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He Was Coughing Up Blood. However His Lungs Regarded O.Ok.

He Was Coughing Up Blood. But His Lungs Looked O.K.

It was the EKG in the emergency room that gave Wallach the last clue he needed to make a diagnosis. An EKG measures the electricity generated by the heart to effectively contract the muscles. A thick, muscular heart will produce an EKG recording that is larger and more exaggerated than normal. The more muscles there are, the greater the signal. But this man’s heart was producing a signal that was smaller than normal. Less current could indicate fewer muscles. Was this man’s heart enlarged by anything other than muscle?

There are diseases that can invade the heart muscles to make them look bigger but weaker. Such a disease could be responsible for all of the man’s symptoms – the thick-looking walls, the overflow into the lungs, the strange EKG, the shortness of breath, even the hemoptysis. “I think you have something serious,” Wallach told the patient. A heart MRI could give you the answer. The patient got this test a few days later. He hadn’t been out of the scanner for more than 20 minutes when his phone rang. It was Wallach. The pictures told the story: The man had a disease called amyloidosis.

Amyloidosis is the end result of many disease processes that ultimately cause zigzag fibers to accumulate in different parts of the body. Cardiac amyloidosis can be the result of a cancer known as multiple myeloma. In this cancer, a type of white blood cell called a plasma cell creates abnormal fibers that can break down and form the sawtooth fibers characteristic of amyloidosis. These jagged fibers can also be age-related. In this version of the disease, carrier proteins known as transthyretins are broken down and take on the abnormal but characteristic irregular folds of amyloidosis. In both diseases, these jagged fibers migrate through the body, penetrate the muscle and collect there – often in the heart muscle.

Blood and urine tests quickly showed that his disease was not due to myeloma. That was a relief; The prognosis for patients with cardiac amyloidosis from multiple myeloma is poor. They often die within a year of being diagnosed. A heart muscle biopsy showed it was age-related amyloidosis. This form of amyloidosis is also progressive, but much more slowly. The patient was referred to a Columbia University cardiovascular surgeon. Sooner or later he would need a heart transplant.

Three years passed before Wallach heard from the patient again. He wrote to tell Wallach that he had received his heart transplant and was fine. He wrote to say thank you, “You saved my life.”

I asked Wallach how he could make this diagnosis if other doctors hadn’t. He called it the Aunt Tilly Sign. “If I were to describe Aunt Tilly to you and send you out into a crowd to find her, you would likely fail. But if you’ve ever seen Aunt Tilly “- he snapped his fingers -” no problem. You would find her in a second. It’s about recognition. “

Lisa Sanders, MD is a contributing writer for the magazine. Her latest book is Diagnosis: Solving the Most Baffling Medical Mysteries. If you have a resolved case with Dr. Sanders, drop her a line at Lisa .Sandersmd @ gmail.com.

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Third Covid shot could also be approach round masking, says Dr. Peter Hotez

Third Covid shot may be way around masking, says Dr. Peter Hotez

Dr. Peter Hotez told CNBC that while the Centers for Disease Control and Prevention’s new Covid masking guidelines are “absolutely” necessary to battle the delta variant and surging cases, there might be an alternative to wearing masks indoors again. 

“There is potentially a way to get around it, and it may be that third immunization,” said Hotez, co-director of the Center for Vaccine Development at Texas Children’s Hospital.

The vaccines are currently proving to hold up against symptomatic illness and against serious illness, ICU admissions and hospitalizations. Hotez, however, noted that the vaccines “are not holding up as well” when it comes to stopping asymptomatic transmission, because the delta variant is so highly contagious. 

New data shows that people infected with the delta strain can carry up to 1,000 times more virus in their nasal passages than those infected with the original strain.

CDC Director Rochelle Walensky said Tuesday recent studies show that those vaccinated individuals who do become infected with Covid have just as much viral load as the unvaccinated, making it possible for them to spread the virus to others.

Hotez explained to “The News with Shepard Smith” that the booster shot could increase the virus- neutralizing antibodies in people who have been vaccinated, and that is important because it could help stop asymptomatic transmission. 

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Purdue Pharma’s Collectors Overwhelmingly Endorse Chapter Plan

Purdue Pharma’s Creditors Overwhelmingly Endorse Bankruptcy Plan

A large majority of Purdue Pharma’s more than 120,000 creditors have voted to approve the company’s bankruptcy plan, a major step toward the eventual release of more than $ 4.5 billion to help cover the cost of the opioid epidemic and its settlement Thousands of lawsuits to be paid against the company and its owners, members of the billionaire Sackler family.

A preliminary poll by cities, states, tribes, insurers, families and caregivers of babies born with withdrawal symptoms after exposure to opioids in utero showed 95 percent are in favor of the plan, the company said.

According to the plan, the Sacklers would give up control of Purdue. The restructured company was to be resurrected under a new name and run by an independently appointed board of directors. Profits the sale of its signature prescription pain reliever, OxyContin, and addiction quenching drugs would go to creditor trusts that would fund addiction prevention and treatment programs.

The Sacklers, who did not file for personal bankruptcy, would pay at least $ 4.5 billion of their personal wealth over nine years (in addition to $ 225 million from a separate civil settlement with the Justice Department).

Neither the company nor the Sacklers would admit any wrongdoing in connection with these lawsuits.

In the past two decades, more than 500,000 people have died from prescription and illegal opioid overdoses in the United States, including a record number in 2020. Purdue, which is widely believed to have helped ignite the problem by causing it Has downplayed OxyContin’s addictive potential and aggressively marketed the drug with misleading campaigns pleaded guilty to two separate Justice Department inquiries.

For the complex plan to take effect, Judge Robert Drain must be signed by the US Bankruptcy Court for the southern borough of New York, a move long awaited and now made even more likely by the wholehearted result of the creditors’ vote. Purdue said it would release the final voting results on August 2nd, a week before a court hearing at which final objections will be raised, but the company does not expect those results to change materially. The judge is expected to rule shortly thereafter.

Although a handful of states, including the Justice Department, have objected to the plan, these efforts do not appear to cause the process to fail. Earlier this month, attorneys general of 15 states, including Massachusetts and New York, were among the most vocal objection, said they had negotiated new terms that made the plan more palatable and now supportive of the plan.

Among the new elements that reached the states and Purdue during the mediation was an agreement by the company to release more than 30 million documents to a public repository, including private communications with attorneys. These documents are expected to reveal the full history of the Company and Sacklers involvement in the sale of OxyContin.

Long known for their philanthropy in the arts, the Sacklers would give up future naming rights to any institutions they donate to until their contributions to the opioid agreement are paid in full.

For almost two years, the opposition states argued that they should be able to reach straight into the pockets of individual sacklers because they were not filing for bankruptcy protection themselves. However, under the terms of the Purdue Plan, the Sacklers and their company are exempt from any civil liability.

Some congressmen have passed legislation to fill a loophole in bankruptcy law. It would allow states, and possibly individuals, to sue for bankruptcy third-party business owners who, like the Sacklers themselves, have not filed for bankruptcy. But by the time the bill is passed, the Purdue plan and the status of the Sacklers will almost certainly be cleared up.

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Mississippi and Louisiana have a number of the worst vaccine charges and highest Covid hospitalizations in U.S.

Mississippi health officials plead with elderly to avoid mass indoor gatherings as delta Covid variant rips through state

Covid cases are doubling across several states and hospitals are starting to fill up again, especially in states with lower vaccination rates as the highly contagious delta variant rips across the country.

Two of the states hit hardest last week — Mississippi and Louisiana and — have the nation’s worst and fourth-worst vaccination rates and rapidly climbing Covid hospitalizations.

Louisiana Health Officer Dr. Joseph Kanter, said Friday the state was in the middle of “a very dangerous surge.” Gov. John Bel Edwards said the outbreak there was so bad, the White House designated Louisiana as a “state of concern.” He and Kanter urged everyone, including fully vaccinated people, to wear masks indoors and work from home when possible.

“To ensure their own safety people in Louisiana should take precautions immediately. Masking and testing will limit death and suffering until we make it through this,” he said in a press release. New Orleans officials issued a citywide indoor mask advisory earlier in the week.

The surge in average new cases, which have jumped by more than 105% over the past week to a seven-day average of 7,592, has some Louisiana residents rushing to get vaccinated, state officials said. Just 41.2% of the state’s residents have had at least one Covid shot, according to CDC data, but many are rushing to get them as evidence mounts that the delta variant is attacking mostly unvaccinated people, state officials said. More than 58,000 Louisianans received their first vaccine doses last week, a 153% increase from the previous week, according to data compiled by the Centers for Disease Control and Prevention.

Medical workers with Delta Health Center wait to vaccinate people at a pop-up Covid-19 vaccination clinic in this rural Delta community on April 27, 2021 in Hollandale, Mississippi.

Spencer Platt | Getty Images

Neighboring Mississippi also saw vaccinations jump last week as average daily cases climbed by more than 132% a seven-day average of 910 new cases per day as of Sunday, according to a CNBC analysis of data compiled by Johns Hopkins University. The state’s administered at least one shot to just 38.6% of its population — ranking it last in the country.

In Mississippi, the state’s given almost 27,000 first doses administered over the seven days through Sunday, 42% more than the prior week.

“Y’all, we’re going to have a rough few weeks,” State Health Officer Dr. Thomas Dobbs, the state’s former top epidemiologist, told reporters at a press conference last week. “Delta is hitting us very strongly. We anticipate that we’re going to continue to put additional pressure on the healthcare system.”

Across the nation, roughly 73% of available hospital beds are currently in use, about 4.5% are taken up by Covid patients, according to CDC data. But they account for a greater share of available ICU beds, comprising about 11.9% of all intensive care patients.

In Louisiana, Covid patients are using 8.4% of all available beds and about 16.8% of ICU beds, according to the CDC. Covid patients in Mississippi are taking up 7.2% of all hospital beds and 23% of ICU beds.

Dobbs said there are currently 13 hospitals across Mississippi that have “zero ICU beds and a significantly higher number than that have less than 10% availability.” He said 93% of the state’s Covid cases and 89% of the deaths in the past month are among unvaccinated individuals.

Vaccination rates there are also climbing. The the state administered almost 27,000 first doses over the seven days through Sunday, a 42% jump from the prior week. Vaccine reluctance is high across the state, officials said, adding that they are trying to convince residents one person at a time to get the shots. State officials pleaded with elderly and vulnerable residents earlier this month to avoid large indoor events.

“We hear it all, from the microchip insertion to the depopulation plan using the vaccine to the magnetizing people. I mean you name it, we’ve heard it,” state health department Chief Medical Officer Dr. Dan Edney told reporters last week.

Hospitals, in the meantime, are keeping a close watch on their ventilator supplies.

“Our number of cases is increasing rapidly,” Dobbs said. “Our ICU utilization is starting to rise to levels not seen since last summer, and we’re also seeing an increase in the utilization of our mechanical ventilators.”

CNBC’s Nate Rattner contributed to this reporting.

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C.D.C. Says Some Vaccinated Individuals Ought to Put on Masks Once more

C.D.C. Says Some Vaccinated Americans Should Wear Masks Again

Revising a decision made just two months ago, the Centers for Disease Control and Prevention said on Tuesday that people vaccinated against the coronavirus should resume wearing masks in public indoor spaces in parts of the country where the virus is surging.

C.D.C. officials also recommended universal masking for teachers, staff, students and visitors in schools, regardless of vaccination status and community transmission of the virus. With additional precautions, schools nonetheless should return to in-person learning in the fall, according to agency officials.

The recommendations are another baleful twist in the course of America’s pandemic, a war-weary concession that the virus is outstripping vaccination efforts. The agency’s move follows rising case counts in states like Florida and Missouri, as well as growing reports of breakthrough infections of the more contagious Delta variant among people who are fully immunized.

“The Delta variant is showing every day its willingness to outsmart us,” Dr. Rochelle Walensky, director of the C.D.C., said at a news briefing on Tuesday.

C.D.C. officials were persuaded by new scientific evidence showing that even vaccinated people may become infected and may carry the virus in great amounts, perhaps even similar to those in unvaccinated people, Dr. Walensky acknowledged at the news briefing.

Data from several states and other countries show that the variant behaves differently from previous versions of the coronavirus, she added: “This new science is worrisome and unfortunately warrants an update to our recommendation.”

“This is not a decision we at C.D.C. have made lightly,” Dr. Walensky added. “This weighs heavily on me.” Americans are tired and frustrated, she said, and mental health challenges are on the rise.

Jen Psaki, the White House press secretary, said at a news conference on Tuesday that changing the masking guidance was crucial to “battling an ever-evolving virus,” and that the Biden administration supported the effort.

“The virus is changing, we are dealing with a dynamic situation,” said Dr. Anthony S. Fauci, the Biden administration’s top pandemic adviser. The C.D.C. is correct to revisit its recommendations as the research evolves, he said.

“I don’t think you can say that this is just flip-flopping back and forth,” he added. “They’re dealing with new information that the science is providing.”

The vaccines remain remarkably effective against the worst outcomes of infection with any form of the coronavirus, including hospitalization and death. But the new guidelines explicitly apply to both the unvaccinated and vaccinated, a sharp departure from the agency’s position since May that vaccinated people do not need to wear masks in most indoor spaces.

Those recommendations, which seemed to signal a winding down of the pandemic, were based on earlier data suggesting that vaccinated people rarely become infected and almost never transmit the virus, making masking unnecessary.

But that was before the arrival of the Delta variant, which now accounts for the bulk of infections in the United States. And it may be followed by others. “The big concern is that the next variant that might emerge — just potentially a few mutations away — could evade our vaccine,” she said.

Some public health experts welcomed the agency’s decision to revise its guidelines. Based on what scientists are learning about the Delta variant’s ability to cause breakthrough infections, “this is a move in the right direction,” said Dr. Celine Gounder, an infectious disease specialist at Bellevue Hospital Center in New York.

The American Federation of Teachers and the National Education Association, the two leading teachers’ unions, strongly endorsed the C.D.C.’s move to universal masking in schools.

“Masking inside schools, regardless of vaccine status, is required as an important way to deal with the changing realities of virus transmission,” said Randi Weingarten, president of the A.F.T. “It is a necessary precaution until children under 12 can receive a Covid vaccine and more Americans over 12 get vaccinated.”

Whether state and local health officials are willing to follow the agency’s guidance is far from certain. And there is sure to be resistance from pandemic-fatigued Americans, particularly in regions of the country where vaccination rates are low and concerns about the virus are muted.

Some jurisdictions, like Los Angeles County and St. Louis County, Mo., have already reinstated mask mandates in response to rising cases. But officials some communities in Los Angeles County have said they will not enforce a mandate. Arkansas, one of the states with the highest numbers, has retained a ban on mask mandates even as vaccination rates lag.

Updated 

July 27, 2021, 4:16 p.m. ET

Businesses, too, are likely to find that new mask recommendations complicate return to office plans in places where the virus is spreading and may necessitate mandates for employees to receive vaccines.

The Washington Post, for example, on Tuesday said it would require proof of vaccination as a condition of employment when workers return to the office in September, after hearing concerns from many employees about the emergence of coronavirus variants.

If businesses believe that such mandates would be beneficial, “we encourage them to do so,” Dr. Walensky said at the news briefing. “We’re encouraging, really, any activities that would motivate further vaccination.”

As recently as last week, a C.D.C. spokesman said that the agency had no plans to change its masking guidance, unless there were a significant change in the science. But researchers have begun to turn up disturbing data.

The Delta variant is thought to be about twice as contagious as the original version of the virus. Some research now suggests that people infected with the variant carry about a thousandfold more virus than those infected with other variants, and may stay infected for longer.

C.D.C. officials were swayed by new research showing that even vaccinated people may carry great amounts of the variant virus in the nose and throat, hinting that they also may spread it to others.

Large so-called viral loads may help explain reports of breakthrough infections in groups of vaccinated people. For example, an outbreak that began in Provincetown, Mass., after Fourth of July festivities there has grown to include at least 765 cases, according to Steve Katsurinis, chair of the Provincetown Board of Health.

Of the 469 cases reported among Massachusetts residents alone, 74 percent were in people who were fully immunized, Mr. Katsurinis said.

Smaller clusters of breakthrough infections have been reported after weddings, family reunions and dinner parties. Some of the infected had symptoms, but the vast majority were not seriously ill, suggesting that immunity produced by the vaccines quickly curbs the virus.

Vaccines “are not a force field,” said Jennifer Nuzzo, an epidemiologist at Johns Hopkins University’s Bloomberg School of Public Health. Instead, vaccination trains the immune system to recognize cells that become infected with the virus.

Understand the State of Vaccine Mandates in the U.S.

“The term breakthrough infection is probably a bit misleading,” she said. “It’s probably more realistic that we talk about breakthrough disease and how much of that is occurring.”

Dr. Walensky on Tuesday again urged people to get vaccinated, noting that the rise of cases and hospitalizations is greatest in places with low vaccination rates and among unvaccinated people.

She acknowledged that some vaccinated people can become infected with the Delta variant and may be contagious, but maintained that it was a rare event. So far vaccinated people account for just 3 percent of hospitalizations, officials have found.

The C.D.C. is not routinely tallying breakthrough infections unless they lead to hospitalization or death among vaccinated Americans. But the agency is tracking more than 20 groups of Americans to see how often breakthrough infections occur and under what circumstances.

Dr. Gounder and other experts said that it is unclear how often vaccinated people transmit the virus to others, but it may be more common than scientists had predicted as the original virus spread last year.

“We’ve seen increasing numbers of breakthrough infections, and it seems like most of those may be happening in places where people are exposed to a lot of Covid,” said Dr. Scott Dryden-Peterson, an infectious disease physician and epidemiologist at Brigham & Women’s Hospital in Boston, who has been reviewing breakthrough infections in Massachusetts.

Vaccinated people — particularly those with weak immune systems or otherwise at high risk — should consider wearing masks even in areas of low transmission, he said: “Masks can effectively reduce the amount of virus that we breathe in and prevent us from getting sick, and so they augment the impact of our vaccine. Almost everywhere in the U.S., it’s a good idea.”

Infections have been rising swiftly in the United States, to more than 56,000 daily cases on average, as of Tuesday, more than four times the number a month ago. Hospitalizations have also been ticking up in nearly all states, and deaths have risen to an average of 275 per day.

“Given what we’re seeing, that’s absolutely needed right now to slow and curb transmission,” Dr. Robby Sikka, a physician who worked with the N.B.A.’s Minnesota Timberwolves, said of the new masking guidance.

“Not everyone who has a breakthrough infection will be at risk for transmission, but it’s imperative to note that there is a risk of transmission,” he said.

But Dr. Sikka noted that relying on states or localities to set masking rules will require more testing than is being done now to identify people with mild or asymptomatic infections. “That’s something that we’re probably not totally prepared to do,” he said.

Given that the virus seems likely to become endemic, permanently embedded in American life, federal officials need to articulate an even clearer plan for long-term masking, Dr. Nuzzo said.

“The question is, what are the off ramps for masking? It’s really important for us to define that,” she said. “If we want to continue to ask people to step up, we need to give them a vision of what we’re working toward.”

The C.D.C. should have simply made a universal recommendation and told all Americans to wear masks indoors, said Ali Mokdad, an epidemiologist at University of Washington and former C.D.C. scientist.

“The director said the guidance is for people in areas of high transmission, but if you look at the country, every state is seeing a rise in transmission,” Dr. Mokdad said. “So why not say, ‘Everybody in the U.S. should be wearing a mask indoors?’ The whole country is on fire.”

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CDC to reverse indoor masks coverage, saying totally vaccinated folks ought to put on them indoors in Covid sizzling spots

CDC to reverse indoor mask policy, saying fully vaccinated people should wear them indoors in Covid hot spots

The Centers for Disease Control and Prevention is expected to recommend Tuesday that fully vaccinated people return to wearing masks indoors in locations with high Covid-19 transmission rates, according to those familiar with the matter.

According to the sources, federal health officials still believe that fully vaccinated individuals represent a very low level of transmission. Still, some people vaccinated could carry higher amounts of the virus than previously thought and potentially pass it on to others, they said.

The CDC is expected to hold a briefing on Tuesday at 3 p.m. ET.

The updated guidelines come before the fall season, when the highly contagious Delta variant is expected to lead to a further surge in new coronavirus cases and many large employers plan to bring workers back to the office. In mid-May, the CDC announced that fully vaccinated people would not need to wear masks in most environments, whether indoors or outdoors.

Continue reading: Americans will need masks indoors as the US is heading for a “dangerous fall” with a surge in Delta Covid cases

Health experts fear that Delta, already the dominant form of the disease in the US, hits states with low vaccination rates. These states are now being forced to reintroduce mask rules, capacity limits and other public health measures that they have largely withdrawn in recent months.

White House senior medical advisor Dr. Anthony Fauci said Sunday that the CDC was considering revising mask guidelines for vaccinated Americans, saying it was “in active consideration”.

“It’s a dynamic situation. It’s in the works, it’s developing like so many other areas of the pandemic, “Fauci, also director of the National Institute of Allergies and Infectious Diseases, told CNN. “You need to look at the data.”

The CDC guidelines are just a recommendation, leaving it up to state and local officials to reintroduce their masking rules for specific individuals. But even before the CDC’s expected guidelines on Tuesday, some regions reintroduced mask mandates and notices as Covid cases rose again.

Several California and Nevada counties are now advising all residents to wear masks in public indoor spaces, regardless of whether they are vaccinated or not. In Massachusetts, Provincetown officials advised everyone to return to wearing masks indoors after the July 4 celebrations resulted in an outbreak of new cases.

Experts say Covid prevention strategies remain critical to protecting people from the virus, especially in areas with medium to high transmission rates in the community.

Dr. Paul Offit, a pediatrician and vaccine advocate who served on advisory boards for both the CDC and the Food and Drug Administration, told CNBC earlier this month that the US is still “undervaccinated” and about half the population is not fully vaccinated be .

Even people who are fully protected have cause for concern when it comes to variants of Covid, Offit said. While the vaccines protect well against serious illness and death, they may not protect as well against minor illness or the spread of Covid to others, he said. No vaccine is 100% effective, he noted.

“It is not a bold prediction to believe that SARS-CoV-2 will be circulating in two or three years. I mean, there are 195 countries out there, most of which haven’t received a single dose of vaccine. ”“ Offit said. “Will it still be circulating in the United States? I think that would be very, very likely.”

Israel released preliminary data last week showing that the Pfizer vaccine was only 39% effective against the virus there, which officials attributed to the rapidly spreading Delta variant. Its effectiveness against serious illness and death remained high, the data showed. US and World Health officials said they would look at Israeli research, which was non-peer-reviewed and had few details.

Pfizer, Moderna, and Johnson & Johnson executives have stated that they expect Americans to need booster vaccinations, and Pfizer has announced it will ask the FDA to approve booster vaccinations as it sees signs of waning immunity. Federal health officials say that otherwise healthy people don’t currently require booster doses of the vaccines, although they may recommend it for the elderly or those with compromised immunity.

– CNBC’s Meg Tirrell and The Associated Press contributed to this report.

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C.D.C. to Suggest Some Vaccinated Folks Put on Masks Indoors Once more

C.D.C. to Recommend Some Vaccinated People Wear Masks Indoors Again

Reversing a decision made just two months ago, the Centers for Disease Control and Prevention is expected to recommend on Tuesday that people vaccinated for the coronavirus resume wearing masks indoors in certain areas of the country.

The change follows reports of rising breakthrough infections with the Delta variant of the virus in people who were fully immunized, and case surges in regions with low vaccination rates. The vaccines remain effective against the worst outcomes of infection with the virus, including those involving the Delta variant.

But the new guidance, the details of which are expected later Tuesday, would mark a sharp turnabout from the agency’s position since May that vaccinated people do not need to wear masks in most indoor spaces.

As recently as last week, an agency spokesman said that the C.D.C. had no plans to change its guidance, unless there were a significant change in the science. Federal officials met on Sunday night to review new evidence that may have prompted the reversal, CNN reported on Tuesday.

“I think that’s great,” said Dr. Celine Gounder, an infectious disease specialist at Bellevue Hospital Center in New York. Based on what scientists are learning about the Delta variant’s ability to cause breakthrough infections, she said, “this is a move in the right direction.”

The C.D.C.’s initial guidance in May said people fully protected from the coronavirus could go mask-free indoors in most scenarios, but recommended that unvaccinated people still wear masks. Those recommendations drew sharp criticism from some experts, who said it was premature given the vast swaths of unvaccinated people in the country.

Dr. Rochelle Walensky, the C.D.C.’s director, at the time pointed to two scientific findings as significant factors. Few vaccinated people become infected with the virus, and transmission seems rarer still, she noted; and the vaccines appear to be effective against all known variants of the coronavirus.

A day after the announcement, the agency released results from a large study showing that the mRNA vaccines made by Pfizer-BioNTech and Moderna were 94 percent effective in preventing symptomatic illness in those who got two doses, and 82 percent effective in those who had received one dose.

But those data, and the C.D.C.’s decision, were based on infections of previous versions of the virus before the Delta variant began sweeping through the country. Reports of clusters of infections among fully immunized people have suggested that the variant may be able to break through the vaccine barrier more often than previous iterations of the virus.

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5 issues to know earlier than the inventory market opens Tuesday, July 27

5 things to know before the stock market opens Tuesday, July 27

Here are the most important news, trends and analysis that investors need to start their trading day:

1. Wall Street dips after another day of record high closes

Traders work on the floor of the New York Stock Exchange (NYSE), July 21, 2021.

Brendan McDermid | Reuters

U.S. futures were under some pressure Tuesday, one day after the Dow Jones Industrial Average, S&P 500 and Nasdaq logged a fifth straight session of gains and another day of record high closes. The Federal Reserve holds its two-day July meeting on Tuesday and Wednesday, with the future for rates, bond-buying, and inflation on the agenda. Big Tech earnings are set to start arriving after the bell Tuesday. The second-quarter earnings season has been stronger than expected. So far, 88% of S&P 500 companies reported a positive EPS surprise, according to FactSet. If that’s the final tally, it would be the highest since FactSet began tracking the metric in 2008.

2. Big Tech earnings start after the closing bell

Tim Cook, CEO of Apple (L), Satya Nadella, CEO of Microsoft (C) and Sundar Pichai, CEO of Google.

Getty Images

3. Tesla tops $1 billion in quarterly net income for first time ever

SpaceX founder and Tesla CEO Elon Musk looks on as he visits the construction site of Tesla’s gigafactory in Gruenheide, near Berlin, Germany, May 17, 2021.

Michele Tantussi | Reuters

Shares of Tesla rose about 1.5% in Tuesday’s premarket, the morning after the electric automaker reported earnings of $1.45 per share on $11.96 billion in revenue. Both beat expectations. Tesla passed $1 billion in quarterly net income for the first time, 10 times higher than the year-ago period. The company also reported a $23 million impairment related the bitcoin it holds on its balance sheet. The world’s largest cryptocurrency plunged more than 40% in Q2, so Tesla’s holdings would be worth much less than the nearly $2.5 billion at the end of the first quarter. During Tesla’s post-earnings conference call, CEO Elon Musk said he won’t likely appear on future calls unless he has “something really important” to communicate.

4. GE, UPS best estimates on earnings, revenue

Larry Culp, CEO, General Electric

Scott Mlyn | CNBC

Shares of General Electric jumped more than 3.5% in premarket trading, after the struggling conglomerate exceeded estimates with second-quarter earnings and revenue. GE on Tuesday also said it expects 2021 free cash flow to be $3.5 billion to $5 billion, up from its prior forecast of $2.5 billion to $4.5 billion. Free-cash flow is closely watched by investors as a sign of the health of GE’s operations and ability to repay debt.

UPS CEO Carol Tome meets with workers

Source: UPS

Shares of United Parcel Service dropped about 2% in the premarket, after the delivery giant on Tuesday reported second-quarter earnings and revenue that beat estimates. Under CEO Carol Tome, UPS has been reining in costs and focusing on high margin packages under her “better not bigger” strategy.

5. House select panel on Capitol attack to hold first hearing

U.S. Representative Liz Cheney (R-WY), with Chairman Bennie Thompson (D-MS) and members of the Select Committee to Investigate the January 6th Attack on the U.S. Capitol speak to reporters after meeting with House Speaker Nancy Pelosi (D-CA) at the Capitol in Washington, U.S. July 1, 2021.

Jonathan Ernst | Reuters

The House select committee investigating the deadly pro-Trump invasion of the U.S. Capitol will hold its first hearing Tuesday. The panel will hear directly from four law enforcement officers about their struggles to defend the Capitol from the mob. Wyoming Rep. Liz Cheney, who was ousted from GOP leadership after refusing to stop criticizing Donald Trump for falsely claiming the 2020 election was rigged, is one of two Republicans appointed to the committee so far. The other Republican is Rep. Adam Kinzinger of Illinois. House Speaker Nancy Pelosi previously rejected two of GOP Leader Kevin McCarthy’s picks for the committee.

— Reuters contributed to this report. Follow all the market action like a pro on CNBC Pro. Get the latest on the pandemic with CNBC’s coronavirus coverage.

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As Virus Instances Rise, One other Contagion Spreads Among the many Vaccinated: Anger

As Virus Cases Rise, Another Contagion Spreads Among the Vaccinated: Anger

As coronavirus cases resurface across the country, many vaccine Americans are losing patience with vaccine holdouts who they believe neglect a civic duty or cling to conspiracy theories and misinformation, even as new patients arrive in emergency rooms and the nation renews mask recommendations.

The pandemic appeared to be leaving the country; Almost a month ago there was a feeling of celebration. Now many of the vaccinated fear for their unvaccinated children and fear that they themselves are at risk for breakthrough infections. Rising case numbers are turning plans to reopen schools and workplaces upside down and threaten another wave of infections that could overwhelm hospitals in many communities.

“It’s like the morning sun came up and everyone was arguing about it,” said Jim Taylor, 66, a retired civil servant in Baton Rouge, LA, a state where fewer than half of adults are fully vaccinated.

“The virus is here and killing people, and we have a proven way to stop it – and we’re not going to. That is rude.”

The rising sentiment adds support for further coercive measures. Scientists, business leaders, and government officials are demanding vaccine mandates – if not from the federal government, then from local jurisdictions, schools, employers, and corporations.

“I’ve gotten angrier over time,” said Doug Robertson, 39, a teacher who lives outside of Portland, Oregon and has three children too young to be vaccinated, including a toddler with serious health.

“Now there’s a vaccine and a light at the end of the tunnel and some people choose not to go to it,” he said. “You are making it darker for my family and others like mine by making this decision.”

On Monday, New York City Mayor Bill de Blasio ordered all city workers to be vaccinated against Covid-19 or subjected to weekly tests until schools reopen in mid-September. Officials in California followed hours later with a similar mandate that covered all government employees and health care workers.

The Department of Veterans Affairs on Monday called for 115,000 local health care workers to be vaccinated over the next two months, becoming the first federal agency to mandate a mandate. Nearly 60 major medical organizations, including the American Medical Association and the American Nurses Association, called for mandatory vaccination of all health care workers on Monday.

“It is time to blame the unvaccinated people, not the ordinary people,” a frustrated Governor Kay Ivey, Republican of Alabama, told reporters last week. “It’s the unvaccinated people who fail us.”

There is no doubt that the United States has reached a turning point. According to a New York Times database, 57 percent of Americans 12 and older are fully vaccinated. Eligible Americans receive an average of 537,000 doses per day, down 84 percent from the high of 3.38 million in early April.

Infections are on the rise as a result of delayed vaccinations and lifted restrictions. As of Sunday, the country recorded 52,000 new cases a day, an average of 170 percent more than the previous two weeks. Hospital stays and death rates are also increasing, though not as rapidly.

Communities from San Francisco to Austin, Texas recommend that people who have been vaccinated wear masks again in public indoor spaces. Citing the spread of the more contagious Delta variant of the virus, Los Angeles and St. Louis, Missouri counties have mandated indoor masking.

For many Americans who were vaccinated months ago, the future looks bleak. Frustration strains relationships even within close-knit families.

Josh Perldeiner, 36, a Connecticut public defender who has a 2-year-old son, was fully vaccinated in mid-May. But a close relative who visits frequently refused to get the syringes, even though he and other family members urged them to do so.

She recently tested positive for the virus after traveling to Florida, where hospitals are filling up with Covid-19 patients. Now Mr Perldeiner is concerned that his son, too young to have a vaccine, might be exposed.

“It’s beyond risk,” he said. “People with privileges are opposed to the vaccine, and it affects our economies and continues the cycle.” As infections rise, he added, “I feel like we are on the same precipice as we were a year ago, when People don’t care if more people die. “

Hospitals have become a particular focus. Vaccination remains voluntary in most facilities and is not required for nursing staff in most hospitals and nursing homes. Many large hospital chains are just beginning to require their employees to be vaccinated.

A city stirs

As New York begins its post-pandemic life, we are investigating the ongoing effects of Covid on the city.

Despite being fully vaccinated, Aimee McLean, a nurse case manager at the University of Utah Hospital in Salt Lake City, is concerned that she will contract the virus in a patient and accidentally pass it on to her father, who has a severe chronic condition Suffers from lung disease. Less than half of Utah’s population is fully vaccinated.

“The longer we get near that number, the more it feels like there is a decent percentage of the population that honestly doesn’t care about us as healthcare workers,” said Ms. McLean, 46.

She suggested that health insurers link hospital bills to vaccination. “If you choose not to be part of the solution, you should be responsible for the consequences,” she said.

Many schools and universities will resume classroom teaching as early as next month. With the increase in the number of infections, the tensions between vaccinated and unvaccinated people have also risen in these settings.

Recommendations from the Centers for Disease Control and Prevention to reopen K-12 schools are tied to community virus transmission rates. In communities where vaccination is delayed, these rates are rising and vaccinated parents are again concerned about school outbreaks. The vaccines are not yet approved for children under 12 years of age.

The American Academy of Pediatrics has recommended that children wear masks in class when schools reopen. School districts from Chicago to Washington began enacting mandates on Friday.

Universities, on the other hand, can often require students and staff to be vaccinated. But many don’t have what frustrates the vaccinated.

“If we respect the rights and freedoms of the unvaccinated, what happens to the rights and freedoms of the vaccinated?” Said Elif Akcali, 49, who teaches engineering at the University of Florida at Gainesville. The university doesn’t require students to be vaccinated, and as rates rise in Florida, it worries about exposure to the virus.

Some even wonder how much sympathy they should have for fellow citizens who are not acting in their own interests. “I feel like if you decide not to have a vaccination and now you get sick, it’s kind of bad,” said Lia Hockett, 21, the manager of Thunderbolt Spiritual Books in Santa Monica, California.

Understand the state of vaccine mandates in the United States

As the virus spreads again, some vaccinated people believe the federal government should start using sticks instead of carrots, like lottery tickets.

Carol Meyer, 65, of Ulster County, NY, suggested withholding incentive payments or tax credits from vaccine objectors. “I have a feeling that in this country we have a social contract with our neighbors, and people who can get vaccinated and choose not to get vaccinated are breaking it,” said Meyer.

Bill Alsstrom, 74, a retired innkeeper in Acton, Massachusetts, said he would not support measures that would directly affect individual families and children, but asked if states that do not meet vaccination goals are withholding federal government funding should be.

Perhaps the federal government should require employees and contractors to be vaccinated, he thought. Why shouldn’t federal funding be withheld from states that don’t meet vaccination goals?

Although it is often viewed as a conservative phenomenon, hesitant and refused vaccination occurs in the United States for a variety of reasons across the political and cultural spectrum. No argument can address all of these concerns, and rethinking is often a slow, individual process.

Pastor Shon Neyland, who regularly pleads with members of his Portland, Oregon church to get Covid-19 vaccines, estimates that only about half of the members of the Highland Christian Center church have been injected. There was tension in the community over vaccination.

“It is disappointing because I was trying to show them that their life is in danger and that this is a serious threat to humanity,” he said.

Shareese Harris, 26, who works in the Grace Cathedral International office in Uniondale, NY, has not been vaccinated and is “taking my time” with it. She fears that the vaccines may have long-term side effects and that they have been brought to market.

“I shouldn’t be convicted or forced into a decision,” said Ms. Harris. “Society will just have to wait for us.”

Rising resentment among vaccinated people may well lead the public to support stronger coercive action, including mandates, but experts warn that punitive action and social exclusion can backfire and end dialogue and outreach.

Elected officials in several communities in Los Angeles County, for example, are already refusing to enforce the county’s new mask mandate.

“Anything that limits the opportunity for honest dialogue and persuasion is not a good thing,” said Stephen Thomas, professor of health policy and management at the University of Maryland School of Public Health. “We are already in isolated, isolated information systems where people are in their own echo chambers.”

Gentle persuasion and persistent urging convinced Dorrett Denton, a 62-year-old home nurse in Queens, to get vaccinated in February. Her employer repeatedly urged Ms. Denton to get vaccinated, but in the end it was her doctor who persuaded her.

“She says to me: ‘You have been coming to me since 1999. How many times have I operated on you and your life was in my hands? You trust me with your life, don’t you? ”Ms. Denton recalled.

“I said, ‘Yes, Doctor.’ She said, ‘Well, trust me on this.’ “

Giulia Heyward contributed the coverage from Miami, Sophie Kasakove from New York and Livia Albeck-Ripka from Los Angeles.

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Health

California is requiring proof of Covid vaccination for state staff

California is requiring proof of Covid vaccination for state employees

Frederic J. Brown | AFP | Getty Images

California will require government employees and some health care workers to provide evidence of Covid-19 or undergo mandatory weekly tests, senior state officials said Monday.

According to a press release, government officials are required to submit records of their vaccination by August 2. All civil servants who have not been vaccinated by then must present a negative Covid test at least once a week.

The new policy for health workers and convention facilities goes into effect on August 9, and health facilities must be fully complied with by August 23, according to the press release.

In government health care facilities, employees who work in a hospital are required to show evidence of a Covid vaccine or show negative coronavirus tests twice a week. Unvaccinated people are advised to wear N95 masks while working. Medical staff in outpatient facilities such as dental practices also have to do a Covid test once a week.

“We are at a point in this epidemic of this pandemic where the choice, the individual’s decision not to be vaccinated, is now profound, devastating and deadly on the rest of us,” Governor Gavin Newsom said at the announcement new arrangement. “This election has led to an increase in the number of cases, growing concerns about rising mortality rates and apparently induced hospitalizations.”

While the state already requires employees to disclose whether they have been vaccinated if they do not wish to wear masks indoors, they do not need to provide proof of vaccination. The new guidelines require proof of vaccination for all civil servants and mandatory tests for those who do not provide proof.

“Our projections are sobering,” said Newsom, noting that state officials are forecasting a “significant increase in hospital admissions” over the next few weeks that will put pressure on local hospitals.

New York Mayor Bill de Blasio recently introduced similar guidelines for city and health workers, NBC New York reported. All employees who fail to provide proof of vaccination by September 13 are required to have a weekly coronavirus test, and all unvaccinated employees must wear a mask at work starting August 2.

The San Francisco Bar Owner Alliance, which represents 500 bars in San Francisco, said it is encouraging its members to require customers to have a negative Covid test or proof of vaccination from July 29, requirements are “welcome to sit outside.” The individual bars have a choice of whether to enforce the requirements or not.

California saw vaccination rates rise 16% last week as the Delta variant quickly spread across the state. It now makes up about 80% of all newly sequenced cases in the state, health officials said.

Los Angeles County recently redesigned its indoor mask mandate regardless of vaccination status.

When asked about a statewide mask mandate, Newsom said the majority of Californians live in jurisdictions that either mandate or encourage the use of masks. “Our focus is on vaccinations, so there won’t be a need.” he said.

The U.S. Department of Veterans Affairs also announced Monday that it will require Covid vaccinations for all health care workers who work in Veterans Health Administration facilities.

“VA is taking this necessary step to protect the veterans it serves,” the agency wrote on its website. It is the first federal agency to mandate vaccinations and give employees eight weeks to get their vaccinations.