Emergence of a Deadly Coronavirus

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New Year’s Eve was canceled in Quebec, or at least that’s how many residents feel after the government imposed a 10 p.m. curfew that will go into effect on Friday night, just as the revelry was set to begin.

The move, which provoked an angry backlash, was the latest attempt by the province to tame the surging Omicron variant as cases rise and hospitals come under intensifying pressure. The government also banned private indoor gatherings beyond members of the same household, forcing many Quebecers to cancel their New Year’s Eve plans.

Under the curfew, which goes into effect at 5 p.m. on Friday, Quebecers will be required to remain indoors from 10 p.m. to 5 a.m., and those who break the rules face fines as high as $4,750. (There are some exemptions, such as dog walkers and essential workers in hospitals.)

Mr. Legault said Thursday that the measures were necessary to protect the province’s health care system.

“Our experts tell us that there’s a risk that we won’t be able to treat all those who need it in the coming weeks,” he said at a news conference, adding that hospitalizations doubled to more than 900 in the past week.

The backlash was palpable on social media as many criticized Mr. Legault for restrictions that some perceived as unnecessarily punishing during a fraught holiday period when travel plans had already been upended.

More than 78 percent of Quebec residents are fully vaccinated, according to data from the Public Health Agency of Canada, above the national vaccination rate of 76 percent.

Éric Duhaime, leader of the opposition Conservative Party in Quebec, criticized the government in a post on Twitter for failing to provide a scientific study to justify the curfew. Others said the curfew — the only one that will be in place in a Canadian province — would undermine peoples’ mental health and violate civil liberties.

The public uproar was particularly acute because it was the second time Quebec had imposed a curfew; the last one, in January, lasted five months.

Canada is among the countries that have seen the biggest surge in new virus cases, which have more than doubled in a week to an average of more than 25,000.

Among other new restrictions, restaurants are to be closed for indoor dining, the start of in-person elementary and high school classes has been delayed until Jan. 17 and places of worship are to be closed except for funerals.

Mr. Legault said the restrictions were aimed at protecting the unvaccinated from themselves, given the high rate of hospitalization among those who have refused be inoculated. That, in turn, prompted criticism from people who said they had respected public health rules and were being unfairly punished for the irresponsible behavior of a minority of Quebecers.

If NYC had a hospitalization rise similar to the rise in Omicron cases, we would be in BIG trouble.

More refrigerator trucks and month-long waits for cremations. Or perhaps more than that.

We had 40,000 positives yesterday—about 10 times what it was about a month ago. We have between 20 and 25% positive tests; whereas it was about 5% a month ago, and less than 2% 2 months ago.

At Northwell, 20% to 40% of patients with COVID-19 were admitted for conditions like heart failure, abdominal pain or stroke and later tested positive for the virus, Battinelli said.

At NYU Langone Hospital-Long Island in Mineola, a majority of COVID-19 patients initially were admitted for something else, said chief medical officer Dr. Marc Adler.

A newly released study suggests white-tailed deer are “highly susceptible” to the coronavirus that causes COVID-19, which could pose prolonged problems amid the pandemic.

Samples taken from 360 white-tailed deer across nine different areas in northeast Ohio early last year found six instances in which a strain of the virus was transmitted to one of the animals from humans, experts said in the study, which was shared on Nature.com.

The research found that about a third of the deer that were sampled had either been infected recently by a strain of the virus or were dealing with an active case.

“Our finding that white-tailed deer are frequently infected with SARS-CoV-2 viruses raises profound questions about the future trajectory of SARS-CoV-2,” the study says.

More than 1 million people in the U.S. were diagnosed with Covid-19 on Monday as a tsunami of omicron swamps every aspect of daily American life.

The highly mutated variant drove U.S. cases to a record, the most -- by a large margin -- that any country has ever reported. Monday’s number is almost double the previous record of about 590,000 set just four days ago in the U.S., which itself was a doubling from the prior week.

It is also more than twice the case count seen anywhere else at any time since the pandemic began more than two years ago. The highest number outside the U.S. came during India’s delta surge, when more than 414,000 people were diagnosed on May 7, 2021.

The stratospheric numbers being posted in the U.S. come even as many Americans are relying on tests they take at home, with results that aren’t reported to official government authorities. That means the record is surely a significant under-estimate.

The data from Johns Hopkins University is complete as of midnight eastern time in Baltimore, and delays in reporting over the holidays may have played a role in the rising rates.

The outbreak is also causing companies to halt their return-to-office steps, with the likes of Goldman Sachs Group Inc. and JPMorgan Chase & Co. adopting the more cautious stance of encouraging staff to resume working from home at the start of the new year.

The silver lining is that deaths from Covid haven’t similarly soared.

Rhode Island has updated its guidelines to allow COVID-positive staffers to work at hospitals and nursing homes that have announced their staffing to be at a crisis level.

The Rhode Island Department of Health told NBC 10 that it aligned its guidance with the new guidance from the Centers for Disease Control and Prevention for health care workers.

The health department says the CDC made the change to accommodate staffing shortages among healthcare workers.

According to the guidance, during a crisis designation, there are no staffing restrictions with prioritization considerations (e.g., asymptomatic or mildly symptomatic).

In the crisis designation, that includes all staff regardless of vaccination status.

For Conventional and Contingency status, staffers regardless of vaccination status need to isolate for five days with or without a negative tests if asymptomatic or mildly symptomatic (with improving symptoms) and continue to wear a well-fitting mask for an additional five days, according to the health department guidance.

Thousands of students and staff members in the Los Angeles Unified School District are set to miss the first day of the spring semester on Tuesday as the COVID-19 Omicron variant continues to surge across the nation. The district announced that as of 4 p.m. on Monday, 65,630 students and staff members have tested positive for COVID-19 in the week before school.

The school district had updated its guidelines for the return to school on Friday in light of the surge. All students and employees had to get tested for COVID-19, regardless of their vaccination status, between January 3 and January 10, and have to prove a negative result to go to school.

The district said that 424,230 students and employees took a baseline test prior to the start of the semester. As of Monday afternoon, the student positivity rate for COVID-19 cases is at 16.6% while the employee rate stands at 14.9%. Los Angeles County, according to its health department, has a testing positivity rate of 22.64% based on the seven-day daily average.

All students and staff will have to submit to weekly testing throughout January, regardless of their vaccination status, the school district said. Anyone who tests positive has to isolate for at least five days, and further isolation will depend on their symptoms. The district is also requiring that masks be worn at all times, both indoors and outdoors, and mandating that employees wear surgical grade masks or higher.

Picture a not-too-distant future when you can book that summer trip to Italy or you don't have to remember to take off your mask for graduation photos. After the past 25 months, forgetting the pandemic for even a little while may sound like a fantasy -- after all, the coronavirus has gotten our hopes up before.
But infectious disease experts say there just may be an end in sight. Maybe.
Well, let's say it's not outside the realm of possibility for 2022.

"I think if we do it right, we're going to have a 2022 in which Covid doesn't dominate our lives so much," said Dr. Tom Frieden, who was director of the US Centers for Disease Control and Prevention under President Obama and is now the CEO and president of Resolve to Save Lives.

What the next part of the pandemic looks like and when it will get there are what Dr. Yvonne Maldonado, an epidemiologist and infectious disease specialist at Stanford Medicine, and experts at federal agencies, academic colleagues and local public health leaders spent the holidays trying to figure out.

There was a general consensus among the experts about what happens next: "We really don't know exactly," Maldonado said.
There are disease models and lessons from pandemics past, but the way the highly infectious Omicron variant popped up meant the scientists' proverbial crystal ball got a little hazy.

"None of us really anticipated Omicron," Maldonado said. "Well, there were hints, but we did not expect it to happen exactly the way it did."

Omicron has done a lot. More than a quarter of the Covid-19 pandemic's total cases in the United States have been reported in the past month, during the Omicron surge, according to data from Johns Hopkins University.
As of Thursday, cases dropped at least 10% compared with last week in 14 states, but 26 states saw cases rise at least 10%, according to Johns Hopkins data.

The wave seems to have peaked in some areas where the Omicron variant first hit in the US, like Boston and New York. But it's still raging out of control in other parts of the country.

In Georgia, for instance, medical leaders in metro Atlanta said hospitals remain overwhelmed. With so many staff out sick, the National Guard now fills in the health care gaps in states like Minnesota. Louisiana Gov. John Bel Edwards said the "tremendous" amount of Covid-19 cases, hospitalizations and deaths has resulted in "as much as we've ever had in the state of Louisiana."

Infectious disease experts, however, see hope in what has happened in South Africa.
"South Africa's kind of our canary in the coal mine because they were able to pick up the Omicron variant first," Maldonado said.

"I anticipate in the short run -- being the next six weeks, four to six weeks -- that it's still going to be pretty rough," said Dr. John Swartzberg, an expert in infectious diseases and vaccinology and clinical professor emeritus at the University of California, Berkeley's School of Public Health. "It will be about the middle of February before we start to really see that things are getting better."

"If this spike flames out quickly, many experts think, there could be a "quiet period."
Swartzberg believes March through spring or into summer will be like last year, with a continued decline in the number of cases. "There will be a sense of optimism, and then we will be able to do more things in our lives," Swartzberg said. "I think May or June is going to really look up for us. I'm quite optimistic."

Part of his optimism stems from the fact that there will be a much larger immune population, between the increasing number of people who are vaccinated and boosted, and those who've caught Covid-19 during the Omicron surge.
"Generally speaking, the level of immunity in our population is going to be much higher than it was going into the Omicron pandemic, and that's going to help us not only with Omicron and Delta, if they're still circulating, but it will also help us with any new variants," Swartzberg said. "To what degree will depend on the availability of medicines to intervene."
That's because the coronavirus will probably never go away completely.

The next variant could be equally or even more transmissible than Omicron. It could give people more severe symptoms -- or no symptoms at all.

"It's not at all clear what comes next," said Dr. George Rutherford, an epidemiologist at the University of California, San Francisco. He said the virus could mutate gradually, like what happened with the Alpha and Beta variants. Or it could make a really large jump, like with Delta and Omicron. "What's next? It's a crapshoot."

The H1N1 flu virus, for example, was a novel virus when it started one of the worst pandemics in history in 1918 -- it infected one-third of the world's population and killed 50 million of them.

That pandemic eventually ended, but the virus is still with us today.

"That was the great-great-grandparent of all the H1N1 viruses we see every year," Maldonado said. "They've had many mutations since then, but it is from the same strain. So it's possible that this virus will do a similar thing."

The US still loses an average of about 35,000 people a year with the flu, according to the CDC. "And we go on with our lives," Swartzberg said. "I don't think it will ever go back to what it was, exactly."

Maldonado says "that's the best-case scenario."

With this flu-like scenario, the world needs to focus on protecting those vulnerable to severe disease, on making sure they get vaccinated and have access to monoclonal antibodies and antivirals, Maldonado said. Vaccine companies would need to make variant-specific vaccines so people can get a Covid-19 shot every year. The country also has to make testing better.


The in-between scenarios would be if there aren't enough antivirals or monoclonals to treat the people who get sick, or if vaccine manufacturers can't make variant-specific vaccines fast enough.

The worst-case scenario is if a variant escapes the protection of vaccines and treatments.
"I think that's less likely to happen," Maldonado said.

The US already has the tools to limit new variants and end the pandemic quickly, Dr. Panagis Galiatsatos says.
"I don't think we need any more scientific breakthroughs, we know how to stop severe Covid: vaccines," said Galiatsatos, an assistant professor of medicine and expert in pulmonary and critical care medicine at Johns Hopkins Medicine.
Face masks and testing also help.

"We have the weapons to transform Covid into nothing but a bad cold," Galiatsatos said. "We have the science. All people will need is access to the interventions, and we need to regain trust."

Only about a quarter of the US population is fully vaccinated and boosted, according to the CDC. The more people who are unvaccinated, the more end up in the hospital. The more cases, the more opportunity for dangerous new variants.
"That's why it's like a 'Choose Your Own Adventure,' " Galiatsatos said. "And I am choosing the kind that puts us in a better frame of mind that we reach people and get more people vaccinated and can end this pandemic and learn to adapt to this."

I think if we do it right

The biggest possibility of "viral qualitative change" is encountering a completely new host environment. For example, transmission through different intermediate hosts, such as transmission across temperature and humidity environments.

The immune system of the new host will push the virus to uncertainty, bringing constant changes and great challenges to the prevention of infectious diseases.

Therefore, extremely dangerous viruses are generally generated by cross-species transmission. This aspect tells us to really stop touching wild animals. On the other hand, it reminds us not to think that the virus will continue to weaken and ignore the virus's cross-species and regional environment. And other modes of transmission, but the possibility of virus enhancement.

Omicron tends to cause less severe illness, especially among the vaccinated. But it’s still too early to know a great deal about the relationship between Omicron and long Covid. Doctors, researchers and patient-led groups have cautioned that milder initial illness does not necessarily mean that Omicron is less likely to lead to long Covid than previous variants.

“You might have mild symptoms because your immune system has managed to fend off the virus in certain parts of your body,” my colleague Apoorva Mandavilli said. “For example, you may not feel a lot of respiratory symptoms. But that doesn’t mean that the virus is not slowly causing damage to some other parts of your body.”

Studies from earlier waves of the pandemic suggest that many people who had mild or asymptomatic reactions later developed long Covid that persisted for months. Omicron symptoms are, for the most part, similar to those of other variants, suggesting that long-term effects could also be similar.

But what about the vaccines — can they help prevent long Covid?

My colleague Pam Belluck dug into the question and found that the science was mixed.

Two large studies found that vaccinated people who had breakthrough infections were two to 10 times less likely to report symptoms weeks after their infections. But another study that analyzed 10,000 patient medical records in the U.S. found that being vaccinated before an infection did not reduce the risk of most symptoms of long Covid.

That said, Apoorva told me that most virologists she had spoken to thought it was unlikely that long Covid would be as common in breakthrough infections.

“I would say don’t be overly anxious,” Apoorva said, referring to vaccinated individuals. “I wouldn’t worry as much with a breakthrough infection, because you have immunity that kicks in at some point and gets rid of the virus.”

“One of the predominant theories is that there is persistent viral material in your body, and that’s what’s causing this long-term inflammation,” Apoorva added. “But if that’s the case, then having your immune system get rid of the virus fairly quickly is not going to make you very sick. It’s also maybe why some people with long Covid feel better after they are vaccinated.”

Our understanding of long Covid is also shifting, and some new research suggests that the symptoms may resolve over time in many people.

“We now have more people who are postinfection over a longer period of time, and as you go along, the percentage of people reporting long Covid symptoms gets smaller and smaller,” Apoorva said. “So the final percentage of people who have persistent symptoms for years, that’s not a huge number — we hope. The problem is we still just know so very little about long Covid.”