Here Are Things Not to Put in Your Vagina

By Jen Gunter, NY Times

From yogurt to oregano oil to lemon juice (OUCH!), the internet is chock-full of suggestions and remedies for women’s sexual health.

June 11, 2018

People always want to know the most unusual object I’ve retrieved from a vagina.

I’ll never tell.

One, because the woman involved could recognize herself and feel betrayed. Yes, some items are that unusual.

The other reason is that the unfortunate sequence of events that ends with a visit to my OB-GYN practice or the emergency room is almost always the unanticipated consequence of sexual experimentation. Lots of objects seem sexually adventurous until the moment one realizes they are not. And realizes that they are stuck.

Sexual experimentation with household items is nothing new, though the nature of the object has changed slightly to match the times — think along the lines of a progression from a soda bottle to a diet soda bottle to an energy water bottle to a Kombucha bottle — over my 25 years of practice.

Another change I’ve noticed in that time is the increased touting of various “natural” and “ancient” vaginal remedies with household items. The reasons could range from “vaginal maintenance” (a term that, as an expert, I struggle to further qualify) to the treatment of yeast infections to contraception to improving sex lives.

There are two themes at play that seem simultaneously opposing yet complementary: that natural is best and that the vagina is so dirty, fragile or in need of nourishment (or all three) that it is one wrong pair of underwear or wet bathing suit away from complete catastrophe.

And this is how lemon juice (ouch), yogurt, garlic (double ouch), cucumber and oregano oil (super, mega ouch) are finding their way into vaginas worldwide. No, you are not reading a recipe for tzatziki sauce.

Many of these supposed natural therapies claim to have supporting science, although what is offered as proof is easily dismissed with a cursory knowledge of reproductive physiology. Lemon juice is recommended to acidify the vagina (it cannot). Yogurt is suggested because its bacteria could help repopulate the healthy, vaginal bacteria (commercial yogurts don’t have the right strains). Sea sponges are recommended for menstrual hygiene (testing has revealed they have bacteria and debris and they could introduce far more oxygen — a bad thing — into the vagina than a tampon or menstrual cup).

What is simultaneously fascinating and depressing is that these “newly discovered ancient therapies” are neither ancient nor effective. Instead they are the result of celebrity wellness sites, social media and even some doctors recycling material from health almanacs and digests that used to be found at the grocery store and repackaging their content under the guise of female empowerment.

What is science with its stodgy physiology and evidence-based medicine against the allure of the patient anecdote and the promise of a cure? Stories and confidence are what sells.

It’s possible that remedies like yogurt, garlic and so on were tried centuries ago as medicine, spermicide or sexual custom. But who cares if something was used historically if it has since been deemed ineffective or harmful? Blood letting for fever, mercury for vitality or syphilis, and animal dung as spermicide are all ancient medicinal practices, but that doesn’t mean we’re revisiting those therapies today.

In other words, all these so-called “ancient” sexual remedies were retired for a reason.

I get the allure. So many women are still uncomfortable speaking openly about genital health, and the internet offers privacy — not to mention community and validation. When all these needs are met, accuracy can seem secondary.

It is always best to see a health care professional for a diagnosis. We women do know our bodies, but there is so much crossover with symptoms that when women attempt self- diagnosis they are likely to misdiagnose more than 50 percent of the time. That’s worse than flipping a coin.

Researching symptoms and treatment options is always good, but to keep your internet hygiene in check (which requires far more effort than vaginal hygiene) these are the things that should send you screaming:

• Run if the therapy is said to be “proven.” The degree to which something is supposedly “proven” to treat a medical condition is inversely proportional to the number of studies supporting that claim.

• Run if something is being sold. Anyone selling a product is by definition biased, whether it is “Big Pharma” or “Big Natural.”

• Run if the recommendation is homeopathic products. A recent study tells us that doctors who recommend homeopathy are more likely to deviate from standard medical guidelines. In other words they are more likely to practice bad medicine.

• Run if the advice relies on testimonials. I would never tell my patient “Well Sarah S. said it worked for her!” Sarah S. is not the same thing as science.

• Run if it involves inserting food vaginally for health reasons. This is nonsense.

• Run if they recommend vaginal cleaning of any kind. For instance, I’ve been hearing about “vaginal steaming.” It’s well meaning, but woefully misinformed. If your bottom is sore, use a sitz bath.

It’s stunning that in this great age of information that can we have so much misinformation about our bodies and our sexuality. The internet has changed the speed at which we can acquire medical information, but certainly not the accuracy.

Dr. Jen Gunter is an obstetrician and gynecologist practicing in California. The Cycle, a column on women’s reproductive health, appears regularly in Styles.

Once a model, California now struggles to tame COVID-19

LOS ANGELES (AP) — Ambulances waited hours for openings to offload coronavirus patients. Overflow patients were moved to hospital hallways and gift shops, even a cafeteria. Refrigerated trucks were on standby, ready to store the dead.

For months, California did many of the right things to avoid a catastrophic surge from the pandemic. But by the time Gov. Gavin Newsom said on Dec. 15 that 5,000 body bags were being distributed, it was clear that the nation’s most populous state had entered a new phase of the COVID-19 crisis.

Now infections have been racing out of control for weeks, and California has routinely set new records for infections and deaths. It remains at or near the top of the list of states with the most new cases per capita.

Experts say a variety of factors combined to wipe out the past efforts, which for much of the year held the virus to manageable levels. Cramped housing, travel and Thanksgiving gatherings contributed to the spread, along with the public’s fatigue amid regulations that closed many schools and businesses and encouraged — or required — an isolated lifestyle.

Another factor could be a more contagious variant of the virus detected in Southern California, although it’s not clear yet how widespread that may be.

California’s woes have helped fuel the year-end U.S. infection spike and added urgency to the attempts to beat back the scourge that has killed more than 340,000 Americans. Even with vaccines becoming available, cases are almost certain to continue growing, and yet another surge is expected in the weeks after Christmas and New Year’s.

On Friday, the number of confirmed U.S. coronavirus cases surpassed 20 million, nearly twice as many as the No. 2 country, India, and nearly one-quarter of the more than 83 million cases globally, according to data from Johns Hopkins University.

In California, the southern half of the state has seen the worst effects, from the agricultural San Joaquin Valley to the Mexico border. Hospitals are swamped with patients, and intensive care units have no more beds for COVID-19 patients. Makeshift wards are being set up in tents, arenas, classrooms and conference rooms.

Hospitalizations statewide have gone up more than eightfold in two months and nearly tenfold in Los Angeles County. On Thursday, the total number of California deaths surpassed 25,000, joining only New York and Texas at that milestone.

“Most heartbreaking is that if we had done a better job of reducing transmission of the virus, many of these deaths would not have happened,” said Barbara Ferrer, the county’s public health director, who has pleaded with people not to get together and worsen the spread.

Crowded houses and apartments are often cited as a source of spread, particularly in Los Angeles, which has some of the densest neighborhoods in the U.S. Households in and around LA often have several generations — or multiple families — living under one roof. Those tend to be lower-income areas where residents work essential jobs that can expose them to the virus at work or while commuting.

The socioeconomic situation in LA County is “like the kindling,” said Paula Cannon, a professor of microbiology and immunology at the University of Southern California. “And now we got to the stage where there was enough COVID out in the community that it lit the fire.”

Home to a quarter of the state’s 40 million residents, LA County has had 40% of the state’s deaths and a third of its 2.2 million cases. The virus has hit Latino and Black communities harder.

Cannon said there’s a moral imperative for people who can follow stay-home orders to help prevent spread that is harder to contain in other areas.

“What you can’t do is say to people, ‘Can you stop living in a house with eight other people, five of whom are working essential worker jobs?’” she said. “This is the structure that we can’t change in LA. This is, I think, contributing to why our levels have suddenly got scarily high and looks like they’re going to keep going up and keep staying that way.”

In March, during the early days of the pandemic, Newsom was hailed for issuing the nation’s first state stay-home order.

The Democrat eased business restrictions in May, and when a broader restart led to another surge, imposed more rules. In early December, with cases out of control, he issued a looser stay-home order. He also closed businesses such as barbershops and salons, halted restaurant dining and limited capacity in retail stores. The latest restrictions apply everywhere except in rural Northern California.

But Dr. Lee Riley, an infectious diseases professor at the University of California at Berkeley, said that while the state managed to flatten the curve of rising cases, it never effectively bent the curve downward to the point infections would die out.

When cases rose in June and July, California was never able to do enough contact tracing to isolate infected people and those they may have exposed before they spread the disease — often unwittingly — to others, he said. And public health directives were never adequately enforced.

“What California did was to maybe delay the peak,” Riley said. Infections “really just never got low enough. And we started lifting the restrictions, and that just allowed the transmissions to just continue to increase. We never really saw a real decline.”

California’s health secretary, Dr. Mark Ghaly, said if state and local leaders had not made difficult decisions early on that saved lives, the current surge might not be the worst the state has seen.

He acknowledged the exhaustion many people feel after enduring months of disruptions to their lives. Public health officials, he said, need to find a way to reach people who have given up or not followed rules on social distancing and masks.

Across California, local officials have reminded people that the fate of the virus lies in their behavior and asked for one more round of shared sacrifice. They reminded people that activities that were safe earlier this year are now risky as the virus becomes more widespread.

“You can practice safety and low-risk behavior from March to October. But all that is erased. Nothing matters except what you are doing to fight the virus right now,” said Corinne McDaniels-Davidson, director of the Institute for Public Health at San Diego State University. “This pandemic is an ultra-marathon. In our culture, we are used to sprints.”

United Airlines working with Centers for Disease Control after suspected COVID-related death during flight to California

By JESSICA SCHLADEBECK, NY Daily News

Health officials are racing to contact those who traveled aboard a United Airlines plane after a passenger exhibiting coronavirus symptoms experienced a “medical emergency” during a flight from Orlando to Los Angeles earlier this week and subsequently died.

United Airlines flight 591 was forced to divert to New Orleans on Monday when a man aboard the aircraft became suddenly ill, according to USA Today. He was dropped off at an area hospital, where he later died, before the plane continued on to California.

United is working with the government to notify passengers who may have been exposed. (Shutterstock)

“At the time of the diversion, we were informed he had suffered a cardiac arrest, so passengers were given the option to take a later flight or continue on with their travel plans,” a United Airlines spokesperson said in a statement on Friday.

“Now that the CDC has contacted us directly, we are sharing requested information with the agency so they can work with local health officials to conduct outreach to any customer the CDC believes may be at risk for possible exposure or infection.”

Prior to boarding a flight, United Airlines requires all passengers to fill out a ready-to-fly checklist, promising they had not tested positive for COVID and did not have symptoms. The questionnaires operate on the honor system and travelers are not required to show proof of health.

A fellow passenger posted on social media in wake of the incident that the deceased’s wife had told emergency responders her husband had been suffering coronavirus symptoms, including a loss of taste and smell, before takeoff.

Four flight attendants who worked aboard Flight 591 entered a 14-day quarantine upon their arrival at Los Angeles International Airport, Taylor Garland, a spokesperson for Association of Flight Attendants-CWA, told NBC Los Angeles.

The CDC said in a statement that they are in the “process of collecting information and proceeding according to our standard operating procedures to determine if further public health action is appropriate.”

1 in 5 prisoners in the US has had COVID-19, 1,700 have died

BETH SCHWARTZAPFEL AND KATIE PARK OF THE MARSHALL PROJECT AND ANDREW DEMILLO OF THE ASSOCIATED PRESS

LITTLE ROCK, Ark. (AP) — One in every five state and federal prisoners in the United States has tested positive for the coronavirus, a rate more than four times as high as the general population. In some states, more than half of prisoners have been infected, according to data collected by The Associated Press and The Marshall Project.

As the pandemic enters its 10th month — and as the first Americans begin to receive a long-awaited COVID-19 vaccine — at least 275,000 prisoners have been infected, more than 1,700 have died and the spread of the virus behind bars shows no sign of slowing. New cases in prisons this week reached their highest level since testing began in the spring, far outstripping previous peaks in April and August.

“That number is a vast undercount,” said Homer Venters, the former chief medical officer at New York’s Rikers Island jail complex.

Venters has conducted more than a dozen court-ordered COVID-19 prison inspections around the country. “I still encounter prisons and jails where, when people get sick, not only are they not tested but they don’t receive care. So they get much sicker than need be,” he said.

Now the rollout of vaccines poses difficult decisions for politicians and policymakers. As the virus spreads largely unchecked behind bars, prisoners can’t social distance and are dependent on the state for their safety and well-being.

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This story is a collaboration between The Associated Press and The Marshall Project exploring the state of the prison system in the coronavirus pandemic.

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Donte Westmoreland, 26, was recently released from Lansing Correctional Facility in Kansas, where he caught the virus while serving time on a marijuana charge. Some 5,100 prisoners have become infected in Kansas prisons, the third-highest COVID-19 rate in the country, behind only South Dakota and Arkansas.

“It was like I was sentenced to death,” Westmoreland said.

Westmoreland lived with more than 100 virus-infected men in an open dorm, where he woke up regularly to find men sick on the floor, unable to get up on their own, he said.

“People are actually dying in front of me off of this virus,” he said. “It’s the scariest sight.” Westmoreland said he sweated it out, shivering in his bunk until, six weeks later, he finally recovered.

Half of the prisoners in Kansas have been infected with COVID-19 — eight times the rate of cases among the state’s overall population. Eleven prisoners have died, including five at the prison where Westmoreland was held. Of the three prison employees who have died in Kansas, two worked at Lansing Correctional Facility.

In Arkansas, where more than 9,700 prisoners have tested positive and 50 have died, four of every seven have had the virus, the second-highest prison infection rate in the U.S.

Among the dead was 29-year-old Derick Coley, who was serving a 20-year sentence at the Cummins Unit maximum security prison. Cece Tate, Coley’s girlfriend, said she last talked with him on April 10 when he said he was sick and showing symptoms of the virus.

“It took forever for me to get information,” she said. The prison finally told her on April 20 that Coley had tested positive for the virus. Less than two weeks later, a prison chaplain called on May 2 to tell her Coley had died.

The couple had a daughter who turned 9 in July. “She cried and was like, ‘My daddy can’t send me a birthday card,’” Tate said. “She was like, ‘Momma, my Christmas ain’t going to be the same.’”

Nearly every prison system in the country has seen infection rates significantly higher than the communities around them. In facilities run by the federal Bureau of Prisons, one of every five prisoners has had coronavirus. Twenty-four state prison systems have had even higher rates.

Not all states release how many prisoners they’ve tested, but states that test prisoners broadly and regularly may appear to have higher case rates than states that don’t.

Infection rates as of Tuesday were calculated by the AP and The Marshall Project, a nonprofit news organization covering the criminal justice system, based on data collected weekly in prisons since March. Infection and mortality rates may be even higher, since nearly every prison system has significantly fewer prisoners today than when the pandemic began, so rates represent a conservative estimate based on the largest known population.

Yet, as vaccine campaigns get underway, there has been pushback in some states against giving the shots to people in prisons early.

“There’s no way it’s going to go to prisoners … before it goes to the people who haven’t committed any crime,” Colorado Gov. Jared Polis told reporters earlier this month after his state’s initial vaccine priority plans put prisoners before the general public.

Like more than a dozen states, Kansas’s vaccination plan does not mention prisoners or corrections staff, according to the Prison Policy Initiative, a non-partisan prison data think tank. Seven states put prisoners near the front of the line, along with others living in crowded settings like nursing homes and long-term care facilities. An additional 19 states have placed prisoners in the second phase of their vaccine rollouts.

Racial disparities in the nation’s criminal justice system compound the disproportionate toll the pandemic has taken on communities of color. Black Americans are incarcerated at five times the rate of whites. They are also disproportionately likely to be infected and hospitalized with COVID-19, and are more likely than other races to have a family member or close friend who has died of the virus.

The pandemic “increases risk for those who are already at risk,” said David J. Harris, managing director of the Charles Hamilton Houston Institute for Race and Justice at Harvard Law School.

This week, a Council on Criminal Justice task force headed by former attorneys general Alberto Gonzalez and Loretta Lynch released a report calling for scaling back prison populations, improving communication with public health departments and reporting better data.

Prison facilities are often overcrowded and poorly ventilated. Dormitory-style housing, cafeterias and open-bar cell doors make it nearly impossible to quarantine. Prison populations are sicker, on average, than the general population and health care behind bars is notoriously substandard. Nationwide, the mortality rate for COVID-19 among prisoners is 45% higher than the overall rate.

From the earliest days of the pandemic, public health experts called for widespread prison releases as the best way to curb virus spread behind bars. In October, the National Academies of Science, Medicine, and Engineering released a report urging states to empty their prisons of anyone who was medically vulnerable, nearing the end of their sentence or of low risk to public safety.

But releases have been slow and uneven. In the first three months of the pandemic, more than 10,000 federal prisoners applied for compassionate release. Wardens denied or did not respond to almost all those requests, approving only 156 — less than 2%.

A plan to thin the state prison population in New Jersey, first introduced in June, was held up in the Legislature because of inadequate funding to help those who were released. About 2,200 prisoners with less than a year left to serve were ultimately released in November, eight months after the pandemic began.

California used a similar strategy to release 11,000 people since March. But state prisons stopped accepting new prisoners from county jails at several points during the pandemic, which simply shifted the burden to the jails. According to the state corrections agency, more than 8,000 people are now waiting in California’s county jails, which are also coronavirus hot spots.

“We call that ‘screwing county,’” said John Wetzel, Pennsylvania’s secretary of corrections, whose prison system has one of the lower COVID-19 case rates in the country, with one in every seven prisoners infected. But that’s still more than three times the statewide rate.

Prison walls are porous even during a pandemic, with corrections officers and other employees traveling in and out each day.

“The interchange between communities and prisons and jails has always been there, but in the context of COVID-19 it’s never been more clear,” said Lauren Brinkley-Rubinstein, a professor of social medicine at UNC-Chapel Hill who studies incarceration and health. “We have to stop thinking about them as a place apart.”

Wetzel said Pennsylvania’s prisons have kept virus rates relatively low by widely distributing masks in mid-March — weeks before even the Centers for Disease Control and Prevention began recommending them for everyday use in public — and demanding that staff and prisoners use them properly and consistently. But prisoners and advocates say prevention measures on the ground are uneven, regardless of Wetzel’s good intentions.

As the country heads into winter with virus infections on the rise, experts caution that unless COVID-19 is brought under control behind bars, the country will not get it under control in the population at large.

“If we are going to end this pandemic — bring down infection rates, bring down death rates, bring down ICU occupancy rates — we have to address infection rates in correctional facilities,” said Emily Wang, professor at Yale School of Medicine and co-author of the recent National Academies report.

“Infections and deaths are extraordinarily high. These are wards of the state, and we have to contend with it.”

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Schwartzapfel reported from Boston and Park from Washington.

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This story has been corrected to remove a reference to infection rates for prison employees nationwide that undercounted staff populations in at least one state. The number of staff infected in North Dakota is one in four, not four in five.”

Body cam footage shows raid on former Florida Covid data scientist’s home

By Casey Tolan and Curt Devine, CNN

(CNN) — Florida state police released body camera videos Thursday afternoon showing officers waiting before they entered the home of a former state data scientist and the testy confrontation that followed when she exited — providing new context about a controversial police raid that has attracted national attention this week.

Officers were serving a search warrant Monday morning at the home of Rebekah Jones, a coronavirus data scientist who was fired from the state and has accused Florida officials of covering up the extent of the pandemic.

The state Department of Law Enforcement is investigating whether Jones illegally accessed a state messaging system to send her former colleagues a message urging them to speak out about coronavirus deaths. Jones, who has feuded with Republican Gov. Ron DeSantis for months, has denied sending the message.

The two videos released by the department show that Jones didn’t exit her Tallahassee home until about 23 minutes after officers first rang the doorbell, and 15 minutes after they first announced themselves as police. Jones has claimed authorities waited 13 minutes while she got dressed.

Officers are seen calling Jones’ cell phone to ask her to leave the house, while one holds a large hammer.

“Police search warrant, open the door!” officers yell several times. “Make sure the whole block hears us,” one agent tells his colleagues.

<img alt=”Raid of former Florida Covid data scientist&amp;#39;s home could affect other state employees, legal experts warn” class=”media__image” src=”//cdn.cnn.com/cnnnext/dam/assets/201208181837-01-jones-interview-1208-large-169.jpg”>

As Jones exits her house, one officer with his gun drawn appears to point the weapon in her direction, although it’s unclear whether anyone pointed a firearm six inches from Jones’ face, as she has claimed in interviews with CNN. Officers are seen holding her by her back and her arms as she shouts at them not to point a gun at her children.

One of the officers scolds Jones for taking so long after she leaves the house.

“That was not smart what you are doing,” the officer tells Jones. “You need to calm down and get your head (inaudible) because you are making all the wrong decisions.”

“All you had to do was answer the door — there was no doubt who we were,” the officer said.

Jones replies that her lawyer had previously told her not to answer the door. She seems confused about what officers want. “What are they looking for? Are they looking for a person?” she asked at one point.

Law enforcement department Commissioner Rick Swearingen said in a statement that “this video demonstrates that FDLE agents exercised extreme patience.”

“Agents afforded Ms. Jones ample time to come to the door and resolve this matter in a civil and professional manner,” Swearingen said. “As this video will demonstrate, any risk or danger to Ms. Jones or her family was the result of her actions.”

But Jones, who has said she delayed in answering the door because she was getting dressed, responded on Twitter on Thursday that the videos prove she was cooperating.

Officers “were ready to break my door down with a sledgehammer,” she wrote. “This is ‘restraint?’ Really???”

The footage released so far mostly shows interactions outside Jones’ home, although officers did enter and search the house. Jones has said that officers in the house pointed guns at her 2- and 11-year-old children and her husband, which the department has denied, and released her own video of the raid showing officers inside with guns drawn. It’s unclear whether those officers were also wearing body cameras.

In other developments, Jones has now raised more than $200,000 on a GoFundMe page that she says will be used for her legal defense and for “moving expenses so my family can get out of the Governor’s reach.”

Pfizer: COVID-19 shot 95% effective, seeking clearance soon

By LINDA A. JOHNSON and FRANK JORDANS, Associated Press

Pfizer said Wednesday that new test results show its coronavirus vaccine is 95% effective, is safe and also protects older people most at risk of dying — the last data needed to seek emergency use of limited shot supplies as the catastrophic outbreak worsens across the globe.

The announcement from Pfizer and its German partner BioNTech, just a week after they revealed the first promising preliminary results, comes as the team is preparing within days to formally ask U.S. regulators to allow emergency use of the vaccine. 

They also have begun “rolling submissions” for the vaccine with regulators in Europe, the U.K. and Canada and soon will add this new data.

Pfizer and BioNTech had initially estimated the vaccine was more than 90% effective after 94 infections had been counted in a study that included 44,000 people. With the new announcement, the company now has accumulated 170 infections in the study — and said only eight of them occurred in volunteers who got the actual vaccine rather than a dummy shot. One of those eight developed severe disease, the company said. 

“This is an extraordinarily strong protection,” Dr. Ugur Sahin, BioNTech’s CEO and co-founder, told The Associated Press.

The companies have not yet released detailed data on its study, and results have not been analyzed by independent experts. Also still to be determined are important questions such as how long protection lasts and whether people might need boosters.

But all eyes are on the progress of potential vaccines as the grim infection rate jumps in the U.S. and abroad as winter weather forces people indoors, in the close quarters that fuels viral spread. 

Pfizer and BioNTech said the vaccine was more than 94% effective in adults over age 65, though it is not clear exactly how that was determined with only eight infections in the vaccinated group to analyze and no breakdown provided of those people’s ages. 

Sahin said there were enough older adults enrolled in the study and among the placebo recipients who became infected that he is confident “this vaccine appears to work in the higher-risk population.”

Earlier this week Moderna, Inc. announced that its experimental vaccine appears to be 94.5% effective after an interim analysis of its late-stage study.

Similar results from two vaccines both made with a brand-new technology — using a snippet of the genetic code of the coronavirus to train the body to recognize if the real virus comes along — likely will add to experts’ reassurance about the novel approach. 

While initial supplies will be scarce and rationed, as the supply grows Sahin said the companies have a responsibility to help ensure access for lower income countries as well.

Pfizer and BioNTech also say now have the required data on the vaccine’s safety needed to seek emergency authorization from the Food and Drug Administration.

The companies didn’t disclose safety details but said no serious vaccine side effects have been reported, with the most common problem being fatigue after the second vaccine dose, affecting about 4% of participants. 

The study has enrolled nearly 44,000 people in the U.S. and five other countries. The trial will continue to collect safety and effectiveness data on volunteers for two more years. 

Pfizer and BioNTech said they expect to produce up to 50 million vaccine doses globally in 2020 and up to 1.3 billion doses in 2021.

U.S. officials have said they hope to have about 20 million vaccine doses each from Moderna and Pfizer available for distribution in late December. The first shots are expected to be offered to vulnerable groups like medical and nursing home workers, and people with serious health conditions.

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AP medical writer Lauran Neergaard contributed to this report. 

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.

Surging virus cases get a shrug in many Midwestern towns

By GRANT SCHULTE, Associated Press

ELMWOOD, Neb. (AP) — Danny Rice has a good sense of how dangerous the coronavirus can be.

What puzzles him are the people who have curtailed so much of their lives to avoid being infected by the virus.

“I’m not going out and looking to catch it,” he said, sitting at a cluttered desk in his auto repair shop in the tiny eastern Nebraska community of Elmwood. “I don’t want to catch it. But if I get it, I get it. That’s just how I feel.”

Plenty of people agree with Rice, and health experts acknowledge those views are powering soaring COVID-19 infection rates, especially in parts of the rural Midwest where the disease is spreading unabated and threatening to overwhelm hospitals.

It’s not that people in Nebraska, South Dakota, North Dakota, Iowa and elsewhere don’t realize their states are leading the nation in new cases per capita. It’s that many of them aren’t especially concerned.

Wayne County, home to 6,400 people in southern Iowa, has the state’s second-highest case rate, yet its public health administrator, Shelley Bickel, says mask-wearing is rare. She finds it particularly appalling when she sees older people, who are at high risk, shopping at a grocery store without one.

“I just want to get on the speaker and say, ‘Why don’t you have your mask on?’ It’s just amazing,” Bickel said.

Jenna Lovaas, public health director of Jones County, Iowa, said even now that her rural county has the state’s highest virus rate, people have opted not to make any changes, such as protecting themselves and others by wearing masks.

“They don’t think it’s real,” she said. “They don’t think it’s going to be that bad or they just don’t want to wear a mask because we’ve made it a whole political thing at this point.”

In part, though, some of those views are hard to fight because of the reality that many people have no symptoms, and most of those who do get sick recover quickly. And treatment advances mean that those who become seriously ill are less likely to die from the virus than when it first emerged in the spring. Even though cases and the death toll are rising, infectious disease experts note that death rates appear to be falling.

Like most people, Jay Stibbe, 52, of Fargo, North Dakota, said he and his family are respectful of COVID-19 protocols and wear masks where required. However, Stibbe said he doesn’t see enough “concrete information” about the virus to stop him from going about his normal life, even though North Dakota leads the nation in the number of virus cases per capita.

“We have an 18-year-old and a 16-year-old, and we certainly believe this is an important time of life to maybe shine a little bit,” he said. “We’re trying to create as much normalcy as we can. We try not to live in fear. We’ve traveled. We go out to dinner.”

In Plattsmouth, Nebraska, Karen Prohaska, 76, said she generally doesn’t wear a mask in her downtown purse and jewelry shop but will put one on at the request of a customer. When customers come into the store with a face covering, she asks if they’d like her to don one as well. Most say no and ask if it’s OK for them to remove theirs.

“I hope that I don’t get the virus, but I’ve never really been a germophobe,” Prohaska said.

The pandemic hasn’t stopped Mary Gerteisen, of Eagle, Nebraska, from visiting her 96-year-old father on weekends to watch football. Gerteisen said she understands the risks, given her father’s age and vulnerability, but she also weighed the fact that he’s in the early stages of dementia and often believes family members have abandoned him.

“There are times when I think that I do need to take the pandemic more seriously,” she said. “But I want to see my dad, and I don’t know much longer I have with him. I would love for him to live to 100-some years old, but if he comes down with (the virus), he’s lived a good, long life.”

Even as virus rates have soared in the Midwest, the Republican governors of Nebraska, Iowa and South Dakota have ruled out requiring masks in all public places, though Iowa Gov. Kim Reynolds this week required masks for indoor events with more than 25 people and outdoor events of more than 100 people. Iowa schools are exempted, and bars and restaurants are only required to ensure social distancing. Meanwhile, North Dakota’s Republican governor, Doug Burgum, imposed statewide mask and business restrictions on Friday after resisting doing so for months. The state had only nine free Intensive Care Unit hospital beds as of Friday.

Although doctors and public health officials have criticized the governors for their lack of action, voters in all of the states last week backed Republicans, including President Donald Trump, who has mocked mask wearing and downplayed the seriousness of a pandemic that has killed more than 240,000 people.

That has left Midwest medical professionals wondering how they will reverse a tide of people being treated for the coronavirus if residents of their states still aren’t taking the illness seriously.

Suresh Gunasekaran, CEO of University of Iowa Hospitals and Clinics in Iowa City, said they’re managing the surge of patients for now but don’t know what will happen if the numbers keep rising.

“The real question is where are we going to be in December? Where are we going to be in January?” he asked. “These are the kinds of questions that I think that we as a state have to continue to ask ourselves but more importantly each local community has to ask themselves.”

Taiwan just went 200 days without a locally transmitted Covid-19 case. Here’s how they did it

By Joshua Berlinger, CNN

As much of the world struggles to contain new waves of the Covid-19 pandemic, Taiwan just marked its 200th consecutive day without a locally transmitted case of the disease.

Taipei’s response to the coronavirus pandemic has been one of the world’s most effective. The island of 23 million people last reported a locally transmitted case on April 12, which was Easter Sunday. As of Thursday, it had confirmed 553 cases — only 55 of which were local transmissions. Seven deaths have been recorded.

Easter was an important milestone in the United States because President Donald Trump had said a month earlier he wanted the country “opened up and just raring to go” by the holiday.

At that point, 1.7 million people had been infected and 110,000 had been killed by the virus — globally. On Friday, those figures had passed 45 million cases and more than 1.1 million deaths, according to Johns Hopkins University.

Taiwan’s landmark achievement comes in a week when France and Germany are enacting new lockdowns and the United States identified a record 88,000-plus cases in a day. The state of Florida, which has a similar population size to Taiwan, with approximately 21 million people, identified 4,188 cases on Wednesday alone.

Taiwan has never had to enact strict lockdowns. Nor did it resort to drastic restrictions on civil freedoms, like in mainland China.

Instead, Taiwan’s response focused on speed. Taiwanese authorities began screening passengers on direct flights from Wuhan, where the virus was first identified, on December 31, 2019 — back when the virus was mostly the subject of rumors and limited reporting.

Taiwan confirmed its first reported case of the novel coronavirus on January 21 and then banned Wuhan residents from traveling to the island. All passengers arriving from mainland China, Hong Kong and Macao were required to undergo screening.

All this happened before Wuhan itself went into lockdown on January 23. By March, Taiwan banned all foreign nationals from entering the island, apart from diplomats, residents and those with special entry visas.

But Taiwan has advantages its counterparts in the West do not.

One is geography — Taiwan is an island, so it’s easier for officials to control entry and exit through its borders.

Learning from Taiwan’s Covid-19 response 07:07

Taiwan also had experience on its side. After suffering through the deadly outbreak of severe acute respiratory syndrome (SARS) in 2003, Taiwan worked to build up its capacity to deal with a pandemic, Taiwanese Foreign Minister Joseph Wu said in an interview last month.

“So, when we heard that there were some secret pneumonia cases in China where patients were treated in isolation, we knew it was something similar,” he said.

Authorities activated the island’s Central Epidemic Command Center, which was set up in the wake of SARS, to coordinate between different ministries. The government also ramped up face mask and protective equipment production to make sure there would be a steady supply of PPE.

The government also invested in mass testing and quick and effective contact tracing.

Former Taiwanese Vice President Chen Chien-jen, who is an epidemiologist by training, said lockdowns are not ideal. Chen also said that the type of mass-testing schemes undertaken in mainland China, where millions of people are screened when a handful of cases are detected, are also unnecessary.

“Very careful contact tracing, and very stringent quarantines of close contacts are the best way to contain Covid-19,” he said.

https://www.cnn.com/2020/10/29/asia/taiwan-covid-19-intl-hnk/index.html

Argentina passes 1 million cases as virus hits Latin America

USHUAIA, Argentina (AP) — At the edge of Argentina in a city known as “The End of the World,” many thought they might be spared from the worst of the coronavirus pandemic.

Sitting far from the South American nation’s bustling capital, health workers in Ushuaia were initially able to contain a small outbreak among foreigners hoping to catch boats to the Antarctic at the start of the crisis.

But as Argentina passed 1 million virus cases Monday, it is now smaller cities like Ushuaia that are seeing some of the most notable upticks. Doctors have had to quadruple the number of beds for COVID-19 patients over the last month. At least 60% of those tested recently are coming back positive for the virus.

“We were the example of the country,” said Dr. Carlos Guglielmi, director of the Ushuaia Regional Hospital. “Evidently someone arrived with the coronavirus.”

Across Latin America, three other nations are expected to reach the 1 million case milestone in the coming weeks — Colombia, Mexico and Peru. The grim mark comes as Latin America continues to register some of the world’s highest daily case counts. And though some nations have seen important declines, overall there has been little relief, with cases dropping in one municipality only to escalate in another.

The trajectory is showing that the pandemic is likely to leave no corner of Latin America unscathed.

“The second wave is arriving without ever having finished the first,” said Dr. Luis Jorge Hernández, a public health professor at the University of the Andes in Colombia.

Argentina has seen cases spiral despite instituting one of the world’s longest lockdowns. Colombia’s major cities have seen a dip, but smaller areas like the department of Caldas in the coffee region are only now reaching a peak. Peru’s overall numbers have dropped, but officials recently reported 12 regions are spiking back up. Mexico, likewise, has seen a rise in a quarter of all states over the last week.

The result is that rather than a second virus wave like that being seen in Europe, epidemiologists anticipate a more sustained, plateau-like trend.

“Our countries are still getting out of the first wave,” said Dr. Marcos Espinal, director of the Pan American Health Organization’s Department of Communicable Diseases. “A great part of the population remains exposed and community transmission continues.”

The virus’ cruel path through Latin America is a consequence of weak public health systems, social factors like poverty and poor government decisions early on that resulted in flawed or limited testing and little contact tracing. Today the region is home to half the 10 countries with the highest total cases around the globe.

Argentina initially registered low virus case numbers but now has one of the highest rates of new daily infections per capita, according to Our World in Data, a non-profit online scientific publication based at the University of Oxford. It is on par with several European countries that are experiencing a resurgence of the virus.

Dr. Adolfo Rubinstein, a former Argentine health minister, said the nation depended too heavily on lockdowns as its primary means of controlling the virus, failing to purchase enough tests in the initial months of the pandemic.

Where the virus is appearing is also shifting. Initially, up to 90% of the confirmed cases were in metropolitan Buenos Aires. Today, 65% of Argentina’s cases are in its provinces and even faraway places like Ushuaia, authorities said.

“Now it is everywhere in the country,” Rubinstein said.

Dr. Carissa F. Etienne, director of the Americas branch of the World Health Organization, warned recently that the coronavirus is appearing in places that were previously not affected, with high numbers popping up in regions like the English-speaking Caribbean.

“In many countries, the pandemic has also moved to less populated areas,” she said.

That can be seen not just in Argentina but in Colombia as well. The city of Manizales in a region known for its coffee farms now registers 440.98 cases per 100,000 residents, far higher than the nationwide average of 284.09 per 100,000, according to the Ministry of Health. Officials say the slower rise in cases allowed them to expand ICU capacity.

“Here we didn’t have a peak like in Europe,” Hernández said. “We had a plateau.”

Throughout the region, testing remains a hurdle. In Peru, officials have relied heavily on antibody tests to identify cases — even though the tests are not designed to make a diagnosis because they can only detect proteins that develop a week or more after infection. Argentina’s testing is still far below that of neighboring countries; on Sunday, just 13,890 were tested, compared to 31,988 the same day in Colombia.

The high percentage coming back positive in Argentina suggests the country is still likely missing vast numbers of infections.

Brazil reached 1 million cases in June and now is up to 5.2 million for the pandemic.

“These are huge undercounts of what is really going on in terms of numbers,” said Felicia Knaul, director of the Institute for Advanced Study of the Americas at the University of Miami. “We need more consistent mask use — but we have to couple that with testing and tracing — or else the numbers are going to rise tremendously.”

In Ushuaia, officials believe truckers carrying in produce from the Buenos AIres region may be responsible for the rise in cases since mid-September. The city famous as a departure point for cruises to the Antarctic had been a model for the nation. Closed off air travel and a halt on tourism left it virus free for months.

But that false sense of comfort may have led people to relax on basic pandemic norms like hand washing and social distancing. The Tierra del Fuego province, which has a population of about 150,000, now has over 8,000 confirmed cases.

In Ushuaia, anxious residents line up in their cars for drive-thru testing. A sports center that had been empty is now set up to take care of patients. One month ago, the regional hospital was treating just seven COVID-19 patients; now it has 28, occupying all of its bed set aside for adults with the illness.

“The failure in Argentina was the low amount of testing,” Guglielmi said.

José Bongiovanni, a lawyer in Ushuaia, said a worry that seemed distant now feels close.

“Living at the end of the world was never easy,” he said. “It’s a lot less easy in a moment like this.”

___

Associated Press journalist Nicolas Deluca reported this story in Ushuaia, AP writer Almudena Calatrava reported from Buenos Aires, and AP writer Christine Armario reported from Bogota, Colombia.

https://apnews.com/article/virus-outbreak-pandemics-health-south-america-argentina-ce8ce2f05963f1be85fc9f009a32a9c0