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Delta COVID Variant Spreading in California’s Unvaccinated

The Los Angeles Times reports that the Delta coronavirus variant is now the third-most common in California, new data show, underscoring the danger of the highly contagious strain to people who have not been vaccinated against COVID-19.

The variant makes up 14.5% of California coronavirus cases analyzed so far in June, up from 4.7% in May, when it was the fourth-most identified variant in California, according to data released by the California Department of Public Health.

Experts say the Delta variant poses a greater chance of infection for unvaccinated people if they are exposed. The variant, first identified in India, may be twice as transmissible as the conventional coronavirus strains. It has been responsible for the rise in cases recently in India, the United Kingdom and elsewhere.

But vaccinated people are well protected against infection and illness from the Delta variant. One recent study found that the full two-dose course of the Pfizer-BioNTech vaccine was 88% effective against symptomatic disease caused by the Delta variant and 96% protective against hospitalization.

Los Angeles County, the nation’s most populous, has confirmed 123 Delta variant cases – 49 of them among residents of Palmdale and Lancaster. Fourteen cases of the Delta variant were in people from a single household.

L.A. County data suggest that vaccines are still overwhelmingly effective in protecting people against the Delta variant, as well as other known variants. Of those 123 confirmed cases of the Delta variant in the county, 89% occurred among people who were not vaccinated against COVID-19, and 2% among those who were partially vaccinated. No one has died from the Delta variant in L.A. County.

The few fully vaccinated people who have been infected with the Delta variant “experienced relatively mild illness,” L.A. County Public Health Director Barbara Ferrer said.

Almost everyone who has died in L.A. County of COVID-19 has been unvaccinated. Data released by the county showed that 99.8% of COVID-19 deaths from Dec. 7 to June 7 occurred among unvaccinated people.

If you are fully vaccinated, you have a lot of protection,” Ferrer said, adding that for the “very small numbers” of people who contracted the Delta variant despite vaccination, “they really did not have serious illness. …This is a pandemic of unvaccinated people.”

The results of outbreaks of the Delta variant elsewhere also support the vaccines’ effectiveness.

Meanwhile, data released by California show that the percentage of the tested population who have antibodies to the coronavirus – a sign of immunity to COVID-19 – is also increasing.

Experts have estimated that 70% to 85% of a population needs to have immunity for a region to develop “herd immunity” to COVID-19, which interrupts the sustained transmission of the virus.

The Delta variant is also spreading nationwide.  From May 9 to May 22, the Delta variant made up less than 3% of analyzed coronavirus samples nationwide. But from June 6 to June 19, that proportion rose to more than 20%.

San Francisco First City to Mandate Employee Vaccinations

The Los Angeles Times reports that the city of San Francisco’s 35,000 employees will need to get vaccinated against COVID-19 or risk losing their jobs.

The new policy would make San Francisco the first major city and county in California to require COVID-19 vaccinations for its employees. Workers who refuse, or fail to provide a religious or medical exemption, could be terminated.

The mandatory vaccination requirement, which goes into effect once the vaccines have been formally approved by the Food and Drug Administration, extends to all city government employees, including police, firefighters, custodians and City Hall clerks. Teachers are not covered by this policy because they are school district employees. Earlier, San Francisco mandated that front-line workers in hospitals, nursing homes and jails be fully vaccinated against COVID-19.

Carol Isen, San Francisco’s director of human resources, said that employees will have until July 29 to report their current vaccination status to the city as a condition of their employment. Staff will need to upload their vaccination cards or documentation showing proof of vaccination through the city’s payroll system. Medical exemptions for employees who are ineligible for a COVID-19 vaccination must be verified by a healthcare provider. Religious exemptions will also be considered.

San Francisco enacted some of the nation’s strictest pandemic regulations and has the highest vaccination rate in the state, with at least 71% of eligible residents fully vaccinated, according to the city’s Department of Public Health. As of Wednesday, 55% of city employees have reported receiving at least one dose of a COVID-19 vaccine, according to the Department of Human Resources.

Not everyone is on board with the new policy. Theresa Rutherford, regional vice president of the Service Employees International Union Local 1021 chapter, said it threatens the livelihoods of front-line essential workers. The chapter represents more than half of all workers employed by the city and county of San Francisco.

At this point, Los Angeles County isn’t planning to follow in San Francisco’s footsteps, according to Public Health Director Barbara Ferrer. “We’d obviously be working very closely with our labor partners, with the Board of Supervisors and the CEO’s office on making a decision of that magnitude,” she said during a briefing Thursday. “You know, there’s about 110,000 county employees, so we would want to really have a healthy discussion with our employees and particularly with our labor partners about what’s the most sensible path forward.”

The University of California and California State University systems have announced they will be requiring all students, faculty and staff on their campuses to be vaccinated.

Research Shows New COVID Variant Spreading in US

Researchers have conducted a study showing that the B.1.1.7 lineage of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that emerged in the UK is now rapidly being displaced as the dominant strain in the United States by the variants of concern B.1.617.2 (Delta) and P.1 (Gamma) that emerged in India and Brazil, respectively.

A pre-print version of the research paper is available on the medRxiv* server, while the article undergoes peer review.

Since B.1.617.2 has displaced B.1.1.7 as the dominant variant in England and other countries, Alexandre Bolze and colleagues from Helix in San Mateo, California, set out to determine whether it is also displacing B.1.1.7 in the United States.

The B.1.617.2 variant was first identified in the United States on March 16th, 2021.

To examine the impact that the B.1.617.2 and P.1 variants of concern have had on the prevalence of B.1.1.7 in the United States, the researchers analyzed PCR and sequencing results of samples collected by the Helix laboratory across the country since April 2021.

The team’s analysis of polymerase chain reaction (PCR) and viral sequencing results collected from across the United States showed that B.1.1.7 is no longer responsible for the majority of new cases in the country.

The percentage of SARS-CoV-2-positive cases that were of the B.1.1.7 lineage dropped from 70% in April 2021 to 42% over a period of just 6 weeks.

Next, the researchers compared the Helix sequencing data by county with the county vaccination rates reported by the CDC.

The study showed that B.1.617.2 had a higher growth rate than P.1 and was growing faster in counties with a lower vaccination rate.

This revealed that the prevalence of B.1.617.2, which is more transmissible but less resistant to vaccination, is higher in counties with lower vaccination rates. By contrast, P.1, which is less transmissible but more resistant to vaccination, is more prevalent in counties with higher vaccination rates.

Moreover, while a study by Public Health England showed that full immunization (two doses) with the AstraZeneca or Pfizer-BioNTech vaccine remains more than 90% effective at protecting against hospitalization following infection with B.1.617.2, the efficacy following one dose is lower, compared with B.1.1.7 infection, says Bolze and colleagues.

The researchers say they expect that B.1.617.2 will soon become the dominant variant in the United States.

June 21, 2021 – News Podcast


Rene Thomas Folse, JD, Ph.D. is the host for this edition which reports on the following news stories: Medical Evidence Required to Add Rather Than Use CVC. Texas Trucker Loses 5th Circuit Battle Over Cal/OSHA Jurisdiction. Indictment Adds Details to Illegal Comp Referral Prosecutions. Spine Device Makers Resolve Sunshine Act Kickback Cases. Fresno P-D Unit to Review Long Term Industrial Claim Absences. Feds Sue Vacaville Nursing Facilities for Illegal Kickbacks. Relaxed Cal/OSHA COVID Standards Effective Today. California Fentanyl Overdose Deaths Jump 2100% in 5 Years. Experts Petition FDA to “Slow Down” Full Vaccine Approval. NSC and, Amazon Team Up to Address Workplace Injuries.

U.S. Supreme Court Rules Against California Union Organizers

The U.S. Supreme Court said California was violating the Constitution with a decades-old regulation that gives union organizers access to agricultural company land for part of the year to talk to workers.

Voting 6-3 along ideological lines, the justices said the 1975 provision, which grew out of the efforts of Cesar Chavez to give farm workers collective bargaining rights, infringed the rights of landowners.

The California regulation grants labor organizations a “right to take access” to an agricultural employer’s property in order to solicit support for unionization. Cal. Code Regs., tit. 8, §20900(e)(1)(C). The regulation mandates that agricultural employers allow union organizers onto their property for up to three hours per day, 120 days per year.

Organizers from the United Farm Workers sought to take access to property owned by two California growers “Cedar Point Nursery and Fowler Packing Company.

The growers filed suit in Federal District Court seeking to enjoin enforcement of the access regulation on the grounds that it appropriated without compensation an easement for union organizers to enter their property and therefore constituted an unconstitutional per se physical taking under the Fifth and Fourteenth Amendments.

The District Court denied the growers’ motion for a preliminary injunction and dismissed the complaint, holding that the access regulation did not constitute a per se physical taking because it did not allow the public to access the growers’ property in a permanent and continuous manner.

A divided panel of the Court of Appeals for the Ninth Circuit affirmed, and rehearing en banc was denied over dissent.

The U.S. Supreme Court reversed and ruled in favor of the landowners in the case of Cedar Point Nursery v Hassid.

The Takings Clause of the Fifth Amendment, applicable to the States through the Fourteenth Amendment, provides: “[N]or shall private property be taken for public use, without just compensation.

When the government physically acquires private property for a public use, the Takings Clause obligates the government to provide the owner with just compensation.

California’s access regulation appropriates a right to invade the growers’ property and therefore constitutes a per se physical taking. Rather than restraining the growers’ use of their own property, the regulation appropriates for the enjoyment of third parties (here union organizers) the owners’ right to exclude. The right to exclude is “a fundamental element of the property right.”

Riverside County DA to Lead EDD Fraud Task Force

The Riverside County Board of Supervisors signed off Tuesday on Riverside County District Attorney Mike Hestrin’s contract with the State of California to take the lead in handling investigations and prosecutions involving unemployment fraud.

According to the report in the Murietta Patch, in a 5-0 vote without comment, the board authorized the agreement with the California Office of Emergency Services, the terms of which are retroactive to Aug. 1, 2020, and will conclude on Dec. 31 of this year. A total $1.25 million is being awarded by Cal-OES.

DA’s staff is now tasked with overseeing the Pandemic Unemployment Assistance & Unemployment Insurance Fraud Task Force.

The funds allocated under the compact can be used for overtime expenses, hiring investigators, paying on-the-job expenses of city attorneys and area law enforcement officers while they build cases to present to the DA’s office, and equipment purchases required for investigations and prosecutions to move forward, according to agency.

The DA’s office is handling a growing number of fraud cases directly tied to jobless claims filed during the coronavirus public health closures. Some investigations are managed by the DA’s Bureau of Investigations; others are being spearheaded by municipal police agencies. Find out what’s happening in Murrieta with free, real-time updates from Patch.

The Riverside Police Department’s Economic Crimes Unit has been particularly busy. Earlier this month, the unit completed an investigation that uncovered the alleged theft of $316,500 in unemployment benefits from the California Employment Development Department. The 28-year-old defendant allegedly stole the identities of 13 people to withdraw the funds using state- issued ATM cards.

A report released on Jan. 28 by California State Auditor Elaine Howle estimated the EDD in 2020 disbursed at least $10.4 billion in benefits based on fraudulent claims, all of which were tied to the federal Pandemic Unemployment Assistance provided under the Coronavirus Aid, Relief & Economic Security Act.

The audit uncovered instances in which the Labor Department’s Office of Inspector General flagged nearly 3 million unemployment claims as likely connected to fraud, but the EDD failed to respond proactively.

Inmates incarcerated in multiple counties, including Riverside, are under investigation. The audit indicated more than $800 million in benefits were distributed to prisoners.

Convictions Show EDD Fraud a Decade Before Pandemic Began

Robert Joseph Maher, 42, formerly of Stockton, was sentenced by U.S. District Judge John A. Mendez to six years and three months in prison for mail fraud and aggravated identity theft.

According to court documents, between November 2010 and February 2018, Maher participated in a scheme to defraud the State of California Employment Development Department (EDD) by filing fraudulent claims for unemployment insurance benefits.

In furtherance of this scheme, Maher and his co-defendant, Michael Herron II, also of Stockton, created fictitious companies and fictitious employees by using the real identities of persons with and without their knowledge. They then filed claims with EDD, falsely stating that the employees had been laid-off or fired. The unemployment benefits were deposited onto debit cards that were mailed to addresses controlled by Maher, Herron, or their associates.

In one instance, Maher and Herron electronically filed an unemployment insurance claim in the name of an identity-theft victim. Maher knew that the victim was a real person because the claim listed the victim’s correct date of birth and social security number. The claim also listed Maher’s address in Stockton as the claimant’s address, which caused a bank to mail an EDD debit card in the victim’s name to Maher’s address.

Maher and Herron then transferred the card’s benefits to Maher’s personal bank account. Maher and Herron also used the victim’s name to register another fictitious business entity that was used in the fraud scheme.

In all, Maher and Herron filed at least 72 fraudulent claims for unemployment insurance benefits, seeking a total of $739,535, of which EDD paid out approximately $609,335. Judge Mendez ordered Maher to pay restitution to EDD in the amount of $609,335.

This case is the product of an investigation by the U.S. Department of Labor – Office of Inspector General, the Federal Bureau of Investigation, and the California Employment Development Department’s Investigation Division. Special Assistant U.S. Attorney Robert J. Artuz is prosecuting the case.

On March 26, 2019, Herron pleaded guilty to similar counts of mail fraud and aggravated identity theft and, on June 25, 2019, was sentenced to six years and three months in prison.

Poorly Organized Ortho Surgical Trays Drive up Costs

A new study tracked instrumentation utilization rates for total knee arthroplasties at two high volume East Coast hospitals: Rothman Orthopaedic Institute in Philadelphia and Main Line Orthopaedics in Bryn Mawr, Pennsylvania. The study, titled “Minimizing Surgical Instrument Burden Increases Operating Room Efficiency and Reduces Perioperative Costs in Total Joint Arthroplasty,” has just been published in the June 1, 2021, edition of The Journal of Arthroplasty.

RyOrtho.com reports that Jess Lonner, M.D., one of the study’s authors and an orthopedic knee surgeon at Rothman, explained the genesis of the study. “Our imperative, as responsible stewards of value-based care, is to deliver the best care possible while controlling costs. As an orthopaedic community we have tackled the obvious big-ticket items – implant costs, length of stay, reducing the use of inpatient rehab and skilled nursing facilities. But there are other opportunities to control costs during the perioperative episode, which are less obvious, but equally important, particularly when taken together. It was my impression that we could improve OR workflow, reduce inefficiencies in instrument processing and ultimately help to control OR costs by ‘optimizing’ surgical trays.”

In any given hospital, the surgical instrument trays used in knee and hip arthroplasty surgery are often poorly organized and overstocked with redundant or underutilized tools. This increases the risk of processing and sterilization errors, increases processing time and expenses, increases the risk of error in tray preparation, increases the time it takes for the OR technician to set up the table, and it puts those who have to lift the heavy trays at risk of work-related injuries from muscular strain. This issue has been looked at in other surgical specialties and a little bit in the subspecialty of knee and hip arthroplasty, but we wanted to study the use of Lean methodology at one hospital to determine the potential cost savings by paring down instrument trays.”

The team randomly selected 35 elective primary total hip and knee arthroplasties performed by four fellowship-trained surgeons. An independent observer noted the type and number of instruments used as well as the timing of different steps in the sterilization process. Using the principles of Lean methodology, the “….surgeons identified redundant or underutilized instruments and agreed upon the fewest number needed for each tray. Instrument utilization rates and processing time were analyzed before and after tray modifications. Annual cost savings were calculated based on a processing factor of $0.59-$11.52 per instrument.”

“What we found was stunning,” said Dr. Lonner, “but not necessarily surprising. When we observed the percentages of instruments in a surgical set that were being used by several different surgeons, it turns out that between 40% and 50% of instruments were unused or underutilized. In our analysis, removing unused instruments and suggesting that surgeons use ‘comparable’ yet redundant tools in some situations, resulted in considerable savings in instrument tray sterilization and processing times and OR table set up times ….leading to substantial direct and indirect cost savings.

In one particular hospital, through the application of Lean methodology, total instrument count could be reduced by roughly 1/3 and the number of instrument sets could be reduced by up to 2/3 in some cases, leading to 40-150 minutes saved during the sterilization process and potential cost savings of nearly $300,000 per year on average for a 1,500 joint replacement case volume.”

“This paper could have substantial implications for hospitals with ORs and perioperative processes which are inefficient (probably the majority of hospitals) and which are looking for ways to control costs, improve workflow, eliminate inefficiencies in the arthroplasty space (definitely the majority of hospitals).”

Employers Face “Hairball” of Post Pandemic Safety Rules

Employment lawyers say companies are watching closely how pandemic return-to-work rules play out nationally, as they look to bring workers back safely and to dispense with mask protocols. “It’s a hairball,” said Eric Hobbs, an employment attorney with Ogletree Deakins in Milwaukee. “It’s all very confusing.”

The report published by Reuters claims that in some states, return to work rules may require identifying those who got a COVID-19 shot with badges or bracelets, raising discrimination issues and complicating hiring in a tightening labor market as the pandemic eases.

The U.S. workplace safety regulator, the Occupational Safety and Health Administration, or OSHA, has not provided clear guidance on the issue. “We continue to let the employer make the determination how to properly do this for their workplace,” OSHA’s acting director, Jim Frederick, told Reuters.

The U.S. Centers for Disease Control and Prevention, which said last month that inoculated people can go without face coverings indoors in most places, has not addressed the thorny issue of how to establish whether someone has been vaccinated.

“What companies are debating right now, and we are too, is: is it necessary to specify on someone’s badge or wear something around their neck that, yes, they are vaccinated and therefore if they don’t have a mask on there’s nothing to worry about?” said Peter Hunt, vice president of brand protection and security at Flex Ltd, a product design and manufacturing company.

However, employers in California’s Santa Clara County, including Christopher Ranch, are required as of June 1 to ascertain if their workers have been vaccinated and check in every 14 days on those who say they have not or who decline to answer.

America’s largest garlic farm needs 1,000 workers to harvest its annual crop, but faces an unexpected hurdle in this year’s recruitment drive: it now must document and track the COVID-19 vaccine status of these seasonal laborers. The timing of the order, in the middle of the busy harvest season, couldn’t be worse.

Ken Christopher, the farm’s executive vice president, said the company has to develop a system to check who has been vaccinated while observing privacy laws and monitoring workers’ adherence to safety protocols and testing. “If the government wants to mandate (a vaccine), that’s one thing,” Christopher said. “But then requiring us to police it, that feels very unconventional.”

Workers in the Silicon Valley county who aren’t vaccinated or refuse to reveal their status to their employer must remain masked and should follow other protocols, such as limiting long-distance work travel and submitting to regular COVID-19 testing.

Christopher said he is considering a mask-free shift for vaccinated workers and another shift for workers who haven’t gotten their shot to avoid discrimination and tension. But asking farm laborers about their vaccination status and entering their details in a database could hurt recruitment efforts, he said.

“It’s the additional information being offered to the government,” said Christopher. “The more layers added on top, the more uncomfortable they are in seeking jobs here.”

Several states, including California, Michigan and Oregon, have their own rules or guidance on documenting vaccination status for workers but they are generally less strict than in Santa Clara County.

In Montana, however, a recently enacted law discourages employers from asking about vaccination status because it could lead to discrimination claims, according to employment lawyers.

California Approves 100M Bailout for Failing Cannabis Industry

Getting cannabis regulations wrong comes at a high cost, as California’s $100 million fund to help floundering marijuana businesses has made clear.

Bloomberg reports that California earmarked money last week to aid companies that are struggling financially in large part because of bureaucratic delays and missteps in transitioning them from temporary licenses into more stringent permanent ones. It’s a cautionary tale for other states that are figuring out how to balance social-equity provisions, tax rates and competing with an illicit market valued at $66 billion last year, according to New Frontier Data.

While California’s 15% tax on legal marijuana has been blamed for pushing consumers to the illicit market, it’s clear that much more has gone wrong. Legalization, which began in 2016, has been messy with rules varying by city and county. The process has also been slow and expensive. That weighed most on small operators, thus many haven’t transitioned to the regulated recreational market, which has more potential than medical.

Steve Allan, chief executive officer of the Parent Company, which has acquired several cannabis firms in California, estimated that only about 700 of the state’s roughly 10,000 dispensaries have become fully legal and regulated. That’s left a swathe of companies in a gray area. Others have tried to make the transition, but are still struggling with the process, he said.

“This money tries to make up for what has been a slow, heavy red-tape process of getting these dispensaries up and going,” Allan said in a phone interview last week.

The biggest issues are that in California it can take as long as two years to get a license and initial costs to open a regulated dispensary start at about $250,000, according to Allan. That’s too big of a hurdle for many smaller operators. Cities and counties also didn’t roll out programs quickly enough to encourage legacy sellers to get licensed because they worried the public wouldn’t like the government helping the once illegal industry, Allan said.

Lawsuits also gummed up the transition. After California gave out its first 100 licenses, it planned to allocate others to “social equity applicants” — minorities and others harmed by the war on drugs. That effort got mired in the courts over who qualified.

Allan doubts the $100 million will bring much relief, calling it a “drop in the bucket” that won’t be enough to save all the struggling dispensaries. Still, his firm plans to keep consolidating what remains of a crowded market that’s still promising.

The state also sees opportunity ahead. Governor Gavin Newsom’s $100 billion “California Comeback” plan calls for $630 million in future tax funds from legalized cannabis to be spent on health care, environmental protection, and public safety.