H5N1

Without oxygen, the government of Amazonas suggests the use of a mass grave

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Via d24am.com, a horrifying report: Without oxygen, the Government of AM suggests the use of a ditch in the interior. By "ditch," I believe Google Translate means "mass grave." Excerpt from the Google translation, with my bolding:

Manaus - The Government of Amazonas instructed a city government in the interior of the state to open ditches to bury its dead because there was no forecast for the arrival of oxygen cylinders in any city in the interior. The guidance is cited by the State Prosecutor's Office (MP-AM), which filed a public civil action this Saturday (16) to compel the State to send oxygen to the municipality of Itacoatiara, 269 kilometers from Manaus.

Justice has already accepted the request. "If the State does not send enough oxygen to the local hospital in Itacoatiara-AM, as already proven, we will have the death of at least 77 people simultaneously due to respiratory failure, due to the lack of material," said Judge Rafael Almeida Cró Brito. The term is 12 hours and the fine is R $20,000 per hour of non-compliance.  

According to the MP, the Interior Secretary of the State Department of Health (SES-AM), Cássio Espírito Santo, went so far as to offer cold rooms to the mayor of the city, Mario Jorge Abrahim, advising to open ditches in the local cemetery, since he did there is a forecast for the supply of oxygen to the municipality. 

The report contacted the state government, asking if there is any plan to send oxygen to the interior, but there was no response. Of the 63 municipalities in the interior, only 11 have hospitals, the others only have health posts.

None of the hospitals in the interior has an ICU bed (Intensive Care Unit). According to the promoter of Itacoatiara, Marcelle Arruda, this Saturday there are 74 patients with covid-19 at the José Mendes Hospital, the only one in the city, receiving oxygen.

"Yesterday (Friday) four died because they lacked oxygen and we fear that everyone can die between today (Saturday) and tomorrow (Sunday) if there is no oxygen," he said. The current demand is 150 cylinders per day. Half of it is being used today, the rest is empty.

COVID-19: Black Americans are getting vaccinated at lower rates than white Americans

Via NBC News, a KHN report by Hannah Recht and Lauren Weber: Black Americans are getting vaccinated at lower rates than white Americans. Excerpt:

Black Americans are receiving Covid vaccinations at dramatically lower rates than white Americans in the first weeks of the chaotic rollout, according to a new Kaiser Health News analysis. 

About 3 percent of Americans have received at least one dose of a coronavirus vaccine so far. But in 16 states that released data by race, white residents are being vaccinated at significantly higher rates than Black residents, according to the analysis — in many cases two to three times higher. 

In the most dramatic case, 1.2 percent of white Pennsylvanians had been vaccinated as of Jan. 14, compared with 0.3 percent of Black Pennsylvanians. 

The vast majority of the initial round of vaccines has gone to health care workers and staffers on the front lines of the pandemic — a workforce that’s typically racially diverse made up of physicians, hospital cafeteria workers, nurses and janitorial staffers.

If the rollout were reaching people of all races equally, the shares of people vaccinated whose race is known should loosely align with the demographics of health care workers. But in every state, Black Americans were significantly underrepresented among people vaccinated so far.

Access issues and mistrust rooted in structural racism appear to be the major factors leaving Black health care workers behind in the quest to vaccinate the nation. The unbalanced uptake among what might seem like a relatively easy-to-vaccinate workforce doesn’t bode well for the rest of the country’s dispersed population. 

Black, Hispanic and Native Americans are dying from Covid at nearly three times the rate of white Americans, according to a Centers for Disease Control and Prevention analysis. And non-Hispanic Black and Asian health care workers are more likely to contract Covid and to die from it than white workers. (Hispanics can be of any race.) 

“My concern now is if we don’t vaccinate the population that’s highest-risk, we’re going to see even more disproportional deaths in Black and brown communities,” said Dr. Fola May, a UCLA physician and health equity researcher. “It breaks my heart.”

Characterisation of the first 250 000 hospital admissions for COVID-19 in Brazil

Via The Lancet Respiratory Medicine: Characterisation of the first 250 000 hospital admissions for COVID-19 in Brazil: a retrospective analysis of nationwide data. The summary:

Background 

Most low-income and middle-income countries (LMICs) have little or no data integrated into a national surveillance system to identify characteristics or outcomes of COVID-19 hospital admissions and the impact of the COVID-19 pandemic on their national health systems. We aimed to analyse characteristics of patients admitted to hospital with COVID-19 in Brazil, and to examine the impact of COVID-19 on health-care resources and in-hospital mortality. 

Methods 

We did a retrospective analysis of all patients aged 20 years or older with quantitative RT-PCR (RT-qPCR)-confirmed COVID-19 who were admitted to hospital and registered in SIVEP-Gripe, a nationwide surveillance database in Brazil, between Feb 16 and Aug 15, 2020 (epidemiological weeks 8–33). We also examined the progression of the COVID-19 pandemic across three 4-week periods within this timeframe (epidemiological weeks 8–12, 19–22, and 27–30). The primary outcome was in-hospital mortality. We compared the regional burden of hospital admissions stratified by age, intensive care unit (ICU) admission, and respiratory support. We analysed data from the whole country and its five regions: North, Northeast, Central-West, Southeast, and South. 

Findings 

Between Feb 16 and Aug 15, 2020, 254 288 patients with RT-qPCR-confirmed COVID-19 were admitted to hospital and registered in SIVEP-Gripe. The mean age of patients was 60 (SD 17) years, 119 657 (47%) of 254 288 were aged younger than 60 years, 143 521 (56%) of 254 243 were male, and 14 979 (16%) of 90 829 had no comorbidities. 

Case numbers increased across the three 4-week periods studied: by epidemiological weeks 19–22, cases were concentrated in the North, Northeast, and Southeast; by weeks 27–30, cases had spread to the Central-West and South regions. 232 036 (91%) of 254 288 patients had a defined hospital outcome when the data were exported; in-hospital mortality was 38% (87 515 of 232 036 patients) overall, 59% (47 002 of 79 687) among patients admitted to the ICU, and 80% (36 046 of 45 205) among those who were mechanically ventilated. 

The overall burden of ICU admissions per ICU beds was more pronounced in the North, Southeast, and Northeast, than in the Central-West and South. In the Northeast, 1545 (16%) of 9960 patients received invasive mechanical ventilation outside the ICU compared with 431 (8%) of 5388 in the South. In-hospital mortality among patients younger than 60 years was 31% (4204 of 13 468) in the Northeast versus 15% (1694 of 11 196) in the South. 

Interpretation 

We observed a widespread distribution of COVID-19 across all regions in Brazil, resulting in a high overall disease burden. In-hospital mortality was high, even in patients younger than 60 years, and worsened by existing regional disparities within the health system. 

The COVID-19 pandemic highlights the need to improve access to high-quality care for critically ill patients admitted to hospital with COVID-19, particularly in LMICs.

2,000,905 COVID-19 deaths

A screenshot from the John Hopkins Coronavirus COVID-19 (2019-nCoV) dashboard:

COVID-19 on Friday morning: Approaching 2 million deaths

A screenshot from the Johns Hopkins Coronavirus COVID-19 (2019-nCoV) dashboard:

Yesterday's case count was 739,328. Yesterday's deaths totalled 15,121.

COVID-19: Where the vaccine rollout went wrong

Via The Los Angeles Times: Coronavirus Today: Where the vaccine rollout went wrong. Excerpt:

It’s no secret that America’s vaccine rollout has been anything but smooth. Many folks are feeling frustrated and angry after trying in vain to find out how to get their shots. Calls to medical offices and pharmacies often end without insight, and emails from doctors lack specifics. 

“Many people are eager to get the vaccine, and they want to know when and where they are going to get it,” said Dr. Eric Toner, a senior scholar with the Johns Hopkins Center for Health Security. “For the most part, people at the local level don’t know, and people at the state level are still trying to figure it out.”  

States are about two months behind in their planning thanks to inadequate funding, said Dr. John Swartzberg, a UC Berkeley infectious disease expert. Health economists said states would need $8.4 billion for their vaccination campaigns, but until recently they’d received only $400 million.  

After the vaccines were developed in record time, the reasons for their fumbled distribution are complicated, my colleague Maura Dolan writes. They can be blamed on multiple governmental failures involving planning, coordination and public communication.  

“Almost every practical question I ask anybody, the answer I get is a shrug of the shoulders,” said Dr. Robert Wachter, chair of the Department of Medicine at UC San Francisco. “It is not good. It just feels like the plans have been made without any attention to the practicalities of the last mile.”  

The problems start right at the top, with the Trump administration. Alex Azar, who leads the Department of Health and Human Services, promised on Dec. 11 that 20 million Americans would get their shots within several weeks. As of Monday, just 9 million had been vaccinated, according to the Centers for Disease Control and Prevention. And administration officials have acknowledged a “planning error” for the availability of doses.  

On the state level, vaccine distribution is being slowed in part by technical problems with a software program designed to coordinate the movement of doses among a sprawling network of providers, officials say. Another issue: the vast number of healthcare providers, including pharmacy chains, that have been slow to prepare communication plans to notify nearby eligible people that they can come in and get their shots. 

A fundamental and longstanding problem is that public health departments are chronically overstretched, said Dr. David P. Eisenman, director of UCLA’s Center for Public Health and Disasters. 

Right now, even as they’re struggling to respond to an overwhelming surge of COVID-19 patients, these health agencies “have to design these massive vaccination programs, and they don’t know where to start,” he said.  

“It is much harder in the United States,” he added, “where we have so much private healthcare that has little to no connection established with public health departments.”

Coronavirus: Global death toll could hit 5 million by March, Chinese researchers say

Update, January 16: Note the exchange in the comments. The SCMP article cites a June 2020 article as having been published on January 8, 2021. So this post is very out date, and I'm happy to stand corrected.

Via the South China Morning Post, a very grim forecast: Coronavirus: global death toll could hit 5 million by March, Chinese researchers say. Excerpt:

A team of Chinese experts has warned that the global impact of the coronavirus pandemic could be worse this year than it was in 2020. 

By the beginning of March, the death toll from Covid-19 could rise to 5 million – from just under 2 million on Thursday – according to figures calculated by a team from China’s Centre for Disease Control and Prevention (CDC), People’s Liberation Army and public health research institutes. 

The researchers, led by professor Xu Jianguo from the CDC, said in a study published on January 8 in the peer-reviewed [Chinese] journal Disease Surveillance that the Chinese government and the public should brace for more external shocks. 

“The development of the pandemic is hard to foresee, but a numerical estimate by modelling can provide some useful information,” Xu said. 

While China has largely brought Covid-19 under control, many countries are still dealing with widespread outbreaks partly driven by mutated strains. Some of the mutations are believed to have emerged in communities where herd immunity had already been established.  

More than 92 million cases have been reported around the world, but that number could rise to 170 million in early March, with the United States likely to be the worst hit, according to Xu’s estimate. 

In the worst case, the number of US cases could hit 32 million, or about 20 per cent of the world total. India, Brazil and Russia would be the next worst hit, with 15.5, 15 and 6 million cases respectively. WHO experts arrive in Wuhan to investigate coronavirus origins 15 Jan 2021 The researchers did not provide an estimate of the possible death toll in the four worst-hit countries and did not immediately respond to a request for comment.

Even in the best scenario – with governments implementing effective measures, people obeying rules such as social distancing and wearing masks, and massive vaccination programmes taking effect – the study said a further 300,000 people would die from Covid-19 by early March. 

To achieve the best scenario the US would have to keep its cases at about 26 million, or no more than 3 million new infections in the intervening weeks, the study said. The US reported more than 1.7 million cases last week alone.  

A researcher at the Institut Pasteur of Shanghai who is investigating the coronavirus but was not involved in the study, said that if 5 million people died by March, it could lead to the collapse of the global health care system. 

“People die en masse when they cannot get even the most basic care in hospitals,” said the person, who asked not to be named. 

The current global fatality rate of Covid-19 is 2.1 per cent, according to figures from Johns Hopkins University in the US. A rise in the death toll to 5 million would represent a death rate of 3 per cent, which was about the level in Wuhan when hospitals were overwhelmed by the then new disease.

China reports first Covid-19 death in 8 months as thousands of Hebei residents are evacuated

Via the South China Morning Post: China reports first Covid-19 death in 8 months as thousands of Hebei residents are evacuated. Excerpt:

China has reported its first Covid-19 death since May as its northern province of Hebei battles an outbreak that also prompted the evacuation of thousands of residents of high-risk areas to a quarantine facility. 

Hebei’s health commission on Thursday reported 81 new cases, 75 of them in its provincial capital Shijiazhuang, taking the total for its current outbreak to 463 known active infections. 

About 5,500 people from three villages in Shijiazhuang’s Gaocheng district, which has been classed as high-risk, were evacuated to a quarantine site at a vocational college on Wednesday, while a second round of mass testing began. 

Nationwide, 138 new infections were recorded – 14 of them imported and the rest local transmissions – taking China’s total infection tally to almost 88,000, with more than 4,600 deaths.

COVID-19 infection gives some immunity, but virus can still be spread, study finds

Via Reuters: COVID-19 infection gives some immunity, but virus can still be spread, study finds. Excerpt:

LONDON (Reuters) - People who have had COVID-19 are highly likely to have immunity to it for at least five months, but there is evidence that those with antibodies may still be able to carry and spread the virus, a study of British healthcare workers has found.   

Preliminary findings by scientists at Public Health England (PHE) showed that reinfections in people who have COVID-19 antibodies from a past infection are rare - with only 44 cases found among 6,614 previously infected people in the study.  

But experts cautioned that the findings mean people who contracted the disease in the first wave of the pandemic in the early months of 2020 may now be vulnerable to catching it again. 

They also warned that people with so-called natural immunity - acquired through having had the infection - may still be able carry the SARS-CoV-2 coronavirus in their nose and throat and could unwittingly pass it on. 

“We now know that most of those who have had the virus, and developed antibodies, are protected from reinfection, but this is not total and we do not yet know how long protection lasts,” said Susan Hopkins, senior medical adviser at PHE and co-leader of the study, whose findings were published on Thursday.

Survey: A third of Americans don't see systemic racism as a barrier to good health

Via WRCBtv.com in Chattanooga, Tennessee: A third of Americans don't see systemic racism as a barrier to good health. Excerpt:

A third of Americans don't see systemic racism as a barrier to good health even after communities of color have been hit the hardest by the Covid-19 pandemic, researchers say.  

The new findings of the ongoing national survey conducted by the RAND Corporation with support from the Robert Wood Johnson Foundation were released Wednesday.  

Among the respondents, 42% do believe that systemic racism is one of the main reasons people of color have poorer health outcomes and 24% said they were neutral. 

A total of 4,143 adults with household incomes of less than $125,000 were part of the survey aiming to measure attitudes and views toward health equity, civic engagement, systemic racism during the Covid-19 pandemic. 

"It really struck us that -- despite the virus's spread across the country to all types of communities -- there's not a consensus view on the effects of systemic racism. Respondents see the impact of low incomes and living in a rural community on a person's health, but race isn't viewed with the same gravity," Katherine Grace Carman, a senior economist at RAND Corporation and the lead author of the report said in a statement. 

Researchers noted that Black respondents (72.5%) are much more likely than White respondents, (33.2%) to believe that systemic racism affects the health of people of color.  

"Our leaders need to understand that we have a lot more work to do to educate people about the root causes of inequities and then enact policies to ensure better health for all," Carman added.  

Medical professionals and public health leaders have previously said that racism, whether intentional or implicit, can help drive racial disparities in health.  

Last month, Dr. Marcella Nunez-Smith, chair of President-elect Joe Biden's Covid-19 equity task force, said that Covid-19 has exacerbated existing health disparities.  

"It is time for us to respond to the crisis of discrimination in healthcare," Nunez-Smith said. 

Since the beginning of the coronavirus pandemic, Black, Latino and Native Americans have disproportionately been hospitalized and died from the virus.  

Several studies have previously suggested that experiences of racism or discrimination raise the risk of emotional and physical health problems, including depression, cardiovascular disease, hypertension -- more than 40% of Black adults have high blood pressure -- and even death. 

The RAND Corporation survey also shows more than 70% of respondents see the pandemic as a moment for positive change and they "believe society should prioritize expanding access to health care and reducing income inequality."