Everyone 16 years of age and older is now eligible to get a COVID-19 vaccination. Get a COVID-19 vaccine as soon as you can. Widespread vaccination is a critical tool to help stop the pandemic.
Johnson & Johnson’s Janssen COVID-19 Vaccine: CDC and FDA have recommended a pause in the use of Johnson & Johnson’s J&J/Janssen COVID-19 Vaccine in the United States out of an abundance of caution, effective Tuesday, April 13. The Advisory Committee on Immunization Practices (ACIP) will hold its second emergency meeting to discuss J&J/Janssen COVID-19 Vaccine on April 23, 2021. People who have received the J&J/Janssen COVID-19 Vaccine within the past three weeks who develop severe headache, abdominal pain, leg pain, or shortness of breath should seek medical care right away. Key Things to Know
COVID-19 vaccines teach our immune systems how to recognize and fight the virus that causes COVID-19. It typically takes two weeks after vaccination for the body to build protection (immunity) against the virus that causes COVID-19. That means it is possible a person could still get COVID-19 before or just after vaccination and then get sick because the vaccine did not have enough time to provide protection. People are considered fully protected two weeks after their second dose of the Pfizer-BioNTech or Moderna COVID-19 vaccine, or two weeks after the single-dose Johnson & Johnson’s Janssen COVID-19 vaccine.
Scientists are still learning how well vaccines prevent you from spreading the virus.
We’re also still learning how long COVID-19 vaccines protect people.
Although COVID-19 vaccines are effective at keeping you from getting sick, scientists are still learning how well vaccines prevent you from spreading the virus that causes COVID-19 to others, even if you do not have symptoms. Early data show the vaccines do help keep people with no symptoms from spreading COVID-19, but we are learning more as more people get vaccinated.
We’re also still learning how long COVID-19 vaccines protect people.
For these reasons, people who have been fully vaccinated against COVID-19 should keep taking precautions in public places, until we know more, like wearing a mask, staying 6 feet apart from others, avoiding crowds and poorly ventilated spaces, and washing your hands often.
You may have side effects after vaccination, but these are normal.
Millions of people in the United States have received COVID-19 vaccines, and these vaccines have undergone the most intensive safety monitoring in U.S. history. This monitoring includes using both established and new safety monitoring systems to make sure that COVID-19 vaccines are safe. These vaccines cannot give you COVID-19. Learn more facts about COVID-19 vaccines.
CDC has developed a new tool, v-safe, to help us quickly find any safety issues with COVID-19 vaccines. V-safe is a smartphone-based, after-vaccination health checker for people who receive COVID-19 vaccines. Learn how the federal government is working to ensure the safety of COVID-19 vaccines.
You may have side effects after vaccination, but these are normal
After COVID-19 vaccination, you may have some side effects. These are normal signs that your body is building protection. The side effects from COVID-19 vaccination, such as chills or tiredness, may affect your ability to do daily activities, and they should go away in a few days. Learn more about what to expect after getting vaccinated.
Availability of Vaccines
What We Know
Vaccines will become widely available, in the coming months.
Although the vaccine supply is currently limited, the federal government is working toward making vaccines widely available for everyone at no cost.
In the coming months, doctors’ offices, retail pharmacies, hospitals, and clinics will offer COVID-19 vaccine. Your doctor’s office or local pharmacy may have contacted you with information about their vaccination plans. Find a COVID-19 vaccine.
Cost of Vaccines
What We Know
The federal government is providing the vaccine free of charge to all people living in the United States, regardless of their immigration or health insurance status.
COVID-19 vaccination providers cannot:
Charge you for the vaccine
Charge you any administration fees, copays, or coinsurance
Deny vaccination to anyone who does not have health insurance coverage, is underinsured, or is out of network
Charge an office visit or other fee to the recipient if the only service provided is a COVID-19 vaccination
Require additional services in order for a person to receive a COVID-19 vaccine; however, additional healthcare services can be provided at the same time and billed as appropriate
COVID-19 vaccination providers can:
Seek appropriate reimbursement from the recipient’s plan or program (e.g., private health insurance, Medicare, Medicaid) for a vaccine administration fee
However, providers cannot charge the vaccine recipient the balance of the bill
Providers may also seek reimbursement for uninsured vaccine recipients from the Health Resources and Services Administration’s COVID-19 Uninsured Program.
What We Know
Population immunity means that enough people in a community are protected from getting a disease because they’ve already had the disease or because they’ve been vaccinated.
Population immunity makes it hard for the disease to spread from person to person. It even protects those who cannot be vaccinated, like newborns or people who are allergic to the vaccine. The percentage of people who need to have protection to achieve population immunity varies by disease.
What We Are Still Learning
We are still learning how many people have to be vaccinated against COVID-19 before most people can be considered protected.
As we know more, CDC will continue to update our recommendations for both vaccinated and unvaccinated people.
What We Are Still Learning
We are still learning how effective the vaccines are against new variants of the virus that causes COVID-19.
Early data show the vaccines may work against some variants but could be less effective against others. We are learning more each day about the characteristics of new variants. CDC will share updates as soon as they are available. Learn more about COVID-19 vaccines and new variants of the virus. hand holding medical light iconFor Healthcare Workers
Clinical Resources: Toolkits and resources for handling, storing and administering the vaccine, including patient education materials.
How can I find a vaccine? To find a COVID-19 vaccine near you:– OR –
In Canada, people have a three-day weekend to look forward to since Sunday is Easter and Good Friday is an official government holiday.
Queue evil leftist government.
However, if you live in Canada and you’re thinking about visiting family or friends outside of the country, even if you want to visit the United States, the head honcho Prime Minister Justin Trudeau, at an insane level, really doesn’t want you to leave the country. And the prime minister is not shy about wanting everyone to know that he is the country’s top tyrant.
On Monday night, Trudeau took to social media to push the idea of canceling any and all plans to travel outside the country for Easter weekend. He suggested that Canadians find other ways to connect with family and friends, maybe virtually touching loved ones for the second Easter in a row will be good for them.
As for any Canadians who would be stupid enough or selfish enough to go against Trudeau’s draconian “suggestions,” he reminded them of just how severe the punishment will be and how unpleasant his government can make you feel under the rules of when the stupid who left Canadian soil try to return home.
“Now is not the time to travel. If you have plans to head somewhere for the long weekend, cancel them. There are other, safer ways for you to connect with your family and friends. For those who need to travel, take note of the measures that are in place when you return to Canada:”
Now is not the time to travel. If you have plans to head somewhere for the long weekend, cancel them. There are other, safer ways for you to connect with your family and friends. For those who need to travel, take note of the measures that are in place when you return to Canada:
According to Narcity, an online media company based in Toronto, Ontario with offices in Montreal, Quebec, the travel rules were established back in January and they create all kinds of obstacles that one must surmount when trying to come home after traveling. In other words, the Trudeau government has made the process the punishment.
The prime minister was only more than happy to remind the great unwashed peasants of the government directives as an incentive to stay put.
“If you’re flying back into the country, you’ll need to show a negative PCR test result before you board the plane. When you land, you’ll need to take another PCR test. You’ll then have to wait at an approved hotel, and at your own expense, for your results to come back.”
Not just any hotel, a “government-approved” one and at your expense.
So, he is telling the people who elected him to office that it’s going to cost them a lot of money just to get back to their homes. And if their PCR tests come back negative then they will be given permission to “head home” and finish up their mandatory two-week quarantine. Isn’t that so nice of them?
Trudeau reminded Canadians that these draconian measures are not optional. If your PCR test comes back positive, you will be remanded to a “designated government facility.”
“If your results come back negative for COVID-19, you’ll be able to head home and finish your mandatory quarantine there. If your test results come back positive, you’ll need to immediately quarantine in designated government facilities. This is not optional.”
If your results come back negative for COVID-19, you’ll be able to head home and finish your mandatory quarantine there. If your test results come back positive, you’ll need to immediately quarantine in designated government facilities. This is not optional.
And if you’re Canadian and you think you’re going to bypass the highly trained border guards and their little dogs by driving a vehicle over the border instead of flying in, then you better think again missy. Travelers in that scenario must show a negative PCR test that was done within 72 hours of arriving at the border before they are even allowed to reenter the country. But then they have to go into a mandatory quarantine and take another test done, showing a negative result before they can leave quarantine.
“If you’re returning through our land border, you’ll need to show a negative PCR test result that was taken within the past 72 hours. On top of that, you’ll have to take a PCR test when you arrive – and you’ll have to take another one toward the end of your 14-day quarantine.”
If you are Canadian and this stuff bothers you, I think this is the time to remind you that your country voted for this. You guys voted Trudeau in as prime minister. It’s like in America in certain cities where the people there cry out that they are being oppressed, but you can’t call it oppression if you keep voting for it and they keep voting for it. Will Canada keep making the same mistake by electing left-wing tyrants?
So, if you came home from abroad and want to start your day again with a double-double and jelly-filled dutchie, you’d better comply and get through your quarantine, because it’s good for you whether you like it or not.
“These border measures are some of the strongest in the world – and they’re in place to keep you, your loved ones, and your community safe. For more information on what you can expect when you return to Canada and how you can get prepared, click here: travel.gc.ca/travel-covid”
These border measures are some of the strongest in the world – and they’re in place to keep you, your loved ones, and your community safe. For more information on what you can expect when you return to Canada and how you can get prepared, click here: https://t.co/7sYIgkMm3U
Southern Californians celebrate at a mass vaccination site in Disneyland’s parking lot in January. CDC head Dr. Rochelle Walensky cautions that for strongest immunity, recipients get both doses of the Pfizer or of the Moderna vaccine. Mario Tama/Getty Imageshide caption
Mario Tama/Getty Images
As the virus that causes COVID-19 continues its global attack, it has done what scientists predicted it would do — it has given rise to new, slightly different strains. How significant some of those strains will be to the pandemic is now under intense study. Meanwhile, demand for the currently available vaccines is outstripping the early supply, and some scientists have sparked controversy by suggesting holding off on booster shots until more people have had their initial shots. That’s something the Centers for Disease Control and Prevention does not endorse — but the agency has extended the timing on the second dose a bit.
What does this all mean for you? Let’s start with the question of second doses.
Why do the manufacturers and CDC advise two doses of the Pfizer and Moderna vaccines?
Simply put, because that’s what was tested — Pfizer BioNTech went for a 21-day interval in its large trial, and Moderna went for 28 days. The companies wanted the highest chance of success; while a one-dose shot would be easier to administer, two-shot vaccinations offered the insurance that if the first shot wasn’t enough, the second one could finish the job. It’s the two-jab immunization that has been shown to be 94% or 95% effective in preventing symptoms of COVID-19.
How protective one dose of these vaccines would be over the long run remains unknown. A Moderna spokesperson toldThe Hill in late December that it expected the double dose would produce the most durable immunity and was not considering a trial of a single dose.
How does my protection build after the first shot and after the second?
The two vaccines currently authorized in the U.S. — Moderna’s and Pfizer’s — are based on helping your immune system recognize certain proteins in the virus’s outer coat. “That stimulates the immune system to make antibodies, and it also stimulates other parts of your immune system,” says Gigi Gronvall, an immunologist with the Johns Hopkins Center for Health Security. Those protective antibodies are relatively easy to measure in blood samples, and studies have shown them increasing in quantity a week or so after someone gets their first dose of vaccine. A week or more after the second dose the level of protective antibodies peaks and then falls off only slightly over four months. How long they last beyond that is under study.
But another part of the immune response — a longer-term response — is much harder to measure. Not much is known yet about when that type of immune protection kicks in or when, if ever, it disappears. Infectious disease specialists think this second part of immunity could prove to be important in providing long-term protection against reinfection. They just don’t have a lot of data on that yet.
What would happen if I stretched the time period between doses? Would that reduce the vaccine’s protection?
While the studies looked at the effect of a strict 21-day interval (for the Pfizer vaccine) before getting the second shot and a 28-day interval for Moderna’s, immunologists say there’s a bit of wiggle room, judging from experience with other vaccines. At a White House press conference last week, new CDC head Dr. Rochelle Walensky said, “We also know that life can get in the way — that some of those doses may be missed. … In these rare circumstances, the second dose may be given up to six weeks or 42 days after the first.”
In an effort to get more people vaccinated, the United Kingdom’s National Health Service is allowing for a 12-week gap between doses for the Pfizer and Moderna vaccines, but the CDC strongly urges not going beyond a six-week interval.
If there’s some immune protection gained after the first dose, why should I bother getting the second jab?
This question greatly concerns vaccine experts. They worry that because the vaccine sometimes causes temporary redness, discomfort or brief fever, some people will not show up for their second dose. Remember that with the Pfizer-BioNTech vaccine, a study published in The New England Journal of Medicine in December found that protection didn’t start until 12 days after the first shot, reaching 52% effectiveness a few weeks later. Participants then got their second shot — so whether that 52% effectiveness would have worn away if they hadn’t got the second dose is unknown. What is known is that a week after the second vaccination, the effectiveness rate hit 95%.
By definition, that means 94 or 95 out of every 100 people fully vaccinated with both doses of these vaccines can be expected to not get sick with COVID-19 symptoms when they run into the most common version of the virus, but it likely takes both doses to reach that level of effectiveness. In early January, the U.S. Food and Drug Administration reiterated that changing course and going to a single dose now — i.e. skipping the second dose — would be “premature and not rooted solidly in the available evidence.” The agency renewed its strong recommendation that the two-dose schedule be followed.
Is it OK if my second dose comes from a different manufacturer?
No one has tested this sort of mixing and matching of the Pfizer and Moderna vaccines. That lack of testing makes virologist John Moore at Weill Cornell Medical College a little unhappy. But, he says, “the two vaccines are sufficiently similar that there’s no reason to doubt that that would still work and be safe.”
The CDC says every effort should be made to get the same vaccine in both jabs, but the agency’s guidance also allows for a switch between the Pfizer and Moderna products “in exceptional situations in which the first-dose vaccine product cannot be determined or is no longer available.” Several vaccines based on different technologies are coming down the line soon; scientists are more hesitant about mixing and matching with those vaccines until tests are done to see how well that works.
I’m hearing about different variants, or strains, popping up. Will the current vaccines protect me from them?
Important new strains of the SARS-CoV-2 virus — the “variants” you’re hearing about — have been identified in the United Kingdom (B.1.1.7), Brazil (P.1) and South Africa (B.1.351), and all three have now been found in the U.S. as well. Those variants are more infectious than the original strain, and researchers in the U.K. have said B.1.1.7 may be more frequently lethal.
Scientists’ concern right now is mostly with the P.1 variant. It has a particularly worrying cluster of mutations that allow the virus to spread more quickly and help it evade the immune system, which might make it easier for people who have already had COVID-19 and have some immunity to, nonetheless, still be vulnerable to reinfection with this new strain.
Early investigations are suggesting the current vaccines, as well as Johnson & Johnson’s candidate vaccine (not yet authorized for use), may be slightly less effective against some of the new variants, in terms of preventing all symptoms. But even against the variants, the vaccines do prevent a lot of mild and moderate cases, the data gathered so far suggest, and are very effective, health officials say, against preventing severe cases, hospitalizations and deaths.
“Viruses cannot mutate if they can’t replicate,” Fauci said Monday at a press conference by the White House’s COVID-19 response team. “If you stop their replication by vaccinating widely … not only are you going to protect individuals from getting disease, but you are going to prevent the emergence of variants.”
Given these new variants, is there anything I can do to improve my chances of avoiding COVID-19?
Sure. Fauci and Walensky, the CDC’s chief, both recommend getting immunized with one of the vaccines authorized in the U.S. as soon as you are eligible — widespread vaccination will very likely help stop the spread of whatever strains of the coronavirus are circulating in your area and lessen the development of new mutations and strains.
I’ve been hearing about new vaccines nearing FDA authorization. What’s coming and should I wait for them?
Don’t wait, all those in the know advise. Take whatever vaccine comes your way when you are eligible. All vaccines authorized for use in the U.S. will be very effective; they are just made via different technologies.
Johnson & Johnson’s single-dose vaccine is a bit of SARS-CoV-2 genetic material hooked onto a harmless virus. It has been tested in the U.S., Brazil and South Africa, and, according to the company’s report of its data, seems to be slightly less effective than the Moderna and Pfizer vaccines in preventing all symptoms of COVID-19, but is highly effective in preventing death and hospitalization from the illness. “When one looks at potential impact on severe disease, it’s 85% percent [effective],” Fauci notes, adding, “There are many people who’d rather have the convenience of a single dose.”
The J&J vaccine also can be transported and kept for long periods of time at refrigerator temperatures — it doesn’t require the deep-freeze storage the Moderna and Pfizer vaccines need. Dr. Paul Stoffels, chief scientific officer at Johnson & Johnson, told NPR last week that his company will apply to the FDA for emergency use authorization in the U.S. this week.
A different candidate vaccine — one from the biotech firm Novavax — is a little further back in completing its clinical testing and consists of a bit of protein from SARS-CoV-2’s outer coat. Last week, the company announced that preliminary evidence from studies in the U.K. indicate the Novavax product is nearly 90% effective, suggesting it can handle the B.1.1.7 variant now prevalent there. But in a separate, smaller part of the study — in South Africa, where 90% of the recorded cases were likely due to the troublesome variant B.1.351 — the effectiveness of the Novavax candidate vaccine in preventing all symptoms was a lower 49%.
Meanwhile, Pfizer and Moderna are both actively working on ways to incorporate added protection against the new variants into their existing vaccines.
That pattern of developing and tweaking existing vaccines as more is learned is actually the usual strategy in stopping the spread of infections, public health officials note.
At a recent NPR/Harvard forum, immunologist Barry Bloom of the Harvard T.H. Chan School of Public Health noted that the history of vaccine manufacture back to smallpox is one that follows continual tinkering and frequent improvements on an initial vaccine before the virus is finally squelched in a big population. “I don’t think the virus is going to win this war,” Bloom says.
How soon might these updated vaccines be available?
Bloom estimates that coming up with a new version of the Pfizer and Moderna products — one that is targeted against problematic variants — would only take about six to eight weeks. After that, of course, it would have to be tested and go through FDA evaluation. Dr. Jesse Goodman, a former FDA chief scientist and now at Georgetown University, notes that the regulatory review could actually go quite quickly if the new vaccines that are developed are essentially the same as the older version, with just a new bit of RNA added. “You might not need the months of placebo-controlled trials” in that case, he says.
Health officials say the process of staying ahead of COVID-19 may eventually prove to be more like what we’re used to seeing with the flu vaccine — where the mix of strains addressed by an annual vaccination is tweaked each year to reflect the predominant strains circulating that season. In that same way, people may eventually be advised to get an annual COVID-19 shot, as well as an annual flu shot.
Should I wait on vaccination until I can get one of those updated shots?
Definitely not. Vaccine experts are clear about the need for us all to get fully immunized as soon as we’re eligible this year. “We need to vaccinate as many people as we can as quickly as we can,” says Fauci. That will help prevent further dangerous mutations and strains from arising.
It seems like the public health advice and what’s known about COVID-19 changes every day. How do I know what’s trustworthy?
It might help to think of COVID-19 science as developing rather than changing — accumulating knowledge can lead to better ways to fight the pandemic. “As science evolves, the application of that new information will too, and there could be changes in the recommendations,” says Dr. Bruce Gellin, president of global vaccination at the Sabin Vaccine Institute. The recent discoveries of variants did not surprise scientists, nor did the slight differences in effectiveness among the new vaccines.
Remember, SARS-CoV-2 is still a very new virus, and more is being learned every day. The CDC’s website is now being updated regularly, so that’s one good place to check for the latest guidance. Or watch this space for updates.
Joanne Silberner, a former health policy correspondent for NPR, is a freelance journalist living in Seattle.
Shark liver oil helps make vaccines more effective, but increased demand for the substance could harm critically endangered species.
By Justin Meneguzzi
PUBLISHED November 13, 2020
Trawling for prey at more than a thousand feet under the surface, the scalloped hammerhead shark relies on a special oil in its liver to survive the crushing pressures of the deep.
Shark liver oil, or squalene, is a fatty substance that provides vital buoyancy for this critically endangered species and many others. But it’s also a lifesaver for humans as a boosting agent in vaccines, called an adjuvant, that improves the immune system and makes vaccines more effective.
One candidate is a vaccine developed in Australia by University of Queensland, in partnership with the Australian biopharmaceutical company CSL and its subsidiary Seqirus. The as yet unnamed vaccine contains the squalene adjuvant MF59, which is sourced from a variety of shark species. It entered human clinical trials earlier this year and, if successful, will result in an initial production of 51 million doses.
Tens of millions of sharks are caught and traded internationally each year—both legally and illegally—the majority for their meat and fins but roughly three million or more for their squalene. It takes the livers of between 2,500 and 3,000 sharks to extract about a ton of squalene.
Conservationists fear that increased demand for squalene for vaccines, among other uses, could further imperil shark species, a third of which are vulnerable to extinction. Today’sPopular StoriesHistory & CultureControversial tunnel under Stonehenge approved over archaeologists’ objectionsScienceIconic radio telescope in Puerto Rico is at risk of collapsingSciencePfizer vaccine results are promising, but lack of data ‘very concerning,’ experts say
Only about one percent of squalene ends up in vaccines, and most goes into cosmetics such as sunscreen, skin creams, and moisturizers. Even so, as the global population booms, the need for vaccines will only increase in coming years, Brendl notes, adding that some medical experts suggest that people will require multiple doses of vaccines against COVID-19.
“We’re not saying that vaccine trials should stop, but if we keep viewing sharks as an easy solution and don’t consider the alternatives that exist, then we’ll just continue to use [squalene] as a template for vaccines,” Brendl says.
In light of declining shark populations, some biotech companies are looking for other sources of squalene. Plants such as sugarcane, olives, amaranth seeds, and rice bran, for instance, all contain the substance. While plant-based alternatives are being tested in studies and clinical trials, regulatory agencies such as the U.S. Food and Drug Administration have yet to approve them as part of a final vaccine product.
‘Livering’—a growing industry
For centuries, people have exploited shark livers for food and energy—liver oil, for example, fueled streetlights across 18th-century Europe. The oil has also long been used in textiles and food coloring, as well as cosmetic products.
Fishermen remove a liver from a shark in Keel Harbour, Ireland, in a historic photo. Photograph by Hulton-Deutsch Collection, CORBIS, Corbis via Getty Images
But it wasn’t until 1997 that Chiron—a former biotech company that’s since been acquired by Novartis—used squalene as an adjuvant in the FLUAD influenza vaccine. Other major pharmaceutical companies, such as GSK and Novartis, began to rely on squalene for their seasonal flu and swine flu vaccines.
While the overwhelming majority of sharks are unintentionally caught by large-scale fisheries pursuing tuna, squid, and salmon, deficiencies in reporting mean it is difficult to disentangle legitimate bycatch from illegal fishing activities. The species of shark being traded is also rarely identified in trade records.
To meet the demand for shark livers, a specialized industry of fishermen, producers, and traders have developed, especially in Indonesia and India. In a process dubbed “livering,” fishermen kill a shark to remove its liver, then throw the rest of the carcass overboard.
In processing centers on land, the livers are minced, boiled, and placed in tanks, where they’re put in a centrifuge to separate the oil from any residue. The oil is then packaged and shipped around the world. One ton of shark liver oil could be worth thousands of dollars, depending on its squalene content. (Learn more about why sharks are overfished for their fins.)
In a 2014 report, the nonprofit WildLifeRisk described a factory in southeastern China that was illegally processing 600 whale sharks—a protected species—and basking sharks a year.
‘Natural white blood cells’
Though all sharks have squalene, fishermen target deep-sea species, which have the biggest livers and thus the highest concentrations of the oil. These sharks are especially vulnerable to overfishing because they mature slowly—some take a decade to begin reproducing.
As a result, nearly half the 60 shark species most wanted for their livers—including the scalloped hammerhead, the longfin mako, and the whale shark—are considered vulnerable to extinction by the International Union for Conservation of Nature (IUCN), the body that sets the conservation status of wild animals and plants.
Many of those species are protected under the Convention on International Trade in Endangered Species of Wild Fauna and Flora (CITES), which restricts or bans fishing of certain marine species such as sharks and rays.
Joanne Cleary,a spokesperson for Seqirus, which uses the squalene adjuvant MF59, told National Geographic that their squalene is sourced from shark species that aren’t protected under CITES. In a follow-up request, Cleary did not say whether Seqirus’ suppliers meet sustainable fishing standards set by the Marine Stewardship Council. (Read how reef sharks are in major decline worldwide.) Sharks 101 Sharks can rouse fear and awe like no other creature in the sea. Find out about the world’s biggest and fastest sharks, how sharks reproduce, and how some species are at risk of extinction.
According to Brendl, of Shark Allies, “just because a fishery avoids protected species doesn’t mean it’s sustainable. Only a handful of species are legally protected, and getting a new one onto protection lists takes years.”
Losing top marine predators, such as the scalloped hammerhead, could be disastrous for the environment, says Austin Gallagher, a National Geographic Explorer and chief scientist at Beneath the Waves, a Virginia-based shark-conservation group.
“Sharks play a crucial role as the natural white blood cells of our oceans,” Gallagher says. “They keep our ecosystems robust by eating other animals that are sick, injured, or not fit to pass on their genes. They’re agents of natural selection in the most poetic way.” (Explore the world of sharks, lords of the sea.)
Purity in question?
Brendl says the onus is on pharmaceutical companies to begin developing viable alternatives to shark squalene to present to regulators. She points out that Novavax, an American vaccine-development company, is already using an alternative squalene adjuvant, Matrix-M, in clinical trials for its experimental COVID-19 vaccine. Matrix-M is made from the bark of the soapbark tree, which is abundant in Chile.
Though the company has deemed the soapbark adjuvant as safe, it has not yet been evaluated as part of a final product submitted to the U.S. Food and Drug Administration.
Cleary, the Seqirus spokesperson, says that “at this stage, [alternative] squalenes have not been approved by regulators for use in vaccines due to the purity levels required.”
However, the Infectious Disease Research Institute found that pharmaceutical-grade squalene produced by the American biotechnology company Amyris met, and in some cases exceeded, the safety and purity profiles of shark-based squalene, according to Chris Paddon, Amyris’s lead scientist.
Amyris is banking on sugarcane as a solution to shark-based squalene, he says. In southeastern Brazil, the company is growing thousands of acres of the bamboo-like sugarcane to be processed into squalene. Just 24 acres of sugarcane could, in theory, produce enough squalene to support one billion COVID-19 vaccines, (Read why vaccines are so crucial to human health.)
Because growers can control the way sugarcane is grown and harvested, it’s possible to ensure the quality of the squalene, Paddon says. “When you use animal products, there are impurities that come with them because of the environment they’re raised in and the places where they’re processed.” Furthermore, Paddon says, growing sugarcane is also cheaper than catching sharks and removing their livers.
Beneath the Waves’ Gallagher adds the pandemic has heightened public scrutiny of the vaccine-development process and exactly what goes into our medicines.
“One of the other significant things that also has come out of this pandemic,” he says, “has been simply shining a light on the greater environmental issue at hand here, which is the significant loss of sharks from our oceans that is happening at a global scale.”ShareTweetEmailCopy
So says the World Doctors Alliance in an Open Letter to World Governments and Citizens of the World.
“We have safe and very effective treatments and preventative treatments for covid, we therefore call for an immediate end to all lockdown measures, social distancing, mask wearing, testing of healthy individuals, track and trace, immunity passports, the vaccination program and so on.”
“It is also abundantly clear that the ‘pandemic’ is basically over and has been since June 2020.”
OPEN LETTER TO ALL THE CITIZENS OF THE WORLD AND ALL THE GOVERNMENTS OF THE WORLD.
Data updated daily.
Last update 29.10.2020
TOTAL SIGNATURES SO FAR: 30,217
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Total pageviews: 580,877
Total unique visitors: 268,151
We were told initially that the premise for lockdown was to ‘flatten the curve’ and therefore protect the NHS from being overwhelmed.
Deaths after flu shots in South Korea fan fears, but authorities find no link. (NO LINK? Are you kidding me?)
SEOUL (Reuters) – Nine people have died after getting flu shots in South Korea in the past week, raising concerns over the vaccine’s safety just as the seasonal inoculation programme is expanded to head off potential COVID-19 complications.
Five new deaths were reported on Wednesday alone, but authorities had no plans to suspend the vaccination programme, unless investigations, including post mortems, revealed a link, which preliminary findings had not.
“We have reviewed whether it is appropriate to continue the vaccination or better to suspend and wait for the results,” health official Kim…
Buddy liked dog stuff: running through the sprinklers, going on long car rides, swimming in the lake. He cuddled the Mahoneys—his owners and family—at the end of tough days. He humored them when they dressed him up as a bunny for Halloween. He was a protective big brother to 10-month-old Duke, the family’s other German shepherd. He loved everyone. He lived up to his name.
In mid-April, right before his seventh birthday, Buddy began struggling to breathe.
Medical records provided by the Mahoneys and reviewed for National Geographic by two veterinarians who were not involved in his treatment indicate that Buddy likely had lymphoma, a type of cancer, which would explain the symptoms he suffered just before his death. The Mahoneys didn’t learn that lymphoma was being considered as the probable cause of his symptoms until the day of his death, they say, when additional bloodwork results confirmed it. It’s unclear whether cancer made him more susceptible to contracting the coronavirus, or if the virus made him ill, or if it was just a case of coincidental timing. Buddy’s family, like thousands of families grappling with the effects of the coronavirus around the world, is left with many questions and few answers.
Until now, Buddy’s identity, the details of his case, and his death were not public. A press release issued by the U.S. Department of Agriculture (USDA) in early June revealed his general location (Staten Island, New York), his breed (German shepherd), his likely source of transmission (a COVID-positive owner), and his status (expected to recover). Public records for the few other pets to have tested positive in the U.S. are similarly sparse.
Upon announcement, Buddy’s milestone case appeared fairly open and shut, but the Mahoneys’ experience over the two and a half months between their dog’s first wheeze and his death was one of confusion and heartbreak. Their story puts a spotlight on the rare experience of being an owner of COVID-positive pet—a distinction shared by only a handful of individuals around the world. While more than four million people have been diagnosed with COVID-19 in the U.S., fewer than 25 pets have. There’s no rubric for how to navigate COVID-19 in your pet dog.
“You tell people that your dog was positive, and they look at you [as if you have] ten heads,” Allison Mahoney says. “[Buddy] was the love of our lives….He brought joy to everybody. I can’t wrap my head around it.” The Mahoneys say they are frustrated that health experts didn’t more closely probe possible connections between COVID and the cascading health problems. After Buddy’s diagnosis, Allison’s husband, Robert, asked New York City veterinary health officials, who were in charge of the case, whether they were interested in doing more testing on Buddy. Robert Mahoney says the officials never asked for further testing or exams.
The narrative for the coronavirus in animals has so far been consistent and narrow: They are rarely affected. When they do get the virus, it’s almost always from an owner. They have mild symptoms. They usually recover. In reality, little is known about how the virus affects the average pet dog.
The New York City Department of Health told National Geographic that because Buddy was severely anemic, it did not want to collect additional blood out of concern for the dog’s health, and that confirmation results indicate it was unlikely that he was still shedding virus—meaning he was probably no longer contagious—by May 20, when he was tested the second time. Buddy wasn’t tested after that date.
For humans, the signs and symptoms of infection vary widely. In some, its presence is barely a flicker. In others, it causes total organ failure. For many, it’s somewhere in between. Having an underlying medical condition increases susceptibility, doctors think. We’re learning more every day.
The narrative for the coronavirus in animals, however, has so far been consistent and narrow: They are rarely affected. When they do get the virus, it’s almost always from an owner. They have mild symptoms. They usually recover.
In reality, little is known about how the virus affects the typical pet dog.
The Mahoneys’ detailed accounts and Buddy’s veterinary records now comprise some of the most comprehensive and granular information the public has on an infected animal. Their story also sheds light on the gaps in public knowledge regarding animals and the novel coronavirus, highlighting what may be a need for a more unified, consistent approach to monitoring and investigating positive cases, and bringing that information back to the research community.
When Buddy, who’d never been sick, developed thick mucus in his nose and started breathing heavily in April, no one except Robert Mahoney believed the dog might have COVID-19. Mahoney himself had been suffering through the virus for three weeks—he was weak, had a scratchy throat, and had lost his sense of taste. “They called me on Easter and said, ‘By the way, here’s your Easter gift: you’re positive,’ ” he recalls.
“Without a shadow of a doubt, I thought [Buddy] was positive” too, he says.
At first, it was difficult to find someone to examine Buddy. His usual vet wasn’t seeing patients because of the pandemic. Another local clinic wouldn’t allow Robert Mahoney to come into the office because he had COVID-19, so they prescribed Buddy antibiotics over the phone. Mahoney says the vet was skeptical that Buddy might have the coronavirus, and the office didn’t have test kits anyway.
The next week, Buddy was still struggling to breathe and had lost his appetite, so the Mahoneys’ 13-year-old daughter, Julianna, who had tested negative, was permitted to bring the dog into the office.
From April 21 to May 15, Buddy continued to lose weight. He became increasingly lethargic. The Mahoneys took him to three different veterinarians on Staten Island, none of whom thought the coronavirus was likely. He got an ultrasound and X-rays, which indicated an enlarged spleen and liver, and he saw a cardiologist, who detected a heart murmur. Buddy spent two and a half weeks on antibiotics and two heart medications, and he was subsequently put on steroids. At this point, Robert Mahoney says, Buddy’s doctors were still doubtful he had the coronavirus, and they had not yet identified lymphoma as a probable cause of his illness.
It was at the third veterinary clinic, Bay Street Animal Hospital, where Mahoney was finally able to have Buddy tested for COVID-19. That was on May 15, one month after Buddy’s breathing trouble began.
A few days later, the clinic called. Buddy’s test results were in: He was positive. Mahoney was told to bring both the family’s dogs to the clinic immediately because health officials needed to confirm Buddy’s results and test Duke, their puppy. When Mahoney arrived at the clinic with the dogs on May 20, he says that “they came greeting me looking like space martians with hazmat suits.”
“For us it was a shock factor for a moment there…how do we protect our staff?” says Robert Cohen, veterinarian at Bay Street who treated Buddy, because little is known about infected dogs’ ability to transfer the virus to other dogs or humans. “We were well-PPE’d,” he says, referring to personal protective equipment such as masks and gloves.
Officials collected samples from Buddy and Duke, then sent them home.
First dog to test positive
On June 2, the New York City Department of Health called Mahoney to tell him that Buddy had indeed contracted the virus. They confirmed that Buddy’s original samples collected on May 15 by his vet were positive for SARS-CoV-2, but the additional samples they collected on May 20 were negative, indicating that the virus was no longer present in the dog’s body, a department spokesperson told National Geographic. Duke had tested negative, but he did have antibodies, indicating he had been infected at some point.
Yet Buddy’s health continued to decline. He soon started urinating uncontrollably and had blood in his urine. Later that month, his breathing became so labored that it sounded “like a freight train,” Allison Mahoney says. In early July, Buddy began to have trouble walking.
Robert Mahoney took him back to the vet each time his health seemed to get worse, which was about every two weeks. He and Allison say they were surprised that no one seemed to consider that the coronavirus—though no longer in his system—may have had lasting effects on Buddy’s health.
“If [health officials] had said, ‘Mahoney family, get in the car and come to [a veterinary lab],’ I would have done it,” says Allison, Nobody even mentioned it.”
Cohen, the veterinarian at Bay Street Animal Clinic, said that his team’s focus was on treating Buddy’s symptoms. “We know that we had a very sick patient,” he says, adding that the clinic was only “peripherally involved in the [SARS-CoV-2] case in a lot of ways.”
He says he had three or four conversations with the New York City Health Department and the USDA about Buddy and whether COVID-19 could be related to any of his health problems. “We had zero knowledge or experience with the scientific basis of COVID in dogs,” he says. Even with all the experts on one call, he says, “there was a lot of silence on the phone. I don’t think anybody knew. I really don’t think anybody knew at that point.”
If [health officials] had said, ‘Mahoney family, get in the car and come to [a veterinary lab],’ I would have done it. But nobody even mentioned it.
Allison Mahoney, Buddy’s owner
On the morning of July 11, Allison found Buddy in the kitchen throwing up clotted blood. “It looked like it was his insides coming out. He had it all over. It was coming from his nose and mouth. We knew there was nothing that could be done for him from there. What are you going to do for a dog with this? But he had the will to live. He didn’t want to go.”
She and her husband rushed Buddy to the vet, and they made the decision to euthanize him. No one asked Robert about a necropsy, he says—only if he wanted to do cremation or a burial. He chose to have Buddy cremated. Although that day was a blur, he says he knows that if he’d been asked about a necropsy to learn more about the virus in his body, “I would have said, ‘Take whatever you need,’ because I don’t want any other dog to suffer like he did.”
After Buddy’s death, Cohen says he asked the New York City Department of Health whether they needed the dog’s body for any follow-up research. The city had to consult with the USDA and other federal partners, Cohen says they told him. By the time the Department of Health got back to him with the decision to do a necropsy, Buddy had been cremated.
On the day Buddy was euthanized, the vet told Robert that new blood work results indicated that he almost certainly had lymphoma, which could explain many of his symptoms.
The Mahoneys say they’re confident the team at Bay Street did their best for Buddy. They acknowledge that these are uncharted waters for everyone. “I think they are learning as well. It’s all trial and error. And they tried to help us the best way they can,” Allison says, although they still wonder whether COVID played a role in Buddy’s fatal illness.
Cohen says he personally relates to the Mahoneys’ confusion and heartbreak because his father died of COVID-19 two weeks ago in a Florida nursing home at age 94.
“I was unable to see him. And I could say exactly the same criticisms [as the Mahoneys] about how his case was handled—the people didn’t act fast enough,” he says. But like the Mahoneys, he acknowledges that “everyone has good intentions,” grappling with the challenges of treating a horrific, widespread, and little-understood disease.
Buddy’s case highlights an important question: Are animals with underlying conditions more likely to get sick from the coronavirus, just as humans are? It also highlights just how little information is available about infected pets.
Most of what’s known about the coronavirus in companion animals comes from research done on dogs and cats in labs, says Elizabeth Lennon, a veterinarian who specializes in internal medicine at the University of Pennsylvania’s School of Veterinary Medicine, who reviewed Buddy’s medical records for National Geographic. The coronavirus in dogs and cats in the real world could look and act differently than in a lab, and that’s what Lennon’s research is trying to discern.
Despite this being her area of study, Buddy’s vet records were the first she’d seen of an infected pet. While writing a funding proposal to study the virus in dogs and cats recently, she says she realized “this is the first time in my life I’ve ever written a grant proposal where I’ve cited more press releases and media reports than actual scientific reports.”
Besides the published research on cats and dogs in labs, scientists also have access to the USDA’s public database of every positive animal case in the U.S., with only basic information. The World Organization of Animal Health maintains a similar database of global cases. The Centers for Disease Control and Prevention (CDC) has an extensive toolkit on its website that includes a regularly updated list of known symptoms in animals, but more specific case data is not currently available to the public or the broader research community.
Twelve dogs and at least 10 cats have tested positive in the U.S. Lennon says few case details have been made available to researchers. “What are their signs? How long did they present? What are the blood work changes?” Lennon asks. (Researchers are scrambling to understand which animals the novel coronavirus—which is believed to have originated in bats—can infect.)
Experts involved in these cases will likely publish the details in scientific journals in the next six to 12 months, she says, but while publication of the scientific research on COVID-19 in humans has generally been fast-tracked, “on the vet side of things, we haven’t seen that acceleration yet.”
Buddy’s case also highlights the need to take a more holistic look at all the known cases of infected pets. There has been “no analysis of all cases as a single unit to determine whether there are risk factors other than living in a house with a positive human,” says Shelley Rankin, chief of clinical microbiology at the University of Pennsylvania School of Veterinary Medicine and a colleague of Lennon’s.
It seems that potentially helpful specific case information isn’t always shared among state veterinarians either. State veterinarians typically take the lead when a pet tests positive, and they report details up to the CDC and USDA. Casey Barton-Bahravesh, director of the CDC’s One Health Office in the National Center for Emerging and Zoonotic Infectious Diseases, says she has a weekly call with state veterinarians to share what the CDC is learning about the virus in animals. It’s not clear, however, whether states are learning enough details of each other’s cases. When National Geographic contacted state veterinarians in the seven states where dogs have tested positive, several said that each state is focused on its own cases and communicating directly with the CDC and USDA.
‘Cart before the horse’
Lennon says that based on research so far, people can feel fairly confident that healthy dogs and cats don’t pose a big risk of infection to humans or each other in most situations. The primary message from the CDC and the World Organization for Animal Health (OIE) is similar: There is no evidence that animals play a significant role in the spread of the virus. Because of that, they do not recommend widespread testing of pets.
If we’re telling the world that prevalence [of animal cases] is low, then we have to look at high [test] numbers.
Shelley Rankin, Chief of clinical microbiology, University of Pennsylvania School of Veterinary Medicine
That doesn’t necessarily make sense to Rankin, who says that broader testing of pets would allow public health experts to say with more confidence that pets aren’t being infected on a broad scale (or playing a significant role in the spread off the virus). “We’ve sort of put the cart before the horse,” she says. “If we’re telling the world that prevalence [of animal cases] is low, then we have to look at high numbers.”
It’s not clear how many animals in the U.S. have been tested. The CDC’s Barton-Bahravesh says her team is working to collect that data, but it’s difficult because reporting of animal testing is not mandatory.
Lennon says more testing would also shed light on whether animals in certain circumstances—such as those with underlying conditions—are more likely to contract the virus or have the virus for longer.
The second dog to test positive in the U.S., in Georgia, and the sixth dog, in South Carolina, have both died, for example, and their deaths were attributed to other conditions. Similar to Buddy’s case, state veterinarian Boyd Parr says that while there was no compelling evidence that the South Carolina dog’s condition made it more susceptible to the virus, there also wasn’t enough data to say that it didn’t.
“Certainly it is likely the underlying condition could weaken the dog’s natural defenses to a lot of things,” he said in an email.
The CDC’s toolkit includes guidance on caring for and treating a positive pet, and safety guidelines for caregivers, but Lennon says it would be helpful to see guidance that specifies what information veterinarians should collect and what tests they perform on a coronavirus-positive animal to build a consistent and complete picture of how the virus affects pets.
There’s also room to create more opportunities for owners of pets with the virus to connect with researchers. In the Mahoneys’ case, they were keen to have Buddy more closely examined but say that they struggled to connect with experts. “It highlights a missed connection for people who are interested in researching this and owners interested in donating samples,” Lennon says.
“My pet was like my son,” Allison Mahoney says. “When he was passing away in front of me, he had blood all over his paws. I cleaned him up before we drove to the vet and stayed with him in the back seat. I said, ‘I will have your voice heard, for all our furry friends. Your voice will be heard, Buddy.’ ”
One of those furry friends is Duke, the Mahoney’s surviving dog. Even though he didn’t get sick, the Mahoneys worry about possible long-term effects of the virus. The puppy has been visibly depressed since Buddy died, the Mahoneys say, and he lies in all of Buddy’s old napping spots.
The Mahoneys hope to pick up Buddy’s ashes this week.
Two German studies, published Tuesday in the peer-reviewed journal JAMA Cardiology, found heart abnormalities in COVID-19 patients months after they had already recovered from the disease caused by SARS-CoV-2.
The first study included 100 patients from the University of Hospital Frankfurt COVID-19 Registry who were relatively healthy adults in their 40s and 50s. About one-third of the patients required hospitalization, while the rest recovered from home.
Researchers looked at cardiac magnetic resonance imaging taken nearly two and a half months after they were diagnosed and compared them with images from people who never had COVID-19. The study found heart abnormalities in 78 patients, with 60 of those patients showing signs of inflammation in the heart muscle from the virus. null
“When this came to our attention, we were struck,” said Dr. Clyde Yancy, chief cardiologist at Northwestern Memorial Hospital and an editor at JAMA Cardiology.
Experts say the prevalence of inflammation is an important connection to COVID-19 as the disease has a clinical reputation for a high inflammatory response. Dr. Thomas Maddox, chair of the American College of Cardiology’s Science and Quality Committee, said heart inflammation could lead to weakening of the heart muscle and, in rare cases, abnormal heart beats.
Yancy said inflammation is the first prerequisite for heart failure and, over a longer period of time, could “leave important residual damage” that could “set up the scenario” for other forms of heart disease. null
“We’re not saying that COVID-19 causes heart failure… but it presents early evidence that there’s potentially injury to the heart,” Yancy said.
Maddox says the study contributes to growing evidence to suggest that heart injury in COVID-19 patients may be a “bystander effect” of the overall inflammatory reaction to the virus instead of direct viral invasion of the heart.
Although the inflammation is indicative of COVID-19, Dr. Paul Cremer, a cardiovascular imager at the Cleveland Clinic, says having imaging before patients were sick could have strengthened the study’s argument that the disease could have caused these heart abnormalities.
The findings come after a Cleveland Clinic study published July 9 in the medical journal JAMA Network Open spotlighted a number of cases of “broken heart syndrome,” or stress cardiomyopathy, doubled during the COVID-19 pandemic. The Bill and Melinda Gates Foundation have invested $350 million to fund treatment and vaccine research to fight coronavirus. USA TODAY
Stress cardiomyopathy occurs in response to physical or emotional distress and causes dysfunction or failure in the heart muscle. Experts say more research is needed to understand the implications of these studies and their long-term effect on the heart.
“We need to understand longer term clinical symptoms and outcome that might occur in patients who’ve had it and recovered,” Maddox said. “That will just take some time to look at as more and more people get the infection and recover.”
Follow Adrianna Rodriguez on Twitter: @AdriannaUSAT.
The body of a suspected covid-19 victim lies in an Indonesian hospital. After the patient died, nurses wrapped the body in layers of plastic and applied disinfectant to prevent the spread of the virus. Photograph by Joshua Irwandi
The image is frightening. A corpse lies stiffly on a hospital bed, wrapped in plastic—a modern mummy. The room is dark, sterile, impersonal. No one sits with the body to mourn the life that was lost.
A suspected victim of COVID-19, the person died in an Indonesian hospital. Nurses, fearful of infection, wound plastic around the body and sprayed it with disinfectant. Now it’s utterly anonymous—physical characteristics shrouded, name and gender unknown, an object waiting to be discarded.
Photojournalist Joshua Irwandi made the image while shadowing Indonesian hospital workers as part of a National Geographic Society grant. The photograph ricocheted through the nation of 270 million people, which has been slow to fight the global pandemic.
“It’s clear that the power of this image has galvanized discussion about coronavirus,” Irwandi said from his home in Indonesia.
But is it enough to change the trajectory of the pandemic in Indonesia, where the Johns Hopkins University Coronavirus Tracker reported 4,665 deaths and 95,418 cases as of July 24—a toll believed to be vastly undercounted?
This sort of question arises every time a photograph seems to distill a current catastrophe. Can an image of death or suffering change public policy or popular sentiment? Even if images from the past have done so, do photographs retain this power in our image-saturated world? And if images can make a difference in the 21st century, what’s taking so long?
On the other side of the world, a photograph by Julia Le Duc provoked such questions a year ago. A young man lies face down in murky water, his child beside him in red pants, dead too, still tucked under his black T-shirt, her arm around his neck as if he were carrying her into the ocean for a refreshing swim. Óscar Alberto Martínez Ramírez, a refugee from El Salvador, drowned trying to cross the Rio Grande into the United States with his daughter Valeria, who was not quite two.
Photographer James Rodriguez, who has documented the aftereffects on Guatemalan families of Donald Trump’s Zero Tolerance policy on immigration, said not long after the photo went viral: “This is beyond what we’ve seen so far. You have a sort of crescendo, so much coverage, so many images. But then comes something like this, that pops. The head inside the T-shirt. You don’t see faces. You don’t see blood.”
“We who work on this issue hope that with the narrative, there is eventually a straw that breaks the camel’s back, to affect public opinion and impact public policy.”
Yet he and others wonder why images of “dead foreigners,” as he put it, appear far more frequently in American media than do images of dead Americans. “With all the gun deaths in the U.S., have you seen a single photo of a child killed?”
To this day he remembers the boy’s first name: Aylan.
Back then, in 2015, predictions were that such a powerful image, photographed by Nilufer Demir, could change opinion about refugees, who were and remain widely distrusted and resented.
Pictures of death or suffering do become iconic, in ways that both hurt and help. Two days after the photos of little Aylan went public, then British Prime Minister David Cameron announced his nation would take in thousands more Syrian refugees.
But other news emerges after photos grab our hearts. The little girl crying in a renowned photo by Getty photographer John Moore, who was documenting family separations at the border, turned out to be just a photo of a little girl crying. Her mother picked her up two minutes afterwards, and all was well.
A year after another image of a Syrian boy became famous—he looked beaten and bloody, forlorn in an orange chair—its subject appeared on the news in Syria in support of the government. He had become a symbol of the government’s terror against its citizens, but now his hair, shaggy and dirty before, was tidy, his face pudgy and smiling. Mohamad Kheir Daqneesh, the boy’s father, criticized Syrian rebels in the TV interview, saying that he feared for his son’s safety after the image received so much publicity. “I changed Omran’s name,” he said. “I changed his haircut, so no one [would] film him or recognize him.”
As I worked on this story, I reported this to a photo editor at National Geographic. “Oh, that’s great news,” he replied. “I think about him every now and again. Good to know he’s ok.”
It has happened before. In 1972, at the height of the Vietnam War, Associated Press photographer Nick Ut, Vietnamese himself and just 19, had just finished photographing a skirmish when a plane sprayed napalm.
In a 2012 interview he replayed the moment: “I saw her left arm burned and the skin peeling off her back. I immediately thought that she was going to die…. She was screaming and screaming, and I thought, ‘Oh my God.’”
His editors debated whether the photo should be sent out. The girl was naked, and they were concerned about offending readers. But one editor insisted, and newspapers around the world published it.
“The next day,” Ut said, “there were anti-war protests all over the world. Japan, London, Paris…. Every day after that, people were protesting in Washington, D.C., outside the White House. ‘Napalm Girl’ was everywhere.”
The girl survived after Ut drove her and other children to a hospital and threatened media exposure if the overwhelmed workers refused to care for them. Now a middle-aged woman, Kim Phuc calls the photographer “Uncle Nick.”
After the 2008 hurricane in Haiti, Miami Herald photographer Patrick Farrell won acclaim for an image of another naked child, this time a boy, pushing a filthy and broken baby stroller, apparently reclaimed from the muddy rubble around him. Again, one boy, leading viewers to wonder about his story, his future, and contrast it with their own.
Farrell, still with the Herald, told me in 2015 that the image was among the first published after the initial Haiti storms. It, along with others, won him a Pulitzer. “They were striking and graphic and painful to look at,” he said, “but they opened people’s eyes, especially in Miami, two hours away by plane. It brought them out of their very comfortable lives.”
More than $4 billion was pledged or donated after the earthquake. Nobody knows what happened to the boy, with whom Farrell never spoke. He believes the image is compelling because “everything is destroyed, but this kid has piled a few things in a stroller and he’s pushing it somewhere. We don’t know where.”
The face of another refugee also captured a crisis and captivated those who saw it. Photographer Steve McCurry’s image of a young Afghan girl at a refugee camp in Pakistan appeared on the cover of the June 1985 issue of National Geographic and remains etched in millions of memories: a girl with tousled hair draped in a rusty red cloth, her eyes huge and fiery with …. what? Fear? Defiance? Determination?
McCurry returned to Pakistan 17 years later to find her, worn and weary. Sharbat Gula had never seen her iconic photo. She had not been photographed since. But her blue-green eyes are recognized and remembered for having cracked open hardened hearts around the world.
Waiting for change
Photographers are inclined to believe that searing images will surely rip others’ hearts so much that they will shred old policies that hurt people so badly. Farrell was certain the image of the drowned Syrian boy would force action on the decades-old refugee crisis.
“People in the States have been breezing through these stories. It’s like a noise you hear but tune out.”
But, so far, Syria remains under siege in every way, its people wounded and dying.
The crisis continues at the U.S.-Mexican border, and in the scrabbling nations south of it.
And in Indonesia, reactions to the image of the COVID-19 victim have been hostile, with the head of the government’s coronavirus taskforce questioning Irwandi’s ethics for taking the photo. In response, the nation’s photojournalism association determined that the photo met journalistic standards,
If powerful photographs can indeed change history these days, history is taking its sweet time.
Susan Ager, a freelance writer based in Michigan, has previously covered the power of photographs for National Geographic.
“Ninety out of 144. That is a failure rate of of 68.75%. We cannot trust ANY of the data.”
– Benjamin Napier
Ninety people who received positive COVID-19 results did not have the virus, according to the Connecticut state Department of Public Health.
The department said the state public health laboratory uncovered a flaw in one of the testing systems it uses to test for SARS-CoV-2, the virus that causes COVID-19, and 90 of 144 people tested between June 15 and July 17 received a false positive COVID test report. Many are nursing home residents.
According to the state Department of Health, the errant testing results were “from a widely-used laboratory testing platform that the state laboratory started using on June 15.”
The VERIFY team breaks down some of the most asked questions about wearing face masks. Author: VERIFY, Jason Puckett (TEGNA), David Tregde Published: 11:26 AM EDT July 21, 2020
The VERIFY team is constantly getting questions from viewers about wearing face masks. Here are some of the most frequently asked.
DO MASKS WORK?
While there is still research being done to determine how effective masks are – experts at the Centers for Disease Control and Prevention, National Institutes of Health, National Institute of Allergy and Infectious Diseases, Mayo Clinic and Johns Hopkins University all say that they serve an important purpose right now. null
The CDC explains that masks aren’t primarily meant to stop the virus from getting to you. They’re meant to stop you or other contagious people from spreading the virus to others.
COVID-19 typically spreads via respiratory droplets, Masks, even those made of cloth, are effective at catching those droplets as people expel them. Since COVID has been shown to be contagious before patients experience symptoms, experts say it’s important to wear a mask before you feel sick.
Do OSHA or other government groups warn against masks?
While some politicians debate the use of masks there are currently no government or medical groups that warn against wearing them.
Can wearing masks cause carbon dioxide poisoning or harm my oxygen levels?
One of the more popular claims against masks says they trap carbon dioxide and cause you to breathe it back in. According to the CDC, that claim is not true.
The CDC explains that carbon dioxide build-up is incredibly rare and only really a concern with sealed respirators and medical-grade devices.
The CDC explained: “Specific to the viral image, it is unlikely that wearing a mask will cause “anoxia,” “asphyxiation,” “hypercapnia,” or “hypercarbia.” While CO2 will slowly build up in the mask over time, any symptoms experienced with low levels of CO2 are resolved upon removal of the mask and breathing room air for a minute. null
Can I use the “Americans With Disabilities Act” to get out of wearing a mask?
Certain viral posts claim that you can cite ADA if you don’t want to wear a mask – there are even printable cards you can carry. But the Department of Justice says these aren’t real and don’t carry legal weight.
It’s also important to note that stores may not be able to force you to wear a mask, but they can legally refuse to serve you if you choose not to wear one.
Picture for illustrative purposes only Image Credit: Pexels
London: British scientists analysing data from a widely-used COVID-19 symptom-tracking app have found there are six distinct types of the disease, each distinguished by a cluster of symptoms.
A King’s College London team found that the six types also correlated with levels of severity of infection, and with the likelihood of a patient needing help with breathing – such as oxygen or ventilator treatment – if they are hospitalised.
The findings could help doctors to predict which COVID-19 patients are most at risk and likely to need hospital care in future waves of the epidemic.
“If you can predict who these people are at Day Five, you have time to give them support and early interventions such as monitoring blood oxygen and sugar levels, and ensuring they are properly hydrated,” said Claire Steves, a doctor who co-led the study.
Besides cough, fever and loss of smell – often highlighted as three key symptoms of COVID-19 – the app data showed others including headaches, muscle pains, fatigue, diarrhoea, confusion, loss of appetite and shortness of breath.
The outcomes also varied significantly; some got mild, flu-like symptoms or a rash and others suffered acute symptoms or died.
The study, released online on June 16 but not peer-reviewed by independent scientists, described the six COVID-19 types as:
1- ‘Flu-like’ with no fever: Headache, loss of smell, muscle pains, cough, sore throat, chest pain, no fever.
2- ‘Flu-like’ with fever: Headache, loss of smell, cough, sore throat, hoarseness, fever, loss of appetite.
3- Gastrointestinal: Headache, loss of smell, loss of appetite, diarrhoea, sore throat, chest pain, no cough.
4- Severe level one, fatigue: Headache, loss of smell, cough, fever, hoarseness, chest pain, fatigue.
5- Severe level two, confusion: Headache, loss of smell, loss of appetite, cough, fever, hoarseness, sore throat, chest pain, fatigue, confusion, muscle pain.
6- Severe level three, abdominal and respiratory: Headache, loss of smell, loss of appetite, cough, fever, hoarseness, sore throat, chest pain, fatigue, confusion, muscle pain, shortness of breath, diarrhoea, abdominal pain.
Patients with level 4,5 and 6 types were more likely to be admitted to hospital and more likely to need respiratory support, the researchers said.
California’s Governor made some tall orders for its citizens as there seems to be no end in sight of the novel coronavirus. As of Monday, California had reported over 320,000 COVID-19 cases with more than 7,000 deaths. Los Angeles County is leading the United States in the number of confirmed cases over 133,000.
Democratic Governor Gavin Newsom announced the mandates during a press briefing Monday that “all bars across the state must close up shop and that restaurants, wineries, tasting rooms, family entertainment centers, zoos, museums, and card rooms must suspend indoor activities” reported Fox News.
Additionally, “all gyms, places of worship, malls, personal care services, barbershops, salons, and non-critical offices in counties on the state’s ‘monitoring list’ had to shut down under the new order. The order affects more than 30 counties which are home to about 80 percent of California’s population.”
At his press conference, Newsom said “we’ve made this point on multiple occasions and that is, we’re moving back into a modification mode of our original stay-at-home order.” He added, “this continues to be a deadly disease.” California imposed a mandatory stay-at-home order in March, the first state to do so.
Newsom’s press briefing came hours after Los Angeles and San Diego school districts announced they will not be reopening for children to attend classes in person for the upcoming school year. New York Governor Andrew Cuomo also held a press briefing Monday with a vaguer plan. Cuomo announced schools can begin in-person learning when they reach “Phase 4” and the infection rate remains at 5 percent or lower over a 14-day average.
California showed optimism in late April when Newsom began allowing certain businesses to reopen “under increasing pressure” Newsom cited the “state’s increased hospital capacity to handle a new surge of cases.” However, “cases began rising in early June and have exploded since, increasing 48 percent in the past two weeks, while hospitalizations have increased 40 percent” reported Fox News.
By Nick Reisman City of Albany PUBLISHED 1:01 PM ET Jun. 23, 2020 PUBLISHED 1:01 PM EDT Jun. 23, 2020
COVID-positive staff unknowingly spread the coronavirus at nursing homes in New York, Gov. Andrew Cuomo said in a TV interview on Tuesday as he continues to face scrutiny for the state’s handling of the virus in long term care facilities and nursing homes.
The virus has led to more than 6,000 confirmed or presumed deaths in nursing homes in New York. Republicans in Congress as well as Democrats at the state level are considering investigations and hearings on the issue.
Cuomo, speaking on MSNBC’s Mornng Joe, pointed to staff who carried the virus into work at nursing homes.
“What all the data says is the reason you had infections in the nursing homes was because the staff brought in the infection,” Cuomo said. “And you look at the communities that had the high infection rate overall, those were communities that had nursing homes with the high infection rate.”
He added, “It is that the staff got infected, they came to work, and they brought in the infection.”
Cuomo has come under fire for a March 25 directive that barred nursing homes from turning away COVID positive patients. He has blamed the policy on the federal government and, in May, barred hospitals from discharging COVID patients to nursing homes.
New York health officials also allowed asymptomatic, but COVID-positive staff to continue working in nursing homes with COVID positive residents. The state reversed that policy on April 29 hours after the policy was first reported.
That policy is a federal CDC guideline which that has agency has kept in place.
Cuomo on Tuesday pointed to the ramped up testing of nursing home staff which initially grew to twice a week and then reduced to once week. Nursing home officials have said the situation in the facilities has stabilized in recent weeks.
“How do you fix that in the future?” Cuomo said. “I don’t know if you can. All you need is one person, an air conditioning repair man, a delivery person and if a virus gets in that nursing home it’s fire through dry grass.”
Coronavirus has been detected in animals, though there has been no confirmation that the disease can be passed to humans from them.
India’s coronavirus death toll passed that of neighbouring China on Friday, with 175 new deaths in 24 hours taking the total to 4,706, according to official data.
India, home to some of the world’s most densely populated cities and a creaking healthcare system, is emerging as a new hotspot with record jumps in new cases in recent days.
In many rural areas, farmers regularly lose crops to monkey populations and have demanded local governments intervene to check their populations.
City authorities in Delhi have used long-tailed langur monkeys to scare away smaller primates from around the Indian parliament.
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A tale of 2 places in the same county: One, preparing to reopen tomorrow in yellow. Another that can't until the county goes green. How business owners are gearing up to bring in customers, even as popular tourist destinations in Hershey stay shut down. @fox43 at 4 and 5! pic.twitter.com/aUnHDNG1Tf
By Scott W. Atlas, John R. Birge, Ralph L Keeney and Alexander Lipton, Opinion Contributors — 05/25/20 08:00 AM EDT 886 The views expressed by contributors are their own and not the view of The Hill 12,263
Our governmental COVID-19 mitigation policy of broad societal lockdown focuses on containing the spread of the disease at all costs, instead of “flattening the curve” and preventing hospital overcrowding. Although well-intentioned, the lockdown was imposed without consideration of its consequences beyond those directly from the pandemic.
The policies have created the greatest global economic disruption in history, with trillions of dollars of lost economic output. These financial losses have been falsely portrayed as purely economic. To the contrary, using numerous National Institutes of Health Public Access publications, Centers for Disease Control and Prevention (CDC) and Bureau of Labor Statistics data, and various actuarial tables, we calculate that these policies will cause devastating non-economic consequences that will total millions of accumulated years of life lost in the United States, far beyond what the virus itself has caused.
Pandemics have afflicted humankind throughout history. They devastated the Roman and Byzantine empires, Medieval Europe, China and India, and they continue to the present day despite medical progress. null
The past century has witnessed three pandemics with at least 100,000 U.S. fatalities: The “Spanish Flu,” 1918-1919, with between 20 million and 50 million fatalities worldwide, including 675,000 in the U.S.; the “Asian Flu,” 1957-1958, with about 1.1 million deaths worldwide, 116,000 of those in the U.S.; and the “Hong Kong Flu,” 1968-1972, with about 1 million people worldwide, including 100,000 in the U.S. So far, the current pandemic has produced almost 100,000 U.S. deaths, but the reaction of a near-complete economic shutdown is unprecedented.
The lost economic output in the U.S. alone is estimated to be 5 percent of GDP, or $1.1 trillion for every month of the economic shutdown. This lost income results in lost lives as the stresses of unemploymentand providing basic needs increase the incidence of suicide, alcohol or drug abuse, and stress-induced illnesses. These effects are particularly severe on the lower-income populace, as they are more likely to lose their jobs, and mortality rates are much higher for lower-income individuals.
Statistically, every $10 million to $24 million lost in U.S. incomes results in one additional death. One portion of this effect is through unemployment, which leads to an average increase in mortality of at least 60 percent. That translates into 7,200 lives lost per month among the 36 million newly unemployed Americans, over 40 percent of whom are not expected to regain their jobs. In addition, many small business owners are near financial collapse, creating lost wealth that results in mortality increases of 50 percent. With an average estimate of one additional lost life per $17 million income loss, that would translate to 65,000 lives lost in the U.S. for each month because of the economic shutdown.
In addition to lives lost because of lost income, lives also are lost due to delayed or foregone health care imposed by the shutdown and the fear it creates among patients. From personal communications with neurosurgery colleagues, about half of their patients have not appeared for treatment of disease which, left untreated, risks brain hemorrhage, paralysis or death.
Here are the examples of missed health care on which we base our calculations: Emergency stroke evaluations are down 40 percent. Of the 650,000 cancer patients receiving chemotherapy in the United States, an estimated half are missing their treatments. Of the 150,000 new cancer cases typically discovered each month in the U.S., most – as elsewhere in the world – are not being diagnosed, and two-thirds to three-fourths of routine cancer screenings are not happening because of shutdown policies and fear among the population. Nearly 85 percent fewer living-donor transplants are occurring now, compared to the same period last year. In addition, more than half of childhood vaccinations are not being performed, setting up the potential of a massive future health disaster.
The implications of treatment delays for situations other than COVID-19 result in 8,000 U.S. deaths per month of the shutdown, or about 120,000 years of remaining life. Missed strokes contribute an additional loss of 100,000 years of life for each month; late cancer diagnoses lose 250,000 years of remaining life for each month; missing living-donor transplants, another 5,000 years of life per month — and, if even 10 percent of vaccinations are not done, the result is an additional 24,000 years of life lost each month.
These unintended consequences of missed health care amount to more than 500,000 lost years of life per month, not including all the other known skipped care.
If we only consider unemployment-related fatalities from the economic shutdown, that would total at least an additional 7,200 lives per month. Assuming these deaths occur proportionally across the ages of current U.S. mortality data, and equally among men and women, this amounts to more than 200,000 lost years of life for each month of the economic shutdown.
In comparison, COVID-19 fatalities have fallen disproportionately on the elderly, particularly in nursing homes, and those with co-morbidities. Based on the expected remaining lifetimes of these COVID-19 patients, and given that 40 percent of deaths are in nursing homes, the disease has been responsible for 800,000 lost years of life so far. Considering only the losses of life from missed health care and unemployment due solely to the lockdown policy, we conservatively estimate that the national lockdown is responsible for at least 700,000 lost years of life every month, or about 1.5 million so far — already far surpassing the COVID-19 total.
Policymakers combatting the effects of COVID-19 must recognize and consider the full impact of their decisions. They need to be aware of the devastating effects in terms of lost life from shutting down significant parts of the economy. The belated acknowledgement by policy leaders of irreparable harms from the lockdown is not nearly enough. They need to emphatically and widely inform the public of these serious consequences and reassure them of their concern for all human life by strongly articulating the rationale for reopening society. https://ebd4fc279229bb5cc4164421271babeb.safeframe.googlesyndication.com/safeframe/1-0-37/html/container.html
To end the loss of life from the economic lockdown, businesses as well as K-12 schools, public transportation, parks and beaches should smartly reopen with enhanced hygiene and science-based protection warnings for any in the high-risk population. For most of the country, that reopening should occur now, without any unnecessary fear-based restrictions, many of which repeat the error of disregarding the evidence. By following a thoughtful analysis that finally recognizes all available actions and their consequences, we can save millions of years of American life.
When the next pandemic inevitably arises, we need to remember these lessons and follow policies that consider the lives of all Americans from the outset.
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More than 600 of the nation’s physicians sent a letter to President Trump this week calling the coronavirus shutdowns a “mass casualty incident” with “exponentially growing negative health consequences” to millions of non COVID patients.
“The downstream health effects…are being massively under-estimated and under-reported. This is an order of magnitude error,” according to the letter initiated by Simone Gold, M.D., an emergency medicine specialist in Los Angeles.
“Suicide hotline phone calls have increased 600%,” the letter said. Other silent casualties: “150,000 Americans per month who would have had new cancer detected through routine screening.”
From missed cancer diagnoses to untreated heart attacks and strokes to increased risks of suicides, “We are alarmed at what appears to be a lack of consideration for the future health of our patients.”
Patients fearful of visiting hospitals and doctors’ offices are dying because COVID-phobia is keeping them from seeking care. One patient died at home of a heart attack rather than go to an emergency room. The number of severe heart attacks being treated in nine U.S hospitals surveyed dropped by nearly 40% since March. Cardiologists are worried “a second wave of deaths” indirectly caused by the virus is likely.
The physicians’ letter focuses on the impact on Americans’ physical and mental health. “The millions of casualties of a continued shutdown will be hiding in plain sight, but they will be called alcoholism, homelessness, suicide, heart attack, stroke, or kidney failure. In youths it will be called financial instability, unemployment, despair, drug addiction, unplanned pregnancies, poverty, and abuse.
“It is impossible to overstate the short, medium, and long-term harm to people’s health with a continued shutdown,” the letter says. “Losing a job is one of life’s most stressful events, and the effect on a person’s health is not lessened because it also has happened to 30 million [now 38 million] other people. Keeping schools and universities closed is incalculably detrimental for children, teenagers, and young adults for decades to come.”
While all 50 states are relaxing lockdowns to some extent, some local officials are threatening to keep stay-at-home orders in place until August. Many schools and universities say they may remain closed for the remainder of 2020.
“Ending the lockdowns are not about Wall Street or disregard for people’s lives; it about saving lives,” said Dr. Marilyn Singleton, a California anesthesiologist and one of the signers of the letter. “We cannot let this disease change the U.S. from a free, energetic society to a society of broken souls dependent on government handouts.” She blogs about the huge damage the virus reaction is doing to the fabric of society.
Dr. Jane Orient, executive director of the Association of American Physicians and Surgeons, also warns that restrictions are having a huge negative impact on non-COVID patients.
“Even patients who do get admitted to hospital, say for a heart problem, are prisoners. No one can be with them. Visitation at a rare single-story hospital was through closed outside window, talking via telephone,” she wrote us. “To get permission to go to the window you have to make an appointment (only one group of two per day!), put on a mask, get your temperature taken, and get a visitor’s badge of the proper color of the day.”
How many cases of COVID-19 are prevented by these practices? “Zero,” Dr. Orient says. But the “ loss of patient morale, loss of oversight of care, especially at night are incalculable.”
Virtually all hospitals halted “elective” procedures to make beds available for what was expected to be a flood of COVID-19 patients. Beds stayed empty, causing harm to patients and resulting in enormous financial distress to hospitals, especially those with limited reserves.
Even states like New York that have had tough lockdowns are starting to allow elective hospital procedures in some regions. But it’s more like turning up a dimmer switch. In Pennsylvania, the chair of the Geisinger Heart Institute, Dr. Alfred Casale, said the opening will be slow while the facility is reconfigured for COVID-19 social distancing and enhanced hygiene.
Will patients come back? COVID-phobia is deathly real.
Patients still are fearful about going to hospitals for heart attacks and even for broken bones and deep lacerations. Despite heroic efforts by physicians to deeply sanitize their offices, millions have cancelled appointments and are missing infusion therapies and even chemotherapy treatments. This deferred care is expected to lead to patients who are sicker when they do come in for care and more deaths from patients not receiving care for stroke, heart attacks, etc.
NPR reported about a Washington state resident who had what she described as the “worst headache of her life.”
She waited almost a week before going to the hospital where doctors discovered she had a brain bleed that had gone untreated. She had multiple strokes and died. “This is something that most of the time we’re able to prevent,” said her neurosurgeon, Dr. Abhineet Chowdhary, director of the Overlake Neuroscience Institute in Bellevue, Wash.
As the number of deaths from the virus begin to decline, we are likely to awaken to this new wave of casualties the 600 physicians are warning about. We should be listening to the doctors, and heed their advice immediately.
Researchers say the new models show how even small differences in timing could have prevented the worst exponential growth of coronavirus cases. Author: TEGNA Published: 5:39 AM EDT May 21, 2020
New modeling shows that if the U.S. adopted coronavirus social distancing measures one week earlier in March, the country could have saved nearly 36,000 additional lives from COVID-19. Researchers say its a sign of how quickly the virus can spread when no measures are in place.
On March 16, President Donald Trump announced guidelines from the White House coronavirus task force aimed at slowing the spread of the virus. He asked Americans to avoid discretionary travel, avoid gathering in large groups and encouraged schools to teach remotely.
Columbia researchers say that had such measures been enacted on March 8, the number of total deaths, as of May 3, could have dropped by nearly 36,000. If the restrictions had gone into effect March 1, the researchers projected that the number of deaths could be 54,000 less, as of May 3.
The team estimated that in New York City alone, the number of coronavirus deaths reported on May 3 could have dropped by nearly 15,000 to just 2,838. The researchers’ findings have yet to be peer-reviewed and were shared online to the preprint site medrxiv.
Superspreading events involving SARS-CoV-2, the virus that causes COVID-19, have been reported.
What is added by this report?
Following a 2.5-hour choir practice attended by 61 persons, including a symptomatic index patient, 32 confirmed and 20 probable secondary COVID-19 cases occurred (attack rate = 53.3% to 86.7%); three patients were hospitalized, and two died. Transmission was likely facilitated by close proximity (within 6 feet) during practice and augmented by the act of singing.
What are the implications for public health practice?
The potential for superspreader events underscores the importance of physical distancing, including avoiding gathering in large groups, to control spread of COVID-19. Enhancing community awareness can encourage symptomatic persons and contacts of ill persons to isolate or self-quarantine to prevent ongoing transmission.
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On March 17, 2020, a member of a Skagit County, Washington, choir informed Skagit County Public Health (SCPH) that several members of the 122-member choir had become ill. Three persons, two from Skagit County and one from another area, had test results positive for SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19). Another 25 persons had compatible symptoms. SCPH obtained the choir’s member list and began an investigation on March 18. Among 61 persons who attended a March 10 choir practice at which one person was known to be symptomatic, 53 cases were identified, including 33 confirmed and 20 probable cases (secondary attack rates of 53.3% among confirmed cases and 86.7% among all cases). Three of the 53 persons who became ill were hospitalized (5.7%), and two died (3.7%). The 2.5-hour singing practice provided several opportunities for droplet and fomite transmission, including members sitting close to one another, sharing snacks, and stacking chairs at the end of the practice. The act of singing, itself, might have contributed to transmission through emission of aerosols, which is affected by loudness of vocalization (1). Certain persons, known as superemitters, who release more aerosol particles during speech than do their peers, might have contributed to this and previously reported COVID-19 superspreading events (2–5). These data demonstrate the high transmissibility of SARS-CoV-2 and the possibility of superemitters contributing to broad transmission in certain unique activities and circumstances. It is recommended that persons avoid face-to-face contact with others, not gather in groups, avoid crowded places, maintain physical distancing of at least 6 feet to reduce transmission, and wear cloth face coverings in public settings where other social distancing measures are difficult to maintain.
Investigation and Findings
The choir, which included 122 members, met for a 2.5-hour practice every Tuesday evening through March 10. On March 15, the choir director e-mailed the group members to inform them that on March 11 or 12 at least six members had developed fever and that two members had been tested for SARS-CoV-2 and were awaiting results. On March 16, test results for three members were positive for SARS-CoV-2 and were reported to two respective local health jurisdictions, without indication of a common source of exposure. On March 17, the choir director sent a second e-mail stating that 24 members reported that they had developed influenza-like symptoms since March 11, and at least one had received test results positive for SARS-CoV-2. The email emphasized the importance of social distancing and awareness of symptoms suggestive of COVID-19. These two emails led many members to self-isolate or quarantine before a delegated member of the choir notified SCPH on March 17.
All 122 members were interviewed by telephone either during initial investigation of the cluster (March 18–20; 115 members) or a follow-up interview (April 7–10; 117); most persons participated in both interviews. Interviews focused on attendance at practices on March 3 and March 10, as well as attendance at any other events with members during March, other potential exposures, and symptoms of COVID-19. SCPH used Council of State and Territorial Epidemiologists case definitions to classify confirmed and probable cases of COVID-19 (6). Persons who did not have symptoms at the initial interview were instructed to quarantine for 14 days from the last practice they had attended. The odds of becoming ill after attending each practice were computed to ascertain the likelihood of a point-source exposure event.
No choir member reported having had symptoms at the March 3 practice. One person at the March 10 practice had cold-like symptoms beginning March 7. This person, who had also attended the March 3 practice, had a positive laboratory result for SARS-CoV-2 by reverse transcription–polymerase chain reaction (RT-PCR) testing.
In total, 78 members attended the March 3 practice, and 61 attended the March 10 practice (Table 1). Overall, 51 (65.4%) of the March 3 practice attendees became ill; all but one of these persons also attended the March 10 practice. Among 60 attendees at the March 10 practice (excluding the patient who became ill March 7, who also attended), 52 (86.7%) choir members subsequently became ill. Some members exclusively attended one practice; among 21 members who only attended March 3, one became ill and was not tested (4.8%), and among three members who only attended March 10, two became ill (66.7%), with one COVID-19 case being laboratory-confirmed.
Because illness onset for 49 (92.5%) patients began during March 11–15 (Figure), a point-source exposure event seemed likely. The median interval from the March 3 practice to symptom onset was 10 days (range = 4–19 days), and from the March 10 practice to symptom onset was 3 days (range = 1–12 days). The odds of becoming ill after the March 3 practice were 17.0 times higher for practice attendees than for those who did not attend (95% confidence interval [CI] = 5.5–52.8), and after the March 10 practice, the odds were 125.7 times greater (95% CI = 31.7–498.9). The clustering of symptom onsets, odds of becoming ill according to practice attendance, and known presence of a symptomatic contagious case at the March 10 practice strongly suggest that date as the more likely point-source exposure event. Therefore, that practice was the focus of the rest of the investigation. Probable cases were defined as persons who attended the March 10 practice and developed clinically compatible COVID-19 symptoms, as defined by Council of State and Territorial Epidemiologists (6). The choir member who was ill beginning March 7 was considered the index patient.
The March 10 choir rehearsal lasted from 6:30 to 9:00 p.m. Several members arrived early to set up chairs in a large multipurpose room. Chairs were arranged in six rows of 20 chairs each, spaced 6–10 inches apart with a center aisle dividing left and right stages. Most choir members sat in their usual rehearsal seats. Sixty-one of the 122 members attended that evening, leaving some members sitting next to empty seats. Attendees practiced together for 40 minutes, then split into two smaller groups for an additional 50-minute practice, with one of the groups moving to a smaller room. At that time, members in the larger room moved to seats next to one another, and members in the smaller room sat next to one another on benches. Attendees then had a 15-minute break, during which cookies and oranges were available at the back of the large room, although many members reported not eating the snacks. The group then reconvened for a final 45-minute session in their original seats. At the end of practice, each member returned their own chair, and in the process congregated around the chair racks. Most attendees left the practice immediately after it concluded. No one reported physical contact between attendees. SCPH assembled a seating chart of the all-choir portion of the March 10 practice (not reported here because of concerns about patient privacy).
Among the 61 choir members who attended the March 10 practice, the median age was 69 years (range = 31–83 years); 84% were women. Median age of those who became ill was 69 years, and 85% of cases occurred in women. Excluding the laboratory-confirmed index patient, 52 (86.7%) of 60 attendees became ill; 32 (61.5%) of these cases were confirmed by RT-PCR testing and 20 (38.5%) persons were considered to have probable infections. These figures correspond to secondary attack rates of 53.3% and 86.7% among confirmed and all cases, respectively. Attendees developed symptoms 1 to 12 days after the practice (median = 3 days). The first SARS-CoV-2 test was performed on March 13. The last person was tested on March 26.
Three of the 53 patients were hospitalized (5.7%), including two who died (3.8%). The mean interval from illness onset to hospitalization was 12 days. The intervals from onset to death were 14 and 15 days for the two patients who died.
SCPH collected information about patient signs and symptoms from patient interviews and hospital records (Table 2). Among persons with confirmed infections, the most common signs and symptoms reported at illness onset and at any time during the course of illness were cough (54.5% and 90.9%, respectively), fever (45.5%, 75.8%), myalgia (27.3%, 75.0%), and headache (21.2%, 60.6%). Several patients later developed gastrointestinal symptoms, including diarrhea (18.8%), nausea (9.4%), and abdominal cramps or pain (6.3%). One person experienced only loss of smell and taste. The most severe complications reported were viral pneumonia (18.2%) and severe hypoxemic respiratory failure (9.1%).
Among the recognized risk factors for severe illness, the most common was age, with 75.5% of patients aged ≥65 years. Most patients (67.9%) did not report any underlying medical conditions, 9.4% had one underlying medical condition, and 22.6% had two or more underlying medical conditions. All three hospitalized patients had two or more underlying medical conditions.
Public Health Response
SCPH provided March 10 practice attendees with isolation and quarantine instructions by telephone, email, and postal mail. Contacts of patients were traced and notified of isolation and quarantine guidelines. At initial contact, 15 attendees were quarantined, five of whom developed symptoms during quarantine and notified SCPH.
Before detection of this cluster on March 17, Skagit County had reported seven confirmed COVID-19 cases (5.4 cases per 100,000 population). At the time, SCPH informed residents that likely more community transmission had occurred than indicated by the low case counts.* On March 21, SCPH issued a press release to describe the outbreak and raise awareness about community transmission.† The press release emphasized the highly contagious nature of COVID-19 and the importance of following social distancing guidelines to control the spread of the virus.
Multiple reports have documented events involving superspreading of COVID-19 (2–5); however, few have documented a community-based point-source exposure (5). This cluster of 52 secondary cases of COVID-19 presents a unique opportunity for understanding SARS-CoV-2 transmission following a likely point-source exposure event. Persons infected with SARS-CoV-2 are most infectious from 2 days before through 7 days after symptom onset (7). The index patient developed symptoms on March 7, which could have placed the patient within this infectious period during the March 10 practice. Choir members who developed symptoms on March 11 (three) and March 12 (seven) attended both the March 3 and March 10 practices and thus could have been infected earlier and might have been infectious in the 2 days preceding symptom onset (i.e., as early as March 9). The attack rate in this group (53.3% and 86.7% among confirmed cases and all cases, respectively) was higher than that seen in other clusters, and the March 10 practice could be considered a superspreading event (3,4). The median incubation period of COVID-19 is estimated to be 5.1 days (8). The median interval from exposure during the March 10 practice to onset of illness was 3 days, indicating a more rapid onset.
Choir practice attendees had multiple opportunities for droplet transmission from close contact or fomite transmission (9), and the act of singing itself might have contributed to SARS-CoV-2 transmission. Aerosol emission during speech has been correlated with loudness of vocalization, and certain persons, who release an order of magnitude more particles than their peers, have been referred to as superemitters and have been hypothesized to contribute to superspeading events (1). Members had an intense and prolonged exposure, singing while sitting 6–10 inches from one another, possibly emitting aerosols.
The findings in this report are subject to at least two limitations. First, the seating chart was not reported because of concerns about patient privacy. However, with attack rates of 53.3% and 86.7% among confirmed and all cases, respectively, and one hour of the practice occurring outside of the seating arrangement, the seating chart does not add substantive additional information. Second, the 19 choir members classified as having probable cases did not seek testing to confirm their illness. One person classified as having probable COVID-19 did seek testing 10 days after symptom onset and received a negative test result. It is possible that persons designated as having probable cases had another illness.
This outbreak of COVID-19 with a high secondary attack rate indicates that SARS-CoV-2 might be highly transmissible in certain settings, including group singing events. This underscores the importance of physical distancing, including maintaining at least 6 feet between persons, avoiding group gatherings and crowded places, and wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain during this pandemic. The choir mitigated further spread by quickly communicating to its members and notifying SCPH of a cluster of cases on March 18. When first contacted by SCPH during March 18–20, nearly all persons who attended the practice reported they were already self-isolating or quarantining. Current CDC recommendations, including maintaining physical distancing of at least 6 feet and wearing cloth face coverings if this is not feasible, washing hands often, covering coughs and sneezes, staying home when ill, and frequently cleaning and disinfecting high-touch surfaces remain critical to reducing transmission. Additional information is available at https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html.
Patients described in this report; health care personnel who cared for them; Skagit County Public Health staff members and leaders, particularly the Communicable Disease investigators; Washington State Department of Health.
1Skagit County Public Health, Mount Vernon, Washington.
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TABLE 1. Number of choir members with and without COVID-19–compatible symptoms (N = 122)* and members’ choir practice attendance† — Skagit County, Washington, March 3 and 10, 2020
Attendance No. (row %) March 3 practice March 10 practice Total Symptomatic Asymptomatic Total Symptomatic Asymptomatic Attended 78 51 (65.4) 27 (34.6) 61 53§ (86.9) 8 (13.1) Did not attend 40 4 (10.0) 36 (90.0) 61 3 (4.9) 58 (95.1) Attendance information missing 4 1 (25.0) 3 (75.0) 0 0 (—) 0 (—) Attended only one practice 21 1 (4.8) 20 (95.2) 3 2 (66.7) 1 (33.3)
Abbreviation: COVID-19 = coronavirus disease 2019. * No choir members were symptomatic at the March 3 practice. † Thirty-seven choir members attended neither practice; two developed symptoms, and 35 remained asymptomatic. § Includes index patient; if the index patient excluded, 52 secondary cases occurred among the other 60 attendees (attack rate = 86.7%).
FIGURE. Confirmed* and probable† cases of COVID-19 associated with two choir practices, by date of symptom onset (N = 53) — Skagit County, Washington, March 2020
Abbreviation: COVID-19 = coronavirus disease 19. * Including the index patient.
Suggested citation for this article: Hamner L, Dubbel P, Capron I, et al. High SARS-CoV-2 Attack Rate Following Exposure at a Choir Practice — Skagit County, Washington, March 2020. MMWR Morb Mortal Wkly Rep 2020;69:606–610. DOI: http://dx.doi.org/10.15585/mmwr.mm6919e6.
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The MGM plan released Tuesday offered a first look at how Atlantic City casinos plan to operate to protect both employees and guests from the coronavirus.
The new rules include:
— Daily temperature checks for all employees, as well as screening measures to determine whether they have infection symptoms and where they are in contact with those who have been infected, such as someone in their household or someone they care for.
— Guests who think they may have been exposed will be “strongly encouraged” to stay at home and not travel.
— All employees must wear masks, and all guests will be encouraged to do so in public areas. The casino will hand out free masks to guests.
— Workers will be trained on proper cleaning procedures and other steps to protect against the virus.
— Employees who handle food, clean public areas and enter guest rooms must wear gloves. Other workers also may required to wear personal protective equipment.
— Guests still will be able to order beverages but not food on the casino floor, and can remove their masks to drink.
— Frequent cleaning and disinfecting of slot machines, tables and kiosks.
— Stations for handwashing and hand sanitizing in high-traffic areas.
— A six-foot social distancing policy will be followed whenever possible, with signs and floor guides to help separate patrons. In areas where the distancing policy cannot be followed, plexiglass barriers will be installed or employees will be given eye protection.
— Poker rooms may not reopen when the rest of the casino does, depending on guidance from state officials and medical experts.
— Plexiglass barriers throughout the casino and lobbies.
— Medical personnel on staff to respond in case a guest or employee tests positive for COVID-19. Exposed areas will be sanitized and efforts will be made for contact tracing, notifying those who may have been in contact with the individual.
— Limits on how many people can share an elevator cab.
— Allowing guests to check in to their hotel rooms digitally without having contact with anyone at the front desk.
— Digital menus and text notifications when tables are ready, eliminating the need to wait in line.
It remains to be seen if the steps are sufficient to win the approval of Unite Here, the union that represents 10,600 Atlantic City workers. Their plan called for having the state gaming commission ensure that the casinos were taking the necessary steps to protect employees and guests.
The union said that the six-foot distance between customers needed to be followed at slot machines and table games, dice and chips needed to be frequently sanitized, buffets needed to be suspended and spas and pools needed to close temporarily.
“It’s good that the company is talking about it, but we need them to work in partnership with frontline workers to come up with a full plan to protect guest and workers,” said Mayra Gonzalez, a line server at Borgata and a member of Unite Here.
“He that takes truth for his guide, and duty for his end, may safely trust to God’s providence to lead him aright.” - Blaise Pascal. "There is but one straight course, and that is to seek truth and pursue it steadily" – George Washington letter to Edmund Randolph — 1795. We live in a “post-truth” world. According to the dictionary, “post-truth” means, “relating to or denoting circumstances in which objective facts are less influential in shaping public opinion than appeals to emotion and personal belief.” Simply put, we now live in a culture that seems to value experience and emotion more than truth. Truth will never go away no matter how hard one might wish. Going beyond the MSM idealogical opinion/bias and their low information tabloid reality show news with a distractional superficial focus on entertainment, sensationalism, emotionalism and activist reporting – this blogs goal is to, in some small way, put a plug in the broken dam of truth and save as many as possible from the consequences—temporal and eternal. "The further a society drifts from truth, the more it will hate those who speak it." – George Orwell “There are two ways to be fooled. One is to believe what isn’t true; the other is to refuse to believe what is true.” ― Soren Kierkegaard