Coronavirus Tidbits #117 1/31/21

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Announcements:

First, there is now a Resources Page here for the most commonly asked questions I’m getting.

Happy to continue to answer your questions/concerns as best I can, so don’t be shy about that.

News 

Mutations:

Regeneron announced that its antibody cocktail (casirivimab and imdevimab) is effective against both the U.K. (B.1.1.7) and South African variant (B.1.351).

But scientists say the coronavirus variant from Brazil (P.1) may be the most worrisome. Here’s why. (NPR)

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And a good thread on vaccines and mutants from @zeynep. Start here:

Diagnostics:

still an incredible, negligent lack of rapid, accurate testing.

Drugs and Vaccines:

Do not take Tylenol or NSAIDS prophylactically (before vaccine).

Tylenol (Paracetamol) is preferred over NSAIDS (ibuprofen, other). Wait to take meds if symptoms develop.

(see Tips for more)

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Chaos in vaccine distribution and administration:

seems widespread across the country. Here in Allegany County, MD, problems noted by Women’s Action Coalition (WAC) members include:

–poor communication between the ACHD and UPMC

–Governor stated ppl 65 and older could get vax. ACHD said they did not have enough vaccines to move to the next phase.  People in the community were so angry about the confusion because they were allowed to register but were cancelled. –Ditto re UPMC saying 75 yo was cutoff, then changing to 65, but no good communication and only a couple of hour window in which to sign up –tried to call 102 separate times today to UPMC during their two hour appointment scheduling time slot and never got through –people who registered  to volunteer with Maryland Responds Medical Reserve Corp and then no one has followed up with them –High risk patients are being left out as they are just going by age now. I would think the ACHD could also get info from the primary care docs as to who they feel are high risk and send them a message or call them so that they might have priority. Of course, that leaves patients without a primary w/o an advocate here. Some suggestions to improve administration –Need a central location for the community to register (rather than different sites w diff criteria).  Give them choices of where to go, including pharmacies and the grocery stores. –Perhaps better to have a pre-registration system and then alert for when the vax is available. — Have a central HQ that tells each site how many vaccines they’ll get.  Have the sites coordinate; once you’re registered, have each site notify each registered person when they can come in.  It would be helpful, if possible, to do this somewhat geographically. Some sites are in remote areas, like Rawlings, which is inaccessible w/o a car. — Have clear information about what group is being seen and publicize it beyond FB, email, e.g., newspaper, radio, senior centers, etc.

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Novavax, Inc’s vax shows with efficacy of 89.3%

in its Phase 3 clinical trial conducted in the United Kingdom (UK) and also significant clinical efficacy against both the rapidly emerging UK and South Africa variants,

https://www.precisionvaccinations.com/2021/01/28/covid-19-vaccine-candidate-demonstrates-efficacy-against-variants

Detailed info about Novavax here: https://www.precisionvaccinations.com/vaccines/nvx-cov2373-covid-19-vaccine

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Johnson & Johnson / Janssen vax

Johnson & Johnson says COVID-19 vaccine 85% effective against severe cases

[It was 100% effective against hospitalization & deaths.]

However, the results varied by region when it comes to less severe cases.

For moderate to severe cases, the company said the vaccine proved to be about 72% effective among U.S. volunteers, 66% in Latin America and just 57% in South Africa.

Johnson & Johnson’s testing of the vaccine included its use against a variant of the disease first identified in South Africa. In fact, the company said 95% of all cases in South Africa involved the B.1.351 variant.

“Among all participants from different geographies and including those infected with an emerging viral variant, Janssen’s COVID-19 vaccine candidate was 66% effective overall in preventing moderate to severe COVID-19, 28 days after vaccination,” the company said in a statement.

Johnson & Johnson’s vaccine is considered to have several advantages over the vaccines available from Pfizer and Moderna.

Unlike the other two, Johnson & Johnson’s vaccine doesn’t require freezing for storage, which makes it logistically simpler to ship. It also comprises of just one shot, instead of the two-shot process for the Pfizer and Moderna vaccines.

Johnson & Johnson’s trials found that some volunteers began showing signs of protection against the coronavirus as early as day 14.

https://www.upi.com/Top_News/US/2021/01/29/Johnson-Johnson-says-COVID-19-vaccine-85-effective-against-severe-cases/6551611925473/

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Heparin targets coronavirus spike protein

Heparin found to inhibit the SARS-Cov2 virus spike protein, by reducing the virus’ ability to attach to human cells and infect them.

The research, published in the journals British Journal of Pharmacology, and Thrombosis and Haemostasis, found that heparin interacts with the spike protein on the surface of coronavirus (SARS-CoV2), destabilising its structure and preventing it from docking with the ACE2 receptor on human cells.

https://new.eurekalert.org/pub_releases/2021-01/uol-htc012821.php

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Novel antiviral drug significantly more potent against SARS-CoV-2

The antiviral drug plitidepsin is between 10 and 100 times more effective against SARS-CoV-2, including the new UK variant, than the NHS approved drug remdesivir, finds new preclinical research involving UCL scientists.

https://medicalxpress.com/news/2021-01-antiviral-drug-significantly-potent-sars-cov-.html?

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How to redesign COVID vaccines so they protect against variants

As evidence grows that new variants of the SARS-CoV-2 coronavirus can evade immunity produced by vaccines or previous infections, scientists are exploring the idea of redesigning the vaccines currently being rolled out worldwide.

Researchers are still debating whether the new variants could undercut the effectiveness of these first-generation COVID-19 vaccines. But some vaccine developers are charging forward with plans to update their shots so that they could better target the emerging variants, such as those identified in South Africa and Brazil. These lineages carry mutations that seem to dampen the effects of antibodies crucial to fending off infection. Researchers are also considering the possibility that vaccines against the coronavirus might have to be updated periodically, as they are for influenza.

The best and most immediate way to combat the threat of emerging variants is still probably to quickly vaccinate as many people as possible with current shots, says Mani Foroohar, a biotechnology analyst at the investment bank SVB Leerink in Boston, Massachusetts: “We need to get vaccines in arms and to smother this virus before it blows up in our face again.”

But Foroohar and others expect that, in the future, a bevy of new vaccines will emerge to take the COVID variants head on. Nature explores the open questions about updating the world’s coronavirus vaccines.

https://www.nature.com/articles/d41586-021-00241-6

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COVID-19 vaccine safety update Advisory Committee on Immunization Practices (ACIP) January 27, 2021

[details adverse events–nothing new]

https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2021-01/06-COVID-Shimabukuro.pdf

Devices:

On reusing masks:

So how about reusing those N95s?

Zeynep: I will give a modified version of what health care workers were advised during the worst of the shortages. Rotating a few is enough for disinfection. Just let them rest for a few days in a non-airtight container (like a paper bag or a Tupperware container with holes) and replace one only when it no longer fits well or the elastics have gone soft, or if it is soiled. It’s also good to use hand-sanitizer before putting them on and taking them off. Handle them gently, because a good fit is essential to getting the most out of it. My sense from having heard a lot from people using all the other disinfection methods, like heat, is that they just increase the risk of damaging the mask.

Zeynep: If I were wearing an N95 just for the weekly grocery store run, I’d probably be fine with alternating two carefully handled masks for many months as long as the elastic works and there’s no soiling. That’s not a lot of use! But if I were wearing one all day, every workday, I’d consider having one for each day and replacing them maybe every month. So that’s about five per month. Could one be really careful and make that two months? Probably.

re Paper masks: People can also purchase braces for surgical masks or make a brace themselves from a template, which really improves fit.

https://www.nytimes.com/2021/01/29/opinion/coronavirus-masks.html

Epidemiology/Infection control:

NIH launched a database to gather reports of neurological symptoms associated with COVID-19.

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Lingering lung, physical, mental symptoms 4 months after COVID

Four months after their release from the hospital, more than half of 238 adult COVID-19 patients in northern Italy still had impaired lung function or mobility issues, and about one-fifth had symptoms of posttraumatic stress disorder (PTSD), a prospective cohort study published yesterday in JAMA Network Open found.

The findings add to growing evidence and discussion of so-called COVID-19 “long-haulers,” or patients with function-impairing symptoms persisting for months after their initial recovery.

https://www.cidrap.umn.edu/news-perspective/2021/01/lingering-lung-physical-mental-symptoms-4-months-after-covid-19

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COVID-19 increases mortality rate 13x among pregnant women

The study followed 240 pregnant women.

Specifically the study found:

  • Pregnant women with COVID-19 had 3.5 times higher COVID-19 associated hospitalization rate than the similarly aged general population in Washington state.
  • COVID-19 mortality rates were 13 times higher in pregnant mothers than in similarly aged individuals. This said, most of the pregnant patients with COVID-19 had asymptomatic or mild COVID-19 disease and healthy pregnancies.
  • The three women who died of COVID-19 in Washington state were from minority ethnic groups and most of them had other conditions such as obesity and hypertension.

Of the 240 pregnant women with SARS-CoV-2 infections detected through June, three died from COVID-19, while 24 patients were hospitalized for COVID-19.  Dr. Kristina Adams Waldorf, an obstetrician-gynecologist with the University of Washington School of Medicine, and senior author of the study, noted that this shows a severe underreporting of mortality related to COVID among mothers in the United States.

https://www.eurekalert.org/pub_releases/2021-01/uowh-cim012621.php

Tips, general reading for public:

StayAtHome

Wash your hands.

Rinse and repeat.

Unsettled question as to how much effect on immune response antipyretics have.

Best advice appears to be: Tylenol (Paracetamol) is preferred over NSAIDS (ibuprofen, other) and better to not take prophylactically. Wait to take meds if symptoms develop.

Antipyretics might blunt the immune response, but did not stop or drastically lower it.

“The timing of administration of antipyretic analgesics appears to be paramount. In all studies that reported a negative effect on antibody response, the medications were given prophylactically. Interestingly, this effect was not seen when acetaminophen was given only four hours after immunization.6 Additionally, all reported decreases in antibody response occurred only with novel antigen vaccination, with little to no impact observed following booster immunizations. These findings underscore the notion that relationship between antigen exposure and the timing of the medication dosage plays a vital role in modifying the immune response,”

https://www.tandfonline.com/doi/full/10.1080/21645515.2016.1183077

https://www.miamiherald.com/news/coronavirus/article248840414.html

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Let fever do its job: the meaning of fever in the Pandemic ERA

academic.oup.com › doi › emph › eoaa044 › eoaa044 [Fever may be beneficial in fighting a host of infections]

Politics:

Vaccine Policies: Ethical Concerns

— Arthur Caplan, PhD, discusses allocation and rationing, cutting the line, mandating the shots

https://www.medpagetoday.com/podcasts/trackthevax/90771?

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The Oklahoma Department of Health is still looking for someone to take its stockpile of hydroxychloroquine, after purchasing $2 million worth last spring. (New York Times)

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BARDA’s slush fund:

A 223-page HHS Inspector General report uncovered a “slush fund” at the Biomedical Advanced Research and Development Authority: monies meant for pandemic preparedness and vaccine research (including for coronavirus) were used instead for activities like removing office furniture, news subscriptions, legal services, and salaries. (New York Times)

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Feel good du jour:

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Austrian man, Erich Schwam, leaves fortune to French village that saved his family from Nazis

https://www.cnn.com/2021/01/30/europe/fortune-french-village-nazi-intl/index.html

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Comic relief:

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Perspective/Poem

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Bits of beauty:

 

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