Tag: strains

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WHO officers strive to determine why delta is a lot extra harmful than earlier Covid strains

WHO officials try to figure out why delta is so much more dangerous than earlier Covid strains

This photo image shows a World Health Organization (WHO) logo on an Android phone.

Avishek Das | Getty Images

World Health Organization officials said they are still trying to understand why the Delta variant is more transmissible and potentially making people sicker than the original strain of coronavirus.

“We’re really trying to better understand why the Delta variant is more portable,” said Dr. Maria Van Kerkhove, WHO technical director for Covid-19, at a press conference on Friday. “There are certain mutations in the Delta variant that allow the virus, for example, to attach itself to a cell more easily. There are some laboratory studies that suggest that there is increased replication in some of the human respiratory systems modeled.”

In the past few weeks, new data on the highly transmissible strain has emerged around the world as scientists try to better understand the new threat. The Centers for Disease Control and Prevention warned lawmakers Thursday that new research suggests the Delta strain is more contagious than swine flu, the common cold and polio. It’s as contagious as chicken pox. It also appears to have a longer transmission window than the original Covid-19 strain and can make the elderly sicker even if they have been fully vaccinated.

Thursday’s warning came in a confidential document that was reviewed by CNBC and authenticated by the federal health authority.

“The virus itself is, as it begins, a dangerous virus. It is a highly transmittable virus. The Delta variant is even more, ”said Van Kerkhove. “It is twice as transferable as the ancestral tribes.”

WHO officials expect other dangerous variants to emerge as countries struggle to distribute the life-saving vaccines to their populations.

“They get fitter the more they circulate, and therefore the virus is likely to become more transmissible because they develop in such a way that they change over time,” said Van Kerkhove.

She said it is imperative that nations follow public health measures like social distancing and the wearing of masks as nations distribute more vaccines around the world, especially those with the lowest vaccination rates.

We need “around 70% coverage worldwide to really slow down transmission and reduce the risk of new variants appearing,” said Dr. Bruce Aylward, Senior Advisor to the WHO Director General.

However, given current trends, health professionals are not optimistic. “This will not be the last variant of the virus you will hear us talk about,” said Van Kerkhove.

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Biden admin spending $1.7 billion monitoring new strains

Biden admin spending $1.7 billion tracking new strains

President Joe Biden responds to a question after commenting on the COVID-19 response and vaccination status in the South Court Auditorium in the White House complex in Washington, DC on March 29, 2021.

Drew Angerer | Getty Images

The Biden government on Friday announced it would allocate $ 1.7 billion to track the highly infectious variants of coronavirus that are now a major threat to the U.S. fight against the pandemic.

The $ 1.9 trillion Covid relief plan that went into effect last month will help improve detection, monitoring and mitigation of “new and potentially dangerous strains,” a press release said White house.

According to the White House, the Covid variants now account for around half of all cases in the United States. The mutations can be up to 70% more transmissible than the original strain, said Rochelle Walensky, director of the Centers for Disease Control and Prevention.

Their continued spread “makes the race to interrupt broadcasts even more difficult and threatens to overwhelm our healthcare system in parts of this country again,” Walensky said at a press conference.

It found that B.1.1.7, the variant originally identified in the UK, represented 44% of the US Covid circulation for the week of March 27th.

The proliferation of variants is contributing to a “very worrying” increase in cases, hospitalizations and emergency room visits, Walensky said. The average daily deaths rose to over 700 for the third day in a row, she said.

The White House said $ 1 billion of the government’s latest coronavirus investment will be used to help the CDC and other health officials expand genome sequencing, which will help them identify mutations.

“The emergence of variants underscores the critical need for rapid and continuous genomic surveillance,” said Walensky.

The White House said $ 400 million of the remaining funds would “fuel cutting-edge research in genomic epidemiology” by establishing six “centers of excellence” that form partnerships between health departments and academic institutions.

The last $ 300 million will be used to strengthen the so-called bioinformatics infrastructure “to create a unified system for sharing and analyzing sequence data that protects privacy but enables more informed decisions,” the White House said.

An initial tranche of $ 240 million will be paid out to US states and territories in early May, with California, Texas and Florida receiving the largest amounts. The White House said more money will be invested over a period of several years.

Health experts continue to urge Americans to get vaccinated against Covid.

Dr. Anthony Fauci, the nation’s leading infectious disease expert, said in a Congressional hearing on Thursday that B.1.1.7 “is very well covered by the vaccines we use” and that so are other variants when the vaccination does not does It does not protect against an initial infection, but against serious illnesses. “

“We are in a race between vaccinating as many people as possible and as quickly as possible and the risk of virus recurrence in our country,” said Fauci.

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Covid variant present in U.Ok. 64% extra lethal than earlier strains: Examine

Covid variant found in U.K. 64% more deadly than earlier strains: Study

A patient is placed in an ambulance outside the Royal London Hospital in London during England’s third national lockdown to contain the spread of the coronavirus. Picture date: Wednesday February 17, 2021.

Ian West | PA Pictures | Getty Images

The highly contagious variant of the coronavirus, first identified in the UK, is linked to a 64% higher risk of dying from Covid-19 than previous strains, according to a new study published in the British Medical Journal.

Researchers from the University of Exeter and the University of Bristol analyzed data from more than 100,000 patients in the UK between October 1 and January 28. They compared the death rates of people infected with B.1.1.7, the variant first found in the UK, and those infected with other previously circulating strains.

The researchers, who released their results on Wednesday, said people infected with B.1.1.7 were between 32% and 104% more likely to die. This corresponds to a central estimate of 64%. The “absolute risk of death in this largely unvaccinated population remains low”.

“Death from COVID-19 is still a rare occurrence in the community, but variant B.1.1.7 increases the risk. Coupled with its ability to spread quickly, B.1.1.7 is a threat that should be taken seriously. “Robert Challen, the lead author of the study in Exeter, said in a press release.

The researchers said B.1.1.7 resulted in 227 deaths in a sample of 54,906 patients. This compares to 141 deaths in roughly the same number of patients infected with other strains.

They said with the variant, which has already been discovered in more than 50 countries around the world, “the analysis provides vital information for governments and health agencies to help prevent its spread.”

The UK identified B.1.1.7 in autumn 2020, which appears to be spreading more easily and faster than other strains. Since then, it has spread to other parts of the world, including the US, which identified 3,283 cases at the Centers for Disease Control and Prevention, according to Tuesday. U.S. health officials say they are working to identify more cases.

The new study comes roughly two months after a CDC study warned that B.1.1.7 could become the dominant strain in the United States. CDC director Dr. Rochelle Walensky told JAMA on Feb. 17 that variant B.1.1.7 is considered to be about 50% more transmissible and early data suggests it could be up to 50% more virulent or deadly.

New variants are particularly a problem for public health officials as they could become more resistant to antibody treatments and vaccines. Senior health officials, including the White House Chief Medical Officer Dr. Anthony Fauci, urge Americans to get vaccinated as soon as possible. The virus cannot mutate if it cannot infect hosts and cannot multiply.

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Recovered Covid sufferers have been reinfected with new virus strains, WHO says

Recovered Covid patients have been reinfected with new virus strains, WHO says

A laboratory technician tests material with a single-channel pipette dropper during processing of the Covid-19 polymerase chain reaction test (PCR) in a laboratory in the South African suburb of Dunkeld in Johannesburg, South Africa on Wednesday, February 10, 2021.

Waldo Swiegers | Bloomberg | Getty Images

Preliminary reports from South Africa show that people who have recovered from Covid-19 have been re-infected with a new, contagious variant of the virus, World Health Organization officials said at a news conference on Friday.

The good news, however, is that vaccines designed to protect against the virus appear to reduce the severity of the disease in those who develop Covid-19, even if they don’t completely protect them from infection, the chief scientist said the WHO, Dr. Soumya Swaminathan.

“The [vaccine] Studies that have so far been carried out in South Africa as well as in Brazil with various candidates have shown complete protection against serious illness, hospitalization and death. A single case was not reported in any of the studies, “she said.

According to the WHO, vaccination can also reduce the spread of new Covid variants.

“There are now reports that when you have the vaccine and you get infected, the viral load is much lower, so you may be less likely to infect others,” Swaminathan said.

Previous Covid infection creates antibodies and cell-mediated immunity that are believed to prevent re-infection, scientists have found. Vaccination also helps individuals build protection against the virus.

However, the researchers are still investigating the extent to which prior infection and vaccination will protect against the new, more infectious variants of the coronavirus.

Increased vaccination efforts alone are unlikely to be enough to control the spread of the UK-native strain of coronavirus, said Dr. Scott Gottlieb, former Commissioner of the Food and Drug Administration, told CNBC on Thursday. Gottlieb said a combination of incoming warmer weather and increased vaccinations could help contain the variant.

Swaminathan at the WHO briefing on Friday stressed the importance of vaccinated people continuing to take precautions such as wearing masks, hand washing and social distancing to control the spread of the virus.

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CDC director warns strains may reverse drop in circumstances, hospitalizations

CDC director warns strains could reverse drop in cases, hospitalizations

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

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New, highly contagious variants of the coronavirus pose a “threat” to the United States and could reverse the recent decline in Covid-19 cases and hospital stays, the head of the Centers for Disease Control and Prevention warned on Monday.

The US reported a 7-day average of 119,900 new Covid-19 cases per day last week, a decrease of nearly 20% from the previous week but is still “dramatically higher” than the summer peak, CDC said -Director Dr. Rochelle Walensky told reporters during a White House press conference about Covid-19.

The nation also reported an average of 9,977 Covid-19 hospital stays per day last week, a decrease of at least 17% from the previous week, she said.

“The continued proliferation of variants remains a major problem and threat that could reverse the recent positive trends we are seeing,” said Walensky. “Please keep wearing a mask and stay 6 feet away from people you do not live with. Avoid travel, crowds, poorly ventilated rooms, and get vaccinated if you can,” she added.

U.S. health officials, including Dr. Anthony Fauci, have raised concerns about the Covid mutations that may be beyond the protection of the vaccines currently on the market. Moderna, Johnson & Johnson and Novavax have previously said that their vaccines may be less effective against B.1.351, the highly contagious strain in South Africa.

On Sunday, South African Health Minister Zweli Mkhize said the country would stop using AstraZeneca’s Covid-19 in its vaccination program after data showed it offered minimal protection against B.1.351, the nascent strain there. He said the government would wait for advice from scientists on how best to proceed after disappointing results from a trial conducted by the University of the Witwatersrand.

As of Sunday, the CDC had identified 690 cases of the B.1.1.7 variant, which were first identified in the UK, Walensky told reporters on Monday. The agency has identified six cases of the South African tribe as well as three cases of P.1, a variant first identified in travelers from Brazil.

Walensky said public health officials are working to find more cases of these variants, adding that federal and state officials have increased genome sequencing 10-fold in the past three weeks. “We expect to find more cases in the coming weeks,” she added.

The U.S. is always working to find out exactly how contagious and deadly the new strains are, said Fauci, the country’s leading infectious disease expert.

British Prime Minister Boris Johnson said last month that early data suggests the strain on the country could be more deadly. Fauci said Monday that there is currently no data to suggest the virus is mutating into a “less virulent” strain, meaning less harmful than the original virus.

The UK data “has yet to be confirmed,” added Fauci. “So far, however, there is no evidence that it is less virulent. Sometimes when viruses mutate in order to spread more efficiently they become less virulent, but we have no data to suggest that this actually happens.”

Meanwhile, Fauci has been pushing for people to be vaccinated as soon as possible, saying last week that the virus cannot mutate unless it can infect hosts and replicate.

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New York’s Cuomo lifts Covid restrictions however worries about new strains

NY Gov. Cuomo briefs the press on Covid pandemic as state distributes vaccines

New York Governor Andrew Cuomo wears a protective face mask as he approaches during a daily briefing following the coronavirus disease (COVID-19) outbreak in Manhattan in New York City, New York, the United States, on July 13, 2020 Word comes.

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New York has seen its worst coronavirus outbreak after the holidays and will begin lifting restrictions on much of the state, but more contagious strains of the virus that have recently surfaced could stifle that progress, Governor Andrew Cuomo said on Wednesday.

Triggered by dinner with family and friends, the vacation spike appears to have peaked on January 4 in New York when the positivity rate, or the percentage of Covid tests that came back positive, hit around 8% across the state. That number has since dropped to roughly 5.6%, Cuomo said.

“I think at this point it’s safe to say that the vacation rush was expected, the vacation rush actually happened, but the vacation rush is over,” Cuomo said during a press conference in Albany.

The Democratic governor said the state will lift restrictions on gatherings and some non-essential business in most of the state – except in parts of the greater New York City area, including Washington Heights, the Bronx and Queens, and the greater Newburgh area in the hinterland.

These areas are still being viewed as “yellow zones” as part of New York’s micro-cluster strategy to target economic restrictions on specific areas where the virus is more prevalent. New York will lift restrictions on any remaining orange and yellow zones, removing tighter restrictions on indoor dining, collecting sizes, and businesses like gyms, barbershops, and hair salons.

Existing Zones in New York State

Source: New York State

As part of the state’s reopening strategy, New York restaurants are only allowed to dine al fresco or take out and delivery. Cuomo said he plans to meet with Mayor Bill de Blasio and health officials to discuss how to reopen indoor dining in the city and that he will provide more details later this week.

However, concerns remain that new, more contagious variants of the coronavirus, first identified in the UK, South Africa and Brazil, could question and threaten the state’s ability to treat an influx of Covid-19 patients.

“The new strains are a real problem and the Covid threat is not over yet,” said Cuomo.

A recent study by the Centers for Disease Control and Prevention estimates that variant B.1.1.7 found in the UK could become the dominant strain of the virus by March. So far, New York has identified 22 Covid-19 cases with the mutated strain, according to recent data from the CDC.

However, the federal agency warns that the number is based on sampling and is not the total number of B.1.1.7 cases that may be floating around.

Cuomo said increasing the number of available hospital beds was not the primary concern of the state but rather the lack of medical staff to treat a wave of new patients if they contracted the virus themselves.

“Yeah, it’s scary, and all I can tell you is we’ll see it and adjust,” said Cuomo. “If it changes, we will change.”

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Biden to limit journey with South Africa, U.Okay., Brazil to sluggish new Covid strains

Biden to restrict travel with South Africa, U.K., Brazil to slow new Covid strains

On January 22, 2021, U.S. President Joe Biden signs Executive Orders for economic relief for families and businesses affected by Covid in the State Dining Room of the White House in Washington, DC.

Nicholas Comb | AFP | Getty Images

President Joe Biden will sign a travel ban on Monday for most non-U.S. Citizens entering the country that was recently in South Africa, where a new strain of Covid-19 was identified, a person familiar with the situation told CNBC .

Biden will also reintroduce travel restrictions on entry for non-US residents from the UK and Brazil, where new strains of Covid have emerged. The restrictions also apply to Ireland and much of Europe. Former President Donald Trump lifted the restrictions shortly before Biden took office.

Reuters reported on the travel restrictions for the first time on Sunday.

Dr. Anne Schuchat, assistant chief director of the Centers for Disease Control and Prevention, told the point of sale that the agency “is introducing this series of measures to protect Americans and also reduce the risk of these variants spreading and worsening the current pandemic.” . “

Before Biden took office, the new White House press secretary Jen Psaki criticized Trump’s efforts to lift international travel restrictions despite more contagious variants emerging around the world.

“We plan to step up public health measures related to international travel to further contain the spread of Covid-19,” Psaki wrote in a tweet.

Trump issued a proclamation last Monday to lift the travel restrictions his administration had put in place at the start of the pandemic for most non-US citizens living in much of Europe, the UK and Brazil as of January 26.

At that time, the US government will begin providing US air travelers, including US citizens, with the latest negative Covid-19 test results before boarding flights.

White House Health Advisor Dr. Anthony Fauci said that available vaccines against new, more contagious strains of Covid-19 appear to be less effective but likely still offer enough protection to be worth buying.

The CDC also announced on Sunday that it would remove the option for airlines flying from countries that do not have Covid-19 tests to request temporary exemptions for some travelers. The agency will implement the order on Tuesday.

The virus has infected more than 25 million people and killed at least 417,000 people in the United States since the pandemic began, according to Johns Hopkins University.

The US has not yet discovered any cases of the South African variant, but several states have discovered the British variant.

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Biden surgeon common choose says U.S. racing to adapt towards new Covid strains

Biden surgeon general pick says U.S. racing to adapt against new Covid strains

Vivek Murthy, named U.S. Surgeon General by President-elect Joe Biden, speaks as Biden announces his team tasked with fighting the Covid-19 pandemic at The Queen in Wilmington, Delaware on December 8, 2020.

Jim Watson | AFP | Getty Images

WASHINGTON – President Joe Biden’s surgeon general said Sunday that the United States is in a race to adapt against the mutant coronavirus, which has spawned a number of potentially more infectious variants of Covid-19.

“The virus is basically telling us that it will keep changing and we need to be prepared for it,” said Dr. Vivek Murthy during an interview with ABC News’ This Week.

“We need to be number one, do much better genome monitoring so we can identify variants when they arise, and that means we need to double up on public health measures like masking and avoiding indoor gatherings,” Murthy said Biden’s candidate for the nation’s next surgeon general, he added.

He also called for an emphasis on treatment strategies as well as further investment in testing and contract tracking methods.

“So the bottom line is we’re in a race against these variants, the virus is going to change and it’s up to us to adapt and make sure we stay ahead,” said Murthy.

On Friday, UK Prime Minister Boris Johnson said the new variant, known as B.1.1.7, was linked to higher mortality rates. When asked, Murthy said the US needs more data on the UK variant before making the same decision.

Dr. Anthony Fauci, Biden’s top medical advisor on Covid-19, told CBS New “Face the Nation” on Sunday that the US “has every reason to believe” that the UK government is claiming the variant is more deadly.

“We must now assume that what was predominantly floating around the UK has some increase in what is known as virulence, especially the virus’ ability to do more harm, including death,” Fauci said, adding that the US will do so I want to keep access to UK health records.

Preliminary analysis of the mutant strain, first identified in the UK, suggests that it could be the culprit for the UK’s top in some cases. Johnson previously said the new variant could also be up to 70% more transferable. The UK government has also confirmed that another infectious variant of the coronavirus identified in South Africa has emerged in the UK.

Continue reading: 5 things to know about the spread of the new strain of Covid in the UK

Last month, Colorado announced the first case of the new and potentially more infectious strain, Covid-19. The Centers for Disease Control and Prevention warned last week that the British variant, already circulating in at least 10 states, could become the dominant variant in the US by March.

Fauci warned Sunday that the Covid-19 vaccines currently on the market may not be as effective against new strains of the coronavirus identified in the UK, South Africa and Brazil.

“We’re going to look at this and monitor it very, very carefully as these things move on,” said Fauci, adding that the Biden government was already planning to modify the vaccines.

“We don’t have to do this now, but the best way to prevent these mutants from developing further is to vaccinate as many people as possible with the vaccines currently available,” he said.

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BioNTech CEO says vaccine is efficient towards new strains

BioNTech CEO says vaccine is effective against new strains

The CEO of German pharmaceutical company BioNTech remains confident that the company’s Covid vaccine, developed in partnership with Pfizer, will be effective against the highly infectious variants of the virus discovered in the UK and South Africa.

“We are confident that based on the mechanism of our vaccine, although there are mutations, we believe that the immune response induced by our vaccine could also treat (a) mutated virus,” said Dr. Ugur Sahin, co-founder and CEO of BioNTech, said CNBC’s Meg Tirrell on Monday.

“Last week we reported another mutation that is present in both the UK and South African variants. This mutation is believed to be important as it could structurally alter the protein. However, it appears that the immune response to our vaccine does also neutralizes mutation. “

His comments were based on research published Thursday showing that Pfizer-BioNTech’s Covid-19 vaccine appeared to be effective against a key mutation in the more infectious variants of the virus discovered in the UK and South Africa.

The study, carried out by US pharmaceutical giant Pfizer and not yet peer-reviewed, suggested that the vaccine neutralized the so-called N501Y mutation. This mutation has been reported in the coronavirus variants discovered in the UK and South Africa.

The variants, which emerged separately, both share a genetic mutation of the so-called spike protein, which the virus uses to penetrate the cells of the body.

Doctors tentatively welcomed the results of the study last week, but cautioned that the research focused only on the N501Y mutation found in both new variants.

BioNTech’s Sahin said the company will be able to present more data in the coming days examining the full set of mutations.

The new vaccine could be ready “within six weeks”.

Pfizer-BioNTech’s Covid vaccine uses messenger RNA or mRNA technology, like Moderna’s. In practice, the US Centers for Disease Control and Prevention says this “teaches our cells how to make a protein – or even a piece of a protein – that will trigger an immune response in our bodies.”

The resulting immune response produces antibodies that protect people from becoming infected with the virus.

Ugur Sahin, co-founder and CEO of Biontech, is on the company premises. Biontech is a biotechnology company that researches vaccines against the coronavirus, among other things. (Photo by Andreas Arnold / Image Alliance via Getty Images)

Andreas Arnold | Image alliance via Getty Images

When asked how fast BioNTech could turn if the existing Covid vaccine were found to be ineffective against new variants, Sahin said “a key benefit” of mRNA technology is that the company is adapting the vaccine relatively quickly could. “”

“We can change the order of the vaccine in a matter of days and, in principle, deliver a new vaccine within six weeks. This is technically possible and if necessary we would go for it,” he said, noting that it is is would also require discussions with regulators such as the Food and Drug Administration.

“We are therefore confident that the technology with which we can react to a mutation or a virus variant with different problems will react extremely quickly,” said Sahin.

Public health experts have raised concerns that the new mutant strains could pose a threat to vaccination efforts. In recent weeks, optimism about the mass adoption of Covid vaccines has been tempered by the resurgent rate of virus spread around the world.

To date, more than 90.3 million people worldwide have contracted the coronavirus, with 1.93 million deaths, according to data from Johns Hopkins University.

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Oxford researcher says future strains might be protected towards

Oxford researcher says future strains can be protected against

Sir John Bell, a professor at Oxford University in the UK, told CNBC on Wednesday that he was confident that Covid-19 vaccines could be upgraded to provide effective protection against future coronavirus mutations.

Bell’s comments on “Closing Bell” come as global attention is focused on a strain of the virus that is widespread in the UK and that may spread more easily than previous variants. It has since been discovered in Colorado and California.

“This is going to be a game of cat and mouse,” said Bell, who worked with AstraZeneca to oversee vaccine development at Oxford. The UK government approved emergency vaccine use on Wednesday after granting limited approval for Pfizer and BioNTech’s vaccine earlier this month.

Studies are currently underway to officially determine whether Oxford-AstraZeneca’s vaccine will protect against the new strain of the virus, Bell said. “We think they probably can, but we just want to be absolutely sure.”

“Given the level of disease in the UK with the new variant … we will have many examples of people who have had the vaccine and are exposed to the virus and we will be able to report fairly quickly on whether the vaccine actually protects against this strain,” added Bell added.

In addition to the coronavirus variant found in Great Britain, a separate strain has come into focus, which was first found in South Africa. Officials at the U.S. Centers for Disease Control and Prevention said Wednesday it may also be floating around in America.

Bell told CNBC that he believes the variant discovered in South Africa has mutations that make it “a little more worrying” than the UK’s predominant strain. Still, Bell expressed confidence in how scientists will deal with virus mutations that escape the protection of existing vaccines.

“If we need to make new vaccines, now that we’ve done the first work, we can make them. I’m sure our friends can do the same with the RNA vaccines,” said Bell. Pfizer-BioNTech and Moderna vaccines were developed using messenger RNA technology, a new approach that uses genetic material to trigger an immune response. Oxford-AstraZeneca’s viral vector vaccine uses a weakened version of a cold virus that causes infections in chimpanzees.

“We are ready if we need to make another vaccine to get closer,” added Bell. He also noted that the vaccine update development process is unlikely to require the same large-scale clinical trials conducted this year, just immunogenicity studies to ensure that an immune response is elicited.

According to Dr. It is not uncommon for viruses to mutate, Scott Gottlieb, a former Food and Drug Administration commissioner who serves on Pfizer’s Board of Directors. “Some viruses like the flu develop their surface proteins very quickly, so we need a different flu vaccine every season,” he told CNBC earlier this month.

Gottlieb said at the time that he also believed the vaccines in place will protect against the strain of virus transmitted in the UK, as the vaccines target the entire spike protein of the coronavirus.

“We are developing antibodies against many different regions of this protein. Even if part of this protein were mutated and some antibodies no longer recognized it, there would be antibodies against other parts of this protein,” he said. “That probably won’t bypass our vaccines that easily, but at some point we’ll have to update the vaccines.”

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