COVID-19: TCTMD’s Daily Dispatch for April 14
We’re curating a list of COVID-19 research and other useful content, and updating it daily.
TCTMD reporter Todd Neale is keeping up on breaking news and peer-reviewed research related to COVID-19 and will update daily. If you have something to share, tell us. All of our COVID-19 coverage can be found on our COVID-19 Hub.
April 14, 2021
Denmark becomes the first country to permanently stop using the AstraZeneca vaccine, over concerns about rare blood clotshttps://t.co/10NJ1lusfr— BBC Breaking News (@BBCBreaking) April 14, 2021
Taking it a step further than countries that have suspended use of the AstraZeneca/Oxford vaccine following reports of rare blood clots in people who have received the shot, Denmark has become the first country to completely abandon it, BBC News reports. “Director General Soren Brostrom said it had been a ‘difficult decision’ but Denmark had other vaccines available and the epidemic there was currently under control.”
In the United States, the Advisory Committee on Immunization Practices (ACIP), which provides guidance to the Centers for Disease Control and Prevention (CDC), will meet Wednesday afternoon to discuss the potential risk of thromboembolic events with the Janssen COVID-19 vaccine from Johnson & Johnson, a day after US regulators paused its use.
The European Medicines Agency (EMA) said it continues to look into the reports of blood clots associated with the Janssen vaccine and the AstraZeneca/Oxford vaccine. The agency expects to issue a recommendation regarding the Janssen shot next week, but noted that it believes the benefits of both vaccines continue to outweigh any potential risk of side effects.
STAT’s Matthew Herper explores how a COVID-19 vaccine might cause rare blood clots. He notes that two recent papers showed that the issue affected people with high levels of antibodies to platelet factor 4, “the same types of antibodies reported, infrequently, after treatment with heparin. That doesn’t explain why a vaccine is causing the immune system to produce those antibodies, or whether other vaccines might do the same. But it provides a first step toward explaining the side effect, which experts say is extremely rare, and to looking into whether the same types of rare clots could occur with other shots.”
Earlier this week, the European Society of Cardiology (ESC) launched a COVID-19 vaccine information page for heart patients, which addresses several frequently asked questions. Of note, the ESC says it’s important for all patients with CV conditions to get vaccinated since they’re at greater risk for dying from COVID-19.
In more-positive vaccine news, Moderna said Tuesday that continuing follow-up in the phase III COVE trial shows that its vaccine remains more than 90% effective against all COVID-19 cases and greater than 95% effective against severe disease about 6 months after administration of the second dose. The company also said its trial in adolescents ages 12 to 17 is fully enrolled and its trial in younger children is currently enrolling.
For the first time during the pandemic, Canada this week overtook the United States in new COVID-19 cases per capita, Bloomberg reports. There have been about 22 new cases recorded per 100,000 people over the past week. Hardest hit is Ontario, where only emergency surgeries are being performed across most of the province as ICUs fill up with COVID-19 patients.
Twenty-seven European Union countries agreed Wednesday to adopt a system of COVID-19 travel passes to assist in welcoming tourists back this summer, Reuters reports. “The certificates would allow those vaccinated, recovered from COVID-19, or with negative test results to travel more easily in the EU, where restrictions on movement have weighed heavily on the travel and tourist industry for over a year.” The European Parliament still needs to give its approval to the proposal.
Bad news for the sedentary population: a large study in the British Journal of Sports Medicine shows that physical inactivity is associated with a greater risk of severe COVID-19 outcomes. Consistent inactivity was tied to increased odds of hospitalization, admission to the ICU, and death compared with either consistently getting the recommended amount of exercise or doing some physical activity. “I continue to believe that exercise is medicine that everyone should take—especially in this era of COVID-19,” one of the study authors said in a press release.
Following reassuring data showing that suicide deaths actually declined in the US last year, a study of 21 high-income or upper-middle-income countries—published in the Lancet Psychiatry—showed no signs that risk of suicide increased in any area between April and July 2020, with decreases observed in 12 countries or areas. The authors caution, however, that “we need to remain vigilant and be poised to respond if the situation changes as the longer-term mental health and economic effects of the pandemic unfold.”
April 13, 2021
All eyes have been on the potential blood clot risk with the AstraZeneca/Oxford COVID-19 vaccine recently, but another shot is now in the spotlight, roiling the worldwide rollout. US regulators have paused use of the Janssen COVID-19 vaccine from Johnson & Johnson while they investigate reports of rare blood clots occurring after vaccination in six women younger than 50, Reuters reports. Johnson & Johnson also said it would delay rollout of its vaccine in Europe; the European Medicines Agency (EMA) said last week it was already looking into the potential risk of thromboembolic events with the shot.
The Johnson & Johnson issues threaten to slow a US vaccination effort that saw a record number of shots administered over the weekend. According to CIDRAP News, there were more than 4 million doses given on Saturday, with the daily average now over 3 million.
Yesterday, officials from the World Health Organization (WHO) said COVID-19 cases had increased worldwide for the seventh week in a row, despite the fact that about 780 million vaccine doses have been administered so far, CIDRAP News reports. At a briefing, WHO Director-General Tedros Adhanom Ghebreyesus, PhD, said, “Make no mistake, vaccines are a vital and powerful tool. But they are not the only tool.”
In an interview with BBC Radio 4, Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases (NIAID), said herd immunity is an “elusive concept,” with no definitive percentage of the population that needs to be vaccinated or recovered from infection to reach it (he has previously estimated 70% to 85%), and that a return to normal life will be gradual as more and more people get their shots.
Data from a preprint study suggest the SARS-CoV-2 variant first detected in South Africa—B.1.351—may elude protection from the Pfizer/BioNTech vaccine, Reuters reports. The story notes that the variant is not prevalent in Israel, where the study took place, and that the research has not yet been peer reviewed.
A study in the Lancet Infectious Diseases provides some reassuring news about the B.1.1.7 variant first detected in the United Kingdom. Though the variant more easily spreads, it was not associated an increase in severe disease or death compared with other strains, as has been suggested by some prior research. A separate study in the Lancet Public Health did not find evidence that the variant alters symptoms or the odds of experiencing “long COVID.”
AstraZeneca’s diabetes medication dapagliflozin (Farxiga) failed to prevent organ dysfunction or all-cause mortality, or to induce a positive change in clinical status, in patients hospitalized with COVID-19 with risk factors for developing serious complications, the company announced yesterday. Full results from the phase III DARE-19 trial will be presented at the virtual American College of Cardiology (ACC) Scientific Session in May.
A research letter in JAMA indicates that breastfeeding women secrete SARS-CoV-2-specific antibodies in breast milk for 6 weeks after vaccination and that the antibodies have strong neutralizing effects. That suggests “a potential protective effect against infection in the infant,” the authors say.
Surgical patients with COVID-19 die in the hospital about twice as frequently as those without COVID-19 (14.8% vs 7.1%), though the complication rate and length of stay do not significantly differ between groups, according to a study in JAMA Network Open. Hospital-acquired conditions and patient safety indicators were more common in the COVID-19 group. “As the COVID-19 pandemic continues and surges, we need to balance patients’ surgical needs with COVID-19-specific risks in the setting of a strained healthcare system,” the authors say.
April 12, 2021
A Chinese official said the country’s homegrown vaccines offer suboptimal protection against SARS-CoV-2, noting that mixing them is a strategy being considered to increase effectiveness, the Associated Press reports. “We will solve the issue that current vaccines don’t have very high protection rates,” Gao Fu, PhD, director of the Chinese Center for Disease Control and Prevention, said at a conference over the weekend. “It’s now under consideration whether we should use different vaccines from different technical lines for the immunization process.” In an interview with the Global Times, however, Gao sought to clarify his remarks, saying that media reports of his statements were “a complete misunderstanding.”
On Monday, Regeneron released positive results from phase III trials of its antibody cocktail made up of casirivimab and imdevimab. When used for the treatment of asymptomatic patients recently infected with SARS-CoV-2, it reduced progression to symptomatic COVID-19. When administered to household contacts exposed to SARS-CoV-2, the cocktail reduced the risk of developing symptomatic infection by 81%. Based on the results of the latter trial, Regeneron will request an expansion of the emergency use authorization granted by the US Food and Drug Administration (FDA) in November 2020 to include prevention of COVID-19 in appropriate populations.
England entered another phase in its path to reopening its economy on Monday, with shops, pubs, and hairdressers welcoming back customers after 3 months of lockdown, Reuters reports. “After imposing the most onerous restrictions in Britain’s peacetime history, Prime Minister Boris Johnson said the reopening was a ‘major step’ towards freedom but urged people to behave responsibly as the coronavirus was still a threat.” Travel restrictions remain in place, with Heathrow Airport, Britain’s biggest airport, reporting that passenger numbers were down 83% in March compared with the same month last year. The United Kingdom has administered nearly 40 million COVID-19 vaccine doses so far.
An expert panel in India, which recently overtook Brazil as the country with the second highest number of confirmed COVID-19 cases after the United States, has recommended emergency approval of Russia’s Sputnik V vaccine, Reuters reports. It would be the third COVID-19 vaccine available in the country if ultimately approved. Despite the surge in infections, hundreds of thousands of Hindu devotees gathered Monday to take a holy bath in the Ganges river.
Some additional CV society meetings for 2021 are moving forward with plans to be at least partly in-person. The Heart Failure Society of America (HFSA) announced last week that its meeting in September will be held using a hybrid format combining virtual elements and sessions on-site in Denver, CO. And the Heart Rhythm Society (HRS) will start providing virtual offerings on June 30 ahead of in-person activities in Boston, MA, at the end of July.
On Friday, Pfizer and BioNTech asked the FDA to clear their COVID-19 vaccine for use in adolescents ages 12 to 15, Politico reports. That comes about a week after the companies announced top-line results of a phase III trial showing that the vaccine was 100% effective and well tolerated in that age group.
Consistent with prior research, a study in JAMA Network Open shows that about one-third (31.1%) of pediatric patients hospitalized with COVID-19 had a severe form of the disease (requiring treatment in an ICU or step-down unit; requiring use of mechanical ventilation; or resulting in death). Those with chronic conditions, younger children, and boys were more likely to develop severe disease.
Two papers in Morbidity and Mortality Weekly Report provides insights into how race and ethnicity are playing into the pandemic in the United States. One shows that compared with white individuals, those who were Hispanic, American Indian or Alaska Native, or Black had higher rates of visits to the emergency department in the last quarter of 2020. The other shows that the proportion of hospitalized patients with COVID-19 was highest for Hispanic or Latino patients; racial/ethnic disparities diminished over the course of the pandemic but remained at the end of 2020.
Rutgers University in New Jersey was the first university to say that it would require students to be vaccinated against COVID-19 before returning in the fall, but the list is now growing, with more than a dozen colleges following suit, NPR reports. The list includes Duke University, the University of Notre Dame, and two Ivy League universities, Brown and Cornell.