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Japan set to extend COVID-19 states of emergency ahead of Games

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The Tokyo 2020 Olympic Games logo, postponed to 2021 due to the coronavirus disease (COVID-19) outbreak, can be seen through a road sign in the Tokyo Metropolitan Government building in Tokyo, Japan on January 22, 2021. REUTERS / Issei Kato

Japan was scheduled to extend the state of emergency in Tokyo and other areas by about three weeks to June 20 on Friday, as the COVID-19 pandemic shows no signs of easing less than two months before the start of the Summer Olympics.

The state of emergency in the capital and eight other prefectures was slated to end on May 31, but the medical system remains heavily burdened.

Japan has seen a record number of COVID-19 patients in critical condition in the past few days, although the number of new infections has slowed.

“The influx of people is creeping up in Osaka and Tokyo and there are concerns that infections will increase,” said Economy Minister Yasutoshi Nishimura, who also leads the country’s coronavirus countermeasures, at the beginning of a meeting with experts.

The experts later approved the government proposal, and Prime Minister Yoshihide Suga is expected to officially announce the extensions later on Friday.

Concerns over variants of the novel coronavirus and a slow vaccination campaign have sparked urgent calls from doctors, some high-profile business people and hundreds of thousands of citizens to cancel the Olympic Games, which are due to begin on July 23.

Japanese officials, Olympic Games organizers and the International Olympic Committee (IOC) have announced that the Games will be held under strict virus prevention measures. IOC Vice President John Coates, who oversees the preparations, said last week the Games will be about whether the host city Tokyo is currently in a state of emergency or not.

Seiko Hashimoto, president of the Tokyo 2020 Organizing Committee, said at a press conference that she had received pledges from India – now fighting a deadly second COVID-19 wave – and from five other countries, all of their Olympic delegates as a countermeasure against a new one Vaccinate variant that emerged in India.

IOC President Thomas Bach has vaccinated 80% of the 10,500 athletes expected in Japan and on Thursday urged the Olympians to get their shots if they could. Participants must also be tested before and after arrival.

“I want to say ‘shut up'”

Comments from IOC officials apparently rejecting Japanese concerns have sparked outrage on social media, including IOC President Thomas Bach, who said at an international athletes forum on Thursday: “Come to Tokyo with full confidence and get ready” and call Tokyo “the best prepared Olympic city of all time” ”

“I want to say” shut up “, said a Twitter user. “Let’s beat up the IOC that denigrates Japan and stop these crazy Olympics.”

Japan has so far recorded about 727,000 coronavirus infections and 12,597 deaths. According to Reuters data, around 6% of the population has been vaccinated. This is the lowest value among the larger, rich countries in the world.

According to the government’s current plan, around 30% of the population would be vaccinated by the end of July, Nishimura said.

After meeting Japanese officials on Thursday, European Commission President Ursula von der Leyen backed hosting the Tokyo Olympics and said the European Union had approved the export of more than 100 million doses of vaccine to Japan, enough to be around Vaccinate 40% of the population. Continue reading

International spectators will not be admitted to the games, but around 90,000 people, including athletes and their delegations, will attend. No decision has been made about local fans yet, and Tokyo 2020’s Hashimoto said the situation regarding the state of emergency needs to be considered.

According to surveys, the majority of Japanese would like the games that were postponed last year due to COVID-19 to either be canceled or postponed again.

That’s a concern for Suga, whose support has waned over his handling of the COVID-19 response and who faces a general election and ruling party leadership contest later this year.

However, the cancellation would bring the prime minister’s own political risk, said some ruling party’s lawmakers.

“The disadvantages would outweigh the merits,” Liberal Democratic Party MP Hajime Funada told Reuters. “It would give the impression that Japan is in such dire straits that it cannot hold the Games.”

Japan’s recent emergency response, as opposed to stricter measures in many countries, has mainly focused on closing alcohol-serving restaurants and those not supposed to close by 8 p.m.

Nomura Research Institute’s senior economist Takahide Kiuchi said an extension of the state of emergency would mean the economy would likely shrink and return to recession in the current quarter. Continue reading

Our standards: The Thomson Reuters Trust Principles.

Pandemic

Novavax Offers U.S. a Fourth Strong Covid-19 Vaccine

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Novavax, a small American company that has benefited from generous support from the U.S. government, announced the results of a clinical trial of its Covid-19 vaccine in the United States and Mexico on Monday, finding that its two-shot vaccine had one offers effective protection against the coronavirus.

In the 29,960-person study, the vaccine showed an overall effectiveness of 90.4 percent, on par with the vaccines from Pfizer-BioNTech and Moderna and higher than the single-use vaccine from Johnson & Johnson. The Novavax vaccine showed 100 percent effectiveness in preventing moderate or severe illness.

Despite these impressive results, the future of the vaccine in the United States remains uncertain and may be needed more in other countries. Novavax says it may not seek emergency clearance from the Food and Drug Administration until the end of September. And with an ample supply of three other approved vaccines, the agency may instruct Novavax to apply for a full license instead – a process that could take several additional months.

The company’s CEO, Stanley Erck, admitted in an interview that Novavax would likely get its first approval elsewhere. The company is also applying in the UK, the European Union, India and South Korea.

“I think the good news is that the data is so compelling that it gives anyone an incentive to pay attention to our records,” said Mr. Erck.

If Novavax gets the green light from the US government, it could be too late to contribute to the country’s first wave of vaccinations. However, many vaccine experts believe that as immunity declines and variants emerge, the country will eventually need booster vaccinations. And the protein-based technology used in the Novavax vaccine can do a particularly good job of enhancing protection, even if people have previously been vaccinated with a different formulation.

“They really can be the right ones for boosters,” said Dr. Luciana Borio, who was the acting Chief Scientist of the FDA from 2015 to 2017.

Last year, the Trump administration’s Operation Warp Speed ​​program awarded Novavax a $ 1.6 billion contract for 100 million future cans. The company gained this tremendous support despite not having launched a vaccine in over three decades.

In January, Novavax announced that its 15,000-person study in the UK found the vaccine to be 96 percent effective against the original coronavirus. Against Alpha, a virus variant identified for the first time in Great Britain, the effectiveness fell slightly to 86 percent. In South Africa, where Novavax conducted a smaller study of 2,900 people and dominated the beta variant, the company found an effectiveness of only 49 percent.

However, the study in South Africa was made difficult by the fact that some of the volunteers had HIV, which is known to interfere with vaccination. In addition, the study was so small that it was difficult to gauge how much protection the vaccine would offer HIV-negative volunteers.

With the support of Operation Warp Speed, Novavax made plans for an even larger late-stage trial in the United States and Mexico. But manufacturing difficulties delayed the launch until December.

By then, the United States had approved the Pfizer-BioNTech and Moderna vaccines. In February, while the Novavax trial was still ongoing, the Johnson & Johnson’s government approved.

While Novavax waited for the study results, Novavax has teamed up with other companies to begin manufacturing massive quantities of its vaccine. In India it has partnered with the Serum Institute and in South Korea with SK Biosciences. Novavax has reached an agreement with Gavi, the Vaccine Alliance, to supply 1.1 billion doses to middle and low income countries.

The company’s scaling difficulties persisted, however, and it took more time to develop specific tests to validate the quality of its product.

The new results were based on 77 test subjects who contracted Covid-19. The volunteers who received the placebo injections got sick far more often than the vaccinated, a statistical difference that led to an effectiveness of 90.4 percent.

“That’s a strong result,” said Natalie Dean, biostatistician at the University of Florida. “It takes you to this high level.”

The vaccine showed the same effectiveness in a group of high-risk volunteers – people who were over 65 years old, had medical risk factors, or had jobs that exposed them to the virus.

Novavax sequenced the genomes of 54 of the 77 virus samples and found that half were alpha, the variant that became predominant in the United States that spring.

The side effects of the vaccine were relatively mild. Some volunteers reported fatigue, headaches, and other minor symptoms. “This vaccine seems to make the arms lighter,” said John Moore, a virologist at Weill Cornell Medicine who volunteered in the Novavax study.

Novavax will file for approval in the US after it completes the development of a quality control test, the managing director said. “You definitely have to test them from Sunday to show that you get the same answer under all conditions,” said Erck. “And that takes time.”

Mr. Erck said the company plans to produce 100 million cans per month by the end of the third quarter and 150 million cans per month by the end of the fourth quarter.

Every week the United States is building up a wider range of approved vaccines from other companies, raising the question of whether the country needs to issue more emergency permits or EUAs.

“The law says that once you have adequate doses, no additional EUAs are required,” said Dr. Borio.

A sign that the FDA is changing its approach to Covid-19 vaccines came last week. An American company called Ocugen had applied for an emergency permit for Covaxin, a Covid-19 vaccine that is now used in India. However, on Thursday the company announced that the FDA had recommended that the standard route to full approval be followed instead, the so-called biologics license application, which takes many additional months.

However, since Novavax has been consulting with the FDA about its studies since last year, Mr. Erck said the company may be able to continue its plans to apply for an emergency clearance.

“So far you have indicated that if you are in favor of an EEA, you can proceed for an EEA,” said Mr Erck. “Anyone could tell you that could change, but I don’t know how to predict it.”

Dr. Paul Offit, a professor at the University of Pennsylvania and a member of the FDA’s Vaccine Advisory Panel, said Novavax’s potent vaccine is most welcome. “The more the better,” he said. “I think there is room for a lot more vaccines because we will be dealing with this virus for years, if not decades.”

Novavax is preparing for this future by researching how its vaccine could work as a booster. A new version of the vaccine contains the proteins of the beta variant first identified in South Africa.

Researchers gave baboons beta boosters that had been vaccinated a year ago in experiments with the original version of the Novavax vaccine. The researchers found that the baboon’s immunity to Covid-19 skyrocketed after this booster, protecting them from beta, alpha, and the original version of the coronavirus.

“When you boost, you see a very high recall response,” said Matthew Frieman, a virologist at the University of Maryland School of Medicine and co-author of the new study. The study has not yet been published in a scientific journal.

Dr. Frieman said the new study offers encouraging evidence that Novavax vaccines might work well as boosters. It also suggested that first-time vaccines people might do well to get a mix of the original and beta versions to expand their protection against new variants, he said.

“Novavax can be used as a booster in the US, but it will certainly be the first vaccine many people around the world will see,” he said.

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To Fix Healthcare After Covid-19, Doctors Must Have The Courage To Change

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Doctors showed great courage during the Covid-19 pandemic. Now you have to show the courage to change … [+] the job.

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Long before doctors battled the coronavirus, their professional ancestors risked their lives fighting the Black Death.

Throughout history, doctors have shown courage: the ability to act regardless of risk or fear.

Think sawing off a gangrenous limb or having brain surgery or treating a disease like Ebola which kills up to 90% of the people it infects. In these harrowing situations, courage alone is not enough. Doctors too, to a certain extent, have to deny objective reality. You need to suppress the existence of fear, detach yourself from its emotions, not admit weaknesses, deny any pain, show single-minded attention to the task at hand, and extinguish any feelings that are trying to escape in the process.

Until recently, no one questioned whether such extreme denial was mentally healthy. The doctors just thought it was necessary.

Courage and denial remain cultural imperatives in today’s profession. These properties are taught to every medical student and hardwired in every doctor.

And they have some unfortunate and tragic side effects.

I remember a talented doctor who returned to work the day after she received a final diagnosis herself. None of her colleagues, friends or patients knew about her illness until she died. In medical culture, this type of emotional distance is the rule, not the exception.

As a nation, we are indebted for the courage and refusal of our doctors. Without their courage and sacrifices over the past year and a half, Covid-19 would have killed many more of our friends and loved ones.

But now that our country has weathered the worst of the pandemic, it is time to address the American health care failures that harmed doctors and patients long before the coronavirus hit land. To do this, doctors need to play a leadership role both in transforming the health system and in challenging their own cultural assumptions.

These changes require more courage and less denial.

1. The courage to ask for help

In a recent article, I wrote about three critical care physicians who had recently gone through hell.

A doctor, a resident, had started his rotation in the intensive care unit with half a dozen Covid-19 patients under his care. All were dead by the end of the month. Another doctor, a die-hard ICU veteran, said she woke up in sweat every day before dawn. The third, a senior officer, watched four of his patients die in a single day.

Psychological defense mechanisms such as denial help doctors suppress fear and bypass grief over the loss of a patient. But as with any coping mechanism, denial is best used in moderation, not permanently. No level of denial, repression, harshness, or hardship could have prepared health care workers for the flood of death that Covid-19 wreaked. No amount of cultural conditioning could adequately prepare clinicians for the pain they have endured. As a result, many feel exhausted at work.

As the saying goes: “You can’t pour from an empty cup”. Too many cups are empty.

According to Medscape’s latest physician survey, 42% of all physicians are burned out. But only 7% of them say they see a therapist to improve their mental health.

It takes courage to challenge the medical profession’s culture of harshness and emotional repression. Doctors need a lot of strength to recognize their limits. And it takes courage to seek help when it is needed.

2. The courage to recognize one’s prejudices

It has become the standard in American culture to point your finger at others and blame others. Doctors are no different. On social media and at medical conferences, doctors are seldom willing to take responsibility for any of the many health care issues.

Take health differences, for example. Ask doctors why black patients have shorter lifespans and poorer health outcomes than whites, and they will blame socio-economic factors such as income, education, and the ills of American health insurance. They point to social determinants (where people were born and raised, work, play and socialize) and social dynamics (such as racial segregation, poverty and educational barriers). Of course, these external factors contribute to health inequalities, but they are not the only factors that play a role.

Research shows that two-thirds of doctors have an implicit black bias. This type of bias is different from open hatred or even conscious bias. But it is no less harmful.

At the start of the pandemic, when test kits were scarce, doctors tested white patients twice as often as black patients with identical symptoms. This makes no logical sense, as black patients were two to three times more likely to die than white patients.

Bias also helps explain why black patients receive 40% less pain medication than white patients after surgery. And it helps us understand why the average black patient receives $ 1,800 less in total medical care per year than a white person with the same health problems.

For decades, doctors have insisted that health inequalities are the fault of American society, existing policy, or other actors in the health system. While we must address these barriers to better health for all, doctors must also show the courage to hold up the mirror to the profession. After all, it is they who decide which patients will be tested and how much pain medication will be given.

Until doctors have the courage to face their prejudices, they will continue to violate the sacred oath of medicine to “do no harm first.”

3. The courage to treat patients like health partners

In the 21st century, the internet has flattened the gap between the experts and everyone else. In healthcare today, patients can explore diseases and treatments in unprecedented depth.

Many doctors believe that weeding out health information from the Internet is a recipe for “bad medicine.” May be. But doctors can’t expect patients to just stop looking for evidence on the internet. It’s not that people are suddenly asking for less information, less transparency, or less convenience from healthcare or other services.

American consumer culture is not going to go away. As a result, more and more Americans are demanding a new kind of doctor-patient relationship – one that looks far less paternalistic and more like a partnership. And this partnership must take into account the needs and wishes of the patient.

Telemedicine is a good place to start. Before the pandemic, only 8% of Americans had had a “virtual visit” to a doctor. Because most doctors had insisted that a good doctor’s practice can only take place in person. Covid-19 has proven that this perception is wrong. A recent survey found that 20% of consumers (55 million Americans) would trade their doctor for a doctor who offers telemedicine.

Historically, doctors have not valued or prioritized the patient’s time, convenience, or preferences. In the future, they won’t have a choice. A more equal doctor-patient partnership requires the courage to embrace alternative approaches to treatment and accept that patients have become (and will remain) savvy healthcare consumers.

4. The courage to uphold the true mission and purpose of medicine

For most of medical history, illnesses plagued doctors. Epidemics killed millions, including doctors who comforted the sick and dying. Entire civilizations died a gruesome death with doctors at their sick beds. And yet doctors never lost their nerve or the desire to help.

Many doctors today feel like victims of a broken system. They blame for-profit insurers, greedy pharmaceutical company executives, and hospital administrators for their professional dissatisfaction. And while they are right to call for sweeping health reforms that will free them from the administrative distractions that keep them from doing their jobs, they must also show the courage to change what they can control.

Doctors are the ones who write the prescriptions that contribute to 60,000 opioid deaths each year. They sign the surprising medical bills that have bankrupted millions of patients and their families. They contribute to the preventable medical errors that kill 200,000 people each year. They perform the 30% of all procedures that researchers at the Mayo Clinic have shown have no clinical value.

American doctors are at a crossroads. You are part of a wonderful and beautiful profession that is currently in crisis. Doctors must continue to uphold the righteous mission and purpose of medical culture. At the same time, they must have the courage to develop the most problematic parts of the culture. Not only does this benefit patients, but it also restores the appreciation the profession deserves.

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As COVID-19 cases wane, vaccine-lagging areas still see risk – The Denver Post

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JACKSON, miss. – New COVID-19 cases are declining in most of the country, even in some states with vaccine-reluctant populations. But almost all states bucking this trend have below-average vaccination rates, and experts warn that pandemic relief in regions where few people are vaccinated may be temporary.

According to data from Johns Hopkins University, case numbers nationwide fell from a seven-day average of nearly 21,000 on May 29 to 14,315 on Saturday in one week. For weeks, states and cities have also been dropping virus restrictions and mask requirements indoors.

Experts said some states are seeing increased immunity because the disease has a high natural rate of spread, killing nearly 600,000 Americans to date.

“We certainly have some benefit to the population from our previous cases, but we paid for it,” said Dr. Thomas Dobbs, Mississippi State Health Commissioner. “We paid for it with deaths.”

More than 7,300 Mississippi residents have died from the pandemic, and the state has the sixth highest death rate per capita.

Dobbs estimates that about 60% of the state’s residents have “some underlying immunity”.

“We are most likely seeing this effect now because we have a combination of natural and vaccine-induced immunity,” said Dobbs.

Only eight states – Alabama, Arkansas, Hawaii, Missouri, Nevada, Texas, Utah, and Wyoming – have seen a seven-day moving average for infection rates from two weeks earlier, according to Johns Hopkins University. All of them except Hawaii have fully vaccinated lower than the US average of 39.7%, according to the US Centers for Disease Control and Prevention.

The 10 states with the fewest new cases per capita during this period all have fully vaccinated rates above the national average. These include the three most vaccinated states: Vermont, Massachusetts, and Connecticut.

Medical experts said a number of factors were playing a role in the decline in case numbers across the country, including vaccines, natural immunity to exposure to the virus, warmer weather, and people spending less time indoors.

But dr. Leana Wen, a public health professor at George Washington University, said she was concerned that the natural immunity of those exposed to the coronavirus could soon wane. And she worries that states with low vaccination rates could become hot spots.

“Just because we’re lucky in June doesn’t mean we’ll continue to be lucky through late fall and winter,” said Wen, former Baltimore city health commissioner. “We could have variants here that are more transmissible and more virulent, and those that have no immunity or have declining immunity could be vulnerable again.”

In Mississippi, about 835,000 people are fully vaccinated, or 28% of the population, compared to the national average of 43%. But despite the lagging vaccination rate, the state’s moving average of new daily infections has declined by about 18% in the past two weeks, according to Johns Hopkins.

Dr. Albert Ko, chairman of the Department of Microbial Disease Epidemiology at Yale, said there was no accurate data to show the percentage of the population in “high exposure” states like Alabama and Texas, but he said estimates assume up to 50%.

“I think it doesn’t deny the importance of vaccination, especially because the antibody levels produced by natural infections are lower than what we have for our best vaccine,” Ko said.

Ko said it is important that those who have been exposed to the disease also get vaccinated because natural immunity doesn’t last as long as vaccine immunity and antibody levels are lower.

Wen said research strongly suggests that vaccinations are beneficial for those who already have antibodies from infection.

“I think it’s a fallacy that many people don’t need to be vaccinated after they recover,” she said.

___

Pat Eaton-Robb contributed to this report from Connecticut.

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