Severity of Disease Among Adults Hospitalized with Laboratory-Confirmed COVID-19 Before and During the Period of SARS-CoV-2 B.1.617.2 (Delta) Predominance — COVID-NET, 14 States, January–August 2021

Link:https://www.cdc.gov/mmwr/volumes/70/wr/mm7043e1.htm?s_cid=mm7043e1_w

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What is already known about this topic?

The SARS-CoV-2 B.1.617.2 (Delta) variant is highly transmissible; however, whether it causes more severe disease in adults has been uncertain.

What is added by this report?

Analysis of COVID-NET data from 14 states found no significant increases in the proportion of hospitalized COVID-19 patients with severe outcomes during the Delta period. The proportion of hospitalized unvaccinated COVID-19 patients aged 18–49 years significantly increased during the Delta period.

What are the implications for public health practice?

Lower vaccination coverage in adults aged 18–49 years likely contributed to the increase in hospitalized patients during the Delta period. COVID-19 vaccination is critical for all eligible adults, including adults aged <50 years who have relatively low vaccination rates compared with older adults.

Author(s): Christopher A. Taylor, PhD1; Kadam Patel, MPH1,2; Huong Pham, MPH1; Michael Whitaker, MPH1; Onika Anglin, MPH1,2; Anita K. Kambhampati, MPH1; Jennifer Milucky, MSPH1; Shua J. Chai, MD3,4; Pam Daily Kirley, MPH4; Nisha B. Alden, MPH5; Isaac Armistead, MD5; James Meek, MPH6; Kimberly Yousey-Hindes, MPH6; Evan J. Anderson, MD7,8,9; Kyle P. Openo, DrPH7,8; Kenzie Teno, MPH10; Andy Weigel10; Maya L. Monroe, MPH11; Patricia A. Ryan, MS11; Justin Henderson, MPH12; Val Tellez Nunez, MPH12; Erica Bye, MPH13; Ruth Lynfield, MD13; Mayvilynne Poblete, MA, MPH14; Chad Smelser, MD15; Grant R. Barney, MPH16; Nancy L. Spina, MPH16; Nancy M. Bennett, MD17; Kevin Popham, MPH18; Laurie M. Billing, MPH19; Eli Shiltz, MPH19; Nasreen Abdullah, MD20; Melissa Sutton, MD20; William Schaffner, MD21; H. Keipp Talbot, MD21; Jake Ortega, MPH22; Andrea Price22; Shikha Garg, MD1; Fiona P. Havers, MD1; COVID-NET Surveillance Team

Publication Date: 29 October 2021

Publication Site: MMWR at CDC

5 Worst Cities for COVID-19 Case Count Trends

Link:https://www.thinkadvisor.com/2021/11/30/5-worst-cities-for-covid-19-case-count-trends/

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The latest COVID-19 Community Profile Report, which is produced by public health specialists at the CDC and another federal agency, shows that the overall number of new COVID-19 cases per 100,000 people fell to 504,056 in the week ending Nov. 28, down 21% from the total for the previous week.

But, at the metropolitan area level, week-over-week changes ranged from a drop of 100% to an increase of 12%.

Author(s): Allison Bell

Publication Date: 30 Nov 2021

Publication Site: Think Advisor

Omicron is starting to spread around the world

Link:https://www.economist.com/graphic-detail/2021/11/29/omicron-is-starting-to-spread-around-the-world

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Days after a new variant of SARS-CoV-2 was identified in southern Africa, countries around the world are confirming that they have found cases of it too. The new strain of the virus, B.1.1.529, was first detected in genetic samples from Botswana and South Africa. (Nearly 150 cases have been confirmed in southern Africa since, although the true number is thought to be higher.) On November 24th South Africa’s health authorities told the World Health Organisation, which quickly labelled it a “variant of concern” and assigned it the Greek letter Omicron. Just how long—and where—it has been circulating is not yet clear.

Publication Date: 29 Nov 2021

Publication Site: The Economist

Simpson’s Paradox and Vaccines

Link:https://covidactuaries.org/2021/11/22/simpsons-paradox-and-vaccines/

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So what the chart in the tweet linked above is really showing is that, within the 10-59 age band, the average unvaccinated person is much younger than the average vaccinated person, and therefore has a lower death rate. Any benefit from the vaccines is swamped by the increase in all-cause mortality rates with age.

I have mocked up some illustrative numbers in the table below to hopefully show Simpson’s Paradox in action here. I’ve split the 10-59 age band into 10-29 and 30-59. Within each group the death rate for unvaccinated people is twice as high as for vaccinated people. However, within the combined group this reverses – the vaccinated group have higher death rates on average!

I and others have written to ONS, altering them to the concerns that this data is causing. It appears from a new blog they have released that they are aware of the issue and will use narrower age bands in the next release.

Author(s): Stuart Macdonald

Publication Date: 22 Nov 2021

Publication Site: COVID-19 Actuaries Response Group

When Will The FDA Approve Paxlovid?

Link: https://astralcodexten.substack.com/p/when-will-the-fda-approve-paxlovid

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For context: a recent study by Pfizer, the pharma company backing the drug, found Paxlovid decreased hospitalizations and deaths from COVID by a factor of ten, with no detectable side effects. It was so good that Pfizer, “in consultation with” the FDA, stopped the trial early because it would be unethical to continue denying Paxlovid to the control group. And on November 16, Pfizer officially submitted an approval request to the FDA, which the FDA is still considering.

As many people including ZviAlex, and Kelsey have noted, it’s pretty weird that the FDA agrees Paxlovid is so great that it’s unethical to study it further because it would be unconscionable to design a study with a no-Paxlovid control group – but also, the FDA has not approved Paxlovid, it remains illegal, and nobody is allowed to use it.

One would hope this is because the FDA plans to approve Paxlovid immediately. But the prediction market expects it to take six weeks – during which time we expect about 50,000 more Americans to die of COVID.

Perhaps there’s not enough evidence for the FDA to be sure Paxlovid works yet? But then why did they agree to stop the trial that was gathering the evidence? Or perhaps there’s enough evidence, but it takes a long time to process it? But then how come the prediction markets are already 90% sure what decision they’ll make?

Author(s): Scott Alexander

Publication Date: 22 Nov 2021

Publication Site: Astral Codex Ten

Ivermectin: Much More Than You Wanted To Know

Link:https://astralcodexten.substack.com/p/ivermectin-much-more-than-you-wanted

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About ten years ago, when the replication crisis started, we learned a certain set of tools for examining studies.

Check for selection bias. Distrust “adjusting for confounders”. Check for p-hacking and forking paths. Make teams preregister their analyses. Do forest plots to find publication bias. Stop accepting p-values of 0.049. Wait for replications. Trust reviews and meta-analyses, instead of individual small studies.

These were good tools. Having them was infinitely better than not having them. But even in 2014, I was writing about how many bad studies seemed to slip through the cracks even when we pushed this toolbox to its limits. We needed new tools.

I think the methods that Meyerowitz-Katz, Sheldrake, Heathers, Brown, Lawrence and others brought to the limelight this year are some of the new tools we were waiting for.

Part of this new toolset is to check for fraud. About 10 – 15% of the seemingly-good studies on ivermectin ended up extremely suspicious for fraud. Elgazzar, Carvallo, Niaee, Cadegiani, Samaha. There are ways to check for this even when you don’t have the raw data. Like:

The Carlisle-Stouffer-Fisher method: Check some large group of comparisons, usually the Table 1 of an RCT where they compare the demographic characteristics of the control and experimental groups, for reasonable p-values. Real data will have p-values all over the map; one in every ten comparisons will have a p-value of 0.1 or less. Fakers seem bad at this and usually give everything a nice safe p-value like 0.8 or 0.9.

GRIM – make sure means are possible given the number of numbers involved. For example, if a paper reports analyzing 10 patients and finding that 27% of them recovered, something has gone wrong. One possible thing that could have gone wrong is that the data are made up. Another possible thing is that they’re not giving the full story about how many patients dropped out when. But something is wrong.

But having the raw data is much better, and lets you notice if, for example, there are just ten patients who have been copy-pasted over and over again to make a hundred patients. Or if the distribution of values in a certain variable is unrealistic, like the Ariely study where cars drove a number of miles that was perfectly evenly distributed from 0 to 50,000 and then never above 50,000.

Author(s): Scott Alexander

Publication Date: 17 Nov 2021

Publication Site: Astral Codex Ten at substack

Covid-19 Breakthrough Hospitalizations Concentrated Among Most Vulnerable

Link:https://www.wsj.com/articles/covid-19-breakthrough-hospitalizations-concentrated-among-most-vulnerable-11637499602

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At the Medical University of South Carolina, nearly all fully vaccinated Covid-19 patients in the ICU have weak immune systems from prior health problems, said Andrew Goodwin, the section chief of critical care. The rest are elderly, which can also compromise the body’s defense against illness.

Truveta Inc., a firm that aggregates hospitals’ medical data for research, found among 1.7 million fully vaccinated people that those with diabetes, chronic lung disease and chronic kidney disease were about twice as likely to be hospitalized for breakthrough cases as vaccinated people without these conditions.

The likelihood of having a breakthrough infection was still low, though confirmed infections were more common for people with these illnesses. About 1.5% of roughly 110,000 people with chronic kidney disease had one, for example. But Truveta found about a quarter of breakthrough patients with chronic kidney disease wound up hospitalized. The likelihood of hospitalizations for people with breakthrough cases but without underlying health problems was about 7.5%.

Breakthrough deaths are hitting older people the hardest, amplifying a well-worn pandemic pattern. Exclusive data the Journal reviewed from the Epic Health Research Network, which analyzes data from the medical-record software company Epic Systems Corp., shows about 80% of breakthrough deaths among the vaccinated are in people ages 65 and older. The data included records for 19.5 million fully vaccinated people. Among all Covid-19 deaths this year, that age group represents closer to 69%, according to the CDC.

Author(s): Jon Kamp, Melanie Evans

Publication Date: 21 Nov 2021

Publication Site: Wall Street Journal

Why Puerto Rico leads the U.S. in COVID vaccine rate — and what states can learn

Link:https://www.npr.org/2021/10/27/1049323911/puerto-rico-leads-the-us-in-covid-19-vaccine-rates-and-what-states-can-learn

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It’s in Puerto Rico, where more than 73% of the total population is fully vaccinated. The U.S. national average is just over 57%.

The high vaccination rate stands in contrast to Puerto Rico’s initial vulnerability to the coronavirus. Four years after Hurricane Maria destroyed the electricity grid, power outages still occur regularly. Many municipalities face a shortage of health care facilities and workers.

The U.S. territory responded with some of the strictest pandemic measures in the country, including nonessential-business closures, stay-at-home orders and mask mandates.

……

Its successes aside, Feliú-Mójer noted that COVID-19 has still killed over 3,200 people in Puerto Rico. And she remains concerned about vaccine equity — particularly in rural communities or among older adults who can’t get out of their homes or don’t know how to make an appointment. She says the high overall vaccination rate can hide gaps in coverage.

“You have to look beyond that big number,” she said in a separate interview with NPR. “But then you look at certain municipalities like Loíza, a town in coastal northern Puerto Rico that’s predominantly Black and [a] very poor municipality. Their vaccination rate is about 55%. And so when you look at some of the social determinants that impact communities like Loíza, then they’re not doing as well.”

Author(s): PATRICK JARENWATTANANON, AYEN BIOR, SARAH HANDEL

Publication Date: 27 October 2021

Publication Site: NPR

Flu rips through University of Michigan campus, bringing CDC to Ann Arbor

Link:https://www.freep.com/story/news/health/2021/11/15/flu-rips-through-university-michigan-campus-brings-cdc-campus/8622063002/

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Influenza is sweeping the University of Michigan’s Ann Arbor campus, with 528 cases diagnosed at the University Health Service since Oct. 6.  

The outbreak is so sudden and large — 313 cases were identified the week of Nov. 8 alone and 37% of flu tests that week were positive — that it’s drawn the attention of federal health leaders.

……

Among those who’ve contracted flu at U-M this fall, 77% didn’t get a flu vaccine. The cases were identified as influenza A (H3N2), said Lindsey Mortenson, UHS medical director and acting executive director.

“While we often start to see some flu activity now, the size of this outbreak is unusual,” said Juan Luis Marquez, medical director at the Washtenaw County Health Department. “We’re grateful for the additional support of the CDC and our ongoing partnership with the university as we look more closely at the situation.”

Author(s): Kristen Jordan Shamus

Publication Date: 15 Nov 2021

Publication Site: Detroit Free Press

COVID-19: Eight Dead, 89 Infected In Outbreak At Connecticut Nursing Home

Link:https://dailyvoice.com/new-york/northsalem/news/covid-19-eight-dead-89-infected-in-outbreak-at-connecticut-nursing-home/819985/

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Eight residents of a Connecticut nursing home have died during a COVID-19 outbreak that has lasted nearly six weeks.

A total of 89 employees and residents have tested positive since the outbreak began at the Geer Nursing and Rehabilitation Center, located in Litchfield County, in the Town of Canaan, on Thursday, Sept. 30.

“Despite seeing significant numbers of residents recovering from Covid,” the facility’s chief executive Kevin O’Connell and nursing director Cady Bloodgood said in a statement. “testing has resulted in one additional positive case among fully vaccinated residents and staff members. Sadly, we have lost eight residents with serious underlying health issues to Covid.”

Author(s): Joe Lombardi

Publication Date: 14 Nov 2021

Publication Site: Daily Voice

An Unsolved Mystery: Why Do More Men Die of Covid-19?

Link:https://www.nytimes.com/2021/11/02/opinion/men-covid-19-deaths.html

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Men are much more likely than women to die of Covid-19 and are more likely to be intubated and have long hospitalizations. This disparity in Covid-related deaths has existed since early in the pandemic, before there were any vaccines. Men are also more likely to develop certain rare complications from some Covid-19 vaccines and to experience a faster decline in measures of immunity once vaccinated. The reasons remain unclear.

Historically, women have been largely excluded from medical studies, and health issues that predominantly affect women have been underresearched. This is both morally wrong and medically foolish because it limits physicians’ ability to deliver optimal care. Rather than ignore sex differences in Covid-19 outcomes, scientists should pay attention to them to better understand the disease and how to treat it.

Data from the Centers for Disease Control and Prevention shows that in the United States, women account for 45.6 percent of Covid-19 deaths so far and men account for 54.4 percent. (Men make up slightly less than half the U.S. population.) Among Americans ages 65 to 84 — the group at highest risk for severe Covid-19 — the gap is even larger: 57.9 percent of deaths have occurred among men and 42.1 percent among women. According to the Brookings Institution, at least 65,000 more men than women have died of Covid-19 in the United States. Globally, the death rate has been about 50 percent higher for men.

A July 2021 study found that compared to women, men with Covid-19 had an almost 50 percent higher rate of respiratory intubation and a 22 percent longer hospital stay.

Author(s): Ezekiel Emanuel

Publication Date: 2 Nov 2021

Publication Site: New York Times

Who Had Covid-19 Vaccine Breakthrough Cases?

Link:https://www.nytimes.com/interactive/2021/10/28/us/covid-breakthrough-cases.html

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Compared with the unvaccinated, fully vaccinated people overall had a much lower chance of testing positive for the virus or dying from it, even through the summer’s Delta surge and the relaxation of pandemic restrictions in many parts of the country. But the data indicates that immunity against infection may be slowly waning for vaccinated people, even as the vaccines continue to be strongly protective against severe illness and death.

“The No. 1 take-home message is that these vaccines are still working,” said Dr. David Dowdy, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health. “If you saw these data for any disease other than Covid, what everyone’s eyes would be drawn to is the difference between the unvaccinated and fully vaccinated lines.”

The data shows notable differences in breakthrough death rates by age and slight differences in both case and death rates by vaccine brand, trends that experts say are important to consider as tens of millions of Americans weigh whether to get a booster shot.

Author(s): Aliza Aufrichtig, Amy Schoenfeld Walker

Publication Date: 28 Oct 2021

Publication Site: NYT