What the 'emergency' blood plasma debacle reveals: If the FDA’s emergency authorisations aren’t used responsibly, they could lose their power

‘The FDA previously came under fire for issuing an EUA for after Trump became fixated on the drug, which the agency later rescinded when the drug proved to be ineffective. With plasma, the agency has again issued an EUA following a loud and public campaign by the president based on little scientific evidence. The Trump administration is reportedly considering using the EUA process to fast-track a COVID-19 vaccine before the November election. “It just seems to be a pattern now,” says Jesse Goodman, a former chief scientist at the FDA now at Georgetown. “I’m very worried that this might happen with vaccines.” A controversial EUA for a vaccine could inflame fears that a vaccine is being rushed out.’

Read here (The Atlantic, August 27, 2020)

US health agency says testing not needed for some exposed to Covid-19, sparking outcry

‘The US Centers for Disease Control and Prevention (CDC) said this week that people who were exposed to COVID-19 but are not symptomatic may not need to be tested, sparking outcry among officials and experts who fear the changed guidance was politically motivated. The advice marks a reversal of the agency's previous position recommending testing for all close contacts of people diagnosed with COVID-19, narrowing the scope of instances where the CDC recommends testing. CNN and The New York Times reported on Wednesday that US public health officials were ordered by high-level members of the Trump administration to push forward with the changes.’

Read here (Channel News Asia, August 27, 2020)

Fearing a 'Twindemic', health experts push urgently for flu shots

‘As public health officials look to fall and winter, the spectre of a new surge of Covid-19 gives them chills. But there is a scenario they dread even more: a severe flu season, resulting in a "twindemic"... The concern about a twindemic is so great that officials around the world are pushing the flu shot even before it becomes available in clinics and doctors' offices... Dr Robert Redfield, director of the US Centres for Disease Control and Prevention, has been talking it up, urging corporate leaders to figure out ways to inoculate employees. The CDC usually purchases 500,000 doses for uninsured adults but this year ordered an additional 9.3 million doses.’

Read here (Straits Times, August 17, 2020) 

US CDC: One-third of COVID-19 patients who aren't hospitalised have long-term illness

‘The Centers for Disease Control and Prevention acknowledged Friday that a significant number of COVID-19 patients do not recover quickly, and instead experience ongoing symptoms, such as fatigue and cough. As many as a third of patients who were never sick enough to be hospitalised are not back to their usual health up to three weeks after their diagnosis, the report found.

"COVID-19 can result in prolonged illness even among persons with milder outpatient illness, including young adults," the report's authors wrote. The acknowledgement is welcome news to patients who call themselves "long-haulers" — suffering from debilitating symptoms weeks and even months after their initial infection.

"This report is monumental for all of us who have been struggling with fear of the unknown, lack of recognition and many times, a lack of belief and proper care from medical professionals during our prolonged recovery from COVID-19," Kate Porter, who is on day 129 of her recovery, wrote in an email to NBC News.

Read here (MSNBC, July 25, 2020)

US CDC report on symptom duration and risk factors for delayed return to usual health

Symptom duration and risk factors for delayed return to usual health among outpatients with COVID-19 in a multistate health care systems network — United States, March–June 2020

Read here (US CDC, July 24, 2020)

Household contacts over 6 times more likely to become infected: South Korea study

‘A recent study by researchers in South Korea, published in the US CDC’s Emerging Infectious Diseases journal, found that SARS-CoV-2 transmission was far more common in household settings compared to public settings. Based on analysis of more than 59,000 contacts of more than 5,700 COVID-19 “index patients,” the researchers found that household contacts were more than 6 times more likely to become infected than non-household contacts. The study identified cases in 11.8% of household contacts, compared to only 1.9% of non-household contacts.

‘Notably, households with an “index patient” aged 10-19 years were at even higher risk for transmission—cases identified in 18.6% of household contacts, compared to 11.8% in households with “index patients” of other ages. The lowest transmission risk among household contacts was for “index patients” aged 0-9 years. In these households, cases were identified in only 5.3% of household contacts; however, this was still greater than the overall risk for non-household contacts. This indicates that children who are infected at school could transmit the infection at home more easily than in other settings, particularly for older children, which would put other family members at increased risk.‘

Source: Newsletter, Center for Health Security, John Hopkins University.

Read here (EID Journal, 2020)

CDC head estimates US coronavirus cases might be 10 times higher than data show

‘In a press briefing on June 25, Dr. Robert Redfield, director of the U.S. Centers for Disease Control and Prevention (CDC), said that the current official count of COVID-19 cases in the U.S. may actually be a drastic underestimate.

‘Redfield said the new, much-higher estimate, is based on growing data from antibody testing, which picks up the presence of immune cells that react to SARS-CoV-2, the virus that causes COVID-19. People will test positive for antibodies to the virus if they have been infected—whether or not they ever got sick or even developed symptoms.’

Read here (Time Magazine, June 25, 2020)

‘They let us down’: 5 takeaways on the CDC’s coronavirus response

• Aging data systems left the agency with blind spots
• The CDC clashed with White House aides who viewed them as the ‘deep state’
• The CDC’s culture slowed its response
• Redfield felt he was ‘on an island’ between his agency and the White House
• Confusing guidance left doctors, public officials and others to look elsewhere

Read here (New York Times, June 3, 2020)

The CDC waited ‘its entire existence for this moment’. What went wrong?

‘The technology was old, the data poor, the bureaucracy slow, the guidance confusing, the administration not in agreement... The coronavirus shook the world‘s premier health agency, creating a loss of confidence and hampering the US response to the crisis...

‘The CDC.’s most fabled experts are the disease detectives of its Epidemic Intelligence Service, rapid responders who investigate outbreaks. But more broadly, according to current and former employees and others who worked closely with the agency, the CDC is risk-averse, perfectionist and ill suited to improvising in a quickly evolving crisis — particularly one that shuts down the country and paralyzes the economy.

“It’s not our culture to intervene,” said Dr George Schmid, who worked at the agency off and on for nearly four decades. He described it as increasingly bureaucratic, weighed down by “indescribable, burdensome hierarchy.”

Read here (New York Times, June 3, 2020)

Evidence for limited early spread of Covid-19 within the United States, January–February 2020

‘The first US cases of nontravel–related COVID-19 were confirmed on February 26 and 28, 2020, suggesting that community transmission was occurring by late February... Four separate lines of evidence (syndromic surveillance, virus surveillance, phylogenetic analysis, and retrospectively identified cases) suggest that limited U.S. community transmission likely began in late January or early February 2020, after a single importation from China, followed by multiple importations from Europe. Until late February, COVID-19 incidence was too low to be detected by emergency department syndromic surveillance for COVID-19–like illness... Enhanced syndromic and virus surveillance will be needed to monitor COVID-19 trends for the duration of the pandemic.’

Read here (US CDC, May 29, 2020)

The fable of the Chinese whistleblower

‘While initial contact between the two CDCs [of the US and China] was interrupted by the New Year holiday, the coordination between the two countries’ public health officials was much closer – and, as WHO Disease Outbreak documentation verifies, the time lags were considerably shorter – than is widely believed in the West. The contrast with America’s response is striking. Whereas 27 days passed from Zhang’s initial report to the Wuhan shutdown on January 23, the US took exactly twice as long (54 days) to go from its first official diagnosis of COVID-19 (January 20) to Trump’s declaration of national emergency (March 13).’

Read here (Project Syndicate, March 18, 2020)

Reviving the US CDC

‘But punishing the agency by marginalising and hobbling it is not the solution. The Administration is obsessed with magic bullets—vaccines, new medicines, or a hope that the virus will simply disappear. But only a steadfast reliance on basic public health principles, like test, trace, and isolate, will see the emergency brought to an end, and this requires an effective national public health agency. The CDC needs a director who can provide leadership without the threat of being silenced and who has the technical capacity to lead today's complicated effort.’

Read here (The Lancet, May 16, 2020)

CDC publishes flowcharts to help communities and businesses weighing whether to reopen

The US Centers for Disease Control and Prevention published six "decision trees" Thursday aimed at helping businesses, communities, schools, camps, daycares and mass transit decide whether it's safe to re-open. The one-page decision trees are much shorter than a much-anticipated, lengthy and detailed document that has been delayed at least once.

Read here (CNN, May 15, 2020)

• For workplace, download here
• For schools, download here
• For restaurants, download here
• For mass transit, download here
• For camps, download here
• For daycare, download here

US CDC had ‘very good interaction’ with China after coronavirus outbreak, says director Robert Redfield

‘Top US health official says colleagues connected with Beijing two days after Chinese health authorities first notified WHO of ‘a cluster of cases of pneumonia’. Discussions took place ‘at a scientific level’ as early as January 2, Redfield testifies to US lawmakers. “I personally had discussions as early, I think the CDC had discussions as early as January 2, and myself, January 3, with a counterpart to discuss this at a scientific level,” Redfield said. “I think we had very good interaction. That’s different than the broader government level.”

Read here (South China Morning Post, May 13, 2020)

US launches SPHERES consortium to monitor, conduct genomic research and share information on the Coronavirus

CDC is leading the SARS-CoV-2 Sequencing for Public Health Emergency Response, Epidemiology and Surveillance (SPHERES), a new national genomics consortium to coordinate SARS-CoV-2 sequencing across the United States. Large-scale, rapid genomic sequencing of the virus that causes COVID-19 will allow public health experts to:

• Monitor important changes in the virus as it continues to circulate.
• Gain important insights to support contact tracing.
• Provide crucial information to aid in identifying diagnostic and therapeutic targets.
• Advance public health research in the areas of transmission dynamics, host response, and evolution of the virus.

Read here (US CDC, April 30, 2020)

CDC confirms six coronavirus symptoms showing up in patients over and over

The Centers for Disease Control and Prevention added six symptoms of the novel coronavirus to its list, suggesting health experts are learning more about the growing number of ways physicians see the virus affecting patients. The symptoms, which the CDC reports could appear two to 14 days after exposure to the virus, are: (1) chills (2) repeated shaking with chills (3) muscle pain (4) headache (5) sore throat (6) new loss of taste or smell. Previously, the CDC listed just three known symptoms: shortness of breath, cough and fever.

Read here (Washington Post, April 28, 2020)

US CDC, in the face of personal protection equipment (PPE) shortages, issues strategies to optimise the supply of PPEs

The strategies of the US Centers for Disease Control and Prevention (CDC) cover eye protection gear, isolation gowns, face masks, N95 respirators and reuse of filtering face respirators and ventilators.

‘CDC’s optimisation strategies for PPE offer options for use when PPE supplies are stressed, running low, or absent. Contingency strategies can help stretch PPE supplies when shortages are anticipated, for example if facilities have sufficient supplies now but are likely to run out soon. Crisis strategies can be considered during severe PPE shortages and should be used with the contingency options to help stretch available supplies for the most critical needs. As PPE availability returns to normal, healthcare facilities should promptly resume standard practices.’

Read here (CDC, April 22, 2020)

Transmission of Covid-19 to health care personnel during exposures to a hospitalised patient

What is already known about this topic? ‘Health care personnel (HCP) are at heightened risk of acquiring COVID-19 infection, but limited information exists about transmission in health care settings.’

What is added by this report? ‘Among 121 HCP exposed to a patient with unrecognised COVID-19, 43 became symptomatic and were tested for SARS-CoV-2, of whom three had positive test results; all three had unprotected patient contact. Exposures while performing physical examinations or during nebuliser treatments were more common among HCP with COVID-19.’

What are the implications for public health practice? ‘Unprotected, prolonged patient contact, as well as certain exposures, including some aerosol-generating procedures, were associated with SARS-CoV-2 infection in HCP. Early recognition and isolation of patients with possible infection and recommended PPE use can help minimise unprotected, high-risk HCP exposures and protect the health care workforce.’

Read here (US CDC, April 17, 2020)

Characteristics of health care personnel with Covid-19: A US CDC profile from Feb 12 to Apr 9, 2020

What is added by this report? ‘Of 9,282 US Covid-19 cases reported among HCP, median age was 42 years, and 73% were female, reflecting these distributions among the HCP workforce. HCP patients reported contact with COVID-19 patients in health care, household, and community settings. Most HCP patients were not hospitalised; however, severe outcomes, including death, were reported among all age groups.

What are the implications for public health practice? ‘It is critical to ensure the health and safety of HCP, both at work and in the community. Improving surveillance through routine reporting of occupation and industry not only benefits HCP, but all workers during the COVID-19 pandemic.’

Read here (US CDC, April 17, 2020)

Coronavirus found in air samples up to 4 metres from patients: China study

’A new study examining air samples from hospital wards with COVID-19 patients has found the virus can travel up to 4m – twice the distance current guidelines say people should leave between themselves in public. The preliminary results of the investigation by Chinese researchers were published on Friday in Emerging Infectious Diseases, a journal of the US Centers for Disease Control and Prevention (CDC).‘

Read here (Channel News Asia, April 11, 2020)