“Attack the evil that is within yourself, rather than attacking the evil that is in others.”
― Confucius
“In the long run, we shape our lives, and we shape ourselves. The process never ends until we die. And the choices we make are ultimately our own responsibility.”
― Eleanor Roosevelt
Dear Friends,
We must all take personal responsibility for all of our decisions and we must make ourselves knowledgeable about all the things that affect us. We need to stop listening to the politicians and media on both sides that sow discourse and try to shape our opinions and decisions without the benefit of all the facts. We cannot let the politicians tell us what they think they want us to hear nor the media who try and shape our opinion rather than report the facts. We must not take everything at face value but research the facts and the information that is being disseminated out there. There is a lot of distortion of both the facts and the truth on both sides and it is up to us to sort through the nonsense and determine what is the truth.
I take Dr. Fauci’s position that Masks are the best thing to help stop the spread especially in this COVID weary country. But no one talks about what is the proper Mask. Cloth masks that are handmade or store bought are fashionable and make all kinds of fashion statements are only about 30% effective. Surgical medical masks that are 3 ply material are 60% effective and N-95 or the Chinese /European equivalent KN-95 are 95% or higher effective. Masks need to fit tightly around the nose and mouth with no spaces around the nose or mouth. There should be a metal strip to allow for the proper fitting around the nose and mouth.
Also, another Fauci-ism: Avoid crowds especially indoor crowds. Now that we are entering Fall and Winter things will be moving in doors. We have the holidays coming up where we will be tempted to get together with family and friends. We must be careful about mixing our personal bubbles with other bubbles. Remember this is an airborne respiratory virus. It can travel up from 6-16 feet through the air and can remain suspended in the air from 10-20 minutes. Most homes do not have HEPA filter or other air purifying systems which can then put you at risk especially when you lower your guard and take your mask off because you think you are in a safe environment.
FACT VS. HYPE
The Institute for Health Metrics and Evaluation at the University of Washington School of Medicine in Seattle suggests that COVID-19 deaths may increase 78% by February 1, 2021 with a projected death toll of 390,000 Americans. The statisticians note that the death rate may only reach 314,000 if Americans wear their masks, but could hit 477,000 if mask requirements are eliminated.
Daily case numbers have begun to rapidly increase across the United States, particularly in the northern half of the nation.
If all Americans use masks, the death toll could be lower and hit around 314,000. If mask mandates are lifted, the total could soar to more than 477,000 deaths.
"The winter surge appears to have begun somewhat later than the surge in Europe," they wrote. "Daily deaths will reach over 2,000 a day in January even with many states re-imposing mandates before the end of the year."
Nearly 40 states are reporting an increase in COVID-19 cases this week, according to data from Johns Hopkins University, and 21 states have hit a record for their seven-day average in new cases.
The national total of new daily cases reached nearly 60,000 on Wednesday and 56,000 on Thursday. The seven-day average is up 16% from the week before.
NOTE: (JAV opinion) This is a modeling projection and pay attention to the phases that I underlined. The number of positive cases is going up. This is true as people are becoming COVID-19 weary. I would like to not only see the number of positive cases which I feel people are becoming immune to, but more importantly the number and age groups of the people who are showing positive signs, the number and age hospitalized and the number and age who die. These specific numbers I feel will have a more specific impact and provide the desired effect among the population as a whole.
FDA Accepted Therapeutic’s: The FDA approved Remdesivir (Veklury) on Thursday for treating hospitalized COVID-19 patients, a first for the disease that started a global pandemic.
Remdesivir, an antiviral that works by limiting SARS-CoV-2 replication, is indicated for hospitalized patients age 12 and up (and at least 40 kg [88.2 lbs.]). Previously, the intravenous drug was solely available under an emergency use authorization (EUA) from the agency.
FDA also announced a new EUA for Remdesivir in hospitalized kids age 12 and older weighing at least 3.5 kg (7.7 lbs.) but less than 40 kg, and in kids under age 12 weighing at least 3.5 kg.
Approval was based on three randomized trials, including the National Institutes of Health-led ACTT-1 trial, a phase III trial that showed that patients with mild, moderate, and severe disease who were treated with up to 10 days of Remdesivir recovered a median 5 days quicker than those on placebo (10 vs 15 days; rate ratio [RR] 1.29, 95% CI 1.12-1.49, P<0.001), and a median 7 days quicker in those requiring oxygen at baseline (11 vs 18 days; RR 1.31, 95% CI 1.12-1.52).
"The approval of Veklury marks an important milestone in efforts to help address the pandemic by offering an effective treatment that helps patients recover faster and, in turn, helps preserve scarce healthcare resources," ACTT-1 investigator Barry Zingman, MD, of the Albert Einstein College of Medicine and Montefiore Medical Center in New York City, said in a press release from drug maker Gilead Sciences.
"Today's approval is supported by data from multiple clinical trials that the agency has rigorously assessed and represents an important scientific milestone in the COVID-19 pandemic," said FDA Commissioner Stephen Hahn, MD, in the agency's announcement.
Other trials that supported approval showed that a 5-day course of the drug was roughly equivalent to a 10-day course, and that some clinical benefit was also seen in patients hospitalized with moderate illness.
ANOTHER CO- MORBIDITY: Patients with cancer and COVID-19 have a higher risk of severe disease and mortality, researchers reported.
Of 89 cancer patients admitted to the intensive care unit (ICU) due to COVID-19, 32 died, a mortality rate of 36%, reported Michael Dang, MD, a critical care fellow at Memorial Sloan Kettering Cancer Center in New York City, at the virtual CHEST conference, the annual meeting of the American College of Chest Physicians
"The landscape of COVID-19 data is continuously changing," Dang said in his oral presentation. "Mortality rates are typically higher than general medical populations, but cancer with COVID-19 is survivable."
NOTE: (JAV OPINION) Cancer is added the list of co morbidities in addition to overweight, heart disease, lung disease, diabetes, immune compromised, liver and kidney issues as well as age.
CDC NEW DEFINITION: The United States Centers for Disease Control and Prevention (CDC) changed the definition of “close contact,” from spending 15 minutes consecutively within 6 feet of a person infected with the novel coronavirus to a total of 15 non-consecutive minutes or longer over a period of time. This difference highlights the risk of transmission from brief but repeated exposures over time. The CDC continues to recommend that individuals exposed to a person who tests positive for COVID-19 should quarantine for 2 weeks.
This change was made after a prison guard in Vermont tested positive for COVID-19 after being exposed to incarcerated people with COVID-19 for 17 minutes total over an 8-hour period. The guard was always masked and wore goggles; however, the incarcerated people were only sometimes masked. Public health officials suggest that COVID-19 spreads more easily than many people believe.
In a statement, CDC officials said the case highlights again the importance of wearing masks to prevent transmission, and that the agency’s guidance can change as new information comes in.
“As we get more data and understand this COVID we’re going to continue to incorporate that in our recommendations,” CDC Director Robert Redfield said at a press conference in Atlanta.
The CDC also says close contact can include hugging and kissing, sharing eating or drinking utensils with someone infected, and providing home care to someone who is sick. Someone sneezing or coughing on you also counts.
The risk of spread is considered to be lower outdoors, but the CDC guidance update “makes scientific sense,” said Dr. Michael Saag, an infectious disease researcher at the University of Alabama at Birmingham.
NOTE: (JAV Opinion) This emphasizes the importance of wearing Masks when out. Wearing the proper mask and wearing it properly and minimizing the exposure of yourself to other people’s bubbles that live outside your bubble. This includes all indoor group activities
COVID AND MORTALITY RATES ARE ON THE DECKLINE: Two new peer-reviewed studies are showing a sharp drop in mortality among hospitalized COVID-19 patients. The drop is seen in all groups, including older patients and those with underlying conditions, suggesting that physicians are getting better at helping patients survive their illness.
"We find that the death rate has gone down substantially," says Leora Horwitz, a doctor who studies population health at New York University's Grossman School of Medicine and an author on one of the studies, which looked at thousands of patients from March to August.
The study, which was of a single health system, finds that mortality has dropped among hospitalized patients by 18 percentage points since the pandemic began. Patients in the study had a 25.6% chance of dying at the start of the pandemic; they now have a 7.6% chance.
Until next time Stay Safe, Stay Well, Stay Distant, Avoid Crowds and wear your Mask
James A Vito, D.M.D.