Daily Covid Briefing
Sept. 5, 2021, 10:31 a.m. ET
Sept. 5, 2021, 10:31 a.m. ET
Just as tourists were starting to return to Guam, the island has reported a record number of new Covid cases, a surge that is filling up hospital beds and dashing hopes of an economic recovery despite a successful vaccination campaign.
The average number of daily new cases has more than doubled to 165 in the past two weeks, according to a New York Times database. The tourism-dependent U.S. territory in the Western Pacific has vaccinated 70 percent of its total population with at least one shot.
Guam’s pandemic response was lauded by some as a success story, as the government contained the virus with mask mandates, quarantines for travelers, temporary closures of nonessential businesses and daily vaccination drives organized by the Guam National Guard. But in July, after reaching its vaccination goals, the government began to relax its travel restrictions and lift social distancing measures.
With case numbers rising, the Centers for Disease Control and Prevention last week issued its highest-level warning about traveling to Guam. The local government began requiring workers and people 12 and older to show a vaccination card to enter restaurants, gyms, movie theaters, sports stadiums and other facilities.
The Guam Tourism Bureau has also suspended its Air V&V program, a vaccination-vacation deal that offered all visitors a vaccine for $100 or less per dose. Chartered flights from Taiwan brought hundreds of vaccine tourists to the island.
“We’ve just been watching the numbers go up and up, and I don’t think we’re going to get any more tourists with this,” said Bob Odell, the owner of a local water sports shop called Guam Ocean Adventures. “It’s really starting to take a toll economically.”
Cases began to rapidly rise in mid-to-late July. Public schools opened classrooms for the new year in mid-August, but they reverted to online learning this past week amid the surge.
Aaron TuQuero, a worker at the ExpressCare Clinic in the Micronesia Mall, said that his team tested about 30 to 50 people per day and had seen a “great number of positive patients.”
“We’re at a high risk of contracting the virus from other countries, and more tourists have been coming in,” he said. “There have not been a lot of live gatherings on the island itself, as far as I can tell.”
Even before the pandemic, Guam had a chronic shortage of nurses and doctors, with only two hospitals serving the entire population, in addition to a U.S. naval hospital that grants limited access. On Friday, the government said that 47 people were hospitalized for Covid and that four were in intensive care units.
“For a small island, that’s a lot,” Mr. Odell said. “You have to stay concerned about this. We can’t let our guard down.”
Opening a window could reduce the amount of coronavirus in a room by half, according to a new observational study of infected college students in an isolation dormitory at the University of Oregon.
The study, which was posted online, is small and has not yet been published in a scientific journal. But it provides real-world evidence for several important principles, demonstrating that the virus spreads from infected people into the air in a room; that the more virus they’re carrying, the more virus builds up indoors; and that both natural and mechanical ventilation appear to reduce this environmental viral load.
“Ventilation is one of the most important mitigation strategies that we have at our disposal,” said Kevin Van Den Wymelenberg, who led the research and directs the Institute for Health in the Built Environment.
The researchers studied 35 University of Oregon students who tested positive for the coronavirus between January and May. All students subsequently moved into single rooms in a Covid isolation dormitory for a 10-day isolation period.
The scientists placed Petri dishes in each room and used an active air sampler to trap aerosols floating around the air. Several times a day, they also swabbed various surfaces in the room, as well as students’ noses and mouths.
Then they used P.C.R., or polymerase chain reaction, testing to determine whether the virus was present in each sample and, if so, at what levels.
The data confirmed that there was a clear link between the amount of virus that students were carrying and the environmental viral load. As the amount of virus in students’ noses and mouths decreased over their isolation period, so did the amount of airborne virus.
“There was a significant correlation between the nasal samples and the air samples in the room,” Dr. Van Den Wymelenberg said.
The viral loads in the rooms were higher, on average, when the students were symptomatic than when they were symptom-free, although the scientists stressed that even asymptomatic students emitted plenty of virus. Several self-reported symptoms, including coughing, were specifically associated with higher environmental viral loads.
The researchers also calculated the mechanical ventilation rate for each room, and asked students to report how often the windows were open. They found that viral loads were about twice as high, on average, in rooms that had the window closed more than half the time.
“Ventilation is really important, and I think we’re just starting to realize how important it is,” said Leslie Dietz, a study co-author and researcher at the University of Oregon.
The study had several limitations, including the fact that it included only young adults and that symptoms and window data were self-reported. The researchers also noted that they did not measure how much of the virus present in the room was viable, or capable of infecting other people.
Americans will most likely pay significantly more for Covid medical care during this new wave of cases — whether that’s a routine test or a lengthy hospitalization.
Earlier in the pandemic, most major health insurers voluntarily waived costs associated with Covid treatment. Patients weren’t responsible for co-pays or deductibles for emergency room visits or hospital stays, and most tests were free, too. But now, insurers are treating Covid more like other conditions, no longer fully covering the costs of care.
The federal rules that make coronavirus testing free include exemptions for routine workplace and school testing, which has become more common. Some patients have already received bills as high as $200 for routine screenings, according to documents patients submitted to a New York Times project tracking the costs of Covid testing and treatment. If you’ve received a bill, you can submit it here.
Some of the highest bills will probably involve Covid patients who need extensive hospital care now that 72 percent of large health plans are no longer offering free Covid treatment, a recent study from the Kaiser Family Foundation found.
This includes Blue Cross Blue Shield of Florida, the largest health plan in a state experiencing one of the country’s worst outbreaks. “When the Covid-19 pandemic began last year, we implemented several emergency provisions to temporarily help our members,” Toni Woods, a spokeswoman, said in a statement. She said the plan was now focused on encouraging vaccinations.
Oscar Health, which sells coverage in Florida and 14 other states, also ended free Covid treatment this week. It cited the widespread availability of the vaccine as a key reason. Jackie Khan, an Oscar spokeswoman, said, “We believe that the Covid vaccine is our best way to beat this pandemic, and we are committed to covering it and testing at $0 for our members.”
The new policies generally apply to all patients, including the vaccinated, people who get sick with a breakthrough infection, and children under 12, who are not yet eligible for the vaccine.
Dr. Kao-Ping Chua, a pediatrician at the University of Michigan who researches Covid care costs, said, “If you have a small kid who gets Covid at school and ends up at the I.C.U., that family is going to now be stuck with the bill even though that patient did not have the ability to get vaccinated.”
Public health warnings against using the anti-parasite medication ivermectin as a treatment for Covid, especially in the large doses meant for livestock, appear to have made little dent in its surging popularity in parts of the United States.
Hospitals and poison control centers across the United States are treating a growing number of patients taking the drug, even though every clinical trial so far has failed to show that it helps patients with Covid.
And the Centers for Disease Control and Prevention reported that almost 90,000 prescriptions for ivermectin were being written per week in mid-August, up from a prepandemic weekly average of 3,600. Veterinary supply store shelves have been emptied of it.
The C.D.C. reported that one person had an “altered mental status” after apparently taking five ivermectin pills — which he had purchased on the internet — daily for five days. Another person drank an ivermectin formula intended for cattle and was hospitalized for nine days with tremors and hallucinations.
The warnings are not enough. Ivermectin has been promoted by celebrities like the podcasting giant Joe Rogan, who listed it this week among the treatments he was given after contracting the virus. Alex Jones, the conspiracy theorist who has been banned from Facebook, YouTube and Twitter, took out a box of ivermectin pills during one of his trademark rants and popped two tablets live on the show that he still manages to stream.
Ivermectin was introduced as a veterinary drug in the late 1970s, and it was later approved for use in humans infected with parasites. Since 1987, its U.S. maker, Merck & Co., has donated billions of doses that have spared hundreds of millions of people from river blindness in Africa and other parasitic diseases. Two scientists shared a Nobel Prize in 2015 for their work in developing the drug. But in the United States, it has limited human applications, like treating lice and rosacea, and has been primarily used to deworm horses, cows and pets — until now.
On Twitter last month, the Food and Drug Administration warned that the drug was not approved for use against Covid and that taking large doses could cause serious harm. “You are not a horse,” its tweet read. “You are not a cow. Seriously, y’all. Stop it.”
In a statement on Wednesday, alarmed health experts from the American Medical Association, the American Pharmacists Association and the American Society of Health-System Pharmacists called for “an immediate end to the prescribing, dispensing and use of ivermectin for the prevention and treatment of Covid-19 outside of a clinical trial.”
Though it has not been shown to be effective in treating Covid-19, people are still clamoring to get the drug, trading tips in Facebook groups and on Reddit. Some physicians have compared the phenomenon with last year’s surge of interest in hydroxychloroquine, though ivermectin has undergone more clinical trials.
One of the largest trials, called the Together Trial, was halted last month because the drug had been shown to be no better than a placebo at preventing hospitalization for Covid. In July, a research paper indicating that the medicine reduced Covid deaths was withdrawn after questions arose about plagiarism and data manipulation.
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