Frequently Asked Questions about COVID-19 — October 27, 2021

  “Shared expectations lead to predictability.”

391. Six out of seven Covid-19 cases in Africa go undetected, per the W.H.O.

         Q:  Are accurate records of the number of Covid-19 cases being kept everywhere?

         A:  It has been often stated that the Covid-19 pandemic anywhere won’t end until it has ended everywhere.  This means that every nation needs to maintain accurate records of how many cases that exist to implement mitigation steps.  The statistics in African countries that were recently reviewed at first indicated that Africa has avoided the worst of this disease.  But the World Health Organization has recently estimated this is not the case.  Matshidiso Moeti, MD, the Africa director at the WHO has recently estimated that about 59 million people in Africa have actually been infected with the coronavirus through mid-October.  The actual number of reported cases that have been reported is only about 15% of this number.  Many nations in Africa do not keep records of deaths or serious illnesses.  This highlights the difficulty ahead as work continues to eliminate this disease.

392. Two reasons for an increase in the number of vaccinated Black Americans

         Q: Are Black Americans still lagging behind Caucasians in becoming vaccinated?

         A:  Actually, recent research found that more Black Americans are now getting their vaccinations for two significant reasons.  First, the gap has been narrowed by the wave of pro-vaccine campaigns and the surge of hospitalizations and deaths this summer, mostly among the unvaccinated and caused by the emergence of the delta variant.  Secondly, the steadfast resistance to vaccines by many in white communities is slowing that group’s progress in becoming vaccinated.  Lucenia Williams Dunn, the former mayor of Tuskegee at first was hesitant about getting vaccinated, but she has since become a leader among the Black population promoting this important preventive measure.  “What people need to understand is some of the hesitancy is rooted in a horrible history.” she said recently.  “And for some, it’s truly a process of asking the right questions to get to a place of getting the vaccine.”  What appears to remain is solving the problem of getting the white anti-vaxxers to follow that same process.

393. An Alaska lawmaker barred from flying over masking rules has Covid.

         Q:  Are any of the state lawmakers against mandates being held accountable?

         A:  In several cases, people who are making it difficult to protect the public health find themselves unprotected because of their actions.  Lora Reinbold, a Republican state senator who has been a local critic of vaccine mandates, was barred from Alaska Airlines after she defied a federal mandate requiring passengers to wear masks.  She disclosed last week that she has tested positive for Covid-19.  Her revelation came as Alaska has been grappling with its worst coronavirus surge of the pandemic.  Ms. Reinbold, 57, argued with employees at Juneau Airport about the mask rule.  She normally uses air travel to reach her district, which otherwise takes more than 19 hours by car and ferry each way to the state capitol in Juneau.  She appealed the ban but it was later upheld “for as long as the federal ban exists.”  As a result, she will not be able to fly until January 18, 2022, even longer if the ban is later extended.  For treatment of her illness, Ms. Reinbold is reportedly taking Ivermectin, and “lots of vitamins.”  She added, “My Vicks Vapo-Rub steamer has been a godsend!”  Later, she added, “I plan to keep my promise to stay OUT of the hospital.  Some of them seem like scary places to me.”

394. Utah’s new cases are dropping, but hospitals remain overwhelmed.

         Q:  If a state’s cases drop, does this relieve the stress on hospitals??

         A:  Part of the stress on hospitals is the diminishing number of human resources – physicians, nurses and other health care workers than were available with previous surges.  This is the case in Utah.  A week ago, Utah had 570 patients hospitalized with Covid-19.  Hospitalizations have been increasing even as the number of new cases has been falling.  The previously infected people who need care remain to stress the hospital system in the state.  Many nurses have removed themselves from caring for Covid patients out of frustration that so many were not vaccinated and need not have fallen ill.  In many instances, health care workers have themselves become ill and died or remain disabled from long-haul Covid effects.  The rate of fully vaccinated people in Utah is below 55%, lower than the national average.  Yet even then, their rate is ahead of its neighbors including Idaho and Wyoming.  (Last week, Connecticut’s rate of fully vaccinated people rose above 70%)

395. There has been an increase in tuberculosis in 2020.

         Q:  There was a reduction in flu cases last year; how have other respiratory cases fared?

         A:  Deaths from tuberculosis, the world’s largest infectious disease killer until the Covid-19 pandemic arrived, have increased for the first time in more than a decade, totaling more than 1.5 million people in 2020.  The W.H.O. estimates this will increase even more in 2021 and again in 2022.  Malaria and HIV are among the other diseases the World Health Organization predicts will also increase.  The cause for this is the current emphasis directing manpower and testing activities toward this new disease – Covid-19.  “This is alarming news that must serve as a global wake-up call for the urgent need for investments and innovation to close the gaps in diagnosis, treatment and care for the millions of people affected by this ancient but preventable and treatable disease,” Tedros Adhanom Ghebreyesus, MD, the W.H.O.’s director general, said in a statement.  One of many hopes for the future rests on the progress made in the development of mRNA vaccines and other therapeutics.  Just last week, a vaccine for malaria was announced, and research is well along for a vaccine for HIV.  Maybe also of TB as well, somewhere down the line.

 

 

 

Frequently Asked Questions about COVID-19 — October 20, 2021

  “Shared expectations lead to predictability.”

386. One should understand statistics before leaping to conclusions.

         Q:  I read that Connecticut has reached 80% vaccinations.  Are we at herd immunity?

         A:  No.  Newspapers reported last week that 80% of the people eligible for vaccinations have been vaccinated.  This looks great and reassuring, as it was intended when it was published.  But it is of little value to demonstrate the progress of the disease.  With children under the age of 12 not yet eligible for vaccinations, they were not considered in that metric.  That 80% of the people does not include an estimated 380,000 kids.   Herd immunity is when enough people who can pass the virus on to others reach a critical level, perhaps as low as 80%.  Children under age 12 can pass the disease on to others, and they would have to be included in a statistic that tracks the progress in containing the pandemic.  One official estimate for how many are fully vaccinated in Connecticut is about 70%.  The current caseload of about 12 newly infected people every day for every 100,000 population illustrates we have a way to go before we will reach herd immunity.

387. It is alleged that Moderna is prioritizing its vaccine for profits by limiting its distribution to the poor.

         Q: How do pharmaceutical companies recover their costs for developing their vaccines??

         A:  In the current push for Covid-19 vaccines, the federal government provided millions of dollars to several companies to develop and test their vaccine products.  Normally, pharmaceutical companies recover their research and development costs by charging for the drugs they develop.  Protective patents on new drugs prevent their formulas from being copied by others, which allows them to be offered as lower-cost generic medications.  The retail costs of pharmaceuticals and the profits of drug companies have always been controversial.  Last week, the New York Times published an article that Moderna’s mRNA Covid vaccine is being supplied to wealthy countries, making billions of dollars while keeping poorer countries waiting.  Moderna has shipped a greater share of its doses to wealthy countries than any other vaccine manufacturer according to Airfinity, a data firm that tracks vaccine shipments.  “They are behaving as if they have no responsibility beyond maximizing their return on investment,” said Tom Frieden, former head of the CDC.  Moderna executives have said they are doing all they can to manufacture more of their doses, but have limited capacity.  Unlike other pharmaceutical companies, Moderna does not sell other medications in other countries, and they are heavily reliant on income from their vaccine to sustain their continued existence.   The controversy has reached a high point over the past few weeks with President Biden publicly demanding that all vaccine manufacturers, especially Moderna, need to invest in expanding their production capacity for manufacturing more Covid-19 vaccine doses.

388. The NBA is showing it is serious about players getting vaccinated.

         Q:  Why are some sports figures not getting vaccinations?

         A:  Kyle Irving is an important member of the Brooklyn Nets basketball team.  When he was asked by the NBA if he had already been vaccinated against Covid, he became evasive.  The problem initially was that New York had passed a requirement that everyone entering facilities such as sports arenas be at least partially vaccinated.  Kyle refused to show proof of his vaccination and was initially told he could only play in games away from home.  He would not be able to be present at the 41 scheduled home games.  The NBA has since given Kyle a choice to get vaccinated or take the entire 2021-2022 season off.  Kyle has a reputation of being a contrarian and not always following all the rules.  But if he sits out the season, it could hurt the Nets’ chances of gathering another NBA championship, and diminish his future chances to play professionally.  Time will tell what his future will be.

389. Anchorage is in turmoil over passing a mask mandate.

         Q:  What is going on in Anchorage, Alaska?  I hear that they can’t even pass a mask mandate locally?

         A:  The Associated Press has been reporting on the political repercussions in Anchorage over requiring masks to be worn indoors.  Alaska has been reporting the highest prevalence of Covid-19 in the United States.  The surge of patients more than a week ago caused the major medical center, Providence Alaska Medical Center, to revert to “crisis standards of care.”   As this is the primary tertiary care hospital in the state, receiving patients from other state hospitals, all the feeder hospitals have, of necessity, also shifted to their “crisis standards of care.”  This has affected more than Covid-19 patients.  Heart surgeries have been canceled to preserve resources for those “more likely to survive.”  Specific instances have been reported.  One patient who needed emergency surgery was not attended to.  A second was taken off dialysis because someone else needed it.  In both cases, the patients who were denied care died.

Anchorage has about 40% of the state’s population.  The state’s governor and local mayor are both against mask mandates, reflecting the vocal minority who are aggressively and vocally opposed to such measures.  But the local governing Assembly, starting in September, held hearings proposing to pass a local ordinance mandating all adults to wear masks indoors.  The proposed ordinance did provide for religious and medical exemptions.  During these hearings, several disruptions occurred.  Police arrested one armed person.  Protesters appeared wearing Stars of David comparing mask requirements to the persecution of the Jews during the Holocaust.  Many who offered testimony issued bold threats to the Assembly members, individually threatening physical violence and property destruction for proposing this mandate.  Last Tuesday, the Assembly voted 9 to 1 to adopt the mandate.  The Mayor, Dave Bronson, vetoed this ordinance the next day, but the Assembly immediately scheduled a meeting to vote to turn down this veto.  Polling shows that a majority of the public supports this mask-wearing mandate.  On Thursday last week, the Assembly voted 9-2 to override the mayor’s veto.  That public meeting was attended by many advocates as well as opponents and was much less anger-ridden.  Many showing signs that stated, “Thank You!”  The now-approved mandate will be due to expire in just 60 days, and also contains a provision the if two of the three hospitals in Anchorage return to normal standards of care for 14 days, the restriction will end earlier.  The vicious anger displayed by the minority is causing great concern over how well this mandate will be followed.

390. Texas ban on any vaccination mandates is challenged by big business.

         Q:  How will corporations who are for vaccination mandates handle Texas’ ban on them?

         A:  Texas governor, Greg Abbott, a strong opponent of vaccine mandates, issued a state order last Monday saying that inoculations against coronavirus should always be voluntary.  His order mandates that no “entity” (business, organization, or group) in Texas can mandate vaccinations for their employees or for people who attend or engage in any offerings provided by these groups.  No requiring service employees to be vaccinated.  No restricting of attendance at sports events, no requiring a vaccination to eat in restaurants or do shopping in stores.   This pitted businesses against the ruling when nationally, employees who hire more than 100 people must conform to OSHA requirements to provide a safe workplace by mandating vaccinations. American Airlines and Southwest Airlines, based in Texas, stated last Tuesday they would not comply with an order from the governor of Texas barring private employers from requiring vaccines.  The Greater Houston Partnership, a business group that includes Exxon Mobil, Chevron, and JP Morgan as members, also came out against the governor’s order saying it “does not support Texas business’ ability and duty to create a safe workplace.”

“Texas has just set itself up for a grand political show, but not a potentially legally sound initiative to stop all vaccine mandates,” said James Hodge, the director of the Center for Public Health Law and Policy at Arizona State University.  “It boils down to a lot more politics than law.”  He reflected, “Courts in the US have a long history of upholding vaccine mandates, and of ruling that protecting public health takes precedence over personal choice.”

 

Frequently Asked Questions about COVID-19 — October 13, 2021

  “Shared expectations lead to predictability.”

381. Experts warn it’s that time of year to get a flu shot

         QWill it be like last year when few people came down with the flu?

         A:  Probably not.  Last year, as the pandemic was surging and before vaccines were available, the public was getting used to mitigation measures including lockdowns, wearing masks, hand washing and social distancing.  An unexpected benefit of these measures was that the seasonal flu was also constrained.  The number of flu cases in the 2020-2021 season was the lowest in the last 23 years.  Like Covid-19, influenza is a respiratory infection transmitted through the air.  This year, with many states loosening their mitigation measures for Covid, the flu is easier to pass along.  “This year we are guaranteed to have the flu, and we are going to have some version of a ‘twindemic,’” said William Schaffner, MD, the medical director of the National Foundation for Infectious Diseases.  “It could really further strain an already extraordinarily stretched, tired-to-the-bone health care system.”

Clarification of several concerns about flu have been offered by infection control experts:

  • Everyone over the age of 6 months, with a few exceptions, should get the flu shot.
  • The flu runs from October through May. Now is the time to be vaccinated.
  • It takes about 2 weeks after getting a flu shot before immunity is established.
  • Both the Covid-19 vaccine and the flu vaccine are needed to avoid this “twindemic.”
  • You can get both vaccines at the same time.
  • Children and pregnant women should get the flu vaccine.
  • Immunity is transferred through the placenta to the unborn child.
  • Antibiotics are not effective against either Covid-19 or seasonal influenza.

Dr. Schaffner stated the coronavirus and influenza viruses causing illness have one thing in common: “We can’t shut it off like a light switch.  But we can dim it.”

382. More than 120,000 American children lost a parent or caregiver to Covid-19

         Q: How many American children have lost a parent due to the pandemic?

         A:  Last Thursday, the medical journal Pediatrics published a study that found the number of U.S. children orphaned may be larger than previously estimated, and that the toll has been far greater among Black and Hispanic Americans.  One of the study’s authors, Alexandra Blenkinsop, MD, of Imperial College London said in a recent statement, “These findings really highlight those children who have been left most vulnerable by the pandemic.”  During 15 months of the nearly 19-month Covid-19 pandemic, more than 120,000 U.S. children lost a parent or grandparent who was a primary provider of financial support and care, the study found.  Another 22,000 children experienced the death of a secondary caregiver.  Researchers estimate the Covid-19 drove a 15% increase in orphaned children, many requiring foster care.  About 32% of all kids who lost a primary caregiver were Hispanic, and 26% were Black.  Hispanic and Black Americans make up much smaller percentages of the population than that.  White children accounted for 35% of kids who lost primary caregivers, even though more than half of the population is white.

383. Other nations are dealing with vaccine mandates in similar ways.

         Q:  Are other countries mandating Covid-19 vaccines like we are?

         A:  Reuters News Service last week published a summary of how several other countries are requiring their citizens to be vaccinated.  In the past, nearly everyone accepted the premise of public health – that the inconvenience for some taking mitigation steps against infectious disease was valued as a protection of the community – the public health.  The Covid-19 pandemic in the U.S. saw an emerging counter to that premise by large numbers of people agitating, demonstrating, even taking violent action to “preserve their personal freedom,” and refusing getting their shots.  It turns out that many other nations are facing similar opposition, requiring alternative steps to achieve an effective level of immunity in the population.

Countries that have mandated vaccinations:

  • For everyone (over age 18) – Indonesia, Micronesia, Turkmenistan.
  • For all workers, or workers in companies over an identified number of employees – Italy, Kazakhstan, Russia, Saudi Arabia, United States.
  • For all healthcare workers – Britain, France, Greece, Hungary.
  • For all nationally/federally employed persons – Canada, Costa Rica, Fiji, United States.
  • For workers and passengers on planes, trains and marine transportation – Canada, Saudi Arabia, Sri Lanka, Turkey.
  • For those caring for the elderly – Australia, Tasmania.
  • For patrons entering restaurants, cinemas and other venues – Britain. Canada, Greece, Lebanon, Netherlands, Saudi Arabia, Switzerland.
  • For school teachers, staff and/or students – Turkey.

For some of these categories, the United States is encouraging state and local jurisdictions, such as school boards corporations and community officials to create the mandates.  The diversity of effort internationally requires anyone traveling to a foreign country to check ahead of time to determine the current requirements for visitors.

384. Over 5,000 college students in Connecticut do not have to be vaccinated.

        Q:  How many Connecticut college students have been granted non-medical exemptions?

        A:  The Hartford Courant published an article this last Sunday that reported that 15% of the 37,116 students currently enrolled at Connecticut community colleges have received non-medical exemptions from being vaccinated.  These 5,479 students are all eligible for receiving a vaccination and have no medical condition preventing this.  But they do not have to get their shots.  The form the students were required to fill out before registering asked simply if they preferred to receive a medical or non-medical exemption.  No explanation was given as to limitations or definitions of a non-medical exemption.  Those not wanting a vaccine, or just not wanting to exert the effort to get one, were thus able to be excused.  Of course, this reduces the number of vaccinated people in the state and increases the risk to others who aren’t vaccinated, and for “breakout” infections to those who are.  Leadership is working to educate the non-medically exempt people to encourage them to get vaccinated anyway.  A review of this process may lead to a revision this winter as the second-semester registrations begin.

385. Iranians turn to Black Market for vaccines as Covid-19 deaths spiral upward.

         Q:  Are there countries that are not getting enough vaccine doses to meet their demand?

         A:  One interesting case study is worth reviewing.  In January, 2021, Iranian Supreme Leader Ayatollah Ali Khamenei suddenly announced that foreign-made Covid-19 vaccines were “forbidden” as they were “completely untrustworthy.”  Nine months later, the country is suffering its greatest surge and a record number of deaths per day.  The nation’s healthcare system is near collapse.  Patients are told to stay home if they became ill. And “do what they can to not get exposed,” said one hospital physician in Tehran.  The scale of the crisis is such that doctors feel they have no choice but to speak out about it openly.  This is a regime that ordinarily does not tolerate dissent.

Since the early days of the pandemic, Iranian officials have declined to cooperate with the World Health Organization.  Added to this are the crippling sanctions levied against Iran that have starved the nation’s healthcare system of resources.  As a result, foreign transactions with Europe and other countries are hampered.  With less than 5% of its 80 million population fully vaccinated, Covid-19 has been surging rapidly out of control.  In August, Khamenei partly reversed his mandate, although he still forbids vaccines produced by the United States and the United Kingdom.  This opened up a lucrative and corrupt black market for vaccines that are only affordable to the well-off.  The drugs can cost the equivalent of $400 – $1,200 per dose (when the average monthly salary is between $150 – $250).

A “corrupt medical mafia” has emerged as the country is dealing with a “scarcity of everything.”  Many lay blame at the foot of the repressive national government, but with its aggressive reaction to dissent, there is little that can be done as the pandemic rages out of control.

Frequently Asked Questions about COVID-19 — October 6, 2021

  “Shared expectations lead to predictability.”

376. “Merck says it has the first antiviral pill found to be effective against Covid.”

         Q:  Is it true there’s a pill out now that can cure Covid-19?

         A:   The headlines loudly proclaimed the “first antiviral pill found to be effective against Covid.”  This took place even before Merck, the pharmaceutical company that developed the drug, has even submitted their data to the scientists at the FDA to begin the process for gaining authorization for its use.  One of the reasons drug companies declare their products effective “by press release” is to create demand for their products, even if they can’t yet be used, even before the unbiased FDA scientists have had the chance to determine their risks and effectiveness.  This new drug gets its name from Norwegian folklore.  Thor was the god associated with storms and thunder and was seen as a protector of humanity.  He is known for carrying a potent weapon – symbol of his mighty power – a war hammer.  In the old-Norse language, this hammer was known as the Mjolnir.  One can sense the marketing discussions behind naming this new pharmaceutical “mulnupiravir” even if it is difficult to pronounce.  Strength.  Protector of mankind.  And, it is worth noting, several other companies are well along in developing and conducting clinical trials of similar oral drugs that can reduce the disease’s ability to become life-threatening.  Hence the need to publicize it early, before the others have the chance.

In Merck’s reports on the initial clinical trial, 775 people in America and overseas had volunteered who were recently infected with Covid-19.  They were divided into two groups.  Half was given the mulnupiravir, and the other half was given a placebo.  Seven percent in the treatment group were hospitalized, but none died.  So, it isn’t “ a cure.”  In the placebo group, there were 8 deaths.  The clinical trial was stopped early because the benefits to those being treated were so significant, it was deemed unethical to deny those in the placebo group its benefits.

The drug was designed to stop the coronavirus from replicating in the infected host by inserting errors in its genetic code. When approved, physicians can prescribe this drug and patients can pick it up at the local drugstore.  The proposed dosage would be taking 4 capsules twice a day for five days. The cost is expected to be $700 per patient.   In anticipation of final approval, the federal government has contracted to purchase 1.7 million courses of therapy to make this drug available   Because it has not yet applied for authority to distribute and use this drug, it is estimated it won’t be available for sick patients until the end of this year – if not later.

377. California mandates vaccinations for all school staff and children statewide.

         Q: Is the decision to require vaccinations in schools always left to local officials?

         A:  Governor Gavin Newsom of California said last Friday that the state would phase in a statewide requirement that all staff including teachers, paraprofessionals, and bus drivers, and all students in all schools must be vaccinated.  Recognizing that vaccinations have yet to be approved for students ages 5 to 12, the state will phase in its mandate for the start of the next school term (January 1 or July 1).  Other states and districts including Washington State, Oregon, and New York City have announced similar rules, but California is the first to create a state-wide mandate for Covid vaccinations.

378. America’s death rate leads all other countries with ample supplies of vaccine.

         Q:  Is our death rate higher or lower than in other countries?

         A:  Last week on Friday, the U.S. reached a total of 700,000 deaths from Covid-19.  Other countries have exceeded this number of deaths.  But when measuring the number of deaths per 100,000 of their citizens, America has the highest death rate.  This is seen to be the result of two factors: the emergence of the more infectious Delta variant last spring, and the politicization of vaccination making large numbers of people in the U.S. unwilling to be vaccinated.   An overwhelming number of U.S. deaths in the last few months have been unvaccinated people, in spite of an abundance of vaccine doses being available at no cost throughout the country.  Out of every 100,000 people who died of Covid since last June, only an estimated 2,900 people were vaccinated. The Covid-19 pandemic has now killed more Americans than died in the influenza pandemic of 1918 and 1919 (about 6675,000 people).   Most of the deaths in the last three-and-half months were concentrated in the south in states with low vaccination rates.

379. Summer sleep-over camps this summer were mostly free of Covid-19.

         Q:  How many summer camps had to close because of COVID this past summer?

         A:  The CDC released a report on camping this past Friday.  It reported that camps that maintained a high vaccination rate for staff and eligible children and did continuous testing for everyone largely stamped out the spread of coronavirus this summer.  But the CDC continued that those summer camps in the less vaccinated Southern states and in the Mountain West that failed to mandate shots for staff or require masks for indoor gatherings remained vulnerable to outbreaks.

Two studies were used by the CDC to contrast the effectiveness of different mitigation levels.  One study looked at 9 camps that mandated vaccines and mask-wearing indoors, A total of 93% of the eligible campers and staff had received their shots.  Only 9 Covid cases were found among the 7,000 campers and staff.  Several of these cases were related to staff visiting sites away from camp on their days off.  The second study examined outbreaks at 28 camps in Louisiana.  Half were sleep-over and half-day camps.  Of all the camps, only one camp mandated vaccinations and one required masks to be worn indoors.  On average, each of these outbreaks involved 12 cases, all attributed to the Delta variant.  Of the 135 infected campers eligible to be vaccinated, 133 had not taken their shots.  All the staff members who became sick had not been vaccinated.

380. Broadway opens its theaters, and then Covid surfaced.

         Q:  We were disappointed when a reopened Broadway production was canceled.  What is going on?

         A.  Last week, several Broadway plays and productions opened in New York City.  All actors, crew members, as well as audiences, are required to be fully vaccinated, and be tested.  One show, Disney’s production of Aladdin, illustrates the complexity of managing risk on Broadway during this pandemic.  Aladdin’s last show was in March 2020.  Rehearsals and planning for a reopening started early.  Its first show in the New Amsterdam Theater opened last week Tuesday.  After that show, several people tested positive for Covid-19.  All those who tested positive had been previously vaccinated and these new cases were “breakthrough” illnesses.  An epidemiologist who was working on the show ordered the show closed after a single day of reopening.  This will allow those testing positive to remain in isolation for the minimum 12 days.  Its second performance is scheduled for October 12.  Disney said it was refunding purchased tickets.

Some other productions have had cast and crew members testing positive, but by using understudies and substitute crew members have been able to maintain continuous performances.

The Broadway League announced last Friday an extension of their vaccine and masking requirements through the end of 2021.  This will apply to all 41 Broadway theaters.  Patrons over the age of 12 must be vaccinated, while testing is required for those 12 and under, and all attendees must wear masks.

Frequently Asked Questions about COVID-19 — September 29, 2021

  “Shared expectations lead to predictability.”

371. Authentic pandemic forms and accountability for forgeries

         Q:  I heard that someone bought a forged CDC vaccine card.  Is this legal?

         A:   The lack of a national data system documenting records of vaccine shots being given prevents the creation of a national “vaccine passport.”  The CDC has printed 3” x 4” copies of its “COVID-19 Vaccination Record Card.” Quantities were given to each group of vaccinators to hand out to people receiving their shots.  This is the only federally issued form one can use to prove they are vaccinated.  It has no photograph to identify the person showing the card is the person who received the vaccine.  It is easy to make a forgery.

Initially, the FBI warned the public against making and selling blank cards.  In April 2021, 40 state attorneys general warned online shopping platforms and social media against selling blank or fraudulently completed forms.  It has since been determined that making or using fake CDC vaccinated cards is a violation of the law prohibiting the wrongful use of government seals.  The cards have the CDC and DHHS government seals on them.  The penalty is up to 5 years imprisonment and a fine.  Arrests and prosecutions have followed and effective accountability has been established.

What about the falsely documented medical or religious exemption forms?  In a similar manner, as above, completion of the required forms can lead to legal consequences.  On February 16, 2021, the Medical Board of California revoked the medical license of Ken Stoller, MD for writing medical exemptions from school vaccinations for 10 students without first examining the students – and charging each $100.  Just last week in Connecticut, the State Medical Examining Board suspended the medical license of retired doctor Sue McIntosh of Durham.  The Department of Public Health said McIntosh signed and mailed out blank vaccine and mask exemption forms without examining the patient.  The statement of charges goes on to say in some cases, McIntosh didn’t even know the patients.

The issue of religious exemptions is more difficult.  The problem is differentiating between the use of the exception based on formal teachings from an established faith leader and that caused by an ad hoc blend of online conspiracies and misinformation, conservative media, and conversations with like-minded other people.  The conflict is between preserving the well-established “freedom of religion” against “maintaining the public good.”  There are no national standards for individuals to follow to claim this exemption.  Many conservative groups are posting their services to appeal any religious exemptions that are issued.  Many court cases are expected to adjudicate this matter.  Meanwhile, many groups mandating vaccinations are not accepting religious exemptions.  United Airlines recently told workers that those who state a religious exemption will be placed on unpaid leave until Covid safety and testing procedures can be developed.

372. The pandemic is morphing into a new disease: “Post-Vax Covid.”

         Q: How are the new variants and increasing vaccinations changing the pandemic?

         A:  Katherine J. Wu, Ph.D., co-authored an electronically published article last week Tuesday that recognizes that the current vaccine diminishes the seriousness and fatality of new cases that are currently identified as “breakout” cases.  “If this virus becomes as inescapable as the culprits behind the common colds and flu,” Katherine states. “we would all have to grapple with one of these infections.”  As Covid-19 continues as an endemic – constantly present but briefer, milder, and less contagious as the pandemic has been for the past 18 months, it will be like the current flu – requiring annual vaccinations but only making people feel ill for few days of sick leave and, except for a small percentage who become hospitalized and may die, recovering without lasting after-effects.  A new situation she refers to as “post-vax covid.”

373. Central Massachusetts is running out of ICU beds

         Q:  Are the only hospitals considering crisis standards of care in Alaska and Idaho?

         A:  One nearby example emerged last week.  The largest hospital network in Central Massachusetts is the UMass Memorial Health Care System.  Last Wednesday, the multiple hospital mid-state group ran out of ICU beds.  “The situation is dire,” said Eric Dickson, MD, president and chief executive of the system.  “I’ve been an emergency physician in (Worcester) for three decades, and I’ve never seen it this bad,” he said.

374. A new CDC report verifies that wearing masks in schools reduces outbreaks.

         Q:  Masks work, people say.  Where’s the scientific proof?

         A:  On September 24, the CDC released a formal report.  In the first month of schools universally reopening, 1,800 schools had to close and go back to remote learning because of the increased number of students who had to stay home because of contact with other(s) who were tested positive.  But this new study also showed that schools that required universal masking were much less likely to see the widespread infection.  Researchers examined two separate studies analyzing overall coronavirus infections in 520 counties with different school masking policies, as well as specific outbreaks in schools in the two largest Arizona districts.  These closures reduced in-person learning hours for more than 933,000          K through 12 students.  Georgia, Kentucky, Tennessee, and Texas each had more than 259 schools closed in August due to outbreaks.  Tennessee closed more than 250 schools.  Both Tennessee and Texas ban school districts from wearing masks, while Georgia and Kentucky allow school districts to decide on their own mask mandates.  In Pima and Maricopa counties in Arizona, Megan John of Arizona State University examined schools that required masks from the first day of school compared to those where mandates were put in place late or not at all.  Of about 1,000 schools in the study, about 48% never required masks, 21% required masks from day one, and 32% required masks after a few days.  The schools requiring everyone (regardless of being vaccinated or not) to wear masks from the first day of school were 3.5 times less likely to have an outbreak than the other schools.  The superintendent of public education in the Arizona Board of Education, Kathy Hoffman said, “It is irresponsible for the state government to stand in the way of local leaders making decisions that protect the health and safety of their students and staff.    …universal masking will continue to be a critical tool in limiting the spread of the virus in our schools.”

375. Updates on Russia’s management of Covid-19

         Q:  How well is Putin managing this disease in Russia?

         ALast week Monday, Russian president, Vladimir Putin attended several in-person meetings including one with president Bashar al-Assad of Syria, a close ally of Russia.  After consultations with medical experts following knowledge that several people at these meetings were infected with coronavirus-19, Putin was advised and he agreed to remain in isolation for a period of time.  The pandemic in Russia is continuing in its severity.  Many citizens are hesitant to take the Russian vaccine, named “Sputnik V.”  This vaccine is recognized as being less effective than any of the approved vaccines used in America.  Russia’s official reported mortality from the coronavirus has been essentially flat at just below 800 deaths per day since July.  The “remarkable stability” of this metric has led to many speculations it is a manufactured number, though officials insist it is accurate.

Frequently Asked Questions about COVID-19 — September 22, 2021

  “Shared expectations lead to predictability.”

366. More hospitals are no longer able to give the routine standards of care.

         Q:  Are hospitals in northern Idaho the only ones giving the “crisis standards of care?”

         A:   The “crisis standards of care” is when guidelines are drafted that staff will use to sort which of the patients who normally would be admitted will be either be required to wait in their cars (or in ambulances) in the parking lot until a bed becomes available, or turned away and sent home without treatment.  Only comfort care (sedatives and painkillers) is usually prescribed.  Last week’s column identified that the state of Idaho was moving to ban mandated mask-wearing and vaccinations for school students, teachers, and staff as well as health care workers.  They now have the lowest vaccination rate of any state in America.  (46% have received at least the first dose!)  Last week on Thursday, the Deputy Director of the Idaho Department of Health and Welfare, Dave Jeppesen stated, “We don’t have enough resources to adequately treat the patients in our hospitals, whether you are there for Covid-19 or a heart attack or because of a car crash.”  The entire state of Idaho has enacted crisis standards of care for all of its 18 acute care hospitals.

In Alaska, the Providence Alaska Medical Center in Anchorage announced It will begin providing crisis standards of care for its patients because they no longer have the resources to treat all patients who appear.  This is especially significant because, for critical care, Providence Alaska Medical Center is the largest hospital in the state and is the primary referral center receiving critical care patients from all the other nine critical care hospitals in that state.

As of last week, there were eight other states that had only 10% or less of their state-wide ICU beds available and were preparing their critical standards of care, should they be required: Alabama, Georgia, Tennessee, Mississippi, Louisiana, Kentucky, Texas, and Arkansas.

This breakdown of our national healthcare system will have repercussions for many years to come as planning finds ways to prevent future similar situations.

367. The number of deaths caused by Covid-19 in the U.S. is exceptionally large.

         Q: How many people have died in America because of this disease?

         A:  Since the beginning of the pandemic in the U.S., there have been nearly 680,000 people whose deaths were attributed to this disease.  This means that one out of every 500 men, women, and children living in the country is no longer living!  And unlike heart disease and cancer, the previous leading causes of death, Covid-19 has claimed a disproportionate number of young people.

368. Most Americans support vaccine and mask mandates.

         Q:  There are a lot of people angry about mandated vaccines and masks.  Is this a problem?

         A:  News reports have increasingly shown instances where people are angrily demonstrating their lack of support for the mandated use of masks or for getting vaccinated.  Last week, findings from a new poll from Monmouth University were released.  Amid the increasing risk of becoming infected by the highly contagious Delta variant, the survey shows that a majority of Americans support the vaccine mandates announced by president Biden last week.  Among other findings in this poll, Americans also support instituting state guidelines for mask-wearing, social distancing, and requiring proof of vaccination for certain activities such as boarding an airplane or reporting to a workplace.  Interestingly, the majority support for these measures is found in both blue states and red states, although a significant number of people, most of whom are Republicans, remain opposed to getting vaccinated.

The poll finds that 66% of Americans support face masks being mandated for all school students, teachers, and staff (68% in blue states and 63% in red states).  The difference between blue states and red states in each of the multiple questions asked did not differ by more than 5%.   The vocal opposition to mandates is obviously not representative of the view of the general public.

369. Opposition to public health methods are becoming laced with anger.

         Q:  What are people thinking?  Crowds are angrily opposing masks and vaccinations!

         A:  Throughout the country, reports are increasing of threatening behavior against officials who, following tradition and legal procedures are being challenged and ostracized.  Politically, we hear of public officials being asked to “find” enough votes to declare an election was won by the actual loser.   In public health, recent events have affected the ability to contain the pandemic – to reduce the chance that new mutations will emerge.  Early on, Anthony Fauci, MD, who led the scientific effort to control COVID-19 received many threats against him and his family.  This caused the federal government to provide him with around-the-clock security detail.  In Florida, school superintendents who mandated face masks in their districts were punished for violating the ban on such mandates by the governor cutting funds equal to their salaries.  Not all such threatening confrontations occur in red states or in the south.   Several weeks ago, Governor Lamont spoke in Chester Connecticut about his plans for reopening schools in September.  A vocal crowd shouted him down repeatedly over his plans for masking of staff and students and vaccines – causing the meeting to end early and the governor leaving amid curses and shouting.  In NH, state representative William D. Marsh, a retired ophthalmologist, had opposed continuing legislation to ban vaccinations and mask requirements.  As a result, he was threatened with removal from his leadership role on the public health committee.  Last week, when it became apparent that the NH legislature was going to refuse to accept large federal funding to expand vaccinations in the state, he changed his party affiliation from Republican to Democrat.

These and other public health examples of threatening and angry demonstrations are part of a much broader undercurrent displaying an emerging trend in the country.  In this week Monday’s Hartford Courant, front page, Clare Feldman said, “the level of vitriol and anger and frustration has risen over the last few years,”  Clare is chair of the Board of Trustees of the Hartford Seminary, and was announcing a change in its name and logo to reflect their emphasis on peacebuilding, interreligious dialogue, and conflict resolution.

Anne Appelbaum has frequently written on the challenges to democracy in America.  In an article in the recent Atlantic Magazine, Anne identifies we are behaving like the Puritans: “A growing illiberalism, fueled by social media, is trampling democratic discourse.  The result is ruined lives and a chilling atmosphere in which mob justice has replaced due process and forgiveness is impossible.”  This is an interesting perspective.

Anne Applebaum  The New Puritans   https://www.theatlantic.com/magazine/archive/2021/10/new-puritans-mob-justice-canceled/619818/

370. Anthony Fauci, MD, identifies the best way to protect unvaccinated children.

         Q:  How can I protect my 11-year-old sixth-grader who cannot yet be vaccinated?

         AUnder intense criticism for the delay in approving vaccines for children under age 12 before school reopened, Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, concisely and accurately identified the best way to protect everyone from the highly infectious Covid-19 currently sweeping the country: “surround them to the extent possible with people who are vaccinated.”  This includes in the school, all teachers, staff, and children over age 13, and at home, all siblings over age 12, parents, and others living in the same abode.

 

Frequently Asked Questions about COVID-19 — September 15, 2021

  “Shared expectations lead to predictability.”

361. A Perspective: Managing Covid-19 from the Far-right Perspective – in Idaho

         Q:  How are Republican states doing managing this pandemic? 

         A:   Some Republican governors are supportive of science and have endorsed proven mitigation strategies.  But several other states have adopted an antagonistic approach to public health measures.  A case in point would be Idaho. State House minority leader, Iliane Rubel stated last week the House speaker Scott Bedke was planning to call a special session of the legislature to pass a bill banning Biden’s mandate for health care workers to become vaccinated.  Idaho hospitals have been overwhelmed with new critically ill Covid patients.  Most of these are unvaccinated. The Idaho Department of Health and Welfare quietly moved last Monday to activate the “crisis standards of care” for hospitals in the northern parts of the state.  This will begin the rationing of care.  Selecting those seriously ill patients who have the greatest benefit with survival to be admitted to the hospital, sending the others back home to receive “comfort care.”  This is the care given to hospice patients – not treating the disease but simply making the patient pain-free and comfortable.  One of the considerations for deciding which patient would benefit from care would be their age.

The Idaho Central Health District includes 4 counties and has a 7-member Health Board.  Ted Epperly, MD for 15 years has served on this board, and has an exemplary record of service, Last June, Ada County commissioner Ryan Davidson fired Dr. Epperly after he promoted using masks to mitigate against Covid.  Several candidates applied for this position including an epidemiologist and an infectious disease physician, Last week, Ryan Cole, MD was appointed to fill this position.  Dr. Cole is an independent pathologist who runs a medical pathology laboratory.   He has no experience with infectious diseases nor with providing patient care.  Dr. Cole has called the Covid vaccines “fake vaccines,” claiming that the current vaccines have killed more than 11,000 people.  He charges that the science used to develop the vaccine “is no longer good science. This is a poisonous attack on our population and it needs to stop now.”  He cites that researchers in April found 3 people died from clots from the J & J vaccine (out of 6.8 million doses administered).  He has referred to vaccines as “clot shots’ and “needle rape.”  He advocates for medications to prevent Covid, especially Ivermectin – the veterinarian de-worming pills that even the manufacturer warns against use by humans and for Covid.

As for the passing a state law prohibiting bans on mandated vaccination, if the hospitals and nursing homes follow that law, they eventually will lose Medicare and Medicare funding and would no longer exist.  Would the absence of these facilities in Idaho then be seen as “acceptable collateral damage?”  Or would such a law be simply ignored instead?  It will be interesting to see how that question will be answered.

362. Early mandates for vaccines show that mandates do succeed.

         Q: Will mandates actually work?

         A:  Since the Pentagon announced last month that active-duty military personnel will soon be required to become vaccinated, the percentage of vaccinated members rose from 76% to 83% – even before the mandate had been issued.  Other groups targeted for mandates have shown many people getting vaccinated before or immediately after the mandates were issued.  Mandates work!

363. It will be hard for businesses to sue to stop OSHA from mandating vaccines.

         Q:  How will the White House, if sued, defend OSHA to mandate workers be vaccinated?

         A:  Depending on how OSHA phrases the regulation requiring vaccinations of employees, the answer could be quite simple.  The requirement to keep the workplace safe could be to require – mandate – every unvaccinated employee to submit a negative COVID test result documentation every week.  Who could argue that the safety of every worker depends on proof that their co-workers won’t infect them with a serious, possibly debilitating, possibly fatal disease?  Any company who retains an employee without a weekly negative test on file could be fined.  The way to remove this weekly testing mandate would be for the employee to get vaccinated.  But the vaccination itself would not be mandatory.

364. The latest “Mu variant” is being studied.

         Q:  Is it true that a new mutation, the Mu variant, evades the current vaccines?

         A:  Officials are constantly on the watch to identify new variants and study them.  One major problem is that any new variant discovered does not immediately disclose how infectious it is, how virulent (or able to cause serious disease) it is.  The latest mutation we are concerned with is the Greek letter “Mu” variant.  It was first identified in the county of Columbia in January.  It has now spread to 42 countries, including the U.S., where it reached its peak in June.  Since then, it has been steadily declining.  In Columbia, however, the Mu variant is responsible for a third of its Covid-19 cases.

There have been more than 11 noteworthy variants to date.  The Mu variant is judged by the World Health Organization as the 12th and labeled it as a “variant of interest.”  This opens up more intensive examination of its characteristics.  Geneticists have identified the Mu had eight different mutations in its spike protein that are also present in other variants, which could lead it to evade immunity from vaccines or prior infections.  But the positive findings to date indicate that the current Delta variant will not be overtaken by this new one, as stated by Tom Wenseleers, evolutionary biologist at the Catholic University of Lenven in Belgium.  Studies yet to be published indicate that the Mu variant may be the most vaccine-resistant of all currently recognized variants.  There are some early indications that this ability to evade vaccines differs by the type of vaccine taken by the infected person.  This variant is becoming relatively less frequent globally except in Columbia.  “Additional evidence on Mu is scarce, similar to Lambda and other regionally prevalent variants,” says Pablo Tsukayama, a microbiologist at Universidad Peruana Cayetano Heredia in Lima Peru.

365. Parents are urged to wait for FDE approval of vaccines for kids under age 12.

         Q:  How can I get my 8-year-old child into a clinical trial to be sure she is vaccinated?

         AClinical trials are now underway, and new participants are not being solicited.  But one must remember that clinical trials are double-blind studies.  This means half the participants are given the investigative drug and the other half a placebo or “sugar pill” with no medication in it.  Neither the patient nor the one giving it knows which pill is which, That’s the “double-blind” part.

Many patients have sought a physician’s prescription for “off label” administration of a vaccine.  This is not advisable, the FDA warns.  Clinical trials are determining the safe dosages for different age levels for each of the vaccines that might be approved.  The purpose of these trials is to identify the most effective dosages for differently aged children, and to discover the risks, if any, to the child’s health.   Parents who want to go off label take the chance of exposing their child to possible risks or to an ineffective dose.

Frequently Asked Questions about COVID-19 — September 8, 2021

  “Shared expectations lead to predictability.”

356. Average hospital cost for a Covid-19 hospitalized patient exceeds $20,000.

         Q:  Does the federal government pay for a Covid-19 patient’s hospital cost? 

         A:   No. Only tests and vaccines are paid for directly with federal funds.  All the rest of the costs including the staffing and program costs for administering these tests and vaccines are not free.  A person’s health insurance covers those costs.  But if a patient now has to be admitted to a hospital, their costs have to be covered by their health insurance if they have such insurance.  Last week, the Hartford Courant published an article based on information shared by the Connecticut Hospital Association.  It was estimated that the unvaccinated patients were by far the largest portion of those admitted to a hospital with Covid-19.  The cost for this group of preventable infections in Connecticut during 2 months for hospital care was estimated to be over $9.2M.  Sarah Kliff, of the New York Times, predicts that in the future, the cost for care will likely cost Americans significantly more.  Earlier, most major health insurers voluntarily waived the costs for Covid-19 treatments.  But with the advent of a significant number of people unwilling to be vaccinated, this is view is changing.  For those with insurance, the expenditures add up, causing the insurers to increase future premium rates for everyone.  Taxpayers have to pay more for Medicare and Medicaid coverage.  For those without insurance, the costs, which can be as much as $20,000 per admission, adds to the family debt requiring long-term financial woes.  If one is unvaccinated and doesn’t have health insurance, getting free shot(s) is a lot less expensive than not being able to afford a reliable used car in the years ahead!

357. The political battle over mandates appears to be growing.

         Q: Why is there such diversity of opinion over how well masks reduce infections?

         A:  Science consistently has proven that masks help reduce airborne infectious diseases,  Whet Moser, a writer/editor for the New York Times, succinctly states that “The fight over masks and vaccines is heating up – especially between president Biden and the governors who hope to defeat him in 2024.”   He goes on the state, “The actions of Republican governors reflect how the views of the party’s base have hardened when it comes to curbing Covid.  Ever-rising death tolls are seen as less politically damaging than imposing coronavirus rules of almost any stripe.”  “Many Republicans are out on an island by themselves,” says Whit Ayres, a veteran G.O.P. pollster.  “It may be a safe political decision for some primary electorates at the moment. But you have to win a general election.”  That’s one view on the political side of the debate.  Science v. politics.  This divide is manifest in many areas.  Climate change.  Abortion rights.  Income disparity.  Voting rights.  Unshared expectations and an unpredictable future.  Take a deep breath!

358. And science continues to bring reason to the foreground – for those listening.

         Q:  So, I hear that masks in school actually increase infections.  Why is this wrong?

         A:  A detailed study completed in May was recently published by the CDC.  It received little public notice at the time.  The study covered more than 90,000 elementary-school students in 169 schools in Georgia between November 16 to December 11 comparing the incidence of Covid-19 cases between schools with certain mitigation measures and those without these measures.  In the findings, the study found “that required mask use among teachers and staff members was 39% in schools that reported one or more strategies to improve classroom ventilation.”  Later, “the CDC recommends …until vaccines are available for students under age 12, universal and correct mask use is a critical prevention strategy.”  This universal use is recommended for teachers, staff, and students.  The press published a series of articles that spoke to the science of this CDC study.  Initially, the comments were based on the lack of a separate analysis on each of the mitigation strategies used in the study.  How relative were ventilation systems different from social distancing different from mask-wearing?  Pure science would indicate that one of these might have a lesser influence and that the reduction of incidence might be due to another.  This quickly expanded by opponents of mandated measures to, “The Science of Masking Kids at School Remains Uncertain,” (New York Magazine, the Intelligencer, article by David Zweig).  Now the debate is turning into proof that mandates just don’t work.

A relevant report has been published that found an unvaccinated elementary teacher in Marin County, California, spread the coronavirus to half of her 24-student class in May and June when in violation of her school district’s rules, she lowered her mask to read aloud.  Twelve of her students, all of whom were wearing masks but under the age of12 and who could not be vaccinated, subsequently contracted the disease.  The Delta variant eventually spread to at least 26 people.  Lisa Santora, MD, deputy health officer at the Marin Health and Human Services studied and filed this report.  “I thought I respected its contagiousness,” she reported of the Delta variant.  But the efficiency of this virus in overtaking the classroom actually “surprised and humbled” her.

359. Questions are raised about “waning immunity” and the value of booster shots.

         Q:  Will getting a third “booster shot” help prevent my getting COVID-9?

         A:  We might remember weeks ago when Pfizer announced it was working to get approval for a third dose of its vaccine to increase its efficiency at preventing serious disease.  At the time, there were no studies indicating the initial vaccines were losing their potency over time.  But then late in July, researchers in Israel reported that many who were vaccinated earlier were now contracting the disease while more recently vaccinated people were not becoming infected.  But in science, “correlation does not prove causation.”

However, that Israeli study lit up headlines worldwide about waning immunity.  In the U.S., these headlines sparked a wide-spread discussion and anxiety about an apparent but not proven increase in outbreak infections.  In turn, this prompted president Biden to announce that Americans should get a booster shot after 8 months delay from receiving their last shot.  But the actual research on immunity decreasing over time is much murkier than the Israeli information implied.  Many scientists feel that a third shot may not be of any value for the expense and time spent to administer these in great numbers.  Initially, the two vaccinated groups compared in Israel – the early group and later group of initial vaccinations, were different in several ways.  The early group was more affluent, did more international travel, and had greater exposure to the Delta variant in foreign countries.  In the U.S., many early vaccinations led to an early feeling of protection before Delta appeared, taking more risks than those who were vaccinated later.  This means that many in this group may be more subject to breakout infections than the more cautious later vaccinees.  Again, the risks of exposure weigh heavier than the length of time the vaccines had been taken.

The following are cited for caution about immediately demanding booster shots:

  • Immunity probably does wane over time, but research is needed to determine to what degree. Those most vulnerable will probably benefit most at first.
  • Currently, booster shots may do little good for most people.
  • A national policy of frequent booster shots has significant financial and other costs.
  • While Americans are focusing on booster shots, other policies could do more to eradicate Covid.
  • As always, we should be open to changing our minds as we get more evidence.

And in spite of president Biden’s enthusiasm, the FDA has not yet authorized any booster shots, and when it does, it may be only for immunocompromised people (people with donated organs, cancer patients, and others who need a more potent dose to reach the immunity levels most of us achieve with the usual one or two doses.)

360. Covid-19 survivors are 35% more likely to have kidney damage than others.

         Q:  Has there been any new findings on long-term problems after surviving Covid-19?

         AA large new research study was conducted by Ziyad Al-Aly, MD, chief of the research and development service at the VA St. Louis Health Care System.  Researchers found a correlation between the severity of early coronavirus infections and lingering kidney damage.  Overall, it was found that as many as 35% of Covid-19 patients were likely to have long-term kidney pathology.  The causative connection between the two is still being studied.   It is assumed that kidneys that regulate and clean the blood, might be especially sensitive to surges in inflammation or immune system activation.  Some suspect that blood-clotting problems often seen in Covid patients might disturb kidney function.  Either way, this large number of Covid-19 patients could lead to a high percentage of patients with lasting kidney problems, which could have a profound impact on our health care system.

Frequently Asked Questions about COVID-19, September 1, 2021

  “Shared expectations lead to predictability.”

351. The Veterinarian drug ivermectin is scandalously used to treat Covid-19

         Q:  Does the FDA-approved pharmaceutical ivermectin work to cure Covid-19? 

         A:   While ivermectin tablets are approved by the FDA, it is not approved for ingestion by humans.  Its effectiveness is to rid large animals (cows and horses) and smaller animals (goats and dogs) of parasites.  An ointment is approved for human external use only to be placed on the scalp to treat for head lice and scabies.  So why are veterinarians having difficulty in receiving supplies of ivermectin?  Why is this drug touted by so many as a cure-all for Covid-19?  Why are poison control centers in many states receiving many calls asking what doses should be taken, or complaining of disquieting side effects after taking this medication?  There are two scandalous stories explaining this current problem.

Surgisphere is an American healthcare analytics company established in 2008 by Sapan Desai . It came under scrutiny in May 2020 after it provided large datasets of information on Covid-19 patients, which were subsequently found to be extremely unreliable.   A study was underway using the Surgisphere questionable database.  This involved ivermectin and another drug, losartan in cancer patients with recent diagnosis of Covid-19.  Questions arose after the study was published by McGill University Health Center in Canada because it was suspected the data used was fraudulent.  Requests for the source data was refused by Surgisphere, and the McGill article was retracted in June 2020.  However, the retracted study continued to be cited by many other researchers in their publications.  The distorted misinformation was spread by Fox News and Facebook that ivermectin is a miracle cure.

Time Magazine ran an article last week about a group called “America’s Frontline Doctors.  (AFLD).  This group has been active on social media, especially Facebook, promoting ivermectin as a “safe and effective treatment” for Covid-19.”  AFLD in the past had been promoting hydroxychloroquine as a miracle cure.  But now the group has set up a scam where people can call in, pay $90.00 for a “consultation,” another fee for a “physician” to “prescribe” ivermectin, then refer the caller to a “pharmacist” who will “fill the prescription” (for a fee sometimes up to $700.00!)  and have it mailed directly to the person willing to pay for all the costs.  Ivermectin is not a prescription drug, and people soon have discovered that they can go to a nearby agricultural supply store and buy it right over the counter – in a tablet form designed to deworm a large animal like a horse or a cow.  AFLD is seen as a leading purveyor of medical disinformation that erodes public confidence and hinders controlling the pandemic.  “They’re the 21 century, digital version of snake-oil salesmen,” says Irwin Redlener, MD, who directs the National Center for Disaster Preparedness at Columbia University.

These scams have led to an awareness that medical research needs sanctions against false data and studies, and for later studies that cite retracted information.  Also, it against the law to charge for medical services and products that are not approved by the FDA

352. FDA’s approval of the Pfizer vaccine is seen as “a huge milestone.”

         Q: What’s the big deal about the FDA approval of the Pfizer vaccine?

         A:  All approved vaccines were authorized by the FDA having been given Emergency Use Authorizations (EUA).  Under an EUA, everyone given their shots have to follow the regimen outlined by that EUA.  For Pfizer, this means 2 shots at least 4 weeks apart.  That’s it. With full approval, a physician can now give a third shot when indicated – 8 or 6 months after the second shot. Vaccine mandates are now allowed, with government, agencies, and businesses being able to require all within their ranks to get vaccinated.  For many who remain hesitant, full approval was a condition on which they have been holding out.  Many more hesitant people can now be expected to become vaccinated.

353. Some Connecticut towns have 80% of their residents vaccinated while other towns have less than 50%; other characteristics have been identified.

         Q:  Are there differences within Connecticut with the percentage of people vaccinated?

         A:  The Hartford Courant last Sunday reported on a forthcoming survey from the non-profit group DataHaven.  This group is also known as the Regional Data Cooperative and is a 501(c)3 nonprofit organization registered as a Public Charity with the State of Connecticut.  It recently completed a comprehensive survey of the vaccination status of state residents.

  • Connecticut ranks third as the most vaccinated state in the U.S.
  • While some towns have 80% of their populations vaccinated, others have less than 50%.
  • Politically, 90% of Democrats are vaccinated compared to 20% of Republicans.
  • An estimated 95% of Asians adults and 85% of white adults are vaccinated, contrasted with 73% of Black adults and 67% of Latino adults.
  • About 90% of people with annual incomes over $100,000 are vaccinated; low-income adults are about 75% vaccinated.
  • About 40% of unvaccinated people are between the ages of 18 and 35, while only 12% are over the age of 65.
  • There is no significant difference between urban residents and those living in more rural communities.

Many organizations are doing outreach to provide valid information to overcome the hesitancy caused by misinformation that social media and others are promoting.  In Waterbury, the Grace Baptist Church uses high school students to serve as vaccine outreach teams.  The number of fully vaccinated people in Connecticut is rising.  At the current rate, it will be early in 2022 before the presumed “herd immunity” will be reached when the pandemic in Connecticut can likely be controlled.

354. Connecticut Anti-vaccine and anti-mask protesters are being more adamant.

         Q:  Shouldn’t people have the freedom to choose if they get vaccinated and wear masks?

         A:  We pointed out previously there is a difference between personal health and public health.  Individuals clearly have the ability to choose whether to receive medical care for themselves.  But in the field of public health, the goal is to protect the public – the community.  For centuries, the community has been given the right to mandate behavior of individuals to protect the population at large.  Adults today who demand they don’t need to be vaccinated against Covid-19, regularly accepted vaccinations as children to be allowed to enter public schools.  Polio has nearly been eradicated because of public health vaccinations.  Smallpox, an often-fatal disfiguring disease has been globally eliminated.  Years of misinformation, governmental inaction allowing individuals to opt-out of required vaccination, have now created a community of people that feel comfortable saying, “No, not me!”   The politicization of vaccines and masks by the Republican Party has turned this group of anti-maskers and anti-vaxxers into aggressive opponents of public health.  Even in Connecticut!  Last Wednesday, in Cheshire, Governor Lamont and public health officials were forced to leave a public meeting when a raucous crowd shouted profanity at the speakers preventing them from explaining the public health measures available for schools to control this pandemic.

“What people need to understand and weigh is, ‘Will this personal choice affect somebody else?’  At that point it’s no longer personal,” stated Ulysses Wu, MD, Hartford Healthcare infectious disease specialist.

355. “More people are testing positive” is confused with “more testing is needed.”

         Q:  What is meant when the news reports that the test positive rate is growing dramatically?

         AA critical data plan for controlling infectious disease is to estimate how many people in a population have the disease and are infecting others.  An accurate estimate is impossible to obtain – this would be to test every person once every day.  The method used by epidemiologists is to test a sample of the population each day and calculate the positive test rate.  And, of course, those that test positive have their contacts traced and are isolated to prevent further expansion of the disease.  If the sample size is too small, it probably will include many people who are showing symptoms that will increase the positive tests in that sample.  This leaves out other infected people that can expand the spread of the disease.  The World Health Organization has set the marker for a more accurate estimate that the number of tests given is adequate at or below a 5% test positive rate.  As of last Sunday, Connecticut’s positive test rate was 4.35%.  This does not mean the percentage of infected people is rising out of control.  It only means that the number of tests given in Connecticut was approaching the WHO level of inadequacy.

In Monday’s Hartford Courant, the headline was, “Homeless shelters say they need more testing.”  It was revealed that in June, the State Health Department started limiting the number of reimbursed tests being offered statewide, and homeless shelters were not able to meet their demand for testing.  As the percent of positive tests rises, the need for more testing increases.

Frequently Asked Questions about COVID-19 — August 25, 2021

  “Shared expectations lead to predictability.”

346. Booster shots for all after 8 months creates a moral dilemma for the U.S.

         Q:  Isn’t the CDC proposal to give everyone booster shots in violation of WHO guidelines? 

         A:   Breakthrough cases of Covid remain extremely rare.  And even more rare are the breakthrough cases that result in serious disease, as many are asymptomatic, and nearly all the rest result in very mild symptoms.  But the extensive news coverage has raised public anxiety and demands for answers.  The CDC recently announced a third booster shot will help those with an immunologic condition (organ transplants, cancer, and other medical impairments) to increase their protection.  Citing studies that show the vaccines currently approved in the US have waning effectiveness after 8 months, the CDC then recently announced plans to provide booster shots to everyone who is already fully vaccinated 8 months after their last shot.

This has created an international outcry.  The U.S. had promised to donate millions of doses to the international COVAX program for worldwide distribution to poorer countries that need them.  The World Health Organization has spoken strongly that the need is for vaccinations to be distributed widely to reduce the chance of new variants emerging. (The Delta variant now ravaging the U.S. first emerged in India.)  The broad booster shots program here to reduce the slight risk of worsening breakout cases is seen as denying the populations of other countries any protection at all.  “We’re planning to hand out extra life jackets to people who already have life jackets while we’re leaving other people to drown without a single life jacket,” Dr. Michael Ryan, executive director of the World Health Organization’s Emergencies Programme, told reporters last Wednesday.  U.S. officials stated they would increase production to meet both needs.  But in reply, it was stated that even then, poor countries will have to wait until 2023 for everyone to be vaccinated.

347. National aid to Mississippi establishes a two-tiered mobile COVID hospital.

         Q: What’s different about the mobile hospital set up in Mississippi??

         A:  The major medical center at the University of Mississippi in Jackson routinely receives medical transfers from multiple hospitals surrounding it.  With the rapidly expanding number of COVID cases caused by the Delta variant and the low vaccination rate in that state, hospital officials were running out of their ability to provide care.  A request was made for a Disaster Medical Assistance Team (“DMAT”) to be sent in.  This program has been in place for many years and provides rapid deployment of medical staff, beds, medical equipment, supplies, and medications to help in disasters.  Recently, FEMA reorganized how these teams will respond to communities overrun with COVID cases.

Few members of the public are aware of the value of monoclonal antibody therapy developed over a year ago.  This is the medication given to then-president Donald Trump when he was flown to Walter Reed National Military Medical Center and caused his rapid recovery.  Monoclonal antibody therapy is for patients who have had symptoms for 10 days or less, and are not hospitalized because their symptoms have become seriously advanced.  Currently, it is administered by infusion – with an IV being given that takes 2 hours to administer.

On arrival, the DMAT team in Mississippi first set up a 20-bed unit in the parking garage which is limited to only giving these preemptive infusions.  As COVID patients arrive in the emergency department, they are triaged or sorted.  Those eligible for monoclonal antibody therapy are sent to this first DMAT unit for their infusions.  Afterward, each patient is sent home with instructions.  The strategy is to intercept the disease progression thus decreasing the need for acute care beds.  It is an outpatient clinic.  The other 30-bed unit set up in another location in the garage is for in-patient, ICU care for more serious cases.  Manufacturers are currently developing a subcutaneous injection that will replace the infusion now used, reducing the logistics and delays for giving this drug locally.

348. CDC has been criticized for creating confusing messages.

         Q:  Why are the CDC instructions so confusing?

         A:  The CDC gives its guidance in detail trying to anticipate how different groups and situations may need alternative strategies.  Roni Caryn Robin, a reporter at The New York Times highlighted in an article that internal communications within the CDC were clearer than the same messages that were released to the public.  She cited an internal communication giving advice on countering the more infectious Delta variant, “Given higher transmissibility and current vaccine coverage, universal masking is essential.”  The advice issued to the public by the CDC advised Americans, vaccinated or not, to wear masks in indoor public settings in areas with substantial or high virus transmission.  By nuance, the CDC allows people to figure out where, when, and why masks are indicated.  Roni Robin reported the conclusion that it would be more effective to state broad conclusions that safely cover everyone, not requiring people to figure if they are to be included or not.  For example, “In all parts of the country, wear a mask in public indoor settings.”

One can only hope that CDC staff reads The New York Times.

349. Canada allows US citizens in, but the US has just extended its ban on Canadians coming here.     

         Q:  When can my daughter who lives in Canada come here to visit?

         A:  For some time, the border between Canada and the U.S. was closed to nonessential travel on both sides.  Family members, as well as tourists on each side of the line, could not cross over because of COVID-19.  Last month, Canadian officials reassessed the risk of infections and set aside the restrictions for U.S. citizens traveling north.  Canada had hoped that this would be reciprocated by the U.S. to allow Canadians to enter the U.S.  But the Department of Homeland Security said in a tweet a week ago Friday that the restrictions on nonessential travel were still needed to minimize the spread of COVID-19 and the delta variant into the U.S.  It extended the ban until at least Sept. 21.  It appears that the determination of risks differs between nations, and this has caused concerns.

350. Of all the variants discovered so far, only 4 have been named “of concern.”

         Q:  What’s the deal with variants?[1]

         AVariants occur when there is a significant change or mutation to a virus’ genetic code over time.  Variants are natural and expected, especially for viruses like COVID that are spreading widely across several distinct geographic locations.  While many different COVID variants have been detected, the WHO has only categorized four as variants of concern: the Alpha, Beta, Gamma, and Delta variants.

Of these four, the Delta variant is the most contagious.  The original strain of COVID had a reproduction number, R0, between two and three, meaning that on average, each person infected with COVID would spread the virus to two to three more people. The CDC estimates that the Delta variant’s R0 is between 5 and 9.

As long as COVID continues to spread throughout the population, we should expect new variants to continue to emerge over time.

[1] The following information in FAQ 350 was provided by Covid Act Now.