Tag Archives: Infectious Diseases

Health

Adult drug use rose during pandemic, but dropped dramatically in youth, study says

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CNN
 — 

Use of marijuana and other substances dropped in teenagers during the first year of the pandemic, according to a new study.

But adults’ use of cannabis, illegal drugs and alcohol, including binge drinking, either stayed the same or increased compared to the two years before Covid-19.

“Substance use decreased between 2019 and 2020 among those aged 13 to 20 years,” wrote first author Dr. Wilson Compton, deputy director of the National Institute on Drug Abuse.

However, “consistent declines were not seen in older persons other than tobacco use reductions, and cannabis use increased among adults ages 25 years and older,” he and his coauthors wrote.

The study analyzed data from the Population Assessment of Tobacco and Health Study, which follows tobacco and other substance use over time among 49,000 US youths and adults.

“A particular strength of this study was the longitudinal design,” said Joseph Palamar, an associate professor of population health at NYU Grossman School of Medicine, who was not involved in the study.

“This design allows us to look at changes among the same people over time as opposed to other national studies which compare different groups of people across time,” he said.

Substance abuse dropped in teenagers between ages 13 and 17, according to the study published Tuesday in the journal JAMA Network Open.

Cannabis use among teenagers ages 13 and 15 dropped by 3.4 percentage points in 2020 compared to 2018 and 2019, while tobacco use declined by about 4 points, the study found. The use of other illegal or misused prescription drugs also fell 2.5 percentage points in this age group.

Use of marijuana in teens ages 16 and 17 dropped 7.3 percentage points in 2020 compared to 2018 and 2019. Tobacco use fell by over 10 points and misuse of drugs sank by nearly 3 percentage points. Binge drinking dipped by 1.6 percentage points across the age group.

“I think availability plays a big part,” Palamar said. “If high schoolers are separated from their friends for a long time and stuck inside, they’ll likely have decreased access to drugs.

“Even if a teen successfully obtained weed, this doesn’t mean he or she had somewhere away from parents to smoke it if the whole family was on lockdown,” he added.

The use of alcohol increased by over five percentage points (from 60.2% to 65.2%) among adults ages 21 to 24 years old in 2020 compared to the previous two years. Binge drinking, however, fell by 2.2 points.

Tobacco use fell by about 8 percentage points, but use of marijuana and other illegal or prescription drugs did not change significantly in this age group, according to the study.

Use of marijuana increased slightly in adults 25 and up, by 1.2 percentage points. Declines in other substance abuse in this age group were not significant, the study authors said.

Tobacco use fell for all adults, the study found. The number of young adults ages 18 to 20 smoking tobacco dropped by just over 15 percentage points in 2020 compared to 2018 and 2019. Smoking also declined by about 8 points in adults ages 21 and up over the same period.

However, a drop in drug use during the early days of Covid did not mean the reduction continued as the pandemic wore on, said Palamar, who has been studying drug availability during that period.

“Decreases in use during the early months of Covid are meaningful, but we need to keep in mind that use of some drugs rebounded,” Palamar said. “For example, we found that seizures of marijuana and methamphetamine decreased after the start of Covid, and then rebounded to a much higher rate later in the year.”

A separate survey of people ages 19 to 30 found they were using marijuana and hallucinogens at high rates in 2021. The Monitoring the Future Study, published in 2022, found 11% of people in this age group used marijuana on a daily basis in 2021, while 43% said they had used it in the past year.

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Covid-19 is a leading cause of death for children in the US, despite relatively low mortality rate

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CNN
 — 

Covid-19 has become the eighth most common cause of death among children in the United States, according to a study published Monday.

Children are significantly less likely to die from Covid-19 than any other age group – less than 1% of all deaths since the start of the pandemic have been among those younger than 18, according to federal data. Covid-19 has been the third leading cause of death in the broader population.

But it’s rare for children to die for any reason, the researchers wrote, so the burden of Covid-19 is best understood in the context of other pediatric deaths.

“Pediatric deaths are rare by any measure. It’s something that that we don’t expect to happen and it’s a tragedy in a unique way. It’s a really profound event,” said Dr. Sean O’Leary, chair of the American Academy of Pediatrics’ Committee on Infectious Diseases.

“Everyone knows that Covid is the most severe in the elderly and immunocompromised and that it’s less severe in children, but that does not mean it’s a benign disease in children. Just because the numbers are so much lower in children doesn’t mean that they’re not impactful.”

In 2019, the last year before the pandemic, the leading causes of death among children and young adults ages 0 to 19 included perinatal conditions, unintentional injuries, congenital malformations or deformations, assault, suicide, malignant neoplasms, diseases of the heart and influenza and pneumonia.

The researchers’ analysis of data from the US Centers for Disease Control and Prevention found that there were 821 Covid-19 deaths in this age group during a 12-month period from August 2021 to July 2022. That death rate – about 1 for every 100,000 children ages 0 to 19 – ranks eighth compared with the 2019 data. It ranks fifth among adolescents ages 15 to 19.

Covid-19 deaths displace influenza and pneumonia, becoming the top cause of death caused by any infectious or respiratory disease. It caused “substantially” more deaths than any vaccine-preventable disease historically, the researchers wrote.

According to CDC data, children are less vaccinated against Covid-19 than any other age group in the US. Less than 10% of eligible children have gotten their updated booster shot, and more than 90% of children under 5 are completely unvaccinated.

“If we looked at all those other leading causes of death – whether you’re talking about motor vehicle accidents or childhood cancer – and we said, ‘Gosh, if we had some simple, safe thing we could do to get rid of one of those, wouldn’t we just jump at it?” And we have that with Covid with vaccines,” said O’Leary, who is also a professor of pediatric infectious disease at the University of Colorado School of Medicine and Children’s Hospital Colorado.

A CDC survey of blood samples suggest that more than 90% of children have already had Covid-19 at least once.

There is uncertainty about exactly how much risk the virus will continue to pose, O’Leary said, but the potential benefits of vaccination clearly outweigh any potential risks.

“Vaccination clearly is our best option right now,” and the benefits clearly outweigh the risks, he said. “Better safe than sorry.”

The findings of the new study, published in JAMA Network Open, may underestimate the mortality burden of Covid-19 because the analysis focuses on deaths where Covid-19 was an underlying cause of death but not those where it may have been a contributing factor, the researchers wrote. Also, other analyses of excess deaths suggest that Covid-19 deaths have been underreported.

As Covid-19 continues to spread in the US, the researchers say that intervention methods such as vaccination and ventilation will “continue to play an important role in limiting transmission of the virus and mitigating severe disease.”

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FDA vaccine advisers vote to harmonize Covid-19 vaccines in the United States

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CNN
 — 

A panel of independent experts that advises the US Food and Drug Administration on its vaccine decisions voted unanimously Thursday to update all Covid-19 vaccines so they contain the same ingredients as the two-strain shots that are now used as booster doses.

The vote means young children and others who haven’t been vaccinated may soon be eligible to receive two-strain vaccines that more closely match the circulating viruses as their primary series.

The FDA must sign off on the committee’s recommendation, which it is likely to do, before it goes into effect.

Currently, the US offers two types of Covid-19 vaccines. The first shots people get – also called the primary series – contain a single set of instructions that teach the immune system to fight off the original version of the virus, which emerged in 2019.

This index strain is no longer circulating. It was overrun months ago by an ever-evolving parade of new variants.

Last year, in consultation with its advisers, the FDA decided that it was time to update the vaccines. These two-strain, or bivalent, shots contain two sets of instructions; one set reminds the immune system about the original version of the coronavirus, and the second set teaches the immune system to recognize and fight off Omicron’s BA.4 and BA.5 subvariants, which emerged in the US last year.

People who have had their primary series – nearly 70% of all Americans – were advised to get the new two-strain booster late last year in an effort to upgrade their protection against the latest variants.

The advisory committee heard testimony and data suggesting that the complexity of having two types of Covid-19 vaccines and schedules for different age groups may be one of the reasons for low vaccine uptake in the US.

Currently, only about two-thirds of Americans have had the full primary series of shots. Only 15% of the population has gotten an updated bivalent booster.

Data presented to the committee shows that Covid-19 hospitalizations have been rising for children under the age of 2 over the past year, as Omicron and its many subvariants have circulated. Only 5% of this age group, which is eligible for Covid-19 vaccination at 6 months of age, has been fully vaccinated. Ninety percent of children under the age of 4 are still unvaccinated.

“The most concerning data point that I saw this whole day was that extremely low vaccination coverage in 6 months to 2 years of age and also 2 years to 4 years of age,” said Dr. Amanda Cohn, director of the US Centers for Disease Control and Prevention’s Division of Birth Defects and Infant Disorders. “We have to do much, much better.”

Cohn says that having a single vaccine against Covid-19 in the US for both primary and booster doses would go a long way toward making the process less complicated and would help get more children vaccinated.

Others feel that convenience is important but also stressed that data supported the switch.

“This isn’t only a convenience thing, to increase the number of people who are vaccinated, which I agree with my colleagues is extremely important for all the evidence that was related, but I also think moving towards the strains that are circulating is very important, so I would also say the science supports this move,” said Dr. Hayley Gans, a pediatric infectious disease specialist at Stanford University.

Many others on the committee were similarly satisfied after seeing new data on the vaccine effectiveness of the bivalent boosters, which are cutting the risk of getting sick, being hospitalized or dying from a Covid-19 infection.

“I’m totally convinced that the bivalent vaccine is beneficial as a primary series and as a booster series. Furthermore, the updated vaccine safety data are really encouraging so far,” said Dr. David Kim, director of the the US Department of Health and Human Services’ National Vaccine Program, in public discussion after the vote.

Thursday’s vote is part of a larger plan by the FDA to simplify and improve the way Covid-19 vaccines are given in the US.

The agency has proposed a plan to convene its vaccine advisers – called the Vaccines and Related Biological Products Advisory Committee, or VRBPAC – each year in May or June to assess whether the instructions in the Covid-19 vaccines should be changed to more closely match circulating strains of the virus.

The time frame was chosen to give manufacturers about three months to redesign their shots and get new doses to pharmacies in time for fall.

“The object, of course – before anyone says anything – is not to chase variants. None of us think that’s realistic,” said Jerry Weir, director of the Division of Viral Products in the FDA’s Office of Vaccines Research and Review.

“But I think our experience so far, with the bivalent vaccines that we have, does indicate that we can continue to make improvements to the vaccine, and that would be the goal of these meetings,” Weir said.

In discussions after the vote, committee members were supportive of this plan but pointed out many of the things we still don’t understand about Covid-19 and vaccination that are likely to complicate the task of updating the vaccines.

For example, we now seem to have Covid-19 surges in the summer as well as the winter, noted Dr. Michael Nelson, an allergist and immunologist at the University of Virginia. Are the surges related? And if so, is fall the best time to being a vaccination campaign?

The CDC’s Dr. Jefferson Jones said that with only three years of experience with the virus, it’s really too early to understand its seasonality.

Other important questions related to the durability of the mRNA vaccines and whether other platforms might offer longer protection.

“We can’t keep doing what we’re doing,” said Dr. Bruce Gellin, chief of global public health strategy at the Rockefeller Foundation. “It’s been articulated in every one of these meetings despite how good these vaccines are. We need better vaccines.”

The committee also encouraged both government and industry scientists to provide a fuller picture of how vaccination and infection affect immunity.

One of the main ways researchers measure the effectiveness of the vaccines is by looking at how much they increase front-line defenders called neutralizing antibodies.

Neutralizing antibodies are like firefighters that rush to the scene of an infection to contain it and put it out. They’re great in a crisis, but they tend to diminish in numbers over time if they’re not needed. Other components of the immune system like B-cells and T-cells hang on to the memory of a virus and stand ready to respond if the body encounters it again.

Scientists don’t understand much about how well Covid-19 vaccination boosts these responses and how long that protection lasts.

Another puzzle will be how to pick the strains that are in the vaccines.

The process of selecting strains for influenza vaccines is a global effort that relies on surveillance data from other countries. This works because influenza strains tend to become dominant and sweep around the world. But Covid-19 strains haven’t worked in quite the same way. Some that have driven large waves in other countries have barely made it into the US variant mix.

“Going forward, it is still challenging. Variants don’t sweep across the world quite as uniform, like they seem to with influenza,” the FDA’s Weir said. “But our primary responsibility is what’s best for the US market, and that’s where our focus will be.”

Eventually, the FDA hopes that Americans would be able to get an updated Covid-19 shot once a year, the same way they do for the flu. People who are unlikely to have an adequate response to a single dose of the vaccine – such as the elderly or those with a weakened immune system – may need more doses, as would people who are getting Covid-19 vaccines for the first time.

At Thursday’s meeting, the advisory committee also heard more about a safety signal flagged by a government surveillance system called the Vaccine Safety Datalink.

The CDC and the FDA reported January 13 that this system, which relies on health records from a network of large hospital systems in the US, had detected a potential safety issue with Pfizer’s bivalent boosters.

In this database, people 65 and older who got a Pfizer bivalent booster were slightly more likely to have a stroke caused by a blood clot within three weeks of their vaccination than people who had gotten a bivalent booster but were 22 to 42 days after their shot.

After a thorough review of other vaccine safety data in the US and in other countries that use Pfizer bivalent boosters, the agencies concluded that the stroke risk was probably a statistical fluke and said no changes to vaccination schedules were recommended.

At Thursday’s meeting, Dr. Nicola Klein, a senior research scientist with Kaiser Permanente of Northern California, explained how they found the signal.

The researchers compared people who’d gotten a vaccine within the past three weeks against people who were 22 to 42 days away from their shots because this helps eliminate bias in the data.

When they looked to see how many people had strokes around the time of their vaccination, they found an imbalance in the data.

Of 550,000 people over 65 who’d received a Pfizer bivalent booster, 130 had a stroke caused by a blood clot within three weeks of vaccination, compared with 92 people in the group farther out from their shots.

The researchers spotted the signal the week of November 27, and it continued for about seven weeks. The signal has diminished over time, falling from an almost two-fold risk in November to a 47% risk in early January, Klein said. In the past few days, it hasn’t been showing up at all.

Klein said they didn’t see the signal in any of the other age groups or with the group that got Moderna boosters. They also didn’t see a difference when they compared Pfizer-boosted seniors with those who were eligible for a bivalent booster but hadn’t gotten one.

Further analyses have suggested that the signal might be happening not because people who are within three weeks of a Pfizer booster are having more strokes, but because people who are within 22 to 42 days of their Pfizer boosters are actually having fewer strokes.

Overall, Klein said, they were seeing fewer strokes than expected in this population over that period of time, suggesting a statistical fluke.

Another interesting thing that popped out of this data, however, was a possible association between strokes and high-dose flu vaccination. Seniors who got both shots on the same day and were within three weeks of those shots had twice the rate of stroke compared with those who were 22 to 42 days away from their shots.

What’s more, Klein said, the researchers didn’t see the same association between stroke and time since vaccination in people who didn’t get their flu vaccine on the same day.

The total number of strokes in the population of people who got flu shots and Covid-19 boosters on the same day is small, however, which makes the association a shaky one.

“I don’t think that the evidence are sufficient to conclude that there’s an association there,” said Dr. Tom Shimabukuro, director of the CDC’s Immunization Safety Office.

Nonetheless, Richard Forshee, deputy director of the FDA’s Office of Biostatistics and Pharmacovigilance, said the FDA is planning to look at these safety questions further using data collected by Medicare.

The FDA confirmed that the agency is taking a closer look.

“The purpose of the study is 1) to evaluate the preliminary ischemic stroke signal reported by CDC using an independent data set and more robust epidemiological methods; and 2) to evaluate whether there is an elevated risk of ischemic stroke with the COVID-19 bivalent vaccine if it is given on the same day as a high-dose or adjuvanted seasonal influenza vaccine,” a spokesperson said in a statement.

The FDA did not give a time frame for when these studies might have results.

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FDA wants to simplify the use and updating of Covid-19 vaccines

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CNN
 — 

The US Food and Drug Administration wants to simplify the Covid-19 vaccine process to look more like what happens with the flu vaccine, according to documents posted online on Monday. That could include streamlining the vaccine composition, immunization schedules and periodic updates of Covid-19 vaccines.

The FDA said it expects to assess circulating strains of the virus that causes Covid-19 at least annually and decide in June which strains to select for the fall season, much like the process to update annual flu vaccines.

Moving forward, the agency said, most people may need only one dose of the latest Covid-19 shot to restore protection, regardless of how many shots they have already received. Two doses may be needed for people who are very young and haven’t been exposed, or for the elderly or immune-compromised, according to the FDA’s briefing document for its vaccine advisers.

The agency is urging a shift toward only one vaccine composition, rather than a combination of monovalent vaccines, which are currently used for primary shots and target only one strain, and bivalent vaccines, which are currently used for booster doses and target more than one strain.

“This simplification of vaccine composition should reduce complexity, decrease vaccine administration errors due to the complexity of the number of different vial presentations, and potentially increase vaccine compliance by allowing clearer communication,” the FDA said.

The FDA’s plan was first reported by National Public Radio.

The agency’s independent vaccine advisers, the Vaccines and Related Biological Products Advisory Committee, are scheduled to meet on Thursday to discuss the future of Covid-19 vaccine regimens, and will be asked to vote on whether they recommend parts of FDA’s plan.

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Jeff Zients to Be Named White House Chief of Staff

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WASHINGTON—President

Biden

is planning to name

Jeff Zients,

an investor and former

Obama

administration official who led the White House’s Covid-19 response, to be his next chief of staff, according to people familiar with the decision.

Ron Klain,

Mr. Biden’s current chief of staff, is expected to step down in the coming weeks after more than two years on the job. The Washington Post earlier reported that Mr. Zients was expected to replace him. Mr. Zients didn’t respond to requests for comment, and the White House declined to comment.

Mr. Zients helmed the White House efforts to increase distribution of the Covid-19 vaccine during the first year of Mr. Biden’s presidency, helping to cobble together a network to make the shots available nationally.

He left the administration in April last year, saying he had no specific job plans, and in recent months was tapped by Mr. Klain to prepare for staff departures and help identify potential replacements, according to people familiar with the matter. Mr. Zients co-chaired Mr. Biden’s presidential transition team in 2020.

The president is turning to Mr. Zients as his next chief of staff because of his reputation as a manager with a history of navigating government bureaucracy, the people familiar with the matter said.

Mr. Zients is expected to bring to the job a more decentralized approach than the one favored by Mr. Klain, who was involved in nearly every aspect of day-to-day operations at the White House, some of the people familiar with the matter said. 

While Mr. Zients is expected to focus on policy and governing, other longtime aides to Mr. Biden are likely to be more involved in advising the president on political matters as he faces investigations from newly empowered House Republicans and prepares to announce his reelection bid. 

White House Chief of Staff Ron Klain and President Biden greeting each other at a White House event.



Photo:

KEVIN LAMARQUE/REUTERS

In the coming year, White House officials expect to focus on implementing a slate of laws signed by the president since he took office, including measures to fix the country’s aging infrastructure, invest in renewable energy and boost semiconductor manufacturing. Options for major legislative breakthroughs will be limited now that Republicans have taken control of the House.

Mr. Zients was a top economic adviser to President

Barack Obama,

serving as the director of the National Economic Council and a senior official at the Office of Management and Budget. Mr. Zients joined the board of

Facebook Inc.

—now part of Meta Platforms Inc.—in 2018 after leaving the Obama administration. He was a top executive with the Cranemere Group, an investment holding company.

At the beginning of Mr. Obama’s presidency, Mr. Zients was appointed the administration’s chief performance officer, a newly created role that centered on making the government more efficient. He later led a mission aimed at fixing HealthCare.gov, the federal website for the Affordable Care Act, when it experienced technological difficulties in 2013. He brought in private companies and technology firms to undertake a rapid review of the platform’s problems.

Mr. Zients is known as a meticulous planner. In his beginning days handling the Covid-19 response, he scheduled hour-by-hour what needed to be done to execute his pandemic plan. He and Mr. Biden spoke three to four times a week while he was overseeing the coronavirus response.

While Mr. Zients’ selection to handle the pandemic was initially criticized by some progressives who said he lacked public health experience, he earned bipartisan praise in hearings for his efforts to rapidly disseminate vaccines after a bumpy rollout during the end of the Trump administration. About 65% of the population, or more than 200 million people, were fully vaccinated by the time he announced in March 2022 that he would be leaving his position. 

He also won high marks for shifting the administration from a more reactive approach to the pandemic to responding to Covid-19 as an ongoing public health issue. He pledged a wartime response to the administration’s global response to Covid-19 but some donations to poor countries fell short of targets because of low demand and limited funding.

Mr. Biden was criticized in 2021 for holding a massive July Fourth party on the South Lawn and declaring “we’re closer than ever to declaring our independence from a deadly virus”  just as the Delta variant began spreading in the U.S., causing another round of shutdowns.  

Later that winter when the Omicron wave caused infections to spike, the lack of testing kits caused long lines and concerns across the country. The president acknowledged in a January 2022 speech that the situation was “frustrating.” 

Messrs. Biden and Zients developed a relationship during the Obama administration, and became closer when Mr. Zients was brought on as an adviser to Mr. Biden’s 2020 presidential campaign. Mr. Zients doesn’t have the kind of decadeslong relationship with Mr. Biden that some of the president’s closest aides have. But those advisers—including senior White House aides

Mike Donilon,

Steve Ricchetti

and

Bruce Reed

—are expected to continue working closely with Mr. Biden as he prepares to announce his reelection bid in the coming month.

“He has the utmost integrity and that’s why everyone trusts him,” said Andrew Slavitt, who was a senior adviser for the Biden administration Covid-19 response. “He over-communicates and seeks out everyone’s views but does it in a way to push the ball down the field every day.”

Mr. Zients’ experience and ties in the business world has engendered skepticism from some progressive groups, many of whom developed close relationships with Mr. Klain.

Matt Stoller, the director of Research at the American Economic Liberties Project, a nonprofit that advocates for strict antitrust enforcement, called Mr. Zients “an ugly choice” for the job, noting that he joined the board of Facebook in the wake of the Cambridge Analytica scandal.

Write to Andrew Restuccia at andrew.restuccia@wsj.com, Stephanie Armour at Stephanie.Armour@wsj.com and Annie Linskey at annie.linskey@wsj.com

Copyright ©2022 Dow Jones & Company, Inc. All Rights Reserved. 87990cbe856818d5eddac44c7b1cdeb8

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Jeff Zients to replace Ron Klain as White House chief of staff

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CNN
 — 

Jeff Zients, who ran President Joe Biden’s Covid-19 response effort and served in high-ranking roles in the Obama administration, is expected to replace Ron Klain as the next White House chief of staff, according to three people briefed on the matter.

Klain is expected to step down in the coming weeks.

The move to replace Klain is particularly important for Biden, who has entered a critical moment in his presidency and his political future. As he continues to weigh whether to seek reelection in 2024, the early stages of a special counsel investigation into his handling of classified documents has rattled Democrats and emboldened congressional Republicans, who now hold the House majority and have pledged their own probes.

Biden decided on Zients after an internal search when it became clear that Klain favored Zients as his successor, a factor that played a big role in the president’s decision. Klain had tapped Zients to lead a talent search for expected staff turnover following the midterm elections, but that didn’t ultimately materialize after Democrats performed better than expected. Klain is now the most significant departure and is being replaced by the person he picked to help bring in new team members.

A source said Klain will continue to be involved and remain close to the West Wing. Biden’s core political and legislative team – which includes Steve Ricchetti, Anita Dunn, Mike Donilon, Jen O’Malley Dillon, Bruce Reed and Louisa Terrell – will continue to advise him. Zients’ new role is being compared to when Jack Lew was Obama’s chief of staff and others, like David Plouffe, focused more on his political portfolio.

Additional political talent is expected to join for the likely re-election campaign, CNN is told.

In replacing Klain with Zients, Biden is turning to a consultant with more business experience than political background as he enters the third year of his presidency.

The decision to pick Zients surprised some internally given that there were differences in Biden’s and Zients’ management styles early on in the administration. But Biden was impressed with his job as the coronavirus response coordinator when Zients inherited what officials described as a “largely dysfunctional” effort by the Trump administration.

Another factor in the search was how this stretch of Biden’s presidency will focus on implementing the legislation enacted in his first two years, and Zients is seen internally as a “master implementor,” one source said. His operational skills were on display as his handled the coronavirus response and helped with the bungled 2013 launch of HealthCare.gov during the Obama administration.

Zients now has a closer relationship with Biden and with his senior advisers and multiple Cabinet members.

While Zients is not viewed as a political operator, his deep experience inside two administrations and his reputation for technocratic skill would likely serve as assets at a time when both are viewed as critical for what Biden faces in the year ahead. Still, he will be tasked with replacing an official who was a central force inside the administration – and someone with a rapport developed over decades with Biden himself.

Klain, who had long planned to depart the White House after Biden’s first two years, has targeted the weeks after the February 7 State of the Union address for the end of his tenure.

A number of top officials had been viewed as top candidates to succeed Klain, including Cabinet members and close Biden advisers such as Ricchetti, counselor to the president, and Dunn, the senior adviser with a wide-ranging strategy and communications portfolio.

But while Zients isn’t among the tight-knit circle of long-tenured Biden advisers, he’s been deeply intertwined with the team since the 2020 campaign, when he served as co-chairman of Biden’s transition outfit.

After the election Biden tapped Zients to lead the administration’s Covid-19 response effort as he entered office with the country facing dueling public health and economic crises. While Zients left that role last spring, he was once again brought into White House operations a few months later when Klain asked him to lead the planning for the expected turnover inside the administration that historically follows a president’s first midterm elections.

Zients was tasked with conducting a wide and diverse search for prospective candidates outside the administration to fill Cabinet, deputy Cabinet and senior administration roles, officials said, in an effort that would be closely coordinated with White House counterparts.

But even as wide-scale turnover has remained minimal for an administration that has taken pride in its stability in the first two years, now, the official leading the planning effort may soon shift into one of, if not the, most critical role set to open.

The White House chief of staff is a grueling and all-consuming post in any administration, and Klain’s deep involvement across nearly every key element of process, policy and politics touching the West Wing only served to elevate that reality.

A long-time Washington hand with ties Democratic administrations – and Biden – that cross several decades, Klain is departing at a moment that officials inside the West Wing have spent the last several months viewing as a high point.

Biden entered 2023 on the heel of midterm elections that resulted in an expanded Senate majority for his Democratic Party and the defiance of widespread expectations of massive GOP victories in the House.

The sweeping and far-reaching cornerstones of Biden’s legislative agenda have largely been signed into law, the result of a series of major bipartisan wins paired with the successful navigation of intraparty disputes to secure critical Democratic priorities.

Biden has made clear to advisers that the successful implementation of those laws – which is now starting to kick into high gear across the administration – is one of their most critical priorities for the year ahead.

But Zients will also inherit a West Wing now faced with a new House Republican majority that is girding for partisan warfare – and wide-scale investigations into the administration and Biden’s family.

This story has been updated with additional information.

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Health

For Future Viral Threats, Health Officials Look to Sewage

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When the virologist Kirsten St. George learned last summer that a paralyzed patient in New York’s Rockland County had tested positive for polio, she turned her attention to the state’s sewers.

Polio is particularly stealthy because most infected people never develop symptoms but can still spread the virus. A wastewater-surveillance network established during the Covid-19 pandemic helped officials at the New York State Department of Health’s Wadsworth Center track polio’s spread in several counties.

New York is now expanding wastewater monitoring and starting to look for flu, RSV, hepatitis A, norovirus and antibiotic-resistant genes in parts of the state, as health officials across the U.S. consider wastewater as a more permanent public-health tool for watching a variety of threats.

“Are we on the brink of another outbreak, if it’s rising? Is it just sort of holding steady?” asked Dr. St. George, Wadsworth’s director of virology. “These are all important public health questions.”   

Dr. Kirsten St. George of the Wadsworth Center is looking for clues in the state’s sewage.
An analysis conducted at the Wadsworth Center indicates the presence of the hepatitis A virus.

Dr. Kirsten St. George of the Wadsworth Center, which is starting to track the spread of pathogens including the hepatitis A virus.

For decades, researchers around the world used wastewater primarily to track poliovirus, which spreads through contact with an infected person’s feces. At the onset of the pandemic, scientists found that the Covid-19 virus’s genetic material could be detected in sewage. That meant sewage might help track other respiratory viruses, too.

Researchers built surveillance networks around the country to track Covid-19 and monitor for variants. 

Now they are starting to leverage that system to search for other pathogens they had wanted to track through the sewers for years including norovirus and antibiotic-resistant microbes, said Amy Kirby, program lead of wastewater surveillance at the Centers for Disease Control and Prevention. 

“Once you have this system, it’s much easier to activate it for a new pathogen,” Dr. Kirby said.

Sewage samples from treatment plants are sent to labs, where genetic material that can come from hundreds of thousands of people is isolated. Researchers usually test samples for pathogens with the PCR technology used in a Covid-19 lab test administered at the doctor’s office.  

Health officials use the data to track changing concentrations of a virus, which can help them monitor the spread of pathogens including flu and RSV for which many people might not be tested. The technique has yielded early evidence of Covid-19 outbreaks and helped officials tailor public messaging and decide where to open testing sites.

Biobot Analytics Inc., which works with the CDC to monitor Covid-19 and the renamed mpox, started tracking opioids in wastewater before the pandemic. It has collected data on substances including fentanyl in more than 100 counties across 47 states. Officials in Cary, N.C., used that data to encourage people to dispose of drugs properly and to distribute more overdose-reversal drugs, Biobot said.

Not everything can be tracked through sewage, and there isn’t a standard national system for collecting data and comparing readings from site to site. Privacy can be a concern in smaller communities or when tracking illicit substances, researchers said, though wastewater data is processed as an anonymous group sample. And some communities that collect wastewater data aren’t using it to guide public-health policy, researchers said. 

The wastewater treatment plant in Schenectady, N.Y., is participating in the study of sewage.
Workers at the Schenectady treatment plant collect samples and ship them for analysis.
Analysis of the wastewater samples is conducted at the Wadsworth Center in Albany, N.Y.

The wastewater treatment plant in Schenectady, N.Y., where workers collect samples and ship them for analysis at the Wadsworth Center in Albany, N.Y.

The National Academies of Sciences, Engineering, and Medicine said in a report Thursday that the U.S. should invest more in the CDC’s wastewater-surveillance network and expand its reach. The report recommended that the CDC should have an open process for picking which pathogens to track and establish an ethics committee, among other steps.  

“We’re at a critical juncture where it has gone from being a grass-roots effort to a more nationally recognized tool,” said Megan Diamond, head of the Rockefeller Foundation’s wastewater-surveillance program, who wasn’t involved with the report.

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After a polio case was confirmed in New York in July, health officials reviewed stored wastewater samples and found poliovirus in wastewater from several counties, including as far back as spring. Health officials urged people who weren’t vaccinated against polio to get the shots and alerted doctors.

The CDC extended poliovirus wastewater testing to a handful of counties with low vaccination rates or potential connections to New York’s polio case.

“What you might expect a virus to do when it starts circulating is exactly what we saw in the wastewater,” said Dan Lang, deputy director of New York’s Center for Environmental Health and head of the state’s wastewater-monitoring program.

No samples tested positive for poliovirus by the end of November, but it was detected again in Orange County last month. Health officials are planning to analyze past samples from additional counties for traces of the virus before deciding whether to widen poliovirus wastewater monitoring when the weather warms and the virus can spread more readily. 

“We’re worried about a big sort of roaring back,” said Dr. Eli Rosenberg, a lead epidemiologist who coordinates New York’s polio response. “We’re using this time now to prepare.”

Poliovirus was found in Orange County, N.Y., last month.

Write to Brianna Abbott at brianna.abbott@wsj.com

Copyright ©2022 Dow Jones & Company, Inc. All Rights Reserved. 87990cbe856818d5eddac44c7b1cdeb8

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Business

Here are the companies that have laid off employees this year

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New York
CNN
 — 

Just this week, Alphabet, Google’s parent company, Microsoft

(MSFT) and Vox Media announced layoffs that will affect more than 22,000 workers.

Their moves follow on the heels of job cuts earlier this month at Amazon, Goldman Sachs and Salesforce. More companies are expected to do the same as firms that aggressively hired over the last two years slam on the brakes, and in many cases shift into reverse.

The cutbacks are in sharp contrast to 2022, which had the second-highest level of job gains on record, with 4.5 million. But last year’s job numbers began falling as the year went on, with December’s job report showing the lowest monthly gains in two years.

The highest level of hiring occurred in 2021, when 6.7 million jobs were added. But that came on the heels of the first year of the pandemic, when the US effectively shut down and 9.3 million jobs were lost.

The current layoffs are across multiple industries, from media firms to Wall Street, but so far are hitting Big Tech especially hard.

That’s a contrast from job losses during the pandemic, which saw consumers’ buying habits shifting toward e-commerce and other online services during lockdown. Tech firms went on a hiring spree.

But now, workers are returning to their offices and in-person shopping is bouncing back. Add in the increasing likelihood of a recession, higher interest rates and tepid demand due to rising prices, and tech businesses are slashing their costs.

January has been filled with headlines announcing job cuts at company after company. Here is a list of layoffs this month – so far.

Google

(GOOGL)’s parent said Friday it is laying off 12,000 workers across product areas and regions, or 6% of its workforce. Alphabet added 50,000 workers over the past two years as the pandemic created greater demand for its services. But recent recession fears has advertisers pulling back from its core digital ad business.

“Over the past two years we’ve seen periods of dramatic growth,” CEO Sundar Pichai said in an email to employees. “To match and fuel that growth, we hired for a different economic reality than the one we face today.”

The tech behemoth is laying off 10,000 employees, the company said in a securities filing on Wednesday. Globally, Microsoft has 221,000 full-time employees with 122,000 of them based in the US.

CEO Satya Nadella said during a talk at Davos that “no one can defy gravity” and that Microsoft could not ignore the weaker global economy.

“We’re living through times of significant change, and as I meet with customers and partners, a few things are clear,” Nadella wrote in a memo. “First, as we saw customers accelerate their digital spend during the pandemic, we’re now seeing them optimize their digital spend to do more with less.”

The publisher of the news and opinion website Vox, tech website The Verge and New York Magazine, announced Friday that it’s cutting 7% of its staff, or about 130 people.

“We are experiencing and expect more of the same economic and financial pressures that others in the media and tech industries have encountered,” chief executive Jim Bankoff said in a memo.

Layoffs are also hitting Wall Street hard. The world’s largest asset manager is eliminating 500 jobs, or less than 3% of its workforce.

Today’s “unprecedented market environment” is a stark contrast from its attitude over the last three years,, when it increased its staff by about 22%. Its last major round of cutbacks was in 2019.

The bank will lay off up to 3,200 workers this month amid a slump in global dealmaking activity. More than a third of the cuts are expected to be from the firm’s trading and banking units. Goldman Sachs

(FADXX) had almost 50,000 employees at the end of last year’s third quarter.

The crypto brokerage announced in early January that it’s cutting 950 people – almost one in five employees in its workforce. The move comes just a few months after Coinbase laid off 1,100 people.

Though Bitcoin had a solid start to the new year, crypto companies were slammed by significant drops in prices of Bitcoin and other cryptocurrencies.

McDonald’s

(MCD), which thrived during the pandemic, is planning on cutting some of its corporate staff, CEO Chris Kempczinski said this month.

“We will evaluate roles and staffing levels in parts of the organization and there will be difficult discussions and decisions ahead,” Kempszinski said, outlining a plan to “break down internal barriers, grow more innovative and reduce work that doesn’t align with the company’s priorities.”

The online personalized subscription clothing retailer said it plans to lay off 20% of its salaried staff.

“We will be losing many talented team members from across the company and I am truly sorry,” Stitch Fix

(SFIX) founder and former CEO Katrina Lake wrote in a blog post.

As the new year began, Amazon

(AMZN) said it plans to lay off more than 18,000 employees. Departments from human resources to the company’s Amazon

(AMZN) Stores will be affected.

“Companies that last a long time go through different phases. They’re not in heavy people expansion mode every year,” CEO Andy Jassy said in a memo to employees.

Amazon boomed during the pandemic, and hired rapidly over the last few years. But demand has cooled as consumers return to their offline lives and battle high prices. Amazon says it has more than 800,000 employees.

At The New York Times DealBook summit In November, Jassy said he believes Amazon “made the right decision” regarding its rapid infrastructure build out but said its hiring spree is a “lesson for everyone.”

Even as he spoke, Amazon warehouse workers who helped organize the company’s first-ever US labor union at a Staten Island facility last year were picketing Jassy’s appearance outside the conference venue.

“We definitely want to take this opportunity to let him know that the workers are waiting and we are ready to negotiate our first contract,” Amazon Labor Union President Chris Smalls said, calling the protest a “welcoming party” for Jassy.

Salesforce

(CRM) will cut about 10% of its workforce from its more than 70,000 employess and reduce its real estate footprint. In a letter to employees, Salesforce

(CRM)’s chair and co-CEO Marc Benioff admitted to adding too much to the company’s headcount early in the pandemic.

– CNN’s Clare Duffy, Matt Egan, Oliver Darcy, Julia Horowitz, Catherine Thorbecke, Paul R. La Monica, Nathaniel Meyersohn, Parija Kavilanz, Danielle Wiener-Bronner and Hanna Ziady contributed to this report.

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Health

Origins of plague could have emerged centuries before outbreaks, study suggests

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CNN
 — 

In the largest DNA analysis of its kind, scientists have found evidence to suggest that historic plague pandemics, such as the Black Death, were not caused by newly evolved strains of bacteria but ones that could have emerged up to centuries before their outbreaks.

The plague-causing bacterium Yersinia pestis is dated to have first emerged in humans about 5,000 years ago. Through animals and trade routes, Y. pestis spread globally over time on multiple occasions, according to a study published Thursday in the journal Communications Biology.

It caused the first plague pandemic in the sixth to eighth centuries and the second one in the 14th to 19th centuries. The latter pandemic is thought to have started with the medieval Black Death outbreak, which is estimated to have killed more than half of Europe’s population. The bacterium also caused the third plague pandemic between the 19th and 20th centuries.

By amassing 601 Y. pestis genome sequences, including modern and ancient strains, researchers from Canada and Australia were able to calculate the time when the bacterial strains likely emerged as a threat. They divided the different strains of the plague bacterium and analyzed each strain population individually.

The strain responsible for the Black Death, which the study says is thought to have begun in 1346, was newly estimated to have diverged from an ancestral strain between 1214 and 1315 — up to 132 years earlier.

The strain of Y. pestis associated with the first plague pandemic was previously recorded as first appearing during the Plague of Justinian, which began in 541. However, the researchers estimated that the strain was already present between 272 and 465 — up to almost 270 years before the outbreak.

“It shows that each major plague pandemic has likely emerged many decades to centuries earlier than what the historical record suggests,” study coauthor and evolutionary geneticist Hendrik Poinar, director of McMaster University’s Ancient DNA Centre in Canada, told CNN via email Thursday.

He added that the bacterium emerged, created small epidemics and then “for reasons we don’t quite understand,” such as famine or war, “it takes off.”

The study authors estimated that individually assessed bacterial strains from the third plague pandemic diverged from an ancestral strain between 1806 and 1901, with highly localized plague cases beginning to appear in southern China between 1772 and 1880 and later diverging into various strains that spread globally out of Hong Kong between 1894 and 1901.

The study also found evidence to support recent academic research suggesting that the third and second plague pandemics were not mutually exclusive events, but that the third was partly the continuation or tail end of the second. Despite the pandemics having their own diverse genetic lineages that evolved differently, the third descended directly from the 14th century strain that caused the second.

Poinar called this finding significant because “it takes into account that most of the history of this bacterium has been a Eurocentric view, so while plague supposedly disappeared from Europe in the 18th (century), it continued to rage in the Ottoman Empire and throughout the Middle East and likely North Africa.”

However, even with so many sequences of the plague bacterium, researchers were not able to determine the path of the global spread of the plague.

A lot of the genetic samples come from Europe. For example, the emergence of the bacterium in Africa has led to 90% of all modern plague cases occurring on the continent, yet there are no ancient sequences from the region, which is represented by just 1.5% of all genome samples — making it difficult to date the appearance of Y. pestis in Africa.

There is also far less surviving historical evidence from the second plague pandemic to help estimate its geographic origins compared with the third, with the earliest textual evidence of the pandemic in Europe coming from the Black Death in 1346, the study authors said. The researchers estimated that the second pandemic originated in Russia.

A study published in the journal Nature in June used DNA analysis to find the plague bacterium in three individuals who are dated to have died in 1338 in what’s now Kyrgyzstan in Central Asia. It provided evidence that the Black Death came from a strain originating in the area near Lake Issyk-Kul in Kyrgyzstan in the early 14th century.

The latest study concluded that more ancient DNA will be needed to refine current estimates on the early events of the second pandemic.

Via email, Poinar described the strain from Kyrgyzstan as “really fascinating” but said that it “still doesn’t sit at the root. So I would guess we’re still looking for something a good 20-50 years earlier.”

He and the other authors noted that the only way to estimate the evolution of the plague bacterium strains precisely “is with well dated sequences, such as those from skeletal remains at Lake Issyk-Kul.”

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Health

Flu, Covid-19 and RSV are all trending down for the first time in months

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CNN
 — 

A rough respiratory virus season in the US appears to be easing, as three major respiratory viruses that have battered the country for the past few months are finally all trending down at the same time.

A new dataset from the US Centers for Disease Control and Prevention shows that the number of emergency department visits for the three viruses combined – flu, Covid-19 and RSV – have dropped to the lowest they’ve been in three months. The decline is apparent across all age groups.

Measuring virus transmission levels can be challenging; health officials agree that Covid-19 cases are vastly undercounted, and surveillance systems used for flu and RSV capture a substantial, but incomplete picture.

But experts say that tracking emergency department visits can be a good indicator of how widespread – and severe – the respiratory virus season is.

“There’s the chief complaint. When you show up to the emergency room, you complain about something,” said Janet Hamilton, executive director at Council of State and Territorial Epidemiologists. “Being able to look at the proportion of individuals that seek care at an emergency department for these respiratory illness concerns is a really good measure of the respiratory disease season.”

In the week following Thanksgiving, emergency department visits for respiratory viruses topped 235,000 – matching rates from last January, according to the CDC data.

While the surge in emergency department visits early in the year was due almost entirely to Omicron, the most recent spike was much more varied. In the week ending December 3, about two-thirds of visits were for flu, about a quarter were for Covid-19 and about 10% were for RSV.

Grouping the impact of all respiratory viruses together in this way offers an important perspective.

“There’s a strong interest in thinking about respiratory diseases in a more holistic way,” Hamilton said. “Transmission is the same. And there are certain types of measures that are good protection against all respiratory diseases. So that could really help people understand that when we are in high circulation for respiratory diseases, there are steps that you can take – just in general.”

Now, Covid-19 again accounts for most emergency department visits but flu and RSV are still the reason behind about a third of visits – and they’re all trending down for the first time since the respiratory virus season started picking up in September.

More new data from the CDC shows that overall respiratory virus activity continues to decline across the country. Only four states, along with New York City and Washington, DC, had “high” levels of influenza-like illness. Nearly all states were in this category less than a month ago.

Whether that pattern will hold is still up in the air, as vaccination rates for flu and Covid-19 are lagging and respiratory viruses can be quite fickle. Also, while the level of respiratory virus activity is lower than it’s been, it’s still above baseline in most places and hospitals nationwide are still about 80% full.

RSV activity started to pick up in September, reaching a peak in mid-November when 5 out of every 100,000 people – and 13 times as many children younger than five – were hospitalized in a single week.

RSV particularly affects children, and sales for over-the-counter children’s pain- and fever-reducing medication were 65% higher in November than they were a year before, according to the Consumer Healthcare Products Association. While “the worst may be over,” demand is still elevated, CHPA spokesperson Logan Ramsey Tucker told CNN in an email – sales were up 30% year-over-year in December.

But this RSV season has been significantly more severe than recent years, according to CDC data. The weekly RSV hospitalization rate has dropped to about a fifth of what it was two months ago, but it is still higher than it’s been in previous seasons.

Flu activity ramped up earlier than typical, but seems to have already reached a peak. Flu hospitalizations – about 6,000 new admissions last week – have dropped to a quarter of what they were at their peak a month and a half ago, and CDC estimates for total illnesses, hospitalizations and deaths from flu so far this season have stayed within the bounds of what can be expected. It appears the US has avoided the post-holiday spike that some experts cautioned against, but the flu is notoriously unpredictable and it’s not uncommon to see a second bump later in season.

The Covid-19 spike has not been as pronounced as flu, but hospitalizations did surpass levels from the summer. However, the rise in hospitalizations that started in November has started to tick down in recent weeks and CDC data shows that the share of the population living in a county with a “high” Covid-19 community level has dropped from 22% to about 6% over the past two weeks.

Still, the XBB.1.5 variant – which has key mutations that experts believe may be helping it to be more infectious – continues to gain ground in the US, causing about half of all infections last week. Vaccination rates continue to lag, with just 15% of the eligible population getting their updated booster and nearly one in five people remain completely unvaccinated.

Ensemble forecasts published by the CDC are hazy, predicting a “stable or uncertain trend” in Covid-19 hospitalizations and deaths over the next month.

And three years after the first Covid-19 case was confirmed in the US, the virus has not settled into a predictable pattern, according to Dr. Maria Van Kerkhove, the World Health Organization’s technical lead for the Covid-19 response.

“We didn’t need to have this level of death and devastation, but we’re dealing with it, and we are doing our best to minimize the impact going forward,” Van Kerkhove told the Conversations on Healthcare podcast this week.

Van Kerkhove says she does believe 2023 could be the year in which Covid-19 would no longer be deemed a public health emergency in the US and across the world, but more work needs to be done in order to make that happen and transitioning to longer-term respiratory disease management of the outbreak will take more time.

“We’re just not utilizing [vaccines] most effectively around the world. I mean 30% of the world still has not received a single vaccine,” she said. “In every country in the world, including in the US, we’re missing key demographics.”

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