• LOCAL: San Francisco averaged 34 new reported cases per day over the last week and as of October 30, 12,320 cases and 代理软件 have been reported since the start of the pandemic. Less than 1% of COVID-19 tests in San Francisco have returned positive each day since the beginning of October. Statewide, 924,259 confirmed COVID-19 cases and 17,575 deaths have been reported in 电脑切换ip软件. There are some concerning signs that the state and the Bay Area may be in the early stages of another surge, with upticks in case counts and hospitalizations. The positive test rate statewide over the last week was 3.3%, up from 2.7% two weeks ago. Imperial County, along the border of Mexico, and Tehama County, in northern California, saw the 中国蓝TV-浙江广电集团视频门户官方网站，奔跑吧在线观看 ...:中国蓝TV是浙江广电集团旗下唯一互联网视频平台，独家提供浙江卫视中国新歌声、中国好声音、奔跑吧兄弟等所有综艺节目高清视频直播点播，并为用户提供各类热门电影,电视剧,综艺,动漫,音乐,娱乐等内容的 … over the last 2 weeks. The director of Tehama County health services has attributed the rise in cases to social gatherings and issued an announcement asking the county to hold off on gatherings. Outbreaks have also occurred in a long-term care facility, a local business, and churches. Several schools were forced to close due to cases within the schools, however these cases were all linked back to infected household members and no transmission has been observed in the schools. The 电脑端代理软件下载 also links the rising COVID-19 case count in the county to social gatherings.

  电脑切换ip软件: The United States, which has remained the global epicenter of the pandemic since March, is well into the 3^rd surge. Daily reported cases are increasing with over 74,000 cases reported/day over the last week, the highest 7-day average since the start of the pandemic. More concerningly, hospitalizations are up over 46% over the last month and 电脑切换ip软件 have started to rise again. Over 电脑切换ip软件of COVID-19 have been reported and more than 229,000 people have died due to COVID-19, although the true toll is certainly higher. The CDC estimated that 299,028 excess deaths occurred in the United States between January 26 and October 3, with the highest burden of excess deaths among adults age 25-44 years and the Hispanic/Latinx population. Two-thirds of these excess deaths were attributed to COVID-19, however the additional excess deaths were likely indirectly related to COVID-19 through lack of access to medical care for other health problems; for example, 40 states have reported an increase in opioid-related mortality since the start of the pandemic. The current surge is widespread; 45 states report increasing case counts with the highest rates in the upper mid-West, including South Dakota, North Dakota, Montana, and Wisconsin. South Dakota leads the nation with a staggering test positivity of 41%. Wisconsin recently opened a field hospital at the State Fairgrounds.

  GLOBAL: There are currently over 45 million reported cases of COVID-19 and 1.1 million deaths globally. The current surge is being experienced throughout the world. In Latin America, cases are rising steadily in Argentina, which largely escaped the first wave, and is currently experiencing the 5^th highest death rate in the world (behind the United States, India, Brazil, and Mexico). In Europe health officials in Belgium and Switzerland warn they could run out of beds in 2 weeks. Poland, which had very few cases during the spring has one of the most rapidly increasing epidemics in Europe. The Warsaw stadium was converted into a field hospital and 4 days ago Polish President Duda announced that he was infected with COVID-19 (just days after meeting with the presidents of Bulgaria and Estonia). In contrast, in China, a single asymptomatic case was reported last Saturday in Xinjiang prompting the government to conduct a mass testing campaign of over 5 million people, which identified an additional 137 asymptomatic infections.

Remdesivir (RDV) is the only antiviral FDA approved for the treatment of COVID-19. SOLIDARITY is a 30country WHO-sponsored open label trial that evaluates mortality among hospitalized patients at all stages of disease severity. 11,266 hospitalized COVID-19 patients were randomized to local standard of care vs. one of four study drugs: RDV, hydroxychloroquine (HCQ), lopinavir/ritonavir with interferon beta, and interferon beta alone. Data collection was limited, and some sites did not have all interventional arms available. The trial permitted steroids, other antivirals, and anti-inflammatories. In a pre-print, they reported no significant impact on the primary endpoint of in-hospital mortality in any of the arms; RDV (RR 0.95, 0.81-1.11), HCQ (RR 1.19 (0.89-1.59), lopinavir/ritonavir (RR 1.10 ( 0.79-1.25), interferon (RR 1.16 (0.96-1.39) nor impact on initiation of ventilation or duration of hospital stay. Focusing on RDV (n=2742 vs. control n=2708), there was no significant difference in mortality by baseline oxygen requirement (none vs. any O₂ vs. intubated). Of note, 47% on RDV received steroids; an analysis of steroid association with outcomes was not presented.

How does this impact our understanding of remdesvir use? The NIH sponsored double blinded RCT of RDV vs. placebo (ACTT-1) in hospitalized patients found mortality varied according to baseline disease severity, with a significant reduction in those on low-flow oxygen (HR 0.30 [0.14-0.64]) in a secondary analysis. In analyses of patients with all stages of disease severity, like SOLIDARITY, they also did not find a statistically significant impact of RDV use on overall mortality at day 29 (HR 0.73, (0.52-1.03).

Conclusion: The short answer to the question is “No”, the SOLIDARITY trial should not be interpreted to mean there is no clinical benefit to RDV use. Indeed, in ACTT-1, RDV was associated with a 50% faster clinical status improvement (primary endpoint), 8 days less oxygen support, lower progression to invasive and non-invasive ventilation, and lower mortality among those on low flow oxygen. We continue to recommend remdesivir for the treatment of patients with COVID-19. We are continuing to study optimal combinations of anti-inflammatories and anti-virals to improve outcomes and reduce mortality in severe COVID-19. Stay tuned.

Reports of elevated proinflammatory cytokines in severe COVID-19 led to interest in studying tocilizumab, an IL-6 receptor monoclonal antibody, and results from three peer-reviewed randomized trials have now been published. In a double-blind, randomized, placebo-controlled 代理软件 at 7 U.S. hospitals of 243 patients with severe COVID-19 and elevated inflammatory markers, tocilizumab did not reduce risk of progression to intubation or death (HR 0.83, 95% CI 0.38 to 1.81). The second trial, an unblinded, randomized, open-label study of 130 patients at French hospitals with moderate or severe COVID-19, demonstrated lower rates of disease progression or death at day 14 in the tocilizumab group (24% vs. 36% with 95% posterior probability of HR <1), however there was no difference in day-28 mortality (adjusted HR, 0.92; 95% CI 0.33-2.53). The third study reported results from a prospective open-label RCT of tocilizumab vs. standard care in 124 patients in Italy with confirmed COVID-19 pneumonia and PaO₂:FiO₂ ratios of 200-300. The study was halted early in the setting of decreasing infections and resulting interim analysis, which showed comparable 14-day clinical worsening or death (rate ratio, 1.05, 95% CI, 0.59-1.86) and comparable mortality rates. These trials have many limitations, including small sample sizes, unclear timing of tocilizumab administration in disease course, lack of blinding and placebo controls, crossover, and potential confounding by other therapies received by the participants. It’s also difficult to compare the studies since the study populations, primary endpoints, and methodologies were different.

Conclusion: Current data does not support the routine use of tocilizumab in hospitalized COVID-19 patients. Additional randomized trial results are expected and may provide additional information on the role, if any, for this medication.

A “close contact” was previously defined by the CDC as someone who spent at least 15 minutes consecutively within 6 feet of a confirmed case. A recent report describes a Vermont correctional officer who had numerous, brief encounters during an 8-hour shift with 6 incarcerated or detained persons (IDPs) with RT-PCR positive, asymptomatic COVID-19. The officer developed mild symptoms one week after the shift and a positive RT-PCR. During contact tracing, it was discovered that, while the officer’s encounters (roughly 1 minute each) did not meet the above definition of “close contact,” they added up to a cumulative 17 minutes of exposure within 6 feet. During all interactions, the officer wore microfiber cloth mask, gown, and goggles. IDPs were masked most (but not all) the time. The officer denied any non-occupational exposures. As a result of the study, the CDC has expanded their definition of “close contact” to someone who spends a cumulative 15 minutes over a 24-hour period within 6 feet of a confirmed COVID-19 case.

电脑切换ip软件: This study may redefine contact tracing for congregate living situations where frequent, close interactions are necessary. However, the CDC has been criticized for a) changing close contact definitions based on one case since contact tracing may become more complicated and b) not including facial mask wearing by the exposed and infected individual in contact definitions.