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Recommendation Regarding the Use of Cloth Face Coverings, Especially in Areas of Significant Community-Based Transmission

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Use of Cloth Face Coverings to Help Slow the Spread of COVID-19

CDC continues to study the spread and effects of the novel coronavirus across the United States.  We now know from recent studies that a significant portion of individuals with coronavirus lack symptoms (“asymptomatic”) and that even those who eventually develop symptoms (“pre-symptomatic”) can transmit the virus to others before showing symptoms.  This means that the virus can spread between people interacting in close proximity—for example, speaking, coughing, or sneezing—even if those people are not exhibiting symptoms.  In light of this new evidence, CDC recommends wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain (e.g., grocery stores and pharmacies) especially in areas of significant community-based transmission.

It is critical to emphasize that maintaining 6-feet social distancing remains important to slowing the spread of the virus.  CDC is additionally advising the use of simple cloth face coverings to slow the spread of the virus and help people who may have the virus and do not know it from transmitting it to others.  Cloth face coverings fashioned from household items or made at home from common materials at low cost can be used as an additional, voluntary public health measure.

The cloth face coverings recommended are not surgical masks or N-95 respirators.  Those are critical supplies that must continue to be reserved for healthcare workers and other medical first responders, as recommended by current CDC guidance.

Recent Studies:

  • Rothe C, Schunk M, Sothmann P, et al. Transmission of 2019-nCoV Infection from an Asymptomatic Contact in Germany. The New England journal of medicine. 2020;382(10):970-971.
  • Zou L, Ruan F, Huang M, et al. SARS-CoV-2 Viral Load in Upper Respiratory Specimens of Infected Patients. The New England journal of medicine. 2020;382(12):1177-1179.
  • Pan X, Chen D, Xia Y, et al. Asymptomatic cases in a family cluster with SARS-CoV-2 infection. The Lancet Infectious diseases. 2020.
  • Bai Y, Yao L, Wei T, et al. Presumed Asymptomatic Carrier Transmission of COVID-19. Jama. 2020.
  • Kimball A HK, Arons M, et al. Asymptomatic and Presymptomatic SARS-CoV-2 Infections in Residents of a Long-Term Care Skilled Nursing Facility — King County, Washington, March 2020. MMWR Morbidity and mortality weekly report. 2020; ePub: 27 March 2020.
  • Wei WE LZ, Chiew CJ, Yong SE, Toh MP, Lee VJ. Presymptomatic Transmission of SARS-CoV-2 — Singapore, January 23–March 16, 2020. MMWR Morbidity and mortality weekly report. 2020;ePub: 1 April 2020.
  • Li R, Pei S, Chen B, et al. Substantial undocumented infection facilitates the rapid dissemination of novel coronavirus (SARS-CoV2). Science (New York, NY). 2020.

Source: https://tools.cdc.gov/api/embed/downloader/download.asp?m=404952&c=407501

Covid19

UC And Cal State Systems To Require COVID-19 Vaccinations For In-Person Fall Classes

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“Receiving a vaccine for the virus that causes COVID-19 is a key step people can take to protect themselves, their friends and family, and our campus communities while helping bring the pandemic to an end,” said Dr. Michael Drake, president of the University of California. Damian Dovarganes/AP hide caption

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Damian Dovarganes/AP

The California State University and University of California systems announced on Thursday that all 33 campuses will require students and staff returning for in-person instruction this fall to be fully vaccinated against COVID-19.

The new directive will go into effect once the Food and Drug Administration gives “full approval” to a COVID-19 vaccine. The Pfizer-BioNTech and Moderna shots currently going into people’s arms only have an Emergency Use Authorization.

CSU Chancellor Joseph Castro said the two higher education systems enroll and employ more than 1 million students and employees, and called the directive “the most comprehensive and consequential university plan for COVID-19 vaccines in the country.”

“Receiving a vaccine for the virus that causes COVID-19 is a key step people can take to protect themselves, their friends and family, and our campus communities while helping bring the pandemic to an end,” said Dr. Michael Drake, president of the University of California, in the joint statement.

The university leaders said the timing of the announcement is intended to give students, faculty and other staff ample time to obtain vaccinations before the start of the fall term. Both UC and Cal State have said schools are preparing for mostly in-person instruction and activities this fall.

Students will be required to update immunization documents with their respective universities as they do with other infectious diseases, including measles, mumps, rubella and chickenpox. Medical exemptions or approved exceptions will have to be cleared prior to campus arrival, according to the latest notice.

Universities across the country have been facing similar decisions as they plan to resume in-person instruction and vaccine availability has become more widespread. As of April 19, all states in the U.S. are offering vaccinations to people ages 16 and up.

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Source: https://www.npr.org/2021/04/22/990015740/uc-and-cal-state-systems-to-require-covid-19-vaccinations-for-in-person-fall-cla

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People With Severe COVID-19 Have Higher Risk Of Long-Term Effects, Study Finds

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Intensive Care Unit nurse Subramanya Kirugulige prepares a bed for an arriving COVID-19 patient at Roseland Community Hospital in Chicago in December. A large study has found that people with severe initial cases of COVID-19 tend to be at greater risk of more health problems later on. Scott Olson/Getty Images hide caption

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The potential lasting effects of COVID-19 infection are many — and people with more severe initial infections are at greater risk for long-term complications, according to a study published Thursday in Nature.

The study, thought to be the largest post-acute COVID-19 study to date, sheds more light on the lingering effects of COVID-19 known as “long COVID.”

Ziyad Al-Aly and his colleagues used the databases of the U.S. Department of Veterans Affairs to examine health outcomes in more than 73,000 people who’d had COVID-19 and were not hospitalized, comparing them with nearly 5 million users of the VA health system who did not have COVID-19 and were not hospitalized.

Six months later, those who’d had COVID-19 were found to be at higher risk of new onset heart disease, diabetes, mental health disorders including anxiety and depression, substance use disorders, kidney disease and other problems.

Al-Aly, chief of research and development service at the VA St. Louis Health Care System, said it was shocking to see that the toll of long COVID is so substantial and multifaceted.

“We knew people have fatigue, we knew people have weakness, we knew about the memory problems or brain fog,” he said. “But when you put it all together, the diabetes and heart problems and kidney problems and liver problems and stroke and brain fog and fatigue and anemia and depression and anxiety — and it’s actually quite jarring.”

It remains difficult for researchers to distinguish which effects are a direct consequence of the viral infection itself, and which are indirect.

Some consequences could be a result of inflammation provoked by the virus, while others could be linked to life changes that might accompany the disease. “When people get COVID and they have to self-isolate and stay at home in quarantine, maybe that is associated with less physical activity, changes in diet, other changes that might also bring about some of those clinical manifestations,” Al-Aly said.

Aftereffects from COVID-19 were seen in the respiratory system, as well as nervous system disorders, mental health problems, metabolic and cardiovascular disorders, malaise, fatigue, musculoskeletal pain and anemia. The authors also found increased use of therapeutics including pain medications (such as opioids), antidepressants, and anti-anxiety medications.

The authors also analyzed the health outcomes of more than 13,600 people who had been hospitalized with COVID-19, and compared them with nearly 14,000 people who had been hospitalized with influenza. They found that compared to those who’d been hospitalized with the seasonal flu, COVID-19 survivors who’d been hospitalized saw increased risk and magnitude of post-infection lung problems and other disorders.

The findings do not suggest that everyone who gets COVID-19 will have long-term health effects.

“The majority of people will have no problems and no consequences down the road. They’ll get maybe sick for a day or two or three or four. They’ll get over the hump. They’ll regain their energy, cough will go away, shortness of breath will go away, fever will go away, and they will feel fine,” he says.

“But it is true, though, that a minority of people, even if they have mild disease, they are at higher risk of developing some of the consequences that we described here. So the risk is not zero – it’s small, but it’s not trivial.”

The study’s subjects skewed male, given the veterans who use VA health care. But while the VA population is about 88% male, the study’s large size means that it still included more than 8,800 women who contracted COVID-19.

The U.S. has had at least 31 million confirmed cases of the coronavirus. It’s not clear exactly what portion of patients experience its lingering symptoms, but Al-Aly says it’s estimated to be 8-10%.

The takeaway from this study, Al-Aly says, is that the health care system needs to get ready for a lot of people living with the consequences of long COVID-19.

“That really represents a significant burden on the health care system that we need to be prepared for,” he says. “We shouldn’t really act surprised two or three years down the road, when people are having of a lot more diabetes or a lot more people with heart disease show up. We shouldn’t really act surprised. We should prepare for it now.”

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Source: https://www.npr.org/sections/coronavirus-live-updates/2021/04/22/989874986/people-with-severe-covid-19-have-higher-risk-of-long-term-effects-study-finds

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Vaccine Passports: Israel, Bahrain Reach Landmark Agreement

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A picture taken on March 29, 2021, shows the new passenger terminal of Bahrain International Airport. Bahrain established diplomatic ties with Israel last year. In Israel and Bahrain, vaccine passports will be entirely digital: a QR code on one’s phone, recognized at both countries’ passport control, according to an Israeli official. Giuseppe Cacace/AFP via Getty Images hide caption

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Giuseppe Cacace/AFP via Getty Images

Israel and Bahrain on Thursday reached what Israel calls the world’s first bilateral agreement for mutual recognition of COVID-19 vaccine passports for quarantine-free travel between two countries, an Israeli diplomat who helped forge the deal tells NPR.

“This is the most effective way to enable movement of people between countries,” says Ilan Fluss, head of the Israeli foreign ministry’s economic division. “A lot of countries are looking at testing, but it is not enough.”

Israel, one of the world’s most vaccinated populations per capita, is a leading proponent of vaccine passports — documents or digital forms confirming that a person is vaccinated against COVID-19 — arguing they are key to reopening economies for tourism and business travel. In some countries, there is opposition to the concept, seen as a violation of privacy and civil liberties.

In Israel and Bahrain, the vaccine passports will be entirely digital: a QR code on one’s phone, recognized at both countries’ passport control, Fluss says. The passports will only contain COVID-19 vaccination information. Personal health records will not be included.

Israel will recognize Bahraini vaccine passports not only for entry, but also to gain access to an Israeli domestic vaccine pass, called the Green Pass, which allows those who are vaccinated against COVID-19 or recovered from the virus to access restaurants, gyms, theaters and other venues.

Israel also grants these passes to citizens who do not wish to be vaccinated, but only for 48 hours and only after they test negative for the virus.

Foreign Minister Gabi Ashkenazi said in a statement that Israel would reach similar agreements with other countries in the coming days. Israel is in talks with the U.S., U.K. and others for mutual vaccine document recognition. The U.S. poses challenges for Israel because its vaccination certificates are often handwritten and not centrally stored digitally.

The pact with Bahrain, a country that established diplomatic ties with Israel last year, paves the way for new Gulf Arab travel to Israel after Israel gradually reopens to foreign visitors in late May, starting with tour groups.

Israel currently recognizes the Pfizer-BioNtech and Moderna vaccines, but not other vaccines available in Bahrain, and is seeking a solution to allow all Bahrainis to enter once the country reopens.

Several countries have already unilaterally recognized Israeli vaccine certificates in a bid to attract Israeli tourists without quarantine requirements, including Greece and Cyprus. Those countries have also announced efforts to forge bilateral travel agreements, as the European Union is working to unveil vaccine passports for EU-wide travel in mid-June.

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Source: https://www.npr.org/sections/coronavirus-live-updates/2021/04/22/989891650/vaccine-passports-israel-bahrain-reach-landmark-agreement

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U.S. Issues More Than 115 ‘Do Not Travel’ Advisories, Citing Risks From COVID-19

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Global travel continues to be risky because of the coronavirus. Earlier this year, passengers from Taiwan wear protective gear as they arrive at France’s Charles de Gaulle Airport, and just this week, the U.S. issued over 100 new travel advisories. Francois Mori/AP hide caption

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Francois Mori/AP

The U.S. State Department has vastly expanded its “Do Not Travel list,” issuing new Level 4 advisories for more than 115 countries and territories this week. The agency cites “ongoing risks due to the COVID-19 pandemic.”

The U.S. Do Not Travel list now includes Canada, Mexico, Germany and the U.K. A Level 3 warning is in place for a smaller group of nations, such as China, Australia and Iceland. Japan is also on the Level 3 list, despite a worrying rise in new coronavirus cases there.

Just a week ago, only 33 countries were on the U.S. Do Not Travel list, according to a cached version of the advisory site. But the State Department warned on Monday that the list would soon include roughly 80% of the world’s countries.

More than 150 highest-level travel advisories are in effect — more closely reflecting guidance from the Centers for Disease Control and Prevention, the State Department says.

The CDC’s own travel health notices also use a four-tier warning system. For many countries newly added to the State Department’s Level 4 list, the CDC cites “a very high level of COVID-19.”

As of last week, Brazil and Russia were two of the only large COVID-19 global hotspots on the State Department’s most serious warning list. They’re now joined by India and virtually all of Europe — places that have seen alarming spikes in new cases.

Bhutan is the only international destination designated as Level 1 — “exercise normal precautions” — on the State Department’s travel advisory list.

Sixteen countries are categorized as Level 2 — meaning travelers should exercise increased caution when visiting places such as Thailand, Vietnam, South Korea, Belize and Grenada.

Many of the new or updated Do Not Travel notices cite high levels of coronavirus transmission in the relevant country. But the State Department says it also takes other factors into account, from the availability of coronavirus testing to any travel restrictions the countries might have against U.S. citizens.

In roughly 35 countries or destinations, the CDC says, details about the level of COVID-19 risk are unknown. The health agency urges Americans to avoid traveling to those spots, which include Afghanistan, Nicaragua and the Solomon Islands.

Regardless of a particular country’s advisory status, the State Department wants all U.S. citizens to reconsider any travel abroad.

“The COVID-19 pandemic continues to pose unprecedented risks to travelers,” the agency said.

More than 3 million people have died from COVID-19 worldwide, according to the World Health Organization. Nearly 144 million coronavirus cases have been reported globally, according to data compiled by Johns Hopkins University.

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Source: https://www.npr.org/sections/coronavirus-live-updates/2021/04/22/989809103/u-s-issues-more-than-115-do-not-travel-advisories-citing-risks-from-covid-19

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