Weekly coronavirus-related chat, questions, and minor updates - week of December 14

On a personal note, my father (with whom my relationship is somewhere in the null to negative range) has been in the hospital for about the last three weeks and the latest update had his health deteriorating. And while I don't have much feeling for the man, be it good or bad, I don't exactly know how to deal with the reality of him dying.

He never knew how to take care of himself to begin with, so he has no assets to inherit. I feel that I should be at his funeral at least for the sake of my family. But given that I don't have much positive to say, I don't know how 'useful' I'll be there. Heck, I don't even know what the funeral will be like since we still have this pandemic.

I'm most worried about my grandmother, since it's her son. I'm worried that this might literally kill her.

The director of the White House security office was hospitalized for three months with COVID-19, had to have his lower right leg amputated as well as his left big toe, and needs a GoFundMe to help cover the costs.

A couple articles from Monday:

Los Angeles Covid-19 Update: Ambulances Waiting 4 Hours To Offload Patients As County-Run Hospitals Have Just 56 Adult ICU Beds Left, Orange County Has None

Southern California as a whole on Monday only had 2.7% of its ICU bed capacity remaining, according to state figures.

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There are 4,203 people hospitalized with COVID in the county, and nearly half of the county’s ICU beds are now occupied by COVID patients. Ferrer says the county will likely have 5,000 people hospitalized with COVID-19 by the weekend.

Angelenos Urged To Avoid ER As COVID-19 Patients Crowd Hospitals

It's a fine line for health officials who have to urge some patients to stay away from hospital emergency rooms, but not the ones who need emergency care.

"Certainly if you need emergency services, you should call 911 or go to your nearest emergency department, and they are able to take care of you," said Dr. Christina Ghaly, director of the county Department of Health Services.

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On Sunday, a day when emergency departments are traditionally not as busy, 81% of the 911-receiving hospitals asked to have advanced-life-support ambulance traffic diverted to other medical facilities at some point during the day due to overcrowded ERs. Ghaly said last week the traditional average of hospitals requesting diversion this time of year is 10% to 15%.

And yesterday:

LA County coronavirus surge fuels Southern California ICU bed shortage

The region’s ICU bed capacity dropped to 1.7% Tuesday, down from 2.7% on Monday and marking the eighth consecutive day of decline. Los Angeles County, which is one of 11 counties in the Southern California region, had 4,404 people in hospitals with COVID-19 on Tuesday — a more than 300% increase over the past month — 21% of whom were in ICUs.

Still, many hospitals have the ability to increase their capacity during surges.

UCLA Health, for example, said in a Tuesday statement that it could add 453 ICU beds to its existing 155 if needed by adding beds to single inpatient rooms and converting other rooms to provide ICU-level care. UCLA Health hospitals had 111 COVID-19-positive patients as of early Tuesday.

Despite that flexibility, the decline in ICU capacity and spikes in new cases, hospitalization and deaths has underscored the severity of this renewed surge even amid the hope brought by vaccines.

4 million Californians opt in to new smartphone COVID-19 exposure alert system

We installed it. For us, it seems unlikely to be useful since we go out so seldom, but it’s in support of the cause.

Reevaluating Children's Role in the Pandemic

A large study from Austria shows that SARS-CoV-2 infects just as many schoolchildren as it does teachers. Other surveys indicate that while young children may show no symptoms, they are quite efficient at spreading the virus.

@‍JustinTrudeau on Twitter

The first batch of doses of Pfizer-BioNTech’s COVID-19 vaccine have arrived in Canada.

https://pbs.twimg.com/media/EpKNHshXYAMg06a?format=jpg

A man who crossed the Irish Sea from Scotland to the Isle of Man "on a jet ski" to visit his girlfriend has been jailed for breaching Covid-19 laws.

4.5 hours on a jetski to travel the 40 km / 25 miles, then he walked an additional 15 miles to his girlfriend's house.

What vaccine distribution planners can learn from Amazon and Walmart

We are two supply-chain experts who have studied vaccine purchasing and distribution. Drawing from our decades-long research into supply-chain management and health care operations, we believe two supply-chain ideas practiced by Amazon and Walmart can help reduce waste and minimize shortages of COVID-19 vaccines.

Instead of shipping vaccines directly to hospitals and pharmacies, states could set up regional “fulfillment centers” in different counties with pooled inventory – much like Amazon’s. These fulfillment centers can restock vaccination sites on demand on a daily or weekly basis as needed. By using this just-in-time distribution strategy, supply could better match demand at specific sites and reduce potential waste of vaccines.

One way to minimize storage needs is to use an approach called cross-docking. Walmart, sometimes called “the king of cross-docking,” popularized this idea that all but does away with excess storage requirements.

Instead of taking deliveries from incoming trucks to intermediate national or state-level warehouses, and then from warehouses to outgoing trucks, cross-docking skips the storage step. You can simply move goods across a loading dock directly from the trucks that came from airports or vaccine manufacturers straight to the outgoing trucks that are headed to various regional fulfillment centers.

New Zealand has been very lucky to have effectively been spared all of the worst tragedies of this saga—we haven't had any major community transmission in months, and with only 25 deaths, we're well positioned to come out of this ordeal with a population suffering no long term health effects (because practically no one has contracted it), and now we've acquired enough doses of four different vaccines to cover our population and our neighbouring countries in the pacific:

Ardern unveils New Zealand Covid vaccine deals as economy rebounds

Ardern said readiness for New Zealand’s “largest-ever immunisation programme” was progressing well, and the country had now pre-ordered vaccines from four providers: 750,000 courses from Pfizer, 5m from Janssen, 3.8m from Oxford/AstraZeneca and 5.36m from Novavax. One course refers to all the doses needed for one person.

[..]

Some of the vaccines will be sent to countries in the Pacific. As part of its vaccine 2021 plan the government announced NZ$75m in funding to help Pacific countries vaccinate their populations.

FDA authorizes first rapid, over-the-counter home coronavirus test

The Food and Drug Administration on Tuesday authorized the first rapid coronavirus test that can be taken at home without prescription and that yields immediate results.

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The FDA allowed the test under an emergency use authorization. The newly approved home test will cost about $30, and the first batches will be shipped out the first week of January, according to Ellume.

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In an interview, Ellume chief executive Sean Parsons said supply initially will be limited to 100,000, with plans to increase manufacturing to 1 million by the middle of next year. Parsons said his company will be announcing a major partnership with a major retailer — such as Walgreens, CVS or Walmart — to sell the test and create policies that would prevent hoarding by consumers. He said Ellume is in talks to supply the tests in the future directly to companies and universities.

The test uses a nasal swab to collect a sample and produces results within minutes using a plastic device similar to a home pregnancy test.

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Ellume’s test requires users to download an app on their smartphone to learn their test result. That app automatically sends data by Zip code to the cloud — ensuring that regional health officials can learn about positive results while keeping the data confidential, the company said.

Boris Johnson has announced new tier 4 restrictions for London, the south-east and east of England, amid a surge in coronavirus cases and alarm concerns about a new strain of coronavirus spreading rapidly in the region.

This new strain may or may not be a big deal, it's too early to tell.

“This variant is strongly associated with where we are seeing increasing rates of covid-19. It’s a correlation, but we can’t say it is causation. But there is striking growth in this variant, which is why we are worried, and it needs urgent follow-up and investigation.”

With its global campaign to test and promote COVID-19 vaccines, China aims to win friends and cut deals

Most leading Western vaccines rely on sexy technologies such as genetically engineered viral vectors, designer proteins, and snippets of RNA. Three of China's leading vaccine candidates use an unfashionable stalwart: the whole inactivated virus, an approach that dates back to the first successful flu vaccine in the 1930s.

And China's vaccine effort is cursed by the country's dramatic success with aggressive public health measures to stop the spread of the virus, SARS-CoV-2, including forced isolation of cases and testing of entire cities. Whereas the raging pandemic in the United States has enabled trials there to quickly deliver signals of efficacy, “China crushed the coronavirus epidemic early, so they lost the opportunity to test the efficacy of their vaccines there,” says epidemiologist Ray Yip, who closely follows COVID-19 vaccine development as an adviser to Bill Gates. “If they had plenty of cases in China, they could have finished an efficacy trial ahead of other people.

So China's vaccine developers have gone abroad. Although the United States has shut them out of Operation Warp Speed, they have brokered deals with 14 other countries on five continents. They have mounted massive trials in the Arab world—and given candidate vaccines to top government officials there—and navigated toxic politics in Brazil, where the pandemic is raging fiercely, to test a vaccine and explore producing it there.

But China isn't just seeking promising venues for clinical trials. Not urgently needing the vaccines at home to fight a virus it has largely quashed, it is playing a global game by pledging to send any proven vaccine to countries that are conducting trials for its candidates, or to share the technologies behind them. “They know they don't need a vaccine to contain the epidemic in China,” Yip says. “They can take their sweet time.”

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At home, too, attitudes toward vaccines contrast with those in the United States and Europe, where mistrust is high, Morrison says. To the consternation of vaccine experts overseas, hundreds of thousands of people in China have already lined up to receive the experimental vaccines—even before their value and safety have been proved. “There has not been a collapse of faith and trust in science and in the state,” Morrison says. “There's less fear about where this is all going.”

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It's a safe bet that one or more of China's overseas trials will announce efficacy data any day. The results so far for other vaccines have fed a growing sense that many of the candidates will wallop what is, from a vaccine's point of view, a somewhat wimpy virus. But China is not waiting for the phase III results before widely using its vaccines at home. Its regulators appear to be satisfied with animal studies, combined with the minimal safety and immune response data from phase I and II trials. In June, CanSino received an emergency use authorization to vaccinate the military, and since then both Sinovac and CNBG have received green lights to vaccinate large populations outside of clinical trials.

Dramatic levels of “friendly fire” from the immune system may drive severe Covid-19 disease and leave patients with “long Covid”

Researchers at Yale University found that Covid-19 patients had large numbers of misguided antibodies in their blood that targeted the organs, tissues and the immune system itself, rather than fighting off the invading virus.

Further tests revealed that the more “autoantibodies” patients had in their blood, the worse their disease. The Covid-19 patients had more antibodies that had turned on them than people with lupus, an autoimmune disease caused by similar wayward antibodies.

Direct link to the preprint study (which, as the article notes, has not yet been peer-reviewed or published in a specific journal)

ICU capacity drops to 0% in Southern California as state reports 379 new deaths, shattering record

The ICU capacity in the 11-county Southern California region has dropped to 0% amid a dramatic surge in coronavirus cases, officials said Thursday.

California hospitals are required to report the total number of all available staffed ICU beds each day. Regional ICU capacity is calculated by subtracting neonatal and pediatric intensive care beds from the number of adult beds.

News of the diminished ICU capacity came as the state announced the deaths of 379 Californians, marking the highest number of fatalities in one day since the pandemic began and surpassing the previous record set the previous day.

South Korea warns of first potential lockdown as coronavirus numbers continue to rise

On Tuesday, South Korea reported 1,078 new cases, the highest daily count since the start of the pandemic, bringing the national total to 45,442. Some 226 patients are in critical condition, while there were an additional 12 deaths Tuesday, increasing total fatalities to 612.

On Wednesday, the acting Mayor of Seoul, Seo Jung-hyup, warned the capital was facing a critical shortage of hospital space, with 77 of the city's 78 ICU beds now occupied by coronavirus patients.

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Last week, military and police were called in to help with contact tracing efforts, while testing centers extended their hours into the night and on weekends to encourage testing in the greater Seoul area. At a briefing announcing new efforts, a top South Korean health official warned the country was facing its "biggest crisis" so far.

San Francisco mandates 10-day quarantine for travelers from outside Bay Area

The order goes into effect on Friday and applies to both visitors and residents.

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The order also requires anyone who comes to San Francisco to quarantine for 10 days if they spent any time outside the following nine Bay Area counties: San Mateo, Santa Clara, Alameda, Contra Costa, Solano, Sonoma, Napa, Marin and Santa Cruz.

True Pandemic Toll in the U.S. Reaches 377,000

Deaths nationwide were 19 percent higher than normal from March 15 to Dec. 5. Altogether, the analysis shows that 377,000 more people than normal have died in the United States during that period, a number that may be an undercount since recent death statistics are still being updated.

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Excess deaths right now look worst in parts of the Midwest where coronavirus cases have been high. But in the summer, when the virus was more common in the South and Southwest, excess deaths were higher in those regions.

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Counting deaths takes time, and many states are weeks or months behind in reporting. These estimates from the C.D.C. are adjusted based on how mortality data has lagged in previous years. It will take several months before all these numbers are finalized.

(Includes graphs for several U.S. states and regions.)

Mutant coronavirus in the United Kingdom sets off alarms but its importance remains unclear

Scientists, meanwhile, are hard at work trying to figure out whether B.1.1.7 is really more adept at human-to-human transmission—not everyone is convinced yet—and if so, why. They’re also wondering how it evolved so fast. B.1.1.7 has acquired 17 mutations all at once, a feat never seen before. “There's now a frantic push to try and characterize some of these mutations in the lab,” says Andrew Rambaut, a molecular evolutionary biologist at the University of Edinburgh.

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But scientists have never seen the virus acquire more than a dozen mutations seemingly at once. They think it happened during a long infection of a single patient that allowed SARS-CoV-2 to go through an extended period of fast evolution, with multiple variants competing for advantage.

One reason to be concerned, Rambaut says, is that among the 17 are eight mutations in the gene that encodes the spike protein on the viral surface, two of which are particularly worrisome. One, called N501Y, has previously been shown to increase how tightly the protein binds to the ACE2 receptor, its entry point into human cells. The other, named 69-70del, leads to the loss of two amino acids in the spike protein and has been found in viruses that eluded the immune response in some immunocompromised patients.

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Scientists previously worried that a variant that spread rapidly from Spain to the rest of Europe—confusingly called B.1.177—might be more transmissible, but today they think it is not; it just happened to be carried all over Europe by travelers who spent their holidays in Spain. Something similar might be happening with B.1.1.7, says Angela Rasmussen, a virologist at Georgetown University. Drosten notes that the new mutant also carries a deletion in another viral gene, ORF8, that previous studies suggest might reduce the virus’s ability to spread.

But further reason for concern comes from South Africa, where scientists have sequenced genomes in three provinces where cases are soaring: Eastern Cape, Western Cape, and KwaZulu Natal. They identified a lineage separate from the U.K. variant that also has the N501Y mutation in the spike gene. “We found that this lineage seems to be spreading much faster,” says Tulio De Oliveira, a virologist at the University of KwaZulu Natal whose work first alerted U.K. scientists to the importance of N501Y. (A preprint of their results on the strain, which they are calling 501Y.V2, will be released on Monday, De Oliveira says.)

Stanford apologizes after doctors protest vaccine plan that put frontline workers at back of line

More than 100 Stanford Medical Center doctors held a raucous protest Friday, accusing the university of prioritizing the wrong health care workers to receive coronavirus vaccines ahead of residents and fellows who work directly with COVID-19 patients.

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Entwhistle explained that Stanford’s vaccine distribution algorithm followed the federal government’s guidance prioritizing health care workers and older employees.

But the protesters accused hospital leaders of ignoring an apparent error in the algorithm — which allowed employees not working directly with patients to be vaccinated first — and that the leadership knew about it as early as Tuesday.

Austria and Switzerland are imposing more lockdown measures again (Austria not until after Christmas), and Italy as well, over the Christmas and New Years holidays.

One in every five state and federal prisoners in the United States has tested positive for the coronavirus, a rate more than four times as high as the general population. In some states, more than half of prisoners have been infected, according to data collected by the Associated Press and the Marshall Project.

Westmoreland lived with more than 100 virus-infected men in an open dorm, where he woke up regularly to find men sick on the floor, unable to get up on their own, he said. “People are actually dying in front of me off of this virus,” he said. Westmoreland said he sweated it out, shivering in his bunk until, six weeks later, he finally recovered.

“The degree of civilization in a society can be judged by entering its prisons.”

Supermarkets in L.A. County see unprecedented coronavirus infection rates

Of the six outbreaks at Food 4 Less locations reported to the county during the pandemic, three — including the one at Hughes’ store — were first logged this month, linked to the current surge, according to a Times analysis of outbreaks posted on the county’s website. An outbreak is defined as three or more cases among staff in a 14-day period.

There have also been new outbreaks reported in December at three Trader Joe’s locations, two Whole Foods Market stores, three Sprouts Farmers Market branches and several smaller grocery chains, county and company records show.

Indoor environments where people are often in close, prolonged contact can become hotbeds for the coronavirus, especially when the pathogen is so widespread, experts say. The Times analysis also found a jump in outbreaks this month at banks, postal outlets, pharmacies, hardware stores and many nonessential businesses.

“Everything becomes more dangerous than it was last month — every type of activity,” said Dr. Kirsten Bibbins-Domingo, an epidemiologist at UC San Francisco. “When 1 in 80 people in L.A. are infected, even if you’re just going to the grocery store … there’s a higher chance today than there was two weeks ago that you’ll be exposed to COVID-19.”

Gunzenhauser recommended consolidating trips to businesses, perhaps visiting the grocery store every other week instead of weekly, if possible. People should also be prepared to leave and return another time if the store is too crowded, lines are long or shoppers aren’t wearing masks.

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Other food retailers that reported outbreaks recently included Gelson’s Markets in Marina del Rey, Super A Foods in Glassell Park and Superior Grocers in City of Industry. Three outbreaks at Vallarta Supermarkets were reported this month. Five of the 10 outbreaks at L.A. County Target locations since the pandemic began were reported in December.

Countries across Europe halt flights from Britain over concerns about coronavirus mutation

The World Health Organization said Sunday that it was in “close contact” with British officials over the new strain, which has now also been detected in the Netherlands, Denmark, and Australia, the BBC reported.

California town says no to new rules, then yes

The unanimous 5-0 vote by Solvang's council on Dec. 7 encouraged businesses to stay open. “As of tonight, they can go about their business as they had done,” Councilman Daniel Johnson said following the vote.

That vote was a last hurrah for Johnson and two other councilors — one of them the mayor — whose terms ended one week later. Their replacements took office this week and quickly denounced the resolution and implored the business community to follow the rules.

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Still, no one seems to be breaking the tough new rules, both say, and even if they were the city wouldn't have the authority to go after most of them. The Santa Barbara County Health Department, for example, licenses the restaurants and could impose fines or pull the licenses of lawbreakers.

“All of us in the food and beverage industry know that we're held accountable by the (county) Health Department and (state) Alcoholic Beverage Control," said Lisa Mesa, who with her husband, Alfred, owns the popular Good Life wine and beer cellar, which has canceled all its tastings.

“While I as a business owner certainly appreciate the gesture by the previous City Council, it’s not enforceable, and I knew that,” she added.

What's more, she said, everyone in town knows the coronavirus is a serious threat even if it hasn't hit Solvang as hard as other places.