Covid and other respiratory viruses in the US and Canada

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If you've tried to look up COVID cases recently, you'll have noticed something has changed

Behind the scenes governments have been steadily dismantling many other elements of a surveillance system that we were so reliant on in the emergency period of the COVID-19 pandemic, writes Casey Briggs.

www.abc.net.au

Governments have been steadily dismantling the COVID surveillance system, but is that a backward step?
By Casey Briggs
Posted 21h ago21 hours ago

Some public health experts think it's a shame we're apparently returning back to the pre-pandemic ways we handled respiratory disease, after we've learned so much.

If you've tried to look up the number of COVID cases in your area recently, you may have found it a frustrating exercise.
The reporting frequency in states and territories has been slowing down, from daily to weekly, and now fortnightly or monthly.
On top of that, what do the numbers even mean now? And how many are being missed?
It's been a long time since we were asked to get a PCR test at the slightest sign of a tickly throat.
Now, the vast majority of cases are going undiagnosed or unreported.
That degradation in data quality is visible for everyone to see, and it's no surprise: it would've been a big ask for us to keep up the COVID surveillance effort of 2020 and 2021 forever.
Likewise, behind the scenes governments have been steadily dismantling many other elements of a surveillance system that we were so reliant on in the emergency period of the COVID-19 pandemic.
Some public health experts think it's a shame that we're apparently returning back to the pre-pandemic ways we handled respiratory disease, after we've learned so much.
Weekly forecasting of COVID-19 has ended
The most recent thing to be discontinued is a weekly series of forecasts and "situational assessment reports" for federal and state officials.
The federal government had been contracting a group of mathematical modellers across multiple institutions to produce it, and it was one of the key regular pieces of advice they received.


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The forecasts gave assessments of the COVID situation, including estimates for the effective reproduction number and transmission potential in each state and territory.
But the government has decided not to continue with that work, and in December, the contract ended.
The health department says the forecasting was in place for the emergency response phase, and has been ended given that COVID-19 is no longer a "Communicable Disease Incident of National Significance".
Professor James Wood from the UNSW school of population health was one of the researchers involved in the work. "I'm not surprised," he says. "For some time, the government hasn't been changing its decisions based on the epidemiological or modelling reports.
"Whether or not cases were going up might be of interest in terms of planning to some extent but … hospital capacity wasn't being continuously strained and so on, so I think the value of it in the short term was less for government."
It's a return toward our pre-pandemic approach to respiratory disease, and that's precisely the strategy: ministers and health officers have been saying for a long time that COVID is now being managed consistent with other communicable diseases like flu.
But some experts argue that we could use the lessons from COVID to do a much better job of tracking and managing flu than we did before.
"It does leave a gap in terms of epidemic intelligence … and what's happening not only with COVID, but flu and RSV and probably in the next year or two, whooping cough as well will be one we'll want to watch," Professor Wood says.
In 2022 the US went through a "tripledemic", where COVID, the flu and RSV all circulated simultaneously in high numbers.
The reality now is that when respiratory diseases are putting pressure on health systems, it won't be because of a single pathogen. It could be several at once.

The majority of COVID cases are unreported now.(Unsplash: Medakit Ltd)
Have we missed an opportunity to make the most of what we've learned?
In the journal Emerging Infectious Diseases this month, a group of public health experts called it a "critical time" to review disease surveillance practices, suggesting an "integrated model of surveillance" that considers multiple respiratory viruses.
"Resuming pathogen-specific surveillance approaches, such as those for monitoring influenza, would represent a missed opportunity to build on learnings from emergency response efforts," the authors wrote.
And ongoing surveillance is important if you want to catch emerging waves, new variants of concern, and entirely new pandemics early.
In order to monitor trends you have to monitor the inter-epidemic period as well the emergency period.
If you only stand things up when concerns arise overseas, you run the risk of acting too late.


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Professor Wood states it more clearly: "We don't have a clear forward plan."
"We've missed a little bit of an opportunity while COVID was in front of everyone's minds to initiate more changes."
The government says something is in the works, and that a National Surveillance Plan for COVID-19, influenza, and RSV is being developed.
"As part of this development process, a comprehensive review of national viral respiratory infection surveillance is being undertaken, including an assessment of current gaps in surveillance, potential novel and/or enhanced surveillance systems and data sources to fill these gaps, and the benefits and limitations of each," the health department says.
"This will include an assessment of the cost-effectiveness and sustainability of population prevalence surveys within the Australian surveillance context."
Professor Wood says this is all happening while COVID-19 continues to have a significant impact.
"Obviously, we're very glad that it's dropped from being something where we were worried about losing 100,000 lives a year in the initial phase, to 15,000 in the Omicron year to maybe 5,000 last year," he says.
"It's a lot better, but that's still worse than flu, right?"
"I do think we have an opportunity here to take that a bit more seriously in terms of how we view it, how we measure it, and how we advise the community on how to deal with it."
Other governments are investing heavily in disease forecasting. What's Australia doing?
Outside Australia, governments have clearly recognised the value of forecasting in public health.
In the US, the Centers for Disease Control and Prevention announced more than US$250 million over five years to establish a network of infectious disease forecasting centres.
That's one of the actions of the CDC's Center for Forecasting and Outbreak Analytics.
It was launched in 2022, directly in response to the COVID-19 pandemic.
The European Union's equivalent to the American CDC, the ECDC, also launched a respiratory forecasting program late last year.

The US Centers for Disease Control and Prevention have established a network of infectious disease forecasting centres.(AP: David Goldman, file)
It shows how other countries are investing in the intelligence that they saw had value through the pandemic, and seemingly prioritising it more than Australia.
The Australian government is in the process of setting up a CDC here. It exists in interim form right now, with staff recruitment expected to happen this year.
That body may have some role in respiratory forecasting, but it is still in its infancy.
The health department says it is now focusing on "the adoption of novel and cost-effective surveillance strategies, with a reduced focus on case notifications".
"The use of sentinel surveillance, healthcare utilisation data, genomic sequencing, and wastewater analysis will allow us to shift our surveillance approach to a more sustainable and integrated system that is more appropriate to the current epidemiological situation," the department said in response to the ABC's questions.
Wastewater analysis was one of the big new developments of the COVID pandemic, but Professor Wood says there's a bit of work to do before we can rely more heavily on it.
"Tools like wastewater or some of the surveys like flu tracking may be promising ways to do this, but they haven't been validated," he says.
"And until we invest in doing some actual prevalence surveys and comparing with a known technique where we know the percentage positive and so on, we're not really confident that this is actually consistently a good measure.
"We don't know. There's been some slightly weird results to wastewater in Europe in the most recent wave."
In the meantime, modellers and public health experts plan to continue some of their work.
"Myself and others in Australia are going to continue to do some forecasting this year," Wood says.
"But we have to set up new data agreements with state carriers, we have to rely on them being interested, and we'll have to find some way to make this something we can continue to fund."

 

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Why California and Oregon Broke With the CDC

Two blue states acknowledge that health precautions need to be balanced with other priorities.

www.theatlantic.com

 

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COVID-19 epidemic at low level but may rise during Spring Festival: National Health Commission - Global Times

www.globaltimes.cn

COVID-19 epidemic at low level but may rise during Spring Festival: National Health Commission
By
Xu Keyue and Du Qiongfang Published: Feb 04, 2024 08:35 PM

• 

Parents and their children wait for treatment at the pediatric emergency and laboratory area of a hospital in Xi'an, Northwest China's Shaanxi Province, on December 1, 2023. Photo: IC

The National Health Commission (NHC) on Sunday said that at present, the COVID-19 epidemic is at a low level in China, but recent surveillance data showed positive case reports have increased slightly, suggesting that the epidemic is on the rise. Due to factors such as the inter-regional movement of people and the increase of crowd gathering around the Spring Festival, the number of COVID-19 cases is expected to rise, according to the health authority.

Currently, the JN.1 variant of the COVID-19 virus has become the dominant strain in local cases in China, with mainly mild infections, Chen Cao, a researcher at the Institute of Viral Diseases of Chinese Center for Disease Control and Prevention (China CDC), said at a press conference on Sunday.

Influenza shows a downward trend, but it is still the most important pathogen of respiratory disease infection, and other respiratory diseases are at a low level, according to the press conference.

The press conference revealed that in February, epidemics of multiple respiratory diseases will continue to spread in China. The flu is expected to fall to a low level around the Spring Festival holiday (February 10-17).

Data shows that the situation of acute respiratory diseases in China has declined for two consecutive weeks after reaching a peak in early December 2023. Cases picked up slightly at the end of December, continued to fluctuate at a high level and declined in the past three weeks.

Mi Feng, spokesperson for the NHC, stated that the diagnosis and treatment of respiratory diseases in outpatient and emergency departments of level II medical institutions and above continued to remain stable.

According to Mi, the current situation is due to travel before the Spring Festival, and the domestic North-South cross tourism boom, as well as increasing overseas sightseeing tours. The mass movement and gathering of people makes it easy to accelerate the spread of respiratory diseases, and respiratory diseases will still maintain a certain epidemic level before and after the Spring Festival.

Li Tongzeng, the chief physician of the infection department at Beijing You'an Hospital, told the Global Times on Sunday that in his hospital, influenza B cases still rank as the highest, with COVID-19 ranking second.

Influenza B is still the main type of flu, with a decrease in cases, while the proportion of COVID-19 cases has increased recently, Li noted.

There are also some cases of mycoplasma, adenovirus and respiratory syncytial virus infections. However, there are still patients with fever or other respiratory symptoms who have not tested positive.

During the Spring Festival holiday, many people will be reunited with their families and visit their elderly relatives, which means the infection rate among the elderly may increase, Li warned, calling for the public to look after their families.

He added that currently, a few elderly people still experience more severe symptoms of COVID-19 infections, and there are also individuals who are experiencing their first infection, which increases the risk of developing a moderate to severe illness.

According to the Sunday press conference, the NHC has made special arrangements for epidemic prevention and control work around the Spring Festival. All localities should strengthen duty, maintain emergency preparedness, and coordinate and dispatch medical and health resources and professional forces, the health authority said. It added that localities should ensure the "120" emergency hotline runs smooth 24 hours a day and all medical institutions should do a good first aid transfer.

During the holiday, hospitals and grassroots medical and health institutions should be fully open, with fever clinics, consulting rooms and strong medical forces. Key departments such as emergency, pediatrics and respiratory departments should have smooth green channels and arrange for medical service guarantee during the festival.

Also, the NHC stressed the significance to protect the elderly, children, pregnant women, patients with chronic basic diseases and other vulnerable groups and meet the needs of the people in need of medical treatment and emergency care.

Li told the Global Times that during the Spring Festival, if people experience symptoms such as a fever, cough or sore throat, they should not visit relatives or attend gatherings. Instead, they should immediately rest and avoid long-distance travel.

 

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The Curious Case Of ‘Free’ Covid-19 Tests

It is up to the public to understand the drawbacks of relying on governments to provide “free” things. Surrender the control of money, get ready to be exploited.

www.forbes.com

The Curious Case Of ‘Free’ Covid-19 Tests
Ge Bai
Contributor
I am a professor of accounting and health policy at Johns Hopkins.

Feb 4, 2024,09:06am EST

United States of America map formed with american dollars bills isolated on white background
GETTY

Starting from November 20th, 2023, every household in the U.S. can order eight “free” at-home Covid-19 tests (four for those that already ordered this fall). How much taxpayers paid for these tests remains undisclosed.

Our government has provided “free” Covid-19 at-home tests to households across the country in four previous rounds. We were told that more than 755 million tests have been provided for the previous rounds. However, no information on pricing or total spending is available for any of them.

Retail price in Germany for Covid-19 at-home tests has been less than $1 each. In the U.S., it’s about $7 and used to be more than $10 before the Food and Drug Administration (FDA) expanded approved vendors. Businessman Bill Gurley described how FDA, influenced by certain test manufacturers, restricted test approval to them, resulting in an uncompetitive market and high test prices in the U.S.

Taxpayers, who ultimately foot the bills, are entitled to ask questions: How much exactly did our government pay for the “free” tests? Among the hundreds of millions of tests bought on our behalf, about how many were used, how many ended up in landfills, and how many are in warehouses waiting to expire?

The “free” test program disadvantages low-income households that order fewer tests. It uses taxpayers’ money to subsidize households that order a lot of tests—regardless of how rich they are; it penalizes households that use fewer or no test—they still must pay through their tax dollars.

This inequity issue is especially problematic for low-income households that would be better off from receiving cash subsidies to buy things that they deem most necessary, rather than receiving “free” tests. They are worse off as they cannot decline “free” tests and get cash instead.

We could have expanded early on the pool of approved test vendors beyond the few politically well-connected ones, allowing competition to drive down prices to the European level. Individuals in need would have been able to buy as many tests as they wish, and private organizations would have afforded to purchase them for financially disadvantaged stakeholders to use.

For low-income households, a cash subsidy that allows a wide range of purchases such as Covid-19 tests could have been substantially more helpful than packages of “free” tests. Taxpayers would have gotten a much bigger bang for their buck.
Despite these shortcomings of the “free” Covid-19 test program, it benefited certain individuals, enriched politically connected interest groups and reaped political gain through virtue signaling.
The “free” Covid-19 test program is merely the tip of the iceberg of inefficient government purchasing and subsidization. Other examples include overpaying Covid-19 PCR tests and the allocation of the relief dollars. They should serve as cautionary tales.
Governments are composed of groups of individuals spending other people’s money. Like everyone else, individuals working in governments have their own self-interest and incentives. It is up to the public to understand the drawbacks of relying on governments to provide “free” commodities or services. Surrender the control of money, get ready to be exploited.

 

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Letters: Absenteeism high because kids are sick

The continuing impact of COVID-19 and other illnesses is an important factor in persistently high absenteeism at Maryland’s schools, a children’s health advocate says.

www.thebaltimorebanner.com

Letters: Absenteeism is high because kids are sick
2/4/2024 5:30 a.m. EST

The continuing impact of COVID-19 and other illnesses is an important factor in persistently high absenteeism at Maryland’s schools, a children’s health advocate says. (Ulysses Muñoz/The Baltimore Banner)
In your recent article, “Far more Maryland students are missing too much school,” an important topic isn’t addressed: absences due to illness. Focusing on attendance might be harming children who need to rest and recover from seasonal and other infections.
Studies show that schools ranked highest as public sources of COVID-19 exposure, and 1 in 6 children have persistent COVID symptoms for three months after infection. Most infections in children are asymptomatic, but chronic symptoms may still develop in the absence of acute symptoms. We must protect children in school settings.
Clean air, high-quality masks and encouraging staying home when sick can substantially reduce acute and chronic illness. The only way to prevent long COVID is to prevent COVID infection.

Long COVID is an umbrella term describing long-term effects after acute COVID infection. Nearly half of those with long COVID meet the diagnostic criteria for myalgic encephalomyelitis (ME or ME/CFS), a chronic neurologic disease. No approved treatments exist for ME or long COVID.

As a child with undiagnosed ME, I pushed through symptoms to meet attendance requirements in school. I continued this pattern in university and work settings until I became permanently disabled. I wish I had received more encouragement to rest and recover and more guidance on managing symptoms.
#MEAction Maryland is advocating for our news publications, elected officials and health department leaders to communicate the risks for long-term effects after infection. We urge you to encourage readers to rest and stay home while sick to limit spread and prevent long-term illness.

 

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Ex-Swiss government minister rejects Covid-19 'hysteria' - SWI swissinfo.ch

Ex-Swiss Finance Minister Ueli Maurer defends his government record in during the pandemic, denying he was anti-vax.

www.swissinfo.ch

Ex-Swiss government minister rejects Covid-19 'hysteria'

Former Swiss Finance Minister Ueli Maurer continues to defend his record during the pandemic. © Keystone / Urs Flueeler

Former Swiss Finance Minister Ueli Maurer has defended his record in government during the coronavirus pandemic and denies he was ever against vaccines.
This content was published on February 4, 2024 - 12:11February 4, 2024 - 12:112 minutes
Keystone-SDA

But in interviews with the Le Matin Dimanche and the SonntagsZeitung newspapers, Maurer repeated earlier controversial comments. “Of course there was hysteria around Covid,” he said in the Sunday interviews.
This hysteria was even “on a global scale”, Maurer added. “We said that Covid was fatal, and based on this assumption, we stretched a health net like we had never seen before. Anyone who dared to ask a critical question was dismissed or treated as a conspirator.”
Maurer also expressed surprise at the negative reaction to comments he made in the media two weeks ago. He dismissed the outcry as an “anti-Maurer reflex” from the media.
But the former government minister did take the opportunity to qualify his earlier interview statement that anti-Covid vaccines are “a lot of hot air”.
“Of course, people immediately said that I was anti-vax, which is not true,” he stated on Sunday.
The usefulness of vaccines is undisputed, but Switzerland went too far by telling everyone to get vaccinated, Maurer said. “I am convinced that in the coming years we will increasingly deal with the damage caused by the vaccine,” he added.
Maurer also answered critics who say he let down small businesses by not allowing more financial aid during the pandemic. “The state cannot be responsible for everything. Nor can it protect everyone from death,” he said.
“The state must help protect society, but it can only distribute the money it first takes from people.”

 

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COVID-19 hospital admissions fall after holiday spike. Why you should still keep your guard up

"We are still seeing hundreds of people hospitalized every month because of COVID-19," said Joseph Wendelken, spokesman for the health department.

www.providencejournal.com

COVID-19 hospital admissions fall after holiday spike. Why you should still keep your guard up
Hospital admissions for COVID-19 have dropped after post-holiday bump, but Health Department says Rhode Islanders should keep guard up
Jack Perry
Providence Journal

PROVIDENCE – The COVID-19 admission level at Rhode Island hospitals has dropped from "medium" to "low," but that doesn't mean Rhode Islanders should let their guard down, according to the state Department of Health.
"Rates of COVID-19 still elevated throughout Rhode Island. We are still seeing hundreds of people hospitalized every month because of COVID-19," said Joseph Wendelken, spokesman for the health department.
The holidays sparked an increase in COVID cases, and the state's hospital admission level was increased from "low" to "medium" on Jan. 5. It fell back to "low" on Jan. 26, according to the health department.

The health department says it uses hospital admission levels as a tool to measure COVID risk statewide. It characterizes levels as "low," "medium" or "high" based on the state's population. "Low" means hospital admissions are below 10 per 100,000 Rhode Islanders per week.
In December, Rhode Island hospitals had 401 admissions for COVID-19, according to the health department. In January, the number was 368, but the health department notes that January data is still being collected, so that number could change.

How many people in Rhode Island died from COVID-19 in January?
In December, Rhode Island had 22 deaths from COVID. In January, the state had 36 COVID deaths. (Again, the health department notes that the January data is still being collected.)
With the increase in admissions last month, Lifespan and Care New England hospitals reinstituted masking requirements. Those requirements are still in place.

"Mask requirements remain at Care New England hospitals and within any of our medical buildings where patients may be present," said Doreen Scanlon Gavigan, public relations manager for Care New England. "We are still seeing a significant number of respiratory illnesses in our community, although levels are beginning to fall. We will continue to monitor indicators closely."

Here are tips to avoid catching or spreading COVID
The health department provided the following COVID-prevention tips:

• Get vaccinated. The 2023-2024 COVID-19 vaccine is recommended for everyone older than 6 months of age. You can get the 2023-2024 COVID-19 vaccine even if you have not received COVID-19 vaccines previously. Vaccine is available throughout Rhode Island. In addition to preventing serious illness and hospitalization, COVID-19 vaccine can also help prevent the spread of COVID-19.
• Get tested for COVID-19 if you have any of the classic symptoms of the disease, such as fever or chills, a runny nose, a cough, achiness, or loss of taste or smell. If you have household or social contact with someone at high risk for getting very sick, consider self-testing for COVID-19 before seeing that person.
• If you are sick, stay home. It is particularly important to avoid contact with people who are more vulnerable to severe illness.
• If you have COVID-19, the CDC’s Isolation Calculator can help you determine how long you should stay home and isolate away from others. COVID-19-specific isolation guidelines are available online.
• If you have a fever but do not have COVID-19, still stay home for at least 24 hours after your fever is gone. Your temperature should be measured without the use of fever-reducing medicines (medicines that contain ibuprofen or acetaminophen).

 

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Covid vaccines are safe

 

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Nearly 1 in 4 American Adults Who Get COVID-19 Suffer From Long Covid

 

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PhD Mathematical Biologist Jessica Rose Explains Her PEER REVIEWED Study of VAERS Data! Viva Frei

 

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COVID-19: A THIRD of young people were 'HAPPIER' in lockdown

 

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Janet Hanlin
Admin

Weekly Ontario Update for Friday, February 2, 2024:
Unless indicated otherwise, information in this update includes data up until Saturday, January 27, so data is delayed. Data relating to deaths is even further delayed as cause of death is taking MONTHS to be determined. So recent deaths are far worse that are reported.

• Recent cases: 1,975 (- 362 over 7 days compared to last week)
  
  
  
  - Average: 281 new cases per day (- 52 per day since last week)
  
  
  
  
  Estimates suggest that the actual number of new cases could be more than 10 times higher than what is being reported due to limited eligibility for testing!
• Weekly positivity rate: 12.2% (- 1.7%)
• Recent deaths: 20 (12 fewer than last week)
  - Average: 3 deaths per day (- 2 deaths per day since last week)
  Recent deaths are a lagging indicator of the current level of new cases. Deaths are underreported because they are based on date of death and by the time the cause of death is reported, it is no longer considered recent!
• Estimated new hospital admissions (January 14 - 20): 103* (- 10, based on initially reported number last week, see next point)
  - Previous week's new hospital admissions for January 7 - 13 have been updated to: 163 (+ 60)
  *Please interpret the COVID-19 hospitalization data with caution.
  The completeness of COVID-19 hospitalization data, which PHO obtains from the provincial Case and Contact Management database (CCM), has been declining over the course of the 2023-24 surveillance period. PHO is currently working on updates to the ORVT that will include enhancements to respiratory outcome indicators (i.e., hospital bed occupancy), which will help to support surveillance and reporting on COVID-19 outcomes. These updates will be live in the coming weeks..
  The completeness of COVID-19 hospitalization data, which PHO obtains from the provincial Case and Contact Management database (CCM), has been declining over the course of the 2023-24 surveillance period. PHO is currently working on updates to the ORVT that will include enhancements to respiratory outcome indicators (i.e., hospital bed occupancy), which will help to support surveillance and reporting on COVID-19 outcomes. These updates will be live in the coming weeks.

Full list of those eligible for testing can be found here (updated): https://www.ontario.ca/.../covid-19-testing-and-treatment...
Sources: Total cases, total deaths, testing levels and wastewater levels: https://www.publichealthontario.ca/.../Respiratory-Virus...
Some additional COVID stats and info: https://twitter.com/MoriartyLab