SARS-CoV-2 and COVID-19 (21)

É uma continuação do tópico SARS-CoV-2 and COVID-19 (20).

Este tópico foi continuado por SARS-CoV-2 and COVID-19 (22).

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SARS-CoV-2 and COVID-19 (21)

1margd
Editado: Maio 3, 2021, 8:31 am

YIKES! Get vaxxed, be careful!

WesElyMD (Vanderbilt ICU, VA) @WesElyMD | 10:45 PM · May 2, 2021:
https://twitter.com/WesElyMD/status/1389174351765835776

1/ A picture is worth 1,000 words

This shows a clear example of what can happen to a person’s body w #COVID. His wife asked me to show it on twitter & urges everyone to get #vaccinate
(w/ consent of pt & wife)

0:15 ( https://twitter.com/WesElyMD/status/1389048534071189512 )

2/ You’ll notice his eyes are swollen shut. (Written permission to show). This is not fluid. It’s AIR from inside his chest leaking out his lungs through muscles & skin to his neck & into his face. He is AWAKE & communicating but had ICU #delirium earlier.

Image-swollen eyes ( https://twitter.com/WesElyMD/status/1389048541687947267/photo/1 )

3/ Look at his chest CT. See the “L” lungs w #Covid pneumonia/#ARDS & also AIR leaking out under his skin. Now go back to 1st tweet & watch again. This is called “barotrauma” (physical damage to body tissues caused by a difference in pressure between a gas space inside) & happens when the lungs get too stiff and pop. Difficult situation. We’re hoping he can heal!

Image-chest CT ( https://twitter.com/WesElyMD/status/1389048551720771586/photo/1 )

4/fin We published this paper about air leaks in #COVID19 #ventilator patientss to discuss this harsh problem. All of this can be prevented by getting the #Vaccine. Please help teach others and let’s get to #herdimmunity.

LINK: https://bit.ly/3vB9c0O

#Covid19 science & #epidemiology warriors like
@EricTopol
@nataliexdean
@michaelmina_lab
@PeterHotez
@DrEricDing
@EpiEllie
are waging an incredible campaign of #education to direct us to get #vaccinated. This wife of my patient asked me if they could help, too.
...share...

2margd
Editado: Maio 3, 2021, 1:33 pm

Reaching ‘Herd Immunity’ Is Unlikely in the U.S., Experts Now Believe

Widely circulating coronavirus variants and persistent hesitancy about vaccines will keep the goal out of reach. The virus is here to stay, but vaccinating the most vulnerable may be enough to restore normalcy.

Apoorva Mandavilli
May 3, 2021, 3:00 a.m. ET

Early in the pandemic, when vaccines for the coronavirus were still just a glimmer on the horizon, the term “herd immunity” came to signify the endgame: the point when enough Americans would be protected from the virus so we could be rid of the pathogen and reclaim our lives.

Now, more than half of adults in the United States have been inoculated with at least one dose of a vaccine. But daily vaccination rates are slipping, and there is widespread consensus among scientists and public health experts that the herd immunity threshold is not attainable — at least not in the foreseeable future, and perhaps not ever.

Instead, they are coming to the conclusion that rather than making a long-promised exit, the virus will most likely become a manageable threat that will continue to circulate in the United States for years to come, still causing hospitalizations and deaths but in much smaller numbers.

How much smaller is uncertain and depends in part on how much of the nation, and the world, becomes vaccinated and how the coronavirus evolves. It is already clear, however, that the virus is changing too quickly, new variants are spreading too easily and vaccination is proceeding too slowly for herd immunity to be within reach anytime soon.

Continued immunizations, especially for people at highest risk because of age, exposure or health status, will be crucial to limiting the severity of outbreaks, if not their frequency, experts believe...

https://www.nytimes.com/2021/05/03/health/covid-herd-immunity-vaccine.html

_______________________________________________________
ETA:

Ashish K. Jha, MD, MPH (Brown SPH Dean) @ashishkjha | 12:58 PM · May 3, 2021:
https://twitter.com/ashishkjha/status/1389263058892201995

Folks being critical or misunderstanding this very good @apoorva_nyc piece
5 points that this piece pulls together nicely

1. Last year, we all assumed herd immunity threshold (HIT) would be 60-70%. Now clear its higher
This is not tragic

2. HIT may be 80%. Seems high
But its possible we might get there. We're about 60% population immunity now
As we improve access, make vaccinations easier, open up to kids, will get into the 70s

3. HIT not an on/off switch. Its not like we hit 80% and disease disappears

Already, we are seeing high levels of population immunity have large effect on dampening cases
My thread from yesterday: https://twitter.com/ashishkjha/status/1388900900886941697?s=20

States like RI, MA, SD already at 70% population immunity. They might get to 80% before long
https://covid19dashboardgt.shinyapps.io/us_immunitylevel/

4. We won't be done even if we get to 80%. We'll need to monitor variants, vaccinate the world, continue testing, etc

5. But this is all manageable. We'll settle into a new equilibrium as we do with many viruses
And COVID won't dominate our lives. And that's what matters

So as we get into summer and fall
No we may not hit herd immunity
But infection numbers will be low
Vaccinated folks will be mainly safe
And with better treatment, infections may become less problematic
And life will return to a recognizable normal
And that'll be good
fin
_____________________________________________________________
ETA

"I think by the end of the summer we will be in a very different position than we are now," President Biden says in Virginia when asked when the US will be back to normal.

- Kaitlan Collins (CNN) @kaitlancollins | 1:30 PM · May 3, 2021

3margd
Maio 3, 2021, 1:14 pm

I trust this gesture is not just in response to US appealing to WTO re rules on Intellectual Property...

Pfizer Inc. @pfizer | 9:00 AM · May 3, 2021:
https://twitter.com/bookpublish101/status/1389234398457843718
Today we have announced we are mobilizing the largest humanitarian relief effort in our company’s history to help the people of India fight the vicious second wave of coronavirus that is currently ravaging the nation.

Supporting India In It's Time of Need
2:33 ( https://twitter.com/pfizer/status/1389203084879011840 )

Right now, Pfizer colleagues at distribution centers in the U.S., Europe and Asia are hard at work rushing shipments of Pfizer medicines that the Government of India has identified as part of their COVID treatment protocol.

We are donating enough of these medicines to ensure that every COVID-19 patient in every public hospital across India can have access to them in the next 90 days free of charge. This effort has the potential to impact the lives of hundreds of thousands of patients.
Image ( https://twitter.com/pfizer/status/1389203422226812928/photo/1 )

These medicines, valued at more than $70M, will be made available immediately, and we will work closely with the government and our NGO partners to get them to where they are needed most.

----------------------------------------------------------------

Debbie Elicksen @bookpublish101 | 11:04 AM · May 3, 2021:
Alberta, Canada could use some, too. Our infection rate is more than double that of India per capita.
Those of us with first shots are not allowed a second shot.
And our provincial leadership just announced they are closing the legislature for two weeks.

4margd
Maio 3, 2021, 2:08 pm

A new study explores why many patients with COVID19 lose their sense of smell or taste, showing the SARSCoV2 virus can persist and promote inflammation in the olfactory system in patients and hamsters.

Guilherme Dias de Melo et al. 2021. COVID-19-related anosmia is associated with viral persistence and inflammation in human olfactory epithelium and brain infection in hamsters. Science Translational Medicine 03 May 2021:eabf8396 DOI:10.1126/scitranslmed.abf8396 https://stm.sciencemag.org/content/early/2021/04/30/scitranslmed.abf8396

Abstract

Whereas recent investigations have revealed viral, inflammatory and vascular factors involved in SARS-CoV-2 lung pathogenesis, the pathophysiology of neurological disorders in COVID-19 remains poorly understood. Olfactory and taste dysfunction are common in COVID-19, especially in mildly symptomatic patients. Here, we conducted a virologic, molecular, and cellular study of the olfactory neuroepithelium of seven patients with COVID-19 presenting with acute loss of smell. We report evidence that the olfactory neuroepithelium may be a major site of SARS-CoV2 infection with multiple cell types, including olfactory sensory neurons, support cells, and immune cells, becoming infected. SARS-CoV-2 replication in the olfactory neuroepithelium was associated with local inflammation. Furthermore, we showed that SARS-CoV-2 induced acute anosmia and ageusia in golden Syrian hamsters, lasting as long as the virus remained in the olfactory epithelium and the olfactory bulb. Finally, olfactory mucosa sampling from patients showing long-term persistence of COVID-19-associated anosmia revealed the presence of virus transcripts and of SARS-CoV-2-infected cells, together with protracted inflammation. SARS-CoV-2 persistence and associated inflammation in the olfactory neuroepithelium may account for prolonged or relapsing symptoms of COVID-19, such as loss of smell, which should be considered for optimal medical management of this disease.

5margd
Maio 4, 2021, 3:50 am

Differential NK* (Natural Killer) cell activity found to contribute to SARS-CoV-2 infection resistance
Susha Cheriyedath | May 3 2021

...asymptomatic individuals...may offer insights into the mechanisms of SARS-CoV-2 resistance and infection.

Analyzing discordant Brazilian couples to study the variability in MHC and LRC genes

...The researchers observed a minor impact in KIR genes and antigen-presentation genes associated with resistance. Genes related to immune modulation involved in NK cell killing activation/inhibition were found to have variants that may contribute to infection resistance. They hypothesized that individuals who produce more significant amounts of MICA, LILRB1, LILRB2, and lower amounts of MICB, would be more prone to SARS-CoV-2 infection.

Based on the study results and the authors’ hypotheses, quantitative differences in these molecules related to NK activity could contribute to SARS-CoV-2 resistance by downregulating NK cell cytotoxic activity in infected individuals but not in their resistant partners.

...To summarize, the authors performed a candidate region study to compare polymorphisms in the LRC and MHC regions in individuals infected with COVID-19 and their partners who were exposed to the virus but were asymptomatic and seronegative for COVID-19. Since all samples in this study were collected in early 2020, all couples studied were likely exposed to the same viral strain.

The findings suggest that genes with a role in innate and adaptive immune responses may play a vital part in viral resistance. Functional assays can provide a way to test this hypothesis of differential NK cell activity between SARS-CoV-2 infected individuals and resistant ones, involving MICB, MICA, and LAIR1/2 molecules.

https://www.news-medical.net/news/20210503/Differential-NK-cell-activity-found-t...

* Natural killer cells, also known as NK cells or large granular lymphocytes (LGL), are a type of cytotoxic lymphocyte critical to the innate immune system that belong to the rapidly expanding family of innate lymphoid cells (ILC) and represent 5-20% of all circulating lymphocytes in humans. The role of NK cells is analogous to that of cytotoxic T cells in the vertebrate adaptive immune response. (Wikipedia)
---------------------------------------------------------------------------

Erick C. Castelli et al. 2021. Immunogenetics of resistance to SARS-CoV-2 infection in discordant couples. MedRxiv, 2021.04.21.21255872; doi: https://doi.org/10.1101/2021.04.21.21255872, https://www.medrxiv.org/content/10.1101/2021.04.21.21255872v1

Preprint not yet peer reviewed.

Abstract
Background
Despite the high number of individuals infected by SARS-CoV-2 who develop COVID-19 symptoms worldwide, many exposed individuals remain asymptomatic and/or stay uninfected. This could be explained by a combination of environmental (exposure, previous infection), epigenetic, and genetic factors. Aiming to identify genetic variants involved in SARS-CoV-2 resistance, we analyzed 86 discordant Brazilian couples where one was infected and symptomatic while the partner remained asymptomatic and seronegative despite sharing the same bedroom during the infection. The discordant partners had comparable ages, and genetic ancestry proportions.

Methods
Whole-exome sequencing followed by a state-of-the-art method to call genotypes and haplotypes across the highly polymorphic MHC and LRC.

Results
We observed a minor impact in antigen-presentation genes and KIR genes associated with resistance. Interestingly, genes related to immune modulation, mainly involved in NK cell killing activation/inhibition harbor variants potentially contributing to infection resistance. We hypothesize that individuals prone to produce higher amounts of MICA (possibly soluble), LILRB1, LILRB2, and low amounts of MICB, would be more susceptible to infection.

Conclusion
According to this hypothesis, quantitative differences in these NK activity-related molecules could contribute to resistance to COVID-19 down regulating NK cell cytotoxic activity in infected individuals but not in resistant partners.

6margd
Maio 4, 2021, 4:14 am

Elsevier journal to retract widely debunked masks study whose author claimed a Stanford affiliation
Retraction Watch | May 2021

...The 2020 paper, “Facemasks in the COVID-19 era: A health hypothesis,” was written by Baruch Vainshelboim, who listed his affiliation as Stanford University and the VA Palo Alto Health System. But the study gained wide circulation earlier this month, thanks in part to some conservative politicians, and became the subject of fact-checks by the Associated Press and Snopes...

https://retractionwatch.com/2021/04/26/elsevier-journal-to-retract-widely-debunk...

7margd
Maio 4, 2021, 9:34 am

Where are the 300 tonnes of emergency Covid-19 supplies that have landed in Delhi in last five days?
No domestic flights have taken off to carry the supplies to other parts of India, nor have states been informed about their share by the Centre.
Arunabh Saikia & Supriya Sharma | 5/3/2021

In the past five days, 25 flights loaded with 300 tonnes of emergency Covid-19 relief supplies have landed in India’s capital from around the world. The supplies include 5,500 oxygen concentrators, 3,200 oxygen cylinders and 1,36,000 remdesivir injections, said a spokesperson of the Delhi International Airport Limited.

The emergency aid could save lives. But it seems not to have reached even those who are gasping for oxygen a few km away...

The Ministry of External Affairs told The Hindu that an Empowered Group of Ministers and officials was fielding requests from state governments. But officials in six states told Scroll.in on Monday that they have not heard from the Centre about whether they will be receiving any share in the emergency supplies...

https://amp.scroll.in/article/993973/where-are-the-300-tonnes-of-emergency-covid...

8margd
Maio 4, 2021, 2:51 pm

Fauci warns against discarding trade rules on Covid vaccines
Biden senior adviser says move would spark legal disputes and delay inoculation campaigns
Anthony Fauci: ‘People are dying around the world and we have to get vaccines into their arms’
Kiran Stacey in Washington | 5/4/2021

...Dr Anthony Fauci, the chief medical adviser to the US president, told the Financial Times that he would oppose a plan to rip up international trade rules to improve vaccine supply in the developing world if it took too long to bear fruit.

The Biden administration is expected to set out its position on intellectual property rights this week during a World Trade Organization meeting.

Fauci told the FT on Monday that he was “agnostic” about how to boost vaccine supply to developing countries. But he added: “Going back and forth, consuming time and lawyers in a legal argument about waivers — that is not the endgame. People are dying around the world and we have to get vaccines into their arms in the fastest and most efficient way possible.”

The proposal to allow countries to temporarily override patent rights for Covid-19-related medical products was put forward at the WTO by India and South Africa in October. The plan was designed to help developing countries make copies of the vaccines without fear of being sued. It has been backed by almost 60 countries, more than 100 members of the US Congress and several former world leaders...

https://www.ft.com/content/2f41b122-5738-4707-a822-0d79276710c5

9margd
Editado: Maio 4, 2021, 3:09 pm

COVID-19 vaccine response weakened by common IBD drug
Charlotte Hartley on May 4, 2021

A large-scale study has found that people using Remicade, which is a drug that treats a number of autoimmune conditions, have a lower antibody response after one dose of a COVID-19 vaccine.

Antibody levels were even lower after one vaccine dose in people using Remicade in combination with immunomodulatory drugs.

However, having had a previous SARS-CoV-2 infection or a second vaccine dose resulted in an improved antibody response.

The researchers recommend that healthcare professionals prioritize people using these types of drugs for second vaccine doses...

https://www.medicalnewstoday.com/articles/covid-19-vaccine-response-weakened-by-...

-----------------------------------------------------------

Nicholas A Kennedy et al. 2021. Infliximab is associated with attenuated immunogenicity to BNT162b2 (Pfizer) and ChAdOx1 (AstraZeneca) nCoV-19 SARS-CoV-2 vaccines in patients with IBD. BMJ Gut https://gut.bmj.com/content/early/2021/04/25/gutjnl-2021-324789

Abstract
Objective
Delayed second dose SARS-CoV-2 vaccination trades maximal effectiveness for a lower level of immunity across more of the population. We investigated whether patients with inflammatory bowel disease treated with infliximab have attenuated serological responses to a single dose of a SARS-CoV-2 vaccine.

Design
Antibody responses and seroconversion rates in infliximab-treated patients (n=865) were compared with a cohort treated with vedolizumab (n=428), a gut-selective anti-integrin α4β7 monoclonal antibody. Our primary outcome was anti-SARS-CoV-2 spike (S) antibody concentrations, measured using the Elecsys anti-SARS-CoV-2 spike (S) antibody assay 3–10 weeks after vaccination, in patients without evidence of prior infection. Secondary outcomes were seroconversion rates (defined by a cut-off of 15 U/mL), and antibody responses following past infection or a second dose of the BNT162b2 vaccine.

Results
Geometric mean (SD) anti-SARS-CoV-2 antibody concentrations were lower in patients treated with infliximab than vedolizumab, following BNT162b2 (6.0 U/mL (5.9) vs 28.8 U/mL (5.4) ...) and ChAdOx1 nCoV-19 (4.7 U/mL (4.9)) vs 13.8 U/mL (5.9)...) vaccines. In our multivariable models, antibody concentrations were lower in infliximab-treated compared with vedolizumab-treated patients who received the BNT162b2 (fold change (FC) 0.29 ...) and ChAdOx1 nCoV-19 (FC 0.39 ...) vaccines. In both models, age 60 years or older, immunomodulator use, Crohn’s disease and smoking were associated with lower, while non-white ethnicity was associated with higher, anti-SARS-CoV-2 antibody concentrations. Seroconversion rates after a single dose of either vaccine were higher in patients with prior SARS-CoV-2 infection and after two doses of BNT162b2 vaccine.

Conclusion
Infliximab is associated with attenuated immunogenicity to a single dose of the BNT162b2 and ChAdOx1 nCoV-19 SARS-CoV-2 vaccines. Vaccination after SARS-CoV-2 infection, or a second dose of vaccine, led to seroconversion in most patients. Delayed second dosing should be avoided in patients treated with infliximab.

10margd
Maio 5, 2021, 7:43 am

First blood-clot patient since CDC's J&J pause treated with alternative blood thinner--encouraging:

Patient treated at UCHealth for vaccine-related blood clot with alternative blood thinner
Richard Cote | May 4, 2021

AURORA, Colo...On April 13, the day the CDC placed a pause on the Johnson and Johnson vaccine, (Morgan Wolfe) a woman in her 40s was brought to UCHealth (12 days after she received the Johnson and Johnson vaccine) suffering from vaccine-induced thrombotic thrombocytopenia (VITT)...clots in her lung and around her brain

...The CDC had warned that the blood clots, which could occur from a rare complication of the Johnson and Johnson vaccine, should not be treated with the usual first-line drug, heparin, which could cause the clots to become worse...The CDC guidance stopped there.

...Dr. R. Todd Clark...assistant (professor) of emergency medicine at the University of Colorado School of Medicine, said he looked at cases involving the AstraZeneca vaccine where patients experiencing similar, severe blood clots were treated with bivalirudin, an alternate blood thinner.

...Doctors at UCHealth treated Wolfe with bivalirudin and the results paid off. After six days in the hospital, she was released and continues to recover at home...

https://www.9news.com/article/news/health/coronavirus/johnson-johnson-vaccine-bl...

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Clark RT, Johnson L, Billotti J, Foulds G, Ketels T, Heard K, Calvello Hynes E, Early outcomes of bivalirudin therapy for thrombotic thrombocytopenia and cerebral venous sinus thrombosis after Ad26.COV2.S vaccination: a case report, Annals of Emergency Medicine (2021), doi: https://doi.org/10.1016/j.annemergmed.2021.04.035 https://www.annemergmed.com/pb/assets/raw/Health%20Advance/journals/ymem/YMEM_20...

Journal pre-proof

ABSTRACT
Objective: Vaccine Induced Thrombotic Thrombocytopenia (VITT) is a newly described disease process in the setting of expanding access to COVID-19 vaccination. CDC guidance recommends treatment with an alternative to heparin in patients suspected of having VITT. No case of a patient with VITT following Ad26.COV2.S Vaccination (Johnson & Johnson/Janssen) treated exclusively with a heparin alternative has been published at this time. We describe early outcomes from the treatment of VITT with bivalirudin as a heparin alternative.

Results: A 40 year old Caucasian female found to have thrombocytopenia, cerebral venous sinus thrombosis,and pulmonary embolism following vaccination for COVID-19 with Ad26.COV2.S. This patient exhibited a steady rise in platelet count, fromplatelets 20x109/Liter at hospital day 0 to 115x109/Liter at discharge on hospital day 6and 182x109/Literon outpatient follow up (day 9). While the patient did display a transient drop in hemoglobin, there was no clinical evidence of bleeding. This patient did not demonstrate any clinical sequalae of thrombosis, and reported resolution of headache.

Conclusions: Vaccination with Ad26.COV2.S appears to be associated with a small but significant risk for thrombotic thrombocytopenia within 13 days of receipt. CDC guidance to consider an alternative to heparin was not accompanied by specific recommended alternatives. A single patient treated with bivalirudin for suspected VITT subsequently experienced symptom improvement, a rise in platelet count, and did not demonstrate any immediate negative outcomes. A provider may consider bivalirudin as an alternative to heparin in patients with suspected VITT following Ad26.COV2.S Vaccination, pending more definitive research.

11margd
Maio 5, 2021, 8:22 am

INDIA

Vincent Rajkumar (Mayo Clinic) @VincentRK | 8:09 AM · May 5, 2021:
As hard as it may be economically, to avoid huge loss of life the following must be done:

-Nationwide lockdown with adequate protections to distribute money & food for workers & the poor
-Vaccinate door-to-door
-Masking
-Massive international aid: meds, oxygen, vaccines

Quote Tweet
Vincent Rajkumar @VincentRK · May 1
I'm convinced India needs a nationwide shelter-in-place order to minimize devastating loss of life from COVID.
This must be implemented with adequate support to the poor.
Agree with this article in @scroll_in @Lakshmi_RKG

Covid-19 crisis: India urgently needs a nationwide shelter-at-home directive – but a humane one
The most urgent reason for this recommendation is to stop further deterioration of India’s healthcare infrastructure.
Sunil Solomon, Lakshmi Ganapathi, Ramnath Subbaraman & Shruti Mehta | Apr 29, 2021
https://scroll.in/article/993572/covid-19-crisis-india-urgently-needs-a-nationwi...

12margd
Maio 5, 2021, 9:38 am

$100 as Incentive to Get a Shot? Experiment Suggests It Can Pay Off.
Lynn Vavreck | May 4, 2021

A cash reward works best with Democrats, and relaxing safety guidelines seems to motivate Republicans, a survey study shows.

...Roughly a third of the unvaccinated population said a cash payment would make them more likely to get a shot.

...Similarly large increases in willingness to take vaccines emerged for those who were asked about getting a vaccine if doing so meant they wouldn’t need to wear a mask or social-distance in public, compared with a group that was told it would still have to do those things...

https://www.nytimes.com/2021/05/04/upshot/vaccine-incentive-experiment.html

13margd
Editado: Maio 5, 2021, 5:35 pm

A single HUGE (200,000 IU) dose of D3 administered to hospitalized COVID patients doubled blood levels of 25-hydroxyvitamin D (to 44.4 ng/mL, still below recommended levels of 50?), but did not affect length of stay, mortality during hospitalization, admissionto the intensive care unit; need for mechanical ventilation, and duration of mechanical ventilation.

Co-author Bruno Gualano, a researcher at FM-USP (Faculdade de Medicina da Universidade de Sao Paulo, Brazil), says, “But that does not mean continuous use of vitamin D cannot have beneficial effects of some kind.”

Study confirms high doses of vitamin D have no effect on COVID-19
Robby Berman | May 4, 2021

Researchers have wondered whether vitamin D may help people avoid SARS-CoV-2 infections and mitigate the effects of COVID-19.

A randomized, double-blind, placebo-controlled clinical trial seeks to test vitamin D’s usefulness in combatting the disease.

The study finds high doses of vitamin D have no effect on key COVID-19 outcomes in particularly ill hospitalized patients.

Further research is needed to investigate whether a deficiency of vitamin D is associated with more severe cases of COVID-19.

...The study found that high doses of vitamin D administered to hospital patients with moderate or severe COVID-19 did not affect the course of the disease.

...The scientists gave participants in the first group a single 200,000-unit dose of vitamin D3 dissolved in peanut oil. They gave those in the second group unaltered peanut-oil placebos.

...The investigation also found no evidence that vitamin D made a person less likely to be admitted to the intensive care unit or less likely to need intubation.

...Co-author Bruno Gualano, a researcher at FM-USP, says, “But that does not mean continuous use of vitamin D cannot have beneficial effects of some kind.”...

https://www.medicalnewstoday.com/articles/study-confirms-high-doses-of-vitamin-d...

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Igor H. Murai etr al. 2021. Effect of a Single High Dose of Vitamin D3 on Hospital Length of Stay in Patients With Moderate to Severe COVID-19A Randomized Clinical Trial. JAMA. Feb 17, 2021;325(11):1053-1060. doi:10.1001/jama.2020.26848 https://jamanetwork.com/journals/jama/fullarticle/2776738

Key Points
Question What is the effect of a single high dose of vitamin D3 on hospital length of stay among hospitalized patients with moderate to severe coronavirus disease 2019 (COVID-19)?

Findings In this randomized clinical trial that involved 240 hospitalized patients with moderate to severe COVID-19, a single dose of 200 000 IU of vitamin D3, compared with placebo, did not significantly reduce hospital length of stay (median of 7.0 vs 7.0 days; unadjusted hazard ratio for hospital discharge, 1.07).

Meaning The study does not support the use of a high dose of vitamin D3 for treatment of moderate to severe COVID-19 in hospitalized patients.

Abstract
Importance The efficacy of vitamin D3 supplementation in coronavirus disease 2019 (COVID-19) remains unclear.

Objective To investigate the effect of a single high dose of vitamin D3 on hospital length of stay in patients with COVID-19.

Design, Setting, and Participants This was a multicenter, double-blind, randomized, placebo-controlled trial conducted in 2 sites in Sao Paulo, Brazil. The study included 240 hospitalized patients with COVID-19 who were moderately to severely ill at the time of enrollment from June 2, 2020, to August 27, 2020. The final follow-up was on October 7, 2020.

Interventions Patients were randomly assigned to receive a single oral dose of 200 000 IU of vitamin D3 (n = 120) or placebo (n = 120).

Main Outcomes and Measures The primary outcome was length of stay, defined as the time from the date of randomization to hospital discharge. Prespecified secondary outcomes included mortality during hospitalization; the number of patients admitted to the intensive care unit; the number of patients who required mechanical ventilation and the duration of mechanical ventilation; and serum levels of 25-hydroxyvitamin D, total calcium, creatinine, and C-reactive protein.

Results Of 240 randomized patients, 237 were included in the primary analysis (mean age, 56.2 ... years; 104 (43.9%) women; mean...baseline 25-hydroxyvitamin D level, 20.9... ng/mL). Median (interquartile range) length of stay was not significantly different between the vitamin D3 (7.0 ...days) and placebo groups (7.0 ... days)...; unadjusted hazard ratio for hospital discharge, 1.07 ... The difference between the vitamin D3 group and the placebo group was not significant for in-hospital mortality (7.6% vs 5.1%; difference, 2.5% ..., admission to the intensive care unit (16.0% vs 21.2%; difference, –5.2%...), or need for mechanical ventilation (7.6% vs 14.4%; difference, –6.8% ... Mean serum levels of 25-hydroxyvitamin D significantly increased after a single dose of vitamin D3 vs placebo (44.4 ng/mL vs 19.8 ng/mL; difference, 24.1 ng/mL ... There were no adverse events, but an episode of vomiting was associated with the intervention.

Conclusions and Relevance Among hospitalized patients with COVID-19, a single high dose of vitamin D3, compared with placebo, did not significantly reduce hospital length of stay. The findings do not support the use of a high dose of vitamin D3 for treatment of moderate to severe COVID-19.

14margd
Maio 5, 2021, 11:44 am

Opinion: Why is Japan failing so badly on vaccinations?
William Pesek | May 4, 2021

A nation famed for first-world logistical competence is running dead last among the 37 members of the Organization for Economic Cooperation and Development members, the club of wealthy nations. This dismal performance isn’t just imperiling the Olympics — or the world’s third-biggest economy. It’s challenging basic notions about whether Japan can change at all.

“Japan’s 1.6 percent rate of vaccination puts it on par with Myanmar, a failed state — not exactly a ringing endorsement of Tokyo’s shambolic rollout,” quips longtime Tokyo resident Jeff Kingston, head of Asia studies at Temple University’s local campus. “This is an own goal of epic proportions.”

explanations... One is that Prime Minister Yoshihide Suga’s Liberal Democratic Party was betting on domestic drugmakers to come up with a homegrown vaccine. When none materialized, Tokyo joined the long line of other nations competing to source vaccines from outside suppliers.

A labyrinthine approval process hasn’t helped...

...As of May 4, the country has recorded just over 10,000 deaths in a population of 126 million. That has reduced the urgency for vaccines or a robust testing program. Japan also has a lively “anti-vaxxer” movement...

...Japanese often expect only doctors or registered nurses to administer them. Dentists raising their hands are being told to stand by.

(If PM Suga’s predecessor, Shinzo Abe) and now Suga, had moved earlier to internationalize labor markets, incentivize innovation, empower women and take on a change-averse bureaucracy, Japan might not be last in the developed-nation class on vaccinations...

...Ironic...to see an event Japan sold as the “Recovery Olympics” highlighting its unreadiness for prime time. Sexism scandals ...

...bureaucratic tussles among government agencies are sowing epic confusion. No one really seems to understand the latest rules on testing, quarantine and contact-tracing protocols, which foreign staff can fly in with athletes, or whether locals can attend events.

...80,000 athletes and support staff are set to arrive this summer in one of the world’s most densely populated cities from all corners of the globe where they can mix and match viral variants. Gee, what could go wrong? Not surprisingly, as many as 80 percent of Japanese think 2021 isn’t the time to risk a giant superspreader event that history might judge harshly...

https://www.washingtonpost.com/opinions/2021/05/04/why-is-japan-failing-so-badly...

15margd
Editado: Maio 6, 2021, 9:18 am

Taking ‘Extraordinary Measures,’ Biden Backs Suspending Patents on Vaccines
Thomas Kaplan, Sheryl Gay Stolberg and Rebecca Robbins | May 5, 2021. Updated May 6, 2021

WASHINGTON — The Biden administration came out on Wednesday in support of waiving intellectual property protections for coronavirus vaccines, siding with international efforts to bolster production amid concerns about vaccine access in developing nations.

The United States had been a major holdout at the World Trade Organization over...proposal, drafted by India and South Africa and backed by many congressional Democrats.

...The European Union has also been standing in the way...negotiations at the over the matter, but that they would “take time given the consensus-based nature of the (World Trade Organization) and the complexity of the issues involved.”

...Stephen J. Ubl, the president and chief executive of the Pharmaceutical Research and Manufacturers of America...“an unprecedented step that will undermine our global response to the pandemic and compromise safety...This decision will sow confusion between public and private partners, further weaken already strained supply chains and foster the proliferation of counterfeit vaccines...“handing over American innovations to countries looking to undermine our leadership in biomedical discovery.”...suspension of patent protections would undermine risk-taking and innovation.

...activists said a waiver alone would not increase the world’s vaccine supply. It must be accompanied by a process known as “tech transfer,” in which patent holders supply technical know-how and personnel. Activists are also demanding that Mr. Biden use his leverage to ensure that manufacturing is scaled up around the globe...

...Lisa Larrimore Ouellette, a patent law professor at Stanford Law School, suggested that the Biden administration’s move may help sway the drug industry to reach “deals that they can live with.”

https://www.nytimes.com/2021/05/05/us/politics/biden-covid-vaccine-patents.html

_____________________________________________________
ETA

If you are up in arms about the patents & costs of vaccines you should REALLY be upset about costs of PCR tests.
At 1.5mm/day & $100 per, this is a $54b market in US alone. Cheap effective antigen tests could be $1-2.
But the “system” blocked those to ensure this massive market.

- Bill Gurley (Benchmark investor) @bgurley | 9:48 PM · May 5, 2021

16margd
Editado: Maio 6, 2021, 7:54 am

"...infection with SARS-CoV2, or COVID-19, is a risk factor for CVST (Cerebral Venous Sinus Thrombosis) (margd: but not with low platelets, thrombocytopenia?). A retrospective analysis using electronic health records showed the incidence of CVST after COVID-19 was 39.0 per million people...compared to any two-week period in the pre-COVID-19 epoch (0.41 per million people)... One study (initially published as a preprint) showed that the incidence of CVST associated with COVID-19 was 10-fold higher than after receiving BNT162b2 (Pfizer) or mRNA-1273 (Moderna) vaccines (39.0 per million people ... versus 4.1 per million people... adjusted RR=6.36..."

According to CDC, the US has suffered 32 million COVID cases and 575,000 people have died. 250 million vaccines have been administered (margd: I assume more mRNA (Pfizer, Moderna), which are not associated with the rare clots, than adenovirus (J&J)?). Now that rare Cerebral Venous Sinus Thrombosis with Vaccine-Induced Thrombotic Thrombocytopenia after adenovirus vaccine is recognized, patients are being treated with appropriate coagulants, i.e., not heparin.
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Rare Blood Clots Are More Likely After COVID-19 Than Vaccine, Report Finds (05:16)
Here and Now | May 05, 2021

The rare blood clot condition that affected a small number of people who got the Johnson & Johnson COVID-19 vaccine is eight to 10 times more likely to occur from a COVID-19 infection than from the vaccine, according to a special report from the American Heart Association/American Stroke Association Stroke Council Leadership...

https://www.wbur.org/hereandnow/2021/05/05/blood-clots-johnson-coronavirus

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Rare blood clots more likely after COVID infection than from vaccine: AHA/ASA special report
Alicia Lasek | May 3, 2021

The blood clot-related condition that’s been reported following some Johnson & Johnson’s COVID-19 vaccinations also is a risk of COVID-19 infection, according to a special report by the American Heart Association/American Stroke Association Stroke Council Leadership.

The organizations on Friday jointly released the report, which covers signs and symptoms of the condition and preferred treatment options. Although “extremely rare” in both cases, the likelihood of blood clots is eight to 10 times higher following a COVID-19 infection than it is after receiving the J&J vaccine, the organizations stated...

https://www.mcknights.com/news/clinical-news/rare-blood-clots-more-likely-after-...

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Diagnosis and Management of Cerebral Venous Sinus Thrombosis with Vaccine-Induced Thrombotic Thrombocytopenia
Karen L Furie on Behalf of the American Heart Association/American Stroke Association Stroke Council Leadership
Originally published 29 Apr 2021 | https://doi.org/10.1161/STROKEAHA.121.035564 | Stroke. 10 p.

Abbreviations

CVST (Cerebral Venous Sinus Thrombosis) Epidemiology and Risk Factors
CVST is an uncommon cerebrovascular disorder...There are other terms used in literature, including dural sinus thrombosis, venous sinus thrombosis, and cerebral venous thrombosis. Previous studies and systematic reviews highlighted the epidemiology and risk factors.... CVST most commonly affects young adults (mean age 35-40 years), predominantly women of childbearing-age. Risk factors for CVST are similar to those for venous thromboembolism (blood clot that starts in a vein); over 80% of patients with CVST have at least one identifiable risk factor for thrombosis and half have multiple predisposing factors. Most common transient risks factors include temporary medical conditions, such as pregnancy and puerperium (period between childbirth and the return of the uterus to its normal size), exposure to drugs (oral contraceptives, chemotherapy), central nervous system or ear and face infections, and head trauma...Chronic risk factors include hereditary or acquired thrombophilias (abnormality of blood coagulation that increases the risk of thrombosis), autoimmune diseases and cancer... Thrombocytopenia (abnormally low levels of platelets) is an uncommon primary cause of CVST... Prior to the COVID-19 pandemic, registries showed a low prevalence and magnitude of the association between thrombocytopenia and CVST (Table 1). It is important to recognize that infection with SARS-CoV2, or COVID-19,is a risk factor for CVST. A retrospective analysis using electronic health records showed the incidence of CVST after COVID-19 was 39.0 per million people...compared to any two-week period in the pre-COVID-19 epoch (0.41 per million people)... One study (initially published as a preprint) showed that the incidence of CVST associated with COVID-19 was 10-fold higher than after receiving BNT162b2 (Pfizer) or mRNA-1273 (Moderna) vaccines (39.0 per million people ... versus 4.1 per million people... adjusted RR=6.36...

Symptoms of CVST

CVST Associated with Vaccine Induced Thrombocytopenia (VITT)
Clinical Characteristics of CVST with VITT

Diagnostic Testing

Management
Subacute/Chronic Management

Reporting

Limitations and Future Directions

17margd
Maio 6, 2021, 9:46 am

Laith J. Abu-Raddad et al. 2021. Effectiveness of the BNT162b2 (Pfizer) Covid-19 Vaccine against the B.1.1.7 (UK) and B.1.351 (SA) Variants (Correspondence). NEJM May 5, 2021 DOI: 10.1056/NEJMc2104974 https://nejm.org/doi/full/10.1056/NEJMc2104974 *

...The BNT162b2 vaccine was effective against infection and disease in the population of Qatar, despite the B.1.1.7 and B.1.351 variants being predominant within the country; however, vaccine effectiveness against the B.1.351 variant was approximately 20 percentage points lower than the effectiveness (more than 90%) reported in the clinical trial and in real-world conditions in Israeland the United States. In Qatar, as of March 31, breakthrough infections have been recorded in 6689 persons who had received one dose of the vaccine and in 1616 persons who had received two doses. Seven deaths from Covid-19 have been also recorded among vaccinated persons: five after the first dose and two after the second dose. Nevertheless, the reduced protection against infection with the B.1.351 variant did not seem to translate into poor protection against the most severe forms of infection (i.e., those resulting in hospitalization or death), which was robust, at greater than 90%...

Image- Table 1 Pfizer vaxx effectiveness against disease and infection in Qatar ( https://twitter.com/DrEricDing/status/1390107362485211136/photo/1 )

18margd
Maio 6, 2021, 9:55 am

Sallis R, Young DR, Tartof SY, et al. 2021. Physical inactivity is associated with a higher risk for severe COVID-19 outcomes: a study in 48 440 adult patients. Br J Sports Med Epub ahead of print: 6 May 2021. doi:10.1136/bjsports-2021-104080 https://bjsm.bmj.com/content/bjsports/early/2021/04/07/bjsports-2021-104080.full...

Abstract
Objectives
To compare hospitalisation rates, intensive care unit (ICU) admissions and mortality for patients with COVID-19 who were consistently inactive, doing some activity or consistently meeting physical activity guidelines.

Methods
We identified 48 440 adult patients with a COVID-19 diagnosis from 1 January 2020 to 21 October 2020, with at least three exercise vital sign measurements from 19 March 2018 to 18 March 2020. We linked each patient’s self-reported physical activity category (consistently inactive=0–10 min/week, some activity=11–149 min/week, consistently meeting guidelines=150+ min/week) to the risk of hospitalisation, ICU admission and death after COVID-19 diagnosis. We conducted multivariable logistic regression controlling for demographics and known risk factors to assess whether inactivity was associated with COVID-19 outcomes.

Results
Patients with COVID-19 who were consistently inactive had a greater risk of hospitalisation (OR 2.26...), admission to the ICU (OR 1.73;...) and death (OR 2.49;...) due to COVID-19 than patients who were consistently meeting physical activity guidelines. Patients who were consistently inactive also had a greater risk of hospitalisation (OR 1.20; ...), admission to the ICU (OR 1.10; ...) and death (OR 1.32;...) due to COVID-19 than patients who were doing some physical activity.

Conclusions
Consistently meeting physical activity guidelines was strongly associated with a reduced risk for severe COVID-19 outcomes among infected adults. We recommend efforts to promote physical activity be prioritised by public health agencies and incorporated into routine medical care.

19margd
Maio 6, 2021, 1:07 pm

"HCV drugs that inhibit papain-like protease (PLpro) synergize with the viral polymerase inhibitor remdesivir to inhibit virus replication, increasing remdesivir’s antiviral activity as much as 10-fold, while 13 those that only inhibit Mpro (main protease) do not synergize with remdesivir."

COVID-19 treatment: Hepatitis C drugs may enhance remdesivir
Erika Watts | May 4, 2021

..Researchers from Mount Sinai Hospital in New York City, NY, believe that a combination of drugs already approved for use in the United States could be the key in treating COVID-19.

The researchers combined remdesivir, which doctors already prescribe to hospitalized patients with COVID-19, with (10) different hepatitis C virus (HCV) medications.

...The research team thought that the HCV drugs could bind to an enzyme called Mpro (Main Protease). This enzyme is SARS-CoV-2’s main protease, which is essential for viral replication.

The team tested the HCV drugs in monkey and human cells. They found that 7 of the 10 drugs could act as a SARS-CoV-2 inhibitor.

...further experiments showed that four of them inhibited a different protease called PLpro.

The four drugs that were effective at boosting the benefits of remdesivir were paritaprevir, grazoprevir, simeprevir, and vaniprevir... increased remdesivir’s effectiveness at reducing viral replication by “as much as 10-fold.”

... one major roadblock to overcome: Remdesivir is not an oral drug. People receive it intravenously in a hospital setting...It can take 30 minutes to 2 hours...daily, and treatment can last for 5–10 days...

https://www.medicalnewstoday.com/articles/covid-19-treatment-hepatitis-c-drugs-m...

----------------------------------------------------------------

Bafna, K., White, K., Harish, B., Rosales, R., Ramelot, T.A., Acton, T.B.,Moreno, E., Kehrer, T., Miorin, L., Royer, C.A., García-Sastre, A., Krug, R.M., Montelione, G.T. 2021. Hepatitis C Virus Drugs That Inhibit the SARS-CoV-2 Papain-Like Protease Synergize with Remdesivir to Suppress Viral Replication in Cell Culture, Cell Reports (2021), doi: https://doi.org/10.1016/j.celrep.2021.109133
https://www.cell.com/cell-reports/pdf/S2211-1247(21)00472-1.pdf (58p pre-proof)

Summary
Effective control of COVID-19 requires antivirals directed against SARS-CoV-2. We assessed ten hepatitis C virus (HCV) protease-inhibitor drugs as potential SARS-CoV-2 antivirals. There is a striking structural similarity of the substrate binding clefts of SARS-4 CoV-2 main protease (Mpro) and HCV NS3/4A protease. Virtual docking experiments show that these HCV drugs can potentially bind into the Mpro binding cleft. We show that seven HCV drugs inhibit both SARS-CoV-2 Mpro protease activity and SARS-CoV-2 virus replication in Vero and/or human cells. However, their Mpro inhibiting activities did not correlate with their antiviral activities. This conundrum was resolved by demonstrating that four HCV protease inhibitor drugs, simeprevir, vaniprevir, paritaprevir, and grazoprevir inhibit the SARS CoV-2 papain-like protease (PLpro). HCV drugs that inhibit PLpro synergize with the viral polymerase inhibitor remdesivir to inhibit virus replication, increasing remdesivir’s antiviral activity as much as 10-fold, while 13 those that only inhibit Mpro do not synergize with remdesivir.

20margd
Maio 6, 2021, 2:39 pm

Eric Topol @EricTopol | 2:15 PM · May 6, 2021:
The one missing link to the US pandemic exit strategy: frequent rapid home antigen testing (provided free in the UK).

New perspective @ScienceMagazine today @profbuchan @LivUniIPH
https://science.sciencemag.org/content/372/6542/571 *
Image-false positives & false negatives ( https://twitter.com/EricTopol/status/1390369532213043202/photo/1 )
--------------------------------------------------------------
*
Marta García-Fiñana, Iain E. Buchan et al. 2021. Rapid antigen testing in COVID-19 responses (Perspective). Science 07 May 2021:
Vol. 372, Issue 6542, pp. 571-572 DOI: 10.1126/science.abi6680 https://science.sciencemag.org/content/372/6542/571

...Slovakia ... UK...

...In places with low SARS-CoV-2 prevalence, mindful of the cumulative harms from COVID-19 restrictions, the emphasis is on restarting social and economic activities while minimizing infections. As research continues to clarify the impact of vaccines on SARS-CoV-2 transmission, there is a need to use rapid antigen testing as a part of comprehensive public health measures that reduce the risk of the virus escaping vaccine or natural immunity through avoidable transmission—for example, testing to secure workplaces and large events as societies reopen after lockdowns. Successful implementation, however, depends on public participation in testing and adequate support to quarantine.

21margd
Maio 7, 2021, 7:13 am

Global COVID-19 death toll more than double the estimates: study
7 May 2021

The COVID-19 pandemic has caused nearly 6.9 million deaths across the world, more than double the number officially recorded, a new analysis from the University of Washington, DC’s Institute for Health Metrics and Evaluation (IHME) estimated.

...The IHME is an independent health research organisation that provides a comparable measurement of the world’s health problems and has been cited in the past by the White House and its reports are watched closely by public health officials.

IHME estimated total COVID-19 deaths by comparing anticipated deaths from all causes based on pre-pandemic trends with the actual number of all deaths caused during the pandemic.

...In the United States, the analysis estimated COVID-19 related deaths of more than 905,000. Official figures from the US Centers for Disease Control and Prevention on Wednesday estimated 575,491 deaths due to the novel coronavirus.

...Meanwhile, India’s...tally has surged past 21 million cases, boosted by a record 412,262 new infections. The number of people who have died due to COVID-19 now totals 230,168, health ministry data showed.

Interviews from medical doctors and village leaders who are involved in the counting the pandemic deaths, however, revealed that the real death toll could be many times higher than the official count...

https://www.aljazeera.com/news/2021/5/7/global-covid-19-death-toll-more-than-dou...

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Estimation of total mortality due to COVID-19
Institute for Health Metrics and Evaluation (IHME) | May 6, 2021
http://www.healthdata.org/special-analysis/estimation-excess-mortality-due-covid...

22margd
Editado: Maio 7, 2021, 7:34 am

B.1.617 (India) entered two out of eight cell lines tested with slightly increased efficiency and was blocked by entry inhibitors.
B.1.617 was resistant against Bamlanivimab, an antibody used for COVID-19 treatment.
B.1.617 evaded antibodies induced by infection or vaccination, although with moderate efficiency.

Poor India... Serious lockdown is in order, with assistance from all of us for those living hand-to-mouth?
In concluding 1990s book The Coming Plague: Newly Emerging Disease in a World Our of Balance, Laurie Garrett predicted such a virus ravaging a populated city such as Mexico City. She had only the location wrong...

Indian SARS-CoV-2 variant shows enhanced host cell entry and immune evasion
Sally Robertson, B.Sc.By Sally Robertson, B.Sc. | May 6 2021

A study conducted by researchers in Germany has found that the B.1.617 variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that has emerged in India entered certain types of lung and intestine cells with slightly increased efficiency compared with the original wild-type strain.

The B.1.617 variant is the lineage thought to be responsible for the sharp rise in coronavirus disease 2019 (COVID-19) cases and deaths in India over recent weeks.

The team – from the German Primate Center in Göttingen, the University of Göttingen Medical Center, the Friedrich-Alexander University of Erlangen-Nürnberg and Hannover Medical School – also reports that the entry of B.1.617 into lung and intestinal cells was blocked following treatment with soluble angiotensin-converting enzyme 2 (ACE2) or the serine protease inhibitor Camostat.

However, this host cell entry was not blocked by the monoclonal antibody Bamlanivimab, which has received emergency use authorization (EUA) as a COVID-19 treatment.

Finally, B.1.617 also partially evaded neutralization by the antibodies induced through natural infection or immunization with the Pfizer-BioNTech BNT162b2 vaccine.

Markus Hoffmann and colleagues say that antibody evasion by B.1.617 may contribute to the rapid spread of this variant....

https://www.news-medical.net/news/20210506/Indian-SARS-CoV-2-variant-shows-enhan...

------------------------------------------------------------

Hoffman M, et al. 2021. SARS-CoV-2 variant B.1.617 is resistant to Bamlanivimab and evades antibodies induced by infection and vaccination. bioRxiv, 2021. doi: https://doi.org/10.1101/2021.05.04.442663 https://www.biorxiv.org/content/10.1101/2021.05.04.442663v1

This article is a preprint and has not been certified by peer review.

Abstract
The emergence of SARS-CoV-2 variants threatens efforts to contain the COVID-19 pandemic. The number of COVID-19 cases and deaths in India has risen steeply in recent weeks and a novel SARS-CoV-2 variant, B.1.617, is believed to be responsible for many of these cases. The spike protein of B.1.617 harbors two mutations in the receptor binding domain, which interacts with the ACE2 receptor and constitutes the main target of neutralizing antibodies. Therefore, we analyzed whether B.1.617 is more adept in entering cells and/or evades antibody responses. B.1.617 entered two out of eight cell lines tested with slightly increased efficiency and was blocked by entry inhibitors. In contrast, B.1.617 was resistant against Bamlanivimab, an antibody used for COVID-19 treatment. Finally, B.1.617 evaded antibodies induced by infection or vaccination, although with moderate efficiency. Collectively, our study reveals that antibody evasion of B.1.617 may contribute to the rapid spread of this variant.

23margd
Editado: Maio 10, 2021, 8:59 am

ETA:
Is COVID-19 a new disease?
Michael Greenwood | May 9 2021
https://www.news-medical.net/news/20210509/Is-COVID-19-a-new-disease.aspx
--------------------------------------------------

Marcin F Osuchowski et al. 2021. The COVID-19 puzzle: deciphering pathophysiology and phenotypes of a new disease entity. The Lancet. Respiratory Medicine. Published: May 06, 2021. DOI:https://doi.org/10.1016/S2213-2600(21)00218-6 https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(21)00218-6/fullt...

Summary
The zoonotic SARS-CoV-2 virus that causes COVID-19 continues to spread worldwide, with devastating consequences. While the medical community has gained insight into the epidemiology of COVID-19, important questions remain about the clinical complexities and underlying mechanisms of disease phenotypes. Severe COVID-19 most commonly involves respiratory manifestations, although other systems are also affected, and acute disease is often followed by protracted complications. Such complex manifestations suggest that SARS-CoV-2 dysregulates the host response, triggering wide-ranging immuno-inflammatory, thrombotic, and parenchymal derangements. We review the intricacies of COVID-19 pathophysiology, its various phenotypes, and the anti-SARS-CoV-2 host response at the humoral and cellular levels. Some similarities exist between COVID-19 and respiratory failure of other origins, but evidence for many distinctive mechanistic features indicates that COVID-19 constitutes a new disease entity, with emerging data suggesting involvement of an endotheliopathy-centred pathophysiology. Further research, combining basic and clinical studies, is needed to advance understanding of pathophysiological mechanisms and to characterise immuno-inflammatory derangements across the range of phenotypes to enable optimum care for patients with COVID-19.

...Conclusions and future perspectives
An overview of current evidence regarding immuno-inflammatory reactions induced by SARS-CoV-2 and subsequent organ-based consequences suggests several conclusions.

First, a new infectious profile is evident: low pathogenic Coronaviridae subspecies of human coronavirus, such as hCoV-229E, hCoV-OC43, and hCoV-NL63, infect the upper airways causing mild-to-moderate (common cold-like) respiratory disease, whereas highly pathogenic viruses settle in the lower respiratory tract, typically causing severe pneumonia and ARDS. SARS-CoV-2 shares features of low and high pathogenic coronavirus subspecies: after infecting the upper respiratory tract, it is capable of subsequently spreading to the lower respiratory tract. This duality, accompanied by the capacity for viral transmission during the incubation period, appears as an evolutionary advantage and a unique feature of this new coronavirus pathogen.

Second, endothelial and epithelial infection appears to predominate, rather than alveolar-centred infection: the disruption of the alveolar epithelial–endothelial barrier is central to the development of severe pneumonia and ARDS. Compared with influenza and SARS, multiorgan involvement and thromboembolic events are more common in COVID-19,...implying that SARS-CoV-2 is an endotheliophilic virus.

Third, the inflammatory response is atypical: although patients with COVID-19 have elevated circulating proinflammatory cytokines over a longer period of time than do patients with influenza,...for example, the concentrations seem to be significantly lower than are typical in non-COVID-19-related ARDS...The inflammatory characteristics thus far observed in patients with COVID-19 suggest that either the systemic cytokine component is not a crucial contributor to COVID-19 severity or that the disease features its own unique, poorly understood, yet detrimental, inflammatory profile.

Fourth, a maladaptive host response is unable to combat the virus: there is a marked association between high viral loads (local and systemic) and the phenotype and magnitude of the dysregulated host response, suggesting that poor control of SARS-CoV-2 virus by the immune response leads to severe COVID-19.

The concept of virus-induced pulmonary vasculitis is consistent with the frequently observed failure of simple ventilatory support in patients with COVID-19. Typically, a substantial V/Q mismatch in COVID-19 is more often a consequence of right-to-left shunt due to inflamed, hyperperfused lungs and failure of hypoxic vasoconstriction. This scenario might trigger a vicious cycle beginning with hypoxia and an increase in respiratory effort and oxygen consumption. If a patient with severe COVID-19 is not able to satisfy their oxygen demand by physiological adaptation of cardiac output and oxygen content, the outcome will be fatal. This concept could help to explain why older patients and patients with obesity who have reduced lung capacity, and patients with cardiovascular comorbidities have the highest risks for unfavourable outcomes.

In conclusion, we propose that COVID-19 should be perceived as a new entity with its own characteristic and distinct pathophysiology. However, the differences between ARDS related to COVID-19 and ARDS of other causes (and other critical illnesses) should not prompt abandonment of the existing consensus principles of critical care, as noted by others....Regardless of whether this notion is confirmed, it is advisable to study COVID-19 pathophysiology without preconceptions based on other critical diseases, which might be misleading for clinical care and treatments. Directions for future research into COVID-19 pathophysiology are proposed in panel 2. An unbiased, gradual assembly of key pieces in the COVID-19 pathophysiological puzzle for different patient cohorts (eg, based on sex, age, ethnicity, pre-existing comorbidities), albeit not as rapid as desired, will eventually create a more accurate depiction of the disease. Armed with this knowledge, existing treatment guidelines could potentially be updated, enabling medical professionals to provide optimum care for patients with COVID-19...

24margd
Editado: Maio 7, 2021, 8:31 am

Highly efficient immune response in asymptomatic SARS-CoV-2 patients
Michael Burgess | May 7 2021

Researchers in Singapore have investigated the role of SARS-CoV-2-specific antibodies and T-cells in asymptomatic individuals suffering from COVID-19. They found that, contrary to some initial hypotheses, asymptomatic individuals mount an adaptive immune response on par with symptomatic individuals, demonstrating that T cell response does not appear to be correlated with symptom severity.

...T-cells are specialized antibodies designed to target specific antigens, such as SARS-CoV-2. T-cells can provide long-term immunity against diseases, as they remain in the body’s system and can be rapidly produced to mount an aggressive response against recurring pathogens.

It had previously been suggested that individuals suffering from less severe symptoms of SARS-CoV-2 produced T-cells in lower volumes, relying instead on general antibodies to mount an immune response. If this were the case, asymptomatic individuals might experience SARS-CoV-2 to a much harsher degree if experiencing future infections of the virus, as they lack the sufficient T-cell memory to deal with the virus rapidly.

Through examination of blood plasma in the study group, the researchers found that both sets of individuals in fact, had mounted sufficient virus-specific T-cell responses, indistinguishable in magnitude from one another...

...Although nearly identical in magnitude in recently infected individuals, the researchers also found that SARS-CoV-2-specific T-cell levels decline more rapidly in asymptomatic individuals.

...This seems to be the first published article describing similar magnitudes of T-cells in both symptomless and symptomatic individuals exposed to COVID-19 and promisingly shows that, although T-cell levels decline faster in symptomless patients, both groups show sufficient immune response with persistent T-cell memory. Although these results are encouraging, the authors warn that the sample was entirely male, and almost all participants were either of Indian or Bangladeshi origin. T-cells of different ethnic groups and females must be addressed in future studies.

...characterizing the immune response of infected individuals remains a critical aspect of understanding and thus controlling the spread of the virus.

https://www.news-medical.net/news/20210507/Highly-efficient-immune-response-in-a...
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Le Bert N., et al. 2021. Highly functional virus-specific cellular immune response in asymptomatic SARS-CoV-2 infection. J Exp Med 2021, doi: https://doi.org/10.1084/jem.20202617, https://rupress.org/jem/article/218/5/e20202617/211835/Highly-functional-virus-s...

The efficacy of virus-specific T cells in clearing pathogens involves a fine balance between antiviral and inflammatory features. SARS-CoV-2–specific T cells in individuals who clear SARS-CoV-2 without symptoms could reveal nonpathological yet protective characteristics. We longitudinally studied SARS-CoV-2–specific T cells in a cohort of asymptomatic (n = 85) and symptomatic (n = 75) COVID-19 patients after seroconversion. We quantified T cells reactive to structural proteins (M, NP, and Spike) using ELISpot and cytokine secretion in whole blood. Frequencies of SARS-CoV-2–specific T cells were similar between asymptomatic and symptomatic individuals, but the former showed an increased IFN-γ and IL-2 production. This was associated with a proportional secretion of IL-10 and proinflammatory cytokines (IL-6, TNF-α, and IL-1β) only in asymptomatic infection, while a disproportionate secretion of inflammatory cytokines was triggered by SARS-CoV-2–specific T cell activation in symptomatic individuals. Thus, asymptomatic SARS-CoV-2–infected individuals are not characterized by weak antiviral immunity; on the contrary, they mount a highly functional virus-specific cellular immune response.

25margd
Maio 7, 2021, 11:17 am

Amazing that Ontario has as many or more cases as Nepal, but seems to be turning corner--knock on wood--thanks to shutdown, vaxx at last, and a resilient hospital system... ( https://www.thewhig.com/news/data-indicates-province-may-not-open-up-in-two-week... ) Variant first reported in India (B.1.617) recently reported (and contained?) in Ontario, so fingers crossed.

Nepal facing ‘human catastrophe’ similar to India’s amid Covid surge
Country appeals for international help, with vaccines in short supply and a reported 47% positivity rate
Thu 6 May 2021 07.21 EDT

Nepal is struggling to contain an explosion in Covid-19 cases, as fears grow that the situation in the Himalayan country may be as bad, if not worse, than in neighbouring India, with which it shares a long and porous border.

Following warnings by health officials earlier this week that the country was on the brink of losing control of its outbreak, Nepal has appealed for urgent international help.

As the country reported its highest daily number of new infections – 9,070 – the prime minister, KP Sharma Oli, who has been criticised for his handling of the crisis, asked the army to help manage emergency facilities to take pressure off the health system.

With vaccines running short and hospitals overwhelmed, serious outbreaks have hit both the capital, Kathmandu, and the south-west and west of the country. The national positivity rate – the percentage of tests that come back positive – is being reported at a staggering 47%. Rates are even higher in some locations....

https://www.theguardian.com/world/2021/may/06/nepal-facing-human-catastrophe-sim...

26margd
Maio 7, 2021, 11:29 am

This New Covid Vaccine Could Bring Hope to the Unvaccinated World
Carl Zimmer | May 5, 2021

...In early 2020, dozens of scientific teams scrambled to make a vaccine for Covid-19. Some chose tried-and-true techniques, such as making vaccines from killed viruses. But a handful of companies bet on a riskier method, one that had never produced a licensed vaccine: deploying a genetic molecule called RNA.

The bet paid off. The first two vaccines to emerge successfully out of clinical trials, made by Pfizer-BioNTech and by Moderna, were both made of RNA. They both turned out to have efficacy rates about as good as a vaccine could get.

In the months that followed, those two RNA vaccines have provided protection to tens of millions of people in some 90 countries. But many parts of the world, including those with climbing death tolls, have had little access to them, in part because they require being kept in a deep freeze.

Now a third RNA vaccine may help meet that global need. A small German company called CureVac is on the cusp of announcing the results of its late-stage clinical trial. As early as next week, the world may learn whether its vaccine is safe and effective.

CureVac’s product belongs to what many scientists refer to as the second wave of Covid-19 vaccines that could collectively ease the world’s demand. Novavax, a company based in Maryland whose vaccine uses coronavirus proteins, is expected to apply for U.S. authorization in the next few weeks. In India, the pharmaceutical company Biological E is testing another protein-based vaccine that was developed by researchers in Texas. In Brazil, Mexico, Thailand and Vietnam, researchers are starting trials for a Covid-19 shot that can be mass-produced in chicken eggs.

Vaccines experts are particularly curious to see CureVac’s results, because its shot has an important advantage over the other RNA vaccines from Moderna and Pfizer-BioNTech. While those two vaccines have to be kept in a deep freezer, CureVac’s vaccine stays stable in a refrigerator — meaning it could more easily deliver the newly discovered power of RNA vaccines to hard-hit parts of the world...

https://www.nytimes.com/2021/05/05/health/covid-vaccine-curevac.html

27margd
Maio 7, 2021, 1:22 pm

"...DNA copies of SARS-CoV-2 sequences can be integrated into the genome of infected human cells..."

Further evidence supports controversial claim that SARS-CoV-2 genes can integrate with human DNA
Jon Cohen | May 6, 2021

A team of prominent scientists has doubled down on its controversial hypothesis that genetic bits of the pandemic coronavirus can integrate into our chromosomes and stick around long after the infection is over. If they are right—skeptics have argued that their results are likely lab artifacts—the insertions could explain the rare finding that people can recover from COVID-19 but then test positive for SARS-CoV-2 again months later.

Stem cell biologist Rudolf Jaenisch and gene regulation specialist Richard Young of the Massachusetts Institute of Technology, who led the work, triggered a Twitter storm in December 2020, when their team first presented the idea in a preprint on bioRxiv. The researchers emphasized that viral integration did not mean people who recovered from COVID-19 remain infectious. But critics charged them with stoking unfounded fears that COVID-19 vaccines based on messenger RNA (mRNA) might somehow alter human DNA. (Janesich and Young stress that their results, both original and new, in no way imply that those vaccines integrate their sequences into our DNA.)

Researchers also presented a brace of scientific criticisms, some of which the team addresses in a paper released online today by the Proceedings of the National Academy of Sciences (PNAS).* “We now have unambiguous evidence that coronavirus sequences can integrate into the genome,” Jaenisch says....

...The real question is whether the cell culture data have any relevance to human health or diagnostics. “In the absence of evidence of integration in patients, the most I can take away from these data is that it is possible to detect SARS-CoV-2 RNA retroposition events in infected cell lines where L1 is overexpressed,” Feschotte says. “The clinical or biological significance of these observations, if any, is a matter of pure speculation at this point.”...

https://www.sciencemag.org/news/2021/05/further-evidence-offered-claim-genes-pan...

-----------------------------------------------------

* Liguo Zhang et al. 2021. Reverse-transcribed SARS-CoV-2 RNA can integrate into the genome of cultured human cells and can be expressed in patient-derived tissues. PNAS May 25, 2021 118 (21) e2105968118; https://doi.org/10.1073/pnas.2105968118 https://www.pnas.org/content/118/21/e2105968118

Significance
An unresolved issue of SARS-CoV-2 disease is that patients often remain positive for viral RNA as detected by PCR many weeks after the initial infection in the absence of evidence for viral replication. We show here that SARS-CoV-2 RNA can be reverse-transcribed and integrated into the genome of the infected cell and be expressed as chimeric transcripts fusing viral with cellular sequences. Importantly, such chimeric transcripts are detected in patient-derived tissues. Our data suggest that, in some patient tissues, the majority of all viral transcripts are derived from integrated sequences. Our data provide an insight into the consequence of SARS-CoV-2 infections that may help to explain why patients can continue to produce viral RNA after recovery.

Abstract
Prolonged detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA and recurrence of PCR-positive tests have been widely reported in patients after recovery from COVID-19, but some of these patients do not appear to shed infectious virus. We investigated the possibility that SARS-CoV-2 RNAs can be reverse-transcribed and integrated into the DNA of human cells in culture and that transcription of the integrated sequences might account for some of the positive PCR tests seen in patients. In support of this hypothesis, we found that DNA copies of SARS-CoV-2 sequences can be integrated into the genome of infected human cells. We found target site duplications flanking the viral sequences and consensus LINE1 endonuclease recognition sequences at the integration sites, consistent with a LINE1 retrotransposon-mediated, target-primed reverse transcription and retroposition mechanism. We also found, in some patient-derived tissues, evidence suggesting that a large fraction of the viral sequences is transcribed from integrated DNA copies of viral sequences, generating viral–host chimeric transcripts. The integration and transcription of viral sequences may thus contribute to the detection of viral RNA by PCR in patients after infection and clinical recovery. Because we have detected only subgenomic sequences derived mainly from the 3′ end of the viral genome integrated into the DNA of the host cell, infectious virus cannot be produced from the integrated subgenomic SARS-CoV-2 sequences.

28margd
Editado: Maio 7, 2021, 5:33 pm

China’s Vaccine Diplomacy Just Got a Big Win. But Can the Country Deliver?

The World Health Organization has approved a Chinese vaccine for emergency use. The announcement comes at a time when officials in the country are warning of a domestic shortage.

Sui-Lee Wee | May 7, 2021

Developing countries racing for coronavirus vaccines now have another dependable option — and China’s reputation as a rising scientific superpower just got a big boost.

The World Health Organization on Friday declared a vaccine made by a Chinese company, Sinopharm, as a safe and reliable way to fight the virus. The declaration marks a significant step toward clearing up doubts about the vaccine, after little late-phase clinical trial data was disclosed by the Chinese government and the company.

The W.H.O. emergency use approval allows the Sinopharm vaccine to be included in Covax, a global initiative to provide free vaccines to poor countries. The possible inclusion in Covax raises hopes that more people — especially those in developing nations — will get access to shots at a crucial moment...

https://www.nytimes.com/2021/05/07/business/economy/china-sinopharm-vaccine-who....

_____________________________________________________

OTOH:
Eric Topol @EricTopol | 1:53 PM · May 7, 2021:
How could the most vaccinated country in the world also have the highest case/capita rate?
https://washingtonpost.com/world/2021/05/06/seychelles-vaccines-covid-cases/ @mradamtaylor

Likely reflects, at least in part, Sinopharm's vaccine efficacy.
By report, 50% for case decrease;
84% decrease severe illness.
It's working, just not really well.

Image-graph new confirmed cases Seychelles v US and UK ( https://twitter.com/EricTopol/status/1390726523796086785/photo/1 )
Image-graph cumulative vaxx doses in Seychelles v US, UK, EU, Israel
( https://twitter.com/EricTopol/status/1390726523796086785/photo/2 )
Image--WaPo article ( https://twitter.com/EricTopol/status/1390726523796086785/photo/3 )

29margd
Editado: Maio 7, 2021, 5:34 pm

India’s Problem Is Now the World’s Problem
Abhijit Banerjee and Esther Duflo | May 6, 2021

...the world needs to look beyond India and avoid yet another mistake of timing. We cannot afford to repeat the experience of the first wave, when we didn’t realize just how quickly a virus can travel. Neither should nations be lulled into a sense of false security by the progress of vaccination campaigns in the United States and Europe.

The B.1.617 variant first found in India is now spreading well beyond the country. In India, some vaccinated people seem to be getting infected. It would be foolish to assume that “better” vaccines available in the West will necessarily save us. Leaders and scientists need to figure out what should be done to combat variants, which may include booster shots, new vaccines, masks and slowing down reopenings.

Most critically, however, we should anticipate the possibility that the virus will spread through Africa, where a vaccination campaign that had barely started is now endangered by the situation in India, which stopped exporting vaccines many countries were relying on.

This would bring disaster in countries where oxygen supplies and hospital beds are extremely limited. The United States and Europe need to get ready to act quickly when necessary. This means shipping and making vaccines as fast as possible, and perhaps even more urgently, this means investing in global surveillance and testing, and being prepared to ship oxygen and equipment and to provide financial support for people in lockdown.

Getting ready now might give us a fighting chance to avoid a repeat of India’s nightmare.

https://www.nytimes.com/2021/05/06/opinion/covid-india-crisis.html

30margd
Maio 7, 2021, 5:14 pm

>22 margd: contd.

Eric Topol @EricTopol | 12:37 PM · May 7, 2021:
Although B.1.617.2 looked OK for some vaccine protection (below) a new UK report today shows it
has high transmissibility, at least as high B.1.1.7 (which is the highest to date) and
has been upgraded to a variant of concern

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attac...
Image--graph variants (except B117) UK, Feb-Mat 4 England
( https://twitter.com/EricTopol/status/1390707410407358464/photo/1 )

Quote Tweet
Eric Topol @EricTopol · 18h
More good news on vaccines and variants.
A sub-lineage of B.1.617 (India) called B.1.617.2 has several more mutations and we didn't know if they'd pose a problem.
But a UK nursing home outbreak among residents w/ 2nd dose AZ vaccine looks very encouraging

https://twitter.com/DevanSinha/status/1390388896433942544
Image--mutations B.1.617 and B.1.617.2 ( https://twitter.com/EricTopol/status/1390488258383998977/photo/1 )

31margd
Editado: Maio 10, 2021, 9:13 am

Eric Topol (Scripps) and Zeynep Tufekci (UNC) have been chiding Eric Feigl Ding (epidemiologist) about alarmism when it comes to variants such as P1. Michael Mina (Harvard champion of home tests) stepped up, somewhat, in Ding's defense--at least re importance of following these variants carefully. Ain't science fun? (ETA: U Saskatchewan's Angela Rasmussen also took swing at Feigl Ding-- for, a year in to this, asking for donations--"grift". Feigl Ding does seem a little excitable & repetitive to me but he shares info with outsiders, and provides some useful tension in Twitter discourse that can be illuminating. IMHO.)

Topol Talks: COVID-19 Variants Are Innocent Until Proven Guilty
Miriam E. Tucker | May 07, 2021

... You mentioned the current COVID-19 crisis in India, where a new variant has been described as a "double mutant," but on Twitter you called it a "scariant." Why?

First of all, the B.1.617 variant isn't a "double mutant." It has 15 mutations. It's a stupid term, focusing on two mutations which largely have been put aside as to concern. One of them is the L452R, which is the same as one of the California variants, and that hasn't proved to be particularly serious or concerning. The other is the 484Q, and it's not clear whether that has any function.

The B.1.617 is not the driver of the catastrophe in India. It may be contributing a small amount, but it has been overhyped as the "double mutant" that's causing it all. Adding to that are what I call "scariant" headlines here in the US when a few cases of that variant have been seen.

I coined the term "scariant" in early February because it was a pretty clear trend. People don't know what variants are. They know a little bit about mutations but not variants, and they're scared. A few variants are concerning, but we keep learning more and more things to decrease the concern. That's why I wrote the New York Times op-ed, to try to provide some reassurance, since there's such paranoia...

https://www.medscape.com/viewarticle/950716#vp_2

32margd
Editado: Maio 8, 2021, 11:26 am

Huh, DH, 68, reported increased resting heart rate on his Fitbit after Pfizer vaxx March 2021.

We THINK he previously acquired COVID-19 in FL emergency dept. at end of Jan 2020. He also had elevated heart rate, for longer period with "COVID" than after-vaxx. "Mild COVID" = as sick as I've ever seen him...

Increased heart rate as a physiological response to SARS-CoV-2 mRNA vaccine
Michael Burgess | May 8 2021

...Using a smartphone-based app that reported physiological activities from smartwatches, Quer and Gadaleta found that resting heart rate increases after receiving a vaccination, especially those who received the Moderna vaccine, previously had contracted COVID, or were under the age of 40.

...Quer and Gadaleta's team...found that resting heart rate increased in participants perhaps up to as much as an additional 1.5 beats per minute after receiving a dosage. Average heart rate additionally did not return to normal levels until four days after a primary jab and six days following a secondary jab.

Although no difference in gender was observed, previous infection by SARS-CoV-2 and the ages of participants did affect heart rate. Indeed, individuals in the under-40s group had the most significant increase in heart rate, and all those under-60 experience significantly higher heart rates than the over-60s group after the second dosage. Previous infection of COVID additionally was associated with higher heart rates, though only after the first jab. Finally, the Moderna vaccine was associated with higher rates of heart rate increase than the Pfizer vaccine, and similarly, this correlated negatively with age.

Normal activity and sleep patterns were slightly disturbed on the first night following the first dosage, with the researchers noting a significant decrease in activity and an increase in sleeping. These returned to nominal levels by the second day after vaccination, however.

This study provides comprehensive and easily accessible evidence of subtle physiological symptoms of the COVID mRNA vaccines - a slight increase in heart rate in the days following a dose, with a minor increase in resting the day afterward...

https://www.news-medical.net/news/20210508/Increased-heart-rate-as-a-physiologic...
---------------------------------------------------------------
Quer G., et al. The Physiologic Response to COVID-19 Vaccination. medRxiv 2021, doi: https://doi.org/10.1101/2021.05.03.21256482, https://www.medrxiv.org/content/10.1101/2021.05.03.21256482v1

This article is a preprint and has not been certified by peer review.

ABSTRACT
Two mRNA vaccines and one adenovirus-based vaccine against SARS CoV-2 are currently being distributed at scale in the United States. Objective evidence of a specific individual’s physiologic response to that vaccine are not routinely tracked but may offer insights into the acute immune response and personal and/or vaccine characteristics associated with that. We explored this possibility using a smartphone app-based research platform developed early in the pandemic that enabled volunteers (38,911 individuals between 25 March 2020 and 4 April 2021) to share their smartwatch and activity tracker data, as well as self-report, when appropriate, any symptoms, COVID-19 test results and vaccination dates and type. Of 4,110 individuals who reported at least one mRNA vaccination dose, 3,312 provided adequate resting heart rate data from the peri-vaccine period for analysis. We found changes in resting heart rate with respect to an individual baseline increased the days after vaccination, peaked on day 2, and returned to normal on day 6, with a much stronger effect after second dose with respect to first dose (average changes 1.6 versus 0.5 beats per minute). The changes were more pronounced for individuals who received the Moderna vaccine (on both doses), those who previously tested positive to COVID-19 (on dose 1), and for individuals aged

33margd
Editado: Maio 9, 2021, 9:08 am

Mucormycosis: The 'black fungus' maiming Covid patients in India
Soutik Biswas | 5/8/2021

Even as a deadly second wave of Covid-19 ravages India, doctors are now reporting a rash of cases involving a rare infection - also called the "black fungus" - among recovering and recovered Covid-19 patients.

What is mucormycosis?

Mucormycosis is a very rare infection. It is caused by exposure to mucor mould which is commonly found in soil, plants, manure, and decaying fruits and vegetables. "It is ubiquitous and found in soil and air and even in the nose and mucus of healthy people," says Dr Nair.

It affects the sinuses, the brain and the lungs and can be life-threatening in diabetic or severely immunocompromised individuals, such as cancer patients or people with HIV/AIDS.
line

Doctor believe mucormycosis, which has an overall mortality rate of 50%, may be being triggered by the use of steroids, a life-saving treatment for severe and critically ill Covid-19 patients.

Steroids reduce inflammation in the lungs for Covid-19 and appear to help stop some of the damage that can happen when the body's immune system goes into overdrive to fight off coronavirus. But they also reduce immunity and push up blood sugar levels in both diabetics and non-diabetic Covid-19 patients.

It's thought that this drop in immunity could be triggering these cases of mucormycosis...

...Doctors say they are surprised by the severity and the frequency of this fungal infection during the second wave, compared to some cases during the first wave last year.

...Patients suffering from the fungal infection typically have symptoms of stuffy and bleeding nose; swelling of and pain in the eye; drooping of eyelids; and blurred and finally, loss of vision. There could be black patches of skin around the nose.

Doctors say most of their patients arrive late, when they are already losing vision, and doctors have to surgically remove the eye to stop the infection from reaching the brain.

In some cases, doctors in India say, patients have lost their vision in both eyes. And in rare cases, doctors have to surgically remove the jaw bone in order to stop the disease from spreading.

An anti-fungal intravenous injection which costs 3,500 rupees ($48) a dose and has to be administered every day up to eight weeks is the only drug effective against the disease.

One way to stall the possibility of the fungal infection was to make sure that Covid-19 patients - both in treatment and after recovery - were being administered the right dose and duration of steroids, says Dr Rahul Baxi, a Mumbai-based diabetologist...

https://www.bbc.com/news/world-asia-india-57027829

34John5918
Editado: Maio 10, 2021, 1:55 am

From the South Sudan Medical Journal, May 2021.

Community epidemic management strategies and COVID-19 in South Sudan

Abstract

South Sudanese people have extensive knowledge and experience of responding to infectious diseases and epidemic outbreaks. This research investigated existing community infectious disease management strategies outside of the clinical healthcare sector, to better understand how communities respond to infectious disease outbreaks. The research demonstrates extensive local methods for infection control and epidemic management which, while they may not reach current clinical standards, provide a strong foundation for collaborative approaches to stopping the spread of COVID-19 and other dangerous diseases. The research suggests that working with local strategies and frontline non-clinical healthcare providers is key to building a trusted and sustained response to COVID-19 and other epidemics.


Challenges faced by elderly patients with cancer in low-and-middle-income countries during the COVID-19 pandemic

Abstract

Studies have shown that elderly people with co-morbidities are at a higher risk of dying from the SARS-CoV-2 virus. The situation is worse for the 70% of the elderly population who reside in low-and-middle income countries (LMICs) with poor access to good healthcare systems. Elderly patients with cancer in LMICs face numerous barriers to accessing quality health information and services. These barriers have been further exacerbated by the ongoing COVID-19 pandemic. It is therefore necessary that solutions to these barriers are proffered and appropriate measures are put in place to mitigate these barriers. This article outlines not only some of the challenges faced by elderly patients with cancer living in LMICs in the wake of the COVID-19 pandemic, it also provides reliable and evidence-based solutions that would be useful to the government and other stakeholders in the health system. This would help to achieve a compassionate, comprehensive and inclusive healthcare for elderly cancer patients in the COVID-19 pandemic era.


What do we know about breastfeeding and COVID-19?

Abstract

This paper summarises the present recommendations on counselling breastfeeding mothers during the COVID-19 pandemic. Present research shows that breastfeeding by infected, and vaccinated, mothers is safe. So, the overriding advice to mothers in South Sudan, and elsewhere, is to carry on giving the same messages: to start suckling immediately after birth, to exclusively breastfeed for the first six months and to breastfeed with complementary foods until at least two years of age. COVID-19 hygiene messages should be explained to mothers, their families and informal midwives/health workers taking into account local beliefs and resources.

35margd
Maio 10, 2021, 8:54 am

One thing COVID has been is a demonstration of the value of multi-disciplinary analyses:

Smashing the COVID Curve: Little Differences in Behavior Decide Between Success and Complete Failure
Institute of Science and Technology Austria | May 10, 2021

...newest findings about epidemic spreading come from Physics professor Björn Hof and his research group at the Institute of Science and Technology Austria (IST Austria), who specialize in fluids and turbulent flows. When early last year Björn Hof had to cancel his scheduled visit to Wuhan, his wife’s hometown, his focus abruptly shifted to epidemic spreading.

“My group normally investigates turbulent flows in pipes and channels,” he explains, “Over the last 10 years we have shown that the onset of turbulence is described by statistical models that are equally used to describe forest fires and epidemics.” Given this experience, programming an epidemic model was a straightforward exercise for Burak Budanur, the group’s theorist and computational expert.

The epidemic curve does not flatten, it collapses
...Either there is an outbreak of considerable size, or there is almost none whatsoever.

Failure yields faster than exponential growth...
Testing of known contacts (not testing per se) is one of the most powerful ways to slow down an epidemic. However, the number of cases that can be traced every day is limited and so is the number of tests that can be administered. As the researchers found out that exceeding these limits at one point during the epidemic has far-reaching consequences...

Marginal differences and disproportionate effects
...The difference between success and failure of a lockdown is marginal, or as Budanur puts it: “A policy that would have worked yesterday will not only take much longer to take effect, but it may fail entirely if it is implemented a single day too late.” Hof adds: “Most European countries only reacted when health capacity limits became threatened. Actually, policymakers should have paid attention to their contact tracing teams and locked down before this protective shield fell apart.”

More recently the team has looked into optimal strategies, where lockdowns are used as a preventive tool rather than an emergency brake. A manuscript that outlines the optimal strategy, which minimizes both, the number of infected people and the required lockdown time, is currently in progress.

https://scitechdaily.com/smashing-the-covid-curve-little-differences-in-behavior...
--------------------------------------------------------------

Davide Scarselli et al. 2021. Discontinuous epidemic transition due to limited testing. Nature Communications volume 12, Article number: 2586 (10 May 2021) DOI: 10.1038/s41467-021-22725-9 https://www.nature.com/articles/s41467-021-22725-9

Abstract

High impact epidemics constitute one of the largest threats humanity is facing in the 21st century. In the absence of pharmaceutical interventions, physical distancing together with testing, contact tracing and quarantining are crucial in slowing down epidemic dynamics. Yet, here we show that if testing capacities are limited, containment may fail dramatically because such combined countermeasures drastically change the rules of the epidemic transition: Instead of continuous, the response to countermeasures becomes discontinuous. Rather than following the conventional exponential growth, the outbreak that is initially strongly suppressed eventually accelerates and scales faster than exponential during an explosive growth period. As a consequence, containment measures either suffice to stop the outbreak at low total case numbers or fail catastrophically if marginally too weak, thus implying large uncertainties in reliably estimating overall epidemic dynamics, both during initial phases and during second wave scenarios.

36margd
Maio 10, 2021, 9:33 am

Vincent Rajkumar (Prof Mayo Clinic) @VincentRK | 9:59 PM · May 9, 2021:
India has more confirmed COVID cases per day than 𝗔𝗟𝗟 other countries in the world 𝙘𝙤𝙢𝙗𝙞𝙣𝙚𝙙.

Now consider that the number of confirmed cases is a fraction of the true cases to get a sense of the humanitarian crisis.

Less than 10% of people in India have had one dose of vaccine. Although the number of people who have received 1 dose of vaccine is not that much lower than the US, the sheer population size of India makes the task much harder. It is why India needs help with vaccine supplies.
Image--% population US, India receiving at least one dose vaxx
( https://twitter.com/VincentRK/status/1391581461460000772/photo/1 )
Image--No. people with at least one dose vaxx May 8 by country, absolute, not per capita
( https://twitter.com/VincentRK/status/1391581461460000772/photo/2 )

--------------------------------------------------

Piyush Sharma @PiyushS24196569 · 9h
India alone sent more Vaccines to the poor countries than ALL other countries in the world COMBINED.
India saw 386k recoveries and 366k new cases in last 24 hours.
We are vaccinating people faster than our ability.
Yes our government has failed but we and our doctors haven't.

37margd
Maio 10, 2021, 9:57 am

YAY! Animal tests look good for development of pan-betaCOVID vaxx apparently active against known variants and related viruses (bat, SARS). "These results demonstrate current mRNA vaccines may provide some protection from future zoonotic betaCoV outbreaks, and provide a platform for further development of pan-betaCoV vaccines."

Just published nature: 1st step towards a pan-coronavirus mRNA nanoparticle vaccine
with activity against all major #SARSCoV2 variants, #SARSCoV1, bat-CoV,
with potent effect in macaques

https://nature.com/articles/s41586-021-03594-0 *
Image-1st page highlighted ( https://twitter.com/EricTopol/status/1391735192906199040/photo/1 )
Image-vaxxed macaque serum cross-neutralization ( https://twitter.com/EricTopol/status/1391735192906199040/photo/2 )

-Eric Topol @EricTopol | 8:41 AM · May 10, 2021

------------------------------------------------------------

* Kevin O. Saunders et al. 2021. Neutralizing antibody vaccine for pandemic and pre-emergent coronaviruses. Nature (10 May 2021) https://www.nature.com/articles/s41586-021-03594-0

This is an unedited manuscript that has been accepted for publication.

Abstract
Betacoronaviruses (betaCoVs) caused the severe acute respiratory syndrome (SARS) and Middle East Respiratory Syndrome (MERS) outbreaks, and the SARS-CoV-2 pandemic1–4. Vaccines that elicit protective immunity against SARS-CoV-2 and betaCoVs circulating in animals have the potential to prevent future betaCoV pandemics. Here, we show that macaque immunization with a multimeric SARS-CoV-2 receptor binding domain (RBD) nanoparticle adjuvanted with 3M-052/Alum elicited cross-neutralizing antibody (cross-nAb) responses against batCoVs, SARS-CoV-1, SARS-CoV-2, and SARS-CoV-2 variants B.1.1.7, P.1, and B.1.351. Nanoparticle vaccination resulted in a SARS-CoV-2 reciprocal geometric mean neutralization ID50 titer of 47,216, and protection against SARS-CoV-2 in macaque upper and lower respiratory tracts. Importantly, nucleoside-modified mRNA encoding a stabilized transmembrane spike or monomeric RBD also induced SARS-CoV-1 and batCoV cross-nAbs, albeit at lower titers. These results demonstrate current mRNA vaccines may provide some protection from future zoonotic betaCoV outbreaks, and provide a platform for further development of pan-betaCoV vaccines.

38margd
Maio 10, 2021, 6:54 pm

(US) FDA authorizes Pfizer’s Covid-19 vaccine for use in adolescents
Helen Branswell | May 10, 2021
https://www.statnews.com/2021/05/10/fda-authorizes-pfizers-covid-19-vaccine-for-...

39margd
Editado: Maio 11, 2021, 4:46 am

Eric Topol @EricTopol | 4:15 PM · May 10, 2021
Covid-19 is a supercarrier story. (!)
90% of the virus load (circulating virions) is harbored by only 2% of individuals
(So much for the 80/20 Pareto principle)
https://pnas.org/content/118/21/e2104547118 *

Still waiting for the rapid home antigen tests that could be done frequently to identify the 2% infected people with high viral loads. They are free in the UK. They only recently became available in the US (BINAX) at $12 each, a no go.

--------------------------------------------------------------------
* Qing Yang. 2021. Just 2% of SARS-CoV-2−positive individuals carry 90% of the virus circulating in communities. PNAS May 25, 2021 118 (21) e2104547118; https://doi.org/10.1073/pnas.2104547118
https://www.pnas.org/content/118/21/e2104547118

Significance
We analyzed data from saliva-based COVID-19 screening deployed on the University of Colorado Boulder campus. Our dataset is unique in that all SARS-CoV-2−positive individuals reported no symptoms at the time of saliva collection, and therefore were infected but asymptomatic or presymptomatic. We found that 1) the distribution of viral loads observed in our asymptomatic college population was indistinguishable from what has been reported in hospitalized populations; 2) regardless of symptomatic status, approximately 50% of individuals who test positive for SARS-CoV-2 seem to be in noninfectious phases of the infection; and 3) just 2% of infected individuals carry 90% of the virions circulating within communities, serving as viral “supercarriers” and likely also superspreaders.

Abstract
We analyze data from the fall 2020 pandemic response efforts at the University of Colorado Boulder, where more than 72,500 saliva samples were tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) using qRT-PCR. All samples were collected from individuals who reported no symptoms associated with COVID-19 on the day of collection. From these, 1,405 positive cases were identified. The distribution of viral loads within these asymptomatic individuals was indistinguishable from what has been previously observed in symptomatic individuals. Regardless of symptomatic status, ∼50% of individuals who test positive for SARS-CoV-2 seem to be in noninfectious phases of the disease, based on having low viral loads in a range from which live virus has rarely been isolated. We find that, at any given time, just 2% of individuals carry 90% of the virions circulating within communities, serving as viral “supercarriers” and possibly also superspreaders.

40margd
Maio 11, 2021, 4:04 am

Merck Statement on Ivermectin use During the COVID-19 Pandemic
February 4, 2021 11:45 am ET

KENILWORTH, N.J., Feb. 4, 2021 – Merck (NYSE: MRK), known as MSD outside the United States and Canada, today affirmed its position regarding use of ivermectin during the COVID-19 pandemic. Company scientists continue to carefully examine the findings of all available and emerging studies of ivermectin for the treatment of COVID-19 for evidence of efficacy and safety. It is important to note that, to-date, our analysis has identified:

No scientific basis for a potential therapeutic effect against COVID-19 from pre-clinical studies;
No meaningful evidence for clinical activity or clinical efficacy in patients with COVID-19 disease, and;
A concerning lack of safety data in the majority of studies.

We do not believe that the data available support the safety and efficacy of ivermectin beyond the doses and populations indicated in the regulatory agency-approved prescribing information...

https://www.merck.com/news/merck-statement-on-ivermectin-use-during-the-covid-19...

41margd
Editado: Maio 11, 2021, 7:05 am

THREAD on latest data on B.1.617.2 (an "India" Variant) in England. Uh oh?

Prof. Christina Pagel (U College London) @chrischirp | 11:41 AM · May 10, 2021:
https://twitter.com/chrischirp/status/1391780417993334785

THREAD on latest data on B.1.617.2 (an "India" Variant) in England.

The Sanger Institute released its latest sequencing data for variants in England today
https://covid19.sanger.ac.uk/about

TLDR: it's not looking good at all. (margd: raw data) 1/6

Sanger removes cases from travellers to England & from surge testing to get a picture of what is happening in the community.

In England, within TWO weeks to 1 May, B.1.617.2 (the new variant of concern) went from 1% to 11% of cases. Other variants less than 1%. Image-graph ( https://twitter.com/chrischirp/status/1391780421411778568/photo/1 )

A massive increase. 2/6

This is concentrated in a few regions: London, the NW (quickest rise), East of England and then E Midlands & SE.

PHE (Public Health England) also highlighted London and NW as particularly concerning in its Friday report
Image-graph ( https://twitter.com/chrischirp/status/1391780424947535872/photo/1 ) 3/6

In the NW cases are concentrated in a few towns with v high proportion B.1.617 w/e 1 May: highest are Blackburn with Darwen (75%), Bedford (73%), Bolton (69%). Image-graph ( https://twitter.com/chrischirp/status/1391780424947535872/photo/1 )

These are obv low numbers of cases. But what is happening to overall covid cases here? 4/6

Downloading data from
Official UK Coronavirus Dashboard
coronavirus.data.gov.uk
https://coronavirus.data.gov.uk/details/download
for each local authority shows that, compared to week before, cases in week to 5th May have increased by 43% (Blackburn), 58% (Bedford) and 91% (Bolton).

It's not more tests - tests look flat & all 3 have growing PCR positivity. 5/6

Under *current* restrictions, within a context of v infectious B117 ("Kent" variant) and *high population immunity* B.1.617.2 seems to be spreading quickly.

Numbers still low(ish) but for how much longer? What will happen after 17th May when so much more opens? 6/6

PS this is not about returning to lockdown, it's about taking this seriously & strengthening public health measure such as contact tracing, support for isolation, testing, masks in indoor spaces (inc schools). it's about getting on top of situation *now*

Andy D @andykiko · 17h:
Isn't this a bit overly dramatic Christina? We're talking 2.3k cases a day currently with 67% of the population with the first vac and the most vulnerable in society full vaccinated + the vaccines have been shown to protect v the variant. Cases will rise but the worst has past

Prof. Christina Pagel:
I don't think it is. Spi-M models showing a moderately bad exit wave were based on high vax efficacy & high transmission. Since then vax efficacy even better against Kent, but we don't know for B16172 *and* it looks *more* transmissible. This puts bad exit wave back in play

Russell Bradshaw @Forensic_Stats · 17h:
Back of envelope calculation is that given the likely transmission advantage, we could soon be looking at case rates doubling roughly every week.
All hinging on whether suppression factors (surge testing, enhanced contact tracing, vaccine roll out etc.) can keep a lid on this.

Prof. Christina Pagel:
cases of B.1617.2 are already doubling every week so it's possible :-(
_______________________________________________________

Anecdotal: AstraZeneca (and COVAXIN, Indian vaxx based on inactivated virus) appear effective against moderate / severe cases of B.1.617.2 (variant first reported in India):

Devan Sinha (Radiology Registrar/Resident | Molecular Medicine, UK) @DevanSinha | 3:31 PM · May 6, 2021:
https://twitter.com/DevanSinha/status/1390388896433942544

15 cases of B1617.2 in care home in London a week after 2nd dose of Oxford/AZ- likely too soon for full effectiveness

0 deaths.

Chance of this outcome without vaccine was ~ 1 in 800 (0.12%)
Image-graph ( https://twitter.com/DevanSinha/status/1390388896433942544/photo/1 )

New concerns as Indian Covid variant clusters found across England
Nicola Davis @NicolaKSDavis | 6 May 2021
https://theguardian.com/world/2021/may/06/new-concerns-indian-covid-variant-clus...
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Vincent Rajkumar (Prof Mayo Clinic) @VincentRK | 5:36 PM · May 10, 2021
https://twitter.com/VincentRK/status/1391869808858238979

One piece of positive news speaking to leaders of 2 large hospitals in India where most healthcare workers were fully vaccinated:
No serious COVID cases among any of the vaccinated healthcare workers during this current crisis. The vaccines are working.

The vaccines available in India are COVISHIELD (Astra Zeneca /SII) and COVAXIN.

There will be anecdotal reports of people who have had severe COVID after full vaccination (2 weeks after 2 doses). But hospital data give a sense of denominator.

Although one could attribute some of the protection to PPE, healthcare workers do go home everyday and face the same exposures as the rest of the population outside of the work setting.

42margd
Maio 11, 2021, 6:40 am

Concern: Pfizer mRNA vaccine reprogramming of innate immune responses. Above my pay grade, but in preprint not yet peer-reviewed, Robertson reports that

"...researchers say that in combination with strong adaptive immune responses, the reprogramming of innate responses could either contribute to a more balanced inflammatory reaction to SARS-CoV-2 infection or a weakened innate immune response."

"The effect of the BNT162b2 vaccination on innate immune responses could also interfere with the responses to other vaccinations..."

(Innate immunity consists of neutrophils, dendritic cells, natural killer cells, macrophages, complements, physical barriers (= rapid, non-specific inflammatory responses). On the other hand, the adaptive immunity contains components such as T cells, B cells, and antibodies to protect us from viruses, bacteria, and other pathogens. https://moosmosis.org/2021/02/23/immunology-101-innate-immunity-vs-adaptive-immu... )

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Research suggests Pfizer-BioNTech COVID-19 vaccine reprograms innate immune responses
Sally Robertson | May 10, 2021

Researchers in The Netherlands and Germany have warned that Pfizer-BioNTech’s coronavirus disease 2019 (COVID-19) vaccine induces complex reprogramming of innate immune responses that should be considered in the development and use of mRNA-based vaccines.

https://www.news-medical.net/news/20210510/Research-suggests-Pfizer-BioNTech-COV...

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F. Konstantin Föhse et al. The BNT162b2 mRNA vaccine against SARS-CoV-2 reprograms both adaptive and innate immune responses. MedRxiv (May 6, 2021) doi: https://doi.org/10.1101/2021.05.03.21256520 https://www.medrxiv.org/content/10.1101/2021.05.03.21256520v1

This article is a preprint and has not been peer-reviewed

Summary
The mRNA-based BNT162b2 vaccine from Pfizer/BioNTech was the first registered COVID-19 vaccine and has been shown to be up to 95% effective in preventing SARS-CoV-2 infections. Little is known about the broad effects of the new class of mRNA vaccines, especially whether they have combined effects on innate and adaptive immune responses. Here we confirmed that BNT162b2 vaccination of healthy individuals induced effective humoral and cellular immunity against several SARS-CoV-2 variants. Interestingly, however, the BNT162b2 vaccine also modulated the production of inflammatory cytokines by innate immune cells upon stimulation with both specific (SARS-CoV-2) and non-specific (viral, fungal and bacterial) stimuli. The response of innate immune cells to TLR4 and TLR7/8 ligands was lower after BNT162b2 vaccination, while fungi-induced cytokine responses were stronger. In conclusion, the mRNA BNT162b2 vaccine induces complex functional reprogramming of innate immune responses, which should be considered in the development and use of this new class of vaccines.

43margd
Maio 11, 2021, 7:01 am

>41 margd: contd.

WHO classifies triple-mutant Covid variant from India as global health risk
Berkeley Lovelace Jr. | May 10 2021

Key Points
A WHO official said Monday it is reclassifying the highly contagious triple-mutant Covid variant spreading in India as a “variant of concern” at the global level.

Maria Van Kerkhove, the WHO’s technical lead for Covid-19, said the agency will provide more details in its situation report Tuesday.

... the variant, known as B.1.617, has been found in preliminary studies to spread more easily than the original virus and there is some evidence it may able to evade some of the protections provided by vaccines. The shots, however, are still considered effective.

...A variant can be labeled as “of concern” if it has been shown to be more contagious, more deadly or more resistant to current vaccines and treatments, according to the WHO....

The international organization has already designated three other variants with the classification:
B.1.1.7, which was first detected in the U.K. and is the most prevalent variant currently circulating throughout the U.S.;
B.1.351, first detected in South Africa, and the
P.1 variant, first detected in Brazil.

https://www.cnbc.com/2021/05/10/who-classifies-triple-mutant-covid-variant-from-...

44margd
Maio 12, 2021, 8:03 am

Vaccine deserts: Some countries have no COVID-19 jabs at all
KRISTA LARSON | May 9, 2021

...The World Health Organization says nearly a dozen countries — many of them in Africa — are still waiting to get vaccines. Those last in line on the continent along with Chad are Burkina Faso, Burundi, Eritrea and Tanzania.

“Delays and shortages of vaccine supplies are driving African countries to slip further behind the rest of the world in the COVID-19 vaccine rollout and the continent now accounts for only 1% of the vaccines administered worldwide,” WHO warned Thursday.

...While the total of confirmed COVID-19 cases among them is relatively low compared with the world’s hot spots, health officials say that figure is likely a vast undercount: The countries in Africa still waiting for vaccines are among those least equipped to track infections because of their fragile health care systems.

https://apnews.com/article/africa-coronavirus-vaccine-coronavirus-pandemic-busin...

45margd
Maio 12, 2021, 11:38 am

Sputnik V COVID-19 vaccine: How much do we know about its side effects?
Minseo Jeong | May 10, 2021

Sputnik V, developed by the Gamaleya National Center of Epidemiology and Microbiology in Russia, was the first COVID-19 vaccine to be authorized. This Snapshot feature discusses some of the common side effects reported in clinical trials, as well as controversies around potential safety concerns of the vaccine...

...An interim analysis of phase 3 clinical trial data, published in The LancetTrusted Source in February 2021, reports on the efficacy and safety of the vaccine. Based on the data, the most common side effects were:

flu-like illness
headache
fatigue
injection-site reactions

These side effects are similar to those of the Pfizer, Moderna, and Johnson & Johnson COVID-19 vaccines, as noted by the Centers for Disease Control and Prevention (CDC)Trusted Source.

Authors of the paper state that 45 out of 16,427 participants who received the vaccine reported serious adverse events, including deep vein thrombosis, hemorrhagic stroke, and hypertension. However, according to the paper, the independent data monitoring committee has confirmed that none of these were considered related to the vaccine.

Despite these data, there is still a significant controversy surrounding the vaccine. Experts have received the results with skepticism due to Russia’s strategy of early approval in August 2020, along with the lack of published raw data or protocol.

https://www.medicalnewstoday.com/articles/sputnik-v-covid-19-vaccine-how-much-do...

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Denis Y Logunov et al. 2021. Safety and efficacy of an rAd26 and rAd5 vector-based heterologous prime-boost COVID-19 vaccine: an interim analysis of a randomised controlled phase 3 trial in Russia. The Lancet Volume 397, ISSUE 10275, P671-681, February 20, 2021. DOI:https://doi.org/10.1016/S0140-6736(21)00234-8 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00234-8/fullt...

46margd
Maio 12, 2021, 12:46 pm

Moderna vaxx: "Covid arm" side effect.

Eric Topol @EricTopol | 11:21 AM · May 12, 2021:

Very rare delayed skin hypersensitivity reactions to @moderna_tx vaccine, aka "covid arm," in 16 people.
Median 7 days after 1st dose, 2 days after 2nd dose;
no contraindication to 2nd dose
https://jamanetwork.com/journals/jamadermatology/fullarticle/2779643 *

Image-photo of rash ( https://twitter.com/EricTopol/status/1392500219493818374/photo/1 )
Image-histology ( https://twitter.com/EricTopol/status/1392500219493818374/photo/2 )

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* Margaret S. Johnston et al. 2021. Delayed Localized Hypersensitivity Reactions to the Moderna COVID-19 Vaccine: A Case Series.
JAMA Dermatol. Published Online. May 12, 2021. doi:10.1001/jamadermatol.2021.1214 https://jamanetwork.com/journals/jamadermatology/fullarticle/2779643

Abstract

...Conclusions and Relevance
Clinical and histopathologic findings of this case series study indicate that the localized injection-site reactions to the Moderna COVID-19 vaccine are a delayed hypersensitivity reaction. These reactions may occur sooner after the second dose, but they are self-limited and not associated with serious vaccine adverse effects. In contrast to immediate hypersensitivity reactions (eg, anaphylaxis, urticaria), these delayed reactions (dubbed “COVID arm”) are not a contraindication to subsequent vaccination.

47John5918
Maio 13, 2021, 12:06 am

Why is the world still being hit by wave after wave of Covid when we know how to stop it? (Guardian) by Helen Clark and Ellen Johnson Sirleaf

Leaders failed to act fast enough when Covid-19 appeared. They must not keep making the same mistakes... Covid pandemic was preventable, says WHO-commissioned report...

48margd
Maio 13, 2021, 2:59 am

Mobile phone app traces COVID: "Roughly one case was averted for each case consenting to notification of their contacts. We estimated that for every percentage point increase in app users, the number of cases can be reduced by 0.8% (modelling) or 2.3% (statistical analysis). These findings provide evidence for continued development and deployment of such apps in populations that are awaiting full protection from vaccines."

Chris Wymant et al. 2021. The epidemiological impact of the NHS COVID-19 App. Nature (12 May 2021) https://www.nature.com/articles/s41586-021-03606-z

This is an unedited manuscript that has been accepted for publication.

Abstract
The COVID-19 pandemic has seen digital contact tracing emerge around the world to help prevent spread of the disease. A mobile phone app records proximity events between app users, and when a user tests positive for COVID-19, their recent contacts can be notified instantly. Theoretical evidence has supported this new public health intervention1–6, but its epidemiological impact has remained uncertain7. Here we investigated the impact of the NHS COVID-19 app for England and Wales, from its launch on 24 September 2020 through to the end of December 2020. It was used regularly by approximately 16.5 million users (28% of the total population), and sent approximately 1.7 million exposure notifications: 4.4 per index case consenting to contact tracing. We estimated that the fraction of app-notified individuals subsequently showing symptoms and testing positive (the secondary attack rate, SAR) was 6.0%, comparable to the SAR for manually traced close contacts. We estimated the number of cases averted by the app using two complementary approaches. Modelling based on the notifications and SAR gave 284,000 (108,000-450,000), and statistical comparison of matched neighbouring local authorities gave 594,000 (317,000-914,000). Roughly one case was averted for each case consenting to notification of their contacts. We estimated that for every percentage point increase in app users, the number of cases can be reduced by 0.8% (modelling) or 2.3% (statistical analysis). These findings provide evidence for continued development and deployment of such apps in populations that are awaiting full protection from vaccines.

49margd
Maio 13, 2021, 8:09 am

US: helps to have access to Internet when you're looking for vaccine "near you".

Find COVID-19 vaccine near you

Find a COVID-19 Vaccine: Search vaccines.gov, text your ZIP code to 438829, or call 1-800-232-0233 to find locations near you.

There are several ways you can look for vaccination providers near you.

Visit Vaccines.gov to find vaccination providers near you. In some states, information may be limited while more vaccination providers and pharmacies are being added. Learn more about COVID-19 Vaccination Locations on Vaccines.gov.
Text your zip code to 438829 or call 1-800-232-0233 to find vaccine locations near you.
Check your local pharmacy’s website to see if vaccination appointments are available. Find out which pharmacies are participating in the Federal Retail Pharmacy Program.
Contact your state health department to find additional vaccination locations in the area.
Check your local news outlets. They may have information on how to get a vaccination appointment.

https://www.cdc.gov/coronavirus/2019-ncov/vaccines/How-Do-I-Get-a-COVID-19-Vacci...

50margd
Editado: Maio 13, 2021, 9:10 am

German researcher who first profiled VITT associated with AstraZeneca and now J&J (post #9 in thread #20) hypothesizes that EDTA, common to drugs and other products, might be responsible.

EDTA is a chemical that binds and holds on to (chelates) minerals and metals such as chromium, iron, lead, mercury, copper, aluminum, nickel, zinc, calcium, cobalt, manganese, and magnesium. (WebMD) EDTA is commonly used to prevent aqueous solutions of drugs from oxidation?

Eric Topol @EricTopol | 8:16 AM · May 13, 2021:
Is it the EDTA (ethylenediaminetetraacetic acid) interacting with platelet factor 4
that's the basis for the very rare adenovirus vaccine-induced immune thrombotic thrombocytopenia (VITT) events ?
Maybe.

Blood Expert Says He Found Why Some Covid-19 Vaccines Trigger Rare Clots
Bojan Pancevski | May 13, 2021

...In Germany, one researcher thinks he has found what is triggering the clots. Andreas Greinacher, a blood expert, and his team at the University of Greifswald believe so-called viral vector vaccines—which use modified harmless cold viruses, known as adenoviruses, to convey genetic material into vaccine recipients to fight the coronavirus—could cause an autoimmune response that leads to blood clots. According to Prof. Greinacher, that reaction could be tied to stray proteins and a preservative he has found in the AstraZeneca vaccine.

Prof. Greinacher and his team has just begun examining Johnson & Johnson’s vaccine but has identified more than 1,000 proteins in AstraZeneca’s vaccine derived from human cells, as well as a preservative known as ethylenediaminetetraacetic acid, or EDTA. Their hypothesis is that EDTA, which is common to drugs and other products, helps those proteins stray into the bloodstream, where they bind to a blood component called platelet factor 4, or PF4, forming complexes that activate the production of antibodies...

https://www.wsj.com/articles/inside-the-hunt-for-a-link-between-some-covid-19-va...

51margd
Maio 13, 2021, 10:13 am

>47 John5918: contd.?

Ellen Johnson Sirleaf and Helen Clark. 2021. Report of the Independent Panel for Pandemic Preparedness and Response: making COVID-19 the last pandemic (Comment). The Lancet (May 12, 2021) DOI:https://doi.org/10.1016/S0140-6736(21)01095-3 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01095-3/fullt...

...the international alert system does not operate with sufficient speed when faced with a fast-moving respiratory pathogen

...countries with successful responses had timely triage and referral of suspected COVID-19 cases to ensure swift case identification and contact tracing, and provided designated isolation facilities, either for all or for those unable to self-isolate. High-performing countries also developed partnerships on multiple levels across government sectors and with groups outside government, communicated consistently and transparently, and engaged with community health workers and community leaders as well as the private sector.

Countries with poor results had uncoordinated approaches that devalued science, denied the potential impact of the pandemic, delayed comprehensive action, and allowed distrust to undermine efforts. Many had underfunded health systems beset by long-standing problems of fragmentation and undervaluing of health workers. They had insufficient capacity to mobilise rapidly and coordinate between national and subnational responses. The denial of scientific evidence was compounded by a failure of leadership to take responsibility or develop coherent strategies aimed at preventing community transmission.

Importantly, COVID-19 has been a pandemic of inequality, exacerbated between and within countries, with the impact being particularly severe on people who are already marginalised and disadvantaged. Inequality has been a determining factor in explaining why the COVID-19 pandemic has had such differential impacts on peoples' lives and livelihoods.

The combination of poor strategic choices, unwillingness to tackle inequalities, and an uncoordinated response system allowed the pandemic to trigger a catastrophic human and socioeconomic crisis.

...strengths on which to build. Open data and open science collaboration were central to alert and response...

...To end COVID-19 the panel recommends the following three immediate actions.

First, high-income countries with a COVID-19 vaccine pipeline for adequate coverage should, alongside their scale-up, commit to provide at least 1 billion vaccine doses to the 92 low-income and middle-income countries of the Gavi COVAX Advance Market Commitment, no later than Sept 1, 2021, and more than 2 billion doses by mid-2022.

Second, major vaccine-producing countries and manufacturers should convene, under the joint auspices of WHO and the World Trade Organization, to agree to voluntary licensing and technology transfer with intellectual property rights to be waived immediately if voluntary action, including action on the required technology transfer, does not occur within 3 months.

Third, the G7 should immediately commit to 60% of the US$19 billion required for the Access to COVID-19 Tools (ACT) Accelerator in 2021 for vaccines, diagnostics, therapeutics, and strengthening of health systems, and a burden sharing formula should be adopthttps://www.librarything.com/topic/331916#ed to fund such global public goods on a continual basis...

52margd
Maio 13, 2021, 11:44 am

05/13/2021 11:00 GMT — More side effects after mixing COVID-19 vaccines?

A new study investigated giving the AstraZeneca vaccine followed by the Pfizer vaccine 4 weeks later, or vice versa. This mixed vaccine schedule led to more frequent side effects after the second dose than giving the same vaccine both times.

Researchers from the University of Oxford in the United Kingdom have been looking into the effects of mixing the vaccine schedule in this way. A preliminary data analysis, published in The Lancet, reports the side effects that volunteers experienced.

Chief Investigator Matthew Snape, associate professor in pediatrics and vaccinology at the University of Oxford, explains:

“The results from this study suggest that mixed dose schedules could result in an increase in work absences the day after immunization, and this is important to consider when planning immunization of healthcare workers.”

However, this is not a cause for general concern, as Prof. Snape said: “There are no safety concerns or signals, and this does not tell us if the immune response will be affected. We hope to report these data in the coming months. In the meantime, we have adapted the ongoing study to assess whether early and regular use of paracetamol reduces the frequency of these reactions.”

Researchers also note that this study only used data from people aged 50 years and above, so the findings may not be applicable to younger people.

https://www.medicalnewstoday.com/articles/covid-19-vaccine-live-updates

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Robert H Shaw et al. 2021. Heterologous prime-boost COVID-19 vaccination: initial reactogenicity data (Correspondence). The Lancet (May 12, 2021) DOI:https://doi.org/10.1016/S0140-6736(21)01115-6 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01115-6/fullt...

...Both heterologous vaccine schedules induced greater systemic reactogenicity following the boost dose than their homologous counterparts, with feverishness reported by 37 (34%) of 110 recipients of ChAd for prime and BNT for boost compared with 11 (10%) of 112 recipients of ChAd for both prime and boost (difference 24%, 95% CI 13-35%). Feverishness was reported by 47 (41%) of 114 recipients of BNT for prime and ChAd for boost, compared with 24 (21%) of 112 recipients of BNT for both prime and boost (difference 21%, 95% CI 8-33%). Similar increases were observed for chills, fatigue, headache, joint pain, malaise, and muscle ache (figure; appendix). There were no hospitalisations due to solicited symptoms, and most of this increase in reactogenicity was observed in the 48 h after immunisation...

53margd
Maio 13, 2021, 5:08 pm

Coronavirus Vaccines Protect Pregnant Women, Another Study Suggests
The shots may also have benefits for infants and do not seem to damage the placenta, according to the latest research.
Emily Anthes | May 13, 2021

Research has shown that pregnant women with Covid symptoms are more likely to be admitted to the I.C.U., require mechanical ventilation and die from the virus than non-pregnant women.

...scientists have accumulated a small but steadily growing body of evidence that the vaccines are safe and effective during pregnancy. Preliminary results from two continuing studies provide additional encouraging news.

The Pfizer-BioNTech and Moderna vaccines produce robust immune responses in pregnant and lactating women, and are likely to provide at least some protection against two dangerous coronavirus variants, according to a study published in JAMA on Thursday. Vaccinated women can also pass protective antibodies to their fetuses through the bloodstream and to their infants through breast milk, the research suggests.

In a second study, published in the journal Obstetrics & Gynecology on Tuesday, researchers found no evidence that either the Pfizer or Moderna vaccines damaged the placenta during pregnancy ( https://journals.lww.com/greenjournal/Fulltext/9900/Severe_Acute_Respiratory_Syn... )...

https://www.nytimes.com/2021/05/13/health/vaccine-pregnancy.html
----------------------------------------------------------------------
Ai-ris Y. Collier et al. 2021. Immunogenicity of COVID-19 mRNA Vaccines in Pregnant and Lactating Women. JAMA. Published online May 13, 2021. doi:10.1001/jama.2021.7563 https://jamanetwork.com/journals/jama/fullarticle/2780202

Abstract
Importance Pregnant women are at increased risk of morbidity and mortality from COVID-19 but have been excluded from the phase 3 COVID-19 vaccine trials. Data on vaccine safety and immunogenicity in these populations are therefore limited.

Objective To evaluate the immunogenicity of COVID-19 messenger RNA (mRNA) vaccines in pregnant and lactating women, including against emerging SARS-CoV-2 variants of concern.

Design, Setting, and Participants An exploratory, descriptive, prospective cohort study enrolled 103 women who received a COVID-19 vaccine from December 2020 through March 2021 and 28 women who had confirmed SARS-CoV-2 infection from April 2020 through March 2021 (the last follow-up date was March 26, 2021). This study enrolled 30 pregnant, 16 lactating, and 57 neither pregnant nor lactating women who received either the mRNA-1273 (Moderna) or BNT162b2 (Pfizer-BioNTech) COVID-19 vaccines and 22 pregnant and 6 nonpregnant unvaccinated women with SARS-CoV-2 infection.

Main Outcomes and Measures SARS-CoV-2 receptor binding domain binding, neutralizing, and functional nonneutralizing antibody responses from pregnant, lactating, and nonpregnant women were assessed following vaccination. Spike-specific T-cell responses were evaluated using IFN-γ enzyme-linked immunospot and multiparameter intracellular cytokine–staining assays. Humoral and cellular immune responses were determined against the original SARS-CoV-2 USA-WA1/2020 strain as well as against the B.1.1.7 and B.1.351 variants.

Results This study enrolled 103 women aged 18 to 45 years (66% non-Hispanic White) who received a COVID-19 mRNA vaccine. After the second vaccine dose, fever was reported in 4 pregnant women (14%; SD, 6%), 7 lactating women (44%; SD, 12%), and 27 nonpregnant women (52%; SD, 7%). Binding, neutralizing, and functional nonneutralizing antibody responses as well as CD4 and CD8 T-cell responses were present in pregnant, lactating, and nonpregnant women following vaccination. Binding and neutralizing antibodies were also observed in infant cord blood and breast milk. Binding and neutralizing antibody titers against the SARS-CoV-2 B.1.1.7 and B.1.351 variants of concern were reduced, but T-cell responses were preserved against viral variants.

Conclusion and Relevance In this exploratory analysis of a convenience sample, receipt of a COVID-19 mRNA vaccine was immunogenic in pregnant women, and vaccine-elicited antibodies were transported to infant cord blood and breast milk. Pregnant and nonpregnant women who were vaccinated developed cross-reactive antibody responses and T-cell responses against SARS-CoV-2 variants of concern.

54John5918
Maio 14, 2021, 4:08 am

COVID is a global humanitarian emergency – act like it (The New Humanitarian)

‘I think sadly for us on the African continent, the COVID pandemic is only just beginning’...

The world has been dealing with the COVID-19 pandemic as a global health crisis, but it’s time we shift gears and recognise it for the global humanitarian emergency that it is...

Without vaccines, we cannot begin to think of a process of recovery, but access remains elusive...

55margd
Maio 14, 2021, 9:06 am

UK prepares surge vaccinations to tackle Covid variant from India
Elliot Smith | May 14 2021

Key Points
Vaccines Minister Nadhim Zahawi told BBC TV on Friday that the government would “flex” its inoculation program to direct more doses to the most affected areas, while second doses could be brought forward.

The Department of Health and Social Care announced that a new “surge rapid response” team would be deployed to Bolton, where the B1.617.2 variant is spreading rapidly...

https://www.cnbc.com/2021/05/14/uk-prepares-surge-vaccinations-to-tackle-covid-v...

56margd
Maio 14, 2021, 9:48 am

A reason to avoid chems in food and drugs AMAP: don't go into a vaxx perhaps already sensitized to a chem? Vaxx reactions are very rare and mostly treatable now that recognized, but...why not minimize prior consumption of chems if one can?

I remember a lecture in an undergrad class from eons ago in which prof reviewed food additives which had other uses in large amount (solvent! pesticide!). Earlier my mom had told me that food colorings & additives were GRAS (generally recommended as safe) by government, so no problem.... I always read packaging's fine print now, e.g., I much prefer turmeric over yellow dye #_ to color my pickled banana peppers!

1. polyethylene glycol (PEG) MAY be responsible for rare allergic reactions associated with Pfizer vax.
PEG is commonly added to food, cosmetics, and pharamaceuticals, e.g., MiraLAX's active ingredient.

2. rare clotting (VITT) associated with AstraZeneca and now J&J vax MAY be caused by EDTA (ethylenediaminetetraacetic acid).
EDTA is a metal ion binder that improves food product stability, shelf life and color retention. EDTA is commonly used to prevent aqueous solutions of drugs from oxidation.

57margd
Maio 14, 2021, 10:10 am

Over 99% Hospitalized 2021 COVID Patients Unvaccinated
Carolyn Crist | May 13, 2021

...Among the 4,300 COVID-19 patients admitted to Cleveland Clinic hospitals between Jan. 1 and April 13, 99.75% were not fully vaccinated.

The study also looked at 47,000 Cleveland Clinic employees who had received one shot, two shots, or no shots. Among those, 1,991 tested positive for the coronavirus in recent months. About 99.7% of those who contracted COVID-19 weren’t vaccinated, and .3% were fully vaccinated...

https://www.webmd.com/vaccines/covid-19-vaccine/news/20210513/over-_99-percent-h...

https://www.cleveland.com/coronavirus/2021/05/cleveland-clinic-finds-997-of-care...

https://www.beaconjournal.com/story/news/2021/05/11/cleveland-clinic-study-emplo...

58margd
Maio 14, 2021, 10:14 am

Jesse D. Bloom et al. 2021. Investigate the origins of COVID-19. Science 14 May 2021: Vol. 372, Issue 6543, pp. 694
DOI: 10.1126/science.abj0016 https://science.sciencemag.org/content/372/6543/694.1

...more investigation is still needed to determine the origin of the pandemic. Theories of accidental release from a lab and zoonotic spillover both remain viable.

...As scientists with relevant expertise, we agree with the WHO director-general..., the United States and 13 other countries..., and the European Union...that greater clarity about the origins of this pandemic is necessary and feasible to achieve. We must take hypotheses about both natural and laboratory spillovers seriously until we have sufficient data. A proper investigation should be transparent, objective, data-driven, inclusive of broad expertise, subject to independent oversight, and responsibly managed to minimize the impact of conflicts of interest. Public health agencies and research laboratories alike need to open their records to the public. Investigators should document the veracity and provenance of data from which analyses are conducted and conclusions drawn, so that analyses are reproducible by independent experts.

Finally, in this time of unfortunate anti-Asian sentiment in some countries, we note that at the beginning of the pandemic, it was Chinese doctors, scientists, journalists, and citizens who shared with the world crucial information about the spread of the virus—often at great personal cost.... We should show the same determination in promoting a dispassionate science-based discourse on this difficult but important issue.

59margd
Maio 14, 2021, 2:14 pm

Pilishvili T, Fleming-Dutra KE, Farrar JL, et al. Interim Estimates of Vaccine Effectiveness of Pfizer-BioNTech and Moderna COVID-19 Vaccines Among Health Care Personnel — 33 U.S. Sites, January–March 2021. MMWR Morb Mortal Wkly Rep. ePub: 14 May 2021. DOI: http://dx.doi.org/10.15585/mmwr.mm7020e2 https://www.cdc.gov/mmwr/volumes/70/wr/mm7020e2.htm

...The first U.S. multisite test-negative design vaccine effectiveness study among HCP found a single dose of Pfizer-BioNTech or Moderna COVID-19 vaccines to be 82% effective against symptomatic COVID-19 and 2 doses to be 94% effective...

60margd
Maio 15, 2021, 3:53 am

India’s Epidemic of False COVID-19 Information
Rahul Bhatia | May 10, 2021

As patients and families frantically seek treatment, elected officials—and some physicians—have fuelled denialism and specious talk of miracle cures...

https://www.newyorker.com/news/dispatch/indias-epidemic-of-false-covid-19-inform...

61margd
Maio 15, 2021, 4:12 am

Think I may mask up in grocery store for a while longer...

Tom Wenseleers (Biologist Statistician) @TWenseleers | 4:17 AM · May 10, 2021:
https://twitter.com/TWenseleers/status/1391668827239370754

Translated from Dutch:

For those who would like to see a graph of the distribution of the Indian variant B.1.617.2...it looks like this based on the (relatively limited) GISAID data. Indian variety has an estimated growth advantage over UK variety B.1.1.7 of 10% / day.
Image-graphs of varieties India regions ( https://twitter.com/TWenseleers/status/1391668815566721026/photo/1 )

Or based on the Sanger Institute data from the UK, we get this (data from travelers and cluster outbreaks have been filtered out). A growth advantage of 10% per day over the UK variant would amount to about 60% more contagious. See if this is confirmed by further research.
Image-graphs varieties UK regions, Jan-May ( https://twitter.com/TWenseleers/status/1391668827239370754/photo/1 )

Indian variant 1.6x more contagious than UK variant, which in turn was 1.6x more contagious than original type would make that Indian variant (1.6)^2 x = Could be 2.6x more contagious than original type. Although benefit mschn is also partly linked to immune evasion.

Link to latest Public Health England report on Indian variant:https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/984274/Variants_of_Concern_VOC_Technical_Briefing_10_England.pdf with accompanying data:

Jan Deschoolmeester @JDSchoolmeester
A more contagious variant also means that you have to vaccinate more people to obtain herd immunity.
Is that 70% still sufficient, or does that deserve an update?

Tom Wenseleers @TWenseleers
Group immunity might even be impossible to achieve at all (taking into account that vaccines are never 100% effective). The red immunity threshold (for a homogeneous population, possibly slightly lower in practice) would then go towards 90%(1-1 / R0) ...

However, this is not necessarily a problem, as long as vaccines adequately protect against serious illness & death. But yes, every vaccination will count ...

62margd
Maio 15, 2021, 4:25 am

Only four men examined, but first study to demonstrate the presence of the COVID-19 virus in the penis long after the initial infection in humans.

Eliyahu Kresch et al. 2021. COVID-19 Endothelial Dysfunction Can Cause Erectile Dysfunction: Histopathological, Immunohistochemical, and Ultrastructural Study of the Human Penis. World J Mens Health* 2021;39:e22. May 07, 2021. https://doi.org/10.5534/wjmh.210055 https://wjmh.org/DOIx.php?id=10.5534/wjmh.210055

* Korean Society for Sexual Medicine and Andrology

63margd
Editado: Maio 15, 2021, 5:08 pm

"In patients hospitalised with COVID-19, high-titre convalescent plasma did not improve survival or other prespecified clinical outcomes."

Recovery Collaborative Group. 2021. Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial. The Lancet Published:May 14, 2021 DOI:https://doi.org/10.1016/S0140-6736(21)00897-7 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00897-7/fullt...

Image-graph mortality over 14 days, convalescent plasma v usual care ( https://twitter.com/EricTopol/status/1393343552176881664/photo/1 )

64margd
Maio 16, 2021, 5:59 am

Vitamin D and COVID-19: What Doctors Know (and Don't Know) So Far
Research continues into whether supplements can prevent or treat coronavirus infections
Rachel Nania | May 6, 2021

https://www.aarp.org/health/conditions-treatments/info-2021/vitamin-d-covid.html

65margd
Editado: Maio 16, 2021, 8:49 am

Multiple Myeloma patients:
15.9% lack SARS-CoV-2 spike antibody response more than 10 days after the second mRNA vaccine dose. The patients actively receiving MM treatment, especially on regimens containing anti-CD38 and anti-BCMA, have lower antibody responses compared to healthy controls. Thus, it is of critical importance to monitor this patient population for serological responses.* Non-responders may benefit from ongoing public health measures and from urgent study of prophylactic treatments to prevent SARS-CoV-2 infection. Non-responders may benefit from ongoing public health measures (masking, herd immunity?) and from urgent study of prophylactic treatments (monoclonal antibodies?) to prevent SARS-CoV-2 infection.

Florian Krammer (viroogist)@florian_krammer | 6:40 AM · May 16, 2021:
https://twitter.com/florian_krammer/status/1393878957951442945
Fatal breakthrough infection after anti-BCMA CAR-T therapy highlights 2 suboptimal immune response to SARS-CoV-2 vaccination in myeloma patients *

Sebastian Swana (science teacher) @sebgs1 | 6:49 AM · May 16, 2021:
More evidence that herd immunity is important to protect vulnerable patients.

Jamie Weisman, M.D. (dermatologist, immunocompromised herself) @jamie_weisman | 8:03 AM · May 16, 2021
We need trials on prophylactic monoclonal antibodies in these populations now!
With new CDC guidelines on unmasking we are gambling with their lives.

----------------------------------------------------------

* Adolfo Aleman et al. 2021 Fatal breakthrough infection after anti-BCMA CAR-T therapy highlights suboptimal immune response to SARS-CoV-2 vaccination in myeloma patients. MedRxiv (May 15, 2021) ; https://doi.org/10.1101/2021.05.15.21256814 https://www.medrxiv.org/content/10.1101/2021.05.15.21256814v1.full.pdf

Preprint. Not yet peer-reviewed.

SUMMARY
Severe acute respiratory syndrome coronavirus (SARS-CoV-2) vaccines are highly effective in healthy individuals. Patients with multiple myeloma (MM) are immunocompromised due to defects in humoral and cellular immunity as well as immunosuppressive therapies. The efficacy after two doses of SARS-CoV-2 mRNA vaccinationin MM patients is currently unknown. Here, we report the case of a MM patient who developed a fatal SARS-CoV-2infection after full vaccination while in remission after 1B cell maturation antigen (BCMA)-targeted chimeric antigen receptor(CAR)-T treatment. We show that the patient failed to generate antibodies or SARS-CoV-2-specific B and T cell responses, highlighting the continued risk of severe coronavirus disease 2019 (COVID-19) in vaccine non-responders. In the largest cohort of vaccinated MM patients to date, we demonstrate that 15.9% lack SARS-CoV-2 spike antibody response more than 10 days after the second mRNA vaccine dose. The patients actively receiving MM treatment, especially on regimens containing anti-CD38 and anti-BCMA, have lower antibody responses compared to healthy controls. Thus, it is of critical importance to monitor this patient population for serological responses. Non-responders may benefit from ongoing public health measures and from urgent study of prophylactic treatments to prevent SARS-CoV-2 infection.

66margd
Editado: Maio 16, 2021, 12:01 pm

Eric Topol (mD scientist Scripps) @EricTopol | 11:37 AM · May 16, 2021:
The case numbers in India continue to descend, which is great to see.
But Uruguay, currently the worst-hit country in the world per capita, is heading back up
Image-graph #cases per million India Uruguay March 1-May 15 ( 11:37 AM · May 16, 2021 )

Ranju T Dhawan @RTD_Ranju
One hopes the trend cited for India reflects a genuine downturn
but the trajectory from ground reports in rural India (mostly undocumented)
warrants pause and caution in the optimism

CerebroDePollo @ChickenBrainUY
They say that when the end of the world comes you should come to Uruguay as it's going to get there much later.
We are now where Europe was 14 months ago.
The only reason it's not much worse is because vaccination is moving at full speed and the elderly are getting Pfizer.

67margd
Maio 17, 2021, 7:21 am

Some people still need to mask up even if vaccinated. Are you one of them?
CNN | May 16, 2021

...“If you have a condition or are taking medications that weaken your immune system, you may NOT be fully protected even if you are fully vaccinated. Talk to your healthcare provider,” the CDC said in the new guidance. “Even after vaccination, you may need to continue taking all precautions.”

...dialysis patients

... HIV/AIDS...Organ transplant...chemotherapy...immunotherapy, stem cell or bone marrow transplants, and other medicines
Diabetes...Obesity...chronic kidney disease, liver and heart disease, and old age.

...cancer itself or treatment

...“Patients with heart disease are at increased risk of adverse outcomes from Covid-19, but they have the same benefits from vaccines as those without heart disease,” (American Heart Association President Dr. Mitchell Elkind) said. “We recommend that patients with heart disease who have been vaccinated, and are not immunocompromised for some other reason, follow CDC guidelines regarding wearing masks and social distancing,” he said.

Because pregnant women are at higher risk for severe Covid-19, Walensky said that the CDC is encouraging them to get vaccinated, and the decision to go unmasked would be an individual one.

...“psoriasis, rheumatoid arthritis, scleroderma, inflammatory bowel disease, Crohn’s disease, ulcerative colitis and lupus”... Medications

...A small study of 26 people with inflammatory diseases found levels of coronavirus antibodies were slightly lower in those patients compared to others, but no one was a “complete non-responder.”

A larger study of 133 people found a “three-fold reduction” in antibodies to Covid-19 compared to healthy controls, with some medications, such as glucocorticoids, worse than others. Still, the antibodies found in patients on medications were “comparable to patients with rapid recovery from COVID-19 and may, therefore, provide sufficient humoral protection,” the study said. The study was a pre-print, meaning it has not been vetted by a journal for publication. While vaccination appears to be effective, (Dr. Cedric “Jamie” Rutland, a pulmonary and critical care physician) said he plays it safe with his patients: “I take them off of those (autoimmune) medications before they get vaccinated, so they can have the appropriate immune response,” he said.

...“Really, again, not everybody has to rip off their mask because our guidance changed on Thursday,” (CDC Director Dr. Rochelle Walensky) said. “So, yes, if you are concerned, please do consult your physician before you take off your mask.”

https://ktvz.com/health/2021/05/16/some-people-still-need-to-mask-up-even-if-vac...

68margd
Maio 17, 2021, 10:54 am

Seven vaccines' neutralization level (test tube) is highly predictive of immune protection (real life)......Our results are consistent with studies of both influenza and seasonal coronavirus infection, for which reinfection is possible 1 year after the initial infection, although it usually results in mild infection...Similarly, after influenza virus vaccination, protective efficacy is thought to decline by around 7% per month...

David S. Khoury et al. 2021. Neutralizing antibody levels are highly predictive of immune protection from symptomatic SARS-CoV-2 infection. Nature Medicine (17 May 2021) https://www.nature.com/articles/s41591-021-01377-8

Abstract
...Modeling of the decay of the neutralization titer over the first 250 d after immunization predicts that a significant loss in protection from SARS-CoV-2 infection will occur, although protection from severe disease should be largely retained. Neutralization titers against some SARS-CoV-2 variants of concern are reduced compared with the vaccine strain, and our model predicts the relationship between neutralization and efficacy against viral variants. Here, we show that neutralization level is highly predictive of immune protection, and provide an evidence-based model of SARS-CoV-2 immune protection that will assist in developing vaccine strategies to control the future trajectory of the pandemic.

...Discussion
...Our work uses available data on immune responses and protection to model both the protective titer and the long-term behavior of SARS-CoV-2 immunity. It suggests that neutralization titer will be an important predictor of vaccine efficacy in the future as new vaccines emerge. The model also predicts that immune protection from infection may wane with time as neutralization levels decline, and that booster immunization may be required within a year. However, protection from severe infection may be considerably more durable given that lower levels of response may be required or alternative responses (such as cellular immune responses) may play a more prominent role.

...Our results are consistent with studies of both influenza and seasonal coronavirus infection, for which reinfection is possible 1 year after the initial infection, although it usually results in mild infection... Similarly, after influenza virus vaccination, protective efficacy is thought to decline by around 7% per month...our study develops a modeling framework for integrating available, if imperfect, data from vaccination and convalescent studies to provide a tool for predicting the uncertain future of SARS-CoV-2 immunity.

69margd
Maio 17, 2021, 3:35 pm

Helen M Parry et al. 2021. Extended interval BNT162b2 vaccination enhances peak antibody generation in older people. MedRxiv (17 may 2021) doi: https://doi.org/10.1101/2021.05.15.21257017 https://www.medrxiv.org/content/10.1101/2021.05.15.21257017v1

This article is a preprint and has not been certified by peer review.

Abstract
...Conclusion: Peak antibody responses after the second BNT162b2 vaccine are markedly enhanced in older people when this is delayed to 12 weeks although cellular responses are lower. Extended interval vaccination may therefore offer the potential to enhance and extend humoral immunity. Further follow up is now required to assess long term immunity and clinical protection...

70margd
Maio 17, 2021, 3:45 pm

EU extends the approved storage period of the unopened thawed vial (Pfizer vaccine) at 2-8°C (i.e. in a normal fridge after taking out of deep-freeze conditions) from five days to one month (31 days).

More flexible storage conditions for BioNTech/Pfizer’s COVID-19 vaccine Share
News 17/05/2021

EMA’s human medicines committee (CHMP) has recommended a change to the approved storage conditions of Comirnaty, the COVID-19 vaccine developed by BioNTech and Pfizer, that will facilitate the handling of the vaccine in vaccination centres across the European Union (EU).

This change extends the approved storage period of the unopened thawed vial at 2-8°C (i.e. in a normal fridge after taking out of deep-freeze conditions) from five days to one month (31 days). The change was approved following assessment of additional stability study data submitted to EMA by the marketing authorisation holder. Increased flexibility in the storage and handling of the vaccine is expected to have a significant impact on planning and logistics of vaccine roll-out in EU Member States.

The changes described will be included in the publicly available information on Comirnaty and will be implemented by the marketing authorisation holder in updated product labelling. Users are reminded to always refer to the label and package leaflet of the supplied product for the correct storage information.

EMA is in continuous dialogue with the marketing authorisation holders of COVID-19 vaccines as they seek to make manufacturing improvements to enhance vaccine distribution in the EU.

https://www.ema.europa.eu/en/news/more-flexible-storage-conditions-biontechpfize...

71margd
Editado: Maio 17, 2021, 6:02 pm

Biden boosting world vaccine sharing commitment to 80M doses
ZEKE MILLER | 5/17/2021

President Joe Biden said Monday that the U.S. will share an additional 20 million doses of COVID-19 vaccines with the world in the coming six weeks...from existing production of Pfizer, Moderna or Johnson & Johnson vaccine stocks, marking the first time that U.S.-controlled doses of vaccines authorized for use in the country will be shared overseas. It will boost the global vaccine sharing commitment from the U.S. to 80 million...“we will not use our vaccines to secure favors from other countries”...

The Biden administration hasn’t yet said how the new commitment of vaccines will be shared or which countries will receive them...

(60 million AZ already shared with India, Mexico, Canada, _______?)

https://apnews.com/article/coronavirus-vaccine-coronavirus-pandemic-health-gover...

72margd
Editado: Maio 18, 2021, 4:27 am

KENYA

Eric Topol @EricTopol | 7:14 PM · May 17, 2021:
https://twitter.com/EricTopol/status/1394431063867330561
Overall, Africa has held up extremely well during the pandemic. A new report from Kenya helps explain why
https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3844795 *
35% Nairobi residents infected (seroprevalent), 50% in households, but less than 1/10th fatality rate compared w/ US and Europe, by @OsoroEric and colleagues

----------------------------------------------------------

* Isaac A. Ngere et al. 2021. High Seroprevalence of SARS-CoV-2 Eight Months After Introduction in Nairobi, Kenya. Preprints with The Lancet. Posted: 17 May 2021. 26p. Available at SSRN: https://ssrn.com/abstract=3844795 https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3844795

Abstract
Background: The lower-than-expected COVID-19 morbidity and mortality in Africa has been attributed to multiple factors, including weak surveillance. We set out to estimate the burden of SARS-CoV-2 infections eight months into the epidemic in Nairobi, Kenya.

Methods: We conducted a population based cross-sectional survey using multi-stage random sampling to select households within Nairobi in November 2020. Sera from consenting household members were tested for IgM and IgG antibodies to SARS-CoV-2. Seroprevalence was estimated after adjusting for population structure and test performance. Risk factors were determined using logistic regression and Infection fatality ratios (IFRs) calculated by comparing our estimates to reported cases and deaths.

Findings: Of 1,164 individuals from 527 households tested, the adjusted seroprevalence was 34·7% (95%CI 31·8-37·6), indicating that approximately 1·5 million Nairobi residents had been infected. Some 261 (49·5%) households had at least one positive participant, and positivity rates increased in more densely populated areas (spearman’s r=0·63; p=0·009). Individuals aged 20-59 years had up to 2-fold higher seropositivity when compared to those aged 0-9 years or ≥60 years. The IFR was 40 per 100,000 infections, with individuals ≥40 years old having higher IFRs.

Interpretation: Over one third of Nairobi residents in half of the households were infected by November 2020, indicating extensive transmission in the city, comparable to countries reporting more severe forms of the pandemic. However, the IFR was >10 margd:-fold lower than that reported in Europe and the United States, supporting the perceived low morbidity and mortality in sub–Saharan Africa.

73margd
Maio 19, 2021, 7:56 am

Indian data suggests runaway COVID infections as deaths hit daily record
Tanvi Mehta, Manas Mishra | May 19, 20216:25

Nearly two-thirds of people tested in India have shown exposure to COVID-19, a chain of private laboratories said on Wednesday, indicating a runaway spread of the virus...

https://www.reuters.com/world/india/india-reports-267334-new-coronavirus-infecti...

74margd
Maio 19, 2021, 8:12 am

Ohio lottery, perception of probability :

Kyle Griffin (MSNBC) @kylegriffin1 | 12:00 PM · May 18, 2021:
Ohio health officials experienced their highest vaccination day in three weeks
after the state announced its $1 million lottery campaign to encourage vaccinations.
-----------------------------------------------------------

Ariel Edwards-Levy (CNN) @aedwardslevy | 1:51 PM · May 18, 2021
there is a fascinating case study here about people's understanding of probability

to be clear, this is not a complaint about the campaign!

just, to a greater extent than usual over the past year, making informed choices about daily life has involved having to assess a number of variably low-probability events in a way that (for me, at least) is often deeply unintuitive

and from a professional standpoint, I'm fascinated by the way we understand and communicate about those probabilities, and use that information to make decisions

(i.e. also, to be clear, this is not a veiled putdown of anyone for whom the campaign might have been an extra nudge!)

Arnon Mishkin @arnonmishkin · 17h
I think folks are demonstrating significant (though subtle) understanding:
P(total value) = ∑ P(winning $1M) + P(not getting COVID).

Katie Mack @AstroKatie · 17h
Perhaps, but given that the cost-benefit balance on getting the vaccine is ALREADY hugely in favor of getting it, even a minuscule chance of winning money bumps up the benefit. (Though I agree that it's a bit weird if so many people were right on that threshold.)

Ariel Edwards-Levy @aedwardslevy · 17h
yeah, as I said, very much not a complaint about either the campaign or the people who may have been motivated by it!

JomFolezzz @JomFolezzz | 8:22 PM · May 18, 2021
This whole last 14 months has been a case study in people’s understanding of probability.

75margd
Maio 19, 2021, 9:41 am

Europe to Reopen for Travel, Easing Rules for American Tourists
Nikos Chrysoloras | May 19, 2021

European Union governments agreed to allow quarantine-free travel for vaccinated tourists and visitors from countries deemed safe, paving the way for the resumption of hassle-free trans-Atlantic flights.

Ambassadors from the EU’s 27 member states backed a proposal to waive quarantine for those with coronavirus inoculations approved by its drug regulator, including shots from Pfizer Inc., Moderna Inc. and Johnson & Johnson. The approval could be finalized this week and implemented soon after.

Unvaccinated travelers can also avoid quarantine if they come from countries that have controlled the Covid-19 outbreak, meaning a 14-day new-case rate of less than 75 per 100,000, according to two officials familiar with the decision...

https://www.bloomberg.com/news/articles/2021-05-19/europe-opens-door-to-vaccinat...

76margd
Maio 19, 2021, 1:50 pm

COVID-19 may reduce gray matter volume in brain, small study suggests
New research examines a potential connection between gray matter volume and COVID-19.
James Kingsland | May 18, 2021

A study found that patients who required oxygen therapy for COVID-19 had lower gray matter volume in the frontal lobe of their brain compared with patients who did not require supplemental oxygen.

Reduced gray matter in the frontal lobe also had links with more severe disability up to 6 months after recovery from COVID-19.

Patients who experienced fever had lower gray matter volume in the temporal lobe compared with those who did not.

However, the study was small, so scientists need to conduct more research to confirm the results.

Around 15% of patients hospitalized with COVID-19 experience neurological complications. The symptoms, which are more common in severely ill patients, include impaired consciousness, confusion, and agitation.

In a new study, researchers led by Georgia State University in Atlanta analyzed the CT scans of patients undergoing evaluations for neurological symptoms at a specialist hospital in Brescia, Italy.

The team assessed the amount of gray matter, which mostly comprises the cell bodies of neurons, in the outer layer or cortex of the patients’ brains.

Out of a total of 120 patients, 58 had COVID-19, while 62 did not. The team matched the two groups by age, gender, and other diseases.

While the researchers found no significant differences in gray matter volume between the two groups, they did find differences among the patients with COVID-19.

Those who needed oxygen therapy had reduced gray matter in the frontal lobes of their brain compared with those who did not.

Lower gray matter volume in the frontal regions also had links with more severe disability — which the researchers measured on the modified Rankin scale — up to 6 months after discharge from the hospital.

In addition, patients who experienced a fever during their illness had reduced gray matter in the temporal lobes of their brain compared with those who did not have this symptom.

Alterations in mood

The study found that reductions in gray matter in the frontal regions of the brain had associations with agitation, suggesting they may underlie the mood changes that recovered patients often experience.

...The study authors suggest that in the future, researchers could potentially use alterations in gray matter in the frontal and temporal lobes to determine the long-term prognosis of patients or evaluate treatment options.

All of the associations remained statistically significant even after the researchers accounted for preexisting cerebrovascular disease — which affects blood vessels in the head, diabetes, and hypertension.

They write that the infection may indirectly damage the identified brain regions due to fever or lack of oxygen.

....Kuaikuai Duan...a graduate research assistant at TReNDS and Ph.D. student in Georgia Tech’s School of Electrical and Computer Engineering...“we cannot rule out the possibility that the observed differences in gray matter were caused by preexisting overweight or obesity.”

...two previous studies that did detect differences in gray matter between patients with COVID-19 and controls involved MRI scans at around 54 and 90 days after diagnosis.

...findings may only apply to patients hospitalized with COVID-19 who experience neurological complications.

https://www.medicalnewstoday.com/articles/covid-19-may-reduce-gray-matter-volume...
--------------------------------------------------

https://pubs.rsna.org/doi/10.1148/radiol.2020201933

Abdelkader Mahammedi and Roberto Gasparotti et al. 2021. Imaging of Neurologic Disease in Hospitalized Patients with COVID-19: An Italian Multicenter Retrospective Observational Study (Research Letter). Radiology (Published Online: May 21 2020) https://doi.org/10.1148/radiol.2020201933 https://pubs.rsna.org/doi/10.1148/radiol.2020201933

Abstract
Introduction...
Materials and Methods...

Study Design and Patient Population
We used a retrospective, multicenter study design from three major institutions in Italy (University of Brescia, Brescia; University of Eastern Piemonte, Novara; and University of Sassari, Sassari). Institutional review board approval and waivers for informed consent were obtained at all institutions. Our inclusion criteria included
(a) hospitalized patients who were positive for COVID-19 by means of real-time reverse-transcriptase polymerase chain reaction testing (Sentinel Diagnostics, Milan, Italy) of respiratory secretions obtained by means of bronchoalveolar lavage, endotracheal aspirate, nasopharyngeal swab, or oropharyngeal swab from February 29 to April 4, 2020;
(b) presence of acute neurologic symptoms during hospital stay; and
(c) any neurologic imaging studies, including brain or spine imaging.
We reviewed the electronic medical records to extract clinical, laboratory, and demographic data.

Image Acquisition...

Image Interpretation
The neurologic imaging characteristics that were evaluated are listed in Table 1. All scans were initially analyzed by the institution’s own neuroradiologists. Subsequently, all images were reviewed by three neuroradiologists in consensus (R.G., L.S., and A.C., with 30, 14, and 32 years of neuroradiology experience, respectively).

Table 1: Neuroimaging Characteristics of Hospitalized Patients with New Onset of Neurologic Symptoms after COVID-19...

Statistical Analysis

Continuous variables are presented as means ± standard deviations and were compared between patients with altered mental status by using the Student t test; categoric variables are presented as frequencies with percentages. All statistical analyses were performed by using software (Stata, version 15; StataCorp, College Station, Tex). P

77margd
Editado: Maio 20, 2021, 8:43 am

Elaine Maxwell. 2021. Unpacking post-covid symptoms (Editorial). BMJ 19 May 2021;373:n1173 doi: https://doi.org/10.1136/bmj.n1173 https://www.bmj.com/content/373/bmj.n1173

Common, burdensome, and highly variable

...Daugherty and colleagues found that certain conditions were more commonly diagnosed after covid-19 than after other viral lower respiratory tract infections... The estimated 14% incidence of new diagnoses up to six months after SARS-CoV-2 infection is strikingly similar to the 13.7% incidence of self-reported symptoms lasting more than 12 weeks found by the UK Office for National Statistics...Primary care clinicians should expect patients with mild initial infections to report long covid or post-covid symptoms just as frequently as those who were critically ill.

...enduring symptoms are more common in women, those living with social deprivation, and those with pre-existing comorbidities... Importantly, they found that 10% of people developed new diagnoses requiring medical attention more than three weeks after the initial infection, with 4% developing more than one new diagnosis. This feature is well described by people with real life experience, who call it the “corona-coaster.” People who present with late onset symptoms (particularly those not admitted to hospital) report that some healthcare professionals do not associate symptoms with covid-19 and do not provide appropriate assessment and treatment...

It is too early to predict how long clinical sequelae will persist after covid-19, but these symptoms clearly create a major personal burden for many people, with some individuals experiencing difficulty returning to work and some unable to care for dependents... Long covid is also putting a strain on healthcare services, which have been already decimated by the pandemic. Identifying risk factors would facilitate triage and faster access to specialist care. However, one of the peculiarities of long covid is its non-linear progression, hampering attempts to predict who will develop particular symptoms and when...a variety of mechanisms could be at play. Applying these risk factors to clinical practice will probably need long covid to be subdivided into more specific phenotypes.

Daugherty and colleagues’ analyses included people aged 18-65, and although symptom reporting is less common outside this age band,6 evidence is growing that children also experience long covid... In older adults, symptoms could be under-reported because of assumptions that they are due to aging or comorbidities. Healthcare professionals should be alert to the possibility of long covid in anyone with confirmed or suspected covid-19. How to treat these longer term consequences is now an urgent research priority.
-------------------------------------------------------------------------

Sarah E Daugherty et al. 2021. Risk of clinical sequelae after the acute phase of SARS-CoV-2 infection: retrospective cohort study
BMJ 19 May 2021;373:n1098 doi: https://doi.org/10.1136/bmj.n1098 https://www.bmj.com/content/373/bmj.n1098

Abstract
...Results 14% of adults aged 65 or younger who were infected with SARS-CoV-2 (27 074 of 193 113) had at least one new type of clinical sequelae that required medical care after the acute phase of the illness, which was 4.95% higher than in the 2020 comparator group. The risk for specific new sequelae attributable to SARS-Cov-2 infection after the acute phase, including chronic respiratory failure, cardiac arrythmia, hypercoagulability, encephalopathy, peripheral neuropathy, amnesia (memory difficulty), diabetes, liver test abnormalities, myocarditis, anxiety, and fatigue, was significantly greater than in the three comparator groups (2020, 2019, and viral lower respiratory tract illness groups) ... Significant risk differences because of SARS-CoV-2 infection ranged from 0.02 to 2.26 per 100 people... , and hazard ratios ranged from 1.24 to 25.65 compared with the 2020 comparator group.

Conclusions The results indicate the excess risk of developing new clinical sequelae after the acute phase of SARS-CoV-2 infection, including specific types of sequelae less commonly seen in other viral illnesses. Although individuals who were older, had pre-existing conditions, and were admitted to hospital because of covid-19 were at greatest excess risk, younger adults (aged 50 or younger), those with no pre-existing conditions, or those not admitted to hospital for covid-19 also had an increased risk of developing new clinical sequelae. The greater risk for incident sequelae after the acute phase of SARS-CoV-2 infection is relevant for healthcare planning.

78margd
Maio 20, 2021, 8:28 am

Elizabeth M. White and Xiaofei Yang. 2021. Incident SARS-CoV-2 Infection among mRNA-Vaccinated and Unvaccinated Nursing Home Residents (Correspondence). NEJM May 19, 2021. DOI: 10.1056/NEJMc2104849 https://www.nejm.org/doi/full/10.1056/NEJMc2104849

...The sample included 18,242 (nursing home) residents who received at least one dose of mRNA vaccine; 14,669 residents (80.4%) received the Pfizer–BioNTech vaccine, and 3573 (19.6%) received the Moderna vaccine. Of these 18,242 residents, 13,048 also received the second dose of vaccine. A total of 3990 residents were unvaccinated...

The incidence of infection decreased over time among both vaccinated residents and unvaccinated residents (Table 1)...

Across all the study groups, most infections were asymptomatic, and the incidence of both asymptomatic and symptomatic infections decreased. Nursing homes that were located in counties with the highest incidence of SARS-CoV-2 infection had the most incident cases but still had large decreases (Table S2). We observed inconsistent patterns in the incidence of infection among residents relative to rates of vaccination among staff members (Table S3).

These findings show the real-world effectiveness of the mRNA vaccines in reducing the incidence of asymptomatic and symptomatic SARS-CoV-2 infections in a vulnerable nursing home population. Our observation of a reduced incidence of infection among unvaccinated residents suggests that robust vaccine coverage among residents and staff, together with the continued use of face masks and other infection-control measures, is likely to afford protection for small numbers of unvaccinated residents in congregate settings. Still, the continued observation of incident cases after vaccination highlights the critical need for ongoing vaccination programs and surveillance testing in nursing homes to mitigate future outbreaks.

79margd
Maio 20, 2021, 4:19 pm

Yafang Cheng et al. 2021. Face masks effectively limit the probability of SARS-CoV-2 transmission. Science 20 May 2021:
eabg6296 DOI: 10.1126/science.abg6296 https://science.sciencemag.org/content/early/2021/05/19/science.abg6296

...Discussion
...Our analysis was focused on respiratory particles and droplets with diameters smaller than 100 μm (traditional physical definition of aerosols...Because of rapid gravitational settling, respiratory droplets larger than 100 μm are removed from the air within seconds, but they may still reach the upper respiratory tract of persons in close contact and cause infections by carrying large numbers of viruses in their very large liquid volume...Such large droplets, however, are very efficiently (~100%) removed even by simple masks ... further emphasizing the importance and efficacy of face masks for preventing infections. Because of the strong size dependence and to avoid ambiguities, we suggest that diameter range should be explicitly specified when discussing airborne transmission by fine respiratory aerosol particles or larger droplets.

Our results have important implications for understanding and communicating preventive measures against the transmission of airborne viruses including SARS-CoV-2. When people see images or videos of millions of respiratory particles exhaled by talking or coughing, they may be afraid that simple masks with limited filtration efficiency (e.g., 30-70%) cannot really protect them from inhaling these particles. However, as only few respiratory particles contain viruses and most environments are in a virus-limited regime, wearing masks can indeed keep the number of inhaled viruses in a low Pinf regime and explain the observed efficacy of face masks in preventing the spread of COVID-19. However, unfavorable conditions and the large variability of viral loads may lead to a virus-rich regime in certain indoor environments, such as medical centers treating COVID-19 patients. In such environments, high efficiency masks and further protective measures like efficient ventilation should be used to keep the infection risk low. The nonlinear dependence of mask efficacy on airborne virus concentration, i.e., the higher mask efficacy at lower virus abundance, also highlights the importance of combining masks with other preventive measures. Effective ventilation and social distancing will reduce ambient virus concentrations and increase the effectiveness of face masks in containing the virus transmission. Moreover, high compliance and correct use of masks is important to ensure the effectiveness of universal masking in reducing the reproduction number ...

80margd
Maio 21, 2021, 6:30 am

As a dual citizen, I am so happy Canada is finally getting the vaxxes it ordered. Then, I saw the deaths graph (last line) of two such similar countries and realized Americans suffered twice as many deaths as necessary. :( Canada's response wasn't perfect, but geez. Commission(s) of some sort will be necessary to make sure lessons are learned! (For both countries.)

Eric Topol @EricTopol | 4:58 PM · May 18, 2021:
Oh Canada.
Your aggressive 1st dose vaccination strategy is looking good!
@OurWorldInData
Image-graph Canada US # 1st dose vaccinations, Dec 20-May 21, 2021 ( https://twitter.com/EricTopol/status/1394759359918313473/photo/1 )
Image-7-day av new cases, Canada US ( https://twitter.com/EricTopol/status/1394759359918313473/photo/2 )

Eric Topol @EricTopol | 1:26 PM · May 19, 2021:
Also notable is that Canada's prevention of covid fatalities, population adjusted, has consistently outperformed the US for the entire pandemic
Image-#deaths, US Canada ( https://twitter.com/EricTopol/status/1395068312220880901/photo/1 )

81margd
Maio 21, 2021, 9:11 am

Impossible choices: How this Brampton (n Toronto) community explains Canada’s COVID-19 crisis like no other
Dakshana Bascaramurty and Vrunda Bhatt | May 20, 2021

...In (postal code) L6P, 89 per cent of residents are racialized, and 66 per cent are South Asian. The median household income is $102,070, which is 45-per-cent higher than the national average, but only because in many homes, several workers pool their earnings. The median individual income is just $26,139. After the first wave of COVID-19, data made clear that race and class were driving forces of the pandemic: precarious employment, lack of paid sick leave, and crowded or multi-generational housing put people at risk for infection and hospitalization. In the third wave, those statistics remain unchanged. Like other neighbourhoods in Montreal, Surrey, B.C., and Toronto, L6P has carried an outsized burden. Residents doing essential work couldn’t stay home. As a result, the test positivity rate has hovered above 20 per cent...The sacrifices residents of L6P have made to keep so many other Canadians safe and comfortable have largely been invisible – most of the workplace spread at factories, warehouses and construction sites in Brampton has not been made public, and only three out of five people who get COVID-19 in Peel shared information about their jobs with public health...It was 10 months into the pandemic before this city of more than 600,000 got its first COVID-19 assessment centre geared to the South Asian community...a suburban patchwork similar to one you’d find in Langley, B.C., Calgary or Bedford, N.S. – brick-clad townhouses, single-family homes with double garages and McMansions on two-acre plots (latter owned by 2d generation MDs et al.)...L6P is one of the fastest-growing parts of the country...half of Pearson’s Toronto's intl airport) 1,500 drivers live in L6P...

82margd
Maio 21, 2021, 9:15 am

>33 margd: black fungus, contd.

CDC
Mucormycosis

Mucormycosis (previously called zygomycosis) is a serious but rare fungal infection caused by a group of molds called mucormycetes. These molds live throughout the environment. Mucormycosis mainly affects people who have health problems or take medicines that lower the body’s ability to fight germs and sickness. It most commonly affects the sinuses or the lungs after inhaling fungal spores from the air. It can also occur on the skin after a cut, burn, or other type of skin injury...

https://www.cdc.gov/fungal/diseases/mucormycosis/index.html

83margd
Maio 21, 2021, 12:34 pm

Gettings J, Czarnik M, Morris E, et al. Mask Use and Ventilation Improvements to Reduce COVID-19 Incidence in Elementary Schools — Georgia, November 16–December 11, 2020. MMWR Morb Mortal Wkly Rep. ePub: 21 May 2021. DOI: http://dx.doi.org/10.15585/mmwr.mm7021e1external icon https://www.cdc.gov/mmwr/volumes/70/wr/mm7021e1.htm

Summary
What is already known about this topic?
Kindergarten through grade 5 schools educate and address the students’ physical, social, and emotional needs. Preventing SARS-CoV-2 transmission in schools is imperative for safe in-person learning.

What is added by this report?
COVID-19 incidence was 37% lower in schools that required teachers and staff members to use masks and 39% lower in schools that improved ventilation. Ventilation strategies associated with lower school incidence included dilution methods alone (35% lower incidence) or in combination with filtration methods (48% lower incidence).

What are the implications for public health practice?
Mask requirements for teachers and staff members and improved ventilation are important strategies in addition to vaccination of teachers and staff members that elementary schools could implement as part of a multicomponent approach to provide safer, in-person learning environments.

84margd
Editado: Maio 21, 2021, 3:00 pm

How the Covid pandemic ends: Scientists look to the past to see the future
Helen Branswell | May 19, 2021

...pandemics always end. And to date vaccines have never played a significant role in ending them. (That doesn’t mean vaccines aren’t playing a critical role this time. Far fewer people will die from Covid-19 because of them.)

...viruses that caused (past) pandemics underwent a transition. Or more to the point, we did. Our immune systems learned enough about them to fend off the deadliest manifestations of infection, at least most of the time. Humans and viruses reached an immunological détente. Instead of causing tsunamis of devastating illness, over time the viruses came to trigger small surges of milder illness. Pandemic flu became seasonal flu.

The viruses became endemic.

If the pattern holds, and it is expected to, SARS-2 will at some point join a handful of human coronaviruses that cause colds, mainly in the winter, when conditions favor their transmission...

When will that happen? That’s the big, unanswerable question. ... Experience from the last four pandemics ... would suggest that viruses morph from pandemic pathogens to endemic sources of disease within a year and a half or two of emerging. But all of those pandemics were influenza pandemics. A different pathogen could mean we’ll see a different pattern.

...Lavine and her co-authors* predicted that as older adults — most susceptible to hospitalization and death with Covid — acquire experience coping with the virus, it will no longer induce severe disease, at least not in most of those people. (Nothing is absolute; flu, for instance, occasionally kills previously healthy people.)

That immune system training will likely turn future Covid-19 infections into the equivalent of a cold, the authors concluded. Over time, as a degree of protection becomes more standard in adults, the people who will most commonly catch Covid will be young kids, in whom infections even now are rarely serious. That’s the pattern with human coronavirus infections.

https://www.statnews.com/2021/05/19/how-the-covid-pandemic-ends-scientists-look-...
-------------------------------------------------------

* Jennie S. Lavine et al. 2021. Immunological characteristics govern the transition of COVID-19 to endemicity. Science 12 Feb 2021: Vol. 371, Issue 6530, pp. 741-745 DOI: 10.1126/science.abe6522 https://science.sciencemag.org/content/371/6530/741.long

85margd
Maio 21, 2021, 3:02 pm


Coronavirus (COVID-19) Infection Survey, UK: 21 May 2021

Estimates for England, Wales, Northern Ireland and Scotland. This survey is being delivered in partnership with University of Oxford, University of Manchester, Public Health England and Wellcome Trust. This study is jointly led by the ONS and the Department for Health and Social Care (DHSC) working with the University of Oxford and UK Biocentre to collect and test samples.

Release date: 21 May 2021
Next release: 28 May 2021

https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditio...

86margd
Editado: Maio 21, 2021, 3:29 pm

BioNTech CEO says COVID-19 vaccine expected to be up to 75 per cent effective against variant first detected in India
0:39 ( https://globalnews.ca/video/rd/61f79f68-b9de-11eb-92de-0242ac110007/ )

BioNTech CEO Ugur Sahin said Thursday that the COVID-19 vaccine developed with Pfizer should be roughly as effective against the new variant first detected in India, with it expected to be 70 to 75 per cent effective at protecting against infections.
--------------------------------------------

ETA: zeynep tufekci (UNC) zeynep | 12:42 PM · May 21, 2021:
I just watched this interview in Turkish and it has been mistranslated. Dr. Sahin says they do expect 70-75% protection against symptomatic illness for B.1.617.2 variant, but he does NOT say "up to". He says it's not a hard number as they're still testing and will know more soon.

Also note that even a slightly reduced efficacy in a vaccine’s ability to prevent mild symptoms does not imply an inability to prevent severe illness or death, and 75% efficacy for any symptoms whatsoever is way higher than anything many had realistically hoped for last year.

Let me emphasize. This was not a precise number provided in a precise manner. For all I can tell from how it went down, he might’ve meant his estimate for minimum efficacy. Regardless, he immediately said don’t really know yet, and we’ll know better in a few weeks. No news here.

Replying to @gstvbjrnstrnd and @mugecevik
He was pressed by the minister, clearly spoke off-the-cuff, and made it clear he didn’t have a precise number. There never should’ve been a news article in my opinion. Let alone the “up to” insertion, however it happened. We will get numbers and then we can talk about them.
--------------------------------------------

Eric Feigl-Ding @DrEricDing | 2:02 PM · May 21, 2021:
https://twitter.com/DrEricDing/status/1395802172554612739
Whoa—Pfizer vaccine & #B16172 variant—the founder of BioNTech estimates their Pfizer vaccine to have a weakened efficacy of just 70-75% efficacy against B.1.617.2 variant (via India). A sizeable drop from 95%.

2) To be clear, 70-75% efficacy still good, but it is nothing like 95%, and not enough to stop using masks. A weakened efficacy for a variant also suggests possible reinfection risk as well and likely more break through infections. This is no time to take off masks.

3) there is a good reason UK and WHO are concerned by the Indian origins #B16172 variant. It’s also poised to become the new dominant variant soon in UK

4) “Since blood tests on the South Africa #B1351 variant had shown similar results, promising real-world data against SA variant of about 75% led him to believe that its actual effectiveness against the Indian variant “might be in the same range.”

5) Dr @larrybrilliant is right—it is *not* enough that the vaccine is “effective” for preventing severe disease, a virus will keep spreading to uninfected and less than fully vaccinated people, which is still a lot of people in UK and the rest of the world

Larry Brilliant* MD, MPH @larrybrilliant | 1:09 PM · May 18, 2021
the word “effective” as in “the vaccine protects me or you” is not the only issue. As B117 “outpaced/displaced” the ancestral strain and B617.2 is now outrunning B117 in the UK this much it means many more cases and hospitals overrun in UK and more counties. Sigh. More to come

Eric Feigl-Ding @DrEricDing | 12:52 AM · May 19, 2021:
NEW—the faster transmission #B16172 variant will likely dethrone #B117 and become the dominant variant in United Kingdom “in a matter of days” and could pose unknown dangers. Since B16172 was upgraded last week by both WHO & UK, it has *doubled* in cases. https://cnbc.com/2021/05/18/covid-variant-from-india-could-become-dominant-in-th...

* Larry Brilliant MD, MPH @larrybrilliant--Epidemiologist, CEO, Pandefense, Snr. Advisor, Skoll Fnd, prev: WHO, Google, Prof, U Mich, CNN, TED Prize. TIME100. co-founder, Seva, The Well: Science & Faith

87margd
Maio 22, 2021, 7:17 am

Mix-and-match COVID vaccines trigger potent immune response
Preliminary results from a trial of more than 600 people are the first to show the benefits of combining different vaccines.
Ewen Callaway | 19 May 2021

...Preliminary results from the (Spanish) trial of more than 600 people — announced in an online presentation* on 18 May — are the first to show the benefits of combining different coronavirus vaccines. A UK trial of a similar strategy reported safety data last week, and is expected to deliver further findings on immune responses soon.

Because of safety concerns, several European countries are already recommending that some or all people who were given a first dose of the vaccine developed by the University of Oxford, UK, and AstraZeneca in Cambridge, UK, get another vaccine for their second dose. Researchers hope that such mix-and-match COVID-19 vaccination regimens will trigger stronger, more robust immune responses than will two doses of a single vaccine, while simplifying immunization efforts for countries facing fluctuating supplies of the various vaccines.

...The Pfizer–BioNTech booster seemed to jolt the immune systems of the Oxford–AstraZeneca-dosed participants, reported Magdalena Campins, an investigator on the CombivacS study at the Vall d’Hebron University Hospital in Barcelona, Spain. After this second dose, participants began to produce much higher levels of antibodies than they did before, and these antibodies were able to recognize and inactivate SARS-CoV-2 in laboratory tests. Control participants who did not receive a booster vaccination experienced no change in antibody levels.

That is what researchers hoped for and expected from mixing different vaccines, a strategy known as a heterologous prime and boost, which has been deployed for vaccines against other diseases, such as Ebola. “These responses look promising and show the potential of heterologous prime–boost regimens,” says Dan Barouch, director of the Center for Virology and Vaccine Research at Beth Israel Deaconess Medical Center in Boston, Massachusetts.

(Zhou Xing, an immunologist at McMaster University in Hamilton, Canada) says the antibody response to the Pfizer boost seems to be even stronger than the one most people generate after receiving two doses of the Oxford–AstraZeneca vaccine, according to earlier trial data. But it is not clear how those responses compare with those seen in people who receive two doses of mRNA vaccines such as Pfizer–BioNTech’s, which tend to trigger an especially potent antibody response after a second dose.

...Last week, a UK study called Com-COV, which analysed combinations of the same two vaccines, found that people in the mix-and-match groups experienced higher rates of common vaccine-related side effects, such as fever, than did people who received two doses of the same vaccine**. In the Spanish CombivacS trial, mild side effects were common, and similar to those seen in standard COVID-19 vaccine regimens. None was deemed severe.

https://www.nature.com/articles/d41586-021-01359-3
--------------------------------------------------------
* (In Spanish)
El uso combinado de las vacunas de AstraZeneca y Pfizer contra el SARS-CoV-2 ofrece una potente respuesta inmunitaria
18/05/2021
https://www.isciii.es/Noticias/Noticias/Paginas/Noticias/Presentaci%c3%b3n-resul...

** Shaw, R. H. et al. Lancet https://doi.org/10.1016/S0140-6736(21)01115-6 (2021).

88margd
Maio 22, 2021, 7:48 am

Press Release
Nation’s largest RN union condemns CDC rollback on Covid protection guidance
National Nurses United | May 14, 2021

...National Nurses United cites concerns with the new guidance including:

A continued high number of Covid cases...
Circulation of Covid variants of concern...
Unanswered questions about vaccines...
Preventing and reducing transmission of Covid requires multiple layers of protective measures...

The recent guidelines are unjust and will disproportionately harm Black, Indigenous, and people of color...

National Nurses United said the new CDC guidance underlines the importance of OSHA issuing a long overdue OSHA emergency temporary standard (ETS) on infectious diseases without delay...

https://www.nationalnursesunited.org/press/nurses-condemns-cdc-rollback-of-covid...

89margd
Maio 22, 2021, 8:13 am

Two vaccine doses needed for strong protection against variant found in India, data show
UK government figures suggest single shot less effective against fast-spreading Covid-19 strain
John Burn-Murdoch, Anna Gross and Sarah Neville | May 22, 2021

...Two vaccine doses provided 81 per cent protection against the B.1.617.2 variant found in India, and 87 per cent against the B.1.1.7 strain first identified in Kent in south-east England, according to the Public Health England data that was presented to a meeting of the government’s New and Emerging Respiratory Virus Threats Advisory Group (Nervtag).

Two people who attended the Nervtag meeting on Friday said the data showed that one dose offered 33 per cent protection against symptomatic infection from B.1.617.2, and 51 per cent against B.1.1.7.

This suggests a single shot offers 35 per cent less protection against B.1.617.2 compared with B.1.1.7, according to Financial Times analysis.

The PHE figures aggregate data from the BioNTech/Pfizer and Oxford/AstraZeneca jabs...

https://www.ft.com/content/a70d423a-7d7c-4736-8828-0a485d7c3a8e

90margd
Maio 22, 2021, 8:32 am

What Activities Can Unvaccinated Children Do? Advice From 828 Experts.
This phase of the pandemic, when adults can be vaccinated but young children cannot, is confusing for many families.
Claire Cain Miller, Margot Sanger-Katz and Kevin Quealy | May 21, 2021

Since vaccinated adults are no longer required to wear masks in public places, should unvaccinated children go to them?

Can families with young children socialize indoors without precautions with other households with unvaccinated children?

When it comes to Covid, how should parents think about children doing outdoor activities this summer where masks aren’t an option, like swimming or eating at a barbecue?

When it comes to Covid, how should parents think about children doing indoor activities this summer where masks aren’t an option, like sleeping indoors at camp or eating inside a restaurant?

This summer, how should parents think about unvaccinated children traveling by plane, assuming they’re masked?

Is it necessary for children to wear masks at outdoor playgrounds or while playing outdoor sports now?

Our survey was distributed by email to members of five groups: the Society for Epidemiologic Research; the Council of State and Territorial Epidemiologists; the Pediatric Infectious Diseases Society; the Decision Sciences for Child Health Collaborative; and the American Academy of Pediatrics subspecialty group on epidemiology, public health and evidence. Responses were collected between April 28 and May 10. After the announcement of the C.D.C.’s new policy on mask use for vaccinated people on May 13, we sent a series of follow-up questions to survey respondents and collected responses between Monday and Thursday. For various reasons, the number of responses differed by question.

https://www.nytimes.com/2021/05/21/upshot/covid-children-advice-experts.html

91margd
Maio 22, 2021, 11:16 am

Dr. Angela Rasmussen (U Saskatchewan) @angie_rasmussen | 11:13 AM · May 21, 2021:
A great reminder from the only human pathogen we successfully eradicated through vaccination:
to immunize the global population against smallpox, the vaccine was manufactured all over the world.

Quote Tweet
Dr Jenner’s House @DrJennersHouse · May 21
Freeze-dried smallpox vaccine was manufactured in laboratories around the world.
These examples in our collection are from Iran, India, Belgium, the USSR, and the UK.

Image-Five boxes of dried smallpox vaccine from different suppliers. ( https://twitter.com/DrJennersHouse/status/1395757551095095296/photo/1 )

92margd
Maio 23, 2021, 8:34 am

Florian Krammer (Icahn virologist) @florian_krammer | 6:21 AM · May 23, 2021
Vaccine effectiveness of BNT162b2 against B.1.617.2 = 88%
Vaccine effectiveness of AZ against B.1.617.2 = 60%

DocMelbourne @MockDelbourne:
Small data set for AZ (12 week dosing means fewer samples) and even these data were taken shortly after the second dose. Every reason to hope that in a few weeks we should have much better data for AZ vs this variant.

Florian Krammer @florian_krammer:
I completely agree. I am happy to see that both vaccines work.

------------------------------------------------------

Jamie Lopez Bernal et al. 2021. Effectiveness of COVID-19 vaccines against the B.1.617.2 variant. 15 p. https://khub.net/documents/135939561/430986542/Effectiveness+of+COVID-19+vaccine...

This preprint reports new research that has not been certified by peer review

Abstract
...Results
Effectiveness was notably lower after 1 dose of vaccine with B.1.617.2 cases 33.5%...compared to B.1.1.7 cases 51.1%...with similar results for both vaccines. With BNT162b2 2 dose effectiveness reduced from 93.4%...with B.1.1.7 to 87.9%...with B.1.617.2. With ChAdOx12 dose effectiveness reduced from 66.1%...with B.1.1.7 to 59.8%...with B.1.617.2.Sequenced cases detected after 1 or 2 doses of vaccination had higher odds of infection with B.1.617.2 compared to unvaccinated cases (OR 1.40...).

Conclusions After 2 doses of either vaccine there were only modest differences in vaccine effectiveness with the B.1.617.2 variant. Absolute differences in vaccine effectiveness were more marked with dose 1. This would support maximising vaccine uptake with 2 doses among vulnerable groups

93margd
Editado: Maio 23, 2021, 8:49 am

To put vaccine connection, if any, in perspective, COVID-19 patients too often suffer severe myocarditis in acute disease and aftermath, e.g., https://www.bmj.com/content/373/bmj.n1098

C.D.C. Is Investigating a Heart Problem in a Few Young Vaccine Recipients
Apoorva Mandavilli | May 22, 2021

...The C.D.C.’s review of the reports is in the early stages, and the agency has yet to determine whether there is any evidence that the vaccines caused the heart condition. It has posted some guidance on its website for doctors and clinicians to be alert to unusual heart symptoms among young people who had just received their shots.

“It may simply be a coincidence that some people are developing myocarditis after vaccination,” said Dr. Celine Gounder, an infectious disease specialist at Bellevue Hospital Center in New York. “It’s more likely for something like that to happen by chance, because so many people are getting vaccinated right now.”

The cases seem to have occurred predominantly in adolescents and young adults about four days after their second dose of one of the mRNA vaccines, which are Moderna and Pfizer-BioNTech. And the cases were more common in males than in females.

“Most cases appear to be mild, and follow-up of cases is ongoing,” the vaccine safety group said. The C.D.C. strongly recommends Covid vaccines for Americans ages 12 and older...

https://www.nytimes.com/2021/05/22/health/cdc-heart-teens-vaccination.html

94margd
Maio 23, 2021, 9:30 am

Krutika Kuppalli et al. 2021. India's COVID-19 crisis: a call for international action (Comment). The Lancet (May 14, 2021) DOI:https://doi.org/10.1016/S0140-6736(21)01121-1 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01121-1/fullt...

...As a group of clinicians, public health professionals, and scientists working in India or with research and clinical collaborators in India, we call for eight steps the international community must take to help address the crisis in India.

(1) expanding health-care capacity
(2) support expanded access to COVID-19 vaccines in India
(3) support the scale-up of laboratory testing and genomic sequencing of SARS-CoV-2
(4) help provide technical assistance and training for people on the ground, especially for non-physician health-care providers to triage, administer testing, care for patients with mild COVID-19, and vaccinate people.
(5) work with state and local partners in India to assist with the logistics of securing and transporting resources, such as oxygen canisters, oxygen concentrators, and medications, operationalising field hospitals, developing isolation and quarantine centres, improving infection prevention and control practices, and expanding telemedicine services.
(6) fill the gaps and ensure that global supply chains of medications are not derailed by helping to support the scale-up of manufacturing in other parts of the world and developing relationships with industry to ensure medications will be available.
(7) strengthen surveillance systems, travel restrictions, and mandatory travel quarantine for individuals returning from India must be implemented to help control the spread of SARS-CoV-2 to neighbouring countries.
(8) work with India to deliberate on and initiate stricter, science-guided mitigation measures to curb the spread of SARS-CoV-2 and call for accurate reporting of COVID-19 cases and deaths.

95margd
Maio 23, 2021, 2:46 pm

The 60-Year-Old Scientific Screwup That Helped Covid Kill
All pandemic long, scientists brawled over how the virus spreads. Droplets! No, aerosols! At the heart of the fight was a teensy error with huge consequences.
Megan Molteni | 05.13.2021

...The distinction between droplet and airborne transmission has enormous consequences. To combat droplets, a leading precaution is to wash hands frequently with soap and water. To fight infectious aerosols, the air itself is the enemy. In hospitals, that means expensive isolation wards and N95 masks for all medical staff.

The books Marr flipped through drew the line between droplets and aerosols at 5 microns. A micron is a unit of measurement equal to one-millionth of a meter. By this definition, any infectious particle smaller than 5 microns in diameter is an aerosol; anything bigger is a droplet. The more she looked, the more she found that number. The WHO and the US Centers for Disease Control and Prevention also listed 5 microns as the fulcrum on which the droplet-aerosol dichotomy toggled.

There was just one literally tiny problem: “The physics of it is all wrong,” Marr says. That much seemed obvious to her from everything she knew about how things move through air. Reality is far messier, with particles much larger than 5 microns staying afloat and behaving like aerosols, depending on heat, humidity, and airspeed. “I’d see the wrong number over and over again, and I just found that disturbing,” she says. The error meant that the medical community had a distorted picture of how people might get sick.

...The medical textbooks simply stated (5-micron figure ) as fact, without a citation, as if it were pulled from the air itself...

https://www.wired.com/story/the-teeny-tiny-scientific-screwup-that-helped-covid-...
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Randall, Katherine and Ewing, E. Thomas and Marr, Linsey and Jimenez, Jose and Bourouiba, Lydia, How Did We Get Here: What Are Droplets and Aerosols and How Far Do They Go? A Historical Perspective on the Transmission of Respiratory Infectious Diseases (April 15, 2021). Available at SSRN: https://ssrn.com/abstract=3829873 https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3829873

Abstract

The COVID-19 pandemic has exposed major gaps in our understanding of the transmission of viruses through the air. These gaps slowed recognition of airborne transmission of the disease, contributed to muddled public health policies, and impeded clear messaging on how best to slow transmission of COVID-19. In particular, current recommendations have been based on four tenets: 1) respiratory disease transmission routes can be viewed mostly in a binary manner of "droplets" versus "aerosols"; 2) this dichotomy depends on droplet size alone; 3) the cutoff size between these routes of transmission is 5 μm; and 4) there is a dichotomy in the distance at which transmission by each route is relevant. Yet, a relationship between these assertions is not supported by current scientific knowledge. Here, we revisit the historical foundation of these notions, and how they became entangled from the 1800s to today, with a complex interplay among various fields of science and medicine. This journey into the past highlights potential solutions for better collaboration and integration of scientific results into practice for building a more resilient society with more sound, far-sighted, and effective public health policies.

96margd
Editado: Maio 24, 2021, 8:20 am

For now, kiddles will want to stay masked up and get vaxxed if they can?

No 10 ‘tried to block’ data on spread of new Covid variant in English schools
Carole Cadwalladr | 22 May 2021

Downing Street leaned on Public Health England not to publish crucial data on the spread of the new Covid variant in schools, documents seen by the Observer have suggested. Scientists, union officials and teachers said that the lack of transparency was “deeply worrying”.

The focus of their anger concerns the pre-print of a PHE (\ Public Health England) report that included a page of data on the spread of the India Covid-19 variant (B.1.617) in schools. But when the report was published on Thursday 13 May, the page had been removed. It was the only one that had been removed from the pre-print. Days later, the government went ahead with its decision to remove the mandate on face coverings in English schools.

Evidence seen by the Observer suggests No 10 (Downing St) was directly involved in the decision not to publish it. The prime minister’s office acknowledged it was in correspondence with PHE officials about presentation of the data but vigorously denied this constituted “interference” or “pressure”.

...Christina Pagel, professor of operational research at University College London, said the situation was very troubling. “It feels like bad news that we’re not being told.

“There is a narrative that schools are safe but the data clearly shows this variant can and does spread in schools. Two weeks ago, the Singaporean health minister closed schools because of the risk of greater spread in children of this variant.

...Jon Richards, head of education for Unison, said the union has repeatedly asked for this data for weeks. “We were told it would be in the report last Thursday but it wasn’t. We were then told it would be published this week but that report has simply not appeared. In the meantime, the government has gone and lifted the rule on face coverings.”...

https://www.theguardian.com/world/2021/may/22/no-10-tried-to-block-data-on-sprea...

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Colin Davis @ProfColinDavis | 7:00 AM · May 24, 2021:
I gather Russell Viner* has been on the radio to tell us again about how schools are not a source of COVID transmission.
So here are a few graphs about what's been happening in Bolton.
First, let's look at which age groups currently have the highest rates of infection.
Image-graph cases by age group ( https://twitter.com/ProfColinDavis/status/1396783107676778498/photo/1 )

* Russell Viner--president of the Royal College of Paediatrics and Child Health. (Wikipedia)

97margd
Maio 24, 2021, 8:03 am

India reportedly orders social media platforms to remove references to ‘Indian variant’ of COVID-19
The scientific community discourages calling virus variants by place names
Kim Lyons | May 23, 2021

India’s government has sent notices to social media platforms ordering them to take down content that refers to an “Indian variant” of the COVID-19 virus...

It was not clear which social media outlets received the letter, but India’s government has recently ordered Twitter to remove tweets and Facebook and Instagram to take down posts that were critical of its handling of the coronavirus pandemic.

...while India’s approach to censoring information about the coronavirus and variants is extreme, WHO and other health organizations and scientists are critical of the practice of referring to viruses and variants with geographic nicknames, since it can be stigmatizing and inaccurate. The WHO’s 2015 guidance for naming infectious diseases discourages using place names, human names, or animal species names.

However, as National Geographic notes in its very good explainer* about how virus variants get their names, the current naming conventions are cumbersome and confusing, making them difficult for non-scientists to grasp or remember. National Geographic reports that WHO is working with virologists to create a new way of naming viruses.

https://www.theverge.com/2021/5/23/22449898/india-social-media-platforms-remove-...

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* How virus variants get their confusing names—and how to make them better
Right now we're stuck with jumbles of letters and numbers, or country names that stigmatize people from that region. Experts have a plan to fix that.
Amy McKeever | April 20, 2021

https://www.nationalgeographic.com/science/article/how-virus-variants-get-their-...

98margd
Maio 25, 2021, 1:16 pm

Eric Topol @EricTopol | 12:47 PM · May 25, 2021:
A 10% reduction in US mobility/Δ physical distancing was associated with
a 17.5% reduction in covid case growth 2 weeks later
-------------------------------------------------


Gregory A. Wellenius et al. 2021. Impacts of social distancing policies on mobility and COVID-19 case growth in the US. Nature Communications volume 12, Article number: 3118 (25 May 2021) https://www.nature.com/articles/s41467-021-23404-5

Abstract
Social distancing remains an important strategy to combat the COVID-19 pandemic in the United States. However, the impacts of specific state-level policies on mobility and subsequent COVID-19 case trajectories have not been completely quantified. Using anonymized and aggregated mobility data from opted-in Google users, we found that state-level emergency declarations resulted in a 9.9% reduction in time spent away from places of residence. Implementation of one or more social distancing policies resulted in an additional 24.5% reduction in mobility the following week, and subsequent shelter-in-place mandates yielded an additional 29.0% reduction. Decreases in mobility were associated with substantial reductions in case growth two to four weeks later. For example, a 10% reduction in mobility was associated with a 17.5% reduction in case growth two weeks later. Given the continued reliance on social distancing policies to limit the spread of COVID-19, these results may be helpful to public health officials trying to balance infection control with the economic and social consequences of these policies.

99margd
Maio 25, 2021, 1:25 pm

Supertasters tend to dislike strong, bitter foods like raw broccoli, grapefruit juice, coffee and dark chocolate. www.supertaster.com

Eric Topol @EricTopol · 1h
Are you a supertaster of bitter?
The taste receptor T2R38 gene variants are associated with some protective covid innate immune features

Henry P. Barham et al. 2021. Association Between Bitter Taste Receptor Phenotype and Clinical Outcomes Among Patients With COVID-19. JAMA Netw Open. May 25, 2021;4(5):e2111410. doi:10.1001/jamanetworkopen.2021.11410 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2780134

Key Points
Question What is the association between the bitter taste receptor phenotype and outcomes after infection with SARS-CoV-2?

Findings In this cohort study of 1935 adults, 266 tested positive for SARS-CoV-2, and those who experienced low intensity of bitter tastes or no bitter tastes (nontasters) were significantly more likely to test positive for SARS-CoV-2, to be hospitalized, and to be symptomatic for a longer duration. Conversely, those who experienced greater intensity of bitter tastes (supertasters) represented 5.6% of patients infected with SARS-CoV-2, suggesting enhanced innate immune protection.

Meaning This study suggests that bitter taste receptor allelic variants are associated with innate immune fitness toward SARS-CoV-2 and can be used to correlate with clinical course and prognosis of COVID-19.

Abstract...
Conclusions and Relevance This cohort study suggests that T2R38 receptor allelic variants were associated with participants’ innate immune response toward SARS-CoV-2. The T2R phenotype was associated with patients’ clinical course after SARS-CoV-2 infection. Nontasters were more likely to be infected with SARS-CoV-2 than the other 2 groups, suggesting enhanced innate immune protection against SARS-CoV-2...

100margd
Maio 25, 2021, 1:44 pm

Eric Topol @EricTopol | 10:59 AM · May 25, 2021:
Study of infectiousness assessing viral load in more than 25,000 people
confirms impact of
B.1.1.7,
timing,
age and that
asymptomatics can be as infectious as those with symptoms, hospitalized

Terry C. Jones et al. 2021. Estimating infectiousness throughout SARS-CoV-2 infection course. Science 25 May 2021:
eabi5273 DOI: 10.1126/science.abi5273 https://science.sciencemag.org/content/early/2021/05/24/science.abi5273

Abstract
Two elementary parameters for quantifying viral infection and shedding are viral load and whether samples yield a replicating virus isolate in cell culture. We examined 25,381 German SARS-CoV-2 cases, including 6110 from test centres attended by pre-symptomatic, asymptomatic, and mildly-symptomatic (PAMS) subjects, 9519 who were hospitalised, and 1533 B.1.1.7 lineage infections. The youngest had mean log10 viral load 0.5 (or less) lower than older subjects and an estimated ~78% of the peak cell culture replication probability, due in part to smaller swab sizes and unlikely to be clinically relevant. Viral loads above 109 copies per swab were found in 8% of subjects, one-third of whom were PAMS, with mean age 37.6. We estimate 4.3 days from onset of shedding to peak viral load (8.1) and cell culture isolation probability (0.75). B.1.1.7 subjects had mean log10 viral load 1.05 higher than non-B.1.1.7, with estimated cell culture replication probability 2.6 times higher.

101margd
Maio 25, 2021, 1:49 pm

B.1.617

Deepti Gurdasani (Queen Mary U of London) @dgurdasani1 | 3:57 AM · May 25, 2021
Myth:
High infection rates in children don't matter because they don't translate to more hospitalisations because - children don't transmit + vaccination.

Fact:
Rapid spread from school age grps into community & exponential rise in hospitalisations in Bolton in line with cases

Image-UK cases by 10 top towns ( https://twitter.com/dgurdasani1/status/1397099613463711744/photo/1 )
Image-UK hospitalization rates ( https://twitter.com/dgurdasani1/status/1397099613463711744/photo/2 )

102margd
Maio 25, 2021, 3:45 pm

No one's safe anymore: Japan's Osaka city crumples under COVID-19 onslaught
Kiyoshi Takenaka | May 24, 2021

Hospitals in Japan's second largest city of Osaka are buckling under a huge wave of new coronavirus infections, running out of beds and ventilators as exhausted doctors warn of a "system collapse", and advise against holding the Olympics this summer.

Japan's western region home to 9 million people is suffering the brunt of the fourth wave of the pandemic, accounting for a third of the nation's death toll in May, although it constitutes just 7% of its population.

The speed at which Osaka's healthcare system was overwhelmed underscores the challenges of hosting a major global sports event in two months' time, particularly as only about half of Japan's medical staff have completed inoculations...

https://www.reuters.com/world/asia-pacific/no-ones-safe-anymore-japans-osaka-cit...

103margd
Editado: Maio 25, 2021, 5:48 pm

COVID-19 Vaccine Breakthrough Infections Reported to CDC — United States, January 1–April 30, 2021. MMWR Morb Mortal Wkly Rep. ePub: 25 May 2021. DOI: http://dx.doi.org/10.15585/mmwr.mm7021e3 https://www.cdc.gov/mmwr/volumes/70/wr/mm7021e3.htm

Zain Chagla (McMaster U) @zchagla | 3:38 PM · May 25, 2021
Breakthrough cases data in United States after 101 million doses (fully vaccinated)
10262 cases, 27% asymptomatic
Of symptomatic, 706 hospitalized for COVID, 160 died (although 28 were asymptomatic)

While these numbers seem scary
In the same interim - 12 million cases of COVID-19 in the USA, 220000 deaths.

So mapped out (clearly not perfect estimate due to time lag etc) but
0.08% of cases and 0.07% of deaths represented by people fully vaccinated.

Vincent Rajkumar (Mayo Clinic) @VincentRK · 1h
Replying to @zchagla
What do you think of the CFR of 1.2% (I excluded the asymptomatic deaths)? And the hospitalization rate of symptomatic COVID of 13%, and the 13% mortality in hospitalized patients? Something is not right.

margd: To be contd.?

104John5918
Maio 26, 2021, 12:06 am

Jane Goodall says humanity's 'disrespect of the natural world' brought on the pandemic (Live Science)

Legendary primatologist Jane Goodall says the COVID-19 pandemic has highlighted the need for humans to develop a new, more sustainable relationship with nature, according to news reports.

"We basically brought this {pandemic} on ourselves by our disrespect of the natural world, forcing animals closer to people, making it easier for a pathogen to jump from an animal to a person," Goodall said in an interview with AFP. "Hopefully this pandemic has woken people up. We must develop a new relationship with the natural world."

Though the exact origin of the novel coronavirus that causes COVID-19 has yet to be found, scientists know the virus originated in an animal before making its way into the human population...

105margd
Maio 26, 2021, 10:50 am

Moderna Vaccine Highly Effective in Adolescents, Company Says
The U.S., which has a surplus of vaccines, could soon have two options for teens while many countries face shortages.
Emily Anthes | May 25, 2021

Moderna said on Tuesday that its coronavirus vaccine, authorized only for use in adults, was powerfully effective in 12- to 17-year-olds. In a clinical trial of the vaccine in adolescents, there were no cases of symptomatic Covid-19 among fully vaccinated teens, the company reported in a news release.

Moderna plans to apply to the Food and Drug Administration in June for authorization to use the vaccine in adolescents. If approved, its vaccine would become the second Covid-19 vaccine available to U.S. adolescents, after federal regulators authorized the Pfizer-BioNTech vaccine for 12- to 15-year-olds earlier this month.

The Pfizer shot was initially authorized for use in people 16 and older, while Moderna’s has been available for those 18 and up...

https://www.nytimes.com/2021/05/25/health/coronavirus-moderna-vaccine-adolescent...

106margd
Maio 26, 2021, 11:26 am

Zach Brennan (Endpoint News) @ZacharyBrennan | 9:38 PM · May 25, 2021
FDA quietly drops an updated guidance this afternoon to note that it may decline to review and process further EUA requests other than those for vaccines whose developers have already engaged with the agency

Interesting move given that other countries often rely on FDA and other stringent regulators’ decisions in making their own decisions on medical products

Vincent Rajkumar (Mayo Clinic) @VincentRK · 31m
Not sure this is a good idea.

107margd
Maio 26, 2021, 12:13 pm

Eric Topol @EricTopol | 11:54 AM · May 26, 2021:
One of the most important essays yet published on #LongCovid,
delving into the toll of immediate disability and cost for a condition that particularly affects young people

https://nature.com/articles/d41586-021-01392-2
Image- 1st p of article ( https://twitter.com/EricTopol/status/1397581938483892228/photo/1 )
Image- COVID's long shadow over a life ( https://twitter.com/EricTopol/status/1397581938483892228/photo/2 )
Image- life and helath lost per demographic Pakistan UK ( https://twitter.com/EricTopol/status/1397581938483892228/photo/3 )

------------------------------------------

Andrew Briggs and Anna Vassall. 2021. Count the cost of disability caused by COVID-19. Focusing only on cases and deaths hides the pandemic’s lasting health burden on people, societies and economies. Nature 593, 502-505 (26 May 2021) doi: https://doi.org/10.1038/d41586-021-01392-2 https://www.nature.com/articles/d41586-021-01392-2

...Next steps
It has always been difficult to assess the comprehensive burden of health and inequity. This is particularly hard in settings where disease surveillance and health-information systems are weak. The COVID-19 pandemic has shown the importance of these systems, and should drive a global effort to improve them.

Poorer nations are streets ahead of wealthy ones in their use of DALYs (disability-adjusted life years). The metric has highlighted emerging patterns of HIV in south India, for example, and has helped to identify the risk factors behind them. They also inform health planning. Ethiopia and Pakistan both recently used DALYs to define the package of services required to roll out universal health care in their countries.

Why the United States is having a coronavirus data crisis

On the basis of this infrastructure, global DALYs attributable to COVID-19 are likely to appear in the next burden of disease estimates from both the WHO and the IHME (University of Washington’s Institute for Health Metrics and Evaluation). Due to be released in the second half of 2021, these should be the first comprehensive assessments of the relative health burden from COVID-19 globally. They could support the change in measurement and perception that we are highlighting, but they are likely to suffer from a paucity of data, with estimates being highly uncertain.

These data gaps appear because many LMICs (low- and middle-income countries) lack the reporting infrastructure required to calculate QALYs (quality-adjusted life years) and DALYs. Apart from South Africa, most countries in sub-Saharan Africa have been unable to count excess deaths from COVID-19, for example, because of inadequate registration systems. Scaling up of testing remains one of the most urgent public-health needs. But it is challenging for governments to prioritize the gathering of information when they cannot afford essential medicines. The scientific community and HICs (high-income countries) should ramp up investment in health information systems to capture service use, morbidity and mortality.

Research funding to build a global picture of COVID-19-related disease is also needed. The full range of symptoms and consequences is not yet known. These might also depend on a person’s underlying health status and access to care. Longitudinal studies, similar to those beginning to report in the United Kingdom and other HICs should be initiated globally. These should assess the mental-health effects and long-term economic impacts of living with chronic diseases in the wake of COVID-19. Countries such as South Africa — which developed infrastructure to track populations over time for epidemics such as HIV — should lead the way.

Data on both deaths and disease in vulnerable groups is often the most challenging to collect, particularly where access to services is poor. But it can be done. Kenya, for instance, is already conducting surveys that can potentially feed into real-time models of COVID-19 transmission and impact. These should be linked with burden-of-disease estimates.

As we count the devastating losses from COVID-19 — of loved ones, jobs, communities, security — the lasting loss of health must also be tallied. Without the right metrics, we can see, understand and respond to only a fraction of the problem.

108stellarexplorer
Maio 26, 2021, 12:17 pm

Good article on the future of the pandemic in the US. Optimistic and welcome.

https://www.newyorker.com/science/medical-dispatch/the-beginning-of-the-end-of-t...

109margd
Maio 26, 2021, 12:23 pm

Eric Topol @EricTopol | 5:30 PM · May 24, 2021
Some improvement in #LongCovid symptoms after vaccination, with little evidence of worsening, in a small series
Image--changes in symptoms one mo. after vaxx ( https://twitter.com/EricTopol/status/1396941761591668736/photo/1 )
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David T. Arnold et al. 2021. Symptoms After COVID-19 Vaccination in Patients With Persistent Symptoms After Acute Infection: A Case Series. Letter. Annals of Internal Medicine (25 May 2021) https://doi.org/10.7326/M21-1976 https://acpjournals.org/doi/10.7326/M21-1976

110margd
Editado: Maio 26, 2021, 1:03 pm

>108 stellarexplorer: Sure hope the end is near! If some variant changes the rules now, it would be worse than a "slap in the belly with a frozen fish" (my dad's expression ;). So tired. Vaxx helped lift spirits but despair would be palpable if we sink back.

111margd
Maio 26, 2021, 2:29 pm

"this study shows that some variants can partially escape humoral immunity induced by SARS-CoV-2 infection or BNT162b2 vaccination, but S-specific CD4+ T-cell activation is not affected by the mutations in the B.1.1.7 and B.1.351 variants"

Daryl Geers et al. 2021. SARS-CoV-2 variants of concern partially escape humoral but not T-cell responses in COVID-19 convalescent donors and vaccinees. Science Immunology 25 May 2021: Vol. 6, Issue 59, eabj1750 DOI:10.1126/sciimmunol.abj1750 https://immunology.sciencemag.org/content/6/59/eabj1750

Abstract
The emergence of SARS-CoV-2 variants harboring mutations in the spike (S) protein has raised concern about potential immune escape. Here, we studied humoral and cellular immune responses to wild type SARS-CoV-2 and the B.1.1.7 and B.1.351 variants of concern in a cohort of 121 BNT162b2 mRNA-vaccinated health care workers (HCW). Twenty-three HCW recovered from mild COVID-19 disease and exhibited a recall response with high levels of SARS-CoV-2-specific functional antibodies and virus-specific T cells after a single vaccination. Specific immune responses were also detected in seronegative HCW after one vaccination, but a second dose was required to reach high levels of functional antibodies and cellular immune responses in all individuals. Vaccination-induced antibodies cross-neutralized the variants B.1.1.7 and B.1.351, but the neutralizing capacity and Fc-mediated functionality against B.1.351 was consistently 2- to 4-fold lower than to the homologous virus. In addition, peripheral blood mononuclear cells were stimulated with peptide pools spanning the mutated S regions of B.1.1.7 and B.1.351 to detect cross-reactivity of SARS-CoV-2-specific T cells with variants. Importantly, we observed no differences in CD4+ T-cell activation in response to variant antigens, indicating that the B.1.1.7 and B.1.351 S proteins do not escape T-cell-mediated immunity elicited by the wild type S protein. In conclusion, this study shows that some variants can partially escape humoral immunity induced by SARS-CoV-2 infection or BNT162b2 vaccination, but S-specific CD4+ T-cell activation is not affected by the mutations in the B.1.1.7 and B.1.351 variants.

112margd
Maio 26, 2021, 2:36 pm

Eric Topol @EricTopol | 9:13 PM · May 25, 2021
Why is it so important to sequence the virus that induced "breakthrough" infections post-vaccination?
20 cases sequenced.
20 variants of concern identified.
Image-table ( https://twitter.com/EricTopol/status/1397360167495168001/photo/1 )
----------------------------------------------------

Abbye E McEwen et al. 2021. Variants of concern are overrepresented among post-vaccination breakthrough infections of SARS-CoV-2 in Washington State. MedRxiv (May 25, 2021) doi: https://doi.org/10.1101/2021.05.23.21257679 https://www.medrxiv.org/content/10.1101/2021.05.23.21257679v1

This article is a preprint and has not been certified by peer reviewed.

Abstract
Across 20 vaccine breakthrough cases detected at our institution, all 20 (100%) infections were due to variants of concern (VOC) and had a median Ct* of 20.2... When compared to 5174 contemporaneous samples sequenced in our laboratory, VOC were significantly enriched among breakthrough infections...

* Cycle threshold (Ct or Cq) is the number of times (cycles) a sample has to be amplified before the virus can be detected. A low Ct value indicates a strong viral load because it took less cycles to detect the virus. A high Ct value indicates a weak viral load because the sample had to be amplified many more cycles to detect it. https://nonnetworknews.com/what-is-cycle-threshold-and-why-it-matters

113margd
Maio 26, 2021, 5:25 pm

Immunity to the Coronavirus May Persist for Years, Scientists Find
Important immune cells survive in the bone marrow of people who were infected with the virus or were inoculated against it, new research suggests.
Apoorva Mandavilli | May 26, 2021

Immunity to the coronavirus lasts at least a year, possibly a lifetime, improving over time especially after vaccination, according to two new studies. The findings may help put to rest lingering fears that protection against the virus will be short-lived.

Together, the studies suggest that most people who have recovered from Covid-19 and who were later immunized will not need boosters. Vaccinated people who were never infected most likely will need the shots, however, as will a minority who were infected but did not produce a robust immune response.

Both reports looked at people who had been exposed to the coronavirus about a year earlier. Cells that retain a memory of the virus persist in the bone marrow and may churn out antibodies whenever needed, according to one of the studies, published on Monday in the journal Nature*.

The other study**, posted online at BioRxiv, a site for biology research, found that these so-called memory B cells continue to mature and strengthen for at least 12 months after the initial infection...

https://www.nytimes.com/2021/05/26/health/coronavirus-immunity-vaccines.html

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* Jackson S. Turner et al. 2021. SARS-CoV-2 infection induces long-lived bone marrow plasma cells in humans.
Nature (24 May 2021) unedited manuscript. https://www.nature.com/articles/s41586-021-03647-4

Abstract
Long-lived bone marrow plasma cells (BMPCs) are a persistent and essential source of protective antibodies1–7. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) convalescent individuals have a significantly lower risk of reinfection8–10. Nonetheless, it has been reported that anti-SARS-CoV-2 serum antibodies experience rapid decay in the first few months after infection, raising concerns that long-lived BMPCs may not be generated and humoral immunity against this virus may be short-lived11–13. Here we demonstrate that in patients who experienced mild infections (n=77), serum anti-SARS-CoV-2 spike (S) antibodies decline rapidly in the first 4 months after infection and then more gradually over the following 7 months, remaining detectable at least 11 months after infection. Anti-S antibody titers correlated with the frequency of S-specific BMPCs obtained from bone marrow aspirates of 18 SARS-CoV-2 convalescent patients 7 to 8 months after infection. S-specific BMPCs were not detected in aspirates from 11 healthy subjects with no history of SARS-CoV-2 infection. We demonstrate that S-binding BMPCs are quiescent, indicating that they are part of a long-lived compartment. Consistently, circulating resting memory B cells directed against the S protein were detected in the convalescent individuals. Overall, we show that SARS-CoV-2 infection induces a robust antigen-specific, long-lived humoral immune response in humans.

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** Gaëlle Breton et al. 2021. Persistent Cellular Immunity to SARS-CoV-2 Infection. BioRxiv Dec 9, 2020.
doi: https://doi.org/10.1101/2020.12.08.416636 https://www.biorxiv.org/content/10.1101/2020.12.08.416636v1

This article is a preprint and has not been certified by peer review.

Abstract
SARS-CoV-2 is responsible for an ongoing pandemic that affected millions of individuals around the globe. To gain further understanding of the immune response in recovered individuals we measured T cell responses in paired samples obtained an average of 1.3 and 6.1 months after infection from 41 individuals. The data indicate that recovered individuals show persistent polyfunctional SARS-CoV-2 antigen specific memory that could contribute to rapid recall responses. In addition, recovered individuals show enduring immune alterations in relative numbers of CD4+ and CD8+ T cells, expression of activation/exhaustion markers, and cell division.

114stellarexplorer
Maio 26, 2021, 5:41 pm

>110 margd: Yes, it would be a hard to accept a new reality dictated by a variant. My sense is that it is the unvaccinated and immunocompromised who are at risk. The vaccines seem to be able to handle variants reasonably well. I may be overly optimistic, but I think there’s reason to expect that to continue. This virus has many tricks up its sleeve, but they are not of infinite variety. Fingers crossed!

115margd
Maio 26, 2021, 5:58 pm

:) stable, low cost,, effective therapeutic--in hamsters at least!

Sham Nambulli et al. 2021. Inhalable Nanobody (PiN-21) prevents and treats SARS-CoV-2 infections in Syrian hamsters at ultra-low doses. Science Advances 26 May 2021: Vol. 7, no. 22, eabh0319 DOI: 10.1126/sciadv.abh0319 https://advances.sciencemag.org/content/7/22/eabh0319.abstract

Abstract
Globally, there is an urgency to develop effective, low-cost therapeutic interventions for coronavirus disease 2019 (COVID-19). We previously generated the stable and ultrapotent homotrimeric Pittsburgh inhalable Nanobody 21 (PiN-21). Using Syrian hamsters that model moderate to severe COVID-19 disease, we demonstrate the high efficacy of PiN-21 to prevent and treat SARS-CoV-2 infection. Intranasal delivery of PiN-21 at 0.6 mg/kg protects infected animals from weight loss and substantially reduces viral burdens in both lower and upper airways compared to control. Aerosol delivery of PiN-21 facilitates deposition throughout the respiratory tract and dose minimization to 0.2 mg/kg. Inhalation treatment quickly reverses animals’ weight loss after infection, decreases lung viral titers by 6 logs leading to drastically mitigated lung pathology, and prevents viral pneumonia. Combined with the marked stability and low production cost, this innovative therapy may provide a convenient and cost-effective option to mitigate the ongoing pandemic.

...DISCUSSION
...preclinical analysis including an extensive toxicopathologic investigation, preferentially in an NHP (non-human primate) model, will be needed before moving this technology into human trials. We envision that PiN-21 (inhalable nanobody) aerosolization treatment could provide both a convenient and cost-effective solution to alleviate disease onset and reduce virus transmission, especially for mild COVID-19 patients who constitute major populations of infections. It may also benefit high-risk groups, such as seniors, immunocompromised individuals, and infants, in both inpatient and outpatient settings. Last, as prevalent circulating variants of SARS-CoV-2 have emerged to evade clinical antibodies and wane vaccine-elicited serologic responses..., this proof-of-concept study will shed light on the use of stable, multi-epitope, and multivalent Nb (nanobody) constructs, in combination with PiN-21, as a novel aerosol cocktail that can be rapidly generated to block virus mutational escape.

116margd
Maio 27, 2021, 7:20 am

#95 in thread 20 didn't give reference. I believe this is it:

Dr. Nahid Bhadelia (George Mason U) @BhadeliaMD | 8:17 AM · May 26, 2021:
*10k reported breakthrough cases, over 101 million vaccinated
(likely an undercount as authors say since this voluntary/passive reporting- but still incredible!)
*64% of breakthrough infections were from variants of concern (only 5% of total were sequenced)
I should clarify- this is incredibly good news. Deaths and hospitalizations even smaller.

Céline Gounder, MD, ScM, FIDSA (Bellevue Hospital) @celinegounder · 14h
I don’t understand why only 5% of COVID vaccination breakthrough infections are being sequenced.
Wouldn’t sequencing breakthrough cases be highest yield for picking up emerging variants?
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COVID-19 Vaccine Breakthrough Infections Reported to CDC — United States, January 1–April 30, 2021. MMWR Morb Mortal Wkly Rep. ePub: 25 May 2021. DOI: http://dx.doi.org/10.15585/mmwr.mm7021e3 https://www.cdc.gov/mmwr/volumes/70/wr/mm7021e3.htm

117margd
Maio 28, 2021, 8:10 am

HALF!

Concerns about missing work may be a barrier to coronavirus vaccination
Alyssa Fowers | May 27, 2021

Nearly half of adults in the United States who have not received a coronavirus vaccine are concerned about missing work as a result of side effects from the shot, according to a Kaiser Family Foundation poll released this month. The findings highlight a key obstacle to vaccination, particularly for the 25 percent of American workers who do not have any paid sick leave...

https://www.washingtonpost.com/business/2021/05/27/time-off-vaccine-workers/

118margd
Maio 28, 2021, 9:26 am

Lessons for world from UK experience with B.1617.2. (#1: get vaccinated...)

uché blackstock, md (MSNBC) @uche_blackstock | 10:58 PM · May 27, 2021:
Not to scare anyone, but really important thread about what’s happening now in the UK.
About 1/3 of the country is fully vaccinated, but they’re seeing a 3rd wave due to the B.1617.2 variant,
especially in pockets of the UK where many are still unvaccinated.

Quote Tweet
John Burn-Murdoch* @jburnmurdoch | 3:17 PM · May 27, 2021:
https://threadreaderapp.com/thread/1397995388267810818.html
(with comments: https://twitter.com/jburnmurdoch/status/1397995388267810818 )
NEW: B.1617.2 is fuelling a third wave in the UK, with not only cases but also hospital admissions rising.
Vaccines will make this wave different to those that have come before, but it remains a concern, and
one that other countries will soon face.

Thread on everything we know:
Image ( https://twitter.com/jburnmurdoch/status/1397995388267810818 )
...

* John Burn-Murdoch @jburnmurdoch--Stories, stats & scatterplots for @FinancialTimes | Daily updates of the coronavirus trajectory tracker | john.burn-murdoch@ft.com | #dataviz

119margd
Maio 28, 2021, 6:01 pm

‘Long COVID’ Study Will Examine Vaccines’ Effect on Patient Symptoms
May 19 2021

A new study is currently enrolling people with long COVID who have not yet been vaccinated. The work could tell researchers what’s driving the condition and offer clues to treatment.

Within the last few months, some people with lingering COVID-19 symptoms have been reporting something surprising: vaccination seems to improve their condition. These patients, known as “long haulers” or people with “long COVID,” suffer from a host of full-body symptoms that can make it difficult to walk, concentrate, and breathe.

Now, scientists have launched a new study to examine just how vaccination affects these individuals, and whether the vaccine can offer clues to treatment. Researchers are currently recruiting people over 18 who have not yet been vaccinated and have had COVID-19 symptoms for more than two months since their initial infection, announced study leader Akiko Iwasaki, a Howard Hughes Medical Institute Investigator at Yale University.

Iwasaki’s team will collect blood and saliva samples before and after vaccination and look at participants’ immune responses. That could tell researchers what’s driving long COVID, and even suggest therapies likely to treat it...

https://www.hhmi.org/news/long-covid-study-will-examine-vaccines-effect-on-patie...

120margd
Maio 29, 2021, 7:09 am

Just How Big Could India’s True Covid Toll Be?
Lazaro Gamio and James GlanzMay 25, 2021

Reported cases 26.9 million
Reported deaths 307,231
Data as of May 24

(Estimates are based on sero-surveys

A conservative scenario
Estimated infections 404.2 million
Estimated deaths 600,000
15 infections per reported case with an infection fatality rate of 0.15%

A more likely scenario*
Estimated infections 539.0 million
Estimated deaths 1.6 million
20 infections per reported case with an infection fatality rate of 0.30%

A worse scenario **
Estimated infections 700.7 million
Estimated deaths 4.2 million
26 infections per reported case with an infection fatality rate of 0.60%

...* Our first, best-case scenario assumes a true infection count 15 times higher than the official number of recorded cases. It also assumes an infection fatality rate, or I.F.R. — the share of all those infected who have died — of 0.15 percent. Both of these numbers are on the low end of the estimates we collected from experts.

...**This scenario uses a slightly higher estimate of true infections per known case, to account for the current wave. The infection fatality rate is also higher — double the rate of the previous scenario, at 0.6 percent — to take into account the tremendous stress that India’s health system has been under during the current wave. Because hospital beds, oxygen and other medical necessities have been scarce in recent weeks, a greater share of those who contract the virus may be dying, driving the infection fatality rate higher...

https://www.nytimes.com/interactive/2021/05/25/world/asia/india-covid-death-esti...

121margd
Maio 29, 2021, 7:18 am

Nova Scotia's positive experience with rapid tests (positive results confirmed with PCRs):

Rapid testing has found at least 10 per cent of Nova Scotia's cases in its third wave
Unlike most provinces which reserve testing only for symptomatic people, Nova Scotia's pop-up centres allow asymptomatic people to simply show up and get a free rapid test
Brian Platt | May 18, 2021 • Last Updated May 19, 2021

While rapid testing remains sorely underused in most of Canada, one province has been innovating with rapid tests from the very beginning — and is now reaping the benefit.

During the third wave that hit Nova Scotia over the past month, the province’s community rapid testing centres have correctly sniffed out at least 285 COVID-19 cases in asymptomatic people, or about 10 per cent of all confirmed cases in this time period, according to the Nova Scotia Health Authority.

...If they had waited until they developed symptoms to get a PCR test, and then waited another 24 hours until they got the PCR results, that’s at least two days where they might have been unknowingly spreading the virus...

https://nationalpost-com.cdn.ampproject.org/c/s/nationalpost.com/news/rapid-test...

122bnielsen
Maio 29, 2021, 7:27 am

>121 margd: Here in Denmark we are using rapid testing on a large scale. To go to a restaurant and eat, you need a green corona passport. To get a green corona passport you need either first vaccination + 14 days or a passed test not more than 72 hours old. So lots of asymptomatic people get tested twice a week. Peolple testing positive in a quick test need to go take a PCR test to check the result. And only positive PCR tests are reported in the daily numbers.

123margd
Maio 29, 2021, 7:47 am

>122 bnielsen: Do test results go to a central database in Denmark? Govt or industry-held?

Wonder if rapid tests would be acceptable to anti-vaxxers / freedumb lovers?

Wouldn't work so well as vaccine passport as condition for boarding plane or cruise ship with their depth of commitment?

(Crossing US-Cdn border by land in Oct 2020, we didn't know for certain until we got there whether our business would be considered essential enough for Cdn authorities to let us pass--and we had invested a lot into collecting food, etc., to keep us busy and fed inside our cottage for two weeks quarantine--plus one week just in case. Would have been upset / depressed if we'd been denied entry. )

124bnielsen
Maio 29, 2021, 11:15 am

>123 margd: Central Govt database. Rapid-tests and CPR and vaccinations. Since yesterday all of us can download an app that displays a QR-code with a green frame if there's a valid corona passport. I.e. anyone who can scan the QR-code can validate it against the database and see if the name on the app matches the name on the corona passport. Rather simple and rather hard to fake.

It seems to function very well with a slight delay between you getting the test result and the corona passport app finding out. (It took 30-40 minutes yesterday. That might have been worst case since many, many Danes downloaded the app yesterday :-)

It's supposed to work as travel-document from July 1st, i.e. all EU countries will accept it as documentation.

Shops are open with a bit restrictions (max number of customers and face mask required). Restaurants and libraries are open with more severe restrictions (max number of customers, face mask required when you're not seated and valid corona passport required and checked on entry.

I'm still working from home but allowed in 20% of the time. Soon to be 50% and by August those restrictions are expected to go away.

Current numbers say about 1000 new cases per day. One third of the population has gotten the first vaccination, so the number of people in ICUs is rather low (100, I think).

125margd
Maio 29, 2021, 2:30 pm

Vincent Rajkumar (Mayo Clinic) @VincentRK | 12:57 PM · May 29, 2021:
This article has some more details on (Viet Nam's new) variant.
It is basically the B.1.617.2 variant plus the Y144 deletion similar to the one found on the B.1.1.7 variant, and
per the report has not previously been described.

Vietnam discovers new coronavirus variant with UK, Indian mutations
Thu Anh May 29, 2021

...Genetic sequencing by National Institute Of Hygiene And Epidemiology found at least four Covid-19 patients in the country carry the hybrid variant.

Le Thi Quynh Mai, deputy head of the institute, said: "We discovered the Y144 deletion on spike protein S of the B.1.617.2 variant. This mutation is similar to the one found on the B.1.1.7 variant."

The B.1.617.2 was first found in India and the B.1.1.7 in the U.K.

Mai said such mutation on the Indian variant is not yet recorded by GISAID, a global science initiative and primary source that provides open-access to genomic data of influenza viruses and the coronavirus responsible for the Covid-19 pandemic. Thus it needs to be monitored and researched further, she said...

https://e.vnexpress.net/news/news/vietnam-discovers-new-coronavirus-variant-with...

126bnielsen
Maio 29, 2021, 6:39 pm

>124 bnielsen: just checked today's numbers. 144 in hospitals, but only 33 of those are in ICU and only 22 of them are on ventilators.

127John5918
Maio 30, 2021, 3:28 am

A reminder that although face masks only cost pennies and most people in the Global North can buy them and wear them without even stopping to think about it, they are still a relatively expensive and difficult to obtain item in many parts of the world.

Catholic Association in South Sudan Distributes Facemasks to Keep Learners in School (ACI Africa)

Members of the Mary Help Association of Christians (ADMA) serving in South Sudan’s Catholic Diocese of Wau have distributed facemasks to school girls to assist them in fighting COVID-19 while they remain in school... the entity would also extend the distribution of the valuable items to the vulnerable women engaged in small scale businesses... “Our activities are targeting vulnerable people who cannot afford to buy facemasks. Our aim is also to empower women in business”...

128margd
Editado: Maio 30, 2021, 8:13 am

Eric Feigl-Ding @DrEricDing · 27m
Even if low risk, would you accept “1% risk of hospitalization” for your child from #COVID19?
Because @fitterhappierAJ lays out the facts on pediatric risk and #LongCovid. See his statement below.

---------------------------------------------------------

Anthony J Leonardi, PhD, MS* @fitterhappierAJ | 7:10 PM · May 29, 2021:
This is my opinion as to why schools should not be held in person
until adults are responsible enough to reach 60-65% community vaccination.

Children should also be vaccinated against the virus, and it's especially necessary
when adults are too negligent to reach 65% communally

Image ( https://twitter.com/fitterhappierAJ/status/1398778767665942535/photo/1 )
Image ( https://twitter.com/fitterhappierAJ/status/1398778767665942535/photo/2 )

* Anthony J Leonardi, PhD, MS @fitterhappierAJ
T-Cell Immunologist (Fas/Akt Feed-forward T-cell differentiation and death)

129margd
Editado: Maio 30, 2021, 10:55 am

Pollster Nate Silver discusses wisdom of vaccine lotteries (segment at ~ 34:00):
https://www.youtube.com/watch?v=ofVSGStV29A

Apparently lotteries especially appeal to risk-takers, magical thinkers, and vaccine-hesitants?

130margd
Maio 30, 2021, 4:35 pm

Eric Topol @EricTopol | 4:12 PM · May 30, 2021
Difficulty breathing is a frequent symptom among people suffering #LongCovid, even w/ mild infections (AMB=ambulatory). A new study suggests small airways disease, manifest by air trapping, may be the underpinning
Image ( https://twitter.com/EricTopol/status/1399096497724006400/photo/1 )

-------------------------------------------------------

Josalyn L Cho et al. 2021. Small Airways Disease is a Post-Acute Sequelae of SARS-CoV-2 Infection. MedRxiv May 30,2021.
doi: https://doi.org/10.1101/2021.05.27.21257944 https://medrxiv.org/content/10.1101/2021.05.27.21257944v1

This article is a preprint and has not been certified by peer review.

Abstract
...Results Of the 100 patients enrolled, 67 were in the ambulatory group. All groups commonly reported cough and dyspnea. Pulmonary function testing revealed restrictive physiology in the hospitalized and ICU groups but was normal in the ambulatory group. Among hospitalized and ICU patients, the mean percent of total lung classified as GGO (ground glass opacities) was 13.2% and 28.7%, respectively, and was higher than in ambulatory patients (3.7%, P

131margd
Maio 31, 2021, 9:58 am

Eric Topol @EricTopol | 9:39 AM · May 31, 2021:

Beginning of a 3rd wave in South Africa, the worst-hit country on the continent
Gerald Imray AP | May 31, 2021
https://latimes.com/world-nation/story/2021-05-31/south-africa-returns-stricter-...

more than 90% of cases are B.1.351 via @Tuliodna
Let's hope the vaccination campaign can get in high gear quickly

Image-graph ( https://twitter.com/EricTopol/status/1399359850077835268/photo/1 )
Image-photo, highlighted article ( https://twitter.com/EricTopol/status/1399359850077835268/photo/2 )

132margd
Maio 31, 2021, 3:46 pm

Maria Van Kerkhove (WHO) @mvankerkhove | 11:31 AM · May 31, 2021:
Today, WHO announces new, easy-to-say labels for #SARSCoV2 Variants of Concern (VOCs) & Interest (VOIs)
They will not replace existing scientific names, but are aimed to help in public discussion of VOI/VOC

Read more here (will be live soon):
https://who.int/activities/tracking-SARS-CoV-2-variants

Image ( https://twitter.com/mvankerkhove/status/1399388129300205569/photo/1 )
Image ( https://twitter.com/mvankerkhove/status/1399388129300205569/photo/2 )
Image ( https://twitter.com/mvankerkhove/status/1399388129300205569/photo/3 )
Image ( https://twitter.com/mvankerkhove/status/1399388129300205569/photo/4 )

----------------------------------------------------------

Florian Krammer @florian_krammer · 55m
Zeta-Eta-Theta? Easy to say (?), easy to mix up. And what are we doing when we are running out of letters?
Sorry, not going to use this. PANGO was fine.

133margd
Jun 1, 2021, 9:07 am

I’m a Pediatrician. Get Your Child Vaccinated.
Kids 12 and up no longer need to get sick with the coronavirus.
Perri Klass | May 29, 2021

...I love vaccines, but I also understand that parents have every right to think critically about decisions for their children, and that the story on COVID-19 vaccination has been evolving rapidly. Some parents wonder if the chances of serious illness in younger children are high enough to justify any risks associated with a new vaccine. Other parents worry that their kids are being vaccinated primarily for the sake of protecting more vulnerable adults. Some are scared of the vaccines because they’ve heard that they’re dangerous in some way that’s being covered up. And others say they’d just like to wait until more information is available.

Let me address those concerns one by one...

https://www.theatlantic.com/ideas/archive/2021/05/pediatrician-kids-vaccine-coro...

134margd
Jun 1, 2021, 9:49 pm

NIH clinical trial evaluating mixed COVID-19 vaccine schedules begins (Release)
Tuesday, June 1, 2021

If you are interested in joining this trial, please visit clinicaltrials.gov and search identifier NCT04889209 for more information.
Please DO NOT contact the NIAID News & Science Writing Branch.

The National Institutes of Health has started a Phase 1/2 clinical trial in which adult volunteers who have been fully vaccinated against COVID-19 will receive booster doses of different COVID-19 vaccines to determine the safety and immunogenicity of mixed boosted regimens. The National Institute of Allergy and Infectious Diseases (NIAID), part of NIH, is leading and funding the study through the Infectious Diseases Clinical Research Consortium, a clinical trials network that encompasses the Institute’s long-standing Vaccine and Treatment Evaluation Units (VTEUs)...

https://www.nih.gov/news-events/news-releases/nih-clinical-trial-evaluating-mixe...

135margd
Jun 2, 2021, 7:56 am

AUSTRALIA

Melbourne lockdown extended (one week) as authorities track bizarre transmission
Victoria’s chief health officer has revealed a bizarre case that became infected in a way not seen before, calling the variant an “absolute beast”.
Rohan Smith | June 2, 2021

...Victoria’s chief health officer Brett Sutton says people are becoming infected with Covid-19 in ways we have not seen before...a person was infected at an indoor enclosed space two hours after an infectious case had left...That’s in the kind of measles category of infectiousness...(also) an outdoor dining setting, well ventilated...stranger to stranger transmission...the ease with which the virus is spreading may be a feature of the Indian variant...

https://www.news.com.au/national/victoria/news/melbourne-lockdown-extended-as-au...

---------------------------------------------------------------

Statement From The Acting Premier
01 June 2021

We now have 60 local cases and more than 350 exposure sites. And a variant of the virus that is quicker and more contagious than we’ve seen before.

To date, the approach has been to track the spread through friends, family and workmates. People spending time together for minutes and hours – not seconds.

What we’re seeing now is something else – something even more serious. At least one in ten current cases have caught this virus from a stranger.

People brushing against each other in a small shop. Getting a take-away coffee from the same cafe. Being in the same place, at the same time for mere moments.

Just walking past someone you’ve never met can mean the virus is jumping to a whole new network.

And when you don’t know someone – you don’t know their name or where they live – you’re looking for one person in 6.6 million.

The best way to stop the virus is vaccination. But as we know, with only two per cent of the population fully vaccinated – if we let this thing run then cases will explode.

If that happens, it's our most vulnerable – our parents and grandparents, Victorians with underlying conditions or compromised immunity – who will pay the price.

It’s why, on the advice of Chief Health Officer Brett Sutton, the current restrictions will remain in place in Melbourne for a further seven days, with some small changes...

https://www.premier.vic.gov.au/statement-acting-premier-2

136margd
Editado: Jun 2, 2021, 8:26 am

Vincent Rajkumar (Mayo Clinic Prof, Blood Cancer J Editor) @VincentRK | 1:36 PM · Jun 1, 2021
https://twitter.com/VincentRK/status/1399782027465998337

UPDATE: Risk Serious Blood Clots following Astra Zeneca/COVISHIELD vaccine. #VITT
~1 in 55,000 with 1st dose. This is higher than we thought initially.
Risk with 2nd dose is 10 times lower.
I'd favor mRNA vaccines, if possible, for age less than 30 years.

As the report indicates, the risk from countries with moderate to high data data quality range from 1 in 26,500 to 1 in 127,300 of first doses.

The risk of dying from (VITT) clots is 20-30%.

People are asking about symptoms. It is severe persistent headache or abdominal pain, dizziness, not feeling well.
The key is to recognize the symptoms based on recent history adenovirus vector vaccine and initiate the right diagnostic work up on time.

IMPORTANT: In countries like India, with high rates of COVID, no mRNA vaccines, and limited vaccine supply, the risk of COVID far outweighs the risk of adenovirus vector vaccine like COVISHIELD.
So even for my family under 30, I have recommended getting the first vaccine offered.

----------------------------------------------------------------------
Risk of Vaccine-Induced Thrombotic Thrombocytopenia (VITT) following the AstraZeneca/COVISHIELD Adenovirus Vector COVID-19 Vaccines
Benjamin Chan,et al. on behalf of the Ontario COVID-19 Science Advisory Table
Version 1.2 | https://doi.org/10.47326/ocsat.2021.02.28.1.0
Updated on May 11, 2021. Version 1.0 and 1.1 are available under Additional Resources.
https://covid19-sciencetable.ca/sciencebrief/risk-of-vaccine-induced-thrombotic-...

137margd
Editado: Jun 2, 2021, 10:38 am

>93 margd: contd.

Israel sees probable link between Pfizer vaccine and myocarditis cases
Jeffrey Heller | June 2, 2021

Israel’s Health Ministry said on Tuesday it had found the small number of heart inflammation cases observed mainly in young men (16-19, 16-30) who received Pfizer’s (PFE.N) COVID-19 vaccine in Israel were likely linked to their vaccination.

...Most patients who experienced heart inflammation spent no more than four days in the hospital and 95% of the cases were classified as mild...

...The European Medicines Agency (EMA) said last week that heart inflammation following vaccination with Comirnaty had been no cause for concern as they continued to happen at a rate that typically affected the general population. It added at the time that young men were particularly prone to the condition.

A U.S. Centers for Disease Control and Prevention advisory group last month recommended further study of the possibility of a link between myocarditis and mRNA vaccines, which include those from Pfizer and Moderna Inc...CDC monitoring systems had not found more cases than would be expected in the population, but the advisory group said in a statement that members felt healthcare providers should be made aware of reports of a "potential adverse event."

https://www.reuters.com/world/middle-east/israel-sees-probable-link-between-pfiz...

138margd
Jun 2, 2021, 11:08 am

Brazilian town experiment shows mass vaccination can wipe out COVID-19
Sofia Moutinho | Jun. 1, 2021

A small commuter town surrounded by sugarcane fields in southeastern Brazil, one of the countries hardest hit by COVID-19, has shown that even a vaccine that had low efficacy in some clinical trials can dramatically control the pandemic virus.

As part of an unusual experiment to track the real-world effectiveness of CoronaVac, a COVID-19 vaccine made by a Chinese company, almost all adult residents of Serrana, in the state of São Paulo, received the required two shots between February and April, long before most would otherwise have become eligible for the vaccine. The results were dramatic. Symptomatic cases of COVID-19 have dropped by 80% since the start of mass vaccination, related hospitalizations fell 86%, and deaths plummeted 95%, the research team in charge of the experiment reported during a press conference yesterday.

Meanwhile, cases have risen out of control in 15 other cities nearby. “Serrana is now an oasis,” says Ricardo Palacios, an epidemiologist at the Butantan Institute, a state-owned research center that produces the vaccine in Brazil. “And it has shown us that it is surely possible to control the epidemic through vaccination.”...

...there has been concern about CoronaVac, which uses an inactivated copy of SARS-CoV-2 to stimulate immunity. Clinical trials conducted in several countries came up with different efficacy values for the vaccine, the lowest being 50% in Brazil—right at the threshold established by the World Health Organization (WHO) for emergency use of a COVID-19 vaccine. Later studies in Brazil that tried to assess the vaccine’s real-world effectiveness have indicated similar levels of protection.

That’s why the data from Serrana are reassuring to many scientists in Brazil, where CoronaVac makes up 80% of all vaccine doses administered.

...WHO announced today that it granted CoronaVac an emergency use listing, a step that should speed the vaccine’s use in many low-income countries...

https://www.sciencemag.org/news/2021/06/brazilian-town-experiment-shows-mass-vac...

139margd
Jun 3, 2021, 9:02 am

"...while hospitalized COVID-19 patients and (Pfizer) vaccinees maintained sufficient neutralizing titers against all three VOC (B.1.1.7, B.1.351, and P.1), 39% of non-hospitalized patients did not neutralize B.1.351. Moreover, monoclonal neutralizing antibodies (NAbs) show sharp reductions in their binding kinetics and neutralizing potential to B.1.351 and P.1, but not to B.1.1.7.

Novel SARS-CoV-2 variants partially resistant to infection- and vaccine-induced immunity, study finds
Dr. Sanchari Sinha Dutta, Ph.D. | Jun 2 2021

A recent study conducted by a team of scientists in the Netherlands and the USA has revealed that while severely affected hospitalized coronavirus disease 2019 (COVID-19) patients and vaccinated individuals are capable of neutralizing the B.1.1.7, B.1.351, and P.1 variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a significant proportion of non-hospitalized patients with less severe COVID-19 remain susceptible to these viral variants...

https://www.news-medical.net/news/20210602/Novel-SARS-CoV-2-variants-exhibit-par...

-----------------------------------------------------------

Tom G. Caniels et al. 2021. Emerging SARS-CoV-2 variants of concern evade humoral immune responses from infection and vaccination. MedRxiv (June 1, 2021) doi: https://doi.org/10.1101/2021.05.26.21257441 https://www.medrxiv.org/content/10.1101/2021.05.26.21257441v1

This article is a preprint and has not been certified by peer review.

Abstract

Emerging SARS-CoV-2 variants pose a threat to human immunity induced by natural infection and vaccination. We assessed the recognition of three variants of concern (B.1.1.7, B.1.351 and P.1) in cohorts of COVID-19 patients ranging in disease severity (n = 69) and recipients of the Pfizer/BioNTech vaccine (n = 50). Spike binding and neutralization against all three VOC was substantially reduced in the majority of samples, with the largest 4-7-fold reduction in neutralization being observed against B.1.351. While hospitalized COVID-19 patients and vaccinees maintained sufficient neutralizing titers against all three VOC, 39% of non-hospitalized patients did not neutralize B.1.351. Moreover, monoclonal neutralizing antibodies (NAbs) show sharp reductions in their binding kinetics and neutralizing potential to B.1.351 and P.1, but not to B.1.1.7. These data have implications for the degree to which pre-existing immunity can protect against subsequent infection with VOC and informs policy makers of susceptibility to globally circulating SARS-CoV-2 VOC.

140margd
Jun 3, 2021, 9:51 am

Fingers crossed for US:
% vaxxed not yet enough for herd immunity +
summer heat forces us indoors for AC +
fall cold forces us indoors for holiday gatherings +
B.1.617.2 (delta) lurks...

Eric Topol @EricTopol | 9:08 AM · Jun 3, 2021:
Hope over fear
Relaxation of mask guidelines did not affect case decline.
But no complacency. Still vulnerability w/ current vaccination rates, especially to B.1.617.2 (delta)
Image-photo w/ highlights of article below ( https://twitter.com/EricTopol/status/1400439181499723784/photo/1 )
Image-graph daily new cases US Mar 15-June 1 2021 ( https://twitter.com/EricTopol/status/1400439181499723784/photo/2 )

----------------------------------------------------------

Covid Hope Over Fear
We look at the effects of the C.D.C.’s new mask guidance on Covid cases and vaccinations.
David Leonhardt | June 2, 2021

When the C.D.C...said that vaccinated Americans rarely needed to wear masks, it caused both anxiety and uncertainty.... Almost three weeks after the change,...the data. So far, it suggests that the optimists were better prognosticators than the pessimists.

Cases keep falling
Shots have stopped falling
‘Some positive reinforcement’: All of this is a reminder that fear is not the only way to motivate healthy behavior during a crisis...

https://nytimes.com/2021/06/02/briefing/covid-19-masks-guidance-vaccinations.htm...

141margd
Jun 3, 2021, 12:57 pm

FACT SHEET: Biden-Harris Administration Unveils Strategy for Global Vaccine Sharing, Announcing Allocation Plan for the First 25 Million Doses to be Shared Globally
White House | June 03, 2021

As we continue to fight the COVID-19 pandemic at home and work to end the pandemic worldwide, President Biden has promised that the United States will be an arsenal of vaccines for the world. To do that, the Administration will pursue several additional measures beyond our robust funding for COVAX: Donating from the U.S. vaccine supply to the world and encouraging other nations to do the same, working with U.S. manufacturers to increase vaccine production for the rest of the world, and helping more countries expand their own capacity to produce vaccines including through support for global supply chains. This vaccine strategy is a vital component of our overall global strategy to lead the world in the fight to defeat COVID-19, including emergency public health assistance and aid to stop the spread and building global public health capacity and readiness to beat not just this pandemic, but the next one.

Today, the Administration announced its framework for sharing at least 80 million U.S. vaccine doses globally by the end of June and the plan for the first 25 million doses.

Specifically, the Administration announced that:

The United States will share vaccines in service of ending the pandemic globally. Today, the Administration announced its framework for sharing these 80 million U.S. vaccine doses worldwide. Specifically, the United States will:

Share 75% of these vaccines through COVAX. The United States will share at least three-quarters of its donated doses through COVAX, supplying U.S. doses to countries in need. This will maximize the number of vaccines available equitably for the greatest number of countries and for those most at-risk within countries. For doses shared through COVAX, the United States will prioritize Latin America and the Caribbean, South and Southeast Asia, and Africa, in coordination with the African Union.

Share 25% for immediate needs and to help with surges around the world. The United States has received requests for vaccines from countries all over the world. The U.S. will share up to one-quarter of its donated doses directly with countries in need, those experiencing surges, immediate neighbors, and other countries that have requested immediate U.S. assistance. Specifically, we will:

Set the stage for increased global coverage. The allocation of this first tranche of donated doses reflects the desire of the United States to respond to all regions and lay the ground for increased supply and access throughout the world.

Prepare for surges and prioritize healthcare workers and other vulnerable populations based on public health data and acknowledged best practice. We will share with countries in urgent need, with a priority on vaccinating frontline workers. The United States will not use its vaccines to secure favors from other countries. The U.S. will work with partners who are both ready and in need. And, our donations will prioritize countries with vaccine readiness plans that prioritize individuals at highest risk of severe disease and those working to help care for them, like health care workers.

Help countries in need and our neighbors. The United States will share vaccines in our region and across our borders. We first made doses available to our closest neighbors – Canada and Mexico. Our dose sharing approach prioritizes Latin American and the Caribbean on a per capita basis.

The U.S. announced the proposed allocation plan for the first 25 Million doses. Based on the framework above and pending legal and regulatory approvals, the United States plans to send our first tranche of 25 million doses:

Nearly 19 million will be shared through COVAX, with the following allocations:

Approximately 6 million for South and Central America to the following countries: Brazil, Argentina, Colombia, Costa Rica, Peru, Ecuador, Paraguay, Bolivia, Guatemala, El Salvador, Honduras, Panama, Haiti, and other Caribbean Community (CARICOM) countries, as well as the Dominican Republic.
Approximately 7 million for Asia to the following countries and entities: India, Nepal, Bangladesh, Pakistan, Sri Lanka, Afghanistan, Maldives, Malaysia, Philippines, Vietnam, Indonesia, Thailand, Laos, Papua New Guinea, Taiwan, and the Pacific Islands.

Approximately 5 million for Africa to be shared with countries that will be selected in coordination with the African Union.

Approximately 6 million will be targeted toward regional priorities and partner recipients, including Mexico, Canada, and the Republic of Korea, West Bank and Gaza, Ukraine, Kosovo, Haiti, Georgia, Egypt, Jordan, Iraq, and Yemen, as well as for United Nations frontline workers.

The sharing of millions of U.S. vaccines with other countries signals a major commitment by the U.S. government. Just like in the United States, we will move as expeditiously as possible, while abiding by U.S. and host country regulatory and legal requirements, to facilitate the safe and secure transport of vaccines across international borders. This will take time, but the President has directed the Administration to use all the levers of the U.S. government to protect individuals from this virus as quickly as possible.

The specific vaccines and amounts will be determined and shared as the Administration works through the logistical, regulatory and other parameters particular to each region and country.

###

https://www.whitehouse.gov/briefing-room/statements-releases/2021/06/03/fact-she...

142margd
Jun 3, 2021, 1:35 pm

COVID-19 Vaccine Incentives
Companies across the United States are offering rewards to their vaccinated customers and employees.*
Contact these companies for more information on how to qualify.

Support to help you get your vaccine
Rewards after you get your vaccine
Employees of these companies are also eligible for additional vaccination support

https://www.vaccines.gov/incentives.html

---------------------------------------------------------

Regional store Meijer (like Walmart) is givinng $10 coupon to fully vaxxed customers: https://www.freep.com/story/news/local/michigan/2021/05/20/meijer-covid-vaccinat...

143margd
Jun 3, 2021, 3:31 pm

>141 margd: contd.

Biden admin reveals plans for first 25 million donated vaccine doses
The move comes after months of internal debate and external pressure.
ERIN BANCO | 06/03/2021

...The donation will come from the U.S. stockpile of Johnson & Johnson, Pfizer and Moderna vaccines.

... the government is also removing Defense Production Act priority ratings for three not-yet-authorized vaccines from AstraZeneca, Novavax and Sanofi because the U.S. is confident in its vaccine supply.

...“While the manufacturers will continue to make these three vaccines, This action will allow U.S-based companies that supply these vaccine manufacturers to make their own decisions on which orders to fulfill first”

...An interagency team including representatives of the National Security Council, State Department and the U.S. Agency for International Development has worked for weeks to determine how to rank donation requests based on factors such as a country's rate of virus transmission and its existing supplies of vaccine and drugs for treating Covid-19.

The Trump administration ordered 300 million doses from AstraZeneca and 100 million each from Novavax and Sanofi, but the development of those vaccines has lagged behind global frontrunners like Pfizer and its partner BioNTech.

...Any country on the receiving end must have a robust distribution infrastructure to ensure the shots are used before they expire. The Biden administration also will need to work with receiving countries on contract language that includes an indemnification clause to protect a vaccine's maker against legal liability for things like adverse reactions...

... the administration was originally concerned about the situation in South Asia, including Nepal and the Philippines, but that the focus has shifted in recent days to South America...

https://www.politico.com/news/2021/06/03/us-donate-covid19-vaccine-global-2021-4...

144margd
Jun 4, 2021, 1:53 am

"Summary: vaccine rollout has been a huge success in the UK – slow and steady has almost won the race, B.1.617.2 (delta) variant makes it a bit more uphill as we near the finish line... Two doses as quickly as supply allows, monitor Ab levels, boost those who need."

David LV Bauer (virologist) @DavidLVBauer | 6:30 PM · Jun 3, 2021:
https://twitter.com/DavidLVBauer/status/1400580669244428289
https://threadreaderapp.com/thread/1400580669244428289.html

Significant loss of antibody neutralisation vs live B.1.617.2 SARS-CoV-2 variant (-5.8x, akin to B.1.351) in @TheCrick / UCLHresearch Legacy study of 250 (!) Pfizer-BioNTech 1/2-dose vaccinees, out today @TheLancet, by @dremmacbw, @MaryYiWeiWu et al. http://thelancet.com/journals/lancet/article/PIIS0140-6736(21)01290-3/fulltext *
Image- https://twitter.com/DavidLVBauer/status/1400580669244428289/photo/1
1/n

Increased age & time since 2nd dose correlated with reduced virus neutralisation across all strains tested. Not a surprise, but given low starting titres vs B.1.617.2, more of a concern to see neutralisation “dropping off”, significantly. Boosters more likely to be needed 2/n

To maximise population coverage, the UK delayed 2nd dose from 3 weeks to ~12 weeks in early 2021. Was a good strategy vs. B.1.1.7, but single-dose vaccine recipients have significantly less ability to neutralise B.1.617.2 -- so strategy now more complicated 3/n

Again, the correlation between increased age and less neutralising ability that we saw with 2-dose recipients is also visible with single-dose recipients. Supports getting 2nd doses in ASAP, esp. in older / vulnerable populations. 4/n
.
.
.
Aside from (1) our lab-based data pointing to reduced neutralisation of B.1.617.2 (delta) by vaccine-induced antibodies, data from PHE suggests it is also (2) more transmissible than Kent, and also (3) more likely to increase hospitalisation risk, see https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attac... 10/n

Our cohort here is close to a "best-case" picture for neutralising antibody titres: relatively young (40y), healthy, and recently-vaccinated. We need to be paying careful attention to other populations w/variants (ethnicity differences? older? immunocompromised?) 11/n

The plus side is that 2 doses give reasonable titres. And there is of course more to immunity than neutralising antibodies (even if that's the clearest correlate of protection we have). 12/n

Summary: vaccine rollout has been a huge success in the UK – slow and steady has almost won the race, B.1.617.2 (delta) variant makes it a bit more uphill as we near the finish line... Two doses as quickly as supply allows, monitor Ab levels, boost those who need. 13/end

----------------------------------------------------------

* Emma C Wall et al. 2021. Neutralising antibody activity against SARS-CoV-2 VOCs B.1.617.2 and B.1.351 by BNT162b2 vaccination (Correspondence). The Lancet (Published:June 03, 2021) DOI:https://doi.org/10.1016/S0140-6736(21)01290-3 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01290-3/fullt...

145margd
Jun 4, 2021, 9:58 am

Canada has a 'narrow window' for containing delta variant, also known as B1617, warns U.K. expert
CBC Radio | June 03, 2021

Some Canadians may be looking at the reopening in the U.K. with some envy but not so fast, says U.K. epidemiologist Dr. Deepti Gurdasani. The delta variant, also known as B1617, first identified in India, is driving a new COVID wave in the U.K. — and it's spreading quickly around the world, including in Canada. Gurdasani has stark advice to Canadian officials: act now to contain this variant or a fourth wave is likely coming. 21:48

"It spread incredibly quickly here in the U.K. So in a matter of four to six weeks, it's a variant that has gone from almost not being present here to being the most dominant variant," (Dr. Deepti Gurdasani, a clinical epidemiologist and senior lecturer in machine learning at Queen Mary University of London said)

...the Public Health Agency of Canada says (the delta variant is) in all ten provinces and the World Health Organization has labelled it a variant-of-concern...spread isn't being quantified in Canada

...Officials in the U.K. say they are looking at the data and will announce a decision on June 14 on whether they'll stick to the original reopening timeline (June 21).

...Researchers at Public Health England studied over 1,000 people confirmed to have the delta strain and found that the Pfizer vaccine was 88 per cent effective and AstraZeneca was 60 per cent effective against the variant two weeks after the second dose...However, the study found both vaccines were only about 33 per cent effective against symptomatic disease three weeks after the first dose.

Given these figures, it's "absolutely critical" to get two doses into Canadians as quickly as possible, advised Gurdasani.

...Dr. Zain Chagla, associate professor of medicine at McMaster University and an infectious disease specialist for St. Joseph's Healthcare in Hamilton, (says) Canada needs to make "a monumental effort" to roll out second doses...While some people in the U.K. got COVID from the delta variant even after being fully vaccinated, they mostly experienced milder illness...Canada's vaccination rate means we're in a far better position now to fight off this variant than we were during the third wave, driven by the alpha variant B117...Places like Australia, Taiwan and Singapore who are dealing with this, and are slower to vaccinate their population, they're going to have more trouble. This variant seems to be effective at finding its way to people that have not been vaccinated."

...Gurdasani:... "bring...community transmission to zero or near zero and maintain... it at that level for as long as possible until most of the population is protected with vaccines."

https://www.cbc.ca/amp/1.6050085

146margd
Jun 4, 2021, 11:18 am

As COVID-19 collides with HIV/AIDS, the pandemic may be taking an ominous turn
Melissa Healy | Thu, June 3, 2021

...(in S Africa) the coronavirus that lingered in (a 36-year-old woman with uncontrolled HIV who was unable to shake the SARS-CoV-2 virus for close to eight months) underwent 13 genetic changes related to its crucial spike protein, along with at least 19 other genetic shifts elsewhere that could change the behavior of the virus. (The driving force behind the patient’s rapid accumulation of genetic changes is probably her impaired immune response due to her unsuccessfully treated HIV)

...if her case turns out to be typical, that picture could change: HIV patients whose infections are not controlled with medication could "become a factory of variants for the whole world," said Tulio de Oliveira, a geneticist at the University of KwaZulu-Natal in Durban, who led the new research....

...Among the surprises: The mutations that emerged in the South African patient did not seem to be a direct response to powerful medications aimed at treating COVID-19. The primary treatment she received in the hospital was supplemental oxygen.

...had she not been enrolled in a study of COVID-19 patients with HIV or tuberculosis, she probably would have been unaware that she might be spreading newly hatched viral variants to others.

...The woman's case may also help explain why more than half of the new coronavirus variants detected to date were first documented in Africa.

The continent is home to an estimated 7.5 million HIV-positive people who are not effectively treated with antiretroviral therapies. Most have impaired immunity, giving the virus a longer period to replicate and mutate...

LA Times via
https://news.yahoo.com/covid-19-collides-hiv-aids-100051925.html

147margd
Jun 4, 2021, 11:41 am

Eric Topol @EricTopol | 11:15 AM · Jun 4, 2021:
The increasing rate of hospitalizations for adolescents with covid during the US pandemic,
~1/3 requiring ICU admission, and why vaccination is important

A new @CDCMMWR report https://cdc.gov/mmwr/volumes/70/wr/mm7023e1.htm?s_cid=mm7023e1_w *
Image-graph of hospitalizations, by age group ( https://twitter.com/EricTopol/status/1400833669711863810/photo/1 )
Image-graph flu hospitalizations ( https://twitter.com/EricTopol/status/1400833669711863810/photo/2 )
Image-graphic 12-17YO ( https://twitter.com/EricTopol/status/1400833669711863810/photo/3 )

--------------------------------------------------------------------------

* Havers FP, Whitaker M, Self JL, et al. 2021. Hospitalization of Adolescents Aged 12–17 Years with Laboratory-Confirmed COVID-19 — COVID-NET, 14 States, March 1, 2020–April 24, 2021. MMWR Morb Mortal Wkly Rep. ePub: 4 June 2021. DOI: http://dx.doi.org/10.15585/mmwr.mm7023e1 https://www.cdc.gov/mmwr/volumes/70/wr/mm7023e1.htm

Discussion
COVID-NET data indicate that COVID-19–associated hospitalization rates were lower in adolescents aged 12–17 years compared with those in adults but exceeded those among children aged 5–11 years during March 1, 2020–April 24, 2021. Moreover, COVID-19–associated hospitalization rates among adolescents increased during March–April 2021, and nearly one third of 204 recently hospitalized adolescents required ICU admission. Rates of COVID-19–associated hospitalization among adolescents also exceeded historical rates of seasonal influenza-associated hospitalization during comparable periods. Recent increased hospitalization rates and the potential for severe disease reinforce the importance of continued COVID-19 prevention measures among adolescents, including vaccination and correct and consistent wearing of masks.

After declines in January and February 2021, weekly population-based rates of COVID-19–associated hospitalization among adolescents increased during March and April, and in two COVID-NET sites (Maryland and Michigan) the highest adolescent COVID-19–associated hospitalization rates in their respective sites since the start of the COVID-19 pandemic occurred during this period. This trend contrasts with hospitalization rates among persons aged 65 years or older, the group with the highest COVID-19 vaccination coverage, among whom hospitalization rates in COVID-NET stabilized during the same period.

Increased hospitalization rates among adolescents might be related, in part, to circulation of particularly transmissible SARS-CoV-2 variants,... the larger numbers of children returning to school or other in-person indoor activities, and changes in physical distancing, wearing masks, and other COVID-19 prevention behaviors.... SARS-CoV-2 transmission occurs more easily in high schools than in elementary schools..., and outbreaks have been associated with high school extracurricular activities.... Vaccination of adolescents is expected to reduce the risk for COVID-19 in these settings.

Population-based COVID-19–associated hospitalization rates among adolescents were lower than were those in adults, a finding consistent with studies showing that illness is generally milder in children than in adults... Nevertheless, severe disease does occur, including that requiring ICU admission and invasive mechanical ventilation. Most (70.6%) adolescents in this study whose primary reason for hospitalization was COVID-19–associated illness had at least one underlying medical condition, which is lower than the percentage of hospitalized adults with an underlying medical condition (92%)... Nearly 30% of these adolescents had no reported underlying medical condition, indicating that healthy adolescents are also at risk for severe COVID-19–associated disease. In addition, approximately two thirds of adolescents hospitalized with COVID-19 were Hispanic or non-Hispanic Black persons, consistent with studies showing an increased incidence of COVID-19 among racial and ethnic minority populations and signifying an urgent need to ensure equitable access to vaccines for these groups... Vaccination is effective in preventing hospitalization among adults...; similarly, widespread vaccination of adolescents will likely reduce COVID-19–associated hospitalizations, and potential sequelae from COVID-19 in adolescents, including multisystem inflammatory syndrome in children (MIS-C), a rare but serious complication of COVID-19...

During a comparable period, adolescent hospitalization rates associated with COVID-19 exceeded those for seasonal influenza, another respiratory virus that can cause hospitalization and death in adolescents and for which a vaccine is recommended in this age group... This widespread circulation of SARS-CoV-2 occurred despite containment measures such as school closures, wearing masks, and physical distancing, none of which had been enacted during the historical influenza seasons. Without these containment measures, the rates of COVID-19–associated hospitalization might have been substantially higher.

The findings in this report are subject to at least five limitations. First, the primary reason for hospital admission was not always clear, and some (45.7%) adolescents who met the COVID-NET case definition were hospitalized for reasons that might not have been primarily related to COVID-19, despite a positive SARS-CoV-2 laboratory test result; these hospitalizations were included in rate calculations. Thus, rates of hospitalizations for COVID-19 might be overestimated. Second, laboratory confirmation depends on clinician-ordered testing and hospital testing policies for SARS-CoV-2 (COVID-NET) and influenza (FluSurv-NET); consequently, hospitalization rates might also be underestimated. Given more widespread testing for SARS-CoV-2 compared with influenza, the lack of adjustment for testing practices likely disproportionately affects influenza rates compared with COVID-19 rates. Third, adolescents hospitalized with MIS-C might not be identified if testing occurred >14 margd: days before admission, potentially leading to an underestimate of severe COVID-19–associated disease. Fourth, the Pfizer-BioNTech COVID-19 vaccine had been approved for and administered to adolescents aged 16–17 years during this study period; therefore, rates of COVID-19–associated hospitalization in adolescents aged 16–17 years might differ from those in adolescents aged 12–15 years who were not previously eligible for vaccination, and could affect the overall hospitalization rate for all adolescents. Finally, hospitalization rates are preliminary and might change as additional data are reported.

Recent increases in COVID-19–associated hospitalization rates and the potential for severe disease requiring ICU admission, including invasive mechanical ventilation, among adolescents indicate an urgent need for vaccination in combination with correct and consistent mask wearing by persons not yet fully vaccinated or when required by laws, rules, or regulations. Highly effective COVID-19 vaccines are now available to adolescents as an additional evidence-based prevention measure (9); expansion of COVID-19 vaccination of adolescents, with particular attention to racial and ethnic minority groups disproportionately affected by severe COVID-19, is expected to reduce COVID-19–associated morbidity within this age group.

148margd
Jun 4, 2021, 3:56 pm

Kashif Pirzada, MD (Toronto emerg) @KashPrime | 3:01 PM · Jun 4, 2021:
If you had AZ vaccine first dose, get an mRNA vaccine for the second dose.
It’s proving to be a much stronger combination, and very safe as well.

Quote Tweet
David Fisman (Prof, UofT) @DFisman | 12:14 PM · Jun 4, 2021:
Important: German data on ChAd/ChAd (AZ/AZ) vs. ChAd/BNT (AZ/Pfizer) vaccine regimens.
TLDR: AZ/Pfizer regimen blows the doors off AZ/AZ wrt anti-spike titres, as well as neutralizing antibody against P1 and B1351.
Hot off the preprint press!
------------------------------------------------------------

Joana Barros-Martin et al. 2021. Humoral and cellular immune response against SARS-CoV-2 variants following heterologous and homologous ChAdOx1 nCoV-19/BNT162b2 vaccination. MedRxiv posted June 3, 2021. 12 p. https://doi.org/10.1101/2021.06.01.21258172 https://medrxiv.org/content/10.1101/2021.06.01.21258172v1.full.pdf

This preprint reports new research that has not been certified by peer review.

Abstract Cerebral venous thrombosis was reported as a rare but serious adverse event in young and middle-aged vaccinees following immunization with AstraZeneca’ s ChAdOx1-nCov-19 vaccine. As a consequence, several European governments recommended using this vaccine only in individuals older than 60 years leaving millions of ChAd primed individuals with the decision to either receive a second shot of ChAd or a heterologous boost with mRNA-based vaccines. However, such combinations have not been tested so far. We used Hannover Medical School’ s COVID-19 Contact (CoCo) Study cohort of healthcare professionals (HCP) to monitor ChAd primed immune responses before and three weeks after booster with ChAd or BioNTech/Pfizer’s BNT162b2. Whilst both vaccines boosted prime-induced immunity, BNT induced significantly higher frequencies of Spike-specific CD4 and CD8 T cells and, in particular, high titers of neutralizing antibodies against the B. 1.1.7 , B.1.351 and the P.1 variants of concern of severe acute respiratory syndrome coronavirus type 2 (SARS - Co V-2 ).

149margd
Editado: Jun 5, 2021, 9:15 am

Looks like nasty B.1.617.2 (first reported in India) is most common in Peel--so a good place to focus vaxx?
(Peel is south of Pearson Intl Airport in Toronto, densely populated with hardworking (not necessarily poor) immigrant population.
Lots of hardworking taxi drivers live there, so opportunity to catch from and transmit to air travellers?)

SARS-CoV-2 Whole Genome Sequencing in Ontario
SUMMARY
Public Health Ontario | May 31, 2021
10p

...Highlights Among samples from May 2 to May 15, 2021 sequenced by PHO Public Health Ontario for representative surveillance, the majority were Pango lineage B.1.1.7 (80.2%), followed by P.1 (6.3%), and B.1.617+ (5.8%).

The proportion that were B.1.617+ increased from 5.2% (May 2-8) to 9.6% (May 9-15).

Among WGS Whole Genome Sequencing results from January 1, 2021 to May 22, 2021, a total of
- 284 samples were identified as B.1.617+.
-41 samples were identified as B.1.617.1
-241 samples were identified as B.1.617.2
-2 samples were identified as B.1.617.3

A total of 889 samples have been identified as the VOI B.1.1.318 from January 1, 2021 to May 22, 2021*...

https://www.publichealthontario.ca/-/media/documents/ncov/epi/covid-19-sars-cov2...
---------------------------------------------------------------

* B.1.1.7 (80.2%)--first reported in UK
P.1 (6.3%)--first reported in Brazil, significant numbers in BC
B.1.617+ (5.8%)--three sub-variants, first reported in India
B.1.1.318- first reported in UK...declared a Variant Under Investigation (VUI) and contained the E484K mutation which is a feature of the South African and Brazilian variants. However, it does not feature the N501Y mutation which appears in variants of concern (VOC) https://www.gmanetwork.com/news/scitech/science/778412/english-health-officials-...

150davidgn
Jun 5, 2021, 8:50 am

I'm not fully up to date, but we did all read this, right?

VIRAL INFLECTION
The Lab-Leak Theory: Inside the Fight to Uncover COVID-19’s Origins
Throughout 2020, the notion that the novel coronavirus leaked from a lab was off-limits. Those who dared to push for transparency say toxic politics and hidden agendas kept us in the dark.
BY KATHERINE EBAN
JUNE 3, 2021

https://www.vanityfair.com/news/2021/06/the-lab-leak-theory-inside-the-fight-to-...

(cf. https://www.librarything.com/topic/319381#7147822 )

151margd
Editado: Jun 5, 2021, 11:03 am

>150 davidgn: Interesting, thanks. Dunno if we'll ever know the truth, but if so, bet it will come from scientists and reporters, not Q-informed conspiracy theorists. (Dr. Seuss, Mr. Potato Head...)

ETA: We've all benefited from the so MANY Chinese names on COVID studies, so it's hateful to think that attacks on people of Asian heritage will resume, but here's a two-year old story from Winnipeg, Canada (via David Frum):

Chinese researcher escorted from infectious disease lab amid RCMP investigation
Public Health Agency of Canada describes it as a possible 'policy breach,' no risk to Canadian public
Karen Pauls · CBC News | Jul 14, 2019

Dr. Xiangguo Qiu, her husband, Keding Cheng, and an unknown number of her students from China were removed from Canada's only level-4 lab on July 5 amidst an RCMP investigation into what's being described as a possible 'policy breach.' ...

...A Level 4 virology facility is a lab equipped to work with the most serious and deadly human and animal diseases. That makes the Arlington Street lab one of only a handful in North America capable of handling pathogens requiring the highest level of containment, such as Ebola.

Security access for the couple and the Chinese students was revoked

...Qiu is a prominent virologist who helped develop ZMapp, a treatment for the deadly Ebola virus which killed more than 11,000 people in West Africa between 2014-2016...Qiu is a medical doctor from Tianjin, China, who came to Canada for graduate studies in 1996. She is still affiliated with the university there and has brought in many students over the years to help with her work.

Currently head of the Vaccine Development and Antiviral Therapies section in the Special Pathogens Program at the lab, Qiu's primary field is immunology. Her research focuses on vaccine development, post-exposure therapeutics and rapid diagnostics of viruses like Ebola.

She is also an adjunct professor in the Department of Medical Microbiology at the University of Manitoba.

Cheng also works at the lab as a biologist. He has published research papers on HIV infections, Severe Acute Respiratory Syndrome (SARS), E. coli infections and Creutzfeldt-Jakob Syndrome...

https://www.cbc.ca/news/canada/manitoba/chinese-researcher-escorted-from-infecti...

-------------------------------------------------------------

PHAC (Public Health Agency Canada) president given until Friday to explain why two scientists let go
Dr. Xiangguo Qiu, husband escorted from NML (National Microbiology Laboratory) in July 2019 over potential policy breach, administrative matter
Joan Bryden | Mar 22, 2021

...PHAC has said their escorted exit had nothing to do with the fact that four months earlier, Qiu had been responsible for a shipment of Ebola and Henipah viruses to China's Wuhan Institute of Virology...

https://www.cbc.ca/news/canada/manitoba/phac-national-microbiology-lab-1.5959996

152davidgn
Jun 5, 2021, 4:26 pm

Here's Chris Martenson dissecting the email string.
https://www.youtube.com/watch?v=DNxoVFZwMYw

"Operation Rice Bowl"?

153Quaisior
Jul 7, 2021, 4:53 pm

>9 margd: I just started getting Remicade (infliximab) infusions at the beginning of this year and I'm still on azathioprine (I have been for years and it worked well until after I gave birth 6 years ago). I'm not sure if it's the study you referenced above or another one, but azathioprine in combination with infliximab causes a further weakening of the immune response to the Covid vaccine. What my medical team did was make sure I had the Covid vaccine at least two weeks after one infusion and at least two weeks before the next. I have no idea if that worked or not though because I haven't had an antibody test. If I can get a third dose of the vaccine (which some immunocompromised patients have been advised to do), I'd like to get my antibody level checked a few weeks afterward. For now, I'm just continuing to do what I've done for the past 16 months, which is stay home as much as possible and wear an N95 mask when I have to go to doctor's appointments and such, and will continue to do so for the foreseeable future.

154margd
Jul 8, 2021, 3:45 am

>153 Quaisior: We still have a ways to go as far as this pandemic goes, but sounds like you and your MDs have a good plan! Though I'm luckily immune at the moment, I continue to wear a mask to stores at least--for immuno-compromised, people with co-morbidities, anti-vaxxers I love, and so as not to contribute to generation/propagation of new variants. Plus I think I had COVID in early 2020, and, though it was mild in comparison to others', it is not an experience I wish to repeat! No colds or flu this past year...that was nice. But so, too, these last couple months have been glimpses of past pleasures--dining with friends on our deck, on a restaurant patio. Hopefully, we soon will all be able to enjoy each others' company without fear.
Este tópico foi continuado por SARS-CoV-2 and COVID-19 (22).