'twindemic' nears

A fall ‘twindemic’? As US nears 200000 coronavirus deaths, experts fear COVID-19, flu may be a deadly combo – msnNOW


COVID-19 widespread testing is crucial to fighting the pandemic, but is there enough testing? The answer is in the positivity rates.


As a physician at a Boston community health center that serves a large minority population, Dr. Julita Mir has had a close-up view of the coronavirus pandemic’s devastating impact, even beyond the obvious.

Mir tells of the patient from Guatemala who tearfully begged for a letter authorizing her to work despite having COVID-19 symptoms, and of a patient from Vietnam who postponed his liver ultrasound for six months as he sheltered in place, only to find out in mid-August that he had a fairly large tumor. Mir also knows of people taking Tylenol before a temperature check so they can pass and get the OK to work that day.

But as the U.S. approaches 200,000 deaths from COVID-19, more than any other country, what really troubles Mir is not so much what she has seen but what she envisions for the upcoming months as a combination of factors threatens to negate recent gains – and result in a deadly fall.

“My main fear is we will see cases of maybe influenza, maybe COVID, maybe some of the other respiratory viruses,’’ Mir said, “and because rapid testing is not available on a widespread basis, we will be in front of the people and we won’t know what they have.’’

Many in the medical community share her concerns.

The return of students to schools and colleges amid the coronavirus prevalence, mixed with the approaching flu season and easing of restrictions after a second round of tightening, makes for a worrisome scenario for public health specialists.

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In California, which has the most people and COVID-19 cases of any state, the daunting challenges ahead may be further complicated by the smoke-filled air from an already hyperactive fire season that still has two months to go.

‘Hard to think of a positive scenario’

Dr. John Swartzberg, professor emeritus of infectious diseases and vaccinology at the University of California-Berkeley, said he expects the current national trend of decreased coronavirus-related deaths to continue through September, but then pick up gradually in October and even more so in November. Deaths from COVID-19 typically trail infections by about a month.

“It’s hard for me to think of a positive scenario where things are going to get better in October and November,’’ said Swartzberg, who is highly critical of the pandemic response by President Donald Trump’s administration. “I don’t see behavior changing adequately. I don’t see testing ramping up. I see political winds continue to be oppressive to doing the right things.’’

Swartzberg spent 30 years in clinical practice and said it wasn’t hard to diagnose the flu through a phone call or in-person consultation with a patient. That changed with the arrival of COVID-19, which presents very similar symptoms to the flu and other diseases caused by respiratory viruses that flourish in the fall and winter, when cold weather prompts people to move indoors. 

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Absent readily available coronavirus testing with quick results – still a major hurdle across much of the country – the resulting confusion and proliferation of cases of COVID-19 and the flu could result in what some are calling a “twindemic,’’ which could overwhelm the health care system.

According to the Centers for Disease Control and Prevention, the flu has killed an average of 37,000 Americans per year since 2010. CDC Director Dr. Robert Redfield has said he’s especially worried about the possible impact on the coronavirus crisis of an early peak to the flu season, which typically gets going in late October, gathers steam in the next two months and crests in January and February.

With children and young adults back in classrooms for the first time since the hurried shutdown of schools and colleges in March, the chances for disease transmission are markedly enhanced, even when it’s still not certain how much kids spread the coronavirus. Recent studies indicate they can be transmitters even if asymptomatic

“There’s a question about what role schools are going to play with COVID, but there’s absolutely no question what role schools play with influenza,’’ Swartzberg said. “Schools are the breeding ground for influenza. The kids bring it home to mom and dad and grandma and grandpa.’’

Older populations are at higher risk for the harshest effects of COVID-19, and developing the illness at the same time or successively with the flu could be fatal.

School reopenings have already yielded clusters of coronavirus cases in several states, at times forcing a return to remote learning. Colleges have been an even bigger trouble spot, reporting more than 10,000 positive tests from the beginning of the fall term through the end of August, and more than a dozen colleges across the country have reported more than 1,000 cases. The University of Alabama alone recorded more than 1,000 cases in the first nine days of class, and more than 2,300 students have tested positive so far. 

A New York Times survey of more than 1,500 institutions of higher learning revealed at least 88,000 infections and 60 deaths since the pandemic began.

A glimmer of hope out of Australia

Dr. George Rutherford, an infectious disease specialist at UC-San Francisco who heads California’s contact tracing program, calls middle schools, high schools and universities “big incubators of COVID-19,’’ pointing out they have been the sources of massive outbreaks in other parts of the world.

Given the early results in the U.S., the prospects for the coming months are not encouraging.

“To have the fate of the western world resting in the hands of 12- to 22-year-olds, it’s a little scary,’’ Rutherford said.

However, Rutherford finds a sign of hope in reports out of Australia, whose flu season precedes and often serves as a harbinger for the one in the U.S. Australia’s winter concluded Aug. 31, and Rutherford said the country of 25 million experienced its mildest flu season in five years.

There might be other reasons at play too, but it appears measures taken to keep the coronavirus at bay were a contributing factor.

“The smart money says there’s been much less circulation of influenza in Australia over this winter and it may well be a secondary effect of increasing respiratory precautions, like wearing masks and social distancing,’’ Rutherford said.

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The Australian government also launched an aggressive immunization campaign, increasing the number of flu vaccines it secured from 13.2 million in 2019 to 18 million and promoting the free shots. One survey revealed in late May that 72% of Australians had either been inoculated for the flu or intended to.

That figure may be out of reach for the U.S., where less than half of Americans received a flu shot last year. Redfield told WebMD last month that the CDC has procured an extra 10 million doses and he’s hoping 65% of Americans will get the vaccine, thereby blunting the impact of the flu coinciding with COVID-19.

Mir, the infectious disease doctor in Boston, said many families have failed to come in to have their children vaccinated this year out of fear of being exposed to the coronavirus.

She has also heard of pushback against a COVID vaccine once it’s available, which is consistent with a Gallup poll released Aug. 7 that showed 35% of Americans would not get the vaccine even if it were free and approved by the Federal Drug Administration.

Vaccine rejection has become a major issue for public health officials, part of what Dr. Anthony Fauci, the nation’s top infectious disease specialist, has referred to as an “anti-science bias.’’ The problem may have been exacerbated by increasing evidence of political pressure on the CDC and the FDA.

‘Failure of public trust’ a complicating factor

Barbara Koenig, a bioethics expert at UC-San Francisco who served on the advisory committee to the CDC’s director, notes that there’s a social dimension to the pandemic response that’s reflected in the public’s attitudes toward wearing face masks, maintaining social distance and accepting vaccinations.

“In some cases the idea that freedom is the most important value is very, very powerful,’’ Koenig said. “We also are existing in a moment of failure of public trust or lack of trustworthiness, and a reduced belief in scientific expertise. Those things make our efforts to deal with both flu and COVID difficult.’’

And they only figure to add to the hardship experienced by patients in health centers like the one where Mir practices. One of those patients, the woman from Guatemala, was not seeking treatment for her illness but rather authorization to work through it.

Mir told her she needed to isolate herself.

“She started crying, saying, ‘I have no money. I live paycheck to paycheck. Give me cough medicine and I promise I’m not going to cough in front of anyone. Give me a letter so I can work this week and feed my family,’’’ Mir recalled. “This is an example of how some people have suffered through this pandemic.’’

According to some forecasts, the suffering will continue. The often-cited COVID-19 model from the University of Washington’s Institute for Health Metrics and Evaluation projects more than 231,000 U.S. deaths by Nov. 3 – Election Day – and more than 279,000 by Dec. 1, five days after Thanksgiving.

Behind the numbers:57% of Republicans polled say death toll is ‘acceptable’

But in the last week, deaths have steadily declined, reaching 650 per day, down from the approximately 1,000 daily deaths the country averaged in August. Meanwhile, the IHME model predicts daily fatalities will peak at 1,038 in October and 2,267 by the end of November.

Though some health experts such as Redfield and Dr. Deborah Birx of the White House coronavirus task force have said the U.S. can still turn around that trajectory with stricter adherence to masking and distancing guidelines, the model’s prediction is in line with what other medical professionals in the private field expect.

Dr. Matt Lambert, an emergency room physician in Washington, D.C., who has expressed skepticism that universities can operate safely with students on campus amid the pandemic, said a synergy between the flu and COVID-19 will lead to a surge in hospitalizations and deaths in the fall and winter.

“Partially because of human behavior, and partially because of how viruses behave seasonally, I think we’ll start to see a trend upward right around the end of October,’’ Lambert said, citing gatherings at schools and elsewhere as a factor. “I think we could see significantly higher numbers than what we’re seeing right now.’’


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As death toll nears 100,000, some Americans break from social distancing during holiday weekend – CNN

(CNN)The number of deaths caused by the novel coronavirus neared 100,000 on Monday, as Americans — some who decided to forgo social distancing — wrapped up their Memorial Day weekends.

As of Monday evening, the number of coronavirus-related deaths had reached 98,218, more than the number of US troops killed in the Korean and Vietnam wars combined.
President Donald Trump commemorated Memorial Day at Arlington National Cemetery and at an event in Baltimore, where he added a tribute to the victims of the virus.
“As one nation, we mourn alongside every single family that has lost loved ones, including the families of our great veterans,” he said at the second event. “Together, we will vanquish the virus and America will rise from this crisis to new and greater heights.”
At a glance, it looked this weekend like many Americans have forgotten about the dangers of coronavirus.
Crowds packed beaches in Florida, Maryland, Georgia, Virginia and Indiana. Many people ventured out without masks and others failed to keep their distance even as officials highlighted the continued importance of both in order to prevent another surge of infections.
It wasn’t just the beaches. Pictures posted on social media showed mostly unmasked people crowded together at Ace Speedway in Elon, North Carolina, on Saturday.
“We’re tired of being stuck in the house. I’m not afraid of this virus one bit,” spectator Becky Woosley told CNN affiliate WGHP.
Speedway co-owner Jason Turner told CNN affiliate WXII that 2,500 fans were admitted — half of the speedway capacity — and that staff encouraged but did not enforce social distancing.
“People have the right to choose where they go and what they do,” he said.
In Daytona Beach, people elbow-to-elbow jammed a main thoroughfare. Mayor Derrick Henry said there’s only so much police can do with a crowd that size.
“They were not practicing social distancing and they did not necessarily respond in a lot of ways that we wanted them to as it relates to the normal expectations of visitors,” he told CNN. “When … you got 300 to 500 people per law enforcement officer, it is a tough order.”
In Missouri, hundreds attended a pool party just days after a similar party in neighboring Arkansas caused a cluster of new coronavirus cases. Arkansas Gov. Asa Hutchinson said the state is now experiencing a “second peak.”
Hutchinson said the first peak saw 160 cases in one day followed by a “deep dip.” On Saturday, there were 163 new cases of Covid-19 in Arkansas.
But in Delaware, Gov. John Carney, who made a trip to Rehoboth Beach, said he was encouraged by what he saw.
“I saw not many people on the beaches,” Carney told CNN’s Wolf Blitzer. “It wasn’t a great beach day in terms of the weather. But on the boardwalk, most of the people, I’d say 80%, were wearing masks as we require.”
Carney said he was impressed by the signage, the 6 foot separation markings and plexiglass shields.

‘They’re willing to take the risk’

Coronavirus cases are trending upward in 18 states, including Alabama. Montgomery Mayor Steven Reed said Monday morning that he thinks the early easing of restrictions in his state has given people “a false sense of security.”
“What we’re seeing is kind of a split community where you have people who believe this is over and have decided they’re going to get back to their normal way of life and they’re willing to take the risk,” Reed said on CNN. “What they’re not considering is the risk they’re posing to others when they do not see some of the symptoms in themselves.”
As health officials warn the deadly virus isn’t yet contained, local leaders across the country are working to enforce regulations put in place for parks, stores, bars and restaurants that have reopened.
In Houston, Mayor Sylvester Turner said authorities will begin enforcing capacity limits for bars and restaurants after the city received hundreds of complaints alleging violations.
“One of my council members sent me some pictures and there were other pictures on Facebook and social media of people around swimming pools, no social distancing, no masks,” he said Monday on CNN. “I just said, we have to pump the brakes.”
Video from a pool party held at Clé nightclub in Houston, where many people without masks were seen crowded around the pool, helped prompt the decision, the mayor’s office said. CNN has reached out to the club.
New Haven, Connecticut, Mayor Justin Elicker said the city has taken out picnic tables and banned cooking out to cut down on crowds.
“New Haven residents have been really good at following the social distancing guidelines but people also feel really cooped up and I think a lot of people are feeling frustrated,” he said.
Mayor Henry from Daytona Beach said enforcing the face mask rule is realistically impossible because of the sheer number of offenders.
“We don’t have enough facilities to harbor that many people who do not follow guidelines,” he said.

Another vaccine candidate to be tested on humans

Maryland-based biotechnology company Novavax announced plans to begin enrolling about 130 people with an experimental vaccine. The company will become the 10th in the world to start a human trial of a potential vaccines against Covid-19.
The first volunteer is expected to be vaccinated Monday evening in Australia, where the initial phase of the trial is being conducted at two sites.
The vaccine produced high levels of neutralizing antibodies in pre-clinical testing, according to a company news release. The data has not been peer reviewed or published in a medical journal.

Spike of cases in Washington, DC

As Americans push to return to normal lifestyles and the country continues lifting coronavirus restrictions, experts say many parts of the country are still not heading in the right direction.
North Carolina recorded its highest single-day surge of new cases over the weekend and parts of Maryland, Virginia, Illinois and other states are still seeing a high number of infections, said Dr. Deborah Birx, the White House coronavirus task force coordinator.
In Washington, DC, health officials are reporting a spike of new cases — an increase that could be a setback for the criteria officials are using to decide when the city will begin its first stage of reopening.
Until this weekend, Washington recorded 11 days of declining community spread of the coronavirus. The city said 14 days of decline were needed before they moved to reopen. Sunday would have marked the 13th day of decline. Instead there was a small spike over the last two days.
But because the spike was a small one, health officials say they’ll consider setting back to the 11th day of the decline instead of starting the count from the beginning.
“We don’t have to go to day zero,” Director of the DC Department of Health, Dr. LaQuandra Nesbitt, said in a news conference call.

A 17-year-old dies in Georgia

In Georgia, one of the first states to begin reopening, officials reported Sunday the state’s youngest coronavirus death.
The victim was a 17-year-old boy, according to data from the Georgia Department of Public Health. The boy had underlying medical conditions. The department didn’t offer any further details.
The US Centers for Disease Control and Prevention say that while many young people who got coronavirus did not have serious problems, health experts are investigating a virus-related complication in children across the country, dubbed multisystem inflammatory syndrome in children.

White House rolls out travel restrictions

As US officials try to get a handle on the spread of the virus, President Donald Trump announced Sunday he was suspending travel into the US for people who had been to Brazil within the past two weeks.
Brazil now is second to the US with the highest number of coronavirus cases, recording more than 363,200 infections, according to Johns Hopkins.
Over the weekend, the country recorded more than 15,000 new infections in just 24 hours.

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