Pediatricians and parents are having difficulty accessing a new immunization used to prevent severe respiratory syncytial virus infections in infants.
The drug, called nirsevimab and sold under the brand name Beyfortus, was approved by the Food and Drug Administration in July. The Centers for Disease Control and Prevention initially recommended that it be given to all infants who are less than 8 months old, and to children 8 to 19 months old who have an increased risk for severe R.S.V.
But the demand for nirsevimab has exceeded the supply right as R.S.V. season has started to pick up. On Monday, the C.D.C. issued an alert about the drugs limited availability and said doctors who currently have doses should prioritize babies who are at the highest risk for severe infections: those who are less than 6 months old and infants who are immunocompromised or have an underlying health condition, such as cystic fibrosis.
To many experts, these revised recommendations make sense, given the supply restrictions. The vast majority of the severe illness and hospitalization is in kids in the first six months of life, said Dr. Coleen Cunningham, the chair of pediatrics at the University of California Irvine and pediatrician in chief for Childrens Hospital of Orange County. Yes, theres still plenty of kids getting sick beyond six months, but theyre much less likely to become seriously ill, she said.
The shortage appears to be affecting both large hospitals and small health clinics. Whether a health care provider has nirsevimab in stock largely depends on when and how much they ordered, said Richard Hughes IV, a vaccine-law expert at the firm Epstein Becker Green.
If clinics and hospitals have not yet ordered the drug, it is unlikely that they will be able to offer it to patients this fall and winter, said Dr. Sean OLeary, the chair of the American Academy of Pediatrics committee on infectious diseases.
In an email to The New York Times, a spokesman for Sanofi, which developed and manufactures nirsevimab in partnership with AstraZeneca, said that the companies are working to accelerate additional supply and explore a number of actions to extend the manufacturing network.
If your child qualifies for the immunization under the C.D.C.s new guidance but your pediatrician doesnt have it, try calling other local clinics to see if they do.
You should also confirm that your insurer will pay for it. Dr. OLeary said that nirsevimab is included in the C.D.C.s Vaccines For Children program, which offers free immunizations to families who otherwise might not be able to afford them. But not all private insurers are currently covering the shot, which has a list price of $495.
The supply issues are most acute for the 100 milligram dose of the drug, which is given to babies weighing more than 10 pounds. There is currently more availability of a 50 milligram dose that is approved for smaller infants and will primarily be given to those born during this R.S.V. season, which runs from October through March.
When nirsevimab was approved, it was heralded as a major advancement for infant health. In the United States, R.S.V. is the top cause of hospitalization for babies less than a year old; it results in 58,000 to 80,000 hospitalizations and 100 to 300 deaths every year among children under 5.
The drug is what is known as a monoclonal antibody therapy. It works somewhat like a vaccine, providing protection against severe disease. But the protection lasts just a few months. Thats because instead of teaching the babys immune system to develop antibodies against the virus, the injection delivers those antibodies directly. But once the antibodies are gone, so is the protection.
Another monoclonal antibody therapy, palivizumab, was approved in 1998 to prevent severe R.S.V. It has historically been reserved for preterm infants who have some of the highest risk because the drug is expensive and must be injected monthly. With the shortage of nirsevimab, the C.D.C. is now recommending that high-risk infants between 8 and 19 months be given palivizumab instead. There is an exception for American Indian and Alaska Native children who live in remote areas and have limited access to health care; they should still be given nirsevimab, if available.
An alternative option also exists for expectant mothers: This summer, the F.D.A. approved an R.S.V. vaccine for people who are 32 to 36 weeks pregnant. The antibodies they develop in response to the vaccine are passed through the placenta to the fetus, so the infant is born with protection against R.S.V.
If you have a young child who does not meet the current C.D.C. guidelines for immunization, your pediatrician is your best resource. Contact them if your child has symptoms like severe coughing, wheezing or shortness of breath.
While the shortage can be frustrating for pediatricians and parents, some experts see it as a positive sign that demand for the immunization is so high. I think this is a reflection of success, Mr. Hughes said. We have this brand-new tool to protect infants, and weve waited so long to be able to do that.
(Precision Vaccinations News)
Tuberculosis (TB) is not only the world's biggest infectious killer, but it also destroys families and livelihoods. Besides the fear of dying from the disease, in many communities, a diagnosis can sentence someone to social isolation, wroteLinda Geddes in an article published by Gavi, the Vaccine Alliance, on October 24, 2023.
While the Bacillus CalmetteGurin (BCG) vaccine provides significant protection against TB disease in infants and young children, new vaccines that block infection and prevent TB disease are urgently needed.
More than 100 years have passed since the first administration of the BCG vaccine; hopes are building that a vaccine that could protect all age groups against all types of TB may finally be in reach.
Fortunately, several TB vaccine candidates are now in late-stage clinical trials, raising hopes that an affordable and effective vaccine may soon be within reach.
Today's BCG vaccines are based on different attenuated strains ofM. bovis.
These BCG vaccines are recommended for newborns in countries with a high burden of TB.
TB vaccines are among the most widely used, reaching more than 80% of infantsin countries where the BCG vaccine is included in routine childhood immunisation programs.
In the United States, vaccinations with the TICE BCG version are limited and generally offered to children in areas experiencing community spreading of TB.
The U.S. CDCreported inMarch 2023 that TBcases increasedby 5% in 2022, with8,300 confirmedcases. In addition, about13 million people live withlatent TB infection in the U.S.
Recent data indicates TB rates are accelerating by double digits in certain Texasareas (Dallas,Hidalgo County,Houston,San Antonio)in 2023.
Gedde's full, unedited article is posted at this link.
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Nearly four years since the start of the coronavirus outbreak, you could be forgiven for believing the pandemic is behind us. But for many, it feels far from over.
Close to two million people face a daily battle with debilitating symptoms of long Covid the lasting symptoms of the virus that remain after the infection is gone with some now housebound, unable to walk and even partially blind.
Alan Chambers, 49, and Allan Reeling, 76, are among those who have been grappling with the illness for years, having caught coronavirus in March 2020, two months after the UKs first two patients tested positive for the virus.
Vicki Chambers (right) is working full-time while also caring for her husband Alan (left)
(Vicki Chambers)
Mr Chambers went from being a fit, healthy, working member of the community who would do anything to help anyone to being ill and isolated in our bedroom, blind in one eye and no longer able to walk unaided, his wife Vicki said.
The father-of-two also suffers from intense pain, constant headaches, chronic fatigue and an erratic heart rate.
Just before he caught Covid, Mr Reeling, of Telford in Shropshire, was going to the gym five times a week. Now, among other symptoms, his issues with balance are so severe that he can fall flat on [his] face when he attempts to stand, he is absolutely frozen stiff and exhausted all the time and he developed a howling in his left ear that was diagnosed as tinnitus.
He told The Independent: It has wrecked the last three and a half years of my life, and it will wreck the rest of my life until the coffin lid is screwed. I wasnt looking at circling the plughole [in a state of decline], but now I think I am circling the plughole.
Allan Reeling, 76, is among those who have been grappling with long Covid for years
(Allan Reeling)
I cant see this getting any better. Id like to see the end of it, but I cant see any prospect of it. On a daily basis, I feel rubbish. Its atrocious, debilitating and depressing.
As of March, an estimated 1.9 million people in the UK have experienced coronavirus symptoms for more than four weeks, according to the latest figures from the Office for National Statistics. Of those, 1.5 million reported the condition had adversely affected their day-to-day activities.
Meanwhile, a major new study led by researchers at Imperial College London has revealed that one in 20 patients have symptoms lasting more than a year.
Carol Vorderman opens up about long Covid struggle
It comes as coronavirus case rates have shown an overall increase since July, with fears the approaching winter will bring a further surge in infections.
Yet in May, the World Health Organisation (WHO) declared that coronavirus no longer represents a global health emergency, which was seen as a symbolic step towards the end of the pandemic.
Dr Jo House, founding member and health advocacy lead at Long Covid Support, said the advocacy group now has 62,000 members, with about 250 more people joining every month.
In their words, they feel forgotten, unheard, disbelieved, isolated, unemployed, disabled, immobile. The emotional cost of dealing with little or no medical support is devastating, said Dr House, who has long Covid, along with her husband, after both caught the virus from a neighbour they were helping in March 2020.
Alan Chambers suffers from intense pain, constant headaches, chronic fatigue and an erratic heart rate
(Vicki Chambers)
Research published in TheLancet in 2021 revealed that long Covid has over 200 symptoms. Dr House said she had noted symptoms from immobility to hair loss to vision issues among patients and described it as a disease that causes multi-organ damage and damages cells in every body system.
Speaking of the impact the condition has had on her and her husband life, Dr House said, We thought we would die and wrote letters to our kids. It took around a year until we could get out the house. I am still only back at work 40 per cent, and our kids are still our carers. Six months in I could hardly get out of bed.
Despite her poor health, she and other medical experts wrote a review of long Covid in October 2020. The Covid Inquiry, which is examining the governments response to the pandemic, heard this month that then-prime minister Boris Johnson labelled the condition bollocks.
Alan Chambers, 49, caught coronavirus in March 2020, two months after the UKs first two patients tested positive for the virus
(Vicki Chambers)
We do feel forgotten, said Rachael Illingworth, 37, who has been debilitated by long Covid for over two years and said she has had to resort to exchanging treatment suggestions with fellow sufferers on Reddit forums because of a lack of other support.
NHS England admitted to The Independent that access to necessary support, treatment and care for long Covid patients is still lacking. It said there was still more to do to ensure support is there for everyone who needs it, so that patients requiring specialist assessment and treatment for long Covid can access care in a timely way.
After being mildly infected with Covid twice, Ms Illingworth, of Basingstoke in Hampshire, said she has been left with serious fatigue, shortness of breath, and brain fog that felt like her mind was wading through treacle.
Rachael Illingworth, 37, who has been debilitated by long Covid for over two years
(Rachael Illingworth)
Previously sporty and active, at her worst, she was struggling to walk up a flight of stairs and unable to catch her breath. She was even having difficulties cooking and getting off the sofa.
After being signed off work for a month, she returned and told of a time she broke down in tears. I stared at words and couldnt formulate a full sentence. I knew what I needed to achieve, but I couldnt move a box of text on a PowerPoint. I ended up in tears because its so debilitating not just physically but also mentally. I have had to completely change the way I live my life.
Despite this, Ms Illingworth said it was a challenge to get doctors to believe or support her. She described being medically gaslit about what condition she had and the severity of it.
After being signed off work for a month, Ms Illingworth returned and told of a time she broke down in tears
(Rachael Illingworth)
The advice Ms Illingworth was given of merely needing to implement lifestyle changes is sadly very common, said Prof House. Many are still being let down. She said her patient surveys even showed that not being believed was worse for some than their long Covid symptoms. Personally, Prof House said she is among the patients who have been told their symptoms are down to anxiety.
Mr Reeling said doctors told him: There is nothing we can do about it. You just have to get on with it and learn to live with it.
There is no cure for long Covid and it affects everyone differently, with treatment to attempt to manage the myriad of symptoms offering the best hope for sufferers.
Similarly, Ms Chambers, of Worcester, said: Weve fought so hard to get help, but no one does anything.
The family has been struggling financially, with Ms Chambers forced to work full-time while caring for her husband. She said she set up a support group on Facebook, Long Covid Support, to help her cope with the intense anxiety she was experiencing.
Mr Chambers is no longer able to walk unaided after being a fit, healthy, working member of the community
(Vicki Chambers)
Mr Chambers is among the 10 per cent of sufferers forced to stop working at a cost of 1.5bn in lost earnings every year, according to the Institute for Fiscal Studies, indicating the conditions lasting impact on Britains economy.
It is for people like Ms Illingworth, Mr Reeling, Dr House and the Chambers, as well as himself, that fellow long Covid sufferer Aaron Campbell, 29, has launched a GoFundMe fundraiser for a nationwide billboard campaign, with the first set to go up in Bournemouth this week.
It adds to the increasing pressure being piled on the UK government, which has also so far received over 74,000 letters demanding it tackle the long Covid crisis as part of a campaign launched by The Long Covid Action Project.
Mr Campbell said his life has been entirely derailed by the long-term effects of the virus, experiencing dramatic hair loss, headaches, fatigue, and increased heart rate.
Long Covid sufferer Aaron Campbell, 29, has launched a GoFundMe fundraiser for a nationwide billboard campaign
(Sophie Dimitriou of Berlin Buyers Club / Aaron Campbell)
The 29-year-old described a bleak outlook for his future. I used to have plans for my career and to travel, but Im worried this might be my life now just waiting for a treatment that might never come.
An NHS spokesperson said: Over the last three years, the NHS in England has invested significantly in supporting people with long Covid, this includes setting up over 100 specialist clinics which have helped over 100,000 people with the long-term physical, cognitive and psychological effects of Covid.
Urging all those eligible to take up the vaccine or booster when offered, a Department of Health and Social Care (DHSC) spokesperson said: We know long Covid can have a debilitating impact, which is why we are backing our world-leading scientists with over 50million to better understand the long-term effects of this virus and make treatments available.
Both the DHSC and the NHS urged anyone concerned about long-lasting symptoms to get in touch with theirGP or to visit the NHS 'Your Covid Recovery' website for further advice on the support available.
Why It Matters: Covid is still dangerous to some Americans.
More than 1,200 people are dying of Covid each week, according to C.D.C. data. Thats a travesty, said Dr. David Kimberlin, a pediatrician at the University of Alabama at Birmingham who represented the American Academy of Pediatrics at the meeting.
Its like an entire neighborhood being wiped out every single week, Dr. Kimberlin added.
About 16,000 people were hospitalized with Covid in the week ending Oct. 14, compared with nearly 23,000 at the same time last year and more than 44,000 in 2021.
Covid hospitalizations among adults aged 75 and older are two to three times as high as among those aged 65 to 74. Rates of hospitalization are highest among Native Americans, Alaska Natives and Black Americans.
Less than 1 percent of Native Americans and Alaska Natives, and 7.6 percent of Black Americans, had received the vaccine as of Oct. 14.
Im really disappointed in the low rates of vaccination, because I think its a major missed opportunity to improve our overall level of health, said Dr. Camille Kotton, a physician at Massachusetts General Hospital and an adviser to the C.D.C.
Most people should be able to get the vaccines at no cost through private health insurance, Medicare or Medicaid. Government programs also make the vaccines available for free to children and adults who are underinsured or uninsured, at least through Dec. 31, 2024.
So far, more than 380,000 doses have been administered to uninsured people at more than 24,000 pharmacies.
Still, many people have reported having trouble finding the vaccine at pharmacies, being charged fees or even mistakenly being turned away. At some pharmacies, demand has outstripped supply, leading to canceled appointments.
Dr. Kotton said her clinic and others had received doses of the vaccine only in the past couple of weeks, and she was cautiously optimistic that the immunization rates would pick up.
According to the Health and Human Services Department, 12 million Americans had been vaccinated by Oct. 14. That number grew to 14.8 million in the week after.
About 36 percent of adults age 75 and older in the survey said they would definitely get the shot, while 26 percent said they would probably do so or were still undecided.
Some experts have argued that immunity from previous infections and vaccinations is enough to protect most young people from severe illness and death from Covid.
The C.D.C. recommended on Sept. 12 that all Americans age 6 months and older receive at least one dose of the latest Covid shots. At the time, advisers to the agency were united in endorsing the vaccines for those at high risk because of their age, race or health status.
But a few advisers also expressed concern about recommending the shots to younger people, especially children, and young males at higher risk for myocarditis, an uncommon side effect. Relatively young and healthy people are at much lower risk of severe illness.
Still, in some patients, the virus can inflict long-term damage to the heart and other organs.
About 38 percent of adults in the survey said they would not choose the vaccine for themselves. About the same percentage of parents said they would not have their children immunized.
We can have the best vaccine in the world, we could have the best ability to access it in the world, Dr. Kimberlin said, but if 40 percent of people say they dont want it, he added, its just going to sit on the shelf.
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The SARS-CoV-2 virus responsible for COVID-19 can cause severe acute respiratory syndrome, contrasting with other coronaviruses that were known to cause mild seasonal colds prior to its emergence in 2019. This raises the question of why one coronavirus affects humans more severely than another. Scientists at the Institut Pasteur, Universit Paris Cit and the VRI have now provided part of the answer by identifying a gateway used by the seasonal coronavirus HKU1 to enter human cells.
HKU1 binds to a different receptor than SARS-CoV-2, which may partly explain the difference in severity between these two coronaviruses. Receptors provide a useful means of elucidating coronavirus transmissibility and pathology as part of surveillance work on viral evolution. These results are published in Nature.
Seven coronaviruses are known for their ability to infect humans. Four of these are generally mild: HKU1, 229E, NL63 and OC43, while the other three are more pathogenic: SARS-CoV-1, Mers-CoV and SARS-CoV-2.
The HKU1 virus was first identified in an elderly patient with severe pneumonia in Hong Kong in 2005. Like SARS-CoV-2, HKU1 mainly infects upper respiratory tract cells. However, it rarely affects the bronchi and alveoli in the lungs. The HKU1 virus causes colds and other mild respiratory symptoms.
Complications may also occur, including severe respiratory tract infections, particularly in young children, the elderly and immunocompromised individuals. It is estimated that 70% of children are infected before the age of 6. In total, 75 to 95% of the global population has been exposed to HKU1, which is comparable to other seasonal human coronaviruses.
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At the cellular level, coronavirus spike proteins are cleaved, or split in two, after binding to their receptors. This cleavage phenomenon is vital for viral fusion, entry and multiplication. Some coronaviruses (SARS-CoV-2 and NL63) use the ACE2 receptor as a gateway for entering cells. Until now, HKU1 and OC43 were the only coronaviruses with unknown receptors.
Through collaboration between scientists at eight Institut Pasteur units, it was possible to identify the TMPRSS2 enzyme as the receptor to which HKU1 binds to enter cells. Once binding has occurred, TMPRSS2 triggers fusion of HKU1 with the cell, leading to viral infection. Through a combination of techniques performed in vitro and in cell culture, the scientists demonstrated that the TMPRSS2 receptor has high affinity with the HKU1 spike, which is not the case for SARS-CoV-2.
"Once a receptor has been identified for a virus, it is possible to characterize target cells more accurately, while also gaining insights on viral entry and multiplication mechanisms and infection pathophysiology," says Olivier Schwartz, co-last author of the study and Head of the Institut Pasteur's Virus and Immunity unit.
"Our findings also shed light on the various evolution strategies employed by coronaviruses, which use TMPRSS2 either to bind to target cells or trigger fusion and viral entry," adds Julian Buchrieser, co-last author of the study and scientist in the Institut Pasteur's Virus and Immunity unit.
These human-pathogenic viruses' use of different receptors probably affects their degree of severity. Receptor levels vary among respiratory tract cells, thus influencing the sensitivity of cells to infection and viral spread. Once the route of viral entry into cells is known, it should also be possible to fight infection more effectively by developing targeted therapies and assess the risk of virulence posed by any future emerging coronaviruses.
In parallel with this work, Institut Pasteur teams led by Pierre Lafaye and Felix Rey have developed and characterized nano-antibodies that inhibit HKU1 infection by binding to the TMPRSS2 receptor. These reagents have been patented for potential therapeutic activities.
More information: Nell Saunders et al, TMPRSS2 is a functional receptor for human coronavirus HKU1, Nature (2023). DOI: 10.1038/s41586-023-06761-7
Journal information: Nature
Oct. 27, 2023 The virus that causes COVID-19 is adapting again, and the variant of Omicron known as BA.2.86 has a new mutation called JN.1, prompting experts to urge us all to remain calm but vigilant.
The coronavirus is constantly mutating to survive the growing antibody pushback it encounters as our bodies learn how to fight it after vaccinations and infections.
Variant BA.2.86 is a concern because of the extensive array of mutations in its spike protein, David Ho, MD, from Columbia University in New York City, and his team point out in their new lab report published this week in the journal Nature.
The worries are reminders of when the first Omicron appeared, they said.
Even though there is less COVID surveillance happening these days, sequences of BA.2.86 nicknamed Pirola by some scientists have already been found in 28 countries around the world since August.
With so little monitoring, experts suspect there are more cases circulating than they've been able to confirm.
With more than 40 new mutations already tallied, the new one called JN.1 has been found in France, Portugal, the United Kingdom, and the U.S., among other nations. New derivatives called JN.2 and JN.3 are also cropping up.
The virus is evolving, says virus tracker Rajendram Rajnarayanan, PhD, from the New York Institute of Technology at Arkansas State University. And, "This is the top dog binding better."
We won't know for a few weeks whether the new variants will be linked to a significant rise in COVID cases or how well immune systems will respond.
"If we had an alert system, I would call this an amber alert," Rajnarayanan said. "It's not an urgent, red alert at this time, but the amber alert is definitely a wake-up call to remind us it's time to pay attention again."
An Amber Alert
In much the same way people already rely on meteorologists to understand Earth's atmosphere and warn of severe events like hurricanes, wildfires, and snowstorms, Rajnarayanan says this is what we are learning to do to help people navigate infectious diseases in their communities.
In the United States, the HV.1 variant, also part of the Omicron group of variants, is currently leading in new COVID infections.
And in the battle between our bodies and the coronavirus, we've already come a long way since the beginning of the pandemic. So many people have some level of immunity from prior infection, vaccines, or both, that scientists monitoring wastewater aren't seeing a rise in infections or COVID-related hospitalizations in the U.S. now.
If we had an alert system, I would call this an amber alert. It's not an urgent, red alert at this time, but ... a wake-up call to remind us it's time to pay attention again.
"But these mutations are popping up fast," Rajnarayanan said. "And it makes sense to monitor them closely. This is also a good time to add more COVID testing and reporting of positive and negative results," he said.
Scientists are already detecting JN.1 in U.S. airports, he said.
And if you haven't gotten an updated vaccine yet, it would be a very good idea to go ahead, said Eric Topol, MD, executive vice president of Scripps Research and editor-in-chief of Medscape.
This is especially important for older people or those who are immunocompromised, he said. In the U.S., the vaccines are approved for all age groups 6 months and older. "It will rev up our immune system, including cellular immunity to enhance protection," he said.
And, of course, preventing infections using public health measures will help work against all strains of the coronavirus and other respiratory viruses that are circulating now, including the flu and RSV.
"What I think we're seeing now is a transition of the virus," said Andrew Pekosz, PhD, a virologist with Johns Hopkins University in Baltimore. "My hope is that we are watching this virus become seasonal."
A shift, Pekosz said, that might make it easier for COVID vaccines to be updated annually in much the same way we update flu shots each year to target circulating strains.
Next Steps
This year, people are getting the XBB-targeted COVID shot, and next year's updated vaccine could focus on another variant, like the JN.1 we are seeing rise now, for example.
Topol said the coronavirus will keeping finding new ways to evade our immune response and become more transmissible to continue infecting us again and again. Thats why he'd like to see new vaccines protect us from what he calls the "relentless evolution of the virus."
He is calling for nasal vaccines that would block entry to the upper airway, which could stop infections in a way we haven't be able to so far. And a new pan-coronavirus vaccine could target all variants at once, offering more protection. "If we had a vaccine nasal or even shots that were completely variant-proof, then we wouldn't have to worry about any of this stuff, he said.
Weekday ridership on BART, which depends heavily on office workers, continues to hover at about 40% of pre-pandemic levels.
Population growth. Transit ridership. Office demand. Property tax revenues. The coronavirus pandemic upended the Bay Area economy and many of the changes are likely to be permanent.
The question now is whether our local elected leaders can meet the moment. Whether they can pivot to plan for a future that will be radically different than previously assumed.
I hope they can. Im fearful they wont.
Revised population forecasts and office work patterns drive this seismic shift. The region has planned based on expectations of a rapidly increasing number of residents. But suddenly those numbers have reversed course, and state forecasts show that the Bay Area wont even return to its pre-pandemic population until midway through the next decade.
Meanwhile, after getting a taste during the lockdown, white-collar workers have embraced working from home, either full-time or on a hybrid schedule. Many employers have also championed the idea, recognizing that they want to keep their treasured workers happy and grabbing the cost savings that come from unloading excess office leases. They understand that remote work is here to stay.
The fallout is monumental. Transit ridership has plummeted. For example, weekday ridership on BART, which depends heavily on office workers, continues to hover at about 40% of pre-pandemic levels.
Bay Area office vacancy rates have hit record levels. The corollary to that is that office values are rapidly declining, and mortgage defaults are increasing. Similarly, the hotel industry is struggling.
In San Jose, weak demand for office and retail space, worsened by a troubled hotel sector, has building owners considering converting commercial properties to housing. In San Francisco, the revenue per hotel room is about 73% of what it was pre-pandemic. A major downtown San Jose hotel is looking to sell one of its two towers in a deal that would convert the space to student housing for nearby San Jose State University.
This should set off alarm bells for local government officials. The rapidly increasing property tax revenues they forecasted before the pandemic will not materialize.
The pain will start to come in about a year, warns Santa Clara County Assessor Larry Stone. He just issued his countys 2023 property assessment, which showed a surprisingly healthy 6.7% increase. But thats because its based on property values in calendar year 2022, which started very strong, but around the middle, Stone says, things started to come unglued.
The big driver of the downturn, which is continuing in 2023, is, not surprisingly, office buildings. The office market is now at the bottom of desired real estate property in Santa Clara County, Stone says. Thats the Silicon Valley, a key driver of the Bay Area economy.
Compounding the problem, but perhaps not as permanent as the office-market realignment, are the huge drop-offs in home sales and new construction, cramped by rapidly rising mortgage rates.
All of this means less property tax revenue to fund schools, counties, cities and special districts. And it couldnt come at a worse time. Local governments were propped up during the pandemic by bailouts, especially from the federal government. Thats ending.
Meanwhile, polling data suggests reluctance by Bay Area residents to venture into the regions three major downtowns each for a different reason: Crime in Oakland, homeless on San Francisco streets and lack of attractions in San Jose.
Failing downtowns, which are key economic drivers, will make it even harder for cities to recover.
Elected officials should be seeing these warning signs as prompts to rethink their financial and project planning. Their resources are limited and will likely become more constrained in the future.
This is the time when they should be reevaluating how they allocate their precious revenues. How they respond will tell us whether they will meet this moment.
Sadly, what were seeing right now is not encouraging.
BART officials, for example, should be rethinking rail service, scaling back because of reduced demand. Instead, they are increasing service, suicidally accelerating the race toward the fiscal cliff thats right in front of them.
Oaklands mayor and City Council members are witnessing the exiting of downtown businesses and visitors because of the justified fear of soaring crime. But the elected officials, while giving lip service to law enforcement, remain unwilling to realign municipal spending to meaningfully increase the number of cops solving crimes and patrolling the streets.
Good governing requires making tough decisions about financial tradeoffs, evaluating the costs and benefits of spending, and considering alternatives to ensure maximum efficiency. It requires acknowledgement that past decisions might not be the best ones today. It requires the courage to change course when justified.
The region is entering the post-pandemic economy. The assumptions of the past must be altered to meet the future. Thats the challenge we face.
Daniel Borenstein is editorial page editor for The Mercury News and East Bay Times.
Test tubes labelled "Bird Flu" and eggs are seen in this picture illustration, January 14, 2023. REUTERS/Dado Ruvic/Illustration/File Photo Acquire Licensing Rights
PARIS, Oct 27 (Reuters) - Romania and Bulgaria have reported outbreaks of highly pathogenic avian influenza among poultry, the World Organisation for Animal Health (WOAH) said on Friday, as Europe faces a seasonal upturn in the deadly disease.
The spread of avian influenza, commonly called bird flu, has raised concerns among governments and the poultry industry after it ravaged flocks around the world in recent years, disrupting supply, fuelling higher food prices and raising the risk of human transmission.
In Romania, the H5N1 virus was detected in a flock of 120 backyard poultry in the village of Tiganesti near the border with Bulgaria, causing the death of 28 birds, the Paris-based WOAH said, citing a report from the Romanian authorities.
Bulgaria, meanwhile, reported earlier this week outbreaks of an H5-type bird flu virus on two poultry farms, WOAH said in a separate notice.
One outbreak in Malko Konare in the Pazardzhik region killed 380 birds out of a flock of 171,911, while another outbreak in Debelets in the region of Veliko Tarnovo killed 5,420 out of 395,045 farm poultry, WOAH said, quoting details from the Bulgarian authorities.
The intergovernmental body last week reported that Poland, the European Union's largest poultry producer, had detected H5N1 bird flu virus among poultry in the north of the country.
Reporting by Gus Trompiz Editing by Chris Reese and Bill Berkrot
Our Standards: The Thomson Reuters Trust Principles.
SARS-CoV-2 Omicron infections were more common and linked to more severe outcomes than influenza and respiratory syncytial virus (RSV) in emergency department (ED) patients in Sweden, especially among those unvaccinated against COVID-19.
The findings were published yesterday in Clinical Infectious Diseases.
Karolinska Institutet researchers assessed rates of 30-day all-cause death, hospitalization, and intensive care unit (ICU) admission of adults seen in six EDs in Stockholm County for Omicron, flu, or RSV infection in 2021-2022 and 2015-2019. Of 6,385 patients in 2021-2022, 76% were infected with Omicron, 17% had flu, and 7% had RSV.
In total, 22.1% of Omicron patients were unvaccinated against COVID-19 before their ED visit, while 75% had received at least two doses.
Thirty-day death rates were 7.9% in the Omicron group, 2.5% in flu patients, and 6.0% in the RSV group. Omicron patients' adjusted death odds ratio (OR) was 2.36 compared with flu and 1.42 compared with RSV. Stronger links were seen in unvaccinated Omicron patients relative to flu (OR, 5.51) and RSV (OR, 3.29).
Death rates at 30 days were 15% among Omicron patients aged 75 years or older, compared with 8% in the 2021-2022 flu group, 12% in the 2021-2022 RSV cohort, 7% among 5,709 prepandemic flu patients, and 9% among 955 prepandemic RSV patients. Among Omicron patients who received at least two COVID-19 vaccine doses, the OR for death was 2.00 compared with flu and 1.20 compared with RSV.
This underscores the need for public health strategies for managing and mitigating the impact of Omicron and other viral respiratory infections, with continued assessments of their comparative severity.
Ninety-day mortality was 11% among Omicron patients, 3.7% in 2021-2022 flu patients, 8.7% in 2021-2022 RSV patients, 5.1% in the prepandemic flu group, and 9.6% in prepandemic RSV patients.
In 2021-2022, 30-day mortality was 2.6% for influenza A patients; none of the 17 influenza B patients died. From 2015 to 2019, 30-day mortality was 3.2% in influenza A patients and 3.8% in influenza B patients.
"This underscores the need for public health strategies for managing and mitigating the impact of Omicron and other viral respiratory infections, with continued assessments of their comparative severity," the authors wrote.
This story originally appeared in The Guardian and is part of the Climate Desk collaboration.
Avian flu has reached the Antarctic, raising concerns for isolated populations of penguins and seals that have never been exposed to the deadly H5N1 virus before. The full impact of the viruss arrival is not yet known, but scientists are raising concerns about possible catastrophic breeding failure of the regions fragile wildlife populations.
The virus was found in populations of a scavenging bird called brown skua on Bird Island, which is part of the British overseas territory of South Georgia and the South Sandwich Islands. These migratory birds probably brought it with them from South America where bird flu is widespread and has already killed an estimated 500,000 seabirds and 20,000 sea lions in Chile and Peru alone.
The current outbreak of the highly infectious variant of H5N1which started in 2021is estimated to have killed millions of wild birds. Researchers have long been concerned about its potential impact on Antarctic wildlife, because many species are found nowhere else in the world, and are not known to have been exposed to bird flu viruses before.
Researchers from the British Antarctic Survey (BAS) took swabs of the birds when they found unexplained mortality and sent them for testing in the United Kingdom.
Ashley Bennison, the BAS science manager for Bird Island, said: This is a particularly sad event to confirm. We will continue to monitor the species on the island as best as we can and keep the science going, but we are unsure of the full impact at the moment.
Bird Island is considered one of the planets richest wildlife sites, home to many endangered bird species as well as 50,000 pairs of breeding penguins and 65,000 pairs of fur seals. The island lies just off the northwest tip of South Georgia, about 600 miles south-east of the Falkland Islands.
A risk assessment on the impacts of bird flu reaching the continent, published by Scientific Committee on Antarctic Research, said fur seals, sea lions, skuas and gulls were the most at risk, followed by penguins, birds of prey, sheathbills and giant petrels.
Dr. Meagan Dewar, the chair of the Antarctic Wildlife Health Networkwho was the lead author of the reportsaid that the disease could result in catastrophic breeding failure in the region, with a devastating impact on many wildlife species.
The report states that ongoing disease surveillance programmes should be established to identify new and emerging pathogens.
H5N1 spread almost 4,000 miles down South America in the space of three months, facilitated by migration routes of wild birds. The fact it had already spread down South America made it likely it would arrive in South Georgia at some point, researchers say.
As a result of the positive tests on Bird Island, most field work that involves animal handling has been suspended. Staff will have to be extra vigilant about ensuring they have clean clothing and field equipment.
The news follows recent research that showed some seabirds in the UKwhere the outbreak was first reportedare starting to show immunity to H5N1.
