are 5 levels of emergency department services represented by CPT codes 99281 – 99285. The ED codes require all three key components (history, examination and medical decision-making) to be met and documented for the level of service selected.

How effective is immunity after Covid recovery relative to vaccination? An Israeli study by Gazit et al. found that the vaccinated have a 27 times higher risk of symptomatic infection than the Covid recovered. At the same time, the vaccinated were nine times more likely to be hospitalized for Covid. In contrast, a CDC study by Bozio et al. claims that the Covid recovered are five times more likely to be hospitalized for Covid than the vaccinated. Both studies cannot be right.

I have worked on vaccine epidemiology since I joined the Harvard faculty almost two decades ago as a biostatistician. I have never before seen such a large discrepancy between studies that are supposed to answer the same question. In this article, I carefully dissect both studies, describe how the analyses differ, and explain why the Israeli study is more reliable. //

The CDC study did not create a cohort of people to follow over time. Instead, they identified people hospitalized with Covid-like symptoms, and then they evaluated how many of them tested positive versus negative for Covid. Among the vaccinated, 5% tested positive, while it was 9% among the Covid recovered. What does this mean?

Though the authors do not mention it, they adopt a de facto case-control design. While not as strong as a cohort study, this is a well-established epidemiological design. //

In the CDC study on Covid immunity, the cases are those patients hospitalized for Covid disease, having both Covid-like symptoms and a positive test. That is appropriate. The controls should constitute a representative sample from the population from which the Covid patients came. Unfortunately, that is not the case since Covid-negative people with Covid-like symptoms, such as pneumonia, tend to be older and frailer with comorbidities. They are also more likely to be vaccinated. //

The problem is that the CDC study answers neither the direct question of whether vaccination or Covid recovery is better at decreasing the risk of subsequent Covid disease, nor whether the vaccine rollout successfully reached the frail. Instead, it asks which of these two has the greater effect size. It answers whether vaccination or Covid recovery is more related to Covid hospitalization or if it is more related to other respiratory type hospitalizations. //

Covariate adjustments will typically change the point estimates somewhat, but it is unusual to see a change as large as the one from 1.77 to 5.49 that was observed in the CDC study. How can this be explained? It must be because some covariates are very different between the cases and controls. There are at least two of them. While 78% of the vaccinated are older than 65, 55% of the Covid recovered are younger than 65. Even more concerning is the fact that 96% of the vaccinated were hospitalized during the summer months of June to August, while 69% of the Covid recovered were hospitalized in the winter and spring months from January to May. Such unbalanced covariates are usually best adjusted for using matching as in the Israeli study. //

Concerning the Covid recovered, there are two key public health issues. 1. Would the Covid recovered benefit from also being vaccinated? 2. Should there be vaccine passports and mandates that require them to be vaccinated in order to work and participate in society?

The CDC study did not address the first question, while the Israeli study showed a small but not statistically significant benefit in reducing symptomatic Covid disease. Future studies will hopefully shed more light on this issue.

Based on the solid evidence from the Israeli study, the Covid recovered have stronger and longer-lasting immunity against Covid disease than the vaccinated. Hence, there is no reason to prevent them from activities that are permitted to the vaccinated. In fact, it is discriminatory.

Many of the Covid recovered were exposed to the virus as essential workers during the height of the pandemic before vaccines were available. They kept the rest of society afloat, processing food, delivering goods, unloading ships, picking up garbage, policing the streets, maintaining the electricity network, putting out fires, and caring for the old and sick, to name a few.

They are now being fired and excluded despite having stronger immunity than the vaccinated work-from-home administrators that are firing them.

The U.S. Food and Drug Administration (FDA) developed DVs to help consumers compare the nutrient contents of foods and dietary supplements within the context of a total diet. The DV for potassium is 4,700 mg for adults and children age 4 years and older //

Mild hypokalemia is characterized by constipation, fatigue, muscle weakness, and malaise //

Magnesium depletion can contribute to hypokalemia by increasing urinary potassium losses [1,33,34]. It can also increase the risk of cardiac arrhythmias by decreasing intracellular potassium concentrations. More than 50% of individuals with clinically significant hypokalemia might have magnesium deficiency //

Kidney stones are most common in people aged 40 to 60 [52]. Stones containing calcium—in the form of calcium oxalate or calcium phosphate—are the most common type of kidney stone. Low potassium intakes impair calcium reabsorption within the kidney, increasing urinary calcium excretion and potentially causing hypercalciuria and kidney stones [16,37]. Low urinary levels of citrate also contribute to kidney stone development. //

there is no evidence that high intakes of potassium cause hyperkalemia in adults with normal kidney function or other adverse effects. Therefore, the committee did not set a UL for potassium.

The findings, the study's authors said, were largely consistent across the categories of age, sex, obesity and cardiovascular risk.

An increase of 17 minutes of moderate-vigorous physical activity per day or 2,312 steps per day or reductions of 249 minutes of sedentary time per day between two testing cycles corresponded with a 5% higher peak oxygen uptake, and individuals with high above-average steps or moderate-vigorous physical activity demonstrated above-average peak oxygen uptake values regardless of their sedentary time per day.

Moderate-vigorous physical activity is defined as a rate of 100 to 129 steps per minute; greater than 130 steps per minute is considered vigorous. A cadence of 60 to 99 steps per minute is considered low-level exertion.

Vitamin D (also referred to as “calciferol”) is a fat-soluble vitamin that is naturally present in a few foods, added to others, and available as a dietary supplement. It is also produced endogenously when ultraviolet (UV) rays from sunlight strike the skin and trigger vitamin D synthesis.

Vitamin D obtained from sun exposure, foods, and supplements is biologically inert and must undergo two hydroxylations in the body for activation. The first hydroxylation, which occurs in the liver, converts vitamin D to 25-hydroxyvitamin D [25(OH)D], also known as “calcidiol.” The second hydroxylation occurs primarily in the kidney and forms the physiologically active 1,25-dihydroxyvitamin D [1,25(OH)2D], also known as “calcitriol” [1].

Vitamin D promotes calcium absorption in the gut and maintains adequate serum calcium and phosphate concentrations to enable normal bone mineralization and to prevent hypocalcemic tetany (involuntary contraction of muscles, leading to cramps and spasms). It is also needed for bone growth and bone remodeling by osteoblasts and osteoclasts [1-3]. Without sufficient vitamin D, bones can become thin, brittle, or misshapen. Vitamin D sufficiency prevents rickets in children and osteomalacia in adults. Together with calcium, vitamin D also helps protect older adults from osteoporosis.

• Conventional scientific opinion has attributed weight gain to a net surplus of calories due to burning fewer calories than taking in.
  Opposing this view, the carbohydrate-insulin model states that diet quality matters more for weight loss than total calorie intake.
• The model posits that the intake of processed carbohydrates and starchy foods leads to changes in the levels of insulin and other hormones, subsequently resulting in increased fat deposition.
• The increased fat deposits lead to hunger and consumption of more calorie-rich foods leading to obesity.
• The model suggests that avoiding processed carbohydrates and starchy foods may be necessary to lose weight instead of restricting calories. //

A recent article published in theAmerican Journal of Clinical NutritionTrusted Source provides a comprehensive description of the CIM, along with testable hypotheses that may help clarify the precise changes in nutrition necessary to lose weight or maintain a healthy weight.

The article’s first author Dr. David Ludwig, told Medical News Today, “If the CIM is right, then the conventional approach to weight loss, the low-calorie diet, is likely to fail for most people over the long term. We argue that people have more control over what they eat than how much. A focus on reducing processed carbohydrates, rather than calorie restriction, may be more effective by lowering the biological drive to store excessive fat.” //

The glycemic index (GI) rates carbohydrates according to how rapidly they raise blood glucose levels after someone has eaten them. The glycemic load is another measure that provides more comprehensive information about the surge in blood sugar levels by considering the GI and amount of carbohydrates a serving of a given food provides.

Consumption of processed and starchy foods that contain rapidly digestible carbohydrates results in a surge in blood glucose levels. Foods with a high glycemic load include processed grains, potato products, and foods with high free sugarsTrusted Source content. Free sugars are all types of sugars that do not occur naturally in whole fruits and vegetables.

In contrast, fats and proteins have a negligible impact on blood sugar levels, whereas fresh whole fruits, minimally processed grains, legumes, nuts, and nonstarchy vegetables typically have a low or moderate glycemic load.

The rapid surge in glucose levels after consuming high glycemic load foods results in the secretion of insulin, which regulates blood sugar levels and helps the muscles, liver, and adipose or fat tissue absorb glucose.

CDC
@CDCgov
New @CDCMMWR shows counties w/ school mask requirements had a smaller increase in pediatric #COVID19 case rates than counties w/o school mask requirements. #MaskUp in schools to help control the spread of COVID-19 in children and adolescents. http://bit.ly/MMWR92421c
2:55 PM · Sep 24, 2021 //

Notice the massaging being done to the language in this announcement. It doesn’t actually say schools with mask mandates show a smaller increase in pediatric COVID-19 case rates. Rather, it says “counties,” and we’ll get to why that is in a minute. Further, the CDC absconds from including in their graphic the actual, numerical difference being touted.

For posterity, here’s the link to the full study so you can see exactly what it actually covers.

https://www.cdc.gov/mmwr/volumes/70/wr/mm7039e3.htm?s_cid=mm7039e3_w

In short, what we have is a “study” that didn’t even cover a period where children were in school — save for a week or so. The “study” is also based on a data set of counties that do not control for prior infection rates, testing capacity, etc. in order to conduct a valid comparison between areas that have school mask mandates and ones that don’t. And even still, they came up with a result that shows almost no difference in the real number of cases.

Lastly, just to put a fine point on all this, the CDC’s own study admits that it’s ecological and should not be used to assign causation in regards to masks and infection rates. They also admit a lack of control regarding several other key variables.

Rapid initiation of nasal saline irrigation: hospitalizations in COVID-19 patients randomized to alkalinization or povidone-iodine compared to a national dataset

A fertility awareness method (FAM) is a modern, evidence-based method of charting one’s menstrual cycle, through observable biological signs unique to each woman, that helps a woman know more about her hormones, overall health, and when during her cycle she is naturally fertile or not. With the information obtained by observing and charting certain biomarkers of fertility, a woman is equipped to reach health goals with greater precision and family planning goals with high rates of effectiveness.

Fertility awareness methods can help a woman understand her body’s menstrual cycle and hormone health and identify and treat reproductive disorders. They can also be used as methods of natural family planning (NFP) that equip a woman to know when she is fertile and when she isn’t, at natural times in her cycle. By avoiding intercourse during periods of her cycle when she is fertile, a woman can use a FAM as a form of natural birth control, and at effectiveness rates that rival pharmaceutical birth control. //

Which FAM should you choose?

The first and most important question is “What do you feel that you can commit to today?” A person’s needs, hormones, and capacities shift over the years, so what works today might not work in a year—or in five years. It’s important to take into account variables like the cost of the method, accessibility to a certified FAM educator (although these days most of them teach online!), and fitting biomarker observations and charting into their schedule. //

One of the greatest advantages of using a fertility awareness method is how they can help identify hormonal imbalances and teach you more about your body than you ever could learn while on hormonal contraception. And that’s why it is crucial to have Reproductive Endocrinologists, OBGYNs, and General Practitioners well versed in fertility awareness methods. //

For more information on getting started charting your cycles with a Fertility Awareness Method or method of Natural Family Planning, check out the following resources:

Alasdair Munro
@apsmunro
·
Sep 16, 2021
The best data by far on #LongCovid is out from the ONS

For kids, the news is incredibly reassuring - parents minds should be put to rest

Rates of common symptoms after #COVID19 at 12 w for kids are extremely low (0% to 1.7%) compared to controls

https://ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/articles/technicalarticleupdatedestimatesoftheprevalenceofpostacutesymptomsamongpeoplewithcoronaviruscovid19intheuk/26april2020to1august2021

Previous ONS statistics have been widely misused, and difficult to interpret due to unavailable methods

This is all put to bed now. Excellent, transparent comparisons with a suitable control group.

Importantly, it includes COVID cases which would be missed by NHS testing

One statistic stands out

At both 4 and 12 weeks, MORE children aged 2 - 11y in the control group were experiencing symptoms than in those who tested positive for #COVID19

Rates of continuous symptoms going on for 12w were also extremely low for kids aged 2 - 16y who had tested positive for #COVID19 (only around 1%)

This was generally low across the study (3% of COVID +ve vs 0.5% of controls) ///

Prediction: COVID will become the next Chickenpox -- get it when you are young to gain immunity will end the scourge

Update: One hospital has denied Dr. Jason McElyea’s claim that ivermectin overdoses are causing emergency room backlogs and delays in medical care in rural Oklahoma, and Rolling Stone has been unable to independently verify any such cases as of the time of this update.

The National Poison Data System states there were 459 reported cases of ivermectin overdose in the United States in August. Oklahoma-specific ivermectin overdose figures are not available, but the count is unlikely to be a significant factor in hospital bed availability in a state that, per the CDC, currently has a 7-day average of 1,528 Covid-19 hospitalizations. The doctor is affiliated with a medical staffing group that serves multiple hospitals in Oklahoma. Following widespread publication of his statements, one hospital that the doctor’s group serves, NHS Sequoyah, said its ER has not treated any ivermectin overdoses and that it has not had to turn away anyone seeking care. This and other hospitals that the doctor’s group serves did not respond to requests for comment and the doctor has not responded to requests for further comment. We will update if we receive more information. //

The rise in people using ivermectin, an anti-parasitic drug usually reserved for deworming horses or livestock, as a treatment or preventative for Covid-19 has emergency rooms “so backed up that gunshot victims were having hard times getting” access to health facilities, an emergency room doctor in Oklahoma said.

This week, Dr. Jason McElyea told KFOR the overdoses are causing backlogs in rural hospitals, leaving both beds and ambulance services scarce.

“The ERs are so backed up that gunshot victims were having hard times getting to facilities where they can get definitive care and be treated,” McElyea said.

“All of their ambulances are stuck at the hospital waiting for a bed to open so they can take the patient in and they don’t have any, that’s it,” said McElyea. “If there’s no ambulance to take the call, there’s no ambulance to come to the call.” ///

https://twitter.com/seanmdav/status/1434356350457290755

According to the National Poison Data System (NPDS), which collects information from the nation's 55 poison control centers, there was a 245% jump in reported exposure cases from July to August — from 133 to 459. //

The NPDS says 1,143 ivermectin exposure cases were reported between Jan. 1 and Aug. 31. That marks an increase of 163% over the same period last year. [700 cases previous year] //

In Mississippi, which has one of the lowest rates of vaccination against the coronavirus, the state Department of Health issued an alert about the surge in calls to poison control in August. The department said that at least 70% of recent calls to the state poison control center were related to people who ingested a version of the drug meant for livestock. ///

70% of the 2% of calls about ivermectin, not 70% of all the calls. https://sfgate.com/news/amp/Health-Dept-Stop-taking-livestock-medicine-to-16405982.php

Yesterday, I wrote on a viral claim involving ivermectin, spread by blue checkmarks across the left, that asserted an Oklahoma hospital was so overwhelmed with overdoses from the animal variant that they were turning away gun-shot victims. That turned out to be so false that the hospital changed its internet homepage with a correction of the disinformation, noting that they did not have a single patient admitted currently that had overdosed on ivermectin.

But as I said when I opened this article, we are apparently going to keep doing this. Another ivermectin hoax has now been exposed, this time over a widely spread claim that Mississippi’s poison control was deluged with ivermectin overdoses representing 70% of total calls.

https://msdh.ms.gov/msdhsite/_static/resources/15400.pdf //

Amy
@AmyA1A
The AP reported that 70% of recent calls to the Mississippi Poison Control Center were from people who had ingested ivermectin to try to treat COVID-19.

The correction acknowledges that it was actually only 2%.

https://sfgate.com/news/amp/Health-Dept-Stop-taking-livestock-medicine-to-16405982.php?__twitter_impression=true
9:53 PM · Sep 5, 2021

Here’s the full correction per the Associated Press which was pushed out to SF Gate.

In an article published Aug. 23, 2021, about people taking livestock medicine to try to treat coronavirus, The Associated Press erroneously reported based on information provided by the Mississippi Department of Health that 70% of recent calls to the Mississippi Poison Control Center were from people who had ingested ivermectin to try to treat COVID-19. State Epidemiologist Dr. Paul Byers said Wednesday the number of calls to poison control about ivermectin was about 2%. He said of the calls that were about ivermectin, 70% were by people who had ingested the veterinary version of the medicine.

So instead of it being 70% of calls being about ivermectin, the actual number was…2%. And of that 2%, 70% of those calls were about the animal variant. In other words, instead of talking about possibly hundreds or thousands of animal variant ivermectin overdose calls, the number is actually infinitesimal, representing only 1.4% of calls.

Animals have been used in the industrialized production of human vaccines since vaccine farms were established to harvest cowpox virus from calves in the late 1800s. From that point, and through the first half of the 20th Century, most vaccines would continue to be developed with the use of animals, either by growing pathogens in live animals or by using animal cells.

Although many vaccines and anti-toxin products were successfully developed this way, using animals in vaccine development – particularly live animals – is not ideal. Research animals are costly and require extensive monitoring, both to maintain their health and to ensure the continued viability of the research. They may be carrying other bacteria or viruses that could contaminate the eventual vaccine, as with polio vaccines from the mid 20th century that were made with monkey cells and eventually found to contain a monkey virus called SV40, or Simian Virus 40. (Fortunately, the virus was not found to be harmful to humans.) Moreover, some pathogens, such as the chickenpox virus, simply do not grow well in animal cells. //

For these and other reasons, using cell culture techniques to produce vaccine viruses in human cell strains is a significant advance in vaccine development.

Weeks ago, when cases and hospitalizations began to rise, I suggested (because of this thing called “data”) that COVID-19 hospitalizations went up because the bar for hospitalizations went down. Simply put, the numbers went up because hospitals lowered their standards for which COVID patients should be hospitalized. The study that The Atlantic published? It suggests that very thing.

So what has taken us so long to get to this point? Well, again, the problem falls on the CDC, NIH, and NIAID, who have not standardized data collection nationally for this pandemic. //

To this day, the CDC does not collect nationalized data for several factors which would help us better analyze how to approach this pandemic, including breakthrough cases and hospitalization case severity. That means that someone admitted to the hospital out of an abundance (and sometimes an overkill) of caution, is counted as the same hospitalization as someone with a much more severe case. To those making decisions at the top, a hospitalization, is a hospitalization, is a hospitalization. //

The federal government requires hospitals to report every patient who tests positive for COVID, yet the overall tallies of COVID hospitalizations, made available on various state and federal dashboards and widely reported on by the media, do not differentiate based on severity of illness. Some patients need extensive medical intervention, such as getting intubated. Others require supplemental oxygen or administration of the steroid dexamethasone. But there are many COVID patients in the hospital with fairly mild symptoms, too, who have been admitted for further observation on account of their comorbidities, or because they reported feeling short of breath. Another portion of the patients in this tally are in the hospital for something unrelated to COVID, and discovered that they were infected only because they were tested upon admission. How many patients fall into each category has been a topic of much speculation. //

Which was the primary motivation for the study, conducted by the VA Boston Healthcare System. The doctors who performed the study took it upon themselves to provide a line, which after a patient meets a certain amount of criteria, could classify them as a severe case. According to the study, (which has not as of yet been peer-reviewed), once patients had to be placed on supplemental oxygen to survive, they could be considered a moderate-to-severe case. What the study found was very interesting. Hospitalized patients, who required supplemental oxygen fell from 64% to 52%. That means that either alternative treatments were more effective, or (and as I have been saying for months) hospitals began admitting patients with less severe symptoms. To further confirm the point, the study found that up until January 2021, 36% of patients who were admitted to the hospital had mild or asymptomatic cases. That number rose to 48% by the end of June 2021.

So why would hospitals do this? The Atlantic article fails to question this, only to find ways that the study may be flawed by offering various caveats. Presumably, and very likely, this has to do with the fact that COVID hospitalizations are reimbursed at a higher rate than would say, your typical health insurance plan.

Favorable outcome on viral load and culture viability using Ivermectin in early treatment of non-hospitalized patients with mild COVID-19 – A double-blind, randomized placebo-controlled trial

Background Ivermectin, an anti-parasitic agent, also has anti-viral properties. Our aim was to assess whether ivermectin can shorten the viral shedding in patients at an early-stage of COVID-19 infection.

Methods The double-blinded trial compared patients receiving ivermectin 0·2 mg/kg for 3 days vs. placebo in non-hospitalized COVID-19 patients. RT-PCR from a nasopharyngeal swab was obtained at recruitment and then every two days. Primary endpoint was reduction of viral-load on the 6th day (third day after termination of treatment) as reflected by Ct level>30 (non-infectious level). The primary outcome was supported by determination of viral culture viability.

Results Eighty-nine patients were eligible (47 in ivermectin and 42 in placebo arm). Their median age was 35 years. Females accounted for 21·6%, and 16·8% were asymptomatic at recruitment. Median time from symptom onset was 4 days. There were no statistical differences in these parameters between the two groups.

On day 6, 34 out of 47 (72%) patients in the ivermectin arm reached the endpoint, compared to 21/ 42 (50%) in the placebo arm (OR 2·62; 95% CI: 1·09-6·31). In a multivariable logistic-regression model, the odds of a negative test at day 6 was 2.62 time higher in the ivermectin group (95% CI: 1·06–6·45). Cultures at days 2 to 6 were positive in 3/23 (13·0%) of ivermectin samples vs. 14/29 (48·2%) in the placebo group (p=0·008).

Conclusions There were significantly lower viral loads and viable cultures in the ivermectin group, which could lead to shortening isolation time in these patients.

The study is registered at ClinicalTrials.gov NCT 044297411.

Double-blind study shows ivermectin reduces disease’s duration and infectiousness • FDA and WHO caution against its use //

Ivermectin, a drug used to fight parasites in third-world countries, could help reduce the length of infection for people who contract coronavirus for less than a $1 a day, according to recent research by Sheba Medical Center in Tel Hashomer.

Prof. Eli Schwartz, founder of the Center for Travel Medicine and Tropical Disease at Sheba, conducted a randomized, controlled, double-blinded trial from May 15, 2020, through the end of January 2021 to evaluate the effectiveness of ivermectin in reducing viral shedding among nonhospitalized patients with mild to moderate COVID-19.

Ivermectin has been approved by the US Food and Drug Administration since 1987. The drug’s discoverers were awarded the 2015 Nobel Prize in medicine for its treatment of onchocerciasis, a disease caused by infection with a parasitic roundworm.

Over the years, it has been used for other indications, including scabies and head lice. Moreover, in the last decade, several clinical studies have started to show its antiviral activity against viruses ranging from HIV and the flu to Zika and West Nile. //

In Schwartz’s study, some 89 eligible volunteers over the age of 18 who were diagnosed with coronavirus and staying in state-run COVID-19 hotels were divided into two groups: 50% received ivermectin, and 50% received a placebo, according to their weight. They were given the pills for three days in a row, an hour before a meal.

The volunteers were tested using a standard nasopharyngeal swab PCR test with the goal of evaluating whether there was a reduction in viral load by the sixth day – the third day after termination of the treatment. They were swabbed every two days.

Nearly 72% of volunteers treated with ivermectin tested negative for the virus by day six. In contrast, only 50% of those who received the placebo tested negative.

IN ADDITION, the study looked at culture viability, meaning how infectious the patients were, and found that only 13% of ivermectin patients were infectious after six days, compared with 50% of the placebo group – almost four times as many.

“Our study shows first and foremost that ivermectin has antiviral activity,” Schwartz said. “It also shows that there is almost a 100% chance that a person will be noninfectious in four to six days, which could lead to shortening isolation time for these people. This could have a huge economic and social impact.”

The study appeared on the MedRxiv health-research sharing site. It has not yet been peer reviewed.

https://www.medrxiv.org/content/10.1101/2021.05.31.21258081v1

Schwartz said other similar studies – though not all of them conducted to the same double-blind and placebo standards as his – also showed a favorable impact of ivermectin treatment.

His study did not prove ivermectin was effective as a prophylactic, meaning that it could prevent disease, he cautioned, nor did it show that it reduces the chances of hospitalization. However, other studies have shown such evidence, he added.

For example, the study published earlier this year in the American Journal of Therapeutics highlighted that “a review by the Front Line COVID-19 Critical Care Alliance summarized findings from 27 studies on the effects of ivermectin for the prevention and treatment of COVID-19 infection, concluding that ivermectin ‘demonstrates a strong signal of therapeutic efficacy’ against COVID-19.”

https://journals.lww.com/americantherapeutics/fulltext/2021/08000/ivermectin_for_prevention_and_treatment_of.7.aspx
//

Schwartz said he became interested in exploring ivermectin about a year ago, “when everyone was looking for a new drug” to treat COVID-19, and a lot of effort was being put into evaluating hydroxychloroquine, so he decided to join the effort.

“Since ivermectin was on my shelf, since we are using it for tropical diseases, and there were hints it might work, I decided to go for it,” he said.

Researchers in other places worldwide began looking into the drug at around the same time. But when they started to see positive results, no one wanted to publish them, Schwartz said.

“There is a lot of opposition,” he said. “We tried to publish it, and it was kicked away by three journals. No one even wanted to hear about it. You have to ask how come when the world is suffering.”

“This drug will not bring any big economic profits,” and so Big Pharma doesn’t want to deal with it, he said. //

“You would think Merck would be happy to hear that ivermectin might be helpful to corona patients and try to study it, but they are most loudly declaring the drug should not be used,” Schwartz said. “A billion people took it. They gave it to them. It’s a real shame.”

A new pre-print Israeli study has found that people with natural immunity to COVID-19 could be 13 times less likely to contract the respiratory virus than those who were solely vaccinated against the disease.

Conducted by researchers at Maccabi Healthcare and Tel Aviv University, the yet-to-be peer-reviewed study found that when comparing individuals previously infected with the virus and those that received two jabs of the Pfizer-BioNTech shot, those with natural infection saw greater protection against the delta variant and breakthrough infection.

“SARS-CoV-2-naïve vaccinees had a 13.06-fold increased risk for breakthrough infection with the Delta variant compared to those previously infected, when the first event (infection or vaccination) occurred during January and February of 2021,” the study read. “The increased risk was significant for symptomatic disease as well. When allowing the infection to occur at any time before vaccination (from March 2020 to February 2021), evidence of waning natural immunity was demonstrated, though SARS-CoV-2 naïve vaccinees had a 5.96-fold increased risk for breakthrough infection and a 7.13-fold increased risk for symptomatic disease.”

The analysis also found that solely vaccinated individuals “were also at a greater risk for COVID-19-related-hospitalizations compared to those that were previously infected.”

The study ultimately concluded that “natural immunity confers longer lasting and stronger protection against infection, symptomatic disease and hospitalization caused by the Delta variant of SARS-CoV-2, compared to the BNT162b2 two-dose vaccine-induced immunity” and that “individuals who were both previously infected with SARS-CoV-2 and given a single dose of the vaccine gained additional protection against the Delta variant.”

https://www.medrxiv.org/content/10.1101/2021.08.24.21262415v1

Accumulating evidence supports ending isolation and precautions for adults with laboratory-confirmed COVID-19 using a symptom-based strategy. This update incorporates recent evidence to inform the duration of isolation and precautions recommended to prevent transmission of SARS-CoV-2 to others, while limiting unnecessary prolonged isolation and unnecessary use of laboratory testing resources. This interim guidance is based upon information available to date and will be updated as new information becomes available. //

Summary of Key Findings

1. Concentrations of SARS-CoV-2 RNA in upper respiratory specimens decline after onset of symptoms. (39,56,61,63,64,66)
2. The likelihood of recovering replication-competent virus also declines after onset of symptoms. For patients with mild to moderate COVID-19, replication-competent virus has not been recovered after 10 days following symptom onset. (1,8,31,36,42,61,66) Recovery of replication-competent virus between 10 and 20 days after symptom onset has been reported in some adults with severe COVID-19; some of these cases were immunocompromised. (56) However, in this series of patients, it was estimated that 88% and 95% of their specimens no longer yielded replication-competent virus after 10 and 15 days, respectively, following symptom onset. Detection of sub-genomic SARS-CoV-2 RNA or recovery of replication-competent virus has been reported in severely immunocompromised patients (e.g., patients with chronic lymphocytic leukemia and acquired hypogammaglobulinemia, lymphoma and immunochemotherapy, hematopoietic stem-cell transplant, chimeric antigen receptor T-cell therapy, or AIDS) beyond 20 days, and as long as 143 days after a positive SARS-CoV-2 test result. (2,6,7,14,74)
3. In a large contact tracing study, no contacts at high risk of exposure developed infection if their exposure to a case patient started 6 days or more after the case patient’s infection onset. (12)
   Recovered patients can continue to have SARS-CoV-2 RNA detected in their upper respiratory specimens for up to 12 weeks after symptom onset. (31,33,34) Investigation of 285 “persistently positive” adults, which included 126 adults who had developed recurrent symptoms, found no secondary infections among 790 contacts to these case patients. Efforts to isolate replication-competent virus from 108 of these 285 case patients were unsuccessful. (31)

CDC initiated national surveillance of pregnancy-related deaths in 1986 because more clinical information was needed to fill data gaps about causes of maternal death. The first year of data reporting was 1987. //

In PMSS, a pregnancy-related death is defined as the death of a woman while pregnant or within 1 year of the end of pregnancy regardless of the outcome, duration, or site of the pregnancy — from any cause related to or aggravated by the pregnancy or its management. Pregnancy-related deaths as defined in PMSS generally do not include deaths due to injury. //

CDC’s National Center for Health Statistics’ National Vital Statistics System (NVSS) reports the national maternal mortality rate: the number of maternal deaths per 100,000 live births. A maternal death is defined as a death while pregnant or within 42 days of the end of pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes. This definition and timeframe are consistent with that used by the World Health Organization for reporting on maternal mortality rates. NVSS uses two pieces of information on the death record to identify maternal deaths — the pregnancy checkbox and the certified recording of the cause of death to assign maternal mortality ICD-10 codes. Identification of maternal deaths using automated processing of death records alone relies upon the death certifier accurately reporting causes of death related to pregnancy and pregnancy status. More information on NVSS maternal mortality coding is available.

Like NVSS, PMSS uses vital records for identification of deaths, including descriptions of causes of death and pregnancy status information on death records. Different from NVSS, PMSS further uses linkages of death records of women of reproductive age to birth and fetal death records within 1 year of the death, media searches, and reporting from public health agencies, health care providers and the public in the identification process. PMSS uses a time frame that includes deaths during pregnancy through 1 year after the end of pregnancy; this timeline allows evaluation of all deaths which might be pregnancy-related. In PMSS, deaths are reviewed by medical epidemiologists who perform an in-depth review of vital records and other data as available (e.g., medical records, autopsy reports) for each death to determine the pregnancy-related mortality ratio. These linkage and review processes by PMSS result in slower reporting than NVSS, but a more rigorous identification of deaths related to pregnancy.