Bay Area gets aggressive, state doubles testing

With U.S. infection rates spiking and a far more modest uptick in California, the Bay Area on Friday enacted additional, hard-charging measures to corral COVID-19: San Francisco hit the brakes on reopening, and Santa Clara County sought a legal order against a church that has been flouting restrictions on indoor gatherings.

Meanwhile, in Southern California, state officials unveiled a swiftly built lab that officials say will double the state’s already substantial coronavirus-testing capacity by spring.

Taken together, the day’s actions underscored California’s resolve to manage the pandemic aggressively, even as other states loosen restrictions and struggle with viral transmission.

San Francisco, which has the lowest positivity rate of any major metropolitan area in the country, announced its rollback of some recent reopening moves amid worrisome indicators, including increases in hospitalizations and infections. Just two weeks ago, the city had moved into the yellow tier on the state’s reopening matrix, the least restrictive level.

Friday’s pivot means that restaurants previously approved to expand to 50% indoor capacity will have to stick to the current 25% occupancy, as will indoor places of worship, museums, zoos, aquariums and movie theaters. Plans to allow indoor pools and bowling alleys have been removed from the city’s reopening trajectory for now.

“The last thing we want to do is go backward,” Mayor London Breed said in a news conference Friday. “The last thing we want to do is tell a business or a school that they can open, then tell them they have to close. So we’re proceeding with caution.”

In the South Bay, Santa Clara County officials announced that they had filed suit in Superior Court to stop Calvary Chapel San Jose from holding indoor services. The church had signaled early on during the pandemic that it was not going to abide county restrictions, instead taking guidance from President Donald Trump’s declarations that in-church worship was an essential function.

In a similar clash with North Valley Baptist in Santa Clara, piles of fines and the threat of a court injunction prompted the church to back down and switch to outdoor services. For Calvary Chapel, fines that reached $350,000 did not deter the services, prompting county officials to ask a judge to make them change their ways.

The church has deemed the move “a request to crush the Church’s constitutional rights” while acknowledging many of the allegations regarding its flouting of the rules. In a legal filing, the defendants argued that their activities are not a genuine threat because they have not been linked to an outbreak. They also noted that crowded police-brutality protests over the summer got no such enforcement scrutiny.

But Dr. Arthur Reingold, division head of epidemiology and biostatistics at the UC Berkeley School of Public Health, wrote in a declaration supporting the county’s court filing that a church outbreak could just be a matter of time without compliance to health protocols.

Reingold wrote that the risks of COVID-19 transmission from large indoor gatherings are already high and that “adding activities like singing,

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SBRT Doubles Pain Response Over Usual RT in Spinal Metastases

A 2-day course of high-dose stereotactic body radiotherapy (SBRT) doubles the complete pain response for patients with painful spinal metastases in comparison with conventional palliative radiotherapy. It is also safe and nondestabilizing, conclude researchers reporting a phase 3 Canadian trial.

“Conventional radiation has historically not achieved high rates of complete response to pain or long-term local control,” commented lead author Arjun Sahgal, MD. “So many years ago, we started building on the idea of using high-dose stereotactic body radiation for the spine.”

Sahgal, who is professor and deputy chief of radiation oncology at Sunnybrook Health Sciences Center, the University of Toronto, Ontario, Canada, explained that his team came up with a plan to use SBRT with 24 Gy in two fractions. This involves only two consecutive treatments, which is very convenient for patients. Conventional radiation requires five or more sessions.

“Now we have shown a doubling of the complete response rate to pain at 3 and 6 months compared with conventional palliative radiation, and patients appreciate fewer treatment sessions, too, so we are helping our patients financially,” Shagal told Medscape Medical News.

He presented the new results during the virtual annual meeting of the American Society for Radiation Oncology (ASTRO).

Patients enrolled in this trial had de novo painful spinal metastases with three or fewer consecutive metastatically involved spinal segments arising from a primary tumor causing pain that was scored at least 2 on the Brief Pain Inventory.

The median baseline worst pain score was 5 in a range of 2 to 10. The median total spinal instability and neoplasia score (SINS) was 7 in a range of 3 to 12, Sahgal noted. “The primary endpoint was complete pain response rate at 3 months,” Sahgal told a press briefing held within the context of the virtual meeting.

Patients were randomly assigned to receive either SBRT with 24 Gy delivered in two fractions over 2 consecutive days or conventional palliative radiotherapy with 20 Gy delivered in five fractions.

Initially, the trial was launched as a phase 2 study, but once investigators could demonstrate that accrual was possible, they converted the trial into a phase 3 study, Sahgal noted.

A total of 114 patients were enrolled in the SBRT arm; 115 patients were enrolled in the conventional radiotherapy arm. All were included in the intent-to-treat analysis. “We found that at 3 months, the complete response rate was 35% in the SBRT arm and 14% in the conventional radiation arm, and the difference was statistically significant,” Sahgal reported.

The complete response rate was sustained at 6 months. It remained at 32% in the SBRT arm and 16% in the conventional radiotherapy arm. There was also a reduction in the total SINS score at 6 months that favored the SBRT arm.

Adjusted for age, sex, performance status, primary cancer, and total baseline SINS, SBRT was almost 3.5-fold more likely to result in a complete pain response rate at 3 months and was about 2.5-fold more likely to yield the same response at 6 months

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