Hospitals in trouble, Moderna booster = 62.5% effectiveness, Supremes hear mandate arguments, get-used-it strategies the new COVID-19 normal, CDC soft pedals testing, and FDA OKs young teen booster
Ashish Jha, M.D., M.P.H.,dean of the Brown University School of Public Health and a COVID-19 commentator (and influencer) on Twitter and elsewhere, put in some service time at the Providence VA Medical Center.
In a 14-tweet thread this afternoon, Jha discusses the trend of fewer hospitalizations from COVID-19 caused by the omicron variant but, in his words, “our healthcare system is in trouble.” Tis a seeming contradiction. But Jha tweets that those being hospitalized are either unvaccinated or high-risk individuals who are vaccinated but not boosted. By his reckoning there is a pool of about 40 million Americans who, even if the omicron variant does tend to result in milder disease, remain at risk for hospitalization because of their vaccination/booster/underlying health status. Jha’s prescription hews pretty closely to the conventional wisdom about how to deal with the omicron phase of the pandemic: ramp up vaccination and boosters, now and as fast as possible. He also endorses the pages from public health playbook: more testing, more avoidanceof indoor crowds and more mask wearing indoors.
Results reported in an preprint posted this morning (Jan. 8) by researchers at Kaiser Permanente Southern California show that two-doses of the Moderna vaccine were only 30.4% effective 14-90 days after vaccination and then fell off afterward. Three doses, though, were 62.5% effective against omicron infection. None of the people with COVID-19, either from the delta or the omicron variant, were hospitalized. The researchers counted 53 hospitalizations from the infection with the delta variant among those who were unvaccinated and two hospitalizations from omicron those the unvaccinated.
The Supreme Court heard oral arguments on Friday (Jan. 7) about lawsuits challenging the Biden administration’s vaccine mandates. Amy Howe of the Scotus blog reported that the justices seemed skeptical about the administration’s authority to impose vaccinate-or-test mandates on large employers but were more receptive to arguments in favor of mandates on healthcare workers at facilities that receive federal funds. Howe reported that of the seven of the eight justices who listened to the arguments in person wore masks; Justice Neil Gorsuch was the exception. Justice Sonia Sotomayor, who has diabetes, listened to the arguments remotely.
In three opinion pieces published online in JAMA on Thursday (Jan. 6), Ezekiel Emanuel, M.D., Ph.D., Michael Osterholm, Ph.D., M.P.H., Celine Gounder, M.D., Sc.M., and others called for a new approach to COVID-19 that would recognize that the disease is going to be a permanent.
Some of the points made in the viewpoints would attract little opposition: greater investment in disease surveillance, more “data infrastructure,” and a research push into vaccines that would protect against as many variants as possible. Others — more vaccine mandates, setting mortality and morbidity benchmarks for imposing public health restrictions, opt-out digital surveillance of vaccinated people — will stir up controversy and downright opposition. The viewpoints garnered headlines partly because but also stressed that research and healthcare priorities need to shift to as abiding COVID-19, a feature, not a bug, of these times.
The Mayo Clinic set a Jan. 3 deadline for its employees. Business Insider reported Thursday (Jan. 6) that 99% of the system’s 73,000 employees had complied or received a religious or medical exemption. Doing the math, the business website reported that means that 700 workers were terminated for following the policy.
"While Mayo Clinic is saddened to lose valuable employees, we need to take all steps necessary to keep our patients, workforce, visitors and communities safe," the clinic said in a statement, reported the news website.
The CDC has come criticism for not making a negative test part of its recommendation for ending isolation after contracting COVID-19. The agency mentioned testing in the updated version of the quarantining and isolation guidelines that it posted on Tuesday (Jan. 4), but it didn’t make a negative test a requirement for ending isolation. The guidelines posted on Tuesday say if you have access to a test and want to use it, the best approach is to use it near the end of the five-day isolation period. If the result is positive, say the guidelines, you should isolate for another five days. If it is negative, you can end your isolation, but you should continue to wear a well-fitting mask at home when you are around others and in public for another five days.
In a preprint published on Tuesday (Jan. 4), researchers at the Houston Methodist healthcare system reported on 1,313 patients with symptomatic cases of COVID-19 caused by the omicron variant. Compared to patients infected with either alpha or delta variants, those with infected with the omicron version of the SARS-CoV-2 virus were “significantly younger, had significantly increased vaccine breakthrough rates, and were significantly less likely to be hospitalized,” the abstract says.
The FDA announced on Monday (Jan. 3) that it had amended the emergency use authorization for the Pfizer vaccine to include a booster shot for people ages 12 to 15. The agency also OKed adding a third dose of the Pfizer vaccine to the primary series for immunocompromised children, ages 5 to 11.