COVID-19: TCTMD’s Dispatch for December Week 3

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.

December 22, 2021

As governments around the world start to reimplement restrictions aimed at slowing the spread of the Omicron variant, a study out of South Africa suggesting a lower risk of hospitalization in people infected with the new variant than with Delta is providing a reason for cautious optimism (Reuters). One of the researchers offered the caveat, however, that it is unclear “whether the picture will be similar in countries where there are high levels of vaccination but very low levels of previous infection.” In South Africa, which first alerted the world to Omicron, a drop in cases may indicate that a surge driven by the new variant may have peaked (Associated Press).

Questions about the severity of infection with Omicron versus other variants are still very much open, with World Health Organization (WHO) officials saying Wednesday that it’s too soon to tell if Omicron is resulting in milder illness (Reuters). The new variant will become the dominant one in Europe by the start of 2022, and it will take 3 to 4 weeks determine whether it is causing less-severe disease, according to the WHO’s regional director for Europe.

The UK, with an eye on minimizing disruption in people’s lives during the holiday season, is shortening the length of COVID-19 self-isolation from 10 to 7 days for those in England who receive a negative test on a lateral flow test 2 days in a row, Reuters reports. An analysis from the UK Health Security Agency (UKHSA) suggested the shorter isolation period “had nearly the same protective effect as a 10-day isolation period without testing.” Meanwhile, while British Prime Minister Boris Johnson said he would not introduce new measures to slow the spread of the virus in England before Christmas, officials in Scotland and Wales have said they will do so.

On Wednesday, the US Food and Drug Administration (FDA) issued its first emergency use authorization for an oral COVID-19 treatment, clearing the way for Pfizer’s Paxlovid to be used in patients with mild-to-moderate disease who are at high risk for progression to severe disease (hospitalization or death). An FDA official called the availability of an oral pill “a major step forward in the fight against this global pandemic.” The move comes shortly after the release of data showing that Omicron now accounts for 73% of new US COVID-19 cases (Associated Press).

Israel will begin offering a fourth dose of COVID-19 vaccine to people older than 60, those with compromised immune systems, and healthcare workers as a way to combat the Omicron threat (Reuters). The additional dose would be given at least 4 months after the third, according to a Health Ministry panel, which also recommended shortening the interval between the second and third shots from 5 to 3 months.

Definitive conclusions cannot be drawn about a possible link between the mRNA vaccines and future ACS risk, according to a correction issued late yesterday on the Circulation journal website, which had last month published an abstract from the virtual American Heart Association (AHA) 2021 Scientific Sessions. All strong conclusions and alarmist phrasing have now been removed from the corrected abstract, with additional wording acknowledging that no rigorous comparisons have been made between vaccinated and unvaccinated subjects, TCTMD reports.

Cancellations are ramping up in the worlds of sports and entertainment. The NHL, which started its Christmas break early, will not allow its players to compete in the Beijing Olympics out of pandemic-related concerns that the league would not be able to complete a full season if they did so (Associated Press). Crowds won’t be allowed at New Year’s Eve celebrations in Los Angeles’ Grant Park or Seattle’s Space Needle and the remainder of iHeartRadio’s annual Jingle Ball tour has been scrapped, USA Today reports. Other celebrations in places like London, Paris, and Morocco have been canceled, while Chinese officials are urging citizens to refrain from traveling during the upcoming holiday season. More Broadway shows are cancelling performances.

In 2020, before vaccines provided some protection against COVID-19, the US saw the greatest drop in average life expectancy—1.8 years—since World War II, according to new data from the US Centers for Disease Control and Prevention (CDC). As reported by PBS NewsHour, average life expectancy fell from 78.8 to 77. “When you have a pandemic that creates such a disruptive effect on people’s lives, you’re going to see deaths directly from the virus, as well as cascading deaths that occur because of the disruptions that occurred to normal health,” one epidemiologist said. “It’s not surprising.” The AP has more on the government numbers, which also show that last year was the deadliest in US history.

A research letter in JAMA showed that of pediatric patients with COVID-19-related multisystem inflammatory syndrome in children (MIS-C) treated in France who were eligible for a vaccine against SARS-CoV-2, not one had been fully vaccinated. Only 21% had received one shot, and the rest had received none. “The absence of MIS-C cases in fully vaccinated children prevented calculation of an HR for this group, but suggests that two doses are warranted for efficient protection,” the authors say.

A study in JAMA Network Open delves into the factors associated with adverse events following COVID-19 vaccination, identifying younger age, full vaccination, female sex, prior SARS-CoV-2 infection, and vaccine brand as key variables. Compared with the vaccine from Pfizer/BioNTech, adverse effects were more likely with the Moderna shot and less likely with the Janssen vaccine from Johnson & Johnson. “These findings suggest that some individuals experience more adverse effects after COVID-19 vaccination, but serious adverse effects are rare,” the authors say.

For cath lab teams, the COVID-19 pandemic has meant canceled and postponed procedures, sick and burned-out staff members, and the need for innovative and lasting ways of prioritizing safe and efficient patient care while keeping themselves healthy. As yet another wave of COVID-19 hits hospitals worldwide, leaders are taking a good, hard look at the kinds of changes made over the last 2 years and realizing many of these adaptations and coping mechanisms may be here to stay. TCTMD’s L.A. McKeown explores the issue in a feature story.

 

Note: The Dispatch will be back Monday, December 27, 2021.

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December 20, 2021

Omicron-driven surges around the world are forcing countries to choose between reimplementing restrictions to stem the spread of the virus just before Christmas or accepting potentially large increases in cases and related problems, a dilemma highlighted by the Associated Press: “Even if it is milder, the new variant could still overwhelm health systems because of the sheer number of infections. Confirmed coronavirus cases in the UK have surged by 50% in a week as Omicron overtook Delta as the dominant variant.” Reuters and the New York Times (with a focus on the US) also detail the decisions facing government leaders ahead of the holidays.

The Netherlands decided on the more-cautious route over the weekend, entering into a strict lockdown that will last into the middle of January (CBS News). Israel has banned travel to the United States, Canada, Belgium, Germany, Hungary, Italy, Morocco, Portugal, Switzerland, and Turkey, effective Wednesday (Associated Press): “In a prime-time address on Sunday, Israeli Prime Minister Naftali Bennett urged parents to vaccinate their children, declaring that the country’s ‘fifth wave’ of coronavirus infections had begun. As of Sunday, Israel’s Health Ministry has reported 175 cases of the new variant.”

Some public health experts in the US are sounding the alarm as Omicron increases its foothold in the country. Departing National Institutes of Health (NIH) Director Francis Collins, MD, PhD, warned of the potential for 1 million daily cases if mitigation strategies aren’t taken seriously (NPR) and Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, noting that Omicron is “just raging around the world” (AP). Fauci said in an interview on NBC that “the real problem” for US hospitals is that “we have so many people in this country who are eligible to be vaccinated who have not yet been vaccinated.”

Moderna’s current booster dose formulation appears to be protective against Omicron based on preliminary lab testing, increasing neutralizing antibody levels against the variant by about 37-fold, the company announced Monday. A booster candidate with double the currently authorized dose raised antibody levels by 83-fold. Even so, the company will continue to develop an Omicron-specific booster in case it’s needed.

The New York Times takes a broad view of vaccine protection against Omicron, writing that even though most of the world’s vaccines likely will not prevent infection with the Omicron variant, there does appear to be protection against severe illness. Even so, “a global surge of infections in a world where billions of people remain unvaccinated not only threatens the health of vulnerable individuals but also increases the opportunity for the emergence of yet more variants. The disparity in the ability of countries to weather the pandemic will almost certainly deepen.”

The European Medicines Agency (EMA) announced Monday that it has recommended conditional marketing authorization for the two-dose COVID-19 vaccine from Novavax, called Nuvaxovid, for people 18 and older. The move was supported by results of two trials demonstrating vaccine efficacy of about 90%. As Reuters notes, it will be the fifth COVID-19 vaccine available in Europe.

Surges in COVID-19 cases are having a major impact on sports and entertainment events in the US and Canada, ABC News reports. Several games were postponed across the three major professional sports leagues currently playing—the NBA, NHL, and NFL—with numerous cancellations hitting the college level. On the entertainment side, the Radio City Rockettes canceled remaining dates of their Christmas Spectacular in New York City, and some recent Broadway shows have been scrapped due to infections.

The risk of myocarditis or myopericarditis appears to be about three- to fourfold higher for those who receive the Moderna COVID-19 vaccine compared with unvaccinated individuals, while the one manufactured by Pfizer is linked to greater risk only for females, according to new Danish population data published last week in the BMJ. But the absolute rate of developing these complications is low, even for younger patients, and the clinical consequences were, for the vast majority, mild, TCTMD’s Yael Maxwell reports. A report out of New Zealand highlights the possibility of severe outcomes, however: a second person in the country has died after developing myocarditis shortly after receipt of the Pfizer/BioNTech shot.

A STAT story describes new data, released by press release last week by University of Hong Kong researchers, that provide some insights into why Omicron spreads faster than prior variants. The investigators “found that over the first 24 hours, Omicron multiplied about 70 times faster inside respiratory-tract tissue than the Delta variant. When they ran the same experiments with the lung tissue, they found Omicron was actually worse at infecting those cells than either Delta or the original strain of the virus that originated in Wuhan. That seemingly helps explain the variant’s infectiousness, and also why it may not be causing as severe sickness as previous variants of the coronavirus—as early data suggest.”