[SEATTLE, Wash.] -MTN The poliomyelitis virus has been detected in the wastewater of the international travel hubs of New York, London, and Jerusalem, indicating that the disease is spreading through the community. King County tests wastewater for several diseases but polio, long eradicated in Washington state, isn’t one of them.
“At this time, we are not testing King County wastewater for poliovirus,” Kate Cole, communications representative for Public Health of Seattle and King County, said.
Polio once struck fear into the hearts of parents until the 1950s, when the first polio vaccine brought the disease, which has no cure, into check. Thanks to widespread vaccination campaigns, the disease, which can cause paralysis and death, was declared vanquished from the United States. By 2016, the complete eradication of polio appeared to be within grasp, with cases numbering in the hundreds appearing in two nations – Pakistan and Afghanistan.
The virus spreading in New York and London is a revertant Sabin type 2 virus, which originates from the Sabin orally administrated polio vaccine. The oral polio vaccine was discontinued in the United States in 2000 but is still used in other nations, mainly to contain polio outbreaks. When a person is vaccinated with the oral vaccine, which uses a weakened version of poliomyelitis, they can shed the virus in their feces for up to a month. If an unvaccinated person comes in contact with a contaminated surface, they can become infected. Eventually, if the weakened virus sickens enough people, it can revert to a more virulent version.
On July 21, the New York State Department of Health reported the first case of community transmission of polio in the United States since 1981. The infected Rockland County resident suffered from paralytic polio, which state officials identified as a “revertant polio Sabin type 2 virus.” In a fully vaccinated population with strong herd immunity, the story would have stopped there. But due to declining vaccination rates, it didn’t. In the following weeks, polio was detected in the wastewater of three New York regions, including New York City.
While polio appearing in the wastewater of two of the largest cities in the world and three travel hubs is alarming, most of the infected have no idea they are a carrier. Up to 75% of people who get infected are asymptomatic – they never experience a single symptom. While many will never know they had polio, they are contagious and quietly spread the disease for up to a month.
For those who get sick, symptomatic polio resembles the flu or a mild case of the Omicron variant of COVID-19. Fatigue, body and joint aches, weakness, stomach distress, and fever. That makes it even harder to spot because many physicians haven’t seen a case of polio in their lives, and mild symptoms mirror more common diseases that are active in the community.
In less than 2% of cases, polio crosses from the digestive tract to the nervous system. One out of two hundred who catch polio will develop paralytic polio, which can be fatal. The chances of experiencing paralysis increase the older a person is. Polio thrives in areas with warm water and populations with poor hygiene, especially children.
According to the National Library of Medicine, in 1981, over 90% of Americans were vaccinated for polio, creating so-called herd immunity. Vaccination rates peaked in 2008. The journal Nature published a study in 2019, reporting the rate had dropped to 80%. Preliminary data indicates that vaccine disinformation has dropped the rate even lower. In some conservative and religious counties, the rate is below 70%.
Travelers who took the oral vaccine, or in rarer cases, are infected with a vaccine acquired case of polio unwittingly spread the disease to the unvaccinated. In closed communities, the disease can spread quickly and silently.
Some epidemiologists believe because polio is spreading in New York City, it has likely spread to other major travel hubs in the United States. Americans have taken to the skies in near-record numbers after two years of COVID-related travel declines. Orlando. Atlanta, Houston, Dallas, Chicago, Minneapolis, Denver, Los Angeles, San Francisco, and Seattle could have cases silently spreading without carriers even knowing.
[Albany, N.Y.] – MTN The New York State Department of Health (NYSDOH) and the Rockland County Department of Health reported the first case of community transmission polio since 1979 in the United States, hospitalizing a New York state resident.
The person was identified as a young adult with no travel history outside of the United States and was hospitalized with paralytic polio. The individual has been released from the hospital, but officials did not indicate if they are experiencing long-term complications.
The NYSDOH reported the Centers for Disease Control sequenced the virus infecting the person and identified it as the Sabin type 2 virus. “This is indicative of a transmission chain from an individual who received the oral polio vaccine, which is no longer authorized or administered in the U.S.,” the official stated.
“This suggests that the virus may have originated in a location outside of the U.S. where the oral polio vaccine is administered since…strains cannot emerge from inactivated vaccines.”
Polio still exists in several countries, and the U.S. Department of Defense and the CDC recommend a poliovirus booster for anyone traveling to those regions. Polio is highly contagious, with 98% of cases presenting as asymptomatic.
Most people who become symptomatic get mild flu-like symptoms such as fatigue, fever, headache, stiffness, muscle pain, and vomiting. The poliomyelitis virus thrives in the gut, and it can take 30 days before an infected person become symptomatic. During the incubation period when someone is infected, the carrier is contagious. This creates silent community transmission that can rapidly spread. Transmission through common swimming areas and in warm, damp areas is enhanced. In the 1950s and 1960s, communities would close swimming pools and other common areas and go into lockdown to stop the spread.
In less than 2% of cases, poliomyelitis moves into the nervous system and spine, which can cause extreme weakness and paralysis, occasionally leading to death. Symptoms are worse for people who are older.
In 1953 over 30,000 Americans were hospitalized, and 3,200 died from a surge in polio cases, which led to the development of a vaccine that was hailed a miracle of science in 1955. Polio was declared eradicated in the United States in 1979, and the use of attenuated live virus vaccinations for poliomyelitis ended in 2000.
“Many of you may be too young to remember polio, but when I was growing up, this disease struck fear in families, including my own,” Rockland County Executive Ed Day said. “The fact that it is still around decades after the vaccine was created shows you just how relentless it is. Do the right thing for your child and the greater good of your community and have your child vaccinated now.”
The NYSDOH is coordinating with the Rockland County Department of Health and the New York City Department of Health and Mental Hygiene (NYCDOHMH) to continue the case investigation, proactively respond, and protect communities against the spread through urging vaccination, which this multi-agency, county-led effort will support.
[OLYMPIA, Wash.] – (MTN) Using the Centers for Disease Control and Prevention’s (CDC) updated criteria for measuring the impact of COVID in a region, 15 Washington counties currently have high community levels of COVID-19. In March, the CDC changed the criteria for defining low, medium, and high to a formula that evaluates new cases, new hospital admissions, and the percent of in-patient staffed beds treating COVID-infected patients.
The University of Washington Virology Lab reported on Monday that test positivity was 15.4% from an Independence Day holiday reduced sample set. The rapidly evolving Omicron variant of COVID has eliminated the tidal waves of new cases that came in spikes every four to six months to a steady but controllable flood.
On November 28, 2021, the first Omicron cases were detected in Washington. A series of superspreader events over the weekend of December 4 in southwestern Washington spread new Omicron cases to 14 counties in less than ten days. By mid-January, Washington hospitals were on the precipice of moving to crisis standards of care.
The Omicron BA.2 variant was detected at the end of January and less than two months later had replaced the original Omicron strain accounting for 84% of new cases. However, on June 12, BA.2 was down to 17% of new cases. The BA.2 variant was replaced with the highly transmissible vaccine and prior immunity resistant BA.2.12 strain, which is already being replaced by BA.5.
Omicron BA.5 is a very vaccine and prior infection immunity resistant variant with similar genetic mutations to the Delta strain. The original vaccines remain effective at preventing hospitalization and severe illness but are offering diminished protection from catching COVID. Prior COVID infections, even from Omicron strains, provide little immunity to the new strains, especially BA.5.
Although the number of people infected by COVID is increasing, the number of deaths remains low due to many people’s broad baseline immunity. Researchers are still trying to understand the impact of long-COVID, defined as experiencing COVID systems or COVID-related complications more than 21 days after infection. It is estimated that 20% to 33% of people infected by coronavirus experience long-COVID. Symptoms can range from “COVID toe,” the loss of taste and smell, to debilitating migraines, joint pain, and fatigue.
Fifteen counties in Washington are feeling the sting from high community transmission of coronavirus, new hospital admissions, and the percentage of hospitalized patients with COVID. Asotin, Chelan, Clallam, Columbia, Douglas, Ferry, Grant, Grays Harbor, Lewis, Lincoln, Pacific, Pierce, Spokane, Thurston, and Walla Walla Counties have been advised to take increased protective measures, including wearing masks indoors.
King County didn’t make the list, but 4,900 people are being tested for COVID daily, and 20.2% of those tests return positive. The figure is artificially high compared to last year when home testing wasn’t widely available, and international travel required a negative PCR test. Additionally, many employers require repeated negative PCR tests in some job fields. Today, most PCR tests are only given to people suspected of having symptomatic COVID and to frontline healthcare workers with recent close exposure.
More troublesome is daily new hospital admissions for COVID cases have climbed to 25 a day in King County, a 54% increase from last week. Hospitalizations are a lagging indicator, spiking two to four weeks after a new case surge.
Many area hospitals are once again at or over capacity. A combination of acute staffing shortages, a return to everyday life, increasing accidents and work-related injuries, and hundreds of patients who can’t be released from the hospital because there aren’t enough transitional and long-term care facilities, has created a perfect storm. The bump in new COVID cases is adding to the problem.
COVID transmission remains low in outdoor, open-air settings. A driver of the increasing number of new COVID cases and hospitalizations has been the region’s cool and wet non-existent spring, keeping people indoors and windows closed. Even with the first days of summer here, the high temperature in Seattle struggled to reach 58 degrees on July 3rd.
While BA.5 is on track to become the next dominant strain in Washington, a new strain is already taking over on the other side of the planet. Omicron BA 2.75 was sequenced in India and is rapidly spreading across the region.
[KIRKLAND, Wash.] – (MTN) Washington state has set new records for COVID cases and hospitalizations, straining every aspect of life and leaving many to wonder, what is next?
Malcontent News has been tracking the Omicron wave in South Africa and the United Kingdom and using the data from these nations to build models for Washington. The path the current surge is taking aligns closely with the progression in South Africa.
New Cases
It took 28 days for the first SGTFs to show up in PCR tests in South Africa at a significant number, to the peak in cases. If Washington follows the same path, new cases in the state should peak on Jan. 17. The last update from the Washington State Department of Health (WSDOH) was supportive of an approaching statewide peak. An analysis of new case data indicated that the Olympic Peninsula, Central Puget Sound, the South Sound counties out to the Pacific Coast have already peaked. In Eastern Washington, many areas are still seven to ten days away.
In South Africa and Europe, cases declined rapidly. If Washington follows the same pattern, new daily cases will be 50 percent of peak by Feb. 2, and then drift to a plateau of 30 to 35 percent of the peak. The plateau will hold until Feb. 14, before starting to decline again.
Washington moved to test only symptomatic and close contacts on Jan. 4. Over the weekend Seattle Children’s Hospital reported they were incapable of testing most pediatric cases for COVID at urgent care clinics, reserving the dwindling supply to only the sickest of patients. The University Washington Medicine is struggling to test staff and immediate family, in compliance with the United States Centers for Disease Control CDC) guidelines.
Clark County residents have appealed to the state for additional testing resources and more access to booster shots. Among the eight locations receiving National Guard support by Jan. 24 for additional testing resources, Vancouver, Washington was not among the locations.
The University of Washington Virology lab is struggling to provide test results to Washington, and some Oregon healthcare providers, processing 12,000 to 14,000 a test a day. On Sunday, 31.9 percent were positive, creating some doubt that a peak in cases has arrived.
Hospitalizations
Hospitalizations are a trailing indicator. We predicted on Dec. 26. that Washington hospitals would run out of available resources by Jan 15. Governor Jay Inslee deployed the national guard and suspended all non-emergency surgeries on Jan. 13, to support overwhelmed hospitals.
In South Africa, seven percent of new Omicron cases resulted in hospitalizations. The unvaccinated made up 82 percent of all COVID hospitalizations. That rate was between 22 and 31 percent of the earlier Delta wave. The exact difference is hard to track after South Africa changed its testing criteria on Dec. 24, testing only people who were symptomatic or had close contacts. Adjusting for South Africa’s higher hospitalization rate versus the United States, and accounting for the lower hospitalization rate among Omicron patients, we initially estimated Washington would experience a 1.14 to 1.34 percent hospitalization rate. Currently, it is between 1.8 and 2.4 percent depending on the hospital region.
The single biggest factor that impacts the outcome of a COVID infection is age. In South Africa, only 5.7 percent of the population is over 60, while 34.1% is under 19. Although it is true that only 26% of the population is fully vaccinated, in Gauteng Province, which bore the brunt of the Omicron wave, 44 percent of the population is fully vaccinated.
In Washington, Stevens, Pend Oreille, Skamania, Asotin, Ferry, Whitman, Klickitat, and Columbia Counties have lower vaccination rates. According to the WSDOH on Thursday, 80 percent of all COVID hospitalizations statewide were unvaccinated – which mirrors the data released from South Africa on Sunday.
In South Africa, the surge of new hospitalizations peaked 10 to 14 days after the new cases reached a peak. If Washington follows that path, new hospitalizations will peak at the end of January.
Despite reports that many cases resulted in short hospitalizations, this was among vaccinated individuals. South Africa found that among unvaccinated individuals, the progress of illness was no different than prior strains of COVID.
The number of hospitalized COVID patients peaked in South Africa on Dec. 31 and remained almost unchanged through Jan. 6. Currently hospitalized coronavirus patients in the African nation are still at 83 percent of peak. The decline has been slow.
For Washington hospitals, this will be an insurmountable challenge. Although the governor announced a pause in elective surgeries statewide on Thursday, many hospitals had already voluntarily taken that step to expand resources. MultiCare reported ten days ago they were forced to implement CDC crisis staffing standards, having COVID positive workers who are experiencing mild to moderate symptoms continue to work.
An analysis of available hospital resources indicated that additional emergency staffing and converting PACUs to COVID wards added 60 to 75 acute care and 10 to 15 ICU beds statewide. With over 250 new COVID patient admissions a day, that added capacity was likely wiped out over the weekend.
If Washington follows the same hospitalization trend, by Jan. 26 the worst of the surge will be hitting our facilities. The number of COVID patients will peak on Feb. 4, and hold until Feb. 10. Although a decline will be accelerating by Feb. 20, a load of 83% of the peak would be unsustainable.
On Friday the WSDOH reported there were 2,135 COVID patients in Washington hospitals, an all-time record. Hospitalizations are increasing 50 percent every week. The IHME model projects almost 4,000 hospitalized coronavirus patients on Feb. 4, either in acute care or the ICU. If Washington follows South Africa, the number would reach 5,038 and then sustain at that level for two weeks before dropping to 4,000.
Last Monday patients were being transferred out of King County to Moses Lake, Richland, and Missoula, Montana. King County hospitals, University of Washington Medicine, and Harborview Medical Center are caring for a record number of COVID patients. In Spokane, Providence and MultiCare hospitals can’t take transfers. Doctors reported angry and desperate phone calls from rural hospitals trying to move patients to larger facilities.
MultiCare and Providence hospitals on both sides of the mountains have deployed tents again. In Everett, Providence Hospital was treating patients in the emergency department waiting room and the halls are lined with patients waiting for beds.
Deaths
Looking to South Africa, the number of deaths from Omicron was significantly lower compared to Delta. The age of the population, a 66% vaccination rate for those over 50, a historically lower COVID death rate compared to Europe and North America, and more available resources contributed to the better outcomes. Additionally, it is summer in South Africa.
COVID-related deaths started to increase on Dec. 11. It is unknown if deaths have reached a peak yet, but on Jan. 16, the 7-day moving average was 105 deaths a day. All signs in South Africa indicate the Omicron surge is reaching its finality.
In Washington, the population is older and in poorer health. Vaccination rates are higher, but almost one-third of the entire population is not only unvaccinated but politically indoctrinated into the status being part of their identity. They not only dismiss vaccination but all proven public health measures such as indoor mask wear.
Unlike prior waves in Washington, Omicron overwhelmed the larger and better equipped Puget Sound region facilities first. Idaho is starting to surge with new cases and Oregon is straining under its own tidal wave of cases. COVID patients in Eastern Washington will have fewer options than ever before.
If Washington follows the same as South Africa, COVID-related deaths will start to peak in mid-February.
Services and Infrastructure
It is estimated eight to ten percent of all American workers are sick, caring for a sick family member, or quarantining. The United States was already dealing with a worker shortage in 2021, which has been made worse by Omicron. By early February, up to 25 percent of all Washington workers could be sidelined with COVID.
Some of the impacts have already rippled through the region. Empty store shelves, recently restocked after the mountain passes reopened, will struggle to stay full. Pharmacists are warning people to refill their medications now, unsure of their ability to serve the community and have an adequate supply of pills.
Postal workers are driving routes for 12 to 16 hours to fulfill deliveries, and school districts are looking for parent volunteers or moving to virtual learning. In some cities such as Seattle, students have staged walkouts due to high infection rates. In Lakewood, the Walmart Super Center was forced to close for three days for a deep cleaning after 63 workers became sick with COVID.
The day-to-day impact for everyone will include school and daycare closures, spotty store shelves, delayed deliveries, and businesses forced into short-term closures due to a lack of staff. The economic fallout could last for much longer.
Without a dramatic increase in support, state healthcare workers and Washington residents will face a brutal five to six weeks where only the absolute sickest individuals will be able to get medical services, and basic goods and services will require patience to find.
[OLYMPIA, Wash.] – (MTN) The Washington State Department of Health reported that the rate of new COVID cases exploded to 541.9 per 100,000 residents on Monday. The same report showed that coronavirus-related hospitalizations increased 49 percent in a week, from 736 on Dec. 26 to 1,099 on Jan. 2.
Several factors impacted today’s report, which may not show the true impact of COVID in Washington. Most tests sites were closed on New Year’s Day across the state, and numerous Western Washington test locations were closed on Dec. 30, 31, and Jan. 2 due to weather, power issues at one location, and insufficient staff. The hospitalization data appeared incomplete to the Malcontent News research team and will likely be updated tomorrow with more data.
A staggering 26 counties have extreme transmission, with another eight experiencing high transmission. Pierce County has the highest case rate in Washington, 771.0 per 100,000 people.
In King County, 25 people on average are hospitalized a day with COVID, breaking the previous record set during the Delta wave in September. Through Dec. 30, hospitalizations are up 81 percent, and the new case rate of 685.1 has never been higher.
The IHME forecasts hospitalizations will peak in early February, and COVID-related deaths will peak in March.
It wasn’t all bad news in the report. The number of Washingtonians who have received booster shots increased significantly from last week. There is strong evidence from multiple studies and hospitalization data from Israel, Europe, and the United Kingdom, that a third booster dose provides robust protection from severe COVID.
In welcome news to many parents, the United States Food and Drug Administration (FDA) authorized booster shots for 12 to 15-year-olds today and shortened the waiting period for the age group from six months after the second dose to five.
On Sunday, Dr. Anthony Fauci indicated that the United States Centers for Disease Control (CDC) was reconsidering new isolation and quarantine guidelines based on feedback. The CDC has faced withering criticism from healthcare providers and frontline workers for cutting quarantine time in half and relying on the honor system for those who are infected by asymptomatic.
Although Omicron has become the dominant strain in the United States, data out of Connecticut and Washington indicates it won’t squeeze Delta out. Complicating treatment and mitigation, ten percent of COVID cases continue to be Delta or so-called Delta Plus.
According to the New York Times, the United States recorded 1,003,043 new COVID cases on Monday, shattering all previous records. The 7 day moving average is approaching 500,000 new cases a day, which Malcontent News believes is a red line for United States hospitals.
There are now 102,479 people hospitalized with COVID, an increase of 41% from a week ago. Daily new hospital admissions now exceed all previous waves, except the first one, which peaked on Jan. 9, 2021. The United States will set a new all-time hospitalization record if the rate of increase remains unchanged during the coming week.
Testing resources in the United States are stretched to the breaking point, with laboratories processing a near-record number of tests daily. Monday night, the Georgia Department of Health tweeted they could not provide an updated COVID report because there is so much data.
University of Washington Medicine (UWM) officially takes over testing sites from King County on Tuesday. UWM announced that they would no longer provide prophylaxis COVID testing for work and travel, reserving resources only for people who are symptomatic or had close contact with someone infected with the coronavirus.
Speculation on how severe the Omicron variant is compared to Delta continues to run rampant. Disease acquired immunity, vaccinations, boosters, and demographic differences between nations have made reaching a concrete conclusion difficult. There is growing evidence that for the vaccinated, especially with boosters, the Omicron variant is mild to moderate for most.
For the unvaccinated, the data is less conclusive. In South Africa, hundreds have died in the last two weeks. While hospitalizations appear to have peaked, the number has remained almost unchanged for a week while the number of ICU patients and those requiring ventilators has grown. A study published by the United Kingdom Health Security Agency tracked 815 hospitalized Omicron patients with a median age of 45.5. The report found that 57 people had died in the group – seven percent. The ages of those who died ranged from 41 to 99.
Texas officials report the first Omicron related fatality in the United States
Editor’s Note: As a policy, Malcontent News does not quote or publish data from pre-print studies. The transmission rate of the Omicron SARS-CoV2 variant is so high it is spreading at a rate faster than the scientific review process. For this reason, we are using pre-print studies in our reporting and analysis for the Omicron variant. We will continue to backlink to all quoted sources to support transparency in reporting.
Updated: Story edited to report first Omicron death in the United States
[KIRKLAND, Wash.] – (MTN) Washington state moved back to high transmission risk for COVID as new cases fueled by the Omicron variant grew 32 percent over the weekend. The highly contagious variant was discovered in South Africa, spreading to over 90 countries in six weeks.
The United States was reminded how serious Covid-19 is this evening, with Texas reporting the first Omicron-related death in the nation. Judge Lina Hidalgo of Harris County, Texas, tweeted that a man in his 50s had died of Omicron. He was unvaccinated and had health issues. It is reported he was treated with monoclonal antibodies, which have been rendered ineffective against the Omicron variant.
The U.S. Centers for Disease Control (CDC) reported 73% of new COVID cases across the United States are the Omicron variant, swamping Delta cases. The World Health Organization estimated cases are doubling every 1.5 to three days.
The CDC estimates that Omicron is 90% of new COVID cases in the New York City area, the Southeast, the Ohio River Valley and Great Lakes states, and the Pacific Northwest. Omicron cases have been detected in 48 of 50 states, with Montana, Indiana, and Vermont confirming cases this afternoon.
On December 20, North Dakota, Montana, Indiana, and Vermont reported their first confirmed Omicron cases and Texas reported an Omicron-related death – Oklahoma and South Dakota lag the rest of the country in genomic sequencing of test samples
In Miami, lines of cars waited for hours to get COVID tests. Governor Ron DeSantis had boasted Florida had conquered coronavirus on Oct. 27, using data from the New York Times. On Monday evening, Florida reported more than 7,000 new cases a day, an increase of almost 300% in two weeks – second only to Hawaii.
The Washington State Department of Health (WSDoH) reported a sharp increase in COVID cases. The counties with the highest rates were distributed across Washington from the Olympic Pennisula to the Palouse. Only Wahikakum County reported low community spread on Monday.
Percent of Total Population Fully Vaccinated
Percentage of Vaccinated People with Booster Dose
Total Population in Group
Average 7-Day New Case Rate
70.00% or above
39.15%
2,343,250
170.1
60.00% to 69.99%
35.36%
1,669,300
136.0
50.00% to 59.99%
32.23%
3,339,300
111.6
40.00% to 49.99%
29.41%
268,975
77.6
32.70% to 39.99%
35.38%
151,850
85.5
7 Day New Covid-19 Cases per 100K average by Vaccination Rate for Total Population, Adjusted for Population by County, Booster percentage is based on totally fully vaccinated, not eligible, Average 7-day New Case Rate <25 normal, =>25 to 99.9 moderate, => 100, high transmission
Federal officials believe the actual case count is much higher due to asymptomatic carriers and home testing, which isn’t reported to county and state health departments.
According to the University of Washington Virology Lab, the genomic sequencing of SGTF COVID test samples was 70% positive for Omicron on Dec. 16. Data provided by Pavitra Roychoudhury, MSc, Ph.D., of the University of Washington Virology Division, showed Omicron cases had been lab-confirmed in Benton, Franklin, King, Pierce, Snohomish, Thurston, Walla Walla, Whatcom, and Yakima Counties.
Researchers had looked at test samples as far back as Nov. 7 from Idaho, Oregon, and Washington.
Frustration was building on social media as Western Washington residents tried to find rapid COVID antigen tests, booster shots, and appointments for children 5 to 11 to get vaccinated. People waited for hours in long lines to get lab tested for Covid-19 and worried about travel plans as the time to get test results back grew past 72 hours.
Seattle Mayor Jenny Durkan announced that the Rainier Beach and West Seattle vaccination clinics will remain open for boosters and vaccinations into January 2022. Tests sites across the city run in cooperation with the University of Washington are expanding hours to try and meet growing demand. There are fixed test sites at Aurora, SODO, Rainier Beach, and West Seattle, as well as seven Curative kiosks placed throughout the City. In partnership with the City of Seattle, UW Medicine has also opened a site at City Hall, which is available to the public. Appointments are encouraged at all locations, and sites will be closed on Christmas Day.
Area hospitals are at capacity even though COVID hospitalizations are low
The number of hospitalized COVID patients in Washington has slowly dropped through December. The WSDoH reported there were 640 hospitalized Covid-19 patients on Sunday, and 81 were on ventilators. The numbers are significantly higher than the end of the Fifth Wave in late May, and area hospitals are already filled with non-COVID patients.
Data from the U.S. Health and Human Services (HHS) found regional hospitals have scant resources to manage another surge. Almost half of the regional hospital beds available are at Swedish on Broadway in Seattle and St. Joseph’s Medical Center in Tacoma. The report indicated there were 730 beds available, but that includes resources for pediatric patients and neonatal incubators. Available ICU beds include NICU incubators, PICU beds, and critical care resources for post-surgical, transplant, trauma, and burn patients.
Hospital
City
Acute Care Total
Acute Care Available
ICU Total
ICU Available
Overlake
Bellevue
264
17
34
4
Swedish – Cherry Hill
Seattle
170
2
42
16
Seattle Children’s
Seattle
308
29
96
12
U.W. Medical Center
Seattle
641
58
139
98
Swedish – Broadway
Seattle
568
90
79
55
Harborview
Seattle
400
9
97
10
Virginia Mason
Seattle
238
20
33
13
EvergreenHealth
Kirkland
251
8
37
2
Swedish – Issaquah
Issaquah
100
8
30
26
Valley Medical
Renton
292
36
50
27
St. Anne’s
Burien
161
44
31
23
Swedish – Edmonds
Edmonds
173
14
9
5
Harrison Memorial
Bremerton
281
36
49
6
MultiCare
Auburn
138
31
16
1
St. Francis
Federal Way
155
45
15
1
St. Anthony’s
Gig Harbor
108
0
16
3
Providence
Everett
611
47
77
8
Tacoma General
Tacoma
310
-9
46
2
Mary Bridge Children’s
Tacoma
83
34
11
4
St. Joseph’s
Tacoma
573
234
76
14
Data is through December 9, 2021, as reported to the U.S. Health and Human Services for all hospitals with more than 50 beds and ICU resources within 30 miles of downtown Bellevue – acute care beds include adult, pediatric, and neonatal, ICU beds include NICU, PICU, and specialized critical care units for post-surgical, trauma, and burns
In a worrying sign from New York, officials reported on Monday night that while many people are experiencing breakthrough cases and having mild symptoms, unvaccinated individuals were 11 times more likely to be hospitalized.
More data released on vaccine and monoclonal antibody effectiveness against Omicron
In an announcement early Monday, Moderna said preliminary data from lab testing found that a booster of the currently available vaccine increased antibody levels to an effective level. The drugmaker said its currently FDA-approved 50 microgram booster increased neutralizing antibody levels 37-fold against Omicron and 83-fold with a 100 microgram “full dose” booster.
An independent study released last week that evaluated the effectiveness of the Pfizer, Moderna, and Johnson & Johnson vaccines had similar results. Vaccine effectiveness appears to be significantly impacted by how long ago someone received their final dose or booster. Multiple studies have found the Johnson & Johnson vaccine is significantly less effective.
Results from a study that reviewed the effectiveness of the Moderna, Pfizer, and Johnson & Johnson vaccines after three months, more than six months, with the previous infection, and with a booster. The Johnson & Johnson vaccine was evaluated using a Modern 50 microgram dose as a booster
A study from the U.K. found that relying on immunity from a previous COVID infection was only 19 percent effective against preventing symptomatic reinfection and 20 percent when relying on vaccination without a booster. The same study found that a booster dose increased protection by 50 to 85 percent. Overall the risk for reinfection was 5.4 times greater than Delta. The study done by the Imperial College of London used PCR test data from Nov. 29 to Dec. 11.
In New York, hospitalists at Mount Sinai Hospital were advised to stop administering monoclonal antibodies because they were ineffective against Omicron. The memo reported that most people seeking treatment had breakthrough infections with mild symptoms that didn’t warrant hospitalization.
Washington state is waiting for the first 552 doses of the monoclonal antibody sotrovimab. Granted Emergency Use Authorization (EUA) by the U.S. Food and Drug Administration (FDA) in May, it is the only remaining effective early treatment for Omicron in the United States.
Concern grows as the hopes of Omicron being “only a cold” fade away
South Africa officials reported 105 COVID-related deaths across the nation on Monday. The number of ICU patients has increased 144 percent since Nov. 25. Omicron appears to have peaked in Gauteng Province but continues to spread rapidly across the nation of almost 60 million.
United Kingdom officials reported another five Omicron COVID-related deaths, bringing the total to 12. Hospitalizations of children under 5 increased 39% week over week, and thousands of healthcare workers have been stricken with Covid-19 infections, causing staffing issues.
A study by the University of Texas Austin for the CDC was made public on Dec. 16. It looked at 18 different scenarios for the spread of Omicron. In ten of those scenarios, the healthcare system in the United States is overrun by patients.
President Joe Biden will address the nation on Tuesday to outline the administration’s new steps to aid states and communities while trying to curb the spread of COVID.
Yesterday, former President Donald Trump addressing a crowd of admirers in Dallas told the audience he had received his booster. A smattering of jeers and boos rippled across American Airlines Center.
“Don’t, don’t, don’t, don’t …” he said.
“There’s a very tiny group over there,” the former President added.
[KIRKLAND, Wash.] – (MTN) A record 93,000 new COVID cases were reported in the United Kingdom by the National Health Service just hours after Trevor Bedford, Ph.D., an Associate Professor, Biostatistics, Bioinformatics and Epidemiology Program Vaccine and Infectious Disease Division, at Fred Hutchinson Cancer Research indicated that where London goes, Seattle will follow five days later.
France closed its borders to the UK on Friday evening and on Saturday, London Mayor Sadiq Khan declared a “major incident” as Covid-19 hospital admissions rose 30% in a week. The National Health Service reported seven people have died from the Omicron variant and believe that “hundreds of thousands” of cases are going unreported. Cases are expected to grow at a dizzying rate well into January.
On Friday, Bedford told reporters that 50 percent of new Covid-19 cases in King County, were likely Omicron and doubling every 2.4 days. The next day, Pavitra Roychoudhury, MSc, Ph.D., of the University of Washington Virology Division tweeted that Omicron was 50 percent of all cases in Washington.
In an interview published on Saturday in the New York Intelligencer, Bedford shared his prediction on what is to come. “I can expect caseloads that are huge. I can easily expect a 50 percent attack rate from Omicron. I can easily expect that.”
“Attack rate,” is how much of the population will be infected – and Bedford predicts that half of the United States population will catch the Omicron variant. Because the United States does not take a national approach to genomic sequencing, and not all hospitals test patients for COVID at admission, the number of people already hospitalized is murky. From the earliest reports, the hospitalization rate was between 2% to 5%.
There was little good news to be found over the weekend on the impact the new wave is going to have on the United States. In the Northeast, Mid-Atlantic, and Great Lakes Region hospitals are already at or over capacity and receiving additional aid from FEMA. Many states are struggling with dwindling testing funds and a lack of data because tracking systems were dismantled over the summer.
A cascade of drug makers indicated late in the week that the current version of monoclonal antibodies in distribution aren’t effective against the Omicron variant. Unlike vaccines, which target all antibodies, monoclonal antibodies only target one. The antibody that was “cloned” in the process was effective against previous variants but doesn’t produce a significant immune response with Omicron.
In a series of studies, only Sotrovimab, produced by GlaxoSmithKline, showed promise against the fast-spreading variant. The monoclonal antibody received Emergency Use Authorization ( EUA) from the U.S. Food and Drug Administration (FDA) on May 26. Health and Human Services (HHS) reported they would be distributing 55,000 doses across the United States this week, with Washington receiving 552.
Back in the UK, the National Health Service reported that on any given day, about one percent of the national health force would be absent from work due to illness. In London, the number of workers calling out sick surged 40 percent. In the United States, healthcare workers have been fleeing the profession for years, while nurses have complained about short staffing for over a decade. Area hospitals will be impacted dramatically if Omicron starts to infect their workforces.
HHS reported over 68,000 people were hospitalized with COVID across the United States. Statewide on Friday, only eight percent of acute care and 12 percent of ICU beds were available. In King County many hospitals are already at or above capacity, but not due to COVID patients. A shortage of staffed skilled nursing and rehabilitation beds has left patients ready for discharge nowhere to go.
Over the summer when patient loads were lower, the Delta wave brought Oregon and Washington hospitals to the brink of crisis standards of care while collapsing the healthcare systems in Idaho and Alaska. Hospitalization rates for COVID and non-COVID patients are already much higher as the region prepares to face the biggest challenge yet.
According to HHS, EvergreenHealth Kirkland had 19 acute care beds available while Overlake had 17. Both hospitals were reporting ICUs near capacity with 3 beds at Evergreen and 4 at Overlake.
During the Delta surge, states learned that activating the National Guard for nurses and doctors was a poor option. Trained hospital staff who are “weekend warriors” were frequently already supporting surging hospital admissions. The activation in some cases made staffing situations worse.
King County residents vented their frustration on social media about the inability to get a booster shot, find home COVID antigen tests, and PCR test results being delayed. In other circles, Seahawks fans raged against the scheduling change against the Rams due to coronavirus.
Officials in the UK pleaded with government officials to implement further public health restrictions to stem the tide of new cases, as models indicate that by January, the island nation could see 3,000 to 4,000 new hospitalizations a day. Londoners were already starting to deal with closed shops and restaurants, and delays in services because so many people have been sickened.
It is unlikely any additional restrictions will be implemented across the United States, where COVID has been turned into a political weapon. The U.S. Department of Homeland Security (DHS) indicated in a Nov. 10 memo, “If a new COVID-19 variant emerges and new public health restrictions are imposed as a result, anti-government violent extremists could potentially use the new restrictions as a rationale to target government or public health officials or facilities.“
Numerous studies and growing real-world data from Africa and Europe indicate that immunity from prior COVID infections or vaccination without a booster provides enough protection to prevent severe COVID symptoms that result in hospitalization and death. Booster shots ideally received within the previous 12 weeks, boost immunity for more.
For people relying on viral vector vaccines such as Johnson & Johnson, AstraZeneca, or Russia’s GNCEM, there appears to be even less protection without a booster. On Thursday, The Centers for Disease Control (CDC) endorsed the recommendation from the Advisory Committee on Immunization Practices (ACIP) to recommend the mRNA Pfizer and Moderna vaccines over Johnson and Johnson. The decision was made due to the waning effectiveness of the J&J vax and nine confirmed fatalities, seven women including one from Seattle, and two men, from vaccine-induced immune thrombotic thrombocytopenia (VITT).
A study published on Dec. 14 found that Moderna with a booster provided the best protection from Omicron, followed by Pfizer with a booster, and then Johnson & Johnson with a Moderna booster. The study also evaluated individuals who had a previous COVID infection and then got vaccinated. They found that immunity was better than vaccination without a booster, but not as robust.
Real-world data from Europe and Africa indicate that relying on immunity from a previous COVID infection is offering little protection from becoming symptomatic. Epidemiologists have stated it is possible to be infected with the Delta and Omicron variants at the same time. It also appears that natural immunity from Omicron won’t protect a person from a later Delta infection.
“The study finds no evidence of Omicron having lower severity than Delta, judged by either the proportion of people testing positive who report symptoms or by the proportion of cases seeking hospital care after infection. However, hospitalisation data remains very limited at this time.”
The challenge for the public and health experts is comparing the current global wave to previous spikes in COVID cases. During the original wave in the spring of 2020, no one had any type of immunity. When the Alpha and Beta waves came in the winter of 2020, vaccines were just rolling out. When Delta arrived the variant was more transmissible and more severe than prior strains. It also was capable of nibbling around the edges of vaccine protection due to its mutations.
Omicron has arrived in a population that has received a variety of mRNA and viral-vector vaccines with different doses as well as disease acquired immunity from different strains. The timing of receiving a vaccine, prior infection, or a combination also impacts how much immunity a person has.
Many people are more mobile and have returned to work and school while simultaneously taking fewer precautions. An additional challenge is the rate of vaccination is not homogenous, with highly vaccinated communities adjacent to vaccine-resistant populations.
All of these factors are obscuring the true nature of Omicron and because the United States does a poor job of genomic sequencing in some states, little is known about the current hospitalized population and which variant patients have.
Although data out of South Africa has been more encouraging, experts had warned that the recent end of the Delta wave, a higher than understood vaccination rate, and the youthful nature of the South Africa population would favor better outcomes. Although only 26% of South Africa’s total population is vaccinated, over 34% of the county was ineligible due to age. On Oct. 20, the nation expanded vaccination to 12 to 17-year-olds and introduced booster shots to adults on Dec. 9. In reality, 44% of South African adults are fully vaccinated, including 61 percent of people over 50. Additionally, only 5.7% of South African residents are 60 or older.
Researchers are watching King County closely for several reasons. The region is a leader in genomic sequencing and research. As Omicron moves through the region it will provide critical data to build a better understanding of transmissibility, the impact on public health measures, prevention and treatment, and how severe Omicron is. King County is highly vaccinated, but has pockets of low vaccine acceptance, providing a more realistic cross-section. Finally, New York City is almost unique compared to other US cities due to its size, reliance on public transit, and the number of people who live in buildings with communal areas.
Dr. Cameron Webb, the senior policy advisor for equity for the White House COVID Response Team shared early symptoms to look for if you start feeling ill.
Sore throat, espeically if it is more than mild
Headache
Fatigue – severe fatigue appears more common in children
Runny nose
Sneezing
Dry cough
County health officials continue to appeal for people to get vaccinated and get a booster shot if they are eligible. They recommend frequent hand washing and wearing an N-95, KN-94, or KN95 mask whenever you’re out of your home, and to stop using cloth masks. When it comes to Christmas and New Year’s celebrations and travel plans, it is recommended to test the day off and celebrate outside or in well-ventilated indoor areas.
Because of the systems put in place by King County Public Health and supported by County Executive Dow Constantine, the region is better prepared to provide vital data to the rest of the nation. It is very likely that by Christmas, Seattle will feel a lot more like March 2020 than December 2021.
Editor’s Note: As a policy, Malcontent News does not quote or publish data from pre-print studies. The transmission rate of the Omicron SARS-CoV2 variant is so high it is spreading at a rate faster than the scientific review process. It is for this reason, we are using pre-print studies in our reporting and analysis for the Omicron variant. We will continue to backlink to all quoted sources to support transparency in reporting.
[SEATTLE, Wash.] – (MTN) Pavitra Roychoudhury, MSc, Ph.D., of the University of Washington Virology Division, reported 13% of tests samples submitted for genomic sequencing on Dec. 8 were positive for the Omicron variant. Tentative confirmation was made using an S Gene Target Failure (SGTF) test, with Dr. Roychoudhury indicating in a tweet that it will take a few days for genomic sequencing confirmation.
Using the data provided by the University of Washington, Omicron variant cases in Washington doubled every 24 hours from Dec. 6 to Dec. 8. The total number of new COVID cases being detected indicates that the Omicron variant is rapidly replacing Delta, not adding to confirmed cases at this time.
At @UWVirology, we continue to screen positive specimens using SGTF. Confirmation by sequencing usually lags by a few days, but we expect the majority of these SGTFs to be Omicron. If so, definitely seeing a rapid rise similar to reports from South Africa, UK, Denmark, etc. https://t.co/Qb1LrEdT6tpic.twitter.com/1d7Rheqoe6
If the rate of new case growth for Omicron continues at the current rate in Washington, it would be the fastest case growth rate observed to date. In South Africa and across the United States, Omicron cases have been doubling every three days. In the United Kingdom, cases have been doubling every two-and-a-half days and in Denmark, every two days.
Lancet Labs in South Africa started seeing an alarming number of PCR tests from the Gauteng Province missing the target S gene in mid-November. Lancet shared the findings with the Network for Genomics Surveillance in South Africa (NGS-SA), which called an urgent meeting on 23 November. “We were shocked by the number of mutations,” says Tulio de Oliveira in a report in Science, a virologist at the University of KwaZulu-Natal and NGS-SA’s principal investigator.
On Nov. 24, Dr. Alex Sigal of the Africa Health Institute received three test swabs with the Omicron variant and started growing the virus to test it against sera from vaccinated and recovered individuals.
On the same day, Lancet sequenced another 100 samples with the missing S gene, and all were positive for the newly discovered variant. The South Africa Department of Health sent their findings to the World Health Organization (WHO) on Nov. 24, and Omicron was labeled a Variant of Concern (VOC) on Nov. 26.
Nevada became the most recent state to report an Omicron variant COVID case on December 14
Preliminary data has emerged over the last week on transmissibility, treatment efficacy, and vaccine effectiveness for Omicron.
A study out of South Africa published on Dec. 2, found that Omicron was 2.5 to 3.5 times more transmissible than Delta. The study, which has not been peer-reviewed, indicated the Rt, a measure of how quickly a communicable disease can spread, is between R12 and R17, which is comparative to measles. On Dec. 8, Hiroshi Nishiura, professor at Kyoto University released a study that found Omicron is 4.2 times more transmissible than Delta with an Rt of R20. If additional research were to find this true, the Omicron COVID variant would be the most transmissible disease observed in the modern medicine era.
Eleven studies and reports, none of which have been peer-reviewed, have been published on vaccine effectiveness in the last 10 days. Studies have evaluated the Pfizer, Moderna, Johnson and Johnson, and AstraZeneca vaccines.
Studies that reviewed the effectiveness of the Pfizer vaccine found that the effectiveness of preventing symptomatic illness dropped from 80% to zero to 35%, depending on the study. Very limited real-world data out of South Africa from Discovery Health released today showed that the Pfizer vaccine was only 33% effective at preventing infection.
The same study found that the Pfizer vaccine was 70% effective at preventing “severe complications of Covid-19,” down from 93% with the Delta variant.
Dr. Peter English, Retired Consultant in Communicable Disease Control, Former Editor of Vaccines in Practice, past Chair of the BMA Public Health Medicine Committee had this to say about the findings.
“Two doses of vaccine are 70% effective at preventing hospitalization. They are not ineffective, but they are much less effective than the 90-95% protection that two doses provided against hospitalization. With a highly infectious variant, this still risks a catastrophic number of hospitalizations.”
Researchers evaluated the sera from 239 vaccinated healthcare workers in the Boston area. The study found that for the Moderna and Pfizer vaccine, more than 50% of individuals had no neutralizing antibodies three months after vaccination. The Moderna vaccine showed a 43-fold decrease in antibodies while the Pfizer vaccine had a 122-fold decrease. The Johnson and Johnson vaccine performed better against the Omicron variant versus Delta but had significantly reduced effectiveness versus the original COVID strain.
For individuals who had a prior Covid-19 infection and then got vaccinated more than six months ago, the Moderna vaccine had a 9-fold decrease in neutralizing antibodies, the Pfizer vaccine had a 12-fold decrease, and the Johnson & Johnson vaccine had a 17-fold decrease.
The study also found an mRNA booster within the last three months provided a significant increase in neutralizing antibodies but did not provide the same level of protection versus the Delta variant. The samples from the Johnson and Johnson test subjects were all boosted with a half-dose of the Moderna vaccine.
Two studies on disease acquired immunity found that protection declined significantly compared to previous variants. A study published on Dec. 2 out of South Africa, which has not been peer-reviewed, found that protection against Omicron dropped 240% for individuals who were previously infected by the original strain, Beta, or Delta, and had never been vaccinated. Another study released on Dec. 9 reached a similar conclusion, and in an alarming find, reported up to 40% of individuals who had a previous Delta infection were experiencing reinfection with Omicron. The Delta wave ended on Sep. 19 in South Africa, suggesting it took less than three months for protection to wane.
Scientists, public health officials, and policymakers have been attempting to determine if Omicron is less severe than the Delta variant. The study released from Discovery Health today reported that Omicron was 29% less severe than the original COVID strain.
“Without seeing a preprint or the report on which this press release is based it is difficult to get a clear understanding of the validity of these conclusions,” said Prof. Paul Hunter, Professor in Medicine at the University of East Anglia and a member of the National Institute of Health Research in the U.K. “If these are valid conclusions then there are both reassuring and worrying findings. The report that reinfections are more common with Omicron has already been published and the evidence is strong that Omicron can increase the risk of infection in people who have already had a COVID infection.”
Other experts warned against reading too much into the Discovery Health report.
Dr. Simon Clarke, Associate Professor in Cellular Microbiology, University of Reading, said, “This press release outlines preliminary observations of Covid-19 in South Africa during the first three weeks of the wave of infections caused by the Omicron. It shouldn’t be forgotten that in the UK, during the initial epidemic there was a 5-week gap between the first diagnosis and the first death. A situation report taken in those first few weeks would not have given us an accurate picture of what was about to happen, so we shouldn’t expect these preliminary indications to be a portent of how the Omicron epidemic will play out here.”
The Centers for Disease Control (CDC) provided detailed information on Dec. 10 about the first 43 Omicron variant cases detected in the United States. The report found that one person required hospitalization and was released after two days. Almost 60% were 39 years old or younger and 33% had recently traveled internationally. Forty of the 43 cases were vaccinated or had a previous COVID infection. Among the 34 who were vaccinated, 14 had received a booster.
Officials believe the high infection rate for vaccinated individuals has created a data fallacy. International travelers are more likely to be vaccinated, younger, and healthier and many were not eligible for a booster.
The Washington State Department of Health (WSDoH) reported 75.3% of all Washingtonians 12 and older are fully vaccinated and almost one in four children five to eleven have received their first dose of the Pfizer COVID vaccine. An estimated 3.5 million residents are eligible for boosters, but only 1.35 million have received one to date.
WSDoH reported the 7 day moving average for new cases is 1,333, and the statewide 7 day moving average new case rate is 83.5 per 100K residents – moderate transmission. The state has been averaging 650 to 700 hospitalized COVID patients a day, with roughly 100 requiring ventilators.
Statewide new admissions for COVID-related illness started increasing on Nov. 27, and through Dec 7. was averaging 92 new admissions a day. On Tuesday there were approximately 642 available staffed acute care and 144 staffed ICU beds throughout Washington.
Knowledge is the best tool to fight against fear. A wise person chooses to be informed so they can make sound decisions. To join the fight against COVID misinformation, you can share this update through your social media platform of choice.
[KING COUNTY, Wash.] – (MTN) Officials in five states have reported Omicron cases from Hawaii to New York, as the world races to better understand the danger the new variant presents.
In Washington, the first set of local COVID data was made available in a week, indicating that hospitalizations are plateaued again and new cases are down. Twenty-six counties no longer have high rates of transmission. There was an increase in new cases among 20 to 49-year-olds compared to last week.
Governor Jay Inslee reported that FEMA was sending two mobile vaccination clinics to King County, with the first one opening on December 20 in Federal Way.
One-third of the 3.3 million booster eligible residents of Washington have leveled up, while in some areas people are searching for appointments to get a third dose.
Almost 75% of residents age 12 and over are now fully vaccinated, and 17% of all Washington children ages 5 to 11 have received at least one dose of the Pfizer vaccine.
Locally, new COVID cases in the Bellevue, Lake Washington, and Northshore School Districts were down from last week. Vaccination rates for children 5 to 11 that live in the three districts are remarkable with some zip codes reporting almost 60% of all kids already receiving their first dose.
In national news, the United States has confirmed ten Omicron variant cases in California, Colorado, Hawaii, Minnesota, and New York. The infections in Hawaii, Minnesota, and several in New York were caused by community transmission.
President Joe Biden announced new programs to try and combat the spread of COVID in the United States, but Republicans in the Senate threatened to have the United States default on the national debt if he implemented meaningful strict measures.
In South Africa officials are becoming increasingly alarmed as new cases and hospitalizations increase exponentially. The Gauteng Province, home to 15.7 million is the hardest hit, but cases were increasing across the nation. Officials there reported COVID hospitalizations increased more than 23% overnight, and ICU admissions jumped almost 40%.
A study published tonight from South Africa reported that people relying on natural immunity had a 240% higher chance of reinfection with the Omicron variant, compared to the Beta or Delta variants.
In disinformation, we explore the claim that the Omicron variant is no worse than a cold or flu.
No promotional consideration has been given, or requested from the n95 project or any manufacturer of masks
Washington State Update for December 2, 2021
Washington state Covid-19 update
After a six-day break from updated and accurate data from the Washington State Department of Health, we’re back. A week ago the question was how much would Thanksgiving travel impact new case rates. The Omicron variant has changed the plot.
Vaccination data for the state was updated. A couple of counties had numbers drop from last week. This has happened before as data gets validated but this update dropped Grant County below 50% – so the brackets changed.
Skagit and Whatcom Counties new cases rates are down about 40% from three weeks ago. The surge of cases among mostly unvaccinated residents is winding down. New
New cases have decreased a smidge compared to last week but do not reveal any significant trends.
Percent of Total Population Fully Vaccinated
Total Population in Group
Average 14-Day New Case Rate
70.00% or above (3 counties)
2,343,250
127.7
60.00% to 69.99% (5 counties)
1,374,000
261.0
50.00% to 59.99% (15 counties)
3,420,400
227.8
40.00% to 49.99% (9 counties)
487,375
234.7
32.30% to 39.99% (6 counties)
151,850
176.7
14-Day New Covid-19 Cases per 100K average by Vaccination Rate for Total Population, Adjusted for Population by County
Through December 2, Washington’s statewide 14-day rolling average is 203.2 Covid-19 cases per 100K, and the 7 day rolling average is 82.7.
No counties have a case rate over 400.0. per 100,000 residents. Twenty-six counties representing 5.65 million Washingtonians have a 7 day moving average case rate under 100.
New cases by age declined for every age group except 20 to 49-year-olds, which increased. Hospitalizations for ages 20 to 34 also increased.
Age Group
7-Day Case Rate
7-Day Hospitalization Rate
Ages 0-11
91.5
0.1
Ages 12-19
83.3
0.5
Ages 20-34
100.1
9.1
Ages 35-49
100.1 (not a typo)
5.5
Ages 50-64
73.8
8.8
Ages 65-79
44.1
10.2
Ages 80+
40.6
17.0
7-day case rate and 7-day hospitalization rate is per 100K within the age group – the target for 7-day case rate is <25.0, but there are other factors such as vaccination rates within the age groups, how many total tests within the 7-day period, and the positivity rate within each age group
The USA Today COVID Tracker has not been updated since November 30 but reports 9,303 Washingtonians have died from Covid-19 related illness.
FEMA sending mobile vaccination clinics to Washington
Governor Jay Inslee announced that FEMA would be sending two mobile vaccination clinics to Washington. The first site will open on December 20 in Federal Way and is slated to operate for a month. A second location is planned but a date and location were not announced.
“This is great news in the ongoing fight against COVID. I am grateful for our strong partnership with the federal government, and these FEMA Family Mobilization Clinics coming to King County is a great result of that partnership,” said Inslee. “This is an innovative model that will help increase equitable access to vaccination for all Washingtonians.”
A constellation of partners is working with FEMA including the Washington State Department of Health, the King County Executive’s Office, and Seattle & King County Public Health.
Some people in Western Washington have reported problems in securing vaccination appointments for boosters due to high demand.
One-third of booster eligible Washingtonians have leveled up
The Washington State Department of Health reported 1.08 million of the 3.3 million eligible for boosters have rolled up their sleeves. There is significant evidence that vaccine and disease acquired immunity declines after five to seven months, but a number of factors such as age and other health issues can affect the duration.
There is some evidence within the genetic sequencing of the Omicron variant that disease-acquired immunity from previous mutations won’t be as strong as vaccine-based immunity.
Over 17% of Washington kids age 5 to 11 have received their first dose of the COVID vax
The Washington State Department of Health reported 116,121 children from 5 to 11 have received their first dose of the Pfizer COVID vaccine, about 17% of all eligible kids in Washington.
The Pfizer vaccine Emergency Use Authorization (EUA) was amended to include 5 to 11-year-olds. They receive two smaller doses and reach fully vaccinated after five weeks. Initial data indicates that due to the stronger immune response of children and adolescents, a booster or third dose is not needed. That could change with time or if another variant emerges that is vaccine-resistant.
Washington state approaching 75% of population 12 and older fully vaccinated
The Washington State Department of Health reported 80.8% of all Washingtonians 12 and older have received at least one dose of the COVID vaccine and 74.6% are fully vaccinated.
Although this is good news, Washington is starting to fall behind other states. The Mayo Clinic reported that Washington was in 10th place for 12 to 17-year-olds fully vaccinated, 9th place for 18 to 64-year-olds, and tied with 32 other states for first place for 65 and older.
Travel Advisories
Due to the confirmation of community transmission of the Omicron variant in the United States, we are advising our readers to reconsider air travel and recreational travel plans. Especially if those plans include going to places with large crowds or major events at enclosed buildings.
Thank you
Thank you to our new subscribers and those of you who have made one-time contributions. On behalf of the entire team, thank you for helping us keep the lights on!
King County, Washington is reporting over 85.0% of age eligible residents are vaccinated with at least one dose. The highest rates of positivity are in areas with low vaccination rates statewide. The FDA has provided full approval of the Pfizer vaccine for anyone 16 and over and EUA approval for the Moderna and Johnson & Johnson vaccines. The Pfizer vaccine has EUA approval for children 5 to 15 years old.
COVID vaccines and boosters are free for anyone 5 and older. Lyft and Hopelink provide free transportation, and KinderCare, the Learning Care Group, and the YMCA offer free childcare during vaccination appointments or recuperation.
It has been a week since the last report and hospital status has improved significantly while the number of COVID patients receiving care remains elevated. The Washington State Department of Health reported 89.4% of staffed acute care beds were occupied with 10.2% of patients infected with Covid-19. There are 706 COVID patients statewide with an estimated 212 in the ICU – 114 requiring ventilators.
Statewide, there are an estimated 753 acute care and 151ICU beds available.
On Wednesday, the 7 day rolling average hospital admission rate for new COVID patients was statistically the same as last week – 65.
Hospital status by region – ICU Occupancy should be below 80%, ICU COVID Patients should be below 20%, Acute Care Occupancy should be below 80%, and Acute Care COVID Patients should be below 10%
– Blackwell (1*/4) – Dickinson/Explorer (2*/7) – Eastlake High (1*/3) – Ella Baker (1*/0) – Evergreen Middle School (1*/0) – Finn Hill Middle School (2*/18) – Inglewood Middle School (1*/0) – Juanita High (2*/39) – Kamiakin Middle School (2*/12) – Keller (2*/7) – Kirkland Middle School (1*/8) – Lakeview Elementary (2*/2) – Lake Washington High School (1*/7) – Mead (2*/7) – Northstar Middle School (12) – Redmond High School (1*/10) – Redmond Middle School (1*/19) – Rush (2*/8) – Thoreau (2*/6)
None
Northshore
YELLOW
– Bothell High School (3*/12) – Canyon Creek Elementary (5**/11) – Canyon Park Middle School (1*/4) – Crystal Springs Elementary (1*/17) – Fernwood Elementary (1*/0) – Frank Love Elementary (1*/10) – Kenmore Elementary (1*/6) – Kenmore Middle School (4*/32) – Kokanee Elementary (0/1) – Leota Middle School (1*/2) – Maywood Hills Elementary (3*/4) – Moorlands Elementary (1*/2) – Northshore Middle School (1*/13) – Ruby Bridges Elementary (0/1) – Shelton View Elementary (0/2) – Skyview Middle School (1*/4) – Sunrise Elementary (2*/2) – Timbercrest Middle School (2*/0) – Wellington Elementary (1*/1) – Woodin Elementary (0/2) Woodmore Elementary (0/4)
None
Local Districts Scorecard – * indicates positive cases only ** indicates 5 or more confirmed positive cases – (x*/y) x is positive cases and 7 quarantined, quarantined does not include positive cases
We redefined the school district statuses. Information for classroom and building closures has been a challenge to obtain, both for closures and reopening. We are adopting moving any school with more than ten active COVID cases reported into the red, and we’ve adjusted the third column to reflect this change.
Based on reader feedback, and improvement in the data we are receiving, we have adjusted how we are reporting data. The Lake Washington and Northshore School Districts are now reported as (X*/Y) or (X**/Y). X represents the number of positive cases while Y represents how many are in quarantine. The number in quarantine does not include positive cases. If there are two asterisks, that indicates five or more confirmed cases within the last 14 days at that school.
Confirmed COVID cases were down in the three school districts we track. The Bellevue School District did not have updated data for quarantined students today.
The Lake Washington School District updates data once a week, and we’ve had no parent confirmed reports on new COVID cases this week.
We continued to encourage parents to request daily updates from the Lake Washington School District. This change would bring the three school districts we track into alignment.
Bellevue-Bothell-Kirkland-Woodinville local COVID news
King County Public Health updated the vaccination rates by zip code and now reports the data from ages 5 and up. Vaccination rates for children between 5 to 11 remain remarkable for the region.
Percentage of King County Residents 5 and older who have received at least one dose of COVID vaccine, December 2, 2021
Zip Code
Percent vaccinated, at least one dose, 5 to 11 years old
Percent vaccinated, at least one dose, 5 and older
98155
46.8%
92.5%
98028
42.7%
88.5%
98011
37.2%
85.2%
98034
38.8%
84.3%
98033
59.5%
93.5%
98072
39.2%
88.2%
98077
35.7%
80.2%
98052
55.0%
94.6%
98004
51.3%
>95.0%
98039
44.6%
90.7%
98005
53.4%
94.8%
98007
32.3%
88.0%
98008
44.5%
91.2%
98053
46.0%
92.9%
98074
50.5%
>95.0%
98075
43.0%
>95.0%
Vaccination rates with at least one dose
National Round-Up
Johns Hopkins University Cumulative Case Tracker reports 137,602 new cases and 1,960 deaths nationwide on Thursday. New cases continue to grow at a significant rate in the United States. There is no way to know if Omicron is driving the increase, but current data indicates that over 99% of new cases are Delta or one of its sublineages.
At least 10 Omicron COVID variant cases confirmed in the United States
Health officials in California, Colorado, Hawaii, Minnesota, and New York confirmed at least one case of the Omicron variant in their states.
Yesterday, the Centers for Disease Control confirmed the first Omicron variant case in the United States. The travel-related case was an 18 to 49-year-old male tested in the San Francisco area. They were fully vaccinated with an mRNA vaccine but not eligible for a booster because six months hadn’t passed since their second shot. They returned from South Africa on November 22 and tested on November 29. They have mild symptoms and are quarantined at home.
Late tonight, California officials reported a second travel-related case in Los Angeles county. That person traveled from South Africa to Los Angeles via London and returned on November 22. They are fully vaccinated but did not receive a booster. They are experiencing mild symptoms and are quarantined at home. Health officials reported they have already contacted and tested all close contacts, and didn’t find any new cases.
This morning Minnesota officials reported a community transmission case. The person identified as male, traveled to New York City to attend an anime convention at the Javits Center from November 19 to 21. The event had 53,000 attendees. They were fully vaccinated with an mRNA vaccine and had received a booster in early November.
Around lunchtime, Colorado officials reported a travel-related case. The woman was fully vaccinated but had not received a booster. She told authorities she had worn a mask during all her travels and developed symptoms after returning home from southern Africa last week. She has mild symptoms and is quarantined at home.
In the late afternoon, New York Governor Kathy Hochul reported five cases in the metro New York City area. There wasn’t little information available on each case, which is a combination of community transmission and travel-related. Two were in Queens, two in Brooklyn, one in Suffolk County, and one was not identified. The condition and vaccination status weren’t readily available.
Close to press time, officials in Hawaii reported their first case of an unvaccinated individual. The person had not traveled so officials believe it was caused by community transmission. The person is unvaccinated and was previously infected with COVID. They were tested on November 29, and currently are experiencing moderate symptoms. The press release from the State of Hawaii Department of Health did not indicate if they were hospitalized.
President Joe Biden announces winter battle plan to fight COVID
Under the threat of letting the United States default on its national debt, President Joe Biden conceded he would not push further vaccine mandates and announced other measures to combat COVID and the Omicron variant.
Requiring travelers entering the country by air to test negative for Covid-19 within a day of departure, regardless of vaccination status or nationality
Extending the requirement that masks be worn on airplanes, trains and public transportation to March 18
Requiring private health insurance companies to cover 100% of the cost of at-home tests for COVID
Public education to encourage 100 million eligible adults to get boosters shots
Editor’s Note: Consider us very underwhelmed.
Global update
New Omicron variant cases and hospitalizations skyrocket in South Africa
The number of new COVID cases and hospitalizations in South Africa is increasing at an alarming rate, with officials concerned that a record peak in infections is only 14 to 21 days away.
The South Africa Department of Health (SADOH) reported 74% of all detected COVID cases in November and 90% of new cases in the last week of the month were the Omicron variant. New cases have increased exponentially since November 24, the same day South African officials alerted the World Health Organization of the new variant.
Officials haven’t provided specifics on how much more transmissible Omicron is to previous variants, only saying that is higher.
New COVID cases in South Africa November 11 to December 2, 2021
SADOH reported 11,535 new cases today, an increase of 468% from a week ago. The 7 day rolling average for new cases jumped to 5,093. South Africa is testing about 52,000 people a day as the positivity rate increase at a significant rate. Officials reported 22.4% of the tests performed on Wednesday as positive for COVID infection.
In Gauteng Province, home to 15.7 million people, the number of hospitalized patients increased 23.4% overnight, jumping from 1,035 to 1,351 total patients. ICU patients increased by 38.5% while people needing oxygen held steady at 15% and ventilator use increased from 27 to 30.
Study from South Africa indicates COVID reinfection risk is very high
Researchers look at data from 2.8 million individuals who had lab-confirmed COVID positive tests at least 90 days before November 27, 2021. Among that group, they identified 35,670 lab-confirmed reinfections. The study found that reinfection with the Beta or Delta variant was infrequent, with disease acquired immunity providing protection. The research did not take the severity of illness into consideration for the initial or subsequent infections.
Reinfection rates from November 1 to November 27 increased by 240%, indicating that natural immunity may not provide much benefit. The results of the study could have implications on the effectiveness of monoclonal antibodies, but more data is required.
The study was done by a number of respected individuals but has not been peer-reviewed.
Disinformation
Although some officials have stated that Omicron cases appear to be mild, disinformation campaigns have latched on to these statements and are claiming an infection is no worse than a cold or flu.
On November 26 and again on November 28, Dr. Angleique Coetzee said that the infections she saw in her private practice were ‘very mild.’ On November 28 she expanded her statement to say that the observation was ‘not anecdotally’ and other clinicians were echoing her findings. She also stated that hospitalizations were not increasing. Her comments were addressed in a World Health Organization Omicron update on the same day.
“There is currently no information to suggest that symptoms associated with Omicron are different from those from other variants. Initial reported infections were among university students—younger individuals who tend to have more mild disease—but understanding the level of severity of the Omicron variant will take days to several weeks.”
We do not believe that Dr. Coetzee is actively spreading disinformation and is speaking from her direct experience as a clinician. We also believe that people are misunderstanding what a ‘mild’ case of COVID means. A mild case is a case that doesn’t require clinical intervention or hospitalizations. With Covid-19 that’s more than a cold or the flu.
Dr. Rudo Mathivha is the head of critical care at Baragwanath Hospital in Soweto, a level 1 trauma center and the largest hospital in the Southern Hemisphere with 3,400 beds. Dr. Mathivha did a series of interviews in South Africa yesterday and reported she was seeing an increase in hospital admissions in children under 5 years old accompanied by a dramatic increase in patients needing high care and admission to the ICU.
“The number of ill patients presenting to hospitals has increased exponentially,” she said.
“We are seeing definitely a change in the demographic profile of patients. We are seeing toddlers under five presenting with symptoms and they are sick enough to require admission and to require supplemental oxygen.”
Researchers don’t know how severe Omicron infections will be at this time, and anyone making claims on the severity, either way, is not presenting informed information. Anyone claiming that Omicron is just a cold is spreading disinformation.
Knowledge is the best tool to fight against fear. A wise person chooses to be informed so they can make sound decisions. To join the fight against COVID misinformation, you can share this update through your social media platform of choice.
[KIRKLAND, Wash.] – (MTN) Health officials and researchers are in a race against time to unlock the secrets of the Omicron COVID variant and its potential impact on public health as more nations report discovered cases.
Washington state is one of the leaders in genomic sequencing of COVID tests samples in the United States, led by the University of Washington Medicine. Standard PCR tests can detect a marker for a potential Omicron variant. Omicron shares a mutation with the Alpha variant that the current PCR tests look for, enabling researchers to see if a specific spike protein has a deletion. That would become a probable case that would be tagged for confirmational sequencing.
President Joe Biden addressed the nation on Monday saying, “there are three messages about the new variant that I want the American people to hear. First, this variant is a cause for concern, not a cause for panic.”
The President went on to praise South African officials and their scientific community for, “the kind of transparency that should be encouraged and applauded.”
Currently, in Washington, 99.6% of new COVID cases are the Delta variant, and 0.4% are Mu. The last cases of the Beta, Epsilon, Eta, and Kappa variants were detected in June and the last cases of Gamma and Iota were in August.
“Omicron has an unprecedented number of spike mutations, some of which are concerning for their potential impact on the trajectory of the pandemic,” the WHO said in a statement today.
“The overall global risk related to the new variant …is assessed as very high.”
On Sunday, Dr. Angelique Coetzee told South Africa Today, “Most of these cases are mild whether they are vaccinated or not. There is no increase in our hospital admissions currently.”
Hospital admission for COVID-19 by week, South Africa Gauteng Province, Public and Private Hopsital, through November 28, 2021
Less than 12 hours later, the hospital admission data from the South Africa Department of Health painted a very different picture. In the previous week, COVID hospitalizations had increased 66% nationwide and 210% in Gauteng Province, the epicenter for Omicron cases. Two weeks ago 135 Covid-19 patients were hospitalized in and around Johannesburg jumping to 580 on Monday morning. Hospitalizations at public and private hospitals increased almost equally and officials at Baragwanath Hospital reported moderate to severe symptoms with almost all patients unvaccinated or partially vaccinated with the Pfizer vaccine.
Dr. Coetzee in her interview on Sunday went on to take a more cautionary position, “Two weeks from now we might say something different, but we urge…people out there please get vaccinated, listen, do the right thing, and stop going to big gatherings.”
She also added the unvaccinated should be worried, saying, “especially if you are above the age of 50, we have seen this many times.”
“There is a saying. You’re not safe until everyone is vaccinated.”
The 7 day rolling average for new COVID cases in South Africa grew to 2,275 on Monday, 90% of new cases are Omicron, and 10.8% of tests are coming back positive
The WHO appeared to address the reports from Dr. Coutzee and her reports on the severity of the new variant in a statement last night. “There is currently no information to suggest that symptoms associated with Omicron are different from those from other variants.”
The statement added, “Initial reported infections were among university students—younger individuals who tend to have more mild disease—but understanding the level of severity of the Omicron variant will take days to several weeks.”
Dr. Coetzee saw her first suspected Omicron variant patient on November 18 and has based her statement of symptoms being mild on two-dozen patients who are mostly university students and younger, and about 50% vaccinated. In an interview with the BBC on Thursday, she stated all were in good health with no comorbidities.
Although she is credited and has self-proclaimed to have “discovered” Omicron, the first detection of the B.1.1.529 variant was collected on November 9 in Botswana and confirmed by South African scientists on November 11. South African officials notified WHO on November 24, a day before Dr. Coutzee stated she contacted South African authorities on her observations.
Despite a lot of unanswered questions, a clearer picture is slowly starting to emerge. The three riddles scientists need to solve are how contagious Omicron is compared to the Delta variant, can it escape public health measures, preventions, and treatments, and if the symptoms are the same, worse, or milder than previous variants.
Here is what is currently known about the Omicron COVID variant.
Symptoms
For children, adolescents, and young adults there is conflicting information. One doctor is reporting mostly mild symptoms that can be treated at home while hospital officials are reporting cases are similar to Delta.
The WHO stated on Sunday, “There is currently no information to suggest that symptoms associated with Omicron are different from those from other variants.”
Transmissiblity
Concern is growing among the CDC, WHO, and a constellation of health officials that Omicron is highly transmissible. At least equal to Delta and possibly higher.
In less than two weeks, Omicron went from almost non-existent to 90% of new cases in South Africa. It appears it can effectively outcompete the Delta variant. However, this introduces bias in the data because the Delta wave had just ended in South Africa. Did Omicron become the dominant strain by outcompeting Delta or due to the absence of Delta? More research needs to be done to answer that question.
There are other variables that could explain the sharp increase in cases that go beyond the simple reproductive number, known as R0. Omicron has so many more mutations than previous strains, it could be benefiting from immune escape. Although the R0 is lower than Delta, its uniqueness compared to previous mutations enables it to reinfect people relying on natural immunity. So overall transmissibility may be lower than Delta, but its ability to escape immunity results in more infections.
Is it in the United States
Cassie Sauer, CEO of the Washington State Hospital Association said on Monday, “I think that there is almost no chance that it’s not [here.]”
The United States does not have a national standard or requirement to genetically sequence some or all COVID tests that come back positive. Those decisions are left up to individual states. It is likely that states with aggressive public health programs such as California, Washington, Colorado, New York, or Massachusetts will identify the first cases.
How long do researchers think Omicron has been circulating
Dr. Trevor Bedford from Fred Hutchinson in Houston, Texas successfully estimated the arrival of the original COVID strain in 2020, using data from the Washington State Department of Health. Using the same methodology, Dr. Bedford’s model indicates that Omicron likely started circulating between September 19 and October 21. There is no evidence to support that the variant originated in South Africa.
Credit – Dr. Trevor Bedford, Fred Hutchinson, Houston, Texas – probability of origin date for Omicron variant
Why are so many travelers testing positive
In total numbers, there aren’t many travelers testing positive. When you consider that in all but two cases the testing of 200 to 250 people on an aircraft has yielded one or two positives, the percentage of breakthrough cases is small. Headlines are blaring two positive cases detected, which is critical to know – they aren’t blaring 248 negative tests on 777 that landed tonight.
Because the people tested are 95% to 100% vaccinated, this creates a false data fallacy. You have an almost exclusive sample of vaccinated people.
In South Africa, the Department of Health has reported almost everyone hospitalized in the last two weeks is unvaccinated or only partially vaccinated. Dr. Coetzee reported 12 of 24 patients she cared for were unvaccinated.
Based on this early data, it appears the current vaccines remain at least moderately effective at preventing infection and remain very effective at stopping moderate to severe COVID.
Are the current vaccines ineffective
There isn’t enough data, and almost every public company making a vaccine announced over the weekend they were testing their current versions against Omicron. Pfizer, Moderna, and Johnson & Johnson announced over the holiday weekend they were testing to see if the current vaccines remained effective.
There is some data out of South Africa that is indicating that vaccines are helping prevent moderate to severe illness and the cases being detected among vaccinated travelers appear to be asymptomatic to mild. However, many of those cases were detected in the last 72 hours and more time is needed to see how these new cases will progress.
In Israel, the first three travel-related cases were fully vaccinated with boosters. One was Pfizer, one was J&J, and one was AstraZeneca. We know that the viral-vector vaccines haven’t performed as well against the Delta variant as the mRNA vaccines.
The evidence suggests that there is more vaccine escape with Omicron, but not outright vaccine ineffectiveness. It still appears to be preventing hospitalizations, which would indicate it would prevent deaths.
Pfizer said they could make a new version if required in 100 days and Moderna said it would take 60 to 90 days. Johnson & Johnson did not provide a timeline but made a statement today they could create an updated version if it was required.
There are some new COVID vaccines in development called subunit vaccinations. There has been no information about the impact Omicron will have on the research.
Is disease acquired immunity still effective
There is growing evidence that immunity gained from a previous COVID infection that isn’t supported by vaccination, is experiencing significant breakthrough numbers.
Researchers are working to determine if the sharp increase in the number of cases and the high positivity rate of tests is due to Omicron being equally or more transmissible than Delta, or if part of the increase is being driven by other factors.
The pattern of mutations found in Omicron is very distant from all previous strains.
Are monoclonal antibodies still effective
There is evidence that Omicron has a significant ability to resist monoclonal antibodies. Specific mutations may have the capability to not only bypass B cells but resist T cells (which isn’t the same as HIV which destroys your T cells).
UW Medicine is evaluating the performance of currently available antiviral treatments and we will know more information in the coming weeks.
Will the new antivirals that are pending approval still be effective
There was a report from Pfizer on Monday morning that Paxlovid is effective against the Omicron variant, which is very good news. This is easy to administer than monoclonal antibodies, easier to distribute, and cheaper.
Nothing has been stated about Monulpiravir from Merck. The FDA will be considering the EUA request this week but there are hints they will label Monulpiravir a Class C drug if the EUA is granted. A Class C drug can’t be used by pregnant women, women actively trying to get pregnant, and nursing mothers because the drug has not been tested to determine if it causes birth defects or pregnancy complications. The FDA has already requested data for Merck to understand the impact better.
What should I do
Health officials recommend you continue to do the same things you are doing now. Get vaccinated if you’re not already. Get a booster shot if you’re eligible, and over 2.4 million Washingtonians are currently eligible. Wear a mask, wash your hands, avoid crowded indoor spaces, and reconsider your short term travel plans if you were planning to fly.
Journalists, activists, and researchers defending the First Amendment
Subscribe to Malcontent News
Register to feed your head holes with the Malcontent News newsletter.
Submitting your e-mail address gives us permission to send you e-mails. We do not sell or distribute our e-mail lists or share them with third parties.
