Tag Archives: Strain

Health

As respiratory viruses strain US health care systems, Biden administration tells states how it’s ready to help

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CNN
 — 

Nearly 20,000 people in the United States were admitted to the hospital for flu last week, almost double the number of admissions from the week before, according to data updated Friday by the US Centers for Disease Control and Prevention.

The CDC estimates that there have been at least 8.7 million illnesses, 78,000 hospitalizations and 4,500 deaths from influenza this season.

In a letter to the nation’s governors Friday, US Health and Human Services Secretary Xavier Becerra notes that flu and other respiratory viruses are “increasing strain” on the country’s health care systems.

In a letter obtained exclusively by CNN, Becerra wrote that the Biden administration “stands ready to continue assisting you with resources, supplies, and personnel.”

Last month, children’s health leaders requested a formal emergency declaration from the federal government to support hospitals and communities amid an “alarming surge of pediatric respiratory illnesses, including respiratory syncytial virus (RSV) and influenza, along with the continuing children’s mental health emergency.”

The Biden administration has not declared a public emergency for RSV or flu, but the Becerra letter outlines ways the public health emergency declaration for Covid-19 can be applied to more broadly address challenges brought on by a confluence of Covid-19 and other respiratory and seasonal illnesses.

“The Administration has exercised regulatory flexibilities to help health care providers and suppliers continue to respond to COVID-19. These flexibilities – while critical in addressing the COVID-19 pandemic – can also help address many of the challenges you face during the spread of non-COVID-19 illnesses, including RSV and flu,” the letter says. “They remain available to you and health care providers as you all make care available in response to flu, RSV, COVID-19, and other illnesses.”

For example, if a hospital has staffing shortages that have been exacerbated by the Covid-19 pandemic, it may use a waiver that would allow increased surge capacity or easier patient transfers – even if the patients need treatment for something other than Covid-19, such as flu or RSV.

The letter also highlights available funding, including $400 million from the US Centers for Disease Control and Prevention to prepare for and respond to public health threats each year, including flu and other respiratory diseases such as RSV, along with data, analysis and other planning resources put together by the federal government. It also notes that the federal government is monitoring the supply chain for critical drugs and devices and that federal health officials over the past month have been engaging with the nation’s governors through a meeting hosted by the National Governors Association.

“As your federal partner, we stand ready to evaluate any request for federal medical assistance and support – including requests for medical personnel and equipment – working in close coordination with you and local jurisdictions to determine the needs and availability of matching resources,” Becerra wrote.

Flu activity has been highest in the South, with hot spots spreading from El Paso to southwest Virginia. All but six states are experiencing “high” or “very high” respiratory virus levels, and seasonal flu activity remains “high and continues to increase,” according to the CDC.

There have been nearly 17 flu hospitalizations for every 100,000 people this season, rates typically seen in December or January. The cumulative hospitalization rate hasn’t been this high at this point in the season in more than a decade.

The latest surveillance data probably does not reflect the full effects of holiday gatherings, as it only captures through November 26, two days past Thanksgiving.

While flu continues to ramp up, RSV has shown signs of slowing nationwide, but test positivity rates are still higher than they’ve been in years, and cumulative hospitalization rates are about 10 times higher than typical for this point in the season. Less than two months in, the RSV hospitalization rate this season is already nearing the total RSV hospitalization rate from the entire 2018-19 season.

There is no vaccine for RSV, but health officials have urged people to get their flu shots and updated Covid-19 boosters heading into winter. With the holiday season – and flu season – underway, Dr. Anthony Fauci warned this week of the potential for an emergency situation.

“When you have very little wiggle room of intensive care beds, when you have like almost all the intensive care beds that are occupied, it’s bad for the children who have RSV and need intensive care. But it also occupies all the beds, and children who have a number of other diseases that require intensive care or ICU, they don’t have the bed for it,” Fauci, director of the National Institute of Allergy and Infectious Diseases, said on CBS’s “Face the Nation” on Sunday. “So if you get to that situation, that’s approaching an emergency.”

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Health

COVID plus flu and RSV spike puts Bay Area hospitals under strain

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Bay Area health officials on Wednesday said a substantial increase in flu activity and other
respiratory viruses
since the start of the month has led to a spike in emergency department visits and is putting a strain on health systems across the region.

“This is the first year where we’re not only facing COVID but also increased influenza activity and unusually high levels of RSV,” Dr. Sarah Rudman, deputy health officer for Santa Clara County, said during a press briefing. “These are two other types of viruses that can also cause possibly the same respiratory symptoms as COVID, but can also cause severe respiratory disease — or even life-threatening disease.”

The
Santa Clara County
health department said that the percentage of emergency department visits for influenza-like illness is three times higher this year than it was during the 2019-2020 flu season, before the start of the COVID-19 pandemic. In response, the agency has launched a
wastewater data dashboard
to monitor flu concentration in the county — one of the first of its kind in the U.S.

The tool, which is used extensively to monitor coronavirus levels, serves as an early warning system for hospitals and health care systems.

“Right now, the wastewater are showing rising levels of flu in every part of our county — in every sewershed that we monitor,” Rudman said.

Bay Area pediatric hospitals are seeing a rise in cases of the respiratory syncytial virus, or RSV, a common viral illness that can cause breathing trouble for infants and young children, and in older adults. It’s part of a nationwide surge that has grown particularly severe in some parts of the country.

On Monday, California
health officials reported the first death
of a child under age 5 who was infected with flu and RSV. The state’s public health department did not disclose where the death occurred. and it’s not clear which virus caused the death.

“We have seen an abrupt increase in all of our RSV cases,” Dr. Vidya Mony, a pediatric infectious diseases specialist at Santa Clara Valley Medical Center, said during Wednesday’s briefing. “If you look at a lot of the curves, it’s almost linear. This is significantly more than we have seen in quite a few years.”

The UCSF Benioff Children’s Hospitals are tallying “very high volumes” of respiratory illnesses including RSV, said chief medical officer Dr. Joan Zoltanski.

“As soon as a bed opens right now, there is someone waiting to take that bed,” she said. “In the emergency room we have many patients, and the patients who are there without a need for very emergent care are waiting much, much longer than normal.”

On Wednesday, Tamalpais Pediatrics, which has several clinics in Marin County, sent out an advisory to its customers that said, “We are experiencing an unprecedented volume of calls, portal messages and visits.”

Dr. Nelson Branco, of Tamalpais Pediatrics, said its offices usually receive 200-300 calls and 100-120 visits on a Monday at this time of year. The practice received over 500 calls Monday and is seeing 170-180 patients daily this week, with those for same-day care mostly for respiratory illness, Branco said.

“A couple weeks ago it was high. Now it’s at a point that I’ve never seen in my more than 25 years of practice,” Branco said.

The volume has not equated to more severe cases of infections, Branco said, but “the few that we’ve needed to send to the hospital, we’ve struggled to find them a place.”

Branco noted that after an early surge in RSV cases, the practice saw more flu cases over the past week or two.

“Those who are the sickest in our office, at all ages, have been testing positive for influenza,” he said.

“In the past couple of weeks, both in our in-patient and our out-patient settings, we have seen an acute surge of patients,” said Mony. “The predominant cause for these hospitalizations are secondary for respiratory viruses, specifically RSV.”

RSV cases dropped dramatically in 2020, the first year of the pandemic. But they
surged last summer
as COVID restrictions eased. While this year’s uptick got off to a slower start, positive tests have recently exceeded the numbers from this time last year,
according to Centers for Disease Control and Prevention data.

Mony added, “I’ve also seen an uptick in COVID-19 infections in our pediatric patients in the past couple of weeks.”

While vaccines for flu and COVID-19 are widely available, there are no shots available to prevent RSV. Health officials instead urge Bay Area residents to follow the measures that also curb the spread of COVID-19 — washing their hands often, wearing masks when indoors, and keeping people who are sick at home as much as possible.

“While all of these viruses can sometimes cause milder illnesses in most older children or younger adults, they’re all especially dangerous for our youngest children, our oldest adult community members, and people with other medical problems,” Rudman said. “Right now, we are already seeing these diseases hit our youngest children.”

Aidin Vaziri and Matt Kawahara are San Francisco Chronicle staff writers. Email: avaziri@sfchronicle.com; mkawahara@sfchronicle.com

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US

Biden warns GOP could set nation on ‘path to chaos’ as democratic system faces strain

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Signs of strain in the nation’s democratic system mounted Wednesday with less than a week left before the midterm elections, as President Biden warned that candidates who refuse to accept Tuesday’s results could set the nation on a “path to chaos.”

Biden’s grim assessment in a speech Wednesday evening came as the FBI and other agencies have forecast that threats of violence from domestic extremists are likely to be on the rise after the election. In Arizona, voters have complained of intimidation by self-appointed drop-box monitors — some of them armed — prompting a federal judge to set strict new limits. And the GOP has stepped up litigation in multiple states in an effort to toss out some ballots and to expand access for partisan poll watchers.

Speaking at Washington’s Union Station — steps from the U.S. Capitol, which was attacked by a pro-Trump mob in the wake of the nation’s last major election — Biden warned of an ongoing assault on American democracy. The president spoke as a growing number of major Republican candidates have said they may follow in former president Donald Trump’s footsteps and refuse to concede should they lose.

“It’s unprecedented. It’s unlawful. And it is un-American,” Biden said. “As I’ve said before, you can’t love your country only when you win.”

A majority of GOP nominees deny or question the 2020 election results

The virtually unprecedented presidential message — a plea to Americans to accept the basic tenets of their democracy — came as millions of voters have already cast their ballots or are planning to go to the polls on Election Day, and as some election officials expressed confidence that the system would hold.

Biden spoke days after an assailant armed with a hammer broke into the San Francisco home of House Speaker Nancy Pelosi (D-Calif.) and, according to police and prosecutors, bludgeoned her 82-year-old husband, Paul. Biden opened by addressing the gruesome early Friday morning assault.

“We must, with one overwhelming unified voice, speak as a country and say there’s no place, no place for voter intimidation or political violence in America, whether it’s directed at Democrats or Republicans,” he said. “No place, period. No place, ever.”

Last week, multiple government agencies, including the FBI and Department of Homeland Security, issued a memo warning that threats posed by domestic violent extremists would probably increase in the 90-day post election period, according to a copy of the document obtained by The Washington Post.

The memo listed possible scenarios that could trigger more violence, including “actual or perceived efforts to suppress voting access.”

“Following the 2022 midterm election, perceptions of election-related fraud and dissatisfaction with electoral outcomes likely will result in heightened threats of violence against a broad range of targets — such as ideological opponents and election workers,” the memo read.

Election officials have said they don’t quite know what to expect, given promises from various Trump-supporting organizations to flood polls and counting stations with partisan observers. Trump allies have urged his backers to lodge frequent challenges, action that officials say could disrupt the process.

Biden has spoken more forcefully about the threats Republicans pose to democracy in recent months. While he began alluding to “MAGA Republicans” in the spring — a moniker he uses to distinguish those aligned with Trump from more traditional conservatives — Biden addressed the issue in unusually blunt terms at a fundraiser in late August, warning that the GOP was headed toward “semi-fascism.”

On Wednesday night, Biden cast the danger to democracy as part of an ongoing assault launched two years ago by Trump and the Republican Party he still leads. The pro-Trump faction of the party, he said, “is trying to succeed where they failed in 2020: to suppress the right of voters and subvert the electoral system itself.”

Even before Biden spoke Wednesday, Republican National Committee Chairwoman Ronna McDaniel issued a statement calling his words “desperate and dishonest.”

“Joe Biden promised unity but has instead demonized and smeared Americans, while making life more expensive for all,” McDaniel said. “While Republicans remain focused on the issues that matter most to voters, Biden and Democrats are flailing.”

The speech Wednesday evening was Biden’s most direct address about the threats the American democratic system faces since Sept. 1, when he delivered a speech outside Philadelphia’s Independence Hall and warned that “too much of what’s happening in our country today is not normal.”

“Donald Trump and the MAGA Republicans represent an extremism that threatens the very foundations of our republic,” he said then.

Shortly after Biden’s Philadelphia speech, top White House officials began talking about doing another similar speech about the threats to democracy, according to a person familiar with the planning who spoke on the condition of anonymity because they were not authorized to speak on the record.

Biden’s speech Wednesday was in the works for several weeks, the person said. But the opening was rewritten to address the assault on Paul Pelosi. Biden also made a point of mentioning Republicans who have been subjected to election threats and violence, including former vice president Mike Pence and Georgia Secretary of State Brad Raffensperger.

Biden urged voters to be patient after the election, noting that rules for counting ballots mean that some outcomes might not be immediately clear.

“It’s always been important for citizens in a democracy to be informed and engaged,” he said. “Now it’s important for citizens to be patient as well.”

And he urged citizens to take the future of democracy into account when making their choices Tuesday, saying they should vote “knowing what we’re at risk of becoming.”

“In our bones, we know democracy is at risk,” he said. “We also know this: It’s within our power, each and every one of us, to preserve our democracy.”

Unlike their Democratic counterparts, many Republicans locked in key races across the country have refused to say whether they will accept the results of Tuesday’s election.

“We’ll see what happens,” Republican Sen. Ron Johnson told reporters in Wisconsin on Tuesday. He is in a tight race with Democratic challenger Mandela Barnes, the lieutenant governor for his state. “I mean, is something going to happen on Election Day? Do Democrats have something up their sleeves?”

The president’s address came as developments in the courtroom and beyond have served to underscore anxieties about whether next week’s elections will run smoothly and whether results will be widely embraced as legitimate.

The Justice Department has said multiple divisions of the sprawling law enforcement agency will be working to ensure the voting process operates safely and smoothly across the country.

The department’s Civil Rights Division, which is charged with enforcing laws relating to voting rights, has said it will monitor the voting process across the country to ensure jurisdictions are complying with federal voting laws. The department has not said how many people it will dispatch or where they would send them. On Election Day 2020, it sent monitors to 44 jurisdictions, including Gwinnett County in Georgia, Broward County in Florida and Fairfax County in Virginia.

Already, the department has weighed in on an Arizona election lawsuit, supporting a claim by the League of Women Voters of Arizona that monitoring ballot drop boxes, including by filming voters depositing their ballots, can amount to illegal voter intimidation.

On Tuesday, U.S. District Judge Michael Liburdi, who was appointed to the bench by Trump, agreed, issuing a far-reaching order restricting what the Arizona group Clean Elections USA or its allies can do or say near ballot boxes. The ruling prevents drop-box watchers from taking photos or videos of voters and using the material to spread baseless allegations of electoral fraud. Clean Elections USA has been among the groups echoing the claims that “ballot traffickers” illegally deposited multiple ballots in drop boxes ahead of the 2020 presidential election.

Bill Gates, chairman of the governing board that oversees Maricopa County, home to most of Arizona’s voters, said “the rest of the world” will be watching how America conducts its elections as truth and misinformation collide.

“There’s a real concern that there’s something wrong with our democratic republic … and that Arizona … and Maricopa County is a place where this sort of battle is taking place,” said Gates, a Republican.

Meanwhile, in Pennsylvania, the state Supreme Court told counties not to count mail-in ballots without handwritten dates but left unanswered key legal questions about the issue, including how it will be resolved should top races in the critical state be tight. GOP voters, as well as the state and national parties, had sued over the issue, arguing that state law requires deeming invalid all ballots lacking a date or bearing an inaccurate date.

Lawyers for Leigh M. Chapman, the top state election official in the administration of Gov. Tom Wolf (D), had argued that multiple courts had previously ruled that undated ballots should be counted, and that counties have no way of determining whether the date on a mail envelope is “inaccurate.” They argued that a decision not to count those ballots would sow confusion and disenfranchise legal voters.

The case was part of a flood of litigation that has already been filed targeting election practices, court action that could spike after Election Day should key races be close. The RNC said it is involved in lawsuits in Michigan, North Carolina and Wisconsin to expand access for partisan poll watchers and challengers.

A judge in Wisconsin on Wednesday ordered a city clerk in Green Bay to give poll watchers more access, a day after a group of watchers filed suit saying they could not observe all aspects of early voting. City officials said they were making more areas available for observation in response to the lawsuit. The RNC praised the ruling as a victory for transparency.

How votes are cast and counted is increasingly decided in courtrooms

Democrats could challenge GOP actions in court, extending election action for days after Tuesday’s vote. Pennsylvania Attorney Gen. Josh Shapiro, the Democratic nominee for governor, told reporters on his campaign bus in Pittsburgh on Tuesday that he would use the courts if necessary to protect the vote.

“I’m confident if there’s a legal process we need to go through, that the will of the people will be respected,” said Shapiro, who is running against state Sen. Doug Mastriano (R), a leading proponent of false claims the 2020 election was stolen.

Mastriano was one of a dozen Republican candidates in competitive races for governor and Senate who declined to say whether they would accept the results of their contests in a September survey by The Washington Post.

In Wisconsin, Republican gubernatorial nominee Tim Michels suggested at a campaign stop Monday that his election would result in permanent GOP control in the state.

“Republicans will never lose another election in Wisconsin after I’m elected governor,” Michels said.

Michels is locked in a tight race with Gov. Tony Evers (D). The five-second clip of Michels saying Republicans would never lose another election if he wins was posted on Twitter by the liberal group American Bridge.

His spokesman later said he meant only that he would do a good job and voters would reward his party, but Democrats feared he was hinting at an overhaul of how state elections are administered.

Emma Brown, Amy Gardner, Colby Itkowitz, Annie Linskey, Patrick Marley, Yvonne Wingett Sanchez, Maria Sacchetti and Annabelle Timsit contributed to this report.



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Health

Docs sound alarm on triple-threat of RSV, flu and COVID as hospitals strain

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Doctors were prepared for a bad flu season but are worried about a multitude of viruses hitting children all at once.

That’s on top of an already active flu season and the threat of COVID-19 as we head into the winter months.

The triple-threat of viruses is especially worrisome for parents concerned their children will get sick at daycare or school.

Doctors told WRAL News they are seeing cases of RSV and flu skyrocket in area hospitals like WakeMed. They are hoping this uptick in cases doesn’t push the healthcare system to capacity.

“It’s definitely a worry,” said one parent, Michelle Lion-Atkins. “It just feels like you can’t escape getting something.”

Dr. David Weber from UNC Hospitals said people with RSV may show cold-like symptoms: fever, cough, fatigue and headache.

“We’re seeing substantially more children than we would expect at this time of the year hospitalized due to RSV, and we’ve seen a few cases of influenza hospitalized,” said Weber.

Viruses like RSV and the flu can be life-threatening for some children.

“Young children have to be careful about seizures due to high fever, turning blue from not enough oxygen,” said Weber. “Lethargy, not eating well.”

WakeMed reports 246 patients battling influenza, up from 130 cases two weeks ago. As for RSV, there are 183 cases.

Pre-COVID data from previous years were about 80 cases a week.

Doctors at UNC Health report approximately 30 cases of influenza and approximately 200 RSV cases.

Jessica Dixon with WakeMed hospital urged families to do their part to prevent the spread of viruses.

“I do think we’re going see these numbers continue to rise over the coming weeks and months,” said Dixon. “Everything you can do to keep sick kids at home is really important to keep your child away from other kids that are sick.”

Health experts told WRAL News prevention measures are important, as there are currently no vaccines approved for protection against RSV.

Children 6 months and older can get their flu shot and COVID-19 vaccine at the same time. The new booster, which targets the original coronavirus and the contagious omicron variant, is available for children five and older.

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Sports

Lakers’ Russell Westbrook cites coming off bench for hamstring strain

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SAN FRANCISCO — Russell Westbrook said he “absolutely” believes that Los Angeles Lakers coach Darvin Ham’s decision to bring him off the bench in L.A.’s preseason finale could have caused the hamstring strain he suffered that night.

“I’ve been doing the same thing for 14 years straight,” Westbrook said following the Lakers’ 123-109 loss to the Golden State Warriors in their regular-season opener Tuesday night. “Honestly, I didn’t even know what to do pregame. Being honest, I was trying to figure out how to stay warm and loose. … That’s something I just wasn’t accustomed to.”

Westbrook was back in the starting lineup against the Warriors — playing with the first unit for the 1,005th time in 1,022 career games — after being limited in the days leading up to it because of his hamstring injury.

He played just five minutes in the exhibition loss to the Sacramento Kings on Friday. He alluded to being able to play more but choosing not to because, “I wasn’t going to risk it in a preseason game.”

Westbrook played 31 minutes against Golden State and finished with 19 points on 7-for-12 shooting, 11 rebounds, three assists, one steal and four turnovers. His plus-minus rating of minus-six was better than that of both LeBron James (-10) and Anthony Davis (-21).

Ham said he wanted Westbrook’s approach to competition to jolt his team from the opening tip.

“You want to start the game off the right way in terms of your energy and being in attack mode, and no one better than him,” said Ham, who spoke to reporters before Westbrook did following the game. “I mean, it’s what we have, and we got some key guys hurt. It’s Game 1, give them a chance to go out and compete at the highest level. I thought he was solid. I thought he was solid. A couple possessions I wish I can get back, but overall, I thought he was solid.”

Before the contest, Ham said he wanted to “establish” a consistent starting unit.

“We don’t want to be one of those teams,” he said, “where teams are swaying according to who their opponent is starting.”

However, asked whether that meant he would stick with his opening-night starters for a stretch of time moving forward, Ham would not commit.

“We’ll see,” he said. “I’m a day-by-day guy.”

Davis said after the game that Westbrook’s bench role against the Kings was merely experimentation.

“I don’t think he was ever out of [the starting group],” Davis said. “I think it was a look [at a different rotation] in Sac.”

It was only the 22nd regular-season game that Davis, Westbrook and James played together since L.A. traded for Westbrook in the summer of 2021. The loss on Tuesday dropped their record together to 11-11. Yet Davis and James were encouraged.

“I think we played well,” Davis said. “We wanted to come out and everybody be aggressive. We didn’t want to — I think last year at times we were playing selfless, like, ‘Here [you take it].’ … It took away our aggression. At certain moments throughout the game, one of us three were aggressive, and it worked out for it to look good.”

As James added, “I thought we all just kind of played free. And it resulted in all three of us pretty much being efficient from the floor.”

TNT analyst Charles Barkley didn’t see it the same way.

“You know how I feel about Russell Westbrook,” Barkley said at halftime of the broadcast. “I admire him. I respect him. It’s time for the Lakers to move him. They have taken all his joy out of life and basketball. … This guy used to be so exuberant and play with great energy and great emotion, I think the wear and tear mentally last year, starting this year. … And the thing is, he’s going to get the blame no matter what, because the Lakers ain’t a championship contender. … I think he needs a fresh start, I think the Lakers need a fresh start, because they’re not contenders.”

Westbrook was asked about Barkley’s comments and whether he has lost joy for the game since joining the Lakers.

“You know, man, I’m super blessed and leaning a lot on my faith,” Westbrook said. “So, I have a lot of great friends and family, good people in my corner that support me through thick and thin, and when I have God in my corner, it doesn’t really matter what happens outside of that. I stay on course, stay focused, stay locked in. That’s all I can ask.

“Everything else that comes around it, I’ll continue doing what I’m doing, stay locked in on my craft and everything else will take care of itself.”

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Health

COVID may have pushed a leading seasonal flu strain to extinction

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Enlarge / A bottle of influenza vaccine at a CVS pharmacy and MinuteClinic on September 10, 2021, in Miami.

The pandemic coronavirus’ debut wrought universal havoc—not even seasonal flu viruses were spared. Amid travel restrictions, quarantines, closures, physical distancing, masking, enhanced hand washing, and disinfection, the 2020-2021 flu season was all but canceled. That meant not just an unprecedented global decrease in the number of people sick with the flu but also a dramatic collapse in the genetic diversity of circulating flu strains. Many subtypes of the virus all but vanished. But most notably, one entire lineage—one of only four flu groups targeted by seasonal influenza vaccines—went completely dark, seemingly extinct.

Researchers noted the absence last year as the flu was still struggling to recover from its pandemic knockout. But now, the flu has come roaring back and threatens to cause a particularly nasty season in the Northern Hemisphere. Still, the influenza B/Yamagata lineage remains missing, according to a study published this week in the journal Eurosurveillance. It has not been definitively detected since April 2020. And the question of whether it’s truly gone extinct lingers.

What B/Yamagata’s absence might mean for future flu seasons and flu shots also remains an open question. For a quick refresher: Four main types of seasonal flu have been circulating globally among humans in recent years. Two are influenza type A viruses: subtypes of H1N1 viruses and H3N2 viruses. The other two are influenza type B viruses: offshoots of the Victoria and Yamagata lineages. (For a more detailed explanation of influenza, check out our explainer here.) Current quadrivalent vaccines target season-specific versions of each of these four types of flu viruses.

Having fewer flu viruses around means it could be easier to match future vaccines to circulating viruses, making seasonal shots more effective. On the other hand, a surprise re-emergence of B/Yamagata could become more dangerous as time passes and people lose immunity. But, before health experts can game out future influenza seasons, they’d like to know if B/Yamagata is truly gone.

Vanished virus

In an article published this week in the journal Eurosurveillance, researchers in the Netherlands sifted through the latest global influenza surveillance data up to August 31, 2022, looking for the missing strain. They note that GISAID, a global database of influenza virus genetic sequences that typically gets thousands of flu sequences each year, has not received a single B/Yamagata sequence with specimen collection data after March 2020.

The World Health Organization’s FluNet surveillance data has had a small number of reports of the missing lineage—43 in 2021, mostly from China, and eight sporadic cases from four countries in 2022. For comparison, there were more than 51,000 detections of B/Yamagata in 2018.

The authors suggest the small number of cases in the last two years may be erroneous detections. Rather than circulating viruses, they may simply be detecting signatures of B/Yamagata from vaccines that carry live-attenuated influenza viruses. Or, they could be genetic contamination from inactivated-virus vaccines. This isn’t just a hypothetical. The authors note that a number of B/Yamagata detections in the US and Scotland were found to be from live-attenuated influenza vaccines rather than real cases of circulating virus.

The researchers call for flu surveillance laboratories to increase efforts to detect any Yamagata cases to determine if it’s truly gone or just lying low. “From a laboratory perspective, we think it would be advisable to increase the capability and capacity to determine the lineage of all detected influenza B viruses around the world as this is critical to determine the absence of B/Yamagata lineage viruses,” they conclude. They also propose that the World Health Organization set up criteria to define when the lineage could be declared “extinct” and what the consequences of what that declaration might be.

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US

California temperatures soar to new records, adding strain to power grid

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Sept 4 (Reuters) – Record high temperatures were expected in California’s Central Valley from Sacramento to outside of Los Angeles on Sunday, with officials warning that the dangerous heat wave could afflict the state through the end of the week and test the limits of the electric grid.

State officials on Sunday were urging residents to limit their power usage for the fifth day in a row as energy demand spiked and temperatures were still on the rise.

The worst of the heat was concentrated in the Central Valley on Sunday. The thermometer could hit 115 degrees Fahrenheit (46 degrees Celsius) by midweek, the National Weather Service said, warning residents to stay indoors to avoid heat-related illness.

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“The heat wave begins in earnest today with dangerous temperatures now forecast to extend through the end of the week,” National Weather Service Sacramento wrote on Twitter on Sunday.

The Southern California city of San Diego, which set a record temperature on Saturday of 95 degrees, could set another record on Sunday, National Weather Service forecaster Tony Fracasso said, although a chance of afternoon thunderstorms could offer some relief.

Crime scene tape barricades the area near burned cars, in the aftermath of the Mill Fire, in Weed, California, U.S., September 3, 2022. REUTERS/Fred Greaves/File Photo

The California Independent System Operator (ISO), which oversees the state’s electric grid, extended a “flex alert” to a fifth day, asking state residents to set their thermostats to 78 degrees or higher, avoid using major appliances, and turn off lights in order to conserve energy.

“Sunday, Monday, and Tuesday in particular are shaping up to be the most difficult of this heat wave,” the agency said in a news release.

It added that the state’s ongoing wildfires and potential new blazes could further strain the power grid by crippling lines and generators. More than two decades of drought and rising temperatures, exacerbated by climate change, have made California more vulnerable than ever to wildfires.

In Northern California’s Siskiyou County, where firefighters were battling the fast-moving Mill Fire that prompted thousands to evacuate their homes, the high temperature forecast for Sunday was 95 degrees.

Two people died in the fire, Siskiyou County Sheriff Jeremiah LaRue told a community meeting on Sunday, according to a video that his office shared on social media.

Temperatures were expected to top 100 degrees in the coming days. The fire had burned more than 4,000 acres and was 25% contained as of Sunday morning, according to the California Department of Forestry and Fire Protection.

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Reporting by Gabriella Borter and Michael Martina; Editing by Mark Porter and Bradley Perrett

Our Standards: The Thomson Reuters Trust Principles.

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Health

New strain found in the UK

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Further analysis is currently ongoing to see if this isolated case is Clade I, another sub-strain of Clade II, or a new clade altogether. 

If it is the more dangerous Clade I then it will mark a momentum shift for the outbreak, just as data suggest the UK was on the verge of extinguishing the outbreak. 

Current guidance states that if a case of monkeypox is known to be imported from West Africa, a region where monkeypox has been endemic for decades, then the individual must be admitted to an HCID hospital unit for monitoring.

As a result, the individual was admitted to the HCID ward at the Royal Liverpool.

Although the case was escalated to being a HCID due to pre-existing rules, it allowed for the genetic screening of the case. 

Dr Sophia Maki, incident director at the UKHSA, said: “We are working to contact the individuals who have had close contact with the case prior to confirmation of their infection, to assess them as necessary and provide advice.

“UKHSA and the NHS have well established and robust infection control procedures for dealing with cases of imported infectious disease and these will be strictly followed and the risk to the general public is very low.

“We remind everyone who is planning to travel to West and Central Africa to be alert for the symptoms of monkeypox and to call 111 if you have symptoms on your return.”

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Health

Overlapping emergencies strain the nation’s public health workforce and threaten critical vaccination campaigns

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Health officials are banking on vaccinations to contain monkeypox and polio before those become standing threats in the United States. They’re counting on updated boosters to restore waning immunity against Covid-19. With influenza expected back in the US this fall, flu shots could be critical to prevent severe illness and keep hospitals from becoming overwhelmed.

While the federal government will facilitate getting these inoculations to states, it will be the 2,820 state and local health departments that will spearhead the work of getting shots into arms, and public health experts say it’s not clear that these offices have enough funding or staff to get the job done.

“I think it’s deeply worrisome,” said Dr. Peggy Hamburg, former health commissioner for New York City and former commissioner of the US Food and Drug Administration. “It’s hard to imagine how state and local health departments can all mobilize, and they desperately do need additional support.”

“I think we have to recognize that this is a very vulnerable time,” said Hamburg, who recently chaired a commission for the nonprofit Commonwealth Fund on how to modernize the nation’s public health system.

After almost three years of contending with vaccine hesitancy, politics and a global pandemic, the nation’s public health workers are frayed and leaving their posts. More than 1 in 4 health department leaders quit their jobs during the pandemic, some after harassment and death threats. Studies are underway to measure how deeply those losses extended to their staff.

Now, these depleted agencies are being asked to tackle new threats like monkeypox without additional funding to handle them.

‘Overwhelmed is an understatement’

Can these agencies pull it off?

“Probably not,” says Caitlin Rivers, an epidemiologist and assistant professor at the Johns Hopkins Center for Health Security in an email to CNN. “Public health is chronically underfunded and understaffed. Substantial capacity was built during the COVID-19 response — for example, contact tracing teams — but many jurisdictions have wound down that infrastructure. Covid money is largely inflexible, so it can’t really be used for other threats like monkeypox.”

The nation’s vaccinators say they are struggling.

“Overwhelmed is an understatement,” said Claire Hannan, executive director of the Association of Immunization Managers.

Hannan said her members have not received any funding to carry out a vaccination campaign against monkeypox. Yet they’ve just been asked the change how the vaccine is given, switching from a more familiar under-the-skin injection to a shallower method that squirts the vaccine between skin layers, something that requires training to do correctly. The hope is that intradermal shots, which require one-fifth of a regular dose, can quickly increase supplies of this hard-to-get vaccine.

As a result, immunization managers are scrambling to find money and staff to order vaccines, manually track inventory, transport shots to the locations where they’re needed, train providers, and collect and send data back to federal health agencies like the US Centers for Disease Control and Prevention.

On top of that, ordering has started for updated boosters to protect against the BA.4 and BA.5 subvariants of the Omicron strain of the new coronavirus, which have been promised to Americans by mid-September.

Allotments in these early orders have been smaller than anticipated, Hannan said, which is forcing city and state health officials to develop plans for who should be first in line to get them, should demand initially outstrip supply.

Additionally, many cities are currently testing their sewage for poliovirus after it was detected recently in Rockland County, New York, and New York City. If additional community spread is suspected, those areas may need to mount vaccination campaigns to protect residents who haven’t had the shot, such as recent immigrants or young children who missed routine immunizations during the pandemic.

Children typically get four doses of the polio vaccine by the time they’re six years of age in the US, but many kids have fallen behind on their shots. Globally, the pandemic led to the largest backslide in childhood vaccination rates in 30 years, according to the World Health Organization. Health officials fear the erosion of this coverage has set the stage for the return of other infectious diseases, like measles.

“A break or a gap in delivery of vaccines sets us up for further outbreaks,” said Dr. Davidson Hamer, an infectious disease specialist at Boston University.

Distrust fuels hostility and hesitancy

Vaccines are considered one of the greatest triumphs of modern medicine, second only to clean water as a cost-effective health intervention. Each year, they prevent millions of deaths around the world. In their first year of use, the Covid-19 vaccines prevented nearly 20 million deaths, a recent study found.

Yet vaccine hesitancy has increased, fueled by misinformation on social media. While more than three-quarters of Americans are vaccinated against Covid-19, 19% say they definitely won’t get a Covid-19 vaccine.

If all these challenges weren’t enough, annual flu shots are due to roll out soon, and they could be especially important this fall.

Influenza made a comeback in Australia this year for the first time since the pandemic began. United States health officials watch Australia’s flu season closely for clues about what could happen here. They’re anticipating that we could see more flu transmission this year than we have for the past two years, and flu vaccinations will be key to preventing hospitalizations and deaths.

“I think right now we have a perfect storm in the vaccine world happening in this country,” said Michael Osterholm, who directs the Center for Infectious Disease Research and Policy.

He points out that even though average daily Covid-19 deaths are much lower than they were in 2020 and 2021, the US is still averaging more than 400 a day, making it the nation’s fourth leading cause of death. Most of those deaths are in unvaccinated people, according to the CDC.

Overall, more than 1 in 5 Americans are still unvaccinated against Covid-19, and that number doesn’t seem likely to budge. Vaccination rates are mostly stagnant.

It would take a more robust public health workforce, and a better funded one, to rebuild confidence in vaccines.

A recent study by The de Beaumont Foundation, a nonprofit that works to strengthen public health, found the public health system needs 80,000 more full-time staff — a whopping 80% increase over current staffing levels — to provide basic community services, like monitoring and controlling the spread of infectious diseases.

Brian Castrucci, president and CEO of that organization, says America won’t be able to restore its public health workforce until people value and respect the work they do.

“What we’ve seen during Covid is a fringe anti-vax movement move more mainstream, endangering our nation’s safety, security and economic prosperity,” Castrucci said. “It’s going to be harder and harder to vaccinate.”

“We are privileged as a society that we haven’t seen children in with crutches from polio. No one’s in an iron lung. And it has made us somewhat numb to the potential of what could really happen,” he said. “These are virulent diseases.”

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Sports

James Paxton Diagnosed With Lat Strain

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Aug. 19: Cotillo tweets that the strain appears to be mild, though Paxton will undergo an MRI to confirm. He’s shut down from throwing for the time being.

Aug. 18: Red Sox lefty James Paxton began a rehab assignment today but left after facing just two batters. This was initially reported to be lat tightness by Chris Cotillo of MassLive, with manager Alex Cora later telling Pete Abraham of The Boston Globe that Paxton has a lat strain.

Cotillo adds that Paxton is seeing a doctor tomorrow to determine the severity of the issue, but there’s no question this is a significant setback for the hurler. Today was his first attempt to pitch in an organized game since undergoing Tommy John surgery in April of last year. He was still going to need some time to ramp up for a starter’s workload and will now have to push that further down the road. Even a mild lat strain usually requires a recovery period of 2-3 weeks, which means the southpaw will likely be sidelined until some time in September even in a best case scenario.

It’s another disappointing development for Paxton, one of many in recent years, following on the heels of an excellent four-year stretch of effectiveness. From 2016 to 2019, he threw at least 121 innings in each season, keeping his ERA under 4.00 in each campaign as well. He had a 22.9% strikeout rate in 2016 but got it up near 30% for the latter three years of that stretch.

Unfortunately, injuries limited him to just five starts in 2020 and then just a single outing in 2021 before landing on the injured list. Despite two essentially lost seasons, the Red Sox took a chance on him this past winter, hoping he could recover his previous form once he returned to health. The contract reflected his uncertain status, with Paxton receiving a $6MM salary here in 2022 while rehabbing. At the end of the year, Boston will have to decide whether or not to trigger two $13MM club options for 2023 and 2024, effectively a two-year, $26MM deal. Should they decline, Paxton will then get to decide on a $4MM player option for next season.

If Paxton had come through this rehab looking like the solid mid-rotation arm he had been previously, there would have been good reason for the Red Sox to consider triggering their option, especially with Nathan Eovaldi, Rich Hill and Michael Wacha slated to reach free agency this fall. There’s also the uncertainty surrounding Chris Sale, who has thrown less than 50 total innings over the past three seasons due to his own injury concerns. However, the longer Paxton remains out of action, the more the needle will move towards the club declining their end of the deal. As for Paxton’s side of things, that will also surely depend upon the severity of his injury and whether he thinks he can top $4MM in the open market this offseason.

In the short-term, the Red Sox surely would have loved for Paxton to come back and help them with the stretch drive here in 2022, but that’s looking increasingly unlikely with today’s setback. Boston is currently four games behind Toronto and Tampa Bay for the final Wild Card spot in the American League, with three other clubs in between them.



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