Category Archives: Covid-19

The West Virginia Department of Health and Human Resources (DHHR) reports as of April 16, 2021, there have been 2,592,544 total confirmatory laboratory results received for COVID-19, with 148,071 total cases and 2,777 total deaths.

DHHR has confirmed the deaths of a 64-year old female from Jackson County, a 45-year old male from Harrison County, a 42-year old female from Logan County, a 95-year old female from Jackson County, and an 84-year old male from Wyoming County.

We offer our deepest sympathy to the families as our state grieves additional losses due to COVID-19, said Bill J. Crouch, DHHR Cabinet Secretary.

CASES PER COUNTY: Barbour (1,342), Berkeley (11,499), Boone (1,861), Braxton (860), Brooke (2,117), Cabell (8,594), Calhoun (271), Clay (451), Doddridge (542), Fayette (3,240), Gilmer (734), Grant (1,237), Greenbrier (2,598), Hampshire (1,686), Hancock (2,699), Hardy (1,431), Harrison (5,377), Jackson (1,891), Jefferson (4,312), Kanawha (13,971), Lewis (1,132), Lincoln (1,391), Logan (2,990), Marion (4,122), Marshall (3,261), Mason (1,931), McDowell (1,467), Mercer (4,548), Mineral (2,751), Mingo (2,409), Monongalia (8,931), Monroe (1,066), Morgan (1,073), Nicholas (1,483), Ohio (4,018), Pendleton (680), Pleasants (831), Pocahontas (638), Preston (2,803), Putnam (4,782), Raleigh (6,082), Randolph (2,490), Ritchie (655), Roane (577), Summers (751), Taylor (1,195), Tucker (524), Tyler (670), Upshur (1,815), Wayne (2,814), Webster (454), Wetzel (1,183), Wirt (378), Wood (7,564), Wyoming (1,899).

Delays may be experienced with the reporting of information from the local health department to DHHR. As case surveillance continues at the local health department level, it may reveal that those tested in a certain county may not be a resident of that county, or even the state as an individual in question may have crossed the state border to be tested.

Free COVID-19 testing is available today in Barbour, Berkeley, Boone, Grant, Greenbrier, Jefferson, Lincoln, Logan, Marshall, Monongalia, Morgan, Nicholas, Putnam, and Wayne counties:

Barbour County

9:00 AM 11:00 AM, Barbour County Health Department, 109 Wabash Avenue, Philippi, WV

1:00 PM 5:00 PM, Junior Volunteer Fire Department, 331 Row Avenue, Junior, WV

Berkeley County

10:00 AM 6:00 PM, 891 Auto Parts Place, Martinsburg, WV

10:00 AM 6:00 PM, Ambrose Park, 25404 Mall Drive, Martinsburg, WV

Boone County

12:00 PM 6:00 PM, Boone County Health Department, 213 Kenmore Dr, Danville, WV

Grant County

Greenbrier County

10:00 AM 5:00 PM, Dorie Miller Park, 396 Feamster Road, Lewisburg, WV

Jefferson County

10:00 AM 6:00 PM, Hollywood Casino, 750 Hollywood Drive, Charles Town, WV

10:00 AM 6:00 PM, Shepherd University Wellness Center Parking Lot, 164 University Drive, Shepherdstown, WV

Lincoln County

Logan County

Marshall County

Monongalia County

9:00 AM 11:00 AM, WVU Recreation Center, lower level, 2001 Rec Center Drive, Morgantown, WV

Morgan County

10:00 AM 6:00 PM, Valley Health War Memorial Hospital, 1 Health Way, Berkeley Springs, WV

Nicholas County

Putnam County

Wayne County

10:00 AM 2:00 PM, Wayne Community Center, 11580 Rt. 152, Wayne, WV

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COVID-19 Daily Update 4-16-2021 - West Virginia Department of Health and Human Resources

MADISON, Wis. (WBAY) The Wisconsin Department of Health Services (DHS) reports four out of every 10 residents in Wisconsin have received a COVID-19 vaccine. As of Sunday, the DHS reports 40.2% of the states population has received at least one dose of the vaccine, which equals 2,339,142 people. Thats an increase of 28,085 people from Saturdays report.

Meanwhile, the state says another 34,474 residents completed their vaccine series, bringing Wisconsins percentage of fully vaccinated people to 27.5%, or 1,603,795 residents.

So far, the DHS reports a total of 3,870,751 doses of the COVID-19 vaccine have been administered in Wisconsin. This comes on the same day the Centers for Disease Control announced that half of all adults in the United States have received at least one COVID-19 shot. Federal officials say almost 130 million people who are 18 or older have received at least one dose of a vaccine, which equals about 50.4% of the total adult population.

County by county vaccine rates will be found below.

Vaccinations by percentage of age group, as of Sunday:

Meanwhile, the DHS revised the states death toll by two, lowering it to 6,709 Sunday. State officials revised the death toll in Sawyer and Washington Counties, lowering each by one. The 6,709 deaths continue to make up 1.14% of all confirmed cases in Wisconsin. Although the state lowered the death toll, it wasnt enough to move Wisconsins seven day death average, which held steady from Saturday at five deaths per day.

The revision comes as the state crosses the 590,000 cumulative case total since February 5 of 2020. The agency reports another 518 new coronavirus cases were confirmed Sunday. New cases were reported in 43 of Wisconsins 72 counties. The state also revised case counts in seven other counties (Walworth, Vilas, Sheboygan, Shawano, Richland, Jefferson and Iowa).

According to the DHS, the new cases are out of 4,507 results from people testing positive or being tested for the first time, or 11.49% of those results. The 7-day average for the positivity rate, which includes those who have had more than one test done, dropped to 3.5% after holding steady at 3.6% for two straight days.

Wisconsin has now seen a cumulative total of 590,458 confirmed coronavirus cases, and is on pace to reach a milestone 600,000 confirmed cases in the next two weeks if the spread of the disease doesnt slow.

The state is averaging 736 new cases per day for the past week. After increasing to 823 on April 14, it has declined daily. The states percentage of active cases -- people diagnosed in the past 30 days who arent medically cleared dropped to 1.5%.

The number of hospitalizations in the past 24 hours is well below average, with 34 patients admitted for COVID-19. The 7-day hospital admission average increased to 60 after holding steady at 58 the past two days.

SUNDAYS COUNTY VACCINATION UPDATES

CLICK HERE to track vaccine data in Wisconsin

CLICK HERE for the First Alert Vaccine Teams guide to vaccine clinics and vaccinators, including phone numbers and websites to make appointments and information on free rides to appointments.

Since February 5, 2020, the DHS reports 3,390,910 people in Wisconsin were tested at least once for the coronavirus. Out of these:

HOSPITAL READINESS

The latest numbers from the Wisconsin Hospital Association (WHA) show there are 318 patients in 136 hospitals across the state, eight fewer than Saturday. However, the number of ICU patients in those same hospitals increased by nine, for a total of 91.

Fox Valley hospitals report they are treating 18 COVID-19 patients, with 6 in ICU. Thats two fewer overall patients and two new ICU patients than Saturday.

10 hospitals in the Northeast region are treating 27 COVID-19 patients, including 6 in ICU. Thats five fewer overall patients and one new ICU patient since Saturday.

For hospital readiness, the WHA reports 275 ICU beds were available in the states hospitals (18.75% of the states supply). A total 2,128 of all hospital beds are available -- ICU, intermediate care, medical surgical and negative-flow isolation (19.04%).

The Fox Valley regions 13 hospitals have 11 ICU beds available among them (10.55%), and 90 total open beds total (10.2%).

The 10 hospitals in the Northeast region had 41 ICU beds (19.8%) and 257 of all bed types (26.88%) open.

These beds are for all patients, not just COVID-19. We use terms like open or available, but a hospital can only put a patient in a bed if it has the staff to care for them, including doctors, nurses and food services.

SUNDAYS COUNTY CASE AND DEATH TOTALS (counties with new cases or deaths are indicated in bold) *

Wisconsin

Michigans Upper Peninsula **

* Cases and deaths are from the daily DHS COVID-19 reports, which may differ from local health department numbers. The DHS reports cases from all health departments within a countys boundaries, including tribal, municipal and county health departments; county websites may not. Also, public health departments update their data at various times, whereas the DHS freezes the numbers it receives by the same time every day to compile the afternoon report.

CDC GUIDANCE ON GATHERINGS

The Centers for Disease Control have announced that fully vaccinated Americans can gather with other vaccinated people indoors without wearing a mask or social distancing.

The CDCs recommendations also say vaccinated people can come together in the same way in a single household -- with people considered at low-risk for severe disease, such as in the case of vaccinated grandparents visiting healthy children and grandchildren.

The CDC is continuing to recommend that fully vaccinated people still wear well-fitted masks, avoid large gatherings, and physically distance themselves from others when out in public. The CDC also advised vaccinated people to get tested if they develop symptoms that could be related to COVID-19.

COVID-19 TRACING APP

Wisconsins COVID-19 tracing app, Wisconsin Exposure Notification, is available for iOS and Android smartphones. No download is required for iPhones. The Android app is available on Google Play. When two phones with the app (and presumably their owners) are close enough, for long enough, theyll anonymously share a random string of numbers via Bluetooth. If someone tests positive for the coronavirus, theyll receive a code to type into the app. If your phones pinged each other in the last 14 days, youll receive a push notification that you are at risk of exposure. The app doesnt collect personal information or location information, so you wont know from whom or where, but you will be told what day the exposure might have occurred so that you can quarantine for the appropriate amount of time.

SYMPTOMS

The Centers for Disease Control and Prevention identified these as possible symptoms of COVID-19:

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40% of Wisconsin residents have received a COVID-19 vaccine, state lowers death toll - WSAW

Abstract

Brazil has been severely hit by COVID-19, with rapid spatial spread of both cases and deaths. We use daily data on reported cases and deaths to understand, measure, and compare the spatiotemporal pattern of the spread across municipalities. Indicators of clustering, trajectories, speed, and intensity of the movement of COVID-19 to interior areas, combined with indices of policy measures show that while no single narrative explains the diversity in the spread, an overall failure of implementing prompt, coordinated, and equitable responses in a context of stark local inequalities fueled disease spread. This resulted in high and unequal infection and mortality burdens. With a current surge in cases and deaths and several variants of concern in circulation, failure to mitigate the spread could further aggravate the burden.

Brazil is the only country that, with a population larger than 100 million, has a universal, comprehensive, and free of charge health care system. Over three decades, this system contributed to reducing inequalities in access to health care and outcomes (1). It also facilitated the management of previous public health emergencies, such as the HIV/AIDS pandemic (2). Despite recent cuts in the health budget (3), it was expected that Brazils health system would place the country in a good position to mitigate the COVID-19 pandemic. With national coordination and through a vast network of community health agents, actions adapted to existing local inequalities (i.e., regional distribution of physicians and hospital beds) could have been implemented (4). However, Brazil is one of the countries most severely hit by COVID-19. As of March 11, 2021, 11,277,717 cases and 272,889 deaths have been reported. Those represent 9.5% and 10.4% of the worldwide cases and deaths, respectively; yet, Brazil shares only 2.7% of the worlds population. In late May, 2020, Latin America was declared the epicenter of the COVID-19 pandemic, mainly because of Brazil. Since June 7, 2020, Brazil ranks 2nd in deaths worldwide.

In Brazil, the federal response has been a dangerous combination of inaction and wrongdoing, including the promotion of chloroquine as treatment despite a lack of evidence (5, 6). Without a coordinated national strategy, local responses varied in form, intensity, duration, and start and end times, to some extent associated with political alignments (7, 8). The country has seen very high attack rates (9) and disproportionally higher burden among the most vulnerable (10, 11), illuminating local inequalities (12). Following multiple introductions of SARS-CoV-2, Brazil had an initial epidemic phase (February 15 to March 18, 2020) with restricted circulation (13), preceded by undetected virus circulation (14). While the initial spread was determined by existing socioeconomic inequalities, the lack of a coordinated, effective, and equitable response likely fueled the widespread spatial propagation of SARS-CoV-2 (12). The goal of this study was to understand, measure, and compare the pattern of spread of COVID-19 cases and deaths in Brazil at fine spatial and temporal scales. We use daily data from State Health Offices covering the period from epidemiological week 9 (February 23-29) to week 41 (October 4-10).

In all states, it took less than a month between the first case and the first death; only 11 days in Amazonas and 21 in So Paulo (table S1). Epidemiological curves for Brazil (fig. S1) hide distinct patterns of initial reporting, propagation, and containment of SARS-CoV-2 across administrative units. As states and cities imposed and relaxed restrictive measures at different times, population mobility facilitated the circulation of the virus and acted as a trigger of disease spread (15). Figure 1, A and B, show that cumulative cases and deaths, respectively, per 100,000 people were not uniformly distributed across municipalities. We used the space-time scan statistic (16) to identify areas that significantly recorded a high number of cases (Fig. 1C and table S2) or deaths (Fig. 1D and table S3) over a defined period.

Cumulative number of COVID-19 cases (A) and deaths (B) per 100,000 people by municipality. Dark lines on the maps show state boundaries. State acronyms by region, North: AC=Acre, AP=Amap, AM=Amazonas, PA=Par, RO=Rondnia, RR=Roraima, and TO=Tocantins; Northeast: AL=Alagoas, BA=Bahia, CE=Cear, MA=Maranho, PB=Paraba, PE=Pernambuco, PI=Piau, RN=Rio Grande do Norte, and SE=Sergipe; Center-West: DF=Distrito Federal, GO=Gois, MT=Mato Grosso, and MS=Mato Grosso do Sul; Southeast: ES=Esprito Santo; MG=Minas Gerais; RJ=Rio de Janeiro; and SP=So Paulo; South: PR=Paran; RS=Rio Grande do Sul; and SC=Santa Catarina. Spatio-temporal clustering of cases (C) and deaths (D) across Brazilian municipalities. Color and number codes in the clusters and the table on the left are the same, and the table indicates the interval during which each cluster was statistically significant. The color gradient (dark red to dark blue) indicates the temporal change based on the initial date of the cluster, and the cluster number indicates the rank of the relative risk for each cluster (tables S2 and S3). Clusters were assessed with the space-time scan statistic (see supplementary materials).

Deaths clustered about a month before cases. This likely reflects problems in surveillance, data reporting, and low testing capacity. The first significant cluster of COVID-19 deaths started on May 18 (Fig. 1D, #5), centered around Recife (capital of Pernambuco). Five other clusters of deaths occurred before the first cluster of cases was observed on June 16 (Fig. 1C, #7). Among those are clusters around Fortaleza and Rio de Janeiro (capital cities of Cear and Rio de Janeiro, respectively), and in a large area including Amazonas, Par, and Amap, states that have a disproportionally lower hospital capacity. Amazonas (whose capital is Manaus) has the highest mortality per 100,000 people in the country, more than double the rate for Brazil. By October, about 76% of its population was estimated to have been infected (9, 17). Except for one cluster in August (Fig. 1D, #1), the duration of death clusters did not reduce over time, ranging from 10 to 13 days. This is different than what was observed in South Korea, where successful containment reduced the duration and the geographic extent of clusters over time (18). A similar pattern was observed for COVID-19 cases (Fig. 1C). In the center and southern areas, clusters occurred later (August and September), corroborating a regional pattern of propagation of SARS-CoV-2 (19).

To understand and compare how COVID-19 cases and deaths spread across Brazil we calculated the geographic center of the epidemic. Trajectories of the center by epidemiological week show that after the introduction in So Paulo, both cases (Fig. 2A and movie S1) and deaths (Fig. 2B and movie S2) progressively moved north until week 20 (starting May 10), when the epidemic started to recede in Amazonas and Cear, but gained force in Rio de Janeiro and So Paulo. Comparing trajectories in each state (fig. S2) we calculated a ratio of the distance the center moved each week to the distance between the capital city and the most distant municipality (tables S4 and S5). In eight states the median weekly ratio for deaths was larger than cases (Fig. 2C), suggesting a faster movement of the focus of deaths.

COVID-19 case- (A) and death-weighted (B) geographic centers by epidemiological week. Thick lines show the geographic center for Brazil, thin lines show the trajectory of the center in each state, and the black dot indicates the state capital city (see supplementary materials). The first case in each state was recorded in the capital city, except for Rio de Janeiro, Rondnia, Bahia, Minas Gerais, and Rio Grande do Sul, and thus the trajectory of the center starts in the interior. This was more common for deaths (14 states did not report the first death in the capital: Rio de Janeiro, Amazonas, Par, Piau, Rio Grande do Norte, Paraba, Esprito Santo, Paran, Santa Catarina, Mato Grosso do Sul, Mato Grosso, and Gois). Figure S2 shows detailed maps for each state. (C) Scatterplot of the median distance that the geographical center of cases (X-axis) and deaths (Y-axis) shifted weekly in each state (measured as the ratio of the distance that the geographical center of cases shifted weekly in each state to the distance between the capital city and the furthest municipality in the state). (D) Scatterplot of the number of days that it took for a state to reach 50 COVID-19 cases (X-axis) after the first case was reported and 50 deaths after the first COVID-19 confirmed death (Y-axis). (E) Scatterplot of the standardized number of cases per 100,000 people (X-axis) and deaths per 100,000 people (Y-axis) by state. The 45-degree lines in (C), (D), and (E) describe equal values for variables in the scatterplot.

On average, it took 17.3 and 32.3 days to reach 50 cases and deaths, respectively. However, in four states deaths accumulated to a 50-count first (Fig. 2D), and in Amazonas, Cear, and Rio de Janeiro the difference between the time it took for cases and deaths to reach a 50-count was 6, 1, and 3 days, respectively (table S1). This short interval suggests undetected (and thus unmitigated) introduction and propagation of the virus for some time. This was confirmed in Cear (20) where a retrospective epidemiological investigation revealed that the virus was already circulating in January. Also, if the initial cases occurred in high-income areas, it is possible that consultations in private practices were not reported into national systems of the Ministry of Health (20) and remained silent to the surveillance system. In addition, testing capacity in Brazil was limited, and the first diagnostic RT-PCR test kits started to be produced in the country only in March. Although efforts of retrospective investigation were not scaled-up in the country, a comparison of standardized rates of cases and deaths per 100,000 people (Fig. 2E) show that in 11 states the death toll was larger than incidence, including Amazonas, Cear, and Rio de Janeiro.

To quantitatively measure the intensity of the spread of COVID-19 cases and deaths over time we used the locational Hoover Index (HI) (21, 22). Values closer to 100 indicate concentration in few municipalities, while those close to zero suggest more homogeneous spreading. If containment measures were effective, we would expect the index to decline slowly, remaining relatively high over time. Also, if measures were effective to avoid a collapse of the hospital system, we would expect a higher index for deaths, compared to cases. Figure 3A shows the HI for Brazil, and a clear trend toward extensive spread for both cases and deaths until about week 30 (July 19-25). The pattern, however, varied across states. In the first week with reported events, Amazonas, Roraima, and Amap had HI below 50 for both cases and deaths. This suggests either undetected circulation of the virus before initial reports (and therefore when reporting started there was already a large fraction of the population that had been infected), or fast and multiple introductions of the virus immediately followed by rapid spatial propagation (tables S6 and S7).

(A) Locational Hoover index (see supplementary materials) for cases (blue line) and deaths (red line) by epidemiological week. The area around each curve indicates the maximum and minimum index observed across states. (B) States and weeks when the locational Hoover index for cases was bigger than the index for deaths, indicating a faster spread of deaths. Bivariate choropleth map of the locational Hoover Index for cases and deaths in epidemiological week 14 (March 29-April 4) (C) and epidemiological week 41 (October 4-10) (D). Since SARS-CoV-2 reached states at different epidemiological weeks, (C) shows data from week 12 for RJ and SP; week 13 for AM, PI, RN, PE, PR, SC, RS, and GO; week 15 for AC; and week 16 for TO. Similarly, (D) shows data for week 33 for MT, and week 39 for ES.

Overall, the spread of COVID-19 was fast. By week 24 (June 7-13) and 32 (August 2-8), all states had HI for cases and deaths, respectively, lower than 50. In nine states, including Amazonas, Amap, Cear, and Rio de Janeiro, the spreading of deaths was faster than cases over several weeks (Fig. 3B), with some overlap with the time when clusters were observed in those areas (Fig. 1, C and D). Figure 3, C and D, show the first and last weekly HI for cases and deaths by states and there are marked contrasts in HI trajectory (tables S6 and S7). By week 41 (October 4-10), COVID-19 deaths in Amap (HI=31.3) had moved to the interior faster than cases (HI=42.9). Rio de Janeiro had the most intense interiorization of both cases (HI=14.9) and deaths (HI=21.9), followed by Amazonas (HI cases=20.2, HI deaths=30.4). Both experienced a shortage of ICU beds, but Amazonas has smaller availability (about 11 ICU beds per 100,000 people vs 23 in Rio de Janeiro), all concentrated in the capital city, Manaus. As the virus moved to the interior a higher demand for scarce and distant resources intensified, not all of which were fulfilled in time to prevent fatalities (23). In Rio de Janeiro, political chaos compromised a prompt and effective response. Leaders were immersed in corruption accusations, the governor was removed from office and face an impeachment trial, and the Secretary of Health was changed three times between May and September, one of whom was arrested (24). In contrast, although Cear also experienced a near-collapse of the hospital system late April to mid-May, and had silent circulation of the virus more than a month before the first case was officially reported (20), it ranked 6th in movement of cases (HI=31.3), but was the antepenultimate in deaths (HI=64.5). This suggests that even with the continued spread of the virus, local actions were successful in preventing fatality. No state had HI for cases higher than 50 by week 41, revealing an extensive pattern of disease spread toward the interior.

Overall, a higher percentage of COVID-19 cases and deaths were observed outside capital cities in weeks 20 (May 10-16) and 22 (May 24-30), respectively (Fig. 4A), with varied patterns across states (table S1). Rio Grande do Sul, Santa Catarina, and Paran, all in the South region, had earlier and concurrent shifts in cases and deaths (in March), and this was the last region to show a major surge in COVID-19. In Rio de Janeiro and Amazonas, the shift in deaths was much later than cases, 10 and 8 weeks, respectively.

(A) Percentage of cases (blue lines) and deaths (red lines) in the state capitals (solid lines) and the remaining municipalities (dashed lines) by epidemiological week. (B) Percentage of reported COVID-19 cases and deaths, and selected variables by epidemiological week. Variables: Stringency Index (STR), Containment Index (CTN), Social Distancing Index (SD), locational Hoover Index for cases (HIc), locational Hoover Index for deaths (HId), percentage of cases in each epidemiological week (PCTc), percentage of deaths in each epidemiological week (PCTd), normalized distance by which the national geographical center of cases shifted in each week (DSTc), and normalized distance by which the national geographical center of deaths shifted in each week (DSTd). Distances were normalized to vary between 0 and 100. The subscript min indicates the minimum value of the index observed among all states in each week; the subscript max denotes the maximum value. (C) Correlation matrix (Pearson). Cells in shades of red or blue are statistically significant: * <0.05, ** <0.01, and *** <0.001. (D) Hierarchical clustering dendrogram by state based on five variables: cumulative deaths per 100,000 people, maximum percentage of deaths in a week, maximum SD, epidemiological week when HId became lower than 50, and the maximum value of effective Rt over the study period (see supplementary materials).

To better capture policies adopted at the national and local levels and their associations with movement of COVID-19 toward the interior of states, we used three indicators, the Stringency Index (STR), the Containment Index (CTN all policies in STR except for the use of masks), and the Social Distancing Index (SD based on mobile devices). Because states introduced measures at different times with various duration, national indices hide much variation (Fig. 4B). We observed expected correlations (table S8) between policy indicators and HI for cases and deaths (Fig. 4C), but a positive correlation between HI and the distance by which the national geographical center of cases shifted weekly. This suggests a pattern of progressive concentration of cases and deaths in few but widespread areas. Considering each state (fig. S3), Amap showed a negative correlation between STR and HI for deaths, indicating that policy measures failed to prevent the movement of deaths (this was the only state where deaths moved to the interior faster than cases by week 41; Fig. 3D).

We used hierarchical clustering analysis (25) in an attempt to group states into categories based on measures that captured the overall COVID-19 mortality burden, intensity of transmission, speed of COVID-19 deaths toward the interior of states, and adoption of distancing measures (Fig. 4D). Categories 3 and 4 include the top 10 states in deaths/100,000 people, as well as those that observed the first spatiotemporal clustering of deaths, and fast reporting and movement of deaths. Category 2 has the highest number of contiguous states and the lowest death burden by week 41. However, all categories combine states with different levels of inequality and distinct political alignment.

In summary, our results highlight the fast spread of both cases and deaths of COVID-19 in Brazil, with distinct patterns and burden by state. They demonstrate that no single narrative explains the propagation of the virus across states in Brazil. Instead, layers of complex scenarios interweave, resulting in varied and concurrent COVID-19 epidemics across the country. First, Brazil is large and unequal, with disparities in quantity and quality of health resources (e.g., hospital beds, physicians), and income (e.g., an emergency cash transfer program started only in June 2020, and by November 41% of the households were receiving it). Second, a dense urban network that connects and influences municipalities through transportation, services, and business (26) was not fully interrupted during peaks in cases or deaths. Third, political alignment between governors and the president had a role in the timing and intensity of distancing measures (7), and polarization politicized the pandemic with consequences to adherence to control actions (27). Fourth, SARS-CoV-2 was circulating undetected in Brazil for more than a month (20), a result of the lack of well-structured genomic surveillance (28). Fifth, cities imposed and relaxed measures at different moments, based on distinct criteria, facilitating propagation (15). Our findings speak to those issues, but also show that some states were resilient, such as Cear, while others that comparatively had more resources failed to contain the propagation of COVID-19, such as Rio de Janeiro.

In such a scenario, prompt and equitable responses, coordinated at the federal level, are imperative to avoid fast virus propagation and disparities in outcomes (12). Yet, the COVID-19 response in Brazil was neither prompt nor equitable. It still isnt. Brazil is currently facing the worst moment of the pandemic, with a record number of cases and deaths, and near collapse of the hospital system. Vaccination has started but at a slow pace due to limited availability of doses. A new variant of concern (VOC), which emerged in Manaus (P1) in December, is estimated to be 1.4-2.2 times more transmissible, and able to evade immunity from previous non-P1 infection (29). That variant is spreading across the country. It became the most prevalent in circulation in six of eight states where investigations were performed (30). As of March 11, 2021, Brazil already reported 40% of the total COVID-19 deaths that occurred in 2020. In January 2021, Manaus witnessed a spike in cases and hospitalizations, a collapse of the hospital system, including a shortage of oxygen for patients (31). The death toll is unbearable, as Manaus already recorded 39.8% more COVID-19 deaths in 2021 than in 2020. Without immediate action, this could be a preview of what is yet to happen in other localities in Brazil. Without immediate containment, coordinated epidemiological and genomic surveillance measures, and an effort to vaccinate the largest number of people in the shortest possible time, the propagation of P1 will likely resemble the patterns here demonstrated, leading to unimaginable loss of lives. Failure to avoid this new round of propagation will facilitate the emergence of new VOCs, isolate Brazil as a threat to global health security, and lead to a completely avoidable humanitarian crisis.

G. James, D. Witten, T. Hastie, R. Tibshirani, An Introduction to Statistical Learning with Applications in R (Springer, 2017).

Instituto Brasileiro de Geografia e Estatistica, Regies de Influncia das Cidades: 2018 (IBGE, Coordenao de Geografia, 2020).

N. R. Faria, T. A. Mellan, C. Whittaker, I. M. Claro, D. S. da Candido, S. Mishra, M. A. E. Crispim, F. C. Sales, I. Hawryluk, J. T. McCrone, R. J. G. Hulswit, L. A. M. Franco, M. S. Ramundo, J. G. de Jesus, P. S. Andrade, T. M. Coletti, G. M. Ferreira, C. A. M. Silva, E. R. Manuli, R. H. M. Pereira, P. S. Peixoto, M. U. Kraemer, N. Gaburo Jr., C. C. da Camilo, H. Hoeltgebaum, W. M. Souza, E. C. Rocha, L. M. de Souza, M. C. de Pinho, L. J. T Araujo, F. S. V. Malta, A. B. de Lima, J. P. do Silva, D. A. G. Zauli, A. C. S. de Ferreira, R. P. Schnekenberg, D. J. Laydon, P. G. T. Walker, H. M. Schlter, A. L. P. dos Santos, M. S. Vidal, V. S. Del Caro, R. M. F. Filho, H. M. dos Santos, R. S. Aguiar, J. L. P. Modena, B. Nelson, J. A. Hay, M. Monod, X. Miscouridou, H. Coupland, R. Sonabend, M. Vollmer, A. Gandy, M. A. Suchard, T. A. Bowden, S. L. K. Pond, C.-H. Wu, O. Ratmann, N. M. Ferguson, C. Dye, N. J. Loman, P. Lemey, A. Rambaut, N. A. Fraiji, M. P. S. S. do Carvalho, O. G. Pybus, S. Flaxman, S. Bhatt, E. C. Sabino, Genomics and epidemiology of a novel SARS-CoV-2 lineage in Manaus, Brazil. medRxiv 2021.2002.2026.21252554 [Preprint]. 3 March 2021. doi:10.1101/2021.02.26.21252554

A. D. Gordon, Null models in cluster validation, in From Data to Knowledge, W. Gaul, D. Pfeifer, Eds. (Springer, 1996), pp. 3244.

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Spatiotemporal pattern of COVID-19 spread in Brazil - Science

Two MIT professors have proposed a new approach to estimating the risks of exposure to Covid-19 under different indoor settings. The guideline they developed suggests a limit for exposure time, based on the number of people, the size of the space, the kinds of activity, whether masks are worn, and the ventilation and filtration rates. Their model offers a detailed, physics-based guideline for policymakers, businesses, schools, and individuals trying to gauge their own risks.

The guideline, appearing this week in the journal PNAS, was developed by Martin Z. Bazant, professor of chemical engineering and applied mathematics, and John W. M. Bush, professor of applied mathematics. They stress that one key feature of their model, which has received less attention in existing public-health policies, is providing a specific limit for the amount of time a person spends in a given setting.

Their analysis is based on the fact that in enclosed spaces, tiny airborne pathogen-bearing droplets emitted by people as they talk, cough, sneeze, sing, or eat will tend to float in the air for long periods and to be well-mixed throughout the space by air currents. There is now overwhelming evidence, they say, that such airborne transmission plays a major role in the spread of Covid-19. Bush says the study was initially motivated early last year by their concern that many decisions about policies were being guided primarily by the 6-foot rule, which doesnt adequately address airborne transmission in indoor spaces.

Using a strictly quantitative approach based on the best available data, the model produces an estimate of how long, on average, it would take for one person to become infected with the SARS-CoV-2 virus if an infected person entered the space, based on the key set of variables defining a given indoor situation. Rather than a simple yes or no answer about whether a given setting or activity is safe, it provides a guide as to just how long a person could safely expect to engage in that activity, whether it be a few minutes in a store, an hour in a restaurant, or several hours a day in an office or classroom, for example.

As scientists, weve tried to be very thoughtful and only go with what we see as hard data, Bazant says. Weve really tried to just stick to things we can carefully justify. We think our study is the most rigorous study of this type to date. While new data are appearing every day, and many uncertainties remain about the SARS-CoV-2 virus transmission, he says, We feel confident that weve made conservative choices at every point.

Bush adds: Its a quickly moving field. We submit a paper and the next day a dozen relevant papers come out, so we scramble to incorporate them. Its been like shooting at a moving target. For example, while their model was initially based on the transmissibility of the original strain of SARS-CoV-2 from epidemiological data on the best characterized early spreading events, they have since added a transmissibility parameter, which can be adjusted to account for the higher spreading rates of the new emerging variants. This adjustment is based on how any new strains transmissibility compares to the original strain; for example, for the U.K. strain, which has been estimated to be 60 percent more transmissible than the original, this parameter would be set at 1.6.

One thing thats clear, they say, is that simple rules, based on distance or capacity limits on certain types of businesses, dont reflect the full picture of the risk in a given setting. In some cases that risk may be higher than those simple rules convey; in others it may be lower. To help people, whether policymakers or individuals, to make more comprehensive evaluations, the researchers teamed with app developer Kasim Khan to put together an open-access mobile app and website where users can enter specific details about a situation size of the space, number of people, type of ventilation, type of activity, mask wearing, and the transmissibility factor for the predominant strain in the area at the time and receive an estimate of how long it would take, under those circumstances, for one new person to catch the virus if an infected person enters the space.

The calculations were based on inferences made from various mass-spreading events, where detailed data were available about numbers of people and their age range, sizes of the enclosed spaces, kinds of activities (singing, eating, exercising, etc.), ventilation systems, mask wearing, the amount of time spent, and the resulting rates of infections. Events they studied included, for example, the Skagit Valley Chorale in Washington state, where 86 percent of the seniors present became infected at a two-hour choir practice

While their guideline is based on well-mixed air within a given space, the risk would be higher if someone is positioned directly within a focused jet of particles emitted by a sneeze or a shout, for example. But in general the assumption of well-mixed air indoors seems to be consistent with the data from actual spreading events, they say.

When you look at this guideline for limiting cumulative exposure time, it takes in all of the parameters that you think should be there the number of people, the time spent in the space, the volume of the space, the air conditioning rate and so on, Bush says. All of these things are kind of intuitive, but its nice to see them appear in a single equation.

While the data on the crucial importance of airborne transmission has now become clear, Bazant says, public health organizations initially placed much more emphasis on handwashing and the cleaning of surfaces. Early in the pandemic, there was less appreciation for the importance of ventilation systems and the use of face masks, which can dramatically affect the safe levels of occupancy, he says.

Id like to use this work to establish the science of airborne transmission specifically for Covid-19, by just taking into account all factors, the available data, and the distribution of droplets for different kinds of activities, Bazant says. He hopes the information will help people make informed decisions for their own lives: If you understand the science, you can do things differently in your own home and your own business and your own school.

Bush offers an example: My mother is over 90 and lives in an elder care facility. Our model makes it clear that its useful to wear a mask and open a window this is what you have in your control. He was alarmed that his mother was planning to attend an exercise class in the facility, thinking it would be OK because people would be 6 feet apart. As the new study shows, because of the number of people and the activity level, that would actually be a highly risky activity, he says.

Already, since they made the app available in October, Bazant says, they have had about half a million users. Their feedback helped the researchers refine the model further, he says. And it has already helped to influence some decisions about reopening of businesses, he adds. For example, the owner of an indoor tennis facility in Washington state that had been shut down due to Covid restrictions says he was allowed to reopen in January, along with certain other low-occupancy sports facilities, based on an appeal he made based in large part on this guideline and on information from his participation in Bazants online course on the physics of Covid-19 transmission.

Bazant says that in addition to recommending guidelines for specific spaces, the new tools also provide a way to assess the relative merits of different intervention strategies. For example, they found that while improved ventilation systems and face mask use make a big difference, air filtration systems have a relatively smaller effect on disease spread. And their study can provide guidance on just how much ventilation is needed to reach a particular level of safety, he says.

Bazant and Bush have provided a valuable tool for estimating (among other things) the upper limit on time spent sharing the air space with others, says Howard Stone, a professor of mechanical and aerospace engineering at Princeton University who was not connected to this work. While such an analysis can only provide a rough estimate, he says the authors describe this kind of order of magnitude of estimate as a means for helping others judge the situation they might be in and how to minimize their risk. This is particularly helpful since a detailed calculation for every possible space and set of parameters is not possible.

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A method to assess Covid-19 transmission risks in indoor settings - MIT News

A new review article published in The Lancet has presented 10 key scientific reasons why SARS-CoV-2, the virus that causes COVID-19, is predominantly spread though the air. The research adds to a growing chorus of experts saying the evidence for airborne transmission is overwhelming and the sooner global health authorities admit this, the sooner more effective measures to better protect the public can be implemented.

Perhaps one of the most vociferous debates over the past 12 months has been over exactly how most people catch COVID-19. As the pandemic spread across the globe in early 2020 the general perspective from most public health experts was that SARS-CoV-2 primarily spread by droplet transmission.

This belief hinged on a traditional binary between droplet and aerosol viral transmission. Aerosol particles have classically been defined as smaller than 5 micrometres (m). They can remain suspended in the air for extended periods of time and can travel significant distances from a source.

Respiratory droplets, on the other hand, are larger particles, often propelled from a source by coughing or sneezing. These particles fall to the ground in seconds and typically dont travel further than six feet (1.8 m) from a source.

The general presumption from early last year was that SARS-CoV-2 primarily spreads via respiratory droplets, and this led to public health advice recommending basic measures such as social distancing, hand washing and frequent cleaning of surfaces. However, as 2020 progressed, more and more case studies presented scenarios whereby large numbers of people were infected in superspreading events despite being significant distances away from a viral source.

A new review published in The Lancet, led by Trish Greenhalgh from the University of Oxford, is arguing there is consistent and strong evidence to suggest SARS-CoV-2 is predominantly transmitted through airborne routes. The researchers lay out 10 streams of evidence from the past year that overwhelmingly support this hypothesis. The review also claims respiratory droplet transmission of this novel virus is based on flawed and outdated models of viral transmission.

The assessment references a large volume of evidence from the past 12 months, including numerous cases studies documenting long-range transmission of the virus between people in adjacent hotel rooms and superspreading events in indoor venues that cannot be explained by droplet transmission. The researchers argue particles as large as 100 m are known to remain suspended in the air for extended periods of time and the old fixed definition of aerosol particles as less than 5 m has led to misunderstandings of how SARS-CoV-2 is spread.

The flawed assumption that transmission through close proximity implies large respiratory droplets or fomites was historically used for decades to deny the airborne transmission of tuberculosis and measles, the researchers write in the study. This became medical dogma, ignoring direct measurements of aerosols and droplets which reveal flaws such as the overwhelming number of aerosols produced in respiratory activities and the arbitrary boundary in particle size of 5 m between aerosols and droplets, instead of the correct boundary of 100 m.

The researchers are far from alone in their call for widespread acknowledgment of airborne SARS-CoV-2 transmission. In early February the editors of the prestigious science journal Nature criticized public health bodies and the World Health Organization for failing to effectively communicate the predominance of airborne transmission.

The editorial recognized a growing acceptance of COVID-19 being spread through the air while suggesting continued recommendations for surface disinfection and other droplet transmission prevention measures are confusing the public and leading to huge investments in expensive disinfection efforts that shift resources away from measures such as improving ventilation in indoor spaces.

This lack of clarity about the risks of fomites compared with the much bigger risk posed by transmission through the air has serious implications, the journal editors write. People and organizations continue to prioritize costly disinfection efforts, when they could be putting more resources into emphasizing the importance of masks, and investigating measures to improve ventilation. The latter will be more complex but could make more of a difference.

The Centers for Disease Control and Prevention (CDC) in the United States is a useful case in point. The CDC still suggests COVID-19 is primarily spread through respiratory droplets. Its current advice claims direct contact is the most common vector for infection, although its information has more recently been updated to note, COVID-19 can sometimes be spread by airborne transmission.

A recent case study published by the CDC described a COVID-19 cluster last year in an Australian church. The study reports 12 people were infected across two days of church services. The primary case patient was a member of the church choir and all the epidemiological evidence points to airborne spread as the best explanation. Nevertheless, the study also notes, this investigation only provides circumstantial evidence of airborne transmission.

Co-author on the new Lancet article Zeynep Tufekci, a writer and sociologist from the University of North Carolina, Chapel Hill, says many of our current precautions based on the droplet transmission hypothesis are still effective. Distancing and masks, for example, are vital tools to prevent infection, but she argues some key public health policies are diverting resources from implementing more useful measures.

Even after a whole year, we still see the widespread practice of unnecessary levels of cleaning to the detriment of public health, use of plexiglass indoors that is far from sufficiently protective and, depending on air flows, may even be contraindicated, instead of attention to ventilation and aerosol risks, says Tufekci. We cannot fix this situation without accurately informing the public so that people feel empowered to make decisions to better protect themselves across different contexts, and adjusting guidelines globally to fit the best available evidence.

A recent editorial published in The BMJ argues traditional scientific definitions of viral transmission need urgent revision. Co-authored by Linsey Marr, an expert in airborne transmission of viruses, the article agrees many of our current infection control measures are useful and shouldnt change even with a broader agreement over the predominance of airborne transmission.

However, a big problem with the current focus on droplet transmission is a lack of emphasis regarding indoor ventilation. Marr and colleagues suggest more attention needs to immediately be paid to ventilation and air filtration technologies for indoor spaces. This will help future-proof our indoor spaces from this and other viruses that may arise.

Covid-19 may well become seasonal, and we will have to live with it as we do with influenza, the researchers write in The BMJ. So governments and health leaders should heed the science and focus their efforts on airborne transmission. Safer indoor environments are required, not only to protect unvaccinated people and those for whom vaccines fail, but also to deter vaccine resistant variants or novel airborne threats that may appear at any time.

The new study was published in The Lancet.

Source: University of Colorado Boulder

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Evidence of COVID-19 airborne transmission overwhelming say experts - New Atlas

Washington is among the top states in the nation that tests viruses specifically for variants, which may spread more easily than the original virus.

SEATTLE Washington's COVID-19 testing capabilities remain a critical part of managing the pandemic, even as vaccinations increase. Everyone in Washington age 16 and older is now eligible for the vaccine.

Laboratories affiliated with the Washington State Department of Health (DOH) are increasing genome sequencing of SARS-CoV-2 to detect ever-spreading variants of the virus.

Genomic sequencing, also known as genotyping, is a process that studies a virus's genetic makeup to detect mutations or variants.

Dr. Scott Lindquist, state epidemiologist at the Washington Department of Health, said Washington is among the top five states in the U.S. that are checking positive COVID-19 tests for specific variants.

About a thousand COVID-19 tests are collected a day in Washington, according to Lindquist. The DOH currently genotypes about 5% of all positive COVID-19 tests ahead of the national average of genotyping 1% to 2%, Lindquist said.

"The last thing on my mind before I go to bed and the first thing when I wake up is COVID and concern about variants and our case count," Lindquist said.

Lindquist said testing is still important at this stage of the pandemic, even as vaccinations increase. People who have been vaccinated should still get tested if they feel symptoms, Lindquist said.

In the latest DOH reporton variants released Wednesday, the B.1.427 and B.1.429 variants, commonly known as the "California variants," and the "UK variant," known as B.1.1.7, are already spreading at a rapid rate in Washington.

"The B.1.1.7 is doubling every two weeks," Lindquist said.

The Biden administration is pumping $1 billion to expand genomic testing efforts to fight variants. Washington will receive $5 million of that in May.

Genotyping for variants may also prove useful in detecting potential virus trends among breakthrough cases. Breakthrough cases happen when a fully vaccinated person becomes infected with the virus.

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Washington state boosts COVID-19 testing for variants, even with vaccinations on the rise - KING5.com

Scott Cohen was on a ventilator struggling for his life with Covid-19 last April when his brothers pleaded with Plainview Hospital on Long Island to infuse him with the blood plasma of a recovered patient.

The experimental treatment was hard to get but was gaining attention at a time when doctors had little else. After an online petition drew 18,000 signatures, the hospital gave Mr. Cohen, a retired Nassau County medic, an infusion of the pale yellow stuff that some called liquid gold.

In those terrifying early months of the pandemic, the idea that antibody-rich plasma could save lives took on a life of its own before there was evidence that it worked. The Trump administration, buoyed by proponents at elite medical institutions, seized on plasma as a good-news story at a time when there werent many others. It awarded more than $800 million to entities involved in its collection and administration, and put Dr. Anthony S. Faucis face on billboards promoting the treatment.

A coalition of companies and nonprofit groups, including the Mayo Clinic, Red Cross and Microsoft, mobilized to urge donations from people who had recovered from Covid-19, enlisting celebrities like Samuel L. Jackson and Dwayne Johnson, the actor known as the Rock. Volunteers, some dressed in superhero capes, showed up to blood banks in droves.

Mr. Cohen, who later recovered, was one of them. He went on to donate his own plasma 11 times.

But by the end of the year, good evidence for convalescent plasma had not materialized, prompting many prestigious medical centers to quietly abandon it. By February, with cases and hospitalizations dropping, demand dipped below what blood banks had stockpiled. In March, the New York Blood Center called Mr. Cohen to cancel his 12th appointment. It didnt need any more plasma.

A year ago, when Americans were dying of Covid at an alarming rate, the federal government made a big bet on plasma. No one knew if the treatment would work, but it seemed biologically plausible and safe, and there wasnt much else to try. All told, more than 722,000 units of plasma were distributed to hospitals thanks to the federal program, which ends this month.

The governments bet did not result in a blockbuster treatment for Covid-19, or even a decent one. But it did give the country a real-time education in the pitfalls of testing a medical treatment in the middle of an emergency. Medical science is messy and slow. And when a treatment fails, which is often, it can be difficult for its strongest proponents to let it go.

Because the government gave plasma to so many patients outside of a controlled clinical trial, it took a long time to measure its effectiveness. Eventually, studies did emerge to suggest that under the right conditions, plasma might help. But enough evidence has now accumulated to show that the countrys broad, costly plasma campaign had little effect, especially in people whose disease was advanced enough to land them in the hospital.

In interviews, three federal health officials Dr. Stephen M. Hahn, the former commissioner of the Food and Drug Administration; Dr. Peter Marks, a top F.D.A. regulator; and Dr. H. Clifford Lane, a clinical director at the National Institutes of Health acknowledged that the evidence for plasma was limited.

The data are just not that strong, and it makes it makes it hard, I think, to be enthusiastic about seeing it continue to be used, Dr. Lane said. The N.I.H. recently halted an outpatient trial of plasma because of a lack of benefit.

Doctors have used the antibodies of recovered patients as treatments for more than a century, for diseases including diphtheria, the 1918 flu and Ebola.

So when patients began falling ill with the new coronavirus last year, doctors around the world turned to the old standby.

In the United States, two hospitals Mount Sinai in New York City and Houston Methodist in Texas administered the first plasma units to Covid-19 patients within hours of each other on March 28.

Dr. Nicole M. Bouvier, an infectious-disease doctor who helped set up Mount Sinais plasma program, said the hospital had tried the experimental treatment because blood transfusions carry a relatively low risk of harm. With a new virus spreading quickly, and no approved treatments, nature is a much better manufacturer than we are, she said.

As Mount Sinai prepared to infuse patients with plasma, Diana Berrent, a photographer, was recovering from Covid-19 at her home in Port Washington, N.Y. Friends began sending her Mount Sinais call for donors.

I had no idea what plasma was I havent taken a science class since high school, Ms. Berrent recalled. But as she researched its history in previous disease outbreaks, she became fixated on how she could help.

She formed a Facebook group of Covid-19 survivors that grew to more than 160,000 members and eventually became a health advocacy organization, Survivor Corps. She livestreamed her own donation sessions to the Facebook group, which in turn prompted more donations.

People were flying places to go donate plasma to each other, she said. It was really a beautiful thing to see.

Around the same time, Chaim Lebovits, a shoe wholesaler from Monsey, N.Y., in hard-hit Rockland County, was spreading the word about plasma within his Orthodox Jewish community. Mr. Lebovits called several rabbis he knew, and before long, thousands of Orthodox Jewish people were getting tested for coronavirus antibodies and showing up to donate. Coordinating it all was exhausting.

April, Mr. Lebovits recalled with a laugh, was like 20 decades.

Two developments that month further accelerated plasmas use. With the help of $66 million in federal funding, the F.D.A. tapped the Mayo Clinic to run an expanded access program for hospitals across the country. And the government agreed to cover the administrative costs of collecting plasma, signing deals with the American Red Cross and Americas Blood Centers.

The news releases announcing those deals got none of the flashy media attention that the billion-dollar contracts for Covid-19 vaccines did when they arrived later in the summer. And the government did not disclose how much it would be investing.

That investment turned out to be significant. According to contract records, the U.S. government has paid $647 million to the American Red Cross and Americas Blood Centers since last April.

The convalescent plasma program was intended to meet an urgent need for a potential therapy early in the pandemic, a health department spokeswoman said in a statement. When these contracts began, treatments werent available for hospitalized Covid-19 patients.

April 19, 2021, 5:56 a.m. ET

As spring turned to summer, the Trump administration seized on plasma as it had with the unproven drug hydroxychloroquine as a promising solution. In July, the administration announced an $8 million advertising campaign imploring Americans to donate their plasma and help save lives. The blitz included promotional radio spots and billboards featuring Dr. Fauci and Dr. Hahn, the F.D.A. commissioner.

A coalition to organize the collection of plasma was beginning to take shape, connecting researchers, federal officials, activists like Ms. Berrent and Mr. Lebovits, and major corporations like Microsoft and Anthem on regular calls that have continued to this day. Nonprofit blood banks and for-profit plasma collection companies also joined the collaboration, named the Fight Is In Us.

The group also included the Mitre Corporation, a little-known nonprofit organization that had received a $37 million government grant to promote plasma donation around the country.

The participants sometimes had conflicting interests. While the blood banks were collecting plasma to be immediately infused in hospitalized patients, the for-profit companies needed plasma donations to develop their own blood-based treatment for Covid-19. Donations at those companies own centers had also dropped off after national lockdowns.

They dont all exactly get along, Peter Lee, the corporate vice president of research and incubations at Microsoft, said at a virtual scientific forum in March organized by Scripps Research.

Microsoft was recruited to develop a locator tool, embedded on the groups website, for potential donors. But the company took on a broader role as a neutral intermediary, Dr. Lee said.

The company also provided access to its advertising agency, which created the look and feel for the Fight Is In Us campaign, which included video testimonials from celebrities.

In August, the F.D.A. authorized plasma for emergency use under pressure from President Donald J. Trump, who had chastised federal scientists for moving too slowly.

At a news conference, Dr. Hahn, the agencys commissioner, substantially exaggerated the data, although he later corrected his remarks following criticism from the scientific community.

In a recent interview, he said that Mr. Trumps involvement in the plasma authorization had made the topic polarizing.

Any discussion one could have about the science and medicine behind it didnt happen, because it became a political issue as opposed to a medical and scientific one, Dr. Hahn said.

The authorization did away with the Mayo Clinic system and opened access to even more hospitals. As Covid-19 cases, hospitalizations and deaths skyrocketed in the fall and winter, use of plasma did, too, according to national usage data provided by the Blood Centers of America. By January of this year, when the United States was averaging more than 130,000 hospitalizations a day, hospitals were administering 25,000 units of plasma per week.

Many community hospitals serving lower-income patients, with few other options and plasma readily available, embraced the treatment. At the Integris Health system in Oklahoma, giving patients two units of plasma became standard practice between November and January.

Dr. David Chansolme, the systems medical director of infection prevention, acknowledged that studies of plasma had showed it was more miss than hit, but he said his hospitals last year lacked the resources of bigger institutions, including access to the antiviral drug remdesivir. Doctors with a flood of patients many of them Hispanic and from rural communities were desperate to treat them with anything they could that was safe, Dr. Chansolme said.

By the fall, accumulating evidence was showing that plasma was not the miracle that some early boosters had believed it to be. In September, the Infectious Diseases Society of America recommended that plasma not be used in hospitalized patients outside of a clinical trial. (On Wednesday, the society restricted its advice further, saying plasma should not be used at all in hospitalized patients.) In January, a highly anticipated trial in Britain was halted early because there was not strong evidence of a benefit in hospitalized patients.

In February, the F.D.A. narrowed the authorization for plasma so that it applied only to people who were early in the course of their disease or who couldnt make their own antibodies.

Dr. Marks, the F.D.A. regulator, said that in retrospect, scientists had been too slow to adapt to those recommendations. They had known from previous disease outbreaks that plasma treatment is likely to work best when given early, and when it contained high levels of antibodies, he said.

Somehow we didnt really take that as seriously as perhaps we should have, he said. If there was a lesson in this, its that history actually can teach you something.

Today, several medical centers have largely stopped giving plasma to patients. At Rush University Medical Center in Chicago, researchers found that many hospitalized patients were already producing their own antibodies, so plasma treatments would be superfluous. The Cleveland Clinic no longer routinely administers plasma because of a lack of convincing evidence of efficacy, according to Dr. Simon Mucha, a critical care physician.

And earlier this year, Mount Sinai stopped giving plasma to patients outside of a clinical trial. Dr. Bouvier said that she had tracked the scientific literature and that there had been a sort of piling on of studies that showed no benefit.

Thats what science is its a process of abandoning your old hypotheses in favor of a better hypothesis, she said. Many initially promising drugs fail in clinical trials. Thats just the way the cookie crumbles.

Some scientists are calling on the F.D.A. to rescind plasmas emergency authorization. Dr. Luciana Borio, the acting chief scientist at the agency under President Barack Obama, said that disregarding the usual scientific standards in an emergency what she called pandemic exceptionalism had drained valuable time and attention from discovering other treatments.

Pandemic exceptionalism is something we learned from prior emergencies that leads to serious unintended consequences, she said, referring to the ways countries leaned on inadequate studies during the Ebola outbreak. With plasma, she said, the agency forgot lessons from past emergencies.

While scant evidence shows that plasma will help curb the pandemic, a dedicated clutch of researchers at prominent medical institutions continue to focus on the narrow circumstances in which it might work.

Dr. Arturo Casadevall, an immunologist at Johns Hopkins University, said many of the trials had not succeeded because they tested plasma on very sick patients. If theyre treated early, the results of the trials are all consistent, he said.

A clinical trial in Argentina found that giving plasma early to older people reduced the progression of Covid-19. And an analysis of the Mayo Clinic program found that patients who were given plasma with a high concentration of antibodies fared better than those who did not receive the treatment. Still, in March, the N.I.H. halted a trial of plasma in people who were not yet severely ill with Covid-19 because the agency said it was unlikely to help.

With most of the medical community acknowledging plasmas limited benefit, even the Fight Is In Us has begun to shift its focus. For months, a clinical research page about convalescent plasma was dominated by favorable studies and news releases, omitting major articles concluding that plasma showed little benefit.

Now, the website has been redesigned to more broadly promote not only plasma, but also testing, vaccines and other treatments like monoclonal antibodies, which are synthesized in a lab and thought to be a more potent version of plasma. Its clinical research page also includes more negative studies about plasma.

Nevertheless, the Fight Is In Us is still running Facebook ads, paid for by the federal government, telling Covid-19 survivors that Theres a hero inside you and Keep up the fight. The ads urge them to donate their plasma, even though most blood banks have stopped collecting it.

Two of plasmas early boosters, Mr. Lebovits and Ms. Berrent, have also turned their attention to monoclonal antibodies. As he had done with plasma last spring, Mr. Lebovits helped increase acceptance of monoclonals in the Orthodox Jewish community, setting up an informational hotline, running ads in Orthodox newspapers, and creating rapid testing sites that doubled as infusion centers. Coordinating with federal officials, Mr. Lebovits has since shared his strategies with leaders in the Hispanic community in El Paso and San Diego.

And Ms. Berrent has been working with a division of the insurer UnitedHealth to match the right patients people with underlying health conditions or who are over 65 to that treatment.

Im a believer in plasma for a lot of substantive reasons, but if word came back tomorrow that jelly beans worked better, wed be promoting jelly beans, she said. We are here to save lives.

Read more:

The Covid-19 Plasma Boom Is Over. What Did We Learn From It? - The New York Times

Notable quotes:

We have felt inspired to reopen temples gradually through a very cautious approach.

When the incidence of COVID-19 in your area is within safe limits, your temple will be reopened.

With courage, let us all press on in the glorious work of the Lord.

Following a period of pandemic-prompted closures, temples around the world are reopening in phases, in adherence to local regulations and safety protocols.

We are grateful for your patience and devoted service during this changing and challenging period. I pray that your desire to worship and serve in the temple burns more brightly than ever.

When will Latter-day Saints be able to return to the temples in their districts? When local government regulations allow it and the incidence of COVID-19 in the area is within safe limits.

Do all you can to bring COVID-19 numbers down in your area so that your temple opportunities can increase. Meanwhile, keep your temple covenants and blessings foremost in your minds and hearts. Stay true to the covenants you have made.

The Church will construct 20 more temples:

Temples are a vital part of the Restoration of the gospel of Jesus Christ in its fullness. Ordinances of the temple fill our lives with power and strengthavailable in no other way. We thank God for those blessings.

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President Russell M. Nelson: 'COVID-19 and Temples ...

One year ago, the First Presidency of The Church of Jesus Christ of Latter-day Saints suspended Church gatherings worldwide on March 12, 2020, in response to growing restrictions related to COVID-19.

Two weeks later, on March 25, the First Presidency announced all temples would close. These were two of many actions taken by Church leaders to help prevent the spread of the virus as the global pandemic unfolded.

In a September Church News article, President Russell M. Nelson, President Dallin H. Oaks and President Henry B. Eyring said Church leaders saw what needed to be done and responded with unprecedented action suspending meetings,closing templesand directing the return ofthousands of missionaries to their home countries.

Then, as circumstances allowed and opportunities arose, they also found ways for members to safely gather, for temple work to be performed and for missionaries to safely share the gospel message.

This timeline shows how the Church has responded and adapted to the COVID-19 pandemic, guided by the Lord through living Prophets and Apostles.

Dec. 31 Wuhan Municipal Health Authorities report a string of pneumonia-like cases to World Health Organization (WHO)

Jan. 29 President Russell M. Nelson reaches out to China, sends protective equipment

Jan. 30 WHO issues Global Health Emergency; death toll reaches 200, with 9,800 confirmed cases

Feb. 4 Church transfers missionaries out of the China Hong Kong Mission

Feb. 21 Church releases information about missionary work, temple work and worship services for members and missionaries in several Asian countries; Taiwan Taipei Temple and Seoul Korea Temple first to close

Feb. 27 First Presidency discourages leaders, members from international travels to April general conference; Church statement reports 14 missions across 17 countries undergoing changes; Fukuoka Japan Temple and Sapporo Japan Temple to close

March 5 Rome Italy Temple first in Europe to close following Italian government directives to close large gathering places; total of 17 countries cancelling or limiting Sunday worship services in affected areas

March 6 Nonnative Korean missionaries return home; Seattle Washington Temple first in U.S. to close as Washington reports highest state death toll to date

March 11 WHO declares COVID-19 a pandemic

March 11 First Presidency announces public will not be admitted to the Conference Center for April general conference; missionaries scheduled to enter MTCs in Provo, Utah, or Preston, England, to be trained remotely; stake and leadership conferences, other large gatherings to be postponed in affected areas; large gatherings suspended on Church-owned college campuses; Asuncin Paraguay Temple first in Latin America to close after country suspends large-scale public events

March 12 Utah Gov. Gary Herbert announces Utah will restrict gatherings of more than 100 people

March 12 First Presidency suspends Church gatherings worldwide; senior missionaries, missionaries with health conditions to return home from 22 European missions; temple closures total 13

March 13 U.S. declares national emergency

March 13 Church temporarily suspends proxy temple work worldwide; Tabernacle Choir at Temple Square cancels concerts and makes changes to broadcasts; RootsTech London postponed until fall 2021; Church closes all public areas in and around Temple Square

March 14 President Nelson shares message of hope on social media channels

March 15 Church members worldwide worship at home for the first time

March 16 Church announces adjustments to missionary work (missionary elders may be released at 21 months, missionaries with health issues may be released, missionary calls will continue); Church releases additional information regarding temple adjustments (limit of 8 guests for living ordinances, distribution centers continue to operate where temples are open); many Church historic sites and more temples close

March 17 Nonnative missionaries in the Philippines to return home; Deseret Industries Thrift stores close to the public

March 18 Church announces temples will only accept appointments for living ordinances from those in local temple district, among other adjustments; Church distribution retail stores reduce hours, close doors in 73 locations; Nonnative missionaries in 26 African missions and the Micronesia Guam Mission to return home; Rio de Janeiro Brazil Temple open house and dedication postponed

March 19 First Presidency announces April general conference to be held from small auditorium with pre-recorded music, only those praying or speaking in attendance

March 20 First Presidency and Quorum of the Twelve say substantial numbers of missionaries will return to home countries, service terms adjusted, no MTCs will receive new missionaries and all will be trained online

March 22 Total of 88 temples closed; Five Church-chartered commercial planes fly more than 1,600 nonnative missionaries in the Philippines back to Salt Lake City; Church releases self-isolation guidelines for missionaries and their families

March 23 All 10 MTCs close, nonnative missionaries in Mexico, Vietnam and India to return to home countries; Utah Area presidency asks families to not congregate at airports as missionaries return home; Oquirrh Mountain Utah Temple, Bountiful Utah Temple first in Utah to close

March 24 Tokyo Olympics postponed until 2021

March 25 First Presidency announces all temples to close; 111 of 168 temples were closed at time of the announcement

March 26 President Nelson extends invitation for worldwide fast; First Presidency and Quorum of the Twelve announce shortened length of service for missionaries returning to the U.S., Canada

March 29 Latter-day Saints and others worldwide follow President Nelsons invitation to fast

March 31 First Presidency announces options for missionaries to return to original or temporary assignment when conditions allow or delay service

April 2 COVID-19 cases top 1 million people in 171 countries across six continents, death toll at least 51,000

April 4-5 General conference; President Nelson calls for a second worldwide fast

April 13 FSY conferences in U.S. and Canada in 2020 postponed

April 14 First Presidency announces more than 110 COVID-19 relief projects in 57 countries

April 17 First Presidency releases new administrative principles for the Church; President Nelson expresses gratitude on social media to those who fasted;

April 24 Global death toll surpasses 200,000

April 27 Tabernacle Choirs 2020 European tour postponed a year

April 30 New missionary assignments made following April 30 deadline; Church properties for camps and conferences to close, treks and Church pageants canceled for 2020; Church donates $5.5 million to COVID-19 relief efforts across the U.S.; 280 relief projects in 80 countries have been initiated

May 6 President Nelson addresses reintegration of Church worship and activities in video on social media

May 7 First Presidency announces phased reopening of temples; 17 temples open for limited living husband-wife sealing ordinances

May 11 Additional 17 temples to reopen for limited husband-and-wife sealing ordinances

May 19 First Presidency announces some meetings, activities to resume

May 28 U.S. death toll surpasses 100,000

June 4 First Presidency announces October general conference to be broadcast but closed again to public

June 17 Washington D.C. Temple open house, dedication dates postponed

June 23 ProjectProtect concludes after six weeks with nearly 6 million masks

July 10 Utah Area presidency urges Latter-day Saints in the state to wear masks in public

July 20 First Presidency announces changes to temple endowment ceremony

July 27 12 temples first to enter phase 2 of reopening plan, begin performing all living ordinances

Aug. 21 Choir leaders announce cancellationof annual Christmas concert featuring the Tabernacle Choir at Temple Square, Orchestra at Temple Square, and Bells at Temple Square

Sept. 1 Winnipeg Manitoba Temple dedication and open house postponed; FamilySearch announces RootsTech 2021 will be a free, virtual event held Feb. 25-27, 2021

Sept. 11 First Presidency outlines guidelines for safely increasing Church activity; stake conferences to begin virtually in November; weekly worship can resume immediately

Oct. 4-5 General conference is broadcast from the Conference Center Theater and closed to the public

Oct. 6-8 Elder Gerrit W. Gong and Sister Susan Gong test positive for COVID-19; all members of the First Presidency and Quorum of the Twelve are tested (results come back negative)

Oct. 22 Church announces annual Christmas concerts on Temple Square will be held virtually, public invited to submit videos

Oct. 30-31 ExpoGenealoga, a virtual family history event in Spanish, is hosted in Mexico

Nov. 4 Church starts deliberate, cautious process in assigning missionaries beyond home countries

Nov. 5-8 FamilySearch Geraes, a virtual family history event in Portuguese, is hosted in Brazil

Nov. 7 First of two Luz de Las Naciones virtual programs this season is streamed online (the other will be Dec. 19)

Nov. 9 Church announces Giving Machines will not be used this season, but the #LightTheWorld service campaign will move forward

Nov. 9 Utah Gov. Gary Herbert orders statewide mask mandate and halts on casual social gatherings as COVID-19 cases in the state skyrocket

Nov. 12 Utah Area Presidency issues four temporary adjustments to meetings and activities; the Church announces plans for Temple Square lights and virtual Christmas devotionals and performances

Nov. 20 President Nelson shares worldwide message on the healing power of gratitude and invites all to #GiveThanks

Dec. 1 Christmas on Temple Square kicks off with virtual concert and tour of the lights; the #LightTheWorld daily service initiative begins

Dec. 5 Elder Dale G. Renlund and his wife, Sister Ruth Renlund, test positive for COVID-19

Dec. 6 Annual First Presidency Christmas Devotional is broadcast from the Conference Center Theater on Temple Square and closed to the public

Dec. 7 First Presidency announces the first four temples moving to Phase 3, reopening for proxy work

Dec. 14 U.S. COVID-19 deaths top 300,000 as vaccinations begin

Jan. 8 Elder Ulisses Soares and his wife, Sister Rosana Soares, tested positive for COVID-19 during holiday break, according to a Church statement

Jan. 15 Global death toll surpasses 2 million

Jan. 15 A letter from President M. Russell Ballard asks local leaders to look for local youth conference and camp opportunities in 2021; FSY conferences in U.S. and Canada postponed until 2022

Jan. 19 Senior Church leaders receive COVID-19 vaccines, encourage members to safeguard themselves and others through immunization

Jan. 21 First Presidency announces April 2021 general conference will be conducted virtually, marking the third-straight virtual conference

Feb. 4 Utah Area Presidency updates COVID-19 safety measures and returns to September 2020 guidelines

Feb. 12 Utah Area Presidency again updates COVID-19 safety measures with focus on Primary children, meetings and activities

Feb. 19 Jerold Ottley, longtime Tabernacle Choir director, dies at age 86 from COVID-19-related illness

Feb. 22 Church donates personal protective equipment, members sew masks to fight COVID-19 in Botswana

Feb. 25-27 All-virtual RootsTech Connect draws more than 1.1 million participants from 242 countries and territories

Feb. 26 Latter-day Saint Charities announces $20 million donation to support UNICEFs COVID-19 vaccination efforts

March 2 Elder Soares and other Church leaders speak in special devotional for Native Americans, many of whom have been hit particularly hard by COVID-19

March 5 Tabernacle Choir and Orchestra at Temple Square Heritage Tour postponed until 2022

March 9 Church pageants canceled for 2021, with Hill Cumorah finale to be 2019 rebroadcast

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Timeline: How the Church has responded to the global COVID ...

After eight senior leaders of The Church of Jesus Christ of Latter-day Saints received the first dose of the COVID-19 vaccination in Salt Lake City on Tuesday morning, the First Presidency issued a statement on vaccinations.

In word and deed, The Church of Jesus Christ of Latter-day Saints has supported vaccinations for generations, the leaders wrote in the statement. As a prominent component of our humanitarian efforts, the Church has funded, distributed and administered life-saving vaccines throughout the world. Vaccinations have helped curb or eliminate devastating communicable diseases such as: polio, diphtheria, tetanus, smallpox and measles. Vaccinations administered by competent medical professionals protect health and preserve life.

The First Presidency also urged Church members, as appropriate opportunities become available, to be good global citizens and help quell the pandemic by safeguarding themselves and others through immunization.

Individuals are responsible to make their own decisions about vaccination, they wrote in the statement. In making that determination, we recommend that, where possible, they counsel with a competent medical professional about their personal circumstances and needs.

All members of the First Presidency and five senior members of Quorum of the Twelve Apostles received the first dose of the COVID-19 vaccine Tuesday morning. The eight leaders and most of their spouses who qualified in Utah for the vaccine because they are over the age of 70 followed health care workers, first responders and other high-priority recipients who received the vaccination in recent weeks.

The following senior leaders received the vaccine: President Russell M. Nelson and his wife, Sister Wendy Nelson; President Dallin H. Oaks and his wife, Sister Kristen Oaks; President Henry B. Eyring; President M. Russell Ballard; Elder Jeffrey R. Holland and his wife, Sister Patricia Holland; Elder Dieter F. Uchtdorf and his wife, Sister Harriet Uchtdorf; Elder Quentin L. Cook and his wife, Sister Mary Cook; and Elder D. Todd Christofferson and his wife, Sister Kathy Christofferson.

As this pandemic spread across the world, the Church immediately cancelled meetings, closed temples and restricted other activities because of our desire to be good global citizens and do our part to fight the pandemic, wrote the First Presidency in the statement. Now, COVID-19 vaccines that many have worked, prayed and fasted for are being developed and some are being provided. Under the guidelines issued by local health officials, vaccinations were first offered to health care workers, first responders and other high priority recipients. Because of their age, Senior Church leaders over 70 now welcome the opportunity to be vaccinated.

After receiving the vaccination, President Nelson issued a personal statement about vaccination on his social media accounts.

With approval from our physician, my wife Wendy and I were vaccinated today againstCOVID-19, the 96-year-old leader wrote.We are very grateful.This was the first week either of us was eligible to receive the vaccine.We are thankful for the countless doctors, scientists, researchers, manufacturers, government leaders, and others who have performed the grueling work required to make this vaccine available. We have prayed often for this literal Godsend.

As a former surgeon and medical researcher, I know something of the effort needed to accomplish such a remarkable feat. Producing a safe, effective vaccine in less than a year is nothing short of miraculous. I was a young surgeon when, in 1953, Dr. Jonas Salk announced that he had developed a vaccine against the cruel and crippling disease of polio. I then watched the dramatic impact that vaccine had on eradicating polio as most people around the world were vaccinated.

For generations, The Church of Jesus Christ of Latter-day Saints has donated considerable resources to making vaccinations available for people in developing countries. Vaccinations have helped to eliminate diseases such as diphtheria and smallpox.My professional and ecclesiastical experiences convince me that vaccinations administered by competent medical professionals protect health and preserve life.

Receiving the vaccine today was part of our personal efforts to be good global citizens in helping toeliminate COVID-19 from the world.

The Church of Jesus Christ hasrecognized the importance ofvaccinations and immunization for decades, according to a Newsroom article.We urge members of The Church of Jesus Christ of Latter-day Saints to protect their own children through immunization,the First Presidency said in 1978.

Since 2002, through its humanitarian organizationLatter-day Saint Charities,the Churchhas helped fund168 projects in 46 countriesto bless more than116 million people.Latter-day Saint Charities gives monetary support to prominent global immunization partners to procure and deliver vaccinations, monitor diseases, respond to outbreaks, train health care workers, and develop elimination and eradication programming. The resultsinclude moreimmunized children andfewerlives lost to measles, rubella, maternal and neonatal tetanus, polio, diarrhea, pneumonia and yellow fever.

Notablesuccess storiesof lateinclude theeliminationofdiseases throughout Africa.In 2019,Latter-day Saint Charities and partners such asUNICEF USA andKiwanis International helpedeliminate maternal and neonatal tetanusinChadandtheDemocratic Republic of the Congo.Late last year,thanks to UNICEF and partners such as Latter-day Saint Charities,Africaeradicated wild poliovirus.And inresponse to a measles epidemic in Chad in 2019,UNICEF and its partnershelped vaccinate 653,535 childrenbetweenthe ages of six months and nine years over a one-week period.

Im glad our turn has come to have this vaccination, President Oaks saidTuesday morning.Were very hopefulthat the general vaccination of the population will help us get ahead of this awful pandemic. Its hopeful, like the light at the end of the tunnel. There is relief and appreciation involved for those who have invented the vaccine and for those who have caused it to be generally available on a sensible priority system.

Originally posted here:

Senior Church leaders receive COVID-19 vaccine, encourage ...