd: new strain in UK, contd.
Here in US, so many states are already running out of hospital beds. Holiday gatherings could push hospitals over the edge--never mind virtually unavoidable introduction of a more infectious strain. A reason, as if we needed one, to be extra cautious...

COVID-19: Is the new coronavirus mutation worse than first thought?
The strain, known as VUI-202012/01, may be up to 70% more transmissible - and brings an "unusually large number" of changes.
Emily Mee | 20 December 2020

...Prime Minister Boris Johnson said the new variant strain, VUI-202012/01, may be up to 70% more transmissible and could increase the R number by 0.4.

The latest figures suggest that this strain is responsible for 43% of new infections in the South East - rising to 59% of new cases in the East of England and 62% in London.

Professor Chris Whitty, England's chief medical officer, said: "Those have gone up very, very fast over the last few weeks."

...Sir Patrick Vallance, the chief scientific adviser, added that "an unusually large number of variants" - 23 different changes - have been identified with this new strain.

...Professor Whitty said there was "no current evidence to suggest the new strain causes a higher mortality rate or that it affects vaccines and treatments", but work was under way to confirm this.

...Professor Whitty said that, as of now, there was no evidence to suggest the new strain affected vaccines and treatments.

...So far, there have been at least seven major groups, or strains, of COVID-19 as it adapts to its human hosts...the L strain...S...V and G...GR, GH and GV...O...mink...A specific mutation, D614G, is the most common variant...the original L strain and the V strain are gradually disappearing...

Dr Emma Hodcroft @firefoxx66 | 1:15 PM · Dec 19, 2020

Where have we seen these variants so far?

For the UK variant:
In the UK, we see sequences from England, Wales (a little hard to see) and Scotland. None in Northern Ireland so far...

For the UK variant:
Outside of the UK, we see very small numbers of sequences in Denmark (a bit hard to see - hidden behind UK circle) & Australia. Their position on the tree indicates that they're likely exports from the UK...

For the South Africa variant (similar to UK strain, evolved independently, fewer mutations):
So far, we only see this in South Africa...

In Europe, the UK & Denmark are the most regular & prolific sequencers. So the variant could be elsewhere & not detected yet.
In Africa, same is true for South Africa.

More coordinated sequencing efforts regionally & globally would help us monitor variants...

COVID-19: Belgium joins Netherlands in halting air travel from UK following new virus strain discovery
The Dutch ban will last until at least the end of 2020, while the Belgian order is only for 24 hours at the moment.
Sharon Marris and Tim Baker | 20 December 2020

...The move comes after Dutch health authorities confirmed at least one case of the (UK) variant

...UK flights to the Netherlands have been stopped (through Jan 1-, a move that Belgium has mirrored (24h for the moment) while also stopping rail connections.

...Germany is also understood to be considering action

...The World Health Organisation (WHO) "close contact" with the UK...

des. 20, 2020, 5:56am

...In Denmark, minks at a farm that got infected months ago later became **reinfected recently**—including with symptoms. Random sampling of 36 animals brought up 26 positives - all reinfected. This needs further study.

Minkfarm i Hjørring smittet med coronavirus for anden gang (Danish language)

- Eric Feigl-Ding @DrEricDing | 10:03 PM · Dec 5, 2020

des. 20, 2020, 7:13am

An Appeal for Rapid Antigen Tests for COVID-19
Letter to Congress from 50 scientists | December 15, 2020

December 15, 2020
An Appeal for Rapid Antigen Tests for COVID-19

On behalf of more than 50 leading infectious disease physicians, epidemiologists, scientists, and community leaders, we are calling on Congress to support widespread and frequent rapid antigen testing as a way to control the spread of the virus, re-open the country and let people return to work and school.

Over the next six months, it is our profound hope that the vaccination of the majority of Americans may bring substantial relief from COVID-19. Until then, widespread and frequent rapid antigen testing is one of the best available public health tools at our disposal today.

Antigen tests can detect contagious people early in the disease, before symptoms develop. Used appropriately, these tests could curb outbreaks of the virus by reducing transmission. They provide a critical layer of protection to supplement masks, social distancing, and other precautions. They can help bridge the gap until broad vaccination is achieved.

Our current testing approach relies heavily on medical diagnostic tests like PCR, which typically takes hours or days to return results. While useful for medical diagnosis, these tests can detect trace amounts of viral RNA, which can persist in the body for weeks after a person has stopped being contagious. Rapid antigen tests are not meant to replace diagnostic tests for symptomatic people or in hospitals. They are a screening tool to protect public health by quickly identifying individuals with contagious levels of the virus.

We appeal to the federal government to:

Allocate funding to deploy these tests. To allow sufficiently frequent use, we should appropriate $500 million - $1 billion to jump-start upfront manufacturing capacity and $5 billion - $10 billion to implement nationwide rapid antigen testing for one year. Such a modest investment would yield huge dividends to health, education, and the economy.

Create a regulatory pathway specifically for public health tests, so that these contagiousness tests can be evaluated distinctly from medical diagnostic tools, which serve a different purpose. It should set reasonable standards for these tests.

As long as SARS-Cov-2 remains prevalent, the economy will not fully rebound. When people feel safer, they will return to school, work, and travel. We urgently need widely available contagiousness tests: to protect public health, allow safe in-school instruction, and to restore our economy. The time to act is now.

Respectfully Signed By:

Michael Mina, MD, PhD. Assistant Professor, Department of Epidemiology, Harvard T. H. Chan School of Public Health, Center for Communicable Disease Dynamics and Associate Medical Director of Microbiology, Brigham and Women’s Hospital, Harvard Medical School

et al.

des. 20, 2020, 12:22pm
Tucker Carlson Defends Telling People They Should Be ‘Nervous’ About Vaccine Rollout: ‘The People In Charge’ Have ‘Moral Rottenness’

Has this dude looked in any mirrors recently? He
appears to be filled with hate and resentment just like
the cult leader he idolizes.

Murdoch has two bomb throwers working on his
sister networks ~ Tucker Carlson and Lew Dobbs.

des. 20, 2020, 6:54pm

These Drugs Might Prevent Severe COVID
Charles Schmidt on December 14, 2020
Even with vaccines on the way, treatments are needed to prevent the disease from getting worse—and to be ready for COVID-25, COVID-37, and so on

One of the current leading contenders for treating mild COVID is an antiviral pill that was previously developed for influenza. At first called EIDD-2801, the drug was found to protect mice from severe lung disease caused by two other coronaviruses—SARS-CoV and MERS-CoV.

Fluvoxamine, a pill used for treating anxiety disorders, shows some promise in treating early COVID.

Drug designers have also come up with a computer-generated synthetic protein that disables SARS-CoV-2 before it gains a foothold in the body. These proteins—called mini binders—deflect the virus more effectively than antibodies in human cells We see this as a prophylactic nasal spray that you could use, say, if you’re going to the airport or if you’re a medical worker going into a risky situation,

evidence that remdesivir, molnupiravir and other compounds are able to block multiple coronaviruses suggests that broad-based antivirals are feasible.

des. 21, 2020, 6:32am

Mutant coronavirus in the United Kingdom sets off alarms but its importance remains unclear
Kai Kupferschmidt | Dec. 20, 2020

...Scientists...are hard at work trying to figure out whether B.1.1.7 is really more adept at human-to-human transmission—not everyone is convinced yet—and if so, why. They’re also wondering how it evolved so fast. B.1.1.7 has acquired 17 mutations all at once, a feat never seen before.

...They think it happened during a long infection of a single patient that allowed SARS-CoV-2 to go through an extended period of fast evolution, with multiple variants competing for advantage.

One reason to be concerned, Rambaut says, is that among the 17 are eight mutations in the gene that encodes the spike protein on the viral surface, two of which are particularly worrisome. One, called N501Y, has previously been shown to increase how tightly the protein binds to the ACE2 receptor, its entry point into human cells. The other, named 69-70del, leads to the loss of two amino acids in the spike protein and has been found in viruses that eluded the immune response in some immunocompromised patients.

...B.1.1.7 (also called VUI-202012/01, for the first “variant under investigation” in December 2020), appears to be spreading faster than other variants in the United Kingdom...PCR tests, which the U.K. conducts by the hundreds of thousands daily and which are far quicker and cheaper than sequencing the entire virus, can help keep track of B.1.1.7.

...further reason for concern comes from South Africa, where scientists have sequenced genomes in three provinces where cases are soaring: Eastern Cape, Western Cape, and KwaZulu Natal. They identified a lineage separate from the U.K. variant that also has the N501Y mutation in the spike gene....

Another worry is that B.1.1.7 could cause more severe disease. There is anecdotal evidence that the South African variant may be doing that in young people and those who are otherwise healthy...

Still, B.1.177, the strain from Spain, offers a cautionary lesson, says virologist Emma Hodcroft of the University of Basel. U.K. scientists initially thought it had a 50% higher mortality rate, but that turned out to be “purely messy, biased data in the early days,” she says. “I think that is a very strong reminder that we always have to be really careful with early data.” In the case of N501Y, more young people may be getting sick because many more are getting infected; Oliveira says some recent post-exam celebrations in South Africa have turned into superspreading events...

...Ravindra Gupta, a virologist at the University of Cambridge...found that virus carrying...two mutations was less susceptible to convalescent plasma from several donors than the wildtype virus. That suggests it can evade antibodies targeting the wildtype virus...Gupta...found that...deletion (in) spike protein...alone made that virus twice as infectious. He is now conducting similar experiments with viruses that carry both the deletion and the N501Y mutation. ...

Does it occur elsewhere?

...scientists say B.1.1.7 may already be much more widespread. Dutch researchers have found it in a sample from one patient taken in early December...Other countries may well have the variant as well, says epidemiologist William Hanage of the Harvard T.H. Chan School of Public Health; the United Kingdom may just have picked it up first because that country has the most sophisticated SARS-CoV-2 genomic monitoring in the world. Many countries have little or no sequencing.

The evolutionary process that led to B.1.1.7 may also occur elsewhere. With vaccines being rolled out, the selective pressure on the virus is going to change, meaning variants that help the virus thrive could be selected for, says Kristian Andersen, an infectious disease researcher at Scripps Research. The important thing in the coming months will be picking up such events, says Andersen. “Whatever enabled the B.1.1.7 lineage to emerge is likely going on in other parts of the world”, he says. "Will we be able to actually detect it and then follow up on it? That, to me is one of the critical things.”

des. 21, 2020, 11:25am

Ontario to implement provincewide lockdown on Christmas Eve, sources say
CBC News · Posted: Dec 20, 2020

Southern Ontario to be under a 28-day lockdown, 14-day lockdown for northern Ontario: sources

...only essential businesses remaining open...
...Winter break would be extended for elementary students for a period of one to two weeks...


A good reason to defer Brexit?

Britain’s isolation grows as more nations ban travel due to coronavirus variant
AP | Dec 20, 2020

...The virus variant has swept across southern England and led to tighter domestic restrictions on people’s movements. For fear of its spread, Canada, India, Hungary and Switzerland have become the latest nations to halt flights from Britain. New York Gov. Andrew Cuomo said he wanted a ban on flights from the U.K. to New York City.

France, Germany, Italy, the Netherlands, Belgium, Austria, Ireland, Poland and Bulgaria had already announced restrictions on U.K. travel hours after British Prime Minister Boris Johnson announced that Christmas shopping and gatherings in southern England must be canceled because of rapidly spreading infections blamed on the new coronavirus variant.

Johnson immediately put those regions into a strict new Tier 4 restriction level, upending holiday plans for millions.

France banned all travel from the U.K. for 48 hours from midnight Sunday, the prime minister’s office announced. The French statement said that would buy authorities time to find a “common doctrine” on how to deal with the threat...

des. 22, 2020, 4:15am

Did the Vatican Say It’s OK To Get the COVID-19 Vaccine?
The Holy See gave Catholics the green light to get vaccinated against the pandemic disease.
Bethania Palma | 21 December 2020

The Vatican said it's morally acceptable for Catholics to receive a coronavirus vaccine, even though the vaccines were developed using research on cells from fetuses that were aborted "in the last century."

Rating: True...

...The statement from the Vatican comes after two U.S. bishops. one in California and one in Texas, stated publicly that they wouldn’t take the vaccines, denouncing them as immoral because of the use of research on aborted fetal cells in their development...

Note on the morality of using some anti-Covid-19 vaccines
Dec 21, 2020

des. 22, 2020, 9:16am

Pandemic now global:

COVID-19 Strikes Antarctica, Its 7th Continent, As Chilean Base Hit With Virus
Aila Slisco | 12/22/20

des. 23, 2020, 3:33am

The UK strain appears to be susceptible to convalescent serum. Virologists are applauding Menachery Lab for quickly sharing their findings. Sounds like more to study but this is welcome news.

The Menachery Lab @TheMenacheryLab | 2:07 PM · Dec 22, 2020:
I would prefer this in a manuscript, but given the time of year and that I'm tired, I'll just tweet the data regarding the UK #COVID19 variant:

PRNT50 values from COVID patients for SARS2 WT WA1 vs a mutant that contains N501Y (among other spike mutations).
Image ( )

At least for N501Y, there is not huge shifts in neutralization based on sera from previously infected COVID patients.

UK Variant has other spike mutations that could impact neutralizations. This does not say anything about transmissibility or infection.

So this wasn't what I expected when I posted.

This is obviously not peer reviewed & we had this mutant and this data before the UK variant was a thing.

Many groups I have talked with have already started working on this, so the definitive data and experiments are on the way

Florian Krammer @florian_krammer | 4:18 PM · Dec 22, 2020:
...Sera from people who had COVID-19 neutralizes the regular SARS-CoV-2 and a variant that has N501Y (the British mutation we are most concerned about) equally well.

McLellan Lab @McLellan_Lab | 5:58 PM · Dec 22, 2020:
I am more concerned about the two deletions in NTD loops than the N501Y substitution

Florian Krammer @florian_krammer | 6:03 PM · Dec 22, 2020:
Yep, needs to be looked at too.

des. 23, 2020, 10:14am


Study Suggests Link Between Sleep Supplement and COVID-19
Krystle Vermes | Dec 22, 2020 addition to melatonin’s effects on sleep, it plays a critical role in calibrating the immune system. Its role as a moderator may lead to it one day protecting the body from going haywire when exposed to disease.

A study* published as recently as November took a closer look at the theory. People who took melatonin seemed to have significantly lower odds of developing COVID-19, and other researchers started to notice a pattern. At the moment, eight clinical trials are currently being carried out to determine if the link between melatonin and the novel coronavirus is legitimate...

* Yadi Zhou et al. 2020. A network medicine approach to investigation and population-based validation of disease manifestations and drug repurposing for COVID-19. PLOS BIOLOGY (November 6, 2020)

...We identified that melatonin usage …is significantly associated with a 28% reduced likelihood of a positive laboratory test result for SARS-CoV-2 confirmed by reverse transcription–polymerase chain reaction assay. Using a PS matching user active comparator design, we determined that melatonin usage was associated with a reduced likelihood of SARS-CoV-2 positive test result compared to use of angiotensin II receptor blockers.. . or angiotensin-converting enzyme inhibitors…. Importantly, melatonin usage… is associated with a 52% reduced likelihood of a positive laboratory test result for SARS-CoV-2 in African Americans after adjusting for age, sex, race, smoking history, and various disease comorbidities using PS matching. In summary, this study presents an integrative network medicine platform for predicting disease manifestations associated with COVID-19 and identifying melatonin for potential prevention and treatment of COVID-19.

Editat: des. 23, 2020, 11:08am

Even young athetes...

Eric Topol (cardiologist) @EricTopol | 9:27 AM · Dec 23, 2020:
Athletes, covid-19, and myocarditis. Until now the MRI studies were without controls. A @VanderbiltU report of 59 athletes w/ 2 control groups found 2 (3%) who were asymptomatic with myocarditis.

Daniel E. Clark e al. 2020. COVID-19 Myocardial Pathology Evaluation in AthleTEs with Cardiac Magnetic Resonance (COMPETE CMR) Ciration (Originally published17 Dec 2020)

des. 23, 2020, 10:02pm

"lipid nanoparticles (LNPs) that help carry it to human cells but also act as an adjuvant, a vaccine ingredient that bolsters the immune response. The LNPs are “PEGylated”—chemically attached to PEG molecules that cover the outside of the particles and increase their stability and life span."

Suspicions grow that nanoparticles in Pfizer’s COVID-19 vaccine trigger rare allergic reactions
Jop de VriezeDec. 21, 2020 , 5:10 PM

...The two vaccines both contain mRNA wrapped in lipid nanoparticles (LNPs) that help carry it to human cells but also act as an adjuvant, a vaccine ingredient that bolsters the immune response. The LNPs are “PEGylated”—chemically attached to PEG molecules that cover the outside of the particles and increase their stability and life span.

PEGs are also used in everyday products such as toothpaste and shampoo as thickeners, solvents, softeners, and moisture carriers, and they’ve been used as a laxative for decades. An increasing number of biopharmaceuticals include PEGylated compounds as well.

...PEGs were long thought to be biologically inert, but a growing body of evidence suggests they are not. As much as 72% of people have at least some antibodies against PEGs, according to a 2016 study led by Samuel Lai, a pharmaco-engineer at the University of North Carolina, Chapel Hill, presumably as a result of exposure to cosmetics and pharmaceuticals. About 7% have a level that may be high enough to predispose them to anaphylactic reactions, he found. Other studies have also found antibodies against PEG, but at lower levels.

“Some companies have dropped PEGylated products from their pipeline as a result,” Lai says. But he notes that the safety record of many PEGylated drugs has persuaded others that “concerns about anti-PEG antibodies are overstated.”

If PEG does turn out to be the culprit, the question is, what can be done? Screening millions of people for anti-PEG antibodies before they are vaccinated is not feasible. Instead, CDC guidelines recommend not giving the Pfizer or Moderna vaccines to anyone with a history of severe allergic reaction to any component of the vaccine. For people who have had a severe reaction to another vaccine or injectable medication, the risks and benefits of vaccination should be carefully weighed, CDC says. And people who might be at high risk of an anaphylactic reaction should stay at the vaccination site for 30 minutes after their shot so they can be treated if necessary.

“At least anaphylaxis is something that happens quickly,” Philips says. “So, it’s something that you can be very much alerted to, prepared to recognize early and be prepared to treat early.”...

Editat: des. 24, 2020, 5:36am

Common childhood vaccine could protect against COVID-19
Tom Regan | December 23, 2020

...University of Georgia molecular biologist David Hurley...and principal investigator Jeff Gold say they recruited 80 people for their study on the MMR vaccine. Those with high levels of vaccine anti-bodies appeared nearly immune to the coronavirus from family members who tested positive for the virus.

“They were living with a husband or wife who had an active disease, but for whatever reason, they never tested positive themselves or contracted any symptoms,” said Gold.

Gold said they saw further evidence of a reduced likelihood of severe COVID infections in populations with mass MMR inoculations, like the US military, where the vaccine is required. Out of 86,000 reported COVID cases, there were 13 deaths.

...According to Gold and Hurley, countries that have had mass MMR inoculations programs in recent years also have had relatively few COVID cases.

Both researchers are waiting for the results of a major clinical trial of the MMR vaccine on 30,000 health care workers to measure its disease fighting effectiveness against the coronavirus.

des. 25, 2020, 9:51am

Pulse Oximeter Devices Have Higher Error Rate in Black Patients
Roni Caryn Rabin | Dec. 22, 2020

A study* showed that the devices, which measure oxygen levels in the blood, were three times more likely to give misleading readings among African-American patients.


Michael W. Sjoding et al. 2020Racial Bias in Pulse Oximetry Measurement (Letter). N Engl J Med 2020; 383:2477-2478 (December 17, 2020) DOI: 10.1056/NEJMc2029240 two large cohorts, Black patients had nearly three times the frequency of occult hypoxemia that was not detected by pulse oximetry as White patients. Given the widespread use of pulse oximetry for medical decision making, these findings have some major implications, especially during the current coronavirus disease 2019 (Covid-19) pandemic. Our results suggest that reliance on pulse oximetry to triage patients and adjust supplemental oxygen levels may place Black patients at increased risk for hypoxemia. It is important to note that not all Black patients who had a pulse oximetry value of 92 to 96% had occult hypoxemia. However, the variation in risk according to race necessitates the integration of pulse oximetry with other clinical and patient-reported data.

In device applications, the Food and Drug Administration requires reporting of demographic subgroups to mitigate risk. However, our findings highlight an ongoing need to understand and correct racial bias in pulse oximetry and other forms of medical technology.

des. 26, 2020, 5:25am

News From the Centers for Disease Control and Prevention
December 22/29, 2020
Hospital Readmission Is Common Among COVID-19 Survivors
Bridget M. Kuehn, MSJ
JAMA. 2020;324(24):2477. doi:10.1001/jama.2020.23910
COVID-19 Resource Center

Nearly 1 in 10 patients who were discharged after receiving inpatient care for coronavirus disease 2019 (COVID-19) earlier this year were readmitted within 2 months, according to a recent study...

Having preexisting pulmonary disease, heart failure, diabetes, or chronic kidney disease increased patients’ odds of readmission...

Editat: des. 27, 2020, 12:18pm

Ashish K. Jha, MD, MPH @ashishkjha | 10:41 PM · Dec 25, 2020
~1M people vaccinated

Less than have had 10 allergic reactions

So, ~1 in 100K

Remember about 1 in 2,000 courses of penicillin leads to allergic reaction

1 in 200 folks have had anaphylaxis to meds at some point

Yes lets sort out cause of vaccine rxns

But perspective helpful

Quote Tweet
James Hamblin @jameshamblin · 8h
This is part of a dangerous trend in reporting each allergic reaction as news. A million people have been vaccinated. A few had allergic reactions. All turned out fine. More will occasionally happen. They don’t all need headlines. It inaccurately skews perception of risk.

des. 27, 2020, 8:43am

Oregon Hospitals Didn't Have Shortages. So Why Were Disabled People Denied Care?
Joe Shapiro | December 21, 2020

...Federal laws, notably the Americans with Disabilities Act and the Affordable Care Act, prohibit health care discrimination — including denial of care — based solely on a person's disability.

The Office for Civil Rights at the U.S. Department of Health and Human Services explained the law in guidance at the start of the pandemic. When care is scarce, doctors are allowed to decide who gets it and who doesn't. They can decide who is most likely to do best with that treatment by making an "individualized assessment of the patient" based on objective medical evidence.

But doctors can't rule out people because they have a specific disability — for example, dementia or using portable ventilators every day to help themselves breathe. "Persons with disabilities should not be denied medical care on the basis of stereotypes, assessments of quality of life, or judgments about a person's relative 'worth' based on the presence or absence of disabilities or age," the civil rights office explained.

OCR issued those guidelines on March 28 after national and state disability groups raised alarm that states had issued rationing plans that allowed discrimination against elderly and disabled people...29 states...issued "crisis standards of care" guidelines to doctors and health care systems about how to allot scarce medical care in case of a crisis — like a terrorism event, a natural disaster or a pandemic.

...In late June, (Oregon State Sen. Sara Gelser, who has an adult son with an intellectual disability, and who chairs Oregon's Senate Committee on Human Services) wrote and co-sponsored an anti-discrimination bill: Senate Bill 1606 (signed into law July 7). It bars doctors from forcing a do-not-resuscitate or do-not-intubate order on disabled or elderly patients, either as a condition of being admitted to the hospital or as a condition for treatment. It requires doctors to honor a person's medical orders for care.

...On Dec. 8, Oregon announced new "crisis care principles" for health care providers, who were then facing a surge of new COVID-19 patients. Once again, there was fear of needing to ration scarce care. This time, the guidance from the Oregon Health Authority focused on the responsibility of doctors and hospitals to provide care in ways that did not discriminate against people on the basis of disability, race and other categories protected by civil rights law.

...The changes in Oregon echoed the evolution of guidelines in other states. State and national disability groups had brought complaints to the Office for Civil Rights at the federal Department of Health and Human Services, the agency that enforces anti-discrimination laws in health care.

...There has always been a bias against people with disabilities in the health care system, (Sen) Gelser says. It was largely hidden.

The coronavirus made it visible — and then the virus made it worse...

des. 28, 2020, 9:54am

COVID-19 Vaccination Considerations for Persons with Underlying Medical Conditions
CDC | Updated Dec. 26, 2020

People who have weakened immune systems
People who have autoimmune conditions
People who have previously had Guillain-Barre syndrome
People who have previously had Bell’s palsy
After vaccination, current guidelines to prevent the spread of COVID-19 should be followed

Editat: des. 28, 2020, 11:08am

Eric Feigl-Ding @DrEricDing | 6:01 PM · Dec 27, 2020:
RATIONING CARE has begun in Southern California w/ 0% ICU beds in many hospitals.
This is from a Pasadena, CA hospital declaring to all patients that #COVID19 emergency rationing of care has begun.
Care will be prioritized by survival likelihood. Sobering. We are now here.
Image--Patient Information Sheet ( )

BREAKING: TSA* screened 1,284,599 people at airport checkpoints nationwide yesterday, Sunday, Dec. 27.
It is the highest checkpoint throughput since the pandemic hit.
It is also the 6th day in the last 10 that volume has surpassed 1M.
If you choose to travel, please wear a mask.
- Lisa Farbstein, TSA Spokesperson TSA_Northeast | 7:54 AM · Dec 28, 2020

* Transportation Security Administration

Editat: des. 29, 2020, 6:24am

UK variant is more transmissible, but not more lethal.

Investigation of novel SARS-COV-2 variant: Variant of Concern 202012/01
Technical briefing document on novel SARS-COV-2 variant.
Public Health England | 21 December 2020. Last updated 28 December 2020

From a public health perspective, 'more transmissible' is not any better than 'more lethal'. Worse, sounds like, especially if failure to distance results in more patients, pushing hospitals over capacity, resulting in soaring mortality rates...

Adam Kucharski @AdamJKucharski | 9:40 AM · Dec 28, 2020
Why a SARS-CoV-2 variant that's 50% more transmissible would in general be a much bigger problem than a variant that's 50% more deadly. A short thread... 1/

As an example, suppose current R=1.1, infection fatality risk is 0.8%, generation time is 6 days, and 10k people infected (plausible for many European cities recently). So we'd expect 10000 x 1.1^5 x 0.8% = 129 eventual new fatalities after a month of spread... 2/

What happens if fatality risk increases by 50%? By above, we'd expect 10000 x 1.1^5 x (0.8% x 1.5) = 193 new fatalities. 3/

Now suppose transmissibility increases by 50%. By above, we'd expect 10000 x (1.1 x 1.5)^5 x 0.8% = 978 eventual new fatalities after a month of spread. 4/

The above is just an illustrative example, but the key message: an increase in something that grows exponentially (i.e. transmission) can have far more effect than the same proportional increase in something that just scales an outcome (i.e. severity). 5/5

des. 29, 2020, 11:13am


Eric Topol (cardiologist, author) @EricTopol | 8:02 PM · Dec 28, 2020:
How long is #LongCovid?
The most extensive symptom assessment and longest duration (7 months) of nearly 3,800 individuals shows how debilitating this is in young, predominantly women, w/ most unable to return to full prior work *
Image--graphs symptom perseverance, severity ( )

This work corroborates prior #LongCovid studies (that are still limited), extends the time window, and confirms the protracted difficulty in return to work and baseline activities

Good summary of #LongCovid multi-system effects in 10-25% of people >3 margd: months after infection by @sarahtoy17 @rddysum @danielas_bot w/ @trishgreenhalgh


* Hannah E. Davis et al. 2020. Characterizing Long COVID in an International Cohort: 7 Months of Symptoms and Their Impact. MedRxiv (Dec 27, 2020) doi:

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

Design International...
Setting Survey...

3,762 respondents from 56 countries completed the survey. 1166 (33.7%) were 40-49 years old, 937 (27.1%) were 50-59 years old, and 905 (26.1%) were 30-39 years old. 2961 (78.9%) were women, 718 (19.1%) were men, and 63 (1.7%) were nonbinary. 8.4% reported being hospitalized. 27% reported receiving a laboratory-confirmed diagnosis of COVID-19. 96% reported symptoms beyond 90 days.

Prevalence of 205 symptoms in 10 organ systems was estimated in this cohort, with 66 symptoms traced over seven months. Respondents experienced symptoms in an average of 9.08 ... organ systems. The most frequent symptoms reported after month 6 were: fatigue ..., post-exertional malaise ..., and cognitive dysfunction .... These three symptoms were also the three most commonly reported overall. In those who recovered in less than 90 days, the average number of symptoms peaked at week 2 ..., and in those who did not recover in 90 days, the average number of symptoms peaked at month 2 .... Respondents with symptoms over 6 months experienced an average of 13.8 ... symptoms in month 7. 85.9% ... experienced relapses, with exercise, physical or mental activity, and stress as the main triggers. 86.7% ... of unrecovered respondents were experiencing fatigue at the time of survey, compared to 44.7% ... of recovered respondents. 45.2% ... reported requiring a reduced work schedule compared to pre-illness and 22.3% ... were not working at the time of survey due to their health conditions.

Patients with Long COVID report prolonged multisystem involvement and significant disability. Most had not returned to previous levels of work by 6 months. Many patients are not recovered by 7 months, and continue to experience significant symptom burden.

des. 29, 2020, 12:57pm

Leana Wen, M.D. @DrLeanaWen* | 9:05 AM · Dec 29, 2020
Here’s the math: If the goal is to reach 80% of Americans vaccinated with a 2-dose #covid19 vaccine, it will take 10 years at our current pace. We are at 1 million vaccinations a week. To get to herd immunity by June 2021, we need to be at 3.5 million vaccinations a day.

1:00 ( )

* Leana Wen, M.D. @DrLeanaWen
Visiting Professor @GWPublicHealth + ER physician. Contributing columnist @WashingtonPost. CNN medical analyst. Frmr Baltimore City Health Commissioner. Mom.

des. 29, 2020, 1:08pm

>112 margd: contd.

Coronavirus Variant Is Indeed More Transmissible, New Study Suggests
Carl Zimmer and Benedict Carey | Dec. 23, 2020

...A team of British scientists released a worrying study on Wednesday of the new coronavirus variant sweeping the United Kingdom. They warned that the variant is so contagious that new control measures, including closing down schools and universities, might be necessary. Even that may not be enough, they noted, saying, “It may be necessary to greatly accelerate vaccine rollout.”

Nicholas Davies, the lead author of the study, said that the model should also serve as a warning to other countries where the variant may have already spread.

“The preliminary findings are pretty convincing that more rapid vaccination is going to be a really important thing for any country that has to deal with this or similar variants,” Dr. Davies, an epidemiologist at the London School of Hygiene and Tropical Medicine, said in an interview.

The study, released by the Center for Mathematical Modeling of Infectious Diseases at the London School of Hygiene and Tropical Medicine, has not yet undergone review by a scientific journal. The study compares a series of models as predictors of data on infections, hospitalizations and other variables; other researchers are studying the variant in laboratory experiments to determine if it is biologically distinct.

The study found no evidence that the variant was more deadly than others. But the researchers estimated that it was 56 percent more contagious...

des. 29, 2020, 2:05pm

>114 margd: The rollout has problems. People will die that might have lived given a perfect implementation. But is there really reason to believe that as we are a mere two weeks into the vaccination campaign, that the pace will not increase as initial problems are addressed?

Editat: des. 29, 2020, 3:19pm

The GB Covid-19 variant is turning out to be but one, possibly of many. Last week in Nigeria another was uncovered by scientists at the African Centre of Excellence for Genomics of Infectious Diseases (ACEGID).
ACEGID director Christian Happi said the variant was found in two out of 200 samples of virus collected from patients between 3 August and 9 October.

The two samples were taken from the same state in Nigeria at different times.

They show a variant "different to the one that has been circulating in Nigeria, different from the one in South Africa and different from the one in the UK," he said in an interview with AFP.
"We have no idea, no evidence to say that this variant is linked to the spike we are seeing in Nigeria or not," said Happi, explaining that samples from the latest cases were being analysed for an answer.
Yet, while cases have surged in Nigeria, a corresponding surge in deaths has not (yet) been evidenced.

Three new unrelated variants have sprung up and been discovered almost simultaneously. There can be little doubt that the novel Coronavirus is highly susceptible to mutation and that these new variants are similarly adapted to infect and produce disease in humans. Therefore, one of the best tools to try to get ahead of Covid-19 would be to conduct massive genomic analyses of as many isolated samples as possible. This is being done on a meaningful scale in Australia. But in the US, only about 1% of the total number of isolates have had genomic analysis done on them.

That means we remain ignorant of the percentage of sick individuals whose infections may be variants to the predominant one. Further, that leaves us in the dark to be able to detect strains that may be more infectious (like Covi-19-GB), or possibly more virulent, or lethal. From that ignorance we could continue to mass manufacture vaccine doses less capable of inducing immunity to an extent that herd immunity may not be achieved.. Immunity to an antigen depends on detailed and exact knowledge of it for the purpose of creating a successful antagonist (vaccine) that stimulates effective immune response (antibody), thus protection.

Let's hope that the intelligence the Biden Administration is harvesting from the national health experts during the transition informs them of the imperative desire to accelerate genomic analysis of meaningful samples of Covid-19 specimens.

Editat: des. 29, 2020, 4:15pm

>116 stellarexplorer: I hope we will improve. I'm reading that we have 50+ roll-out plans and apparently no overarching plan, state plans are insufficiently funded, 500 doses were lost to bad handling, more than a few examples of doses going to people whose turn it was not. On the upside only three countries are doing better per capita. With those new opportunistic strains emerging, though, we ALL need to do much better!!

U.S. likely to fall short of goal to vaccinate 20 million people against Covid before end of year
Noah Higgins-Dunn, Will Feuer | Dec 29 20203:07 PM EST

With only a few days left before the new year, the United States will likely fall short of its goal to vaccinate 20 million Americans by the end of 2020.

The Centers for Disease Control and Prevention said just over 11.4 million doses had been distributed but only about 2.1 million had been administered as of Tuesday.

The CDC cited data reporting lags and the pending launch of the federal government’s partnership with pharmacy chains as reasons for the gap between delivered and administered doses...

des. 29, 2020, 5:00pm

>117 Limelite: New variants are being created all the time. Every time the virus reproduces there's a chance of a mutation and with billions of viruses being created every time someone is infected every person infected will lead to many variants. Most of the time the mutation is to a part of the virus that has no effect on its functioning. The UK variant seems to be more infectious which makes it significant but is there any reason to believe that these other variants have significant differences?

des. 29, 2020, 8:02pm

>119 jjwilson61:

Variants that we can describe as insignificant, as you say, occur every time the virus infects a new host. But, most often never contribute to changes that make Covid-19 more infectious, or virulent, or lethal. However, the Covid-19-GB has given clues that it is much more infectious. So, some do. Determinant studies as yet to be made.

We can't yet expect the Nigerian and South African variants to have revealed their "meaning" as yet. A population needs to establish itself, if it ever will. And that requires time needed to gather, analyze, and set up a study with a control group.

Remember, quite a large number of people have to have the new variant for us to even have a chance of discovering it. I have no idea how many thousands of cases among the millions and millions of infected humans are required for the odds of finding a new variant become probable.

That we have a GB virus that seems to have made a significant and swift impact in Britain, and -- it is believed -- already is distributed throughout most of the world the implication exists that it may out compete the prevalent form and become the new dominant variant. This could be considered Covid-19 3.0, Wuhan and the present dominant variety being 1.0 and 2.0.

Considering we're only beginning to find out the long term persistence of symptoms, how different age groups, sexes, races, and pre-existing conditions affect response to the virus, we have no way of knowing if a new variant is a threat to public health, especially if we don't perform genomic analysis on as many cases as possible. Further, such studies may possibly give us clues on whether or not our present vaccines will be adequate and let us be able to alter them to respond to a variant, rare, or one on a path to become the new dominant one.

And the US is paying lip service to what may very well be crucial.

des. 30, 2020, 2:57am

Covid-19: Oxford-AstraZeneca coronavirus vaccine approved for use in UK
James Gallagher | Dec 30, 2020

...the Oxford-AstraZeneca vaccine will lead to a significant increase in vaccination as it is cheap and easy to mass produce.

Crucially it can be stored in a standard fridge - unlike the Pfizer-BioNTech jab which needs ultra cold storage at -70C - so it will be far easier to get the Oxford vaccine to care homes and GP surgeries.

...Public Health England said the country was facing "unprecedented" levels of infections, and health officials in parts of Wales, Scotland and the south of England voiced concerns about the increasing pressure on the NHS.

...The immunisation campaign will now shift to giving as many people as possible their first dose of vaccine.

The aim will be to give as many vulnerable people some protection from Covid-19.

...A Department of Health and Social Care spokesperson said: "The priority should be to give as many people in at-risk groups their first dose, rather than providing the required two doses in as short a time as possible.

"Everyone will still receive their second dose and this will be within 12 weeks of their first. The second dose completes the course and is important for longer term protection."...


S Korea not on this graph, but I thought I read that its vaccination program was among the best:

Max Roser @MaxCRoser | 2:20 PM · Dec 28, 2020:
Impressive how fast Israel is vaccinating its population.

They are already at 4.3%. And within the last 24 hours they reported that an additional 1% of their population received the first dose of the vaccine.

From @OurWorldInData's vaccination dataset:
Image--graph of % vaccine doses administered by top countries ( )


Rich countries will get access to coronavirus vaccines earlier than others:
World Map ( )


Just wondering: given cross-reactivity and that human coronavirus cause ~20% of colds,
will we see fewer colds when most people are vaccinated against SAR-CoV-19?

des. 30, 2020, 3:04am

>121 margd: Excellent news about the UK approval

Editat: des. 30, 2020, 3:31am

>118 margd: My personal view is that the issue is in significant part due to the federal government punting to overstretched and underfunded states, all the more under duress after almost a year of Covid-19. A new administration will do something to facilitate matters, which will be infinitely more than the current one is doing.

Trump took this position quite directly today in tweeting “It is up to the States to distribute the vaccines once brought to the designated areas by the Federal Government.”

If he doesn’t want the federal government to do this job, and hasn’t worked hard to make sure there is an efficient plan in place, no wonder it’s been much slower and less efficient than it otherwise would. Call me a blind optimist, but I really foresee this getting better over time, especially after Jan 20.

Editat: des. 30, 2020, 3:32am

>120 Limelite: I appreciate that you are calling attention to a potential risk, and we should do everything possible to exercise caution, and as proactively as we can.

Another point of view is that never before in history has as much scientific and intellectual power been brought to bear on one pathogen; that the virology and epidemiology communities are now well aware of the issue and are not ignoring it; and that the new vaccine technologies give us powerful tools should we ever need to modify Covid-19 mRNA vaccines. These ideas don’t guarantee that no harm will come from SARS-CoV-2 mutation, but they are relevant when considering how to regard the inevitable mutations that will arise.

Editat: des. 30, 2020, 10:48am

COVID-19 in the U.S.: How do Canada's provinces rank against American states?
Jesse Tahirali | August 5, 2020 10:30AM EDT Last Updated Wednesday, December 30, 2020

des. 30, 2020, 11:43am

>121 margd: Astrazeneca "The priority should be to give as many people in at-risk groups their first dose, rather than providing the required two doses in as short a time as possible. Everyone will still receive their second dose and this will be within 12 weeks of their first. The second dose completes the course and is important for longer term protection."

If I understand below correctly,
After first dose, efficacy increases even if second dose delayed to 12 weeks.
If anything, wait may increase ultimate efficacy.

Nick Hassey @nickhassey | 2:55 AM · Dec 30, 2020
...The second graph on the left shows the protection from the Oxford/AZ vaccine after one Standard (not lower) Dose (the first is the pooled estimate from two)
Image--graph* ( )

2nd is discussion from the paper** of when people got the second dose.
Image--excerpt from results** ( )

In other words, clear protective benefits from one dose. And waiting 12 weeks for a second dose doesn't seem like it had any adverse effects either. If anything it *might* have helped.

Anyway great, GREAT news.

* Figure. Kaplan-Meier cumulative incidence of primary symptomatic, NAAT-positive COVID-19.
Cumulative incidence of symptomatic COVID-19 after two doses (left) or after first standard dose in participants receiving only standard-dose vaccines (right). Grey shaded areas show the exclusion period after each dose in which cases were excluded from the analysis. Blue and red shaded areas show 95% CIs. LD/SD=low-dose prime plus standard-dose boost. MenACWY=meningococcal group A, C, W, and Y conjugate vaccine. NAAT=nucleic acid amplification test. SD/SD=two standard-dose vaccines given.

Merryn Voysey et al. 2020. Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK. The Lancet (December 08, 2020) DOI:

des. 31, 2020, 8:15am

These patients rarely make it, apparently, but, crushed by COVID cases, LA hospitals won't even try.
Careful tonight, Angelenos--and everyone!

Ryan Gamlin, MD @RyanGamlin | 1:24 PM · Dec 30, 2020:
OOH arrests w/o field ROSC now NOT being transported to hospital per #LosAngeles #EMS triage protocol.


Eric Feigl-Ding @DrEricDing | 6:48 AM · Dec 31, 2020
NEXT LEVEL BAD—this radical change in ambulance rules means if an EMT paramedic cannot resuscitate a heart beat, a patient will not be transported to any hospital in Los Angeles.

This is worse than rationing Hospital care. We have reached this.

0:51 From Leah McElrath. TikTok ( )

des. 31, 2020, 8:54am

>127 margd: Not a nice way to celebrate the new year. Sorry for the Angelenos.

Editat: gen. 1, 4:05am

(ETA--a PHARMACIST!! Now arrested.)

Wisconsin health-care worker ‘intentionally’ ruined more than 500 coronavirus vaccine doses, hospital says
Andrea Salcedo | Dec. 31, 2020

Over the weekend, a (Grafton, a city of nearly 12,000 just north of Milwaukee) Wisconsin hospital announced that it had been forced to toss more than 500 doses (57 vials) of the (Moderna) coronavirus vaccine because an employee accidentally left dozens of vials unrefrigerated overnight.

...the employee at the Aurora Medical Center in Grafton, Wis., later admitted to purposefully removing more than 50 vials of the Moderna vaccine from a refrigerator, the hospital announced, rendering them useless.

The hospital has fired the employee...The employee’s tampering will delay the inoculation process for hundreds of people

...Grafton police said that the FBI and the Food and Drug Administration have now joined an investigation into the incident.

It’s not yet clear what motive the employee may have had to destroy the vaccines. A spokesperson with the hospital said it would release more details about its investigation on Thursday.


Christopher Hooks (Texas Monthly) @cd_hooks | 1:09 AM · Dec 31, 2020:

Just talked to a pharmacist in the panhandle who’s currently watching 30 doses of the vaccine go bad
because they can’t find enough “eligible” recipients. We had a year to figure this out

des. 31, 2020, 11:54am

Bob Wachter (Chair, UCSF Dept of Medicine) @Bob_Wachter | 10:32 AM · Dec 31, 2020:

U.S. is now considering idea of a single vaccination shot, delaying shot #2 until months later. Last wk, I thought that was a bad idea – the trials that found 95% efficacy were 2 shots; why add extra complexity & a new curveball. But facts on the ground demand a rethink. (1/7)

The two main changes are the slower-than-expected vaccine rollout and the new variant virus being found in the U.S. Both demand that we turbocharge the process of getting a large chunk of the population at least partly protected. (2/7)

Here's my back-of-the-envelope math:
- Single shot seems to be about 80% protective after a month
- 2nd shot adds some efficacy (up to 95% protective), and maybe (tho not yet proven) some durability.
- New variant is here, and undoubtedly far more widespread than we know. (3/7)

- Variant is ~55% more infectious than old one. Even though it's not more deadly, this means that if we engage in same behaviors, many more will get Covid & thus far more will die. UK shows that once here, it spreads fast.
- We seem incapable of changing behavior very much. (4/7)

- As has been widely reported, the roll-out is going far slower than we hoped.
- According to most vaccine experts, delaying shot #2 by a few months is unlikely to materially diminish the ultimate effectiveness of two shots (critical point; we should be testing to be sure). (5/7)

Taken together, if we have vaccine doses to distribute in Jan-Apr, it seems increasingly evident that a strategy of getting as many people (particularly high-risk) their first shot ASAP will save far more lives than sticking with the two shot plan. (6/7)

Far better to have 100M people who are 80% protected than 50M people who are 95% protected, particularly as we are facing a foe that is getting smarter and nastier. Or at least it seems that way to me. You? (7/7)

Bayram Yenikaya @bayram_yenikaya | 11:06 AM · Dec 31, 2020:
I have seen news reports that say the first dose is 50% effective. Which study shows 80%?

Michael Mina (Epidemiologist, Immunologist, Physician, Harvard Public Health/Medical School) @michaelmina_lab | 11:32 AM · Dec 31, 2020:
That was a misread of the data. You have to look at the time period after the vaccine had a chance to kick in. When you do that, the (limited) data we do have showed a 92%efficacy for both vaccines after a single dose and before dose two.

Editat: des. 31, 2020, 12:05pm

>130 margd:

I saw a news item on BBC last night suggesting that this would be the British strategy too. First shot to get immediate short term protection for as many people as possible, with the second shot for long term protection following after 8 to 12 weeks.

Editat: des. 31, 2020, 1:59pm

Los Angeles Times @latimes | 9:15 AM · Dec 31, 2020:

Roughly 20% to 40% of the L.A. County’s front-line workers who were offered the vaccine declined to get the shot.

So many in Riverside County refused the vaccine — an estimated 50% — that officials met to strategize how best to distribute the unused doses...

Some healthcare workers refuse to take COVID-19 vaccine, even with priority access
Doubts about the vaccine among health care workers could have serious implications for public health, say experts.
Dec 31, 2020

gen. 1, 3:53am

...“Florida has evidence of the first identified case of the UK COVID-19 variant in Martin County. The individual is a male in his 20s with no history of travel. The Department is working with the CDC on this investigation. We encourage all to continue practicing COVID-19 mitigation,” the Florida Department of Health said on Twitter Thursday....

Editat: gen. 4, 4:54am

VOC (Variant of Concern), UK B117 strain: According to Gurdasani (below), because the R number associated with the variant *during* lockdown was 1.45 compared with 0.92 for other strains, and because the variant is currently dominant among children, we need to close schools, until we can make them safe, & prevent onward transmission to older, more vulnerable populations. (R is the average number of people each person with a disease goes on to infect.)

Deepti Gurdasani (Sr Lecturer Queeen Mary U London Epidemiology) @dgurdasani1 | 5:36 PM · Dec 31, 2020:

The Imperial report on the new UK B117 strain is out. Very concerning findings, that highlight why we need to act on this *now*. These findings suggest that the situation within the UK is likely to get much worse than it is now. Here's why-

First, this study is perhaps one of the most comprehensive evaluations of the impact and spread of the B117 variant- combining epidemiological national evidence with genomic data from large numbers of samples across the UK.

The study examines something called 'spike dropout' as a proxy indicator for the new B117 variant. The B117 variant includes a deletion in the virus genome which has been associated with a different read-out on some PCR tests, - referred to as 'spike dropout'

While 'spike dropout' (S-)* does not necessarily signify the B117 variant, as this deletion can occur out with the B117 variant >97 margd:% of tests showing S- since mid-Nov have been attributed to the new variant, given it's high prevalence relative to other variants.

We see a very rapid rise in frequency of the B117 variant in London, SE England & E of England - rising to 80% by mid-Dec. Looking at the distribution across England, the estimated frequency varies by region between 15% in Yorkshire to 85% in SE England.
Image ( )
Image ( )

What does this mean?
While the variant is still at low levels across many parts of England, the trajectory in some regions (Oxford & Birmingham) suggest rapid recent increases in frequency - which means it will likely follow the same trajectory as other areas unless we act now.

Studying the Rt** associated with the variant strain compared to the previous one suggests an Rt ~1.74x times greater for cases with the variant compared with the previous strain. This is a huge advantage. It would for example mean an R of 0.9 increasing to 1.6.

Worth noting that the multiplicative increase is estimated within the current context, and many not extrapolate the same way to other contexts.

Distribution of the new variant compared to the previous variant by age group suggests that the ratio between S- (variant proxy)/S+ (normal strain) is highest for those in the 0-9 yr and 10-19 yr group - data till mid-Dec. This is concerning on many levels.
Image--Fig 4 ( )

It's clear that the variant is more dominant (1.2x) in children aged 0-9 yrs and 0-19 yrs. There could be many reasons for this - including transmission dynamics - due to high levels of unmitigated transmission in schools during lockdown - which has favoured the variant.

It could also mean that children with the variant are more likely to develop symptoms and therefore be tested. Given these are not random samples from healthy people, but results based on pillar 2 testing***, we need to interpret these cautiously.

This also does not necessarily mean increased biological susceptibility in children vs adults, & shouldn't be interpreted as such.

Irrespective of the relative prominence of the variant among children the prevalence of the variant is greatest among 10-19 yrs among those tested.

The data also suggests that the standard variant is still predominant among older age groups (at least among those tested) who are most susceptible to severe COVID-19.

Why is this important?
This really highlights the potential impact of waiting to act. We know that virus transmission that begins in younger age groups inevitably spreads to older people, and ultimately results in severe illness & death. We've seen this pattern before.

The geographical & age distribution suggests that although the the UK pandemic is in a critical state now, there's real potential for it to get a *lot* worse. We know increases in R correlate strongly with the variant frequency. We can see the frequency rising in other regions.

We can see it spreading outside South & East England. Given this is only at a frequency of 15% in some regions (and increasing), a rise would increase R much more than it is now, and worsen spread significantly.

Similarly, if infection in children is not curbed, the new variant will likely rapidly become dominant in adults as well, and potentially lead to even more rapid spread of infection in older groups where infection is more likely to be deadly & create further pressure on the NHS

The study shows that the R number associated with the variant *during* lockdown was 1.45 compared with 0.92 for other strains.

This means that cases with the variant continued to rapidly grow during the last lockdown. The variant is associated with an increase in R of 0.4-0.7

It's clear that although the situation is dire now, there is potential for it to get much worse & given the rises we're seeing in variant frequency in other regions, if we don't act now, not only with exponential rise continue, but the rate of rise will increase.

This may also mean more cases among older age groups- while the variant is currently dominant among children, the situation is likely to get much worse if this gains dominance among adults, who will be more likely to spread to other adults & older people - which means more deaths

To illustrate this with an example-
Say 15% of a region has the variant now, and has an overall R of 1.1 (fairly realistic given the rises we're seeing in much of England where the variant isn't dominant yet).

Assuming R of 1.7 for the VOC (Variant of Concern, UK B117) and 1 for the standard strain, the variant would be expected to rise to >70 margd:% frequency within a month. This would mean an increase in R to 1.5 in this period from 1.1. In terms of case numbers it would be devastating.

Assuming 2000 daily cases in a region at baseline, in real terms, this would mean - 62,000 daily cases in 2 months time, vs 5,187 had the R remained constant at 1.1.

And an order of magnitude greater no. of deaths
(assuming similar age distribution which may not be the case)

All the evidence is pointing in the same direction- we need to act urgently to curb spread across *all* of the UK. Letting this variant spread is not an option. And we need to close schools, until we can make them safe, & prevent onward transmission. This is critical now.

Full report here: ****

(ETA per Gurdasani: Sorry just want to (correct above) that as R increases, doubling *time* will fall, not doubling rate. Thanks @BorisBarbour for pointing out this error.)

* R--the average number of people each person with a disease goes on to infect

** 'S-' --The B117 variant includes a deletion in the virus genome which has been associated with a different read-out on some PCR tests, - referred to as 'spike dropout'

*** What are the Pillars? Tests in the UK are carried out through a number of different routes:
Pillar 1: swab testing in Public Health England (PHE) labs and NHS hospitals for those with a clinical need, and health and care workers
Pillar 2: swab testing for the wider population, as set out in government guidance
Pillar 3: serology testing to show if people have antibodies from having had Covid-19
Pillar 4: serology and swab testing for national surveillance supported by PHE, ONS, Biobank, universities and other partners to learn more about the prevalence and spread of the virus and for other testing research purposes, for example on the accuracy and ease of use of home testing

Erik Volz​ et al. 2020. Transmission of SARS-CoV-2 Lineage B.1.1.7 in England: Insights from linking epidemiological and genetic data. Imperial College of Medicine (Dec 31, 2020). 37 p.

The SARS-CoV-2 lineage B.1.1.7, now designated Variant of Concern 2020 12/01 (VOC) by Public Health England, originated in the UK in late Summer to early Autumn 2020. We examine epidemiological evidence for this VOC having a transmission advantage from several perspectives. First, whole genome sequence data collected from community-based diagnostic testing provides an indication of changing prevalence of different genetic variants through time. Phylodynamic modelling additionally indicates that genetic diversity of this lineage has changed in a manner consistent with exponential growth. Second, we find that changes in VOC frequency inferred from genetic data correspond closely to changes inferred by S-gene target failures (SGTF) in community-based diagnostic PCR testing. Third, we examine growth trends in SGTF and non-SGTF case numbers at local area level across England, and show that the VOC has higher transmissibility than non-VOC lineages, even if the VOC has a different latent period or generation time. Available SGTF data indicate a shift in the age composition of reported cases, with a larger share of under 20 year olds among reported VOC than non-VOC cases. Fourth, we assess the association of VOC frequency with independent estimates of the overall SARS-CoV-2 reproduction number through time. Finally, we fit a semi-mechanistic model directly to local VOC and non-VOC case incidence to estimate the reproduction numbers overtime for each. There is a consensus among all analyses that the VOC has a substantial transmission advantage, with the estimated difference in reproduction numbers between VOC and non-VOC ranging between 0.4 and 0.7, and the ratio of reproduction numbers varying between 1.4 and 1.8. We note that these estimates of transmission advantage apply to a period where high levels of social distancing were in place in England; extrapolation to other transmission contexts therefore requires caution.

gen. 1, 10:03am

CDC Vaccination Tracker (US map)
Total Number of People Initiating Vaccination per 100,000 (by state, last update Dec 30)

gen. 2, 4:42am

60% of Ohio nursing home workers refuse vaccine
Marty Schladen - December 30, 2020

...“Our bigger concern is the amount of staff who are not taking it,” DeWine said. “I don’t have data in front of me, but anecdotally, it looks like somewhere around 40% of staff at nursing homes are taking the vaccines and 60% are not taking it.”

Those figures are disturbing not only because of what they might say about attitudes toward the vaccines among the larger population. They also mean that most staffers will be unprotected as they move between the outside world and nursing homes filled with vulnerable people — some of whom will not be able to take the vaccine for medical reasons.

Even so, DeWine said he isn’t going to make anybody take it.

“I’m not going to compel anybody to do it, but I’m urging people to take that vaccine,” he said. “It’s very important,”

It’s not clear why the governor isn’t imposing such a requirement.

All 50 states have laws requiring — with exemptions — that children be vaccinated before going to school. Also, many healthcare facilities require employees to be vaccinated.

A DeWine spokesman didn’t immediately respond when asked why DeWine wouldn’t order Ohio nursing homes to follow suit...

Editat: gen. 2, 5:58am

Short social distancing and huge vaccine ramp-up, sounds like lockdowns and school closings might be in our future: In UK, "...B.1.1.7 SARS-CoV-2 lineage...continued to grow during a lockdown in which other lineages shrank. These analyses suggest that stricter measures are required to contain the B.1.1.7 lineage..."

As with flu (but not measles), it may be that COVID will shape shift (somewhat at least) to escape our efforts to contain it, and future vaccines will have to adapt. Good news is that new vaccine technology (mRNA) can adapt more quickly than older technologies.

Apoorva Mandavilli (NYT) @apoorva_nyc | 11:11 AM · Jan 1, 2021:
Deep breaths: “Conditions during lockdown were usually enough to suppress older variants, but not B.1.1.7”

Jeffrey Barrett (statistical geneticist) @jcbarret | 6:31 AM · Dec 31, 2020:
In both papers*, if we look across all English regions, in the overwhelming majority B.1.1.7 expands during lockdown while other lineages contract. We almost never see the reverse. Conditions during lockdown were usually enough to suppress older variants, but not B.1.1.7.
Image ( )

* Erik Volz et al. 2020. Report 42 - Transmission of SARS-CoV-2 Lineage B.1.1.7 in England: insights from linking epidemiological and genetic data Imperial College of London (Dec 31, 2020)

* Harald Vöhringer et al. 2020. Lineage-specific growth of SARS-CoV-2 B.1.1.7 during the English national lockdown
SARS-CoV-2 coronavirus. ( Preliminary report. ) nCoV-2019 Genomic Epidemiology (Dec 2020)

...Findings: We find strong and consistent evidence that B.1.1.7 proliferated (R greater than 1) during the English lockdown in 87% (213/244) of lower tier local authorities with an average R value of 1.25. At the same time other lineages contracted (R less than 1) at an average R value of 0.85 in most regions, leading to 83% (203/244) of regions showing B.1.1.7 proliferation while other lineages diminished.

Implications: The emerging B.1.1.7 SARS-CoV-2 lineage spreads faster than its predecessors. It continued to grow during a lockdown in which other lineages shrank. These analyses suggest that stricter measures are required to contain the B.1.1.7 lineage.

noa-witheringly @noawitheringly | 11:32 AM · Jan 1, 2021:
"Conditions" during the UK "lockdown" in question included FULLY OPEN, OVERcrowded daycares, primaries&secondaries, all maskLESS (except for secondaries pupils in communal spaces ONLY) with windows generally CLOSED /barely open, with NO rota &NO blended learning...

Priscilla Gilman @priscillagilman | 1:48 PM · Jan 1, 2021:
Lockdown in England included open schools, many w maskless students. We need full, strict, time-limited lockdowns to suppress this new variant, or it will outstrip the vaccine.

The Coronavirus Is Mutating. What Does That Mean for Us?
Officials in Britain and South Africa claim new variants are more easily transmitted. There’s a lot more to the story, scientists say.
Apoorva Mandavilli | Dec. 20, 2020 Updated Dec. 29, 2020

...Like all viruses, the coronavirus is a shape-shifter. Some genetic changes are inconsequential, but some may give it an edge.

Scientists fear the latter possibility, especially: The vaccination of millions of people may force the virus to new adaptations, mutations that help it evade or resist the immune response. Already, there are small changes in the virus that have arisen independently multiple times across the world, suggesting these mutations are helpful to the pathogen.

The mutation affecting antibody susceptibility — technically called the 69-70 deletion, meaning there are missing letters in the genetic code — has been seen at least three times: in Danish minks, in people in Britain and in an immune-suppressed patient who became much less sensitive to convalescent plasma.

...The new genetic deletion changes the spike protein on the surface of the coronavirus, which it needs to infect human cells. Variants of the virus with this deletion arose independently in Thailand and Germany in early 2020, and became prevalent in Denmark and England in August.

...The new genetic deletion changes the spike protein on the surface of the coronavirus, which it needs to infect human cells. Variants of the virus with this deletion arose independently in Thailand and Germany in early 2020, and became prevalent in Denmark and England in August.

...a vast majority of people worldwide have yet to be infected, and that has made scientists hopeful.

...Immunizing about 60 percent of a population within about a year, and keeping the number of cases down while that happens, will help minimize the chances of the virus mutating significantly, Dr. (Emma Hodcroft, a molecular epidemiologist at the University of Bern in Switzerland) said.

Still, scientists will need to closely track the evolving virus to spot mutations that may give it an edge over vaccines.

Scientists routinely monitor mutations in flu viruses in order to update vaccines, and should do the same for the coronavirus, said Trevor Bedford, an evolutionary biologist at the Fred Hutchinson Cancer Research Center in Seattle.

...The good news is that the technology used in the Pfizer-BioNTech and Moderna vaccines is much easier to adjust and update than conventional vaccines. The new vaccines also generate a massive immune response, so the coronavirus may need many mutations over years before the vaccines must be tweaked, Dr. Bedford said.

In the meantime, he and other experts said, the Centers for Disease Control and Prevention and other government agencies should set up a national system to link viral sequence databases with on-the-ground data — like whether an infection occurred despite vaccination...


Discovery of Virus Variant in Colorado and California Alarms Scientists
A more contagious version of the coronavirus may alter the course of the pandemic in the United States, researchers said.
Apoorva Mandavilli | Dec. 30, 2020

....The virus’s debut in the United States underscores the need for urgent steps to tamp down transmission, experts said. If the variant is spreading in this country, it will bring not just an increase in the number of cases, but also of hospitalizations and deaths.

...“In places like the U.S. and the U.K., where the health care system is already at its breaking point, a huge surge of new cases on top of the exponential spread we’re already seeing is going to be really, really bad,” said Angela Rasmussen, a virologist affiliated with Georgetown University in Washington.

“Not only is that going to potentially increase the number of Covid deaths, but it’s also probably going to increase the number of deaths from other causes as well.”

...The news ramps up the urgency to get Americans vaccinated because it raises the threshold for so-called herd immunity — the percentage of people who must be inoculated to contain the threat. That threshold may be 90 percent now, versus the 70 percent experts previously estimated.

At least two million Americans must be vaccinated each week to prevent the health care system from buckling even under the current surge, experts estimate, let alone an increase brought on by the new variant.

The mutant virus seems to spread in the same ways that the coronavirus always has, suggesting that well-known precautions — shutting down nonessential businesses and instituting mask mandates and physical distancing — will hold the virus at bay.

“It’s not like this variant suddenly has new capabilities, or that it can suddenly cross over large distances outdoors,” Dr. Rasmussen said.

But the ease with which the new version spreads implies that even more stringent restrictions may be needed, scientists said. “This variant was not stopped by the stronger interventions that were put in place in the U.K. in November,” Dr. (Bill Hanage, an epidemiologist at the Harvard T.H. Chan School of Public Health) said. “And that means that we need more.”...

gen. 2, 6:29am

I suspect that US will reconsider prioritizing 1st dose once B.1.1.7 takes hold and once 1st priority folks (healthcare workers, longterm care residents) have received 2nd dose.

Dr Anthony Fauci says US will not delay second doses of Covid vaccine
American infectious disease expert disagrees with UK’s plans to prioritise first doses
Edna Mohamed | 1 Jan 2021

...Dr Fauci told CNN: “We know from the clinical trials that the optimal time is to give it on one day and for the Moderna jab which is also approved in the US wait 28 days and for Pfizer 21 days later.” He added that while you can “make the argument” for stretching out the doses, he would not be in favour of doing that....

gen. 2, 10:38am

Africa’s first COVID-19 wave was atypical. Its second could be, too.
Its more than 50 countries are on diverse journeys—illustrated by unexpected outbreaks, death surges fueled by stigma, and some puzzling places with abundant spread but low hospitalization rates.
Linda Nordling | December 22, 2020

...Africa’s COVID-19 numbers have remained mercifully low this year. Despite being home to 17 percent of the world’s population, the continent has only reported 3.4 percent of global COVID-19 cases and 3.5 percent of deaths.

The continent’s youth is one obvious reason. Africa’s median age is below 20, half that of the United States, and older adults are more likely to develop severe cases of the disease. Some scientists believe the warmer climate is playing a role, as it allows people to spend more time outside where COVID-19 risk is lower. Other researchers believe exposure to parasitic infections or other widely-circulating coronaviruses—such as those that cause the common cold—could have primed African immune systems to fight COVID-19. But there is little evidence so far to support these theories... (margd: sunshine and diet (more D)? virtually no Neanderthal immune genes?)

South Africa: An unexpected rise
Zambia: Stigma fuels at-home deaths
Ghana: Missing the mild cases

gen. 2, 11:01am

Long before anyone knew of SARS-CoV-2, a small band of government and university scientists uncovered a prototypical key that unlocked life-saving immunizations.
Jillian Kramer | December 31, 2020

Jason McLellan, a structural virologist at the University of Texas at Austin
Barney Graham, deputy director of the National Institute of Allergy and Infectious Diseases Vaccine Research Center
structural biologist Andrew Ward was one of the leading cryo-EM experts in the U.S.
Kizzmekia Corbett, a postdoctoral research fellow in Graham’s laboratory


Great job, but we shouldn't forget:
Katalin Karikó, now a senior vice president at BioNTech
Professor Zhang Yongzhen, Shanghai Public Health Clinical Center
Dr. Ugur Sahin and Dr. Özlem Türeci, BioNTech

gen. 3, 7:50am

Small Number of Covid Patients Develop Severe Psychotic Symptoms
Pam Belluck | Dec. 28, 2020

Most had no history of mental illness and became psychotic weeks after contracting the virus. Cases are expected to remain rare but are being reported worldwide.

...In interviews and scientific articles, doctors described:

A 36-year-old nursing home employee in North Carolina who became so paranoid that she believed her three children would be kidnapped and, to save them, tried to pass them through a fast-food restaurant’s drive-through window.

A 30-year-old construction worker in New York City who became so delusional that he imagined his cousin was going to murder him, and, to protect himself, he tried to strangle his cousin in bed.

A 55-year-old woman in Britain had hallucinations of monkeys and a lion and became convinced a family member had been replaced by an impostor....

gen. 3, 2:54pm

Feds may cut Moderna vaccine doses in half so more people get shots, Warp Speed adviser says
BRIANNA EHLEY | 01/03/2021

Federal officials have said the U.S. will need to vaccinate roughly 80 percent of the population to achieve herd immunity against the coronavirus.

The federal government is in talks with Moderna about giving half the recommended dose of the company's Covid-19 shot to speed up immunization efforts, the head of the Trump administration's vaccine rollout said on Sunday.

Operation Warp Speed chief adviser Moncef Slaoui said there is evidence that two half doses in people between the ages of 18 and 55 gives “identical immune response” to the recommended one hundred micorogram dose, but said the final decision will rest with the FDA.

“It will be based on facts and data to immunize more people,” Slaoui said on CBS' "Face the Nation," adding, ”of course we continue to produce more vaccine doses.”...

...the U.K., last week shifted its guidance to get as many people as possible their first dose, while potentially delaying the second dose, sparking concern among scientists who say there is no evidence to suggest the vaccine is effective without completing the full regimen.

Slaoui balked at the idea of taking a similar approach in the U.S., saying it would not be responsible to give initial doses without ensuring people get their second dose without data to back it up.

Editat: gen. 4, 5:50am

>134 margd: contd. Sounds like US, Canada, etc. will want to reconsider onsite schooling, non-pharmaceutical measures (masks to lockdowns), and ramped up vaccinations to prevent B117-driven increase in cases, hospitalizations & deaths... The UK strain has metasticized. Tinkering around with incoming planes will not be enough to spare us its toll.

Deepti Gurdasani (Sr Lecturer Queen Mary U London Epidemiology) @dgurdasani1 · Jan 1

I wrote yesterday about the spread of the UK B117 variant based on data up to the 13th Dec warning that it could become dominant across much of the UK & across most age groups. Recent data released up to end of Dec now suggests that this has already happened. Short thread.

Recent data from LSHTM shows that the B117 is either dominant, or very close to dominant in most regions with rapid increases being seen all across England. No region appears to have been spared, and it's very nearly out-competed the usual strain completely in SE England.
Image: graphs of B117 in areas of England ( )

This means that we will continue to see increases within the next few weeks in other parts of England, where it will likely completely replace the previous strain as it has in much of SE England. This is very bad news- because it makes the spread much harder to contain.

It also shows the rapidity with which spread occurs geographically, and the difficulty in containing this, even with restrictions in place. An important lesson for countries which have identified cases or imports and are trying to contain this. Aggressive & fast
Without this, these strains are likely to get established very quickly, with the consequences of increased transmissibility, and increased R numbers, making the pandemic very hard to contain regionally & globally.

Unfortunately, as expected although the variant appears to have first become dominant among under 20 yr olds, more recent data suggests spread to older age groups, where it is now similarly dominant, although still less dominant in over 70s still.

Quote Tweet
Nick Davies @_nickdavies · Jan 1
Replying to @i_petersen
Thanks Irene. See image, sorry for bad labelling! Essentially the major pattern is that it doesn't seem to have spread into 80+ quite as quickly. Over November, 0-19s were slightly overrepresented but that seems to have somewhat settled out now. (1/2)
Image--graph cases by age group Oct-Jan ( )

We are now clearly in the position where this variant will replace the previous one within a few weeks, which means that R is likely to increase even further than currently. Movement to older age groups will be felt in terms of rising cases, hospitalisations & deaths soon.

We're already too late on this, and our window to contain spread regionally & within age groups has unfortunately passed. But the situation is going to get worse, given current trends across England. We need an urgent strict national lockdown right now & schools going remote.

Unfortunately between 20-25,000 deaths in January are already baked in, given most of those who will die in the next 3-4 weeks have already been infected. But if we don't act now, we'll see many more in February, and the real risk that the NHS will not be able to treat everyone.

This may further increase fatality rates. And R number will continue to rise until the variant completely replaces the previous viral strain across England. This means the doubling rate of cases will continue to fall over the coming week, with much faster spread.

We're in a very difficult position now. The Imperial study suggests that even with lockdown, although the growth of the variant reduced, it didn't reverse (R remained above 1). It will be very difficult to contain this without very strict measures in place.

This means that unless we really commit to a strict & robust strategy to contain this, we're in for mass death - not just from COVID-19 but also from other diseases as NHS services are overwhelmed. We need a clear plan from govt *now*. A policy of half-way measures won't work.

Link to the paper can be found here:

Report (6 p ): Continued spread of VOC 202012/01 in England (31 December 2020)
An update to
Estimated transmissibility and severity of novel SARS-CoV-2 Variant of Concern 2020 12/01 in England (23 December 2020)


Graph: UK daily average cases (March 1-Jan 2)

Editat: gen. 4, 7:12am

17 Dec update to 4 Nov 2020 paper on children, schools and transmission - 17 December 2020
prepared by the (UK) Children’s Task and Finish Group (TFC) on children, schools and transmission | 31 December 2020
28 p

...Impacts on teachers and school staff...
•ONS CIS data from 2 Sept-16thOct show no evidence of difference in the rates of teachers/education workers testing positive for SARS-CoV-2 compared to key workers and other professions (medium confidence). This is seen even when combining different categories of school staff in the analysis.
•The Schools Infection Survey(SIS) confirms that, even with testing, there are low levels of infection in schools. As staff included in the SIS study are in school, these figures will reflect the levels of infection without clear symptoms in teachers only (as symptomatic individuals should not be attending).
•Whilst the SIS data may suggest a higher rate of infection among secondary school staff included in the survey than in primary schools, the estimates have wide and overlapping confidence intervals, and the difference is not statistically significant. More broadly, caution should be taken when interpreting theSIS findings: the SIS data is unweighted, and so cannot be generalised to the school population as a whole.
•Analysis of DfE attendance data,which includes reports of those absent with confirmed COVID-195indicates that whilst the percentage of students with confirmed infection is greater in secondary school than primary school students, the percentage of teachers with confirmed infection appears to be similar across primary/secondary schools(medium confidence)...

...(Household transmission) This is based on data up to the 2nd December 2020 (margd: before UK's new strain B117 emerged)
•This analysis shows that children and young people are more likely to bring the virus into the household than those aged 17+. They are also less likely to catch the virus within the household. This is consistent with previous analysis of household transmission (14 October).
•External exposure shows how likely someone is to be the first case in their household. Young people (aged 2-16) are much more likely than those aged 17+ to be the first case in their household. In particular, those aged 12 to 16 are nearly 7 times as likely to be the first case in their household, compared to those 17+.
•Transmissibility shows how likely someone is to pass the virus on within the household, if they are the first positive case. The analysis shows that 2 –16 year olds are more than twice as likely to pass on the virus within their household compared to people aged 17+.
•Susceptibility shows how likely someone is to catch the virus, if someone else in their household has brought it in. Children aged 16 or under are less likely to get the virus from someone within their household compared to people aged 17+...

gen. 4, 9:09am

Myoung-Hwa Lee et al. 2020. Microvascular Injury in the Brains of Patients with Covid-19 (Correspondence). NEJM (December 30, 2020) DOI: 10.1056/NEJMc2033369

...In a convenience sample of patients who had died from Covid-19, multifocal microvascular injury was observed in the brain and olfactory bulbs by means of magnetic resonance microscopy, histopathological evaluation, and immunohistochemical analysis of corresponding sections, without evidence of viral infection. These findings may inform the interpretation of changes observed on magnetic resonance imaging of punctate hyperintensities and linear hypointensities in patients with Covid-19. Because of the limited clinical information that was available, no conclusions can be drawn in relation to neurologic features of Covid-19.

gen. 4, 10:44am

Eric Feigl-Ding (epidemiologist economist) @DrEricDing | 6:23 AM · Jan 4, 2021:
NEAR VERTICAL—I expect this near-vertical case surge line may soon be the US in a few weeks.
We know the new B117 #SARSCoV2 variant is already here in the US, and we know it is in active community transmission mode. Exponential math is fast. And US is at ICU capacity. #COVID19

Quote Tweet
Dr Nisreen Alwan (epidemiologist, U Southampton) @Dr2NisreenAlwan · 4h
The UK curve is a vertical line now. Not bending it ultimately means NHS not coping.
This may mean people needing critical care not receiving it. If the whole country is over capacity
then patients needing ICU can’t be sent to other remote units like what’s happening now.
Image--COVID cases per million by country Mar 1-Jan 3
( )

Editat: gen. 4, 10:56am

Independent SAGE* (as opposed to UK govt. Scientific Advisory Group for Emergencies)
comment on proposal to reschedule second dose of SARS-CoV-2 vaccines in the UK
-3rdJanuary 2020
3 p

A new variant of COVID-19 is out of control in Great Britain – it’s a finely balanced decision but delaying a second dose of vaccine is justifiable, but only as part of a comprehensive ambitious strategy to suppress infections ...


* Independent SAGE* (as opposed to UK govt. Scientific Advisory Group for Emergencies)
What is Independent SAGE?
Independent SAGE is a group of scientists who are working together to provide independent scientific advice to the UK government and public on how to minimise deaths and support Britain’s recovery from the COVID-19 crisis

Who’s in charge?
Sir David King, the former chief Scientific Adviser to the UK government, chairs the group and oversees its reports.

Is it officially recognised?
No. Independent SAGE is independent of government and does not answer to it. It does however share its work openly with the government as well as with the public.

Are the scientists paid?
No. All the scientists involved are doing this as unpaid voluntary work. They are all committing hours of their time every week to discuss the science, explain it to and discuss it with the public and produce reports. They are putting advice into the public domain because

gen. 4, 12:51pm

Germany mulls delaying second COVID-19 vaccine shot, Denmark approves delay
Andreas Rinke Nikolaj Skydsgaard | Jan 4, 2020

BERLIN/COPENHAGEN (Reuters) - Germany was weighing on Monday whether to allow a delay in administering a second dose of the COVID-19 vaccine from BioNTech and Pfizer to make scarce supplies go further, after a similar move by Britain last week.

Separately, Denmark approved on Monday a delay of up to six weeks between the first and second shots of the vaccine...

gen. 4, 4:37pm

UK in recent days has had more than 10% of all new COVID cases on Earth
despite having less than 1% of the world's population.

- Steven Dennis (Bloomberg) @StevenTDennis |3:15 PM · Jan 4, 2021

Editat: gen. 5, 12:21pm

South African SARS CoV2 'More Worrying' Than British B117 Variant

The variant has rapidly replaced other strains in South Africa, with initial research linking it to higher viral loads and possibly increased transmissibility. In an as yet unpublished paper (abstract available online), scientists issue an initial ominous warning.
Here, we describe a new SARS-CoV-2 lineage (501Y.V2) characterised by eight lineage-defining mutations in the spike protein, including three at important residues in the receptor-binding domain (K417N, E484K and N501Y) that may have functional significance.
In plain English: We have pinpointed 8 mutated traits that make this a significant new variant. 3 of them involve the spike protein, the part of the virus that our current vaccines are based on. We are particularly worried and disturbed because these changes aren't to any old portion of the spike protein; they're changes to the most important part -- the receptor-binding domain. That's the part the vaccines are specifically formulated to attach antibodies to in order to keep the virus from entering the cell, making you deathly ill, or killing you.

"Functional significance": The important part of the spike protein that allows the virus to penetrate the cells' wall of healthy individuals and infect them. Current vaccines are built to create antibodies that -- like a lock in a key -- physically bind to that site and nullify its ability to penetrate and infect your cells.

A change that alters "functional significance" can mean physical alteration of the penetrating portion of the spike to an extent that current vaccine formulation may not recognize the changed shape as the place to attach and stimulate antibody production, rendering it impotent to protecting recipients.
Whilst the full significance of the mutations is yet to be determined, the genomic data, showing the rapid displacement of other lineages, suggest that this lineage may be associated with increased transmissibility.
B117 variant is now the dominant one in GB; the rate of infection curve in GB is now vertical due to it. The hint in the abstract is that the SAf variant may be even more virulent and that we don't have any idea yet in what other ways it could be much more dangerous to humans than the present world dominant virus or the British candidate to become the world dominant version, or -- even worse -- to be a second dominant version so significantly different from B117 as to re-infect people who had either B117 or the current world dominant form, or to infect people simultaneously, like having the flu and Covid-19 at the same time.

Regardless of what we don't know, and that's considerable, what we do know about viral mutations is that the only way we have to combat them from evolving so rapidly is to reduce the level of human contact concentration. Viruses mutate every time they enter a new host. The most successful mutations lead to increased replication. Increased replication produces heavier viral load. Heavier load produces severe sickness. All we can do is to attempt to interdict and decrease opportunities for infection by not offering up our bodies to the virus, unprotected.

All we have are the defenses of wearing masks and physical distancing, until we have herd immunity. Herd immunity may not come if we keep offering the current dominant virus and its upcoming heirs easy targets and fertile territory to ever more quickly mutate and outstrip our ability to formulate sufficiently robust vaccines against the inevitable further new forms.

gen. 5, 5:56am

The Lab-Leak Hypothesis
For decades, scientists have been hot-wiring viruses in hopes of preventing a pandemic, not causing one. But what if …?
By Nicholson Baker

Editat: gen. 5, 6:50am

Re vaccines, hope when second dose delay and halved doses are considered, authorities make sure such regimes do not inadvertently select for vaccine escape. Especially since they do not know if vaccinated people, while protected from serious disease, can transmit virus to other people.
En/na SARS-CoV-2 and COVID-19 (17) ha continuat aquest tema.