Author: WorkCompAcademy

The Los Angeles Times reports that research conducted in Southern California has confirmed the dramatic erosion of the Pfizer-BioNTech COVID-19 vaccine’s protection against “breakthrough” coronavirus infections.

The new study, one of the largest and longest to track the effectiveness of a vaccine in Americans, found that the vaccine’s ability to protect against infection stood at 88% in its first month, then fell to 47% after just five months.

But even as the Delta variant became the predominant strain across the Southland, the vaccine’s effectiveness at preventing COVID-19 hospitalizations held steady at close to 90% for as long as six months. What’s more, it maintained that power across vaccine recipients of all age groups.

The study, funded by Pfizer and published Monday in the journal Lancet, also provides strong new evidence that the waning immunity against infection probably would have been seen with or without the arrival of the Delta variant.

Researchers found that a fresh inoculation with the Pfizer-BioNTech vaccine protected just as well against an infection with the Delta variant as it did against infection with other versions of the coronavirus.

Second, the vaccine’s ability to keep vaccinated people out of the hospital remained high across a span of time when the Delta variant gained ground in Southern California.

And third, breakthrough infections were more closely linked to the amount of time that had lapsed since vaccination than they were to the particular viral variant involved.

By showing that waning immunity, not the Delta variant, was the likely reason for the rise in breakthrough infections, the study suggests it may not be necessary to reformulate a Pfizer-BioNTech booster that specifically targets Delta. For now, at least, a third shot identical to the first two would probably extend the vaccine’s early record of protection against all strains, including Delta.

The protection provided by the Pfizer vaccine beyond six months has been an open question, hinted at only by Israeli studies that suggest COVID-19 hospitalization rates rise in those above 60 years of age.

In another recent study, researchers from Emory University and Stanford found that six months after being inoculated with the Pfizer vaccine, roughly half of 56 young and middle-aged adults had no detectable neutralizing antibodies against the SARS-CoV-2 virus. The reduced immunity was particularly dramatic against the coronavirus variants Delta, Beta and Mu.

That study was posted last week on BioRXiv, a site where researchers share preliminary work before it has been peer-reviewed. But its findings of “a substantial waning of antibody responses” – as well as a drop in the immunity provided by T cells – suggest that a third booster immunization “might be warranted,” its authors wrote.

Our ability to sense heat, cold and touch is essential for survival and underpins our interaction with the world around us. In our daily lives we take these sensations for granted, but how are nerve impulses initiated so that temperature and pressure can be perceived? This question has been solved by this year’s Nobel Prize laureates.

The laureates identified critical missing links in our understanding of the complex interplay between our senses and the environment.

University of California, San Francisco David Julius utilized capsaicin, a pungent compound from chili peppers that induces a burning sensation, to identify a sensor in the nerve endings of the skin that responds to heat. Scripps Research in La Jolla, California scientist Ardem Patapoutian used pressure-sensitive cells to discover a novel class of sensors that respond to mechanical stimuli in the skin and internal organs. These breakthrough discoveries launched intense research activities leading to a rapid increase in our understanding of how our nervous system senses heat, cold, and mechanical stimuli.

Prior to the discoveries of David Julius and Ardem Patapoutian, the understanding of how the nervous system senses and interprets our environment still contained a fundamental unsolved question: how are temperature and mechanical stimuli converted into electrical impulses in the nervous system?

In the latter part of the 1990’s, David Julius saw the possibility for major advances by analyzing how the chemical compound capsaicin causes the burning sensation we feel when we come into contact with chili peppers. Capsaicin was already known to activate nerve cells causing pain sensations, but how this chemical actually exerted this function was an unsolved riddle.

After a laborious search, a single gene was identified that was able to make cells capsaicin sensitive. The gene for capsaicin sensing had been found! Further experiments revealed that the identified gene encoded a novel ion channel protein and this newly discovered capsaicin receptor was later named TRPV1. When Julius investigated the protein’s ability to respond to heat, he realized that he had discovered a heat-sensing receptor that is activated at temperatures perceived as painful.

While the mechanisms for temperature sensation were unfolding, it remained unclear how mechanical stimuli could be converted into our senses of touch and pressure. Researchers had previously found mechanical sensors in bacteria, but the mechanisms underlying touch in vertebrates remained unknown. Ardem Patapoutian, wished to identify the elusive receptors that are activated by mechanical stimuli.

The breakthrough by Patapoutian led to a series of papers from his and other groups, demonstrating that the Piezo2 ion channel is essential for the sense of touch. Moreover, Piezo2 was shown to play a key role in the critically important sensing of body position and motion, known as proprioception. In further work, Piezo1 and Piezo2 channels have been shown to regulate additional important physiological processes including blood pressure, respiration and urinary bladder control.

The California Insurance Guarantee Association (CIGA) was created by legislation in 1969 as an association of insurers that makes payments to policyholders of property/casualty, workers’ compensation and “miscellaneous” insurers when the member insurance company becomes insolvent and is unable to do so. It is a statutory entity that depends on the establishing legislation for its existence and for a definition of the scope of its powers, duties and protections.

CIGA is funded by premium surcharges upon applicable lines of insurance, and those surcharges are limited by statute to a maximum of 2%.

The purpose of CIGA is to pay “covered claims” of member insurance companies that have become insolvent. CIGA’s total liability for any single claim is $500,000, other than claims for workers’ compensation, which are not limited. CIGA does not have to pay a claim to the extent that it is covered by any other insurance of a class covered by this law and available to the claimant or insured (Insurance Code §1063.1(c)(9)(A)).

There are several catastrophic risks that contribute CIGA’s need to be able to access large amounts of cash including pandemic risks, the risk of a devastating earthquake occurring during work time in a major city, and potential losses due to wildfires and other natural disasters.

In 2003, Assembly Bill 227 (Vargas) provided express authority for CIGA to issue up to $1.5 billion in bonds to fund workers’ compensation claims payments for injured workers of insolvent insurers. At the time and beginning in the late 1990s, CIGA had assumed responsibility for paying covered claims of 27 insolvent workers’ compensation insurance companies. The Legislature placed a sunset provision on the original bonding authority and has extended the date on four separate occasions.

The California legislature has passed, and Governor Newsom has just signed AB 1541 a fifth extension of this bonding authority. The last date upon which CIGA is authorized to issue bonds would change from January 1, 2023 to January 1, 2026.

Specifically, this new law extends the existing ability of CIGA to request the issuance of bonds by the California Infrastructure and Economic Development Bank to more expeditiously and effectively provide for the payment of covered claims arising from insolvencies of insurance companies providing workers’ compensation insurance.

This year the California legislature passed SB 788, and sent the bill to Governor Newsom for signature. The bill would have added the following language to Labor Code 4663, one of the permanent disability apportionment statutes.

“The approximate percentage of the permanent disability caused by other factors shall not include consideration of race, religious creed, color, national origin, gender, marital status, sex, sexual identity, or sexual orientation.” The source of this bill was the California Applicants’ Attorneys Association. Assembly amendments in the legislative process removed genetic characteristics and age as factors that would be prohibited.

Most of the legislative effort to limit apportionment over the last few years has been in response to case law. In April 2017, the Court of Appeal published its decision in the case of City of Jackson v WCAB (Rice) which confirmed apportionment to genetic factors. Christopher Rice was a police officer who suffered a spine injury. A PQME found that genetic factors were significant factors in his permanent impairment. The Court of Appeal reversed the WCAB which refused to allow apportionment to genetics.

The letter response by Governor  Newsom reads as follows:

“I am returning Senate Bill 788 without my signature. This bill would preclude a physician from using certain characteristics as the basis for apportionment of permanent disability.”

“Current law states that physicians shall not apportion the percentage of permanent disability awarded based on the gender,race, or other personal characteristic of the employee and provides protection from the inappropriate application of apportionment law.”

“Instead, physicians are required to apportion the disability award based solely upon the employee’s own medical history and medical evidence.”

“While I support efforts to combat bias within the medical profession, this bill creates confusion with well-settled law, which is likely to result in increased litigation and subsequent delays to much-needed benefits to workers.”

“Ongoing efforts by the Division of Workers’ Compensation to implement mandatory continuing education of medical-legal evaluators related to current anti-bias is better suited to achieve the intent of this bill.”

On this recurrent legislative issue, Newsom followed vetoes by Governor Brown on several apportionment bills passed by the legislature in years past.

In 2018, Governor Brown vetoed AB 479. This proposed law would have set limits to apportionment of permanent disability in cases involving breast cancer. Brown’s veto message noted that it was similar to three previous measures that he has vetoed, Assembly Bill 570 in 2017, Assembly Bill 1643 in 2016 and Assembly 305 in 2015.

Brown said that AB 479, and its predecessors, have repeatedly singled out specific conditions and proposed a special set of rules that apply to them. This would result in an even more complex workers’ compensation system that would essentially be “disease by statute,” which would ultimately burden injured workers seeking quick resolution to their claims.