Coronavirus Tidbits #135 4/18/21

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

Tidbits will likely be a bit shorter and a little less frequent for the next little bit.

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

Latest post: Johnson & Johnson Covid-19 Vaccine Rollout Is Paused – How Much Should You Worry?


COVID disrupts healthcare in low- and middle-income countries re TB, HIV, and Malaria

according to a new report by the Global Fund to Fight AIDS, Tuberculosis, and Malaria.

The fund found that, from April to September 2020, HIV testing fell 41%, TB referrals declined 59%, and malaria diagnoses fell 31% among 502 health facilities in 32 LMICs in Africa and Asia.

According to 85% of the surveyed facilities, COVID-19 was the main reason patients no longer sought healthcare, with most reporting fear of transmission (28%), disruption to public transit (20%), lockdown or stay-at-home orders (20%), and general delayed care-seeking behaviors (15%). For instance, antenatal care visits fell 43%, and in seven Asian countries, they fell 66% while consultations for children under 5 dropped 74%.

During the pandemic, 45% of health facilities reported having sufficient personal protective equipment, and across 24 countries in Africa, only a minority of facilities could conduct COVID-19 antigen rapid diagnostic tests (11%) and polymerase chain reaction tests (8%).

Apr 13 The Global Fund report and press release


still an incredible, negligent lack of testing.

Common Hospital PCR Test Affected by Viral Variant

may miss some of the variants.

Drugs and Vaccines:

Second COVID Shot: No Side Effects? No Problem

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FDA and CDC pause Johnson & Johnson vaccine

Statement From: Director – Center for Biologics Evaluation and Research (CBER)

Peter Marks M.D., PhD.; April 13

As of April 12, more than 6.8 million doses of the Johnson & Johnson (Janssen) vaccine have been administered in the U.S. CDC and FDA are reviewing data involving six reported U.S. cases of a rare and severe type of blood clot in individuals after receiving the J&J vaccine. In these cases, a type of blood clot called cerebral venous sinus thrombosis (CVST) was seen in combination with low levels of blood platelets (thrombocytopenia). All six cases occurred among women between the ages of 18 and 48, and symptoms occurred 6 to 13 days after vaccination. Treatment of this specific type of blood clot is different from the treatment that might typically be administered. Usually, an anticoagulant drug called heparin is used to treat blood clots. In this setting, administration of heparin may be dangerous, and alternative treatments need to be given.

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Please see my counterargument to the FDA: We should NOT have a hold on J&J vaccine. This will hurt far more people.

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Thrombotic Thrombocytopenia After COVID-19 Vaccination Explained

The NEJM published an Original Article on April 9, 2021, focused on ‘Thrombotic Thrombocytopenia after ChAdOx1 nCov-19 (AstraZeneca) Vaccination. …

Beginning 5 to 16 days after vaccination, the patients presented with one or more thrombotic events, except for 1 patient, who presented with fatal intracranial hemorrhage. Of the patients with one or more thrombotic events, 9 had cerebral venous thrombosis, 3 had splanchnic-vein thrombosis, 3 had a pulmonary embolism, and 4 had other thromboses; of these patients, 6 died.

Of the 11 original patients reviewed, 9 were women, with a median age of 36 years.

This NEJM article concluded by stating, ‘Vaccination with ChAdOx1 nCov-19 (AstraZeneca) can result in the rare development of immune thrombotic thrombocytopenia mediated by platelet-activating antibodies against PF4, which clinically mimics autoimmune heparin-induced thrombocytopenia.'(HIT)

This reaction has been reported only with the ChAdOx1 nCov-19 vaccine, which has been used in approximately 25% of vaccine recipients in Germany and in 30% of those in Austria.

The NEJM defines ‘severe heparin-induced thrombocytopenia (HIT) as a well-known prothrombotic disorder caused by platelet-activating antibodies recognizing multimolecular complexes between cationic PF4 and anionic heparin.’

HIT is characterized by a platelet-count fall of more than 50% at 5 to 10 days after the start of heparin and hypercoagulability. Platelet factor 4–heparin antibody testing has a high negative but low positive predictive value. Treatment involves therapeutic-dose anticoagulation.

Finally, we suggest naming this novel entity vaccine-induced immune thrombotic thrombocytopenia (VITT) to avoid confusion with heparin-induced thrombocytopenia, says the NEJM.

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Monoclonal antibody recommendation update

NIH is now recommending monoclonal antibody cocktails such as bamlanivimab plus etesevimab or casirivimab plus imdevimab, but against bamlanivimab monotherapy.

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South African variant can ‘break through’ Pfizer vaccine, Israeli study says

But among patients who had received two doses of the vaccine, the variant’s prevalence rate was eight times higher than those unvaccinated – 5.4% versus 0.7%.

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Antibody binding-site conserved across COVID-19 virus variants

A tiny protein of SARS-CoV-2, the coronavirus that gives rise to COVID-19, may have big implications for future treatments, according to a team of Penn State researchers.

Using a novel toolkit of approaches, the scientists uncovered the first full structure of the Nucleocapsid (N) protein and discovered how antibodies from COVID-19 patients interact with that protein. They also determined that the structure appears similar across many coronaviruses, including recent COVID-19 variants — making it an ideal target for advanced treatments and vaccines. They reported their results in Nanoscale.

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Fit matters most when double masking to protect yourself from COVID-19

A study published today in JAMA Internal Medicine shows that wearing two face coverings can nearly double the effectiveness of filtering out SARS-CoV-2-sized particles, preventing them from reaching the wearer’s nose and mouth and causing COVID-19. The reason for the enhanced filtration isn’t so much adding layers of cloth, but eliminating any gaps or poor-fitting areas of a mask.

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Big Ass Fans

Former CDC Director Robert Redfield, MD, has joined Big Ass Fans, a company that charges $9,450 for fans with ion-generating technology it says kills SARS-CoV-2, Kaiser Health News reported.

Redfield lends his scientific credibility to a technology that academic air quality experts have questioned, KHN reported.

He follows in the recent footsteps of former White House coronavirus response coordinator Deborah Birx, MD, who signed on with the company ActivePure last month. It also touts virus-killing technology and also sells some devices that don’t comply with certain indoor air quality rules, KHN reported, citing its own investigation.

Epidemiology/Infection control:

Biden officials rebuff appeals to surge Covid-19 vaccine to Michigan amid growing crisis ~ ~ ~

Past COVID-19 infection does not fully protect young people from reinfection

Study finds that participants who had not previously been infected with SARS-CoV-2 (seronegative) had a five times greater risk of infection than participants who were previously infected, but seropositive people are still at risk of reinfection

A past COVID-19 infection does not completely protect against reinfection in young people, according to an observational study of more than 3,000 healthy members of the US Marines Corps most of whom were aged 18-20 years, published in The Lancet Respiratory Medicine journal.

The authors say that despite previous infection and the presence of antibodies, vaccination is still necessary to boost immune responses, prevent reinfection, reduce transmission, and that young people should take up the vaccine wherever possible.

In the study, between May and November 2020, around 10% (19 out of 189) of participants who were previously infected with SARS-CoV-2 (seropositive) became reinfected, compared with new infections in 50% (1,079 out of 2,247) of participants who had not previously been infected (seronegative).

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Coronavirus | Indian ‘double mutant’ strain named B.1.617

The ‘double mutant’ virus that scientists had flagged last month as having a bearing on the spread of the pandemic in India, has a formal scientific classification: B.1.617.

Other than a place on the coronavirus’s evolutionary history, it also brings focus on the role the variant may be playing in the pandemic, which is now seeing nearly 100,000 fresh infections daily and a conflict between the Centre and some States on the availability of vaccines.

The variant is common in India — how much in every state though is unclear — and has a couple of defining mutations, E484Q and L425R, that enable them to become more infectious as well as evade antibodies. Though these mutations have individually been found in several other coronavirus variants, the presence of both these mutations together have been first found in some coronavirus genomes from India.

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Five Cases of ‘Double Mutant’ Variant First Seen in India Also Found in California

These mutations have also significantly mitigated neutralisation by some, but not all, emergency-use monoclonal antibody drugs.

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More nuanced approach to deciding who gets COVID-19 vaccine needed in face of third wave

Job site and neighborhood risks should be taken into account when setting priorities, authors argue

“The third wave is showing us that the most vulnerable are people in economically marginalized neighbourhoods, Amazon factories and Superstores, where there are a lot of people in close proximity, a group that wasn’t prioritized for vaccination before.”

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Leaving middle seat vacant on planes can reduce SARS-CoV-2 exposure

by up to 57% in a laboratory-based modeling study, according to results published in MMWR Morbid Mortal Wkly Rep. 2021;doi:10.15585/mmwr.mm7016e1.

Tips, general reading for public:


Wash your hands.

Rinse and repeat.


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Prisoners cont. w high infection rate and disproportionate deaths from Covid and neglect

Three COVID-positive inmates at a San Diego prison were found unresponsive in their cells after failing to receive medical treatment. (inewsource)

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Obligatory vaccination not against human rights, European court says

The European Court of Human Rights (ECHR) in Strasbourg said Thursday that compulsory vaccinations are legal in a ruling that might create a precedent for Covid-19 vaccination programmes. The ruling came after a complaint by Czech families regarding compulsory jabs for children. “The measures could be regarded as being ‘necessary in a democratic society,'” the court said, adding that compulsory vaccines were in line with the “best interests” of children.

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Feel good du jour:

Today is April 4th, World Stray Animals Day.. I wanted to share my favorite video of my son Fevzi, who was kicked by a monster while living on the streets, was crippled, but recovered after long treatments and is now a loving cat ❤ Love Heals.. ❤

— Sarper Duman (@sarperduman) April 4, 2021


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Comic relief:

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(Actually a baby musk ox)


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Opinion: Foreign-trained doctors like me were asked to help fight Covid-19. Now we’re being tossed aside

Bits of beauty:

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