New Omicron variants

"In recent months, scientists have identified multiple new Omicron subvariants of SARS-CoV-2. First spotted in South Africa and the United States, the subvariants—BA.4, BA.2.12.1, and BA.5—have driven new upticks in cases in both nations. The new versions of Omicron are even better at evading the protection offered by vaccines, a previous infection, or a combination of the two. So far, it’s unclear whether the new subvariants will drive a spike in cases worldwide as their predecessors, the Omicron BA.1 and then BA.2 strains, did this past winter and spring, respectively.

“We’re definitely entering a resurgence in South Africa, and it seems to be driven entirely by BA.4 and BA.5,” Penny Moore, a virologist at the University of the Witwatersrand in Johannesburg, South Africa, tells Science. “We’re seeing crazy numbers of infections. Just within my lab, I have six people off sick.”

Read more: https://www.the-scientist.com/news-opinion/what-you-should-know-about-new-omicron-subvariants-70012?

So let's see what the Biden administration does about this.  More fear and panic.  Forced closures?  Mask mandates.  It's obvious from the number of publicized cases of fully vaxxed plus 2 boosters (like Jen Psaki, Kamala Harris and Bill Gates), that this is highly infections and seems to laugh off the vaccines.

"Nature reports that if SARS-CoV-2 continues along this path, its evolution could resemble that of respiratory illnesses that are seasonal and come in waves. The coronavirus’s pattern of infection may also become more predictable, as new mutations in the virus exploit vulnerabilities in population-wide immunity, driving periodic waves of infection. “It is probably what we should expect to see more and more of in the future,” Moore tells Nature. Scientists may get better at predicting how long immunity to COVID-19 will last and when waves will hit."

The New York Times reports similar fears: “…A virus that shows no signs of disappearing, variants that are adept at dodging the body’s defenses, and waves of infections two, maybe three times a year — this may be the future of Covid-19, some scientists now fear. The central problem is that the coronavirus has become more adept at reinfecting people. Already, those infected with the first Omicron variant are reporting second infections with the newer versions of the variant — BA.2 or BA2.12.1 in the United States, or BA.4 and BA.5 in South Africa. Those people may go on to have third or fourth infections, even within this year, researchers said in interviews. And some small fraction may have symptoms that persist for months or years,

"It seems likely to me that that’s going to sort of be a long-term pattern,” said Juliet Pulliam, an epidemiologist at Stellenbosch University in South Africa. “The virus is going to keep evolving,” she added. “And there are probably going to be a lot of people getting many, many reinfections throughout their lives.”

Hand hygiene is not a no-brainer

“Healthcare workers also need to learn the proper technique for hand hygiene. People are supposed to rub their hands together for a minimum of 15 seconds when washing their hands. When Renee Watson, RNC, BSN, CPHQ, CIC, manager of infection prevention and epidemiology at Children's Healthcare of Atlanta asks physicians and staff to mime rubbing their hands together to wash hands in a training session, however, they usually drop off around seven or eight seconds. Even people who think they wash their hands for the full 15 seconds typically do not meet that minimum in the training exercise, she says. Awareness of both the proper technique and one's execution of this technique is therefore critical to ensuring hand hygiene compliance and preventing infections.

Another important lesson is the difference between soap and water and alcohol sanitizers, according to Ms. Watson. Alcohol hand sanitizers are more effective at eliminating pathogens except when hands are visibly soiled, when the caregiver has blood and body fluids on their hands or when they have worked with specific organisms that require mechanical removal — for which soap and water should be used, she says. “

4 essentials of hand hygiene

TB is making a strong comeback

There is now a TB strain that is totally drug resistant (TDR-TB) to add to the extensively drug resistant (XDR-TB) strain, identified in 2006, and the Multidrug-resistant TV (MDR-TB), which emerged in the early 1990s.  Those in the U.S. and Europe who have any of these difficult to treat strains of the old disease that was once thought conquered, have recently been in South Africa, but it has also emerged in India (2012), Iran (2009) and Italy (2007). 

In the U.S. MDR-TB accounted for 1.3% of the 10,528 cases of TB in 2011, and there were 6 cases of XDR-TB.  One woman who returned to TN from South Africa with XDR-TB had a strain that took 2 years to treat, including 90 days in isolation.  Eventually, she was cured.  Most people in the U.S. who have TB are foreign born, or were born into communities where the foreign born live.  Others at risk are homeless (aka undomiciled in NYC), substance abusers, and people with HIV.

Emerging Infectious Diseases, March 2013

JAMA, March 20, 2013

Traveling? Watch out for "tourista"

In 2008 and 2009 I travelled internationally and developed severe diarrhea and vomiting on the return trips to the United States. As a result of the 2008 trip, I spent a few days in the hospital. So, if you're doing any travel this summer (I'm definitely not), here are a few precautions (all of which I followed) from Harvard Men’s Health Watch, April 2010.

Traveler’s diarrhea, or “tourista,” is a well-known hazard for visitors to developing countries where sanitation is flawed. Here are some tips to prevent intestinal infections:

•Wash your hands with soap and water or an alcohol-based hand gel before you eat.
•Avoid salads, uncooked vegetables, and unpasteurized milk and cheese.
•Only eat fruit that you’ve washed in clean water and peeled yourself.
•Do not eat undercooked or rare food. Eat cooked foods while they
are still piping hot. Be especially wary of food from street vendors.
•Avoid the water unless you have boiled it yourself; chemical disinfectants
and water filters are available for use in special circumstances. Don’t use ice made from untreated water. Don’t use untreated water to brush your teeth. In general, unopened bottled or canned beverages are safe, as is coffee or tea made from boiled water.
•Ask your doctor about taking along antibiotics in case prevention fails.
•Above all, suspect everything.

Back to basics in credit and health

There's a parallel in health care to the economic crisis--and you might die of this problem before your pension recovers because there is little attention to the basics of the spread of infection. When I was hospitalized for 2 days upon our return from Italy in June, I was not impressed by the cleanliness and sanitation of the first class hospital paid for by my first class health insurance (the bills aren't all in yet, but it is over $6,000) through Medicare and State Teachers. On the other hand, the staff was pleasant, attentive and caring, and I'm sure they score A+ on that. That I spread whatever I had around the ER waiting area for 8 hours didn't seem to matter.

Our country seems to be collapsing from the clutter and fall out of "the next best thing." In health care it is antibiotics and endless expensive social studies about gaps based on race, gender, and quality of insurance coverage, and in government it is faulty loan practices by the lenders because of social engineering from Congress also sick with gapitis.

There are well established steps to prevent infections in hospitals. And even today with widespread information available on the growth of super bugs, doctors may ignore them. Even in the 1980s when I worked in the Veternary Medicine Library at Ohio State I was seeing a return to interest in infectious diseases--antibiotics having already run out of miracles. We knew in the 1990s that workers in vet hospitals were transmitting bacteria to their sick charges, or taking things home to their own pets, just because of poor disinfection of rooms, equipment, and (!) artificial fingernails, which are terribly difficult to keep clean.

Laura Landro writes on super bugs in today's Wall St. Journal, and it isn't anything new that will save us--it's a return to basics.

[Peter Pronovost, a professor at Johns Hopkins University School of Medicine] With no new antibiotics immediately on the horizon for either class, preventing infections "comes down to blocking and tackling," Dr. Pronovost says -- quickly diagnosing infections, using appropriate antibiotics and "going back to basics" such as getting health-care workers to wash hands.

In partnership with the Michigan Hospital Association, Dr. Pronovost developed a program to prevent bloodstream infections, which can be caused by both gram-negative and gram-positive bacteria and often strike patients in ICUs with large catheters inserted into their veins. With five practices -- handwashing, draping patients before inserting the lines, cleaning the skin properly, avoiding catheters in the groin and removing them as soon as possible -- the consortium reported that the rate of infections in Michigan ICUs dropped by 66% over an 18-month period. The process saved more than 1,729 lives and $246 million.

Dr. Pronovost says that while the steps are well-established, his research shows doctors skip steps more than a third of the time. Today, the Agency for Healthcare Research and Quality, part of the federal Department of Health and Human Services, plans to announce that it will provide funding to expand Dr. Pronovost's program to 10 other states.

If you borrowed money for a home before the mid-90s, you can probably come up with five basics that the Congress and lending institutions have been igoring for a decade.

1. good job
2. good credit rating
3. no more than 1/3 of monthly income for housing expenses
4. neighborhood with sound housing stock
5. 20% down so buyer would have something invested

Time to clean up the bugs in hospitals and Congress.

Perhaps the dumbest thing in this article by Ms. Landro is the report that HHS plans to expand funding for Pronovost's program to 10 other states. Haven't we known this for a century? More posters reminding doctors to scrub down (up?) at a million dollars a pop?

4238

Can't blame MRSA on illegal immigrants

That's not a rumor you want to start, but I heard Laura Ingraham mention it right after talking about the TB guy who's made a number of flights legally from Mexico into the U.S. A whole alphabet soup of government agencies have dropped the ball on this one, and it's not an illegal immigrant issue.

Neither is MRSA (what I heard: as an aside she asked where these germs were coming from right after talking about the TB infected Mexican . . . like we can't grow our own!). It's a problem which started in the 1970s with hospitals overusing antibiotics, patients having shorter stays, and the staph bug moving on out to the community. In 1998, the CDC reported on the problem with nosocomial infections (infections that originally preyed on the weakest and sickest in hospitals)

By the late 1980s and early 1990s, several different classes of antimicrobial drugs effective against gram-negative bacilli provided a brief respite. During this time, methicillin-resistant S. aureus (MRSA) and vancomycin-resistant enterococci (VRE) emerged, signaling the return of the "blue bugs." In 1990 to 1996, the three most common gram-positive pathogens—S. aureus, coagulase-negative staphylococci, and enterococci—accounted for 34% of nosocomial infections, and the four most common gram-negative pathogens—Escherichia coli, P. aeruginosa, Enterobacter spp., and Klebsiella pneumoniae—accounted for 32%

The most recently updated MRSA page at CDC was done this week--the earlier one was from 2005, but the recent concern apparently caused them to revise it.

Methicillin-resistant Staphylococcus Aureus (MRSA) is a type of staph that is resistant to certain antibiotics. These antibiotics include methicillin and other more common antibiotics such as oxacillin, penicillin and amoxicillin. Staph infections, including MRSA, occur most frequently among persons in hospitals and healthcare facilities (such as nursing homes and dialysis centers) who have weakened immune systems (see healthcare-associated MRSA).

MRSA infections that are acquired by persons who have not been recently (within the past year) hospitalized or had a medical procedure (such as dialysis, surgery, catheters) are known as CA-MRSA infections. Staph or MRSA infections in the community are usually manifested as skin infections, such as pimples and boils, and occur in otherwise healthy people.

The most recent guidelines run to 219 pages, but to sum it up, WASH YOUR HANDS, PEOPLE, and don't let a medical staff person touch you until they do. "Improved hand hygiene practices have been associated with a sustained decrease in the incidence of MRSA and VRE infections primarily in the ICU (p. 49)"

3218 How's your hygiene?

Today Medscape.com and a lot of other sources reported:

Staph Infections Rise Among Athletes

"An alarming rise in cases in the general population and athletic community of methicillin-resistant staphylococcus aureus has led to the Centers for Disease Control and Prevention to issue warnings about the dangers of staph infections. Staph has long been a health hazard for athletes who share towels, whirlpools, and common areas like locker rooms. The CDC is working closely with several sports organizations, including the NFL and NCAA, to educate athletes on hygiene and preventive measures to stop the spread of MRSA that has increasingly found its way into locker rooms, weight rooms, and athletic training facilities."

Guess I'll just keep walking around the condo grounds for exercise.

Here's a link to the CDC page on staph infections and MRSA

Tundra Medicine Dreams has a very interesting MRSA story about an Alaskan Native who used an unsanitary steambath.

3201 Chlorhexidine Gluconate

You've probably heard all the scare stories about the number of people who get sick or die in hospitals--from an unrelated cause. Think NOSOCOMIAL (hospital-acquired)*. The stories, may be hyped a bit, but are most likely true and a quick literature search in Google will bring up articles from the mid-70s. Even architects study the problem. Also veterinary medicine has a big problem. (Which is why I think no health staff should have artificial nails--now there's a good science project for your kid.) But here's some good news.

"A team of Dutch doctors has come up with a cheap, simple, and effective way to reduce nosocomial infection after cardiac surgery using a commonly available disinfectant, chlorhexidine gluconate.

The procedure should be applicable to all forms of major surgery, the lead investigator, Dr Patrique Segers (Academic Medical Center, University of Amsterdam, the Netherlands), told heartwire. Segers and colleagues report their findings in the November 22, 2006 issue" of JAMA. Story from Medscape.com

"Prevention of Nosocomial Infection in Cardiac Surgery by Decontamination of the Nasopharynx and Oropharynx With Chlorhexidine Gluconate: A Randomized Controlled Trial," Patrique Segers; Ron G. H. Speekenbrink; Dirk T. Ubbink; Marc L. van Ogtrop; Bas A. de Mol, JAMA. 2006;296:2460-2466.

*Within hours after admission, a patient's flora begins to acquire characteristics of the surrounding bacterial pool. Most infections that become clinically evident after 48 hours of hospitalization are considered hospital-acquired. Infections that occur after the patient's discharge from the hospital can be considered to have a nosocomial origin if the organisms were acquired during the hospital stay. definition from eMedicine.