Would like to see published data on the number of influenza tests done in the United States in 2020 and 2021 compared to prior years. Medicine isn’t finding influenza because’s it’s not being looked for. There is a new cash cow in town.

Fauci’s statement in this interview suggest that wearing a mask is FAR more effective than flu shots since the apparent success (questionable) of wearing a mask has wiped out influenza better than prior years.

From 2019:

All see: RT-PCR Ct Value – Case Definition for the Vaccinated

Source

BY KEN CARLSON MAY 05, 2021 03:46 PM, UPDATED MAY 05, 2021 07:41 PM

Between Jan. 1 and April 28, California public health officials recorded 3,084 breakthrough cases of COVID-19 in people who were fully vaccinated. That’s out of 12.9 million people who were fully vaccinated.

“As more time passes and more people are fully vaccinated, it is likely that additional post-vaccination cases will occur,” the California Department of Public Health said in a statement. “The number of post-vaccination cases remains small.”

The California Department of Public Health said it’s trying to find COVID-19 cases among vaccinated people by reviewing case and vaccine records.

Post-vaccination cases are recorded if a person tests positive for SARS-Cov-2 two weeks after receiving the single-dose Johnson & Johnson shot or completing the two-dose Moderna or Pfizer vaccination.

The state health department did not have information on hospitalizations and deaths attributed to breakthrough cases.

As of April 26, the Centers for Disease Control and Prevention recorded 9,245 breakthrough cases among 95 million vaccinated in the United States, including 132 deaths. That’s an infection rate of .01 percent.

According to the federal agency, 45 percent of the post-vaccination cases were people age 60 and older. In 15 percent of the deaths, the person tested positive for the coronavirus but their death was not related to COVID-19. (double standard -FPS)

Nationally, the breakthrough cases included 835 hospitalizations, with about 70 percent of those patients exhibiting COVID-19 symptoms.

According to a CDC website, the efforts to study breakthrough cases are based on voluntary reporting from state health departments and not all cases will be counted. The CDC has not updated the number of breakthrough cases in nearly 10 days.

California’s health department said the data on breakthrough cases is consistent with findings the coronavirus vaccines are most effective in preventing severe illness.

“Given no vaccine is 100 percent effective at preventing COVID-19, we expect to find more post-vaccination cases as we continue to look for them and as additional data are received,” the state agency said.

Stanislaus County has reported 20 breakthrough cases of COVID-19 in people who were fully vaccinated.

Kamlesh Kaur, a county health services spokesperson, said of the 20 breakthrough cases one person was hospitalized. The county Health Services Agency is investigating whether the patient was hospitalized due to complications of COVID-19.

State and federal agencies are monitoring for cases of COVID-19 illness in vaccinated people to make sure the vaccines are effective. And thus far the number of confirmed cases is considered encouraging.

Health officials said they expect to identify more post-vaccination cases because the coronavirus vaccines are not 100 percent effective in preventing COVID-19 illness. The often-stated purpose of the vaccines administered by county clinics, pharmacies and health care providers is prevention of serious illness, hospitalization and death.

The vaccines are expected to minimize illness for those who become infected and make it less likely that people spread the contagious disease.

Kaur said the number of post-vaccination cases is low when considering 141,072 county residents have been fully vaccinated.

“The vaccines are supposed to prevent severe disease,” Kaur said. “This shows it is working.” (CDC changed how the the Ct of the RT-PCR test for the vaccinated -FPS)

Kaur said the county health agency is part of the effort to make sure the coronavirus vaccines are working. The information gathered on breakthrough cases is reported to the state, she said.

Andrew Sheeler of The Sacramento Bee contributed to this report.

Source

By MARISA KENDALL

PUBLISHED: November 1, 2020 at 6:00 a.m. | UPDATED: November 2, 2020 at 8:47 a.m.

The coronavirus pandemic seems largely to have spared the Bay Area’s homeless communities — few members have succumbed to the virus, and pandemic programs moved thousands of people into hotels and trailers.

Despite those efforts, the number of homeless people dying is skyrocketing.

Deaths in Alameda County’s unhoused communities increased 40% during the first nine months of 2020, compared to the same period last year. In Santa Clara County, deaths climbed 33%. They rose a staggering 123% in San Francisco.

Contra Costa County reported the lowest increase — 30% — but cautioned the Coroner’s Division may not accurately capture the housing status of all decedents. And while San Mateo reported just 20 deaths between January and September, that’s 54% higher than last year.

Those spikes were not directly caused by the virus: Just four of the 560 deaths reported in five-county Bay Area were confirmed COVID-19 cases. Instead, experts say, homeless populations are getting older and sicker, drug use is soaring, and the pandemic has made it more difficult for unhoused people to access healthcare and other services. And, there are more people on the streets to begin with.

For the outreach workers who get to know these people, and struggle to find them housing and help, each death is devastating. But it’s also a reminder of what is at stake when local officials write policies to address homelessness.

“Every year we lose people that we have cared for. That we have served,” said Andrea Urton, CEO of HomeFirst, which holds an annual memorial for unhoused people who die in Santa Clara County. “And we want to make sure the people in power, the people responsible for approving the housing, the people responsible for making sure services are engaged in the community — we want them not to forget out unhoused neighbors. We want them to remember if they don’t do something, someone is going to die and it will be on their hands.”

Each death provides a snapshot into the dangers of life on the streets. People died of drug overdoses and chronic alcoholism. They died in fires or drowned while intoxicated. They were hit by cars and trains, died by hanging or gunshot wounds, and succumbed to hypothermia. Some were malnourished. Men and women in their 70s died of heart disease, and babies not yet born died with methamphetamine in their systems.

“Homelessness is really devastating to health,” said Dr. Margot Kushel, a UCSF professor of medicine at Zuckerberg San Francisco General Hospital and director of the UCSF Center for Vulnerable Populations. “And it’s devastating to mental health.”

As the homelessness crisis has grown in the Bay Area, the number of people dying without a home also has increased steadily. But now, in some places, it’s happening more quickly. For example, in San Francisco, deaths increased by less than 10% between 2017 and 2018, and 2018 and 2019. This year, they’re up 123%.

The last state-wide count of homeless residents was in 2019, and the next won’t happen until January, so it’s impossible to tell how much of this year’s surge in deaths can be explained by a spike in the overall unhoused population.

In San Francisco, this year’s big increase in deaths likely is due to drug overdoses, according to Dr. Barry Zevin, medical director of street medicine and shelter health for the Department of Public Health.

Zevin’s office has not yet finalized cause of death information for the cases, but addiction and overdoses — with fentanyl at the forefront — have become a plague on San Francisco’s streets.

“It’s an out of control, massive drug crisis,” said 50-year-old Thomas Wolf, a drug policy reform advocate who faced addiction and homelessness himself in San Francisco before entering rehab in 2018.

And it’s not just San Francisco. In Alameda County, drugs or alcohol caused or contributed to more than a third of deaths in the first nine months of this year — compared to less than a quarter in 2017.

“Pretty much everywhere, in all the encampments, we see drug use,” said Alameda County Sheriff’s Office spokesman Sgt. Ray Kelly. “Fentanyl has been probably one of the worst drugs that has come into our society. It really is, it’s just as bad as the pandemic. It’s killing people at alarming rates.”

And coronavirus is making it worse, Kushel said. Typically, health professionals advise drug users to use with someone else, in case of an overdose. But with congregating discouraged during the pandemic, more people are getting high alone.

The pandemic also has impacted the region’s many elderly homeless residents who suffer from chronic health issues such as heart failure and diabetes, Kushel said.

As COVID-19 disrupted normal health services, most doctors began conducting preventative care appointments virtually instead of in-person — making it hard for unhoused people without access to a computer, phone or internet to receive care. That interruption is especially devastating for homeless communities, where about half of people are over 50, and people’s bodies generally break down at the same rate as someone 20 years older, Kushel said.

That helps explain why deaths spiked this year despite a massive push by state and local authorities to move unhoused people into hotels and other temporary housing, in an effort to protect them from COVID-19. Many of the people in the program already were chronically ill, and for some — like 65-year-old Terry Hammer — a bed indoors wasn’t enough. Four months after moving into a Milpitas hotel, Hammer, who had struggled with alcoholism for years, died of sudden cardiac arrest in August.

Though they couldn’t save everyone, Kushel still thinks those efforts made a significant impact.

“No matter how bad it is,” she said, “it would have been much worse had we not done all these things.”

Source

By Scott Greenstone Dec. 26, 2020 at 6:00 am Updated Dec. 29, 2020 at 10:08 am

Tish Roth and her husband Imra VanWolvelaere stand at the entrance to a homeless encampment in Seattle where people tested positive and a warning sign was put up by those living in the area. (Steve Ringman / The Seattle Times)

When more than a dozen people tested positive for the coronavirus at a homeless camp in South Park in July, despair set in.

“How long do I have to live?” Kenny Palazzo asked his case manager, Dawn Whitson, when he tested positive. Whitson, who works for REACH, the outreach arm of a local nonprofit drug treatment provider, told him he would most likely live, but he needed to isolate in a hotel and quarantine.

But Palazzo didn’t, and neither did almost everyone else who tested positive in this camp. They worried their belongings would be stolen while they were gone. Rumors swirled about homeless people being shipped off to FEMA camps or locked up.

Palazzo just didn’t want to die alone.

“If I was going to die, I was going to die on my own terms,” Palazzo said recently, recounting that time.

These hurdles foreshadow the massive barriers King County will face in 2021 trying to vaccinate thousands of homeless people in King County — particularly people living outside. So far, it is unclear where they will fall in vaccine priority.

People staying in homeless shelters are in the second tier of prioritization, along with other settings where people share space like nursing homes and correctional facilities. But the U.S. Centers for Disease Control and Prevention hasn’t yet offered much guidance on outdoor encampments. And in King County at last count, people living outside made up nearly half the homeless population at more than 5,500 — though that number has likely risen since the pandemic.

When it’s their turn, vaccinating the population of people living outdoors will be a huge logistical feat: Health officials must figure out how to distribute it to a geographically disparate group of people who are often impossible to find and tend to distrust institutional medicine — and then likely do it all again with a second dose.

On top of that, Seattle and King County’s public health department, which will be leading the charge, is staring down a federal funding cliff at the end of the year if Congress doesn’t extend emergency relief dollars, which may mean the agency has to lay off the staff who would distribute the vaccine to homeless and low-income people, King County’s public health officer said in a news conference earlier this month.

“We don’t have enough to sustain our work or build our work,” said TJ Cosgrove, who leads the public health department’s response to homelessness amid COVID-19. “This is ‘perfect storm’ stuff.”

As of yet, there have been few large-scale documented outbreaks outdoors: At the start of the pandemic, health workers feared a possible decimation of the homeless population, based on factors like a 50-year-old average life expectancy and high rates of preventable disease — but that fear hasn’t materialized in Seattle.

Experts say it’s something of a mystery why outbreaks never arose in the Seattle area’s homeless encampments, which have grown during the pandemic as shelters shrunk.

“We have been looking actively for it — as intensively as I think anyone can,” said Dr. Helen Chu, an infectious disease doctor who recently published a study on COVID-19 spread in Seattle-area shelters. “And we haven’t found it.”

Why hasn’t COVID-19 spread in homeless camps?

In July, in the South Park camp,Whitson and nurses from nonprofit health care provider Neighborcare Health told people to isolate in their tents and wear masks, but not everyone did, Whitson said. When the nearby food bank shut down with its own COVID-19 case, Whitson and Neighborcare worked frantically to deliver dozens of pizzas so people didn’t leave the camp looking for food.

Nevertheless, the outreach staff braced themselves for what they’d been expecting since the beginning of the pandemic.

“We really thought that was going to open the flood gates,” Whitson said, “that it would spread like wildfire. People know each other, they spend time with each other in tents and shelters. All of us expected this to be, like, the beginning.”

But the wave never came. The 15 cases associated with that site are the only ones that have been tracked outside to this day.

The camp in South Park where coronavirus emerged is a tight-knit group of people: Dean Williamson grew up with Kenny Palazzo in Renton and is his next-door neighbor today, staying in a tent less than 30 feet away.

“We shared cigarettes, we’re around each other every day,” Williamson said.

Williamson’s first coronavirus test was inconclusive and his second was negative, but he went to a publicly funded motel room in Kent anyway to stay away from the other campers who did test positive. When he came back, COVID-19 hadn’t spread to the other people in the camp or outside, and no one had had symptoms. He grew suspicious.

“This deadly, deadly virus that, for some reason, doesn’t affect homeless people?” Williamson said. “A bunch of political [expletive] is going on.”

There are many theories floating around about why only 15 COVID-19 cases have been found in outdoor communities in King County. The most obvious one is that the residents are outside all the time, where the virus doesn’t spread as quickly. They rarely gather in large groups, so there’s a low chance of a “super-spreader” event, according to Dr. Stephen Hwang, a Toronto doctor currently studying the spread of COVID-19 in homeless populations there.

“Being in a tent with four friends is probably lower risk than being in a shelter with a hundred other people,” Hwang said. “It’s really a numbers game.”

It’s also possible the virus already made its way through the population but undetected: 80% of the positive cases in King County shelters have been asymptomatic, according to Chu, the Seattle researcher. She thinks that’s because many of the old and particularly vulnerable homeless people were moved to hotels. But that percentage still strikes her as surprisingly high.

“Homeless people tend to have a lot more problems that would make them have symptomatic infection,” Chu said.

And there could be many more cases official counts miss. Only about 600 tests have been conducted in outdoor settings, according to Public Health – Seattle & King County, a fraction of the more than 14,000 tests in shelters.

The only reason it was caught at the South Park camp, Whitson and an outreach nurse said, was because a camper went to a local hospital for cancer treatment and tested positive there.

Vaccine skepticism

After his friends made it through COVID-19 apparently unscathed, Williamson no longer wears a mask except when bus drivers make him, and he says he won’t take the vaccine.

“If I got a bug and died, I could accept that. Really,” Williamson said. “I’ve had a good life.”

Many homeless people — who are often treated poorly in hospitals or by medical professionals, they say — are skeptical of doctors and prescribed treatments. About 45% of homeless people surveyed by the Seattle Flu Study got flu vaccinations so far this year.

Cosgrove, with King County’s public health department, pointed to the county’s success persuading thousands of homeless people to get vaccinated in the past three years. In an interview, he was more optimistic about being able to retain the staff that would distribute the vaccine to people living outside.

With his workforce intact, he hopes to replicate the agency’s ability to reach people during the last few years’ hepatitis A outbreak in the homeless population. So far, Public Health has vaccinated more than 5,500 people and hepatitis A diagnoses have plummeted.

Jody Rauch, a public health nurse who coordinates homelessness efforts with the Healthcare for the Homeless Network, said it’s because outreach workers keep coming back to the same places and building relationships over time.

“Sometimes it’s the second time — sometimes it’s the fifth time,” Rauch said.

Those relationships could be the key for this outbreak as well. At South Park, while Palazzo might be on the fence about a vaccine personally, he trusts Whitson, his outreach worker.

“If they came out with a good vaccine … I would take it,” Palazzo said. “I’d call Dawn and ask her if it was OK.”

Source

By GALE HOLLAND STAFF WRITER AUG. 21, 2020 8 AM PT

When the COVID-19 pandemic erupted, advocates predicted that a “time bomb” was about to go off in the homeless community.

Many homeless people live under conditions worse than those of a refugee camp, with health problems that predispose them to severe illness. Researchers feared they’d succumb in high numbers to the worst ravages of the disease.

But the powder keg has yet to go off. There has been little spread of the novel coronavirus in Los Angeles’ street encampments. Some shelters have had outbreaks, but most of those infected had no symptoms.

Of the more than 1,300 cases among homeless people in L.A. County, fatalities by mid-August stood at 31, a mortality rate comparable to or better than that of the overall population. An influential early paper had estimated the numbers were likely to go as high as 400 deaths and 2,600 hospitalizations.

“It definitely is and has been better than we expected,” said Heidi Marston, executive director of the Los Angeles Homeless Services Authority. Marston and county officials said an aggressive public health response, including a homeless hotel program, is paying off.

But homeless people in the rest of California and across the nation have had a better-than-expected time of it as well. And one reason might be the environment where nearly three-quarters of L.A.’s homeless people live: outside.

Social distancing is what everyone does with homeless people.

-UCLA ASSOCIATE PROFESSOR RANDALL KUHN

Living outside normally “weathers” homeless people, teeing them up for a host of diseases and early death. But during COVID-19 crisis, outside is safer than indoors because fresh air disperses droplets containing the virus and there’s more room to keep people apart, the Centers for Disease Control and Prevention has said. A small Japanese study released in April found the risks of transmission in a closed space were 19 times greater than in the open.

Of the 83 homeless service settings that Los Angeles County officials tracked for COVID-19 outbreaks, 19% were encampments, with 11% of the cases. The rest were shelters, hotels or recuperative centers.

“It’s possible being outside is protective relative to inside,” said Dennis P. Culhane, University of Pennsylvania professor and homelessness researcher who co-authored the early COVID-19 study.

Even in shelters, COVID-19 has not been the catastrophe that was predicted. Shelters in Boston, San Francisco and Nashville have had outbreaks, and at the Union Rescue Mission on skid row, 107 residents and staff were infected, leading to three deaths.

But most of those infected had no symptoms: In Boston, where every shelter resident was tested, the asymptomatic rate was 70% to 90%, said Dr. James O’Connell, assistant professor at Harvard Medical School and president of Boston Health Care for the Homeless Program, who called the finding “bizarre.”

“There is still much to learn to try to understand what trulyimpacts susceptibility,” said Dr. Anne Rimoin, professor of epidemiology at UCLA.

The apparent resiliency of homeless people in the face of a pandemic has so confounded expectations that researchers are looking at disparate and sometimes far-fetched causes. A small French study found less severe and symptomatic COVID cases among heavy smokers (most homeless people use tobacco). But an Italian study concluded the opposite, O’Connell said.

Researchers linked deficiencies of Vitamin D, which is absorbed from the sun, to more severe cases of COVID-19. But homeless people in Boston were tested and have the same vitamin deficiencies as other people, O’Connell said.

Could the virus have mutated into a milder strain? Or did homeless people build up a special resistance from bouts with previous coronaviruses or other illnesses?

“It has certainly crossed my mind, although I’m not sure there is any data to support that,” said Margot Kushel, professor of medicine at UC San Francisco and head of a university institute to end homelessness. “An easier explanation is the data on homeless infections is poor, and the homeless community is cut off from the rest of society.”

“We weren’t doing no traveling,” skid row resident Donald Stratton, 59, said last month, adding that he doesn’t know anyone who has tested positive for the virus.

“People down here are quarantined already,” said Natosha Smith, 41, who volunteers at the Los Angeles Community Action Network.

“Social distancing is what everyone does with homeless people,” said UCLA associate professor Randall Kuhn, co-author with Culhane of the early paper.

Testing of homeless people got off to a slow start, and an unknown number of homeless people might have died of stroke, cardiac arrest or other causes without their conditions being recognized as complications of COVID-19. Not all jurisdictions track deaths of homeless people, and homelessness is not always noted on death certificates.

“It’s hard to say that there have not been super-spreader events among people experiencing homelessness because we are far from having universal surveillance testing and most cases have been asymptomatic,” Bobby Watts, chief executive of the National Health Care for the Homeless Council in Nashville, said in an email.

Robert Kim-Farley, epidemiologist and infectious disease expert at the UCLA Fielding School of Public Health, said we won’t really know how homeless people in L.A. are faring until they undergo seroprevalence testing, which looks for antibodies left by past infections.

“The county is trying to do some additional targeting of subgroups, and it would make a lot of sense among homeless people, ” Kim-Farley said.

“I’m not so sure we can say there hasn’t been a huge hit,” Culhane said.

In the meantime, nearly every corner of the homeless delivery system has been modified to meet the COVID-19 challenge. Hundreds of wash stations have been placed near homeless encampments, pop-up testing went up on skid row and the Venice Boardwalk, and 26 city recreation centers were turned into temporary shelters, although most have since been closed — prematurely, critics said.

Project Roomkey, the hotel program, fell short of its goal but placed more than 4,000 medically fragile homeless individuals in lodgings. The city suspended encampment sweeps, although some service providers are worried about a recent City Council vote to resume cleanups around bridge-housing shelters, which are intended to be transitions to permanent housing.

“Cleanings are good but disrupting people’s lives is not a positive thing,” said Dr. Coley King, director of homeless services at the Venice Family Clinic.

“The Centers for Disease Control guidance has not changed on how to handle encampment cleanups: by not disrupting the people,” Marston said. “We’re hoping to find some middle ground, maintaining the cleanliness everybody wants to see but so we’re not putting people at further risk unnecessarily.”

Outreach workers handed out masks, food and water, while screening homeless people for virus symptoms and educating them about social distancing and other precautions.

“Quite a few teams are out there every day advocating for people to see if they need water, food and to do wellness checks so any symptoms are quickly evaluated … and to see if they need to go to the emergency room or be referred to isolation or quarantine,“ said Dr. Silvia Prieto, a county Department of Public Health official.

At the Salvation Army’s shelter in Bell, one of the largest in the nation, the population was more than halved, from 480 in March to 220. Two-person sleeping cubicles were reduced to one and residents sit two to a table in the cafeteria, separated by blue plexiglass.

“When it first started, people used to line up with masks hanging half off their face. Now they are very diligent about masks and social distancing,” said Bell Shelter Director Steve Lytle. “It is certainly a more muted environment.” He added that the shelter put on a Juneteenth celebration, a pride event and an In-N-Out burger truck day to lift spirits.

“It can be a little bit overwhelming after a while; you can’t be yourself at times,” said Bell Shelter resident Mahuro Cortez, 49. “But it feels so good to have a place to be.”

On skid row, homeless people are taking their health into their own hands. Stephanie Arnold Williams cranked out masks from her sewing station in a big white tent at 5^th and San Pedro streets, and the Los Angeles Community Action Network ginned up sidewalk wash stations from barrels.

At a recent Sunday Strong event at Community Action Network’s headquarters at 6th Street and Gladys Avenue , scores of people ran their hands under a wash station, grabbed masks and danced, pranced and vogued up a socially distanced line for sack meals with a side of hand sanitizer. The food was provided by grass-roots groups Miss Rodgers’ Neighborhood, Polo’s Pantry and Eayikes.

“Just because they’re homeless doesn’t mean people are not concerned about their health,” General Dogon, an organizer with the network, said over the ear-splitting sounds of Marvin Gaye and Watts 103rd Street Rhythm Band.

“We can’t let our guard down. These are very vulnerable people,” Kim-Farley said.

Source

By JANIE HARAugust 16, 2020

SAN FRANCISCO (AP) — When the coronavirus emerged in the U.S. this year, public health officials and advocates for the homeless feared the virus would rip through shelters and tent encampments, ravaging vulnerable people who often have chronic health issues.

They scrambled to move people into hotel rooms, thinned out crowded shelters and moved tents into designated spots at sanctioned outdoor camps.

While shelters saw some large COVID-19 outbreaks, the virus so far doesn’t appear to have brought devastation to the homeless population as many feared. However, researchers and advocates say much is unknown about how the pandemic is affecting the estimated half-million people without housing in the U.S.

In a country that’s surpassed 5 million identified cases and 169,000 deaths, researchers don’t know why there appear to be so few outbreaks among the homeless.

“I am shocked, I guess I can say, because it’s a very vulnerable population. I don’t know what we’re going to see in an aftermath,” said Dr. Deborah Borne, who oversees health policy for COVID-19 homeless response at San Francisco’s public health department. “That’s why it’s called a novel virus, because we don’t know.”

More than 200 of an estimated 8,000 homeless people in San Francisco have tested positive for the virus, and half came from an outbreak at a homeless shelter in April. One homeless person is among the city’s 69 deaths.

In other places with large homeless populations, the numbers are similarly low. In King County, which includes Seattle, more than 400 of an estimated 12,000 homeless residents have been diagnosed. In Los Angeles County, more than 1,200 of an estimated 66,000 homeless people have been diagnosed.

It’s slightly higher in Maricopa County, which includes Phoenix, where nearly 500 of an estimated 7,400 homeless people have tested positive, including nine who died.

Health experts say the numbers don’t indicate how widespread the disease is or how it might play out long term. It’s unknown how many people have died of conditions indirectly related to the virus. While the coronavirus may dissipate more easily outdoors than indoors, living outside has its own risks.

With public libraries and other places closed, homeless people say they’re short on food and water, restrooms and cash. In San Francisco, 50 homeless people died over an eight-week period in April and May — twice the usual rate, said Dr. Barry Zevin, medical director of the public health department’s street medicine program.

The official causes are pending, but Zevin notes that fentanyl overdoses are rising and stay-at-home orders may prevent people from getting help quickly. He knew isolation could result in more overdoses.

“I think that’s happened, and whether it’s more or less than I would have expected, I don’t know,” he said. “It’s frustrating to be able to forecast something as a problem, do everything you can to prevent it as a problem, but it’s absolutely a case of competing priorities.”

Good data is difficult to get on the homeless population because hospitals and death certificates don’t track housing status, says Dr. Margot Kushel, director of the Center for Vulnerable Populations at the University of California, San Francisco.

She was hesitant to draw conclusions about how the pandemic has affected homeless people overall but said “this may be an example where being outside and unsheltered, just in terms of COVID, maybe let people be at lower risk. But again, part of that is that we just don’t really know.”

New York City has reported more than 1,400 infections and 104 deaths among homeless residents out of more than 226,000 positive cases and 19,000 deaths. Roughly 60,000 people live in shelters, unlike in West Coast cities where many more are unsheltered.

But because New York’s shelters have more children than the general population, when deaths are adjusted for age, the mortality rate for homeless people is 67% higher than for the overall population, said Giselle Routhier, policy director for the Coalition for the Homeless.

“That’s extraordinarily high, in our opinion,” she said.

While advocates push for private hotel rooms for homeless people, a massive 1,200-person shelter at San Diego’s convention center is showing it’s possible to keep the case count low by strictly adhering to 6-foot (2-meter) spacing, frequent cleaning and mask-wearing.

“We have a team of firefighters that walk the floors to put the cots back where they’re supposed to be,” said fire Deputy Chief Chris Heiser, who is incident commander for the shelter.

He estimates about 3,000 people have come through. And of more than 6,000 COVID-19 tests administered, 18 so far have been positive. San Diego County has reported more than 200 positive cases and no deaths among its nearly 8,000 homeless people.

Richard Scott, who is in his mid-50s, moved to the convention center about three months ago after his roommate, who is medically fragile, told him that he could either stay home and not work or leave. Since then, Scott has slept on a cot alongside about 500 men in a cavernous room with high ceilings and a big floor.

Sometimes there’s a theft or disruptive person, but overall Scott calls it a safe place to stay.

“We wash our hands 20 times a day — well some of us — and we get our temperatures checked every day, and they’ve been real strict about that, too,” Scott said. “I’m so happy being here; it’s a blessing.”

Virginia McShane, 63, sleeps in a separate part of the center. She arrived in April after she could no longer afford a $25-a-night hostel.

“We’ve got a back entrance and a front entrance, and that keeps the air circulating pretty good, so I think that’s why all of us haven’t come down with the coronavirus,” she said.

The rates at which homeless people have tested positive for COVID-19 are all over the place, says Barbara DiPietro, senior policy director for the National Health Care for the Homeless Council, which is working with the Centers for Disease Control and Prevention to study the issue.

Surveillance testing of more than 10,000 people at shelters and encampments nationwide has resulted in a rate just over 8%. But DiPietro says over 200 testing events of homeless residents in five cities showed rates ranging from 0 to 66%.

“So this is a wildly variant, moving target depending on who and how and when you test,” she said.

___

Associated Press writer Anita Snow contributed to this story from Phoenix.

Source

You sometimes hear about lawsuits that result in damage awards with enough zeros to make your mind spin. Millions. Billions.

Despite what some people think, filing a lawsuit is never a get-rich-quick scheme. A single lawsuit can take years to get through the courts, the litigation process is expensive and time-consuming. But in some situations, it’s the only way to get what you deserve if you’ve been injured, whether in a car accident, truck accident, slip and fall, workplace accident, toxic exposure, by a defective product or medical device, or by a pharmaceutical drug.

Prescription drugs are a great relief to many of us because they treat everything from minor infections to serious, life-threatening conditions. Sometimes the risks outweigh the benefits, and that’s a conversation each person needs to have with their doctor before beginning a new drug or treatment.

Often, when a drug is recalled or when lawsuits are filed, it’s because the manufacturer failed to warn doctors and patients about dangerous side-effects or long-term issues. When the manufacturer doesn’t share important risk information with doctors, the doctors can’t provide their patients with a clear picture of the risks and benefits. As a result, patients use a drug that they think will help them, but they can end up having serious health problems in the long term.

The subject of many of the largest drug lawsuit settlements to date is how companies have misrepresented the drugs and their uses to physicians. In many of these cases, the lawsuits were filed because drug manufacturers promoted their products for uses outside of the scope of FDA approval.

Why do pharmaceutical companies misrepresent drugs?

Put simply: money.

When a company can claim that a drug is used for more purposes than it’s actually approved for, it can sell more product. And, in some cases, these uses aren’t inherently unsafe — they’re just not approved by the FDA.

But sometimes they are unsafe.

Some of the cases involve drugs being prescribed at higher doses than recommended, and in other cases the drugs have yet to be tested in clinical trials.

This is like Big Pharma playing roulette with your health. Your doctor is acting in good faith and prescribing medications according to what the manufacturer specifies is correct. That’s why the manufacturers are the ones being sued — they’re misleading doctors and the public about how these drugs function and what they can do.

Fortunately, in recent years the negligent actions of pharmaceutical companies are being called into question and lawsuits have been filed. These settlements are huge, even for some of the largest pharmaceutical manufacturers in the world.

Pharmaceutical company settlement amounts

Let’s take a look at the top 10 pharmaceutical settlements, in order of dollar amounts (highest to lowest). These can include a combination of criminal fines and civil settlements:

Company	Amount of penalties	Year
GlaxoSmithKline	$3 billion	2012
Pfizer	$2.3 billion	2009
Johnson & Johnson	$2.2 billion	2013
Abbott	$1.5 billion	2012
Eli Lilly	$1.42 billion	2009
Merck	$950 million	2011
Amgen	$762 million	2012
AstraZeneca	$520 million	2010
Actelion	$360 million	2018
Purdue Pharma	$270 million	2019

1. GlaxoSmithKline,  $3 billion

Drugs: Paxil, Wellbutrin, Avandia

GlaxoSmithKline holds the dubious distinction of being forced to pay the largest health care fraud settlement in U.S. history. The criminal fine was $956,814,400 with a forfeiture of $43,185,600. $2 billion was paid to resolve civil liabilities under the False Claims Act.

The penalties are related to deceptive marketing, including off-label promotion and kickbacks, and failure to report safety data.

GSK agreed to pay based on:

• Promoting Paxil, Wellbutrin, Advair, Lamictal, and Zofran for off-label and non-covered uses, in addition to paying kickbacks to physicians for prescribing those drugs.
• Giving kickbacks to physicians for prescribing Imitrex, Lotronex, Flovent, and Valtrex.
• Making false and misleading statements about Avandia’s safety.
• False reporting to the Medicaid Drug Rebate Program.

2. Pfizer,  $2.3 billion

Drugs: Bextra, Geodon, Zyvox, Lyrica

The criminal fine was $1.3 billion, and the additional $1 billion was for civil allegations under the False Claims Act. Pfizer falsely promoted Bextra, antipsychotic drug Geodon, antibiotic Zyvox, and antiepileptic Lyrica. The company was also accused of paying kickbacks related to these drugs and submitting false claims to government health care programs based on uses that weren’t medically accepted.

Bextra was pulled from the market in 2005 after it was deemed unsafe.

3. Johnson & Johnson,  $2.2 billion

Drugs: Risperdal, Invega, Natrecor

Criminal fines and forfeiture totaled $485 million, and civil settlements amounted to $1.72 billion.

In the early 2000s, Risperdal was approved to treat schizophrenia. However, the company’s sales representatives were promoting the drug to physicians as a treatment for elderly dementia patients for anxiety, agitation, depression, hostility, and confusion. There were also allegations that Risperdal was marketed for other unapproved uses, such as prescription to children and individuals with mental disabilities.

Invega and Natrecor were also included in these lawsuits as having been illegally marketed for off-label and unapproved uses.

4. Abbott,  $1.5 billion

Drug: Depakote

Criminal fines in this action were $700 million and civil settlements were $800 million. Abbott promoted Depakote as a drug to control agitation and aggression in elderly dementia patients, and for schizophrenia. The FDA hadn’t approved the drug for either of these uses. For 8 years, the manufacturer marketed Depakote for this purpose in nursing homes, even though there wasn’t any evidence that the drug was safe and effective when used that way.

In fact, the FDA had approved Depakote for epileptic seizures, bipolar mania, and migraine treatment. The manufacturer had actually discontinued clinical trials of Depakote for dementia treatment in 1999 because of adverse events, yet they still continued to market it publicly.

5. Eli Lilly,  $1.42 billion

Drug: Zyprexa (generic: olanzapine)

Eli Lilly promoted antipsychotic drug Zyprexa for uses outside the FDA’s approval, which resulted in criminal fines of $515 million and civil settlements of $800 million.

The FDA approved olanzapine in 1996 for treating psychotic disorders. It was later approved for treatment of manic episodes of bipolar disorder, and then for short-term treatment of schizophrenia. It was not approved for treatment of dementia or Alzheimer’s Disease.

However, Eli Lilly was marketing Zyprexa to primary care physicians even though it wasn’t a drug intended for the primary care market. As a result, physicians were prescribing it for patients of all ages for anxiety, irritability, depression, nausea, Alzheimer’s, and other issues.

6. Merck,  $950 million

Drugs: Vioxx (generic: rofecoxib)

The assessed penalties related to sales of Vioxx were $321,636,000 in criminal fines, $426,389,000 in civil settlements, and $201,975,000 distributed to Medicaid states.

The criminal component to the case related to Merck promoting Vioxx for treatment of rheumatoid arthritis when it wasn’t approved by the FDA for that use.

7. Amgen,  $762 million

Drug: Aranesp

Amgen introduced Aranesp for uses and at dosage levels that the FDA specifically didn’t approve because there wasn’t enough evidence to establish its safety. Amgen introduced the drug for oncology and nephrology physicians to prescribe to patients with anemia from chronic kidney disease or chemotherapy. The doses were larger and less frequently administered than what the FDA had approved.

Amgen also promoted Aranesp for cancer patients with anemia but who weren’t receiving chemotherapy, which was not an FDA-approved use. In fact, the FDA had determined that using it in that manner could cause an increased risk of death.

Amgen paid a criminal fine of $136 million and criminal forfeiture of $14 million. It paid $612 million to the federal government and $24.8 million to the states as its civil settlements.

8. AstraZeneca,  $520 million

Drug: Seroquel

Seroquel is an antipsychotic drug manufactured by AstraZeneca that was approved in 1997 by the FDA for treatment of psychotic disorders. In 2000, that approval was proposed to be narrowed to short-term treatment of schizophrenia only. In 2004, it was narrowed to short-term treatment of acute manic episodes associated with bipolar disorder. It was later approved for bipolar depression.

However, during this time, the manufacturer was marketing the drug for additional uses like treatment of aggression, Alzheimer’s, anger management, anxiety, attention deficit hyperactivity disorder, bipolar maintenance, dementia, depression, mood disorder, post-traumatic stress disorder, and sleeplessness — even though the FDA hadn’t approved Seroquel for those uses.

In addition, AstraZeneca paid kickbacks to doctors for authoring articles about the drug being used in ways that weren’t approved.

9. Actelion,  $360 million

Drug: Tracleer, Ventavis, Veletri, Opsumit

Each of these drugs is used to treat pulmonary arterial hypertension. Although the drugs are safe for patients to use, the manufacturer was sued because it violated the False Claims Act and Anti-Kickback Statute.

Actelion used a foundation to illegally pay copays for thousands of Medicare patients taking these drugs, which would also induce patients to buy them because the prices would be higher otherwise. It essentially set up a fund to cover copays of its own drugs, which undermines the Medicare copay structure which is designed to prevent drug price inflation. Actelion was then able to raise the price of Tracleer by nearly 30 times the overall rate of inflation.

10. Purdue Pharma, $270 million

Drug: OxyContin

Purdue Pharma has been accused of playing a role in the U.S. opioid epidemic. A recent settlement, which was with the state of Oklahoma, acknowledges that the manufacturer didn’t adequately warn physicians and the public about the risks of becoming addicted to OxyContin.

The settlement will go toward funding treatment centers, reimbursing the state for its related expenses, and medicine for addiction treatment.