COVID? No Geographic Area Too Remote

"The virus that causes COVID-19 spreads easily between people in close quarters on board ships, and the chance of getting COVID-19 on cruise ships is very high [even if people are fully vaccinated and have received a booster]."

"CDC has issued an Order that requires face masks to be worn by all travelers while on public transportation including all passengers on board and all personnel operating maritime conveyances traveling into, within, or out of the United States. Masks are also required while indoors at U.S. transportation hubs, including seaports and ferry terminals. Travelers are not required to wear a mask in outdoor areas of a conveyance."

U.S.Centers for Disease Control  

"[The decision] is particularly perplexing considering that cases identified on cruise ships consistently make up a very slim minority of the total population onboard."

"The majority of those cases are asymptomatic or mild in nature, posing little to no burden on medical resources onboard or onshore."

Cruise Lines International Association

 

"We don't like to see even one case, but our experience is a fraction of the comparable statistics of virtually any other comparable location or industry."

"Few businesses are subject to such intense scrutiny, regulation and disclosure requirements by so many authorities."

Richard Fain, CEO, Royal Caribbean

The Celebrity Summit cruise ship prepares to depart from Port Miami, Saturday, Nov. 27, 2021, in Miami. (AP Photo/Lynne Sladky)

"[The spread of the Omicron variant] may shape how some destination authorities view even a small number of cases, even when they are being managed with our vigorous protocols."

"Some destinations have limited medical resources and are focused on managing their own local response to the variant [when they refuse a cruise ship entry to their waters and deny docking permission]."

"Should it be necessary to cancel a port, we will do our best to find an alternative destination,"

Carnival spokesperson AnneMarie Mathews  

All travellers -- even those fully vaccinated, according to the U.S.Centers for Disease Control -- should avoid cruises. The agency had received reports of 5,013 COVID-19 cases on ships in American waters between December 14 and 29, representing a massive increase over the previous two weeks when 162 cases were reported. Some 91 ships carrying passengers from U.S. waters reported cases in the past seven days that meet the threshold for CDC investigation and recommendation.

 

 Understandably, the Cruise Lines International Association is a trifle annoyed at this intervention and  interruption in their tourism business, thriving now, having recovered from the 'floating coffin' era of a year earlier when the global pandemic had just begun its disastrous sweep through the world. It is the cruise industry's focus to offer tourism on a grand scale, each of these monster vessels carrying the equivalent of a fair-sized town to exotic destinations. It is the mission of the CDC to stop pandemics in their tracks -- if at all possible.

 

Over 80 cruise ships are now being investigated by the U.S. Centers for Disease Control and Prevention, all of which have experienced COVID-19 outbreaks. A new colour-coded system was implemented by the cruise industry and the CDC to help monitor and control virus outbreaks. 85 ships from Norwegian Cruise Lines, Disney, Carnival Corp. and Royal Caribbean Cruise Lines were given yellow flags, triggering a CDC investigation.

 

A yellow flag denotes that coronavirus cases were reported in over 0.10 percent of passengers; with 6,500 passengers on board a cruise ship; seven or more cases have been diagnosed during the previous week, and yet other cases reported among the liner's crew. 25 ships operated by Royal Caribbean were given a yellow label; one, the Odyssey of the Seas, began skipping ports, heading back to Fort Lauderdale Florida after 55 people on board tested positive for COVID-19.

 

The Seven Seas Mariner, Manfred Segerer/ullstein bild/Getty Images

 Should sustained transmission of COVID-19 go on to overwhelm medical resources on board, the CDC will review a ship for proposed red status; none yet have been labelled with a red flag. The alert system of colour-coding numbers of affected passengers applies only to ships  sailing or planning to enter U.S. waters. In Canada, Transport Canada banned cruise ships in Canadian waters for a year, a ban scheduled to be lifted in February 2022. Canadians continue to be advised by government to avoid all travel on cruise ships outside the country for the present.

 

COVID-19 has led the cruising industry to gigantic losses of an estimated $32 billion, aside from the hit to the industry's reputation which suffered from early reports of mass COVID outbreaks, leaving ships marooned with sick passengers, refused entry to ports. In self-defence the cruise industry enacted strict COVID0-19 mitigation protocols with testing, vaccination mandates, enhanced ventilation systems, mask-wearing, physical distancing and other public health protocols.

 

But COVID-19 is a dangerously sneaky, pervasive, pernicious threat, particularly the Omicron variant. With the best of avoidance protocols in place, the virus eerily turns up in the most unexpected places. While it's easily understood that the virus can proliferate and infect prodigiously as nature permits it to do, in an environment where in effect, thousands of people are sitting ducks on a ship, despite heroic efforts to keep everyone safe, it's a little more difficult to explain how in the most isolated place on the planet, COVID still showed up.

 

As it did in Antarctica at the Princess Elizabeth Polar Station where two thirds of Belgium's 25 staff have been infected. Despite being fully vaccinated, living far from civilization, polar researchers contracted the coronavirus. None of those infected exhibited severe symptoms. The outbreak occurred despite staff passing multiple PCR tests, quarantining, and living in one of the most remote areas on the planet. It entered with a scientist new arrived, who had been cleared by tests prior to arrival.

 

The Princess Elisabeth Polar Station in Antarctica in 2009. Photo by Philippe SIUBERSKI/AFP via Getty Images/File

 

 

 

 

Your Usual Dinnertime Tipple of Wine?

"Our study is now one more mosaic stone in the evidence which is coming to show that what we believed for decades might not be true."

"We undertook this research to ask, what kind of people are these [past habitual drinkers]? What characteristics do they have?

"If people talk about alcohol, they always warn of becoming alcohol dependent ... but these people are less than two percent of the health disorders which may accrue from alcohol. Prevalent health disorders -- cardiovascular disorders and cancers -- should be much more stressed, and particularly breast cancer. It's very, very important because it's the number one cancer among females."

"Alcohol has a very, very long tradition in culture. So, it will be a huge endeavour to go ahead with this message that the best is to stay abstinent from alcohol."

"We have all these lessons learned from the tobacco industry and the alcohol industry which acts in a very, very similar way. So they support studies and investigations about these hypotheses, and particularly resveratrol."

"The main message is that people should remember to reduce their drinking [regardless] of whether they are high consumers or very low consumers."

"[The best way to prevent alcohol-related health disorders] -- namely cardiovascular disease and cancers, and mortality as well -- [is not to drink it at all, which is in line with the World Cancer Research Fund's recommendations]."

Ulrich John, University Medicine Greifswald, Germany 

The study contradicts most national guidelines which say there may be health benefits to one or two glasses of wine. Photograph: Inti St Clair/Getty Images

 

But ... but we've been assured for years -- decades -- that moderate consumption of alcohol is highly beneficial to human health -- haven't we? Now along comes research published in the journal PLOS Medicine that tells us otherwise. The study by Ulrich John of University Medicine and his colleagues in Greifswald, Germany carries an unequivocal message: if you consume alcohol and cite its health benefits, you might see merit at this point in reconsidering your devotion to alcohol as health-beneficial.

This Germany-based research team studied 4,028 adults, finding that increased mortality among abstainers may be explained in part by other factors; alcohol for example, or drug dependence, smoking and a general history of poor health. A glass of wine or a pint of beer daily to benefit health is being prescribed in many countries by doctors; belief in the benefits of modest amounts of alcohol is that widespread and pervasive. 

Older epidemiological studies inexorably led to this interpretation "with many shortcomings", suggesting that alcohol abstainers have a higher mortality rate than those who consume low to moderate amounts. No significant difference in mortality between abstainers in good health and those who drank moderately was found by the new study, countering recommendations to drink alcohol for good-health reasons.

Other health behaviours, suggested by accessible evidence, including sedentary lifestyle, tobacco and substance use, have a dose-dependent relationship with mortality and health disorders; in that the greater the exposure, the higher the risk that follows. In light of which Dr.John found it "very implausible" that alcohol should be singled out as an exception, with health benefits.

Dr. John's research group investigated 4,028 adults between 1996 and 1997 with the use of standardized diagnostic interviews, including "very exact" information on health, alcohol and drug use along with smoking habits. The researchers revisited their data two decades later, which included mortality information, and drew comparisons between alcohol abstainers and low to moderate drinkers to find that 91 percent of alcohol abstainers were former drinkers, and 72 percent identified with one at least risk factors, such as a former alcohol or drug use disorder; former risky alcohol consumption; efforts to cut down or stop drinking; daily tobacco smoking; or fair to poor health.

They found no statistically significant difference in mortality rate between the health abstainers without any "factors that predict early death" and those who consumed low to moderate amounts of alcohol. The Women's Health Initiative Observational Study showed drinking even small amounts of alcohol increases the risk of breast cancer, the most common type of cancer worldwide, the second-leading cause of death from cancer among women in many countries.

Alcohol consumption has the potential to raise blood pressure levels and it has been linked to increased risk of hypertension, itself a major cause of premature death. Unfortunately, there is no strong global movement to alert populations to the dangerous effects of alcohol, a hugely socially accepted relaxant. Risks associated with articles praising "immune-boasting cocktails" aside, as well as those promoting the antioxidant properties of red wine, alcohol benefits from its undeserved health-halo effect.

Resveratrol, an anti-oxident, is found in over 70 plant species, in particular grapes and it is often cited as vital to the purported health benefits of wine. "It is not known whether there is a safe and effective dosage for chronic disease prevention", the conclusion reached by the Linus Pauling Institute. However, most supplements contain 250 to 500 milligrams of resveratrol, while a 150-millilitre (five-ounce) glass of red wine contains less than a milligram (0.2 - 0.5 milligrams). "You have to take huge amounts to have an effect", cautioned Dr.John. "And based on the evidence we have right now these hypotheses do not make sense."

So the conclusion that Dr.John's study reaches, along with an increasing body of evidence, is that no matter how much you drink, drink less. Those who take note, might alter drinking habits, limiting it to a glass of wine on holidays and abstaining for all other ordinary, daily events. "Many people do not know that they are, in essence, alcohol dependent. And this is the best way to learn (by abstaining for defined periods of time)."

Long COVID -- Skeptics and Believers -- Symptoms, Research

"[Once the virus is cleared, the body's immune activation goes rogue, unleashing auto-antibodies that turn on its own tissues and proteins. Somehow the immune system has become confused and rowdy], and what you're left with is the collateral damage."

"I just kept thinking, I'm a trained immunologist. I know what might be happening to me, and I'm getting this anxious. What's happening to other people who don't know about it."

"We need to find out what exactly is happening. We need to do studies in bigger numbers, in collaborations, over time."

"And the people who are fighting this, who are going through this, need to come and get themselves enrolled in studies and stick to the study so that we can understand this disease."

"Because unless we understand it and see it and report it and be honest about what we are seeing, we'll not be able to get to the bottom of this."

Manali Mukherjee, assistant professor, Department of Medicine, McMaster University

"The long COVID thing, has been slightly overblown, and as soon as you do proper epidemiological studies you find the incidence is much, much lower."

Sir John Bell, immunologist, Regius Professor of Medicine, University of Oxford

"This has been seen post influenza, it's been seen after SARS."

"We have to be really cautious about not under appreciating how chronic and persisting these symptoms can be."

"[Yet there is] absolutely [still skepticism among the medical and scientific community] because we're dealing with a condition that is new."

"Anyone can be impacted by this, young and old alike, and even if you were asymptomatic during initial infection."

"We are dealing with a real entity here."

Dr.Fahad Razak, internist, epidemiologist, St.Michael's Hospital, Toronto

 

There is disagreement among medical specialist over the appearance and presence and indications of long COVID; some convinced it is real and destructive, others dismissive of it as a bit of patient hysteria. Dr.Mukherjee is in the former group. She has been suffering symptoms associated with long COVID, and as a medical professional has been studying the phenomenon. As a person, she is also someone who was diagnosed in January with COVID-19. Since then she has been struggling with staggering fatigue, sudden plummeting blood pressure and difficulty in focusing "There were good weeks and then there were bad weeks", she explained.

 

In her incidental capacity as a scientist, she is the recipient of a half-million dollar grant in federal funding to study the syndrome she now suffers from. A condition lacking a prognosis or any kind of treatment, which has afflicted an uncertain number of people. People who describe lungs that feel as though they're packed in flour, brain fog that feels like dementia, and a level of fatigue unlike anything they might have previously imagined, much less experienced.

 

The answer to these symptoms, Dr.Mukherjee believes, is somewhere located in the immune system, a hyper-stimulated immune response once the virus has cleared. World-wide there have been 271 million cases of the SARS-CoV-2 virus infecting people with COVID. According to some researchers, long COVID represents the next "looming Catastrophe", where estimates of prevalence range from two percent of the COVID "recovered", up to 89 percent. 

"Long haulers" have identified a world of symptoms affecting close to every organ system in the body. No cause has to this point been proven, even the definition of what it is that defines long COVID "is still very much in evolution", said Steven Phillips, vice-president of science and strategy at the COVID Collaboration. And, he elaborates, while the symptoms are very real "and really seriously afflict people", the problem remains complex, difficult to diagnose and unpredictable.

There are studies published that have found people who report symptoms are sometimes absent evidence of antibodies against SARS-CoV-2. According to the World Health Organization, one in ten people infected with COVID will go on to experience symptoms that go on beyond four months post-COVID. Yet the underlying biological causes are unclear. Post-COVID conditions according to the Public Health Agency of Canada, are defined as one or more symptoms that persist or recur 12 weeks or longer following a COVID diagnosis -- that are not attributable to any other diseases.

Symptoms are wide-ranging, from those most frequently reported -- fatigue, headache and brain fog -- to the more rarely reported such as paranoia. In addition for those experiencing life-threatening infections, spending time in an intensive care unit can acquire life-transforming complications, according to Margaret Herridge, co-leader of a study of one-year outcomes in people infected with COVID. 

 

People who spend a week or longer in an ICU, immobilized and heavily sedated on a ventilator, can experience fatigue, nerve and muscle injury lasting months, as well as cognitive dysfunction affecting memory, attention and problem-solving. An estimated 25 to 35 percent of ICU survivors experience anxiety, depression and PTSD.

"Our data suggest that a full recovery after one year is not possible for some patients, for whom it will take longer to attain their baseline health state before COVID-19", researchers in a Chinese team whose study was published in The Lancet, of  COVID hospital survivors infected in Wuhan's first wave which found at a 12-month followup most had returned to work and their normal lives while those with "persisting, severely impaired health status are rare".

Another, French study involving close to 27,000 people whose blood had been screened for antibodies to SARS-CoV-2 found people who believed they had been infected, but whose infection could not be confirmed by the antibody test, were more likely to report symptoms of long COVID. "Beliefs regarding the causes of these symptoms may influence their perception and promote maladaptive health behaviours", wrote the French scientist in their controversial report.

 

‘I had neurological symptoms early on. Everything felt foggy and far away. I forgot everything – even things that had happened a few minutes earlier.’ Photograph: Tero Vesalainen/Getty Images/iStockphoto

"[Over one hundred symptoms have been ascribed to long COVID; the] one most reported, and most debilitating, is terrific cognitive problems, terrific brain fog."

"People say they have absolutely no energy and absolutely no motivation."

"There's a whole neuro-scientific literature now to show that when the immune system is activated it does have a very localized effect on your brain."

"There's no implication this is depression. There is no indication that this is mental illness. We just happen to be repurposing this medication for this very, very difficult to understand condition."

Dr.Roger McIntyre, Toronto psychiatrist

The Ageism-Gendered Gap

"Everyone started this pandemic saying COVID doesn't discriminate. It absolutely does. And it preys on every societal vulnerability we have ... biological and social, in particular."

"Older women are much more likely to be living in poverty -- and women outlive men. We know the greatest at-risk older population are older single women as they are disproportionately poorer. And those who are racialized are hit the hardest."

Dr.Samir Sinha, geriatrician, co-chair, National Institute on Ageing, Ryerson University 

In Brooklyn, N.Y., a cafe on the Coney Island boardwalk draws people of all ages, soaking up the sun in the pandemic, October 2020. Ageism, a new study finds, is “prevalent, ubiquitous and insidious” and not getting enough global attention.  JOHN PENNEY

 

According to geriatrician Dr.Paula Rochon, founding director of the Women's Age Lab at Women's College Hospital, Toronto, the global pandemic has highlighted inequities already in society. For example, poverty and pension gaps for older women, making them more reliant on underfunded social services like long-term care.

Over 47 percent of women over age 90 live in collective housing like nursing homes, in comparison with 33.3 percent of men in similar living arrangements, according to Statistics Canada. And while 33.2 percent of men in their 90s live as part of a couple, only 4.3 percent of women do. There are complexities leading to this situation, where women are likelier to become caregivers, first to children and then to older family members.

They may, as a result of these biological, social commitments, spend less time in the paid workforce and thus earn less and therefore become less likely to end up with a well-funded retirement. Women tend to live longer and since they tend as well to marry men slightly older than themselves, their future brings them a longer period of time alone.

Women receive 26 percent less in annual pension payments than men in the 38-member countries of the Organization for Economic Co-operation and Development. In Canada, poverty rates for older women register close to 1.5 times that of men, increasing with age. Sometimes women are more likely to require long-term care than men simply as a result of being unable to afford home care.

 

 

2021 to 2030 has been declared by the United Nations as the "decade of healthy aging". The World Health Organization earlier this year announced that the pandemic response has had the effect of revealing the extent of ageism leading to poorer health outcomes, isolation and ultimately premature death ... accompanying billions in socio-economic costs.

It is in fact, both because of their age and their gender that women face the double curse of "gendered ageism". "It's not just about aging or about women, but the intersection of the two", explains Dr. Rochon. Early in the pandemic's onset women in Canada faced greater risk factors for developing COVID-19 since two of three long-term care residents are women and the vast majority of health-care workers are themselves female.

On the other hand, as the pandemic continued, rates of infection,  hospitalization and death were steeper for men.  Slightly over half of all pandemic deaths have been male in Ontario. In Ontario, over 2,000 men between ages 60 and 79 died, in comparison to about 1,200 women in the same age group. Likely because men may also have taken more risks in precautionary mask wearing. Men are also known to be more likely to smoke leading to chronic conditions that leave them more vulnerable.

Older men and women have different risk factors for loneliness and social isolation, other syndromes the conditions arising from pandemic challenges has revealed. Those people who experience loneliness are more likely to seek out medical services. A key gap in medical knowledge is whether older women and men bear unique risk factors for loneliness.

"It's important to know how gender affects risk, because that affects potential treatments", explained epidemiologist Rachel Savage, a scientist with the Women's Age Lab, in acknowledging that contributors to loneliness include widowhood and declining health, conditions seemingly equal for both older men and women. "And lastly, women may just be more candid about being lonely. It may be more of a matter of how we ask the question", said Dr.Savage.

Only three of the ten countries with the highest number of COVID deaths -- Italy, Spain and Germany -- kept data by gender, and none of the ten countries reported a gender breakdown of deaths in long-term care homes, pointed out Dr.Savage.

The COVID-19 pandemic has underlined the inequities faced by older women, say researchers. Photo by PASCAL POCHARD-CASABIANCA /AFP via Getty Images

In For The Long Haul With COVID

"This is remarkably important work. For a long time now, we have been scratching our heads and asking why long COVID seems to affect so many organ systems."

"This paper sheds some light, and may help explain why long COVID can occur even in people who had mild or asymptomatic acute disease."

Zyad Al-Aly, director, clinical epidemiology centre, Veterans Affairs St.Louis Health Care System, Missouri

 

"We don't fully understand long COVID, but these changes could explain ongoing symptoms."

"[The research] provides a warning about being blase about mass infection in children and adults."

"We don't yet know what burden of chronic illness will remain in years to come. Will we see young-onset cardiac failure in survivors, or early onset dementia?"

"These are unanswered questions which call for a precautionary public health approach to mitigation of the spread of the virus."

Raina MacIntyre, professor of global biosecurity, University of New South Wales, Sydney

"Our results collectively show that while the highest burden of SARS-CoV-2 is in the airways and lung, the virus can disseminate early during infection and infect cells throughout the entire body, including widely throughout the brain."

NIH Study authors

 

A new study concludes that the coronavirus causing COVID-19 has the ability to spread within days from the airways to the heart, brain and just about every bodily organ system, in addition to which it may persist for months. The study authors describe their work as the most comprehensive analysis to the present of the SARS-CoV-2 virus's widespread distribution and duration in both body and brain. 

 

Scientists at the U.S. National Institutes of Health discovered that the pathogen has the capacity to replicate in human cells beyond the respiratory tract.

The manuscript, pre-released on line, is currently under review preparatory to publication in the journal Nature; its results spell out delayed viral clearance as a possible contributor to the pernicious symptoms stubbornly wracking the minds and bodies of long-COVID sufferers. Knowing how the virus is able to persist, as well as the body's response to a viral reservoir has the potential to aid in improving care for those sufferers.

The investigative discoveries and the techniques used are yet to be reviewed by independent scientists, and relate to data gathered from fatal COVID cases, and not from people suffering with long COVID or "post-acute sequelae of SARS-CoV-2", the authors point out. Numerous earlier studies provide evidence both for and against the possibility that the coronavirus has the propensity to infect cells outside the airways and lungs.

 

Undertaken at the National Institutes of Health in Bethesda, Maryland, the research is based on sampling extensively, and analysis of tissues reserved during autopsies on 44 American patients who failed to survive their encounter with the coronavirus. Daniel Chertow, who heads the NIH emerging pathogen section, wrote that the burden of infection outside the respiratory tract and the time it takes to clear the virus from infected tissues, particularly in the brain, fail to be characterized.

Persistent SARS-CoV-2 RNA was detected by the study group in multiple parts of the body, as well as throughout the brain, for up to 230 days after symptom onset, which may represent infection with defective virus particles, seen as well in persistent infection with the measles virus. The NIH team's post-mortem tissue collection was comprehensive, occurring within about a day of the patients' demise.

A variety of tissue preservation techniques to detect and quantify viral levels was also used, along with growing the virus collected from multiple tissues, including lung, heart, small intestine and adrenal gland. Pathological data can be drawn from the study supporting findings of previous research indicating, as an example, that SARS-CoV-2 directly destroys heart muscle cells, and those who survive an infection suffer cognitive deficits.

Infection of the pulmonary system may result in an early "viremic" phase where the virus is seeded throughout the body, including in patients experiencing mild or no symptoms, posit the NIH researchers. An example given was that of a juvenile included in the autopsy study who was presumed to have died from unrelated seizure complications, suggesting infected children with mild COVID-19 onset are also able to experience systemic infection.

Getty -- The Atlantic

Protecting Prison Inmates From the Spread of COVID-19

"It 's not a surprise we're facing outbreaks and, at this stage of the pandemic, it's unconscionable that we haven't taken action to address the known sources of transmission."

"It seems that what was done in the first wave of the pandemic has been largely abandoned. I think they need to ramp up both diversion and decarceration [releasing people from custody]."

"It paid dividends from a public health perspective. COVID doesn't stay behind the walls of a prison. Staff go back to their homes and communities every evening: They shop in the same stores we do."

"I'd say it's already a disaster, but it could get much worse."

Professor Justin Piche, University of Ottawa, Prison Pandemic Partnership member

 

"It was quite shocking to see it [provincial jails in Nova Scotia] depopulate so fast -- and see that it could happen without any increase in the crime rate, without any danger to public safety."

"I think there is a genuine concern we won't be as lucky with this new variant."

Dr.Adelina Iftene, law professor, Dalhousie University 

The Ottawa-Carleton Detention Centre reported a COVID-19 outbreak that ran from May 22 to June 21, 2021. (Andrew Lee/CBC)

 

According to data released by the Canadian Correctional Service, 81.7 percent of inmates in federal prisons are fully vaccinated. For comparison close to 87 percent of the Canadian population over age twelve is fully vaccinated. However, in maximum-security institutions vaccination rates are considerably lower. Maximum-security facility, Collins Bay Institution sees merely35.4 percent of inmates fully vaccinated, whereas at the minimum-security Joyceville Institute also in Kingston, Ontario, over 96 percent of inmates have been fully vaccinated.

Older inmates, according to the data, are likelier to be fully vaccinated than their younger peers, while white (88.9 percent) and Indigenous (88.4 percent) inmates are more likely to be fully vaccinated than are visible minority (75.4 percent) inmates. Vaccine hesitancy is clearly at work in some groups during the pandemic's grip. Fully 97 inmates and 13 staff members at the Ottawa-Carleton Detention Centre have contracted COVID-19 since the start of the pandemic. 

Data compiled by the Prison Pandemic Partnership informs that roughly 10,000 inmates and guards have contracted COVID-19 throughout Canada's corrections system, from the start of the pandemic to the present, translating into a COVID-19 rate of approximately 26 percent, or five times the 4.8 percent infection rate seen in the country's general public.

According to Andrew Morrison, spokesperson for the Ministry of the Solicitor General, all inmates are screened for the coronavirus on admission from police custody into the institutions, or when transferred from one to another. Those who fail to pass screening are placed in medical isolation, while others are temporarily forwarded to an intake unit for several weeks before eventually joining the general prison population.

There are numerous prisons in Ontario dealing with COVID outbreaks, where both inmates and prison staff have contracted the coronavirus. Prisons in Brockville, Milton and Windsor, Ontario have had to cope with outbreaks serious enough that they've had to transfer inmates to other institutions temporarily. Living in relatively close quarters, sometimes multiple prisoners occupying a single cell, ensures the prison population is vulnerable to infection.

Social distancing is difficult, ventilation poor, health care services limited and inmates are often under0-vaccinated. Early in the pandemic an awareness of the potential for this kind of situation to develop saw police, lawyers and judges take action meant to reduce jail system pressures. What resulted was an increase in the number of people released on bail, and those serving weekend sentences were granted temporary absences.

Measures such at those served to reduce the prison population in the province by roughly 30 percent, from 8,300 pre-pandemic, to 5,800. Some prisons by the summer of 2020 were half full. Resulting in provincial jails during the first COVID wave kept under control. In Nova Scotia a case study examining the province's decision-making saw the prisons depopulated by 41 percent early on during the pandemic; only one COVID case was recorded during the first wave.

Since then, prison population numbers have crept back up. According to Dr. Piche of University of Ottawa, provincial jails there have refilled as well. Some 7,400 inmates were behind bars in the province at the start of December with Ontario's inmate population standing at 11.4 percent lower than when the pandemic began.

In an effort to reduce jail capacity, people serving intermittent sentences will once again be given temporary absence passes, according to a December 3 memorandum from the Ministry of the Solicitor General. Leaving officials to review inmate files to determine whether some can be released early. "Those who have been convicted of serious crimes, such as violent crimes or crimes involving guns, would not be considered for early release", according to the memo.

All institutions have suspended personal visits during outbreak situations. All non-essential inmate transfers have been halted. 

 

All inmates have been transferred out of the Brockville Jail due to a COVID-19 outbreak. (Google Street View)

 

Psychoanalysing Gift-Giving

"What we find in our work is that thoughts count pretty importantly for the givers."

"Putting a lot of thought, spending time thinking about what a recipient might like tends to make the givers feel closer and more connected to a receiver."

"If thoughtfulness comes not from the amount of thought you put into a gift but just from the fact that you were thinking about somebody and you got them something -- maybe when they weren't expecting it -- that's really meaningful."

Nicholas Epley, John Templeton Keller Professor of Behavior Science and Director of the Center for Decision Research at the University of Chicago Booth School of Business 

"We think that people would prefer something we've chosen for them rather than what they've explicitly asked for. When in fact, people actually like when they get a gift that they actually like."

"Giving love is a blessing and so is receiving love. One doesn't have to be superior to the other."

"[Givers often] only think as far as what it's like to be the instantaneous recipient of a gift. They think a showy, expensive present -- will really drop jaws to the floor, and it might."

"[But] the gift giver walks away from the interaction and the recipient is left with a beautiful, expensive thing that collects dust..."

Marisa G.Franco, psychologist, friendship expert

"Givers often end up overshooting, getting things that are maybe more unique or more narrow than what the receiver might want."

"They'd rather have that Visa gift card or Amazon gift card that allows them to get whatever they want or need."

Mary Steffel, Associate Professor of Marketing, Northwestern University

Samir Hussein     Getty Images

 

Research he conducted, states Dr. Epley from his academic perch as a professor of behavioural science, points out that when people receive gifts it can be seen how much they appreciate the gift by their reaction expressing the 'dominant effect' of the gift. Insider knowledge; how well the giver knows the preferences of the recipient plays a dominant role in this type of transaction. Even so, in some situations the perceived thought that led to the choice of gift plays a dominant role.

In some instances people's aversion to simply giving cash or gift cards reflecting their perception that it's too impersonal acts as a deterrence in that type of choice. The practical choice of a gift card can be viewed as a lazy decision, taking the easy road rather than investing in the anxious mind search to think of what a particular person would appreciate most from a giver. Recipients, on the other hand, may have a decided preference for gift cards, but hesitate to make that suggestion for fear of offending.

People on the receiving end who are given experiential gifts like event tickets, gift certificates to restaurants or special trips, tend to feel more emotionally fulfilled, more connected than those who receive merely material gifts, and a greater attachment to the thoughtful nature of the gift giver, according to results of multiple studies published in the Journal of Consumer Research in 2016,

According to Dr.Steffel, a benefit of giving experiences relates to a person's time expenditure making them feel enriched by the experience. "Time-poor" people tend to value a gift that endows them with the gift of time. "You can buy them time by hiring a babysitter for them so that they have the space to go out and spend their time in ways that are satisfying for them."

Additionally those very special gifts that needed a lot of effort put into them; for example, something handmade, or an item that took an extensive search; can be important ways in which givers can "symbolically show just how much they care", explained Dr. Steffel. More ideally, added Dr.Franco, a gift that someone took additional effort into acquiring is best when it reflects what the recipient is known to want for themselves.

A heartfelt gift can sometimes take on the guise of sentimentality, according to experts where research shows that givers' inclination is to move away from sentimentality to avoid awkwardness, whereas in reality potential recipients in actual fact appreciate gifts with emotional value attached. 

Sam Maglio, a consumer psychologist who co-authored a paper in 2017 studying effects of buying a gift for someone that you also bought for yourself, states: "sharing is caring". Relaying the information to someone being gifted that the giver thought that an item they bought first for themselves and thought so highly of they felt inspired to give a like item to someone else, is a spur to the giftee appreciating the item all the more.

Dr.Franco spoke as well of the obligation of appreciation from the receiver to the gifter: "It's a skill to be good at accepting gifts. Someone had a positive feeling that they wanted to express toward you in the act of giving, and a receiver should be able to recognize that, whether the gift given is something wanted and thus appreciated, or not."

Gift giving as seen on NBC’s The Office.

NBCGetty Images

"Sharing is caring. Our data shows that receivers feel closer to gift givers when they say, 'I bought the same thing for myself'."

"[More so than] 'It got great reviews online' or 'I put a lot of effort into it'."

Sam Maglio, consumer psychologist

Purchasing the Wrong Drug for COVID

 "...You have to purchase the right drug, not the wrong drug [to be prepared with effective COVID-19 treatments]."

"If they haven't spent the money, hold off for the good drug. If they have, try to get a refund."

Dr.Jeffrey Glenn, virologist, Stanford University

Image of antiviral medication Molnupiravir. (Merck & Co. via AP)

 

Good advice, but advice Canada, reacting rashly, failed to observe. Instead, the government of Canada proceeded directly, even before Health Canada had sufficient background investigative data through completed pharmaceutical research, to decide whether to give the Merck drug Molnupiravir, clearance for use in Canada as an approved drug. Health Canada is in the process of evaluating Molnupiravir under a "rolling submission" that began in August. Full data from its phase 3 trial has not yet been transmitted.

Despite which, the Canadian government has taken it on good (naive) faith that the drug will live up to its manufacturer-touted expectations, absent affirmatively positive results. So it has committed itself by buying 500,000 courses of the yet-to-be-approved medicine at a cost of approximately $450 million, with an option to purchase yet another half million courses with the pills to be manufactured in Ontario.

Now, a new analysis by British scientists argue Merck's phase 3 trial's main finding boasts a 30 percent reduction in hospitalization among patients taking the pills in early COVID onset. That modest reduction is held not to be statistically significant, particularly since the second half of the trial saw superior outcomes for patients receiving a placebo in place of the drug. Moreover, according to the U.K. paper, patient-level databases that could be investigated for "the risk of bias or medical fraud" have not been made available.

"Spending money on a drug that at best is only minorly effective is inappropriate use of Canadian taxpayers' money", observed Ed Mills, part time McMaster University professor, heading one of the world's largest COVID treatment studies. And several days previously the French health minister, stating study results "weren't good" revealed that the French government had cancelled its order for the drug.

In its defence Merck Canada spoke of its MOVE-OUT trial recently published in the New England Journal of Medicine, where it found the drug to have significantly reduced risk of hospitalization and death for high-risk, unvaccinated patients with mild to moderate COVID symptoms. Merck had licensed several generic manufacturers in India to produce the drug for lower-income countries.

Two of the companies -- Aurobindo and MSN -- conducted trials on moderately affected patients but stopped their trials when they indicated no benefit from the drug. A third Indian trial of over 1,200 mild patients reported that Molnupiravir did reduce hospitalizations with other benefits, in as-yet unpublished results.

Whether Canada could under its contract with Merck cancel its agreement is under question. Andrew Hill, a University of Liverpool pharmacologist and co-author of the British paper, evaluated the cost of the Merck pill, concluding with his colleagues that the company is charging wealthy countries like Canada approximately $898 per course of Molnupiravir. 

 

Convenient, easy-to-take oral treatment to prevent hospitalization and death in the unvaccinated and "breakthrough" vaccinated patients is generally viewed as an important medication.

Pfizer has also announced its creation of such a pill and its product was the more impressive of the two, in that its Paxlovid was seen through trials to reduce the risk of hospitalization for high-risk unvaccinated patients given the pill five days within exhibiting symptoms by 88 percent. The U.S. Food and Drug Administration granted it approval on Wednesday.

Molnupiravir was originally developed as a possible antidote to an encephalitic-causing virus, at Emory University, and then as a flu treatment. It was transformed from flu to a COVID treatment once the pandemic began, with Merck partnering with Ridgeback Biotherapeutics. The drug interferes in RNA replication, inhibiting reproduction of the virus.

Merck announced October 4 that its drug cut hospitalization in 762 unvaccinated patients with such risk factors as cancer and obesity by a substantial 50 percent, then halted enrolment of new patients through its multi-country MOVE-OUT trial which randomly assigned patients to Molnupiravir or a placebo within five days of symptoms appearing. However, when results returned on the other 646 already enrolled patients, the benefit shrank to 30 percent, only just qualifying as statistically significant.

Added to which the surprising outcome that patients in the second half of the group who received a placebo performed better than those who received Molnupiravir -- effectively reversing the first-half results. 15 patients of the 322 on placebo ended up in hospital, while 20 of the 324 drug-treated patients were hospitalized. A rather inexplicably awkward turn-about. "That almost never happens", concluded Dr.Hill.

Dr.Hill recommended that rather than buying the Merck drug, Canada should turn to investing in fluvoxamine, a generic anti-depressant that the Together trial headed by Dr. Mills found to reduce hospitalization in similar patients by a like 30 percent, but at a much smaller fraction of the cost.

 Merck’s experimental oral COVID-19 antiviral drug, Molnupiravir.  Credit...Merck

Early Consensus on Omicron? Not Quite!

"There is something going on ... in terms of the difference in the immunological response for Omicron vs Delta."

"[Findings suggested breakthrough infections and reinfections from Omicron were] less severe [and that immune protection from T-cells and B-cells] mediated [Omicron's] progression to severe disease [despite diminished antibody protection]."

"It's about what [it] means in terms of absolute numbers as, if the numbers are so big it can still cause a substantial public health problem even if, per case, the risk of severe disease is less."

Professor Cheryl Cohen, epidemiologist, University of Witwatersrand, South Africa

 

"It is primarily young and vaccinated people who are infected with Omicron, and when we adjust for this, we see no evidence that Omicron should result in milder disease."

Henrik Ullum, director, Statens Serum Institut, Denmark

According to health-care data out of South Africa, Denmark and the United Kingdom, findings appear to indicate by separate research teams that fewer cases of severe disease will erupt from Omicron, despite its higher rate of infectiousness, than the previous COVID-19 iteration, Delta. Despite that finding, there remains insecurity of knowledge about the ever-mutating, ever surprising SARS-CoV-2 virus to the point that these same researchers caution that health services can still be strained owing to the new variant's high degree of infectiousness.

All are in agreement that unvaccinated groups remain the most at-risk for infection. And that the proportion of all cases developing severe disease remains lower than with other variants, despite Omicrons breakthrough infections and reinfections causing mild symptoms. Omicron now accounts for a major proportion of COVID-19 cases in a growing number of countries, including the United States. The study carried out by South Africa's National Institute For Communicable Diseases found among those who tested positive in October and November, Omicron was 80 percent less likely to be admitted to hospital than Delta cases.

The same research team released a second analysis controlling for vaccination status, finding that once admitted to hospital Omicron and Delta cases from recent weeks held similar likelihood of progressing to a serious condition. Over 10,000 Omicron cases formed the basis for the analyses, including over 200 hospital admissions. Research out of Denmark indicated that among those who tested positive between November 12 and December 15, Omicron cases appeared three times less likely for hospital admission than cases with other variants, while cautioning that outbreaks among  younger groups could skew data.

 

 

Omicron -- in the absence of evidence for any intrinsic reduction in severity -- is not precluded from resulting in less severe outcomes at the population level, given that a greater share of cases are among people with some protection against severe disease through prior infection or vaccination. "Due to Omicron's higher immune evasion, this pattern will persist in a population-level assessment", explained Professor Samir Bhatt, at University of Copenhagen.

The British study analyzed data from PCR-test confirmed cases in England between Dec.1 and Dec.14, concluding that "Overall, we find evidence of a reduction in the risk of hospitalization for Omicron relative to Delta infections, averaging over all cases in the study period". According to Imperial College researchers, risk of any visit to hospital with Omicron was between 20 and 25 percent lower than with the Delta strain. Britain reported over 100,000 new cases of COVID-19 on Wednesday, the first time since wide-spread testing was available.

People who had received at least two vaccine doses remained substantially protected against hospitalization, even if protection against infection has largely been lost against the Omicron variant, according to their estimates. Denmark on Sunday introduced a suite of measures to contain Omicron's spread; among which was theatre and museum closures and capacity limits in bars, restaurants and shopping centres.

A drop-off in severity could make the decision of countries like Britain and the United States not to impose restrictions "just about tenable", according to Professor Peter Garred, clinical immunologist at Copenhagen's Rigshospitalet, Denmark's largest hospital.

Technicians in Durban, South Africa, conduct antibody testing in a laboratory at the African Health Research Institute Technicians conduct antibody testing at the African Health Research Institute in Durban, South Africa Waldo Swiegers/Bloomberg

"[Policymakers should be a] little careful about making the narrative that it's more mild [because it would be] some weeks [before the variant's impact on hospitals becomes clear]."

"I fear that because of the infectiousness of Omicron ... what we see right now will be very different n just about two weeks' time."

Professor Thea Kolsen Fischer, head, virus and microbiological specialist diagnostics, Staten Serum Institut, Denmark

Omicron? Take a Deep Breath and Carry On -- With Boosters

"[Within weeks Omicron will dominate in more countries of the region], pushing already stretched health systems further to the brink."

Hans Kluge, European head, World Health Organization

"It [large public event restrictions following Christmas] will also mean unfortunately that large scale Hogmanay [traditional Scottish New Year events] celebrations, including that planned here in our capital city [Edinburgh], will not proceed."

Nicola Sturgeon, first minister, Scotland

"Even if measures [in response to the Omicron variant] are introduced immediately, there may not be time to fully ascertain whether they are sufficient before decisions are needed on further action."

"The situation could develop quickly over the coming weeks and decision-makers may need to act while there is still a high level of uncertainty including considering the potential need for stringent response measures."

Sage COVID advisory committee, United Kingdom

 

"The honest truth is that the booster programme, which I think will work, is not going to work soon enough if there is a big wave here soon. It takes time to get them into people and it takes time for them to make an immune response."

"We need to buy time. If in three weeks it’s died out, then fine, we can all relax, but right now is the time when you could prevent there being a big wave. The more people can work from home now the better, until we are more definite about what’s going to happen."

Adam Finn,  professor of paediatrics, University of Bristol, member of the Joint Committee on Vaccination and Immunisation, U.K.

Bipartisan members of the U.S. House and Senate hold a moment of silence for 800,000 American lives lost to COVID-19 on the steps of the Capitol in Washington, D.C., on Tuesday. (J. Scott Applewhite/The Associated Press)

 

Israel is set to become the first country in the world to provide fourth doses of COVID-19 vaccine to people over age 60, in reaction to national concerns over the viral spread of the Omicron variant. A fourth dose was recommended by the country's Health Ministry, the decision welcomed by the government, with Prime Minister Naftali Bennett saying it was "great news that will help us overcome the Omicron wave that is spreading around the world."

"My message is -- don't waste time, go get vaccinated", the Israeli prime minister urged the population. The Soroka Medical Center in Beersheba spoke of a notice that a 60 year-old man had died weeks after being admitted to the coronavirus ward. A patient that suffered from a variety of COVID-unrelated serious illnesses. "His morbidity stemmed mainly from pre-existing sicknesses and not from respiratory inspection arising from the coronavirus", the hospital clarified. Nonetheless, initial news of the death had attributed it to Omicron, while it turned out Delta was the culprit.

Similarly the Texas Department of State Health in the United States also reported at roughly the same time, the first Omicron death to have taken place, in Harris County. A conservative commentator with a huge following had tweeted the man was fully vaccinated and had in fact also received a booster shot. 

 

Evidently not: "The death reported this afternoon was of a man between the ages of 50-60 years old who was unvaccinated and had been infected with COVID-19 previously. The individual was at higher risk of severe complications from COVID-19 due to his unvaccinated status and his underlying health conditions", came the corrected update from Harris County Public Health.

 

Germany, Scotland, Ireland, the Netherlands and South Korea have reimposed partial or full lockdowns along with other modes of social distancing measures recently, among many other countries experiencing a swift incursion of the Omicron variant. Nightclubs and bars have been ordered to close in Portugal, people told to work from home. 

 

In Italy a COVID state of emergency has been extended to March 31, the government ruling that all EU member-country visitors must have a test taken before arrival, requirements reflected for many non-EU countries. In France,  tightening controls for travellers from Britain are being contemplated, despite that visitors must show a negative test less than 48 hours old, currently.

 

People line up for their booster dose outside a COVID-19 vaccination centre in south London on Tuesday. (Hannah McKay/Reuters)

Omicron in South Africa

"At this early point, we believe there is hope that the severity is lower. [However], we should not be lulled into any type of complacency."

"[The higher risk of breakthrough infections compared to Delta also means masking, distancing and] caution [and] prudence [remain important]."

"There is no reason to panic in this regard, [infection of children remaining low], without question."

"[South Africa is seeing a steep trajectory of new infections] indicating very rapid spread. This is clearly a highly contagious variant of SARS-CoV-2."

Dr.Ryan Noach, CEO, Discovery Health

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Discovery Health, the largest private health insurance administrator in South Africa, has released an analysis based on over 211,000 positive COVID-19 test results; 41 percent derived from adults who had two doses of the Pfizer-BioNTech vaccine. Some 78,000 of those test results were attributed to the newly-discovered Omicron infections occurring between November 14 and December 7, when the variant was first noted to be in circulation.

Researchers studied the Pfizer real-world vaccine effectiveness against Omicron infection hospital admissions and the risk of reinfection for those people known to have been previously infected with SARS-CoV-02 [with circulating antibodies]. Scrutiny concluded that people infected with Omicron seemed less likely to develop severe disease in comparison to adults who had been infected in the first wave of COVID in South Africa.

The risk of hospital admission was 29 percent lower for adults, once adjusted for age, sex, underlying health conditions and vaccine status. The encouraging drop in severity suggests an "apparent de-linking" of infections with hospitalizations, according to a slide presentation given at a press briefing. During the first three weeks of South Africa's Omicron wave, hospital admissions and death from infections rose rapidly, while at this point both have decreased their steep ascent.

All this, while keeping in mind that South Africa has a high rate of background immunity, meaning in the first waves to strike the population infections were widespread. Fully 72 percent of the population in Gauteng -- the outbreak epicentre and province where Omicron was first identified in November -- is felt to have been previously infected, in particular throughout the Delta wave. 

What remains unclear at this juncture is how Omicron will evolve in other countries with lower vaccination or lower rates of prior infections. "We have to see what happens in other parts of the world before we can make a call on this" Glenda Gray, president CEO of the South African Medical Research Council, cautioned. Should a surge emerge it would overwhelm health systems through sheer case volume, Dr.Noach added.

 

He stressed that the single most important intervention is vaccination. The evidence is that those who are vaccinated experience milder infections; primarily it is the unvaccinated that end up in hospital and needing supplemental oxygen. Children under 18 years of age appear to have a 20 percent higher risk of hospitalization, yet child admissions to hospital remain very low.

Most COVID infections in children admitted to hospital are picked up incidentally during routine screening when children present for problems unrelated to COVID, according to anecdotal reports. During the study period, children were 51 percent less likely as opposed to adults, to test positive for COVID. Most children experience mild symptoms: sore throat, congestion, headache and fever, resolving within three days.

In the current Omicron wave, two doses of Pfizer-BioNTech provide 33 percent protection. representing a significant drop from the 80 percent protection in earlier waves, but the vaccine appears to be providing 70 percent protection against severe complications requiring hospital admission. "Whilst protection against hospital admission reduced from the highs of 93 percent in South Africa's Delta-driven variant, 70 percent is still regarded as very good protection", concluded the investigators.

That level of protection held in all age groups, in people aged 18 to79. For those previously infected with COVID, reinfection risk appeared significantly higher compared to earlier variants -- those infected with Delta face a 40 percent relative risk of reinfection with Omicron, according to data suggestion; a possible function of waning antibodies

The infection  appears to have a shorter incubation period (three to four days). A scratchy or sore throat the most common early symptom to appear, similar to earlier waves. Nasal congestion, dry cough and muscle aches and pains are other typical features of Omicron onset, with lower back pain a hallmark symptom. But there appears to be less respiratory distress; leading to lower admission numbers to ICUs in comparison to previous waves.