H5N1

Priorities for the COVID-19 pandemic at the start of 2021: Statement of the Lancet COVID-19 Commission

Via The Lancet: Priorities for the COVID-19 pandemic at the start of 2021: statement of the Lancet COVID-19 Commission. Excerpt:

The Lancet COVID-19 Commission calls for three urgent actions in the COVID-19 response (our broader overview is available on our website). 

First, all regions with high rates of new COVID-19 cases, including the USA and the European Union (EU), should intensify measures to minimise community transmission alongside rapid deployment of COVID-19 vaccines. 

Second, governments should urgently and fully fund WHO and the Access to COVID-19 Tools (ACT) Accelerator, including COVAX. 

Third, the G20 countries should empower the International Monetary Fund (IMF) and multilateral development banks to increase the scale of financing and debt relief. 

Success on all three priorities—containment of transmission, rapid vaccination, and emergency finance—will require improved global cooperation. The high rates of community transmission (>100 new COVID-19 cases per million per day) in the USA, Europe, South Africa, and other countries show the emergence of new variants of SARS-CoV-2, such as lineage B.1.1.7 in the UK, 501Y.V2 in South Africa, and additional variants emerging in California, USA, and in Brazil. 

New lineages are increasing transmission of infection and raising risks in regions that have been less affected by COVID-19, including in sub-Saharan Africa. Additionally, acquired immunity from earlier COVID-19 infections might be less protective against reinfection with some of the new SARS-CoV-2 variants. Mutant lineages might also reduce the efficacy of COVID-19 vaccines and require adapted vaccines or boosters. 

The numbers of new COVID-19 cases in east Asia and the Pacific (<10 new cases per million per day in most countries) have been consistently below those of Northern America and Europe. The lower numbers of COVID-19 cases in these countries result from the successful implementation of comprehensive containment measures: border restrictions and other limits on movement; behavioural changes including widespread use of face masks and physical distancing; active surveillance by public health systems, including mass testing, backward tracing (to identify the sources of outbreaks), and forward tracing (to identify the contacts of new cases); and the quarantine of all suspected cases and the use of facility-based isolation of confirmed cases of COVID-19. 

The USA and the EU failed to implement such comprehensive measures, and there was generally excessive decentralisation of containment efforts across the 50 US states and 27 EU members in 2020. Lack of centralised coordination undermined control of COVID-19, not least because of interstate travel in the USA and intercountry travel in the EU. Both the USA and EU need to step up more top–down coordination in 2021. 

Stronger health systems that incorporate universal health coverage and community-based health workers are vital in the response to COVID-19. At least half of the world's population lacks access to essential health services. Strengthening community-based and gender-responsive health systems will be essential to implement inclusive and comprehensive COVID-19 immunisation campaigns. 

The global roll-out of COVID-19 vaccines to date is neither inclusive nor adequately planned. COVAX has targeted immunisation coverage of at least 20% of the population in each participating country by the end of 2021, and has contracted for 2 billion doses of COVID-19 vaccines. Yet the timely supply of vaccines to COVAX is in question, as high-income countries (HICs) step to the front of the queue for limited supplies of COVID-19 vaccines. 

As of Feb 9, 2021, 148·08 million COVID-19 vaccine doses had been delivered, of which 115·67 million were delivered in the USA (43·21 million), China (40·52 million), the EU (18·36 million), and the UK (13·58). Other countries in Africa, Latin America and the Caribbean, and Asia (not including China) have received very few vaccine doses or none at all. 

This unequal access to COVID-19 vaccines is partly due to the difficulty of managing the ultracold supply chain needed for the two mRNA vaccines, but it is also due to the vaccine supply deals negotiated by HICs directly with the vaccine producers, rather than through COVAX.

Coronavirus today: Surviving post-COVID-19 medical bills

Via the Los Angeles Times, another reason to be glad we live in Canada: Coronavirus Today: Surviving post-COVID medical bills. Excerpt:

Good evening. I’m Amina Khan, and it’s Tuesday, Feb. 9. Here’s what’s happening with the coronavirus in California and beyond. 

We’re learning a lot about the long-term damage the coronavirus can inflict on victims, including breathing problems and chest pain. As the pandemic rages on, another lasting condition has emerged among COVID-19 survivors: overwhelming medical bills that threaten to cripple them financially just as they’re trying to get back on their feet. 

 Take Patricia Mason, who was rushed to the emergency room by her husband and didn’t see him again for nearly a month. The 51-year-old Vacaville woman was transferred to a different hospital in the middle of the night as her condition deteriorated; two days later, her doctor put her chances of survival at less than a 30%. 

Mason did make it through her ordeal last spring, but she did not emerge unscathed, my colleague Maria L. La Ganga reports. She suffers from brain fog, her joints are swollen and painful, and she takes baby aspirin and a handful of supplements every day. 

And then there’s the bill for saving her life: $1,339,181.94. Mason and her husband are on the hook for $42,184.20 of that total. 

The couple, with five jobs and nine mostly-grown kids between them, knows there’s zero chance of paying it off in full. And they’re not alone. 

“The deck is absolutely stacked against the consumer and the patient,” said Sabrina Corlette, co-director of the Center on Health Insurance Reforms at Georgetown University. She added that “getting answers about why certain things are on the bill is almost impossible.” 

During the Obama administration, the federal government put a cap on the amount most insurance plans can require patients to pay. But not all plans have so-called out-of-pocket maximums. Even when they do, the annual limit for a family was $16,300 last year. That ceiling rose to $17,100 this year, though insurance companies can adopt a lower limit. Regardless, that kind of money is still hard for many families to spare during the worst recession in nearly a century. 

Mason is insured through her husband’s union on a plan administered by Blue Shield of California, but it’s what’s called a self-funded plan that happens to be “grandfathered in” and doesn’t have to abide by federal out-of-pocket maximums. The Kaiser Family Foundation estimates that 61% of Americans who get their insurance through their jobs are covered by these kinds of self-funded plans, though it’s unclear how many are also exempt from the federal out-of-pocket limit. 

Many insurance companies said early in the pandemic that they would waive all out-of-pocket costs for policyholders’ COVID-19 treatment. But most waivers do not include self-funded plans. 

A lot of folks could find themselves in the same boat as Mason. 

“I don’t have $42,000 to spare,” Mason said. “I am lucky enough to be alive, so we take that into consideration. But the reality is I don’t have [the money]. It’s not going to happen.”

COVID-19 in California: A different kind of double jeopardy

Via The Los Angeles Times: Coronavirus Today: A different kind of double jeopardy. Excerpt:

At a time when public officials are practically begging residents to not leave their homes because of COVID-19, the Los Angeles County Superior Court system — the largest in the country — is still requiring people to venture forth for in-person hearings, including eviction proceedings and trials. That’s despite the recent deaths of three court employees from COVID-19, and despite the fact that being in enclosed spaces with other people provides an easy opportunity for the coronavirus to spread. 

In traffic courts, scores of people wait in hallways and courtrooms to contest speeding citations, my colleague Matt Hamilton reports. In criminal courts, shackled defendants sit with masks drooping off their faces, and some lawyers remove their masks when addressing a judge. One judge even allowed a witness to testify without a mask. 

“Every single day the courts are going through procedures without precautions to keep people safe and holding proceedings that result in people getting kicked out onto the street. It’s a public health disaster,” said Adam Murray, executive director of Inner City Law Center. “If you walk into eviction or traffic courtrooms, you are not seeing wealthy or middle-income people. It’s poor people who have to go in and adjudicate their cases in person.” 

Staff and legal groups have pushed for more rigorous methods of screening the public, such as temperature checks. But they haven’t gotten them. 

Although lawmakers instituted some eviction moratoriums, which have reduced the flow of eviction cases, such measures typically require tenants to come to court to demonstrate why the moratorium applies. Often, moratorium is a bit of a misnomer, as the measures don’t necessarily stop landlords from filing eviction lawsuits. 

These practices pose real exposure risks for Angelenos like Juan Garcia, who rode the bus to a downtown L.A. court to contest an eviction. The disabled widower used a cane as he navigated the Stanley Mosk Courthouse, waited among dozens in a hallway for his hearing, then asked a judge for more time to secure low-income housing — at least another month or two. The judge set an eviction trial for April. 

“I don’t know what I’m going to do,” Garcia, 60, said outside the courtroom, wrestling with the prospect of homelessness. 

L.A. Superior Court has taken steps to significantly reduce foot traffic, and officials estimate 65% fewer people circulate in the system’s 38 courthouses than before the pandemic. Roughly 4,500 people appear remotely each day for hearings. And all of the 600 or so courtrooms across the county have the capability to conduct remote proceedings, said court spokeswoman Ann Donlan. 

But many in-person hearings are still taking place, and the criminal courts held nearly 70 jury trials in the final four months of 2020. Sometimes, the parties in a case insist on an in-person hearing. Some litigants lack internet or phone access, or don’t know a remote option is available. And unless a litigant has taken the steps to secure a waiver from the court, each remote appearance comes at a cost: $15 for audio and $23 for video. 

In eviction cases like Garcia’s, where tenants have just five court days to respond and most tenants lack legal representation, attorneys say that judges often require in-person proceedings, jeopardizing the health of lawyers, clients and court staff. 

Court officials say its operations are essential and its services, like providing restraining orders in domestic violence cases and protecting defendants’ due process rights, require keeping courthouses open. But others say many operations can be put off for now. 

“There is no urgency for a person with a traffic citation to be there now,” said Lauren Zack, an attorney with Public Counsel.

One year, 400,000 coronavirus deaths: How the US guaranteed its own failure

Via The New York Times, what journalists like to call a "damning indictment": One Year, 400,000 Coronavirus Deaths: How the U.S. Guaranteed Its Own Failure. Excerpt, with my bolding:

“We will manage the hell out of this operation,” Mr. Biden said on Friday. “Our administration will lead with science and scientists.” 

The strategy signals a shift from the past year, during which the Trump administration largely delegated responsibility for controlling the virus and reopening the economy to 50 governors, fracturing the nation’s response. Interviews with more than 100 health, political and community leaders around the country and a review of emails and other state government records offer a fuller picture of all that went wrong:  

• The severity of the current outbreak can be traced to the rush to reopen last spring. Many governors moved quickly, sometimes acting over the objections of their advisers. The reopenings nationally led to a surge of new infections that grew over time: Never again would the country’s average drop below 20,000 new cases a day.  

• Science was sidelined at every level of government. More than 100 state and local health officials have been fired or have resigned since the beginning of the pandemic. In Florida, leading scientists offered their expertise to the governor’s office but were marginalized, while Gov. Ron DeSantis turned to Dr. Scott W. Atlas, a Trump adviser, and others whose views were embraced in conservative circles but rejected by scores of scientists. 

• While the president publicly downplayed the need for masks, White House officials were privately recommending that certain states with worsening outbreaks require face coverings in public spaces. But records show that at least 26 states ignored recommendations from the White House on masks and other health issues. In South Dakota, Gov. Kristi Noem, boasted to political allies about not requiring masks even as her state was in the midst of an outbreak that became one of the worst in the nation. 

Gov. Jared Polis of Colorado said states had faced difficult choices in balancing the virus — often hearing competing voices on how to do it best — and said Mr. Trump had left them without the political support they needed as they urged the public to accept masks and social distancing. “The single biggest thing that would have made a difference was the clarity of message from the person at the top,” Mr. Polis said in an interview.  

The pandemic indeed came with significant challenges, including record unemployment and a dynamic disease that continued to circle the globe. Without a national strategy from the White House, it is unlikely that any state could have fully stopped the pandemic’s spread.  

But ​the majority of deaths in the United States have come since the strategies needed to contain it were clear to state leaders, who had a range of options, from mask orders to targeted shutdowns and increased testing. Disparities have emerged between states that took restrictions seriously and those that did not.  

America now makes up 4 percent of the world’s population but accounts for about 20 percent of global deaths. While Australia, Japan and South Korea showed it was possible to keep deaths low, the United States — armed with wealth, scientific prowess and global power — became the world leader: it now has one of the highest concentrations of deaths, with nearly twice as many reported fatalities as any other country.

Deaths of despair and the incidence of excess mortality in 2020

Via the National Bureau for Economic Research: Deaths of Despair and the Incidence of Excess Mortality in 2020. The abstract, with my bolding:

Weekly mortality through October 3 is partitioned into normal deaths, COVID, and nonCOVID excess deaths (NCEDs). Before March, the excess is negative for the elderly, likely due to the mild flu season. From March onward, excess deaths are approximately 250,000 of which about 17,000 appear to be a COVID undercount and 30,000 non-COVID. 

Deaths of despair (drug overdose, suicide, alcohol) in 2017 and 2018 are good predictors of the demographic groups with NCEDs in 2020. The NCEDs are disproportionately experienced by men aged 15-55, including men aged 15-25. 

Local data on opioid overdoses further support the hypothesis that the pandemic and recession were associated with a 10 to 60 percent increase in deaths of despair above already high pre-pandemic levels.

The long-term impact of the COVID-19 unemployment shock on life expectancy and mortality rates

Via the National Bureau of Economic Research: The Long-Term Impact of the COVID-19 Unemployment Shock on Life Expectancy and Mortality Rates. The abstract, with my bolding:

We adopt a time series approach to investigate the historical relation between unemployment, life expectancy, and mortality rates. We fit a Vector-autoregression (VAR) for the overall US population and for groups identified based on gender and race. 

We find that shocks to unemployment are followed by statistically significant increases in mortality rates and declines in life expectancy. We use our results to assess the long-run effects of the COVID-19 economic recession on mortality and life expectancy. 

We estimate the size of the COVID-19-related unemployment to be between 2 and 5 times larger than the typical unemployment shock, depending on race/gender, resulting in a 3.0% increase in mortality rate and a 0.5% drop in life expectancy over the next 15 years for the overall American population. 

We also predict that the shock will disproportionately affect African-Americans and women, over a short horizon, while white men might suffer large consequences over longer horizons. These figures translate in a staggering 0.89 million additional deaths over the next 15 years.

Columbia students threaten to withhold tuition fees amid Covid-19 protest

The students at my alma mater have been notably quiet since the unpleasantness of 1968, but they're getting restless again. Via The Guardian: Columbia students threaten to withhold tuition fees amid Covid protest. Excerpt:

Almost 1,800 students at Columbia University in New York are threatening to withhold tuition fees next year, in the latest signal to US academia of widespread preparedness to act on demands to reduce costs and address social justice issues relating to labor, investments and surrounding communities. Maryland college dedicates new memorial in effort to confront legacy of slavery Read more 

In a letter to trustees and administrators of Columbia, Barnard College and Teachers College, the students said: “The university is acutely failing its students and the local community.”  

They accused the university of “inaction” since the start of the Covid-19 pandemic in March, when students began demonstrating against what they say are exorbitant tuition rates “which constitute a significant source of financial hardship during this economic depression”. 

The letter referred to national protests over structural racism, accusing the university of failing to act on demands to address “its own role in upholding racist policing practices, damaging local communities and inadequately supporting Black students”.  

Emmaline Bennett, chair of the Columbia-Barnard Young Democratic Socialists of America and a master’s student at Teachers College, told the Guardian the university and other colleges had made no effort to reduce tuition fees as they moved to remote learning models necessitated by pandemic conditions.  

“We think it says a lot about the profit motive of higher education, even as the economy is in crisis and millions of people are facing unemployment,” Bennett said. “This is especially true of Columbia, which is one of the most expensive universities in the US.”  

Demands outlined in the letter include reducing the cost of attendance by at least 10%, increasing financial aid by the same percentage and replacing fees with grants.  

Such reforms, the letter said, should not come at the expense of instructor or worker pay, but rather at the expense of bloated administrative salaries, expansion projects and other expenses that do not directly benefit students and workers.  

The university, the letter said, must invest in community safety solutions that prioritise the safety of Black students, and “commit to complete transparency about the University’s investments and respect the democratic votes of the student body regarding investment and divestment decisions – including divestment from companies involved in human rights violations and divesting fully from fossil fuels.  

“These issues are united by a shared root cause: a flagrant disregard for initiatives democratically supported within the community. Your administration’s unilateral decision-making process has perpetuated the existence of these injustices in our community despite possessing ample resources to confront them with structural solutions.  

“Should the university continue to remain silent in the face of the pressing demands detailed below, we and a thousand of fellow students are prepared to withhold tuition payments for the Spring semester and not to donate to the university at any point in the future.”

COVID-19: Malaysia will close Top Glove factories and screen workers

Via the South China Morning Post: Coronavirus: Malaysia will close Top Glove factories and screen workers; Indonesia hits 500,000 cases. Excerpt:

Malaysia will close some of Top Glove’s factories in stages to screen its employees for Covid-19 after a major increase in coronavirus infections, a senior minister said on Monday. 

A total of 28 factories will be closed in stages after 1,889 Top Glove workers tested positive for the virus, Senior Minister of Security Ismail Sabri Yaakob. 

Top Glove is the world’s largest latex-glove maker and has seen record high profits this year as demand for medical gloves and protective gear skyrocketed due to the pandemic. 

Meanwhile, across Malaysia’s Sabah region on Borneo island, stateless residents and undocumented migrants are fleeing public health officials conducting coronavirus screenings, fearful of being detained or deported. 

The race to tackle Covid-19 in Sabah, Malaysia’s biggest palm oil producing state, is being complicated by an estimated 1 million undocumented migrants and stateless residents who account for a third of the population. 

Sabah accounts for nearly half of Malaysia’s 54,775 recorded Covid-19 infections and more than half its 335 deaths despite having barely a tenth of the Southeast Asian country’s population. But health officials fear the real picture could be much worse as people evade screenings in fear of detention or deportation. 

“We see authorities coming, we do what we’ve always done: run,” said Ahmad Han, an undocumented migrant living on the outskirts of Semporna district in Sabah. 

As of November 17, nearly one-fifth of the state’s infections involved foreigners, according to government data. They included stateless indigenous communities as well as refugees and migrant workers from neighbouring Philippines and Indonesia, countries that have the highest number of coronavirus cases in the region.

US passes 11 million COVID-19 cases as Washington Gov. Jay Inslee announces new restrictions

Via The Washington Post: U.S. passes 11 million coronavirus cases as Washington Gov. Jay Inslee announces new restrictions. Excerpt:

Coronavirus cases reported in the United States passed 11 million on Sunday, as the nation shatters records for hospitalizations and daily new infections and as leaders turn to new, painful restrictions to stem the pandemic’s long-predicted surge.

The milestone came one week after the country hit 10 million cases, a testament to just how rapidly the virus is spreading — the first 1 million cases took more than three months. This new wave has increased covid-19 hospitalizations past the peaks seen in April and July, straining health-care systems and pushing some reluctant Republican governors to enact statewide mask mandates for the first time.  

Other states are reenacting stay-at-home orders and store closures. Washington Gov. Jay Inslee (D) on Sunday announced a slew of new rules, including a halt to indoor operations at restaurants, bars, gyms and more, and a ban on indoor social gatherings with people outside one’s household. At a news conference, Inslee acknowledged that slowing the virus would come at a steep price for struggling businesses, even as the state works to distribute millions more in aid. 

He appealed to the federal government to step in with more help, as Congress remains deadlocked on a stimulus package and as President Trump’s refusal to concede the election delays the transition to a new administration. That holdup extends to the formal transfer of information on the national pandemic response.  

“All of us who feel, as I do, the pain of the small-business people ought to be pounding the doors of the Congress and the new president, who I’m glad we’re going to have, to really get this job done,” Inslee said.  

Washington’s restrictions are not as tough as its stay-at-home order issued in March but extend into nearly every aspect of daily life. Wedding and funeral receptions are forbidden, religious services and in-store retail forced to operate at reduced capacity. Even outdoor social gatherings must be kept to a maximum of five people from outside one’s household. 

Inslee and other leaders in the state emphasized the need to intervene early amid spiraling statistics, even as Washington posts some of the lowest numbers for new coronavirus infections in the country. The number of hospital patients with covid-19 recently rose about 40 percent in a week, officials said, and Seattle’s mayor said that nearly a fifth of the city’s cases have come just in the past two weeks. 

Clint Wallace of Spokane, who has been an ICU nurse for two decades, joined Inslee at Sunday’s news conference to plead with residents for their help. He called the ICU “as busy as I’ve seen it." 

“We are exhausted,” Wallace said of health-care workers around the state. 

State and local officials nationwide are reinstating restrictions to fight the virus. New Mexico and Oregon on Friday ordered extensive new statewide shutdowns, while the Navajo Nation — devastated early on the by the virus — reissued its stay-at-home order for at least three weeks. The Navajo Nation said cases threaten to swamp the health system on the southwestern reservation without immediate action. 

North Dakota Gov. Doug Burgum (R) on Friday issued a statewide mask mandate and new capacity limits on businesses, less than a week after Utah Gov. Gary R. Herbert (R) announced a similar mask order in the face of overwhelmed hospitals warning that they might have to ration care.  

“Our situation has changed, and we must change with it,” Burgum said in a late-night video message.  

But state rules are just one piece of the puzzle, and some leaders are looking to Congress and the incoming president to take stronger action, as Trump — still denying his election loss — largely tunes out the pandemic’s surge and stalls the handoff to his successor.  

Ron Klain, Joe Biden’s incoming chief of staff, said Sunday it’s critical for the president-elect’s transition team to start working with Trump administration officials to ensure “nothing drops in this change of power” that could imperil the distribution of a potential coronavirus vaccine. 

“Joe Biden is going to become president of the United States in the midst of an ongoing crisis. That has to be a seamless transition,” Klain said on NBC News’s “Meet the Press.”  

President Trump’s White House is blocking the administration from formally cooperating with Biden, forcing the president-elect’s transition team to continue preparations with recently departed government officials and other experts. That means Biden’s team has not heard from Trump’s about vaccine development and other work to combat the pandemic.  

A health expert on Biden’s covid-19 advisory board said there’s “a lot of information that needs to be transmitted. It can’t wait until the last minute.”

Picard: You cannot slow the spread of COVID-19 by loosening restrictions

Via The Globe and Mail, André Picard writes: You cannot slow the spread of the coronavirus by loosening restrictions. Excerpt:

Ontario Premier Doug Ford readily concedes that the spread of coronavirus is “out of control” in parts of suburban Toronto, but has decided to loosen, not tighten, public-health restrictions. In a province racking up more than 1,000 new infections daily, he calls this a “fair compromise.” 

A week ago, Alberta’s average number of new coronavirus cases was 275; now it’s 730. Despite that threefold increase, Premier Jason Kenney has dismissed the idea of any sort of lockdown. He describes this do-nothing approach as “balancing” Loading... the need for protecting the population from a deadly pandemic and the desire to protect the economy.  

Fasten your seatbelts folks (voluntarily of course, no rules required) because much of Canada is now barreling down the Barrington Highway. 

What the Great Barrington Declaration says, when you cut through the pomposity, is that profits matter more than people, that we should let the coronavirus run wild and, if the vulnerable die in service of economic growth, so be it.  

Mr. Ford and Mr. Kenney have, in their words and (in)actions, embraced this approach.  

Other provinces where COVID-19 cases are increasing markedly, such as British Columbia, Manitoba and Saskatchewan, and Quebec, where numbers are holding steady at a high level, have been a little less crass about their “open for business” ambitions, but they haven’t exactly brought down the hammer either. 

Canada is now recording more than 4,000 new coronavirus cases daily, double the peak we saw in the spring. It will be 5,000 daily by the end of the week. And next week, 10,000?  

At some point, there has to be a realization that, if you want to halt the spread of a pandemic illness, half-measures are not sufficient.