In The News (18)

My Covid-19 Bubble Is Enormous Getting together with family for Thanksgiving without quarantining beforehand is like “bringing a loaded pistol for Grandma’s head” .......... “You’re going to say ‘Hi’ at Thanksgiving, ‘It’s so nice to see you,’” he said in a recent briefing, and then “you’re either going to be visiting her by FaceTime in the I.C.U. or planning a small funeral by Christmas.” 

The Lady and the Trump Unfeeling royals offer no respite from unfeeling Republicans. .......... this country is shot to hell and running on empty. ...... It’s outrageous that Congress left town for the holidays this weekend without passing Covid relief. ........  when Blair had to beg Queen Elizabeth to show more emotion ......... describes the palace as “a cold frozen tundra, an icy dark, loveless cave with no light, no hope, anywhere, not even the faintest crack.” ............. Dream on, Donald. Of his wooing, Diana told a friend, “He gives me the creeps.” Di, we know how you feel. 

Politics, Science and the Remarkable Race for a Coronavirus Vaccine The furious race to develop a coronavirus vaccine played out against a presidential election, between a pharmaceutical giant and a biotech upstart, with the stakes as high as they could get. ............  Few corporate competitions have unfolded with so much at stake and such a complex backdrop. 

‘प्रचण्डलाई फेरि महानायक बन्ने अवसर छ’ ‘प्रचण्ड र माधव कमरेडबीचको उच्च तहको सहकार्यले कम्युनिस्ट आन्दोलनलाई बचाउँछ’

It’s Time to Hunker Down A devastating surge is here. Unless Americans act aggressively, it will get much larger, very quickly. .......... Good news is arriving on almost every front: treatments, vaccines, and our understanding of this coronavirus. ........ Pfizer and BioNTech have announced a stunning success rate in their early Phase 3 vaccine trials—if it holds up, it will be a game changer. Treatments have gotten better too. A monoclonal antibody drug—similar to what President Donald Trump and former Governor Chris Christie received—just earned emergency-use authorization from the FDA. Dexamethasone—a cheap, generic corticosteroid—cut the death rate by a third for severe COVID-19 cases in a clinical trial. ............. We may soon get cheaper, saliva-based rapid tests that people can administer on their own, itself a potential game changer. .............  a devastating surge is now under way. And worse, we are entering this dreadful period without the kind of leadership or preparation we need, and with baseline numbers that will make it difficult to avoid a dramatic rise in hospitalizations, deaths, and potential long-term effects on survivors. ........... it’s not just confirmed cases that are on the rise. The United States is also experiencing a steep increase in hospitalizations, as well as about 1,500 reported deaths a day; those are the highest numbers since mid-May, and they are still rising sharply. ............. The Pfizer-BioNTech vaccine—or Moderna’s vaccine—may be available in the United States to health-care workers and other high-priority people as early as the end of this year. But it won’t be distributed widely until well into 2021, even in the best-case scenario—and the Pfizer vaccine needs two doses, about 21 days apart. ......... we desperately need to flatten the curve again before hospitals nationwide are overrun ............ The bottleneck for medical care isn’t just lack of space, or even equipment, which we may be able to increase, but staff—trained nurses and doctors who can attend to patients, and who cannot be manufactured out of thin air. ........... Fewer nonurgent but important surgeries, more overworked medical staff, and overburdened emergency rooms could all contribute to worsening health outcomes for many other viruses that peak in winter months, like influenza, as well other ordinary medical conditions. ................ This seasonality is not a huge surprise, which makes our lack of preparation even more tragic. The 1918 flu pandemic saw an earlier, milder wave in the spring; a lull in the summer; and a deadlier surge starting in the fall. Other coronaviruses endemic to us are also sharply seasonal, tending to peak in winter. This may be because the humidity and temperature conditions of fall and winter favor the virus more. It may also be because we spend more time indoors during the winter. Most likely, it’s a combination, along with other factors (less vitamin D? less light?). Whatever the causes, public-health experts knew a fall and winter wave was a high likelihood, and urged us to get ready. But we did not. ....................... Once the numbers are this large, it’s very easy for them to get much larger, very quickly—and they will. When we start with half a million confirmed cases a week, as we had in mid-October, it’s like a runaway train. Only a few weeks later, we are already at about 1 million cases a week, with no sign of slowing down. ................ We are barely nine or 10 months into this pandemic, and we have not experienced a full-blown fall or winter season. Everything that we may have done somewhat cautiously—and gotten away with—in summer may carry a higher risk now, because the conditions are different and the case baseline is much higher. ............... More people at the grocery store will be positive. A casual gathering of friends may be harder to hold outdoors. Even transmission from surfaces may pose a higher risk now, because lower humidity levels may improve the survivability of the virus. ......................  any gathering outside one’s existing quarantine pod should be avoided for now—especially if it is indoors. ....................  Pods should not expand unless absolutely necessary. .............. Shop in bulk, so you can do fewer trips to the store. ........... Many colleges are ending school and sending students home, for what could be a country-wide super-spreader event. ........... It might also be time for ordinary people to consider using higher-quality masks (N95s and KN95s)—something that public-health experts have long recommended. ............ As long as they are put on and taken off carefully (use hand sanitizer before and after), such masks are reusable after being left in a paper bag or breathable container for at least five days ..........  We are no longer in the open-ended, dreadful period of spring 2020, when we did not know if we’d even have a vaccine, whether any therapeutics would work, and whether we’d ever emerge from the shadow of this pandemic. We can see the cavalry coming, but until it’s here, we need to lock ourselves down once again.

How Many Americans Are About to Die? A new analysis shows that the country is on track to pass spring’s grimmest record. ............  the virus has, with ruthless regularity, killed at least 1.5 percent of all Americans diagnosed with COVID-19 over the past four months. .............. predicting the virus’s death toll in the near term has become a matter of brutal arithmetic: 150,000 cases a day, times 1.5 percent, will lead to 2,250 daily deaths. .................. In the spring, an enormous outbreak hit the New York metro area, infecting perhaps 20 percent of all New Yorkers, more than 1.6 million people. But up through mid-May, as the initial outbreak wound down, fewer than 200,000 cases were confirmed with PCR tests. (Almost 16,000 people had died in New York City alone by then.) ............... three out of four infections still go unconfirmed. ..............  How many people might die during the third surge? ........... the lagged case-fatality rate has averaged 1.8 percent since August ............ Every 100,000 cases would mean roughly 1,800 dead Americans a few weeks later. ............. the country would hit an average of 2,000 deaths a day on November 30. ......... For all our talk of better treatments and more widespread testing, we do not yet see evidence that those factors have led to major declines in the death rate over the past three months. ........... the standard of care is likely to fall in places experiencing major surges. Treatment of severe COVID-19 is an intricate and laborious process; understaffed and exhausted units are unlikely to sustain the level of care that has improved the case-fatality rate. ............. the entire state of Iowa is now out of staffed hospital beds, with more than 3,000 cases being diagnosed every day. ............... The pandemic is out of control and many, many people are dying. The longer we continue along our current path, the higher the death toll will rise.

‘No One Is Listening to Us’ More people than ever are hospitalized with COVID-19. Health-care workers can’t go on like this. ........... health-care workers do not have the luxury of looking away: They’re facing a third pandemic surge that is bigger and broader than the previous two. In the U.S., states now report more people in the hospital with COVID-19 than at any other point this year—and 40 percent more than just two weeks ago. ................  Some health-care workers told me that COVID-19 patients are the sickest people they’ve ever cared for: They require twice as much attention as a typical intensive-care-unit patient, for three times the normal length of stay. ...............  Hospitalizations lag behind cases by about two weeks; by Thanksgiving, today’s soaring cases will be overwhelming hospitals that already cannot cope. “The wave hasn’t even crashed down on us yet,” Perencevich said. “It keeps rising and rising, and we’re all running on fear. The health-care system in Iowa is going to collapse, no question.” .............. This cumulative knowledge means that death rates from COVID-19 are much lower now than they were in the spring. Flattening the curve worked as intended, giving health-care workers some breathing room to learn how to handle a disease that didn’t even exist this time last year. ............. If death rates have fallen thanks to increasing medical savvy, they might rise again as nurses and doctors burn out. ............ Every day, they’ll need to be flipped onto their stomach, and then onto their back again—a process that requires six or seven people. They’ll have several tubes going into their heart and blood vessels, administering eight to 12 drugs—sedatives, pain medications, blood thinners, antibiotics, and more. All of these must be carefully adjusted, sometimes minute to minute, by an ICU nurse. None of these drugs is for treating COVID-19 itself. “That’s just to keep them alive,” Neville, the Iowa nurse, said. An ICU nurse can typically care for two people at a time, but a single COVID-19 patient can consume their full attention. Those patients remain in the ICU for three times the length of the usual stay. ............... a third pandemic surge that is bigger and broader than the previous two. .................. Nurses and doctors are also falling sick themselves. “The winter is traditionally a very stressful time in health care, and everyone gets taken down at some point” ............  The third COVID-19 surge has intensified this seasonal cycle, as health-care workers catch the virus, often from outside the hospital. ...........  “but now the entire nation is on fire.” No one has reinforcements to send. ...........  COVID-19 has eaten away at the emotional core of their work. “To be a nurse, you really have to care about people,” Neville said. But when an ICU is packed with COVID-19 patients, most of whom are likely to die, “to protect yourself, you just shut down. You get to the point when you realize that you’ve become a machine. There’s only so many bags you can zip.” .............. across the country, doctors and nurses have struggled with the same anxieties as everyone else—loneliness, extra child-care burdens, the stress of a tumultuous year, fear. “The lines between our personal lives and our careers have completely gone” ...............  “I’ve had conversations with people who’ve been nurses for 25 years, and all of them say the same thing: ‘We’ve never worked in this environment before’” ...........  As hard as the work fatigue is, the “societal fatigue” is harder ........... He is tired of walking out of an ICU where COVID-19 has killed another patient, and walking into a grocery store where he hears people saying it doesn’t exist. ............ The next months will be bleak. .......... ending a steady stream of gaslighting and misinformation from the federal government itself. ............ Biden will inherit a health-care system that is battered at best and broken at worst, a polarized electorate, and many local leaders who are doubling down on bad policies. Trump won Iowa by eight points ...........  the best strategy remains the obvious one: Keep people from getting infected at all. ...... Once again, the nation must flatten the curve. This need not involve a lockdown. We now know that the coronavirus mostly spreads through the air, and does so easily when people spend prolonged periods together in poorly ventilated areas. People can reduce their risk by wearing masks