COVID-19: TCTMD’s Dispatch for October Week 2

We’re curating a list of COVID-19 research and other useful content, and updating it regularly.

COVID-19: TCTMD’s Dispatch for October 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.

October 15, 2021

Numbers of COVID-19 cases and deaths continue to retreat around the world, according to the latest update from the World Health Organization (WHO). For the week ending October 10, there were about 2.8 million cases and 46,000 new deaths reported, representing declines of 7% and 10%, respectively, compared with the previous week. Only Europe saw an increase in new weekly cases (by 7%) and deaths (by 11%). CIDRAP News has more.

On Thursday, a US Food and Drug Administration (FDA) advisory committee unanimously supported booster doses of Moderna’s COVID-19 vaccine for certain groups, including people 65 and older, younger adults with risk factors for severe COVID-19, and those whose jobs put them at high risk for serious complications with the disease, STAT reports. On Friday, the advisory panel turned to the need for booster doses following the single-dose Janssen vaccine, ultimately voting unanimously to recommend a second shot for adults 18 years or older at least two months after the first. “I think this frankly was always a two-dose vaccine,’ committee member and infectious disease expert Paul Offitt is quoted in the New York Times. Booster doses of the vaccine from Pfizer/BioNTech have already started rolling out in the US.

Combined vaccine for prevention coronavirus infection caused by SARS-CoV-2 virusResults of a mix-and-match COVID-19 vaccine study have been released as a preprint on the medRxiv server, indicating that for people who received the Janssen vaccine, a stronger immune response was induced with mRNA boosters than with a second Janssen shot. For people who initially received one of the mRNA vaccines from Pfizer/BioNTech or Moderna, either of those shots seems to provide a similar boost in immune response. But there are some caveats to the study, which has not yet been peer reviewed, NPR notes: “First of all, the study wasn't designed to compare one booster to another, rather to see what kind of immune response each generated individually. In addition, the researchers tested full doses of all the vaccines—not the half-dose that Moderna is seeking authorization for in its booster.”

Meanwhile uncertainty over what stance the US will ultimately take on mix-and-match vaccines after announcing it is loosening border restrictions remains big news for its closest neighbors. As CBC News observes, millions of Canadians received a mixed dose regimen, as did citizens of France, Germany, and Italy. “While it's welcome news that the US will reopen its shared land border with Canada to non-essential travel in early November, some Canadians with mixed vaccine doses aren't celebrating just yet.”

The FDA announced the date (November 30) for an advisory committee meeting to consider an emergency use authorization for molnupiravir, Merck and Ridgeback’s investigational oral antiviral agent for the treatment of mild-to-moderate COVID-19 in adults at risk for progression to severe disease. Earlier this month, the companies announced that the drug nearly halved the risk of hospitalization or death in an interim analysis of a phase III trial.

A UK laboratory has been suspended over concerns that it may have handed out over 43,000 false-negative SARS-CoV-2 test results, mostly to people in southwest England, which could have contributed to spread of the virus, Reuters reports. The UK Health Security Agency said Friday “it was an isolated incident in one laboratory, with samples now being redirected to other labs, and overall testing availability was unaffected.” Meanwhile, England’s weekly reproduction R number remained unchanged at 0.9 to 1.1. If that figure is above 1, it means spread is increasing, whereas values below 1 mean spread is declining.

Short- and long-term consequences of SARS-CoV-2 infection are common, a systematic review in JAMA Network Open confirms. The median proportion of COVID-19 survivors who experienced postacute sequelae of COVID-19 was 54% at 1 month, 55% at 2 to 5 months, and 54% at 6 months or beyond. These commonly involved mental health, pulmonary, or neurologic disorders, and functional mobility impairments. The long-term effects “occur on a scale that could overwhelm existing healthcare capacity, particularly in low- and middle-income countries,” the authors say.

ACTIV-4b No Antithrombotic Therapy Needed for COVID-19 Outpatients copyAntithrombotic therapy does not provide a benefit for clinically stable but symptomatic outpatients with COVID-19, results of the ACTIV-4b trial, now published in JAMA, affirm. Neither aspirin nor apixaban (Eliquis; Bristol Myers Squibb) at prophylactic or therapeutic doses reduced what were already very low rates of major adverse cardiopulmonary outcomes versus placebo, and both modestly increased bleeding. “Clinicians are stuck with this problem of, what do we do with symptomatic outpatients with COVID-19? And I think this is one of those examples where we learned the hard way that maybe less is more,” the senior author told TCTMD.

The first part of a CIDRAP News commentary on the impact of masks during the COVID-19 pandemic “explains the differences in cloth face coverings and surgical masks, the science of respiratory protection, and the hierarchy of disease controls.” The authors state that “at the outset, we want to make clear that we are not ‘anti-mask.’ Rather, we are in favor of wearing the most protective facepiece for the setting—such as a non-fit tested respirator when spending more than a few minutes in a crowded indoor space—and in combination with other interventions.” The second part of the commentary, to be published sometime Friday, will delve into the quality of the evidence around masks.

Researchers discuss the potential utility of cardiac magnetic resonance (CMR) imaging in the setting of COVID-19 in a “state-of-the-art paper” in JACC: Cardiovascular Imaging. “At this time, our understanding of COVID-19-related cardiovascular involvement is incomplete, and multiple studies are planned to evaluate patients with COVID-19 using CMR,” they note.

Man peering through some blindsWhen researchers provided their perspectives on COVID-19 to news organizations or on social media during the pandemic, threats of physical or sexual violence—and even death—often followed, a feature story in Nature highlights. The journal’s survey revealed that more than two-thirds of researchers reported negative experiences and 22% received threats of violence. Others said their employers had received complaints about them or their home address had been exposed. Six reported physical attacks.


October 13, 2021

The United States will open its land borders with Canada and Mexico for fully vaccinated travelers starting next month, ending a 19-month ban on nonessential trips, the Associated Press reports. “The new rules, announced Wednesday, will allow fully vaccinated foreign nationals to enter the US regardless of the reason for travel starting in early November, when a similar easing of restrictions is set to kick in for air travel into the country. By mid-January, even essential travelers seeking to enter the US, like truck drivers, will need to be fully vaccinated.”

covid third dose boosterLast week, World Health Organization (WHO) advisors recommended that people who are moderately or severely immunocompromised should receive a third COVID-19 vaccine dose, guidance that applies to any of the shots the WHO has approved for emergency use, CIDRAP News reports. As the story notes, “WHO leaders have previously urged countries to postpone broader use of booster doses to free up more vaccine for countries that had much less access to supplies.”

South Korea has formed a panel to debate a strategy on how to live with COVID-19 over the long term, Reuters reports. “Under the strategy, the government aims to relax coronavirus restrictions for citizens who can prove they have been fully vaccinated, while encouraging asymptomatic and mild COVID-19 patients aged below 70 to recover at home, the health ministry said last week.” Also, the government will focus on numbers of hospitalizations and deaths rather than on new daily infections. Requirements to wear masks would be dropped under the new policy.

Ahead of a Thursday advisory committee meeting, US Food and Drug Administration (FDA) scientists said Moderna “had not met all of the agency's criteria to support use of booster doses of its COVID-19 vaccine, possibly because the efficacy of the shot’s first two doses has remained strong,” Reuters reports. Though the booster doses increased protective antibodies, “the difference in antibody levels before and after the shot was not wide enough, particularly in those whose levels had remained high.” The scientists did not make a strong conclusion about whether the boosters should be approved, STAT reports.

CureVac has withdrawn its first-generation COVID-19 vaccine candidate (CVnCoV) from consideration by European regulators and will instead focus its efforts on developing second-generation mRNA vaccines with GlaxoSmithKline, the company announced Tuesday. “The company will also terminate its advance agreement with the European Commission to sell it 405 million doses of the vaccine after approval,” the New York Times reports.

telehealth covid heart failureTelehealth can enable clinicians to provide care for outpatients with heart failure without sacrificing outcomes, suggests the experience of a large US healthcare system during the COVID-19 pandemic. Nearly 90% of clinic visits for HF in the Saint Luke’s Health System were conducted via telehealth in early 2020, without significant increases in mortality or the need for acute care, researchers report in JACC: Heart Failure. “As the pressures of the COVID-19 pandemic abate, these data suggest that telehealth outpatient visits in patients with heart failure can be safely incorporated into clinical practice,” the authors say. TCTMD’s Caitlin Cox has the story.

TCTMD also takes a deeper dive into the HEP-COVID results, published last week, showing that a therapeutic dose of low molecular weight heparin was effective in reducing major thromboembolism and death in non-ICU-level patients. 

A “state-of-the-art review” in the Journal of the American College of Cardiology digs into research on use of lipid-modulating agents to prevent or treat COVID-19. “These agents may inhibit viral entry by lipid raft disruption or ameliorate the inflammatory response and endothelial activation,” the authors say. “In addition, dyslipidemia with lower high-density lipoprotein cholesterol and higher triglyceride levels portend worse outcomes in patients with COVID-19.” Of 40 randomized trials, only two have reported preliminary results and most of the rest are ongoing.

Investigations into the origins of the COVID-19 pandemic continue, with China planning to test tens of thousands of blood samples dating back to 2019 from the city of Wuhan, according to CNN. Meanwhile, the WHO has proposed 26 experts to form its new Scientific Advisory Group for the Origins of Novel Pathogens (SAGO), including several who served on a prior mission to China to look into the origins of SARS-CoV-2 (Reuters). SAGO’s first mandate will be to assess the status of probes into the COVID-19 pandemic, WHO officials say in a Science editorial.

STAT’s Helen Branswell has provided a primer on what’s known about mixing and matching COVID-19 vaccines, an approach taken in some parts of the world due to either supply issues or concerns of certain adverse effects, like blood clots with the adenoviral-vector vaccines. She notes that later this week, advisors for the US Centers for Disease Control and Prevention (CDC) will hear about the results of a mix-and-match trial testing authorized vaccines in different combinations.

children going back to schoolA PNAS study shows an association between the opening of schools in the United States and the spread of SARS-CoV-2, with a return to in-person learning tied to an increase in the growth rate of COVID-19 cases by 5 percentage points on average. The relationship was stronger when staff members were not required to wear masks. “These findings support policies that promote masking and other precautionary measures at schools and giving vaccine priority to education workers,” the authors say.


October 11, 2021

Molnupiravir was developed by Merck & Co and is an antiviral Covid-19 therapyMerck is seeking emergency use authorization (EUA) from the US Food and Drug Administration (FDA) for molnupiravir, its investigational oral COVID-19 drug. Data from a planned interim analysis of the MOVe-OUT study show that 7.3% of nonhospitalized adults with mild-to-moderate disease who received molnupiravir were hospitalized or died through day 29 after randomization, the company says, versus 14.1% of the placebo arm (P = 0.0012). 

Iceland has become the latest Nordic nation to express concerns about the safety of Moderna’s Spikevax mRNA vaccine in younger patients, Bloomberg reports. They join Norway and Denmark, which have stopped using the vaccine in anyone under age 18, as well as Sweden and Finland, which are restricting use to people over age 30.

The numbers of infants and children who were up-to-date on routine preventive-care inoculations declined in 2020 compared with the previous year, according to a retrospective review published in JAMA Pediatrics. The researchers say interventions are needed “to promote catch-up vaccination, particularly focusing on populations in which disparities in vaccination coverage were evident prior to the pandemic."

New South Wales, which includes the city of Sydney, emerged today from 107 days of strict lockdown protocols that were put in place in June as a result of surging Delta variant cases. As Reuters reports, state Premier Dominic Perrottet called it “Freedom Day,” as cafes, gyms, and restaurants reopened to fully vaccinated customers.

Smiling black family have fun at home with little kidsIn a nod toward herd immunity and pandemic control, a nationwide Swedish study published in JAMA Internal Medicine shows that unvaccinated people living in households with family members who received at least one dose of vaccine, or who have had a COVID-19 infection, are less likely to become infected themselves. The risk decreased among nonimmune family as the numbers of protected family increased.

The pandemic was responsible for an additional 76 million cases of anxiety disorders globally in 2020. Writing in the Lancet, Australian researchers say women were disproportionately affected, accounting for 52 million of the additional cases.

High-efficiency particulate air (HEPA) filters and ultraviolet light resulted in successful removal of airborne SARS-CoV-2 from two hospital wards of COVID-19 patients, British researchers say in a study published on the preprint server medRxiv.

Young woman suffering from coldAlthough influenza and other respiratory viruses were suppressed by measures to curb the spread of COVID-19, experts warn in Nature that easing restrictions, coupled with immunologically naive people, could lead to a serious rebound this winter and stress the importance of getting the flu vaccine.

In California, infections rapidly switched from the Alpha to the Delta variant sometime between late May and late July 2021, according to sequencing data from 6,798 SARS-CoV-2–positive specimens. Reporting in Morbidity and Mortality Weekly Report, investigators note that by July 21 of this year, 95% of all infections could be attributed to the Delta variant.

Children looking forward to outdoor trick-or-treating got some good news this weekend from Anthony Fauci, MD, chief medical adviser to US President Joe Biden and director of the National Institute of Allergy and Infectious Diseases (NIAID). On CNN’s State of the Union program, he encouraged them to “go out there and enjoy Halloween as well as the other holidays that will be coming up.”

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

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Todd Neale is the Associate News Editor for TCTMD and a Senior Medical Journalist. He got his start in journalism at …

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