H5N1

Europe’s deadly second wave: How did it happen again?

Via The New York Times: Europe’s Deadly Second Wave: How Did It Happen Again? Excerpt:

By early June, scarred and battered, Europe was emerging from the depths of its fight against the coronavirus pandemic.  

Strict lockdowns in most countries had lifted health care systems off their knees, just as the United States and others were fighting record caseloads. The weather was warming up, the European Union was encouraging borders to reopen and Europeans were desperate for a break. 

They paid dearly for it. 

A devastating second wave has forced reluctant governments back into lockdowns or restrictions and inflicted new scars on European economies. The optimism of the summer is gone, replaced with the realization that loosening precautions led to thousands of deaths just months before vaccines may arrive.  

We now know that the second wave in Europe has become deadlier than the first. Nearly 105,000 people died of Covid-19 in November in 31 countries monitored closely by the European Centre for Disease Prevention and Control, surpassing April’s total, official data shows. About as many people are dying in Italy each day as when Bergamo was the center of the world’s attention. 

And in most countries, daily deaths are jumping higher this fall than ever before. 

Western European countries such as Italy and Belgium, which were hit hard the first time, are suffering nearly as badly now. Portugal is doing even worse. Some countries, including Germany, have done roughly the same, while others have done somewhat better, including Britain. Norway, Ireland and Finland have done best of all.  

But most notably, nearly every country in Central and Eastern Europe — which as a region largely skirted the first outbreak — is now seeing alarming spikes in cases and deaths. Dramatic springtime scenes of sick western Europeans stranded on stretchers outside packed hospitals are now playing out in Bulgaria and elsewhere in eastern Europe.

Yemen: In a country stalked by disease, Covid-19 barely registers

Via The Guardian: Yemen: in a country stalked by disease, Covid barely registers. Excerpt:

On a ward in Ataq general hospital, in the dusty central province of Shabwa in Yemen, six-month-old Muna Bassam is lying on her back, eyes closed, her distended belly moving up and down with the labour of breathing.  

In the corridor outside her room, a poster shows before-and-after photos of several children admitted to the ward who have managed to recover from acute malnutrition – still painfully thin, but smiling and alert.  

Muna’s family have already taken her to hospital once before. Worried about being able to pay for her treatment and fuel to return to the village, their prayers for her this time around are even more urgent. 

“My wife and I had 20 children. Eleven of them died,” said the baby’s grandfather, Abdullah. “But that was a long time ago. This should not still be happening today.”

Elsewhere in the overwhelmed hospital, children are suffering with cholera, diphtheria and dengue fever, contagious diseases that have stalked Yemen since the outbreak of war six years ago. For patients and doctors here, in what the UN says is the world’s worst humanitarian crisis, coronavirus barely registers.  

“We don’t have a neurosurgeon. We don’t have a maternity ward. We treat 20 children a month for malnutrition and now we are admitting more and more people severely ill with complications from dengue fever – more than 3,000 cases so far this year. The generator doesn’t always keep the equipment on,” says Dr Ali Nasser Saeed, the hospital director. “Coronavirus is nowhere near our biggest problem.”

Inslee: As COVID-19 hospitalizations increase, Washington could face ‘catastrophic loss of medical care’

Via The Seattle Times: Inslee: As coronavirus hospitalizations increase, Washington could face ‘catastrophic loss of medical care’. Excerpt:

OLYMPIA — Washington could face a “catastrophic loss of medical care” in the coming weeks if the increase in COVID-19 cases continues, Gov. Jay Inslee said Tuesday. 

Tuesday’s remarks came as Washington shattered its previous record for daily cases of the new coronavirus. State health officials reported 3,482 new cases statewide, along with 35 new deaths. King County alone reported 888 new cases. 

The previous record was 2,589 cases in one day, reported just a week ago on Nov. 17. 

Increasing numbers of hospitalizations for the new virus mean hospitals could have to delay treatment for cancer, and procedures like knee or hip replacements, Inslee said in a news conference. 

“But they will also have to move into a critical-care situation where they simply cannot provide care for critically ill people whose life is threatened,” said Inslee. “And we’ll have to move to some degree to a triage situation to see who can get that care.”  

But, “In December [at] some point, unless something changes, we very well could be in a situation with catastrophic loss of medical care in the state of Washington,” said Inslee. The state has asked the Bellevue-based Institute for Disease Modeling for more projections, he said.  

State Health Officer Dr. Kathy Lofy, also at the news conference, added that hospitalizations continue to rise, and “We’re very concerned about what this is going to mean for our hospitals.” 

“Hospitals have begun delaying nonurgent procedures,” she said, “and if this trajectory continues, they are going to need to delay most of their surgeries.” 

The question over hospital capacity isn’t just about space or equipment, but about having enough staff on hand to handle caseloads.  

Health care workers are fatigued after months of the pandemic and some are falling ill. The increase in cases nationwide may limit the ability of medical workers from outside the area to help, according to Inslee and Nathan Schlicher, Washington State Medical Association president.

COVID-19 and excess all-cause mortality in the US and 18 comparison countries

Via JAMA Network, a research letter: COVID-19 and Excess All-Cause Mortality in the US and 18 Comparison Countries. I've bolded some passage in the text:

The US has experienced more deaths from coronavirus disease 2019 (COVID-19) than any other country and has one of the highest cumulative per capita death rates. An unanswered question is to what extent high US mortality was driven by the early surge of cases prior to improvements in prevention and patient management vs a poor longer-term response. We compared US COVID-19 deaths and excess all-cause mortality in 2020 (vs 2015-2019) to that of 18 countries with diverse COVID-19 responses. 

Methods 

We compared the US with Organisation for Economic Co-operation and Development countries with populations exceeding 5 million and greater than $25 000 per capita gross domestic product. For each country, we calculated the COVID-19 per capita mortality rate and grouped countries by mortality: (1) low (COVID-19 deaths, <5/100 000), (2) moderate (5-25/100 000), and (3) high (>25/100 000). We used Poisson regression for comparisons across countries.  

We calculated the difference in COVID-19 deaths between each country and the US through September 19, 2020 (week 38) under 3 scenarios: if the US had a comparable per capita COVID-19 mortality rate to each country from the start of the pandemic (February 13) or if the US mortality rate became comparable to other countries beginning May 10 or June 7, to allow lag time for policy interventions. (See the Supplement for formulas.)  

We also considered all-cause mortality per capita for countries with publicly available data through July 25, 2020 (week 30). This measure is robust to country-level differences in COVID-19 death coding and captures indirect pandemic effects. We estimated excess all-cause mortality (the difference between mean 2020 deaths and deaths in corresponding weeks of 2015-2019) for each country and the US, compared rates across countries using Poisson regression with country and week fixed effects (Supplement), and estimated the difference in excess all-cause mortality between each country and the US as described above. We used R software (version 4.0.2) for all analyses. 

Results 

On September 19, 2020, the US reported a total of 198 589 COVID-19 deaths (60.3/100 000), higher than countries with low and moderate COVID-19 mortality but comparable with high-mortality countries (Table 1). For instance, Australia (low mortality) had 3.3 deaths per 100 000 and Canada (moderate mortality) had 24.6 per 100 000. Conversely, Italy had 59.1 COVID-19 deaths per 100 000; Belgium had 86.8 per 100 000. If the US death rates were comparable to Australia, the US would have had 187 661 fewer COVID-19 deaths (94% of reported deaths), and if comparable with Canada, 117 622 fewer deaths (59%).  

While the US had a lower COVID-19 mortality rate than high-mortality countries during the early spring, after May 10, all 6 high-mortality countries had fewer deaths per 100 000 than the US. For instance, between May 10 and September 19, 2020, Italy’s death rate was 9.1/100 000 while the US’s rate was 36.9/100 000. If the US had comparable death rates with most high-mortality countries beginning May 10, it would have had 44 210 to 104 177 fewer deaths (22%-52%) (Table 1). If the US had comparable death rates beginning June 7, it would have had 28% to 43% fewer reported deaths (as a percentage overall).  

In the 14 countries with all-cause mortality data, the patterns found for COVID-19–specific deaths were similar for excess all-cause mortality (Table 2). In countries with moderate COVID-19 mortality, excess all-cause mortality remained negligible throughout the pandemic. In countries with high COVID-19 mortality, excess all-cause mortality reached as high as 102.1/100 000 in Spain, while in the US it was 71.6/100 000. However, since May 10 and June 7, excess all-cause mortality was higher in the US than in all high-mortality countries (Table 2).  

Discussion 

Compared with other countries, the US experienced high COVID-19–associated mortality and excess all-cause mortality into September 2020. After the first peak in early spring, US death rates from COVID-19 and from all causes remained higher than even countries with high COVID-19 mortality. This may have been a result of several factors, including weak public health infrastructure and a decentralized, inconsistent US response to the pandemic.

Limitations of this analysis include differences in mortality risk: the US population is younger but has more comorbidities compared with the other countries. In addition, since late August death rates have increased in several countries, and how mortality will compare with the US throughout fall remains unknown.

South Dakota gripped by COVID-19 pandemic amid Kristi Noem's no-mask approach

Via The Guardian, a long, scathing report:South Dakota gripped by pandemic amid Kristi Noem's no-mask approach. Excerpt:

Isolating herself from family after a Covid-19 diagnosis on the Rosebud Sioux Reservation in South Dakota, grandmother Cheryl Angel had few options for safe shelter and ended up far afield traipsing from one lonely hotel room to another. 

“Our tribe didn’t have anything set up, and if it weren’t for my relatives, I would have died in there,” she said.  

Relatives made two-hour drives to leave breakfast and supper outside her impromptu isolation ward, while inside she followed instructions to use a steroid inhaler four times a day and learned to inject herself with an epinephrine medication when she felt faint. 

She vowed that if she survived the deadly disease, she would do all she could to help others receive better treatment, as South Dakota fell further into the grip of the coronavirus pandemic. 

By the time her two sons caught coronavirus this fall, Angel had recovered and become involved in a grassroots community encampment taking care of homeless fellow Native Americans on Sioux land on the outskirts of Rapid City, in the west of the state.  

Physician Nancy Babbitt, who agreed to supervise training for coronavirus testing at the settlement, Camp Mniluzahan, lamented the heightened risks such vulnerable residents are facing amid state governor Kristi Noem’s determinedly hands-off pandemic policy – including being the only state without a mask mandate to curb infection.  

“My experience dealing with Covid-19 in South Dakota is one of failed leadership. Our governor has made it clear it’s up to the people, so we have to come up with creative ideas to help stop the spread,” Babbitt said.

Belgium: 'No plan would have been adequate' to deal with Covid-19

Via The Brussels Times: 'No plan would have been adequate' to deal with Covid-19.

Even if Belgium had been up to date on planning for an epidemic, it wouldn’t have been enough, according to Dr Piet Vanthemsche, co-chairman of the Economic Risk Management Group (ERMG) and former Influenza Commissioner. 

While the pandemic plan drawn up in 2006 during the H5N1 flu epidemic should have been updated, it likely wouldn’t have been enough, Vanthemsche told the special committee of the House charged with examining Belgium’s management of the Covid-19 epidemic on Friday. 

According to him, this plan could have served as a basis when the Covid-19 epidemic broke out, even though “no plan would have been adequate to deal with this pandemic.” 

Vanthemsche was appointed inter-federal Influenza commissioner in 2005, in order to fight H5N1 influenza. He remained in this position until the summer of 2006, after drawing up a pandemic plan.  

“This plan could have provided a basis for fighting the pandemic. Yes, there was a structure, but a plan is just a plan,” he said. “When you look at the epidemiological aspects (of Covid-19), no plan would have been really adequate. Any plan has to be corrected and adapted during a crisis.”

COVID-19: 5,000 'extra' heart deaths since March

Via BBC News: Coronavirus: 5,000 'extra' heart deaths since March. Excerpt:

Almost 5,000 more people have died from heart problems in England than would be expected since the start of the pandemic, the British Heart Foundation has warned. 

Analysis by the charity found excess deaths are 7% above predicted levels. 

It is urging people not to delay checks or treatment during the second wave of the virus.  

NHS England said hospitals are redesigning services so that care can go ahead safely.  

The BHF analysed mortality data in England between the start of the first national lockdown on 20 March and 30 October.  

It found 73,799 cases where heart or circulatory disease was named as the underlying cause of death. That is 4,785 higher than the number projected by Public Health England over the same time period. 

In around a quarter of the additional or excess cases, Covid-19 was mentioned on the death certificate, suggesting that in the majority of cases other factors were to blame. 

Pandemic impact 

The charity suggested some patients could be delaying treatment because they did not want to put pressure on the NHS, while others may have been concerned about visiting their GP or hospital for fear of catching the virus.  

Pressure on NHS services because of the pandemic has also led to delays to some operations and routine heart care.  

"Going forward, we have to learn the lessons from this pandemic," said Dr Sonya Babu-Narayan, associate medical director at the British Heart Foundation and a consultant NHS cardiologist.  

"It's a new disease and it's understandable that we may not have anticipated every consequence. We wouldn't want the very people who need the NHS the most being the ones staying at home trying to protect it."  

As the UK went into lockdown on 23 March, there was a sharp fall in people seeking help for suspected heart attacks.  

Admissions for the most serious type of heart attack, caused by a complete blockage of an artery supplying part of the heart, fell by about a quarter, while rates of admission for heart attacks caused by a partial blockage of blood supply to the heart fell by 42%, according to research by the University of Oxford. 

Don't ignore chest pain 

Numbers improved over the summer but doctors fear a second wave of the virus and a second lockdown in England will again prevent some patients being diagnosed or treated. 

The British Heart Foundation said it is important people seek medical advice if they have symptoms such as long-lasting chest pain or increased breathlessness.

US records seventh consecutive day of more than 100,000 new Covid-19 cases

Via The Guardian: US records seventh consecutive day of more than 100,000 new Covid cases. Excerpt:

Coronavirus continue to surge in the US, after the country recorded a seventh consecutive day of more than 100,000 new cases.  

Monday also saw the US surpass 10m total cases and reach an overall death toll of 238,256.  

There were 111,433 new cases on Monday and 590 new deaths, according to data compiled by Johns Hopkins University. 

Hospitalizations were also rising, with more than 59,000 hospitalized nationwide, reported the Covid Tracking Project, which saw the biggest single-day increase since 10 July. It found South Dakota had the highest hospitalization rates in the country and that Illinois had reported more than 10,000 cases for four days straight.  

Joe Biden, the president-elect, has warned the US is “facing a very dark winter” and that even with Pfizer’s announcement that it has a vaccine it believes is 90% effective, 200,000 more lives could be lost in the next few months. 

Alex Azar, secretary of health and human services, said on Tuesday the government will have enough of the vaccine by the end of December “to have vaccinated our most vulnerable citizens”.  

By the end of January, he told NBC, there will be enough for all healthcare workers and first responders, with March or early April targeted for a general vaccination program. 

In the meantime, states are struggling to cope. In El Paso, Texas, officials have six mobile morgues and have requested four more, CNN reported. The state was approaching 1m infections.  

Ohio’s chief medical officer, Dr Bruce Vanderhoff, warned of an “unprecedented spike” in hospital use and a growing demand on staff.  

“If we don’t control the spread of this virus, we won’t be able to care for those who are acutely ill without postponing important, but less urgent, care,” he said. “We anticipate that this kind of shift could happen in a matter of weeks if trends don’t change.”  

In Utah, Governor Gary Herbert warned of a “dire situation” in hospitals, declared a state of emergency, issued a mask mandate and restricted social gatherings. 

“This is a sacrifice for all of us,” he said. “But as we slow the spread it will make all the difference for our overworked healthcare workers, who desperately need our help.”

Alberta physicians call for 'sharp' two-week lockdown to curb spread of COVID-19

Via CBC News: Alberta physicians call for 'sharp' two-week lockdown to curb spread of COVID-19. Alberta is often considered the most "American" of our provinces in its dislike of taxation and government regulation. Excerpt:

With COVID-19 cases increasing dramatically, a group of physicians from across the province is calling on the Alberta government to impose an immediate two-week emergency lockdown. 

In a letter sent Monday to Premier Jason Kenney, Health Minister Tyler Shandro and Dr. Deena Hinshaw, Alberta's chief medical officer of health, the group warned that the province's acute-care system could soon be overburdened if no extra restrictions are imposed. 

"We believe that the conversation should not be framed as a choice between 'lockdown' akin to the prolonged experience in April-June, or no mandatory restrictions," said the letter, signed by more than 70 physicians.  

"Instead, the province should consider a two-week short, sharp lockdown, or 'circuit-breaker,' to drop the effective reproductive number and allow contact tracing to catch up. We believe it is time we had clear direction from our provincial government. We need rules not suggestions." 

The letter urged political and health leaders to "show the leadership the moment requires" in order to stave off further crisis and loss of life.  

After the two-week lockdown, the letter said, the province could turn to "targeted regional control measures" similar to those in Manitoba, Ontario and British Columbia, which have sliding scales of restrictions based on the number of cases, hospital admissions and the capacity of its intensive care units.  

Signatories of the letter include intensive care physicians, emergency physicians, general internists, pulmonologists, infectious disease specialists and family doctors. 

Kenney has refused to enact any new lockdowns, arguing the measures could hurt the economy and affect people's mental health. He has continued to urge Albertans to take personal responsibility and follow guidelines.  

The premier repeated that message at a news conference with Hinshaw on Friday.  

Dr. Noel Gibney, professor emeritus at the University of Alberta's school of medicine, said Kenney's responses prompted him to write the letter and circulate it among physicians in Alberta. 

"It's just such a jarring response at a time when clearly the information is that this is getting bad," he said. "And the premier's response was to say, 'Well, behave yourselves.' It's kind of like a father to teenagers. 'Behave yourself or you'll get time out.'"

Over the last three weeks, the letter said, the numbers of  cases, hospitalizations and ICU admissions have dramatically increased, with the latter two numbers hitting an all-time high over the weekend. 

On Sunday, Alberta Health reported 727 new cases. But on its website, the province noted that was "preliminary data and subject to reconciliation."  

Alberta Health reported 644 new cases on Monday, with 192 people in hospital, including 39 patients in ICU.   

Consequences could be 'catastrophic,' letter warns 

"If this rate of increase continues unabated, our acute care health system will be overrun in the near future," the letter said.  

"There have been advances in the care of critically ill COVID-19 patients based on research over the last nine months that have resulted in significant reductions in mortality and time to recovery. However, if the rate of COVID-19 spread continues, the consequences to the people of Alberta will be catastrophic."

Trump's COVID-19 pandemic response didn't hurt him as much as Democrats expected

Via The Washington Post: The Health 202: Trump's pandemic response didn't hurt him as much as Democrats expected. Excerpt and then a comment:

Democrats expected the 2020 presidential election would be a referendum on President Trump’s handling of the coronavirus pandemic. 

But it may not have hurt Trump so much — even as his opponent Joe Biden appears closer to victory this morning after winning key states of Wisconsin and Michigan.   

Even as the United States faces yet another grim surge from the virus – new coronavirus cases topped 100,000 for the first time on Wednesday, and the virus has already killed more than 233,000 Americans – exit polls suggest more voters ranked the economy at the top of their worries. 

One-fifth of voters said the pandemic was the most important issue as they filled out their ballots. 

That's according to data collected by Edison Research, a consortium of television networks. But a larger slice of voters — around one-third of all voters and 6 in 10 Trump voters — said they were primarily motivated by the economic fallout that has resulted from the highly infectious virus and state-mandated shutdowns trying to contain it.  

And there’s plenty of reason for their angst. Twenty-five million people are now on unemployment aid. Disposable personal income is falling. The airline, hotel and restaurant industries have projected hundreds of thousands of additional job losses without additional government relief.  

“People are sick of the pandemic,” said Carlos del Rio, professor of medicine and global health at Emory University. “The economy is a more immediate concern.”

Discouraging as this news may be, it only points out the need for healthcare workers and scientists to communicate far better than they have so far.