Abuelo and I would always joke that he would never see another public health crisis like the COVID-19 pandemic in his lifetime. My grandfather was 83, after all, and a retired physician who enjoyed reading the news and staying connected to medicine

As his sole grandchild pursuing a medical career, I know that we shared a special bond. Abuelo was my role model and once I started medical school, I used our weekly phone calls to convey to him how excited I was to be following in his footsteps. Frequent visits home were well spent with trips to Abeulo’s house and more medical chats. 

But,  early in my unorthodox second year of medical school amid the COVID-19 pandemic, Abuelo suddenly passed away, taking with him a part of my medical journey.

Now I am eagerly approaching the end of my didactic learning at the Medical College of Georgia, in Augusta. Augusta University Health, the primary teaching affiliate for the Medical College of Georgia, continues to lead local vaccine efforts in the Central Savannah River Area. Students from the Medical College of Georgia and the College of Nursing at Augusta University are encouraged to participate in the effort in both non-clinical and clinical roles including by observing patients, loading syringes, and administering vaccines. 

After months of being confined to primarily virtual, lecture-based learning, many of us eagerly jumped at the opportunity to assist on the frontlines.

The COVID-19 vaccine had been accessible to our community members aged ≥75 years for about a week when I first made time to volunteer at a vaccine clinic. Sitting in the 15-minute post-vaccine waiting area as an observer, I couldn't help but notice the elderly patients. Several were accompanied by spouses, children, or grandchildren. The scene reminded me of the close relationships Abuelo had with his family in his last years of life. 

I wondered what he would have thought about the national vaccine distribution. I imagined him sitting next to me in the vaccine clinic and saying, “Amanda Marie, I am so proud.”

After a shift as a non-clinical volunteer, I felt it was time to learn how to administer the vaccine. The old teaching method “see one, do one, teach one” held true in the vaccine clinics, and after a couple of practice “jabs,” I was administering vaccines up to 8 hours-a-week while also showing many of my colleagues how they could help. I vaccinated people from all walks of life—different ages, occupations, ethnicities—but one couple stood out for me.

I greeted the older couple, linked arm-in-arm, as they took a seat at my station. Taking their vaccination cards, I asked them to confirm their names and dates of birth. I recognized the last name as Spanish and heard them anxiously whispering to each other as I completed their paperwork. Rarely do I do this, but I took a chance and asked where they were from.

I thought immediately about my grandparents. Abuelo graduated from the University of Havana Medical School, and he brought his family, including my father, to the United States from Cuba in the early 1970s.

I shared this with the couple as I rolled up their sleeves to give them their first doses of the new COVID-19 vaccine. They smiled and told me they had also immigrated from Cuba in the ‘70s. Acknowledging our shared history in both Spanish and English, they said that my family must be so proud of me. 

I had to fight back tears as I prepped them for the vaccine. I imagined what it would have meant to Abuelo to have been here and to have received the vaccine from me, too.

I often am still shaken thinking about the connection I shared with the couple from Cuba. While Abuelo is no longer with me, his legacy resonates deeply and will shape the physician I become. And he was right—he will never see another global pandemic. But I know that I will hold tightly to my memory of him and be better prepared should another one occur in my own lifetime.

Articles

As a second-year medical student volunteers at a COVID-19 vaccine clinic, the Spanish last name shared by the elderly couple now in front of her is a poignant reminder of why she chose medicine. 

Vaccine Clinic: If Abuelo Could See Me Now 

In 2019, reported annual cases of sexually transmitted diseases (STDs) in the US reached an all-time high for the sixth consecutive year, according to the 

 published April 13, 2021, by the Centers for Disease Control and Prevention (CDC). The annual report is based on case notification data provided to the CDC through the National Notifiable Diseases Surveillance System. 

The report showed significant increases in reported cases of chlamydia, gonorrhea, and syphilis. Exactly how much did cases increases? And in which populations? Find key takeaways in the 7-question quiz below. 

Slideshows

Rates of reported STD cases in the US have reached an all-time high, again. Are you caught up on the latest CDC numbers? Try your hand at these 7 questions to find out. 

US STD Rates Reach New Heights: A Quiz on CDC’s 2019 STD Surveillance Report

How many people in the US have been vaccinated against COVID-19?

Centers for Disease Control and Prevention

, as of today, May 7, 2021, at 1:34 PM, EDT:

The 5 states with the highest percentage of population fully vaccinated are:

How many cases of COVID-19 have been confirmed in the US?

, as of today, May 7, 2021 at 2:21 PM, EDT, there have been:

The 5 states with the highest total confirmed cases are:

 with 62 184 reported fatalities, followed by 

How many cases of COVID-19 have been confirmed globally?

Data from the Johns Hopkins COVID-19 interactive map and the CDC on COVID-19 vaccinations, cases, and deaths in the US and on cases and deaths worldwide.

COVID-19 Updates: US Vaccinations and Global Cases and Deaths as of May 7, 2021

Higher consumption of sugar-sweetened beverages (SSB) in adulthood and adolescence is associated with a more than 2-fold risk of early-onset colorectal cancer (EO-CRC, age <50 years at diagnosis), according to a new study 

Notably, the researchers, from Washington University School of Medicine, calculated that each serving-per-day increment of SSB intake among adolescents aged 13-18 years was associated with a 32% higher risk of EO-CRC.

Investigators point to a significant increase in incidence of EO-CRC in high-income countries over the past 20 years. They note that adults born around 1990 had 2 times the risk of colon cancer and 4 time the risk of rectal cancer compared to those born around 1950. There has been a parallel increase in consumption of SSB during this period with highest consumption found among adolescents and young adults aged 20 to 34 years.

The authors write that SSBs are the leading (39%) source of added sugar in the US diet and 12% of the population consume >3 servings per day.

"Colorectal cancer in younger adults remains relatively rare, but the fact that the rates have been increasing over the past three decades -- and we don't understand why -- is a major public health concern and a priority in cancer prevention," said senior author Yin Cao, ScD, an associate professor of surgery and of medicine in the Division of Public Health Sciences at Washington University, in a Washington University School of Medicine 

 "Due to the increase in colorectal cancer at younger ages, the average age of colorectal cancer diagnosis has gone down from 72 years to 66 years. These cancers are more advanced at diagnosis and have different characteristics compared with cancers from older populations."

In framing their rationale for the study, the authors cite the expanding body of evidence for a plausible link between metabolic conditions (eg, adulthood and adolescent obesity, early-onset type 2 diabetes) and EO-CRC. They state that investigation of a potential link between SSB intake throughout the life course with EO-CRC risk is a critical step to help reduce disease burden. The current study was designed to help address gaps in knowledge about the association.

The investigators used data from the Nurses Health Study II (NHSII), a large ongoing prospective study of >116 000 US female registered nurses aged 25-42 years at enrollment in 1989. Using results of a validated food frequency questionnaire (FFQ) administered in the study ever 4 years, a group of 95 464 women was identified who had reported types and estimated amounts of adulthood beverage intake. A subset of that group (41 272 participants) reported beverage intake at age 13–18 years using a validated high school-FFQ in 1998.

Adjustment for putative CRC risk factors in adults

Race, height, BMI, menopausal status & menopausal hormone use, family history of CRC, packyears of smoking, physical activity, regular use of aspirin or NSAIDs, current use of multivitamins, intake of alcohol, red and processed meat, dietary fiber, total folate, and total calcium.

Adjustment for putative CRC risk factors in adolescents

Race, height, BMI at age 18 years, pack-years of smoking before age 20 years, intake of alcohol at age 15–17 years, red and processed meat, dietary fiber, total folate, and total calcium at age 13–18 years, multivitamin use at age 13–18 years and physical activity at grade 9–12.

The primary end point of interest was the diagnosis of incident invasive EO-CRC (age <50 years at diagnosis) followed by analysis of association with SSB intake.

Participant records were reviewed for information on potential CRC risk factors, including family history of bowel cancer, lifestyle, regular use of aspirin or non-steroidal anti-inflammatory drugs and vitamin supplements, and colonoscopy/sigmoidoscopy.

Information was also collected on participants’ teenage health, including weight and lifestyle.

Among 95 464 women studied, there were 109 incident EO-CRC cases over up to 24 years of follow-up (average ~14 years).

 Higher SSB intake in adulthood was associated with a higher risk of EO-CRC after adjusting CRC risk factors. Compared with individuals who consumed <1/serving week, women who consumed ≥2 servings/day had a 2.2-fold higher risk of EO-CRC (RR 2.18; 95%CI 1.10 to 4.35; p

=0.02), with a 16% higher risk per each additional serving/day of SSB intake (RR 1.16; 95%CI 1.00 to 1.36).

SSB intake in adolescents also was associated with a higher risk of EO-CRC. Each serving/day increment of SSB intake at age 13–18 years was associated with a 32% higher risk of subsequently developing EO-CRC (RR, 1.32; 95%CI 1.00 to 1.75). Estimates were only slightly attenuated after adjustment for adulthood intake of SSBs and total calories slightly attenuated the effect estimates.

When they analyzed the impact of substituting SSBs with artificially sweetened beverages (ASBs), as well as coffee, reduced fat milk, or total milk, investigators found a 17% - 36% lower risk of EO-CRC.

In a stratified analysis for adulthood SSB intake and risk of EO-CRC, the positive association did not substantially vary by family history of CRC, BMI, alcohol use, cigarette use, and adolescent SSB intake (all p

"Despite the small number of cases, there is still a strong signal to suggest that sugar intake, especially in early life, is playing a role down the road in increasing adulthood colorectal cancer risk before age 50," said Cao in the Washington University statement. "This study, combined with our past work linking obesity and metabolic conditions to a higher risk of early-onset colorectal cancer, suggests that metabolic problems, such as insulin resistance, may play an important role in the development of this cancer in younger adults."

The authors note, too, that given downward trends, “limiting SSB intake may serve as an effective and actionable strategy to curb the rising incidence of EO-CRC.”

The authors point to several study limitations, including the observational design, the homogeneity of participants, and the low number (<2%) of participants with diabetes (limited ability to stratify results by personal history of diabetes).

A new study found that women who consumed ≥2 servings/day of sugar-sweetened beverages had a 2.2-fold higher risk for early onset CRC vs those who had less than 1 serving/week. 

Sugar-sweetened Drink Consumption May Increase Risk for Early-onset Colorectal Cancer 

, as of today, May 6, 2021, at 5:05 PM, EDT:

, as of today, May 6, 2021 at 4:21 PM, EDT, there have been:

 with 62 131 reported fatalities, followed by 

COVID-19 Updates: US Vaccinations and Global Cases and Deaths as of May 6, 2021

Researchers in Denmark found that 1 in 4 patients with myocardial infarction (MI) have atypical symptoms—such as breathing difficulties, extreme exhaustion, and abdominal pain—and were less likely to receive emergency help and more likely to die within 30 days compared to those with chest pain.

The study was published today online ahead of print in 

European Heart Journal – Acute Cardiovascular Care

, a journal of the European Society of Cardiology (ESC).

“We found that atypical symptoms were most common among older people, especially women, who called a non-emergency helpline for assistance,” said study co-author and PhD candidate Amalie Lykkemark Møller, Nordsjællands Hospital, Hillerød, Denmark, in an 

. “This suggests that patients were unaware that their symptoms required urgent attention.”

Though symptom recognition is critical in reducing delays in treatment for patients with MI, “Little is known about how symptoms influence the actions of patients and medical services and impact survival,” Møller added in the press release.

For this reason, researchers aimed to examine the associations between initial symptoms, the chance of receiving an emergency dispatch, and 30-day mortality among patients with acute MI.

Møller and colleagues collected data on all calls made to a 24-hour medical helpline and an emergency number in Copenhagen, Denmark from 2014 to 2018. Both emergency services registered the primary symptom and the response.

Researchers identified adults aged ≥30 years who were diagnosed with MI within 72 hours of the call. Study participants were then divided into groups according to their primary symptom.

During the 5-year study period, a specific primary symptom was recorded for 7222 of 8336 heart attacks. The most common symptom reported was chest pain (N=5219), followed by breathing problems (N=556).

“People with atypical symptoms more often called the helpline, which could indicate that their symptoms were milder, or they were not aware of the severity. Vague symptoms may contribute to health staff misinterpreting them as benign.”

Along with breathing difficulties, other atypical symptoms reported were extreme exhaustion, impaired consciousness, and abdominal pain; however, Møller noted that in most cases these issues are not caused by MI.

“Unfortunately, people in this situation will not know the cause, but we hope our study improves awareness – particularly among older patients and health professionals – that it could be a heart attack,” Møller said in the press release.

The prevalence of chest pain was highest among men aged 30-59 years calling the emergency number and lowest among women aged ≥79 years calling the medical helpline. Atypical symptoms were mainly found among older patients, particularly women, who called the medical helpline, according to the ESC press release.

The results also showed that among patients with chest pain, 95% of emergency calls and 76% of non-emergency calls received emergency dispatch. For participants with atypical symptoms, however, 62% of emergency calls and 17% of non-emergency calls received emergency dispatch.

“Taken together, our results show that heart attack patients with chest pain were three times more likely to receive an emergency ambulance than those with other symptoms,” Møller added in the press release. “People with atypical symptoms more often called the helpline, which could indicate that their symptoms were milder, or they were not aware of the severity. Vague symptoms may contribute to health staff misinterpreting them as benign.”

The 30-day mortality rate for participants with chest pain was 5% among those who called the emergency number and 3% among those who called the medical helpline. Mortality rates were higher among participants with atypical symptoms: 23% and 15% of participants died within 30 days after calling the emergency number and medical helpline, respectively.

After standardizing for age, sex, educational level, diabetes, previous MI, heart failure, and chronic obstructive pulmonary disease, the 30-day mortality rate was 4.3% for participants with chest pain and 15.6% for those with atypical symptoms.

“Death within 30 days was more than three-fold higher in those with atypical symptoms compared to chest pain,” Møller concluded. “This could be due to treatment delays caused by not receiving the appropriate emergency dispatch. However, it is unknown whether an increase in emergency dispatches alone would improve survival among heart attack patients with atypical symptoms – we aim to investigate this in future research projects.”

Atypical symptoms were most common among older patients with myocardial infarction, especially women, who called a non-emergency helpline for assistance, study authors found.


Atypical Symptoms of Heart Attack Associated with 3-fold Higher Mortality Rate, New Study Finds

In persons with type 2 diabetes (T2D), poor adherence to medications, as measured using biochemical urine testing, is associated with a significantly higher prevalence of micro- and macrovascular complications compared with taking medications as prescribed, a new study finds.

Researchers in the Netherlands assessed real-world adherence to 3 main drug classes in patients with T2D to determine the association of poor treatment adherence with complications, treatment targets, and baseline demographics. Results appear in the April issue of 

Investigators, led by Jelle Beernink, of Ziekenhuis Groep Twente, Almelo, the Netherlands, analyzed study entry data on 457 patients in the observational prospective cohort DIAbetes and LifEstyle Cohort Twente (DIALECT) study. Baseline urine samples were analyzed using liquid chromatography–tandem mass spectrometry to determine participant adherence to oral antidiabetic drugs, antihypertensive agents, and statins. 

The primary outcomes of interest were microvascular and macrovascular complications and treatment targets of LDL-C, A1c, and blood pressure. Cross sectional analysis was performed at baseline.

Average age of study participants was 64 years and average duration of diabetes was 11 years.

The majority of participants were identified as adherent, with 89.3% having detectable levels of all prespecified metabolites on evaluation of 24-hour urine samples. Medication adherence overall, based on urinalysis, was 95.7% for OADs, 92.0% for antihypertensive medications, and 95.5% for statins.

Prevalence of microvascular complications was significantly higher among nonadherent vs adherent patients (81.6 v. 66.2%; P = 0.029) and the same was true for macrovascular complications (55.1 vs. 37.0%; P = 0.014). The percentage of patients reaching an LDL-C target of ≤2.5 mmol/L also was lower (67.4 vs 81.1%; P = 0.029) in nonadherent patients.

Baseline demographics and clinical variables were comparable between those who were and were not adherent with treatments. There were some notable differences, however, with smoking being more prevalent among those poorly adherent (28.6% vs 15.0%); number of medications being taken higher in that group (median 8 vs 7); and A1c and LDL-C levels also being higher.  

Based on binary logistic regression analysis, higher BMI, current smoking, elevated serum LDL-C, higher A1c, presence of diabetic kidney disease, and presence of macrovascular disease all were associated with nonadherence.

It is possible, the authors suggest, that lack of adherence to prescribed regimens was not recognized by the treating physicians, which in turn, they conclude, "emphasizes the importance of objective detection and tailored interventions to improve adherence."

The authors note that the relatively high baseline adherence with medication (89.3%) may be a characteristic of the study cohort given it was drawn from specialty outpatient clinics of 2 hospitals, participants having been referred from primary care after being unable to reach A1c targets or for the presence of cardiovascular complications. 

Beernink et al write that people “treated in specialist care may feel more urgency to adhere to their treatment in comparison with patients treated in primary care."

However, among poorly adherent participants in this group micro- and macrovascular disease were significantly higher and important cardiometabolic treatment targets were not met. It is possible, the authors suggest, that lack of adherence to prescribed regimens was not recognized by the treating physicians, which in turn, they conclude, "emphasizes the importance of objective detection and tailored interventions to improve adherence."

Robust analyses of urine metabolites detects poor adherence with prescribed treatment in T2D and is associated with prevalence of micro- and macrovascular complications. 

T2D Complications Associated with Objective Measure of Poor Medication Adherence 

The COVID-19 pandemic resulted in a surge in demand for health care, leading to widespread shortages of PPE, staffing, hospital beds, and more. During this time, the Institute for Safe Medication Practices (ISMP) issued a 

 that raised concerns about the alarming conditions, which one nurse described as ‘pandemic nursing,’ and which was increasing the risk for errors.

While many of these errors reared an ugly head much more frequently as the pandemic progressed, they are unfortunately all too common in a non-pandemic setting as well. The lessons learned over the past year and a half can, and should, result in the development of best practices that become standard at hospitals nationwide.

 have been estimated to be a third-leading cause of death. Remaining vigilant after the COVID-19 pandemic can help us fight this ongoing, silent pandemic.

Problem 1: Inadequate staffing and resources

Inadequate staffing and resources have added fuel to the fire and contributed to several reported errors. One problem, as the ISMP report notes, is that nurses often spent several hours in a patient’s room in isolation and so brought in everything they needed for that visit at one time. If they ended up with leftover medications or supplies, they often put them in a drawer or closet to use later.

Unfortunately, it’s all too easy to forget to bring something into a room initially, too. In many situations where that happened, it was common for a nurse to search those same drawers and closets to attempt to find what they needed. That increases the risk of giving the wrong medication or using the wrong type of medical device.

PPE shortages also meant nurses could only change gloves between patients and were in the same PPE for an entire shift, often sweating profusely which caused physical discomfort and added to the mental and physical fatigue. 

ISMP recommends involving pharmacy staff in safety huddles and discussing specific medication concerns with them.

They also recommend numerous solutions to help prevent medication errors, most of which are also best practices that should be continued long after the world has gained better control of COVID-19.

Simple solutions to help prevent errors include

Different packaging (eg, syringe vs IV bag)

Standardizing to a single concentration of a high-risk infusion

Standardizing the infusion rate and ensuring Smart Pumps are programmed as such

For common infusions, using premixed, commercially available solutions that look different

Clearly labeling all IV lines between the smart pump and the source container

Establishing a process for conducting independent double checks before critical infusions

Conducting daily safety huddles with doctors, nurses, and pharmacists

The high volume of patients during the pandemic, combined with strained resources and difficulty in maintaining standards of practice, have all contributed to stress and have strained the culture of safety. Errors have often gone unreported for fear of retribution.

One nurse interviewed by ISMP noted the critical care nurses were being given 2 seriously ill, ventilated patients and 1 recovering patient per shift, a far cry from the standard 

 of an ICU. Combine that with administration of multiple 

 per patient and physical and emotional exhaustion and it creates an environment ripe for errors.

Unfortunately, many of the solutions those same nurses suggested were falling on deaf ears, according to the ISMP report. Managers and leadership were frustrated by the frequency of errors and felt unable to do anything about it, so blame was turned on individual nurses, or if it was unclear who made the error, the nursing staff as a whole.

Some ways to reduce stress and promote a positive culture include:

 is a hallmark of high reliability organizations – seek solutions from those with the most experience, which in this case is frontline staff.

Management and hospital leadership should take an active role in seeking opportunities for improvement.

Management and hospital leadership should also lead in creating a 

Supporting frontline leaders, while holding them accountable, will help their department to do their best work.

 have published tips on supporting frontline staff.

Surges of COVID-19 patients flooding emergency departments and ICUs required not only more material resources but also more human resources. Unfortunately, there is no way to quickly scale up on experienced critical care staff.

 to last-year medical students, offering them an internship or job at the hospital until their residency started, and 

 were brought back into practice. Doctors who had 

 in critical care, like psychiatrists and ophthalmologists, were also being reassigned to the critical care setting.

These factors increased the risk for errors. In particular, a lack of experience with ventilator management 

 as a cause of errors in some cases. Add to that the initial absence of any treatment guidelines for COVID-19 because its cause was a novel virus, and you end up with a very challenging – and dangerous – health care environment.

 to address inexperienced staff was to have experienced critical care physicians supervise larger teams of physicians and nurses less experienced with critical care. Doing so allowed them to maximize the amount of care they were able to safely provide.

 with the authors, describes some potentially long-lasting effects of the COVID-19 pandemic on medical education, including:

Exploring the possibility of earlier graduation of medical students

Expanding public health education in medical schools, which could help with other public health crises, like the opioid epidemic or disparities in health care

Shifting medical school education philosophy from one of knowledge to one of problem solving.

Patients infected with COVID-19 have overwhelmed hospitals and their personnel.  The consequences of depleted resources, severe stress, and inexperience hold essential lessons. 

Preventing Medical Errors: Pandemic Lessons Learned 

The US Preventive Services Task Force (USPSTF) on May 5 posted a draft recommendation statement indicating that evidence is insufficient to determine the benefits and harms of taking most vitamin, mineral, and multivitamin supplements to prevent heart disease and cancer. 

However, while the benefit or harm of most supplements is unclear, the task force found specifically no benefit associated with taking vitamin E (I recommendation) and that harms outweigh benefits associated with taking beta-carotene (D recommendation). There is no evidence that either of them reduces the risk of heart disease and cancer.

“The Task Force recommends against the use of vitamin E or beta-carotene for the prevention of heart disease and cancer,” said Task Force member John Wong, MD in a Task Force 

. “The evidence shows there is no benefit to taking vitamin E and that beta-carotene can be harmful because it increases the risk of lung cancer in people already at risk, such as those who smoke, and also increases the risk of dying from heart disease or stroke.”

 is based on review of 14 180 unique citations and 351 full-text articles drawn from common medical databases for the period between January 2013 and August 2020. Surveillance continued for relevant literature through January 22, 2021.

“Because heart disease and cancer are the two leading causes of death in the US, we want to look at whether taking vitamins and minerals help [sic] prevent these important diseases,” said Chyke Doubeni, MD, MPH, a task force member and inaugural director of the Mayo Clinic Center for Health, Equity and Community Engagement Research, in the statement. “However, there is not enough evidence to know if taking vitamin, mineral and multivitamin supplements prevent these conditions, so the task force is calling for more research.”

The draft recommendation does not apply to people who are or who may become pregnant, according to the recommendation statement. For these individuals, the task force previously issued a separate statement that recommends folic acid supplements.

"We conclude that most vitamin and mineral supplements provide no clinically important protective effects for CVD, cancer, or all-cause mortality in healthy adults without known nutritional deficiencies , with vitamin E having the strongest body of evidence demonstrating no benefit for most outcomes relevant to this review. These conclusions are generally consistent with those of the previous review for the USPSTF on this topic."

The Task Force states in the draft, also, that because the focus of the review on CVD and cancer, it does not address other potential benefits of supplemental vitamins and minerals on other outcomes. In addition, the studies reviewed are in predominantly healthy populations without known deficiencies and so the review does not cover therapeutic supplementation in those with medical conditions or nutritional deficits.

Authors wrote that more research is needed on the effects of vitamin D, vitamin C, and folic acid administered with other B vitamins on CVD and cancer prevention.

“The evidence base demonstrating no benefit of vitamin E on cancer and CVD is robust and does not warrant resource investment in major new de novo studies,” wrote review authors. “Given the risks identified for beta-carotene, we see no need for further research on the role of beta-carotene in CVD and cancer prevention, nor, by extension, for vitamin A.”

The public can comment on the draft recommendation on 

The USPSTF states that evidence is insufficient to determine benefits and harms of most supplements for prevention of the diseases but warns against vitamin E and beta-carotene. 

USPSTF: Vitamin E, Beta-carotene Supplementation Not Recommended for CVD, Cancer Prevention 

, as of today, May 5, 2021, at 1:42 PM, EDT:

, as of today, May 5, 2021 at 1:08 PM, EDT, there have been:

 with 61 967 reported fatalities, followed by 

Data from the Johns Hopkins COVID-19 interactive map and the CDC on COVID-19 vaccinations, cases, and deaths in the US and on cases and deaths worldwide. 