H5N1

COVID-19 in Brazil, epi-week 39

The CONASS PANEL | COVID-19 dashboard has the numbers for ep-week 38, ending today. First, today's numbers:

The week saw 115,813 new cases, a bit more than last week's 112,979. So cases haven't really fallen for about 4 weeks. Deaths were very slightly lower this week: 3,523, compared to last week's 3,692:

The US in the pandemic as of October 2, 2021

A few charts describe the situation in the United States as we approach the second anniversary of the first reports of a novel pneumonia in Wuhan. First, the Johns Hopkins Coronavirus COVID-19 (2019-nCoV) dashboard, with American figures highlighted:

Note the 28-day numbers: in themselves, they reflect a medical disaster, but they're just the cases and deaths reported in the last four weeks. All told, 700,000 dead Americans reflect a greater toll than the US suffered in the 1918-19 influenza pandemic, or in the Civil War.

 

Some charts from Our World in Data give us some perspective, but not much consolation. First, new cases:

While the count is falling, it's still well over 100,000 a day.

Daily deaths are just beginning to drop, to roughly 1,900 a day—far better than the awful spike last winter, but still bad. So is the count of vaccination doses:

The Americans, and the world, will be a long time in understanding why a rich, powerful nation succumbed so badly to COVID-19, when it should have led the world in an effective response.

The police as public health crisis

Via The Lancet: Fatal police violence by race and state in the USA, 1980–2019: a network meta-regression. The summary and then a comment:

Background  

The burden of fatal police violence is an urgent public health crisis in the USA. Mounting evidence shows that deaths at the hands of the police disproportionately impact people of certain races and ethnicities, pointing to systemic racism in policing. Recent high-profile killings by police in the USA have prompted calls for more extensive and public data reporting on police violence. 

This study examines the presence and extent of under-reporting of police violence in US Government-run vital registration data, offers a method for correcting under-reporting in these datasets, and presents revised estimates of deaths due to police violence in the USA.  

Methods  

We compared data from the USA National Vital Statistics System (NVSS) to three non-governmental, open-source databases on police violence: Fatal Encounters, Mapping Police Violence, and The Counted. We extracted and standardised the age, sex, US state of death registration, year of death, and race and ethnicity (non-Hispanic White, non-Hispanic Black, non-Hispanic of other races, and Hispanic of any race) of each decedent for all data sources and used a network meta-regression to quantify the rate of under-reporting within the NVSS. Using these rates to inform correction factors, we provide adjusted estimates of deaths due to police violence for all states, ages, sexes, and racial and ethnic groups from 1980 to 2019 across the USA.  

Findings  

Across all races and states in the USA, we estimate 30 800 deaths (95% uncertainty interval [UI] 30 300–31 300) from police violence between 1980 and 2018; this represents 17 100 more deaths (16 600–17 600) than reported by the NVSS. Over this time period, the age-standardised mortality rate due to police violence was highest in non-Hispanic Black people (0·69 [95% UI 0·67–0·71] per 100 000), followed by Hispanic people of any race (0·35 [0·34–0·36]), non-Hispanic White people (0·20 [0·19–0·20]), and non-Hispanic people of other races (0·15 [0·14– 0·16]). This variation is further affected by the decedent's sex and shows large discrepancies between states. Between 1980 and 2018, the NVSS did not report 55·5% (54·8–56·2) of all deaths attributable to police violence. When aggregating all races, the age-standardised mortality rate due to police violence was 0·25 (0·24–0·26) per 100 000 in the 1980s and 0·34 (0·34–0·35) per 100 000 in the 2010s, an increase of 38·4% (32·4–45·1) over the period of study.  

Interpretation  

We found that more than half of all deaths due to police violence that we estimated in the USA from 1980 to 2018 were unreported in the NVSS. Compounding this, we found substantial differences in the age-standardised mortality rate due to police violence over time and by racial and ethnic groups within the USA. Proven public health intervention strategies are needed to address these systematic biases. State-level estimates allow for appropriate targeting of these strategies to address police violence and improve its reporting.

Canada is not much different. We have used our police, including the well-marketed Royal Canadian Mounted Police, to suppress Indigenous and other minority peoples, with increasingly poor results. I suggested a solution back in 2007: Disband the RCMP. 

Covid is killing rural Americans at twice the rate of people in urban areas

Via NBC News, a report by Lauren Weber of Kaiser Health News: Covid Is killing rural Americans at twice the rate of people in urban areas. Excerpt:

Rural Americans are dying of Covid at more than twice the rate of their urban counterparts — a divide that health experts say is likely to widen as access to medical care shrinks for a population that tends to be older, sicker, heavier, poorer and less vaccinated.  

While the initial surge of Covid-19 deaths skipped over much of rural America, where roughly 15 percent of Americans live, nonmetropolitan mortality rates quickly started to outpace those of metropolitan areas as the virus spread nationwide before vaccinations became available, according to data from the Rural Policy Research Institute.  

Since the pandemic began, about 1 in 434 rural Americans have died from Covid, compared with roughly 1 in 513 urban Americans, the institute’s data shows. And though vaccines have reduced overall Covid death rates since the winter peak, rural mortality rates are now more than double that of urban ones — and accelerating quickly.  

In rural northeastern Texas, Titus Regional Medical Center CEO Terry Scoggin is grappling with a 39 percent vaccination rate in his community. Eleven patients died of Covid in the first half of September at his hospital in Mount Pleasant, population 16,000. Typically, three or four nonhospice patients die there in a whole month.  

“We don’t see death like that,” Scoggin said. “You usually don’t see your friends and neighbors die.”

Part of the problem is that Covid incidence rates in September were roughly 54 percent higher in rural areas than elsewhere, said Fred Ullrich, a University of Iowa College of Public Health research analyst who co-wrote the institute’s report. He said the analysis compared the rates between nonmetropolitan, or rural, areas and metropolitan, or urban, areas. In 39 states, he added, rural counties had higher rates of Covid than their urban counterparts.  

“There is a national disconnect between perception and reality when it comes to Covid in rural America,” said Alan Morgan, head of the National Rural Health Association. “We’ve turned many rural communities into kill boxes. And there's no movement towards addressing what we're seeing in many of these communities, either among the public, or among governing officials.”  

Still, the high incidence of cases and low vaccination rates don’t fully capture why mortality rates are so much higher in rural areas than elsewhere. Academics and officials alike describe rural Americans’ greater rates of poor health and their limited options for medical care as a deadly combination. The pressures of the pandemic have compounded the problem by deepening staffing shortages at hospitals, creating a cycle of worsening access to care.  

It's the latest example of the deadly coronavirus wreaking more havoc in some communities than others. Covid has also killed Native American, Black or Hispanic people at disproportionately high rates.  

Vaccinations are the most effective way to prevent Covid infections from turning deadly. Roughly 41 percent of rural America was vaccinated as of Sept. 23, compared with about 53 percent of urban America, according to an analysis by The Daily Yonder, a newsroom covering rural America. Limited supplies and low access made shots hard to get in the far-flung regions at first, but officials and academics now blame vaccine hesitancy, misinformation and politics for the low vaccination rates.

'State of crisis': Canadian Medical Association calls for lockdowns in Alberta and Saskatchewan

Via CBC News, a report by The Canadian Press: 'State of crisis': Canadian Medical Association calls for lockdowns in Alberta and Saskatchewan.

The Canadian Medical Association is calling for lockdowns in Alberta and Saskatchewan to protect their "crumbling" health-care systems.  

Both western provinces are setting hospitalization records for COVID-19, with intensive care capacity running slim.  

Dr. Katharine Smart, president of the national association, is urging the federal and provincial governments to take immediate action.  

The association is calling for short, controlled lockdowns, often called "firebreakers" or "circuit-breakers," which would close schools and non-essential businesses.

Time for 'courageous action': CMA president  

It also wants mandatory vaccinations in health-care settings and an increase in the mobility of health workers and intensive care capacity between provinces.  

Smart says it's time for "courageous action" and politics must be put to the side to allow for collaboration between levels of government.  

"We are now witnessing an unprecedented health-care crisis in Alberta and Saskatchewan — and patients and health workers are experiencing unfathomable choices and consequences," Smart said in a statement Wednesday.  

"Early relaxation of public health measures has left two crumbling health-care systems in their wake and the dire realities are now in full view.  

"What is happening is as heartbreaking as it was preventable. We are now in a situation where it's all hands on deck to address the state of crisis."

'I'm going to die, aren't I?': Sask.'s unvaccinated express regret about not getting COVID-19 jab

Via CBC News: 'I'm going to die, aren't I?': Sask.'s unvaccinated express regret about not getting COVID-19 jab. Excerpt:

As Saskatchewan makes its way through its fourth wave of COVID-19, health-care workers across the province are sharing their difficult experiences continuing to treat those suffering from the virus.   

Dr. Alex Wong, an infectious diseases doctor at Regina General Hospital, is one of the workers who has taken to social media to give the public a glimpse of the reality inside the province's ICUs.   

Wong said he's heard dying patients express regret about not getting a COVID-19 vaccine dose when they had a chance.   

He used an example of one man who was unvaccinated.   

"'I should have had my shots ... my wife had hers. She kept kept telling me to get mine. I'm going to die, aren't I?'" Wong recalled the man saying.

The man was able to speak with his family one last time before he was taken to the ICU to be intubated, a procedure to assist someone when they are no longer able to breathe on their own.   

"He told them how sorry he was over and over again," Wong said, "and, unfortunately, three days later, he died alone." 

Wong believes many of those who come into the hospital without a vaccine do so because Saskatchewan's reopening plan for the summer gave them a false sense of security.  

The people felt that COVID-19 was over or, at the very least, was no longer a concern, Wong said.  "We've seen so many people in a hospital like this, and they are so regretful." 

'It is so hard right now'  

Wong and other health-care workers have shared their stories, hoping that they would serve as lessons for those who remain unvaccinated or who have family members who are unvaccinated.

Vaccination remains one of the most important tools against the virus, as it reduces the most serious effects of COVID-19 and prevents the spread of the virus from those who are infected.

But vaccination isn't the only tool available to help stop the spread, Wong said. Saskatchewan residents can wear masks indoors — as mandated by the province — but they can also avoid large gatherings.

"Honestly, some people will listen to this and just roll their eyes and think again that I'm just fear-mongering or whatever," he said. "But it is so hard right now, what it is that we're dealing with in our hospitals, in our ICUs."

How the US vaccine effort derailed and why we shouldn’t be surprised

Via The Guardian: How the US vaccine effort derailed and why we shouldn’t be surprise. Excerpt:

There are very specific, well-documented reasons that Americans are hesitant to take vaccines. They vary from the troubling way the medical system treats people of color, to vaccine misinformation campaigns overwhelmingly popular in conservative circles, to logistical challenges.  

But population health researchers, whose work considers how society as a whole is fairing, said low vaccine uptake may be looked at another way: as the predictable outcome of a campaign subject to entrenched social forces that have diminished American health and life expectancy since the 1980s.  

“When I look at this I do see a very familiar pattern,” said Dr Steven Woolf, a prominent population health researcher at Virginia Commonwealth University. “When Operation Warp Speed came out I thought I was just seeing a modern example of this old problem where the scientific community developed the vaccine at ‘warp speed,’ but the implementation system for getting it out into the community was inadequate”.  

Woolf calls this “breakthrough without follow-through”. In that light, the plodding vaccination campaign could be seen as one more aspect of the American “health disadvantage”.  

The phrase describes a paradox: the US houses among the most advanced medical and research centers in the world, but performs poorly in basic health metrics such as maternal mortality and infant mortality; accidental injury, death and disability; and chronic and infectious disease.

"So much of the whole issue of social determinants of health and the US ‘health disadvantage’ is rooted in a lack of trust and a lack of trustworthiness in many parts of our society,” said Laudan Y Aron, a senior fellow at the Urban Institute’s health policy center. 

A key piece of research in this area is a 2013 report by a panel chaired by Woolf, directed by Aron, and funded by the National Institutes of Health. Called US Health in International Perspective: Shorter Lives, Poorer Health, the report describes how Americans spend more than double per person on healthcare compared to 17 peer nations, but rank near the bottom in health outcomes.  

The phenomenon is described as “pervasive”, impacting all age groups up to 75, with life expectancy declining especially for women. In just a few examples, Americans have the highest infant mortality, children are less likely to live to age five, and the US has the worst rates of Aids among peer nations.  

The US also has the highest or among the highest rates of cardiovascular disease, obesity, chronic lung disease and disability. Together, these risk factors culminate in Americans having the worst or second worst probability of living to age 50.  

Americans know intuitively that their healthcare is expensive, frustrating and often unfair. Remarkably, even amid the pandemic, roughly 30 million Americans went without health insurance, exposing them to potentially ruinous medical debt.  

“It’s also really interesting how often the messaging is: talk to your doctor, talk to someone you trust,” said Aron. “Yet, we don’t really acknowledge how many people don’t have a doctor, or a doctor they have a trust-based relationship with them”.

COVID outbreaks plague LAPD and fire agencies, data show

Via The Los Angeles Times: COVID outbreaks plague LAPD and fire agencies, data show. Excerpt:

Los Angeles County health officials have identified hundreds of coronavirus outbreaks at police and fire agencies since the start of the pandemic, according to data obtained by The Times through a public records request.  

The outbreaks, accounting for more than 2,500 coronavirus cases, have occurred in public safety agencies large and small across the county. More than half, however, were in just two agencies: the Los Angeles Police Department and the Los Angeles Fire Department — where members are actively fighting public health measures to control such spread.  

Of 211 identified outbreaks of three or more coronavirus cases at police or fire agencies in L.A. County between March 2020 and last month, 112 were linked to the LAPD and LAFD, according to the data.  

The LAPD had 37 identified outbreaks, accounting for 1,061 cases, while the LAFD had 75 identified outbreaks, accounting for 553 cases, the data show.  

Another 18 outbreaks were identified at the L.A. County Sheriff’s Department, accounting for 334 cases, and 44 at the L.A. County Fire Department, accounting for 211 cases, the data show.  

The figures reflect a consistent and ongoing spread of infection within police and fire stations from the start of the pandemic through the present, and offer an important backdrop to the growing effort by police officers and firefighters to push back on measures such as vaccine mandates.  

In response to a new L.A. ordinance mandating that all employees be vaccinated by next month unless they are granted a medical or religious exemption, both LAPD and LAFD employees filed lawsuits challenging the requirement. Thousands more have filed notice that they intend to claim an exemption.  

City officials have said that 56% of LAPD employees and 58.5% of sworn LAFD employees have been fully vaccinated, according to recent data. Those rates lag behind the 68% of L.A. County residents 12 and older who are fully vaccinated, according to county data.

Most LAPD officers who have tested positive since June were unvaccinated. Ten LAPD employees have died from the virus.