Vaccine fatigue and confusion as a signature of a new Covid-19 wave emerges: a public health perspective in the EU

Public health experts warn of vaccine fatigue and confusion over types of shot available as a new Covid-19 wave begins to brew in Europe.

“With lots of people now being boosted and vaccinated and with people having some immunity from an Omicron infection, it’s also a very, very different sort of population landscape for a variant to emerge in,” he said. “All the signs are, I think, the best part of the scenario in terms of not seeing these massive increases in cases.”

WHO data released late on Wednesday showed that cases in the European Union reached 1.5 million last week, up 8% from the prior week, despite a dramatic fall in testing. Globally, case numbers continue to decline.

Because “every major holiday has led to a bump in cases throughout the entire pandemic, it stands to reason that we’re going to see a clear increase in infections, and cases and hospitalizations, unfortunately, over the next few weeks,” he says.

The BQ subvariants of Omicron have risen to dominate transmission in the US. BQ.1 and its offshoot BQ.1.1 are descendants of BA.5; they have five and six key mutations, respectively, in their spike proteins that help them evade immunity created by vaccines and infections. Because of these changes, they’re growing more quickly than BA.5 did.

European and British officials have endorsed the latest boosters only for a select groups of people, including the elderly and those with compromised immune systems. Public health experts said that the “choice” of vaccine as a booster is likely to add to confusion.

“For those who may be less concerned about their risk, the messaging that it is all over coupled with the lack of any major publicity campaign is likely to reduce uptake,” said Martin McKee, professor of European public health at the London School of Hygiene and Tropical Medicine. “So on balance I fear that uptake will be quite a bit lower.”

Penny Ward, visiting professor in pharmaceutical medicine at King’s College London, said: “Another confounder is that quite a high proportion of the population might have also had a Covid episode in recent months.”

During the first nine months of this year, the weekly vaccine doses in the EU were between 3-6 million per week, compared with 1 million and 1.4 million during September, according to the ECDC data.

What are we waiting for in Europe? The U.S. response to the outbreak of COVID-19 and the aging of the immune system

In many places life went back to normal in 2022, as countries stopped using preventive measures. Governments scaled back mandates or ended them altogether. It was possible to travel internationally again.

According to Italy’s Gimbe science foundation, the current government is ill prepared for the autumn-winter season and that a publication on the management of the Pandemic has been blocked.

British officials warned last week of the strain on the National Health Service due to renewed flu and Covid-19 activity.

There hasn’t been a national surge yet. The number of people getting infected, hospitalized and dying from COVID in the U.S. has been gently declining from a fairly high plateau.

The first hint of what could be in store is what’s happening in Europe. The U.K, France and Italy have all seen an increase in the number of infections.

The Center for Infections Research and Policy at the University of Minnesota says that the events of Europe in the past have foretold the future of the United States. The message for us in this country is that we have to be ready for what they will see in Europe.

“We look around the world and see countries such as Germany and France are seeing increases as we speak,” says Lauren Ancel Meyers, director of the UT COVID-19 Modeling Consortium at the University of Texas at Austin. I’m given pause by that. It makes us unsure about what we will expect in the weeks and months ahead.

The experience of the U.S. will not be in line with Europe’s, according to an epidemiologist at the University of North Carolina who helps run the COVID-19 Scenario Modeling Hub.

That’s because it’s not clear whether Europe’s rising cases are related to people’s greater susceptibility to new subvariants they’ve not yet been exposed to. Different countries have different levels of immunity.

But the new variants are particularly devastating for millions of Americans who have weakened immune systems. New research suggests that changes in these variants make them impervious to the last lab-created antibodies available to help treat and prevent severe cases of Covid-19, and the US government has run out of money to incentivize the creation of new ones.

The Covid-19 Winter Resurrection: How Many Americans are Vaccined and How Many People Have gotten a Booster?

“It’s really too early to say something big is happening, but it’s something that we’re keeping an eye on,” says Amy Kirby, national wastewater surveillance program lead at the Centers for Disease Control and Prevention.

Rubin says there is evidence of increased transmission in the northern part of the country. The winter resurgence is beginning.

It’s not clear whether this gang of new variants will continue to run around together, each sharing a piece of the Covid-19 infection pie, or whether one will rise to outcompete the others, as has happened in previous surges.

“We have a lot more immunity in the population than we did last winter,” says Jennifer Nuzzo, who runs the Pandemic Center at the Brown University School of Public Health.

A lot of people have gotten the disease, and that’s due to people having gotten vaccine. Some people have gotten it multiple times. “That builds upmunity in the population and reduces risk of severe illness, which is another benefit,” Nuzzo says.

Another crucial variable that could affect how the impact of a rise of infections is how many people get one of the new bivalent omicron boosters to shore up their waning immunity.

According to the latest data from the CDC, 14.8 million people have gotten an updated bivalent booster six weeks into the campaign promoting it. That’s less than 10% of the population that’s eligible to get one.

The demand for the newest boosters is still low so far. More than 200 million people are eligible, but so far less than 8 million have gotten one of the new boosters.

Those at high risk should understand the value of getting vaccine and making sure they stay up to date on their boosters.

About 14 percent of eligible Americans have gotten an updated Covid-19 booster, and 1 in 5 people in the US are completely unvaccinated according to the CDC.

“Don’t wait. If you wait, you put yourself at risk,” Dr. Anthony Fauci, President Biden’s chief medical adviser and director of the National Institute of Allergy and Infectious Disease, said Friday at an AARP event. “We’re entering the colder months of the late fall and the early winter. We’re all going to congregate with our families and friends for the holidays. It’s great if you’re up to date. If you are not, get vaccinated now.”

Fortunately, most of the precautions you can take will help keep you safe against the flu or the rssv. The winter is still young, and the flu is still being passed around at high levels in many places, which means many people are still ill with flu-like symptoms. More infections may start to surface in the coming days as people return from trips, schools reopen and people get back to work after the holidays.

Routine paediatric vaccinations took a serious hit throughout the first year of the pandemic. In 2020, Mosser and his colleagues estimate that 8 million to 9 million missed doses of routine childhood vaccines were caused by COVID-19. Some parts of Asia saw a big drop in rate, but high-income countries in other areas also experienced slight dips at the start of the epidemic.

Preventing death with antipyretic drugs: a Covid-19 outpatient warning to older adults before the Delta and Omicron surges last year

The study analyzed and extrapolated data from 26.8 million older Americans and others enrolled in a Medicare fee-for-service health plan through the end of 2021. It included data from the Delta and Omicron surges last year.

With this report, we hope that Americans will get updated with their vaccinations and be prepared for the fall and winter.

Becerra said the administration continues to urge people to get the updated Covid-19 boosters now available for ages 12 and up. The US Food and Drug Administration is being requested to authorize updated boosters for children as young as 5 years old.

This is my final newsletter before I leave for a book leave. I’ll be back in late January. I look forward to reading the work of the other Times journalists until then, as they will be writing The Morning.

A lot of deaths are preventable with Paxlovid alone, according to the White House Covid response coordinators. The daily deaths could fall to about 50 a day if every American 50 and over received a course of Paxlovid or a therapy known as monoclonal antibodies, he predicted.

The warning echoes what other experts think will happen in the coming months, while other modelling suggests that infections won’t happen in very long.

The Good News About Vaccines Against New BA.5 and BA.2 Subvariants: Go Get It Before Halloween, And Make Sure You Get It Early

We’re very closely watching three of the subvariants that appear to have a lot more immune escape. Now, the good news about them is while they seem to do a better job of escaping immunity, they are derived from BA.5 or BA.2, its closely related cousin, and the new vaccines we have, which protect you against BA.5 should really continue to work really quite well against these new variants. We do not know all the details. We are studying that right now. There are more reasons for people to get this vaccine.

I’ve been recommending to all my family and friends that they get it before Halloween. I mean, go get it now. And the reason is if you get it before Halloween, you’re going to have a really high degree of protection as you get into Thanksgiving, as you get into the holidays. You have to be careful with this, you can’t time it too tightly. So in general, my recommendation is go get it, go get it soon. And certainly get it before Halloween.

The Accelerated Approval Integrity Act: Implications for Covid-19 vaccines, therapeutics and vaccine-compositeness

“We desperately need to simplify the vaccination schedule,” says Megan Ranney, a physician and public-health specialist at Brown University in Providence, Rhode Island. “If we’re going to sustain our ability to vaccinate the country, we have to move toward a more standardized schedule, from a behavioural-science point of view.” She says that the proposal to single out the vaccine composition for the whole series will alleviate some of the confusion and it will boost vaccine take up. The changes make a lot of sense.

Now, let me be very clear, for some high-risk people — I think about my elderly parents who are in their 80s — they might need a shot more than once a year. They might need one again in the spring. But for a majority of people, we’re at a point where it’s a once-a-year shot, it’s not that inconvenient, not that big a deal, and it’s a great way to protect yourself.

I can understand the argument, on an emotional level, that when it comes to your body and life, you should be able to assume whatever risk you want. There is an argument that in certain situations, such as a deadly disease affecting millions, there should be a lower bar for evidence and more willingness to assume risks. The idea that absolute certainty about a product’s safety or efficacy is not always needed was on display in the F.D.A.’s emergency use authorization for Covid-19 vaccines and therapeutics (which had strong early evidence that they worked well and were safe). Relief can be provided in a crisis, but its use should be exceptional.

The manufacturer is required to keep collecting data about the drug’s safety and effectiveness when it is given accelerated approval by the F.D.A. If the confirmatory data is not convincing, the product may lose its approval. This isn’t always happening. A report by the Department of Health and Human Services’ Office of the Inspector General found that the number of drug applications that have incomplete confirmatory trials has gone up.

The Accelerated Approval Integrity Act was introduced in the House in March and is a step toward addressing these deficiencies. The bill would require drug companies to enter into an agreement with the F.D.A. on how the follow-up studies will be conducted before accelerated approval is granted. It would force more frequent updates from follow up studies, and it would simplify the process for removing ineffective products from the market.

More reforms may be needed, but adding this kind of rigor will go a long way toward making it possible for clinicians, patients and insurers to have more confidence in the system and in the treatments it approves.

The Covid-19 Recombinant Variant: A Scrabble Manifestation of Vaccine Development and Epidemic Predictions

In the United States, these are BQ.1, BQ.1.1, BF.7, BA.4.6, BA.2.75 and BA.2.75.2. In other countries, the recombinant variant XBB has been rising quickly and appears to be fueling a new wave of cases in Singapore. The cases are rising in Europe and the UK.

Dr. Peter Hotez, who co-directs the Center for Vaccine Development at Texas Children’s Hospital, says he thinks of them collectively as the Scrabble variants because they use letters that get high scores in the board game like Q, X and B.

The variant accounted for over 1 in 3 new Covid-19 infections nationwide last week according to estimates from the US Centers for Disease Control and Prevention.

The new branches of the Omicron family tree are related to one another in many ways, but they descend from slightly different branches.

The year of Covid lockdowns was 2020 and the year of vaccines was 2021, it was the year of worldwide reopening. 2023 will be the year of variant prediction. The first Covid variants of concern that were identified—from Alpha in the UK to Beta in South Africa—muddied the picture of where the pandemic would go next. Alpha was superior to Beta in terms of being able to transmit. What would the longer-term pattern of evolution look like?

“What is likely to happen is that we have several co-circulating, semi-dominate lineages going into the winter season,” said Nathan Grubaugh, an associate professor of epidemiology at the Yale School of Public Health.

With convergent evolution, several different lineages can obtain the same transmissibility levels.

Most pathogens, such as the flu andRSV, are mostly affected by this. “Now that the virus has adapted pretty well to human transmission, most of what is circulating has high fitness.”

The Covid-19 Response: The Mix of New Variants is Harder to Evaluate than BA.5, but the Importance of Genetic Drift

Maria Van Kerkhove, the Covid-19 response technical lead for the World Health Organization, said Wednesday that the large mix of new variants was becoming more difficult for WHO to assess because countries were dialing back on their surveillance.

“The projections vary a little, but generally, most people feel somewhere in the middle of November that they’ll wind up being a substantial proportion and have bumped BA.5 off as the dominant variant,” Fauci told CNN.

These are different from the others and are the result of genetic drift. They share portions of their genes with that virus.

“It isn’t that different from BA.5 that it would completely escape the protection that you would get from vaccine” – if people would just get the shot, Fauci said.

The risk of hospitalization for people who got the booster was less than the risk for people who had received two to four doses of the original vaccine. The risk of hospitalization was less if you got two to four doses of the original vaccine and then had your final dose five to seven months later.

Mark Zeller, a project scientist who monitors the variations at the Scripps Research institute, said he expected the wave to be larger than the BA.5 wave. But Zeller says he doesn’t expect this winter’s surge to reach heights of January’s Omicron wave.

The changes in these genes may help them escape the immunity created by vaccines and past infections, which could make them more susceptible to infections.

Crucially, some of the variants also appear to be impervious to the last lab-created antibodies available to ward off severe Covid-19 infections: an antibody treatment called bebtelovimab, which is made by Eli Lilly, and the combination of two long-acting antibodies in Evusheld, a shot made by AstraZeneca that helps keep people who are immunocompromised from getting sick in the first place.

A person with immune function that has been blunted by drugs is in need of antibody therapies. These are people whose bodies don’t respond to vaccines.

White House Covid-19 Response Coordinator Dr. Ashish Jha says the federal government has been spurring the development of new monoclonal antibodies during the pandemic by promising to purchase new therapies after they’re made.

“So even if we got money today, it would take us many months to bring a monoclonal into the marketplace, and we don’t have the money today anyway,” Jha told CNN.

Antibodies are a losing proposition for companies because it takes millions of dollars of investment to make them and because the virus is evolving so fast, they might be effective for only a few months.

Cold War Implications for Immune Systems and Human Immunity: The Case of the Franco-France Omicron Surge and the First Flu Wave

He says current realities require that the government continue to incentivize the production of new therapies, and he expects that the Biden administration will again try to ask Congress to pass more funding to do that.

COVID-19 restrictions mean we are more susceptible to these viruses. The current surge in the Northern Hemisphere raises questions about what will happen in the future.

There could be a flu wave later this winter. That’s what happened in some parts of the Southern Hemisphere’s winter, and it often occurs in the Northern Hemisphere too.

Hensley says that this is because the population “is more immunologically naive than what we would expect in most years”. Children are most likely to get an infectious disease by their second birthday. When your kids are three to four years of age, you are going to have kids who have never seen the movie.

In August 2021, researchers in France came up with a way to describe the reduction in immunity. The term has taken on a life of it’s own on the social networking site. Matthew Miller, an expert on the immune system at a Canadian university, says it’s nonsense that some people take it to mean that a lack of exposure has irrevocably damaged the immune system.

Another open question is how these viruses compete and interfere with one another. Infections with only one virus can lead to a strong immune response that can prevent another from being infections. The Omicron surge began the decline of last year’s first wave of flu. Perhaps Omicron infection provided some short-lived protection against flu. Or maybe the Omicron surge simply convinced people to mask up and keep their distance.

Covid-19 peaks and valleys in the past and now: How likely are we to see more sick people during the next big wave of winter?

According to Pitzer, peaks and valleys might look a lot like they did before the epidemic. She isn’t placing any bets. But she says: “I do expect that this winter is probably going to be the last unusual winter.”

Experts expect that Thanksgiving gatherings will stir up social networks and give new coronavirus subvariants fresh pockets of vulnerable people to infect. The past two years, case and hospitalizations have risen after the holiday.

The associate director of bioinformatics and infectious disease at the genetic testing company said that coronavirus positivity is going up. It is increasing fastest among 18- to 24-year-olds.

Positive test results can be an indication that transmission is on the rise, as more than half of Covid-19 tests return positive results.

More cases are expected, according to Luo. I don’t know if they’re measured in a way that measures cases right now, but I think in general you should see more sick people. I definitely am.”

If people test for Covid-19 at home and don’t report their results, cases may not be picked up as quickly by official counts.

The BQ variant is not known what will happen. We might not see the big waves of winters past though, since there is no resemblance to the original Omicron variant, with its jaw-dropping peak of nearly a million new daily infections.

BQ.1 has dominated transmission in the UK because of its superior performance in terms of cases, hospitalizations and deaths. Something similar happened in France and Germany, notes Michael Osterholm, an infectious disease expert who directs the Center for Infectious Disease Research and Policy at the University of Minnesota.

Bill Hanage, an epidemiologist at the Harvard T.H. Chan School of Public Health, thinks our behavior and our social contacts might be bigger determinants of whether cases will rise this go-round than whatever variant is in the lead.

“It’s probably got a bit more of a fitness advantage, so what we’re seeing is gradual replacement without a massive change in the total number of Covid-19 cases,” he said.

There isn’t a guarantee that BQ.1 and BQ.1.1 will have an impact. They’ve shown marked resistance to the antibodies that are available to protect and treat people who are vulnerable to severe Covid-19 infections. From that standpoint, there’s good reason for people to be cautious if they have weakened immune systems or will be around someone who does.

Scientists at Los Alamos National Labs recently completed a study on what drove the effects of 13 dominant variant of coronavirus as they migrated from one nation to another. The study includes data up to the end of September and was published as a preprint ahead of peer review.

Manifestation of masks in the US: How many other variants are in the mix and what kind of behavior do we need to adopt?

The number of previous cases in a country, the percentage of people who wore masks, average income and the percentage of the population older than 65 ran a distant second, third, fourth and fifth, respectively.

Korber says that how many other variants are in the mix is an important factor when a new variant starts to rise.

Korber said that when Alpha arrived in the US, it was evolving its own variant that was very distinctive and had a competitive edge over what it had to face in England.

But Korber isn’t making any predictions. She says she is not sure what’s going to happen, pointing to Asia as the cause of her uncertainty.

“XBB. 1.5 has a specific variant that makes it easier to spread through the population, and also gives it a slight advantage in this regard,” said Jesse Bloom of the Fred Hutchinson Cancer Center in Seattle.

“To me, it’s a good time, when it’s possible, to wear masks,” she said. Masks protect the wearer as well as others around them. “And get the booster if you’re eligible and it’s the right moment for you,” especially as we gather around the table to feast with our friends and family.

“It’s a time to exercise a little additional caution to prevent that wave that we don’t want to see happening, or at least make it a smaller bump,” Korber said

Do we really need a booster when we’re dealing with the epidemic of childhood Covid-19? A case study from the Association of Immunization Managers

Of course, that is a good deal. It also shows that a twice-boosted 87-year-old is at an increased risk of death from Covid than a unvaccinated 70 year-old. Some real risk is what it is. It’s now clear that the current levels of American deaths are a symptom of the old problem of unvaccinated people in the United States, as if it were ever comfortable to say.

One answer is that as a country, we prefer just to not see those deaths at all, regarding a baseline of several hundred deaths a day as a sort of background noise or morbid but faded wallpaper. We don’t need to understand who is dying or why in part because we don’t want to reckon with the fact that around 300 Americans are now dying from Covid-19 every day, at a rough pace of about 100,000 per year, making it the country’s third leading cause of death. This is normalization at work, but it is also a familiar pattern: We don’t exactly track the ups and downs of cancer or heart disease either.

Hannan of the Association of Immunization Managers says when vaccines first came out, there was a huge effort to go into nursing homes and get everyone vaccinated. She says that doesn’t work because of low demand and lack of infrastructure and because everyone is different when it comes to when they need a booster. “You go there one day and you might vaccinate a handful of people,” she says.

The Food and Drug Administration is trying to better protect the littlest children in the nation, at a time when children hospitals are packed with tots suffering from other respiratory illnesses including the flu.

–Pfizer’s vaccine requires three initial doses for tots under age 5 — and those who haven’t finished that vaccination series will get the original formula for the first two shots and the omicron-targeted version for their third shot.

He said that Pfizer and its partner, BioNTech, will give the FDA data sometime next month to determine whether the tots will need an omicron-targeted booster.

COVID-19 vaccine uptake challenges – a case study of Ugandan ebola victims and its impact on the public and health sector

A lot of researchers are working on evidence-based tools that can help families make informed vaccine decisions, and the process can also be scaled up. Salmon and his colleagues have developed an online tool called Let’s Talk COVID Vaccines, which delivers tailored information based on each user’s concerns. Let’s Talk Shots is expected to launch within a few weeks. The United Nations children’s charity, UNICEF, has been adapting the team’s approach for international use, and Omer says that the team has created a training strategy to help health-care workers to bolster COVID-19 vaccine uptake based on similar principles of targeted messaging. “It’s not just intuition — these are specific techniques derived from motivational interviews, and derived from experiments on how to correct misinformation,” he says.

“Given the emergency of highly transmissible variants and immune-evading variants like Omicron, it is a remarkable success and an extraordinary achievement,” said Galvani, founding director of the Yale Center for Infectious Disease Modeling and Analysis.

About 14% of the US population lives in an area that meets the CDC’s criteria for a “high” Covid-19 community level, including New York City, Los Angeles County and Maricopa County, Arizona – a sharp increase from less than 5% last week but far below levels of prior surges. And at this level, the CDC recommends wearing a mask indoors.

Four weeks ago, I visited Mulago National Referral Hospital, in Kampala, where I used to work. It is the home to one of Uganda’s isolation wings. During my visit, I witnessed some of the challenges the government and health-care workers were faced with to contain the outbreak without vaccines. The Sudan strain of ebola was found in Uganda and killed 56 people, including the capital city, and spread to 9 districts. If it spills into neighbouring countries, it could trigger a regional crisis.

First, the COVID-19 vaccines were preceded by decades of consistent funding in vaccinology. Even though there have been more-recent investments in research on antimicrobial resistance and early-stage antibiotic development, they pale in comparison to the levels.

Seven years ago, I wrote about this problem in a Nature column. Yet despite the COVID-19 wake-up call, this remains one of the biggest chinks in our pandemic-preparedness armour.

These barriers are not unchanging. If we insist on change, it is possible, even if we have learned nothing thus far. Personal experiences with Covid-19 increased Americans commitment to changing structural barriers to equitable care.

Some countries should take the lead. They should ensure that agencies such as the Coalition for Epidemic Preparedness Innovations (CEPI), based in Oslo, and the International AIDS Vaccine Initiative (IAVI), based in New York City, are fully funded to do this work, which will involve close collaboration with government research agencies as well as Gavi, the Vaccine Alliance, and the WHO.

Flu Vaccine Fatigue: Implications for the Future of Public Health Policy and Practice in the U.S., and What Happens when Kids Get Their Flu Shot

The CDC’s data shows that the number of flu vaccines given in pharmacies this season is larger than the number last year, as more adults are choosing to have the flu shot at a pharmacy. It is a sign that there are more opportunities to reach out to a wider group of people who are less likely to have a primary care provider.

“There’s the old saying, ‘familiarity breeds contempt.’ It seems that familiarity breeds a certain nonchalance, but that might be a bit strong.

“The public health message – and I think we did it very effectively – was, you can’t protect yourself against Covid right now, but you can definitely take flu off the table,” said LJ Tan, chief strategy officer for the Immunization Action Coalition and co-chair of the National Adult and Influenza Immunization Summit, nonprofits dedicated to improving vaccination coverage in the US.

“If it were a vaccine like measles, where it is really effective and it’s not repeated, it might be different,” Hackell said. “But we have to compare it to Covid and flu vaccines, where the efficacy is less than dramatic, and when there’s a lot of controversy going on, I think that spills over.”

It seems like there is fatigue, moral injury, and it’s on the part of providers as well. The chair of the American Academy of Pediatrics Committee on Practice and ambulatory medicine said that they aren’t pushing it as hard. “It gets very difficult to keep having these unproductive conversations over and over again. And there’s so much more respiratory illness now that I don’t know that the time is there to have these long discussions when your office is packed with sick kids.”

Source: https://www.cnn.com/2022/12/13/health/flu-vaccine-fatigue/index.html

Vaccines for the Elders: How Should Older Adults Get the Flu and Covid-19 Vaccinations? A Tale of Two Faces

But despite the convenience of getting both shots at once, there’s evidence that linking the two isn’t the best way to boost coverage rates for either.

“We give multiple vaccines to our kids at the same time, but we haven’t typically done that for adults,” said Tan, former liaison to the CDC’s vaccine advisory committee for the American Medical Association.

Trying to persuade people to do something new can add to the hesitancy that’s already become so pervasive and make them less likely to come in at all. Instead, people seem to be much more likely to accept the offer of a flu vaccine at an appointment they scheduled to get a Covid-19 vaccine booster, or vice versa.

The initial concern about the safety, especially for elders, has continued. The vaccines are being tested to see if they’re stable for elders. The government has put a lot of effort into making sure that there is trust and confusion about these vaccines. I read quite a lot of misinformation about the vaccine’s side effects on Chinese social media.”

The message might finally be sticking. At Walgreens locations, co-administration of the flu and Covid-19 vaccine is 70% higher this year than it was last year, according to data shared with CNN.

A Rejoinder to Alexander Fleming’s Precursor’s Warnings on Superbugs and Antimicrobial Subscriptions

He said that the decline that they were seeing four weeks ago is gone. I want us to know that we need to be better than we are right now.

Alexander Fleming warned of this in his 1945 Nobel prize lecture, and in the decades since, his warnings have proved extremely prescient. In 2019, antibiotic-resistant infections were responsible for nearly 1.3 million deaths globally — more than either HIV or malaria. That figure could reach 10 million per year by 2050 unless significant action is taken. Data from the US Centers for Disease Control and Prevention and The Pew Charitable Trusts indicates that COVID-19 has exacerbated the problem for a variety of reasons, including the widespread overuse of antibiotics early in the pandemic.

It was tempting to suppose that a new small-molecule antibiotic could be delivered quickly during a global superbug emergency, but that would be a mistake. There are two key differences that we need to highlight.

There are steps we can take now that will give the world a fighting chance against new superbugs. The broken antibiotic market needs to be fixed, pharmaceutical companies are not sufficiently incentivized to engage in the costly research and development needed to create new antibiotics. Changing the way we pay for these drugs by linking antibiotic revenue to value to public health is key. The bipartisan Pioneering Antimicrobial Subscriptions to End Upsurging Resistance (PASTEUR) Act, introduced to the US Congress, could be one way to do this, by offering sizable, upfront funding commitments to companies that deliver innovative, high-priority antibiotics. The effectiveness of the new drug in fighting antibiotic- resistantbacteria would be the main factor determining the commitments, not the volume of prescriptions. This approach gives companies a steady return on investment by supporting responsible stewardship of new antibiotics necessary to preserve effectiveness. Other countries, such as the United Kingdom, with its ‘Netflix’ model, are doing similar things by paying for new antibiotics on a subscription rather than per use basis.

The White House is preparing to face the return of the Covid-19 flu: Tools, tools and resources for the response coordinators, health officials and the public

Just when you thought it was safe to bring your Aunt Mary for a holiday visit, the flu is rearing its head again, and Covid-19 numbers are creeping up again.

Health officials are emphasizing the availability of the protective measures, tests and treatments that they say will be key to preventing a repeat of the Covid-19 surges of the past two winters.

Older people have been bearing the brunt of the rise in covid-19 hospitalizations. Hospitalization rates are four times higher for seniors than for any other age group.

There was a large spike in cases last winter when there was the rise of the Omicron coronaviruses variant, but the White House does not think that this season needs to be the same.

The White House has tools, infrastructure and know-how to manage this moment, according to the response coordinators.

The Biden administration has been in daily contact with state and local public health leaders, monitoring hospital levels, he said. And the federal government has medical personnel, supplies and other resources ready if states and communities need them.

For a limited time, the government is reopening Covidtests.gov to give Americans more access to free tests. You can order up to four tests at home for your family in the US.

Those 50 and older should be evaluated for treatment if they test positive for Covid-19, according to Jha on CNN on Thursday.

If people would use those tools, we could get through the Covid-19 season.

Free Covid-19 Antigen Testing in the Early 2021s? Comment on “The Rise of the Increasing Community Access To Testing Program” by Dr. Megan Ranney

In Philadelphia, when schoolchildren come back from the winter break, they will be required to wear masks for 10 days as a “proactive measure” to reduce the spread of Covid-19 and other respiratory illnesses, a district spokesperson said.

Editor’s Note: Dr. Megan Ranney is the deputy dean at the School of Public Health at Brown University and a professor of emergency medicine at the university’s Warren Alpert Medical School. Her views are her own in this commentary. Read more opinion on CNN.

It’s true that four tests per family are not a lot. They are an example of a group of wins against Covid-19 that should be celebrated and looked at closely for lessons learned.

The first under-appreciated fact is that frequent, easily accessible antigen testing for all remains a key part of Covid-19 mitigation – and rapid at-home testing for Covid-19 is now available to (almost) all of us. A few days before a holiday party, perform an at- Home test to reduce the risk of unintentional virus spread, if you get sick after being exposed to the virus.

It may be tough to remember now, but it wasn’t until the spring of 2021 that at-home testing even became available to the public. They were difficult to find at that time. Not surprisingly, huge disparities in use were observed in those early months. Minorities, the elderly and low-income people were less likely to use them.

Insurers, including Medicare, reimburse consumers for up to eight tests per month per person. The Increasing Community Access To Testing program provides free community testing at more than 15,000 sites across the United States. According to one government official, more than 50% of tests performed through this program are for uninsured individuals. Programs similar to this have been put in place with food banks, schools, and health centers.

Source: https://www.cnn.com/2022/12/16/opinions/free-covid-19-tests-matter-ranney/index.html

Prescription Delivery of Paxlovid to Those Without The Pharmacy: A New Partnership between Walgreens, Uber Health and DoorDash

Better yet, just last week, a new partnership was announced between Walgreens, Uber Health and DoorDash to facilitate the timely delivery of Paxlovid to those who cannot get to the pharmacy. According to Walgreens, this program can reach 92% of Americans. In combination with existing prescription delivery services from CVS and RiteAid, this newest partnership may reduce the chance that someone sick has to go out and expose others in order to get their Paxlovid prescription. It also provides immense benefit to those who can’t get transportation or child care or are disabled.

There are no FDA-approved tests forInfluenza andRSV due to bureaucracy. Additionally, oseltamivir (commonly known as Tamiflu) is not as effective as Paxlovid, and there are no good treatments for RSV. Moreover, telehealth has already been shown to increase over-prescription – and unnecessary prescription – of some treatments, such as antibiotics; any wider scale test-to-treat program would have to be careful to make sure it doesn’t further worsen overuse of antivirals and antibiotics. It is largely dependent on one’s insurance or ability to pay for other types of healthcare, as opposed to payment for Covid-19 tests and treatment.

We have developments to celebrate the holiday season as well. We have some amazing new tools for reducing disease and severe illness that are available to everyone.

Kates told NPR that it was going to be an uphill battle. “I do think it’s a tough sell just because of where we are on this point in the pandemic.”

China rolled back COVID restrictions in early December, and now scientists estimate that the country could be facing more than 10 million new cases each day. Several teams predict hundreds of thousands of people could die over the next few months.

“There’s no doubt that China is in for a bad couple of months,” says James Wood, an infectious-disease modeller at the University of New South Wales in Sydney, Australia.

“It is never too late to flatten the curve,” says Xi Chen, an economist at Yale University in New Haven, Connecticut, who studies China’s public-health system.

Wood said that it might be too late for China to benefit from fourth doses because of the widespread transmission that has already happened. He isn’t convinced an extra dose will make a big difference to transmission because circulating Omicron variants of the virus shows a strong ability to evade the body’s immune response.

On 13 December, the government announced that people aged 60 and older, and other high-risk groups, should get a fourth dose of vaccine, preferably one based on a different technology from their primary dose. More than 200 million people in China who are older than 60 years old have not received a third dose.

The model forecasts that the total number of deaths could be reduced to around 290,000 between now and April if China brings in certain measures when the death rate passes a certain threshold. These involve reimposing restrictions, high rates of third- and fourth-dose vaccination and high antiviral drug treatment for at-risk groups. Widespread mask use could reduce deaths still further, to around 230,000. Adherence to masking is high in China, and the loosened restrictions have lead to people choosing to restrict their movement. “They will not [let it] rip.”

Both studies agree on the number of deaths and their consequences. The similarity is related to the fact that the herd immunity will only be achieved after a large and difficult to control spread of transmission throughout the country.

The risks of allowing these infections to flourish are clear. Zimbabwe is currently working to contain a huge measles outbreak that claimed the lives of more than 750 children between April and October. A state of emergency is in place in New York because of the resurgence of a disease that was eradicated in the US.

Better data will help to identify places where intervention is needed to prevent immunizations from being too low. O’Brien says that the WHO has been working with member nations to adopt the agency’s district health information system, called DHIS2, which makes it easier to share granular within-country information about vaccine administration and coverage. She notes that most of the children caught with the drugs live below the poverty line in settlements with inadequate housing and basic services, in rural villages and conflict zones. “They’re born outside of a facility, they’ve never gotten a single vaccination, they’re sort of uncounted and unseen,” she says. “It’s really hard to plan to go out and vaccinate children who you don’t even know exist.” One of the goals of the Immunization Agenda 2030 is to reduce the number of zero-dose children by half, which the WHO estimates could save as many as 50 million lives over the next 10 years.

Elsewhere, repeated surges in infection and death are giving way to a constant thrum of loss, as well as debilitation caused by long COVID. A focus on COVID-19 has also affected the fights against AIDS, malaria and tuberculosis. Although precise counts are difficult to obtain, overall death rates in many countries remain higher than before COVID-19 hit.

Concerns about the COVID-19 shots may be fueling hesitancy around other vaccines. But some who study vaccine uptake are already concerned. “It’s going to take time to get data, but I would not be surprised if we see substantial drops in routine vaccines — especially in populations that have really been refusing COVID vaccines,” says Salmon. Some indications of reduced vaccine use among pregnant people in the US are currently being looked into by Omer. And even though these are still preliminary findings, he says “my concern is that this is sort of an iceberg where we’re just beginning to see the tip”.

And the possibility remains that this mistrust will spread globally. There is a globally coordinated, very deep, negative network of people using social networks to spread their beliefs and promote their anti-vaccine agenda said an anthropologist at the London School of Hygiene and Tropical Medicine. In South Africa, Ndwandwe sees such vaccine hesitancy propagating mainly in more affluent communities that have the time and resources to find information — and misinformation — on the Internet. “TikTok is one of the more dangerous platforms that I have seen,” she says. “That’s where a lot of these things are happening.” The conversation is driven by radio broadcasts, religious leaders or posters in poorer communities if they have easy internet access.

There were optimistic proclamations, too. The Prime Minister of the Republic of Danes said that the disease no longer poses a threat to society. In September, US President Joe Biden claimed that the PAIN was over. Tedros Adhanom was the director-general of the World Health Organization and he hopes COVID-19 will end in three years.

Growth rates of circulating variant in genetic data, as well as tests of vaccine properties, are some of the data that teams use when choosing a vaccine. Variation in what different groups have been exposed to is another problem. Some countries may have more preexisting immunity than others, and hence variants that can evade this immunity have more of an advantage. Different strains of flu dominate in different countries and continents.

As the executive director of the Association of Immunization Managers,Claire Hannan helps to run vaccination programs in all 50 states.

Now, the public health approach is changing. For instance, Hannan says, “the CDC is doing an initiative to put a number of single-dose vials in long-term care facilities that have the right storage equipment.” That way, even if one resident of the facility is ready for a booster, staff at the nursing home could get a single dose out of the pharmacy-grade fridge and vaccinate that person on the spot.

With the winter holidays upon us and people gathering with loved ones, Sandra Lindsay says to think about Grandma. Lindsay was the first person in the U.S. to receive a COVID-19 vaccine in December 2020 as a critical care nurse, and now she’s vice president of public health advocacy at Northwell Health in New York. She says that everyone has a responsibility to their loved ones. Stay home if you are sick. Grandma — take her to get vaccinated as a Christmas gift.”

Baur has worked with community health workers who are out in Maryland pounding the pavement, talking to people about vaccination, and it’s slow going. “I don’t think that we or anybody else doing this work has found any particular message or fact or phrase that is kind of really changing hearts and minds,” Baur says.

The mass vaccination system that popped up during the pandemic isn’t how most adults get vaccinated, she points out. So as those systems close down, it may be time to put the focus back on health care providers, like doctors, who can have a relationship with patients and really hear their concerns and answer their questions.

There are many strategies to combat vaccine hesitancy, including focused on misinformation, trust in public health, and politics. “I decided to take an angle that’s a little bit different, which is to look at how to improve the vaccination experience,” says Moore of Immunize.org.

The Autism Society for America has come up with innovative ways to help families and children get vaccinations, which can be distressing for people with the neurological condition. They have some simple, low-cost ideas like putting on headphones, listening to your favorite music, or using a little plastic “shot blocker” to make the shot hurt less.

I recently tried a variation of this when I had my 7-year-old daughter, Noa, get a bivalent booster. There is more of a fear of needles in kids than there is in adults. I bought an over-the-counter lidocaine patch (marketed for back pain) at the drugstore and cut it to fit her bicep. I stuck it on her arm before we left. I drew an outline on the skin so that the immunizer could give her the shot. Noa said she was happy that the shot didn’t hurt, and that she hadn’t cried. She inquired if she could use it on every shot from now on.

A World Wide Crisis on Chinese Vaccines for COVID (Implications for the Effectiveness of Coronavac and Sinopharm)

There’s concern about new variations of COVID emerging in China, but they can emerge anywhere in the world as COVID continues to circulate.

The American media shared a lot of misinformation about the Chinese vaccines. I read both English and Chinese media stories and I see some news stories that have been translated into Chinese. There are new stories in the US questioning the efficacy of these vaccines, even though they have been approved by the World Health Organization.

The Chinese vaccines are not “mRNA vaccines,” like the ones Pfizer and Moderna manufacture. Instead both CoronaVac and Sinopharm use an older, but well-proven, technology: they contain an inactivated – or killed – form of the SARS-CoV-2 virus.

Cowling says there’s good level of protection for three doses of either vaccine. And remember, health experts in the U.S. also recommend people over age 60 receive at least three doses of the Pfizer or Moderna vaccine as well.

Cowling thinks the misinformation may be related to looking at the effectiveness of the vaccine against an infectious disease.

After three to four months after the inoculation, all vaccines ended up being useless against infections, thanks to the emergence of the immune-evading variant, delta and omicron.

Over a hundred countries have been administered Sinopharm and CoronaVac. Half of all shots were made up of them. There have been no reports of severe side effects with these vaccines.

New COVID-19 can sneak around immunity and help keep people sick during the first pandemic winters, says Dr. Shikha Garg

According to Dr. Shikha Garg, a medical epidemiologist, there are some areas where activity is going up or down. “But in most areas, it’s been declining.”

“The current increase in cases that we are seeing really began around the Thanksgiving holiday when people gathered. The infections have accelerated as we went into the larger holiday season like Hanukkah and Christmas.

There’s no evidence the new variant causes people to be sicker than the previous versions. And the immunity that people have from getting infected and vaccinated should protect most from getting really sick. So no one thinks this winter will be anything like the first two horrific pandemic winters. But XBB.1.5 can partially sneak around immunity as easily as anything before it. And it has developed something none of its predecessors had: a mutation that lets it infect cells more easily than the others. That makes this version of COVID-19 even easier to catch.

Source: https://www.npr.org/sections/health-shots/2023/01/06/1147372029/new-covid-omicron-subvariant-spreading-fast-data

COVID-19 Vaccines – Vaccinations and Implications for Health Care in the US, as proposed by the FDA

Avoid crowded, poorly-ventilated parties, restaurants, bars and other places; test before gathering; and put that mask back on in dangerous situations. You should check with your doctor if you get sick.

The FDA is considering updating COVID 19-vaccines once yearly, a similar approach to updating the influenza vaccine. At a meeting of the FDA’s vaccine advisory panel on 26 January, some researchers argued that the plan would help to simplify the country’s complex COVID-19 immunization schedule and might boost uptake as a result.

But administering the jab before the winter surge could avert a rush of hospitalizations, noted Peter Marks, head of the FDA’s Center for Biologics Evaluation and Research in Silver Spring, Maryland. Hospitals in the US ran out of capacity this season because of people with flu andRSV, which is why clinics are swamped in winter.

Standardizing vaccine composition for the primary and booster series would probably mean that the bivalent vaccine would become the main formulation for people who haven’t yet had a primary series.