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Trump’s rapid recovery from Covid-19, while welcome, ‘amplifies’ public misunderstanding of disease

Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, speaks during a House Select Subcommittee on the Coronavirus Crisis hearing in Washington, D.C.

Erin Scot | Pool | Reuters

Health officials have struggled to convey the seriousness of Covid-19 to many Americans. President Trump’s rapid recovery from the disease, while welcome by all, makes the challenge even more difficult, Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases acknowledged.

Trump’s quick bounce-back from his infection will likely underscore the mistaken belief some people have that the disease does not present significant health risks, Fauci said in an interview with STAT.

“We’re all glad that the president of the United States did not suffer any significant consequences of it,” Fauci said. “But … because he is such a visible figure, it amplifies some of that misunderstanding that people have that it’s a benign disease and nobody has anything to worry about.”

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The wide range of clinical manifestations of the disease — some people experience no symptoms, while others have everything from flu-like symptoms to life-threatening and even fatal pneumonia and blood clots — makes conveying the dangerousness of Covid-19 incredibly challenging, he said.

“It’s just a lot of understandable mixed signals, that it’s either serious or it’s not serious. It’s deadly or it’s not deadly. To me, that’s been the bane of trying to get a message across to people,” he said.

“It’s a problem that goes well beyond the president’s illness.”

Trump, who was considered at high risk of having severe Covid-19 because of his age, weight, and sex, was hospitalized for four days earlier this month after testing positive for the SARS-CoV-2 virus, which causes Covid-19. First lady Melania Trump also tested positive for the virus; White House doctors described her case as milder than the president’s. She did not need to be hospitalized.

The president required supplemental oxygen on at least two occasions before he was taken by helicopter to Walter Reed National Military Medical Center on Oct. 2. In the four days he was there, Trump was treated with an experimental antibody cocktail, the antiviral drug remdesivir, and the steroid dexamethasone.

He has since resumed work, holding a rally Monday in Florida where he declared himself to be immune to Covid-19, and heading to Iowa, a Covid-19 hot spot, on Wednesday. He has also tweeted that people should not let fear of the disease run their lives, asserting that he feels better now than he did 20 years ago.

Trump also continues to insist the virus will soon disappear, even though daily infection numbers are climbing in most parts of the country. So far in the pandemic, more than 7.8 million Americans have been infected and more than 215,000 have died.

Since movement restrictions were eased in the summer, many cases have occurred in young adults, a demographic group that rarely dies from the disease. Fauci and others have struggled to find a way to persuade people

Nevada Revokes Halt on Rapid Antigen Testing in Nursing Homes

A week later, however, Admiral Giroir cracked down on Nevada’s “illegal” prohibition on BD’s and Quidel’s tests, which he said had imperiled the residents and staff of nursing homes across the state. “They cannot supersede the PREP Act,” he said.

The false positives that had emerged, Admiral Giroir said, were not only expected but “actually an outstanding result.” No test is perfect, he said.

In the Nevada statement, Dr. Azzam reaffirmed his concerns with the number of false positives that had arisen. “If this laboratory data discrepancy had been reported to Dr. Giroir, we would hope he would have taken the same action as Nevada,” he said. “We too want more testing with rapid turnaround in Nevada, but the results of those tests must be accurate, as they affect clinical care.”

The state’s nursing facilities can resume use of BD’s and Quidel’s products, according to a new Nevada directive issued on Oct. 9. But Nevada’s department of health also recommended that all antigen test results, positive or negative, be confirmed by a laboratory test that relies on a slow but very accurate and reliable technique called polymerase chain reaction, or P.C.R. False negatives, officials noted, risk exposing healthy people in nursing homes to someone who is unknowingly contagious. False positives, on the other hand, could prompt the placement of a person who is well into a unit with sick people, also increasing the chance of infection.

“Both of these scenarios could result in causing harm to a population that we have collectively worked so hard to protect,” the directive said. State health officials, it said, would also continue to investigate the use of BD’s and Quidel’s products.

“We need to better understand the issue before encouraging mass use of such tools among our most vulnerable citizens,” Dr. Azzam said. “We are not saying the tests have no use, we are just saying pause for further review and additional training.”

In a statement, Admiral Giroir said he and his colleagues were “pleased” about Nevada’s reversal. “This serves as a valuable public policy discussion that benefits the public interest by deterring unilateral prohibitions or similar actions in other states or jurisdictions,” he said.

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HHS pushes back against Nevada’s rapid test pause for Covid-19

The federal government is pushing back on an order from Nevada’s department of health to suspend rapid Covid-19 tests in nursing homes — suggesting the decision “can only be based on a lack of knowledge or bias,” according to a letter signed by Dr. Brett Giroir, assistant secretary for the U.S. Department of Health and Human Services.

The move comes one week after the Nevada Department of Health and Human Services mandated that long-term care facilities in the state stop using two Covid-19 antigen tests that had been supplied by the federal government.

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State health officials in Nevada said the antigen tests, which can deliver results within 15 minutes, had an unusually high number of false positives. That indicates a person is infected when in fact he or she is not.

Covid-19 antigen tests are designed to detect certain proteins on the surface of the coronavirus. More sophisticated tests — called PCR tests — look for the virus’s genetic material in a sample. These are more accurate, but can take up to three days to get a result.

The federal government began rolling out the antigen tests, made by Quidel and Becton, Dickinson and Company, to nursing homes nationwide in August.

Quick results are important, because “nursing homes have accounted for as much as 40 percent” of the overall Covid-19 deaths in the U.S., Giroir said Friday on a call with reporters.

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But within a month of that test rollout, the Nevada department of health said it began to receive “anecdotal reports” of false positives. By October, health officials in the state determined the rate of false positives was 60 percent.

That’s a major problem, said Dr. Michael Wasserman, president of the California Association of Long Term Care Medicine. “If you have a large number of false positives, it will throw your facility into complete chaos and panic.”

“We’re already in a pandemic,” Wasserman said. “We don’t need more chaos.”

On Oct. 2, health officials in Nevada sent a letter to its nursing home facilities advising them “to immediately discontinue the use of all Covid-19 point of care (POC) antigen tests until the accuracy of the tests can be better evaluated.”

Part of the issue relates to staffing, which is already a stretched resource at many nursing facilities.

Indeed, the tests were meant for workers inside nursing homes, including possible asymptomatic staffers.

“This is obviously necessary to keep an unaware infected individual from coming into a nursing home, and starting a potentially devastating outbreak,” Giroir said. He added that if an individual does have a false positive, it would be detected by a PCR test within 48 hours, and the person could return to work. (The Centers for Disease Control and Prevention recommends that positive antigen tests are confirmed with a PCR test.)

But Wasserman said the false positives can decimate a nursing home’s staff.

“You already have people who

Federal Official Threatens Nevada for Halting Rapid Tests in Nursing Homes

The leader of the nation’s coronavirus testing efforts condemned Nevada’s health department on Friday for ordering nursing homes to discontinue two brands of government-issued rapid coronavirus tests that the state had found to be inaccurate.

“Bottom line, the recommendations in the Nevada letter are unjustified and not scientifically valid,” Adm. Brett Giroir, an assistant secretary of Health and Human Services, said in a call with reporters on Friday. The state’s actions, he said, were “unwise, uninformed and unlawful” and could provoke unspecified swift punitive action from the federal government if not reversed.

The rapid tests, which were distributed to nursing homes around the country in August by the federal government, were supposed to address the months of delays and equipment shortages that had stymied laboratory-based tests.

“The important issue is to keep seniors safe,” Admiral Giroir said in an interview on Friday. Antigen tests, he added, were “lifesaving instruments” that had been called “godsends” by some nursing home representatives. About 40 percent of the country’s known Covid-19 deaths came from nursing homes, according to a New York Times analysis.

But Nevada officials had discovered a rash of false positives among two types of rapid tests, manufactured by Quidel and Becton, Dickinson and Company, that had been used in the state’s nursing homes. Both tests look for antigens, or bits of coronavirus proteins, and had been advertised as producing no false positives.

Among a sample of 39 positive test results collected from nursing homes across the state, 23 turned out to be false positives, the state reported. (The bulletin did not specify whether negative results from the antigen tests, of which there were thousands, had been confirmed, leaving the number of false negatives unknown.)

“I would consider that to be a significant number of false positives,” said Omai Garner, a clinical microbiologist at the University of California, Los Angeles.

Admiral Giroir contended that such rates of false positives are to be expected, and are “actually an outstanding result.” No test is perfect, he said.

He also said that the federal government expected the state to promptly rescind its unilateral prohibition, which he described as a violation of the Public Readiness and Emergency Preparedness Act.

An Aug. 31 guidance from Admiral Giroir’s office stipulated that PREP Act coverage “preempts” states from blocking the use of coronavirus tests that have been authorized by the Food and Drug Administration on people in congregate settings, like nursing facilities.

What Nevada has done is “illegal,” he said. “They cannot supersede the PREP Act.”

The federal government’s formal response to Nevada’s health department, dated Oct. 8 and signed by Admiral Giroir, portrayed the state’s officials as scientifically incompetent and their actions as “improper” under federal law. “Your letter can only be based on a lack of knowledge or bias, and will endanger the lives of our most vulnerable,” Admiral Giroir wrote.

Should the state hold its ground, “there can be penalties from the federal side,” he said in an interview on Friday, but declined to provide details.

Abbott says new data shows rapid COVID-19 test used at White House is highly accurate

By Manojna Maddipatla and Carl O’Donnell

(Reuters) – Abbott Laboratories on Wednesday released early data from a study on the accuracy of its ID NOW COVID-19 test, which is used in the White House, that could help alleviate concerns the diagnostic frequently fails to detect the virus.

Interim data from Abbott’s 1,003-participant study shows that its test, which can deliver results in under 15 minutes, correctly identified positive COVID-19 cases 95% of the time when used within seven days of symptom onset.

The U.S. Food and Drug Administration issued an emergency use authorization for the test in March, but said in May that early data suggested it could sometimes fail to detect the virus in sick patients. Abbott said it would conduct multiple studies of the test in a variety of healthcare settings.

U.S. President Donald Trump, his wife Melania and several members of the White House staff have contracted COVID-19, raising questions about whether Abbott’s test was reliable enough to be used as the White House’s daily screening tool.

A study conducted by Cleveland Clinic in April showed the test detected the virus in around 85% of cases, lower than many other COVID-19 tests. Other studies, including one by New York University, raised similar concerns.

The FDA said it had received 302 “adverse event” reports as of Sept. 30, including numerous accounts of false negatives – results showing people were not infected when they actually were.

Rapid tests such as Abbott’s are generally less accurate than molecular diagnostic tests, which are the industry gold standard but must be sent to a laboratory to produce results, a process that often takes several days.

Rapid tests are also seen as essential tools to help schools and businesses reopen and stay open.

The latest results confirm the data submitted to the FDA in March that won emergency use authorization for the test, Abbott said. (https://refini.tv/2GLCVA4)

Abbott said it has so far shipped more than 12 million ID NOW tests to all 50 states.

(Reporting by Manojna Maddipatla in Bengaluru; Editing by Saumyadeb Chakrabarty and Bill Berkrot)

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Nevada Halts Use of Rapid Coronavirus Tests in Nursing Homes, Citing Inaccuracies

Kristen Cardillo, BD’s vice president of global communication, said the company was aware of the situation in Nevada and was “conducting thorough investigations.” She added that “based on the information in the directive and the total tests performed, we believe the rate of reported false positives is well within what we would expect for the BD Veritor System.”

Representatives for the Department of Health and Human Services did not respond to requests for comment.

Concerns have also been raised about the ability of antigen tests to accurately pinpoint infections, especially if administered during a period when a person harbors low levels of the coronavirus. BD’s test is advertised as having a false negative rate of 16 percent. Quidel’s is just above 3 percent. The directive from Nevada’s department of health did not report whether the negative antigen test results from nursing homes — there were nearly 3,700 such results — had been confirmed by P.C.R.

In a call with LeadingAge members on Monday, Adm. Brett Giroir, who has been leading the nation’s testing efforts, said antigen tests were “clearly a lifesaving option,” and for many facilities the best test available, given the delays, expenses and shortages that had plagued P.C.R. tests.

“It is perfectly acceptable for congregate care, particularly nursing homes, to use an antigen test, even if they are, quote, off-label,” Dr. Giroir said in the interview. “Just because they don’t have an authorization doesn’t mean they’re not good for it.”

In response to questions about false positives, Dr. Giroir reminded LeadingAge members that in places where the coronavirus is scarce, false positives should be expected to outnumber true positives and do not necessarily invalidate the usefulness of a test. “That’s a function of the way life is,” Dr. Giroir said.

The halt to antigen testing in Nevada’s nursing homes comes just days after health experts criticized the White House, which is now in the midst of a coronavirus outbreak, for a misguided overreliance on rapid testing. For months, officials used two products made by Abbott Laboratories, the ID NOW and the BinaxNOW, to test people without symptoms — another off-label use — while eschewing masks and physical distancing. In September, the White House also began distributing millions of BinaxNOW tests to communities across the country, including nursing homes around the country.

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Rapid COVID Testing Coming To Airport Near You, XpresCheck Test Could Boost Air Travel

KEY POINTS

  • XpresCheck rapid COVID tests began at JFK and Liberty airports Wednesday
  • The company hopes to expand nationwide
  • The test delivers results in 13 minutes

The airline industry, devastated by the coronavirus pandemic, is about to get a boost: Health and wellness company XpresSpa Group Inc. began conducting rapid COVID-19 testing at Kennedy International Airport in New York and Newark Liberty Airport in New Jersey, with plans to expand the program nationwide.

With the pandemic still raging across the United States, Americans have been reluctant to get on airplanes, with the total number of passengers averaging about 25% of last year’s levels.

More than 7.5 million Americans have been infected by the coronavirus and more than 211,000 have died from COVID-19.

Though the virus doesn’t spread easily on flights because of air circulation systems, the Centers for Disease Control and Prevention warns exposure to people in close quarters and frequently touched services put travelers at increased risk. The CDC estimated last month 11,000 people potentially had been exposed to the virus on flights.

XpresSpa began performing its ExpresCheck rapid COVID-19 tests Wednesday, expanding its polymerase chain reaction and blood antibody testing programs.

“We believe rapid COVID-19 testing at airports can play a major role in slowing the virus spread and decreasing the risk of new community outbreaks linked to travel as cases continue to rise throughout many states,” XpresSpa CEO Doug Satzman said in a press release.

He added: “Having a rapid test inside the airport immediately upon travel could also eliminate the need for a full 14-day quarantine in states where that applies.”

The tests would be voluntary for both travelers and airport workers. The company currently is focusing on airline employees and those who are showing COVID-like symptoms.

The test uses Abbott’s portable rapid molecular ID Now COVID test, which delivers results in 13 minutes. The test, however, has yet to gain full Food and Drug Administration approval although it has been cleared for emergency use, and has been criticized for false negatives, which are possible until an infection has reached its height and depending on how the test is performed.

Even with rapid COVID-19 tests available, travelers would still need to wear masks and practice social distancing.

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Use of Coronavirus Rapid Tests May Have Fueled White House Covid-19 Cluster, Experts Say

At least eight people who attended the White House’s recent Supreme Court nomination ceremony for Amy Coney Barrett have tested positive for the coronavirus, and public health experts say they expect more attendees to be diagnosed in coming days.

The White House says it has relied on rapid testing to help prevent the spread of Covid-19 among officials and guests. Officials don’t wear masks or socially distance because they are tested daily. The president is also tested for the coronavirus every day, as is anyone who comes in close contact with him.

The administration relied on

Abbott Laboratories

’ ID Now rapid test at the Sept. 26 event for Judge Barrett. After guests tested negative, they were ushered to the Rose Garden, where few people were wearing masks. The White House didn’t comment on whether anyone screened at the event tested positive.

Public-health experts say the White House isn’t using the test appropriately, and that such tests are not meant to be used as one-time screeners. Regardless of the type or brand of test, any strategy that relies solely on testing is insufficient for protecting the public against the virus, epidemiologists and researchers say.

President Trump’s schedule in the week before he was diagnosed with Covid-19 included a Rose Garden event, a presidential debate, and visits to three states. Photo: Getty Images

“What seems to have been fundamentally misunderstood in all this was that they were using it almost like you would implement a metal detector,” said Ashish Jha, dean of Brown University’s school of public health.

All tests, including those processed in a lab, can produce false negatives, he and other experts say. Some studies have shown that the Abbott Now ID test, which can produce a result in minutes, has around a 91% sensitivity—meaning 9% of tests can produce false negatives.

“A metal detector that misses 10% of weapons—you’d never, ever say that’s our only layer of protection for the president,” said Dr. Jha.

Such rapid tests trade some accuracy for speed, and need to be administered multiple times to a person over a period of days or weeks to be useful for screening, he said. The idea is that if the test misses the virus one day for whatever reason, it will be more likely to catch it on another.

“No test detects the virus immediately after the person becomes infected,” said an Abbott spokesperson in a statement. “Today we have lab-based and rapid tests that help reduce the risk in society and slow the spread of the virus. The goal should be to test often—or if that’s not possible, to test if you’ve been exposed or have symptoms—and find out if you have it. If so, you’ll know to isolate to prevent spread.”

A multipronged approach is vital, epidemiologists and researchers say. That includes socially distancing, masks and avoiding crowds.

Former New Jersey Gov. Chris Christie and other guests at the ceremony for Judge Barrett. Mr. Christie has tested positive for coronavirus.



Photo:

Rod Lamkey –

Rapid Coronavirus Test Kits Are Headed For Washington

OLYMPIA, WA — The Washington State Department of Health expects a federal shipment of nearly 150,000 rapid coronavirus testing kits will arrive within five to 10 days, officials announced late Wednesday. By November, the state anticipates it will have received 2.3 million kits.

Right now, the Abbott BinaxNOW antigen tests are approved only for people exhibiting symptoms, but the state may later extend their use to include anyone who is exposed to a confirmed case. According to DOH, the tests are typically less accurate than standard molecular tests, and their effectiveness for people without symptoms has not undergone rigorous study. Interpreting the results can also be complex.

According to the Abbott website, the test involves taking a nasal swab and inserting it into a test card. Within minutes, results are available and can be stored on an optional app, which generates a new QR code for each test result.

Health officials plan to deploy the first batch to community health centers, tribal clinics and hospitals. Plans for where to distribute future shipments are still in progress.

“The first distribution of 149,000 kits, along with the benefit of rapid results, will increase access to diagnostic testing for Washingtonians, and particularly priority populations,” the Department of Health wrote. “That will help individuals with symptoms get quicker results and assist all of us in tracking the virus and stopping additional transmission and illness.”

The public will be able to view antigen test results via a weekly report from the Department of Health, tracked separately from PCR tests and antibody tests.

“The goal in publicly reporting antigen test results is to increase transparency not just into our process, but into COVID-19 activity statewide,” said Lacy Fehrenbach, deputy secretary of health. “People across the state need a line of sight into these results as these tests become more popular and accessible, so we can understand emerging trends.”

This article originally appeared on the Seattle Patch

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Experts: Tackling Poverty and Racism as Public Health Crises Requires Rapid Action | National News

Late last month, the Healthcare Anchor Network, a coalition of more than three dozen health systems in 45 states and Washington, D.C., released a public statement declaring: “It is undeniable: Racism is a public health crisis.” In the wake of the killing of George Floyd in May, many states, cities and counties across the United States issued similar declarations, according to the American Public Health Association.

While it is becoming clear that ZIP code may matter more to longevity than genetic code, some public health experts have been sounding the alarm for decades. Indeed, poverty and racism have an enormous – and devastating – impact on health, according to a panel of experts brought together for a webinar hosted by U.S. News & World Report as part of the Community Health Leadership Forum, a new virtual event series.

In Chicago, as just one example, life expectancy between some neighborhoods can vary by 30 years, because of factors like access to health care, education, nutritional food sources, income and what many call systematic disinvestment dating back decades.

COVID-19 has made such inequities impossible to ignore. Expected at first to be “the great equalizer,” hitting all demographics equally hard, the novel coronavirus has caused impoverished, mostly Black and underrepresented minority populations to suffer far more death and ill health effects than their white peers.

COVID-19 “attacks vulnerabilities in a truly diabolical way,” said featured speaker Wes Moore, chief executive officer of Robin Hood, one of the nation’s leading anti-poverty organizations.

“We are going to need a concerted and a collective effort to deal with a calcified and hard problem” of poverty and racism and how they influence health, Moore said. Half of the population of New York City lived in poverty for at least one year over the past four years, Moore said, and the probability of dipping back into poverty within a year was 37% – even before COVID-19 hit. “The data continues to reinforce the fact that … [poverty] is not a choice of the person who is feeling the weight of poverty, it’s society’s choice,” Moore said.

Those in poverty are far more likely to have preexisting conditions like asthma, diabetes and obesity, Moore noted, putting them at greater risk of death from COVID-19 and other illnesses.

In his new book, “Five Days: The Fiery Reckoning of an American City,” Moore examined the 2015 death of Freddie Gray and its aftermath in the city of Baltimore. Moore wrote that Gray, born premature and underweight to a heroin-addicted mother, had grown up in poverty and was exposed to lead at a far greater rate than the limit recommended by the Centers for Disease Control and Prevention. “Freddie Gray never had a shot,” Moore said, because he was failed by every social system, including the health system, and not just law enforcement.

Yet Moore remains optimistic. “We are not yet what we can be; our responsibility to get there is our responsibility to get there,” he said. Citing a