Different Regions, Different COVID Protocols Going Forward

As the pandemic winds down, what’s next? There’s pressure to re-open the US border with Canada — but things are still far from normal, as vaccine cards and variations of them take form (in Germany, a negative COVID test is required to visit non-essential stores). Fall out from the pandemic continues as hospitals struggle to keep up with people making up for missed screenings and appointments. In Texas, nurses are losing their jobs as they fight against mandatory vaccinations.

In other news:

  • Andrew Bostom, M.D. asks that more studies be done on the growing number of heart-related events in young vaccine recipients, at Rational Ground
  • Barton Swaim has an interesting discourse on the unintended consequence of masking in a Wall Street Journal editorial
  • Martin Kulldorff and Jay Bhattacharya on the risk-benefit ratio of vaccinating kids in The Hill
  • A look at data, chance, and more with regard to COVID’s origin from David R. Henderson and Charles L. Hooper in AIER
  • Timandra Harkness on how the UK’s “risk-averse approach embraces authoritarianism” at Unherd

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COVID News

Pressure builds to open U.S.-Canada border

https://www.washingtonpost.com/world/2021/06/22/canada-us-border-coronavirus-restrictions/

TORONTO — A Florida man takes out ads to call out the U.S. and Canadian governments for failing to lift border restrictions. Lawmakers use salty-ish language. Business owners worry about losing a second lucrative summer season.

As restrictions on nonessential travel across the U.S.-Canada land border enter their 16th month this week, pressure is rising on both sides for Prime Minister Justin Trudeau and President Biden to crack it open — even a little — or to provide something, anything, about what a reopening plan might look like.

Ottawa on Monday did announce some changes at the border, to start July 5. They’d allow Canadian citizens and permanent residents who are fully inoculated with a Health Canada-authorized vaccine, and who test negative for covid-19 before and after arrival, to bypass some quarantine and testing requirements.

Hospitals face influx of patients who delayed care, revenue shortfalls

https://www.wbrc.com/2021/06/17/hospitals-face-influx-patients-who-delayed-care-revenue-shortfalls/

BIRMINGHAM, Ala. (WBRC) – For the first time in 14 months, Alabama hospitals are emerging from the COVID-19 fog.

“We’ve had a 35 percent decline in patients in hospital and our seven day average is now down to around 220 patients in hospital,” said Dr. Don Williamson, Executive Director of the Alabama Hospital Association. “That’s dramatically better than we were just a month ago.”

Hospitals are still far from normal operation, exchanging critically ill COVID-19 patients for those who are chronically ill.

“The troubling thing that we are seeing now, we’re seeing patients being admitted now with higher acuities, people who may otherwise have come in during the pandemic,” Williamson said.

Williamson said doctors are treating a wealth of patients with advanced disease, specifically heart disease, diabetes and cancer.

“One of the legacies of COVID going forward is not only going to be the loss due to COVID, but it’s going to be the more severe diseases we’re seeing as a result of deferred care or delayed care as a result of COVID,” Williamson noted. “That’s an unexpected and unfortunate corollary to the pandemic that we dealt with.”

EXPLAINED: What is Berlin’s new compulsory testing requirement for shops and hairdressers?

Anyone who wants to visit a non-essential shop or get a haircut in Berlin now has to present a negative Covid test result. Here’s what you need to know.

The Berlin government agreed new Covid-19 measures which come into force on Wednesday.  They include tighter rules on testing and mask-wearing – but they steer clear of a return to a strict lockdown.

Here’s a guide to how you can go shopping in the capital.

Are shops open and can I go to them?

Yes. Berlin recently allowed non-essential shops, such as clothes retailers and toy shops, to reopen after the shutdown with a “click and meet” system. This allowed people to book an appointment to visit a shop.

Instead of closing shops after Covid cases increased, Berlin has decided to introduce new measures in a bid to keep stores open to customers.

So “click and meet” has now been replaced with “test and meet”.

Over 150 Texas Hospital Workers Are Fired or Resign Over Vaccine Mandate

https://www.nytimes.com/live/2021/06/22/world/covid-vaccine-coronavirus-mask

More than 150 staff members at a Houston-area hospital were fired or resigned on Tuesday for not following a policy that requires employees to be vaccinated against Covid-19.

The hospital, Houston Methodist, had told employees that they had to be vaccinated by June 7 or face suspension for two weeks. Of the nearly 200 employees who had been suspended, 153 of them were terminated by the hospital on Tuesday or had resigned, according to Gale Smith, a spokeswoman for the hospital.

Ms. Smith said employees who had complied with the vaccine policy during the suspension period were allowed to return to work a day after they became compliant.

The hospital did not specify how many workers had complied and returned to work.

Commentary/Analysis

Burgeoning Evidence of Myopericarditis After COVID-19 Vaccination in Young People: A Call For Acknowledgment, Pause, and Serious Study

The Vaccine Adverse Event Reporting System [VAERS] (1) is a passive or “spontaneous” Centers For Disease Control and Prevention [CDC] and U.S. Food and Drug Administration [FDA] vaccine safety and monitoring system (2). Designed primarily for “safety signal detection,” VAERS describes potential associations between vaccine administration and adverse events, “hypothesis generation,” that could merit formal investigation (2). A recent example, which appears increasingly germane to COVID-19 vaccination–in particular, to mRNA COVID-19 vaccines available in the U.S. (i.e., from Pfizer and Moderna) (3)–was the relationship between smallpox vaccination and the development of myopericarditis in military personnel, especially young men (4-8). Although not “hypothesis generating,” per se, a subsequent VAERS analysis (7), utilizing influenza vaccination (and other vaccinations) as a control, independently validated the association between smallpox vaccination and myopericarditis, as well as the lack of association, described earlier (8), with influenza vaccination. Although caveats about attributing “causality” to VAERS adverse events associations with vaccination (1, 2) are appropriate, the system chronically under-reports adverse events of possible interest (9).

Why Shutdowns and Masks Suit the Elite

https://www.wsj.com/articles/why-shutdowns-and-masks-suit-the-elite-11624038950

Is the benefit of not contracting Covid-19 worth the cost of going without the bodily presence of, say, one’s children and grandchildren for months on end? Put that way, I suspect most Americans’ answers would range from “probably not” to “hell, no.” But in 2020 public-health experts and their defenders in the media proceeded as though “yes” were the only conceivable answer. That suggests our cultural elites and policy makers haven’t thought deeply, or at all, about what the human person is.

“I’m worried that our risk calculus has shifted in a dramatic way,” Mr. Snead says. “You think about the flu, you think about other diseases that could be dangerous—or just driving your car—and it feels to me that our risk tolerance is basically zero at this point. And what does that mean? Is the point of human life simply to hide away in a bubble-wrap container so that you don’t ever encounter any risk?”

The ill-advised push to vaccinate the young

https://thehill.com/opinion/healthcare/558757-the-ill-advised-push-to-vaccinate-the-young

The idea that everyone must be vaccinated against COVID-19 is as misguided as the anti-vax idea that no one should. The former is more dangerous for public health. The COVID-19 vaccines have been one of the few bright spots during this pandemic. While anyone can get infected, the old have a thousand-fold higher mortality risk than the young.

By vaccinating older people, the country has saved thousands of lives.

There is intense pressure on young adults and children to be vaccinated. Universities such as Colombia, Cornell, Harvard and Stanford require all students to get the shot as a condition of attending college normally. Young people looking for work are discriminated against if they are not vaccinated. It makes public health sense to require some vaccinations in some settings. However, in the case of COVID vaccines for young people, such mandates harm public health.

The Origin of SARS-CoV-2

Since March 2020, the world has reeled from the Covid-19 pandemic caused by the SARS-CoV-2 virus. According to Johns Hopkins University & Medicine, there have been 177 million known cases and 3.8 million deaths worldwide.

Covid-19 touches much more than just the medical world. It and responses to it have devastated economies around the world. But it also raised issues of free inquiry, truth, and trust. Have people in positions of power lied to us? Have they put us at undue risk?

Did the coronavirus come from nature or from a lab experiment? The answer to that question suggests the best responses for individuals and governments to take to prevent a recurrence. If we are to have any hope of successfully preventing massive deaths and economic chaos in the future, we must understand the virus’s origin.

We are hostages to Government fear

https://unherd.com/2021/06/we-are-hostages-to-government-fear/

As “Liberation Day” recedes into the future, it feels like we’re trapped in an endless limbo — something between Purgatory and that bit in a horror film where the characters are all laughing in relief at finally being safe, but you know there’s still half an hour to go.

Most of the vulnerable have been vaccinated, and weekly deaths are still below the five-year average. Over the past week, an average of 10 people died from Covid-19 every day in the UK, a drop of 9% on the week before’s toll. Although each death is a human tragedy, we would not normally reorganise society on this scale to prevent 3,560 deaths per year.

Research

Mortality and critical care unit admission associated with the SARS-CoV-2 lineage B.1.1.7 in England: an observational cohort study

https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(21)00318-2/fulltext

Summary

Background

A more transmissible variant of SARS-CoV-2, the variant of concern 202012/01 or lineage B.1.1.7, has emerged in the UK. We aimed to estimate the risk of critical care admission, mortality in patients who are critically ill, and overall mortality associated with lineage B.1.1.7 compared with non-B.1.1.7. We also compared clinical outcomes between these two groups.

Methods

For this observational cohort study, we linked large primary care (QResearch), national critical care (Intensive Care National Audit & Research Centre Case Mix Programme), and national COVID-19 testing (Public Health England) databases. We used SARS-CoV-2 positive samples with S-gene molecular diagnostic assay failure (SGTF) as a proxy for the presence of lineage B.1.1.7. We extracted two cohorts from the data: the primary care cohort, comprising patients in primary care with a positive community COVID-19 test reported between Nov 1, 2020, and Jan 26, 2021, and known SGTF status; and the critical care cohort, comprising patients admitted for critical care with a positive community COVID-19 test reported between Nov 1, 2020, and Jan 27, 2021, and known SGTF status. We explored the associations between SARS-CoV-2 infection with and without lineage B.1.1.7 and admission to a critical care unit (CCU), 28-day mortality, and 28-day mortality following CCU admission. We used Royston-Parmar models adjusted for age, sex, geographical region, other sociodemographic factors (deprivation index, ethnicity, household housing category, and smoking status for the primary care cohort; and ethnicity, body-mass index, deprivation index, and dependency before admission to acute hospital for the CCU cohort), and comorbidities (asthma, chronic obstructive pulmonary disease, type 1 and 2 diabetes, and hypertension for the primary care cohort; and cardiovascular disease, respiratory disease, metastatic disease, and immunocompromised conditions for the CCU cohort). We reported information on types and duration of organ support for the B.1.1.7 and non-B.1.1.7 groups.

Findings

The primary care cohort included 198 420 patients with SARS-CoV-2 infection. Of these, 117 926 (59·4%) had lineage B.1.1.7, 836 (0·4%) were admitted to CCU, and 899 (0·4%) died within 28 days. The critical care cohort included 4272 patients admitted to CCU. Of these, 2685 (62·8%) had lineage B.1.1.7 and 662 (15·5%) died at the end of critical care. In the primary care cohort, we estimated adjusted hazard ratios (HRs) of 2·15 (95% CI 1·75–2·65) for CCU admission and 1·65 (1·36–2·01) for 28-day mortality for patients with lineage B.1.1.7 compared with the non-B.1.1.7 group. The adjusted HR for mortality in critical care, estimated with the critical care cohort, was 0·91 (0·76–1·09) for patients with lineage B.1.1.7 compared with those with non-B.1.1.7 infection.

Interpretation

Patients with lineage B.1.1.7 were at increased risk of CCU admission and 28-day mortality compared with patients with non-B.1.1.7 SARS-CoV-2. For patients receiving critical care, mortality appeared to be independent of virus strain. Our findings emphasise the importance of measures to control exposure to and infection with COVID-19.

Funding

Wellcome Trust, National Institute for Health Research Oxford Biomedical Research Centre, and the Medical Sciences Division of the University of Oxford.

Charts and Graphics

International News

Lisbon residents confined to region at weekends as COVID spikes

https://www.reuters.com/world/europe/lisbon-residents-confined-region-weekends-covid-spikes-2021-06-17/

LISBON, June 17 (Reuters) – Residents of the Lisbon region will not be allowed to leave the area at weekends as authorities scramble to control a spike in COVID-19 infections, the government said on Thursday.

People living in the 18 municipalities of Lisbon’s metropolitan area will be banned from leaving from 3 p.m. on Friday until 6 a.m on Monday. Those living outside the area will not be allowed in.

Coronavirus cases in Portugal, population 10 million, jumped by 1,350 on Wednesday, the biggest increase since late February.

Most new cases were reported in and around Lisbon.

“The government made this decision so the situation in Lisbon does not spread to the rest of the country,” Cabinet Minister Mariana Silva Vieira told a news conference.

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