Tuesday 21st of September 2021

the covid dilemma...

covidcovid

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Coronavirus disease 2019 (covid-19) has spread across the world. As of 4 July 2021, more than 183 million confirmed cases of covid-19 have been recorded worldwide, and more than 3.97 million deaths have been reported by the World Health Organization .1 

 

 

The clinical spectrum of covid-19 ranges from asymptomatic infection to fatal disease.23 The virus responsible for causing covid-19, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), enters cells via the angiotensin-converting enzyme 2 (ACE2) receptor.4 

 

Once internalized, the virus undergoes replication and maturation, provoking an inflammatory response that involves the activation and infiltration of immune cells by various cytokines in some patients.5 The ACE2 receptor is present in numerous cell types throughout the human body, including in the oral and nasal mucosa, lungs, heart, gastrointestinal tract, liver, kidneys, spleen, brain, and arterial and venous endothelial cells, highlighting how SARS-CoV-2 can cause damage to multiple organs.67

 

 

Long covid—mechanisms, risk factors, and management

BMJ 2021; 374 doi: https://doi.org/10.1136/bmj.n1648 (Published 26 July 2021)Cite this as: BMJ 2021;374:n1648

 

 

 

The impact of covid-19 thus far has been unparalleled, and long term symptoms could have a further devastating effect.8 Recent evidence shows that a range of symptoms can remain after the clearance of the acute infection in many people who have had covid-19, and this condition is known as long covid. The National Institute for Health and Care Excellence (NICE) defines long covid as the symptoms that continue or develop after acute covid-19 infection and which cannot be explained by an alternative diagnosis. This term includes ongoing symptomatic covid-19, from four to 12 weeks post-infection, and post-covid-19 syndrome, beyond 12 weeks post-infection.9 Conversely, The National Institutes of Health (NIH) uses the US Centers for Disease Control and Prevention (CDC) definition of long covid, which describes the condition as sequelae that extend beyond four weeks after initial infection.10 People with long covid exhibit involvement and impairment in the structure and function of multiple organs.11121314 Numerous symptoms of long covid have been reported and attributed to various organs, an overview of which can be seen in fig 1. Long term symptoms following covid-19 have been observed across the spectrum of disease severity. This review examines the long term impact of symptoms reported following covid-19 infection and discusses the current epidemiological understanding of long covid, the risk factors that may predispose a person to develop the condition, and the treatment and management guidelines aimed at treating it.

 

...

 

 

Research Questions
  • What is the precise epidemiology of long covid and how will novel variants of covid-19 affect the epidemiology and severity of long covid?

  • What are the major risk factors for long covid and how do we best reduce an individual’s risk of developing long term post-covid-19 symptoms?

  • Which symptoms, or set of symptoms, can we use to classify long covid, clinically and phenotypically, with the aim of improving diagnosis and management?

  • What is the optimal treatment and management strategy for long covid and is this strategy non-specific or will it require targeting and tailoring to specific patients?

 

Read more:

https://www.bmj.com/content/374/bmj.n1648

 

FREE JULIAN ASSANGE NOW !!!!!!!!!!!!!!!!!!!!!!!!!

hypoxemia...

 

When Anne Elliott moved to the UK in 2019 the plan was to enjoy a carefree working holiday before returning to Australia for the serious stuff: marriage, mortgage, kids.

Elliott, a critical care nurse, took a job at the Chelsea and Westminster Hospital in the heart of the city. A few months later COVID-19 had begun to spread and when the first wave hit the UK, she found herself on the frontline.

“We were completely blind-sided by the scale of it,” says Elliott who worked with critically ill COVID patients in the hospital's intensive care unit. “We had no PPE. We had cardboard walls with duct tape to corner off sections of the emergency and ICU to COVID patients. It took us completely by surprise.”

As the weeks passed Elliott discovered first hand the damage COVID-19 could do. She caught the disease herself and although she recovered, it was months before she felt well again.

At work, Elliott cared for uncountable numbers of COVID-19 patients with stretched resources: watching on as the hospital's medical consultants were forced to choose which patients would be given access to the top level of care and placed on a ventilator. She estimates roughly 40 per cent missed out.

 

...

 

When someone is infected with COVID-19 the immune system sends white blood cells to battle the virus where they release inflammatory molecules designed to kill off the virus. But it leaves behind fluid and pus that clogs up the lungs and disrupts the vital transfer of oxygen.

“If you get this widespread pneumonitis or vasculitis, then these vessels will start clogging up the air sacs and airways,” says Parnis. “They start clogging up with mucus as part of an inflammatory process that can also cause blood clotting, or thrombosis."

An emergency physician like Parnis might find patients arriving at the hospital emergency department about now showing symptoms of breathlessness and rapid breathing as the body attempts to source more oxygen.

This stage of the illness marks another turning point: COVID-19 patients can react in one of two ways.

Some continue to fight the virus, the immune system is activated, and the patient can be helped by extra oxygen from nasal prongs – like those in the maligned advertisement we’ve seen on our televisions recently – or steroid medication such as dexamethasone which Parnis says helps to reduce the "storm of inflammation".

But other COVID patients are not so lucky.

The infection can lead to Acute Respiratory Distress Syndrome which creates an oxygen-deprived state called hypoxemia. A deadly cycle begins.

The patient struggles to breathe as oxygen levels in the blood plummet, leading to mental confusion and delirium.

Parnis says that while a healthy body would have oxygen saturation levels of over 95 per cent, a struggling COVID patient can have oxygen readings in the 60s.

"If a patient presents in that way it would make your own heart race," he says. "At that level of oxygenation you're thinking this is big trouble, this person could go into a cardiac arrest if we can't get on top of that oxygen level."

It's a scenario unsettlingly familiar to Elliott who remembers many patients arriving at the ICU struggling for breath.

"We used to get very, very distressed people coming up from the ward to ICU who were hypoxic and they were quite agitated, trying to rip everything off, breathing rapidly but they still couldn't get enough air," she says.

If you took an X-ray of a COVID patient's lungs at this point in the disease you would see solid white patches where air spaces, that typically appear black on an X-ray, should be.

Those white patches represent the fluid, pus, mucus and dead lung cells that impair the lung and interfere with breathing and oxygen transfer. In a healthy respiratory tract little hair-like structures called cilia swish around and clear out debris and mucous, but in a COVID-affected patient the cilia are attacked and disabled by the virus.

 

Read more:

https://www.abc.net.au/news/2021-07-31/how-covid-delta-kills-patients-virus/100335290

 

freefree

vague effecivation...

 

Earlier this month National Cabinet released a four-phase COVID response plan. It wasn’t so much a plan – it had no dates and no thresholds – but more a back-of-the-napkin [Gus: I don't know why but I read back-of-the-nappy on first read] thought bubble. It was sensible, but vague.

National Cabinet now faces the hard task of converting vagueness into a real plan. To do this it must answer the question: what proportion of the Australian population needs to be vaccinated before we can open our international borders?

This means allowing stranded Australians to return, letting footloose people travel overseas, and welcoming international tourists and students again.

 

Well qualified experts differ on the requisite threshold for vaccinationpartly because there are so many unknowns, such as how quickly the Delta variant of COVID would spread through Australia if we open up, and how effective the different vaccines will prove to be in preventing transmission.

But new Grattan Institute modelling shows it would be dangerous for Australia to open up before at least 80 per cent of the population is vaccinated.

Here’s what we found, and how we came to the 80 per cent figure. Let’s start with the good news.

Vaccines offer substantial protection

Both vaccines on offer in Australia – Pfizer and AstraZeneca – are effective at preventing infections from the Delta strain. Two doses of Pfizer offers about 88 per cent protection against infection, while two doses of AstraZeneca offers about 67 per cent protection.

Vaccinated people can still catch COVID, but those that do pass it on to about half as many others compared to the unvaccinated.

Evidence from the United Kingdom, Canada, and the European Union – areas with higher vaccination levels than Australia – also suggests both vaccines offer substantial protection against hospitalisation and death from COVID. A vaccinated person is about 95 per cent less likely than a vaccinated person to end up in hospital with COVID.

Now for the bad news.

The delta strain is far more infectious

Researchers estimate the Delta variant is 50 per cent to 100 per cent more infectious than the Alpha variant, which itself was more transmissible than the variant that was dominant throughout 2020.

 

The effective reproduction number, or Reff, tells us how many people one infected person will spread the virus to, taking into account behaviour and public health measures in place designed to reduce transmission, such as masks and physical distancing.

The Reff changes according to the public health measures in place, such as mask mandates.If the Reff of the Delta variant in Australia is around 6 without vaccination, having 50 per cent vaccination coverage will reduce the Reff to 3.

But the national goal must be to bring the Reff down to below 1, which would mean each person who was infected would infect less than one other person – and the virus would eventually peter out.

The higher the vaccination rate, the lower the effective reproduction number. Each person vaccinated offers a chance of breaking a chain of transmission that might lead to an outbreak.

Not only are vaccinated people less likely to become infected, they are also less likely to pass the virus onto others if they are.

The higher the vaccination rate, the lower the effective reproduction number...

 

Read more:

https://thenewdaily.com.au/news/coronavirus/2021/07/30/vaccinate-80-per-cent-grattan/

 

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Meanwhile the police was well prepared and no-one turned up at the protests...

 

freefree

trumpian warp speed...

 

By Alex Azar

 

Among the many debatable issues around Covid-19 is one unassailable fact: The coronavirus is nonpartisan. It makes no judgment about one’s political leanings. The vaccines that were developed to fight this virus have no political bias, either.

And yet the reluctance and even refusal of many Americans — including many of my fellow conservatives and Republicans — to get a Covid-19 vaccine is a frustrating irony for those of us who worked to expedite these vaccines. While the vaccines have had doubts cast upon them by politicians throughout their production and rollout, whether a person lives in a red or a blue state has no bearing on the vaccines’ efficacy. They work incredibly well, and more than 160 million fully vaccinated Americans are proof.

Whether such skepticism is rooted in political misgivings, conspiracy theories or lack of accurate and timely information, there are still millions of Americans unwilling to take the simplest of steps to end this pandemic. That makes it incumbent upon all leaders and health experts to be honest about how safe and effective the vaccines are and urge vaccination.

I know the vaccines’ features intimately because as secretary of Health and Human Services, I oversaw their development, testing, approval and distribution from April of 2020 until January of this year. After leaving office, I watched with pride as vaccination rates rose through the early months of the year, and then with dismay as the daily number of vaccinations declined.

Any claims that the vaccines are unsafe or ineffective, or that corners were cut are not true. Americans should understand that the process by which our team helped expedite these vaccines was called Operation Warp Speed for good reason. With the numbers of cases and deaths climbing in April of 2020 and the economy contracting, we had no time to lose. Masks and social distancing could offer only so much protection. Lockdowns, which devastated economies around the world, could only forestall the virus’s inevitable spread.

 

Safe and effective vaccines were our best hope of liberating America from the pandemic. As hospital wards filled beyond capacity, we needed to develop the vaccines much faster than the typical timeline would allow. At the same time, we made sure that there was no compromise on safety by conducting some of the largest and most extensive vaccine clinical trials ever.

After the U.S. government committed to spending more than $2 trillion on Covid-19 relief, I set a stretch goal that was intended to be both audacious and motivational — a “moon shot” — similar to President John Kennedy’s 1961 proclamation that we were going to the moon by the end of the decade. In this case, our goal was to produce 300 million vaccine doses by January 2021.

Operation Warp Speed committed to funding upfront various stages of development, including testing vaccines in humans to prove they are safe and effective, as well as the manufacturing of the vaccines.

We provided funding to test vaccines in large populations, and we got results faster than ever before. The vaccines produced remarkable protection against Covid-19 and were extremely safe. After studying all the data in depth, the Food and Drug Administration granted emergency use authorizations.

Some who are hesitant to get vaccinated point to the fact that the vaccines remain under emergency-use authorization rather than full approval. It’s vital for Democratic and Republican leaders to explain clearly and repeatedly that the F.D.A. held these vaccines to such high standards that the only real difference is that full approval requires steps like analyzing longer-term safety and efficacy data, and inspecting manufacturing facilities. Hundreds of millions of doses of these vaccines have now been given to Americans over the past year, providing us with some of the most robust real-world evidence of their safety and efficacy that we’ve ever had for new vaccines. A vast majority of adverse events with the vaccines occur in the first 42 days or so.

The current and former leadership of the F.D.A. and the Centers for Disease Control and Prevention — of both parties — are unanimous in encouraging all eligible Americans to take the vaccines. Political, public health and thought leaders must educate about the benefits of the vaccine, not hector or preach. This information must come from respected and trusted figures in the various hesitant communities.

We did not reach our stretch goal of producing 300 million doses by January, but we hedged our bets by investing in a portfolio of vaccines and had tens of millions of doses of vaccine in production by the end of January. Many governors were able to begin general vaccination programs by March, and we had a surplus of vaccine by the end of the second quarter.

As I reflect, we could have done a better job in reminding the media and the public of all that could go wrong with vaccine development and manufacturing. We also should have explained more clearly the operational complexities that would accompany a large scaling up of distribution.

We could have done more to address vaccine hesitancy. We focused a great deal of our efforts at the start on the groups that we thought might be most hesitant. We demanded all clinical trials included a diverse, representative sample of participants, and the Department of Health and Human Services provided funding for an effort by the Morehouse School of Medicine to coordinate a network of national, state, territorial, tribal and local organizations to deliver trusted information to racial and ethnic minority communities.

But we did not predict the politicization of vaccines that has led so many Republicans to hold back. As of mid-July, 43 percent of Republicans said that they have not been vaccinated and definitely or probably wouldn’t be, versus 10 percent of Democrats, according to a poll from The Associated Press-NORC Center for Public Affairs Research. I’m glad former President Trump got vaccinated, but it would have been even better for him to have done so on national television so that his supporters could see how much trust and confidence he has in what is arguably one of his greatest accomplishments.

The vaccines could be a victory lap for the Republican Party, and I call upon all party leaders and conservatives to double down on encouraging vaccination. Party leaders like Gov. Ron DeSantis of Florida are making clear that vaccines save lives. Sean Hannity of Fox News is now telling viewers to “please take Covid seriously.” Representative Steve Scalise of Louisiana shared a photo of himself recently getting vaccinated. I urge more of this from trusted voices on the right.

More than 600,000 Americans have died of Covid-19, but vaccines can prevent more loss. Getting vaccinated is an absolute necessity to end the pandemic.

Conservatives need to do our part, and the Biden administration must find voices that will be trusted in conservative communities to explain the data and integrity of the vaccine programs. They would also do well to continue to acknowledge the historic achievement of the Trump administration in expediting these vaccines. I’m not naïve about the partisan issues and the mistrust between parties at play — but a measure of political graciousness could go a long way to depoliticize the issue.

In seeking to end this pandemic, the Biden administration is exhorting all unvaccinated adults in our country to get their shots, and I fully support it in this call. It would be tragic to see more lives needlessly lost when we are so close to beating this virus once and for all.

 

Alex Azar was secretary of health and human services under President Donald Trump. He oversaw Operation Warp Speed, the program to accelerate the development, manufacturing and distribution of Covid-19 vaccines and drugs.

 

Read more:

https://www.nytimes.com/2021/08/03/opinion/covid-vaccine-safety.html

 

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FREE JULIAN ASSANGE NOW !!!!!!!!!!!!!!!!!!!!!

 

le salaire de la peur...

 

BY Michael Pascoe

 

 

I sincerely hope I’m wrong, but shorn of euphemisms and false hopes, here is the Morrison and Berejiklian governments’ COVID plan for summer: Let it rip.

When 64 per cent of the population is vaccinated – 80 per cent of adults and almost no children – the Prime Minister and New South Wales Premier want our restraints to be lifted, allowing the disease to run riot through the population.

The vaccinated and unvaccinated alike in populated areas will  encounter the virus. Most of the vaccinated will be fine, or at least not sick enough to require hospitalisation. They’ll still play a role in spreading it, as will those under 16 that the governments prefer to pretend don’t count in vaccination targets.

 

Unvaccinated adults will suffer the same fate they are suffering now – a high percentage of very serious illness requiring hospitalisation.

In round numbers, of the 7,000 active cases in NSW on Monday, 64 were in ICU – nearly one per cent – with another 328 elsewhere in hospitals.  All up, 5.6 per cent require hospital beds.

Hundreds of thousands of cases

Given the infectiousness of the Delta variant, letting the virus rip could rapidly mean hundreds of thousands of cases, overloading our health system.

As previously explained, our intensive care units are hospitals’ “centre of gravity” – once the ICU is full, much of a hospital’s other functions become impossible. Thus hitting a vaccination percentage won’t guarantee an end to lockdowns and restraints – it will be the ICU case load that determines “freedom”.

But as we’re witnessing daily in the NSW government’s media conferences, once Delta gets established to the tune of hundreds of cases it’s hellishly hard to contain. If it gets established in the thousands, well, good luck.

And then there are the implications of “long COVID” for adults and whatever the virus is doing to children. We’re still finding that out as the rate of children’s infections spiral.

If the Prime Minister and the NSW Premier are being truthful in their announced intentions, it looks like they’re determined to do a Boris – follow the British experiment in letting the virus have its way with the population.

Obvious and terrible consequences

The hard-headed outcome is eventual herd immunity. Pretty much everyone who can get it will get it, with the obvious consequences.

 

It threatens to be horrific and not just for those who chose not to be vaccinated. Their decision will impact people in car accidents, people undergoing open-heart surgery, those awaiting surgery – everyone needing hospitalisation.

The hospitalisation of the unvaccinated will end up killing people not infected with COVID.

Which is why it is galling to see governments pussyfooting about mandating vaccination, bowing to the anti-vaxers and assorted ratbags.

If it gets to the feared stage of ICU overload, nobody will want to again see Scott Morrison saying what he said on Tuesday about the Afghans his government is leaving behind to the Taliban – “we wish it were different”.

And as for the airly-mentioned 50 and 70 per cent vaccination targets (in reality, 40 and 56 per cent of the population), forget about it.

That’s the straight outlook. I would like to be wrong, but opening up at a 64 per cent vaccination rate will do that.

There is another possibility: the Morrison and Berejiklian governments continue to be less than straight with us – as the fake 80 per cent figures gets closer and Delta persists, we’ll own up to a real 80 per target with restraints and lockdowns part of the furniture depending on ICU figures as the virus makes its way through the unvaccinated.

In either case, yet again, the handling of our reality continues to undermine confidence in leadership.

 

Read more:

https://thenewdaily.com.au/news/coronavirus/2021/08/17/pms-plan-let-covid-rip/