COVID-19: TCTMD’s Dispatch for April Week 1

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.

April 7, 2022

COVID-19 cases are up in 28 US states, with hospitalizations rising in four. Becker’s Hospital Review sums up the latest numbers.

Chinese officials continue to impose strict measures on cities with spiking cases, but as the New York Times reports, in Shanghai—currently facing its worst outbreak since the pandemic’s outset—citizens are protesting “with a rare outpouring of criticism. Parents have organized petitions, imploring the government not to separate children infected with the coronavirus from their families. Patients have demanded to speak with higher-ups about shoddy conditions at isolation facilities. Residents have confronted officials over containment policies that they see as unfair or inhumane, then shared recordings of those arguments online.”

It’s too early to recommend a fourth dose of an mRNA vaccine, the European Centre for Disease Prevention and Control and the European Medicines Agency’s COVID-19 task force announced yesterday, citing “no clear evidence” in support of another booster in people with healthy immune systems. “However, both agencies agreed that a fourth dose (or second booster) can be given to adults 80 years of age and above after reviewing data on the higher risk of severe COVID-19 in this age group and the protection provided by a fourth dose,” a press release states.

In the United States, by contrast, the Food and Drug Administration (FDA) is hosting a meeting of its vaccine advisors today to discuss when, how often, and to whom boosters should be given. Last week, the agency authorized a fourth dose to people 50 and older and those who are immunocompromised. STAT is following today’s discussions. “Among the things we’ll be watching for at this meeting of the Vaccines and Related Biological Products Advisory Committee, or VRBPAC, is whether any panelists question that decision, or ask why they weren’t consulted before it was made.”

STAT, in partnership with the Harris Poll, has surveyed Americans to find out their willingness to get a COVID-19 booster. As Ed Silverman reports, six out of 10 Americans say they will get another booster if it’s recommended for them and just under 25% said they’d only get a second booster shot if a new variant emerges or cases in their area surge. Nearly one in five people surveyed said they have no intention of getting a booster.

All of that decision-making is coming amid new studies showing mixed results for booster doses. An analysis of more than 1.2 million people tallied in the Israeli Ministry of Health database, for example, suggests that cases of confirmed SARS-CoV-2 infection and severe illness were lower after a fourth dose of the Pfizer/BioNTech vaccine than they were following the standard three doses. Tellingly, however, “protection against confirmed infection appeared short-lived, whereas protection against severe illness did not wane during the study period,” researchers write in the New England Journal of Medicine.

A second paper in the NEJM, this one looking at third-dose effectiveness of mRNA vaccines against Delta and Omicron among front-line healthcare workers in the HEROES-RECOVER trial at eight sites in six US states, had different findings again. Here, a third vaccine dose provided 91% protection against Delta infection, but just 60% against Omicron infection—similar to what’s been seen in prior studies, the authors note. However, they add, “despite indicating a decline in vaccine effectiveness, these results show continued effectiveness against clinically severe outcomes related to both variants.”

A systemic review and meta-analysis of fluvoxamine, a selective serotonin reuptake inhibitor (SSRI) used for the treatment of obsessive-compulsive disorder and depression, “showed a high probability of being associated with reduced hospitalization in outpatients with COVID-19,” authors report in JAMA Network Open. “Ongoing randomized trials are important to evaluate alternative doses, explore the effectiveness in vaccinated patients, and provide further refinement to these estimates. Meanwhile, fluvoxamine could be recommended as a management option, particularly in resource-limited settings or for individuals without access to SARS-CoV-2 monoclonal antibody therapy or direct antivirals.”

Many Americans—and America-watchers—were leery of vaccines approved under the FDA’s emergency use pathway, opting to wait for “full” regulatory approval before getting vaccinated. Now, an analysis of vaccine uptake after final FDA approval of the Pfizer/BioNTech vaccine on August 23, 2021, indicates that while there was a 36% relative increase in “cumulative vaccinations” (equal to 3.51 million doses), uptake of first doses dipped by 16%. Those trends suggest that while some people might have waited on their second doses for the FDA to fully review the data, formal approval did not provide much of a nudge to people already wary of getting inoculated against COVID-19. “Individuals who have not received any dose of a COVID-19 vaccine may be behaviorally distinct from those who have chosen to receive at least one dose,” investigators speculate in JAMA Network Open.

Respiratory distress as a harbinger of worsening COVID-19 sparked a surge in sales of pulse oximeters that could be used at home to measure oxygen saturation. Now, a randomized trial of more than 2,000 patients assigned to the COVID Watch 2-week program involving twice-daily automated text messages inquiring about symptoms of dyspnea and offering rapid callbacks from nurses when appropriate, or to the monitoring program supplemented with home pulse oximetry, reports that the latter approach “did not result in a greater number of days alive and out of the hospital than subjective assessments of dyspnea alone.” Results were published as a research letter in the NEJM.

Updated findings from the North American COVID-19 Myocardial Infarction (NACMI) registry indicate that the profile of STEMI patients with COVID-19 has evolved over the first 2 years of the pandemic. As TCTMD’s Caitlin Cox reported from the American College of Cardiology 2022 Scientific Session earlier this week, in-hospital deaths between 2020 and 2021 decreased by a relative 25%, in large part due to the availability of COVID vaccines. COVID-19-positive patients with STEMI most likely to suffer severe complications in this most recent snapshot are those who did not get vaccinated.

The monoclonal antibody sotrovimab is no longer authorized to treat COVID-19 in any US region, the FDA announced this week. That reflects the continuing spread of the BA.2 Omicron subvariant. “Data included in the healthcare provider fact sheet show the authorized dose of sotrovimab is unlikely to be effective against the BA.2 subvariant,” a press release states.