February 2022

Some medical experts have expressed concern that COVID-19 preventative measures, like masking and remote schooling, are potentially weakening children’s immune systems by shielding them from the usual childhood illnesses.

“There’s a lot of reasons to believe that kids need to be exposed to things to keep their immunity complex, so that should they encounter something very dangerous, they have aspects of their immunity that might cross over and help protect them against those things,” says Sara Sawyer, a professor of molecular, cellular and developmental biology at the University of Colorado Boulder.

At birth, vulnerable infants get antibodies from their mother’s breast milk, which helps protect them until they can build their own immunity. It’s no accident that babies start putting things in their mouths as soon as they gain enough dexterity to pick things up.

“They’re doing that because they’re sampling the environment and building their immunity. That’s an evolutionary trait,” Sawyer says. “They’re exposing their body to germs in a certain, level way to build their immunity. So, some people would argue that childhood illnesses, like colds and stomach bugs, build our immunity so that when more dangerous things come along, we’re prepared and we don’t get as sick from those more dangerous things.”

Even before the pandemic, epidemiological evidence suggested that children in more developed countries, where handwashing and the use of sanitizer are more prevalent, might have less-developed immune systems compared to kids in developing nations who are routinely exposed to more bacteria, viruses and allergens. This makes kids in more industrialized countries more vulnerable to developing autoimmune diseases, according to what’s known as the “hygiene hypothesis.”

“The hygiene hypothesis is actually quite controversial because it’s thought that our exposure to microbes isn’t the only factor,” says Cody Warren, a virologist and immunologist who is a postdoctoral fellow at the University of Colorado Boulder. “A lot of this could also be dictated by genetics, diet, and the environment that we live in. That also shapes our immune system… it’s a real multifactorial thing that we can’t fully account for just by wearing masks. There are other things that go into that equation.”

Warren, the father of three young children, says spending lots of time outdoors is one way to balance the negatives of isolation.

“Just exploring microbes in the environment also is benefiting [and] training our immune system,” Warren says. “Our immune systems get trained through the foods that we eat, which also have microorganisms on them. And so, despite the fact that we’ve kind of been hunkered down a little bit, I do feel that our immune systems will catch up.”

There are other things parents can do, he says, to boost their children’s immune systems during pandemic times.

“One of the most important things you can do is just to stay up to date on vaccines. That’s one of the best ways that we have to train our immune systems,” Warren says. “But also, equally important is making sure our children have a good diet and they regulate stress. It’s been well documented that both of those — having a good diet, a less stressful environment — can have a positive impact on our immune system.”

Once public health officials say masks are no longer necessary, Sawyer thinks pointing out the positives of putting our masks away could reassure hesitant parents who worry about their children getting sick.

“Maybe we should have a public conversation about the possible reasons to take that mask off, if they are in school, and get back to the normal repertoire of relatively safe childhood illnesses,” she says. “The plus side of childhood illnesses is that they can build up that hornet’s nest of immunity that could protect kids against new things that then come along.”
…

Hong Kong’s fifth wave of coronavirus could see thousands of deaths, a new study said.

Slammed by the city’s fifth wave of COVID-19, Hong Kong is facing its worst health period since the pandemic began two years ago. It has forced the city’s government to implement strict measures, including compulsory tests for all Hong Kong residents.

February has seen thousands of new cases, mostly from the omicron variant. A new daily high of 10,010 infections was recorded Friday.

A study by the University of Hong Kong considered the potential outcomes from the current wave of coronavirus cases. One of the worst scenarios outlined that if the hospitals were to be overburdened, Hong Kong could see 7,000 COVID-19-related deaths by the end of June.

“The infection fatality risk may increase by 50% when the health care system becomes overburdened, in which case the cumulative number of deaths could further increase to 4,231 – 6,993,” the study said.

But it also said deaths could be half that number, about 3,200 by mid-May, if health measures remained.

‘Zero-COVID’ plan

Hong Kong had adopted a “zero-COVID” strategy, aligned with Beijing’s effort to control the pandemic across China. It had some success, with authorities quickly clamping down on rare outbreaks by contact tracing, social restrictions, mass testing and quarantine.

Fan Hung-ling, chairman of the Hong Kong Hospital Authority, told the Chinese state’s Global Times that the strategy was “our country’s basic policy” and “won’t change.”

Earlier this month, Chinese President Xi Jinping ordered the city’s authorities to get the fifth wave under control. Xi is due to visit Hong Kong July 1, marking the 25th anniversary of the city’s return to China from Britain.

Last week, Hong Kong Chief Executive Carrie Lam unveiled new measures for the city, including a requirement that residents have proof of vaccination against COVID-19 to enter various premises.

On Wednesday, Lam also announced compulsory testing for all residents by March, with a goal of boosting the city’s vaccination rate to 90%.

Dr. David Owens, an honorary assistant clinical professor at Hong Kong University, had hoped for a different plan of action.

“I would have preferred we would have shifted all of our energies that would effectively [be focused on] things that would save lives,” Owens told VOA. “That would be mitigation, to roll out vaccinations to the elderly and vulnerable. I have also argued we should move to rapid testing so we can break the transmission chains quickly.”

Need for home isolation

Dr. Karen Grepin, associate professor at the University of Hong Kong’s School of Public Health, responded to the mass strategy campaign.

“It is likely it will happen at a time very close to the peak of the outbreak and thus it will likely identify literally hundreds of thousands of cases, including likely many who are no longer infectious. It is unlikely that we will be able to isolate even a fraction of these cases, so unless it is coupled with a comprehensive home isolation strategy, it will have little impact on transmission,” Grepin told VOA.

According to data from the Hong Kong Hospital Authority, public hospitals are averaging an occupancy rate of 89%.

One health worker at Hong Kong’s United Christian Hospital, who chose to remain anonymous, admitted she was “afraid” of the pending testing program.

“Patients were crying,” she said. “A male patient said he had not eaten for 12 hours. And another patient said he wanted to commit suicide. And I started to cry. I cannot offer any more for them.

“I am so afraid of the universal testing program. We don’t have enough manpower for that. The government is so keen on a zero-COVID strategy. To me, it is a zero-medical staff strategy. The morale is worsened every day in the frontline.”

She described her job’s current conditions as like “working in a market.”

“It was so difficult to pass through the waiting hall,” she said. “We have to shout out to search the patients.”

Patients in beds outdoors

Last week, Hong Kong’s Caritas Hospital saw dozens of patients lying in hospital beds outside in cold weather, waiting to be admitted. But occupancy is was at 102%, the Hospital Authority said.

A nurse working at the hospital, who also chose to remain anonymous, said elderly patients “have nowhere to turn.”

“Patients are not severely sick from my ward, but [have a] lack of self-care ability. The virus is widely breaking out in elderly care homes and homes for disabilities. They cannot do self-isolation, as they are from the same care center. The staff [are] probably infected. Therefore, the patients literally have nowhere to go even if they turn negative,” she told VOA.

Hong Kong residents have also spoken to VOA about pandemic fatigue, venting their frustrations at the government’s new health measures.

And some expatriates are also looking to leave the city altogether. A Facebook group aimed at helping expatriates leave Hong Kong has already gained over 3,000 members, only days after being created.

Singapore for some

British citizen Niall Trimble, a job recruitment director at Ethos BeathChapman, an executive recruitment firm in Hong Kong, has decided to move elsewhere in Asia.

“I would say the reason for leaving is the lack of flexibility compared to other places on the COVID situation,” he told VOA. “As a recruiter across technology and financial services I am already seeing a huge influx of candidates looking to move to Singapore and also clients looking to move operations to Singapore.”

Hong Kong’s economy fell into a two-year recession in 2019 and 2020. But last year the city saw growth of 6.4% as coronavirus cases remained low.

But Hong Kong has now recorded at least 84,000 cases, with 2022 alone seeing more infections than the last two years combined.

Hong Kong’s finance chief unveiled a budget of over $20 billion to cope with the outbreak, which will include an electronic spending voucher for each resident.

Hong Kong authorities are set to loosen the strategy on rapid testing and allow home isolation for positive cases, the South China Morning Post reported Friday.
…

Most Americans live in places where healthy people, including students in schools, can safely take a break from wearing masks under new U.S. guidelines released Friday. 

The Centers for Disease Control and Prevention outlined the new set of measures for communities where COVID-19 is easing its grip, with less of a focus on positive test results and more on what’s happening at hospitals. 

The new system greatly changes the look of the CDC’s risk map and puts more than 70% of the U.S. population in counties where the coronavirus is posing a low or medium threat to hospitals. Those are the people who can stop wearing masks, the agency said. 

The agency is still advising that people, including schoolchildren, wear masks where the risk of COVID-19 is high. That’s the situation in about 37% of U.S. counties, where about 28% of Americans reside.  

The new recommendations do not change the requirement to wear masks on public transportation and indoors in airports, train stations and bus stations.  

The CDC guidelines for other indoor spaces aren’t binding, meaning cities and institutions even in areas of low risk may set their own rules. And the agency says people with COVID-19 symptoms or who test positive should wear masks.

Risk is generally lower 

But with protection from immunity rising — both from vaccination and infection — the overall risk of severe disease is now generally lower, the CDC said. 

“Anybody is certainly welcome to wear a mask at any time if they feel safer wearing a mask,” CDC Director Dr. Rochelle Walensky said in a news briefing. “We want to make sure our hospitals are OK and people are not coming in with severe disease. … Anyone can go to the CDC website, find out the volume of disease in their community and make that decision.” 

Since July, CDC’s transmission-prevention guidance to communities has focused on two measures: the rate of new COVID-19 cases and the percentage of positive test results over the previous week.  

Based on those measures, agency officials advised people to wear masks indoors in counties where the spread of the virus was deemed substantial or high. This week, more than 3,000 of the nation’s more than 3,200 counties — greater than 95% — were listed as having substantial or high transmission.  

That guidance has increasingly been ignored, however, with states, cities, counties and school districts across the U.S. announcing plans to drop mask mandates amid declining COVID-19 cases, hospitalizations and deaths. 

With many Americans already taking off their masks, the CDC’s shift won’t make much practical difference for now, said Andrew Noymer, a public health professor at the University of California-Irvine. But it will help when the next wave of infection — a likelihood in the fall or winter — starts threatening hospital capacity again, he said. 

“There will be more waves of COVID. And so I think it makes sense to give people a break from masking,” Noymer said. “If we have continual masking orders, they might become a total joke by the time we really need them again.” 

Color-coded information

The CDC is also offering a color-coded map — with counties designated as orange, yellow or green — to help guide local officials and residents. In green counties, local officials can drop any indoor masking rules. Yellow means people at high risk for severe disease should be cautious. Orange designates places where the CDC suggests masking should be universal. 

How a county comes to be designated green, yellow or orange will depend on its rate of new COVID-19 hospital admissions, the share of staffed hospital beds occupied by COVID-19 patients and the rate of new cases in the community. 

Mask requirements have ended in most of the U.S. in recent weeks. Los Angeles on Friday began allowing people to remove their masks while indoors if they are vaccinated, and indoor mask mandates in Washington state and Oregon will be lifted in March. 

State health officials are generally pleased with the new guidance and “excited with how this is being rolled out,” said Dr. Marcus Plescia of the Association of State and Territorial Health Officials. 

“This is the way we need to go. I think this is taking us forward with a new direction going on in the pandemic,” Plescia said. “But we’re still focusing on safety. We’re still focusing on preventing death and illness.” 

The CDC said the new system will be useful in predicting future surges and urged communities with wastewater surveillance systems to use that data, too.
…

Drugmaker Johnson & Johnson and three major distributors finalized nationwide settlements over their role in the opioid addiction crisis Friday, an announcement that clears the way for $26 billion to flow to nearly every state and local government in the U.S.

Taken together, the settlements are the largest to date among the many opioid-related cases that have been playing out across the country. They’re expected to provide a significant boost to efforts aimed at reversing the crisis in places that have been devastated by it, including many parts of rural America.

Johnson & Johnson, AmerisourceBergen, Cardinal Health and McKesson announced the settlement plan last year, but the deal was contingent on getting participation from a critical mass of state and local governments.

Friday was the deadline for the companies to announce whether they felt enough governments had committed to participate in the settlement and relinquish the right to sue. The four companies notified lawyers for the governments in the case that their thresholds were met, meaning money could start flowing to communities by April.

“We’re never going to have enough money to immediately cure this problem,” said Joe Rice, one of the lead lawyers who represented local governments in the litigation that led to the settlement. “What we’re trying to do is give a lot of small communities a chance to try to change some of their problems.”

While none of the settlement money will go directly to victims of opioid addiction or their survivors, the vast majority of it is required to be used to deal with the epidemic. The need for the funding runs deep.

Kathleen Noonan, CEO of the Camden Coalition of Healthcare Providers, said a portion of the settlement money should be used to provide housing to people with addictions who are homeless.

“We have clients who have a hard time staying clean to make it in a shelter,” she said. “We would like to stabilize them so we can help them recover.”

Dan Keashen, a spokesman for Camden County government, said officials are thinking about using settlement money for a public education campaign to warn about the dangers of fentanyl. They also want to send more drug counselors into the streets, put additional social workers in municipal courts and pay for anti-addiction medications in the county jail.

Officials across the country are considering pumping the money into similar priorities.

California Gov. Gavin Newsom’s proposed budget calls for using $50 million of the state’s expected $86 million share this year for youth opioid education and to train treatment providers, improve data collection and distribute naloxone, a drug that reverses overdoses.

In Florida’s Broward County, home to Fort Lauderdale, the number of beds in a county-run detoxification facility could be expanded from 50 to 70 or 75, said Danielle Wang French, a lawyer for the county.

“It’s not enough, but it’s a good start,” she said of the settlement.

With fatal overdoses continuing to rage across the U.S., largely because of the spread of fentanyl and other illicitly produced synthetic opioids, public health experts are urging governments to use the money to ensure access to drug treatment for people with addictions. They also emphasize the need to fund programs that are proven to work, collect data on their efforts and launch prevention efforts aimed at young people, all while focusing on racial equity.

“It shouldn’t be: ready, set spend,” said Joshua Sharfstein, a former secretary of the Maryland Department of Health who is now a vice dean of public health at Johns Hopkins University. “It should be: think, strategize, spend.”

In a separate deal that also is included in the $26 billion, the four companies reached a $590 million settlement with the nation’s federally recognized Native American tribes. About $2 billion is being set aside for fees and expenses for the lawyers who have spent years working on the case.

New Brunswick, New Jersey-based Johnson & Johnson has nine years to pay its $5 billion share. The distributors — Conshohocken, Pennsylvania-based AmerisourceBergen; Columbus, Ohio-based Cardinal Health; and Irving, Texas-based McKesson — agreed to pay their combined $21 billion over 18 years. To reach the maximum amounts, states have to get local governments to sign on.

The settlements go beyond money. J&J, which has stopped selling prescription opioids, agrees not to resume. The distributors agree to send data to a clearinghouse intended to help flag when prescription drugs are diverted to the black market.

The companies are not admitting wrongdoing and are continuing to defend themselves against claims that they helped cause the opioid crisis that were brought by entities that are not involved in the settlements.

In a joint statement, the distributors called the implementation of the settlement “a key milestone toward achieving broad resolution of governmental opioid claims and delivering meaningful relief to communities across the United States.”

The requirement that most of the money be used to address the opioid crisis contrasts with a series of public health settlements in the 1990s with tobacco companies. In those cases, states used big chunks of the settlement money to fill budget gaps and fund other priorities.

The amount sent to each state under the opioid settlement depends on a formula that takes into account the severity of the crisis and the population. County and local governments also get shares of the money. A handful of states — Alabama, New Hampshire, Oklahoma, Washington and West Virginia — have not joined all or part of the settlement, mostly because they have their own deals or are preparing for trial.

In Camden, Lisa Davey, a recovery specialist for Maryville Addiction treatment Center, was at a needle exchange this week handing out naloxone, a drug that reverses overdoses, and asking people if they wanted to start treatment.

Davey said she wants to see detoxification and treatment programs receive more funding to keep people in them for longer. As it is, she said, users can detox and be back out on the streets in search of drugs within days.

“They need more time to work their recovery,” she said.

A man picking up clean needles who asked to be identified only as Anthony P. said he was 46 and had struggled with addiction since he was a teenager. He said he’d like to see an effort to cut off fentanyl and related synthetic opioids that are driving overdose death rates from the drug supply.

“Fentanyl’s got to go,” he said.

Martha Chavis, president and CEO of Camden Area Health Education Center, which runs the needle exchange, said one need is offering services like hers in more places. Now, users from far-flung suburbs travel into Camden to get clean needles and kits to test their drugs for fentanyl.

The settlement with J&J and the three distributors marks a major step toward resolving the vast constellation of lawsuits in the U.S. over liability for an epidemic that has been linked to the deaths of more than 500,000 Americans over the past two decades.

Other companies, including business consultant McKinsey and drugmakers Endo, Mallinckrodt and Teva, have reached national settlements or a series of local ones. OxyContin maker Purdue Pharma and a group of states are in mediation through U.S. Bankruptcy Court to try to reach a nationwide settlement.

The crisis has deepened during the coronavirus pandemic, with U.S. opioid-related deaths reaching a high of more than 76,000 in the 12 months that ended in April 2021, largely because of the spread of fentanyl and other lab-made drugs. A recent report from a commission by The Lancet medical journal projected that 1.2 million Americans could die of opioid overdose between 2020 and 2029 without policy changes.

John F. Kelly, a professor of psychiatry in addiction medicine at Harvard Medical School, said he wants to see money from the settlements go not just for treatment, recovery and support efforts but also to build systems designed to prevent this sort of epidemic from happening again.

“Some kind of national board or organization could be set up … to prevent this kind of lack of oversight from happening again — where industry is allowed to create a public health hazard,” he said.
…