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U.S. officials change virus risk groups, add pregnant women – Rimbey Review

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NEW YORK — The nation’s top public health agency on Thursday revamped its list of which Americans are at higher risk for severe COVID-19 illness, adding pregnant women and removing age alone as a factor.

The Centers for Disease Control and Prevention also changed the list of underlying conditions that make someone more susceptible to suffering and death. Sickle cell disease joined the list, for example. And the threshold for risky levels of obesity was lowered.

The changes didn’t include adding race as a risk factor for serious illness, despite accumulating evidence that Black people, Hispanics and Native Americans have higher rates of infection, hospitalization and death.

Agency officials said the update was prompted by medical studies published since CDC first started listing high-risk groups. They sought to publicize the information before Independence Day weekend, when many people may be tempted to go out and socialize.

“For those at higher risk, we recommend limiting contact with others as much as possible, or restricting contacts to a small number of people who are willing to take measures to reduce the risk of (you) becoming infected,” said CDC Director Dr. Robert Redfield.

The same advice holds for people who live with or care for people at higher risk, Redfield added.

Previously, the CDC said those at high risk of serious illness included people aged 65 years and older; those who live in a nursing home or long-term care facility; and people with serious heart conditions, obesity, diabetes, liver disease, chronic kidney disease, chronic lung disease, and conditions that leave them with weakened immune systems.

In the changes, CDC created categories of people who are at high risk and people who might be at high risk.

Those who are at high risk include people with chronic kidney disease, chronic inflammatory lung disease, obesity, serious heart conditions, sickle cell disease, Type 2 diabetes, and weakened immune systems because of organ transplants. The threshold for obesity concern was lowered from a body mass index of 40 down to 30.

The CDC said people are at increasing risk as they get older, but it removed people 65 and older as a high risk group.

The list of people who might be at high risk includes pregnant women, smokers and those with asthma, diseases that affect blood flow to the brain, cystic fibrosis, high blood pressure, dementia, liver disease, scarred or damaged lungs, Type 1 diabetes, a rare blood disorder called thalassemia, and people who have weakened immune systems due to HIV or other reasons.

Pregnant women joined the list on the same day a CDC report found they accounted for about 9% of lab-confirmed COVID-19 cases in women of childbearing age. About 5% of women of childbearing age are pregnant at any given time.

The report showed that pregnant women had higher rates of hospitalization, of admission to a hospital intensive care unit and of winding up on a breathing machine vs. young women who weren’t pregnant. There was no clear evidence of a higher death rate among pregnant women, however.

It’s not completely surprising, said Dr. Denise Jamieson, chair of obstetrics and gynecology at the Emory University School of Medicine. Pregnant women have been found to be at higher risk from other infectious respiratory diseases, likely because the lungs decrease in the volume as the uterus grows, Jamieson said.

What is surprising, she said, is that CDC didn’t place pregnant women in the highest risk category.

“To me this is the most compelling evidence to date that pregnant women are at increased risk,” said Jamieson, who spent 20 years at CDC as a reproductive health expert.

Earlier this week, CDC officials called on a panel of experts to help them identify groups that should be prioritized for coronavirus vaccinations if one becomes available and supplies are limited.

Pregnant women could be among that group. So could certain racial and ethnic groups.

CDC officials shared data with the Advisory Committee on Immunization Practices that showed, compared with white Americans, coronavirus hospitalization rates were 4 times higher for Hispanics, 4.5 times higher for Black people, and 5.5 higher for American Indians and Alaska Natives. A recent study in the Atlanta area suggested that being Black was as large a risk for hospitalization as having diabetes, being a smoker or being obese.

“If we fail to address racial and ethnic groups as at high risk for prioritization, whatever comes out of our group will be looked at very suspiciously and with a lot of reservation,” said Dr. Jose Romero, chair of the expert panel.

“They are groups that need to be moved to the forefront,” he said.

CDC officials say they expect to come out with recommendations for racial and ethnic minority groups soon.

___

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.

Mike Stobbe, The Associated Press

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Kelowna councillor says outbreak a reminder we are not out of the woods – Kelowna News – Castanet.net

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“This is a wake up call.”

That was the reaction of Kelowna city councillor Ryan Donn upon hearing news at least eight people have tested positive for COVID-19 after attending private gatherings and visiting downtown restaurants and bars over a 12-day period.

“We are still in the middle of a pandemic,” said Donn.

“There’s still social distancing needed. We still need to wash our hands.”

According to Interior Health, those infected may have attended gatherings in downtown Kelowna and along the waterfront from June 25 to July 6.

Interior Health is advising anyone is the area during those days may have been exposed.

“We have all these guidelines in place in Phase 3. We don’t want to go back to Phase 2,” said Donn.

“And, there were six people from outside our boundaries, and now they’re going back to where they came from.”

The identities of the restaurants and pubs visited by the eight people infected are not being identified by Interior Health at this time.

Interior Health medical health officer Dr. Silvina Mema said the health authority doesn’t yet have a complete list, and don’t want to create a false sense of security.

“We don’t have evidence that the cases got the disease at these businesses, only that they were there while sick,” she said in a release to Castanet News.

Donn says if you look at a map of Canada then the United States, there’s some pride in the fact we have done as well as we have in Canada.

“That comes from taking action and listening to the professionals, and we don’t have politicians disagreeing. They’re all agreeing,” he said.

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COVID-19 in B.C. alert: Eight infected individuals from Lower Mainland and Alberta attended events in Kelowna – Straight.com

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A large-scale potential COVID-19 exposure incident spanning several days in British Columbia’s Interior, involving individuals from outside the region, has prompted a public notification.

Interior Health issued a news release today (July 10) to alert anyone who attended gatherings in Kelowna’s downtown and waterfront areas from June 25 to July 6 that they might have been exposed to the coronavirus.

Eight individuals who have been tested positive for COVID-19 had attended private gatherings and visited various businesses in Kelowna, including restaurants and bars, within that time frame.

In addition, health officials are especially concerned about Canada Day and holiday weekend events.

Interior Health stated that six of the infected individuals live outside of the Interior Health region, and CBC News reported that some of the individuals were from the Lower Mainland and Alberta.

Contact tracing is currently being conducted and public health team members will inform any known contacts to isolate for 14 days.

Due to the number of locations and cases involved, anyone who attended any events on those dates is asked to monitor themselves for symptoms of COVID-19, such as fever, cough, breathing problems, loss of sense of taste or smell, fatigue, body aches, runny nose, diarrhea, headaches, sore throat, red eyes, or vomiting.

Anyone who develops symptoms should immediately self-isolated and contact healthcare providers or Interior Health testing centres to arrange for testing.

Interior Health is working with other jurisdictions to determine what the source of the outbreak is.

Over this past week, new daily case counts in B.C. have steadily increased, from seven cases on July 6 to 25 cases today.

Recent public exposure incidents have taken place at three nightlife venues in Vancouver while cases have been confirmed at a McDonald’s in Surrey, a gym in Burnaby, and flights to and from Vancouver. 

Although travel-related businesses have been reopening in B.C. as part of the province’s Phase 3 of its reopening plan, many communities remain concerned about the possibility of travellers bringing the coronavirus into their regions.

The Haida Nation is opposing the reopening of two luxury fishing lodges reopening without their consent, as they have stated that even one case of COVID-19 could be devastating to their communities due to limited healthcare services and only two ventilators available. 

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Why it may be harder to catch COVID-19 from surfaces than we first thought – CBC.ca

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This is an excerpt from Second Opinion, a weekly roundup of eclectic and under-the-radar health and medical science news emailed to subscribers every Saturday morning. If you haven’t subscribed yet, you can do that by clicking here.


Disinfecting groceries, wiping down packages, cordoning off playgrounds. 

While those approaches to avoiding COVID-19 infection became commonplace early on in the pandemic, the virus may not transmit as easily on surfaces as was originally thought — and experts say it may be time to shift our focus on how we protect ourselves.

To date, there have been “no specific reports” of COVID-19 directly from contact with contaminated surfaces, even though research consistently shows the virus can survive on them for several hours or days, the World Health Organization said on Thursday.

The update was part of a new scientific brief released by the UN agency outlining its stance on how COVID-19 spreads, after an open letter from more than 200 experts to change its messaging on the possibility it transmits through the air.

Despite the lack of concrete evidence on surface transmission, the WHO still maintains  contaminated surfaces – also known as fomites – are a “likely mode of transmission” for COVID-19.

Surfaces ‘not a significant risk’ for COVID-19

But experts from a variety of disciplines aren’t convinced, and some warn the focus on surfaces has been overblown.

Emanuel Goldman, a microbiology professor at the New Jersey Medical School of Rutgers University, said in an article published in The Lancet journal earlier this week that the risk of COVID-19 infection from surfaces is “exaggerated.”

“This is not a significant risk,” he told CBC News. “Not even a measurable risk.”

Goldman said the evidence for infection from surfaces was based on lab experiments that were unrealistic when compared to real life situations and used extremely large amounts of virus to test if it could survive over extended periods of time.

Linsey Marr, an expert in the transmission of viruses at Virginia Tech who has studied the survival of COVID-19 on surfaces, said that while it’s possible people could get infected from surfaces, it’s still unclear if it’s actually happening.

Restaurants with patios, shopping malls and hair salons are among the businesses allowed to reopen as Toronto begins phase two of a stepped return to pre-COVID-19 operations on June 24, 2020. (Evan Mitsui/CBC)

“I think the thinking has changed,” Marr said, adding the perceived risk of transmission from contaminated surfaces is lower than it was earlier in the pandemic when not much was known about the coronavirus.

She said in order to be infected with COVID-19 from a surface, a person would have to transfer it to their fingers where it would need to survive long enough to enter the body by touching the eyes, nose or mouth. 

“We know that virus can survive [on surfaces] and then the question is, can people pick those up and transfer them into their respiratory tract?” Marr said. “You have to have a lot of virus on there to cause infections.”

The average person infected with COVID-19 also isn’t typically shedding large amounts of the virus at any given time, noted infectious disease specialist Dr. Zain Chagla, an associate professor at McMaster University in Hamilton.

“Viruses aren’t that environmentally hardy,” he added.

“They’re built to infect humans. They’re built to infect cells. As soon as they leave the human host and enter the environment, they become more and more unstable.”

Watch | Are you safer from COVID-19 indoors or outdoors?

Andrew Chang asks an infectious disease doctor whether it’s safer to be indoors or outdoors during the coronavirus pandemic. 1:02

Eugene Chudnovsky, a professor of physics at the City University of New York whose research has focused on the spread of the virus, said the threat of infection from a surface like a doorknob really depends on the conditions to which it was exposed.

“If there are just a few people touching it in an hour, it’s very unlikely it will contain the infective dose of the virus,” he said.

“But if this is a door that is getting opened every few seconds for a lengthy bit of time and there is a significant number of symptomatic infected people who are touching it during a few hours, it can accumulate a significant amount of the virus.”

Disinfecting surfaces ‘not as necessary as we thought’

One of the reasons the evidence for COVID-19 infection from surfaces is lacking is because it’s difficult to track through contact tracing.

“You can start asking people about conversations they had and places they were, but when you start asking them about surfaces they’ve touched, it gets much, much harder to really pin it down,” said Erin Bromage, an associate biology professor at the University of Massachusetts Dartmouth who researches infectious diseases.

“They’re probably associated with a few percentage of transmissions, probably at the highest, which is a lot lower than what we find say for influenza – but it seems to be not a major driver with this particular pathogen.”

The Public Health Agency of Canada maintains it is “not certain how long COVID-19 survives on surfaces,” and says the risk of infection from things like packages is low. It does, however, still list contaminated surfaces as a common route of infection.

The U.S. Centers for Disease Control and Prevention updated its guidelines on surface transmission of COVID-19 in May, saying it “may be possible” a person can get COVID-19 by touching a surface that has the virus on it but it’s not “the main way the virus spreads.”

“There’s just a growing narrative that the degree of transmission through fomites is probably less than what was earlier anticipated,” said Dr. Isaac Bogoch, an infectious disease physician at Toronto General Hospital.

“The vast majority of transmission seems to be through close contact with an infected individual, primarily in an indoor setting.”

He said the change in thinking around the risk of COVID-19 infection from surfaces means that the average person’s groceries are probably much less of a threat than a visit to the grocery store.

“It reinforces hand hygiene, but it also tells us that the need to disinfect every surface that comes into the house is probably not as necessary as we thought it was earlier on in the pandemic,” he said. “It’s not hurting anybody, but it’s just not necessary.”

WATCH | How to handle your groceries during the COVID-19 outbreak:

The coronavirus can live up to several days on some surfaces, but experts say there’s no reason to worry about the groceries you bring home. CBC News shows you how basic hygiene will keep you safe from your groceries. 1:36

Bromage, who wrote a viral blog post in May shared by millions explaining the places people are most at risk of COVID-19 infection, said the risk of transmission from surfaces on things brought into the home is “quite low” in countries like the U.S. and Canada.

“It’s probably something to be aware of,” he said, “but something that we don’t need to focus a lot of anxiety and attention on.”

Chagla said the initial focus on surface contamination also sparked a common practice that could be downright harmful: wearing latex gloves while running errands or shopping.

Discared gloves are pictured at North York General Hospital on May 26, 2020. (Evan Mitsui/CBC)

“Going to the grocery store wearing a pair of gloves is probably not the cleanest thing to be doing,” he said.

While health-care workers and food service staff wear gloves for infection control reasons, Chagla stressed they’re used for specific purposes, and short periods of time.

Wearing gloves for extended stretches while touching various objects can lead to cross-contamination the longer you’re wearing them, he said, which winds up being less helpful than just washing or sanitizing your bare hands regularly.

‘Misinterpretation’ of data

For parents of young children who are concerned about the risk of COVID-19 infection from surfaces like playgrounds, which have been off limits in cities like Toronto for months, the lack of evidence is no doubt frustrating.

Marr thinks the guidance on children avoiding playgrounds has been “misguided” throughout the pandemic.

“Playgrounds are probably one of the safer places for kids to congregate, if they have to congregate,” she said. “And the reason why is that sunlight kills off the virus pretty effectively. So if it is on surfaces, I don’t think it’s going to last very long.”

Chagla said at this point in the pandemic, there’s no “good reason” why playgrounds should remain closed, given the combination of sunlight and open-air ventilation making them a relatively low-risk activity.

Marr said the real risk of infection from playgrounds is largely from kids who are in close contact with each other, not from the surfaces they’re interacting with.

Howard Njoo, Canada’s deputy chief public health officer, said Wednesday that officials are weighing the evidence on infection in children, but that the risk seems low. 

Caution tape is wrapped around a swing set at a playground in Regina on June 10. (Kirk Fraser/CBC)

“From the science, what we know is that certainly young people, children, are less likely to have more severe consequences if they do get infected with the virus,” he said.

“It also appears that in terms of transmission, young children — at least in some of the studies i’ve seen — do not appear to be as efficient or effective in terms of transmitting the virus to others.”

Goldman said misguided policy decisions from governments and businesses pushed him to speak out about the lack of evidence for COVID-19 risk from surfaces.

“The problem is the public policy was driven by this misinterpretation of the data,” he said.

“It’s not that the data were wrong, but they were not the right data. It was not data that applied to the actual situations that are relevant.”

Goldman said these policy decisions can be “counterproductive” because they can “dilute” effective prevention measures like physical distancing and wearing a mask to stop the spread of COVID-19.

“It’s actually harmful to have the wrong interpretation of the data,” he said. 

“I think it’s time to say the emperor has no clothes.”


To read the entire Second Opinion newsletter every Saturday morning, subscribe by clicking here.

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