H5N1

COVID-19 in Brazil: 41,411 new cases, 1,333 deaths

A screenshot from the CONASS PANEL | COVID-19 dashboard:

Is this the messiest phase of the pandemic in America?

Via the Columbia Journalism Review, Jon Allsop writes: Is this the messiest phase of the pandemic in America? Excerpt:

Much COVID coverage has continued to underscore the divide between the vaccinated and the unvaccinated. The focus on vaccine hesitancy has only grown in urgency. 

“It’s almost like we need two kinds of newscasts, or two versions of the weather report,” Brian Stelter, CNN’s chief media correspondent, said on Sunday. “The forecast is pretty sunny for the vaccinated, but it’s quite bleak in some states for the unvaccinated.” As Stelter also noted, however, the pandemic is still a story of risk calculations, and “those nuances don’t always come through in the media coverage.” 

The vaccinated are inevitably affected by such calculations, especially when, as with mask mandates, they are collective. And, in recent weeks, there has increasingly been media chatter about “breakthrough infections” that have occurred in fully vaccinated people, especially when those people have been famous. 

A COVID outbreak among vaccinated New York Yankees players generated a welter of news stories, as did a case at the White House. Reporters peppered Jen Psaki, the White House press secretary, with questions about the latter, and asked if she would commit to full transparency should there be more such cases in the future. 

As coverage of breakthrough infections has increased, some commentators have argued, with ample justification, that it ought to decrease again. Such infections are neither common nor unexpected, and they almost always involve mild or asymptomatic illness; by hyping isolated cases, the argument goes, the press risks inducing undue worry among the vaccinated and undue skepticism among the unvaccinated. 

A big part of the problem here is that data on breakthroughs is lacking, making it harder for reporters to properly contextualize anecdotal examples. The CDC once tracked all such infections, but in May, it narrowed its focus to breakthroughs that precede hospitalization or death—a move that the agency said would ​​“help maximize the quality of the data collected on cases of greatest clinical and public health importance,” but which has also, undoubtedly, exacerbated uncertainty as to the scope of the problem, depriving the public of a centralized data source and leaving reporters and experts to instead pick over leaked CDC estimates and local tallies that aren’t standardized. 

As Apoorva Mandavilli, a science reporter at the New York Times, pointed out yesterday on the paper’s Daily podcast, while most breakthrough infections are not individually serious, they can play a role in overall viral spread. Which brings the story right back ’round to the unvaccinated.

Breakthrough infections aren’t our only data blind spot at the moment. Recently, a number of states, including Nebraska and Florida, stopped reporting daily tallies of cases, hospitalizations, and deaths, and moved to weekly reporting instead. (As the AP’s Josh Funk writes, Nebraska briefly stopped all of its data reporting after the governor declared an end to the state’s health emergency, only to backtrack.)

“Doing this weekly report just leaves you completely in the dark about what’s going on,” Cindy Prins, an epidemiologist at the University of Florida, told the Tampa Bay Times. “And then on Friday, all of a sudden, like, boom, you get this surprise number.”

Nationally, daily COVID testing rates—which were arguably never high enough to provide a truly accurate picture of the state of the pandemic in the US—have declined substantially from their peak. Data collection and reporting can be labor-intensive, and it’s legitimate, of course, to debate where stretched health bureaucracies should direct their resources for maximum benefit in this new phase of the pandemic—but as I’ve written before, from a journalist’s point of view, the more data we have, the more reliable the picture of the world that we can build.

Meanwhile, there’s still a lot we don’t fully understand about the science of the virus, with new variants, in particular, proving confounding. “It’s a bit maddening, because it felt like we got to a point where we got to know this virus a little bit,” Mandavilli said yesterday on The Daily. “Delta has really changed that entire calculation. There are just so many more questions than I think we expected to have at this point. And it feels a little bit like an inflection point—another one—where the country could go in either direction.”

I agree. In fact, I’d make the case that this stage of the pandemic is the most complicated and uncertain that America has yet faced—not the worst, by any means, but perhaps the hardest for people, and the media, to get their heads around. The problems that bedeviled our early coverage of the pandemic—a lack of scientific certainty and consensus; inadequate data flows—are still problems, in ways new and infuriatingly unchanged. And the mitigation measures we had to cover back then—while never the beneficiaries of political consensus—were relatively blunt compared to the more subjective and situational risk calculations of this moment, which still very much apply, even as cases rise again. The vaccines are magnificent, but we still don’t know everything about them.

The situation differs substantially by place, and it can be hard to easily compare them. And it’s arguably more urgent than ever that Americans look out on the world, large swathes of which are desperately struggling right now.

COVID-19 in Brazil:18,999 new cases, 578 deaths

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Doctors, nurses and other health groups call for mandatory vaccinations for all health workers

Via The Washington Post: Doctors, nurses and other health groups call for mandatory vaccinations for all health workers. Excerpt:

Medical groups representing millions of doctors, nurses, pharmacists and other health workers on Monday called for mandatory vaccinations of all U.S. health personnel against the coronavirus, framing the move as a moral imperative as new infections mount sharply. 

“We call for all health care and long-term care employers to require their employees to be vaccinated against covid-19,” the American Medical Association, the American Nurses Association and 55 other groups wrote in a joint statement shared with The Washington Post. “The health and safety of U.S. workers, families, communities, and the nation depends on it.” 

The statement — issued by many groups calling for a mandate for the first time — represents an increasingly tough stance by the medical and public health establishment amid the sluggish pace of national vaccinations. It comes as new cases rip through the nation, driven by the hyper-transmissible delta variant. Confirmed coronavirus infections have nearly quadrupled during July, from about 13,000 cases per day at the start of the month to more than 50,000 now, according to The Post’s tracking. Hospital leaders in states such as Alabama, Florida and Missouri have implored holdouts to get vaccinated, citing data that the shots prevent hospitalizations and even death. 

But many workers in the health field remain unvaccinated, despite having priority access to coronavirus vaccines, which first became available in December. More than 38 percent of nursing home staff were not fully vaccinated as of July 11, despite caring for patients at elevated risk from the coronavirus, according to data collected by the Centers for Medicare and Medicaid Services and analyzed by LeadingAge, which represents nonprofit nursing homes and other providers of elder care. 

An analysis by WebMD and Medscape Medical News estimated that about 25 percent of hospital workers who had contact with patients had not been vaccinated by the end of May.

COVID-19 in Brazil: 18,129 new cases, 476 deaths today

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The numbers continue to go up and down. I have no idea why.

COVID-19 in Brazil: 38,091 new cases, 1,108 deaths today

A screenshot from the CONASS PANEL | COVID-19 dashboard:

Case numbers have dropped sharply from yesterday, but we now have the numbers for epi-week 29, which ended today:

The case count has jumped by about 55,000 from last week, to 328,086. The week's deaths were 8,182, barely lower than last week's 8,373.

‘Forget herd immunity’: Hong Kong experts say better to prepare to live with Covid-19, but more must get their jabs

Via the South China Morning Post: ‘Forget herd immunity’: Hong Kong experts say better to prepare to live with Covid-19, but more must get their jabs. Hong Kong's experts have seen it all, right from H5N1 in 1997. I give their opinions a lot of weight. Excerpt:

“I don’t think we will be able to achieve herd immunity in Hong Kong through vaccination alone,” said Professor Benjamin Cowling, a leading University of Hong Kong epidemiologist who recently published findings that Sinovac induced much lower levels of antibodies, the protein in the blood that fights the virus. 

He said herd immunity could be achieved through inoculation only if everyone was vaccinated with the highly effective mRNA jabs, such as BioNTech’s. 

But the 7.5 million doses of BioNTech available are enough for only half the population, with vaccines not yet available to children aged below 12. 

“If a location has a high vaccination coverage but has not yet reached herd immunity, one choice is to reopen and prepare for an ‘exit wave’,” he said, referring to a final, inevitable rise in infections when the community opens up and discards social-distancing measures.

England, for example, declared July 19 its “Freedom Day” from virus restrictions. With about 68 per cent of its citizens having received at least one dose of vaccine, the country lifted most pandemic restrictions and is now expected to see more than a million infections in the coming months. 

That option is considered impossible for Hong Kong, whose leaders have clung to the goal of “zero local infections” in the hope of meeting tough requirements set by Beijing for resuming cross-border travel. 

The city has logged a 47-day streak of no local infections as of Saturday, although there have been imported cases. 

Cowling said: “Another policy choice would be to continue with a ‘zero Covid’ strategy to protect public health until additional rounds of booster doses can be administered to further increase population immunity.”  

But that could end up a moving target if more coronavirus variants emerged, he added. 

“I expect that most locations in the world will learn to live with the virus, managing it in a similar way to the seasonal flu,” he said. Assistant Professor Kwok Kin-on of Chinese University’s school of public health said the original goal of a 70 per cent vaccination rate assumed that one infected person could spread the virus to three others – the transmission rate of the original virus strain – and that the two available vaccines would maintain 60 to 95 per cent efficacy rates. 

But the arrival of variants changed all that. Scientists estimate that a person infected with the Delta variant can pass it on to at least five others.

Instead of chasing herd immunity, Kwok said it might be better to focus on whether vaccinated people had severe symptoms when infected with Covid-19 or the variants. 

“Covid-19 has a much higher mortality rate than flu. We hope to bring down the mortality rate of Covid-19 through vaccination,” he said. 

“If one is infected but will recover after resting for two days, can we accept that? If we find it acceptable, the problem is solved.” 

Hong Kong has so far seen 23 imported cases of fully vaccinated people who fell ill with Covid-19, of which 19 were infected with variants. But the severity of their symptoms and mortality rates were lower in general.

Kwok said if the mortality rate of Covid-19 could be brought down to a level comparable to the flu, normality could be resumed. 

“Would we impose lockdown or social-distancing measures because of the flu?” he asked. 

Professor Lau Yu-lung, chairman of the Centre for Health Protection’s scientific committee on vaccine preventable disease, said the city should be prepared to live with the virus once it had hit a high vaccination rate. 

He said: “Achieving a zero-infection status is just to let society continue to operate and have time to reach at least an 80 per cent full vaccination rate. When we have reached that state, we will not see a large number of deaths and a high hospitalisation rate.” 

Cowling said Hong Kong could start planning to reopen and relax pandemic measures once vaccinations pass the 70 per cent mark, even without herd immunity.

Canada could avoid the worst of a 4th wave — but we're not out of the woods yet | CBC News

Via CBC News: Canada could avoid the worst of a 4th wave — but we're not out of the woods yet. Excerpt:

Canada will likely face a fourth wave of the pandemic as the highly contagious delta variant continues to spread ahead of borders and schools reopening, but there's growing optimism another surge won't bring the country back to a crisis point. 

Canadian immunologists, virologists and infectious disease specialists say we could fare better than in previous waves, with a lower rate of serious infections, due to the effectiveness of COVID-19 vaccines and the willingness of Canadians to get vaccinated.  

But our rollout is plateauing and there are still huge swaths of the population that are unvaccinated — either by choice or due to a lack of access or eligibility — including millions of Canadian kids who are heading back to school in just over a month. 

"We're going to see rises in case counts at some point again," said Matthew Miller, an associate professor of infectious diseases and immunology at McMaster University in Hamilton.  

"Probably similar to last year, as we head into the fall and the cold weather arrives. But those bumps are hopefully just that — tiny hills, and not mountains like the earlier waves."

How bad will Canada's 4th wave be? 

The severity of Canada's fourth wave will largely be determined by levels of COVID-19 immunity in the population from vaccines or prior infection, which can prevent community transmission from rising and stop severe cases from overwhelming hospitals. 

Canada has had more than 1.4 million cases of COVID-19 so far, yet only 2.6 per cent of Canadians were found to have antibodies due to prior coronavirus infection in early 2021. 

"The question is — is there sufficient population immunity? No," said Raywat Deonandan, a global health epidemiologist and associate professor at the University of Ottawa.  

"And the reason for that is because we measure population immunity by recovered cases and vaccinations."

More than 80 per cent of eligible Canadians aged 12 and up have received at least one shot, and more than 60 per cent have had two. But that number drops to about 70 per cent with one dose and just over 50 per cent fully vaccinated when you consider the country's entire population. 

Although Canada has "nowhere near enough" immunity yet, Deonandan says we can "artificially create" adequate protection by using interventions like masking indoors to help with "building walls" around unvaccinated Canadians as COVID-19 becomes more seasonal. 

COVID-19 in Brazil: 108,732 new cases, 1,324 deaths

The case count has more than doubled yesterday's numbers, to above 100,000 again. A screenshot from the CONASS PANEL | COVID-19 dashboard:

The surreal lives of Arkansas nurses fighting Covid-19 inside the hospital and denial on the outside

Via CNN, a discouraging report: The surreal lives of Arkansas nurses fighting Covid-19 inside the hospital and denial on the outside. Excerpt:

(CNN)Sunny worked as a nurse on a Covid-19 floor of a hospital at the height of the pandemic. The work was hard, but what made it surreal was doing it while living in small town Arkansas, where many people, even some in her own family, said the virus was overblown -- "just the flu." 

"It's extremely difficult to watch so many people die, and then have people tell you on Facebook or in Walmart that you're a liar," Sunny said. Sometimes that would come from the loved ones of the patients she was taking care of. 

"We had people accuse us of giving their loved one something else so that they would die and we could report it as Covid. We heard it more than once that we were fudging the numbers, or we were killing people on purpose to make Covid look like it was worse than it was, or to make it look real when it wasn't," she said. 

Sunny asked CNN not to use her real name, because some dedicated Covid-19 deniers have harassed health care workers, or tried to get outspoken ones fired.

The politicization that led people to believe Covid-19 was some kind of scam is now affecting how many get vaccinated. 

Just 36% of Arkansans are fully vaccinated, the third-lowest rate in the country. This week, Arkansas had its biggest spike in cases since February, and it has the worst case rate in the country. The state government is offering incentives to get vaccinated, like free lottery tickets. It hasn't convinced many; Gov. Asa Hutchinson has said it's not working. 

Sunny fears that could mean the Delta variant will make many people in her community sick, and push some nurses to quit. 

"A lot of nurses have compassion fatigue. And I am really scared of how that's gonna play out, because a lot of the cases that we're seeing are in non-vaccinated individuals." 

"Nurses were really the symbol for this pandemic and all of the hate was centered around us -- the hate, the fear, the respect, all of it," Sunny said. A lot of nurses have PTSD from 2020, she said, "And now we're having people come in and look us in the face and be like, 'No I didn't get the vaccine, and now I'm sick."