Covid-19 Updates & Info

[Togtdyalttai]

I've been extremely cautious throughout the pandemic: the only times I go out are to work, where I stay in a private office except for restroom trips and warming up my lunch, and to the grocery store once every two weeks. In six weeks once my mom has immunity, I plan to be less cautious: talk to people in person at work, see friends outside of work, go to grocery stores more frequently, get take out from restaurants, and maybe go on a road trip. But I'm not going to fly or eat at a restaurant until I've been vaccinated at the earliest, and possibly not until positivity rates are down to around 1% and case numbers under 5/100,000.

[ti-amie]

‘It’s a mess’: Biden’s first 10 days dominated by vaccine mysteries
Biden’s team is still trying to locate upwards of 20 million vaccine doses that have been sent to states — a mystery that has hampered plans to speed up the national vaccination effort.
By TYLER PAGER, ADAM CANCRYN and JOANNE KENEN
01/30/2021 07:00 AM EST

Joe Biden promised he’d bring in a competent, tested team to run the pandemic response, set ambitious vaccination targets and impose strict public health guidelines.

His team arrived at the White House with a 200-page response plan ready to roll out. But instead, they have spent much of the last week trying to wrap their hands around the mushrooming crisis — a process officials acknowledge has been humbling, and triggered a concerted effort to temper expectations about how quickly they might get the nation back to normal.

After a week on the job, Biden’s team is still trying to locate upwards of 20 million vaccine doses that have been sent to states — a mystery that has hampered plans to speed up the national vaccination effort. They're searching for new ways to boost production of a vaccine stockpile that they've discovered is mostly empty. And they're nervously eyeing a series of new Covid-19 strains that threaten to derail the response.

“It’s the Mike Tyson quote: ‘Everybody’s got a plan until they get punched in the mouth,’” said one person with knowledge of the vaccine effort who’s not authorized to discuss the work. “They are planning. They are competent. It’s just the weight of everything when you sit down in that chair. It’s heavy.”

Biden officials leading the coronavirus response launched a series of regular briefings this week to keep the public informed on the state of the pandemic and government efforts to contain it and rush vaccines out to as many Americans as possible.

But the briefings were short on details. And behind the scenes, officials say, the team was still struggling to get a handle on basic information, liaise with the career government workers who have been running the response and build out a long-term strategy for bringing — and then keeping — the virus under control.

“One of the virtues of a well-run transition is that by the time you take the reins, you have developed some rapport and trust with the career people you’re working with,” the person familiar with the administration’s work said. The “courtship has been unnaturally short,” the person added.

“Nobody had a complete picture," said Julie Morita, a member of the Biden transition team and executive vice president at the Robert Wood Johnson Foundation. "The plans that were being made were being made with the assumption that more information would be available and be revealed once they got into the White House.”

It's a steep challenge that Biden officials said they'd been anticipating for weeks, amid a rocky transition period that left them scrambling to piece together vaccine distribution plans and coordinate with state health officials.

Yet in the days since taking over, the Covid response team has confronted a situation that officials described as far worse than expected — and that has prompted public assessments so dour they surprised some who had worked on the administration's former transition team.

On Tuesday, Biden warned that the "vaccine program is in worse shape than we anticipated or expected," echoing complaints from his chief of staff, Ron Klain, that a "plan didn't really exist."

Biden's Covid response team has since made a concerted effort not to heap blame on the Trump administration, one official said — even as their vague allusions to a worse-than-expected situation have prompted speculation about what specific problems they've encountered.

But people with knowledge of the response detailed fresh concerns that are centered largely on the federal government's vaccine supply. Biden's team is still trying to get a firm grasp on the whereabouts of more than 20 million doses of Covid-19 vaccine that the federal government bought and distributed to states but has yet to record as being administered to patients.

Only a small percentage of those unaccounted for doses — roughly 2 million, two officials said — is due to lags in data reporting, the Biden team believes. That would mean the rest of the crucial supply is boxed away in warehouses, sitting idle in freezers or floating elsewhere in the complex distribution pipeline that runs from the administration to individual states.

That’s a dilemma that predated the Biden team’s arrival, with Biden himself hammering the vaccine rollout’s first weeks under the Trump administration as a “dismal failure.”

Yet the response team underestimated at the outset how difficult it would be to fix.

The Biden transition had only received high-level briefings on the distribution effort in the runup to the inauguration on Jan. 20, a transition official said, and was largely kept out of detailed discussions about the on-the-ground operation. The team didn't get granular access to Tiberius — the central government system used for tracking vaccine distribution — until the transition's final days.

It was not until after Biden was sworn in that the Covid response team discovered the system was blinded to much of the route that vaccines traveled from the government's distribution hubs to people's arms.

Instead, once the vaccine shipments are delivered to the states, responsibility for tracking them has been left up to states’ individual public health systems. The administration then only gets an update once the doses are actually administered and an official record is submitted.

“I think they were really caught off guard by that,” said one adviser. “It’s a mess.”

Top Biden officials have stressed that the missing doses are spread out across the states, which remain largely responsible for getting them to the health providers charged with vaccinating the tens of millions of people waiting in line for shots.

But the Covid team has since had to spend hours on the phone with various state officials trying to manually track down the unused doses, a time-consuming task that's sapped resources and has yet to give officials a full picture of where exactly supplies are going.

They've also sought to persuade health providers to stop holding doses in reserve, a practice borne out of concerns people wouldn't be able to get the second shot of their two-dose regimen — but one that's no longer necessary and has only contributed to the confusion, according to two people with knowledge of the discussions.

On a call with White House officials Tuesday, Arkansas Republican Gov. Asa Hutchinson vented that some states are bearing the brunt of the blame for the uneven rollout because of those reserves — a nuance not reflected in the federal numbers, according to notes of the call obtained by POLITICO.

The complaint prompted a pledge from Centers for Disease Control and Prevention Director Rochelle Walensky to issue clearer guidance for how states should manage their allocated vaccines.

Illinois Democratic Gov. J.B. Pritzker later blamed a Trump administration program that designated pharmacies to distribute vaccines to long-term care facilities for “bringing our numbers way down” because of how slow it has been to get shots in arms.

The White House has since given states permission to seize unused doses from the pharmacy program and reallocate them elsewhere.

“There is no doubt they are doing a better job,” George Helmy, the chief of staff for New Jersey Democratic Gov. Phil Murphy, said about the Biden administration. “We have a true partner who is being transparent and collaborative.”

As they grapple with the immediate distribution issues, federal officials have also raced to build out detailed plans for eventually distributing the shots to broader populations beyond health care workers and older Americans — a project that people familiar with the effort say the Trump administration never even started on.

And though the Biden team had planned to boost the pace of vaccine manufacturing over time, some Biden officials said they were shocked to learn soon after Inauguration Day that there was little in the federal vaccine reserve — and that the companies producing the shots were nowhere near capable of churning out as many doses as the Trump administration had projected in the preceding months.

The Biden administration has since warned that supplies will remain limited until the summer, raising the possibility of ongoing shortages even as the nation's daily vaccination rate picks up.

The White House cheered promising data on a new single-dose vaccine from Johnson & Johnson on Friday. But production obstacles have dampened expectations for its immediate impact, with one federal official likening the anticipated early flow of shots to "a trickle."

That has turned the Covid team's first days into something closer to a triage operation than the more orderly rollout that the administration had hoped for, especially as much of the federal health department operates on a skeleton staff made up of career officials and a handful of early political appointees.

And though the Biden administration is still pressing ahead with building mass vaccination sites and long-planned preparations for the long-term response effort, officials said the time lost navigating this early set of difficulties has set back a response already likely to consume much of Biden's first year in office.

"This isn't over any time soon," said Craig Fugate, a former Obama administration FEMA administrator who worked on the transition. "There may not be a bright red line where when we cross that line we're done, we're finished and everything's going to be great."

Rachel Roubein contributed to this report.

https://www.politico.com/news/2021/01/3 ... tes-463953

[ti-amie]

See me, I'd have Jen Psaki come out and say "it's a s**t show people. We're trying to track down just what the he** they did but so far we can't find any records of anything. We're doing the best we can and will keep you informed."

That's why I'm not in politics. Because that is damn sure what the GOP would've done.

[ponchi101]

Agree. There is a moment in which being diplomatic and measured means nothing.
I would go further: I would tell the press "make a team of five, and we will let you come in and see what we are dealing with. Yes, smartphones and all".

[JazzNU]

The long term care facility part is really interesting to hear. Because we have a ton of seniors in the state, plenty in LTC. Our county releases daily numbers and breaks out numbers in nursing facilities and prisons. I try to remember to check every day and I've been surprised to see fairly high LTC numbers and certainly no decrease and I've wondered why that is when they should be moving into the second shot phase at this point. We're not hearing much about healthcare workers getting sick, seems like it should've been the same case in the LTC by now.

[Deuce]

Perth, Australia - a city of 2 Million people - has gone into lockdown after 1 case - yes - ONE CASE - of COVID-19 was detected in the city.

Hey - if you're going to fight the virus, you might as well do it properly and completely.
Australia is among the most strict countries in terms of management of the virus. No-one can argue with their success so far.
See story below...

Perth’s 5-day lockdown isn’t an overreaction to a single case — it’s basic common sense

.

[dryrunguy]

To ponchi's question, I have been changed. I will be among the last to be vaccinated, but once I am, my behavior will not change much. No hugging, no shaking hands, no congregating... I am worried about the variants of today and the variants of the future. And the next pandemic is out there--just waiting for its next host that will give it the opportunity to replicate and mutate.

At some point, I will consider the idea of getting together in person with selective friends. But I will do it ONLY on my terms.

I realize this point of view is extreme. I know that. I want to see the future differently.

But like I said, I have been changed. Some would call it damaged.

[ti-amie]

[ti-amie]

[JazzNU]

There's a vaccine scandal in Philadelphia affecting over a million. It's barely a blip on the national news. The Villages has like 75,000 people living there, not a mystery why it's not getting national attention. Hopefully his grandmother gets a vaccine soon, but he's not thinking like a journalist, he's thinking like a grandson.

[ti-amie]

That ish in Philly is wild. How do you give a 22 year old with no background in health (or anything else) a contract like that?! He even took vaccine home to give to his girlfriend. The Twitterati are all over it.

[patrick]

At DeSantis Senior First plan, it will probably be 2023 before the regular population will get vaccinated at this pace.

[ponchi101]

Message to self: Avoid the Covid topic on Mondays. It is too much...

[ti-amie]

Sorry ponchi.

New diabetes cases linked to covid-19
Researchers don’t understand exactly how the disease might trigger Type 1 or Type 2 diabetes, or whether the cases are temporary or permanent. But 14 percent of those with severe covid-19 developed a form of the disorder, one analysis found.

By Erin Blakemore
Feb. 1, 2021 at 1:15 p.m. EST

Mihail Zilbermint is used to treating diabetes — he heads a special team that cares for patients with the metabolic disorder at Suburban Hospital in Bethesda, Md. But as the hospital admitted increasing numbers of patients with covid-19, his caseload ballooned.

“Before, we used to manage maybe 18 patients per day,” he said. Now his team cares for as many as 30 daily.

Many of those patients had no prior history of diabetes. Some who developed elevated blood sugar while they had covid-19, the illness caused by the novel coronavirus, returned to normal by the time they left the hospital. Others went home with a diagnosis of full-blown diabetes. “We’ve definitely seen an uptick in patients who are newly diagnosed,” Zilbermint said.

Although covid-19 often attacks the lungs, it is increasingly associated with a range of problems including blood clots, neurological disorders, and kidney and heart damage. Researchers say new-onset diabetes may soon be added to those complications — both Type 1, in which people cannot make the insulin needed to regulate their blood sugar, and Type 2, in which they make too little insulin or become resistant to their insulin, causing their blood sugar levels to rise. But scientists do not know whether covid-19 might hasten already developing problems or actually cause them — or both.

As early as January 2020, doctors in Wuhan, China, noticed elevated blood sugar in patients with covid-19. Physicians in Italy, another early hot spot, wondered whether diabetes diagnoses might follow, given the long-observed association between viral infections and the onset of diabetes. That association was seen in past outbreaks of other coronavirus illnesses such as SARS.

A year after the pandemic began, the precise nature and scope of the covid-diabetes link remain a mystery. Many of those who develop diabetes during or after covid-19 have risk factors, such as obesity or a family history of the disease. Elevated blood glucose levels also are common among those taking dexamethasone, a steroid that is a front-line treatment for covid-19. But cases also have occurred in patients with no known risk factors or prior health concerns. And some cases develop months after the body has cleared the virus.

John Kunkel, a 47-year-old banking executive in Evening Shade, Ark., was one of the surprise cases. He was hospitalized with covid-19 in early July. During a follow-up visit with his doctor, he learned he had dangerously high blood glucose levels and was readmitted. Kunkel has since received a diagnosis of Type 2 diabetes.

“I had no preexisting health issues,” he said. “I was blown away. Why?”

Kunkel has had five emergency room visits and three hospital stays since getting covid-19. He recently lost his job because he was unable to return to work, given his continuing health problems. “Will you get your life back?” he asked. “Nobody knows.”

As many as 14.4 percent of people hospitalized with severe covid-19 developed diabetes, according to a global analysis published Nov. 27 in the journal Diabetes, Obesity and Metabolism. The international group of researchers sifted through reports of uncontrolled hyperglycemia, or high blood sugar, in more than 3,700 covid-19 patients across eight studies. While those diagnoses might be the result of a long-observed response to severe illness, or to treatment with steroids, the authors wrote, a direct effect from covid-19 “should also be considered.”

“I had no preexisting health issues,” he said. “I was blown away. Why?”

Concerns that covid-19 might be directly implicated also were supported, they said, by the exceptionally high doses of insulin that diabetes patients with severe covid-19 often require and the dangerous complications they develop.

Researchers do not understand exactly how covid-19 might trigger Type 1 or Type 2 diabetes, or whether the cases are temporary or permanent. But they are racing to find answers to these and other questions, including whether the novel coronavirus may have spawned an entirely new type of diabetes that might play out differently from the traditional forms of the disease.

Francesco Rubino, a diabetes surgery professor at King’s College London, is convinced there is an underlying connection between the diseases.

Over the summer, he and a group of other diabetes experts launched a global registry of patients with covid-19-related diabetes. After they spread the word with an editorial in the New England Journal of Medicine, more than 350 institutions from across the world responded, he said.

The database is accumulating patients — over 150 so far — although it will take months for researchers to sift through the data to draw any conclusions. “We really need to dig deeper,” Rubino said. “But it sounds like we do have a real problem with covid and diabetes.”

Some of the cases reported to his database do not fit the usual profile of Type 1 diabetes, in which the pancreas produces little or no insulin, or Type 2, in which people become insulin resistant, he said. Usually, a patient with one type of diabetes will experience specific complications; for instance, those with Type 1 may burn through their fat stores, or those with Type 2 may experience a syndrome that can involve severe dehydration and coma as the body pumps excess blood sugar into the urine. In some patients with covid-19, though, complications cross types.

“There’s a good chance that the mechanism of the diabetes isn’t typical,” Rubino said. “There could be a hybrid form. It’s concerning.”

Rubino is especially worried about reports of diabetes diagnoses after mild or asymptomatic coronavirus infections. As the number of novel coronavirus infections continues to rise, he said, “you could see a significant new volume of diabetes diagnoses.”

Diabetes already is increasing at an alarming rate in the United States. An estimated 34.2 million people, or 10.5 percent of the population, have the disorder, according to federal health data. And approximately 1 in 3 Americans, or 88 million people, have prediabetes, which indicates they are on a path to Type 2. If left uncontrolled, the disease can damage many parts of the body and is associated with serious complications including heart disease, stroke, blindness, kidney failure and nerve damage.

But whether those with diabetes that is newly diagnosed after covid-19 will have a lifelong problem is unclear. After the 2003 SARS pandemic, Chinese researchers tracked 39 patients with no history of diabetes who had developed acute diabetes within days of hospitalization with SARS. For all but six, blood sugar level had fallen by the time they were discharged, and only two still had diabetes after two years. The researchers also found evidence that the SARS virus might attack insulin-producing beta cells in the pancreas.

Beta cells play starring roles in both types of diabetes: The bodies of those with Type 1 attack and destroy the cells altogether, halting insulin production. Type 2 diabetics become resistant to the insulin they produce, so the beta cells make more and more, and eventually are worn out.

“If scientists could figure out how or if viral infection can damage beta cells, or what role viruses play in the development of the disease, it would be a real turning point,” said Katie Colbert Coate, a diabetes researcher and research instructor in medicine at Vanderbilt University Medical Center.

Though people with diabetes are no more susceptible to contracting covid-19 than those without, they are at much higher risk of severe complications or death once they do. In the early days of the pandemic, just over a third of those who died of covid-19 in British hospitals had preexisting cases of diabetes. Doctors in Wuhan also noticed that those with newly diagnosed diabetes were more likely to need intensive care than those who had diabetes before they contracted covid-19.

New diagnoses of diabetes in people with no classic risk factors also are scattered throughout case reports: A 37-year-old, previously healthy Chinese man who went to the hospital with a severe, and in some cases fatal, diabetes complication; a 19-year-old German who developed Type 1 diabetes five to seven weeks after a novel coronavirus infection but who lacked the antibodies commonly associated with the autoimmune disease.

Doctors at Children’s Hospital Los Angeles, meanwhile, noticed an increase in the number of Type 2 diagnoses in children, as well as a severe complication of diabetes. After some of them showed evidence of past coronavirus infections, Senta Georgia, an investigator in the hospital’s Saban Research Institute, began looking deeper. Her research, which repurposes tissue from primates used in vaccine tests, is undergoing peer review.

“Only with the scientific public square can we put all of this data out there, evaluate its strengths and weaknesses … until we really get the information we need,” Georgia said.

Such reports also have increased the sense of urgency for researchers like Coate, who dropped other work and began looking for keys to understanding the mechanism of the disease by examining how covid-19 might damage beta cells or other structures in the pancreas. She and others are asking whether certain covid symptoms predict whether a patient is vulnerable to diabetes and, most important, whether the disease’s onset is an effect of the immune response or a result of the virus directly attacking insulin-producing cells.

ACE2 receptor cells, the novel coronavirus’s entryway into the body, could provide one answer. When the spike proteins that surround the virus latch onto a host cell with an ACE2 receptor, they open up a cellular doorway that allows the virus to hijack the cell.

Strong evidence of ACE2 receptors on beta cells could confirm the long-standing suspicion that viruses trigger diabetes. But the research findings are inconclusive: Since the pancreas breaks down quickly after death, obtaining good samples from autopsied humans is difficult. And each study has its own limitations.

Last year, Cornell University researchers grew human pancreas cells and managed to infect them with SARS-CoV-2, as the novel coronavirus is technically known. They found ACE2 receptors on the cells, but the cells had been cultivated in a laboratory, not a human body.

Coate and her colleagues at Vanderbilt University were able to confirm the presence of ACE2 receptors in the physical structures of the pancreas, but their study focused on patients without covid-19 and found no evidence of the receptors on the insulin-producing beta cells. An Italian study did find the receptors in beta cells, but the donors did not have covid-19, either. Until receptors in pancreatic beta cells in tissue from covid-19 patients can be consistently confirmed by other researchers, the hunt for the mechanism underlying the diabetes-covid-19 connection continues. So does research on ways covid-19 might harm other parts of the endocrine system, which also might play a role in the disease mechanism.

For newly diagnosed patients such as nurse practitioner Tanisha Flowers, the answers can’t come soon enough.

Infected in April while working in a covid-19 ward in a Richmond hospital, the 40-year-old was diagnosed with diabetes in October. She now takes daily medications, watches her diet and is all too aware that she may be diabetic for life.

“I’m not myself anymore,” Flowers said. “No one knows what the lasting outcomes are.”

https://www.washingtonpost.com/health/2 ... -diabetes/

[JazzNU]

New diabetes cases linked to covid-19
Researchers don’t understand exactly how the disease might trigger Type 1 or Type 2 diabetes, or whether the cases are temporary or permanent. But 14 percent of those with severe covid-19 developed a form of the disorder, one analysis found.

That is disturbingly high. It'd be interesting to see if that number remained steady with in-depth research.

Not sure why this doesn't mention it, but covid was thought of as a respiratory disease early on because of all the lung issues, but many are increasingly classifying it as a vascular disease. In that context, the sudden onset of diabetes makes a good deal more sense.