Dr. Irene Papaconstadopoulos, M.D. PC: County of Maui / Akak
A Maui pediatrician provided safety and efficacy information to parents considering the COVID-19 vaccination for children in the 5-11 year age group.
Dr. Irene Papaconstadopoulos, M.D., Medical Director at C.H.A.M.P.S. Pediatrics in Khei, where she practices as a private pediatrician said, As a pediatrician and a mom of two boys that are in this age group, I was anticipating a lot of excitement that we saw already, but also a lot of questions and concerns, which are reasonable from parents.
She credited state and county officials as well as the Department of Health the Immunization Branch with the speedy distribution of the vaccines upon obtaining Emergency Use Authorization.
In my office, I have personal experience, but seeing also from other pediatricians offices, clinics, pharmacies, and the hospital, weve already vaccinated hundreds of kids on Maui with the first dose, and we havent seen any adverse effects, Dr. Papaconstadopoulos noted during a press briefing on Friday hosted by Maui Mayor Michael Victorino.
Dr. Papaconstadopoulos said she is getting a lot of questions from parents, as expected, and weighed in on the most common concerns below:
Dr. Papaconstadopoulos addressed what she called a misconception that COVID-19 in children is rare and not common as in adults, or serious. In doing so, she pointed towards numbers compiled in recent studies.
From the beginning of the pandemic, up to October 2021, in the 5-11 age group, there have been to date about two million cases of COVID-19 that are confirmed. There are probably more than that. We know from studies now, that by measuring neutralizing antibodies in this age group, that children are just as likely as adults to get COVID-19, said Dr. Papaconstadopoulos.
We have had 8,300 hospitalizations in the US in children 5-11 years old. A third of those required pediatric ICU admission. Two-thirds of those have had co-morbiditiesthe most common of which were asthma and obesity. And one-third of all of those hospitalizations were previously healthy children, she said.
To put things a little bit into perspective, the total number of children 5-11 in the US is about 25 million. The total number of deaths per year that we have in that age group prior to COVID is about 2,000-2,300 total. Thats a total numberand the most common cause are accidents in this age group, congenital heart defects, congenital anomalies, and neoplasms (cancer), said Dr. Papaconstadopoulos.
She described this age group as a healthy age group saying, It is not expected to be hospitalized or to die. The total number of deaths from COVID-19 from the beginning of the pandemic in this age group is around 100. That puts COVID-19 right now as the eighth leading cause of death in children 5-11 years old. It is more serious, more common than bacterial sepsis.
Some people may not remember, but prior to approving the Meningococcal vaccine that we routinely give in children at 11 years old, we had about eight confirmed deaths per year in that age group from meningococcal sepsis or bacterial meningitis. So no amount of death is acceptable in this age as long as we have an effective and safe vaccine, said Dr. Papaconstadopoulos.
Regarding risks, Dr. Papaconstadopoulos said this age group has the unique risk that its the highest risk for MIS-Cthats the Multisystem Inflammatory Syndrome in children, having the most common age presentation of 9 years old.
She noted that MIS-C presents itself about 2-4 weeks after an infection with COVID-19.
Now these children may not have had severe COVID-19. They may have had very mild symptomsfever, cough, congestionand 2-4 weeks later we see that its a reaction of their immune system, which causes a systematic inflammatory response. Theres inflammation in multiple organ systems, including the heart, causing a condition commonly known as Myocarditis. So children with MIS-C60-70% of those required pediatric ICU, and 1-2% of those died. The total number of cases of MIS-C from the beginning of the pandemic are 5,217 as of October 2021and 40% of those cases were in children 5-11 years old, she said.
Dr. Papaconstadopoulos said we still do not know the long term effects of COVID-19 in children (long haul COVID).
Currently there is a study to look into that. I dont think there is any primary care physician who hasnt seen the mental health toll that COVID-19 has taken on kids, she said.
We can now say that the risk of COVID-19 is similar to pre-COVID influenza rates. So it has the same risk as the influenza prior to COVID for children this age, said Dr. Papaconstadopoulos.
The FDA Emergency Use Authorization was based on the results from a clinical trial that included about 4,300 children between the ages of 5-11.
So what they did is they vaccinated about 3,000 of the children and about 1,500 received placebo. They compared the neutralizing antibody titers in this age group to the neutralizing antibody titers from a larger study in 16-25 year olds, and they found that with 1/3 of the dose, they had an equivalent responsean equivalent production of antibodies. Because the study was done during the Delta surge, we know that it protects also from the Delta variant, said Dr. Papaconstadopoulos.
The vaccine, she said, is 90% effective in preventing COVID-19 infection.
I found it interesting that 9% of the children in this study already had antibodiesthey already had COVIDso they tolerated the vaccine well. It actually boosted their immune responses, said Dr. Papaconstadopoulos.
During the study, the children were monitored for side effects, and they continue to monitor for two months later.
We know historically that the most common adverse effects from vaccines will be shown within the first two months after vaccination. That is why they put that limit. In medicine at some point, there has to be a decision of when we know enough to start protecting the rest of the decision, said Dr. Papaconstadopoulos.
In that amount of children, the side effects were generally mild to moderate. There were less frequent side-effects than the 12 years and older. The most common was pain at the site of the injection (about 70%); 40% experienced fatigue; 28% headache; 12% muscle pain; and about 10% reported chills with fever, she said.
She noted that cases of myocarditis (inflammation of the heart muscle); and cases pericarditis (inflammation of the outer lining of the heart) have been reported in children after the second dose of the vaccine in ages 12 and above.
This study had no cases of myocarditis, but the total number of the participants, 4,000, is pretty small to show us very rare adverse effects. So that is why theyre continuing to monitor, said Dr. Papaconstadopoulos.
Parents should keep in mind that the virus itself, the actual infection from COVID-19 is more likely to cause myocarditis than the vaccine. And we know by numbers that it is about 37 times more likely in older kids 12 [years] and above, the virus to cause the myocarditis, and a much more severe myocarditis than the vaccine, she said.
The vaccine itself has caused in young male adultsand the risk is about 54 cases per 1 million doses of the second dose of the vaccine administered to males ages 12-17. And almost all of those cases resolved completely without leaving permanent sequelae, she said.
Dr. Papaconstadopoulos said that the FDA, the American Academy of Pediatrics, the Infectious Disease Society of America, and multiple health organizations endorse this vaccine, because the overall benefits outweigh the risks.
Anything we do, and any decision we make has a risk and a benefit, and right now its clear that the safest way to protect our children from the complications of COVID, and as Dr. [Lorrin] Pang said previously, we dont know how much we are going to see in the future, the safest way right now to protect them right now is by vaccinating them. The risk right now to vaccinate is lower than getting COVID in this age group, said Dr. Papaconstadopoulos.
In speaking, she urged parents to discuss these topics with their pediatrician and family doctor, and make the decision that is best for their family.
For a while, during the worst of the pandemic last year, European governments largely seemed to reach a consensus. Barring a few exceptions (such as Sweden), countries in the region locked down their economies, keeping people at home in a bid to slow the pace of infection. In time, bolstered by plentiful vaccines, the continent has seen a resumption of near-normalcy: Public-health restrictions have loosened, and travel has restarted.
But as temperatures drop, and as rising cases place Europe back in the epicenter of the pandemic, the continent is once again being forced to grapple with tougher measures in a desperate bid to alleviate pressure on hospitals that are coming under strain. This time, however, European countries are no longer in broad agreement on the best path forward.
While several countries have followed Frances lead by implementing vaccine passports as a way to encourage people to get vaccinated, others are poised to follow the alternative recently set out by Austria, which this week instructed millions to stay home except for essential activities, such as going to work, grocery shopping, and exercise. Unlike previous national lockdowns, however, this one applied to only a subset of the country: the unvaccinated. Yesterday, the Austrian government took it one step further, announcing that restrictions would extend to the rest of the population for a maximum of 20 days starting next week and that vaccination would become obligatory as early as February.
The goal of both models is ultimately the sameto get more people vaccinatedbut the differences are key. In France, vaccination is strongly encouraged, though not necessarily required. Under its vaccine-passport system, those who are unvaccinated can still access public spaces if they can provide proof of having recently recovered from a COVID-19 infection, or a negative COVID test. In Austria, the opposite has now become true: Not only are unvaccinated people (excluding those who have recently recovered from COVID and children under the age of 12) poised to be barred from public spaces even after the national lockdown ends, facing fines of up to 1,450 euros ($1,640) if they fail to comply, but they will soon be subject to legal repercussions if they refuse to get a jab.
The question facing governments in Europe and elsewhere is which approachcarrot versus stickwill prove the most effective. By singling out the unvaccinated, Austria may succeed in increasing its vaccination rate, but it also runs the risk of driving vaccine skepticism even further.
In Austria, the unvaccinated still make up a sizable proportion of the population. Nearly a third of the country, or roughly 2 million people, has opted against getting a jabresulting in one of the lowest vaccination rates in Western Europe. Meanwhile, the country continues to break records for daily reported cases just as intensive-care units in some parts of the country near capacity.
To hear Austrian Chancellor Alexander Schallenberg tell it, this weeks drastic intervention wasnt designed to punish those who arent vaccinated. Rather, it was meant to prevent those who have been vaccinated from being held hostage by the unvaccinated minority. To subject everyone to new restrictions (as the government has now been compelled to do, albeit for a time-limited period) would be to risk undermining the incentives that compelled so many people to get vaccinated in the first place. It would also fail to address the fact that the growing strain on the countrys ICUs is largely being driven by unvaccinated patients. Austrias neighborsGermany, the Czech Republic, and Slovakiahave since announced that they will follow suit with tighter restrictions on the unvaccinated.
At some point, reality has to hit home: If the health-care system reaches its limits, then additional steps have to be taken eventually, Eva Schernhammer, the epidemiology-department chair at the Medical University of Vienna, told me. In the minds of some, she said, it just doesnt feel right [for] the government to impose measures on those who have done everything they can just to protect those who didnt.
David Frum: Vaccinated America has had enough
The challenge of addressing the lag in vaccination is what ultimately drove French President Emmanuel Macron to mandate the use of vaccine passports earlier this year. Despite what many naysayers said about the impact that such a strategy would have on more vaccine-hesitant populations (mea culpa, I was one of them), this approach has largely been viewed as a success. Even though France is one of the worlds most vaccine-hesitant countries, it has now vaccinated roughly three-quarters of its population, according to the governments vaccine trackernearly double the number of people who indicated that they would be willing to get a jab at the end of last year. Although the countrys infection rate continues to rise, it remains low relative to that of many of its neighbors.
But what worked for France hasnt necessarily worked for Austria. Despite implementing its own vaccine-passport system this year, the countrys vaccination rate has nonetheless stagnateda trend that has been attributed in part to the high levels of vaccine hesitancy among Europes German-speaking countries, where dispassionate public-health messaging has been supplanted by vocal anti-vaccine sentiment and conspiracy theories. In Austria, this phenomenon has manifested most notably in the rise of the new vaccine-skeptical People Freedom Fundamental Rights Party (known by its German acronym, MFG), which recently garnered enough support to enter one of the countrys largest regional parliaments.
So far, the unvaccinated lockdown in Austria appears to be having its desired effect, with some vaccination centers reportedly seeing an uptick in people seeking a first dose. But it has also spurred thousands of people to protest the new measures, which many have decried as discriminatory. Now that the lockdown is being extended to everyone, and now that vaccinations will soon be made a legal requirement, those protests are only likely to grow. One risk facing the Austrian government is that these new measures could spur even further support for parties such as the MFG and the more established far-right Freedom Party, whose leader said the new restrictions make Austria tantamount to a dictatorship. Another risk is that they could push those who are merely hesitant about getting a COVID vaccine to adopt a more hard-line anti-vax position.
One thing that people really want is some level of choice, and one of the Achilles heels of vaccines has been the feeling that its government-driven and its not about choice, Heidi Larson, the director of the Vaccine Confidence Project at the London School of Hygiene and Tropical Medicine, told me. Larson noted that although vaccine passports offer some element of choice (in that the unvaccinated can opt to provide a negative COVID test instead), unvaccinated-only lockdowns and vaccine mandates could be seen as more punitive.
Read: The pandemics next turn hinges on three unknowns
But perhaps the greatest risk for Austria right now is that these measures alone wont be enough to minimize hospitalizations, which is the primary metric that the government is focused on. That the tightening of restrictions in recent weeks isnt yet reflected in the numbers is a worrying sign, Schernhammer said.
You can impose rules, but if people dont follow, then it gets hard to do anything, she said. We have reached uncharted territory already, because what happens now will be seen in the ICU in two weeks.
By: Aaron PaynePosted on: Saturday, November 20, 2021
ATHENS, Ohio (WOUB) A little more than half of Athens County residents have started the COVID-19 vaccination process as of Saturday, according to the Ohio Department of Health.
The data surrounding vaccinations started in Athens County as of Nov. 20, 2021. [ODH]A total of 50.25% of the county has received at least one dose of the vaccine. Meanwhile, 46.38% has been fully vaccinated and 7,321 additional doses have been administered.
Athens County has now had 8,171 total cases of COVID-19 since the beginning of the pandemic after 17 new cases were reported Saturday.
The Ohio Department of Health confirmed the numbers on Nov. 20, 2021.
According to ODH data, the cases involved seven people 0-19, five people 20-29, three people 60-69, one person 30-39 and one person 80+.
There are 226 known active cases in the county as of Saturday and 7,851 recovered cases, according to ODH.
Anyone experiencing respiratory symptoms is asked to call their primary care physician, urgent care, or emergency department before arriving for care to let them know that they believe they are experiencing symptoms related to COVID-19 virus.
An age breakdown of Athens Co. COVID-19 cases for Nov. 20, 2021. [ODH]Saturday at 2 p.m., the Ohio Department of Health announced 1,639,070 confirmed and probable cases of COVID-19 statewide after 5,590 cases were reported in the last 24 hours. There have been 84,073 hospitalizations since the start of the pandemic.
ODH makes the following recommendations to protect yourself from illness:
Ohios coronavirus call center is open to answer questions from 8 a.m. to 9 p.m. daily. The hotline number is 1-833-4-ASK-ODH or 1-833-427-5634. More information is available atcoronavirus.ohio.gov.
In the wake of federal vaccine mandates in the U.S., debate has erupted over the waves of fire fighters,police staff, and other workers who have applied for religious exemptions to getting their COVID-19 shots. The number of applications is likely to spike as the January 4 vaccination deadline nears for large private businesses and some healthcare facilities. And one common reason people give for religious exemptions is the link between vaccines and human fetal cells.
Its true that such cells have been used either in the testing or development and production of COVID-19 vaccines. The cells are grown in a laboratory and were derived from a few elective abortions performed more than three decades ago. These same cell lines are also used to test and advance our understanding of several routine drugs, including Tylenol, ibuprofen, and aspirin, and they continue to be used for treatment research in diseases such as Alzheimers and hypertension.
So many people dont realize how important fetal cell lines are to develop life-saving medicines and vaccines that they rely on every day, says Amesh Adalja, an infectious disease expert at Johns Hopkins Center for Health Security. Their use in developing COVID-19 vaccines isnt anything different or special.
For some religious leaders, the science is informing their recommendations. In a December 2020 statement, the U.S. Conference of Catholic Bishops referred to these cell lines as morally compromised for their connection, albeit remote, with abortions. But they reiterated the message from the Vatican justifying the use of vaccines, lacking alternatives, as an act of charity and moral responsibility in situations of serious health danger, such as the COVID-19 pandemic.
Although its unclear how many religious exemptions for COVID-19 shots have been granted so far, those applying are required to prove religious sincerity and in some cases attest that they will also avoid the routine drugs developed using fetal cells.
But doctors worry that some peoples objections may stem in part from misunderstandings of the science. Richard Zimmerman, a family medicine specialist at the University of Pittsburgh School of Medicine and a part-time physician at Pittsburghs East Liberty Family Health Care Center, says that some of his patients have voiced scepticism because they believe the COVID-19 vaccines contain cells from aborted fetuses. This is incorrect.
Here is the history of how fetal cells are used in drug development, where the cells come from, and why its been so hard to find alternatives.
Unlike bacteria, viruses need a host to survive; they can only grow and reproduce inside the host cells they infect. Vaccines typically deliver small doses of weakened or inactivated versions of the virus, or key parts of it, to give the host body a preview of the pathogen without causing illness. This enables the immune system to remember a specific virus and how to destroy it if the body ever encounters the germ in the future.
To mass produce vaccines, manufacturers need a way to make enormous quantities of the viral components.
Scientists use fertilized chicken eggs, for instance, as hosts to multiply influenza viruses and produce the annual flu vaccines. But vaccines manufacturers prefer to grow the virus in mammal cells, mainly because they help prevent the virus from mutating and help scale production.
In the early days, scientists used animal cells. But they later realized that these cells can harbor other undesirable animal viruses, which would then contaminate the vaccine. For instance, an early version of the polio vaccine administered extensively between 1955 and 1963 was produced using monkey cells. But scientists later found out the cells were contaminated with a monkey virus called SV40.
The other issue was that some human viruses didnt grow as well in non-human animal cells. So scientists turned to human fetal cells to produce vaccine viruses.
They were known to rarely contain contaminating viruses, says cell biologist Leonard Hayflick at the University of California, San Francisco. He created the oldest fetal cell strain, known as WI-38, from an elective abortion in Sweden in the early 1960s. Hayflick knew that human fetal cells, unlike adult human cells, were less likely to contain unwanted viruses.
Over the years, though, scientists have identified other animal cells that could be safely used to develop vaccines against certain viruses. African green monkey kidney cells, for instance, have been used to develop several vaccines, including certain ones for polio and smallpox.
But especially with new human viruses, there is preference for using a human cell line, says Alessondra Speidel, a biomaterials scientist at Swedens Karolinska Institute, possibly because theyre likely to infect and grow better in human than animal cells.
To create fetal cell strains, scientists must isolate millions of cells from tiny pieces of tissue collected from a dead embryo. Each cell can divide into two nearly 50 times. And these cells can be frozenor in some cases, immortalizedso that today the cells being used come from tissue collected decades ago.
Hayflick, for instance, has frozen ten million human fetal lung cellsderived from one aborted fetusin each of 700 glass vials after the original cell population had doubled seven times. Given their potential to continue doubling at least another 30 times, each vial can yield tens of thousands of kilos of cells, he says. Thats enough cells to supply the world's vaccine manufacturers with WI-38 cells for several years. These lung cells are currently used to produce vaccines for varicella, rubella, hepatitis A, and rabies. Other scientists have transformed fetal kidney and retinal cells so that they become immortal, dividing forever. The PER.C6 cell line, for instance, is derived from immortalized retinal cells from an 18-week-old fetus aborted in 1985.
Johnson & Johnson uses PER.C6 to produce its COVID-19 vaccine. The company used these cells to grow adenovirusesmodified so that they wouldnt replicate or cause diseasethat were then purified and used to deliver the genetic code for SARS-CoV-2s signature spike protein. The J&J vaccine does not contain any of the fetal cells that once housed the adenovirus because they were extracted and filtered out.
Pfizer and Moderna used another immortal cell line, HEK-293, derived from the kidney of a fetus aborted in the 1970s. The cells were used during development to confirm that the genetic instructions for making the SARS-CoV-2 spike protein worked in human cells. This was like a proof-of-concept test, Speidel says, and the fetal cells were not used to produce either of these mRNA vaccines.
The issue is whether one believes that it is ethically acceptable to develop and use life-saving medicines, vaccines, and treatments that are dependent on a cell line that was created using aborted human fetal cells a half century ago, says Frank Graham, a molecular virology and medicine expert and emeritus professor at Canadas McMaster University, who created the HEK-293 cell line.
Even if future vaccines can somehow avoid the use of these fetal cell lines, its hard to ignore their foundational role. The same applies to the widespread use of these cells in studying several common diseases like diabetes and hypertension and advancing their treatments.
And beyond the science, the message that has resonated most with several of Zimmermans vaccine-hesitant patients is one of altruism. Nobody wants to be the one who triggers an infectious disease on their loved one, he says.
Novak Djokovic in Melbourne, Australia, in February. He is the reigning Australian Open mens singles champion and has declined to divulge his vaccination status.Credit...Asanka Brendon Ratnayake/Reuters
The Australian Open in January will become the first Grand Slam tennis tournament to require that players be fully vaccinated against the coronavirus, a decision that casts doubt on the participation of Novak Djokovic of Serbia, the No. 1-ranked mens player, who has declined to divulge his vaccination status.
Craig Tiley, the Australian Open tournament director, confirmed the tournaments policy in a television interview in Melbourne on Saturday.
The announcement ended months of speculation and mixed messages from Australian government officials. Federal authorities had indicated that unvaccinated players might be able to enter Australia and compete in the tournament in Melbourne after a 14-day quarantine period. But Daniel Andrews, the premier of the state of Victoria, has been adamant that players will need to be fully vaccinated, just as Australian Open spectators and on-site employees will be required to be vaccinated.
Melbourne, Victorias capital, has experienced some of the strictest coronavirus measures in the world, with six separate stay-at-home orders over an 18-month period.
It is the one direction that you can take that you can ensure everyones safety, and all the playing group understands it, Mr. Tiley said of requiring players to be vaccinated. Our patrons will need to be vaccinated. All the staff working the Australian Open will need to be vaccinated, but when were in a state where theres more than 90 percent of the population fully vaccinated theyve done a magnificent job with that its the right thing to do.
Source: Center for Systems Science and Engineering (CSSE) at Johns Hopkins University. The daily average is calculated with data that was reported in the last seven days.
Steve Simon, the chief executive of the Womens Tennis Association, said in an interview this past week that over 70 percent of the W.T.A.s top 300 singles players and top 100 doubles players had been vaccinated and that all of the singles and doubles players who competed in the recent W.T.A. finals in Mexico had been vaccinated.
Andrea Gaudenzi, the chairman of the mens tour, said in an interview on Friday that the vaccination rate for the top 100 mens singles players was above 80 percent.
We are moving toward 90 percent, 95 percent of fully vaccinated, he said. A lot will do it in the off-season with one shot.
But it seems all but certain that some qualified players will not make the journey to Australia because of the policy.
All four Grand Slam tournaments, including the U.S. Open, allowed unvaccinated players to participate this year, as have regular tour events.
Djokovic, a nine-time Australian Open singles champion, has yet to confirm whether he will defend his title next year. He and his wife, Jelena, contracted the coronavirus in June 2020 during an exhibition tour that he had helped to organize in Serbia and Croatia.
He has expressed concern about vaccines and has said repeatedly that he would wait for the Australian Opens policy to be made clear before making a decision on participating.
The Centers for Disease Control and Prevention on Friday endorsed booster shots of the Pfizer-BioNTech and Moderna coronavirus vaccines for all adults, a move that brings tens of millions fully vaccinated people a step closer to a third shot.
Boosters are recommended six months after the second shot of the Pfizer-BioNTech or Moderna vaccines. With this final step, boosters should be available this weekend, allowing many Americans to get a shot before the Thanksgiving holiday.
The new recommendations say that everyone 50 and older most of whom have other risk factors as well as those 18 and older living in long-term care facilities should get a booster. Other Americans who are 18 and older may opt for one if they wish, based on individual risk and benefit.
Several advisers said at the meeting that they hoped the simpler age-based guidelines would ease some of the confusion around who is eligible for the extra shots.
An advisory committee to the C.D.C. unanimously voted in favor of the booster shots. Dr. Rochelle Walensky, the agencys director, later formally accepted the recommendation. The recommendations align with President Bidens promise in August that all adults would be eligible for extra doses.
Desperate to dampen even a dim echo of last winters horrors, the administration is betting that booster shots will shore up what some have characterized as waning immunity among the fully vaccinated.
The Food and Drug Administration authorized boosters of the Pfizer-BioNTech and Moderna vaccines for all adults on Friday, but the C.D.C. generally makes the recommendations followed by the medical profession.
In recent days, several states have broadened booster access to all adults on their own.
Addressing the panelists, Dr.SamPosner, the acting director of the National Center for Immunization and Respiratory Diseases, acknowledged that previous eligibility categories were complicated to implement and said he hoped that simplifying them will reduce confusion.
After a brief respite, coronavirus infections are inching up again, particularly in parts of the country where cooler weather is hustling people indoors. Research suggests that the shots may help forestall at least some infections, particularly in older adults and those with certain health conditions.
The C.D.C.s decision lands just as Americans are preparing to spend the holidays with family and friends. Given the tens of millions of Americans who have yet to receive a single dose of vaccine, holiday travel and get-togethers could send cases skyrocketing, as they did last year.
Several European countries are also offering boosters to all adults in a bid to contain fresh waves of infections. France has gone so far as to mandate booster shots for people over age 65 who wish to get a health pass permitting access to public venues.
Noah Weiland and Dan Levin contributed reporting.
Pregnant women who had Covid-19 when they delivered their babies were almost twice as likely to have a stillbirth as healthy women who did not have Covid, according to a Centers for Disease Control study released on Friday that examined more than 1.2 million deliveries in the United States from March 2020 to September 2021.
While stillbirths were rare overall, representing less than 1 percent of all births, 1.26 percent of the 21,653 women with Covid experienced a stillbirth, compared with 0.64 percent of women without Covid. Even after adjustments were made to control for differences between the groups, women with Covid were 1.9 times as likely as healthy women to have a stillbirth.
The risk of stillbirth has been even higher for women with Covid since the Delta variant has been dominant: While the risk of stillbirth for women with Covid was 1.5 times as high as that of healthy women before July, when Delta became dominant, it was four times as high from July to September. As many as 2.7 percent of deliveries to women with Covid were stillbirths during the period studied while Delta was dominant.
There had been reports suggesting an increased risk, but stillbirths are hard to study, because luckily they are uncommon, said Dr. Denise Jamieson, the chief of gynecology and obstetrics at Emory Healthcare. This is some of the strongest evidence of the increased risk, and probably the strongest data pointing to the risks specifically tied to Delta.
The C.D.C. strongly encourages pregnant and breastfeeding women and women planning or trying to become pregnant to be vaccinated against Covid, but resistance has been strong, even though pregnancy is on the C.D.C.s list of health conditions that increase the risk of severe disease.
Studies have shown that pregnant patients who are symptomatic are more than twice as likely as other symptomatic patients to require admission to intensive care or interventions like mechanical ventilation, and they may be more likely to die. They are also more likely to experience a preterm birth.
Another C.D.C. study issued on Wednesday described the cases of 15 pregnant women in Mississippi who died of Covid during their pregnancy or shortly afterward, including six who died before the Delta variant became dominant and nine who died from July to October, while Delta was dominant.
Of the women who died, nine were Black, three were white and three were Hispanic. The median age was 30. Fourteen of the women had underlying medical conditions, and none were vaccinated. Five of the deaths occurred before vaccinations were available.
Austria on Friday became the first Western democracy to announce that it would mandate Covid vaccinations for its entire adult population as it prepared for a nationwide lockdown starting Monday.
The extraordinary measure by Austria, which only days ago separated itself from the rest of Europe by introducing a lockdown for the unvaccinated, who are driving a surge of infections, made for another alarming statement about the severity of the fourth wave of the virus in Europe, now the epicenter of the pandemic.
But it also showed that increasingly desperate governments are losing their patience with vaccine skeptics and shifting from voluntary to obligatory measures to promote vaccinations and beat back a virus that shows no sign of waning, rattling global markets at the prospect that still tentative economic recoveries will be undone.
Some European countries, including Germany, which once seemed a model of how to manage the virus, are now facing their worst levels of infections in the nearly two years since the pandemic began. The surge, health authorities say, is being driven by stubborn resistance to getting vaccinated in deep pockets of the population, cold weather driving people indoors, loosened restrictions and possibly waning immunity among those previously vaccinated.
Source: Center for Systems Science and Engineering (CSSE) at Johns Hopkins University. The daily average is calculated with data that was reported in the last seven days.
For a long time maybe too long I and others assumed that it must be possible to convince people in Austria to voluntarily get vaccinated, Chancellor Alexander Schallenberg of Austria said on Friday. We therefore have reached a very difficult decision to introduce a national vaccine mandate.
With its latest move, Austria significantly moved ahead of other European countries that have inched up to, but not crossed, a threshold that once seemed unthinkable. The announcement drew an immediate threat of violent protest this weekend by leaders of anti-vaccine movements and the far-right Freedom Party, which compared the governments latest mandates with those of a dictatorship.
Many European countries have already instituted mandates in all but name only requiring strict health passes as proof of vaccination, recovery from infection or a negative test to partake in most social functions, travel or to go to work. Many already require children to be vaccinated against measles and other illnesses to attend school.
The notion of requiring vaccination in adults against Covid was a line that Europe had seemed unwilling to cross, however, with leaders often contrasting their respect for civil liberties with authoritarian-styled countries.
But just as lockdowns have become a fact of life, vaccine mandates are increasingly becoming plausible. German lawmakers in Parliament voted on Thursday to force unvaccinated people going to work or using public transit to provide daily test results. The countrys vaccination rate among adults is about 79 percent, one of the lowest in Western Europe.
On Friday, Jens Spahn, the acting health minister in Germany, was asked whether a general lockdown was possible for the country. We are in a position where nothing should be ruled out, he said.
The specter of a lockdown in Germany, Europes largest economy, sent jitters through European markets hungering for economic recovery and sales during the Christmas shopping season.
Austrias new vaccine mandate will take effect in February, in the hopes that as many people as possible will be motivated to sign up for their initial inoculations, but also booster shots, Austrias health minister, Wolfgang Mckstein, said.
It also gave leaders time to formalize legal guidelines for the mandate, he said, adding that there would be exceptions for people who are not able to be vaccinated.
An earlier version of this briefing item incorrectly described the nature of Austrias planned nationwide lockdown. It will be among the first in Europe since the spring, not the first.
Gov. Bill Lee said on Friday that he would not renew Tennessees state of emergency, ending measures that he first put in place in response to the coronavirus outbreak in March 2020.
The governor announced the decision in a tweet:
Mr. Lee added that he would consider temporarily reinstating the measures should the state face any future surges, but that his administration was evaluating opportunities for permanent deregulation.
Recently, cases in Tennessee reached a peak in early September before dropping steeply, but infections have been rising again in recent days.
Source: State and local health agencies. Daily cases are the number of new cases reported each day. The seven-day average is the average of a day and the previous six days of data.
Mr. Lee, a Republican, has been active in rolling back pandemic restrictions. Last week, he signed a bill into law that prohibited government entities, schools and private businesses in Tennessee from requiring Covid vaccinations or proof of vaccination and limited their ability to impose mask mandates. The law also prohibited health care providers from vaccinating minors without the written consent of a parent or legal guardian.
On Wednesday, the governor made a pitch to law enforcement personnel who were leaving states with restrictive mandates to join the Tennessee Highway Patrol, going so far as offering to help pay their moving expenses.
With the holiday travel season nearing, Canadian officials announced several measures on Friday meant to standardize international travel and make it easier for Canadians taking short trips to re-enter the country.
Travelers who are fully vaccinated with the shots from Sinopharm, Sinovac and Covaxin will be allowed to enter Canada starting Nov. 30, opening the door wider to people from countries like India, Brazil and China, where those vaccines are more frequently administered.
Currently, Canada only accepts travelers who have received the Pfizer-BioNTech, Moderna, Oxford-AstraZeneca or Johnson & Johnson vaccines, the four shots approved in the country. The expanded list will align with the vaccines cleared for use by the World Health Organization.
Dr. Theresa Tam, Canadas chief public health officer, said that the case rates associated with each of the vaccines were about the same.
All that is very reassuring, Dr. Tam said. She added that although Sinopharm, Sinovac and Covaxin are not authorized in Canada, because theyve gone through the W.H.O. process in terms of evaluation of safety, of efficacy and of quality, weve taken that into account as we increase the list of vaccines for Canadian border measures.
Source: Center for Systems Science and Engineering (CSSE) at Johns Hopkins University. The daily average is calculated with data that was reported in the last seven days.
Additionally, people leaving Canada by land or by air for less than 72 hours will no longer be required to provide proof of a negative Covid-19 test to re-enter the country. The price and processing time of P.C.R. tests which can cost more than $100 and take longer than a day for results were widely seen as deterrents to travel.
This change applies only to Canadians, permanent residents and Indigenous people registered under the Indian Act. It also takes effect Nov. 30.
The government will take a firm stance against unvaccinated travelers entering and leaving the country beginning on that date as well, with very few exemptions, said Omar Alghabra, Canadas transport minister. He added that only fully vaccinated travelers would be able to fly from a Canadian airport or board a Via Rail or Rocky Mountaineer train.
Starting Jan. 15, Canada will also phase out most previously granted travel exemptions for those who are unvaccinated. This will affect professional and amateur athletes, foreign students, truck drivers and other essential workers who cross the border, and adults over 18 traveling to reunite with a family member.
Other categories of unvaccinated or partly vaccinated travelers such as refugees, marine crews and agricultural workers will be able to enter only with limited approval.
BRUSSELS The European Unions drug regulator on Friday recommended the use of a pill, developed by Merck, that was found in a clinical trial to halve the rate of hospitalizations and deaths in high-risk Covid patients who took it soon after infection.
The drug, molnupiravir, has yet to be authorized by E.U. countries, but in recommending its administration, the European Medicines Agency paved the way for its use within the next few months.
Several E.U. countries, including France and Italy, have already placed orders for supplies of the drug.
Britain became the first country this month to authorize the use of the pill. Its regulator authorized it for vaccinated and unvaccinated people who have Covid and are at high risk of becoming severely ill. The treatment could be authorized in the United States as soon as early December.
The European Medicines Agency said the drug could be taken by adults who do not require supplemental oxygen and who are at increased risk of developing severe coronavirus cases. The pill should be administered as soon as possible after diagnosis of Covid-19 and within five days of the start of symptoms, the agency said in a news release.
The agency also said on Friday that it had begun reviewing a similar drug developed by Pfizer, called Paxlovid.
Scientists and government leaders have called the drugs game changers in efforts to end the pandemic if their efficacy in clinical trials holds up in the real world. Unlike monoclonal antibodies, which are typically administered by health care professionals at a hospital or clinic, the pills would be dispensed at pharmacies and taken at home, providing a cheaper and easier way to treat coronavirus infections, including in poorer countries.
Merck has agreed to let other manufacturers make and sell its pill in 105 developing nations, including many where vaccination rates are critically low. It has also licensed eight large Indian drug makers to produce generic and cheaper versions of Mercks pill.
In the United States, Pfizer applied to the Food and Drug Administration this past week to authorize Paxlovid, and the Biden administration plans to buy a stockpile of the pill that could be administered to as many as 10 million people.
Canada approved the use of Pfizer-BioNTechs coronavirus vaccine for children ages 5 to 11 on Friday, adding more than 2.8 million young people to those eligible for a shot.
Some provinces, including Ontario and Saskatchewan, have already announced plans to start scheduling appointments for young children as soon as the doses arrive. Canadas first order enough for all eligible children to receive one dose is expected to begin arriving on Sunday, Filomena Tassi, Canadas minister of public services and procurement, said at a news conference. She added that the government was working with Pfizer on a second order.
Overall, this is very good news for adults and children alike, Dr. Supriya Sharma, chief medical adviser at Health Canada, the agency responsible for drug authorization in the country, said at another news conference. It provides another tool to protect Canadians and, to the relief of many parents, will help bring back a degree of normality to childrens lives, allowing them to more safely do the things that they have missed during the last 20 months.
Pfizers is the first coronavirus vaccine to be approved in Canada for children ages 5 to 11. Health Canada based its approval on a clinical trial comprising 4,600 children, Dr. Sharma said, with 3,100 children receiving two doses of the vaccine spaced three weeks apart and 1,500 receiving a placebo.
There were four adverse reactions unconnected to the vaccinations, and none of the children experienced heart inflammation or severe allergic reactions.
Source: Center for Systems Science and Engineering (CSSE) at Johns Hopkins University. The daily average is calculated with data that was reported in the last seven days.
The pediatric doses each one-third of the adult dose will be stored in vials with an orange cap, and the cartons labels will have orange borders, to differentiate them from the adult vials, Christina Antoniou, a spokeswoman for Pfizer Canada, said in an email.
The reduced dose for children results in antibody levels comparable to those from the larger dose in adults, said Dr. Jeffrey Pernica, an infectious diseases specialist at McMaster Childrens Hospital in Hamilton, Ontario. For parents wondering if they should wait until their child turns 12 to get the larger dose, Dr. Pernica noted, the immune response produced by the pediatric vaccine is just as strong.
I dont think waiting would have any significant benefit, he said.
Nearly 75 percent of all Canadians, or more than 28.5 million people, are fully vaccinated.
More than 16,800 coronavirus cases have been reported in Canada in the past seven days, according to national public health data, with the highest per capita rates in Yukon and the Northwest Territories. First Nations reserves are also experiencing high per capita infection rates.
While the number of severe cases has declined nationwide, hospitals in some areas are inching closer to capacity limits, said Dr. Theresa Tam, Canadas chief public health officer. She added that newly reported cases were highest among children.
As Austria prepares to go into a national lockdown next week, the health minister in neighboring Germany suggested on Friday that a similar measure remained an option for his far larger country as coronavirus cases there continue to reach record levels.
We are in a position where nothing should be ruled out, the minister, Jens Spahn, told a news conference in response to a reporters question about a lockdown for both vaccinated and unvaccinated people.
His remarks came one day after lawmakers in Parliament voted to force unvaccinated people going to work or using public transit to provide daily test results. The countrys vaccination rate among adults is about 79 percent.
Source: Center for Systems Science and Engineering (CSSE) at Johns Hopkins University. The daily average is calculated with data that was reported in the last seven days.
Chancellor Angela Merkel and state governors also agreed on Thursday night to require proof of vaccination or recovery from coronavirus infection for people entering restaurants, bars and hair salons or attending events in states where hospital beds are becoming scarce.
But some German states are going it alone.
On Friday, the governor of Bavaria, which has some of the countrys worst hot spots, announced measures including the cancellation of all Christmas markets and the closing of bars, clubs and nightclubs until at least Dec. 15. The celebrated Christmas market in the states capital, Munich, was canceled earlier this week.
Theaters, cinemas, operas and spectator sports will be allowed to remain open at 25 percent capacity for people who are vaccinated or who have recovered from the virus and show a negative test result. Restaurants will close at 10 p.m.
Districts with high infection rates will close down completely, leaving only essential shops, day cares and schools open.
We are facing a corona drama, the states governor, Markus Sder, said. The numbers are exploding in the shortest time span and the beds are full, he added, referring to overwhelmed hospitals. Some patients there are being moved to less crowded hospitals in northern Germany.
The governor of Saxony also announced new restrictions on Friday. Starting on Monday, a ban will be introduced on some events and larger gatherings regardless of the inoculation status of those attending.
Oregonians 18 and older could be allowed to get COVID-19 Pfizer-BioNTech and Moderna vaccine booster shots as early as Saturday.
A key federal panel Friday recommended that all adults who got either of the two vaccines six or more months earlier be allowed to get a booster. A scientific panel working on behalf of western states will review the recommendation Friday, the last step before Oregon officials authorize the shots. The panel is almost certain to follow suit and the Oregon Health Authority is expected to issue policy based on the groups decision Saturday.
We ask for patience as vaccine providers ramp up to administer boosters, the health authoritys public health director Rachael Banks said in a statement.
Oregon health officials announced 1,090 new coronavirus cases Friday and 28 deaths connected to COVID-19.
Even as deaths and hospitalizations decline, Oregons COVID-19 death toll is nearing 5,000. The state has one of the lowest coronavirus death rates per capita, according to the U.S. Centers for Disease Control and Prevention. With about one case for every 100,000 Oregonians, Oregon has had the second-lowest case rate since the pandemic began, with only Vermont having fewer total cases per 100,000 residents.
Where the new cases are by county: Baker (13), Benton (17), Clackamas (79), Clatsop (2), Columbia (17), Coos (21), Crook (21), Curry (1), Deschutes (97), Douglas (60), Grant (6), Harney (2), Hood River (11), Jackson (49), Jefferson (21), Josephine (30), Klamath (33), Lake (1), Lane (83), Lincoln (16), Linn (64), Malheur (6), Marion (97), Morrow (6), Multnomah (140), Polk (22), Tillamook (5), Umatilla (23), Union (6), Wasco (3), Washington (111), Wheeler (1) and Yamhill (26).
Who died: Oregons 4,887th death connected to the coronavirus is a 56-year-old Josephine County man who tested positive Aug. 27 and died Sept. 1 at his residence.
The 4,888th death is a 51-year-old Josephine County man who tested positive Nov. 4 and died Nov. 15 at Asante Three Rivers Medical Center.
Oregons 4,889th death is a 75-year-old Lane County woman who tested positive Aug. 27 and died Sept. 1 at McKenzie-Willamette Medical Center.
The 4,890th death is a 37-year-old Multnomah County woman who tested positive Aug. 22 and died Sept. 1 at Providence Portland Medical Center.
Oregons 4,891st death is a 75-year-old Multnomah County woman who tested positive Aug. 26 and died Sept. 2 at her residence.
The 4,892nd death is a 35-year-old Washington County woman who tested positive Aug. 5 and died Sept. 3 at Providence St. Vincent Medical Center.
Oregons 4,893rd death is a 57-year-old Deschutes County man who tested positive Aug. 25 and died Sept. 3 at his residence.
The 4,894th death is a 61-year-old Deschutes County man who tested positive Aug. 17 and died Sept. 2 at St. Charles Bend.
Oregons 4,895th death is an 85-year-old Deschutes County man who tested positive Sept. 14 and died Sept. 30 at his residence.
The 4,896th death is a 96-year-old Klamath County woman who tested positive Sept. 2 and died Oct. 3 at her residence.
Oregons 4,897th death is a 68-year-old Columbia County man who tested positive Sept. 3 and died Sept. 25 at Legacy Emanuel Medical Center.
The 4,898th death is a 74-year-old Polk County woman who tested positive Jan. 18 and died Sept. 20 at Salem Hospital.
Oregons 4,899th death is an 82-year-old Jackson County man who first became symptomatic Nov. 11 and died at Asante Rogue Regional Medical Center.
The 4,900th death is a 73-year-old Jackson County man who tested positive Oct. 25 and died Nov. 4 at his residence.
Oregons 4,901st death is an 80-year-old Douglas County woman who tested positive Nov. 13 and died Nov. 18 at her residence.
The 4,902nd death is a 37-year-old Douglas County man who tested positive Nov. 11 and died Nov. 18 at his residence.
Oregons 4,903rd death is a 52-year-old Douglas County woman who tested positive Oct. 23 and died Nov. 16 at Mercy Medical Center.
The 4,904th death is an 87-year-old Deschutes County man who tested positive Oct. 30 and died Nov. 16 at St. Charles Bend.
Oregons 4,905th death is a 65-year-old Umatilla County man who died Oct. 8 at his residence.
The 4,906th death is an 80-year-old Umatilla County woman who tested positive Aug. 3 and died Nov. 2 at her residence.
Oregons 4,907th death is a 71-year-old Umatilla County woman who died Oct. 8 at her residence.
The 4,908th death is a 60-year-old Umatilla County man who tested positive Oct. 30 and died Nov. 15 at his residence.
Oregons 4,909th death is a 67-year-old Umatilla County woman who tested positive Oct. 25 and died Nov. 16 at Good Shepherd Medical Center.
The 4,910th death is a 91-year-old Umatilla County man who tested positive Oct. 18 and died Nov. 14 at his residence.
Oregons 4,911th death is a 69-year-old Wasco County man who tested positive Oct. 12 and died Nov. 16 at Mid-Columbia Medical Center.
The 4,912th death is a 49-year-old Multnomah County man from who tested positive Aug. 29 and died Sept. 23 at Kaiser Permanente Sunnyside Medical Center.
Oregons 4,913th death is an 82-year-old Multnomah County woman who died Oct. 27 at her residence.
The 4,914th death is a 59-year-old man from Marion County who died Aug. 10 at his residence.
Unless otherwise noted, all either had underlying medical conditions or health officials were confirming whether they did.
Hospitalizations: 407 people with confirmed cases of COVID-19 are hospitalized, down 12 from Thursday. That includes 94 people in intensive care, down 10 from Thursday.
Vaccines: 6,192 people have been reported newly vaccinated since Thursday.
Since it began: Oregon has reported 384,062 confirmed or presumed infections and 4,914 deaths, among the lowest per capita numbers in the nation. To date, the state has reported 5,890,034 vaccine doses administered, fully vaccinating 2,642,003 people and partially vaccinating 260,603 people.
To see more data and trends, visit https://projects.oregonlive.com/coronavirus/
Fedor Zarkhin
fzarkhin@oregonian.com; 503-294-7674
You need to provide evidence of vaccination and a negative test before travel to AustraliaHi Simon, if you are flying into Sydney from Europe, do you need to have a test within 24 hours and does it have to be at a private pathology lab? So confused right now.
-Kim
Hi Kim,
It's not within 24 hours, but you do need to have had a negative test and provide evidence of that negative test within three days (72 hours) of your planned departure.
It doesn't say whether that testhas to be done at a private lab, but without knowing where in Europe you are, that might be your only option.
It does make clear that it has to be a supervised lab test, so not one that you've done yourself.
Here's what the health department website says:
You must show evidence that you have been vaccinated, at least 7 days prior to international travel into or out of Australia, with a vaccine approved or recognised by the Therapeutic Goods Administration (TGA).
You must provide evidence of a negative COVID-19 PCR test taken within 3 days of your flights scheduled departure to your airline when you check-in for a flight to travel into Australia.
The website says:
At check-in, you must provide proof of an accepted negative supervised laboratory COVID-19 test using a respiratory sample or saliva.
Accepted tests include Polymerase Chain Reaction (PCR), which may also be reported as RT-PCR or PCR.
Rapid Antigen Tests (RATs) are not accepted and neither areserology tests.
Just for completeness, the recognised vaccines are as follows:
Two doses at least 14 days apart of:
Or one dose of:
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KALISPELL Health care professionals at Logan Health treated their first COVID-19 positive patient with Monoclonal Antibody (mAb) Treatment on Nov. 20, 2020.
Logan Health was one of the first hospitals in the country to treat COVID-19 patients with Monoclonal Antibodies thanks to an emergency use authorization by the US Food and Drug Administration (FDA).
It has provided a benefit to keep people out of the hospital, and really its nice to be able to offer something to people who are in this high-risk category, that are definitely at high-risk to being admitted, Logan Health Nursing Supervisor of Infusion and Vascular Access Jesse Arneson told MTN News.
Keeping COVID-19 related hospitalizations down was the goal when three health care professionals at Logan Health came together in the fall of 2020 to bring mAb treatments to the Flathead.
Jesse Arneson discusses Monoclonal Antibody Treatment
Antibody treatments are designed to provide your immune system with kind of a little help along the way to attack this infection, these specific antibodies are designed to get stuck on the spikes of the virus so that basically in a sense will neutralize its effect, said Arneson.
Health care professionals Arneson, Leah Scaramuzzo and Melissa Edmister studied the clinical trial for guidance, understanding how the drug works and assessing risks before deciding to bring monoclonal antibody treatments to Logan Health.
I was arraigning for the space and to make it happen, and Jesse was getting the nurses lined up, Leah was the one pulling the data so that we could have the conversations and move forward with it together, Logan Health Clinical Manager for Oncology and Infusion Melissa Edmister explained.
Logan Health is currently providing mAb treatment by infusion, with patients receiving four consecutive injections in the arm or abdomen.
Melissa Edmister discusses Monoclonal Antibody Treatment
Scaramuzzo said they spent countless hours talking directly with pharmaceutical companies on how to safely provide antibody treatment to patients.
We had multiple conversations with them back and forth about the best way to administer, safe way to administer because we wanted to make sure that our patients were safe when we administer the drug, and our team was comfortable and competent to do so, added Scaramuzzo.
Monoclonal Antibody treatments are designed to treat COVID-19 patients with mild to moderate symptoms regardless of vaccination status within days of the onset of symptoms. Patients must meet emergency use authorizations guidelines to receive treatment and have a referral from a physician.
And between the provider and the patient the decision is made of the risks versus benefits and the patient would then qualify for the actual administration of the medication, said Scaramuzzo.
Leah Scaramuzzo discusses Monoclonal Antibody Treatment
Edmister said the small team of health care professionals in charge of the treatment has now treated close to 2,000 patients. She noted some patients start to feel better within days, others in just hours.
A lot of people kind of start gradually feeling better over the next day and so kind of by the next morning theyre feeling much better but literally Ive seen people within an hour start feeling better, its miraculous when it kicks in like that, added Edmister.
Edmister said they are now treating up to 25 patients a day with monoclonal antibodies, working up to 16-hour days to provide the best care possible for their patients.
Logan Health reminds Flathead residents that vaccination is still the best strategy to prevent COVID-19 infection and severe illness.
The vaccination campaign team from UNICEF arrived in a small motorboat last month in the flooded village of Wernyol, not far from the capital of South Sudan, and met with elders under a tree on a small patch of dry land.
The team ran point by point through a briefing sheet of facts about coronavirus and the vaccine, hoping to pre-empt what they assumed would be a flurry of questions from the elders about the shot and its side effects.
But first and foremost, what the elders wanted to know was: when will the rains stop?
In recent years, it has sometimes felt as if rain is the only thing some South Sudanese have ever known. The result is the worst flooding in parts of South Sudan in six decades, affecting about a third of the country.
For most of the 11 million people in this landlocked nation in east central Africa, one of the poorest countries on Earth, the coronavirus pandemic is not at the top of the list of problems.
Many people have fled Wernyol and other villages in the state of Jonglei, while those who remain have lost their crops, their livestock and their homes. With fish almost the only food available, malnutrition is rampant, as is disease.
In Pawel, another submerged village a few hours down a river that only a few years ago was a road, the village leader, James Kuir Bior, 50, was a little skeptical with the U.N. representatives about how the coronavirus vaccine stacked up against all the villages other needs.
We need medicines and nets, Mr. Bior said as a thin covering of clouds overhead hinted at still more rain. Now all we can think about is how to get out of this flooding.
Villagers recognize the pandemic as a threat. Just perhaps not a very pressing one.
We heard people are dying, Mr. Bior said, but we havent seen anyone sick here. And besides, he said, When you are starving, you dont think about other things you need to feed your stomach first.
In any case, the question of vaccines was moot for these villages until the floodwaters receded. The nearest airstrip was submerged under several feet of water, so the shipment of Johnson & Johnson shots intended for the area was stuck in Juba, the capital. The airstrip finally reopened in mid-November, and vaccination is scheduled to begin on Friday, Nov. 26.
South Sudan, the worlds newest nation, was born in hardship and plenty of hope, but little seems to have changed since the day in 2011 that its people voted to secede from Sudan. The decade since has been one of political conflict and humanitarian crises.
Last month, I spent almost a week traveling with a U.N. team assessing the flood damage and preparing for the vaccine rollout in the region, much of it accessible these days only by canoe and small motorboat.
In Pawel, roughly a dozen men met to discuss the imminent arrival of the vaccine, the elders listening semi-attentively as a team from the U.N. relief agency led by Dau Deng, 41, filled them in. The young men nearby played chess, even less interested, as the temperature hovered near 100 degrees.
It was like that in many of the places we went.
A virus born half a world away, even one that has killed millions of people, could not compete with the threat lapping at their homes.
David Ayiik Deng Riak, a projects officer with Community in Need Aid, a local organization, said disease was no stranger to the region. Malaria is the leading parasitic disease in this area, he said, followed by respiratory infection, and then of course, parasitic worms.
Nov. 20, 2021, 8:17 p.m. ET
The flooding has made everything still worse. It is now common to see people wading to hospitals with waterborne illnesses like dysentery, giardia, hepatitis and schistosomiasis. Because people are staying in the water for the whole day, Mr. Riak said.
Although testing is scarce, there is a little evidence that South Sudan has a major Covid problem.
What the children are dying from is malaria, diarrheal diseases, respiratory infections, said Yves Willemot, a UNICEF communications officer. We have one child out of 10 that dies before the age of 5, and they dont die from COVID-19, he said.
South Sudan is currently administering some 152,000 doses of the Johnson & Johnson vaccine donated from the United States through COVAX, the global distribution program. It is the third batch of vaccines the country has received, and the ministry of health, backed by various U.N. agencies, is training vaccinators and grappling with the logistical hurdles of distribution.
When the first batch of vaccines arrived in South Sudan in March, there was so little capacity to distribute it that the government decided to donate half of it to neighboring Kenya so it wouldnt go to waste. A second batch of the AstraZeneca-University of Oxford vaccine arrived on Aug. 31, but was due to expire only a month later. Despite the tight window, officials say, all of it was used.
Now a third batch is in the country, this time the Johnson & Johnson vaccine, which requires only one shot instead of two.
The vaccine is not the only thing to have made it to South Sudan. So have some of the unfounded rumors about it that circulate in many parts of the world. In Pawel, one village elder raised one of the concerns directly.
Will we be able to do our duties as men? asked John Majak Deu, 58, as some of the young chess players finally looked up, and giggled. We were told by some of our sons, these people in the United States, that this vaccine is not good. It will cause infertility.
The U.N. workers assured him that infertility is not a side effect of the vaccine.
But there seems to be less hesitation in other areas.
In South Sudans capital, Juba, there was a steady stream of people at vaccination sites across the city in October.
At one site, the Gurey Primary Health Care Centre, Johnson Gaga, 22, had little use for rumors around his neighborhood that the vaccine spreads to the liver and causes death within a year. He wanted his shot so that he could continue studying abroad, in Uganda.
If you dont have vaccine. he said, they wont let us in.
