During his midweek COVID-19 briefing, Gov. Jim Justice sounded a cautious note of optimism. Anyone who has taken a look at the states maps lately can see more green blooming across our counties. In fact, 27 of the 55 are now in the lowest-risk category on the Department of Health and Human Services COVID alert map.
That is good news. But on the other hand, at the time of that briefing there were 3,574 active virus cases in the state, 596 hospitalized, 135 in intensive care units 78 on ventilators and 31 had died since the previous days report.
The number of deaths will trail, and we will still escalate a little bit, Justice said. But we are making progress and maybe the skies are looking better.
If that progress is to continue, West Virginians will have to continue maybe even step up their efforts to combat the virus. Easing off the accelerator is the wrong approach. COVID-19s variants dont need much of a window to attack.
If you have not yet gotten vaccinated or boosted, do so. Think carefully about whether it is still necessary to wear a high-quality mask in some communities. We cannot declare this fight won just yet. Mountain State residents must push as hard as ever to get the job done. Dont give up now.
A study released in The Lancet Respiratory Medicine by Providence, one of the largest health systems in the United States, confirms the overall effectiveness of vaccines in preventing severe infection resulting in hospitalization from Covid-19, but also shows a substantial decline in protection after six months. Completed by a team of clinicians and scientists in the Providence Research Network, the study examined data from nearly 50,000 hospital admissions between April and November of 2021, finding that vaccines were 94% effective at preventing hospitalization 50-100 days after receiving the shot but fell to 80.4% 200-250 days later, with even more rapid declines after 250 days.
In addition to examining the effectiveness of vaccines over time, the Providence study was also able to identify factors associated with reduced vaccine effectiveness. Key risk factors for a severe "breakthrough" infection included advanced age (80+), comorbidities such as cancer, transplants, chronic kidney disease, hypertension, or heart failure, the amount of time that had elapsed since being vaccinated, and the type of vaccine one received. For the latter factor, the study found that the Moderna vaccine offered the best overall protection over time, while the Pfizer-BioNTech vaccine offered initial protection equivalent to Moderna's but declined more rapidly over time. Persons receiving the Janssen vaccine also had higher odds of experiencing a severe breakthrough infection compared to Moderna.
This data helps us understand differences in waning protection by vaccine type and identify the key risk factors for severe breakthrough infections to help inform the targeting of potential vaccine booster programs. Unlike most other studies, our data stretched beyond six months, where we found evidence of rapidly waning protection, especially for patients 80 or older. We were also able to identify important differences by vaccine type and patient characteristics that should help inform potential booster programs."
Amy Compton-Phillips, M.D., Providence chief clinical officer
The Providence study, one of the largest of its type, showcases the value of connecting a network of researchers with large scale health care data to help health systems, public health agencies, policymakers, and patients and community members learn and react more quickly to emergent or endemic health challenges. Overall, the data supports the importance of vaccinations for protection against hospitalization, and also clearly evidences the need to boost that protection after 200 days, particularly for patients age 80 and up or with specific medical conditions that increase their risk of severe infection.
"Additional protection may be warranted for everyone, but especially for these populations," said Ari Robiscek, M.D., Providence chief medical analytics officer. "In addition to promoting general vaccine uptake, clinicians and policy makers should consider prioritizing booster shots toward those most at risk for severe Covid-19."
Source:
Journal reference:
Wright, B.J., et al. (2022) Comparative vaccine effectiveness against severe COVID-19 over time in US hospital administrative data: a case-control study. The Lancet Respiratory Medicine. doi.org/10.1016/S2213-2600(22)00042-X.
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Purpose
It has been noted in international literature that acute surgical admissions and number of operations reduced as a result of coronavirus disease2019 (COVID-19). This study assesses the impact of the COVID-19 pandemic on the number of acute surgical admissions, operations, and length of stay (LoS) at the Sunshine Coast University Hospital (SCUH), Queensland, Australia.
A retrospective study was conducted on patients admitted to the Acute Surgical Unit (ASU) during March and April for the years 2018, 2019, and 2020. Admission data for ASU patients in 2018 and 2019 were combined (pre-COVID) and compared with 2020 (COVID) to determine impact of the pandemic on presentations and procedures.
ASU admissions reduced in 2020 (461 patients) compared with pre-COVID years (mean: 545 patients per year). There was an increase in the number (%) of operations performed in 2020, 175 patients (38%) compared with pre-COVID years, mean 158 patients (29%), p = 0.001. There was a significant decrease in the number (%) of functional presentations in 2020, 29 patients (6.3%) compared with pre-COVID years, mean 105 patients (9.6%), p = 0.04. LoS was not significantly different (52 hours vs. 54 hours, p = 0.11).
COVID-19 has reduced the absolute number of acute surgical admissions at SCUH. This effectively reduced triage workload. Contrary to the literature, this study did not demonstrate a reduction in the number of operations or change in LoS. These data could be used by health administrators to help with resource allocation during future pandemics.
In early March 2020, Australia reported its first death from coronavirus disease 2019 (COVID-19). Throughout the month of March, many more Australians tested positive for COVID-19. Educational institutions began to close, and airlines began suspending flights. By mid-March, Australia banned all international arrivals by non-citizens and residents. By the end of March, the Australian Prime Minister introduced lockdown and the closure of all non-essential services, and the Queensland Premier introduced tight social distancing restrictions. These lockdown laws had a profound effect on peoples movement and behaviors [1]. In 2021, these restrictions have continued, and lockdown rules are ever-changing.
Prior to the COVID-19 pandemic, there was a paucity of information in the literature with regard to surgical admission rates during pandemics. During the Ebola virus outbreak in West Africa, hospital admission rates reduced and surgical procedures reduced up to 50% [2-5]. COVID restrictions in Canada and Hong Kong resulted in a reduction in hospital admissions and surgical procedures [6,7].
Since the beginning of the pandemic, there have been multiple retrospective analyses on the effects of COVID-19 on different parts of the health sector. A study performed by O'Connell et al. in the Republic of Ireland assessed patients presenting to their emergency surgical service between March 1, 2020, and April 3, 2020, and compared it with the preceding three years. They noted a 42.8% reduction in the number of patients admitted and a 25.4% reduction in operations [8]. Another study by Callan et al. in the United Kingdom found a similar reduction in admissions, though the rate of operations remained the same as before [9]. A study performed by Moustakis et al. in South Africa compared surgical admissions in the weeks before lockdown and during the lockdown and found a reduction in both non-trauma and trauma admissions [10].
The COVID-19 pandemic has had a significant effect on health systems worldwide and in Australia [11]. While elective surgery was reduced to category 1 (defined as needing treatment within 30 days) cases only in both the public and private health systems on the Sunshine Coast, there was no change to emergency surgery or the rostering of the Acute Surgical Unit (ASU) in the Sunshine Coast Hospital and Health Service (SCHHS). Despite this, there has been an anecdotal decline in the number of acute surgical presentations across the SCHHS. The reason for this perceived reduction is unclear, and it is hypothesized that the COVID-19 pandemic should not affect acute surgical admissions on the Sunshine Coast, as it is presumed that acute surgical presentations should be independent of co-existing viral infection and community quarantine. The objective of this study is to assess the impact of the COVID-19 pandemic on the number of public acute surgical admissions and to document any variance in length of admission as well as operative versus non-operative management as a consequence of COVID-19. The SCHHS comprises the following public facilities: Sunshine Coast University Hospital (SCUH), Nambour General Hospital, Caloundra Hospital, Gympie Hospital, and Maleny Hospital. These facilities service the Sunshine Coast, Hinterland, and Gympie regions. The policy both pre-COVID and during COVID is for all acute surgical presentations at these peripheral hospitals to be transferred to SCUH ASU, therefore enabling us to capture all acute surgical admissions on the Sunshine Coast.
This retrospective clinical audit was performed at the SCUH. Ethics exemption was obtained from the Metro North Health Human Research Ethics Committee (HREC Reference: Project ID 64819 LNR/2020/QPCH/64819). Baseline patient demographic and clinical details were obtained via the electronic patient medical record (iEMR).
The study population comprised all patients who were admitted under the ASU at SCUH for the dates March 1 to April 30 for the years 2018, 2019, and 2020. The same time frame each year was used to minimize the effect of seasonal fluctuations. Patients were excluded from the study if the majority of their care took place at another facility, under another inpatient team, or if they were under the age of 18 years. Patients were further categorized by age, gender, length of stay, readmission within seven days, and disposition. Medical diagnosis was made based on the discharge summary or working diagnosis at the end of the admission if a discharge summary was not completed. Treatment was categorized as antibiotics, surgical, endoscopic, or radiological intervention. Endoscopic intervention included gastroscopy, colonoscopy, and endoscopic retrograde cholangiopancreatography (ERCP), while radiological intervention included percutaneous drainage, and embolization. Outcomes were categorized as discharged (treatment complete), discharged against medical advice, transferred to another facility, or died in hospital.
Within the diagnostic categories, the functional category represented patients with an impairment of normal bodily function without evidence of acute surgical pathology, trauma was defined as all patients who sustain a mechanism or display physiological features of trauma requiring admission, biliary pathology included cholelithiasis and all related complications, and malignancy was defined as presentations where symptoms were a direct consequence of cancer.
As the objective of the study was to analyze the effect of the global pandemic on acute surgical admissions, the data from 2018 and 2019 were combined as pre-COVID data and compared with 2020 as COVID data.
Where appropriate, summary statistics are presented as number (%) for binary and categorical data, mean (SD) for normally distributed continuous data, and median (IQR) for non-normal continuous data. The Shapiro-Wilk test was used to determine the normality or otherwise of the data. Further binary comparisons were performed using either the standard Students t-test for normally distributed continuous data or the Wilcoxon sign-rank test for non-normal continuous data or Fishers exact test for categorical data. Stata Version 15.0 (StataCorp, College Station, TX) was used throughout, and the level of significance was set at p < 0.05.
Demographic variables between the pre-COVID and COVID data are presented in Table 1. The only significant difference was an increase in male gender in 2020.
The distribution of diagnoses from the pre-COVID and COVID data is presented in Table 2. In 2020, there was a statistically significant increase in the number of patients with appendicitis and malignancy. In 2020, there was a statistically significant decrease in the number of patients with a functional diagnosis and the number of patients with a hernia.
Treatment interventions by category for pre-COVID and COVID patients have been presented in Table 3. There was a statistically significant increase in the percentage of patients who received antibiotics or who underwent surgery in 2020. The increase in endoscopic procedures from pre-COVID to COVID approached significance (p = 0.06).
Further categorization of surgical, endoscopic, and radiological interventions has been presented in Table 4. In 2020, there were statistically significant increases in patients who underwent appendicectomy, abscess incision and drainage, and ERCP. There was a statistically significant decrease in the number of patients who did not undergo any procedure.
Analysis of the operative versus non-operative management of appendicitis and hernias has been presented in Table 5. Fishers exact test was used to compare operative rates for transferred patients, if it was assumed all, or none of the transferred patients underwent an operation.
The COVID-19 pandemic had a significant effect on Australian healthcare systems, including acute surgical patients. This retrospective analysis of acute surgical presentations during the COVID-19 pandemic and social isolation on the Sunshine Coast documented significant variation when compared with previous years. The number of admissions to the ASU for 2018 was 528 compared with 562 in 2019, while in 2020 the number of admissions was 461. The annual increase in total admissions in the pre-COVID years could be partly explained by the population increase on the Sunshine Coast from 356,823 to 361,870 (growth rate of 1.41%) [12]. Despite a population increase in 2020 to 367,180, there was an 18.34% decrease in the number of acute surgical admissions for 2020 compared with the average from the pre-COVID.
Analysis of admission diagnosis revealed that there was a significant decrease in the number of functional admissions to the ASU in 2020 when compared with previous years. In the pre-COVID data set, these admissions made up 9.6% of all acute surgical admissions, and during COVID, they only comprised 6.3% of the admissions. This decline could be explained by the public health lockdown initiatives, which may have deterred patients without pathology requiring surgical intervention from presenting to the hospital. Importantly, there was no significant decrease in patients with organic surgical pathologies in 2020 compared with previous years, with the exception of hernias. In the pre-COVID data set, the percentage of patients with a hernia diagnosis that proceeded to an operation was 37% compared with 86% for 2020. This suggests that during 2020, patients with uncomplicated hernias did not present to the hospital during lockdown.
The only pathologies with a statistically significant increase in 2020 were appendicitis (13.5% vs. 8.4%) and malignancy (1.7% vs. 0.6%). The percentage of patients with appendicitis who underwent an appendicectomy in 2018/2019 was 73% compared with 90% in 2020. In 2018, 17 patients with a diagnosis of appendicitis were transferred to Sunshine Coast University Private Hospital under a public/private contract. When it was assumed that all transferred patients underwent an appendicectomy, the rate of operatively managed appendicitis was 91%, indicating no change in rates of appendicectomy post-COVID. While there is current evidence to suggest that some cases of appendicitis can be managed conservatively with a similar efficacy to surgical intervention [13], this was not the policy of the SCHHS during the study years analyzed.
There was also a significant increase in the percentage of patients who underwent a procedure and/or received antibiotics in 2020 compared with previous years. This could be attributed to the increase in appendicitis and the decrease in patients with functional presentations and uncomplicated hernias.
There was no statistically significant difference between the pre-COVID and COVID populations with regard to the duration of stay and rates of readmission. This is an important note, as duration of stay and readmission rates are measures of morbidity. In contrast, a study in the United Kingdom found that the COVID-19 lockdown resulted in prolonged admissions and higher rates of complications [14]. Another study in New Zealand found that there were fewer acute surgical admissions, though there were increased rates of complications and length of stay [15].
It has been noted in the international literature that acute surgical admissions and number of operations reduced because of COVID-19. The SCUH noted a significant drop in acute surgical admissions; however, there was an increase in surgical operations and no significant decrease in patients with acute surgical pathology. This could be a consequence of the difference in the burden of COVID-19 between Australia and other countries. Although Australia had similar lockdown rules to other countries, our geographical isolation meant that there were significantly less cases of COVID-19 and that our health systems were not overwhelmed. There was no redirection of service provision in surgery to ICU and emergency at SCUH, and there was no reduced access to emergency theater nor changes in standard of operation (i.e. avoidance of laparoscopic surgery). This study, therefore, demonstrates that the reduction in acute surgical admissions is more likely a result of the public avoidance of hospitals rather than redistribution of workload and highlights the importance of the continued function of the ASU during future pandemics. It may also service as insight into resource allocation, possibly supporting the continuation of Categories 2 and 3 elective surgery throughout the pandemic.
While the study demonstrated that there was no significant change in the percentage of patients with acute surgical pathologies between 2020 and the pre-COVID years, this study is limited by the fact that the SCUH was only operational for four years prior to 2020, and an analysis of a longer time frame may improve the data. Further limitations include the minimal impact of COVID-19 on Australia in 2020 with low case numbers of COVID-19 and inconsistent and ever-changing lockdown rules at the start of the pandemic. Further analysis of the duration of symptoms and severity of disease at presentation may give an insight into whether the public health lockdown laws caused any detriment to patient outcomes by prolonging sickness prior to hospital presentation.
This study demonstrated a decrease in the total number of acute surgical admissions, mainly in the functional presentation category. There was an increase in the percentage of patients who had surgery, but there was no significant change in the length of hospital stay. Further analysis into patient outcomes, such as time to surgery and post-operative complications, could be useful to assess other effects of the pandemic on patient care. This study provides valuable information regarding the possible trends to be anticipated in future global pandemics to help with resource allocation.
Scientists released a pair of extensive studies over the weekend that point to a large food and live animal market in Wuhan, China, as the origin of the coronavirus pandemic.
Analyzing a wide range of data, including virus genes, maps of market stalls and the social media activity of early Covid-19 patients across Wuhan, the scientists concluded that the coronavirus was very likely present in live mammals sold at the Huanan Seafood Wholesale Market in late 2019 and suggested that the virus spilled over into people working or shopping there on two separate occasions.
Members of the Wuhan Hygiene Emergency Response Team leaving the closed Huanan Seafood Wholesale Market on Jan. 11, 2020. Noel Celis/Agence France-Presse
The studies, which together span 150 pages, are a significant salvo in the debate over the beginnings of a pandemic that has killed nearly six million people across the world. The question of whether the outbreak began with a spillover from wildlife sold at the market, a leak from a Wuhan virology lab or some other event has given rise to pitched debates over how best to stop the next pandemic.
When you look at all of the evidence together, its an extraordinarily clear picture that the pandemic started at the Huanan market, said Michael Worobey, an evolutionary biologist at the University of Arizona and a co-author of both new studies.
Several independent scientists said that the studies, which have not yet been published in a scientific journal, presented a compelling and rigorous new analysis of available data.
Its very convincing, said Dr. Thea Fischer, an epidemiologist at the University of Copenhagen, who was not involved in the new studies. The question of whether the virus spilled over from animals has now been settled with a very high degree of evidence, and thus confidence.
Map of Wuhan showing the location of the Huanan Seafood Wholesale Market.
Huanan Seafood
Wholesale Market
Huanan Seafood
Wholesale Market
But others pointed to some gaps that still remained. The new papers did not, for example, identify an animal at the market that spread the virus to humans.
I think what theyre arguing could be true, said Jesse Bloom, a virologist at the Fred Hutchinson Cancer Research Center. But I dont think the quality of the data is sufficient to say that any of these scenarios are true with confidence.
In a separate study published online on Friday, scientists at the Chinese Center for Disease Control and Prevention analyzed genetic traces of the earliest environmental samples collected at the market, in January 2020.
By the time Chinese researchers arrived to collect these samples, police had shut down and disinfected the market because a number of people linked to it had become sick with what would later be recognized as Covid. No live market animals were left.
Photos of animals for sale in the Huanan market.
Animals for sale in the Huanan market in 2019 and 2014, including raccoon dogs, Malayan porcupines and a red fox. Source: Michael Worobey et al., preprint via Zenodo. Photos taken by a citizen and posted to Weibo in 2019 (first three), and by Edward C. Holmes in 2014.
The researchers swabbed walls, floors and other surfaces inside the market, as well as meat still in freezers and refrigerators. They also caught mice and stray cats and dogs around the market to test them, while also testing the contents of the sewers outside. The researchers then analyzed the samples for genetic traces of coronaviruses that may have been shed by people or animals.
Although the Chinese researchers conducted their study over two years ago, it was not until Fridays report that they publicly shared their results. They reported that the Huanan market samples included two evolutionary branches of the virus, known as lineages A and B, both of which had been circulating in early Covid cases in China.
These findings came as a surprise. In the early days of the pandemic in China, the only Covid cases linked to the market appeared to be Lineage B. And because Lineage B seemed to have evolved after Lineage A, some researchers suggested that the virus arrived at the market only after spreading around Wuhan.
But that logic is upended by the new Chinese study, which finds both lineages in market samples. The findings are consistent with the scenario that Dr. Worobey and his colleagues put forward, in which at least two spillover events occurred at the market.
The beauty of it is how simply it all adds up now, said Jeremy Kamil, a virologist at Louisiana State University Health Shreveport, who was not involved in the new studies.
Although the Huanan market was an early object of suspicion, by the spring of 2020 senior members of the Trump administration were promoting the idea that the new coronavirus had escaped from the Wuhan Institute of Virology, a coronavirus laboratory located eight miles away on the other side of the Yangtze River.
Theres no direct evidence that the new coronavirus, SARS-CoV-2, was present at the lab before the pandemic. Researchers there have denied claims of a lab leak.
But the Chinese government has come under fire for not being forthcoming about the early days of the pandemic.
The report from the Chinese C.D.C. about the Huanan markets samples, for example, had remained hidden. Starting in June 2020, two newspapers, The South China Morning Post and The Epoch Times, reported on what they claimed were leaked copies of the report.
In January 2021, a team of experts chosen by the World Health Organization traveled to China to investigate. Collaborating with Chinese experts, the group released a report in March 2021 that contained previously undisclosed details about the market. They noted, for example, that 10 stalls in the southwest corner of the market sold live animals.
The report also noted that 69 environmental samples collected from the market by the Chinese C.D.C. had turned up positive for SARS-CoV-2. But the frozen meat and live animals had all tested negative.
A member of the Wuhan Hygiene Emergency Response Team inside the closed Huanan market on Jan. 11, 2020. Noel Celis/Agence France-Presse
Still, the W.H.O. left many researchers dissatisfied. Dr. Worobey and Dr. Bloom both signed a letter, along with 16 other scientists in May 2021, calling for more investigation into the origins of Covid including the possibility that SARS-CoV-2 had escaped from a lab.
The W.H.O. experts had identified 164 cases of Covid-19 in Wuhan over the course of December 2019. Unfortunately, the cases were marked by fuzzy dots scattered across a nearly featureless map of Wuhan.
Dr. Worobey and his colleagues used mapping tools to estimate the longitude and latitude locations of 156 of those cases. The highest density of December cases centered around the market a relatively tiny spot in a city of 11 million people. Those cases included not just people who were initially linked to the market, but others who lived in the surrounding neighborhood.
Spatial analysis of Covid cases in Dec. 2019.
Huanan Seafood
Wholesale Market
Concentration of Covid cases in Dec. 2019
Huanan Seafood
Wholesale Market
Concentration of Covid cases in Dec. 2019
Source: Michael Worobey et al., preprint via Zenodo The New York Times
The researchers then mapped cases from January and February of 2020. They drew upon data collected by Chinese researchers from Weibo, a social media app that created a channel for people with Covid to seek medical help. The 737 cases pulled from Weibo were concentrated away from the market, in other parts of central Wuhan with high populations of elderly residents, the study found.
Spatial analysis of Covid cases in Jan.Feb. 2020.
Huanan Seafood
Wholesale Market
Concentration of Covid cases in Jan.Feb. 2020
Huanan Seafood
Wholesale Market
Concentration of Covid cases in Jan.Feb. 2020
Source: Michael Worobey et al. The New York Times
These patterns pointed to the market as the origin of the outbreak, Dr. Worobey and his colleagues concluded. The researchers ran tests that showed it was extremely unlikely that such a pattern could be produced merely by chance.
Its very strong statistical evidence that this is no coincidence, Dr. Worobey said.
But David Relman, a microbiologist at Stanford University, raised the possibility that these patterns might be just evidence that the market boosted the epidemic after the virus started spreading in humans somewhere else.
The virus would have arrived in a person, who then infected other people, he said. And the neighborhood of the market, or the market itself, became a kind of a sustained superspreader event.
Dr. Worobey and his colleagues argue against that possibility, pointing to signs of spillovers within the market itself.
The researchers reconstructed the floor plan of the Huanan market based on the W.H.O. report, the leaked Chinese C.D.C. study and other sources. They then mapped the locations of positive environmental samples, finding that they clustered in the area where live animals were sold.
Strikingly, five of the samples came from a single stall. That stall had been visited in 2014 by one of the co-authors of the new studies, Edward Holmes, a virologist at the University of Sydney. On that trip, he had taken a photograph of a cage of raccoon dogs for sale at the time.
The Huanan Seafood Wholesale Market in Wuhan, China.
Huanan Seafood
Wholesale Market
West Side
Huanan Seafood
Wholesale Market
West Side
Huanan Seafood
Wholesale Market
West Side
Diagram of the Huanan market.
Huanan Seafood Wholesale Market
West Side
Coronavirus found in stall
Stall selling live mammals
Stall selling unknown meat
Photograph of raccoon dogs caged over birds in 2014.
Huanan Seafood Wholesale Market
West Side
Coronavirus found in stall
Stall selling live mammals
Stall selling unknown meat
Photograph of raccoon dogs caged over birds in 2014.
Huanan Seafood Wholesale Market
West Side
Stall where coronavirus was found
Stall selling live mammals
Stall selling unknown meat
Photo of raccoon dogs caged over birds in 2014.
Distribution of coronavirus samples in the Huanan market.
Huanan Seafood Wholesale Market
West Side
Distribution of positive coronavirus samples
in the market
Huanan Seafood Wholesale Market
West Side
Distribution of positive coronavirus samples
in the market
Huanan Seafood Wholesale Market
West Side
Distribution of positive coronavirus samples
in the market
Source: Michael Worobey et al. The New York Times; Satellite image via Google Maps
Here's a quick wrap of what's happening in COVID-19 news across Australia.
This will be updated throughout the day, so if you do not see your state or territory, check back later.
You can jump to the COVID-19 stories you want to read by clicking below.
Victoria has recorded threeCOVID-19 deaths.
The number of people in hospital with the virus has risen slightly to 283, up from the 274 hospitalisations recorded on Sunday.
There are 42patients in intensive care units, sevenof them on ventilators.
There are 5,852new infections, taking the number of active case in the state to 41,205.
Another six COVID deaths were recorded in NSWin the 24 hours to 4pm yesterday.
There are 1,136 COVID-19 cases in hospital, 55 of them in intensive care.
That is slightly down from yesterday's figures, which had 1,146 people in hospital and 58 people in intensive care.
There are 5,856 new cases in the state.
There are 11 people with COVID-19 in hospital in Tasmania.
However, the state's Department of Health says only four are being treated specifically for their COVID symptoms.
There are no COVID patients in intensive care, the same as yesterday.
There areno new deaths.
The staterecorded 734 new COVID cases, a slight rise from yesterday.
A man in his 80s died with COVID-19 as the ACT recorded464 new cases in the 24 hours to 8pm yesterday.
ACT health authorities announced the man's death this morning, but did not reveal his vaccination status or whether he had underlying health conditions.
There are 44 people in hospital with the virus in Canberra but none are in intensive care.
Almost four in five (78 per cent) of Canberra children aged five to 11 have received a vaccine dose and more than 67per cent of Canberrans aged 16 and older have received their booster.
South Australia recorded another death, a man in his 80s.
There are currently 109 people with COVID-19 in hospital, slightly less than yesterday's 114.
Of those in hospital, 10 are in intensivecare and two people are on ventilators.
There were 1,358 new cases recorded in the state today.
Today also marks the resumption of elective surgery in SA.
"If your surgery or procedure was postponed, you will have kept your place on the list and your surgery or procedure will be rebooked," SA Health said in a tweet.
There were1,136 new local cases of COVID-19 recorded in the state, with another four travel-related cases.
Yesterday, the state recorded1,021 new local cases.
There arecurrently 11 COVID-19 patients in hospital and a total of5,540 active cases in the state.
There are 96 COVID-19 cases in hospital, four of those in intensive care.
Those numbers aredown slightly from yesterday's figures of 101 patients in hospital and six in intensive care.
There are 392 new cases, making for a total of 4,397 active cases in the territory.
The Victorian government has confirmed it is ending the state's COVID isolation payments.
The payment, introduced in July 2020, offered $450 to people who had to stay at home while waiting forPCR test results.
Victoria's Industry Support and Recovery Minister Martin Pakulasaid the program was no longer needed thanks to the availability of rapid antigen tests.
He said demand for the payments had reduced dramatically,but other support would still be offered.
Tomorrow will be the final day to claim the payment.
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Way back in 2020, some people stuck at home fantasized on social media about the fun things they would do when the coronavirus pandemic ended even about what they would wear as if a light would switch on at some point.
That seems like a lifetime ago.
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There is no magical moment, just a gradual, balky transition to a more relaxed state of vigilance that, depending on new variants and possible surges, could be temporary.
So it seemed a bit anticlimactic when California officially shifted from the pandemic status to an endemic approach.
Gov. Gavin Newsom made that call, having already softened mask mandates. Some critics accused him of making a political decision. Public opinion certainly brought pressure to loosening things up, but that had been the case for a while. Newsom didnt act until it was clear the drop in COVID-19 caseloads and hospitalizations was a trend, not a blip.
The determination that COVID-19 is now endemic suggests that the virus continues to exist in the state and remains dangerous but can be managed. The World Health Organization declared the outbreak a pandemic in March 2020 when the disease was growing exponentially and spreading across the globe.
Theres been some confusion about all this. Even Newsom said its not necessarily over.
This pandemic wont have a defined end. There is no finish line, he said on Feb. 17 as he announced the shift.
With coronavirus on the wane, it would be nice to think the harsh divisions exposed during the course of the outbreak also will subside.
It might be best to hold on to that thought for a while. As long as mandates exists, there will be protests. Masks are still required in various public and private buildings and on public transportation notably airliners, which have experienced high-profile disputes over masks that at times turned violent. Many governments and businesses require their employees to be vaccinated.
Some parent groups and school board members are insisting that the state should drop the indoor mask mandate for schoolchildren. The Rancho Santa Fe School District last week decided to make masks optional, in defiance of the state mandate, as Kristen Taketa of The San Diego Union-Tribune reported.
Other districts are struggling to abide by the state rules in the face of anti-mask protests.
The San Diego Unified School District, meanwhile, has pushed back its vaccine mandate for students, as a lawsuit challenging the policy is on appeal.
Nevertheless, opinion polls show mask and vaccine mandates have had continuous majority support in California, despite the louder minority that opposes them which can skew public perception.
A survey by the UC Berkeley Institute of Governmental Studies showed nearly two-thirds of California voters, and a majority of parents, backed mask and vaccine mandates in K-12 schools.
Unless courts intervene, some vaccine mandates for schools, governments and businesses arent going anywhere.
Mask mandates are a different story. So, how will people behave as mask requirements fall away? Will we end up with mostly vaccinated people continuing to wear masks frequently, while the unvaccinated dont the opposite of what should happen?
Or will those people, vaccinated or not, who agreed that masks help slow the spread of COVID-19 simply feel more comfortable or even forgetful going without as they see more people not wearing them?
Will some people, particularly those who are immunocompromised, be less willing to go to public places?
There are other uncertainties. Dropping masks could have an unintended side effect: the return of sniffles and stomach bugs, said The Boston Globe, quoting doctors predicting a resurgence of non-COVID infections this spring.
The Centers for Disease Control and Prevention on Friday loosened its recommendation for wearing masks indoors. The CDC had been recommending people in areas with substantial levels of transmission most of the country wear masks indoors. The new community-level recommendation is based on three metrics: hospitalizations, hospital capacity and level of new cases.
The CDC lists San Diego as a high-level county and recommends masks continue to be worn indoors. Other high-level counties in California are Los Angeles, Fresno and Kern.
Some experts have been urging relaxed mask mandates for weeks, while others say its still too early.
People are tired of wearing masks and increasingly question why theyre necessary as they see that the infection risk and severity has declined. One theory holds that easing up when cases and hospitalizations are down could build trust so if things get hot again, people will be more game to put them back on.
That notion probably doesnt apply to the many people who refused to mask up even during the depths of the pandemic.
But a lot has changed since those dark days. Development of vaccines was the big one and more than 80 percent of eligible San Diego County residents are fully vaccinated.
Individual testing has improved, and the monitoring of sewage to detect the virus may prove to be a vital early-warning system of coming surges.
The pressure, or the lack thereof on hospitals, will continue to be a key barometer of whether more public restrictions will be implemented. The various moves in the past to shut down public activity was mostly about flattening the curve of infections to keep hospitals from being overwhelmed. If medical staffing and hospital capacity needs can be foreseen in advance, that could go a long way toward warding off tougher mandates.
The hope is to jump on a virus hot spot early before it turns into a raging wildfire. Inherent in this strategy is an acknowledgement these fires may never be extinguished entirely.
There are plenty of unknowns, of course, such as whether vaccination research can keep up with mutating viruses.
California and the rest of the nation will deal with that as it comes. For now, it seems the order of the day is to move on from the pandemic. Though some mandates remain, there are more choices available without having to violate them.
We may be facing a new reality after the new normal of the pandemic. But the expectations of returning to a pre-COVID normal have to be held in check.
That doesnt mean you shouldnt break out that sharp-looking outfit. But keep a mask handy.
Tweet of the Week
Goes to Steve Herman (@W7VOA) of Voice of America.
Reporters Q: Why doesnt (Biden) want to speak with Putin right now?
Press Secretary Jen Psaki: Because hes invading a sovereign country.
Staff writer Paul Sisson contributed to this column.
It is now well known that SARS-CoV-2, the virus that causes COVID-19, can mutate to evade vaccine protection against infection. The Omicron variants BA.1, B1.1 and BA.2 can infect those who were previously infected by other variants, even when vaccinated. A third booster shot offers some protection from an Omicron infection, but it wanes after three or four months, leaving most people susceptible to reinfection. That said, the immunity conveyed by prior infection or vaccination still dramatically reduces the incidence of hospitalization and death.
We have also come to realize that our main saviors against COVID-19 turn out not to be antibodies, but rather another part of the immune system: T cells. Studies show that the strength of our long-lived T-cell response to the virus proteins especially by T cells that recognize the spike protein strongly correlates with the degree of protection.
There are two types of T cells, CD4+ and CD8+, which are distinguished by proteins on their surface. Because CD4+ T cells mostly assist in the production of antibodies, the CD8+ T cells are the real heroes of the story. Once they identify an invader they remember from a previous encounter, they act quickly to move in for the kill, demolishing infected cells and cutting short the life cycle of the virus.
Until Omicron, the differences in neutralization by vaccine-induced antibodies and by monoclonal antibodies were relatively minor. But the process by which T cells recognize viral proteins is very different from that of antibodies, which recognize structures on the intact viral protein. We know that these critical structures, particularly those of the exterior spike protein, differ from variant to variant. It is precisely such structural diversity that allows the virus to evade most antibodies made in response to natural infection and vaccination.
By contrast, T cells do not recognize intact proteins. Rather, T-cell recognition occurs when a viral protein within a cell is chopped into short segments and cradled in the grip of a cellular protein called MHC type 1. MHC type 1 presents the viral fragment to the T cell at the cell surface, where the T cell can recognize the combination of the viral fragment presented by the MHC type 1 protein.
T cells recognize and react to a very broad array of viral protein fragments. For SARS-CoV-2, these fragments overlap very little with the regions of the virus that are sensitive to neutralization by antibodies. That is why T-cell responses to viral infection are generally preserved across variants.
Until Omicron, vaccines that use one viral protein raised almost the same T-cell response to all variants. But now the situation has changed. Our MHC type 1 proteins are diverse, and each recognizes a unique set of viral protein fragments. Our reaction to viral proteins thus depends on their sequence and that of our own particular MHC type 1 set of proteins.
Consider a recent study by Gaurav D. Gaiha and his colleagues, examining T-cell responses to the Wuhan, Delta and Omicron strains in people who have been either infected, vaccinated and boosted, or infected and vaccinated but not boosted. They found that most people who are infected after vaccination have strong and durable CD4+ and CD8+ responses to all three variants.
But there was one worrying discovery. Approximately 20% of those vaccinated showed a decline of greater than 50% in T-cell response to Omicron, compared to the Wuhan and Delta variants. These poor T-cell responses were not correlated with sex or age, and follow-up experiments revealed that the difference was due to lower CD8+ reactivity, rather than to the CD4+ T-cell response.
The authors speculate that CD8+ T cells inability to respond to Omicron may be due to a lack of recognition of the mutated peptides. Indeed, their theoretical calculations are consistent with the hypothesis that changes in the amino acid sequence of the Omicron spike protein underlie the observed blind spots in T-cell recognition. Inherited differences in the ability to recognize specific protein fragments likely account for some peoples failure to mount anti-Omicron defenses. The authors offer the conjecture that it is possible that these individuals will have reduced protection against severe disease.
One sobering conclusion is that Omicron has drifted so far from the original strain that 20% of people in the study may not be fully protected either from infection or from hospitalization and death. However, the study found that a third vaccine dose increases T-cell responses by 20 times or more.
While the Omicron spike protein was able to escape T cells in a subset of individuals, Gaiha told me, what we learned is that this deficiency in T-cell recognition can be overcome by booster vaccination. In addition, we found that non-spike proteins could be attractive targets for second-generation vaccines to protect against future SARS-CoV-2 evolution.
Gaiha espouses an optimistic interpretation. But Omicron is a warning that future variants may escape both antibodies and T-cell immunity. We cannot predict whether a variant will arise that evades the vaccines ability to protect against infection and serious illness, but we must be prepared for such a threat, lest we remain unguarded against it.
William A. Haseltine, a scientist and entrepreneur, is chairman and president of ACCESS Health International, a global health think tank.
Mayor Eric Adams announced on Sunday that New York City was poised to eliminate school mask mandates and vaccine requirements for restaurants, gyms and movie theaters, by March 7, if case numbers remain low.
The rollback of pandemic restrictions, which had served as a crucial weapon in the citys battle against the coronavirus, is a milestone that many hope will help to restore a sense of normalcy in the city and boost its economic recovery.
Mr. Adams has said for weeks that he is eager to remove virus-related restrictions across the city, including mask mandates in schools. In a statement on Sunday, he promised a final decision by Friday, saying: I want to thank the millions of New Yorkers who have gotten vaccinated to help stop the spread. New Yorkers stepped up and helped us save lives by reaching unprecedented levels of vaccination.
The mayor said he wanted to give business owners time to adapt a nod to the toll that the virus and related restrictions have taken on small businesses. Both Mr. Adams and Gov. Kathy Hochul have focused on reviving the economy in New York City, where the unemployment rate has remained stubbornly high.
The news came hours after Ms. Hochul announced the statewide mask mandate for schools would be lifted, empowering local officials to assess the need for additional restrictions in their schools. Vaccine mandates in New York City for municipal workers and private employers remain in effect.
My friends, the day has come, Ms. Hochul said, reiterating that the decision, which is set to take effect on Wednesday, came in consultation with public health and education officials.
In making her announcement, Ms. Hochul said that the mask mandate had been a vital aid in battling the Omicron surge. When I look back at what was going on just a short time ago, I am so happy that we did have a mask requirement in place for schools at the time, she said. Thats how we kept these numbers from getting even worse.
The states decision does not supersede those of individual districts and counties like New York City, which can still impose mask mandates and other restrictive measures.
The rollbacks came a day after New York announced a statewide seven-day average positivity rate below 2 percent and hospitalizations under 2,000 for the first time since before the Omicron surge. The drop is part of a national decrease in coronavirus cases. Across the state, hospitals that were forced to limit elective procedures as a result of the virus have been approved to resume normal operations.
New York Citys vaccine mandate for indoor dining, movie theaters and gyms, known as the Key to NYC program, was put in effect by Mr. Adamss predecessor, Bill de Blasio, as an essential strategy to encourage New Yorkers to get the Covid vaccine and to reduce the spread of the virus. Dr. Jay Varma, a top health adviser to Mr. de Blasio, emphasized on Sunday that the vaccine mandate for all employees in New York City who work in person was still in effect, and he called on the Education Department to make high quality masks available for students who still wanted to protect themselves.
Mr. Adams has focused on the citys recovery and public safety during his first weeks in office and encouraged tourists to return. He has repeatedly encouraged New Yorkers to return to offices and argued that low-wage workers and small businesses depended on them.
For the first time last week, New York City released data showing that just 59 percent of students in city schools had received at least one dose of the vaccine. But even that rate contained significant disparities between neighborhoods and schools, the education nonprofit Chalkbeat reported, finding that the most vaccinated district in Manhattan had a vaccination rate more than double that of the least vaccinated district in Brooklyn. Vaccination rates are much higher among adults; more than 96 percent of New Yorkers who are 18 and older have received one dose.
Dr. Uch Blackstock, a doctor who focuses on health equity, said that there were wide inequities in vaccine rates among schools and that her children would continue to wear masks at their public schools in New York City.
Removing mask policies in these schools is dangerous, she wrote on Twitter.
The announcement on masks in schools seems poised to end a bitter and divisive chapter in the states pandemic history. Schools have increasingly become battlegrounds in a polarized national conversation between teachers, parents, students and politicians over what measures are appropriate to defend against the virus.
Ms. Hochul has been under pressure to roll back the states rules on masking in schools since she allowed the mandate for businesses to lapse earlier this month. At the time, the governor promised to revisit the question of masks in schools after students returned from their midwinter break in early March, but she found herself under increased pressure after nearby states with Democratic governors, including Connecticut, New Jersey and Delaware, announced plans to lift their mandates.
Then, on Friday, the Centers for Disease Control and Prevention in Washington released new guidance that masks and social distancing were necessary only in areas where infection risk was high, clearing the way for the lifting of many virus prevention measures.
That announcement came as the agency shifted its strategy in assessing risk from one based on case counts to one that weighs the stress on hospitals by coronavirus patients, as well as new cases per 100,000 people over the previous week. The guidance starkly changes the virus assessment nationwide from one in which 95 percent of counties were considered high risk to one in which most Americans could return to lives without masking or social distancing.
Sundays announcements were celebrated by many across the state. Kathryn Wylde, president of the Partnership for New York City, said that the rollbacks were welcomed.
The business community is eager to get beyond pandemic conditions and restrictions, she said.
And Republicans cheered the news on masks in schools. The unmasking of our school children is a long overdue victory for kids and parents, educators and common sense, State Senator Rob Ortt, a Republican and the minority leader who has pushed for a rollback of the mandate, said in a statement.
Although Ms. Hochuls decision leaves actual implementation power to the states hundreds of school districts, the announcement is a major moment in New Yorks halting efforts to keep its public schools open amid the pandemic. That is especially true in New York City, which first closed its sprawling system of roughly 1,600 schools in March 2020 and has kept strict virus mitigation measures in place since schools began to reopen in September 2020. The city lifted its outdoor mask mandate for schools only this past week.
The United Federation of Teachers, which represents teachers in New York City struck a pensive note, with its president, Michael Mulgrew, saying the union would confer with our own independent doctors, look at the data from take-home test kits and random in-school testing this week, and make sure all of that is taken into account as New York City reviews its own school masking policy.
And while many support the end of mandates, the shift will almost certainly concern a significant number of New Yorkers who believe it is premature. A recent poll from the Siena College Research Institute found that 58 percent of New York registered voters believed the state should hold off on lifting the mask mandate in schools until reviewing data from early March. That same poll, which was taken two weeks ago, found that 45 percent of respondents disapproved of the states rollback of mask mandates in private businesses.
