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The Coronavirus Is Plotting a Comeback. Right here’s Our Likelihood to Cease It for Good.

The Coronavirus Is Plotting a Comeback. Here’s Our Chance to Stop It for Good.

Across the United States, and the world, the coronavirus seems to be loosening its stranglehold. The deadly curve of cases, hospitalizations and deaths has yo-yoed before, but never has it plunged so steeply and so fast.

Is this it, then? Is this the beginning of the end? After a year of being pummeled by grim statistics and scolded for wanting human contact, many Americans feel a long-promised deliverance is at hand.

We will win against the virus and regain many aspects of our pre-pandemic lives, most scientists now believe. Of the 21 interviewed for this article, all were optimistic that the worst of the pandemic is past. This summer, they said, life may begin to seem normal again.

But — of course, there’s always a but — researchers are also worried that Americans, so close to the finish line, may once again underestimate the virus.

So far, the two vaccines authorized in the United States are spectacularly effective, and after a slow start, the vaccination rollout is picking up momentum. A third vaccine is likely to be authorized shortly, adding to the nation’s supply.

But it will be many weeks before vaccinations make a dent in the pandemic. And now the virus is shape-shifting faster than expected, evolving into variants that may partly sidestep the immune system.

The latest variant was discovered in New York City only this week, and another worrisome version is spreading at a rapid pace through California. Scientists say a contagious variant first discovered in Britain will become the dominant form of the virus in the United States by the end of March.

The road back to normalcy is potholed with unknowns: how well vaccines prevent further spread of the virus; whether emerging variants remain susceptible enough to the vaccines; and how quickly the world is immunized, so as to halt further evolution of the virus.

But the greatest ambiguity is human behavior. Can Americans desperate for normalcy keep wearing masks and distancing themselves from family and friends? How much longer can communities keep businesses, offices and schools closed?

Covid-19 deaths will most likely never rise quite as precipitously as in the past, and the worst may be behind us. But if Americans let down their guard too soon — many states are already lifting restrictions — and if the variants spread in the United States as they have elsewhere, another spike in cases may well arrive in the coming weeks.

Scientists call it the fourth wave. The new variants mean “we’re essentially facing a pandemic within a pandemic,” said Adam Kucharski, an epidemiologist at the London School of Hygiene and Tropical Medicine.

The United States has now recorded 500,000 deaths amid the pandemic, a terrible milestone. As of Wednesday morning, at least 28.3 million people have been infected.

But the rate of new infections has tumbled by 35 percent over the past two weeks, according to a database maintained by The New York Times. Hospitalizations are down 31 percent, and deaths have fallen by 16 percent.

Yet the numbers are still at the horrific highs of November, scientists noted. At least 3,210 people died of Covid-19 on Wednesday alone. And there is no guarantee that these rates will continue to decrease.

“Very, very high case numbers are not a good thing, even if the trend is downward,” said Marc Lipsitch, an epidemiologist at the Harvard T.H. Chan School of Public Health in Boston. “Taking the first hint of a downward trend as a reason to reopen is how you get to even higher numbers.”

In late November, for example, Gov. Gina Raimondo of Rhode Island limited social gatherings and some commercial activities in the state. Eight days later, cases began to decline. The trend reversed eight days after the state’s pause lifted on Dec. 20.

The virus’s latest retreat in Rhode Island and most other states, experts said, results from a combination of factors: growing numbers of people with immunity to the virus, either from having been infected or from vaccination; changes in behavior in response to the surges of a few weeks ago; and a dash of seasonality — the effect of temperature and humidity on the survival of the virus.

Parts of the country that experienced huge surges in infection, like Montana and Iowa, may be closer to herd immunity than other regions. But patchwork immunity alone cannot explain the declines throughout much of the world.

The vaccines were first rolled out to residents of nursing homes and to the elderly, who are at highest risk of severe illness and death. That may explain some of the current decline in hospitalizations and deaths.

But young people drive the spread of the virus, and most of them have not yet been inoculated. And the bulk of the world’s vaccine supply has been bought up by wealthy nations, which have amassed one billion more doses than needed to immunize their populations.

Vaccination cannot explain why cases are dropping even in countries where not a single soul has been immunized, like Honduras, Kazakhstan or Libya. The biggest contributor to the sharp decline in infections is something more mundane, scientists say: behavioral change.

Leaders in the United States and elsewhere stepped up community restrictions after the holiday peaks. But individual choices have also been important, said Lindsay Wiley, an expert in public health law and ethics at American University in Washington.

“People voluntarily change their behavior as they see their local hospital get hit hard, as they hear about outbreaks in their area,” she said. “If that’s the reason that things are improving, then that’s something that can reverse pretty quickly, too.”

The downward curve of infections with the original coronavirus disguises an exponential rise in infections with B.1.1.7, the variant first identified in Britain, according to many researchers.

“We really are seeing two epidemic curves,” said Ashleigh Tuite, an infectious disease modeler at the University of Toronto.

The B.1.1.7 variant is thought to be more contagious and more deadly, and it is expected to become the predominant form of the virus in the United States by late March. The number of cases with the variant in the United States has risen from 76 in 12 states as of Jan. 13 to more than 1,800 in 45 states now. Actual infections may be much higher because of inadequate surveillance efforts in the United States.

Buoyed by the shrinking rates over all, however, governors are lifting restrictions across the United States and are under enormous pressure to reopen completely. Should that occur, B.1.1.7 and the other variants are likely to explode.

Updated 

Feb. 25, 2021, 9:03 p.m. ET

“Everybody is tired, and everybody wants things to open up again,” Dr. Tuite said. “Bending to political pressure right now, when things are really headed in the right direction, is going to end up costing us in the long term.”

Looking ahead to late March or April, the majority of scientists interviewed by The Times predicted a fourth wave of infections. But they stressed that it is not an inevitable surge, if government officials and individuals maintain precautions for a few more weeks.

A minority of experts were more sanguine, saying they expected powerful vaccines and an expanding rollout to stop the virus. And a few took the middle road.

“We’re at that crossroads, where it could go well or it could go badly,” said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.

The vaccines have proved to be more effective than anyone could have hoped, so far preventing serious illness and death in nearly all recipients. At present, about 1.4 million Americans are vaccinated each day. More than 45 million Americans have received at least one dose.

A team of researchers at Fred Hutchinson Cancer Research Center in Seattle tried to calculate the number of vaccinations required per day to avoid a fourth wave. In a model completed before the variants surfaced, the scientists estimated that vaccinating just one million Americans a day would limit the magnitude of the fourth wave.

“But the new variants completely changed that,” said Dr. Joshua T. Schiffer, an infectious disease specialist who led the study. “It’s just very challenging scientifically — the ground is shifting very, very quickly.”

Natalie Dean, a biostatistician at the University of Florida, described herself as “a little more optimistic” than many other researchers. “We would be silly to undersell the vaccines,” she said, noting that they are effective against the fast-spreading B.1.1.7 variant.

But Dr. Dean worried about the forms of the virus detected in South Africa and Brazil that seem less vulnerable to the vaccines made by Pfizer and Moderna. (On Wednesday, Johnson & Johnson reported that its vaccine was relatively effective against the variant found in South Africa.)

About 50 infections with those two variants have been identified in the United States, but that could change. Because of the variants, scientists do not know how many people who were infected and had recovered are now vulnerable to reinfection.

South Africa and Brazil have reported reinfections with the new variants among people who had recovered from infections with the original version of the virus.

“That makes it a lot harder to say, ‘If we were to get to this level of vaccinations, we’d probably be OK,’” said Sarah Cobey, an evolutionary biologist at the University of Chicago.

Yet the biggest unknown is human behavior, experts said. The sharp drop in cases now may lead to complacency about masks and distancing, and to a wholesale lifting of restrictions on indoor dining, sporting events and more. Or … not.

“The single biggest lesson I’ve learned during the pandemic is that epidemiological modeling struggles with prediction, because so much of it depends on human behavioral factors,” said Carl Bergstrom, a biologist at the University of Washington in Seattle.

Taking into account the counterbalancing rises in both vaccinations and variants, along with the high likelihood that people will stop taking precautions, a fourth wave is highly likely this spring, the majority of experts told The Times.

Kristian Andersen, a virologist at the Scripps Research Institute in San Diego, said he was confident that the number of cases will continue to decline, then plateau in about a month. After mid-March, the curve in new cases will swing upward again.

In early to mid-April, “we’re going to start seeing hospitalizations go up,” he said. “It’s just a question of how much.”

Now the good news.

Despite the uncertainties, the experts predict that the last surge will subside in the United States sometime in the early summer. If the Biden administration can keep its promise to immunize every American adult by the end of the summer, the variants should be no match for the vaccines.

Combine vaccination with natural immunity and the human tendency to head outdoors as weather warms, and “it may not be exactly herd immunity, but maybe it’s sufficient to prevent any large outbreaks,” said Youyang Gu, an independent data scientist, who created some of the most prescient models of the pandemic.

Infections will continue to drop. More important, hospitalizations and deaths will fall to negligible levels — enough, hopefully, to reopen the country.

“Sometimes people lose vision of the fact that vaccines prevent hospitalization and death, which is really actually what most people care about,” said Stefan Baral, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health.

Even as the virus begins its swoon, people may still need to wear masks in public places and maintain social distance, because a significant percent of the population — including children — will not be immunized.

“Assuming that we keep a close eye on things in the summer and don’t go crazy, I think that we could look forward to a summer that is looking more normal, but hopefully in a way that is more carefully monitored than last summer,” said Emma Hodcroft, a molecular epidemiologist at the University of Bern in Switzerland.

Imagine: Groups of vaccinated people will be able to get together for barbecues and play dates, without fear of infecting one another. Beaches, parks and playgrounds will be full of mask-free people. Indoor dining will return, along with movie theaters, bowling alleys and shopping malls — although they may still require masks.

The virus will still be circulating, but the extent will depend in part on how well vaccines prevent not just illness and death, but also transmission. The data on whether vaccines stop the spread of the disease are encouraging, but immunization is unlikely to block transmission entirely.

“It’s not zero and it’s not 100 — exactly where that number is will be important,” said Shweta Bansal, an infectious disease modeler at Georgetown University. “It needs to be pretty darn high for us to be able to get away with vaccinating anything below 100 percent of the population, so that’s definitely something we’re watching.”

Over the long term — say, a year from now, when all the adults and children in the United States who want a vaccine have received them — will this virus finally be behind us?

Every expert interviewed by The Times said no. Even after the vast majority of the American population has been immunized, the virus will continue to pop up in clusters, taking advantage of pockets of vulnerability. Years from now, the coronavirus may be an annoyance, circulating at low levels, causing modest colds.

Many scientists said their greatest worry post-pandemic was that new variants may turn out to be significantly less susceptible to the vaccines. Billions of people worldwide will remain unprotected, and each infection gives the virus new opportunities to mutate.

“We won’t have useless vaccines. We might have slightly less good vaccines than we have at the moment,” said Andrew Read, an evolutionary microbiologist at Penn State University. “That’s not the end of the world, because we have really good vaccines right now.”

For now, every one of us can help by continuing to be careful for just a few more months, until the curve permanently flattens.

“Just hang in there a little bit longer,” Dr. Tuite said. “There’s a lot of optimism and hope, but I think we need to be prepared for the fact that the next several months are likely to continue to be difficult.”

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CDC examine finds nursing dwelling residents have been reinfected with worse case of Covid

CDC study finds nursing home residents were reinfected with worse case of Covid

A general overview of the Centers for Disease Control and Prevention (CDC) headquarters in Atlanta.

Tami Chappell | Reuters

A new CDC study found that some elderly people who appeared to have recovered from the coronavirus later had a second, even worse case – suggesting that asymptomatic or mild cases may not offer much protection against re-infection with Covid- 19 offer.

The study, published Thursday in the Centers for Disease Control and Prevention’s Weekly Report on Morbidity and Mortality, looked at two separate outbreaks that occurred three months apart in a qualified care facility in Kentucky. According to the study, 20 residents and five health care workers tested positive for the virus between mid-July and mid-August.

The second outbreak, between late October and early December, was worse: 85 residents and 43 healthcare workers tested positive for the virus. Among residents who tested positive during the first outbreak and were still living at the facility, five tested positive a second time more than 90 days after their first positive test.

Although Covid-19 reinfections do occur, they are generally rare.

Through frequent monitoring after the initial outbreak, all five residents had at least four negative tests between outbreaks, suggesting that they may have been re-infected with the virus later. Reinfection means that a person who had Covid-19 recovered and then got it again, according to the CDC.

“The history of exposure, including when the roommate infections occurred and symptoms recurred during the second outbreak, suggests that the second positive RT-PCR results represented new infections after the patients appeared to clear the first infection,” wrote Alyson Cavanaugh , one of the researchers who led the study.

While only two of the five residents showed mild symptoms during the first outbreak, all five potentially reinfected residents showed signs of illness the second time. The two residents who reported symptoms during the first outbreak “experienced more severe symptoms during the second infectious episode, according to the study.” One resident was hospitalized and subsequently died.

According to the study’s researchers, this was “noteworthy” as it suggests the possibility that people who show mild to no symptoms when they first become infected are “not creating a sufficiently robust immune response to prevent re-infection”. The results “suggest the possibility that the disease may be more severe during a second infection.”

“The results of this study underscore the importance of maintaining public health mitigation and protection strategies that reduce the risk of transmission, even in those with a history of COVID-19 infection,” wrote Cavanaugh.

Some limitations were noted in the study. Because the samples were not stored, the researchers were unable to perform genome sequencing, a laboratory technique that breaks down the virus’ genetic code to confirm re-infection. “There are no additional test results to prove the initial test result is really positive,” they said during the initial outbreak.

It is believed that the risk of re-infection for the general population is still low, but nursing home residents may be particularly at risk due to their coexistence and high number of exposures, according to the study.

“Qualified care facilities should employ strategies to reduce the risk of SARS-CoV-2 transmission in all residents, including those previously diagnosed with COVID-19,” Cavanaugh wrote.

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Kids Are Consuming Hand Sanitizer. Right here’s The way to Preserve Them Protected.

Children Are Consuming Hand Sanitizer. Here’s How to Keep Them Safe.

Alcohol-based hand sanitizers became a must have during the pandemic. But as sales rose and families stocked up, poison centers received more and more calls about small children they’d accidentally picked up.

Even now, roughly a year after the frenzy of stocking up on disinfectants began, hand sanitizer is still easy to get hold of in many households, and calls to the country’s poison control centers are at a faster pace than before the pandemic.

In the past year, there were more than 20,000 exposures to hand sanitizer in children under 6, an increase of 40 percent over 2019. This is based on data from the American Association of Poison Control Centers obtained from the New York Times.

Most of these exposures involved children up to 2 years of age who had ingested the disinfectant. In many cases, no symptoms were noted, which means the child may have just taken or licked a brief taste, which usually doesn’t have significant health effects, said Dr. Justin Arnold, the Medical Director of the Florida Poison Information Center Tampa. In other cases, vomiting, coughing and mouth irritation occurred in children.

While most cases are mild, by properly storing the disinfectant and monitoring young children while using it, parents can avoid the stress of calling poison control or taking an unnecessary trip to the emergency room.

The increase in exposures has continued over the past few months. In January, for example, almost 34 percent more exposure to hand sanitizer was reported in children under 6 than in the previous year.

Exposure to household cleaners such as liquid laundry detergent packs, bleach, all-purpose cleaners, drain cleaners, and oven cleaners also increased, increasing 10 percent in children under 6 years of age in the first few months of the pandemic. This comes from a report published in August by the American Association of Poison Control Centers.

But when it comes to hand sanitizer that we regularly reach for when we’re outside and all our hands frothed up, it’s easy to let go of your guard, experts said. Mainly because hand sanitizer does not come with a child-resistant closure.

“People don’t realize how toxic it is when ingested, what effects it has, and what to do to store it safely,” said William Eggleston, clinical toxicologist at the Upstate New York Poison Center in Syracuse, NY. and an assistant professor at Binghamton University School of Pharmacy.

It depends on how much is swallowed.

If children take enough alcohol-based hand sanitizer, they can get “dangerously drunk,” said Dr. Diane Calello, a pediatric toxicologist and executive and medical director of the New Jersey Poison Center.

Last spring, Dr. Calello co-authored a report by the Centers for Disease Control and Prevention on the rise in calls to poison centers warning parents to keep hand sanitisers, detergents and disinfectants away from children. The report highlighted the case of a preschooler who became unresponsive in her home near a 64-ounce bottle of ethanol-based hand sanitizer. Her blood alcohol level was 0.27 percent, more than three times the legal limit above which an adult is not allowed to drive.

Updated

Apr. 25, 2021, 2:50 p.m. ET

Hand sanitizer is 60 to 95 percent alcohol, a much higher concentration than beer, wine, or most liquor. A child weighing 20 pounds who drank a tablespoon or two could get high, said Dr. Calello and “a little drunk” appear.

“If a dose goes higher, they can become very sleepy and have difficulty breathing, just like we see with severe alcohol intoxication in adults,” she added.

After drinking a small amount of alcohol, children are more likely than adults to experience dangerous blood sugar drops, which can make them sluggish from about six to ten hours after consumption, said Dr. Calello.

Ingesting disinfectants can also be irritating to the throat or stomach, especially if they’re formulated with isopropyl alcohol, an ingredient often found in alcohol, the experts say.

Keep all hand sanitizer out of the reach of children – and out of sight, even if you only have a small bottle tucked in a purse or backpack.

“It is important for parents to treat it like household drugs,” said Dr. Eggleston.

You may be wondering if your family should avoid hand sanitizer entirely. While hand washing is the most effective way to get rid of germs, the CDC nonetheless recommends using a hand sanitizer with at least 60 percent alcohol to help prevent the spread of the coronavirus when soap and water are not readily available.

If you have children under 6 at home, supervise them while they use it, said Dr. Arnold.

“You don’t want the kid to pump their own and start trying,” he added.

There was a surge in calls to U.S. poison centers in July and August after the Food and Drug Administration warned about hand sanitizer, which may contain methanol, which can be toxic if ingested. Hand sanitisers should never contain methanol.

“You can die if you drink methanol – and people do,” said Dr. Calello.

However, the absorption of methanol into the skin is “quite low,” she added.

You can visit the FDA website for a list of disinfectants that should not be used (including several brands imported from Mexico that contain methanol). If you find you have any of these products at home, the FDA recommends placing the hand sanitizer bottle in a hazardous waste container, if available, and contacting your local waste disposal center for advice on the safest disposal. Do not flush, pour it down the drain, or mix it with other liquids.

If your child has swallowed hand sanitizer, don’t try to induce vomiting, the experts said. Call Poison Control at 1-800-222-1222 for quick instructions on best course of action.

If your child is passed out, behaves abnormally, has difficulty waking up, or has difficulty breathing, call 911.

“Fortunately, the milder cases are much more common,” said Dr. Calello. “More likely we’ll say, ‘Stay home, watch him, I’ll call you back in an hour or half an hour.’ In this way we keep a lot of people away from the hospital by giving them real-time telephone instructions. “

You should also call poison control if your child has hand sanitizer in their eyes. In the United States, there were about 900 reports of eye exposure in children under 6 years of age in 2020, up 54 percent from 2019. A recent JAMA Ophthalmology study in France, reviewing data from poison centers, found this hand to be related to the eye Disinfectant exposure in children increased seven-fold in 2020 compared to 2019, and the number of surgeries performed to Addressing the resulting chemical injuries required has increased.

“In an emergency, any clean liquid can be used to rinse the eye after chemical exposure,” wrote Dr. Kathryn Colby, an ophthalmologist at New York University’s Grossman School of Medicine, in a comment published in JAMA Ophthalmology last month. “Finally,” she added, “parents need to understand the importance of an eye exam when exposure occurs in children,” as early diagnosis and treatment is critical.

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Dr. Scott Gottlieb on Pfizer’s efforts on a 3rd Covid vaccine shot

Dr. Scott Gottlieb on Pfizer's efforts on a third Covid vaccine shot

Pfizer board member Dr. Scott Gottlieb told CNBC on Thursday that the company is researching two different methods to provide vaccination protection against new coronavirus variants.

In an interview on Squawk Box, Gottlieb said the first approach focused on whether a booster shot using the current formulation of the two-dose vaccine would provide additional defense. Pfizer and its German partner BioNTech announced a test that was not examined until early Thursday.

“There is reason to believe that just boosting the existing vaccine against these new variants will give you extra protection,” said Gottlieb, a former Food and Drug Administration commissioner in the Trump administration.

The second endeavor is to modify the existing vaccine so that stronger immunity to virus mutations can be achieved, explained Gottlieb. The companies announced in a press release on Thursday that they are discussing the launch of this research study with regulators.

While new coronavirus variants affect public health officials, particularly the contagious strain first found in South Africa, Gottlieb said any change to the vaccine formulation would offer broad protection.

“What you want to do is not necessarily develop a vaccine that is specifically against [B.1.351], the change we’ve seen in South Africa, “said Gottlieb, who headed the FDA from 2017-2019.” You want to develop a protein sequence that is sort of a consensus sequence and that incorporates enough of the changes we’ve seen around the world that you have a vaccine that protects no matter what the virus does against itself. “

It is widely believed that the virus variant discovered in South Africa poses a greater challenge to existing vaccines than other new strains, such as the one originally discovered in the UK

For example, Johnson & Johnson reported that their vaccine was 72% effective in preventing symptomatic Covid in the US and 57% in South Africa, where the B.1.351 strain dominates. However, the vaccine provided 85% protection against severe Covid throughout the trial. Part of this has also been carried out in regions of Latin America where different variants exist.

The U.S. FDA is expected to use J & J’s vaccine soon after the agency’s emergency vaccine board meeting scheduled for Friday.

Pfizer-BioNTech and Moderna vaccines, which already have an emergency approval in the US, were tested in large phase three studies before the new variants were discovered. However, Pfizer and BioNTech conducted a study examining the variant found in South Africa. This indicated some reduction in antibody production, even though the vaccine was still neutralizing the virus.

In addition, Moderna has said that its two-dose vaccine appears to produce a weaker immune response against the South African variant, while adding that the antibody response remains at levels believed to provide protection.

Moderna announced Wednesday that it has shipped an optimized version of its vaccine to the National Institutes of Health to start various studies on variant protection. Similar to Pfizer, the company will also be testing a lower-dose booster shot of its current two-dose formulation.

Limited available doses have been a barrier to covid shots being given to more people once government approval has been granted. In the U.S. in particular, that situation has improved as companies ramp up production, and Gottlieb noted that J & J’s possible approval of the single-dose vaccine will also help expand access.

Should a booster shot be needed to ensure better protection against variants, Gottlieb was confident that the dosage might be available. “I don’t think we have to ration supplies if we want to give people a third booster in the fall,” he said.

“The challenge will be to think about the new vaccine variant and whether and when you would switch to this vaccine and how much you would produce,” said Gottlieb. “That will be a decision you need to make before these new variants of vaccines are likely to get approved. You may not want to switch all of your manufacturing, but you want to switch some of it.” He added, “You will likely have to make that decision sometime this summer.”

Disclosure: Scott Gottlieb is a CNBC employee and a member of the boards of directors of Pfizer, genetic testing startup Tempus, healthcare technology company Aetion, and biotech company Illumina. He is also co-chair of the Healthy Sail Panel of Norwegian Cruise Line Holdings and Royal Caribbean.

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Vaccine Hesitancy in Most cancers Sufferers

Vaccine Hesitancy in Cancer Patients

Ideally, cancer patients who want the shot could get it in their cancer centers rather than a mass distribution location. But a bumpy rollout and age restrictions have frustrated many people with cancer. If the shot is offered, Dr. Brawley still has his patients in active therapy and those in follow-up care. Certainly, they may not react as strongly as someone with an intact immune system. They do receive some protection, however, and are not harmed, as Moderna and Pfizer’s current vaccines are not made from live viruses (like measles, rubella, mumps, and smallpox were). Live virus vaccines must be avoided by severely immunocompromised individuals.

Updated

Apr. 25, 2021, 9:04 p.m. ET

Moderna and Pfizer’s coronavirus vaccines, explains Dr. Brawley, are made from messenger ribonucleic acid (mRNA) using a new technology. Its genetic material causes the vaccinated person to produce the same proteins that are found in the spikes of the novel coronavirus.

“The vaccinated person’s immune system then recognizes these proteins as foreign and produces antibodies against them,” said Dr. Brawley. “Another immune cell, a dendritic cell, also records the proteins as foreign.”

Dr. William Nelson, director of the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, agreed that “the worst that can happen to cancer patients vaccinated with the coronavirus vaccine” is “a bad reaction.” The worst reactions are likely to occur in people dealing with B-cell lymphoma and multiple myeloma, he explained, since these therapies often use drugs that target antibody-producing cells in the body. “For people undergoing a bone marrow transplant,” advised Dr. Nelson, vaccinations should likely be scheduled three to six months after the transplant to ensure immune regeneration has occurred.

As important as the vaccines are, Dr. Nelson urged people with cancer as well as their families and friends to “remain vigilant when it comes to wearing masks, social distancing, hand washing, etc.” Because cancer patients often have low white blood cell counts, their symptoms – fever, muscle pain, headache, dry cough – cannot be distinguished from those of Covid-19. “Now these patients must also be quickly tested for the coronavirus and isolated in a suitable facility so that their intravenous antibiotics can be infused.”

When the health authorities in my state of Indiana announced that they would be vaccinating people over 70, I had no problem signing up for an appointment online. When I took my first shot in a small medical facility, it was full of people buoyed by high hopes for widespread, so-called herd immunity. My own optimism has been overshadowed by regular news this winter of maskless receptions, rallies, protests, parties, and raves, as well as personal conversations with people who fear vaccinations in general.

As Eula Biss explained in her brilliant prepandemic book On Immunity, fear of the government, the medical establishment, and public interference with the private establishment can stifle the collective trust that attaining immunity requires. Because cancer patients are often affected by anxiety, they may be particularly prone to these types of anxieties.

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Covid variants might ‘undermine all of our efforts’

CDC director warns strains could reverse drop in cases, hospitalizations

Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention.

Chip Somodevilla | Getty Images

New, highly transmissible variants of Covid-19 “may” “reverse” the nation’s control of the pandemic and could undermine “all of our efforts” against the disease if the virus proliferates in different parts of the world, Chief of the United States Centers for Disease Control and Prevention said on Wednesday.

Senior U.S. health officials have warned in recent weeks that the emergence of highly contagious variants, particularly of strain B.1.1.7 from the UK, could reverse the current downward trend in infections in the U.S. and delay the nation’s recovery from the pandemic.

The problem is not limited to the United States. As the coronavirus spreads, it makes large numbers of copies of itself, and each version is a little different from the previous one, experts say. The more people become infected, the more likely it is that problematic mutations will occur.

“Even if you weren’t necessarily inclined to be part of the global health effort, we have to, as any effort we are making here in this nation could potentially be undermined immediately from these variants,” said CDC Director Dr . Rochelle Walensky on Wednesday told the National Academy of Medicine and the American Public Health Association.

Scientists are not surprised by the emergence of the variants, and have repeated that the vaccines currently available should continue to work against them, although they may not be as effective as against the original “wild” strain.

Moderna announced Wednesday that it was shipping cans of a booster shot specifically targeting the variant common in South Africa known as the B.1.351 strain to the National Institutes of Health.

“We know this virus knows no geographic boundaries and that with the rapid spread of Covid-19 variants that can reverse advances in fighting this pandemic, it is more urgent than ever to address this reality,” said Walensky .

The US reports a weekly average of around 71,562 new Covid-19 cases per day, a 12% decrease from the previous week, and a significant decrease from the average of new cases in the US in early January of nearly 250,000 cases per day, according to a CNBC Analysis of data compiled by Johns Hopkins University.

Although not every country reports similar declines, global Covid-19 cases in the United States have declined for six consecutive weeks, according to the latest World Health Organization situation report released on Tuesday.

The decline is welcome news as countries battle to get their starting doses of Covid-19 vaccines. While some nations have been administering vaccines since December, some are just getting their first shots.

The first shipment of vaccines delivered under the World Health Organization’s COVAX program arrived in Ghana on Wednesday. Some experts have previously said that an equitable distribution of vaccines may be too late as wealthier nations have made their own deals with vaccine manufacturers and claimed their initial dose supply.

“The Covid-19 pandemic is a clear reminder of how closely we are connected as a global community,” said Walensky.

– CNBC’s Berkeley Lovelace Jr. and Natasha Turak contributed to this report.

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Can Zapping Our Brains Actually Remedy Melancholy?

Can Zapping Our Brains Really Cure Depression?

The brain is an electrical organ. Everything that is going on there is the result of millivolts switching from one neuron to another in certain patterns. This increases the tempting possibility that, if we ever deciphered them, we could electrically adjust these patterns to treat neurological disorders – from Alzheimer’s to schizophrenia – or even to optimize desirable traits like intelligence and resilience.

Of course, the brain is so complex and difficult to access that it is much easier to imagine than to do. However, a couple of studies published in the journal Nature Medicine in January show that electrical stimulation can treat compulsive urges and symptoms of depression with surprising speed and precision. By mapping the participants’ brain activity in response to certain sensations, the researchers were able to personalize the stimulation and change moods and habits far more directly than is possible through therapy or medication. The results also showed the extent to which symptoms that we tend to classify as a single disorder – depression, for example – may include electrical processes that are unique to each person.

In the first study, a team from the University of California at San Francisco surgically implanted electrodes in the brain of a woman whose severe depression had proven resistant to other treatments. For 10 days, they delivered impulses through the electrodes to different areas of the brain at different frequencies and had the patient record her level of depression, anxiety and energy on an iPad. The influence of certain impulses was significant and nuanced. “Within a minute, she would say,” I feel like I’m reading a good book, “says Katherine W. Scangos, psychiatrist and lead author of the study, who described the effect of a different pulse as” less cobwebs and cotton. ”

The researchers also recorded what kind of immediate brain activity coincided with periods of low mood or energy. The aim was to use these responses to control the placement of another set of electrodes that would provide what is known as deep brain stimulation – a technique that allows neurons to restore their loss of function by zapping them with a steady, high-frequency electrical pulse. So far, it has been most commonly used to treat movement disorders such as Parkinson’s. It has also shown promise for depression. “But because different people experience depression differently, there are likely multiple neural circuits involved,” says Scangos. She and her colleagues wondered if a “more personal approach” could make treatment more effective. Based on their mapping of the patient’s brain activity, they programmed the electrodes in such a way that they recognize their depressive states and, in response, emit stimulation, similar to how a pacemaker acts on the heart. This experimental treatment is continued over the long term when the patient goes about her daily life.

Deep brain stimulation is too invasive to use except in extreme circumstances. In the second study, however, the researchers used a non-invasive technique called transcranial AC stimulation to deliver electrical pulses through electrodes on the participants’ scalps. The aim was to curb compulsive behavior. Previous studies have shown that the frontal orbital cortex, an area in the brain’s reward network, may play a role in enhancing such behaviors by viewing them as beneficial. So the researchers attached the electrodes to 64 volunteers and recorded the number of hertz that their orbital frontal cortex fired when they won a financial reward in a game.

It was crucial that the frequency varied slightly from person to person. Using this personal frequency, the researchers stimulated the same area in each participant for 30 minutes a day for five days in a row. They found that this reduced the number of compulsive behaviors among the volunteers by an average of nearly 30 percent over the next three months. (None of the volunteers had a diagnosis of obsessive-compulsive disorder. However, all reported varying degrees of repetitive tendencies, and those whose symptoms were most intense showed the greatest relief.) The researchers hypothesized that the stimulation helped the orbital frontal cortex hold You contribute to the optimal rhythm and thus improve coordination with other areas of the reward network.

The results confirmed the idea that personalized brain stimulation requires not only determining the right target area, but also the right rhythm. “The neural code – it’s frequency specific,” says Robert MG Reinhart, one of the study’s authors and director of the Laboratory for Cognitive and Clinical Neuroscience at Boston University. “The information processing channel in the brain is just like a channel you can tune into on the radio.” The study also showed that traits such as compulsiveness existed on a spectrum. At present, a person who is troubled by these characteristics but not disabling may not seek treatment, especially if accompanied by side effects, as is often the case with medication. However, brain stimulation could one day fix all kinds of conditions that we are now inaccurately targeting with drugs, says Reinhart. “If you want to go futuristic, you can imagine someone zapping themselves to get over a transatlantic flight. What people use coffee for today. “

Psychiatrists won’t be Prescribing brain stimulation to the masses anytime soon. However, by identifying the neural circuitry that leads to certain symptoms and showing that changes in the timing of their fire can alter those symptoms, they offer new ways to think about psychiatric disorders. “There’s still a lot of stigma about depression that many patients feel,” Scangos says. The subject of her study was no exception: “The fact that there was such an immediate response when we stimulated made her feel like I was not doing anything wrong. There is something in my brain that can be addressed. “

Labeling a collection of symptoms with a diagnostic label such as “depression” is useful as it helps doctors more effectively find successful treatment, which is currently a lengthy process of trial and error. “The million dollar question is how to tailor the best treatment for the patient and how to avoid treatments that don’t work,” says Helen Mayberg, neurologist and director of the Nash Family Center for Advanced Circuit Therapeutics at the Icahn School of Medicine on Mount Sinai; She was co-author of a commentary on the two studies. As neuroscientists map the brain activity of more and more patients, they are nearing the opportunity to offer a series of tests that show Scangos says, “If you have this type of depression, this drug is your best response.”

If we could address these symptoms head-on, we could ultimately get rid of the diagnostic categories altogether, says Alvaro Pascual-Leone, medical director of the Wolk Center for Memory Health at Hebrew SeniorLife and professor of neurology at Harvard Medical School. Instead of using a standard label for depression or obsessive-compulsive disorder, according to Pascual-Leone, doctors could instead ask, “What is the disability symptom this person is exhibiting?” And then treat them specifically.

Currently, these studies offer everyone additional evidence that “our brains are made of plastic,” says Shrey Grover, graduate student and co-author of the study at Boston University. “And we can rewire the brain in a number of ways.” These include psychotherapy and pharmacology. Our neural activity also changes when we learn; it changes as we get older. This means that we can improve the way our minds work at any point in our life, even without advanced technology.

However, the plasticity of the brain makes it all the more puzzling that certain psychological states are so difficult to dispel. Research into personalized brain stimulation also explores the bigger question of why moods or habits that are mild or awkward in some people – such as a careful review of a tax form or a deep sadness about the death of a loved one – are chronic and debilitating in others. “There is nothing that is right in this matter,” says Reinhart. “It’s like the water is flowing in the sink and you can mop the floor, but nobody turns off the tap.”

Kim Tingley is a contributing writer for the magazine.

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Tiger Woods’ accidents are ‘harder to heal,’ says surgeon

Tiger Woods' injuries are ‘more difficult to heal,’ says surgeon

The orthopedist Dr. Scott Boden has broken down the extent of Tiger Woods’ injuries and his recovery in CNBC’s “The News with Shepard Smith” after the golfer’s devastating crash on Tuesday morning.

“We know it’s an open fracture, which means that the bone has at least temporarily entered the skin and broken in multiple places. This was a very high-energy fracture that makes it a little more difficult.” to heal, “said the professor of orthopedic surgery at Emory University School of Medicine.

Los Angeles County Sheriff Alex Villanueva said Woods was fortunate to be alive after crashing his sport utility vehicle on a steep, winding road in Palos Verdes, south of Los Angeles.

Tiger Woods is “awake, responsive, and recovering” from lengthy surgery to repair what a doctor calls a “major injury” to his right leg. This emerges from a statement posted on his official Twitter account on Wednesday at 12:30 p.m. (CET). It is the 10th operation for the 45 year old golfer.

Dr. Anish Mahajan, chief medical officer at Harbor-UCLA Medical Center, said Woods suffered “comminuted open fractures” in the upper and lower portions of his right leg. To stabilize Wood’s leg, doctors had to insert a rod, screws, and pins into his foot and ankle.

Boden told host Shepard Smith that the additional information about the golfer’s ankle and foot injuries says a lot about recovery time.

“If these injuries affect the smooth articular surface of the bones on which they move in the ankle or foot, it could be a problem in long-term recovery and arthritis and restore full range of motion,” Boden said in a Wednesday evening interview.

Boden also noted that “there is a risk of infection” but that we do not know the size of the skin opening so “we cannot be sure about it”. He added that while the rebound will be tenacious, “it is never advisable to count tigers when it comes to making a comeback.”

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A New Coronavirus Variant Is Spreading in New York, Researchers Report

A New Coronavirus Variant Is Spreading in New York, Researchers Report

A new form of coronavirus is spreading rapidly in New York City and has a worrying mutation that can make vaccines less effective, two research teams have found.

The new variant, named B.1.526, first appeared in samples collected in the city in November. By the middle of this month, roughly every fourth virus sequence was in a database shared by scientists.

A study of the new variant, led by a group at Caltech, went online on Tuesday. The other was sent to a preprint server by researchers at Columbia University, but is not yet public.

The study has not been peer-reviewed or published in a scientific journal. However, the consistent results suggest the variant’s prevalence is real, experts said.

“It’s not particularly good news,” said Michel Nussenzweig, an immunologist at Rockefeller University who was not involved in the new research. “But just knowing about it is good because then maybe we can do something about it.”

Dr. Nussenzweig said he was more concerned about the New York variant than the one that was quickly spreading in California. Another contagious new variant discovered in the UK currently affects around 2,000 cases in 45 states. It is expected to be the most widespread form of the coronavirus in the United States by the end of March.

Researchers looked at the virus’s genetic material to see how it might change. They examine genetic virus sequences taken from a small fraction of the infected in order to record the emergence of new versions.

Caltech researchers discovered the rise in B.1.526 by looking for mutations in hundreds of thousands of viral genetic sequences in a database called GISAID. “There was a recurring pattern and group of isolates in the New York area that I hadn’t seen,” said Anthony West, a computational biologist at Caltech.

He and his colleagues found that two versions of the coronavirus were more common: one with the E484K mutation seen in South Africa and Brazil, which is believed to help the virus partially evade vaccines; and another with a mutation called S477N that can affect how tightly the virus binds to human cells.

By mid-February, the two together made up about 27 percent of the viral sequences stored in the database in New York City, said Dr. West. (At the moment both are summarized as B.1.526.)

Columbia University researchers took a different approach. They sequenced 1,142 samples from patients at their medical center. They found that 12 percent of people with the coronavirus were infected with the variant that contains the E484K mutation.

Updated

Apr. 24, 2021, 8:33 p.m. ET

Patients infected with the virus that carried this mutation were, on average, about six years older and more likely to be hospitalized. While the majority of patients were found near the hospital – particularly in Washington Heights and Inwood – there were several other cases scattered across the metropolitan area, said Dr. David Ho, director of the Aaron Diamond AIDS Research Center.

“We’re seeing cases in Westchester, the Bronx and Queens, lower Manhattan, and Brooklyn,” said Dr. Ho. “So it seems to be widespread. It’s not a single outbreak. “

The team also identified six cases of the variant that beat the UK, two infections with a variant identified in Brazil, and one case of the variant adopted in South Africa. The latter two have never been reported in New York City, said Dr. Ho.

University investigators have alerted New York state and city authorities as well as the Centers for Disease Control and Prevention, said Dr. Ho. He and his colleagues plan to sequence about 100 viral genetic samples daily to monitor the increase in variants.

Other experts said the sudden appearance of coronavirus variants was worrying.

“Given the involvement of E484K or S477N, coupled with the fact that the New York area has strong immunity to the spring wave, this is definitely a good thing,” said Kristian Andersen, a virologist at the Scripps Research Institute in San Diego, who did not participated in the new research effort.

The E484K mutation has appeared independently in many different parts of the world, suggesting that it offers a significant benefit to the virus.

“Variants that have an advantage will increase in frequency pretty quickly, especially as the numbers decrease overall,” said Andrew Read, an evolutionary microbiologist at Penn State University.

The team of Dr. Ho reported in January that the monoclonal antibodies made by Eli Lilly and one of the monoclonal antibodies in a cocktail made by Regeneron are powerless against the variant identified in South Africa.

Several studies have now shown that variants containing the E484K mutation are less susceptible to vaccines than the original form of the virus. The mutation disrupts the activity of a class of antibodies that almost everyone makes, said Dr. Nut branch.

“People who have recovered from the coronavirus or who have been vaccinated are very likely to be able to fight off this variant, there is no doubt about that,” he said. But “they might get a little sick.”

They could also infect others and keep the virus floating around, which could delay herd immunity, he added.

However, other experts were a little more optimistic. “These things are a little less well controlled by vaccines, but they are no orders of magnitude less, which would scare me,” said Dr. Read.

As the virus evolves, the vaccines need to be tweaked, “but in the scheme of things this isn’t a huge concern compared to having a vaccine missing,” said Dr. Read. “I’d say the glass is three quarters full compared to where we were last year.”

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Moderna to start trials of Covid vaccine booster photographs for variant from South Africa

NY will begin offering shots to people with underlying health conditions this month

A health care worker gives a picture of Moderna COVID-19 to a woman at a pop-up vaccination site operated by SOMOS Community Care during the coronavirus disease (COVID-19) pandemic in New York on January 29, 2021 Vaccine.

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Moderna announced on Wednesday that a new Covid-19 vaccine, which is said to offer better protection against the highly contagious variant of coronavirus that is widespread in South Africa, has been delivered to the National Institutes of Health.

The vaccine – which Moderna names mRNA-1273.351 – can be tested in an early clinical trial to see if it can be used as a booster against the South African strain, also known as B.1.351. Moderna has found that its current two-dose regimen produces a weaker immune response against the South African strain, although the company said the antibodies in patients remain above levels expected to protect against the virus.

“Moderna is committed to making as many updates as necessary to our vaccine until the pandemic is under control,” said the company’s CEO, Stephane Bancel, in a press release. “We hope to show that booster doses can be given at lower doses when needed, which will allow us to make many more doses available to the global community when needed in late 2021 and 2022.”

US health officials are increasingly concerned about new, emerging variants of the virus, particularly strain B.1.351, which has been shown to reduce the effectiveness of vaccines both in market and in development. Over the past few weeks, the White House Chief Medical Officer, Dr. Anthony Fauci, urged Americans to get vaccinated as soon as possible before potentially new and even more dangerous variants of the virus emerge.

As of Tuesday, the Centers for Disease Control and Prevention had identified 1,881 cases of variant B.1.1.7, which were first found in the UK. The US authorities said they had identified 46 cases of the strain B.1.351 from South Africa and five cases of P.1, a variant first discovered in Brazil. The more people become infected, the more likely it is that even more problematic mutations will occur, say medical experts.

On Monday, the Food and Drug Administration released updated guidelines that modified Covid-19 vaccines that work to protect against new, emerging variants may be approved without the need for lengthy clinical trials. The FDA would approve the new vaccine as an amendment to a company’s originally approved emergency filing, thereby expediting the regulatory review process.

Moderna first announced on January 25 that it was working on a booster shot to protect itself against the variant in South Africa.

The company announced on Wednesday that it is evaluating three approaches to increasing immunity. The first approach would use variant-specific booster vaccinations such as mRNA-1273.351, but at a lower dose than the original vaccine. The second would combine the original vaccine with a variant-specific vaccine into a single shot at 50 micrograms or less, Moderna said. The third would test a third shot of the original vaccine at a lower dose.

Moderna said it also plans to test the original vaccine and new booster shot as a two-dose regimen in people without coronavirus antibodies.

Separately, the company also announced that it is expected to produce up to 1.4 billion doses of Covid-19 vaccine by 2022. It has also raised its global base production estimate from 600 million cans to 700 million cans this year.

According to Moderna, the 1.4 billion doses in 2022 assume the vaccine will be given at its current level of 100 micrograms. If the vaccine turns out to be effective at a lower dose, the company could deliver up to 2.8 billion doses by 2022, the company said.

Moderna has signed a contract with the US government for 300 million cans. The company has shipped around 55 million cans to the US to date. The first 100 million cans are expected to be shipped to the US by the end of the first quarter of 2021, the second 100 million cans by the end of May 2021, and the third 100 million cans by the end of July 2021.