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Infection Control Problems Persist in Nursing Homes During COVID


The new analysis draws on self-reported data from nursing homes collected by the federal government over four weeks from late August to late September. While some states fared much worse than others, all 50 states and the District of Columbia had one or more nursing homes that reported inadequate PPE supply, staff shortages, staff infections and resident cases. Forty-seven states reported at least one COVID-19 death among residents.

The analysis found that more than 28,000 residents tested positive for COVID-19 during the four-week reporting period, and more than 5,200 residents died, showing that the virus is still raging in nursing homes. More than 84,000 long-term care residents and staff have died since January, and more than 500,000 residents and staff have contracted the disease, according to the Kaiser Family Foundation’s tally, accounting for roughly 40 percent of the national death toll. Long-term care providers include assisted living, adult day care centers and more, while AARP’s new analysis features just nursing home data.

“This is a nationwide crisis, and no state is doing a good job,” says Bill Sweeney, AARP’s senior vice president of government affairs, adding that the results of AARP’s analysis are “profoundly disappointing.”

“While the pandemic has been unexpected to all of us, basic infection control should have been going on in nursing homes for a long time,” he says. “These are places where people are vulnerable to infection, whether it’s COVID or something else, so for these facilities to still not have basic PPE, even now, with a deadly virus in the air, is outrageous and unacceptable.”

Staff infections nearly match resident infections

For months, providing adequate PPE and developing plans to mitigate staffing shortages have been “core principles” set out by the Centers for Disease Control and Prevention (CDC), for COVID-19 infection control in nursing homes, which generally house older adults with underlying conditions who are at increased risk of infection and severe illness from the disease. PPE stops the transfer of infectious droplets through the air, while adequate staffing ratios mean better care and less person-to-person contact.

Yet in 18 states, more than 30 percent of all nursing homes reported PPE shortages, and in 26 states and the District of Columbia, more than 30 percent of nursing homes are experiencing staff shortages. N95 respirators were the most in-demand PPE item across the country, with 11 percent of all nursing homes reporting shortages. And nursing home aides (certified nursing assistants, nurse aides, medication aides and medication technicians) were the most in-demand staff, with 27 percent of all nursing homes reporting shortages.


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FDA faults quality control at Lilly plant making Trump-touted COVID drug

By Dan Levine and Marisa Taylor

(Reuters) – U.S. drug inspectors uncovered serious quality control problems at an Eli Lilly and Co pharmaceutical plant that is ramping up to manufacture one of two promising COVID-19 drugs touted by President Trump as “a cure” for the disease, according to government documents and three sources familiar with the matter.

The Lilly antibody therapy, which is experimental and not yet approved by regulators as safe and effective, is similar to a drug from Regeneron Pharmaceuticals that was given to the president during his bout with COVID-19.

Trump, who credits the Regeneron drug with speeding his recovery, has called for both therapies to become available immediately on an emergency basis, raising expectations among some scientists and policy experts that the administration will imminently release an Emergency Use Authorization (EUA) for the drug. The president’s push is key to his efforts to convince voters he has an answer to the pandemic that has killed more than 215,000 Americans.

But the findings by the U.S. Food and Drug Administration inspectors at the Lilly manufacturing facility, which have not been disclosed previously, could complicate the drugmaker’s bid for a so-called emergency use authorization (EUA) from the federal agency, two of the sources and two outside legal experts told Reuters. That’s because U.S. law generally requires compliance with manufacturing standards for authorization of a drug.

The three sources who spoke to Reuters requested that their names be withheld so they could speak freely without fear of retaliation.

Inspectors who visited the Lilly plant in Branchburg, New Jersey, last November found that data on the plant’s various manufacturing processes had been deleted and not appropriately audited, government inspection documents show.

“The deleted incidents and related audit trail were not reviewed by the quality unit,” the FDA inspectors wrote. Because the government inspection documents reviewed by Reuters were heavily redacted by the FDA it was not possible to see the inspectors’ more specific findings.

Following its November inspection, the FDA classified the problems as the most serious level of violation, resulting in an “Official Action Indicated” (OAI) notice.

That “means that the violations are serious enough and have a significant enough impact on the public health that something needs to be fixed,” said Patricia Zettler, a former associate chief counsel at the FDA who is now a law professor at Ohio State University.

Separately, Lilly said on Tuesday it had paused its clinical trial for the COVID drug in hospitalized patients “out of an abundance of caution” over a potential safety concern. The company did not release information on what the problem was and declined to say how the news might affect their EUA request.

In response to Reuters’ questions on Monday about the manufacturing issues, Lilly confirmed the OAI notice but declined to provide details on what prompted the FDA action. The drugmaker said it has launched a “comprehensive remediation plan,” has increased staffing at the site and was working “aggressively” to address all concerns raised during

How coronavirus’s genetic code can help control outbreaks

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The six British patients seemed to have little in common besides this: Each was dealing with kidney failure, and each had tested positive for the coronavirus.

They were among scores of virus-stricken people showing up at Addenbrooke’s Hospital in Cambridge in the early weeks of April. Had they lived in the United States instead of the United Kingdom, the link that allowed the contagion to spread among them might have slipped by unnoticed.

But the U.K. had done something in the early days of the pandemic that the United States and many other nations had not. It funded a national push to repeatedly decode the coronavirus genome as it made its way across the country. The process reveals tiny, otherwise invisible changes in the virus’s genetic code, leaving a fingerprint that gives scientists valuable glimpses into how the disease is spreading. It’s a cutting-edge technique that was not widely available in prior global pandemics but that researchers believe can help hasten the end of this one.

[The code: How genetic science helped expose a secret coronavirus outbreak]

Experts cite this practice, known as “genomic epidemiology,” as one more tool the United States has failed to fully employ in the fight against the virus. Though it first sequenced the 3 billion-base-pair human genome 20 years ago and spends more on basic biomedical research than almost any other nation, the United States has yet to muster the kind of well funded and comprehensive national effort that could produce a more precise accounting of how covid-19 is infiltrating communities around the country.

In the case of the six British patients, sequencing revealed they had been infected by almost identical sub-strains of SARS-CoV-2, the virus that causes covid-19. Epidemiologists soon determined that all six had visited the same outpatient dialysis clinic on the same day of the week. Many had ridden in the same small transport van that regularly brought patients for treatment from across the surrounding area.

Officials promptly put in place new safety measures, including mandatory masks and intense cleaning of the van and the chairs at the dialysis clinic.

“And, you know, we’ve had no further cases,” said Estée Török, an infectious-disease expert at the University of Cambridge who helped decipher the outbreak. Studying the virus’s genome “helps to highlight cryptic or hidden transmission. That’s the real power of it — you can detect outbreaks and act while they’re happening.”

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Estée Török, an infectious-disease expert at the University of Cambridge, and her colleagues have sequenced and catalogued thousands of viral genomes since the spring. (Photos by Anastasia Taylor-Lind for The Washington Post)

Already, the United Kingdom has sequenced at least 72,529 coronavirus genomes, nearly as many as the rest of the world combined. By contrast, U.S. labs have produced less than half as many sequences as their British counterparts, based on data from the GISAID Initiative, a global database of coronavirus genomes. That’s despite the fact that the United States is battling an epidemic that’s massively larger.

Pubs shut in Liverpool as UK tightens virus control measures

British Prime Minister Boris Johnson on Monday ordered pubs in Liverpool to shut as part of a new strategy to tackle a surge in coronavirus cases, as staff at three field hospitals across the country were told to prepare for a wave of admissions.

The northwest English city is the first to be placed at “very high risk” under a new three-tiered system designed to bring order what has become a complex web of local restrictions.

Johnson, heavily criticised for his government’s response to the outbreak, said he did not want to impose a new nationwide lockdown.

But said he could not allow Covid-19 to “let rip” and risk the death toll — the highest in Europe at almost 43,000 — spiralling even higher.

“This is not how we want to live our lives,” the Conservative leader, who himself was hospitalised with coronavirus in April, told the House of Commons.

“But this is the narrow path we have to tread between the social and economic trauma of a full lockdown and the massive human and economic cost of an uncontained epidemic.”

Inter-household mixing will be banned indoors and in private gardens while pubs, bars, gyms, betting shops and casinos will close from Wednesday in Liverpool, which has a population of about 1.5 million.

Johnson said businesses forced to close would be supported under a new government programme to fund two-thirds of an employee’s monthly wages, as well as extra support for local contact tracing and enforcement.

Other areas of England will be classed either as “medium”, in which current nationwide rules limiting social gatherings to six will apply, or “high”, where different households are banned from mixing indoors.

Whole swathes of northern England already facing local restrictions will automatically enter the “high” risk tier.

Earlier, the state-run National Health Service (NHS) announced that three field hospitals across northern England, in Manchester, Sunderland and Harrogate, would be mobilised to accept new patients.

They are among a string of temporary hospitals, named after nursing pioneer Florence Nightingale, put up by the military in conference centres and stadia coronavirus as swept across the UK earlier this year.

Testing for hospital staff is also being stepped up in high-risk areas, as health officials warned infection rates were rising across the country and in all age ranges, not just the young.

Almost 14,000 new coronavirus cases were reported across the UK on Monday, with 50 further deaths. 

“The number of cases has quadrupled in the last three weeks. There are now more people in hospital with Covid than when we went into lockdown on March 23,” Johnson said.

– ‘Wholly disproportionate’ –

A UK-wide stay-at-home order was lifted in June but England, whose health policy is controlled by the UK government, and the devolved administrations in Wales, Scotland and Northern Ireland have all since imposed new measures to stop the spread of the virus.

They include blanket restrictions on social gatherings, in addition to more localised measures. 

Pubs in England must shut at

Some U.S. doctors flee to New Zealand where the outbreak is under control and science is respected

Prime Minister Jacinda Ardern speaks to media at a press conference ahead of a nationwide lockdown at Parliament on March 25, 2020 in Wellington, New Zealand.

Hagen Hopkins | Getty Images

Dr. Judy Melinek knew it was time to make a change when she started fear for her health and safety.

While working as acting chief forensic pathologist for Alameda County in California, she read early reports about a virus in Wuhan, China. By June, after repeatedly sounding the alarm about the need for health workers to have sufficient personal protective equipment, she’d had enough. She also hoped for temperature checks, social distancing and masks, but she noticed that not all of the staff in her office were taking these steps.

And then an email appeared offering her the opportunity to relocate to New Zealand, a country that has reported less than 2,000 coronavirus cases and 25 deaths, drawing widespread praise from around the world for its science-led response. Melinek jumped at the opportunity. 

After a period of quarantine, she’s now living and working in Wellington City, New Zealand. She’s been impressed so far. “There’s a lot more respect for the government and for science here,” she said. 

Melinek is part of a wave of U.S. doctors plotting a move to New Zealand. A spokesperson for Global Medical Staffing, a recruitment group that helps doctors find short and long-term positions around the world, noted that inquiries have increased about relocating to New Zealand from the U.S. as more physician jobs have been affected during the pandemic. In addition, more physicians currently employed in New Zealand who already located are choosing to extend their contracts “because of fewer reported cases of Covid-19,” meaning that there’s a slight dip in open roles. 

Melinek has been open about her decision on social media, and has subsequently heard from half dozen of her peers considering doing the same. She expects the number to keep rising as the pandemic continues. “America will suffer an exodus of professionals to other countries that have responded better, with economies that have recovered faster,” she said. 

In the the United States, where the federal government has largely left the response for the pandemic up to the states, more than 213,000 people have died from the virus. Across the country, some states have largely reopened, despite recent surges in cases. An outbreak that tore throughout the White House has spread to at least 37 people, including President Donald Trump, according to a website tracking the infections. 

New Zealand, by contrast, recently declared victory over the virus after eradicating community spread for the second time. 

In addition, many public health workers and scientists based in the United States say they have faced online harassment and threats while sharing guidance to the public about measures to keep them safe, including masks and social distancing. New Zealand’s Prime Minister Jacinda Ardern has repeatedly praised scientists, and offered empathy to the public at the most trying times, including during the early lockdown. 

New Zealand

Coronavirus spread ‘could get out of control’

People queue up outside a coronavirus testing centre offering walk-in appointments in east London. (Getty)
People queue up outside a coronavirus testing centre offering walk-in appointments in east London. (Getty)

With the recent increase in COVID cases and hospitalisations, a medical leader has issued a dire warning that the spread of the disease “could get out of control”.

Helen Stokes-Lampard, chairwoman of the Academy of Medical Royal Colleges, said the “indications are not looking good” as she urged people to stick to local lockdown measures.

She said the nation was at a “tipping point” and warned coronavirus transmission could “get out of control”.

Stokes-Lampard said: “As a society, as a population, we all have a responsibility to do our best to reduce transmission because if this gets out of control, as we fear it is – and we are at that tipping point right now.

“This isn’t a joke, this isn’t scaremongering.”

A sign by Wembley Park tube Underground station in London that thanks NHS staff who are on the front line battling coronavirus. (AP)
A sign by Wembley Park tube Underground station in London that thanks NHS staff who are on the front line battling coronavirus. (AP)

Her comments come as figures released on Wednesday showed there were a further 14,162 daily coronavirus cases in the UK.

This is the second highest daily figure in the entire pandemic, though more testing is now being carried out compared to the first wave in the spring – and the government has said over 100,000 people a day were contracting the virus at the peak in April.

Nevertheless, northern cities where the spread of the virus is faster are potentially facing tougher local lockdown measures.

Reflecting on recent figures, she told BBC Breakfast: “We will be getting more data later today but all of the indications are not looking good.

“In the last month alone we have gone from a few hundred a people a day in hospital with coronavirus, to thousands.

“Right now we have got over 3,100 people in hospital with coronavirus around the UK.”

Watch: Coronavirus in numbers: UK death toll rises to 42,515

Revealing that 500 patients are currently in intensive care, Stokes-Lampard added: “A month ago we only had 60 people in the whole of the UK in ITU beds. So we are seeing a very worrying trend at the moment…

“As the cases go up, a few weeks later hospital admissions do go up, a few weeks after that unfortunately intensive care [use] goes up and deaths go up.”

Sage adviser John Edmunds said on Tuesday that a second national lockdown was needed to deal with the uptick in positive tests.

He told BBC’s Newsnight: “We need to take much more stringent measures, not just in the north of England, we need to do it countrywide, and bring the epidemic back under control.”

People queue outside a COVID-19 testing centre in Walthamstow, London. (Getty)
People queue outside a COVID-19 testing centre in Walthamstow, London. (Getty)

Stokes-Lampard said that coronavirus “does not know boundaries”, adding that the country needs to “work with it, rather than trying to expect it to conform to the way that we want to live”.

On local lockdown rules, she added: “I think the variation in rules –

Gilead Sciences resumes control of remdesivir distribution

Mannequins with face masks and designer clothing fill a window at a Diane Von Furstenberg store in New York City on September 8, 2020. Photo by John Angelillo/UPI | License Photo