coronavirus – Page 16

The Supreme Court can’t get its story straight on vaccines

Posted on February 7, 2022 by Lone Candle

“the Supreme Court handed down a pair of unsigned opinions that appear to be at war with each other.

The first, National Federation of Independent Business v. Department of Labor, blocks a Biden administration rule requiring most workers to either get vaccinated against Covid-19 or to routinely be tested for the disease. The second, Biden v. Missouri, backs a more modest policy requiring most health care workers to get the vaccine.

There are some things that differentiate the two cases. Beyond the fact that the first rule is broader than the second, the broader rule also relies on a rarely used provision of federal law that is restricted to emergencies, while the latter rule relies on a more general statute.

But the Court gives little attention to substantive differences between the laws authorizing both rules. Instead, it applies an entirely judicially created doctrine and other standards in inconsistent ways. The result is two opinions that are difficult to reconcile with each other.

The NFIB case relies heavily on something known as the “major questions doctrine,” a judicially invented doctrine which the Court says places strict limits on a federal agency’s power to “exercise powers of vast economic and political significance.” As the NFIB opinion notes, the vaccinate-or-test rule at issue in NFIB applies to “84 million Americans” — quite understandably a matter of vast economic significance.

But, if this manufactured doctrine is legitimate, then it’s not at all clear why it doesn’t apply with equal force in both cases. As Justice Clarence Thomas points out in a dissenting opinion in the Missouri case, the more modest health workers’ rule “has effectively mandated vaccination for 10 million healthcare workers.” That’s still an awful lot of Americans!

What if the Biden administration had pushed out a rule requiring 20 million people to get vaccinated? Or 50 million? The Court does not tell us just how many millions of Americans must be impacted by a rule for it to count as a matter of “vast economic and political significance.” And it’s hard to draw a legally principled distinction between 10 million workers and 84 million.

Similarly, in NFIB, the Court notes that the agency which created the broad rule at issue in that case is the Occupational Safety and Health Administration (OSHA) which, as its name suggests, deals with health threats that arise in the workplace, and Covid-19 is not unique to the workplace. “COVID–19 can and does spread at home, in schools, during sporting events, and everywhere else that people gather,” the majority opinion notes.

But, as the three liberal justices point out in dissent, OSHA regulates threats that exist both inside and outside the workplace all the time, including “risks of fire, faulty electrical installations, and inadequate emergency exits.” It’s not at all clear why Covid-19 is any different. And the only explanation that the majority opinion gives — that a vaccination “cannot be undone at the end of the workday,” unlike the donning of fire-safety gear — applies with equal force to both the OSHA rule and the narrow health worker’s rule that the Court refused to block. Doctors’ vaccinations can’t be undone any more than an office worker’s can be.

The Court, in other words, appears unable to articulate a principled reason why some vaccination rules should stand and others should fall.”

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“The opinions suggest that the Court will uphold rules that five of its members think are good ideas, and strike down rules that five of its members think are bad ideas.”

We’ll never have a normal flu season again

Posted on February 6, 2022 by Lone Candle

“Before the pandemic, the flu alone could sometimes push hospital systems into crisis mode, where they cancel elective procedures and limit other kinds of care. Now there’s Covid-19, which has done the same thing on its own.

Suddenly conjuring more hospital capacity every winter to handle the expected surges of flu and Covid-19 is not going to happen. Thousands of additional hospital beds are not coming in the next few years, and the US would not have the doctors and nurses to staff them anyway. It will take much longer — years or maybe decades — to improve the gaps in America’s health care infrastructure and workforce that have been exposed during Covid-19.

This means the imperative to “flatten the curve,” to limit the spread of these viruses to stop hospitals from being overwhelmed, will be with us for a long time. But the makeup of the curve will change, measuring multiple diseases instead of one.”

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“Vaccination is the best way to stop a bad Covid-and-flu season before it starts.”

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“Surveillance is critical, starting with early-warning systems. Public health institutions have long monitored the flu and they are already tracking Covid-19 in a similar manner. Monitoring the amount of virus detected in local wastewater has proven to be a reliable leading indicator of new Covid-19 waves during the pandemic. And widespread, reliable testing will be essential — including at-home tests for both Covid-19 and the flu.”

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“Frequent testing lets people know that they should isolate. If they are at higher risk of severe illness, they can get on antivirals quickly. The current therapies are most effective at stopping serious symptoms that could require hospitalization if they are taken within the first few days of an illness. Research in the last decade has found that flu antivirals are too often underprescribed for patients who would benefit most; improving prescription rates is only more critical now that the health system will be contending with both the flu and Covid-19 going forward.”

Omicron vs. the Unvaccinated and the Vaccinated

Posted on January 31, 2022 by Lone Candle

“The highly contagious omicron variant of the COVID-19 virus often does an end run around the immunological protections of vaccination or prior infection. But recent data from the U.K. and Canada indicate that these breakthrough omicron infections are much less dangerous than first-time infections in unvaccinated people.

Ontario public health authorities report that as of yesterday, 2,093 and 288 people are being treated for omicron variant infections in hospitals and intensive care units (ICUs), respectively. The hospitalization rate per million among unvaccinated people stands at 532.7; it’s 105.9 for folks vaccinated with at least two doses. This means that the reduction of hospitalization risk for those inoculated with at least two doses is 80.1 percent.

The ICU occupancy rate per million is 135.6 for unvaccinated people and just 9.2 for those who have gotten two doses of COVID-19 vaccines. So vaccination reduces the ICU risk by 93.2 percent.”

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“These British and Canadian findings mirror those most recently reported by the New York State Health Department. It finds that the daily rate per 100,000 of COVID-19 hospitalizations stands at 4.56 for fully vaccinated people, compared to 58.27 for unvaccinated people. That means vaccinations are 92.3 percent effective at preventing hospitalization from COVID-19.”

Why Covid-19 is always one step ahead of the US response

Posted on January 25, 2022 by Lone Candle

“The Biden administration’s response to the omicron variant is belatedly kicking into gear. The White House announced Wednesday that it would soon ship 400 million N95 masks to US pharmacies and community health centers to be given away. Americans can submit their bills for at-home tests to their health insurer for reimbursement, and on Tuesday, a new federal website launched that lets people order a few free at-home coronavirus tests.

Free tests and free masks are finally here — after some public health experts have been calling for them since omicron was first detected around Thanksgiving or even earlier. But the tests and masks might not arrive in Americans’ hands until the end of the month.

“By the time the masks and tests get there, the surge will probably be over,” Monica Gandhi, an infectious diseases doctor at the University of California San Francisco, told me. It’s possible — but far from certain — that the omicron wave has already peaked. The average number of daily cases has dropped by 50,000 in the last week, a 6 percent decline.”

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“Experts point to three main factors in the US government’s slow response to omicron: an over-reliance on vaccines, a failure to develop contingency plans, and the fracturing of the expert consensus on what the appropriate public health interventions would be.”

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“There are limits on what the federal government can do under our federalist system of government. Mask mandates and social distancing restrictions are largely the purviews of state and local authorities. The Biden administration did attempt to take sweeping actions, such as a vaccine mandate for large employers, that got tied up in the courts.”

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“Public health experts were never a monolith. But early in the pandemic, there was a fairly clear consensus about what to do about Covid-19: Close some businesses, ban most large gatherings, mandate masks, and develop a vaccine. A New York Times survey of hundreds of epidemiologists found in the summer of 2020 that more than half were in agreement about the timeline for resuming many activities that had been stopped because of Covid-19, such as vacationing within driving distance or eating out at a restaurant.

But as the pandemic has dragged on, expert opinions diverged. In spring 2021, the Times ran another survey of epidemiologists, asking them how long people would need to wear masks indoors, the answers varied wildly; 20 percent said half a year or less, while another 26 percent said people would wear masks indefinitely, at least in certain situations. As the Biden administration debated booster shots this summer and fall, some experts were full-throated supporters of giving everybody an additional dose, while other prominent experts argued boosters made sense only for certain people.”

The shape of the omicron wave is becoming clearer

Posted on January 21, 2022 by Lone Candle

“The omicron variant has helped drive the United States into uncharted territory for the pandemic. The country was reporting an average of more than 400,000 new Covid-19 cases every day as of January 3, easily eclipsing last winter’s record of 250,000. And infections are still spiking, with the number of newly reported cases quadrupling since the beginning of December.
There is still a lot of uncertainty with the omicron variant: We’re still learning exactly how transmissible it is, how likely it is to cause severe disease and for whom. But we know more now than we did when it first began spreading in the US.

All the early indications were that omicron was even more transmissible than its predecessors, at least in part because of its ability to partially evade preexisting immunity, and that has proven to be true. While earlier CDC estimates that the variant took over in the US in mid-December turned out to be overstated, omicron now appears to have surpassed the previously dominant delta variant in its share of new US cases.

With cases rising, so is the number of patients in the hospital with Covid-19. But, at least so far, hospitalizations are not rising as rapidly as infections, lending credence to the theory that omicron leads to less severe disease, particularly for vaccinated people. Deaths have barely budged over the last month, with about 1,250 new deaths being reported every day as of January 3, essentially unchanged from the 1,125 daily average on December 3. While there is always a time lag between new reported cases and the data showing more serious illness, the evidence, including biological research findings, that omicron poses less of a threat to each individual patient is only growing.”