COVID-19: TCTMD’s Dispatch for July 4

We’re curating a list of COVID-19 research and other useful content, and updating it regularly.

TCTMD COVID-19 Dispatch

Since March 2020, TCTMD reporters and editors have been keeping tabs on breaking research and policy news--our COVID-19 Dispatch is now updated three days a week. If you have something to share, tell us. Our in-depth coverage of COVID-19 and the heart can be found on our COVID-19 Hub.

July 4, 2022

Two studies of enoxaparin for thromboprophylaxis in COVID-19 have come up empty-handed. ETHIC, an open-label, multicenter, randomized, controlled, phase 3b trial conducted at 15 centers in six countries found no benefit to low-molecular weight heparin in unvaccinated symptomatic COVID-19 outpatients for a composite of all-cause mortality and hospitalization at 21 days, as compared with standard of care.

Likewise, OVID, a randomized, open-label, parallel-group, investigator-initiated, phase 3 trial of outpatients aged 50 years or older, conducted at eight centers in Switzerland and Germany, found no difference in a composite of hospitalization and all-cause death within 30 days between treated and untreated patients. Both trials were stopped early for futility. They are published this week in Lancet Haematology

COVID-19 DispatchCOVID-19 has been blamed for widening existing inequalities: now survey results by McKinsey and Company suggest that men are more likely than women to be offered the option of remote work. As Becker’s Hospital Review summarizes, “men have more opportunities to work remotely full time than women do, with 38 percent of full-time employed men having remote work options, but only 30 percent of women having the same opportunity.”

A July 1, 2022 workshop co-chaired by the European Medicines Agency (EMA) and the US Food and Drug Administration (FDA) under the umbrella of the International Coalition of Medicines Regulatory Authorities saw regulators agreeing on key principles for the adaptation of vaccines to tackle virus variants, “ensuring global regulatory alignment,” a press release states. 

Last week, the FDA committed to updating vaccines for the fall, but as the New York Times reports, the two mRNA vaccine-makers poised to offer updated boosters targeting the BA.4 and BA.5 strains say they won’t be ready until October—and that’s likely too late for the current surge in cases. 

Obesity is a known risk factor for more severe COVID-19 illness, hospitalization, and death, but a new study in Lancet Diabetes & Endocrinology shows that vaccines appear to offer protection across the spectrum of body mass index (BMI). The study of more than 9 million adults in England showed that people with low or high BMI were at greater risk than healthy-weight, vaccinated adults, but vaccinated fared better than unvaccinated. Notably, the researchers say, underweight people were less likely to be vaccinated.  

A longitudinal observational study of healthcare workers with prior SARS-CoV-2 infections not requiring hospitalization indicates that the likelihood of developing Long COVID is reduced in people who have had two or three mRNA vaccine doses. Lasting symptoms were more common in the first wave of the pandemic than in subsequent waves, and in people with older age, higher BMI, allergies, and/or obstructive lung disease, researchers write in JAMA

COVID-19 DISPATCH tctmdAn analysis of vaccination facilities and uptake of vaccines in children aged 5-11 indicates that pediatric clinics, family medicine clinics, and federally qualified health centers increase the likelihood of childhood vaccinations. While most US counties had pharmacies or public health centers offering vaccines to kids, those facilities more recognizable by parents as providing pediatric care appeared to boost confidence in vaccine safety, improving access, researchers write in Morbidity and Mortality Weekly Report. “Providers that serve as a medical home for routine pediatric care has important implications for COVID-19 vaccination coverage.”


June 30, 2022

heat mapCOVID-19 cases have risen around the world to the highest level since April, CIDRAP News reports. The latest update from the World Health Organization (WHO) shows the number of weekly cases increased by 18% in the week ending June 26 compared with the week prior, reflecting growing numbers in four of six regions. The number of weekly deaths remained relatively stable, increasing by 3%. The more-transmissible Omicron BA.4 and BA.5 subvariants now account for most infections (55%).

Coinciding with that news was an announcement from the US Food and Drug Administration (FDA) on Thursday recommending inclusion of an Omicron BA.4/BA.5 spike protein component in future COVID-19 vaccine booster doses. The decision follows endorsement of that move from an advisory committee earlier this week (Associated Press). “The FDA has been planning for the possibility that vaccines would need to be modified to address circulating variants and previously provided guidance to industry on how to do so efficiently,” Peter Marks, MD, PhD, director of the FDA’s Center for Biologics Evaluation and Research, said in a statement.

A systematic review in the BMJ underscores the importance of adequate ventilation to stem the spread of SARS-CoV-2 indoors, showing that long-distance airborne transmission (over more than 2 meters) can occur in restaurants and workplaces, on public transportation, and in other indoor venues. Stephanie Dancer, a microbiologist, raises questions about the quality of the “tenuous” evidence in an accompanying editorial, but says it “validates the premise that tiny respiratory particles containing SARS-CoV-2 freely transmit throughout inadequately ventilated environments. . . . Now, indeed, is the time for an indoor air revolution.”

In the US, maternal deaths jumped by 33.3% after March 2020, “a figure higher than the 22% overall excess death estimate associated with the pandemic,” researchers write in JAMA Network Open. The increase was greatest among Hispanic and non-Hispanic Black women. “Change in maternal deaths during the pandemic may involve conditions directly related to COVID-19 (respiratory or viral infection) or conditions exacerbated by COVID-19 or other healthcare disruptions (diabetes or cardiovascular disease) but could not be discerned from the data,” the authors note. CIDRAP News has more.

boy getting a shotThe risk of developing myocarditis or pericarditis after receiving an mRNA-based COVID-19 vaccine is rare overall, but it does fluctuate based on factors such as vaccine type and the interval between doses, affirms a study in JAMA Network Open. Risk was higher with the Moderna vaccine than with the Pfizer/BioNTech shot and when the interval between the first two doses was 30 days or less, versus 56 days or more. “You can make slight tweaks to your program to make things a little bit safer,” a study author told TCTMD, adding, however, “that these are really rare side effects.”

Real-world data from Israel published in the New England Journal of Medicine indicate that the Pfizer/BioNTech vaccine provided moderate protection against documented SARS-CoV-2 infection among children ages 5 to 11 at a time when Omicron was becoming the dominant variant. Vaccine effectiveness was 17% after the first dose and 51% after the second dose. Effectiveness against symptomatic COVID-19 was 18% after the first dose and 48% after the second.

A research letter in NEJM suggests that some people infected with either the Omicron or Delta variants of SARS-CoV-2 shed culturable virus for more than 5 days after they first display symptoms or test positive for the virus, perhaps raising questions about the recommend shortening of the isolation period for infected patients from 10 to 5 days by the US Centers for Disease Control and Prevention (CDC). The authors note, however, that “although culture positivity has been proposed as a possible proxy for infectiousness, additional studies are needed to correlate viral-culture positivity with confirmed transmission in order to inform isolation periods.”

Nonpharmaceutical interventions implemented during the pandemic in France, like social distancing and mask wearing, were associated with a decline in pediatric cases of invasive pneumococcal disease (IPD), influenza, and respiratory syncytial virus (RSV), although the pneumococcal carriage rate remained the same, according to a study in JAMA Network Open. The findings suggest that targeting influenza and RSV “may be able to prevent a large proportion of IPD cases without creating gaps in the pneumococcal ecological niche, which is the main limitation of current pneumococcal conjugate vaccines,” the authors say. An invited commentary further discusses the implications.

On Wednesday, the FDA revised the labeling for tixagevimab co-packaged with cilgavimab (Evusheld; AstraZeneca), which is authorized for use as preexposure prophylaxis of COVID-19 for select individuals, to recommend repeat dosing every 6 months if protection is still needed. Previously, there was no specific recommendation regarding dosing interval.

Pfizer and BioNTech, partners on one of the most widely used COVID-19 vaccines, will start testing vaccines designed to protect against a variety of coronaviruses in the second half of the year, Reuters reports. “Their experimental work on shots that go beyond the current approach include T-cell-enhancing shots, designed to primarily protect against severe disease if the virus becomes more dangerous, and pan-coronavirus shots that protect against the broader family of viruses and its mutations,” the story notes.

screaming catA Nature news story discussed the first reported case of a person catching SARS-CoV-2 from a cat. Scientists in Thailand determined that the transmission happened after a cat that was being tested for the virus sneezed in the face of a veterinary surgeon, who was wearing a mask and gloves but no eye protection. A researcher notes that animal-to-human transmission of SARS-CoV-2 is rare.


 

June 27, 2022

black family celebrating birthdayVaccinations against COVID-19 likely saved nearly 20 million deaths in 2021, a modelling study in the Lancet concludes. That number would have been even higher if the original vaccination coverage targets set by the COVID-19 Vaccines Global Access (COVAX) Facility and World Health Organization had been met. “In low-income countries, we estimated that an additional 45% (95% CrI 42–49) of deaths could have been averted had the 20% vaccination coverage target set by COVAX been met by each country, and that an additional 111% of deaths could have been averted had the 40% target set by WHO been met by each country by the end of 2021,” the authors conclude.

As STAT points out, “That makes the recent report both a dramatic demonstration of the protective power of these shots and a grim tally of the consequences of an uneven and inequitable vaccine rollout.”

One of the largest studies to date—this one from southern China—confirms that COVID-19 vaccines do not increase the risk of MACE in people with preexisting cardiovascular disease. “At the time of the vaccination rollout in Hong Kong, there was a lot of vaccine hesitancy, especially among those with chronic health conditions, including those with cardiovascular diseases,” senior study author Esther W. Chan, PhD (The University of Hong Kong, China), told TCTMD. The paper was published last week in Cardiovascular Research, and TCTMD’s Yael Maxwell has the details.

The US Food and Drug Administration’s Vaccines and Related Biological Products Advisory Committee meets tomorrow to discuss whether (and how) the composition of COVID-19 vaccines should be modified to better target newer strains of the virus. The meeting will be broadcast live on YouTube.

As a New York Times article explains, however, the most recent clinical trials testing vaccinations targeting Omicron and its subvariants may be too little, too late. “The virus is evolving so quickly that new vaccine formulations are out of date before such trials are even finished,” writes Sharon LaFraniere.

terminologyThe American Heart Association and the American College of Cardiology (AHA/ACC) have released a document outlining definitions of various cardiovascular and noncardiovascular complications of SARS-CoV-2 infection, writes TCTMD’s Todd Neale. The paper, published online last week in both Circulation: Cardiovascular Quality and Outcomes and the Journal of the American College of Cardiology aimed “to standardize the definitions of the various terms people use, so that when they talk to each other, everybody kind of knows what the words mean and what’s going on with them,” said Sandeep Das, MD (UT Southwestern Medicine Center, Dallas, TX), vice chair of the writing committee.

The true burden of COVID-19 in children remains unclear, especially as new variants emerge, but as a study from Nicaragua makes clear, very young children may actually be the most vulnerable. Among 1,824 kids who underwent testing for seropositivity, children under the age of 2 were the ones most likely to be hospitalized, and—notably—one in five symptomatic SARS-CoV-2 episodes were among kids who’d already recovered from a prior COVID-19 infection, researchers write in JAMA Network Open.

An accompanying editorial offers some takeaways for parents and physicians grappling with the risks/benefits of vaccinating young children, now that vaccines in many parts of the world have been approved in children 6 months and older.

The UK government has made its first compensation payments to bereaved families and patients who were injured or died as a result of a COVID-19 vaccine. “Vikki Spit from Cumbria is believed to be the first person to receive compensation, after her 48-year-old partner, Zion, became ill eight days after receiving the AstraZeneca vaccine,” Jacqui Wise writes in the BMJ. “A handful of other people have received payments in the past few days under the government’s vaccine damage payment scheme (VDPS), which pays out up to a maximum of £120,000 (€140,000; $150,000).”

nurse giving vaccineInvestigators who were among the first to rigorously document how platelet-activating antiplatelet factor 4 (PF4) antibodies induced by adenovirus vector-based vaccines lead to vaccine-induced immune thrombotic thrombocytopenia (VITT) have now turned their attention to the possibility that subsequent COVID-19 infection in VITT survivors could trigger the same potentially lethal antibody reaction. In a research letter published in the New England Journal of Medicine over the weekend, Andreas Greinacher, MD, and colleagues conclude—reassuringly—that cross-reactivity between PF4 and the SARS-CoV-2 spike protein resulting in VITT recurrence triggered by infection is unlikely. “Our finding that COVID-19 does not restimulate anti-PF4 antibodies in patients with a history of VITT provides further insights into the pathogenesis of this disorder and may be helpful in counseling patients regarding further COVID-19 vaccination with an mRNA vaccine,” they write.

Sickle cell trait (SCT) is associated with increased risk of mortality and acute kidney failure following COVID-19, write the authors of a genetic association study published in JAMA Internal Medicine. “Our findings suggest that SCT can further contribute to worse outcomes in individuals of African ancestry, and there is a need for new treatment strategies to improve clinical outcomes of COVID-19 in individuals with SCT.”


June 23, 2022

female doctorOn June 17, the US Food and Drug Administration (FDA) accepted the unanimous advice of its advisory panel and expanded the emergency use authorization for both Moderna and Pfizer’s vaccines to children as young as 6 months, with the Centers for Disease Control and Prevention (CDC) endorsing that decision and issuing its own recommendation a day later. Now, reports STAT, parents may be wondering which vaccine is the right one. “We can’t tell you which is best for your child,” write Helen Branswell and Matthew Herper. “But we can tell you that in this age group, the Pfizer-BioNTech and the Moderna vaccines probably differ more than they do in any other age group on the vaccination spectrum.”

New York City, once the “epicenter of the COVID pandemic” in the US has opened vaccine hubs around the city, including Times Square, to serve children 6 months and older, the New York Times reports.

The European Medicines Agency (EMA) has recommended granting a marketing authorization for the COVID-19 inactivated, adjuvanted vaccine VLA2001, made by the French company Valneva, for use in the primary vaccination of people from 18 to 50 years of age, making it the sixth vaccine approved in European member states. An EMA statement summarizes the data in support of the decision.

usaVery little about the COVID-19 pandemic could be described as “equitable,” most notably the deeper impact the virus has had on lower income and marginalized communities. Now research by the CDC makes clear that oral antiviral drugs in the US, effective at preventing progression to severe disease, have been disproportionately dispensed to neighborhoods with the most socially and economically stable communities. Between December 23, 2021, and May 21, 2022, more than 1 million oral antiviral prescriptions were filled in the US, but rates were highest in “low-vulnerability zip code” regions (373.3 per 100,000 people) and lowest in areas with the highest vulnerability (287.4 per 100,000 people). That’s despite these zip codes having the largest number of dispensing sites, investigators write in Morbidity and Mortality Weekly Report.

A Kaiser Family Foundation analysis delving into the inequitable distribution of oral antivirals Paxlovid and Lagevrio has further insights, concluding: “While treatments are available at facilities across the country and nearly all people live in a county with such a facility, regardless of their income, race/ethnicity, or whether they live in a metro or non-metro area, some disparities in access persist among the potentially highest risk and highest need counties.” 

Also in MMWR this week, investigators looked at hospitalizations and emergency department visits among COVID-19-positive patients prescribed Paxlovid in California. The upshot: such encounters were rare among patients taking Paxlovid (< 1%). “The rarity of these outcomes is consistent with evidence from recent case reports and large observational studies, which found that symptoms experienced by patients with COVID-19 rebound after treatment with Paxlovid are milder than those experienced during the primary infection and are unlikely to lead to hospitalization,” the authors conclude.

During the Omicron surge, a fourth dose of the Pfizer/BioNTech vaccine, as compared with three, was associated with a “34% protection against infection, 64% to 67% against hospitalizations for mild-to-moderate and severe illness, and 72% against deaths” among residents of long-term care facilities, researchers report in JAMA Internal Medicine.

Early in the COVID-19 pandemic, scientists identified a “Kawasaki-like” illness in kids and teens that was soon given the moniker multisystem inflammatory syndrome in children (MIS-C). But as for Kawasaki Disease (KD) itself, the pandemic period has offered some unexpected clues about the triggers of this little-understood condition. A cohort study published in JAMA Network Open indicates that rates of KD fell by 28% in the US and remained low during periods of COVID-19-related masking and school closures. “These findings suggest that social behavior is associated with exposure to the agent(s) that trigger KD and are consistent with a respiratory portal of entry for the agent(s),” authors conclude. A press release has more.

footThe rise of virtual medical meetings during the pandemic have led some physicians and researchers to think about the carbon footprint of meeting travel. A cohort study in JAMA Oncology estimates that 469.4 metric tons of CO2 emissions were avoided as a result of an oncology conference going virtual in 2021, “the equivalent of the annual emissions of 102.4 passenger vehicles.” Those calculations accounted for emissions associated with online conference streaming (0.91 metric tons) and food delivery (0.70 metric tons). “Recognizing that in-person meetings may likely continue in the postpandemic era, professional societies may wish to consider prioritizing sustainability and environmental outcomes and enacting these considerations in their planning,” authors say.



June 16, 2022

 US National Institute of Allergy and Infectious Diseases (NIAID) Director Anthony Fauci, MD, has tested positive for COVID-19 and is experiencing “mild symptoms,” the agency announced yesterday. Fauci, who is also chief medical advisor to President Joe Biden, is fully vaccinated and has received two boosters. “He has not recently been in close contact with President Biden or other senior government officials,” the statement reads. “Dr. Fauci will follow the COVID-19 guidelines of the Centers for Disease Control and Prevention [CDC] and medical advice from his physician and return to the NIH when he tests negative.”

braveA US Food and Drug Administration advisory panel voted unanimously yesterday to recommend that the agency extend indications for use for both the Moderna and Pfizer/BioNTech coronavirus vaccines to children as young as 6 months old. As the New York Times notes, a separate meeting of the Advisory Committee on Immunization Practices (ACIP), which provides guidance to the CDC, meets tomorrow to issue its own recommendations. One day earlier, according to STAT, FDA advisors had recommended extending the use of the Moderna vaccine to children ages 6 through 17, matching the Pfizer vaccine authorization.

The European Medicines Agency (EMA) has announced a rolling review of a tweaked Pfizer/BioNTech vaccine intended to provide better protection against Omicron and its subvariants. The companies, in their own statement, note that this review is initially based on chemistry, manufacturing, and controls, with clinical data, including immunogenicity, still to come. As previously noted in the Dispatch, Moderna also has an Omicron-targeting vaccine for which it announced positive results last week.

Newer Omicron sub-lineages are gaining ground in the Unites States, STAT reports. “More than one in five COVID-19 infections last week were caused by BA.4 and BA.5, according to updated estimates posted Tuesday by the Centers for Disease Control and Prevention,” writes Andrew Joseph. “That’s up from 13% the week prior. The rest of the cases are from the BA.2 lineages.”

Dispatch 2 There are growing calls to harmonize approaches for the identification and treatment of post-COVID symptoms. As TCTMD’s Todd Neale reports, a multidisciplinary group of experts working in clinics set up to manage postacute sequelae of SARS-CoV-2 infection (PASC) across the United States has come out with a consensus statement focused on assessing and treating patients suffering from cardiovascular complications of long COVID. And in the Lancet Respiratory Disease, researchers propose an international consensus-based “core outcome set” to provide a framework for standardized assessment of adults with post-COVID-19 conditions, “aimed at facilitating clinical care and research worldwide.”

Among adults critically ill with COVID-19 who are undergoing tracheal intubation, administration of a fluid bolus does not significantly decrease the incidence of cardiovascular collapse, a randomized controlled trial in JAMA concludes. Fluid bolus administration had been hypothesized to help reduce the risk of severe hypotension leading to cardiac arrest or death and has been recommended in three national ICU tracheal intubation guidelines, the authors note.

One of the largest studies to date affirms that the adenovirus-based Oxford/AstraZeneca COVID-19 vaccine is associated with greater risks of thromboembolic events—particularly cerebral venous thrombosis (CVT)—and thrombocytopenia. The new analysis, based on data from three Nordic countries and published in JAMA Network Open, indicates that hospitalizations for coagulation disorders and cerebrovascular disease were increased for three vaccines analyzed, but most notably and consistently for the Oxford/AstraZeneca shot. TCTMD has the details.

Omicron is causing significantly more hospital-acquired SARS-CoV-2 infections than earlier strains of COVID-19 responsible for the surge in infections last winter, authors write in JAMA. “Possible reasons include the Omicron surge’s very high community and healthcare worker incidence rates, as well as Omicron’s greater contagiousness. Sources of nosocomial infections include healthcare workers, visitors, and other patients.”

vaccinePolarized responses to COVID-19 vaccines may be having spillover effects on uptake of influenza vaccines, a research letter in the New England Journal of Medicine concludes, following an analysis of national US data. “Although inferences about specific policies and messaging promoting COVID-19 vaccination are beyond the scope of this ecologic study, our findings suggest that after the widespread availability of COVID-19 vaccines, factors associated with COVID-19 vaccination rates (eg, safety concerns and mistrust of COVID-19 vaccines or government) may have spilled over to affect influenza vaccination rates.”


June 13, 2022

airportOn Sunday, the United States dropped the mandatory preflight negative test for anyone wishing to travel to the country, a hurdle long lobbied against by travelers, airlines, and the tourism industry. Like in many other countries, the requirement has been in place since January 2021, but it lasted far longer in the US than elsewhere. According to Reuters, the requirement that noncitizens be vaccinated against COVID-19 before travelling to the United States will remain in place for now.

Neighboring Canada, one of the few countries worldwide to still do random airport tests on arriving passengers, announced over the weekend that it is suspending the program, although it warns the intention is to bring it back in some form next month at “off-site” locations, a CBC article notes.

Frontline physicians in the United Kingdom who developed long-COVID symptoms lasting months or years say they’ve been denied financial support by the government, the Guardian reports. A personal independence payment (Pip) is “a non-means-tested benefit helping people with the extra living costs of their chronic illness or disability,” but a range of healthcare workers quoted in the article say their applications for the benefit have been turned down.

One of the largest studies to date testing ivermectin for the treatment of mild-to-moderate COVID-19 in the outpatient setting has found no meaningful benefit of the antiparasitic drug for shortening symptom duration or preventing hospitalization. Authors conclude that a 400 µg/kg dose taken daily for 3 days “resulted in less than 1 day of shortening of symptoms and did not lower incidence of hospitalization or death among outpatients with COVID-19 in the United States during the Delta and Omicron variant time periods.” Preprint results (not yet peer-reviewed) from ACTIV-6 were published to MedRxiv yesterday. Ivermectin is US Food and Drug Administration (FDA) approved for human use to treat infections caused by some parasitic worms, head lice, and certain skin conditions but is not recommended for use in COVID-19. Multiple studies to date have shown no benefit of the drug, which is most commonly used to treat worms in pets and livestock.

“Substantial” funding is available in the United States to improve ventilation in schools to help reduce transmissions of COVID-19 and other respiratory illnesses, though only a minority of schools surveyed are implementing changes that could help the most, researchers write in Morbidity and Mortality Weekly Report. Rural and mid-poverty schools were the least likely to have implemented more expensive, resource-intensive strategies such as the installation of high-efficiency particular air (HEPA) filtration systems. Summertime, investigators say, is a great time to try to get ventilation improvements done that could lead to reduced illness next year.

A vaccine intended for use in people who recovered from a prior COVID-19 infection is safe and helped to bolster the natural immunity afforded by the prior exposure, results of a phase II trial of the FINLAY-FR-1A vaccine confirm. “The vaccine elicited a greater than 31-times increase in anti-receptor binding domain-IgG antibodies compared with prevaccination rates, and the seroconversion rate was 302 (84%) of 358 on day 28 after vaccination,” authors write in the Lancet: Respiratory Medicine. “The geometric mean titers of live-virus neutralization test increased from 15.4 (95% CI 10.3-23.2) to 400.3 (272.4-588.1) and high response was found against Alpha, Beta, and Delta variants of concern.”

613Briefing documents posted online by the FDA ahead of a June 15, 2022, meeting of its vaccine advisory panel make it clear that the agency supports extending COVID-19 vaccinations to children aged 6 months and older. “Available data support the effectiveness of the Pfizer-BioNTech COVID-19 Vaccine three-dose primary series (3 µg each dose) in preventing COVID-19 in the age group of 6 months through 4 years,” the document concludes. While the agency’s Vaccines and Related Biological Products Advisory Committee is meeting to review Pfizer/BioNTech’s application for amendment, some experts, according to the New York Times, expect regulators may use the opportunity to extend the authorization for both the Pfizer/BioNTech and Moderna products.

Earlier in the pandemic, racial and ethnic minority groups were bearing the brunt of COVID-19, experiencing greater infection rates, worse illness, and higher mortality, while also having lower rates of vaccination. That picture is shifting over time, according to the latest US Centers for Disease Control and Prevention (CDC) data, published in Morbidity and Mortality Weekly Report last week. “By the end of November 2021, disparities in vaccination coverage for some racial and ethnic groups narrowed, and coverage was similar for non-Hispanic Black (78.2%), Hispanic (81.3%), Native Hawaiian and other Pacific Islander (75.7%), and non-Hispanic white (78.7%) adults.” A New York Times explainer, “COVID and Race,” has more, including details as to why death rates in white Americans are now higher than those for Black, Latino, and Asian Americans.

The latest study of blood donations in the United States suggests that seroprevalence levels, stemming from vaccinations and infections, reached almost 95% in the United States by December 2021. “Despite this, record levels of infection and reinfections were reported as the Omicron variant became predominant in early 2022,” authors write in JAMA. “The high infection rates are likely related to increased transmissibility and enhanced immune escape mutations of the Omicron variant, along with waning protection from previous vaccination and infection.” 



June 9, 2022

The United States has set out its plans for extending COVID-19 vaccinations to children under the age of 5 years provided vaccines are cleared by the US Food and Drug Administration, a move expected as early as next week, the New York Times reports. The Centers for Disease Control and Prevention would typically also need to recommend their use, although uptake is expected to be lower in this younger group.

Moderna announced yesterday that a modified version of its mRNA vaccine—a “bivalent booster” (mRNA-1273.214)— is more effective against the Omicron variant than its original mRNA-1273 vaccine. “Looking at these data alongside the durability we saw with our first bivalent booster candidate, mRNA-1273.211, we anticipate more-durable protection against variants of concern with mRNA-1273.214, making it our lead candidate for a fall 2022 booster,” a press release states. 

mother holding babyBabies exposed to COVID-19 in utero have a higher chance of developing neurodevelopmental changes, a study in JAMA Network Open concludes. Among 7,772 infants delivered during the COVID-19 pandemic in this analysis, those born to the 222 mothers who tested positive for SARS-CoV-2 while pregnant were significantly more likely to receive a neurodevelopmental diagnosis in the first 12 months after birth. The findings “highlight the need for prospective investigation of outcomes in children exposed to COVID-19 in utero,” beyond the other established risks of preterm delivery and birth complications, authors say.

An FDA advisory panel voted 21-0 with one abstention that the agency should approve the Novavax COVID-19 vaccine. The recombinant protein vaccine is a “more-traditional” vaccine formulation, similar to that used for diseases like influenza, and is already approved in more than 40 countries worldwide, a Reuters summary notes. If the FDA follows its advisors’ advice, the vaccine would be the fourth approved for the United States. The World Health Organization cleared the product, NVX-CoV2373, which can be stored at regular refrigeration temperatures, for emergency use back in December 2021.

An analysis of more than 7,000 heart failure patients treated in a large New York City health system indicates that patients who were fully vaccinated or boosted were dramatically less likely to die, be hospitalized, or require ICU care over subsequent months, as compared with their unvaccinated or only partially vaccinated peers. TCTMD’s Todd Neale has the details from the short communication, published in the Journal of Cardiac Failure.

“Immune escape” is an increasingly common COVID-19 catchphrase as Omicron variants continue to proliferate, and is the focus of multiple studies this week:

  • In the New England Journal of Medicine, investigators explore the pathways for variant evolution and immune evasion among immunocompromised patients and how these might differ in patients treated with monoclonal antibodies versus those capable of mounting a partial immune response. “Our results underscore the potential importance of selective pressures such as the use of monoclonal antibodies—in combination with the lack of an effective endogenous immune response—in promoting the emergence of SARS-CoV-2 escape mutations,” the authors warn.
  • A study in Cell details how spike sequences of BA.4 and BA.5, while closely related to the BA.2 substrain, have additional mutations in the receptor binding domain of spike that may help explain why triple vaccination with the AstraZeneca or Pfizer vaccines are offering less protection as compared with the BA.1 and BA.2 subvariants, paving the way for repeat Omicron infections.
  • In the Lancet Infectious Diseases, authors of a research letter approach the same “escape” questions from the stance of the therapeutic monoclonal antibodies against the different Omicron strains, noting, for example, that bamlanivimab, casirivimab, etesevimab, imdevimab, and tixagevimab had less effect against BA.2 and several subvariants than against the parental strain. Bebtelovimab, on the other hand, “was approximately twofold more effective against BA.2 and all Omicron subvariants tested than the parental virus.”

uk thank you workersAn analysis of national electronic health records across England paints a full picture of the demographic factors, frequency of comorbidities, impact of the two principal COVID-19 waves, and the effect of vaccination on COVID-19 severity on 57 million people alive and registered with a general practitioner. Authors describe what they deem to be 10 different COVID-19 phenotypes, associated with five severity categories, and unique disease and mortality “trajectories” for the different pandemic waves. This type of modelling, they write in the Lancet Digital Health, could prove useful for policy makers facing new variants and new waves.


June 6, 2022

A new COVID-19 vaccine may be coming, with the US Food and Drug Administration (FDA) expected to make a decision about authorizing the shot from Novavax within weeks, the Associated Press reports. “The Novavax vaccine already is used in parts of Europe and multiple other countries, but FDA clearance is a key hurdle. And health experts are closely watching to see if a new tool offers advantages, either in enticing vaccine holdouts or maybe even offering somewhat broader immunity.” Agency advisors are set to discuss the vaccine on Tuesday, and documents released ahead of the meeting indicate that rare cases of myocarditis—which have been linked to the mRNA vaccines—will be a topic of discussion for this shot, too (CIDRAP News).

uncapped syringeTens of millions of COVID-19 vaccine doses, representing about 11% of those distributed by the US government, have been wasted, NBC News reports. Between December 2020 and the middle of May 2022, fully 82.1 million doses were discarded. “The overall amount of waste is in line with World Health Organization estimates for large vaccination campaigns,” the story notes. “But public health experts said the waste is still alarming at a time when less than half of fully vaccinated Americans have a booster shot—which is critical to fight newer, more contagious virus strains—and when many poorer countries continue to struggle with vaccine supply.”

The proportion of people around the world with substantial levels of antibodies against SARS-CoV-2—either from infection or vaccination—reached 67% in October 2021, up from just 16% in February 2021, according to an update released by the World Health Organization (WHO) last week: “Due to a steep rise in the number of infections in many countries following the emergence of Omicron and increasing vaccine coverage, both vaccine- and infection-induced population seroprevalence levels are expected to have increased substantially since October 2021, albeit with sustained regional and subpopulation variations.”

The number of COVID-19 cases in the United States fell for the first time since late March, according to the latest numbers from the Centers for Disease Control and Prevention (CDC) released last week. As of June 1, Becker’s Hospital Review notes, the 7-day case average was 100,684, down 8.5% from the week before. On average, hospitalizations increased 4.7% and deaths dropped 23.1%.

basketball shotBooster COVID-19 vaccination during the Omicron wave was associated with a 57% lower risk of any SARS-CoV-2 infection and a 61% lower risk of symptomatic infection among the highly vaccinated population of NBA players, researchers report in JAMA. CIDRAP News gives more details.

A preprint study, detailed by Reuters, indicates that Pfizer’s Paxlovid reduces COVID-19-related hospitalizations and deaths in both vaccinated and unvaccinated patients age 65 and older during a period of rising Omicron variant prevalence. But the data, from Clalit Health Services in Israel, suggest that the antiviral treatment does not prevent severe outcomes in younger individuals. Another study, also out of Israel and published in Clinical Infectious Diseases, shows that Paxlovid reduces severe COVID-19 or mortality in the Omicron era, but that it appears more effective in older patients and those who are immunosuppressed or have underlying neurological or cardiovascular disease.

Compared with white individuals living in Alaska, American Indians or Alaska Natives in the state have greater risks of COVID-19 and associated hospitalization and death, according to data in Morbidity and Mortality Weekly Report. That mirrors other studies conducted during the COVID-19 era and during the influenza A (H1N1) pandemic of 2009.

sniffer dogMore evidence points to the ability of specially trained dogs to sniff out SARS-CoV-2 infections. A study in PLOS One shows that compared with nasopharyngeal RT-PCR testing, dogs detected the virus in nasopharyngeal, saliva, and sweat samples with 97% sensitivity and 91% specificity (reaching 100% and 94%, respectively, in asymptomatic individuals). Use of dogs could be an alternative to standard testing “when it is necessary to obtain a result very quickly according to the same indications as antigenic tests in the context of mass screening,” the authors say. CIDRAP News has more.


June 2, 2022

crowd of peopleCOVID-19 cases among Americans emerging from the Memorial Day holiday earlier this week were six times higher than this time last year, according to ABC News, noting that millions of Americans traveled for the long weekend at levels not seen since before the onset of the pandemic. That’s based on official case counts from the US Centers for Disease Control and Prevention (CDC), but real numbers are likely far higher, given the widespread availability of at-home testing.

More broadly, COVID-19 cases are up 9% in the Americas, with pediatric cases doubling over the last 2 weeks in the US, even as global cases fell by 11% and deaths by 3%, CIDRAP News summarizes. A lack of transparency from North Korea, however, is making it difficult to factor in new cases there, which potentially number in the millions, according to frustrated World Health Organization (WHO) officials quoted in the story.

In South Africa, new COVID-19 infections have surged in recent months, despite studies suggesting that 98% of the population has antibodies from prior infection, vaccination, or both, the New York Times reports. A new study, “released Thursday but not yet peer-reviewed, analyzed the prevalence of two types of antibodies in 3,395 blood donors collected mid-March across the country in order to estimate prevalence at the national level,” the story explains. “About 11% had antibodies that, according to the study’s authors, suggest that a person had been vaccinated but not recently infected.”

Elsewhere on the continent, an analysis of 47 countries making up the WHO African region published in the Lancet Global Health estimates that the number of SARS-CoV-2 infections between January 2020 and December 2021 was more than 505 million, but infers that just 1.4% of infections (one out of 71) were reported. “Deaths are estimated at 439,500,” authors say, “with 35.3% (one in three) of these reported as COVID-19-related deaths.” Those numbers, they write, confirm other studies suggesting that the African region has had a similar number of COVID-19 infections compared with other parts of the world, but fewer deaths.

There’s more evidence that an mRNA booster can ratchet up the efficacy of Johnson & Johnson’s single-dose Janssen (Ad26.COV2.S) vaccine against the Omicron variant of COVID-19. Writing in a letter to the editor in the New England Journal of Medicine, authors calculated the vaccine effectiveness of four different homologous and heterologous vaccine doses, concluding that, regardless of original vaccine course, “all the regimens that included a booster dose, as compared with no vaccination, offered protection against symptomatic Omicron infection, although vaccine effectiveness was highest for the regimens that included a booster dose of an mRNA vaccine and was lowest for the homologous Ad26.COV2.S/Ad26.COV2.S regimen.” 

Also in the NEJM, Israeli investigators tracked the immunity protection afforded by SARS-CoV-2 infection as compared with that conferred by vaccination, and how these wane with time. The upshot: people previously infected with SARS-CoV-2, regardless of whether they had received any dose of vaccine before or after infection, saw their protection against reinfection decrease with time, but the level of protection maintained over this interval appeared higher than that conferred by a second vaccine dose in someone who was previously uninfected. Notably, write the authors, “a single dose of vaccine after infection reinforced protection against reinfection.”

woman looking at food in storeThe US National Institutes of Health-funded HEROS study has some intriguing new epidemiological insights, among them the observation that people with food allergies are less likely to catch COVID-19, and—as other studies have documented—that obesity and high body mass index are associated with a higher risk of SARS-CoV-2 infection. Asthma, however, did not increase risks. Additional observations are in the paper published this week in the Journal of Allergy and Clinical Immunology. One theory for the lower risk in people with food allergies, a press release notes, is that “type 2 inflammation, a characteristic of allergic conditions, may reduce levels of a protein called the ACE2 receptor on the surface of airway cells. SARS-CoV-2 uses this receptor to enter cells, so its scarcity could limit the virus’s ability to infect them.”

COVID-19 has had “substantial global collateral CV damage” when it comes to the delivery of cardiovascular services around the world, particularly in low- and middle-income countries that were already lagging behind their higher-income counterparts, a systematic review and meta-analysis published this week in the European Heart Journal makes clear. Declines in services were seen across the globe, although countries outside of Europe and North America experienced steeper reductions in hospitalizations and primary PCIs for STEMI and worse short-term outcomes for certain conditions.

A review of all live births in Norway between September 2021 and February 2022, published in JAMA Internal Medicine, found that babies born to women who received a second or third dose of COVID-19 vaccine during the last two trimesters of pregnancy had a lower incidence of SARS-CoV-2 infection during their first months of life as compared with infants born to unvaccinated women. “The findings of this study provide early evidence to suggest that infants benefit from passive protection from SARS-CoV-2 infection following maternal COVID-19 vaccination during pregnancy,” the authors conclude, noting that similar protection has been documented with studies of pertussis and influenza vaccination during pregnancy.

man covering eyesPatients hospitalized with COVID-19 have objective evidence of damage, including cardiovascular damage, to multiple organ systems up to 2 months after discharge, and these abnormalities have a relationship to long COVID symptoms, according to a prospective study published last week in Nature Medicine. As TCTMD’s Todd Neale reports, imaging, ECG, and biomarker tests performed 28 to 60 days after patients left the hospital revealed injuries to the heart, lung, and kidney that were typically not seen in contemporary controls without COVID-19. As senior author Colin Berry, MBChB, PhD, told TCTMD, the study lends support to the belief that “long COVID does have a pathological basis to it.”


***THE DISPATCH WILL RETURN AFTER MEMORIAL DAY***

May 26, 2022

covid graph doing downThough some parts of the world continue to deal with rising COVID-19 numbers, including the Americas and the Western Pacific region, cases have again started to decline from a global perspective after a week of stabilization, according to the latest update from the World Health Organization (WHO). New cases fell 3% from the prior week, with an 11% reduction in new deaths. CIDRAP News has more.

Earlier this week, the US Centers for Disease Control and Prevention (CDC) issued an alert regarding the potential for “COVID-19 rebound” after treatment with Pfizer’s oral antiviral therapy Paxlovid. The agency maintains its recommendation to use the therapy for patients with mild-to-moderate COVID-19 who are at risk for progression to severe disease, but newly advises patients with a rebound to re-isolate for at least 5 days and wear a mask for 10 days after the start of rebound symptoms. A STAT story discusses the efforts going into uncovering the reasons for the rebound phenomenon.

Taiwan, which managed to limit the number of locally transmitted COVID-19 cases to less than 15,000 for all of 2021, is now seeing about 80,000 cases each day as it eases restrictions with an eye on living with the virus, a Reuters article notes. “Unlike some countries where new case spikes overwhelmed medical systems and disrupted everyday life, Taiwan hospital beds earmarked for COVID patients are at 56% occupancy. Shops, restaurants, and gyms remain open, and gatherings continue, with mandatory mask-wearing.”

Full vaccination is associated with less secondary transmission of COVID-19 and a shorter duration of viable viral shedding compared with partial or no vaccination, according to a study in JAMA Network Open. That provides “important evidence that despite the possibility of breakthrough infections, COVID-19 vaccinations remain critically useful for controlling the spread of SARS-CoV-2,” the authors say. A commentary delves into the implications.

sweden covidSweden is recommending a fifth COVID-19 shot for people older than 65 and others deemed to be at risk for serious illness, including pregnant women, those who are immunocompromised, and patients with heart and lung disease, the Associated Press reports. The policy takes effect September 1.

Some studies have suggested that COVID-19 vaccination not only protects against severe outcomes from acute SARS-CoV-2 infection, but also limits long COVID symptoms months later. A new study in Nature Medicine, however, indicates that protection against long COVID is not absolute—vaccinated people with breakthrough infections still had an elevated risk of postacute sequelae, though it was lower than that seen in unvaccinated individuals. “Altogether, the findings suggest that vaccination before infection confers only partial protection in the postacute phase of the disease; hence, reliance on it as a sole mitigation strategy may not optimally reduce long-term health consequences of SARS-CoV-2 infection,” the researchers write. The findings are disappointing, the lead author told the Washington Post.

A study from CDC researchers, published in Morbidity and Mortality Weekly Report, provides some insights into the occurrence of post-COVID conditions up to a year after the initial infection, showing that about one in five people ages 18 to 64 and one in four people 65 and older had at least one condition that could be linked to COVID-19. The greatest risks were seen for acute pulmonary embolism and respiratory signs or symptoms. Here’s more from the New York Times.

Another study, this one in the Annals of Clinical and Translational Neurology, indicates that a subset of patients who were not hospitalized for COVID-19 can have neurologic symptoms, fatigue, and compromised quality of life that lasts more than a year after the initial infection. At a median follow-up of 14.8 months, a range of symptoms that included “brain fog,” numbness/tingling, headache, dizziness, blurred vision, tinnitus, and fatigue remained prevalent. Vaccination did not have an impact on cognitive function or fatigue.

Though a fourth dose of the Pfizer/BioNTech vaccine gives added protection against SARS-CoV-2 infection and severe COVID-19 compared with three doses in people 60 and older, its effects fade faster than those seen with a third dose, researchers report in the BMJ. Effectiveness against infection peaked 3 weeks after administration of the fourth dose (at 65.1%), falling to just 22.0% by 10 weeks.

environmental pollutionLong-term exposure to air pollution, particularly ground-level ozone, is associated with greater risks of hospitalization, ICU admission, and death among patients with COVID-19, according to a study in CMAJ. “However,” the authors say, “uncertainty still remains in the mechanisms of how long-term air pollution might affect COVID-19 severity, which calls for future research.”


May 23, 2022

According to the latest numbers from the US Centers for Disease Control and Prevention (CDC), released late last week, most Americans live in areas with low levels of COVID-19, although many parts of the country have moved into medium and high levels. The 7-day average of new cases increased by 18.8% compared with the prior period, with hospitalizations up 24.2%. The average of new deaths declined slightly, by 1.2%.

child getting vaccinePfizer and BioNTech said Monday that a third, 3-µg dose of their COVID-19 vaccine elicited “a strong immune response, with a favorable safety profile” in children ages 6 months to under 5 years in a phase II/III trial. Vaccine efficacy, a secondary endpoint, was 80.3% at a time when the Omicron variant was dominant. “These top-line safety, immunogenicity, and efficacy data are encouraging, and we look forward to soon completing our submissions to regulators globally with the hope of making this vaccine available to younger children as quickly as possible, subject to regulatory authorization,” said Albert Bourla, Pfizer’s chairman and CEO. US Food and Drug Administration (FDA) advisors will meet June 14 and 15 to discuss the use of this vaccine and the one from Moderna in young children (Reuters).

Excess mortality related to COVID-19 in Massachusetts was actually higher when Omicron was the dominant variant than when Delta was widely circulating, despite reports that Omicron presents less risk, researchers report in JAMA. “The present findings indicate that a highly contagious (although relatively milder) SARS-CoV-2 variant can quickly confer substantial excess mortality, even in a highly vaccinated and increasingly immune population,” they say.

Over the course of the pandemic, COVID-19-related mortality has continued to fall among older individuals, with particularly large declines in death rates in those 80 and older, according to a study in JAMA Network Open. In contrast, mortality increased over time among younger adults. “Possible factors underpinning these changing patterns are higher vaccination prevalence and less exposure to infection among older individuals,” the authors suggest. “This advantage may have increased over time as younger individuals returned to work and other activities and the Delta variant emerged.”

money with maskThe COVID-19 pandemic did not drive up medical debt among Americans, an analysis of credit reports in JAMA Health Forum suggests. “We found no evidence of a net association between the COVID-19 pandemic and medical debt, overall or across areas with different incomes and pandemic severity. These results are consistent with any increase in medical debt being offset by decreases in elective medical procedures and new healthcare-related governmental policies,” the authors write.

Over the weekend, the New York Times released a story delving into what’s known about long COVID, or postacute sequelae of COVID-19 (PASC), including discussions around diagnosis, risk factors, the impact of vaccination, and medical care. Studies estimate that 10% to 30% of people report medical issues months after the initial infection. “Such lingering medical issues are so varied that one study by a patient-led research group evaluated 203 symptoms that may fluctuate or even appear out of the blue after people seem to have recovered,” the article notes.

People with low body weight have less waning of COVID-19 vaccine immunity 6 months after receipt of two doses of the Pfizer/BioNTech shot, according to a study in JAMA Network Open. The researchers conclude: “A booster shot . . . may be given later than 6 months after the second dose in young and middle-aged healthy persons with low body weight.” CIDRAP News has more.

A study out of Israel, published in JAMA, indicates that the severity of multisystem inflammatory syndrome in children (MIS-C) associated with SARS-CoV-2 infection was reduced when Omicron was circulating. “Possible explanations include the Omicron variant itself, previous infection with SARS-CoV-2, vaccination against SARS-CoV-2, and improvement in treatment over time,” its authors note.

man with mask looking out windowA study published last week in Psychological Medicine shows that depression, worry about COVID-19, and loneliness prior to SARS-CoV-2 infection are associated with a greater risk of hospitalization for COVID-19. “Assessment of psychological distress may identify patients at greater risk of hospitalization,” the researchers say. “Future work should examine whether addressing distress improves physical health outcomes.”


May 20, 2022

covid north koreaThe estimated number of COVID-19 cases in North Korea is approaching 2 million just a week after the country—which has an unvaccinated population—admitted it had an outbreak, the Associated Press reports. The story notes that “the outbreak could be worse than officially reported since the country lacks virus tests and other healthcare resources and may be underreporting deaths to soften the political impact on authoritarian leader Kim Jong Un.”

Shanghai, China, continues to emerge from its latest round of lockdowns, with plans to reopen four of its 20 subway lines on Sunday (Associated Press). Also restarting will be 273 bus lines that connect major urban centers, airports, train stations, and hospitals. “The lockdown of China’s largest city”—done as part of a “zero COVID” strategy—“has dealt a blow to the economy and frustrated residents, particularly as many countries elsewhere in the world move away from such harsh measures as they try to live with the virus.”

COVID-19 cases are rising in several parts of the world, with a weekly update from the World Health Organization (WHO) showing increasing infections in the Eastern Mediterranean, Western Pacific, Americas, and African regions (CIDRAP News). WHO officials are warning health systems in the Americas to prepare for surges (New York Times). An official said there are over 27% more cases in the region, driven by increases in the US. On Wednesday, federal officials said one-third of Americans live in areas where spread of the virus is so high that they should consider wearing a mask indoors.

As COVID-19 numbers continue to rise across the United States, the Centers for Disease Control and Prevention (CDC), decided yesterday to recommend booster doses of the Pfizer/BioNTech vaccine in children ages 5 to 11 (New York Times). The US Food and Drug Administration (FDA) authorized that use earlier in the week.

fda websiteOn Monday, the FDA declined to authorize fluvoxamine, a generic antidepressant, as a treatment for COVID-19, STAT reports. In a two-page summary, the agency said a group of doctors that has been advocating for use of the drug failed to prove that it was effective. FDA reviewers note that in one particular trial, “the treatment benefit of fluvoxamine was not persuasive when focusing on clinically meaningful outcomes such as proportion of patients experiencing hospitalizations or hospitalizations and deaths.”

Children and teens with congenital and acquired cardiovascular conditions are particularly susceptible to severe COVID-19 outcomes, according to a study in JAMA Network Open. Cardiac arrest, cardiogenic shock, heart surgery, cardiopulmonary disease, heart failure, hypotension, nontraumatic cerebral hemorrhage, pericarditis, and biventricular defects all were associated with increased COVID-19 severity. CIDRAP News provides more details.

More than three-quarters of patients with long COVID were not hospitalized for the initial infection, according to a report from FAIR Health based on private insurance claims. “The new study adds to a growing body of evidence that, while patients who have been hospitalized are at greater risk for long COVID, people with mild or moderate initial coronavirus infections—who make up the vast majority of coronavirus patients—can still experience debilitating post-COVID symptoms including breathing problems, extreme fatigue, and cognitive and memory issues,” a story in the New York Times notes.

A UK study published in the BMJ suggests that receipt of a COVID-19 vaccine after testing positive for SARS-CoV-2 may prevent long COVID symptoms, with sustained improvement after a second dose, although the researchers say longer follow-up is necessary. And an accompanying editorial notes that “a clear explanation for how vaccines might reduce the multisystem manifestations of long COVID is still lacking.” Here’s more from STAT.

In an explainer video, STAT’s Helen Branswell explores why there isn’t a nasal vaccine for COVID-19 yet. “If we want to prevent mild COVID infections, we’re going to need vaccines that protect us where infections start: in the mucus membranes of the nose, mouth, and throat. And for that, we’re likely going to need intranasal vaccines,” Branswell says, noting that “the development process is tricky.”

airport dogNew data published this week in BMJ Public Health affirm that specially trained dogs can accurately sniff out COVID-19 among travelers passing through an airport. “One of our findings highlights the importance of continuous retraining as new variants emerge,” the researchers say, adding that “using scent dogs may present a valuable approach for high-throughput, rapid screening of large numbers of people.” CIDRAP News provides more details.


May 16, 2022

New Zealand Prime Minister Jacinda Ardern has tested positive for COVID-19, joining other members of her family, the Associated Press reported late last week. Ardern, who is fully vaccinated, said she still plans to travel to the United States later this month to discuss trade and give a commencement address at Harvard University.

shanghai skyline at nightAuthorities in Shanghai, China, says its lockdown meant to stem a recent outbreak of SARS-CoV-2 will start easing, the Associated Press reports. Fewer than 1 million people in the city of more than 26 million remain under strict lockdown, and the vice mayor said 15 of 16 districts in Shanghai had eliminated virus transmission.

Readmission after a prior hospitalization for severe COVID-19 is common, investigators write in the CMAJ. Relatively little attention has been paid to readmission rates, the authors say, and while these appear similar to those following discharge for other medication conditions, more research is needed to understand postacute COVID symptoms and outcomes.

In a randomized trial, prone positioning did not significantly boost outcomes over usual care among adults with COVID-19 and acute hypoxemia. There were no differences between groups in terms of endotracheal intubation within 30 days (primary outcome), mortality at 60 days, or other events, although the researchers note in JAMA that “the effect size for the primary study outcome was imprecise and does not exclude a clinically important benefit.”

Among immunosuppressed patients, two doses of the COVID-19 vaccine from Moderna result in stronger seroresponses than two doses of the Pfizer/BioNTech shot, according to a study in JAMA Network Open. “These findings suggest that choice of mRNA vaccine platform is important in optimizing immune responses to SARS-CoV-2 vaccination and can help inform strategies for booster doses in high-risk, immunosuppressed populations,” the researchers write.

costs of healthcareWith help from the government, US hospitals fared well financially during the first year of the pandemic, according to an analysis in JAMA Health Forum. Though operating margins were substantially reduced, overall profit margins were similar to those in prior years, with government, rural, and smaller hospitals having even higher profit margins. The findings suggest “that the COVID-19 relief fund effectively offset the financial losses for hospitals during the COVID-19 pandemic.” CIDRAP News has more.

Two other studies in JAMA focus on the pediatric population. One shows that during a period of dominance for the Omicron variant, estimated vaccine effectiveness for two doses of the Pfizer/BioNTech shot was “modest and decreased rapidly,” although a booster dose increased it. The other demonstrates that unvaccinated children and teens had greater risks of infection and hospitalization compared with their vaccinated peers, with declining risk as Omicron became more prevalent. “The encouraging message should be that although vaccine protection for children and adolescents was lower in the Omicron era than with previous variants and that such protection wanes rapidly, vaccine effectiveness against hospitalization remains high and booster doses confer additional protection,” an editorial states.

The Omicron variant is more likely than prior strains to cause croup in children, researchers report in Pediatrics. Of the 75 children admitted to Boston Children’s Hospital with COVID-associated croup through the middle of January 2022, 81% were during the period of Omicron dominance. Most were male (72%) and discharged from the emergency department (88%). The “preliminary findings lend compelling evidence to the hypothesis that the Omicron variant causes laryngotracheobronchitis,” the authors say. CIDRAP News has more details.

woman clutching chestAsthma + Lung UK reports a doubling in the number of people looking for help with long COVID symptoms over the last 6 months, with about 500,000 visiting its website or calling its helpline over that span, according to Bloomberg. The charity’s chief executive said: “As we near the grim milestone of 2 million people living with long COVID, there is still a dismal lack of treatments for this disabling condition, which is leaving people fighting for breath and devastating every aspect of their life, health, work, and relationships.”

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Shelley Wood is Managing Editor of TCTMD and the Editorial Director at CRF. She did her undergraduate degree at McGill…

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