Nosocomial Covid-19 Infections

Regrettably, covid-19 among hospital staff is common even after all the precautions with masks, shields and other personal protective equipment. Studies show that front-line health-care workers in the United States have a covid-positive rate that is four times greater than the general population.

Patients are getting infected with covid-19 in the hospital. It happened to one of mine and killed him. — https://www.washingtonpost.com/health/acquiring-covid-19-in-the-hospital/2020/12/31/8cac8b82-3a50-11eb-9276-ae0ca72729be_story.html

Tracking Covid mortality in healthcare workers is imprecise for a number of reasons. Any estimates are likely to be lower than the true number.

More than 2,900 US healthcare workers have died in the Covid-19 pandemic since March, a far higher number than that reported by the government, according to a new analysis by the Guardian and KHN.

Guardian/KHN find nearly 3,000 US health workers died of Covid — https://www.theguardian.com/us-news/2020/dec/23/us-healthcare-worker-deaths-covid-19-pandemic

How the Lives of Older Citizens Changed in 2020

We all know that Baby Boomers and seniors have had an incredibly challenging time during this pandemic. Older generations have shown particular resilience through this time, with many not being able to see friends and family for months. All in the name of rightly protecting their health. With Government and media messaging telling seniors they are the most vulnerable group, their determination to power through this challenge has been apparent across the world.

A representative group of 1,409 Baby Boomers and seniors from the USA and Canada were polled on behalf of Amica Senior Lifestyles, using Amazon’s online survey platform, Mechanical Turk. Survey responses were fielded in September and October 2020. They were asked a variety of questions relating to their lifestyle changes during and after the global pandemic. The age breakdown of our survey sample was as follows: 
55-64 (24.6%)
65-74 (70.8%)
75-84 (3.8%)
85+ (0.9%)
https://www.amica.ca/conversations/baby-boomers-seniors-coronavirus-statistics#lockdown

The source article is fairly long so I’ve provided the Table of Contents clickable links. I hope they work. Technology adaptation is tougher for the older ones. Did you know my smartphone has a CAMERA?

The Pandemic Will Not End Soon – a Case Study in Finger Pointing and Blame Games

Some vaccine experts, though, said they are not surprised by the speed of vaccine distribution so far. “It had to go this way,” Paul Offit, a professor of pediatrics at Children’s Hospital of Philadelphia, told STAT. “We had to trip and fall and stumble and figure this out.”

Claire Hannan, executive director of the Association of Immunization Managers, said some of the gap between doses administered and delivered is likely due to a program run by CVS and Walgreens to vaccinate those in nursing homes. States participating in the program have to set aside 50% of their doses, which Hannan said could account for a share of the difference between doses shipped and doses administered nationally.

“I don’t think it’s bad,” she said of the pace of distribution so far. “I think it was always going to be like this. And I think that this is actually the easy part.”

Frustration over vaccine rollout builds, as new variant reported in U.S. for first time — https://www.statnews.com/2020/12/29/public-health-experts-grow-frustrated-with-pace-of-covid-19-vaccine-rollout/?utm_campaign=rss

We are definitely so screwed.

The Pandemic Will Not End Soon — Over half of U.S. adults ‘unlikely’ to get COVID vaccine under emergency use authorization

The coronavirus vaccine is finally a real thing and millions of people have already received it. While the rollout has the world cheering, researchers from Virginia Commonwealth University finds many Americans aren’t exactly chomping at the bit to be the first in line for the vaccine under an emergency use authorization. Their survey reveals 53.1 percent are definitely, likely, or somewhat unwilling to get the shot under emergency use conditions.

Over half of U.S. adults ‘unlikely’ to get COVID vaccine under emergency use authorization — https://www.studyfinds.org/half-adults-unlikely-to-get-covid-vaccine/

Journal Reference

Willingness to get the COVID-19 vaccine with and without emergency use authorization

Published:November 19, 2020 DOI:https://doi.org/10.1016/j.ajic.2020.11.018

We are so screwed.

New variant does not increase reinfection risk, disease severity, deaths — Science Chronicle

Preliminary results from a cohort study show no statistically significant difference in hospitalisation, 28-day case fatality and reinfection between the new variant and wild-type comparator cases. Preliminary results from a cohort study show no statistically significant difference in hospitalisation and 28-day case fatality between cases with the new variant (VOC 201212/01) and wild-type comparator cases. […]

New variant does not increase reinfection risk, disease severity, deaths — Science Chronicle

Phase 3 trial of Novavax investigational COVID-19 vaccine opens

In animal tests, NVX-CoV2373 vaccination produced antibodies that blocked the coronavirus spike protein from binding to the cell surface receptors targeted by the virus, preventing viral infection. In results(link is external) of a Phase 1 clinical trial published in the New England Journal of Medicine, NVX-CoV2373 was generally well-tolerated and elicited higher levels of antibodies than those seen in blood samples drawn from people who had recovered from clinically significant COVID-19. NVX-CoV2373 also is being evaluated in a Phase 2b trial in South Africa, now fully enrolled with 4,422 volunteers, and data from a Phase 1/2 continuation trial in the United States and Australia is expected as early as first quarter 2021. Novavax also recently completed enrollment of more than 15,000 volunteers in a Phase 3 trial of the candidate vaccine in the United Kingdom, which is also testing two injections of 5 mcg of protein and 50 mcg of Matrix-M adjuvant administered 21 days apart.

Phase 3 trial of Novavax investigational COVID-19 vaccine opens — https://www.nih.gov/news-events/news-releases/phase-3-trial-novavax-investigational-covid-19-vaccine-opens

N501Y mutation in SARS-CoV-2 virus causes increased infectivity, disease severity in mice — Science Chronicle

Chinese researchers found N501Y mutation in a mouse-adapted SARS-CoV-2 virus strain. In the mouse model, the N501Y mutation was found to increase the binding affinity of the virus with the mouse ACE2 receptor. The mutation in the mouse-adapted strain also caused increased virulence. In a preliminary report posted on December 19, Dr. Andrew Rambaut from […]

N501Y mutation in SARS-CoV-2 virus causes increased infectivity, disease severity in mice — Science Chronicle

Interesting article and the last paragraphs must be emphasized.

Dr. Gagandeep Kang, Professor of Microbiology at CMC Vellore, however, cautions that emergence of N501Y mutation has been seen on other occasions. According to her, the N501Y mutation in a strain that has been adapted to infect a mouse model cannot be compared with the N501Y mutation seen in the new variant infecting humans. And the severity of diseases caused by the mutation in the mouse model has no relevance to humans, she says.

“At this time, one can only say the mutation increases binding affinity in humans and hence increased transmissibility. Nothing can be said about disease severity,” says Dr. Kang.  

COVID-19 in the Elderly (case study and literature review)

Summary

Age is a risk factor for increased morbidity and mortality in COVID-19 infections.

Elderly men have increased mortality compared to elderly women.

Elderly patients can present differently. Delirium can be the primary symptom of COVID-19 infection, as can persistent hypoxia.

Consider COVID-19 in the setting of altered mental status and geriatric falls.

Elderly patients in the ED who live in nursing homes should undergo COVID-19 testing.

Elderly individuals with COVID-19 tend to have increased lesions and lobar involvement on chest CT.

Laboratory diagnostics may differ based on age, and the geriatric population may have lymphopenia, higher CRP values, and increased D-dimer on testing.

COVID-19 in the Elderly — http://www.emdocs.net/covid-19-in-the-elderly/?utm_source=feedly&utm_medium=rss&utm_campaign=covid-19-in-the-elderly

The full article takes some time to read but it’s well worth it if you are into the clinical stuff.

Vaccine Distribution SNAFU – Blame it on the Algorithm or “It Looked Good on Paper”

Residents are the lowest-ranking doctors in a hospital. Stanford Medicine has about 1,300 across all disciplines. Only seven made the priority vaccination list, despite the fact that this week, residents were asked to volunteer for ICU coverage in anticipation of a surge in COVID-19 cases.

“Residents are patient-facing, we’re the ones who have been asked to intubate, yet some attendings who have been face-timing us from home are being vaccinated before us,” said Dr. Sarah Johnson, a third-year OB-GYN resident who has delivered babies from COVID-positive patients during the pandemic. “This is the final straw to say, ‘We don’t actually care about you.’”

Only Seven of Stanford’s First 5,000 Vaccines Were Designated for Medical Residents – https://www.propublica.org/article/only-seven-of-stanfords-first-5-000-vaccines-were-designated-for-medical-residents

Stanford Medicine demonstrates how much they care about their residents.

Here’s an interesting breakdown of lessons learned.

In its earliest attempts at explaining the problem, Stanford’s administrators laid blame with the algorithm. Despite best intentions, they explained, the algorithm had made a mistake that the humans had to answer for.

This is a bit like blaming the hammer for missing the nail.

3 lessons from Stanford’s Covid-19 vaccine algorithm debacle — https://www.statnews.com/2020/12/21/stanford-covid19-vaccine-algorithm/

Operation Warp Speed also experienced some hiccups.

“It looked very good on paper,” Perna said. “Paper plans are very good. Execution is where we learn, and we adapted accordingly.”

‘I failed’: Operation Warp Speed leader takes responsibility for Covid-19 vaccine distribution confusion — https://www.statnews.com/2020/12/19/operation-warp-speed-leader-takes-sole-responsibility-for-covid-19-vaccine-distribution-confusion/?utm_campaign=rss

Remember “Everybody has a plan until they get punched in the mouth”