“Shared expectations lead to predictability.”
101. Positive update: reported new cases and deaths decrease
Q: Is progress being made in controlling COVID-19?
A: Reuters News Service documented that the number of reported new cases of COVID-19 last week in the United States fell by 17%. This was the fifth straight week of declining reported cases. The number of deaths also continues to decline with the 6,700 deaths reported last week being 9% lower than the previous 7 days. Even then, the United States still has the worst outbreak globally with about a quarter of all cases in the world.
An Associated Press report published August 26 quoted experts identifying the most critical factor leading to the decline in reported cases has been the increased wearing of masks. Monica Gandhi, MD an infectious disease expert at the University of California credits the public’s growing understanding of how the virus spreads.
This reporting also cited a reduced level of testing as part of this reduction. Jonathan Quick, MD, who heads the pandemic response for the Rockefeller Foundation stated, “We’re grossly under-testing in some of the places that are still having high caseloads.” He singled out Georgia, Mississippi, North Dakota and Texas. The state with the greatest increase in new cases last week (a 50% increase) was South Dakota, Infections have been increasing there since the annual motorcycle rally in Sturgis, which saw more than 100,000 people from August 7 to 16. It is also worthy of note that even though the number of new reported cases in America has recently declined, the current 43,000 new cases per day is far higher than the average of 34,000 daily cases during last spring.
- Negative update: CDC guidance impacting on the control COVID-19.
Q: Is the number of tests reaching the goal of 4 million tests per day?
A: Two CDC guidelines were recently modified, which impact on controlling new COVID-19 infections. The first was concerning quarantine restrictions for all international travelers and for domestic travel from states with high levels of COVID-19 cases. Previous guidelines called for travelers into the country from abroad to be quarantined for 14 days. The same previous guidelines are to be self-imposed by people traveling between states from an area with a high concentration of cases. Last week, those guidelines were revised by eliminating quarantines for asymptomatic people who might be carrying the virus. By contrast, this revision does provide detailed guidance – to follow state and local requirements, not traveling if you feel sick, even detailed protective steps to take when pumping gasoline. But the issue of asymptomatic patients infecting healthy people is now ignored.
A second set of revisions have more potential for increasing the spread of the disease. Throughout this pandemic, everyone has been guided to get tested if they have been in contact with a person who has tested positive. Last week, these guidelines were rewritten to recommend that only people who show symptoms need to be tested. If followed, this guidance will dramatically reduce the number of people being tested. It would also disable the classic public health program of tracing, testing and isolation. Identifying people who were in contact with any infected person before they can spread the disease would not be possible. And ultimately, the disease will rapidly become more prevalent. The New York Times reported, “Two federal health officials have said the shift came as a directive to the CDC from higher ups at the White House and the Department of Health and Human Services.” Similarly, the Washington Post reported that the change “was directed by the White House’s coronavirus task force.” This corresponds to the president’s frequent claim that increased testing results in a greater number of cases. Many have faulted that reasoning by suggesting if we stopped offering pregnancy tests, we would have fewer babies being born.
Connecticut has joined with New York and New Jersey for collaborative COVID planning. All three governors have stated they will not follow these recommendations and will continue to expand testing and tracing. In fact, Reuters News Service has reported that, “a majority (33) of U.S. states have rejected the new Trump administration COVID-19 testing guidance in an extraordinary rebuke of the nation’s top agency for disease prevention.” Many of the other states reported they have not yet decided if they would comply. “This is the states almost all-out rebelling against the new guidelines,” said Michael Mina, assistant professor of epidemiology at the Harvard School of Public Health. Reuters continued by stating, “Public health experts said a rupture of this magnitude with the CDC may be unprecedented and shows a deepening distrust of the Trump administration and its response to the pandemic.”
- Abbott’s new “BinaxNOW COVID-19” $5 rapid test authorized
Q: When will we have a rapid turnaround test available?
A: Abbott Laboratories has already launched six different COVID-19 tests that have received Emergency Use Authorization (EUA) by the FDA. Last week, the FDA granted an EUA for the latest Abbott antigen test referred to as BinaxNOW COVID-19. It simply exists as a card, about the size of a credit card, on which a nasal sample swabbed by a health care professional is deposited. If the person is positive, within 15 minutes a colored stripe appears. A negative finding can then be paired using a provided application allowing the person to show the negative results on their cell phone as a “digital health pass.”. The EUA was granted on data from initial studies provided by Abbott. These data showed that positive readings were shown for 97,1% of the 35 people who had the disease, and negative readings were shown for 98,5% of the 67 people who were not actually infected. If continued data collected under the EUA confirms these findings, a more accurate and reliable test will confirm this as a vitally important test. Each test costs about $5.00. It is now designed for “point of care” use (not yet for home use) because the sample has to be taken by a trained heath care provider wearing PPE. Abbott is now planning to have 20 million test cards shipped for use during September and 50 million tests during October.
- Vaccines in other countries
Q: How well advanced is vaccine development in other countries?
A: The Russian approval of its COVID-19 vaccine has already been reported in this column. Apparently, their approval bypassed the traditional third phase of testing, which would have demonstrated its safety and effectiveness. Last week, it was reported by Russian Deputy Prime Minister Tatiana Goliikova that Russia is preparing to approve a second vaccine in September or October. Western experts have been skeptical, warning that until all internationally approved testing and regulatory steps have been taken, no vaccine should be released for public use. Now it has been learned that the People’s Republic of China has apparently been deploying its own vaccine since July. While its vaccine is still experimental and undergoing trials, it is being used for over a month to immunize health care personnel and border guards.
The Washington Post’s columnist Michael Gerson noted that “vaccine nationalism” creates chaos and provides “bad medicine.” He cites that a robust 20-year-old in a town devoid of infection could be a priority for vaccination in one country while a physician in another country with severe case loads would not be eligible for vaccination there. He also cited that increasing infections in some countries can present a direct threat to other countries that have effectively eliminated the disease. Covid-29 does not recognize national boundaries.
105. FDA warns against hand sanitizer packaging.
Q: I’ve heard about some hand sanitizer having flavoring added. Is his true?
A: Thursday last week, the Food and Drug Administration warned against some hand sanitizer products being packaged to look like food or drinks. Several products have appeared on the market that look like beer cans, children’s food pouches, water bottles. Juice bottles and even vodka bottles. Some products have cartoons on them that appeal to children. Some do have added food flavors like chocolate or raspberry. FDA Commissioner Stephan Hann said in a statement, “These products could confuse consumers into accidently ingesting a potentially deadly product.” Ethyl alcohol in high concentration can be toxic. And some hand sanitizers are still being sold that use methanol, a highly toxic substance.
