U.S.                                                                  California

                                   CASES               DEATHS                                     CASES                DEATHS       

December 2020    19,111,443              341,149                                2,120,610               24,241

2021   Timeline

January                  26,185,362             441,319                                3,310,949               40,702

February                 28,602,101             513,137                                3,563,578              51,953

March                    30,459,874              552,072                               3,668,277              59,240

April                        32,225,012              574,280                               3,742,115              62,078

May                        33,261,284              594,468                               3,789,227              63,247

June                       33,624,871              603,966                               3,814,890              63,569

July                         34,434,136              610,859                              3,903,052               64,231 

August                   39,057,368               638,700                              4,326,204              65,757 

September            43,471,906              698,149                              4,720,860               69,130

October                45,979,056               746,021                             4,915,796               71,950

November            48,214,360               776,586                             5,060,666               74,152

December            54,859,966              825,816                              5,515,250               76,520

2022 Timeline

January                74,333,528              884,265                               8,292,735              79,801

February              79,025,644              949,957                                8,961,636              85,043

March                  81,780,503          1,007,320                                 9,102,677              89,052

April                     82,658,881           1,018,326                                 9,192,666              90,145

May                     86,065,680           1,032,094                                9,574,768               91,591

June                    86,967,132           1,015,938                              10,024,838               92,113

July                     90,733,888            1,027,886                              10,367,437               92,784

August                94,199,489           1,043,864                              11,052,866               94,959

September         96,067,772           1,506,416                              11,233,276               95,796

October             97,450,859           1,070,266                              11,363,979               96,892

November                 98,568,849               1,079,197                                       11,492,488                   97,437                                                               

UPDATED WEEKLY - Last updated on 27 November 2022, 4:15 pm PST, John Hopkins Corona Virus Dashboard and Worldometer

Cases Worldwide  

                            John Hopkins                                                               Worldometer

• TOTAL CASES     -    641,521,886                                   TOTAL CASES     -   646,132,673

              Recovered      -                                                             Recovered      -   624,613,202

• TOTAL DEATHS   -       6,630,691                                    TOTAL DEATH     -       6,636,186

POPULATION - is 334,805,269 as of 27 November 2022, 4:15 pm PST, based on Census U.S. and World Population Clock.

Cases in the U.S.

• TOTAL CASES     -    98,568,849                                    TOTAL CASES      -   100,465,087

              Recovered      -                                                            Recovered       -     97,992,073

• TOTAL DEATHS   -     1,079,197                                     TOTAL DEATHS    -       1,104,755

*Unemployment increases to 3.7%

*306,000 jobs added in October.

Cases in California

• TOTAL CASES     -   11,492,488                                     TOTAL CASES       -       11,461,654

              Recovered      -                                                            Recovered        -       11,219,783

• TOTAL DEATHS   -         97,437                                      TOTAL DEATHS     -              97,458

*California unemployment rate was 3.9%

11/27/2022                   Cases (WHO)                    Deaths (WHO)                Recovered (WHO)

• Texas                  -    8,049,636                            91,893                             7,905,021
• Florida                -    7,239,181                            82,875                             7,113,951
• New York           -    6,536,342                            74,037                             6,419,131
• Illinois                  -   3,860,866                             40,247                            3,758,453
• Pennsylvania     -   3,350,067                             47,271                            3,275,797
• N. Carolina        -   3,268,501                             27,347                                N/A
• Ohio                   -   3,227,759                             40,466                            3,151,782
• Georgia             -   2,928,661                             41,024                            2,877,719
• Tennessee         -   2,384,048                              28,293                           2,350,137
• Arizona              -   2,324,560                              31,709                           2,257,641
• Alabama*         -   1,545,099                              20,631                           1,493,863
• Louisiana          -    1,470,441                              18,261                           1,493,863
• W. Virginia        -      613,165                                7,594                               604,907

               *  Rated last in vaccine distribution at 52%, fully vaccinated

** correction

             *** no updated information at this reporting

United States progress                                       Updated 27 November 2022, 4:15 pm PST,

• Doses Distributed                                                      918,653,695
• Doses Administered                                                 653.502.647
• 1st dose administered                                             267,804,921           80.7%                       
• Primary series administered                                    228,390,445           68.8%
• Booster administered**                                           111,367,843           49.1%
• 2nd Booster**                                                              26,796,838           40.6%
• Bivalent Booster                                                         37,635,032           12.1% 
• Total population                                                     334,805,269

                *Updated information

             ** No updated information at this reporting

• https://usafacts.org/visualizations/covid-vaccine-tracker-states/
• https://coronavirus.jhu.edu/vaccines/us-states
• https://www.worldometers.info/coronavirus/country/us/
• https://coronavirus.jhu.edu/vaccines/us-states
• https://covid.cdc.gov/covid-data-tracker/#vaccinations
• https://usafacts.org/visualizations/weekly-unemployment-claims/?utm_source=bing&utm_medium=cpc&utm_campaign=ND-Jobs&msclkid=b11efd9b16dc12762fd79d422c12da27
• https://www.edd.ca.gov/newsroom/unemployment-may-2021.htm
• https://www.bls.gov/
• https://www.bls.gov/news.release/laus.nr0.htm
• https://www.worldometers.info/world-population/us-population/

NOVEMBER BLOG

COVID UPDATE

Respiratory Syncytial Virus (RSV) in Children.  What is respiratory syncytial virus (RSV) in children?  RSV is a viral illness causing symptoms such as trouble breathing.  It’s the most common cause of inflammation of the small airways in the lungs, bronchiolitis, and pneumonia in babies.  RSV is spread when a child comes into contact with fluid from an infected person’s nose or mouth, such as a contaminated surface, then touching their eyes, mouth, or nose.  Or it may occur by inhaling droplets from an infected person’s sneeze or cough.   Children are more at risk for RSV when around others with the virus and in yearly outbreaks in communities, classrooms and childcare centers, but more common in winter and early spring months.

Which children are at risk for RSV?  RSV can affect any age group but causes the most problems for the very young and very old.  Most babies are infected at least once by the time they are 2 years old and can be re-infected with the virus anytime throughout life.  RSV infection in older children and adults may present like an episode of severe asthma.  Babies born prematurely or with heart, lung, or immune system diseases are at increased risk for more severe illness.

What are the symptoms of RSV in a child?  Symptoms start about 2 to 5 days after contact with the virus.  Early phases of RSV in babies and young children, is often mild like a cold.  In children younger than age 3, RSV may move into the lungs and cause coughing and wheezing and in some children, the infection turns to a severe respiratory disease requiring treatment in a hospital to assist breathing.  RSV symptoms can seem like other health conditions. Consult your healthcare provider regarding risks, benefits and possible side effects of all treatments.

The most common symptoms of RSV include:

• Runny nose
• Fever  
• Cough
• Short periods without breathing or apnea
• Trouble eating, drinking, or swallowing
• Wheezing
• Flaring of the nostrils or straining of the chest or stomach while breathing
• Breathing faster than usual, or trouble breathing
• Turning blue around the lips and fingertips 

How is RSV treated in a child?  Treatment will depend on your child’s symptoms, age, and general health.  Antibiotics are not used to treat RSV.  Treatment for RSV helps ease symptoms and may include:

• More fluids - make sure your child drinks plenty of fluids.  If needed, an intravenous or IV line may be established to give fluids and electrolytes.
• Oxygen - extra oxygen given through a mask, nasal cannula, or an oxygen tent.
• Suctioning of mucus - a tube may be inserted into the lungs to remove extra mucus.
• Bronchodilator medicines - may be used to open the child's airways, usually administered in an aerosol mist by a mask or through an inhaler.
• Tube feeding - may be done if a baby has trouble sucking.  Inserted into the baby’s nose and nutrition is sent through the tube into the stomach.
• Mechanical ventilation – if very ill, a child may be put on a breathing machine or ventilator to help with breathing.
• Antivirals – monoclonal antibody treatment are available for severe infections, treatment may include antiviral medicines.

RSV in children: Symptoms, treatment and what parents should know.  Updated 5:29 PM EDT, Fri October 28, 2022.  For many, RSV causes a mild illness that can be managed at home.  On average, an infection lasts five days to a couple of weeks and it will often go away on its own, says the CDC.  Sometimes, the cough can linger for up to four weeks, pediatricians say.

• Fever and pain can be managed with non-aspirin pain relievers like acetaminophen or ibuprofen.  
• Also, make sure your child drinks enough fluids.  RSV can cause dehydration.  Once children stop eating or urine output has decreased signals the child may need to see a pediatrician or emergency department.
• If child’s chest is moving up and down when they breathe or their cough won’t let them sleep, they may need supplemental oxygen or need a nebulization treatment.

VARIANT UPDATE

They’ve done it again!!!!  T R A N S F O R M E D!!!  The next U.S. COVID wave is coming.  Why it will be 'much weirder than before.'  Thurs.,October 13, 2022 at 1:00 PM.  First variants were named after Greek letters, like Omicron.   Then came BA.5.  Now there is BA.2.75.2, BA.4.6, BF.7 and BQ.1.1.  There’s an even newer transformer - XBB.

Scientists are seeing Omicron descendants arising simultaneously but advantageous mutations that help them dodge existing immune defenses are driving new waves of infection.  Of all 300 post-BA.5 sub-lineages currently being monitored by the World Health Organization — a group that includes BA.4.6, BF.7 and BA.2.75, which have risen as a proportion of U.S. cases in recent weeks.

Experts are most concerned about two Omicron spinoffs that have barely even registered in America yet:  BQ.1.1 and XBB.  Why?  Because they’re “escape” variants!  Earlier sub-lineages had a few advantageous mutations – XBB, B.Q.1.1 and now including BN.1 and BA.2.75.2 — boasting at least six changes in the right places on the virus’s spike protein.  Some researchers have referred to them as the “pentagon” or “hexagon” variants, ranking as the "most antibody-evasive” strains ever tested, according to Yunlong Richard Cao, an immunologist at Peking University in Beijing.

First, the most vulnerable, the immunocompromised and the elderly, do not produce lasting or strong antibody response after infection or vaccination.  Monoclonal antibody treatments have helped shield them from severe illness.  Many of these treatments were abandoned after previous variants rendered them useless.  Recent lab experiments have shown that remaining antibody therapies, bebtelovimab and Evusheld, don’t work against XBB and B.Q.1.1.

Second is increased spread.  Dr. Cao’s experiments show that XBB is “significantly more immune evasive against plasma from all breakthrough infections,” including recent BA.5 infections.  The more the virus circulates the more chances it has to reach people who could get seriously ill.  Less than 5% of eligible Americans have received the updated bivalent BA.5 shot. 

In the United Kingdom, BQ.1.1 infections are doubling every week, a growth rate that exceeds other leading sub-lineages.  Germany, France and Belgium are experiencing similarly rapid B.Q.1.1 growth.  From Italy to Austria to Sweden, COVID hospitalizations are rising as the weather cools.   Meanwhile, XBB is driving steep COVID case surges in Singapore and Bangladesh, two of the first countries where it has achieved dominance.

BQ.1.1 is a descendant of BA.5; XBB a descendent of BA.2.  By further broadening immunity, the new bivalent boosters are the best defense.  93% of U.S. seniors have received their first two vaccine doses and only 45% have received their two recommended booster shots, with the number for bivalent boosters much lower.  CDC data has shown that vaccine protection against COVID hospitalization fell from 80% to roughly 60% during the various Omicron waves.  Without boosters — and with more evasive variants — it’s likely to slip further.  Three years in, the virus still has tricks up its sleeve!  Will Pi, another radically new variant like Omicron?

What Is BF.7?  New COVID Sub-variant Spreading In US.  The Centers for Disease Control and Prevention is currently monitoring another COVID variant, as the U.S. heads into another wave of the virus this fall.  The BF.7 sub-variant, also known as BA.5.2.1.7, is a sub-lineage of the BA.5 strain of the virus and has grown in other regions of the world.  BF.7 has the potential to be more transmissible than BA.5. Not much is known about the BF.7 sub-variant such as its severity and response to the latest Omicron vaccines.  BF.7 may not be the only sub-variant seen this year.  

The BF.7 sub-variant comprises 1.7% of new COVID cases, finding its way on the CDC's watch list and nearing the number of cases of the BA.4 sub-variant, at 1.8%.  The majority of COVID cases in the country is still the BA.5 sub-variant at 84.8% and BA.4.6 at 10.3%, according to the CDC.

25% of the BF.7 cases worldwide have been in Belgium, with Denmark, Germany and France seeing 10% of cases.  Dr. Stuart Ray, vice chair of medicine for data integrity and analytics at Johns Hopkins Department of Medicine, its "reasonable to think BF.7 is gaining a foothold."  

CDC starts tracking BF.7: 5 notes on the sub-variant.  The CDC recently started tracking BF.7, the third most-prevalent strain in the U.S.  Things to know:

• BF.7 accounts for 2.3% of COVID-19 cases the week ending Sept. 24, according to the CDC, up from 1.6% the week prior.
• BF.7 has one additional genetic mutation in the spike protein compared to BA.5.  “Its parental strain.  Data indicates this specific genetic change could reduce the efficacy of Evusheld," indicated CDC spokesperson Jasmine Reed. 
  • AstraZeneca's, “Evusheld” is a monoclonal antibody drug that still works against BA.4 and BA.5.
• There are no signs BF.7 would impede COVID-19 vaccines or diagnostic tests
• The New England region has the highest proportion of BF.7 cases in the U.S. at 3.9%.

Preparing for the BF-7 COVID-19 variant and flu season.  SEPTEMBER 29, 2022.   Alpha, Beta, Gamma, Delta, Omicron, BA-4, BA-5, and now comes BF-7.  Each variant brings new challenges and BF-7 has changes that may make it evasive to immunity, meaning if you’ve had Omicron, you may be susceptible to BF-7. 

When it comes to vaccines and their effectiveness against BF-7, evidence points to the fact it should do the same for the new variant, especially if you have the BA-5 booster.  As a country "our immunity to the flu is dramatically lower than what it usually is.  As far as protecting yourself against the latest cold bug, it's the same old handwashing and distancing from folks hacking and sneezing. 

VACCINE UPDATE

FDA releases important information about risk of COVID-19 due to certain variants not neutralized by Evusheld.  Update 10/3/2022.  The FDA added important information to the Fact Sheets for Evusheld, tixagevimab co-packaged with cilgavimab, to inform health care providers and individuals receiving Evusheld of the increased risk for developing COVID-19 when exposed to variants of SARS-CoV-2 that are not neutralized by Evusheld.

Fact Sheet for Healthcare Providers - Health care professionals should inform patients of the risk and advise patients who develop signs or symptoms of COVID-19 to test for SARS-CoV-2 and promptly seek medical attention, including starting treatment for COVID-19.     

Evusheld, currently the only option for pre-exposure prophylaxis or PrEP of COVID-19 authorized under Emergency Use Authorization, EUA, for use in immunocompromised individuals and individuals who the COVID-19 vaccination is not recommended due to severe adverse reaction.  It is authorized to be administered every six months.  Evusheld is not a substitute for COVID-19 vaccination. 

The FDA continues to recommend Evusheld as an option for PrEP to prevent COVID-19, in combination with getting vaccinated and boosted.  Evusheld  offers protection against many of the currently variants and may offer protection against future variants.  

What You Should Know: 

• Talk with your health care provider about appropriate treatment options if you develop COVID-19.
• If you develop COVID-19 symptoms, notify your health care provider and test right away to identify which variant of SARS-CoV-2 you may have contracted.
• If recommended by your health care provider, get vaccinated or boosted with a bivalent booster to help increase protection against SARS-CoV-2 infection.

What Health Care Providers Should Know. There are several treatments that are authorized or approved to treat certain patients with mild-to-moderate COVID-19 who are high risk for progression to severe disease, including hospitalization or death.

• Paxlovid,
• Veklury or remdesivir,
• Bebtelovimab,
• Lagevrio or molnupiravir

How to Protect Yourself?  Getting vaccinated is your best bet!

IT’S NOT OVER!

Stay safe.  Mask.  Social distance.  Frequent hand washing.  Avoid crowds

ALWAYS CONSULT YOUR PERSONAL HEALTH CARE PROFESSIONAL

• https://www.cbsnews.com/pittsburgh/news/preparing-for-the-bf-7-covid-19-variant-and-flu-season/
• https://www.beckershospitalreview.com/public-health/cdc-starts-tracking-bf-7-5-notes-on-the-subvariant.html
• https://www.ibtimes.com/what-bf7-new-covid-subvariant-spreading-us-3615920
• https://www.fda.gov/drugs/drug-safety-and-availability/fda-releases-important-information-about-risk-covid-19-due-certain-variants-not-neutralized-evusheld
• https://news.yahoo.com/the-next-us-covid-wave-is-coming-why-it-will-be-much-weirder-than-before-200044795.html
• https://www.cnn.com/2022/10/23/health/rsv-symptoms-treatments-wellness/index.html
• https://www.stanfordchildrens.org/en/topic/default?id=respiratory-syncytial-virus-rsv-in-children-90-P02409&sid=