H5N1

China records almost 60,000 Covid-related deaths after abrupt shift in policy

Via the South China Morning Post: China records almost 60,000 Covid-related deaths after abrupt shift in policy. I wish I could believe it. Excerpt:

China said on Saturday it had recorded almost 60,000 Covid-related deaths between December 8 and January 12, and the current wave has already peaked.   

It is the first time China has released a death toll since its abrupt pivot away from the zero-Covid policy last month.  

Jiao Yahui, director of the National Health Commission’s medical affairs department, said medical institutes had recorded 5,503 deaths as a result of respiratory failure triggered by Covid infection and 54,435 deaths of people infected with Covid-19 but with underlying conditions, such as cancer or cardiovascular diseases.  

The average age of those who died was 80.3, and 90 per cent of fatalities were aged 65 or over.  

Jiao also said the current wave of cases had peaked. “The number of fever clinic visitors is generally on a downward trend after peaking, both in cities and rural areas,” she added.  

Jiao said the number of emergency patients was also declining and the ratio of patients who had tested positive for Covid-19 was steadily falling as well.  

Jiao said there had been 128,000 patients with severe Covid-19 on January 5, but the number had dropped to 105,000 by January 12.  

The use rate for intensive care hospital beds was 75.3 per cent, she added.  

Among the critically ill Covid-19 patients on January 12, there were 97,000 patients with severe underlying conditions, accounting for 92.8 per cent. The remainder, some 7,357 people, had Covid only.

‘It’s insane’: China’s doctors struggle to cope amid COVID surge

Via Sixth Tone: ‘It’s Insane’: China’s Doctors Struggle to Cope Amid COVID Surge. Excerpt:

Just weeks after China ended its “zero-COVID” policy, Dr. Xu Zuping and her outpatient department find themselves confronting an unprecedented crisis.  

The team in Shanghai is treating up to 600 patients a day — almost 20% more than the same period last year, Xu estimates. And they’re having to do so with four out of six doctors infected with COVID-19.  

“I’ve worked at this hospital for over 30 years, but I’ve never seen the emergency room as busy as it is now,” says Xu, who spoke with Sixth Tone using a pseudonym to protect her privacy. “Ambulances keep arriving with people in a critical condition. When I treat my patients, I constantly worry about whether there are enough seats in the infusion center.” 

Hospitals all over China are struggling to cope as a wave of COVID-19 infections rips through the population. Doctors describe shocking levels of overcrowding, shortages of key supplies, and medical teams weakened by mass infections.  

China abruptly dismantled its strict “zero-COVID” system in early December, and since then the virus has spread at breakneck speed. It’s unclear how many people have been infected, but local authorities estimate that case numbers in Shanghai alone have surpassed 10 million.

A surge in hospitalizations soon followed. According to China’s health commission, around 8% of COVID-19 patients in China developed pneumonia in 2022. Though this appears to be a relatively low ratio, it translates into a huge number of people with lung infections due to China’s vast population.   

By the end of December, Xu’s department was already receiving record numbers of patients. The team is based at one of two major hospitals in Chongming — an island on the northeastern tip of Shanghai, where the Yangtze River bleeds into the East China Sea.  

Most of the patients are in their 80s and 90s, and the vast majority have pneumonia, Xu says. The hospital’s emergency room has been completely overrun.  

“Given the crisis at the emergency room, we can no longer transfer patients for hospitalization,” she says. “The few remaining beds in the inpatient department are reserved for patients from the emergency room.”

What went wrong with the coronavirus pandemic in Florida

Via The New York Times: What Went Wrong With the Coronavirus Pandemic in Florida. Excerpt:

The Florida story is a cautionary tale for dealing with the current incarnation of the coronavirus. The United States has used the vaccines as its primary pandemic weapon. But Florida shows that even a state that made a major push for vaccinations — Florida ranks 21st among states and Washington, D.C., in giving people of all ages at least one shot — can be crushed by the Delta variant, reaching frightening levels of hospitalizations and deaths.

“Clearly the vaccines are keeping most of these people out of the hospital, but we’re not building the herd immunity that people hoped,” Mr. DeSantis said at a news conference this past week. “You’ve got a huge percentage of people — adults — that have gotten shots, and yet you’ve still seen a wave.” 

Morgues and crematories are full or getting there. Public utilities in Orlando and Tampa have asked residents to cut back on water usage so liquid oxygen, which is used in water treatment, can be conserved for hospitals. As of Friday, Florida was recording an average of 242 virus deaths a day, nearly as many as California and Texas combined, though a few states still had a higher per capita rate, according to public health data tracked by The New York Times. 

Florida’s pandemic data, more scant since the state ended its declared Covid-19 state of emergency in June, reveals only limited information about who is dying. Hospitals have said upward of 90 percent of their patients have been unvaccinated. Exactly why the state has been so hard-hit remains an elusive question. Other states with comparable vaccine coverage have a small fraction of Florida’s hospitalization rate.

The best explanation of what has happened is that Florida’s vaccination rates were good, but not good enough for its demographics. It has so many older people that even vaccinating a vast majority of them left more than 800,000 unprotected. Vaccination rates among younger people were uneven, so clusters of people remained at risk. Previous virus waves, which were milder than in some other states, conferred only some natural immunity. 

And Florida is Florida: People have enjoyed many months of barhopping, party-going and traveling, all activities conducive to swift virus spread. 

Unlike in places like Oregon, which is clamping down again, adopting even outdoor mask mandates, Mr. DeSantis continues to stay the course, hoping to power through despite the devastating human toll. A Quinnipiac University poll released this past week found that Mr. DeSantis’s approval rating was 47 percent.

He and other state officials have sought to steer away from measures that could curtail infections, banning strict mask mandates in public schools. The biggest school districts imposed them anyway, and on Friday, a state judge ruled that Florida could not prevent those mandates, a decision the Department of Education plans to appeal. 

Florida has experienced more deaths than normal — from all causes, not just Covid-19 — throughout the pandemic. In the early weeks of 2021, with cases surging and the vaccine rollout kicking off, the state averaged 5,600 deaths each week, about a third more than typical for that time of year, according to mortality figures from the Centers for Disease Control and Prevention. The deaths dropped and then went back up. 

These excess deaths are important, both because a number of Covid-19 deaths occur outside hospitals, and because the virus may contribute to deaths from other causes as a result of the strain on the health system.

In the first week of August, the state recorded another 5,600 deaths. But because mortality rates normally drop during summer months, the figure was more than 50 percent above what’s typical.

“We’re seeing a ton of people calling us to report the Covid deaths,” said Dr. Stephen J. Nelson, the Polk County medical examiner. “They’re typically young people that have been sick for a while.”

The picture of who is dying, however, is complicated.

About 82 percent of people 65 and older in the state are fully vaccinated, about average for the nation. That has still left a relatively large number of older people — about 819,000 — unvaccinated or only partially vaccinated, said Jason L. Salemi, an epidemiologist at the University of South Florida. If the unvaccinated also take fewer other precautions, he added, that would put them directly in the virus’s path.

“The Delta variant is exceptional at finding vulnerable populations,” he said.

The situation in nursing homes, where infections can spread swiftly, has also been problematic. While vaccination rates among older Floridians as a whole have been good, the rate of nursing home residents who are fully vaccinated — an average of 73.1 percent in each home — is lower than every state but Nevada, according to the C.D.C. About 47.5 percent of nursing home staff members were fully vaccinated as of Aug. 15, the lowest of any state but Louisiana.

Investigation of a severe SARS-CoV-2 outbreak in a long-term care home early in the pandemic

Via CMAJ: Investigation of a severe SARS-CoV-2 outbreak in a long-term care home early in the pandemic. The abstract:

BACKGROUND: The implementation of outbreak management measures has decreased the frequency and severity of SARS-CoV-2 outbreaks in Ontario long-term care homes. We describe the epidemiological and laboratory data from one of the first such outbreaks in Ontario to assess factors associated with its severity, and the impact of progressive interventions for infection control over the course of the outbreak. 

METHODS: We obtained line list and outbreak data from the public health unit to describe resident and staff cases, severity and distribution of cases over time and within the outbreak facility. Where available, we obtained data on laboratory specimens from the Public Health Ontario Laboratory and performed whole genome sequencing and phylogenetic analysis of viral specimens from the outbreak. 

RESULTS: Among 65 residents of the long-term care home, 61 (94%) contracted SARS-CoV-2, with a case fatality rate of 45% (28/61). Among 67 initial staff, 34 (51%) contracted the virus and none died. When the outbreak was declared, 12 staff, 2 visitors and 9 residents had symptoms. Resident cases were located in 3 of 4 areas of the home. Phylogenetic analysis showed tight clustering of cases, with only 1 additional strain of genetically distinct SARS-CoV-2 identified from a staff case in the third week of the outbreak. No cases were identified among 26 new staff brought into the home after full outbreak measures were implemented. 

INTERPRETATION: Rapid and undetected viral spread in a long-term care home led to high rates of infection among residents and staff. Progressive implementation of outbreak measures after the peak of cases prevented subsequent staff cases and are now part of long-term care outbreak policy in Ontario. 

Effect of socioeconomic inequalities and vulnerabilities on health-system preparedness and response to COVID-19 in Brazil: A comprehensive analysis

Via The Lancet Global Health: Effect of socioeconomic inequalities and vulnerabilities on health-system preparedness and response to COVID-19 in Brazil: a comprehensive analysis. The summary:

Background 

COVID-19 spread rapidly in Brazil despite the country's well established health and social protection systems. Understanding the relationships between health-system preparedness, responses to COVID-19, and the pattern of spread of the epidemic is particularly important in a country marked by wide inequalities in socioeconomic characteristics (eg, housing and employment status) and other health risks (age structure and burden of chronic disease). 

Methods 

From several publicly available sources in Brazil, we obtained data on health risk factors for severe COVID-19 (proportion of the population with chronic disease and proportion aged ≥60 years), socioeconomic vulnerability (proportions of the population with housing vulnerability or without formal work), health-system capacity (numbers of intensive care unit beds and physicians), coverage of health and social assistance, deaths from COVID-19, and state-level responses of government in terms of physical distancing policies. We also obtained data on the proportion of the population staying at home, based on locational data, as a measure of physical distancing adherence. 

We developed a socioeconomic vulnerability index (SVI) based on household characteristics and the Human Development Index. Data were analysed at the state and municipal levels. Descriptive statistics and correlations between state-level indicators were used to characterise the relationship between the availability of health-care resources and socioeconomic characteristics and the spread of the epidemic and the response of governments and populations in terms of new investments, legislation, and physical distancing. We used linear regressions on a municipality-by-month dataset from February to October, 2020, to characterise the dynamics of COVID-19 deaths and response to the epidemic across municipalities. 

Findings 

The initial spread of COVID-19 was mostly affected by patterns of socioeconomic vulnerability as measured by the SVI rather than population age structure and prevalence of health risk factors. The states with a high (greater than median) SVI were able to expand hospital capacity, to enact stringent COVID-19-related legislation, and to increase physical distancing adherence in the population, although not sufficiently to prevent higher COVID-19 mortality during the initial phase of the epidemic compared with states with a low SVI. 

Death rates accelerated until June, 2020, particularly in municipalities with the highest socioeconomic vulnerability. Throughout the following months, however, differences in policy response converged in municipalities with lower and higher SVIs, while physical distancing remained relatively higher and death rates became relatively lower in the municipalities with the highest SVIs compared with those with lower SVIs. 

Interpretation 

In Brazil, existing socioeconomic inequalities, rather than age, health status, and other risk factors for COVID-19, have affected the course of the epidemic, with a disproportionate adverse burden on states and municipalities with high socioeconomic vulnerability. Local government responses and population behaviour in the states and municipalities with higher socioeconomic vulnerability have helped to contain the effects of the epidemic. 

Targeted policies and actions are needed to protect those with the greatest socioeconomic vulnerability. This experience could be relevant in other low-income and middle-income countries where socioeconomic vulnerability varies greatly.

Long-term care and COVID-19 in Canada: The first 6 months

Via the Canadian Institute for Health Information: Long-term care and COVID-19: The first 6 months.

March 30, 2021 — The COVID-19 pandemic has disproportionately affected Canada’s retirement homes and long-term care (LTC) homes. Our release takes a closer look at the impact of COVID-19 on LTC residents and staff during the first 6 months of the pandemic (known as Wave 1) and provides early comparisons of outbreaks, cases and deaths between the first and second waves (to February 15, 2021). 

Key findings 

• COVID-19 cases among residents of LTC and retirement homes increased by nearly two-thirds during Wave 2 compared with Wave 1.  

• Compared with pre-pandemic years, in Wave 1, LTC residents had fewer physician visits; fewer hospital transfers; and less contact with friends and family, which is associated with higher rates of depression.  

• In all provinces where it could be measured, the total number of resident deaths was higher than normal during this period, even in places with fewer COVID-19 deaths. 

• Provincial and national inquiries (to date) on COVID-19 in LTC have made similar recommendations and speak to long-standing concerns in the sector.

Download the CIHI report here. 

CBC News has published a news story: Canada's nursing homes have worst record for COVID-19 deaths among wealthy nations: report. Excerpt:

Canada has the worst record for COVID-19 deaths in long-term care homes compared with other wealthy countries, according to a new report released on Tuesday by the Canadian Institute for Health Information (CIHI).

The study found that the proportion of deaths in nursing homes represented 69 per cent of Canada's overall COVID-19 deaths, which is significantly higher than the international average of 41 per cent.

In Canada, between March 2020 and February 2021, more than 80,000 residents and staff members of long-term care homes were infected with the coronavirus. Outbreaks occurred in 2,500 care homes, resulting in the deaths of 14,000 residents, according to the report.

"COVID-19 has exacted a heavy price on Canada's long-term care and retirement homes, resulting in a disproportionate number of outbreaks and deaths," the report's introduction says.

The study, which primarily focused on the first six months of the pandemic, found that across the country, nursing home residents received less medical care. They had fewer visits from doctors, and there were also fewer hospital transfers when compared with other years.

Researchers also looked beyond the coronavirus to all deaths in care homes.

"Resident deaths — for all causes, not just from COVID-19 infection — increased by 19 per cent in British Columbia, Alberta, Manitoba, Ontario and Newfoundland and Labrador," the report said. "There were 2,273 more deaths than the average in the five years prior to COVID-19, with the largest increase occurring in April 2020."

Last spring, Ontario experienced the largest increase in "excess deaths" at 28 per cent, while B.C. had the smallest at just four per cent, the study found.

"It really tells us that there were things that we could have done to avoid a lot of the deaths that we saw in Canada and that countries, frankly, that were better prepared prior to the pandemic, that had better funded systems, they performed far better than Canada has," said Dr. Samir Sinha, director of health policy research and co-chair at the National Institute on Ageing, a partner in the study with CIHI.

"Relative to other nations in the world, Canada has actually the worst record overall."

BC: New figures reveal local Fraser Valley COVID-19 death toll

The Fraser Valley Current is new online journal covering the region east of Vancouver. It's off to a promising star: Exclusive: New figures reveal local COVID death toll. Excerpt:

At least 66 Abbotsford residents and at least 70 Langley residents died during the first two waves of the COVID pandemic putting both cities’ fatality rates well above the provincial average, according to new figures exclusively obtained by The Current. 

The numbers were released to The Current following a freedom of information request and reflect deaths up to Feb. 5. The province has never proactively released city-level death figures, and no data from the last month is available. 

Despite also having high case counts, Chilliwack has managed to avoid the high fatality rates of its neighbours to the west; its death rate was one-fifth that of Langley and Abbotsford. (Precise figures for places like Chilliwack with fewer than five deaths over a single time period were redacted by the Provincial Health Services Authority.) 

The death rate in Langley and Abbotsford is well above the provincial average, whether one measures by total population, or the number of seniors older than 75. 

There has been about one death for every 175 seniors over the age of 75 in the two communities. The rate in Chilliwack is five times lower, and half the provincial average. Numbers aren’t available for Mission or the valley’s smaller towns. 

Burnaby and Prince Rupert had the province's highest death rates, based on cities' population of older seniors. Thanks to vaccinations, deaths have decreased dramatically since Feb. 5. There had been 1,246 deaths prior to that date. But more than 170 people have still died in the month and a half since.

AstraZeneca-Oxford COVID-19 vaccine now recommended for those 65 and older in Canada

Just in from CBC News: AstraZeneca-Oxford COVID-19 vaccine now recommended for those 65 and older in Canada. Excerpt:

The committee that makes recommendations on the use of newly approved vaccines in Canada has changed its guidelines on the AstraZeneca-Oxford COVID-19 vaccine and is now recommending it be given to those over the age of 65. 

The National Advisory Committee on Immunization (NACI) expanded its recommendations on Tuesday. 

"While all available vaccines in Canada are safe and effective, NACI still recommends that in the context of limited vaccine supply initial doses of mRNA vaccines should be prioritized for those at highest risk of severe illness and death and highest risk of exposure to COVID-19," said a statement from the committee.

(Pfizer-BioNTech and Moderna are mRNA vaccines, while the AstraZeneca-Oxford dose is a viral vector vaccine.) 

Earlier this month, the committee had recommended Canadians over 65 not receive an AstraZeneca-Oxford shot, while Health Canada, the regulator, had authorized it to be used in adults of all ages. 

NACI's initial recommendations were based largely on AstraZeneca-Oxford's clinical trial data and didn't examine real-world evidence past Dec. 7 — months before the effectiveness of the vaccine was fully realized in other countries for older age groups. 

On Tuesday, the committee said it has since considered three recent real-world effectiveness studies — including new evidence from the United Kingdom, which has been administering the AstraZeneca vaccine to people 65 years of age and older — to inform its change in recommendation. 

"This evidence demonstrates that the vaccine is safe and effective in older adults, particularly against severe COVID-19 disease and hospitalization," said the committee.

BC accelerates timeline for first vaccine doses, rolls out appointment system for seniors over 80

Via CBC News, I can now look forward to getting my first shot sometime late this month or early in April, and the second probably in early August: B.C. accelerates timeline for first vaccine doses, rolls out appointment system for seniors over 80. Excerpt:

Every eligible adult in British Columbia should be able to receive a first dose of a COVID-19 vaccine by late July after the approval of a new vaccine and a decision to delay second doses. 

Health officials announced the accelerated timeline Monday as the province moved into the second, seniors-focused phase. 

Starting Monday, health authorities will contact residents and staff of independent living centres, and those living in seniors' supportive housing, as well as home-care support clients and staff. 

Seniors who do not live in care can call to book their own appointment based on a staggered schedule, which is as follows:  

•  From March 8: Seniors over the age of 90 (those born in or before 1931) and Indigenous people over the age of 65 (those born in or before 1956). 

• From March 15: Seniors over the age of 85 (those born in or before 1936). 

• From March 22: Seniors 80 and older (those born in or before 1941). 

The phone numbers are listed on the provincial government's website. Phones lines are open 7 a.m.-7 p.m. PT. Those who live in the Fraser Health region have the option to book online. 

If a senior cannot call to book themselves, a family member, friend or support person can do so on their behalf. The immunization clinic location will be confirmed on the call, with vaccinations starting as early as March 15 for the first group.

The province is using a staggered schedule so the call centre is not overwhelmed by thousands of calls at once. People are being asked only to call when they are eligible. 

Shifts in office and virtual primary care during the early COVID-19 pandemic in Ontario, Canada

Old people use a lot of primary care, and my wife and I have seen what a difference the pandemic has made in the quantity and quality of that care. Via CMAJ: Shifts in office and virtual primary care during the early COVID-19 pandemic in Ontario, Canada. The abstract:

BACKGROUND: Globally, primary care changed dramatically as a result of the coronavirus disease 2019 (COVID-19) pandemic. We aimed to understand the degree to which office and virtual primary care changed, and for which patients and physicians, during the initial months of the pandemic in Ontario, Canada. 

METHODS: This population-based study compared comprehensive, linked primary care physician billing data from Jan. 1 to July 28, 2020, with the same period in 2019. We identified Ontario residents with at least 1 office or virtual (telephone or video) visit during the study period. We compared trends in total physician visits, office visits and virtual visits before COVID-19 with trends after pandemic-related public health measures changed the delivery of care, according to various patient and physician characteristics. We used interrupted time series analysis to compare trends in the early and later halves of the COVID-19 period. 

RESULTS: Compared with 2019, total primary care visits between March and July 2020 decreased by 28.0%, from 7.66 to 5.51 per 1000 people/day. The smallest declines were among patients with the highest expected health care use (8.3%), those who could not be attributed to a primary care physician (10.2%), and older adults (19.1%). In contrast, total visits in rural areas increased by 6.4%. Office visits declined by 79.1% and virtual care increased 56-fold, comprising 71.1% of primary care physician visits. The lowest uptake of virtual care was among children (57.6%), rural residents (60.6%) and physicians with panels of ≥ 2500 patients (66.0%). 

INTERPRETATION: Primary care in Ontario saw large shifts from office to virtual care over the first 4 months of the COVID-19 pandemic. Total visits declined least among those with higher health care needs. The determinants and consequences of these major shifts in care require further study.