As we go to press, there are no intensive care unit (ICU) beds available in two of five regions of California — the San Joaquin Valley and Southern California. There are no ICU beds available in the big UCLA hospital system. The Bay Area is not doing much better, with ICU capacity having fallen below 10 percent, though it’s now back to 11. Officially, u.s. COVID deaths are over 330,000 as of December 25, with almost 19 million confirmed cases. In California there have been over 2 million confirmed cases and 24,000 deaths. The world case count is over 80 million, with 1.76 million deaths recorded. No doubt the total is actually much higher. Merry xmas and happy new year.
It’s important to remember that it didn’t have to be this bad. The trump regime initially decided to ignore the virus, then provided constant disinformation, refused to put sufficient resources into testing, contact tracing, and protecting “essential workers” including failing to provide good respirators and other PPE, and to require changes in working conditions in meat packing and other industries. Hospitals are still “conserving” PPE by denying it to workers who take care of COVID patients. The pandemic followed a decade, under both republicans and democrats, of pandemic unplanning, including the dismantling of local, state, and national equipment stockpiles and public health infrastructure.
A hostile god?
If you needed more proof that there is no justice, trump reportedly survived his October bout with COVID. Some blame an obviously uncaring god, while others believe trump never had the virus. But he had the best possible medical care, including hospitalization at Walter Reed National Medical Center and then in a specially constructed ICU at the white house. And he had physician Sean Conley who admitted lying to the press in order to be “upbeat” about trump’s condition. Odd how the word “upbeat” takes on such specific meanings.
In the less privileged world we inhabit, there’s an outbreak of COVID-19 at FCI Dublin. The bureau of prisons (bop) reported that cases almost doubled during the week ending December 22, from 136 to 219. Since the beginning of the pandemic, the bop reported 172 people in federal prisons who died, and two staff members, out of a total system population of 124,000 and 36,000 staff. Per bop, there are also about 14,000 people incarcerated in federal private prisons, of whom more than 1000 have contracted COVID-19, and 13 have died.
About twenty of California’s prisons have reported over 100 new cases within the past 14 days, with a reported total of 6,682 new cases system-wide. Of the almost 100,000 people still incarcerated in California’s state prisons, a total of 37,000 (more than a third) have been confirmed infected, and 114 have died. It took several federal court proceedings to establish a testing program for prison employees so that they would not continue to bring and transmit the virus in the prisons, and regular employee testing did not occur at several facilities until July. Although the prisons established a “universal masking” policy, there are still many reports of guards not using masks or respirators. There have been eleven thousand confirmed cases among California prison employees and almost 3300 cases have occurred within the past 14 days. Eleven prison employees have died.
Preferably, people with airborne diseases such as TB, or COVID, should be placed in rooms with special ventilation systems that reduce the risk of circulating the virus, called “airborne infection isolation rooms.” But there are nowhere near enough isolation rooms to handle the number of patients hospitalized with COVID. Other than the newish California Health Care Facility (CHCF) in Stockton, prisons have few or no functional isolation rooms. So public health advice is to put patients in individual rooms with a closed door to reduce transmission, or to cohort them with other COVID patients. In hospitals, people placed in these rooms can communicate with the nursing station through intercoms or phones. In prisons, people with COVID illness are often incarcerated in the “administrative segregation” area (aka “the hole”) These cells, designed for punishment, have no direct communication with the outside, and with the door shut, no way to call for help. Rarely, the sickest incarcerated people are moved to community hospitals, where, despite their being intensely sick and often on ventilators they are handcuffed to the bed under constant surveillance. (Please see Corona Virus in Prison for more about conditions in prisons.)
The impact of immigration enforcement
ICE currently reports 456 active COVID cases among the 16,000 people currently incarcerated in their facilities. ICE claims a total of over 8,000 people who have tested positive in their facilities, although testing at ICE was slow to start and remains sporadic. ICE’s data has been challenged as unreliable and inconsistent by Vera Institute of Justice.
California has six ICE facilities, five are operated by private prison companies. There have been large COVID outbreaks at three – Otay Mesa (operated by CoreCivic), and Mesa Verde and Adelanto (operated by Geo group).
ICE detention is not only spreading COVID among incarcerated immigrants, but to the communities surrounding them. A December report by the Detention Watch Network found that “COVID-19 due to ICE’s negligence was dramatic. Across the United States, the COVID-19 caseload surged over the summer of 2020. ICE exacerbated the pandemic. Between May and August, our analyses reveal that ICE detention facilities were responsible for over 245,000 COVID-19 cases throughout the country.”
ICE also spread COVID 19 to other countries through deportation of infected immigrants. For example, between March and September, the u.s. deported 5,949 people to Guatemala on 78 deportation flights. Not all people were tested on arrival, but of those who were, 332 were positive. On some flights over 90 percent of the people were positive.
Although federal OSHA has turned down the unions’ petitions for an emergency temporary standard to protect workers from COVID, several state OSHA plans have now passed emergency standards, including Virginia, Washington, Oregon, Michigan, and finally California. California was the only state that before the pandemic had a regulation to protect workers in health care, prisons and certain other higher risk workplaces from aerosol transmissible diseases including TB, measles, and pandemic outbreaks such as COVID. The regulations in the other states apply to health care, but mostly by referring to CDC recommendations, which have been weak. But then again, so has enforcement by OSHA. Early in the pandemic, the governor’s executive order directed Cal/OSHA to avoid actual enforcement except in extreme cases, and try to advise employers.
Here’s some good news, the CDC has finally acknowledged that COVID is spread through inhalation of aerosols and that “It is possible that COVID-19 may spread through the droplets and airborne particles that are formed when a person who has COVID-19 coughs, sneezes, sings, talks, or breathes. There is growing evidence that droplets and airborne particles can remain suspended in the air and be breathed in by others, and travel distances beyond 6 feet (for example, during choir practice, in restaurants, or in fitness classes). In general, indoor environments without good ventilation increase this risk.” Better late than never?
As the pandemic has developed, it has become clear that like congregate living facilities and prisons, crowded workplaces provide an opportunity for the virus to spread once introduced. Since many of the workers in “essential businesses” are people of color, this magnifies the epidemic in communities of color, who are disproportionately affected by, and dying of, this disease.
California’s new emergency regulation, and the regulations in the other states, apply to all workplaces (except workers in California covered by the existing regulation), and have additional requirements for workplaces with outbreaks or higher risk of outbreak, such as meat packing, food processing, warehousing, and agriculture. None of these regulations actually mandate significant process changes, such as slowing down the line speed in food processing.
In California, the United Farm Workers and individual workers went to court to require the Foster Farms chicken processing facility in Livingston to follow the local health department’s orders and recommendations. The Livingston plant employs about 4000 people. An outbreak that started in the summer eventually led to 392 detected infections and 9 deaths. Sections of the plant were briefly shut down at the beginning of September, and infections eventually decreased through testing and exclusion of infected workers. Then in December, at least 48 new infections were detected, and employees went to court to demand that the company follow the August orders from the local health department. They were granted a temporary restraining order. A new outbreak has occurred in two other FF facilities in Fresno.
Many states now have some form of workers compensation presumptions for COVID infections. That means that employers in the affected industry now have the burden to prove that the COVID was not acquired in the workplace, for example, in the case of a nurse filing for workers compensation. Some of these mandates are being challenged in court.
Vaccination – the “light at the end of the tunnel”
Two weeks ago, the u.s. began distribution of the Pfizer/BioNTech vaccine, which requires two doses, three weeks apart. According to the New York Times, although the government has obtained almost ten million doses (half of what it had initially promised by the end of the year), only about two million people have been vaccinated so far. This fragile vaccine, which requires storage at minus 70 degrees C (minus 94 degrees F), is being distributed by FedEx and UPS, to designated health care facilities. A similar but somewhat less fragile vaccine from Moderna, requiring only common freezer temperatures, started being distributed last week. It requires two doses, 4 weeks apart. Both vaccines are said to confer some immunity about 10 days after the first shot.
As of December 23, the state was scheduled to receive 1,762,900 doses this month, but had only received 437,900 and 70,258 people have been vaccinated. Almost 2,000 doses of the Pfizer vaccine shipped to California had to be returned because they had been stored in the trucks at temperatures below the required range.
The CDC has recommended priorities for who should receive the vaccines first, which are based on a health care industry dominated Advisory Committee on Immunization Practices. Each state can set its own priorities. California has a Drafting Guidelines Workgroup and a Community Vaccine Advisory Committee, which is charged with providing input on, among other things “equity.” For the first round of doses, health care organizations seem to have pretty much autonomy on who actually gets vaccinated. For example, physician residents at Stanford University hospital held a protest last week because only 7 of the 1000 residents who were actually caring for COVID patients were vaccinated, while higher level teaching staff, who didn’t have patient contact, were vaccinated instead.
Neither ACIP nor the CDC has recommended vaccinating people incarcerated in local, state or federal prisons or in immigration detention as a priority. California has begun administering COVID-19 vaccine to the “high risk” people incarcerated in the state’s prisons and to health care workers in the prison system. On December 22 the CHCF reportedly vaccinated a total of 65 employees and incarcerated people. 2400 people are incarcerated in the facility, and 150 are currently COVID positive. The state plans to include the women’s facility (Chowchilla) and the medical facility (Vacaville) in the early vaccine distribution. According to the LA Times, the prison system has received 18,600 doses of the Moderna vaccine and 3,259 of the Pfizer vaccine.
The corona virus has spike proteins on the outside of the virus which can latch onto a receptor on the human cell membrane on the outside of certain cells, particularly in the respiratory system. Once they have latched on and entered the cell, the human cell begins to create more of the virus, which is then released into the body. The goal of all COVID-19 vaccines is to get the body to recognize the spike protein and create antibodies to block the virus from binding to human cell receptors and trigger other immune responses.
The Pfizer and Moderna vaccines are the first human vaccines that directly inject messenger RNA (mRNA). mRNA is part of normal cellular processes. It generally brings genetic information from the DNA contained in the cell nucleus, to structures in the cytoplasm (the area inside the cell but outside the nucleus) that create proteins. These two vaccines contain the mRNA to create the corona virus spike protein directly. Because mRNA molecules are relatively easy to break apart, the vaccines also include lipid nanoparticles to protect the virus, and the vaccines are stored at very cold temperatures. The lipid particles also help the mRNA enter the cell, and it is hoped they will also reduce any unwanted immune reaction to the vaccine.
The AstraZenica/Oxford and the Johnson and Johnson/Janssen vaccines, which are still in clinical trials, (and reportedly the Russian and Chinese vaccines), use weakened or inactivated adenovirus, to carry DNA which contains the genetic code to manufacture the spike protein, into the cell. Once in the cell, mRNA is produced to make the spike protein. Because DNA is a more stable molecule, the vaccine is easier to distribute with regular refrigeration.
The intention of all the vaccines is to create the “spike protein” of SARS-CoV-2 (without the virus), so that a vaccinated person produces antibodies to block the receptors and prevent the coronavirus from entering the human cell. In response to the vaccine and the spike protein certain types of immune cells will also learn to recognize infected cells and inactivate the virus or destroy the cell.
The Pfizer and Moderna vaccines have emergency use authorization (EUA) from the food and drugs administration (fda). It is expected that the clinical trials of the AstraZenica and J&J vaccines will conclude in early 2021, and if successful the companies will also seek an EUA from the fda. The fda has issued a lot of EUAs for COVID-19, including a number that it has had to withdraw. Most famously, on March 28 it authorized the use of trump’s beloved hydroxychloroquine and chloroquine, antimalarial drugs that had no proven effect on COVID, and then revoked the EUA on June 15. It has also revoked emergency authorizations for medical devices, certain respirators, and antibody tests for COVID-19.
Generally clinical trials of new vaccines take years to conduct and evaluate. In this case, the phase 3 trial period (for safety and efficacy) was only about 3 months, which is not long enough to determine long-term effects. Maybe the COVID vaccines will provide long-term immunity, or maybe the immunity will wear off, and regular boosters will be required. Pharmaceutical manufacturer data, such as that used for the EUAs, often turns out to exaggerate good effects, and not include adverse effects which sometimes emerge later, as the drug is used more widely. So many people are wary of taking the vaccine while others are trying to become first in line. COVID-19 is a serious illness, that even kills people with access to medical care, and survivors may have long term organ damage.
A number of health care employers, and other employers, are either making COVID vaccination a condition of employment (when offered) or trying to get states to pass laws requiring vaccination. This follows almost two decades of agitation from health care employers for states to adopt flu vaccine mandates. Many health care systems also require workers to prove immunity to measles. Generally, health care workers and their unions support access to vaccines, but not mandates.
Vaccination has been a successful strategy against infectious disease and has saved many lives. If the u.s. and russia would destroy their existing germ warfare stockpiles of smallpox, the disease would be eradicated. Polio, which causes serious illness, including paralysis and death, has been eliminated in most countries, and before the COVID pandemic, and trump’s defunding of the world health organization, was on its way to eradication in the next few years. I was vaccinated three times against polio. I got measles with my older sister, but my younger sister was part of a trial of the measles vaccine. A few years later, our unvaccinated younger neighbor tragically died of measles.
Like everyone else I am sick of the pandemic, sick from capitalism, and trying not to be sick with COVID. Hopefully you are too.