Coronavirus Tidbits #161 10/10/21

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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 

Giving flu, COVID vaccines at same time appears to be safe, effective

Giving the flu vaccine at the same time as the second dose of the AstraZeneca/Oxford or Pfizer/BioNTech COVID-19 vaccine appeared to be safe and induce immunogenicity, according to a non-peer-reviewed study in The Lancet yesterday.

“Our findings demonstrate that concomitant administration of six different combinations of COVID-19 and influenza vaccines raises no safety concerns, produces acceptable reactogenicity profiles and preserves immunogenicity.”
Sep 30 Lancet preprint study

https://www.cidrap.umn.edu/news-perspective/2021/10/covid-19-scan-oct-01-2021

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FDA to hold Advisory Committee meetings next week on J&J and Moderna boosters, and EUA for kids’ vax

https://www.fda.gov/news-events/press-announcements/fda-hold-advisory-committee-meetings-discuss-emergency-use-authorization-booster-doses-and-covid-19

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Half of severe COVID-19 patients have symptoms after a year, Wuhan study finds

Sept. 29 (UPI) — Older people and those who suffer more serious illness initially are more likely to experience lingering symptoms of COVID-19 up to one year after being infected, according to a study in Wuhan, China, published Wednesday by JAMA Network Open.

Among study participants, all of whom were hospitalized during their initial illness, 45% had at least one lingering symptom of COVID-19 one year after they were infected, according to the researchers.

Of the more than 2,400 COVID-19 patients included in the study, 28% still had severe fatigue one year after contracting the virus, the data showed.

https://www.upi.com/Health_News/2021/09/29/COVID-19-long-covid-Wuhan-study/8171632922723/

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One in seven patients miss cancer surgery during COVID lockdowns: study

One in seven cancer patients around the world have missed out on potentially life-saving operations during COVID-19 lockdowns, a new study reveals.

https://medicalxpress.com/news/2021-10-patients-cancer-surgery-covid-lockdowns.html?

Diagnostics:

still an incredible, negligent lack of testing.

Patient Flags COVID-19 Test That Cost More than a Tesla

In June 2020, Travis Warner, of Dallas, and his wife sought out COVID-19 tests after one of his employees tested positive. In a huge relief for the couple, their tests came back negative. But some of the costs were astonishingly high, Kaiser Health News reported.

https://khn.org/news/article/pricey-covid-test-costs-more-than-tesla-surprise-billing-texas/

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Biden Admin to Buy More At-Home COVID Tests, Expand Free Testing Sites

https://www.medpagetoday.com/infectiousdisease/covid19/94894?

Drugs and Vaccines:

What we know – and don’t know – about Merck’s new Covid-19 pill Molnupiravir

reduced hospitalizations by 50% (in patients who were mildly-mod ill); it also appeared to have an impact on whether patients survived. But it costs $700/5 day course.

https://www.statnews.com/2021/10/04/what-we-know-and-dont-know-about-mercks-new-covid-19-pill/

but study of Molnupiravir in moderately ill pts was suspended for lack of efficacy

https://www.reuters.com/business/healthcare-pharmaceuticals/aurobindo-pharma-stop-molnupiravir-trial-moderate-covid-19-patients-2021-10-08/

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Remdesivir Appears Effective in COVID Outpatients, Too

– But enrollment halted early, and few patients were actually hospitalized

https://www.medpagetoday.com/meetingcoverage/idweek/94819?

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Convalescent plasma futile as treatment for critical COVID-19 patients

https://medicalxpress.com/news/2021-10-convalescent-plasma-futile-treatment-critical.html?

full study from REMAP-CAP at https://jamanetwork.com/journals/jama/fullarticle/2784914

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Moderna continues to resist ramping up COVID-19 vaccine production for international donations. 

“The U.S. government co-invented the vaccine. We’ve spent over $8 billion,” the official said.

In the meantime, Moderna is also facing – and resisting – growing pressure from activists and international organizations to share the formula for its vaccine with manufacturers in other countries.

The Biden administration earlier this year formally backed waiving patent protections for Covid-19 vaccines to expand production worldwide. But that proposal is fiercely opposed by both drug manufacturers and some European countries.

https://www.politico.com/news/2021/10/07/biden-admins-moderna-international-donations-515537

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Blood thinners: Patients admitted to hospital less, Reduce deaths by half

see Outbreaknewstoday (link is breaking WP)

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Long-Acting Antibody Combination for Prophylaxis of Symptomatic COVID-19 

AstraZeneca is requesting an EUA for AZD7442, a combination of two LAABs – tixagevimab (AZD8895) and cilgavimab (AZD1061) – derived from B-cells from patients after a Covid infection https://www.precisionvaccinations.com/2021/10/05/long-acting-antibody-combination-prophylaxis-symptomatic-covid-19-files-authorization ~ ~ ~

What level of antibody response protects against COVID-19 death?

In a study of patients with COVID-19 being treated in intensive care units, people who mounted only a low antibody response against the SARS-CoV-2 virus faced a higher risk of dying.

The study, which is published in the Journal of Internal Medicine, also found that patients with strong antibody responses against the virus had low levels of viral RNA in their blood. On the contrary, those with poor antibody responses had high viral RNA levels and disseminated viral proteins in the blood.

The results could help establish the optimal antibody levels needed for an individual to overcome COVID-19 when critically ill. The study also provided evidence of the importance of antibodies against the spike protein of SARS-CoV-2 to block the virus’ replication. These are the antibodies that are induced by vaccination.

https://www.eurekalert.org/news-releases/930470

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Natural infection versus vaccination: Differences in COVID antibody responses emerge

Hope for a future without fear of COVID-19 comes down to circulating antibodies and memory B cells. Unlike circulating antibodies, which peak soon after vaccination or infection only to fade a few months later, memory B cells can stick around to prevent severe disease for decades. And they evolve over time, learning to produce successively more potent “memory antibodies” that are better at neutralizing the virus and more capable of adapting to variants.

Vaccination produces greater amounts of circulating antibodies than natural infection. But a new study suggests that not all memory B cells are created equal. While vaccination gives rise to memory B cells that evolve over a few weeks, natural infection births memory B cells that continue to evolve over several months, producing highly potent antibodies adept at eliminating even viral variants.

The findings highlight an advantage bestowed by natural infection rather than vaccination, but the authors caution that the benefits of stronger memory B cells do not outweigh the risk of disability and death from COVID-19.

“While a natural infection may induce maturation of antibodies with broader activity than a vaccine does-a natural infection can also kill you,” says Michel C. Nussenzweig, the Zanvil A. Cohn and Ralph M. Steinman professor and head of Rockefeller’s Laboratory of Molecular Immunology. “A vaccine won’t do that and, in fact, protects against the risk of serious illness or death from infection.”

https://medicalxpress.com/news/2021-10-natural-infection-vaccination-differences-covid.html

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Devices:

Real-world data show that HEPA filters clean COVID-causing virus from air

An inexpensive type of portable filter efficiently screened SARS-CoV-2 and other disease-causing organisms from hospital air.

Research at a hospital swamped by people with COVID-19 has confirmed that portable air filters effectively remove SARS-CoV-2 particles from the air – the first such evidence in a real-world setting1. The results suggest that air filters could be used to reduce the risk of patients and medical staff contracting SARS-CoV-2 in hospitals, the study’s authors say.

https://www.nature.com/articles/d41586-021-02669-2

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Epidemiology/Infection control:

Children and Covid

As the delta coronavirus variant spread and kids returned to school, the number of new child coronavirus cases spiked and remains exceptionally high, according to a report from The American Academy of Pediatrics and the Children’s Hospital Association. Children are making up nearly 27% of new cases, according to the report.

FDA Advisory Committee to meet next week on EUA for vax in 5-11 yo

Viral loads similar between vaccinated and unvaccinated people

A new study from the University of California, Davis, Genome Center and UC San Francisco shows no significant difference in viral load between vaccinated and unvaccinated people who tested positive for the delta variant of SARS-CoV-2. It also found no significant difference between infected people with or without symptoms.

https://medicalxpress.com/news/2021-10-viral-similar-vaccinated-unvaccinated-people.html?

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Study: Political systems influenced how countries initially responded to COVID-19

An international study led by Keele University’s Emeritus Professor Michael Rigby has assessed the factors that influenced how different countries’ responses affected early control of COVID-19.

https://medicalxpress.com/news/2021-10-political-countries-covid-.html?

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Data — or Lack Thereof — Is Negatively Affecting U.S. Pandemic Response

The recent debate about COVID-19 booster shots has exposed a “fundamental weakness” that has inhibited the U.S. response to the pandemic, the Washington Post reported. The weakness is that, “The data is a mess.”

Questions still swirl about how many people have been infected, how many fully vaccinated people have had breakthrough infections, and when fully vaccinated people need booster shots, the Post reported. And American officials have often had to look to data from abroad.

“Critically important data on vaccinations, infections, hospitalizations and deaths is scattered among local health departments, is often out of date and hard to aggregate at the national level, and it is simply inadequate for the job of battling a highly transmissible and stealthy pathogen,” the Post wrote.

Ali Mokdad, PhD, an epidemiologist at the University of Washington’s Institute for Health Metrics and Evaluation, told the Postthat he is uncertain about his continuing level of protection from the COVID-19 vaccine. Mokdad, a healthy 59-year-old, received his second shot more than 6 months ago.

“Do we know how much immunity I have against hospitalization in the U.S.? No,” Mokdad told the Post. “Do we know how much immunity I have against death? We don’t.”

https://www.washingtonpost.com/health/2021/09/30/inadequate-us-data-pandemic-response/

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Why easing COVID restrictions could prompt a fierce flu rebound

As pandemic restrictions ease, other respiratory viruses are returning in unexpected ways.

The COVID-19 pandemic is continuing to have unusual and unexpected effects on a number of respiratory diseases – some have been quashed, others have ploughed through and still more are rebounding off-season. These fluxes are complicating medical responses to the pandemic, but also providing scientists with an opportunity to study how these viruses spread.

As cold-and-flu season ostensibly starts in the Northern Hemisphere, researchers warn to expect the unexpected. “If anyone tells you they know, they don’t know,” says epidemiologist John Paget at the Netherlands Institute for Health Services Research in Utrecht. Most agree that influenza will eventually rebound, possibly fiercely, as travel restrictions and societal interventions designed to curb the coronavirus, such as mask-wearing, wane. “Once we let our good health practices lapse, then flu is likely to hit hard,” says Robert Ware, a clinical epidemiologist at Griffith University in Queensland, Australia.

VIRAL SHIFT: histogram showing the number of influenza cases recorded from 2009 to 2021

Seasonal flu typically kills 290,000-650,000 people a year worldwide. But for most of 2020 and 2021, it practically vanished from much of the globe. FluNet, a tool for tracking global virological data on influenza maintained by the World Health Organization, shows that the proportion of positive flu tests has remained roughly flat since April 2020, despite increased surveillance (see ‘Viral shift’).

Source: Foley, D. A. et al. Clin. Infect. Dis. https://doi.org/10.1093/cid/ciaa1906 (2021).

https://www.nature.com/articles/d41586-021-02558-8

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The infectious staff worker had slight symptoms….

Another detail….all were doubly vaccinated with Pfizer in Feb 2021.

More complete details and actual wording in 3 parts Acute hospital outbreak of Delta among night shift staff in ED. Of 15 people who used a common break room during the shift, with max occupancy of 4 at a time, 14 tested positive. Index case came to work with mild symptoms.(1/3)

The hospital had no provision for use of antigen self-test kits if symptomatic. Policy was staff asked not to come to work if symptomatic but attend for a PCR test and await results. (2/3)

All 15 staff were fully vaccinated >150 days prior to the incident. The break room had open window ventilation but no air handling, HEPA filtration, or CO2 monitoring. (3/3)

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Tips, general reading for public:

StayAtHome

Wash your hands.

Rinse and repeat.

Politics:

Requiring the COVID Vaccine: The Legal Battle Ahead

https://www.medpagetoday.com/podcasts/trackthevax/94859?

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Public Health Is an Afterthought in Biden Administration’s $65 Billion Pandemic Preparedness Initiative

by Joshua P Cohen

… the White House plan omits inclusion of a substantial amount of investment in the long-term sustainability of state and local public health. Local public health departments have lost 55,000 jobs since the 2008 recession. And, the problem of a resource-constrained public health sector goes back many decades. In essence, as the sociologist Paul Starr wrote, public health in the U.S. has been relegated to a secondary status. It’s less prestigious than clinical medicine and poorly financed. The White House plan does little to change that.

https://www.forbes.com/sites/joshuacohen/2021/10/02/public-health-is-an-afterthought-in-biden-administrations-65-billion-pandemic-preparedness-initiative/

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Feel good du jour:

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Comic relief:

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Perspective/Poem

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Bits of beauty:

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