What We’ve Learned — and Failed to Learn — from a Million COVID Deaths

Link: https://www.governing.com/now/what-weve-learned-and-failed-to-learn-from-a-million-covid-deaths

Excerpt:

The pandemic is not done. The number of new infections — surely an undercount due to unreported home tests — again tops 75,000 per day. The number of hospitalizations has climbed 20 percent over the past two weeks. The Biden administration has warned there could be 100 million more Americans infected by early next year. Yet Congress seems unwilling to provide more money for basic responses such as tests and vaccines, even as it becomes increasingly clear that even mild cases can lead to dangerous long-term damage.

Yet there are positive developments to consider as well. Vaccinations and certainly boosters are not where they should be, but three out of four Americans have received at least a single dose and two-thirds are fully vaccinated. The Commonwealth Fund has estimated that, absent vaccines, an additional 2.3 million Americans would have died, and 17 million more would have been hospitalized. Public health measures such as masking have largely fallen out of favor, but they helped prevent a death toll that could have been even more terrible.

“A million is way too many people, but as a result of the work that has been done, through public health and vaccination, it’s a number that’s a lot lower than it might have been,” says David Fleming, a distinguished visiting fellow at the Trust for America’s Health. “If we did not do those things, we would not be looking at the 1 million death threshold, we’d be looking at the 3 million death threshold.”

Author(s): Alan Greenblatt

Publication Date: 12 May 2022

Publication Site: Governing

Severe hepatitis of ‘unknown origin’ in children being investigated in Canada

Link: https://www.cbc.ca/news/health/liver-disease-mystery-1.6431872

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Excerpt:

Public health officials say they’re investigating cases of severe liver disease “of unknown origin” among children in Canada as global scientists race to understand a mysterious hepatitis outbreak that has affected nearly 200 youths around the world.

“The Public Health Agency of Canada is aware of reports of severe acute hepatitis of unknown origin in young children in Canada,” the department said in a statement on Tuesday, in response to questions from CBC News.

“These are being investigated further to determine if they are related to cases in the United Kingdom and the United States. As the investigation evolves, we will keep the public updated accordingly.”

The latest available data from the World Health Organization (WHO) shows at least 169 cases of acute hepatitis of unknown origin have been reported in close to a dozen countries, with the bulk of the reports — 114 — from the U.K. 

Author(s): Lauren Pelley

Publication Date: 26 April 2022

Publication Site: CBC

1 death, 17 liver transplants in multi-country outbreak of hepatitis in children, WHO says

Link: https://www.cnn.com/2022/04/23/health/multi-country-outbreak-of-hepatitis-in-children/index.html

Excerpt:

At least 169 cases of acute hepatitis in children aged one month to 16 years old have been identified in an outbreak that now involves 11 countries, the World Health Organization (WHO) said on Saturday.

Among the cases of acute hepatitis, at least one child has died and 17 children have required liver transplants, the WHO said in a news release.

“It is not yet clear if there has been an increase in hepatitis cases, or an increase in awareness of hepatitis cases that occur at the expected rate but go undetected,” the WHO said in a statement. “While adenovirus is a possible hypothesis, investigations are ongoing for the causative agent.”

Author(s): John Bonifield, Emma Tucker

Publication Date: 23 April 2022

Publication Site: CNN

Inside Nebraska’s Surprisingly Effective Covid Strategy

Link: https://www.politico.com/news/magazine/2022/04/22/nebraska-covid-response-pete-ricketts-00026993

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This conversation about protecting hospitals, back in the era when New Yorkers were still being encouraged to go to restaurants, well before the coasts’ contagion began closing in on the Midwest in earnest, helped define what became, by some measures, one of the most effective and balanced Covid responses in the United States. Ricketts is a mandate-shunning Republican who runs a heavily Republican and rural state with a middling vaccination rate — factors that have been linked to worse pandemic health outcomes in other states. He never ordered a statewide shutdown when 43 other governors, Democrats and Republicans, did so; he has stood against, or even supported lawsuits over, local mask requirements; he has told state agencies not to comply with federal vaccine mandates and gotten scolded by the U.S. secretary of defense for objecting to such requirements for the National Guard. And yet by the fall of last year, when POLITICO crunched the data of state pandemic responses on a combination of health, economic, social and educational factors, one state came out with the best average: Nebraska.

The state had the best economic performance of any in the pandemic up to that point, and its students, according to available data, appear to have suffered little to no learning loss. Whereas many states saw a trade-off between health and wealth in the pandemic — often corresponding to more-restrictive Democratic leadership and less-restrictive Republican leadership, respectively — Nebraska also scored above the national average for health outcomes POLITICO evaluated last year (20th of 50 states). Nebraska was the first state to accumulate a 120-day stockpile of PPE in the nationwide scramble for supplies; was a national leader in opening schools; and was among the quickest getting federal aid to small businesses. As of now, its cumulative pandemic death toll per capita is near the lowest of all 50 states, according to the Kaiser Family Foundation. This, however, is grading on a hideous curve in a country that hasn’t managed the pandemic well in general: More than 4,000 Nebraskans have lost their lives to Covid. Lawler of the University of Nebraska Medical Center, who helped design the state’s early Covid response but has since grown critical of Nebraska’s approach, notes that South Korea has 14 times lower per capita Covid mortality than Nebraska. “Nobody,” he told me via text, “should be patting themselves on the back for doing 14 [times] worse.”

Author(s): Kathy Gilsinan

Publication Date: 22 April 2022

Publication Site: Politico

The Most Detailed Map of Cancer-Causing Industrial Air Pollution in the U.S.

Link: https://projects.propublica.org/toxmap/?utm_source=sailthru&utm_medium=email&utm_campaign=datastore&utm_content=river

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ProPublica’s analysis of five years of modeled EPA data identified more than 1,000 toxic hot spots across the country and found that an estimated 250,000 people living in them may be exposed to levels of excess cancer risk that the EPA deems unacceptable.

The agency has long collected the information on which our analysis is based. Thousands of facilities nationwide that are considered large sources of toxic air pollution submit a report to the government each year on their chemical emissions.

But the agency has never released this data in a way that allows the public to understand the risks of breathing the air where they live. Using the reports submitted between 2014 and 2018, we calculated the estimated excess cancer risk from industrial sources across the entire country and mapped it all.

The EPA’s threshold for an acceptable level of cancer risk is 1 in 10,000, meaning that of 10,000 people living in an area, there would likely be one additional case of cancer over a lifetime of exposure. But the agency has also said that ideally, Americans’ added level of cancer risk from air pollution should be far lower, 1 in a million. Our map highlights areas where the additional cancer risk is greater than 1 in 100,000 — 10 times lower than the EPA’s threshold, but still high enough to be of concern, experts say.

Author(s): Al Shaw and Lylla Younes, Additional reporting by Ava Kofman

Publication Date: last updated 15 Mar 2022, accessed 16 Mar 2022

Publication Site: ProPublica

Dialysis Provider Expects COVID-19 Mortality to Stay High

Link:https://www.thinkadvisor.com/2022/02/11/dialysis-provider-expects-covid-19-mortality-to-stay-high/

Excerpt:

A company that provides care for people with serious kidney disease is assuming that COVID-19 mortality will be higher this quarter than it was in the fourth quarter of 2021.

Executives from DaVita, a Denver-based kidney dialysis provider, talked about their pandemic mortality outlook Thursday, on a conference call the company held to go over earnings for the latest quarter with securities analysts.

DaVita’s patient population is much older and sicker than any commercial life or health insurer’s enrollees, but the company’s experience could give insurers a preview of what might happen to the mortality level for their highest-risk insureds.

….

“While it’s too early to accurately forecast incremental mortality in 2022, given a significant uptick in infections in January, we expect COVID-driven mortality in the first quarter to be at or above what we experienced in Q4,” Joel Ackerman, DaVita’s chief financial officer, said on the earnings call.

Author(s): Allison Bell

Publication Date: 11 Feb 2022

Publication Site: Think Advisor

COVID-19 cases rise every day in Denmark, but the country is confident it can live without restrictions for now

Link:https://www.abc.net.au/news/2022-02-13/denmark-has-taken-living-with-covid-to-a-whole-new-level/100812736

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At the beginning of February, the Danish government decided COVID-19 was no longer a “socially critical disease” and it scrapped all restrictions.

Danes aren’t even legally required to quarantine.

Denmark was among the first countries in the world to implement a lockdown, in March 2020, amid the rapid spread of COVID-19.

It also invested heavily in genomic sequencing to track new variants like the BA.2 sub-variant of Omicron, which is now dominant in Denmark and even more transmissible than the original strain.

And when the Omicron variant began spreading rapidly last year, Denmark reimposed restrictions on workplaces, hospitality and schools in December.

But Tyra Grove Krause, the chief epidemiologist at Denmark’s State Serum Institute, said it also sparked a major rethink in the country’s approach to COVID-19.

Author(s): Nick Dole

Publication Date: 12 Feb 2022

Publication Site: ABC News Australia

Book Review: Lifespan

Link:https://astralcodexten.substack.com/p/book-review-lifespan

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Excerpt:

David Sinclair – Harvard professor, celebrity biologist, and author of Lifespan – thinks solving aging will be easy. “Aging is going to be remarkably easy to tackle. Easier than cancer” are his exact words, which is maybe less encouraging than he thinks.

There are lots of ways that solving aging could be hard. What if humans worked like cars? To restore an old car, you need to fiddle with hundreds of little parts, individually fixing everything from engine parts to chipping paint. Fixing humans to such a standard would be way beyond current technology.

Or what if the DNA damage theory of aging was true? This says that as cells divide (or experience normal wear and tear) they don’t copy their DNA exactly correctly. As you grow older, more and more errors creep in, and your cells become worse and worse at their jobs. If this were true, there’s not much to do either: you’d have to correct the DNA in every cell in the body (using what template? even if you’d saved a copy of your DNA from childhood, how do you get it into all 30 trillion cells?) This is another nonstarter.

Sinclair’s own theory offers a simpler option. He starts with a puzzling observation: babies are very young [citation needed]. If a 70 year old man marries a 40 year old woman and has a baby, that baby will start off at zero years old, just like everyone else. Even more interesting, if you clone a 70 year old man, the clone start at zero years old.

….

So Sinclair thinks aging is epigenetic damage. As time goes on, cells lose or garble the epigenetic markers telling them what cells to be. Kidney cells go from definitely-kidney-cells to mostly kidney cells but also a little lung cell and maybe some heart cell in there too. It’s hard to run a kidney off of cells that aren’t entirely sure whether they’re supposed to be kidney cells or something else, and so your kidneys (and all your other organs) break down as you age. He doesn’t come out and say this is literally 100% of aging. But everyone else thinks aging is probably a combination of many complicated processes, and I think Sinclair thinks it’s mostly epigenetic damage and then a few other odds and ends that matter much less.

Author(s): Scott Alexander

Publication Date: 1 Dec 2021

Publication Site: Astral Codex Ten

If you’re vaxxed, you’re more likely to be killed by lightning than die of COVID: study

Link:https://nypost.com/2022/02/08/lightnings-more-likely-good-odds-for-vaxxed/

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Excerpt:

Those odds can be gauged from a study by researchers at the National Institutes of Health, published by the Centers for Disease Control and Prevention. They tracked more than 1 million vaccinated adults in America over most of last year, including the period when the Delta variant was surging, and classified victims of COVID according to risk factors such as being over 65, being immunosuppressed or suffering from diabetes or chronic diseases of the heart, kidney, lungs, liver or brain.

The researchers report that none of the healthy people under 65 had a severe case of COVID that required treatment in an intensive-care unit.

 Not a single one of these nearly 700,000 people died, and the risk was minuscule for most older people, too. Among vaccinated people over 65 without an underlying medical condition, only one person died.

In all, there were 36 deaths, mostly among a small minority of older people with a multitude of comorbidities: the 3% of the sample that had at least four risk factors.

Author(s): John Tierney

Publication Date: 8 Feb 2022

Publication Site: NY Post

U.S. Pathology and Laboratory Society Endorses NKF-ASN Joint Task Force

Link:https://www.kidney.org/news/u-s-pathology-and-laboratory-society-leadership-endorses-nkf-asn-joint-task-force

Excerpt:

The final NKF-ASN Task Force report recommends:

  • The use of the CKD-EPI 2021 eGFR creatinine equation for calculating eGFRcr in adults.2,3 This new equation is recommended because a race coefficient is not included in its computation and reporting.  The CKD-EPI 2021 eGFR creatinine equation included diversity in its development and does not disproportionately affect any one group.3
  • National efforts are also underway to facilitate increased, routine, and timely use of cystatin C (CPT 82610), especially to further evaluate eGFRcr in adults who are at risk for or have chronic kidney disease, or in individuals with abnormally high or low muscle mass.  The CKD-EPI 2021 eGFR using creatinine and cystatin C (eGFRcr-cys) is more accurate, more closely approximates measured GFR and supports better clinical decisions than either marker alone.2,3   

Publication Date: 8 Feb 2022

Publication Site: National Kidney Foundation

Supplements: COVID-19; Racial and Ethnic Disparities: Chapter 13

Link:https://adr.usrds.org/2021/supplements-covid-19-disparities/13-covid-19-supplement

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Among beneficiaries with CKD, mortality during COVID-19 hospitalization was approximately 40% during the first wave of the pandemic but decreased thereafter, reaching an average of 18% from July to December (Figure 13.10).

During all of 2020, the incidence of in-hospital death during COVID-19 hospitalizations was 21.5% among older Medicare beneficiaries with CKD, 18.8% among beneficiaries undergoing dialysis, and 19.3% among beneficiaries with a kidney transplant.

Between epidemiologic week 13 of 2020 and epidemiologic week 8 of 2021, the number of prevalent dialysis patients fell from 567,303 to 555,264, an unprecedented decline of over 2% (Figure 13.11).

Among patients undergoing dialysis, mortality was consistently elevated, relative to recent historical norms, between epidemiologic week 12 of 2020 and week 10 of 2021. Among patients with a kidney transplant, excess mortality was persistent through the second quarter of 2021 (Figure 13.12a).

The cumulative number of deaths among dialysis patients in 2020 was 18% higher than in 2019, while the cumulative number of deaths among transplant patients in 2020 was 41% higher than in 2019 (Figure 13.12b).

Publication Date: accessed 9 Feb 2022

Publication Site: U.S. Renal Data System

COVID-19 and its Impact on Kidney Patients Utilizing U.S. Dialysis Centers

Link:https://www.kidney.org/news/covid-19-and-its-impact-kidney-patients-utilizing-u-s-dialysis-centers

Excerpt:

The National Kidney Foundation (NKF) and the American Society of Nephrology (ASN) stress the precarious position people with kidney failure, who are immunocompromised, face as the recent Omicron wave continues to spread among patients and staff at dialysis facilities. Cases of COVID-19 are causing serious illness, forcing shortened treatment times for patients, and exacerbating shortages in staff and supplies that impede access to this life-sustaining treatment. COVID-19’s impact on people with kidney diseases has resulted in the first decline in the number of patients on dialysis in the United States in the 50-year history of the Medicare ESRD Program.

…..

There are 783,000 individuals in the United States who have kidney failure, and just under 500,000 of these individuals require life-sustaining dialysis delivered in a dialysis center three times a week, four hours a day. During dialysis treatments, patients typically sit near other patients and staff in facilities that are not always well ventilated. Many of these patients are older, low-income, and from historically disadvantaged communities, and most have underlying conditions like diabetes and cardiovascular diseases.

Despite concerted efforts by dialysis organizations, nephrologists, and other clinicians to slow its spread, COVID-19 continues to run rampant through dialysis facilities. According to data from the US Renal Data System, 15.8% of all patients on dialysis in the United States had contracted COVID-19 as of the end of 2020. During the winter 2020 wave, weekly deaths due to COVID-19 peaked at nearly 20% and annual mortality during 2020 was 18% higher than in 2019.[1]

Despite these high rates of infection and mortality, dialysis patients were not prioritized for access to immunization when the vaccines became available a year ago even though evidence shows that the immune response to vaccination is blunted in dialysis patients. Furthermore, although antibody levels decline more rapidly in dialysis patients than in the general population[i], dialysis patients were not prioritized by the Food and Drug Administration (FDA) or the Centers for Disease Control and Prevention (CDC) when third doses of the vaccine were approved in August.[2] In addition, dialysis patients were also excluded from the groups eligible to receive prophylactic long-acting antibody therapy targeting the SARS-CoV-2 virus. Lastly, the National Institutes of Health did not receive funding for COVID-19 research to help people with kidney diseases or failure in any of last year’s relief packages.

[1] https://adr.usrds.org/2021/supplements-covid-19-disparities/13-covid-19-supplement

Publication Date: 18 Jan 2022

Publication Site: National Kidney Foundation