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Boris Johnson Unveils Three-Tier Lockdowns To Slow Outbreak Despite Local Allies’ Pushback

KEY POINTS

  • Boris Johnson has announced a three-tiered system of lockdowns to combat the resurgent pandemic
  • Under the system, Liverpool would close pubs and ban gatherings. Manchester, another outbreak hotspot, has not agreed to the measures
  • Other countries in Europe and the United States also face a second wave, threatening to overwhelm hospitals and intensive care units

British Prime Minister Boris Johnson on Monday announced a new three-tiered lockdown plan as COVID-19 surges once more across Europe and the United States. Under the plan, virus hotspots like Liverpool and Greater Manchester would close pubs and also ban gatherings. Greater Manchester has not yet agreed to the measure, and local leaders in Liverpool and across the U.K. have voiced objections to the implementation of the measures.

West Midlands Mayor Andy Street said in a statement that the restrictions were “not something regional leaders supported, nor what I believed would be happening following extensive conversations over recent days”

Labour Party leader Keir Starmer told parliament that he doubted the government’s ability to contain the spread of the virus even with new regulations.

“I’m now deeply skeptical the government has actually got a plan to get control of this virus,” Starmer said. 

The U.K. has over 603,000 cases and nearly 43,000 deaths from COVID, according to Johns Hopkins University.

Johnson himself had previously said he wanted to avoid further lockdowns, but rising infection numbers have forced his hand. Previously unused hospitals built to manage the initial COVID-19 outbreak are being employed to deal with patient overflow. 

In April, Johnson tested positive for COVID and later recovered.

BBC News reported on Oct. 5 that some speculation has lingered over whether he fully recovered. Johnson has stated that he was “as fit as several butchers’ dogs.”

Almost 14,000 new coronavirus cases were reported across the UK on Monday Almost 14,000 new coronavirus cases were reported across the UK on Monday Photo: AFP / Paul ELLIS

Britain isn’t the only country in Europe dealing with the resurgent virus. German Chancellor Angela Merkel met with cabinet members Monday to discuss new measures against the virus and has a more significant meeting Wednesday with the various state Premiers. 

French intensive care units are being pushed to capacity after youth populations sheltered the virus, reexposing more vulnerable demographics. Their hospitals are understaffed, and it could be months before new personnel can finish training.

The United States is dealing with its own second wave. Daily new cases spent four days over 50,000, fuelled by both populations and governments unwilling to follow prevention guidelines. The disease isn’t distributed evenly across either the U.S. or U.K.: low infection rates in New York City and London have officials moving forward with plans for an air corridor ahead of the holiday tourism season. 

A stateside vaccine is likely months away. The exact trends that threw France back into the thick of the pandemic have also played out across the U.S.

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CDC study: ‘Urgent need’ to slow spread of coronavirus among young adults

A Centers for Disease Control and Prevention (CDC) study released Friday warned that there is an “urgent need” to address the spread of the coronavirus among young adults. 

The study found that increases among transmission in younger people are often a precursor to transmission among older, higher-risk people. 

The study examined 767 counties in June and July that were “hot spots,” meaning they had high levels of virus spread. The study found that the spread of the virus, measured by the percentage of positive tests, began rising first in people aged 24 and under, before later rising in older, more vulnerable age groups. 

The findings “provide evidence that among young adults, those aged 18–24 years demonstrate the earliest increases in percent positivity; and underscore the importance of reducing transmission from younger populations to those at highest risk for severe illness or death,” the study said 

“Addressing transmission among young adults is an urgent public health priority,” it added.

The CDC study’s emphasis on slowing the spread of the virus among young people stands in contrast to the strategy often articulated by President TrumpDonald John TrumpBiden campaign raises over M on day of VP debate Trump chastises Whitmer for calling him ‘complicit’ in extremism associated with kidnapping scheme Trump says he hopes to hold rally Saturday despite recent COVID-19 diagnosis MORE to “protect the vulnerable” while allowing younger, lower-risk people to go on with their lives. 

“We are aggressively sheltering those at highest risk, especially the elderly, while allowing lower-risk Americans to safely return to work and to school,” Trump said in his Republican National Convention speech in August. 

Many experts have warned that given that young people can transmit the disease to older people, the best way to protect the vulnerable is to reduce the spread of the virus overall. 

“As we often say in public health: there is no peeing section of the swimming pool,” tweeted Ashish Jha, dean of the Brown University School of Public Health, tweeted last month. “We’re in this together.”

The study found that positivity rates began increasing for people aged 24 and under 31 days before a county was identified as a hot spot. Older groups’ positivity only started rising later and also peaked after the spread of the virus had already peaked among younger people. 

There was regional variation, as the South and West saw more of the trend of transmission among the young later becoming transmission among the old than the Northeast and Midwest. 

A separate CDC study released Friday found that young people reported “social or peer pressure to not wear a mask,” as well as “exposure to misinformation” and “conflicting messages” about the importance of masks. 

“Exposure to misinformation and unclear messages has been identified as a driver of behavior during an outbreak, underscoring the importance of providing clear and consistent messages about the need for and effectiveness of masks,” the study states. 

This was to be the year for California’s homeless. Instead it’s a slow ‘train wreck’

Los Angeles Homeless Services Authority outreach worker Monica Palma, center, visits with Kim M. and her dog Dee-O-G who live homeless under the Santa Monica Freeway along Venice Boulevard in Los Angeles on July 8. <span class="copyright">(Genaro Molina / Los Angeles Times)</span>
Los Angeles Homeless Services Authority outreach worker Monica Palma, center, visits with Kim M. and her dog Dee-O-G who live homeless under the Santa Monica Freeway along Venice Boulevard in Los Angeles on July 8. (Genaro Molina / Los Angeles Times)

The message wasn’t lost on Daniel Gonzalez.

Early in the pandemic, one of the first things Imperial County did to ward off the virus was close the public bathrooms and, later, public cooling centers. In this sprawling Southern California desert, where summer brings blistering triple-digit heat, that lack of access could amount to a death sentence for people without shelter.

People like Gonzalez, homeless the past two years, were simply not a priority.

Months into the coronavirus shutdown, Gonzalez, 47, felt lonely. Calexico’s quiet downtown had emptied out. July highs were topping 110, and it was uncomfortable wearing a mask in the swelter. But not having a place to rinse off or wash up, that was just a hazard.

Standing outside a closed restroom in Calexico’s Border Friendship Park, looking out over the complex of metal bars and security equipment that marks the U.S.-Mexico border, he waited for dinner. Every night at 7:30 p.m., volunteers assembled at the park to serve a hot meal to anyone in need. A few weeks before, pressured by the organizers, the county started dropping off hand-washing stations right before the meal, only to whisk them away as soon as it was served.

Gonzalez lined up. At least it was something.

This was supposed to be the year that California finally did something about its epidemic of homelessness. On Feb. 19, Gov. Gavin Newsom stood before lawmakers in the state Capitol, and delivered an unprecedented State of the State address devoted entirely to the homelessness crisis.

California is home to one-quarter of the nation’s homeless population, a grim distinction painfully visible not only on city sidewalks, but also along the state’s freeways and farm levees, in its urban parks and suburban strip malls.

Past administrations had mostly ignored the problem, Newsom said, but he’d be different. “It’s a disgrace that the richest state in the richest nation — succeeding across so many sectors — is falling so far behind to properly house, heal and humanely treat so many of its own people,” he told the crowd.

But even as Newsom spoke, a different epidemic was advancing silently across the state. Exactly one month later, he would order a far-reaching statewide shutdown, asking every person in California not working in an essential industry to shelter at home in an effort to stave off COVID-19.

It was a complicated ask for the more than 150,000 Californians without a home.

For two weeks in March, Newsom’s top homelessness advisor, Jason Elliott, gathered with academics, service providers and county representatives at the emergency operations center just outside Sacramento to confront the menace that COVID-19 presented for tens of thousands of people living outside, often without access to clean water or basic hygiene.

They pored over data

UAB doctor who had COVID-19 would advise Trump to ‘go slow’

The treatment President Donald Trump is receiving for COVID-19 is probably the first of its kind and could help him improve quickly. But Dr. Michael Saag, an infectious disease expert at UAB who came down with COVID-19 back in March, would advise the president to “go slow.”

“The symptoms wax and wane, so there will be moments where he will feel pretty good, and he’ll think he’s through it, and then it will come back in a very haunting way 12 hours later,” Saag said. “The people who I see who suffer the most from fatigue are the ones who tried to do too much too quickly. So I would say definitely take it easy for at least the next week. The more he tries to do, the slower his recovery will be from the fatigue.”

Saag, a professor of medicine and infectious diseases at UAB, said much of Trump’s treatment, as gleaned from medical briefings, shows the strides physicians have made in the past six months in fighting coronavirus.

Trump entered Walter Reed Medical Center Friday, with reports emerging later of a spike in fever and fatigue. Doctors revealed that Trump experienced two incidents, on Friday and Saturday, where his oxygen levels dropped.

According to medical briefings, the president has been given the steroid dexamethasone on Saturday, in addition to remdesivir, an antiviral drug. He has also received an experimental antibody cocktail that is being tested by the drug maker Regeneron.

Remdesivir and dexamethasone are drugs that already have a track record of being used with COVID-19 patients, Saag said. The Regneron therapy, however, is new, and Saag said he didn’t know of any other patients who have used it in conjunction with remdesivir and dexamethasone.

To understand how the drugs work, Saag said its important to know how the virus attacks the body. SARS-CoV-2, which causes coronavirus, attacks the body, reproducing “like crazy” within the body and triggering a response from the patient’s immune system. The problem is that the virus complicates the immune system’s ability to “cool down,” causing many of the well-known symptoms – shortness of breath, coughing, fever.

Remdesivir is usually given intravenously for five days, twice-a-day, he said. The Regneron therapy attacks the spike protein of the virus, blocking the ability of the virus to enter cells in the body. Together, the two drugs are meant to keep the virus from replicating.

“To my knowledge, (Trump) is the first person in the world to receive the drugs together,” he said. “That said, it makes perfect sense to choose that approach, even though there is no data to support it.”

Dexamethasone takes on the other problem – that of an overactive immune system.

“After the immune system attacks a virus, it has a way of tapping the brakes and slowing down,” Saag said. “The COVID virus has an almost unique ability to interfere with the immune system’s shutting down. What you end up with, especially in people who get older, there’s an out-of-control immune system

Slow Lung Decline Typical in Systemic Sclerosis

The interstitial lung disease that develops in a subset of patients with systemic sclerosis tends to be heterogeneous, with the majority of patients experiencing a slow pattern of decline in lung function, analysis of outcomes in the European Scleroderma Trials and Research (EUSTAR) database found.

Among patients with available lung function data for 12 months of follow-up, 12% had significant progression of decline in forced vital capacity (FVC), meaning a decline of more than 10%; 15% had moderate progression (decline of 5% to 10%); 48% were stable (decline or improvement of less than 5%); and 25% showed improvement (increase of 5% or more), noted Oliver Distler, MD, of University Hospital Zurich in Switzerland, and colleagues.

And over 5 years of follow-up, 58% of patients showed a slow pattern of decline, with more 12-month periods of stability or improvement than of decline, the researchers reported in their study online in Annals of the Rheumatic Diseases.

The proportion of patients with systemic sclerosis who develop interstitial lung disease and the pattern of disease progression have not been fully elucidated, and risk factors to predict who may be at high risk for progression and irreversible organ damage are uncertain. The availability of an approved treatment that can reduce the decline in lung function in systemic sclerosis (nintedanib, Ofev) highlights the unmet need of initiating treatment early, before lung fibrosis and damage has occurred.

To explore these concerns, Distler and colleagues assessed the prevalence, disease course, and risk factors among patients enrolled in EUSTAR since 2010.

Of the 6,004 patients with systemic sclerosis included in the database, 2,259 had imaging evidence of interstitial lung disease and 826 had lung function data for at least 12 months and were included in the analysis.

In a multivariate analysis, baseline factors that were associated with significant progression in lung disease at 12 months were:

  • FVC, OR 1.02 (95% CI 1.01-1.03, P<0.001)
  • Symptoms of reflux or dysphagia, OR 1.97 (95% CI 1.14-3.40, P=0.016)
  • Modified Rodnan skin score, OR 1.06 (95% CI 1-1.12, P=0.036)

Among the 535 patients who had at least three FVC measurements over 5 years of follow-up, 9% had major declines of more than 20% in FVC; 14% had significant declines of 10-20%; 14% had moderate declines of 5-10%; 39% were stable, with changes of less than 5%; and 24% showed improvements.

During each 12-month period of the 5 years of follow-up, significant progression of interstitial lung disease was observed in 13-18%, and moderate progression in 9-10%. “These progressive periods rarely appeared in consecutive 12-month periods, and progressive periods were mostly followed by stable periods,” the researchers noted.

Whereas 58% of patients showed a slow pattern of decline in FVC, a steadily progressive pattern, with more periods of decline than stability or improvement, was observed in 34% of patients, and in 8% a rapidly progressive course was seen, meaning consecutive periods of decline without intervening periods of stability or improvement.

In a multivariate linear mixed-effect regression analysis, baseline factors that were most