How many fully vaccinated Americans have received a booster dose?

Centers for Disease Control and Prevention (CDC)

, as of today December 1 2021, at 4:00 PM, EDT, 

 in the US have received a booster dose of COVID-19 vaccine since August 13, 2021. 

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

 as of today, November 12, 2021, at 3:25 PM, EDT:

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

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

, as of today, December 1, 2021 at 5:23 PM, EDT, there have been:

The 5 states with the highest total confirmed cases are:

 California has the highest number of deaths due to COVID-19

 with 74 545 reported fatalities, followed by 

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

Articles

Data from the CDC on boosters and US vaccination rates and from the Johns Hopkins COVID-19 interactive map on cases and deaths in the US and worldwide.

COVID-19 Updates: US Vaccinations, Booster Doses, & Global Data as of December 1, 2021

A US Food and Drug Administration (FDA) advisory committee voted 13-10 to recommend the investigational oral antiviral molnupiravir (Merck, Ridgeback Biotherapeutics) for adults at high risk for progressing to severe COVID-19.

While the Antimicrobial Drugs Advisory Committee (AMDAC) was largely split, the panel ultimately voted that the known and potential benefits of molnupiravir outweighed the risks for the treatment of mild-to-moderate COVID-19 in high-risk persons who are within 5 days of symptom onset.

Efficacy was a point of concern among panel members because of updated results from the phase 3 MOVe-OUT trial of molnupiravir that showed the novel drug was not as effective as previously thought.

 the first set of results from the phase 3 trial in October 2021, which showed a relative risk reduction of approximately 50% in the molnupiravir treatment arm; however, the 

 showed a relative risk reduction of approximately 30%.

There was also considerable discussion about the safety of molnupiravir, particular among pregnant women, after preclinical studies suggested embryo-fetal toxicity among those who received the medication.

In addition, there was a lot of back and forth on the risk of drug resistance if patients do not complete the 5-day course, as well as potential mutagenicity. Ultimately, the lack of “real-world” options propelled many committee members to vote yes.

"There's a potential concern for a lack of availability for an alternative therapy for those at high-risk, perhaps considering the loss of efficacy with monoclonal antibodies with variants," said Michael Green, MD, of the University of Pittsburgh School of Medicine, who voted yes during the 

The panel noted that their decision may be temporary as other drugs in the pipeline could present better data. For example, 

 recently announced their novel oral COVID-19 antiviral reduced the risk of hospitalization and death by 89% in non-hospitalized high-risk adults with COVID-19.

The final decision to grant emergency use authorization to Merck for molnupiravir is now up to the FDA, and while it does not need to follow the AMDAC’s recommendation, it historically has.

The 13-10 vote was not without controversy as panel members discussed concerns over the novel antiviral's safety risks and modest efficacy. 

FDA Advisory Committee Narrowly Backs Merck’s Oral COVID-19 Antiviral

The US Centers for Disease Control (CDC) announced early this afternoon that the first case of infection with the 

virus had been detected in the US. The patient had traveled from South Africa, is quarantining, and has mild symptoms that appear to be resolving. 

That is the most recent update as of this writing on the rapidly flowing stream of news on the status of the spread of 

Following are topline excerpts from reports posted in the past 3 days by leading news outlets to bring you up to date.     

Slideshows

The Omicron variant of COVID-19 was today identified for the first time in the US, according to the CDC. Get a topline look at other recent breaking news in this slide show.  

Omicron Variant Update: Notes on Headline News 12-1-2021

Now that any US adult aged ≥18 years can receive a COVID-19 booster dose, have they actually started getting it? According to the US 

Centers for Disease Control and Prevention

, as of November 29, 2021, a number of fully vaccinated persons have already rolled up their sleeves in several states. Which states have the highest percentage of fully vaccinated adults with a booster dose? Scroll through the slides below for the top 10. 

Find out which states have the most fully vaccinated persons who have received a COVID-19 booster dose in this quick slideshow. 

COVID-19 Booster Shot Report Card: 10 Highest-ranked States

, as of today November 30 2021, at 4:14 PM, EDT, 

, as of today, November 30, 2021 at 4:23 PM, EDT, there have been:

 with 74 437 reported fatalities, followed by 

COVID-19 Updates: US Vaccinations, Booster Doses, & Global Data as of November 30, 2021

Pharmacologic options for obesity management have been limited, but increased understanding of the pathophysiology of the disease of obesity has given rise to promising drug targets and novel therapeutic strategies, according to the authors of a  recent review in 

The authors point to a broad range of systems and tissues being investigated as sites of targets for pharmacotherapy including the central nervous system, gastrointestinal hormones, adipose tissue, kidney, liver, and skeletal muscle.

Scroll through the slides below for concise summaries of new obesity drugs under investigation and coming into play in 2021.

Obesity and its causes are the focus of extensive research evaluating new therapeutic targets. Get an at-a-glance update on progress and FDA approvals during 2021

Obesity Drugs in Development: A brief overview of the pipeline 

Bariatric surgery among patients with obesity and nonalcoholic steatohepatitis (NASH) significantly lowered the risk of adverse liver outcomes and major adverse cardiovascular events (MACE) vs nonsurgical management according to results from a recent Cleveland Clinic study published online in JAMA.

Specifically, the investigators report that undergoing bariatric surgery was associated with an 88% reduction in risk of progression of fatty liver to cirrhosis, liver cancer, or liver-related death and with a 70% reduction in risk for MACE. In the absence of approved pharmacotherapy for fatty liver disease, according to lead investigator Ali Aminian, MD, director of Cleveland Clinic’s Bariatric & Metabolic Institute, the findings provide support for bariatric surgery as a therapeutic option for this high-risk population.

“The SPLENDOR study shows that in patients with obesity and 

, substantial and sustained weight loss achieved with bariatric surgery can simultaneously protect the heart and decrease the risk of progression to end-stage liver disease,” said study senior investigator, Steven Nissen, MD, chief academic officer of the Heart, Vascular and Thoracic Institute at Cleveland Clinic, 

. “This is the first study in the medical field reporting a treatment modality that is associated with decreased risk of major adverse events in patients with biopsy-proven NASH.”

To compare the effects of bariatric surgery with nonsurgical management of 

 in patients with NASH, Cleveland Clinic investigators drew on data from the Surgical Procedures and Long-term Effectiveness in NASH Disease and Obesity Risk (SPLENDOR) study. SPLENDOR, which was designed to assess the long-term associations between bariatric surgery and future risk of progression to cirrhosis and MACE, collected data from 25 828 patients who had a liver biopsy performed between 2004 and 2016 and were followed through March 2021.

Of the 25 828 patients for whom liver biopsy data were available, 1158 fulfilled enrollment criteria, including having clinical obesity and confirmed histological diagnosis of NASH and presence of liver fibrosis (histological stages 1-3). The final study sample was 63.9% women, had a median age of 49.8 years, and median BMI of kg/m

; 650 patients underwent bariatric surgery (Roux-en-Y gastric bypass, sleeve gastrectomy) and 508 received nonsurgical care. The median follow-up for all patients was 7 years. After overlap weighting, the researchers report, distribution of baseline covariates, including histological severity of liver injury, was well-balanced.

Primary outcomes of interest for Aminian and colleagues were the incidence of major adverse liver outcomes and MACE. Major adverse liver outcomes included progression to clinical or histological cirrhosis, development of hepatocellular carcinoma, liver transplantation, or liver-related mortality. MACE was defined as a composite of coronary artery events, cerebrovascular events, heart failure, or cardiovascular death. Associations with bariatric surgery were estimated using the Firth penalized method in a multivariable-adjusted Cox regression analysis framework.

“No treatment other than bariatric surgery has been shown to have such a significant effect in reducing the risk of severe outcomes or death in patients with NASH. Bariatric surgery should be considered a first-line treatment for these patients.”

Shanu N. Kothari, MD, 
President, American Society for Metabolic and Bariatric Surgery

At the end of the follow-up period, in the unweighted data set, 5 patients who received bariatric surgery and 40 in the nonsurgical group experienced major adverse hepatic outcomes, according to the study. MACE in the unweighted data set was experienced among 39 patients in the bariatric surgery group and among 60 who did not undergo surgery.

Among the patients analyzed with overlap weighting methods, the cumulative incidence of major adverse liver outcomes at 10 years was 2.3% (95% CI, 0-4.6) in the bariatric surgery group and 9.6% (95% CI, 6.1-12.9) in the nonsurgical group (adjusted absolute risk difference [ARD], 12.4% [95% CI, 5.7-19.7]; aHR, 0.12 [95% CI, 0.02-0.63]; 

=.01). The cumulative incidence of MACE assessed at 10 years in the bariatric surgery group was 8.5% (95% CI, 5.5%-11.4%) and 15.7% (95% CI, 11.3-19.8) in the nonsurgical group (adjusted ARD, 13.9% [95% CI, 5.9-21.9]; aHR, 0.30 [95% CI, 0.12-0.72]; 

The investigators report that 4 patients (0.6%) died from surgical complications, including 2 with gastrointestinal leak and 2 with respiratory failure, within the first year of bariatric surgery.

“No treatment other than bariatric surgery has been shown to have such a significant effect in reducing the risk of severe outcomes or death in patients with NASH,” said Shanu N. Kothari, MD, president of the American Society for Metabolic and Bariatric Surgery, 

 “Bariatric surgery should be considered a first-line treatment for these patients.”

Association of bariatric surgery with major adverse liver and cardiovascular outcomes in patients with biopsy-proven nonalcoholic steatohepatitis.

 JAMA. 2021;326:2031-2042. doi:10.1001/jama.2021.19569

In patients with biopsy-proven NASH, the SPLENDOR study is the first to report a medical modality associated with decreased risk of major adverse events. 

Bariatric Surgery Lowered Risk of Major Adverse Liver, CV Outcomes in NASH 

WHO Warns of ‘Very High’ Risk From Omicron as Questions Remain

Biden calls Omicron a ‘cause for concern, not a cause for panic.’

 the 15th letter in the Greek alphabet, is now used to identify the SARS-CoV-2 variant B.1.1.529 which the World Health Organization (WHO) designated a variant of concern on November 26, 2021. 

The designation was made based on evidence presented to the WHO's Technical Advisory Group on Virus Evolution that Omicron has several mutations that may affect how the variant behaves, ie, the severity of disease it causes, its degree of transmissibility, and the variant's immune escape potential--that is, whether it can bypass protection offered by current COVID-19 vaccines.

Omicron was first identified in South Africa and reported to the WHO on November 24; it has now been detected in Australia, Belgium, Botswana, Britain, Denmark, Germany, Hong Kong, Israel, Italy, the Netherlands, France, Canada, and South Africa. At least 44 countries have imposed travel restrictions from several African countries, 

. Japan and Israel have banned all foreign nationals from entering their countries. Health officials in Canada confirmed the country's first 2 cases in Ottawa on Sunday, November 28. 

There have been 50 mutations identified in the B.1.1.529 lineage, the most concerning being more than 30 in the spike protein region, the area that facilitates a virus' entry into the host cell, enhancing its transmissibility as well as the potential for immunoescape.

WHO notes, however, that it is not clear yet whether the variant is more transmissible compared to other recent variants, including Delta. While the number of persons testing positive for Omicron has increased in areas of South Africa where circulation has been identified, studies have been launched to understand if the variant is to blame or if other factors may be implicated.

There are as yet no data to clarify whether Omicron causes more severe disease compared to other variants, and WHO again points to Delta as the primary comparator. “Preliminary data suggest that there are increasing rates of hospitalization in South Africa, but this may be due to increasing overall numbers of people becoming infected, rather than a result of specific infection with Omicron,” states WHO. Nor is there any suggestion that symptoms associated with Omicron infection are different from those seen with currently circulating variants.

 a South African physician who was among the first clinicians to suspect a different strain of the coronavirus among patients he saw said that “the symptoms of the Omicron variant were so far mild and could be treated at home.” The chair of South African Medical Association, also speaking to Reuters, said that no patients so far have reported loss of smell or taste and there has been no major drop in oxygen levels observed.

According to WHO, initial reported infections were among university students who overall tend to have milder infection and symptoms.

Better understanding of both infectivity and transmissibility of Omicron will likely take several weeks, the WHO stressed, as will accruing information on whether the variant can potentially render current vaccinations less effective.

“Work is already under way to look at the immune escape potential of B.1.1.529 in the laboratory setting,” note scientists with South Africa’s National Institute for Communicable Diseases (NICD) in 

. “Based on our understanding of the mutations in this lineage, partial immune escape is likely, but it is likely that vaccines will still offer high levels of protection against hospitalization and death.”

Effectiveness of current tests is currently not in question, according to WHO, as the widely used PCR assays continue to detect infection, including with Omicron. Research is underway to assess any potential impact of the variant on other tests including rapid antigen detection tests. Treatments for COVID-19 also are being assessed for efficacy against Omicron infection but WHO stresses that both corticosteroids and IL-1 receptor antagonists will continue to be effective against severe COVID-19.

In statements to Reuters leaders from both Pfizer-BioNTech and Moderna said virus mutations have been anticipated since the beginning of the pandemic and that the companies are working closely with authorities to process information as soon as it is available.

"We expect new variants to continue to emerge wherever the virus is spreading. Vaccination remains critical to protect those in our communities at high risk of hospitalisation and death, to reduce strain on the health system, and to help slow transmission. This must be in conjunction with all the other public health and social measures, so we advise the public to continue to follow COVID-19 protocols by: ensuring good ventilation in all shared spaces, wearing masks, keeping 1.5m distance from other and washing or sanitising hands and surfaces regularly. 

"These non-pharmaceutical interventions are still proven to prevent the spread of all SARS-CoV-2 viruses."

South African National Institute for Communicable Diseases

The Omicron variant of the SARS-CoV-2 virus is spreading quickly, jumping continents with infected travelers. The best protection remains vaccination and indoor precautions. 

Omicron Variant is Moving Quickly but Much Remains Unknown, says WHO

Health care professionals, like persons in all walks of life, may hold strong negative attitudes and stereotypes about individuals with obesity. These negative attitudes, whether conscious or not, can have a negative impact on clinical encounters, quality of care, and patient outcomes.

This quick quiz is based on current research into weight bias among health care providers, and particularly those in primary care. The answers you choose may give you insight into your own personal prejudices.  

Weight bias themes in primary care are the subject of contemporary research. Which options you choose to these 8 questions may offer insight into your own unconscious prejudices. 

Obesity Stigma in Clinical Practice: Ask Yourself these 8 Questions 

, as of today November 23 2021, at 5:25 PM, EDT, 

, as of today, November 23, 2021 at 4:22 PM, EDT, there have been:

 with 73 879 reported fatalities, followed by 