Coronavirus Tidbits #132 3/28/21

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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 

Disturbing level of vaccine hesitation in HCWs

About 4 in 10 healthcare workers haven’t gotten a COVID-19 vaccine yet, and more than 1 in 3 say they aren’t confident the vaccines have been thoroughly tested for safety and effectiveness, according to a new poll from The Washington Post and the Kaiser Family Foundation.

The survey queried more than 1,300 front line healthcare workers between February and March, finding just over half (52%) had received at least their first dose of a COVID-19 vaccine at the time. Other findings were more worrisome for vaccination efforts: 3 in 10 said they weren’t sure they were going to get a vaccine, while 1 in 6 said they would quit if their employer forced them to get vaccinated. By comparison, 70% of Americans believe healthcare workers who work with patients should be required to get vaccinated.

The survey also found disparities across health care, with Black healthcare workers reporting lower vaccination rates, as well as those in lower-paying jobs in the field, such as home health aides. Unsurprisingly, politics also played a role in vaccination rates and opinions, with Republicans more likely to express concern over vaccines and Democrats reporting higher vaccination rates.

Education levels also influence vaccination rates, with those with postgraduate degrees reporting higher rates, compared to those with bachelor’s degrees, who reported higher rates of vaccination than those with associate’s degrees.

Income has played a significant role as well.

https://www.healthexec.com/topics/covid-19/surprising-number-healthcare-pros-are-skeptical-covid-19-vaccine

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Diagnostics:

still an incredible, negligent last of testing.

Drugs and Vaccines:

COVID Shot While on a Blood Thinner?

The needle diameter used for injections is very fine, typically 22-25 gauge. It has been shown that intramuscular flu shots in patients on full-dose warfarin (Coumadin, Jantoven) do not increase the risk for bleeding at the site of the injection.

Similarly, it is reasonable to think that the risk for significant bleeding into the muscle is also not increased in a patient who takes a direct oral anticoagulant — apixaban (Eliquis), dabigatran (Pradaxa), edoxaban (Savaysa), or rivaroxaban (Xarelto) — or other anticoagulant like enoxaparin (Lovenox) or fondaparinux (Arixtra).

CDC’s Advisory Committee on Immunization Practices recommends scheduling vaccination prior to taking the blood thinner for the day, if possible. It also suggests using a fine-gauge needle (23-gauge or smaller) and applying firm pressure to the injection site, without rubbing, for at least 2-5 minutes. The patient or family should be given information on the risk for development of a hematoma.

https://www.medpagetoday.com/infectiousdisease/covid19/91624?

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AstraZeneca Vaccine Unfairly Under Fire Over Clot Risk?

— Statistics, WHO, hematologists argue the risk isn’t real

https://www.medpagetoday.com/infectiousdisease/covid19/91641?

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GlaxoSmithKline and Vir Biotechnology file for EUA for their Monoclonal Antibody

for pts w mild-to-moderate COVID-19 who are at risk for progression to hospitalization or death.

Results of a recent interim analysis, based on data from 583 patients enrolled in a phase 3 trial, demonstrated an 85% (p=0.002) reduction in hospitalization or death in those receiving VIR-7831 compared to placebo, the primary endpoint of the trial.

As a result, the Independent Data Monitoring Committee recommended that the trial be stopped for enrollment due to evidence of profound efficacy.

https://www.precisionvaccinations.com/2021/03/26/biotech-companies-submit-vir-7831-early-treatment-covid-19-authorization

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U.S. Halts Distribution of Lilly’s Bamlanivimab Monotherapy, Citing SARS-CoV-2 Variant Resistance

it will continue to distribute bamlanivimab in combination with etesevimab (LY-CoV16 or JS-16), another Lilly antibody. The combination won FDA authorization for emergency use last month.

ASPR said it is also continuing to distribute another antibody combination that has been granted an EUA by the FDA, Regeneron Pharmaceuticals’ two-antibody combination or “cocktail REGEN-COV™ (casirivimab and imdevimab). Healthcare providers with supplies of bamlanivimab can order etesevimab alone to create the combination.

https://www.genengnews.com/news/u-s-halts-distribution-of-lillys-bamlanivimab-monotherapy-citing-sars-cov-2-variant-resistance/

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Devices:

Epidemiology/Infection control:

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B117 variant exhibits higher transmission rates

B117, first identified in the United Kingdom, may have a 50% to 100% higher reproduction rate, according to a Mar 25 Nature study. This finding echoes recent studies such as a Science article published at the beginning of March.

https://www.cidrap.umn.edu/news-perspective/2021/03/covid-19-scan-mar-25-2021

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Vitamin D Levels Tied to COVID-19 Risk for Blacks

Among Black people with vitamin D levels below 40 ng/mL, risk of testing positive for COVID-19 was more than twice that of those with levels of 40 ng/mL or greater.

However, no significant associations between vitamin D levels and COVID-19 risk were noted for white individuals, they noted in JAMA Network Open.

https://www.medpagetoday.com/infectiousdisease/covid19/91723?

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Cancer Patients Respond Poorly to First COVID mRNA Vax Dose

— Results emphasize need to avoid long delay between doses

Barely one-quarter of patients with cancer obtained protection against COVID-19 after one dose of the Pfizer/BioNTech vaccine, a prospective study showed.

The data found a “strikingly low” 28% immune efficacy rate in patients with cancer, including 13% in patients with blood cancers. In contrast, first-dose seroconversion occurred in 97% of a healthy control group.

A second dose at day 21, however, brought adequate immunity to nearly all the cancer patients,

https://www.medpagetoday.com/infectiousdisease/covid19/91726?

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A study published in Viruses documents a case of vertical SARS-CoV-2 transmission from a mother to a fetus in the second trimester of pregnancy.1

https://www.technologynetworks.com/proteomics/news/proteomics-confirms-vertical-transmission-of-sars-cov-2-from-mother-to-fetus-347012?

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COVID-19 illness in relation to sleep and burnout

Background Sleep habits and burnout have been shown to be associated with increase in infectious diseases…

Results Among 2884 exposed HCWs, there were 568 COVID-19 cases and 2316 controls. After adjusting for confounders, 1-hour longer sleep duration at night was associated with 12% lower odds of COVID-19 (p=0.003). Daytime napping hours was associated with 6% higher odds, but the association varied by countries, with a non-significant inverse association in Spain. Compared with having no sleep problems, having three sleep problems was associated with 88% greater odds of COVID-19. Reporting burnout ‘every day’ was associated with greater odds of COVID-19 (OR: 2.60, 95% CI 1.57 to 4.31, p trend across categories=0.001), longer duration (OR: 2.98, 95% CI 1.10 to 8.05, p trend=0.02) and severity (OR: 3.26, 95% CI 1.25 to 8.48, p trend=0.02) compared with reporting no burnout. These associations remained significant after adjusting for frequency of COVID-19 exposures.

Conclusions In six countries, longer sleep duration was associated with lower odds of COVID-19, but the association with daytime nap may not be consistent across countries. Greater sleep problems and high level of burnout were robustly associated with greater odds of COVID-19. Sleep and burnout may be risk factors for COVID-19 in high-risk HCWs.

https://nutrition.bmj.com/content/early/2021/03/03/bmjnph-2021-000228?

Tips, general reading for public:

StayAtHome

Wash your hands.

Rinse and repeat.

Politics:

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Feel good du jour:

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Great pics!

Comic relief:

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https://twitter.com/RexChapman/status/1374159105947021312?s=20

Perspective/Poem

Bits of beauty:

 

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