COVID-19: TCTMD’s Daily Dispatch for July Week 2

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

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July 16, 2021

A rise in COVID-19 cases across the US is leading to the return of some restrictions that had been shed in recent months. Chicago, IL, for instance, will require unvaccinated travelers from Missouri and Arkansas to either quarantine for 10 days or show the results of a negative COVID-19 test, the AP reports; other states could be added if case numbers continue to increase. In Los Angeles County, CA, officials have reinstated a mandate to wear masks indoors, even for vaccinated people.

Remdesivir was associated with a longer time to hospital discharge, with no impact on 30-day survival, in a study of US veterans hospitalized with COVID-19 published in JAMA Network Open, seemingly at odds with prior studies showing a benefit. “The researchers suggest that the prescribed regimen (5 or 10 days) may have led to longer hospitalizations as patients finished the treatment course, and a related commentary agrees,” a story from CIDRAP News notes, providing context to the finding. In the commentary, Gio Baracco, MD, says, “The real-life application of a drug promising to hasten discharge from the hospital as its primary beneficial outcome must include an assessment of how easy it is to do so and make it clear that once a patient reaches that point, they can discontinue the drug. The paradoxical findings in [this study] compared with the study used for its authorization illustrate this point very clearly.”

Patients taking statins before being hospitalized for COVID-19 are less likely to die, particularly in the subset with a history of CVD and/or hypertension, show findings from the American Heart Association’s COVID-19 Cardiovascular Disease Registry published in PLOS ONE. “These observations support the continuation and aggressive initiation of statin and antihypertensive therapies among patients at risk for COVID-19, if these treatments are indicated based upon underlying medical conditions,” the authors say.

The monoclonal antibody therapy consisting of the combination of bamlanivimab and etesevimab reduces COVID-19-related hospitalization and death compared with placebo in high-risk patients with mild or moderate COVID-19, show phase III results published in the New England Journal of Medicine. By day 29, 2.1% of patients on active treatment had reached that endpoint, compared with 7.0% of those taking placebo. The therapy also led to a faster decline in viral load.

A controversial JAMA Pediatrics study suggesting that dangerous levels of carbon dioxide accumulate behind face masks worn by children has been retracted: “Following publication, numerous scientific issues were raised regarding the study methodology, including concerns about the applicability of the device used for assessment of carbon dioxide levels in this study setting, and whether the measurements obtained accurately represented carbon dioxide content in inhaled air, as well as issues related to the validity of the study conclusions. In their invited responses to these and other concerns, the authors did not provide sufficiently convincing evidence to resolve these issues, as determined by editorial evaluation and additional scientific review.”

Symptoms of long COVID are not frequently found in children 6 months after serologic testing for SARS-CoV-2, according to research published in JAMA. In the study of Swiss children (median age 11), 4% of those who were seropositive and 2% of those who were seronegative reported at least one symptom lasting beyond 12 weeks. The most frequent symptoms reported in seropositive children were tiredness, difficulty concentrating, and increased need for sleep.

A July 22 meeting of the Advisory Committee on Immunization Practices (ACIP), which provides guidance to the US Centers for Disease Control and Prevention (CDC) will tackle two issues regarding COVID-19 vaccination: the possible link between the Janssen vaccine from Johnson & Johnson and Guillain-Barré Syndrome and clinical considerations around booster doses in immunocompromised people. The draft agenda can be found here.

A large UK study published in the Lancet confirms that in-hospital complications are common in patients hospitalized with COVID-19. Of note, roughly one in every eight patients (12.3%) developed some type of cardiovascular complication, most commonly arrhythmia, congestive heart failure, and cardiac arrest. “Our study shows it is important to consider not just death from COVID-19, but other complications as well,” the lead author said in a press release. “This should provide policy makers with data to help them make decisions about tackling the pandemic and planning for the future.”

An analysis in Pediatrics, as reported by TCTMD managing editor Shelley Wood, shows that among children who develop multisystem inflammatory syndrome (MIS-C) related to COVID-19, most cardiac complications resolve within a few months. The findings are reassuring, according to the lead author. “However, I would urge parents to continue to be vigilant about following guidelines to protect their children from COVID-19 infection or exposure,” she told TCTMD.

On Thursday, US Surgeon General Vivek Murthy, MD, MBA, issued a warning about COVID-19 misinformation, giving tips on what various segments of the population can do to combat it, CIDRAP News reports. “If you're not sure, don't share,” Murthy said at the White House, referring to social media posts. “We expect more from our technology companies; we are asking them to operate with greater transparency and accountability. We're asking them to monitor misinformation more closely.”

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July 14, 2021

Globally, there was a 10% increase in new COVID-19 cases over the previous week, according to the latest situation report from the World Health Organization (WHO) published Tuesday. And after 9 consecutive weeks of declines, deaths ticked up by 3%. There have now been over 186 million confirmed cases and 4 million deaths reported around the world.

A snapshot of what’s happening around the world (from Reuters and the AP): The African nation of Tunisia is dealing with a surge in cases, recording its highest daily death toll of the pandemic on Tuesday (157). In Australia, Sydney has extended a lockdown imposed in response to a fresh outbreak until at least July 30. US COVID-19 cases are on the rise, with the number of new daily cases doubling over the past 3 weeks. And a cluster of infections at a Japanese hotel where Brazilian Olympians are staying is raising concerns about the upcoming Tokyo Olympics.

On Wednesday, the European Medicines Agency (EMA) and the European Centre for Disease Prevention and Control (ECDC) issued a joint update on COVID-19 urging people to get completely vaccinated to ensure maximum protection. That’s particularly important, they say, because of the rapid spread of the Delta variant, which the ECDC estimates will account for 90% of all SARS-CoV-2 strains circulating in Europe by the end of August.

Though fully vaccinated people might be getting infected with the more-transmissible Delta variant, most remain asymptomatic or develop only mild symptoms, a WHO official said earlier this week, CNBC reports. “However, hospitalizations are rising in some parts of the world, mostly where vaccination rates are low and the highly contagious Delta variant is spreading, she said.”

The US Food and Drug Administration (FDA) announced yesterday that it is revising fact sheets for the Janssen COVID-19 vaccine from Johnson & Johnson to include information about a possible link between the shot and Guillain-Barré syndrome, a neurological disorder. There have been 100 reports of GBS submitted to the Vaccine Adverse Event Reporting System (VAERS) following administration of roughly 12.5 million doses. “Although the available evidence suggests an association between the Janssen vaccine and increased risk of GBS, it is insufficient to establish a causal relationship. No similar signal has been identified with the Moderna and Pfizer-BioNTech COVID-19 vaccine,” the agency said. The Advisory Committee on Immunization Practices (ACIP), which provides guidance to the US Centers for Disease Control and Prevention (CDC), will meet on July 22 to discuss the issue.

In a consensus statement published Tuesday in Infection Control & Hospital Epidemiology, seven public health groups back mandatory COVID-19 vaccination for healthcare workers, with exemptions for those with medical contraindications to all available COVID-19 vaccines and other exemptions required by law. “Prior experience and current information suggest that a sufficient vaccination rate is unlikely to be achieved without making COVID-19 vaccination a condition of employment,” the authors write. France and Greece both announced plans this week to require COVID-19 vaccination for healthcare workers, the Washington Post reports.

The Pfizer/BioNTech vaccine is effective at preventing SARS-CoV-2 infection in pregnant women, suggests a retrospective study conducted in Israel. According to data published in JAMA earlier this week, the risk of infection was 0.33% in vaccinated women and 1.64% in the unvaccinated. That represents a relative 78% reduction with the vaccine, although the authors acknowledge that the absolute risk difference is small.

A STAT story delves into when and how we will know that COVID-19 booster shots are necessary, but amongst the uncertainty, one thing is clear: “Public health officials, not pharmaceutical executives, will be making the final call on when and whether booster shots will be needed.” Considering the fact that many people around the world haven’t received even one dose, however, WHO Director-General Tedros Adhanom Ghebreyesus, PhD, criticized the idea of giving boosters and said the vaccine companies should prioritize getting their shots to low- and middle-income countries. After meeting with Pfizer to discuss boosters on Monday, US officials reiterated that they’re not necessary for fully vaccinated people at this point, Reuters reports.

People who received an influenza vaccine 2 weeks to 6 months before getting COVID-19 had lower risks of sepsis, stroke, deep vein thrombosis, and disease requiring emergency or intensive care, according to a study presented at the European Congress of Clinical Microbiology & Infectious Diseases (ECCMID). As reported by CIDRAP News, the flu vaccine was not associated with a lower risk of death. In a press release, the lead author said “influenza vaccination may even benefit individuals hesitant to receive a COVID-19 vaccine due to the newness of the technology. Despite this, the influenza vaccine is by no means a replacement for the COVID-19 vaccine and we advocate for everyone to receive their COVID-19 vaccine if able to.”

National Nurses United, “the largest union of registered nurses,” called on the CDC to reinstate “the recommendation for everyone to wear masks in public or in physical proximity to others outside their own household,” regardless of vaccination status. Executive Director Bonnie Castillo, RN, notes the recent increase in COVID-19 cases across the US, and says the CDC’s relaxation of its mask guidance in May “failed to account for the possibility—which preliminary data from the United Kingdom and Israel now indicates is likely—of infection and transmission of the virus, especially variants of concern, by fully vaccinated individuals.”

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July 12, 2021

Pfizer will meet with US health officials on Monday to discuss the need for a third booster dose of its COVID-19 vaccine developed with partner BioNTech, Reuters reports. The companies said last week that they will seek authorization for the booster shot, although the US Food and Drug Administration (FDA) and US Centers for Disease Control and Prevention (CDC) have said that boosters are not yet necessary. Vaccine experts believe there is not yet enough evidence to support third doses, although Israel has started providing boosters to at-risk adults.

A COVID-19 outbreak spurred by the Delta variant has gotten worse in Australia despite the lockdown in Sydney, Reuters reports. “New South Wales state reported 112 new locally transmitted COVID-19 cases, almost all in Sydney, despite the country's biggest city entering its third week of lockdown. Case numbers have been at record levels for at least three days. There was, however, a glimmer of light as the number of newly-infected people who were out in the community while infectious dropped to 34 from 45 on Sunday.” Officials are mulling whether the lockdown, due to end on Friday, will be extended.

Not surprisingly, most parts of the United States seeing increasing COVID-19 activity have low vaccination rates, NPR reports: “New, localized hot spots are emerging, especially in stretches of the South, the Midwest, and the West. And, according to an analysis NPR conducted with Johns Hopkins University, those surges are likely driven by pockets of dangerously low vaccination rates.”

The US recently fell short of President Joe Biden’s goal to get 70% of adult Americans at least partially vaccinated by July 4, and an analysis by Becker’s Hospital Review concerningly indicates that 14 states won’t meet that threshold until 2022 at the current pace of vaccination. The worst-performing state, North Dakota, isn’t projected to meet the mark until September of next year.

Preliminary results of the RAPID trial, published on a preprint server, provide hints that therapeutic heparin improves outcomes in moderately ill patients hospitalized with COVID-19, although the study missed its primary endpoint. The rate of the composite of death, invasive/noninvasive mechanical ventilation, or ICU admission at 28 days was lower in the therapeutic-dose group, although the difference was not statistically significant (16.2% vs 21.9%; OR 0.69; 95% CI 0.43-1.10). Mortality alone, however, was significantly less likely with therapeutic dosing (1.8% vs 7.6%; OR 0.22; 95% CI 0.07-0.65). Despite the mixed results, on Twitter, the lead author says that a meta-analysis of available trials, including RAPID, “clearly indicates that therapeutic heparin is beneficial in moderately ill ward patients.”

Adding azithromycin to standard care does not reduce subsequent hospitalizations or death within 28 days among outpatients with mild-to-moderate COVID-19, according to results of the randomized ATOMIC2 trial published in the Lancet Respiratory Medicine. The rate of that composite outcome was 10% in those who received azithromycin and 12% among those who received standard care alone (adjusted OR 0.91; 95% CI 0.43-1.92).

The first document case of a person contracting two SARS-CoV-2 variants at the same time has been reported at the European Congress on Clinical Microbiology & Infectious Diseases (ECCMID), according to Reuters. A 90-year-old Belgian woman, who was not vaccinated, died in March after becoming infected with both the Alpha and Beta variants, both of which were circulating in Belgium at the time. “It is therefore probable that this woman was infected by two different people with two variants of the virus. Unfortunately, we do not know how this infection happened,” a molecular biologist said.

The second COVID-19 wave seen in South Africa was deadlier than the first, according to findings in the Lancet Global Health. After adjustment for weekly COVID-19 hospital admissions, in-hospital mortality was a relative 31% higher during the second wave. “Although some of the increased mortality can be explained by admissions in the second wave being more likely in older individuals, in the public sector, and by the increased health system pressure, a residual increase in mortality of patients admitted to hospital could be related to the new Beta lineage,” the authors say.

The pandemic saw a marked increase in use of telemedicine, and a new study in JAMA Health Forum shows that such visits in the US were more likely to be used for the management of long-term conditions (77.2%) than for short-term conditions (26.8%) or preventive diagnoses (2.7%). Office-based care, which rebounded somewhat in the second half of 2020, involved management of long-term conditions in 58.0% of cases, short-term conditions in 23.0%, and preventive diagnoses in 25.6%. “In contrast to office-based care, telemedicine was more commonly used for established patients and substantially greater delivery of psychiatric or behavioral treatments rather than preventive care,” the authors report.

A report from several United Nations agencies indicates that COVID-19 likely played a leading role in worsening world hunger and malnutrition levels last year, Reuters reports. “Unfortunately, the pandemic continues to expose weaknesses in our food systems, which threaten lives and livelihoods. No region of the world has been spared,” the agencies said.