Centers for Disease Control and Prevention (CDC) Director Rochelle Walensky gives her opening statement during the Senate Health, Education, Labor and Pensions hearing on "Next Steps: The Road Ahead for the COVID-19 Response" on Capitol Hill in Washington, U.S., November 4, 2021. REUTERS/Elizabeth Frantz
WASHINGTON, Dec 10 (Reuters) - The seven-day average of COVID-19 cases in the United States was up 37% and average deaths per day climbed 28%, Centers for Disease Control and Prevention Director Rochelle Walensky said on Friday.
Initial data suggests that COVID-19 vaccine boosters help to bolster protection against the Omicron variant of the coronavirus, Walensky said at a White House briefing.
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Reporting by Ismail Shakil, Ahmed Aboulenein, and Jeff MasonEditing by Sonya Hepinstall
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Lorenzo Reyes is back with his three locks for Week 14 on the NFL schedule. Find out why he thinks the under is fully in play between the Lions and Broncos.
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The Detroit Lions' first win came at a price.
The Lions had three moreplayers test positive for COVID-19 on Saturday, bringing the total number of COVID cases to seven in the six days since their 29-27 win over the Minnesota Vikings.
The Lions placed cornerbacks Ifeatu Melifonwu and Mark Gilberton the reserve/COVID-19 list Saturday, and placed linebacker Tavante Beckett on practice squad COVID-IR.
On Monday, the Lions placed center Evan Brown on reserve/COVID. On Thursday, cornerback Bobby Price joined Brown on the list. And Friday, the Lions placed safety Tracy Walker and running back Jamaal Williams on reserve/COVID.
The Lions, who previously declared three players out (and a fourth doubtful) because of injuries forSunday's game against the Denver Broncos,will be without at least 19% of their 53-man roster because of injury or illness for the game.
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The Lions elevate six COVID replacements from their practice squad for the affected players - cornerbacks Nickell Robey-Coleman and Corey Ballentine, linebacker Curtis Bolton, tight end Shane Zylstra, running back Craig Reynolds and defensive tackle Bruce Hector -but Sunday's game could have a distinct preseason feel.
Walker, Williams, Brown and Melifonwu were expected to play significant roles Sunday, and the Lions are down to two healthy cornerbacks, starters Amani Oruwariye and Jerry Jacobs, on their 53-man roster.
Williams was ticketed for starting running back duties with D'Andre Swift out for a second straight week with a shoulder injury. Godwin Igwebuike and Jermar Jefferson are expected to share the workload in his absence, withReynolds also in the mix.
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Ryan McCollum is expected to make his first career start at center in place of Brown, himself an injury replacement for Frank Ragnow.
Dean Marlowe will replace Walker, the Lions' best defensive back this season, at safety.
And the Lions have options on their 53-man roster (Will Harris, with C.J. Moore or Jalen Elliott playing safety in sub packages) and practice squad (Robey-Coleman, Ballentine and Parnell Motley) to help their depleted cornerback corps.
The Lions (1-10-1) reconfigured practice this week to account for an illness outbreak that coach Dan Campbell said Wednesday was not COVID related.
On Wednesday, the Lions practiced in shifts, with the offense working in the morning and the defense in the afternoon, so as to avoid spread between position groups.
On Thursday, the Lions held 21 players out of practice, bringing McCollum and offensive skill players in for an afternoon workout and sending linemen on both sides of the ball home early.
The Lions held a normal practice Friday, but listed 12 players on theirinjury report withan illness other than COVID. Neither Melifonwu nor Gilbert was among that group.
Ten players were listed as questionable due to an illness, including Alim McNeill, Levi Onwuzurike and Charles Harris, who did not practice Friday.
NFL spokesperson Brian McCarthy said by email Saturday the league has no plans to investigate the Lions' COVID spread "beyond the standard genomic sequencing" the league does to determine where cases originate.
In general, McCarthy saidmost cases around the NFL have been the result of community spread.
Contact Dave Birkett atdbirkett@freepress.com. Follow him on Twitter@davebirkett.
Gideon Meyerowitz-Katz is an epidemiologist and writer based in Sydney, Australia. His work covers chronic disease, the pandemic response, and more recently, error detection in science. In this op-ed, he discusses issues with research that have become increasingly apparent during the pandemic.
There are no two ways about it: Science is flawed. Were not talking about the philosophical leanings of science or the origins of white coats and linoleum-floored laboratories, but about the nuts and bolts of the process by which we determine whether things are true or false.
In the decades before the pandemic, scientists spent endless hours wrestling with the painful fact that much of the knowledge base of science and medicine is reliant on research that is flawed, broken, or potentially never occurred at all.
Science has a gap between its mechanics and outputs. The mechanics of science are fine. The machines always get bigger and more efficient. New tools are always developed. Techniques become more sophisticated over time, and more knowledge is acquired.
The outputs of science are not. The culture of academia demands publication and warrants little retrospection about potential errors this means that mistakes are rarely corrected, and even outright fraud is often left undetected in academic literature.
And then along came a pandemic, and the gaps in science widened to an inescapable chasm. While biomedical research has had obvious and immediate success in COVID-19 mitigation, it has been accompanied by an enormous tidal wave of garbage, which instantly overwhelmed our garbage mitigation mechanisms.
From fraud to wasteful research to papers so error-filled that it is amazing that theyve been published, the pandemic has produced a tidal wave of woeful scientific output that has, nevertheless, had staggering consequences for peoples lives.
Take ivermectin. It is an amazingly successful antiparasitic medication that has treated literally billions of people in the time since it was invented, and it has almost eliminated some parasitic diseases from the world.
It has also been globally promoted as a cure for COVID-19 by a group of passionate fans. It is likely that more ivermectin has been taken to prevent or treat COVID-19 than any other single medication, except perhaps dexamethasone.
And yet, we do not know if ivermectin is actually useful in the treatment of COVID-19 at all.
A recent review from the Cochrane collaboration long considered the gold standard in medical research concluded that ivermectin should not be used for the treatment or prevention of COVID-19 outside of well-conducted clinical trials, which is a stark contrast to the hundreds of millions of doses still being taken for those exact reasons.
In early 2020, people were desperate for any kind of treatment for COVID-19. A melange of partial evidence emerged.
This included: a laboratory study showing that the drug acted as a strong antiviral in a petri dish, a study in a French nursing home where the residents took ivermectin to treat a scabies outbreak and seemed to subsequently enjoy higher survival rates, and preprint reporting that ivermectin reduced the mortality from COVID-19 by 90%.
All three were weak evidence in different ways. Single in vitro studies are very poorly predictive of eventual clinical outcomes, and the nursing home paper was an accidental and uncontrolled observational study what if the residents had never been exposed to SARS-CoV-2 in the first place?
The clinical study was entirely fabricated and later withdrawn from the preprint server, subsequent to great scandal.
The ivermectin story somehow got even worse from there. In late 2020, studies started popping up showing what can only be described as simply incredible results for the medication a 90% mortality benefit or a 100% reduction in cases when used as a prophylactic.
After nearly a year, myself and other data sleuths demonstrated that many of these studies probably never happened, but the damage was well and truly done long before the first fake paper was retracted.
A meta-analysis of ivermectin, which is usually considered the gold standard of research practices, found a huge benefit for the drug. However, the paper has not been corrected, even though the studies underlying its results were found to be likely fraudulent.
In any other discipline media, government, private enterprise such an analysis would be taken down with apologies immediately. Instead, the paper is allowed to stand as a testament to the general disinterest of the scientific world in correcting errors.
This story couldve been told very differently. Imagine a world where the initial laboratory paper came with a disclaimer, where the fraudulent preprint was looked on with skepticism immediately, and where the positive trials were assessed for fraud before they were even published.
Instead, at every stage, the process of highlighting concerns with data is ignored, with peer-review being the only flimsy barrier to publication for terrible research.
When we most needed effective fact-checking, our grand institutions of scientific research instead reviewed studies in a matter of days, if not hours, and posted fraudulent studies online to be shared across the world.
Its tempting to say that research into ivermectin is uniquely flawed, but thats clearly not true realistically, it would be remarkable if a broken system produced only one failure.
Trials of favapiravir, another repurposed COVID-19 medication, have recently been retracted due to data concerns.
There are now nearly a dozen studies looking at whether vitamin D has a benefit in COVID-19 that have been corrected or withdrawn entirely over the last 18 months.
The website Retraction Watch keeps a running tally of the pandemic-related studies that have been retracted. As of publication, the figure is 199 and growing every week.
Even worse, those are just the papers that people have looked into. Errors in science are rarely noticed because there is simply no reward for pointing out other peoples mistakes.
If we were to start looking at all of the useless, wasteful, terribly done research, we might expand that number to thousands, or even tens of thousands of papers.
There are published ecological studies of ivermectin where researchers compare entire countries drug use and COVID-19 mortality. These studies use mass drug administration protocols as their measure of the number of people who received ivermectin during the pandemic. This is despite those protocols mostly being disrupted or canceled early in 2020.
One study of vitamin D was retracted from the SSRN preprint server after it became clear that the authors had incorrectly labeled it as a randomized trial, though they had not randomized the participants at all. It has since been republished largely unchanged, with no mention of the previous retraction at all in the final paper.
None of this is to say that there is no good science. The vaccine trials alone are perhaps the most impressive scientific work that has ever been done, with efficacious immunizations developed, tested, and trialed in under 1 year.
The RECOVERY and SOLIDARITY clinical trials, which looked at repurposed drugs to treat COVID-19, have almost certainly saved millions of lives during the pandemic.
The problem is that large, well-conducted clinical trials are far from the norm. In a recent systematic review of hydroxychloroquine for COVID-19, the median number of people enrolled per arm in clinical trials was 59 one study looked at just two patients.
Without even carefully assessing these studies, we can say that most of them were probably a waste of time.
Indeed, if you look at the meta-analytic model from this review, virtually our entire knowledge of hydroxychloroquine for COVID-19 comes from just two studies, which recruited about 70% of all the people whom this drug had ever been tested on.
This is despite nearly 300 trials of the drug registered on clinicaltrials.gov, and the highest research spend of any single medication in the early pandemic.
If all of those tiny trials had been linked together, they may have achieved something useful, but instead, were left with two good studies and a smattering of largely pointless research.
All of this is, perhaps, the predictable outcome of a system that pushes publication above all else and punishes error-checking with disdain, scorn, and lawsuits. Publishing a terrible study can earn you praise and promotions; at worst, it might end up a line on your CV somewhere.
Checking studies for errors publicly earns you a steady payment of hate mail and death threats, and it nets you none of the citations, publications, and awards that academia regards as important.
Science has some enormous issues. Unless we can find a way to reward error-checking with actual money, we will continue to accept that a worrying proportion of our research output the studies that we use to make life-and-death decisions is either fake or incredibly problematic.
While it is tempting to think of this as a tedious problem among eggheads, that couldnt be further from the truth.
It is not unlikely that you or your family have personally been impacted by bad research during COVID-19 maybe you were given hydroxychloroquine during a hospital stay or took some metformin just in case. Perhaps you live in a place that reopened schools based on a study with mathematical errors or were told that masks constituted child abuse due to a paper that was later withdrawn.
Overall, there is a real impact of bad science in our everyday lives that the pandemic has thrown into stark relief.
Worse still, we know another pandemic is coming eventually. If we dont fix these issues now, the next time a new disease spreads through our world, we will be doomed to repeat the mistakes of COVID-19. And that is perhaps the most worrying thought of all.
A growing surge of COVID-19 patients is stressing already packed hospitals and causing more cancellations of elective procedures.
"We have a severe bed shortage crisis," said UMass Memorial Health President Eric Dickson. "The patients are backing up into the emergency department that need to be admitted into the hospital."
The latest coronavirus surge is impacting hospitals across Massachusetts, and hospital officials worry the situation will get worse as the coronavirus spreads over the holiday season. On Thursday, there were 1,238 COVID-19 patients hospitalized in the state, up from 1,026 a week earlier. To make more room for patients as cases swell, the state is recommending hospitals reduce certain elective services and procedures a strategy some hospitals had already implemented.
Dickson noted the charts showing new cases and hospitalizations look similar to last year at this time. He encourages people to get vaccinations and booster shots, as well as wear masks and keep their distance from crowds. Without those precautions, he expects the situation will worsen.
"And if last year is a predictor of what we're going to see this year, the worst will be somewhere in the first couple of weeks of January, and then we'll start to see some relief," he said. "But that's going to be a rough, rough six to eight weeks, if that's what we have to go through."
Dickson said UMass Memorial Health is seeing roughly twice as many COVID-19 patients as it had a week ago. On top of that, he said patient numbers are up because staffing problems at skilled nursing facilities have made it harder to move patients out of the hospital and into those facilities. And 100 hospital beds at St. Vincent's Hospital are not available because of an ongoing nurses strike.
"It's all adding up to be like the perfect storm for an inpatient bed crisis here in Central Mass.," he said.
Mass General Brigham hospitals had 205 COVID-19 inpatients on Friday, up from 128 three weeks ago.
The Wellforce Healthcare system which includes Tufts Medical Center, Lowell General and Melrose Wakefield hospitals has seen a 26 percent increase in COVID-19 patients over just the last week.
"We've been living at or over capacity now for weeks," said Terry Hudson-Jinks, the chief nursing officer at Tufts Medical Center. "And the patients here with COVID equates to about an additional inpatient unit or two of additional patients."
The state Department of Public Health released new guidance to hospitals Friday to reduce certain nonessential elective services and procedures by fifty percent, starting next week. The state also issued an emergency order providing hospitals with some flexibility on nursing staff ratios for ICUs.
The Commonwealths hospitals continue to face significant challenges due to staffing shortages, Health and Human Services Secretary Marylou Sudders said in a written statement. Todays actions will help alleviate pressures by providing hospitals with staffing flexibility in order to reopen inpatient capacity in licensed and alternate space not currently being utilized.
Some hospitals, including Tufts Medical Center and UMass Memorial Health, have already limited elective procedures beyond the state's new recommendations in an effort to create more capacity as patient numbers swell.
Tufts Medical Center opted to cancel all in-patient elective procedures.
"And that was helpful for the past month," Hudson-Jinks said. "This week, we're finding that that's just not enough space to care for the patients that need our care. So we're beginning to review patients who are on the ambulatory side of elective procedures and canceling or rescheduling those cases so that we can create space to care for additional patients that need our care. We're really in our surge mode we're surging and looking for space and resources so that we can be larger to care for more sick patients every day. "
Hudson-Jinks said those canceled outpatient procedures include some joint surgery and orthopedic procedures, as well as some minor gastrointestinal procedures. She said they don't take postponing that kind of care lightly, but the decision was necessary to care for patients with immediate and often life-threatening needs.
UMass Memorial Health opted to postpone some, but not all, elective services at this time.
"You can stop doing mammography and redeploy the people for other areas," Dickson said. "But that only means that you're going to see people with later stage breast cancer down the line because you didn't do that early screening."
He said one of the reasons the hospitals were full now, even before the latest COVID surge, is the consequence of important screening and outpatient work that was delayed in the earlier surges.
"I'm not criticizing the decision to to stop doing ambulatory procedures and visits at the time," he said. "But you're just kicking the can down the road and it actually becomes a bigger problem down the line. It doesn't go away."
One difference that will make dealing with the current surge harder, Dickson said, is that this time the state hasn't set up field hospitals to care for the overflow. FEMA assistance for that kind of facility would require a disaster declaration by Gov. Charlie Baker. Baker said earlier this week that there are no plans for now to set up field hospitals, but that he's exploring the idea of bringing in the National Guard to support the state's healthcare system during the surge.
Dickson said he understands Baker has a lot to consider before making a disaster declaration.
"I understand that he's got a very difficult job in terms of understanding the impact it would have elsewhere on the economy within the state," he said. "So for right now, we're going to just have to manage this."
OSTERHOLM: You cannot outrun the game clock with this pandemic. This virus will find you and, unfortunately, many of the outcomes are very sad. Look at what's happening right now in the US. We have health care systems around the country, including in my home state of Minnesota, that are hanging on by a thread. We've seen health care systems virtually broken by this pandemic. They just couldn't provide critical care to non-Covid patients.
If you're not going to get vaccinated for yourself, please get vaccinated for your loved ones and for the community because this is a very challenging situation.
The other thing to emphasize is that I don't know if the Omicron variant will replace the Delta variant. But I think it is likely. Could that be a good thing? Maybe if it results in milder illness than we see with the Delta variant. But nonetheless, you still are going to get infected if you are not vaccinated.
BERGEN: Can the pandemic continue indefinitely? We are already almost two years into it in the US.
OSTERHOLM: I look at this through a lens of evolution. Early on in the pandemic, I anticipated this would go at least 18 months. That was because the only real perspective I had to understand what this coronavirus might look like was previous influenza pandemics. And I think that many of us assumed that at some point it would become a seasonal infection like influenza after two years or so.
I got a rude awaking earlier this year in March and April when I saw the new Alpha variant emerge as well as the Beta and Gamma variants, and I had a sense that this was going to change how the pandemic would unfold. As a result, I thought that some of the darkest days of the pandemic would be ahead of us and that was at a time in the spring when case numbers were dropping markedly in the United States and vaccine was flowing. But I realized that variants were like 210-mile-an-hour curveballs, and we couldn't predict if they might have increased transmissibility or the ability to cause severe illness. This conclusion was not popular among many of my colleagues and policy makers.
BERGEN: Do you have a theory about why Delta emerged first in India?
So there just hasn't been a predictability about why or where Covid will take root.
If I could understand why surges occur or why they go away or why they don't happen, then I'd be in a better place to answer questions about where Covid is headed. All I can tell you is when a surge starts, the level of vaccination has a tremendous impact on how much pain and suffering occur with that surge.
BERGEN: The travel bans on South Africa and other African countries -- are they helpful?
A "travel ban" is something that nations might do initially just to lock things down while they understand what's going on -- it is not meant to be a long-term solution. It's like police at a crime scene. They lock it down for several hours to gather information and then open it back up again.
The political reaction of implementing a travel ban is not helpful in most cases. If it gives you 24 to 36 hours to at least get a lay of the land about what's happening, then I think it can be useful. But if it persists after that, particularly when you have widespread transmission of the virus in other parts of the world already, it's counterproductive.
OSTERHOLM: I based my estimates at the time on historic data from previous pandemics.
The reality is you can't model beyond 30 days out. Just look at what is happening right now. We can't even predict why these surges occur or when they occur. Who, 30 days ago, could have developed a model that would accurately predict what we're seeing right now with Omicron? Who could have predicted that?
BERGEN: Do we know how deadly the Omicron variant is compared to previous variants?
OSTERHOLM: While it's early, I believe that Omicron is less virulent than Delta. The variant is being studied in South Africa, which is important because the virus has been in that country longer than others. And we do know that hospitalizations, serious illness and deaths are lagging indicators. Rates often rise two to three weeks after rises in case numbers start to occur. But as of today, the epidemiologic and clinical data on Omicron cases around the world support this virus is less lethal than Delta.
OSTERHOLM: When we first investigated the Covid-19 vaccines, we had to prioritize the assessment of the safety of the vaccines, which was done well. But we never really understood how to best use the vaccine in terms of number of doses, dose spacing, even the dose amount to maximize our immune response both for the short and long-term. We know that oftentimes the best immune response occurs when you have an extended period between the doses; in other words, allowing the immune system to basically recover and be capable of this enhanced response with the next dose. Look at how many vaccine schedules we have where that's the case.
The whole world should have access to three doses of a mRNA Covid vaccine and there would be nothing more tragic to me than having someone protected by a two-dose regimen for six to eight months, and then to get seriously ill and die because they didn't get a booster. I think that one day this won't even be a question. It will be a minimum three-dose vaccine.
OSTERHOLM: Two things: One is that this pandemic has really provided a window into our global vaccine capacity in a way nothing else has ever done before.
I think that there's been some red herrings in terms of what the issues are. For example, we keep hearing about technology transfer and giving these countries the ability to make their own vaccines, and yet the expertise needed to make these vaccines is really at a premium. It's very difficult to find people who know how to do this. So, it's not enough to transfer technology to a low-income country if you don't provide the expertise to make these vaccines. It's not as simple as making chicken soup.
Also, our focus has been almost solely on getting vaccines to people around the world, which is surely important. But we haven't been thinking nearly enough about what it would take to turn a vaccine into a vaccination, that needle into the arm. We have seen the challenges in this country with administering vaccinations, and those challenges also exist around the world.
So, just shipping a couple of pallets of vaccines to a low-income country may be a useless effort if, in fact, they don't have the infrastructure to deliver the vaccine and they don't have a means for helping the population understand how and why they should want to be vaccinated. What this whole situation has highlighted, is the fact that we have a lot more work to do to understand not just how to make vaccines, but also how to turn vaccines into vaccinations.
