COVID-19: TCTMD’s Daily Dispatch for August Week 4

​Since March 2020, TCTMD reporter Todd Neale has been writing up breaking news and peer-reviewed research related to COVID-19 every weekday. In July 2021, we transitioned to Mondays, Wednesdays, and Fridays. If you have something to share, tell us. All of our COVID-19 coverage can be found on our COVID-19 Hub.
 

August 27, 2021

Among over 1,200 patients from Wuhan, China, who recovered after being hospitalized for COVID-19 in early 2020, about half still had a least one persistent symptom at 12 months—most commonly fatigue and muscle weakness. The Lancet paper also reports that ongoing shortness of breath and lung impairments were common, especially in those who had severe illness.

An Israeli study addresses emerging concerns about vaccine-related myocarditis by showing the complication occurs rarely with the Pfizer/BioNTech shot, resulting in 2.7 extra cases of myocarditis per 100,000 vaccinated persons compared with unvaccinated controls. In the study, published in the New England Journal of Medicine, cases were more frequent in men than women and at a median age of 25. Making the argument in favor of vaccination, there were 11 extra cases of myocarditis per 100,000 among individuals who contracted COVID-19 compared with those who did not.

Blood clots, meanwhile, are elevated in the first few weeks after getting either the Oxford-AstraZeneca or Pfizer-BioNTech vaccine, but the increased risk is not as high as it is in patients infected with COVID-19, according to a study of nearly 30 million people in England. Vaccinated patients also had substantially lower risks of thrombocytopenia and stroke, investigators report in the BMJ.

Days after receiving full US Food and Drug Administration (FDA) approval for its two-dose vaccine, Pfizer has begun to make its case for a third booster shot in individuals ages 16 and older. According to the Associated Press, the vaccine manufacturer expected to have the application process completed by the end of the week.

The United States has a greater percentage of people age 65 and older who are unvaccinated compared with the United Kingdom, Spain, and Canada, according to the New York Times. In many counties in the South and Mountain West regions of the United States, seniors who are not fully vaccinated account for more than 10% of the population.

The closure of schools, sports programs, and playgrounds as a result of the pandemic has led to a decrease in cardiovascular fitness and an increase in body mass index (BMI) among young children in Austria. While these adverse changes may be temporary for some, “there is no information on the recovery of healthy children after a long period of enforced inactivity,” the investigators write in JAMA Network Open.

Proning is widely used in hospitalized COVID-19 patients to improve oxygen levels but lacks standardized protocols. Based on a literature review, researchers reporting in the Journal of Frailty and Aging have created a five-step protocol that includes images of a patient’s positioning during the maneuver, monitoring recommendations, and other advice.

Despite concerns that the COVID-19 pandemic and related restrictions could worsen suicidal behavior among military veterans, a group that has historically had high rates of suicidal ideation and attempts, new data on more than 3,000 US veterans suggest that is not the case. While there was no significant increase in suicidal behavior between November 2019 and December 2020 among uninfected veterans, those with COVID-19 were more than twice as likely to report suicidal ideation, according to the report in JAMA Psychiatry.

Africa, where vaccines are in short supply and only a little more than 2% of the entire continent is vaccinated, tripled its vaccination rates in the last week, according to the Associated Press. However, the World Health Organization (WHO) says that while Africa will receive 117 million doses in the coming months, they will need an additional 34 million just to reach a 10% vaccination target.

Meanwhile, new infections are breaking records in Australia and New Zealand. Sydney reported more than 1,000 new infections in a single day for the first time, while Auckland hit a new daily high of 68 cases, according to the Centers for Infectious Disease Research and Policy.

Today’s Dispatch was contributed by L.A. McKeown.

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August 25, 2021

In June and July, COVID-19 hospitalizations among unvaccinated adults have cost the US healthcare system $2.3 billion, according to an analysis from the Kaiser Family Foundation. That figure is based on an estimated 113,000 preventable COVID-19 hospitalizations each costing an average of $20,000. “Still, this ballpark figure is likely an understatement of the cost burden on the health system from treatment of COVID-19 among unvaccinated adults,” the authors write, noting that the estimates do not include outpatient treatment and that cases, hospitalizations, and deaths have continued to rise.

US Food and Drug Administration (FDA) approval of the COVID-19 vaccine from Pfizer/BioNTech “will make it nearly impossible to successfully challenge mandates by employers,” according to legal experts interviewed by Reuters. The approval earlier this week was followed by a deluge of announcements by companies and other groups stating that they would require vaccinations. In the US, the Pentagon said members of the military must begin getting their shots immediately, the AP reports. And the American Medical Association (AMA) has come out in favor of mandates to get the pandemic under control. The American Academy of Pediatrics (AAP) warned against off-label use of the vaccine in children younger than 12.

Israel’s booster program, after less than a month, appears to be paying dividends in terms of lower rates of infection and severe disease driven by the Delta variant, Reuters reports. “On July 30, it began administering a third dose of the Pfizer/BioNtech vaccine to people over 60, the first country to do so. On Thursday it expanded eligibility to 30-year-olds and up whose second dose was given at least 5 months prior, saying the age may drop further.”

UK researchers have reported that protection provided by two doses of the Pfizer/BioNTech vaccine weakens within about 6 months (Reuters). Within the ZOE COVID study, the effectiveness fell from 88% to 74% after 5 to 6 months. For the Oxford/AstraZeneca vaccine, effectiveness dropped from 77% to 67% after 4 to 5 months. The findings highlight the potential benefit of booster shots. On Wednesday, Johnson & Johnson announced that a booster dose following its single-shot regimen “provided [a] rapid and robust increase in spike-binding antibodies.”

The World Health Organization (WHO) continues to say that booster shots should be delayed, however, advocating for efforts to increase coverage rates in countries where very few people have been vaccinated. WHO Director-General Tedros Adhanom Ghebreyesus, PhD, said Monday that stronger variants of the virus may develop if coverage isn’t improved globally, Reuters reports. “In addition, there is a debate about whether booster shots are effective at all,” he said.

Japan has expanded a COVID-19 state of emergency to eight more prefectures in response to a continuing rise in cases, the AP reports. “With four new prefectures added to a separate ‘quasi-emergency’ status, 33 of Japan’s 47 prefectures are now under some type of emergency measures.” Tokyo has been subject to emergency measures since July 12.

Between May 1 and July 25, 2021, one-quarter of SARS-CoV-2 infections in Los Angeles County were in fully vaccinated people, with 3.3% in those partially vaccinated and 71.4% in those who had not received any shots, according to data in Morbidity and Mortality Weekly Report. Infection and hospitalization rates were 4.9 and 29.2 times higher, respectively, in unvaccinated people. “The data reminds us that if you are not vaccinated you are the highest at risk,” Rochelle Walensky, MD, director of the US Centers for Disease Control and Prevention (CDC) said at a press briefing, reports CIDRAP News.

A second study in MMWR shows that in the HEROES-RECOVER cohorts made up of frontline workers in the United States, vaccine effectiveness declined from 91% in the months before the Delta variant circulated widely to 66% after it became predominant. The authors caution that “this trend should be interpreted with caution because vaccine effectiveness might also be declining as time since vaccination increases and because of poor precision in estimates due to limited number of weeks of observation and few infections among participants.”

Patients, not healthcare workers, are the main source of SARS-CoV-2 spread in the hospital, according to a study in eLife. “Further, the data were consistent with a pattern of superspreading, whereby 21% of individuals caused 80% of transmission events,” the authors note. CIDRAP News has more.

The economic consequences of the COVID-19 pandemic led to an estimated 267,208 extra infant deaths across 128 low- and middle-income countries last year, which represents a 6.8% increase over what was expected, researchers report in BMJ Open. “While efforts towards prevention and treatment of COVID-19 remain paramount, the global community should also strengthen social safety nets and assure continuity of essential health services,” they say.

Across the US, zoo animals—including bears, baboons, tigers, and others—are getting COVID-19 vaccines made specifically for animals, according to a story in National Geographic. The vaccines are being provided by Zoetis, a veterinary pharmaceutical company that plans to send about 11,000 doses of the vaccine to more than 80 institutions at no cost.

 

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August 23, 2021

As anticipated, the US Food and Drug Administration (FDA) gave full approval to the COVID-19 vaccine from Pfizer/BioNTech on Monday, a move that public health experts hope will nudge at least some holdouts toward getting their shots. The approval covers people 16 and older, with emergency authorization remaining in place for adolescents ages 12 to 15. “While millions of people have already safely received COVID-19 vaccines, we recognize that for some, the FDA approval of a vaccine may now instill additional confidence to get vaccinated,” Acting FDA Commissioner Janet Woodcock, MD, said in a statement. “Today’s milestone puts us one step closer to altering the course of this pandemic in the US.” The United States is the first country to grant full approval to the vaccine.

CIDRAP News gives a roundup highlighting intensified restrictions in global COVID-19 hot spots, with the worldwide tally of confirmed cases now over 210 million and deaths over 4.4 million. New Zealand’s lockdown has been extended until August 24, and stricter curbs have been implemented in New South Wales, Australia, as the Sydney area continues to experience a surge. Vietnam will use the military to enforce a lockdown in Ho Chi Minh City and has extended a lockdown in Hanoi by 15 days. Sri Lanka instituted a 10-day lockdown on Friday.

The Gulf Coast of the United States, where vaccination rates are relatively low, is straining under a wave of COVID-19 cases driven by the Delta variant that have left the area with no ICU beds available, the New York Times reports. “The people inundating the hospitals along the Gulf Coast are not the high-risk, often older ones who were most vulnerable in the earlier waves of the pandemic. The Delta variant is spreading among younger people, many who thought they had nothing to fear and did not get vaccinated.”

About 75 doctors staged a walkout on Monday to protest the number of unvaccinated COVID-19 patients at their hospital in Palm Beach Gardens, FL, The Week reports, citing MSNBC’s Morning Joe. “It's incredibly frustrating because we know vaccines are safe and effective,” one of the physicians said. “And it’s people who go out and talk against them that really go against physicians and medicine and science. . . . It’s not the message we want to get across to people. Vaccines are safe and we need to get our communities vaccinated.”

Sweden’s lax approach to COVID-19 control—with no full-scale lockdown—does not appear to have worked, as its COVID-19 death rate is up to 10 times higher than in neighboring countries, according to a story from Business Insider. The strategy was not associated with a major economic advantage either. “Sweden became a dream for many people to think one can do it differently,” one expert said, adding, however, that “it was maybe not a good idea.”

A surge in COVID-19 hospitalizations has officials in Orlando, FL, calling on residents to cut back on their water use as a way to preserve the supply of liquid oxygen for critically ill patients, the Washington Post reports. “The region has faced shortages of liquid oxygen as people critically ill with COVID-19 stream into hospitals in need of respiratory therapy. The demand has become so high that the city’s water regulator warned that water quality could falter if consumers do not cut back,” the story notes, explaining that “the city’s water regulator uses liquid oxygen as part of its process for removing foul-smelling hydrogen sulfide from water pumped in from the Lower Floridan Aquifer.”

A third dose of the vaccine from Pfizer/BioNTech boosts protection against infection and severe COVID-19 among people 60 and older compared with those receiving two doses, according to data published Sunday by Israel’s Ministry of Health (Reuters). Protection against infection 10 days after a third dose was reportedly four times higher than after two doses, with protection against serious illness and hospitalization that was five to six times higher.

People with COVID-19 appear to be most infectious from 2 days before to 3 days after developing symptoms, researchers report in JAMA Internal Medicine. Moreover, “infected contacts of asymptomatic index patients were less likely to present with COVID-19 symptoms, suggesting that quantity of exposure may be associated with clinical presentation in close contacts.”

The FDA reiterated over the weekend that ivermectin, routinely used to treat or prevent parasites in animals (with some approved parasite-related indications in people), should not be used by humans as a means to combat COVID-19, saying on Twitter: “You are not a horse. You are not a cow. Seriously, y’all. Stop it.” Ivermectin has been proposed by some as an effective treatment for COVID-19 despite a lack of strong evidence. “The FDA has not reviewed data to support use of ivermectin in COVID-19 patients to treat or to prevent COVID-19; however, some initial research is underway,” the agency says. “Taking a drug for an unapproved use can be very dangerous. This is true of ivermectin, too.”