Coronavirus Tidbits #194 5/29/22

Emergency medical staff report high levels of burnout amid COVID

Two-plus years into the pandemic, an online survey of emergency-medicine professionals in 89 countries reveals that 62% reported one or more symptoms of COVID-19–related burnout syndrome, and 31% reported two.

Women reported more burnout than men (64% vs 59%), as did nurses versus doctors (73% vs 60%). High levels of burnout were tied to frequent understaffing (70% vs 37% of those with adequate staffing) and a higher risk of wanting to leave their workplace (87% vs 40% of those who didn't want to leave). Only 41% of respondents said they had access to support programs.

https://www.cidrap.umn.edu/news-perspective/2022/05/emergency-medical-staff-report-high-levels-burnout-amid-covid-19

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In long COVID, blood markers are linked to neuropsychiatric ills

In a new study of long COVID published March 13, 2022, in the Annals of Neurology, UC San Francisco researchers identified biomarkers present at elevated levels that may persist for many months in the blood of study participants who had long COVID with neuropsychiatric symptoms.

The results hold promise for the development of lab tests to gauge long COVID risks and to evaluate new therapies to tackle a form of COVID that has at times been thought of as a subjective syndrome that's difficult to describe and measure...

https://medicalxpress.com/news/2022-05-covid-blood-markers-linked-neuropsychiatric.html

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Long COVID risk falls only slightly after vaccination, huge study shows

Results suggest that vaccines offer less protection against lingering symptoms than expected.

Nature Sara Reardon 25 May 2022

Vaccination against SARS-CoV-2 lowers the risk of long COVID after infection by only about 15%, according to a study of more than 13 million people¹. That’s the largest cohort that has yet been used to examine how much vaccines protect against the condition, but it is unlikely to end the uncertainty.

Long COVID — illness that persists for weeks or months after infection with SARS-CoV-2 — has proved difficult to study, not least because the array of symptoms makes it hard to define. Even finding out how common it is has been challenging. Some studies^2,3 have suggested that it occurs in as many as 30% of people infected with the virus. But a November study⁴ of about 4.5 million people treated at US Department of Veterans Affairs (VA) hospitals suggests that the number is 7% overall and lower than that for those who were not hospitalized.

Another mystery has been whether long COVID is less likely to occur after a breakthrough infection — one in a person who has been vaccinated. In a 25 May study¹ in Nature Medicine, nephrologist Ziyad Al-Aly at VA Saint Louis Health Care System in St Louis, Missouri, and his colleagues — the same team that authored the November study — looked at VA health records from January to December 2021, including those of about 34,000 vaccinated people who had breakthrough SARS-CoV-2 infections, 113,000 people who had been infected but not vaccinated and more than 13 million people who had not been infected.

Chinks in the armour

The researchers found that vaccination seemed to reduce the likelihood of long COVID in people who had been infected by only about 15%. That’s in contrast to previous, smaller studies, which have found much higher protection rates. It’s also a departure from another large study⁵, which analysed self-reported data from 1.2 million UK smartphone users and found that two doses of a COVID-19 vaccine halved the risk of long COVID.

The authors of the latest study also compared symptoms such as brain fog and fatigue in vaccinated and unvaccinated people for up to six months after they tested positive for SARS-CoV-2. The team found no difference in type or severity of symptoms between those who had been vaccinated and those who had not. “Those same fingerprints we see in people who have breakthrough infections,” Al-Aly says.

https://www.nature.com/articles/d41586-022-01453-0

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Long Covid symptoms

CDC: COVID survivors struggle with pulmonary embolisms, breathing issues

A large study of adults in the United States who survived COVID-19 during the first 2 years of the pandemic found that they had twice the risk of developing pulmonary embolism or respiratory conditions in the year following infection.

In other developments, US Centers for Disease Control and Prevention (CDC) tracking today shows that the more transmissible BA.2.12.1 Omicron subvariant is now the dominant strain, as illness levels continue a steady rise across the country.

Seniors had higher risk of neuro, mental conditions

The new findings on post COVID-19 conditions come from a CDC analysis of a large electronic health record database that compared outcomes in people ages 18 and older who received a COVID-19 diagnosis in a clinic, emergency department, or hospital with people from the same settings who weren't sick with the virus.

The study included 353,164 COVID-19 patients and 1,640,776 controls. The findings appear today in an early online edition of Morbidity and Mortality Weekly Report (MMWR).

Researchers looked at 26 clinical conditions that had been previously linked to post-COVID illness. Patients were followed until their first occurrence of one of the 26 conditions or until Oct 31, 2021.

Of patients ages 18 to 64 years old, one in five COVID survivors experienced a condition linked to previous infection. Of those 65 and older, one in four experienced one of the conditions.

For both groups, the highest risk were for pulmonary embolism and respiratory symptoms. However, seniors had a higher risk of neurological conditions and four mental health conditions, which included mood disorders, other mental conditions, anxiety, and substance-related disorders. Researchers said those findings were concerning, because older people are already at higher risk for stroke and neurocognitive impairment.

The authors wrote that the findings are consistent with earlier studies showing that post-COVID problems occur in 20% to 30% of patients, with some requiring follow-up care. They said COVID prevention strategies and routine assessment for post-COVID conditions are critical for reducing the impact of the disease and its longer-term complications.

They also said more research is needed to better understand the physiologic mechanisms that contribute to the post-COVID conditions.

https://www.cidrap.umn.edu/news-perspective/2022/05/cdc-covid-survivors-struggle-pulmonary-embolisms-breathing-issues

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The @NIH #LongCOVID study finds 6 distinct forms of long-duration post-#COVID19 that likely require 6 different forms of treatment & recovery.https://t.co/2ckZKT5X00 pic.twitter.com/tuFxNwdRgv

— Laurie Garrett (@Laurie_Garrett) May 27, 2022

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SARS-CoV-2 causes some children to develop multisystem inflammatory syndrome (MIS-C), which has similar symptoms to #Kawasaki disease (KD). #NIH-funded research at @UCSanDiego has found MIS-C and KD are on the same immune response continuum as #COVID19. https://t.co/u0hCufhbuL

— Lawrence A. Tabak (@NIHDirector) May 27, 2022

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Pfizer reports strong COVID vaccine protection in kids under 5, will file with FDA

In closely watched developments, especially among parents and healthcare providers, Pfizer and BioNTech today announced strong efficacy for a three-dose regimen of the child-sized dose of their mRNA vaccine in kids ages 6 months to 4 years old.

Moving forward with 3-dose series

The new findings come more than 3 months after the two companies abruptly delayed submitting the emergency use authorization (EUA) application for the vaccine to allow them more time to evaluate whether a two- or three-dose primary series would be best.

The 3-microgram dose for the smallest children is one-tenth of the adult dose and was selected for its safety, tolerability, and immunogenicity. Earlier trials, however, found that the reduced dose didn't prompt a significant immune response in children 2 years and older, suggesting that a third dose may be needed.

In a statement today, the companies said the third dose was well tolerated among 1,678 children under age 5, with a safety profile that was similar to placebo. Vaccine efficacy was 80.3% at a time when the Omicron variant was dominant.

Ugr Sahin, MD, BioNTech's chief executive officer and cofounder, said officials from the two companies are preparing documents and expect to submit the EUA application to the US Food and Drug Administration (FDA) later this week, with submission to the European Medicines Agency and other regulatory agencies in the coming weeks.

Given the new timeline for expected submissions, the FDA today said its vaccine advisory group will meet on Jun 14 to discuss Moderna's EUA request for kids ages 6 through 17. The Vaccines and Related Biological Products Advisory Committee (VRBPAC) will meet on Jun 15 to talk about both Moderna's EUA request for kids age 6 months through 5 years and Pfizer-BioNTech's EUA request for kids 6 months through 4 years.

https://www.cidrap.umn.edu/news-perspective/2022/05/pfizer-reports-strong-covid-vaccine-protection-kids-under-5-will-file-fda

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Study: Omicron caused 3 times as many deaths as Delta in Massachusetts

More adults died of COVID-19 in Massachusetts in the first 8 weeks of the SARS-CoV-2 Omicron variant surge than in the entire 23-week Delta period, suggests a modeling study published today in JAMA.

A team led by a Brigham and Women's Hospital researchers estimated excess deaths—a higher-than-expected number of fatalities—during Delta dominance (Jun 28 to Dec 5, 2021), the transition to Omicron (Dec 6 to 26, 2021), and Omicron dominance (Dec 27, 2021, to Feb 20, 2022) in Massachusetts.

The team applied models to 2014 to 2019 US Census population data and Massachusetts Department of Health all-cause death data from Jan 5, 2015, to Feb 8, 2020. They determined the variant periods using regional wastewater sampling data.

More excess deaths occurred in the 8-week Omicron period (2,294; 12,231 observed, 9,937 expected) than in the 23-week Delta surge (1,975; 27,265 observed, 25,290 expected), suggesting that Omicron—despite it generally causing milder infections—was deadlier overall. The per-week incidence rate ratio of Omicron to Delta for excess death was 3.34.

All adult age-groups saw statistically significant excess deaths during both periods, although more deaths occurred in older adults.

"In terms of excess death, we found that Omicron was actually much worse for Massachusetts than Delta,” lead author Jeremy Faust, MD, said in a Brigham and Women's news release.

If Omicron causes less severe COVID-19, he said, "What we’re seeing here may reflect just how much more infectious Omicron has been. This could mean that highly contagious variants, even if they cause relatively milder illness, can still lead to substantial excess mortality, even in a highly vaccinated population."
May 20 JAMA research letter
May 20 Brigham and Women's Hospital news release

https://www.cidrap.umn.edu/news-perspective/2022/05/news-scan-may-20-2022

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Study finds sensory loss in ~100% of active COVID infections, which is twice as high as self-reports

The loss of smell and taste with a COVID-19 infection during the delta surge was a prevalent symptom and wasn't prevented by vaccination, new research suggests.

https://medicalxpress.com/news/2022-05-sensory-loss-covid-infections-high.html?

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🚨URGENT🚨: One of the most prestigious virology labs in the world, the ones who confirmed BA 2 was more pathogenic than BA 1, Sato Labs, released a new study that finds that the VOCs BA4/5 as well as BA 2.12.1 are more INFECTIOUS and PATHOGENIC over BA 2 https://t.co/3EFRpC39do

— SARS News Network (SNN) 🦠 😷 (@COVIDnewsfast) May 27, 2022

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BTI relative risk and absolute excess burden at 6 months for death, particularly increased for clot-related, lung sequelae pic.twitter.com/em3KgnPxoM

— Eric Topol (@EricTopol) May 25, 2022

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Monkeypox:

CDC considers expanding test capacity

With the United States on the lookout for more monkeypox cases, federal health officials this week said they’re considering expanding testing networks, even as they’ve stressed the current two-step process is not delaying treatment or containment of the outbreak.

For possible monkeypox cases, swabs from the patient are sent to both a local or state lab for initial testing, and to the Centers for Disease Control and Prevention for confirmatory testing. The initial tests identify whether the sample is an orthopox — the genus that monkeypox belongs to — while the CDC verifies that it is in fact monkeypox. The process explains why local communities are announcing suspected cases, followed by confirmation a few days later.

The CDC has faced questions about whether the protocol might prolong infection detection, at a time early in the outbreak when active case investigations and severing transmission chains can prevent the virus from becoming established in communities. The scrutiny is heightened by memories of the Covid-19 pandemic’s early days, when faulty tests and slow regulatory action left the country with a dearth of testing capacity — and a hindered ability to track the virus as it exploded.

But with monkeypox, regional and federal health authorities have underscored they’re treating any suspected cases as presumptive cases, using that information to steer clinical care of patients and to launch contact tracing. They’re not waiting on CDC confirmation to do that.

https://www.statnews.com/2022/05/27/monkeypox-test-capacity-cdc-considers-expanding/

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In the first four months of 2022, DRC has reported 1,238 monkeypox cases, including 57 deaths (CFR 4.6%).

Plague:

Through May 1, DRC has seen 88 cases of plague, including 2 deaths (2.0% CFR). Lokpa remains the epicentre reporting 95% of cases reported this year.

Typhoid fever:

In 2022, through May 1, 634,401 suspected cases of typhoid fever including 279 deaths were recorded in the Democratic Republic of the Congo.

In addition, outbreaks of yellow fever, meningitis and circulating vaccine-derived poliovirus type 2 (cVDPV2) are reported and being monitored.

http://outbreaknewstoday.com/more-than-ebola-drc-reports-cholera-measles-monkeypox-plague-and-typhoid-outbreaks-44511/

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Warning signs ahead of monkeypox outbreak went unheeded, experts say

STAT By Helen Branswell May 26, 2022

[If you want to follow one person about #Monkeypox, it should be Helen Branswell]

Monkeypox appears to have exploded out of nowhere in the past two weeks, spreading across Europe, the Americas, and other regions. But warning signs appear to have gone unheeded.

An unusual and long-running outbreak in Nigeria should have served as notice that it was only a matter of time before this orthopoxvirus pushed its way to the center of the infectious diseases stage, experts say.

After decades without cases, Nigeria experienced a large monkeypox outbreak starting in 2017 that continues to this day. Prior to this year, that outbreak spread beyond Nigeria’s borders eight times, with infected people traveling to the United States, the United Kingdom, Israel, and Singapore.

https://www.statnews.com/2022/05/26/warning-signs-ahead-of-monkeypox-outbreak-went-unheeded-experts-say/

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...and transmission will continue to persist in new places at low-ish levels via highly connected parts of the interaction network (https://t.co/Wofyml7DCX), creating opportunities for spillover into local animal populations (& hence further risk of spilling back in humans). 2/2

— Adam Kucharski (@adamjkucharski) May 26, 2022

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Tecovirimat may limit monkeypox symptom duration, infectiousness

A study on the use of antivirals in seven monkeypox patients in the United Kingdom suggests that the smallpox drug tecovirimat could shorten symptoms and contagiousness.

The authors said it is the first report on in-hospital and household transmission of monkeypox outside of Africa.

The study did not include any cases from this most recent outbreak.

Tecovirimat may hold promise

In the observational study, published yesterday in The Lancet Infectious Diseases, the National Health Service England High Consequence Infectious Diseases (Airborne) Network retrospectively studied patient charts for virologic findings and response to the off-label antivirals tecovirimat and brincidofovir in four men and three women diagnosed as having monkeypox in Liverpool and Newcastle, England, from Aug 15, 2018, to Sep 10, 2021.

Three patients acquired monkeypox in the United Kingdom, including a healthcare worker infected at work and a child and adult who were household contacts of a person infected in West Africa. All patients, who were young and had no underlying illnesses, were hospitalized owing to the risk of viral transmission rather than to the severity of disease.

Signs and symptoms included the presence of the virus in the blood, prolonged viral DNA in the upper respiratory tract, low mood likely related to isolation or perceived stigma, and, in one patient, a deep-tissue abscess that tested positive for the virus on polymerase chain reaction (PCR) testing. Five patients with prolonged PCR-positivity after the crusting of all lesions were isolated for 22 to 39 days.

The three patients treated with 200 milligrams (mg) oral once-weekly brincidofovir had to stop treatment after developing elevated liver enzymes, indicating liver inflammation or injury.

The patient given 200 mg of oral tecovirimat twice daily for 2 weeks had no adverse effects and shed viral DNA for only 10 days. The authors wrote, "The patient treated with tecovirimat had a shorter duration of symptoms and upper respiratory tract viral shedding than the other patients in the series."

One patient had a mild resurgence of monkeypox 6 weeks after hospital release. All patients had mild illnesses and full recoveries.

A challenging, resource-intensive disease

The authors cautioned that the sample size was very small but said the need for monkeypox treatments is urgent.

"Although optimum infection control and treatment strategies for this potentially dangerous pathogen are not established, our first-use data suggest brincidofovir has poor efficacy; however, prospective studies of tecovirimat in human monkeypox are warranted," they wrote.

https://www.cidrap.umn.edu/news-perspective/2022/05/antiviral-drug-may-limit-monkeypox-symptom-duration-infectiousness

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Other:

Why criminalizing medical errors is not the answer

The recent criminally negligent homicide conviction of former Vanderbilt University Medical Center nurse RaDonda Vaught for administering the wrong medication to a patient and causing their death may have a deeply negative impact on healthcare and patient safety far beyond the death of a single patient.

https://healthexec.com/topics/healthcare-management/healthcare-policy/why-criminalizing-medical-errors-not-answer

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