H5N1

New Zealand Covid update: 82 new cases as outbreak worsens despite nationwide lockdown

Via The Guardian: New Zealand Covid update: 82 new cases as outbreak worsens despite nationwide lockdown.

New Zealand’s Covid-19 outbreak has worsened, with 82 new cases taking the total infected to 415. 

All of Saturday’s cases were in Auckland, with the Pacific community again over-represented with 62 cases. 

New Zealand has reached day 11 of a harsh lockdown designed to curb the spread of the virus. The vast majority of recent cases are coming from household contacts, and not gatherings or essential workplaces. However, New Zealand’s battle to eliminate the highly infectious Delta variant appears delicately poised.

The NZ prime minister, Jacinda Ardern, has previously advised she expected cases to near a peak after eight to 10 days, and on Friday said the government did not expect further “big jumps” in cases. 

New Zealand has extended its nationwide lockdown until Tuesday. Ardern said her cabinet would decide on the lockdown setting in Auckland and the neighbouring Northland region on Monday, but said it was likely Auckland would stay in level 4 – the highest setting – for another two weeks. 

Saturday’s total of 82 – up from 70 on Friday – is New Zealand’s fifth-worst day for cases during the entire coronavirus pandemic. 

On 17 August, the government put the nation into full lockdown after only a single community case was detected in the city of Auckland. New Zealand has reported 26 deaths from the virus in a population of 5 million since the pandemic began. 

New Zealanders lived virus-free in the six months leading up to the latest outbreak, going to workplaces, shops and sport stadiums without needing to wear masks, while children attended school. Then a traveller returning from Sydney brought the Delta variant, which escaped from a quarantine hotel.

The outbreak has grown to about 350 known cases and is straining New Zealand‘s contact-tracing system as workers try to track down 30,000 other people who might have been exposed. 

The lockdown prevents most people from leaving home other than to exercise, or to buy groceries or medicine. Retail stores are closed, as are restaurants – including takeaway – schools and most businesses. 

New Zealand’s vaccine rollout has been the slowest of any developed nation, with only 39% of people having gotten at least one shot and 22% fully vaccinated. The country chose to use only the Pfizer vaccine and did not approve its use until two months after US regulators first approved it for emergency use. 

The government blamed the initial slowness of the rollout on Pfizer’s delivery schedule. 

Vaccinations have sped up rapidly since the outbreak began, with health workers now giving doses to nearly 2% of the population every day.

Vietnam logs additional 12,103 COVID-19 cases

Via VietnamPlus: Vietnam logs additional 12,103 COVID-19 cases.

Hanoi (VNA) – Vietnam recorded an additional 12,103 COVID-19 infections, including 12,097 domestic and six imported cases, in the past 24 hours to 6pm on August 28, the Ministry of Health announced. 

Ho Chi Minh City, the country’s current largest pandemic hotspot, logged the highest number of infections with 5,481 cases. It was followed by the neighbouring provinces of Binh Duong with 4,049 cases and Dong Nai, with 797 infections. 

The remainders were detected in Long An (451), Tien Giang (241), Dong Thap (143), Da Nang (109), Khanh Hoa (92), Quang Binh (90), Kien Giang (77), Nghe An (70), Hanoi (61), Dak Lak (60), Binh Thuan (49), Can Tho (37), Ba Ria - Vung Tau (35), Ben Tre (25), Thua Thien Hue (24), Thanh Hoa (22), An Giang (20), Phu Yen (16), Soc Trang (16), Quang Ngai (15), Bac Lieu (13), Quang Nam (13), Tra Vinh (13), Binh Phuoc (13), Hau Giang (11), Binh Dinh (11), Dak Nong (8 ), Vinh Long (6), Ninh Thuan (6), Ha Tinh (6), Ca Mau (5), Lam Dong (4), Lang Son (3), Gia Lai (2), Bac Ninh (2), and Bac Giang (1). 

Of those, 6,468 cases were found in the community and the rest in locked down areas and quarantine sites. 

The new infections brought the country's total number of infections since the pandemic broke out in early 2020 to 422,469. 

Also on August 28, a further 12,375 patients were given the all-clear from coronavirus SARS-CoV-2, raising the total number of recoveries to 210,989. 

Meanwhile, 352 fatalities related to the disease were reported on the same day, lifting the country’s death toll 10,405. 

More than 304,000 doses of vaccines were administered on August 27. The country has to date administered over 19.15 million doses of vaccines, with more than 2.32 million people having been fully vaccinated.

Cuba reports 6,850 new Covid-19 cases and 83 deaths

Via Prensa Latina:Cuba reports 6,850 new Covid-19 cases and 83 deaths.

Havana, Aug 28 (Prensa Latina) The Cuban Ministry of Public Health reported 6,850 new contagions with the SARS-Cov-2 coronavirus, which causes Covid-19, and 83 deaths in the last few hours, due to complications from the disease. 

At his daily news briefing on television, Dr. Francisco Duran, national director of Epidemiology at the Ministry of Public Health (MINSAP), noted that Cuba has accumulated 634,161 Covid-19 patients and 5,667 deaths since the outbreak of the pandemic in the country in March 2020.

Outbreak associated with SARS-CoV-2 B.1.617.2 (Delta) variant in an elementary school — Marin County, California, May–June 2021

Via MMWR: Outbreak Associated with SARS-CoV-2 B.1.617.2 (Delta) Variant in an Elementary School — Marin County, California, May–June 2021. The summary:

What is already known about this topic? 

The SARS-CoV-2 B.1.617.2 (Delta) variant is highly transmissible. Prevention guidance in schools varies by jurisdiction. What is added by this report? During May 23–June 12, 2021, 26 laboratory-confirmed COVID-19 cases occurred among Marin County, California, elementary school students and their contacts following exposure to an unvaccinated infected teacher. The attack rate in one affected classroom was 50%; risk correlated with seating proximity to the teacher. 

What are the implications for public health practice? 

Vaccines are effective against the Delta variant, but transmission risk remains elevated among unvaccinated persons in schools. In addition to vaccination, strict adherence to multiple nonpharmaceutical prevention strategies, including masking, are important to ensure safe school instruction.

Hospital admission and emergency care attendance risk for SARS-CoV-2 delta (B.1.617.2) compared with alpha (B.1.1.7) variants of concern

Via The Lancet Infectious Diseases: Hospital admission and emergency care attendance risk for SARS-CoV-2 delta (B.1.617.2) compared with alpha (B.1.1.7) variants of concern: a cohort study. The summary:

Background 

The SARS-CoV-2 delta (B.1.617.2) variant was first detected in England in March, 2021. It has since rapidly become the predominant lineage, owing to high transmissibility. It is suspected that the delta variant is associated with more severe disease than the previously dominant alpha (B.1.1.7) variant. We aimed to characterise the severity of the delta variant compared with the alpha variant by determining the relative risk of hospital attendance outcomes. 

Methods 

This cohort study was done among all patients with COVID-19 in England between March 29 and May 23, 2021, who were identified as being infected with either the alpha or delta SARS-CoV-2 variant through whole-genome sequencing. Individual-level data on these patients were linked to routine health-care datasets on vaccination, emergency care attendance, hospital admission, and mortality (data from Public Health England's Second Generation Surveillance System and COVID-19-associated deaths dataset; the National Immunisation Management System; and NHS Digital Secondary Uses Services and Emergency Care Data Set). The risk for hospital admission and emergency care attendance were compared between patients with sequencing-confirmed delta and alpha variants for the whole cohort and by vaccination status subgroups. Stratified Cox regression was used to adjust for age, sex, ethnicity, deprivation, recent international travel, area of residence, calendar week, and vaccination status. 

Findings 

Individual-level data on 43 338 COVID-19-positive patients (8682 with the delta variant, 34 656 with the alpha variant; median age 31 years [IQR 17–43]) were included in our analysis. 196 (2·3%) patients with the delta variant versus 764 (2·2%) patients with the alpha variant were admitted to hospital within 14 days after the specimen was taken (adjusted hazard ratio [HR] 2·26 [95% CI 1·32–3·89]). 498 (5·7%) patients with the delta variant versus 1448 (4·2%) patients with the alpha variant were admitted to hospital or attended emergency care within 14 days (adjusted HR 1·45 [1·08–1·95]). Most patients were unvaccinated (32 078 [74·0%] across both groups). The HRs for vaccinated patients with the delta variant versus the alpha variant (adjusted HR for hospital admission 1·94 [95% CI 0·47–8·05] and for hospital admission or emergency care attendance 1·58 [0·69–3·61]) were similar to the HRs for unvaccinated patients (2·32 [1·29–4·16] and 1·43 [1·04–1·97]; p=0·82 for both) but the precision for the vaccinated subgroup was low. 

Interpretation 

This large national study found a higher hospital admission or emergency care attendance risk for patients with COVID-19 infected with the delta variant compared with the alpha variant. Results suggest that outbreaks of the delta variant in unvaccinated populations might lead to a greater burden on health-care services than the alpha variant.

Vietnam: Caseload tops 410,000, additional 386 deaths reported Friday

Via VietNam News: Caseload tops 410,000, additional 386 deaths reported Friday. This explains the staggering 17,428 cases reported this evening by BNO News: 4,508 of them are earlier cases in Binh Duong, only now added to the tally. And Binh Duong now has 4,187 new cases. Excerpt:

HÀ NỘI —The total number of COVID-19 cases in Việt Nam reached 410,366 as more than 17,000 new patients were reported on Friday night. 

Of those, 12,920 new patients were reported across the country during the day, and 4,508 cases previously detected in Bình Dương but only added to the system on Friday. 

Out of the cases reported during the day, only 19 were imported and the rest were domestic cases. 

HCM City led the country in the number of new cases again with 5,383, followed by Bình Dương (4,187), Đồng Nai (996), Long An (454), Tiền Giang (312), Đà Nẵng (202), Tây Ninh (132), Khánh Hòa (131), Quảng Bình (125) and Đồng Tháp (122). New patients were also found in An Giang (91), Bình Thuận (87), Hà Nội (77), Cần Thơ (72), Thừa Thiên Huế (70), Đắk Lắk (63), Bà Rịa - Vũng Tàu (59), Nghệ An (57), Bến Tre (31), Bình Định (29), Thanh Hóa (28), Kiên Giang (28), Phú Yên (21), Trà Vinh (19), Bình Phước (17), Hậu Giang (15), Vĩnh Long (14), Quảng Trị (13), Quảng Ngãi (9), Sóc Trăng (8 ), Cà Mau (8 ), Ninh Thuận (6), Hà Tĩnh (6), Quảng Nam (5), Ninh Bình (5), Hà Nam (4), Gia Lai (4), Sơn La (3), Bạc Liêu (3), Bắc Ninh (2), Bắc Giang (2) and Hải Dương (1). 

Out of the domestic cases, 6,627 were reported as community infections as they were found in communities outside quarantine areas and locked down zones. 

Reports from health officials on Friday also said 386 deaths have been recorded. 

They include 356 deaths reported during the day in HCM City (287), Bình Dương (34), Đồng Nai (13), Khánh Hòa (10), Long An (7), Đà Nẵng (2), Bến Tre (1), Sóc Trăng (1), Thanh Hóa (1), and 30 recorded in Phú Yên from the beginning of the month. This brings the country’s total deaths to 10,053.

Association between air pollution exposure and mental health service use among individuals with first presentations of psychotic and mood disorders

Via The British Journal of Psychiatry: Association between air pollution exposure and mental health service use among individuals with first presentations of psychotic and mood disorders: retrospective cohort study. The abstract:

Background 

Growing evidence suggests that air pollution exposure may adversely affect the brain and increase risk for psychiatric disorders such as schizophrenia and depression. However, little is known about the potential role of air pollution in severity and relapse following illness onset. 

Aims 

To examine the longitudinal association between residential air pollution exposure and mental health service use (an indicator of illness severity and relapse) among individuals with first presentations of psychotic and mood disorders. 

Method 

We identified individuals aged ≥15 years who had first contact with the South London and Maudsley NHS Foundation Trust for psychotic and mood disorders in 2008–2012 (n = 13 887). High-resolution (20 × 20 m) estimates of nitrogen dioxide (NO2), nitrogen oxides (NOx) and particulate matter (PM2.5 and PM10) levels in ambient air were linked to residential addresses. In-patient days and community mental health service (CMHS) events were recorded over 1-year and 7-year follow-up periods. 

Results 

Following covariate adjustment, interquartile range increases in NO2, NOx and PM2.5 were associated with 18% (95% CI 5–34%), 18% (95% CI 5–34%) and 11% (95% CI 3–19%) increased risk for in-patient days after 1 year. Similarly, interquartile range increases in NO2, NOx, PM2.5 and PM10 were associated with 32% (95% CI 25–38%), 31% (95% CI 24–37%), 7% (95% CI 4–11%) and 9% (95% CI 5–14%) increased risk for CMHS events after 1 year. Associations persisted after 7 years. 

Conclusions 

Residential air pollution exposure is associated with increased mental health service use among people recently diagnosed with psychotic and mood disorders. Assuming causality, interventions to reduce air pollution exposure could improve mental health prognoses and reduce healthcare costs.

See also this Guardian report on the study.

Kerala records more than 30,000 COVID-19 cases for three days in a row

Via The Week: Kerala records more than 30,000 COVID-19 cases for three days in a row.

For the third consecutive day, Kerala recorded over 30,000 COVID-19 cases, on Friday. 

As many as 32,801 cases were reported in the state in the past 24 hours, with a test positivity rate of 19.22. The state had reported 31,445 cases on Wednesday and 30,000 cases on Thursday. 

As many as 179 deaths were reported on Friday, taking the death toll due to the pandemic to 20,313. 

Malappuram district had the most number of positive cases at 4,032, followed by Thrissur (3,953) and Ernakulam (3,627). 

The state now has 195,254 active cases. 

As many as 18,573 people recovered from the pandemic in the past 24 hours. 

The opposition Congress, meanwhile, continued its attack on the state government led by Chief Minister Pinarayi Vijayan over the rising coronavirus cases, saying the COVID-19 management has been "hijacked" by the officials and the state was hiding details about deaths and claiming a low fatality rate. 

"We had raised a serious allegation that the government was deliberately showing a low death rate related to COVID-19. The government has been hiding around 25,000 deaths in Kerala and has been claiming that the death rate is low in the state. This means that the government has been hiding the death rate in the state to take credit," leader of opposition in the state assembly, V.D. Satheesan had told reporters. 

"There is no role for the chief minister or the health minister here. Everything is decided by some officials. They have hijacked the COVID-19 management. The CM and the health minister are parroting the officials," he further said. 

Since July 27, after restrictions were relaxed for a few days on account of two festivals, Kerala has been logging more than or close to 20,000 almost every day. On Thursday, the state reported 30,007 cases.

Inside a Florida hospital's COVID unit: 'Don't let me die'

Via USA Today: Inside a Florida hospital's COVID unit: 'Don't let me die'.

TALLAHASSEE, Fla. -- Inside the COVID-19 unit at Tallahassee Memorial HealthCare, a thin curtain separates life and death.  

The curtain divides every patient room in two. On one side, a man gasps for air every 20 seconds as nurses gather around his bedside. They hold hands, hug one another and comfort the man as best they can. 

"Knowing that their family can't be there at that time, you (the nurse) are the one that is combing hair, playing music," says registered nurse Emily Brown, who works at Tallahassee Memorial HealthCare. "We're praying; we're holding their hands." 

One nurse uses a rag to wipe his eyes. 

From the other side of the curtain, another man asks for a glass of water. A nurse chuckles. She says, "I think we can get you that."  

He doesn't know his roommate was just given morphine to provide comfort in his final moments. 

A red-level surge 

TMH has three levels of COVID-19 patients cared for in different areas of the hospital. 

Green-level patients have the least severe cases and should soon return home. Yellow-level patients have moderate cases and typically need some form of oxygen. Red level is for those most likely on ventilators and considered intensive care patients.  

Red level, most often, is where people die. 

And people are dying. Daily. At a faster rate than ever before. 

At least two people have succumbed to the virus each day this week at TMH. More than 60 people have died so far in August. 

Florida is among eight states that have already surpassed their previous records for COVID-19 hospitalizations. The state has seen some of the highest rates of cases, hospitalizations and deaths, along with some of the lowest vaccinations rates in the country.

This week, Tallahassee has experienced the largest surge in cases and hospitalizations since the start of the pandemic in March 2020. 

Monday, when the Tallahassee Democrat, part of the USA TODAY Network, was allowed in to the ward, there were 125 patients admitted to TMH. Of those patients, 107 were unvaccinated and two were children. 

There were 43 patients considered critically ill in the ICU and 39 of them were unvaccinated.  

By the end of the day, there had been three deaths and 12 new patients admitted.  

There will be more. The sick keep coming.

Kerala's COVID-19 lessons for India and Modi's government

Via Reuters: Kerala's COVID-19 lessons for India and Modi's government. Excerpt:

MALAPPURAM, India, Aug 26 (Reuters) - Vilified by Indian Prime Minister Narendra Modi's party for its high COVID-19 cases, Kerala's apparent poor record may actually hold crucial lessons for the country in containing the outbreak as authorities brace for a possible third wave of infections. 

The opposition-ruled, densely populated southern state is currently reporting the most number of coronavirus cases in the country and accounts for the second-highest national tally - unflattering headline numbers that Modi's Bharatiya Janata Party (BJP) has seized upon as a reflection of bungled local leadership. 

However, a Reuters analysis of national and state data, and interviews with epidemiologists and Kerala health authorities paint a different picture. 

It shows the state's containment measures have helped to catch infections early, allowing authorities to better manage the illness and dramatically lower the death rate - a stark contrast to people dying in carparks and outside hospitals for lack of oxygen and beds in big cities like Delhi at the height of the health crisis a few months earlier.

"While the federal government may have its views on rapid antigen tests, it is important to consider that the state's strategies have by and large succeeded in not just keeping mortality low but also in being able to detect one in six cases compared to one in 33 nationally," said Rajib Dasgupta, head of the Centre of Social Medicine & Community Health at New Delhi’s Jawaharlal Nehru University. 

The efficient detection rate and its population density at more than twice the national average explain the high number of cases in Kerala. 

All the same, at 0.5%, Kerala still has the lowest fatality rate among all but one thinly populated state. The national figure is 1.4% and it is 1.3% for the country's most populous state, Uttar Pradesh.

The difference comes down to Kerala's reliance on rapid antigen tests to detect and strictly isolate infected people at home, an approach the federal health ministry has sharply criticised but which state officials argue has helped them to better allocate hospital beds and oxygen supplies for those who really need them. 

The government-recommended RT-PCR tests are more accurate but take longer to produce results, meaning by the time a positive COVID-19 case is confirmed the infected person is more likely to have developed severe symptoms and passed it on to others in a vicious cycle of more infections and deaths. 

Kerala's rapid test results allow for early treatment in home isolation which then narrows the virus' path to infections, state officials say. 

These factors, along with the strained medical resources across much of India, largely explain why the overall national death rate is much higher than in the Communist-run state. 

Kerala officials also say a state-run support service that includes phone consultation, provision of drugs and pulse oximeters that detect blood oxygen levels for people recovering at home provide a bulwark in the battle against the disease. 

Delhi had a similar support structure but it collapsed when cases surged. 

"We do have a different model and our fatality rate shows our model is on the right track," Kerala Health Minister Veena George told Reuters. 

But Kerala officials acknowledge that the fast-evolving pandemic can undo even the best thought-out plans unless authorities remain nimble and flexible.