COVID-19: TCTMD’s Dispatch for April 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.

April 28, 2022

As COVID-19 “closes in on” the US White House, a STAT feature explores “how much risk” 79-year-old President Joe Biden faces as many in his inner circle test positive with breakthrough infections and large in-person, indoor events proceed as planned.

Meanwhile Anthony Fauci, the White House’s chief medical advisor and director of the National Institute of Allergy and Infectious Diseases, is toning down statements he made on PBS NewsHour earlier this week. On Tuesday, Fauci said the US was “out of the pandemic phase” but on Wednesday described this to the Washington Post as the start of the “control phase.” Later, to NPR, he clarified that the US has “passed the acute component” phase. “We are now transitioning—not there yet, but transitioning—to more of an endemicity, where the level of infection is low enough that people are starting to learn how to live with the virus, still protecting themselves by vaccination, by the availability of antivirals, by testing," he said. NBC News has more.

Moderna has requested emergency use authorization from the US Food and Drug Administration (FDA) to permit the use of its COVID-19 vaccine in children aged 6 months old to 2 years, and in those aged 2 years to 6. “Similar requests are underway with international regulatory authorities,” a press release states. “Positive interim results from the Phase 2/3 KidCOVE study, announced on March 23, 2022, showed a robust neutralizing antibody response in the 6 month to under 6 years of age group after a [25-μg] two-dose primary series of mRNA-1273, along with a favorable safety profile.”

An updated review and meta-analysis in JAMA Network Open attempts to assess the impact of new COVID-19 strains on “secondary attack” rates in households. Now including 135 studies of more than 1.3 million participants in 36 countries, the analysis suggests that household secondary attack rates have actually increased with time (and more infectious strains). Rates of co-habitants falling ill when someone else in their household caught the virus were higher for Omicron (42.7%), Alpha (36.4%), and Delta (29.7%) than for previously reported estimates (18.9%). Critically, full vaccination appeared to be protective—reducing susceptibility and infectiousness, “but more so for Alpha than Delta and Omicron,” investigators say.

New numbers reported in Morbidity and Mortality Weekly Report tracking disparities in age-adjusted death rates (AADR) by race and ethnicity suggest the pattern is shifting. “In 2020, racial and ethnic disparities in COVID-19 AADR were reported among US residents,” the authors write. “From 2020 to 2021, disparities in AADR ratios from COVID-19 decreased significantly by 14.0%–40.2% for most racial and ethnic groups, including non-Hispanic white persons, who accounted for 59.6%–65.2% of all decedents.” AADRs decreased, however, for Black (-6.1%), Asian (-1.9%), and Hispanic persons (-1.2%). “Providing effective preventive interventions, including vaccination and clinical care, to all communities in proportion to their needs can help to decrease racial and ethnic disparities in COVID-19 deaths,” they conclude.

Mask mandates are dropping along with vaccine “passports” and mandatory testing, yet the pandemic “rages on” for people who are immunocompromised, according to a medical news feature in JAMA. “Since the rollback of nonpharmaceutical interventions to limit the spread of SARS-CoV-2, ‘it’s getting more dangerous’ for individuals who are immunocompromised,” transplant surgeon Dorry Segev, MD, PhD, told journalist Rita Rubin. “FDA-approved drugs intended to protect people with weaker immune systems aren’t easily accessible, and physicians may be confused by other messaging.  

As noted previously in the Dispatch, the monoclonal-antibody combination AZD7442, composed of tixagevimab and cilgavimab (Evusheld; AstraZeneca), was approved in December 2021 in immunocompromised adults as a defense against COVID-19. Results of the phase III trial were published last week in the New England Journal of Medicine.

Lessons from COVID-19 can be applied to the humanitarian crisis caused by Russia’s war on Ukraine, according to a letter in the Lancet this week. “The possibilities for action at the individual level should not obscure the fact that the main levers for action in this area are at the political level,” the authors write. “Decision makers, institutions, and civil society must continue to recognize and act to reinforce the importance of solidarity, equality, and freedom as the ethical values that constitute our democracies.”

Disruptions to childhood vaccinations as a result of the COVID-19 pandemic has led cases of measles to surged by almost 80% worldwide, the United Nations Children’s Fund and the World Health Organization (WHO) said yesterday. “Some 23 million children missed out on basic childhood vaccines in 2020 that would ordinarily be delivered through routine health services, the agencies’ statistics show—3.7 million more than in 2019,” a New York Times story summarizes.

April 25, 2022

Fears of widespread lockdowns in response to rising COVID-19 numbers in Beijing—as has already been done in Shanghai—have led to panic buying of groceries in the Chinese capital, Reuters reports. Authorities in Chaoyang, Beijing’s diplomatic district, “late on Sunday ordered those who live and work there to be tested three times this week as Beijing warned the virus had ‘stealthily’ spread for about a week before being detected.” The AP has more on the situation.

About 60,000 more Americans died of COVID-19 in 2021 than in 2020, according to new numbers in Morbidity and Mortality Weekly Report. The disease remained the third leading cause of death, being listed as the underlying cause in 415,399 deaths, behind heart disease (693,021 deaths) and cancer (604,553 deaths). A separate paper delves into racial/ethnic disparities in COVID-19 deaths.

The latest COVID-19 numbers from the US Centers for Disease Control and Prevention (CDC), published Friday, show that hospitalizations increased for the second week in a row, this time by 8.2%. The current 7-day daily average is 1,582, up from 1,463. According to Becker’s Hospital Review, hospitalizations are now up in 21 states. Average daily deaths, on the other hand, fell by 9.4% compared with the prior week, the tenth straight week showing a decline.

The global vaccination effort is slowing, and it’s now clear that the world will fall short of the World Health Organization’s goal of fully vaccinating 70% of every country’s population by June 2022, according to the New York Times. “And there is a growing sense of resignation among public health experts that high COVID vaccination coverage may never be achieved in most lower-income countries, as badly needed funding from the United States dries up and both governments and donors turn to other priorities.”

A modeling study in CMAJ highlights the potential danger of falling short of vaccination goals, indicating that unvaccinated people increase the risk of SARS-CoV-2 infection for those who are vaccinated even when vaccination rates are high. “Many opponents of vaccine mandates have framed vaccine adoption as a matter of individual choice,” the authors write. “However, we found that the choices made by people who forgo vaccination contribute disproportionately to risk among those who do get vaccinated.”

Though existing COVID-19 vaccines continue to offer protection, research continues into how they might be improved as the pandemic drags on (Associated Press). “COVID-19 vaccinations are at a critical juncture as companies test whether new approaches like combination shots or nasal drops can keep up with a mutating coronavirus—even though it’s not clear if changes are needed,” the story notes.

COVID-19 prophylaxis with monoclonal antibodies among exposed, unvaccinated household contacts in the US appears to be a winning strategy, researchers report in JAMA Network Open. In the modeling study, this approach “was estimated to avert 528 hospitalizations and 84 deaths in a low-transmission scenario and 1,404 hospitalizations and 223 deaths in a high-transmission scenario,” they say. “The program was also estimated to be cost saving to payers in the high-transmission scenario as a result of averted hospitalizations.”

As mask mandates disappear for public transport, many people may be wondering whether wearing a mask continues to provide some protection against COVID-19, an issue explored by Becker’s Hospital Review: “Plenty of factors play into the level of protection provided from wearing a mask—the type of mask, duration of exposure to an infected person, and the mode of transportation the mask-wearer is using to name a few. While some environments may pose higher risks than others, a number of studies have indicated masks offer at least some degree of protection to the wearer.”

COVID-19 restrictions had a moderate effect on adults’ mental health, CIDRAP News reports, citing two studies published in the Lancet Public Health. One, based on data from 15 countries, showed that “more-stringent COVID-19 policies were associated with poorer mental health,” say researchers, adding that “elimination strategies minimized transmission and deaths, while restricting mental health effects.” The other study, out of Australia, showed a small overall effect on wellbeing, albeit with a greater detrimental impact among women. In contrast, a study in JAMA Network Open indicated that “the substantial deterioration in mental health seen in the UK during the first lockdown did not reverse when lockdown lifted, and a sustained worsening was observed across the pandemic period.”

The COVID-19 vaccine from Pfizer/BioNTech provides a sustainable cellular and humoral response in patients receiving active treatment for solid tumors, according to a research letter in JAMA Oncology. None of the patients included in the analysis developed COVID-19 in the year after vaccination.

Fewer than three in every 10 patients (28.9%) discharged after a COVID-19 hospitalization reported being fully recovered in a prospective, longitudinal cohort study published in the Lancet Respiratory Medicine. Female sex and obesity were major risk factors for not being recovered. “No specific therapeutics exist for long COVID and our data highlight that effective interventions are urgently required,” one of the researchers said in a press release.