American Medical Association Recognizing your exceptional contributions this Doctors’ Day

National Doctors’ Day is an opportunity to show our appreciation for the exceptional contributions of America’s physicians.

A single day to recognize all that you do—each and every day—is not enough, especially after this last year. Yet it is a moment for us, and the entire country, to express the depth of our gratitude for your courage, sacrifice, and dedication in the face of immense uncertainty and stress.

On this National Doctors’ Day, the future is looking significantly brighter because of your efforts. Thank you for everything. We have never been prouder, and more honored, to work on your behalf.


Susan R. Bailey, MD
American Medical Association

CALIFORNIA — In the midst of an otherwise grim moment for California during a holiday fueled surge of coronavirus cases, Gov. Gavin Newsom on Wednesday introduced a phased reopening plan for getting children back into the classroom — in-person. And the plan could come to fruition as soon as February 2021.

The $2 billion framework was designed to prioritize the Golden State’s youngest students, beginning with transitional kindergarten through second grade. The plan also prioritizes children with disabilities and those who Newsom said Wednesday “have struggled more than most with distance learning.”

In order to reopen, schools will be required to draft a coronavirus safety plan and submit it to the state for approval. And on the state’s end, Newsom said he plans to ramp up testing at schools and provide teachers with protective gear such as millions of surgical masks for free.

The state also plans to launch a public contact tracing system that will track infections among students and educators. Educators and school staff will also join other essential workers in getting vaccinated during Phase 1B of distribution, Newsom said.

And while the push is meant to resume in-person learning as much as possible, distance learning will still be available under the framework.

“Distance learning will still remain an option for parents and students,” he said Wednesday. “There’s a lot of trepidation, we recognize that a lot of anxiety, about going back into the classroom, which one has to clearly acknowledge. Not just for our teachers but also for our parents, particularly with kids who may have unique conditions.”

The plan is posed for “immediate action” in January.

Despite all efforts, the timing is undeniably tricky.

The county in which the school is in will need to meet a seven-day average case rate of fewer than 28 cases per 100,000 people per day. While this requirement is far greater than previous requirements to reopen without a waiver, that rate may be difficult to attain amidst the state’s largest surge yet.

“Offering as many California students in-person instruction as safely and as quickly as possible must be a team effort,” said California State PTA President Celia Jaffe in a Wednesday statement. “All of us agree that, even during a global pandemic, learning is non-negotiable, and students learn best when they can be safely receiving instruction in school.”

Many of California’s schools, especially in regions hit the hardest by the pandemic, have remained shuttered since March, placing significant strain on families statewide.

“It’s just so much more difficult for a 4-year-old to focus on a device than a 14-year-old,” Newsom said during the news conference, mentioning that he is a father of four young children.

And many parents, including state officials themselves, have not been particularly fond of the Zoom classroom setting, with some even taking to the streets to protest distance learning in California.

Newsom, among many other well-to-do Californians, has received backlash for sending his own children back to a private in-person school while encouraging families to stay at home.

Wednesday’s plan also marks the first time the governor has rolled out a sure-footed pathway for reopening schools statewide.

Some advocates of the plan said Wednesday that families of color, who are among those hit the hardest during the pandemic, will benefit from the reopening the most.

“The pandemic and remote learning are delivering a double dose of harm to California public education,”Public Advocates Managing Attorney John Affeld wrote in a statement Wednesday.

“Black and Brown students especially are falling further behind academically and socio-emotionally and the school system as a whole is losing credibility with the public, despite heroic efforts,” he said. “The solution to both problems is getting students back on campus safely, in person with their teachers and their peers.”

The framework was also announced during a time where teachers and those apart of the California Federation of Teachers have expressed concern over rushing the reopening of schools.

“We cannot support our schools being reopened in a manner that is unsafe for students, teachers, staff, or their families,” Jeffrey Freitas, President of the California Federation of Teachers wrote to the state on Dec. 16. “The teachers and classified professionals of CFT ask that science and community safety, not political pressure, be the guiding force in any discussion about reopening our schools to in-person instruction.”

The letter was in response to Democratic legislators who unveiled a plan this month that could force school districts to reopen when counties fall back into the red tier.

Despite the governor’s ambitious timeline, it remains to be seen how counties, especially in hard hit regions such as Southern California and San Joaquin Valley, will be able to return to in-person instruction.

Recently, the Los Angeles Unified School District recently canceled all in-person classes on campuses in response to the current surge in cases.

LAUSD Superintendent Austin Beutner, along with superintendents from Long Beach, San Diego, Fresno, Oakland, Sacramento, and San Francisco, sent a letter to the governor last month calling for a coordinated statewide plan for returning students to the classroom.

Those superintendents issued a joint statement Wednesday that they will be reviewing Newsom’s proposal “to make sure the guidelines address the needs of students and families served by large, urban school districts across the state.”

Debra Duardo, Los Angeles County’s superintendent of schools, praised the governor for providing guidance for the plan and said she would be “engaging our 80 district superintendents in conversations” in January and would work in conjunction with county health officials to discuss a path forward.

“Furthermore, I continue to urge the state to prioritize the vaccination of K-12 and early education teachers, administrators and staff as an essential step in getting our public schools and early learning and care centers fully reopened,” Duardo said. “Right now, L.A. County is facing a horrific surge of COVID cases. The absolute best thing we all can do to reopen our schools is to strictly follow public health guidelines. Please help by avoiding gatherings, staying at home as much as possible, wearing your masks and maintaining a six-foot distance from others when you do need to leave home.”

Assemblywoman Suzette Martinez Valladares, R-Santa Clarita, said Newsom’s announcement was long overdue.

“We cannot continue to fail our future, our kids,” she wrote in a Twitter post. “Europe has kept in-person learning open for the majority of the pandemic. Which now provides us with evidence that schools are not major spreading centers. The social and emotional development during the foundational years of preschool to second grade cannot be replicated through distance learning. Returning young students to schools is vital and long overdue. Most states had plans in place months ago.”

Currently, most of the Golden State’s counties remain under the purple tier with four of the state’s five designated regions under Newsom’s Regional Stay-At-Home order, which was just extended for Southern California and the San Joaquin Valley.

And Newsom further announced Wednesday that a staggering 432 coronavirus related deaths had been reported in the last 24 hours, boosting the seven-day average to 239 deaths. California recorded 30,921 cases on Tuesday with a 36,295 seven-day average.

Hospitalizations have also increased 36.5 percent in the last 14 days, Dr. Mark Ghaly, the state’s health secretary announced Tuesday.

“Much of what we’re seeing can be stopped if we make collective decisions to stop it,” Ghaly said in a news conference Tuesday. “We are in this moment where it can really make a difference…”

The City News Service contributed to this report.


A more contagious version of the coronavirus may alter the course of the pandemic in the United States, researchers said.

One confirmed case and one suspected case of the new variant were found in two National Guard members assigned to the Good Samaritan Society, a nursing home in Simla, Colo.

A contagious variant of the coronavirus spreading through Britain has left that nation grappling with new lockdowns, curtailed air travel and a surge in infections. Now it has appeared in Colorado and California, threatening to complicate what had seemed a hopeful, if halting, path to recovery from the pandemic.

Scientists do not know how widely the new mutant may have spread in the United States. But the answer to that question will color virtually every aspect of the response: hospital treatment, community lockdowns, school closures and more.

“The overall picture is pretty grim,” said Bill Hanage, an epidemiologist at the Harvard T.H. Chan School of Public Health.

The variant’s arrival also makes it all the more imperative that Americans receive vaccinations in great numbers, and more quickly, scientists said. A pathogen that spreads easily is more difficult to contain, and a greater percentage of the population must be inoculated to turn back the pandemic.

Yet even as the variant surfaced, officials with the Trump administration acknowledged on Wednesday that the vaccine rollout was going too slowly. Just 2.6 million people had received their first dose as of Monday morning, far short of the 20 million goal.

“We agree that that number is lower than what we hoped for,” said Moncef Slaoui, scientific adviser to Operation Warp Speed, the federal effort to accelerate vaccine development and distribution.

The federal government has enrolled 40,000 pharmacy locations in that program designed to accelerate vaccine distribution, Mr. Slaoui and other officials said.

The variant, called B.1.1.7, is not thought to be more deadly than other versions of the virus, nor does it seem to cause more severe illness. Masks, physical distancing and hand hygiene are still the best ways to contain its spread. Current vaccines are likely to be effective against it and any others that may emerge in the short term.

But given the mutant’s apparent contagiousness, scientists fear that its toehold in the United States augurs another difficult chapter in the pandemic. Gov. Gavin Newsom of California announced on Wednesday that a case of the variant had been discovered in the state.

Officials in San Diego County later identified the patient as a man in his 30s who had not traveled outside the United States, suggesting the virus was transmitted by someone else in the community — a sign that the new version is already spreading. A household contact of the man has developed symptoms, the officials said, and is being tested.

Officials in Colorado confirmed one patient and identified a second suspected case, both men in the National Guard assigned to a nursing home in Simla, Colo., about 80 miles southeast of Denver. The confirmed patient also had not traveled.

“There’s no reason to think that that community is particularly special in any way,” Dr. Hanage said. “It’s completely reasonable to think it’s in a lot of other places, but we just haven’t looked for it yet.”

Officials at the Centers for Disease Control and Prevention said on Wednesday that they were working with state laboratories in California, Delaware and Maryland to analyze patient samples for infection. Agency scientists also plan to analyze up to 3,500 viral genomes each week to detect the new mutant and others as they emerge.

The virus’s debut in the United States underscores the need for urgent steps to tamp down transmission, experts said. If the variant is spreading in this country, it will bring not just an increase in the number of cases, but also of hospitalizations and deaths.

That’s because a variant that infects more people will reach more who are vulnerable or frail, leading to more illness and fatalities even if the virus itself is not more deadly.

The number of people hospitalized for Covid-19 daily has been rising relentlessly since October, totaling nearly 125,000 on Wednesday. Those numbers are expected to swell as a result of family gatherings over the holidays.

“In places like the U.S. and the U.K., where the health care system is already at its breaking point, a huge surge of new cases on top of the exponential spread we’re already seeing is going to be really, really bad,” said Angela Rasmussen, a virologist affiliated with Georgetown University in Washington.

“Not only is that going to potentially increase the number of Covid deaths, but it’s also probably going to increase the number of deaths from other causes as well.”

People infected with the variant may need different care than earlier coronavirus patients, further burdening the health care system, experts said.

“We’re still learning how these variants might respond to drugs and other Covid-19 treatments, including monoclonal antibodies and convalescent plasma,” Dr. Henry Walke, the C.D.C.’s incident manager for Covid response, said at the news briefing.

The news ramps up the urgency to get Americans vaccinated because it raises the threshold for so-called herd immunity — the percentage of people who must be inoculated to contain the threat. That threshold may be 90 percent now, versus the 70 percent experts previously estimated.

At least two million Americans must be vaccinated each week to prevent the health care system from buckling even under the current surge, experts estimate, let alone an increase brought on by the new variant.

The mutant virus seems to spread in the same ways that the coronavirus always has, suggesting that well-known precautions — shutting down nonessential businesses and instituting mask mandates and physical distancing — will hold the virus at bay.

“It’s not like this variant suddenly has new capabilities, or that it can suddenly cross over large distances outdoors,” Dr. Rasmussen said.

But the ease with which the new version spreads implies that even more stringent restrictions may be needed, scientists said. “This variant was not stopped by the stronger interventions that were put in place in the U.K. in November,” Dr. Hanage said. “And that means that we need more.”

That is likely to prove difficult at a time when many Americans are already defying restrictions.

On Wednesday, about a quarter of the shoppers going into the Simla Food Store in Colorado left their faces uncovered, only half a block from the nursing home where the mutant virus is believed to have surfaced.

“They chew us out because they don’t think all this is real,” said Cené Kurtchi, 71, who runs a cafe in town and requires patrons to wear masks. “I think part of it is politics, part of it is denial. People don’t want to admit even a little place like Simla is at risk.”

British authorities first detected the mutant virus in September. They reported earlier this month that the variant quickly became predominant, accounting for more than 60 percent of new cases in London and surrounding areas.

“I would expect a similar trajectory” in the United States, said Trevor Bedford, an evolutionary biologist at the Fred Hutchinson Cancer Research Center in Seattle. The variant probably accounts for fewer than 1 percent of cases now, he estimated, but might constitute the majority of cases by March.

The variant has 23 mutations, compared with the original virus discovered in Wuhan, China. Seventeen mutations appeared since the virus diverged from its most recent ancestor, said Muge Cevik, an infectious disease expert at the University of St. Andrews in Scotland and a scientific adviser to the British government.

The speed with which the virus acquired so many alterations worries scientists, who had expected the coronavirus to evolve far more slowly.

Current vaccine candidates should continue to protect people from illness, several experts said. But the appearance of the new variant, which contains at least one mutation that weakens the body’s immune protection, makes it likely that vaccines may need regular adjustment, much as they do to remain effective against the influenza virus.

Scientists are still unsure how much more easily the mutant spreads. Initial estimates were around 70 percent greater transmissibility, but the figure has since been revised to 56 percent and may dip even lower, Dr. Cevik said.

But with every new person it infects, the coronavirus also has more chances to mutate, and therefore more chances to happen upon mutations that give it an advantage — by making it more transmissible, for example, or less susceptible to the immune system.

“If you have enough of that going on, huge amounts of virus replication throughout the world, then you are going to get many different variants,” said Dr. Dan Barouch, a virologist at Beth Israel Deaconess Medical Center in Boston.

“If a virus essentially is better adapted to the human host, then it will quite rapidly overtake the global population.”

Dr. Cevik offered one nugget of optimism. Early reports from Britain hinted that the new variant spreads more readily among young children. But those suggestions were based on trends in older teenagers, who respond to the virus much as adults do, and can be explained by clusters in high schools, Dr. Cevik said.

“It was really early speculation and caused a lot of distress,” she said. “There is no evidence to suggest this new variant was more common in certain age groups.”


As the holidays approach, we send our best wishes to you and your family for a safe, healthy season. We know that it has been a long and difficult year for many. We all badly want to spend time with friends and families.

There is exciting news that highly effective, safe vaccines and improved treatments are on the horizon. But with the COVID-19 virus spreading fast in the Bay Area and beyond, it’s more important than ever to guard against infection now. 

It is tragic that so many people around the world are still suffering, and in many cases dying, just as we see a light at the end of the tunnel. Help is on the way — if we can just keep taking the safest steps a little longer.

Here are our recommendations for staying healthy until the global pandemic is well-controlled:Stay close to home. We urge you to skip travel except for truly essential reasons.
If you must travel, get tested 3 to 6 days after returning home. Also, isolate yourself from others for 14 days after your return, even if your test is negative.Wear masks when you are with other people who are not in your household bubble. Also wear masks whenever you are in a public space or building.Limit gatherings. Don’t have meals or celebrations with people outside of your household bubble.
If you must meet with people who are not part of your household, you can lower the risks with these steps: Limit the time you are exposed to others.Stay in highly ventilated areas, preferably outdoors.Keep 6 feet away from others, especially while eating or drinking.Wash your hands often.Make a special effort to stay away from others if you don’t feel well. That’s true even if you have only mild symptoms of COVID-19.
Symptoms include congestion, cough, muscle ache, feeling tired or short of breath, headache, loss of taste or smell, or a fever.Stay away from other people with any COVID-19 symptoms.Don’t delay seeking preventive care or treatment with your care team.Get tested if you have been exposed to someone with COVID-19 or have even mild symptoms of COVID-19. For information on testing, see Stanford Health Care’s website.We have a wonderful opportunity this holiday season to share the gift of safety and health. You can take special care to prevent new infections through the holidays.

With that, we can look forward to a much more normal world next spring and summer. Then we can plan to join with all of our friends and families for a very joyous holiday season next year.

Sincerely, Your Stanford Health Care Team

Source: Standford Healthcare