“The moral test of a government is how it treats those who are at the dawn of life, the children; those who are in the twilight of life, the aged; and those who are in the shadow of life, the sick and the needy, and the handicapped.” – Hubert Humphrey
passionate pachyderms
Pharmacist Steve steve@steveariens.com 502.938.2414
The Centers for Disease Control and Prevention (CDC) on Wednesday announced shorter coronavirus-related quarantine periods ahead of anticipated holiday travel.
The CDC announced two acceptable quarantine periods, though noted that the previously-established 14 days of quarantine is the best way to reduce risk of virus spread.
Officials said quarantine can now end after 10 days without a COVID-19 test, if the person reports no symptoms, or after seven days with a negative test result if the person reports no symptoms.
The agency advised people should still watch for symptoms for COVID-19 14 days after exposure. The announcement arises from analysis of new research and modeling data. The shorter length of quarantine is hoped to reduce economic hardship and lessen the stress on the public health system amid a rising number of infections.
The CDC plans to update its webpage with the new guidance on Wednesday.
The announcement follows news from just a day prior, when Fox News obtained exclusive documents on the expected release of guidance.
Fox News obtained an internal CDC document on Tuesday which outlined the proposed changes. A source told Fox News that the changes have been discussed with and approved by the White House Coronavirus Task Force.
On July 16, 1945, the U.S. performed the first atomic bomb test in New Mexico. As the blast wave reached Enrico Fermi, the noted physicist and inventor of the world’s first nuclear reactor, who was among those watching the explosion some 10 miles away, he dropped bits of paper in order to see how far they would be blown. Fermi reasoned that the distance traveled by the paper could be used to make a quick calculation of the bomb energy yield.
His estimation was 10 kilotons of TNT. The actual energy of the blast was 18.6 kilotons of TNT.
Fermi’s quick calculation was within an order of magnitude and therefore within the mathematics of such things. His estimate was impressive. Fermi was famous for many things, but his bits-of-paper trick cemented his fame in what is now referred to as a back-of-the-envelope calculation: the use of estimated or rounded numbers to make rapid ballpark calculations, usually done on a scrap of paper like the back of an envelope.
Americans consistently score low on tests for mathematics. Most Americans consider themselves bad at math and nearly one in five adults suffer from high levels of math anxiety. This is a particularly bad time to be bad at math as we try to make sense of numbers about infection and death by COVID-19.
What Fermi understood is that the real test of math aptitude is the ability to logically estimate. The trick is to break down a seemingly complex equation into smaller parts where the number becomes manageable and relatable.
This is particularly important when the number is really big or really small. What Fermi was actually contemplating with falling bits of paper was the number of people that the bomb would kill.
Recently, Pfizer announced it had a vaccine that is looking like it will be 95% effective against COVID-19. Pfizer, like Fermi, is also thinking about death.
Sometimes an estimation needs a little more background and an understanding of what is at stake. Census data from 2019 estimated the U.S. population at 328.2 million people. We know that about 10 million people in the U.S. have so far contracted COVID and we will assume that prior infections confer immunity and those individuals will not be vaccinated. We can now work with the total population uninfected and unvaccinated to be 318.2 million people.
Many people have said they would refuse a COVID vaccine, and this position, known as vaccine hesitancy, makes it difficult to predict how many people would actually accept a COVID vaccine. For DTP (diphtheria, tetanus, pertussis), a required vaccine, the vaccine rate was 83% of the target population. Polio vaccine uptake was 92.7%. These are long-standing and generally well-accepted vaccines, but for other equally effective vaccines, the vaccine acceptance rate is actually falling.
Let’s assume a relatively high rate of 80% uptake for a new COVID vaccine. This means 20% of 318 million people won’t get vaccinated — about 64 million people. Recall that the Pfizer vaccine is claimed to be 95% effective, so 5% of the vaccinated population will get no benefit and will still be at risk for catching COVID-19. The number of the original vaccinated population that will get no benefit is 13 million and when we add this to 64 million unvaccinated people, we get 77 million people.
COVID-19 does not kill everyone who becomes infected. The amount of killing is called the infection fatality rate and for COVID-19, that number has been estimated to be 0.65%, but may be as high as 2%. If every unvaccinated or ineffectively vaccinated person still got COVID-19, the number of Americans that would still die would range from 500,000 to two million — and that’s with a vaccine that is 95% effective.
To put that into perspective, that means COVID-19 would kill the equivalent of every single person in a city the size of Tampa, Miami, Long Beach, or Minneapolis — or even in a city as large as Phoenix, San Diego, or Philadelphia.
We have left off important information from our back-of-the-envelope equation: How long will it take to vaccinate 254 million people? How long will it take to make enough vaccine doses for 254 million people?
In 1972, smallpox was considered eradicated in Europe. In March of that year, the former country of Yugoslavia suffered an outbreak. The government sprang into action and reacted swiftly. On March 16, 1972, martial law was declared, population movement was severely restricted, and in effect, the entire country was placed under quarantine. The army was used to enforce the quarantine and over a period of approximately 3 months, the entire population of 18 million was vaccinated and the outbreak ended.
Of course, 18 million is a much smaller number than 254 million and I doubt Americans would look kindly on the imposition of martial law for months and months while we carry out vaccinations. As a result, we can expect that our back-of-the-envelope calculation, which assumes mass, instantaneous vaccination, actually underestimates the number of people still vulnerable to COVID-19.
There are other complications: Moderna’s and Pfizer’s vaccines use mRNA technology, which requires very cold storage with dry ice. We now learn that although the toilet paper shortage is under control, the dry ice shortage is getting worse. Moderna claims its mRNA vaccine only needs more conventional freezer and refrigeration temperatures.
To produce the needed quantity of vaccines is no small feat and might require a level of commitment that up until now we have failed to achieve.
We must also consider who will benefit from this vaccine aside from those whose lives are saved. It was recently reported that Pfizer CEO Albert Bourla sold 62% of his stock in the company on the same day the company announced the results of its COVID-19 vaccine trial. The value of his stock sell-off was about $5.6 million earned in a single day. Others in the company also sold stock and earned millions of dollars.
In 2018, the median individual income in the U.S. was $33,706 per year. It would take that person with that income about 169 years to earn $5.6 million dollars.
The lived reality of COVID-19 is that it has become a new cause of premature death. To get a sense of how many Americans have died so far from COVID-19, you would need to add up all the American deaths in the Korean War, the Vietnam War, and the Iraq and Afghanistan Wars, as well as the number of people killed annually in car accidents and by firearms, as well as the number of people killed annually by the flu.
A 95% effective vaccine will likely reduce the number of people killed by COVID-19, but that will not be nearly enough to bring death by COVID-19 to a halt. In order to do that, we will likely need a plan of action far beyond what to this point we have been willing to do.
The announcement of the development of 95% effective vaccines is good news, but it is no cause for celebration. Even with a perfect, instantaneous rollout, hundreds of thousands of people would continue to die.
At the end of the day, the real tragedy might be how little we did for so long and how we can abide 260,000 deaths in this country so far and not really feel it.
Canada has banned the export of some prescription medicines in order to prevent a shortage in the country.
The decision is in response to a US plan that would allow for drugs to be imported from Canada to make them cheaper for Americans.
Although prescription drug prices in Canada are higher than some nations, they are cheaper than the US.
A number of Canada’s drug suppliers and residential treatment center had warned that the plan, implemented by President Trump, would cause shortages.
The pandemic has already increased demands for some medicines, according to the AFP news agency.
A statement from Canada’s health ministry said the country sources 68% of its drugs from overseas and therefore it was important to avoid any disruptions to supplies.
“Companies will now also be required to provide information to assess existing or potential shortages when requested, and within 24 hours if there is a serious or imminent health risk,” the statement said.
Mr Trump signed an executive order in July to allow for the legal importation of cheaper drugs from Canada.
A month later, Canadian Prime Minister Justin Trudeau said he was happy to help other nations with their supplies if possible but his priority was protecting the needs of Canadians.
Drugmakers have faced intense criticism from US politicians – including Mr Trump – as well as insurance companies and patients’ groups over the high cost of new medicines and price hikes in some older generic drugs.
President-elect Joe Biden has previously spoken of potentially importing drugs to bring down costs.
This is the hack that proved America’s elections can be stolen using a few lines of computer code. The ‘Hursti Hack’ in this video is an excerpt from the feature length Emmy nominated documentary ‘Hacking Democracy’. The hack of the Diebold voting system in Leon County, Florida, is real. It was verified by computer scientists at UC Berkeley. To watch the full movie, visit http://www.hackingdemocracy.com For updates, visit the official Facebook page at http://www.facebook.com/hackingdemocr… HACKING DEMOCRACY – Directed by Simon Ardizzone and Russell Michaels The disturbingly shocking HBO documentary HACKING DEMOCRACY bravely tangles with our nation’s ills at the heart of democracy. The film the Diebold corporation doesn’t want you to see, this revelatory journey follows tenacious Seattle grandmother Bev Harris and her band of extraordinary citizen-activists as they set out to ask one simple question: How does America count its votes? From Florida and California to Ohio and Washington State, filmmakers Simon Ardizzone, Russell Michaels and Robert Cohen starkly reveal a broken system riddled with secrecy, incompetent election officials, and electronic voting machines that can be programmed to steal elections. Equipped only with a powerful sense of righteous outrage, the activists take on voting machine industry, exposing alarming security holes in America’s trusted voting machines. They even go dumpster diving at a county election official’s office in Florida, uncovering incendiary evidence of miscounted votes. But proving our votes can be stolen without a trace culminates in a duel between Diebold voting machines and a computer hacker from Finland – with America’s democracy at stake. ‘Hacking Democracy’ was nominated for an Emmy award for Outstanding Investigative Journalism. “Disturbing stuff. . . It’s not shocked-shocked you feel watching this; it’s genuine shock.’ – The New York Times “It is hard to imagine a documentary that is more important to the civic life of the nation — let alone one that is so compelling and ultimately moving” – Baltimore Sun After we filmed the ‘Hursti Hack’ California’s Secretary of State ordered an investigation. The best computer scientists at UC Berkeley analysed the Diebold voting machines’ computer source code. The UC Berkeley Report can be found here: https://www.sos.state.tx.us/elections… Page 2 of the report states: “Harri Hursti’s attack does work. Mr. Hursti’s attack on the AV-OS is definitely real. He was indeed able to change the election results by doing nothing more than modifying the contents of a memory card. He needed no passwords, no cryptographic keys, and no access to any other part of the voting system, including the GEMS election management server.” We hope that as many people as possible will vote because the bigger the turnout the harder it is for someone to rig the total national results.
See previous you tubes on Covid 19 we have a national health car crisis with people believing masks are the answer when the truth masks only are the first part of control, second and most importantly are HANDS and direct spread
Science’s COVID-19 reporting is supported by the Pulitzer Center and the Heising-Simons Foundation.
In late June, Sanne de Jong developed nausea, shortness of breath, sore muscles, and a runny nose. At first, she thought it might be lingering effects from her COVID-19 infection in the spring. De Jong, 22, had tested positive on 17 April and suffered mild symptoms for about 2 weeks. She tested negative on 2 May—just in time to say farewell to her dying grandmother—and returned to work as a nursing intern in a hospital in Rotterdam, the Netherlands.
But when her symptoms re-emerged, her doctor suggested she get tested again. “A reinfection this soon would be peculiar, but not impossible,” she told De Jong, who by then had again lost her sense of smell and had abdominal pains and diarrhea.
The call from her municipal health service came on 3 July. De Jong had tested positive again. “You’re kidding me!” she recalls saying.
Scientists are keenly interested in cases like hers, which are still rare but on the rise. Reinfections hint that immunity against COVID-19 may be fragile and wane relatively quickly, with implications not just for the risks facing recovered patients, but also for how long future vaccines might protect people. “The question everybody wants to answer is: Is that second one going to be less severe most of the time or not?” says Derek Cummings, who studies infectious disease dynamics at the University of Florida. “And what do reinfections teach us about SARS-CoV-2 immunity in general?”
South Korean scientists reported the first suspected reinfections in April, but it took until 24 August before a case was officially confirmed: a 33-year-old man who was treated at a Hong Kong hospital for a mild case in March and who tested positive again at the Hong Kong airport on 15 August after returning from a trip to Spain. Since then, at least 24 other reinfections have been officially confirmed—but scientists say that is definitely an underestimate.
To count as a case of reinfection, a patient must have had a positive polymerase chain reaction (PCR) test twice with at least one symptom-free month in between. But virologist Chantal Reusken of the Dutch National Institute for Public Health and the Environment (RIVM) explains that a second test can also be positive because the patient has a residue of nonreplicating viral RNA from their original infection in their respiratory tract, because of an infection with two viruses at the same time or because they had suppressed but never fully cleared the virus. So most journals want to see two full virus sequences, from the first and second illnesses, that are sufficiently different, says Paul Moss, a hematologist at the University of Birmingham. “The bar is very high,” Moss says. “In many cases, the genetic material just isn’t there.”
Even if it is, many labs don’t have the time or money to clinch the case. As a result, the number of genetically proven reinfections is orders of magnitude lower than that of suspected reinfections. The Netherlands alone has 50 such cases, Brazil 95, Sweden 150, Mexico 285, and Qatar at least 243.
The Hong Kong patient’s second infection was milder than the first, which is what immunologists would expect, because the first infection typically generates some immunity. That may explain why reinfections are still relatively rare, says Maria Elena Bottazzi, a molecular virologist at Baylor College of Medicine and Texas Children’s Hospital.
They could become more common over the next couple of months if early cases begin to lose their immunity. Reinfections with the four coronaviruses that cause the common cold occur after an average of 12 months, a team led by virologist Lia van der Hoek at Amsterdam University Medical Center recently showed. Van der Hoek thinks COVID-19 may follow that pattern: “I think we’d better prepare for a wave of reinfections over the coming months.” That’s “bad news for those who still believe in herd immunity through natural infections,” she adds, and a worrisome sign for vaccines.
And there are hints that people who have serious COVID-19 mount the strongest responses, just as in the two other serious human diseases caused by coronaviruses, severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome. Both trigger high antibody levels that last up to 2 years, and T cell responses to SARS can be detected even longer. Because of these persistent immune defenses, “I expect that most reinfections will be asymptomatic,” says Antonio Bertoletti, an infectious disease specialist at the National University of Singapore. He says being reinfected might even be a good thing, “since you will continue to boost and train your immune system.”
Not all reinfections seen so far are milder. “We see all different combinations,” Reusken says. The second time Luciana Ribeiro, a surgeon in Rio de Janeiro, got sick, it was much worse. She was first infected by a colleague in March, developed mild symptoms, and tested negative afterward. Three months later, Ribeiro had symptoms again—she could no longer smell her breakfast, she says—but she didn’t immediately get a test because she thought she was immune. When she grew more and more tired, she requested a computerized tomography scan. “It showed that half of my lungs were affected,” Ribeiro says. “‘This clearly is COVID,’ the radiologist told me. I didn’t believe it, but I tested positive.”
Ribeiro thinks she was reinfected by a patient in the intensive care unit where she works, and that her second episode may have been worse because virus-laden aerosols produced during a medical procedure entered her lungs. But she has another theory as well: “It could be that the virus has become more virulent in the meantime.”
So far, no proof exists of mutations that would make the virus more pathogenic or that might help the virus evade immunity. But a recent preprint by a team at the Swedish Medical Center in Seattle suggests one may exist. The team describes a person who was infected in March and reinfected 4 months later. The second virus had a mutation common in Europe that causes a slight change in the virus’ spike protein, which helps it break into human cells. Although symptoms were milder the second time, neutralization experiments showed antibodies elicited by the first virus did not work well against the second, the authors note, “which could have important implications for the success of vaccine programs.”
And some scientists worry about another scenario that could make the second episode worse: enhanced disease, in which a misfiring immune response to the first infection exacerbates the second one. In dengue fever, for example, antibodies to an initial infection can actually help dengue viruses of another serotype enter cells, leading to a more severe and sometimes fatal second infection. In some other diseases, the first infection triggers ineffective, nonneutralizing antibodies and T cells, hampering a more effective response the second time around.
A recent preprint published by Chinese researchers suggested patients whose first COVID-19 infection is very severe may have ineffective antibodies, which might make them more prone to severe reinfections. But so far there’s no evidence from reinfected patients to suggest enhanced disease is at work in COVID-19—although scientists haven’t ruled it out either. Vaccination against some diseases can also trigger enhancement later—a known or suspected complication of vaccines against dengue and respiratory syncytial virus in humans and a coronavirus disease in cats. But there is no evidence that candidate COVID-19 vaccines do so, Cummings says. “Having worked with dengue I can say the empirical basis for enhanced disease is just not there, while it was very strong in dengue.”
De Jong’s virus samples were both sequenced in Reusken’s lab, with a surprising outcome: The sequences were not identical, but showed so much similarity that RIVM virologist Harry Vennema says she probably did not clear the virus in April and that it started to replicate again in June. “I did have a lot of stress after that first episode because my grandmother died,” De Jong says. “Maybe that had an impact on my immune system.”
That makes her case different from a true reinfection—although Vennema says perhaps they should be considered similar, because in both cases the immune system failed to mount a protective response. His lab has found at least one similar case, he says, suggesting some unconfirmed reinfections might actually be a resurgence of the original virus.
Other coronaviruses can also cause persistent infections, says Stanley Perlman of the University of Iowa. In 2009, his team showed that an encephalitis-causing mouse coronavirus can linger in the body and continuously trigger immune responses, even if it doesn’t replicate. And in a preprint posted on 5 November, a team of U.S. scientists shows SARS-CoV-2 can persist for months inside the gut. Persistent infections, they suggest, may help explain the extraordinarily long-lasting symptoms that afflict some COVID-19 survivors.
De Jong is experiencing some of those symptoms. Although she tested negative in September and has high levels of neutralizing antibodies, suggesting she is protected for at least a couple of months, she still suffers from gastrointestinal complaints, fatigue, and cognitive impairment. De Jong says her story is a warning to people who had the virus and think they’re now invulnerable: “Please be cautious. You can get it again.”
This chart is suppose to be from the CDC. It indicates that only 9.2% of opiate OD’s are from pharma opiates, BUT – the title on the graph says “ILLICIT DRUGS”… so none of the OD’s from a pharma opiate alone the person DID NOT HAVE A RX FOR THE PHARMA OPIATE IN THEIR TOXICOLOGY ? There are ten columns and six columns indicated that illegal Fentanyl was found in toxicology – either the sole reason for the OD or in combination with other substances. Those percentages add up to at least 50% of all OD’s from this group of OD’s.
Two important years to note in this graph. 2012, reportedly the year that opiate Rxing peaked and 2016 the start of the CDC guidelines.
All the lines – except the > 65 y/o shows a sharp upturn.
From 2012 to 2017 all the values more than doubled.
Does this suggest that those >65/yo continued to get at least a moderate amount of pain medication ?
What we still don’t know – either because the CDC doesn’t have the data or doesn’t share the data, if these OD’s were accidental overdoses or SUICIDES ?
Does this also suggest that illegal Fentanyl started showing up on the street as “Heroin” or the street dealers were mixing in illegal Fentanyl to increase the available supply. Heroin has to be grown whereas illegal Fentanyl is chemical reactions and the only limits to the quantity that can be produced/obtained is obtaining the basic chemicals and space to “mix the chemicals and package the final product”.
It was claimed that Illegal Fentanyl was less expensive than Heroin and mg to mg it was at least TWELVE TIMES the potency.
Newton’s Third Law of Motion. It states, “For every action, there is an equal and opposite reaction”… so it would appear that for every action by the Federal/State bureaucracies to stop addiction and OD’s … DID JUST THE OPPOSITE
Robert Safian, MD, wrote system’s board about toxic culture, pursuit of profit over people
In ongoing drama at Michigan’s Beaumont Health system, one of its long-time cardiologists has sent two letters to its board calling for executives to be fired.
“The longer corporate leadership remains, the greater our decline,” Robert Safian, MD, wrote in one of the letters, which was obtained by local news site Deadline Detroit.
The letters come after healthcare workers and local leaders fought off a proposed merger between eight-hospital Beaumont and 26-hospital Advocate-Aurora. Executives called off the deal in early October, after many physicians opposed it and expressed a lack of confidence in corporate leadership via an internal survey.
In the letters, Safian requested the board terminate CEO John Fox as well as the system’s chief operating officer and chief medical officer. Safian said more than 100 “physician-leaders” at Beaumont’s Royal Oak hospital alone will make major changes to their practices this year, including relocating, “as a result of the toxic culture” at Beaumont.
“When hospital leadership cuts costs by cutting essential services, forcing physician leaders out of the institution, failing to support unique programs, bartering physician and nursing services to the lowest bidder, severely reducing supplies, mandating use of equipment against the will of physicians, and instituting any other ‘cost-saving’ strategies that are anti-patient, then leadership has crossed the line into fiscal irresponsibility (malfeasance?),” wrote Safian, who has been with Beaumont since 1991.
Noting executives and administrators accepted bonuses in March — including $2.6 million for Fox — Safian added: “And to use financial hardship as a justification for cuts, and then to receive financial incentives to make such cuts, is ethically and morally reprehensible.”
This year Beaumont has accepted a combined $866.9 million in CARES Act funds, including $363.1 million in grants that do not have to be paid back, according to Good Jobs First. Sources and reports say Beaumont also sits on more than $2 billion in reserves. (Beaumont did not list reserves in its most recent federal Form 990 tax filing, from 2018, and system representatives did not answer MedPage Today’s questions about them.)
Brian Berman, MD, Beaumont’s former pediatrics chief, was fired after he objected to Royal Oak emergency center cutbacks, according to Deadline Detroit. He was escorted out of the hospital in front of his staff.
Safian writes that an internal medicine and emergency room physician were also terminated for raising concerns. Kelly Levasseur, DO, who directed the pediatric ED, resigned because she lacked “confidence in corporate leadership.”
“Corporate leadership has created a culture of fear and intimidation, and many Beaumont workers, including physicians, have been ‘forced out’ after disagreeing with corporate decisions. This toxic culture has been progressively worsening over the last few years,” he wrote.
The urology department chair, 25 orthopedic surgeons, and a cardiology practice have sent letters to board chair John Lewis, a former Comerica executive, complaining about Beaumont executives.
Safian also asserted that more than 200 Beaumont nurse anesthetists were coerced into signing contracts with NorthStar, which Beaumont hired this year to replace its longtime independent anesthesia services provider. Meanwhile, dozens of anesthesiologists are leaving the system, he said.
The NorthStar decision “has upset the personal and professional careers of hundreds of Beaumont anesthesiologists and [nurse anesthetists], and has created a situation in which the quality of our specialty anesthesiology services in 2021 will be much lower than what we have experienced for the last 3 decades,” he wrote.
Safian could not be reached for comment this week, but he emailed MedPage Today when the Advocate-Aurora deal fell through on Oct. 2: “Merger is relatively minor in terms of imminent threat to the system.”
In calling for Beaumont executives to be removed, Safian echoed the sentiments expressed in a letter written by Mark Shaevsky, JD, a prominent local attorney and former board member, in August. “There’s been a lack of respect for professionals in the organization,” Shaevsky told MedPage Today then, with Fox aiming primarily to achieve a 4% operating margin despite Beaumont’s nonprofit status.
Fox’s employment contract with Beaumont was extended by two years beyond this year, he said during an August interview with a local publisher.
Beaumont is planning a time to discuss Safian’s first letter, according to a statement it provided to Becker’s Hospital Review last week, saying that the letter contains several errors.
A Beaumont spokesperson did not respond to MedPage Today’s request for comment on Tuesday.
