Coronavirus Update March 2022

[dk168]

Despite being triple-vaccinated, and continued to wear mask in crowded places, I tested positive on a LFT this morning, after feeling unwell since Sunday and tested negative in the past 2 days.

I believe I caught it from a Rum Tasting Session on Thursday 24 February, or being the pub the following day, as a number of friends who attended these two events have also been tested positive.

Feeling cr@p like a very bad cold, the dry cough is the worst, however, I am thankful that I have no loss of taste and smell so far!

Taking it easy today, and I have cancelled my social engagements until Sunday as I believe I should self-isolate even if there is no legal requirement to do so in England.

Good job I am working from home nowadays.

Stay safe everyone, it is far from over!

DK

 

[Ally T]

Urgh

Gentle hugs & feel better soon.

 

[missy]

Sending you healing vibes @dk168 and gentle (((hugs))).

 

[missy]

"
The latest masking guidance from the Centers for Disease Control and Prevention is designed to be less disruptive to people's daily lives, recommending masks in fewer places and raising the threshold for what counts as "high" level of virus spread in the community. But like all such policy changes, it will take some getting used to. Here’s what to know about the new recommendations as you continue to navigate your day-to-day life in a shifting pandemic. And here's a rundown of how the guidance affects travelers.

As coronavirus cases fall and public health mandates loosen around the country, Americans are still pessimistic about U.S. recovery. Forty-four percent of American adults approve of President Biden's handling of the pandemic, down from about 60 percent over the summer, according to a new Washington Post-ABC News poll. Fifty percent say they disapprove. The president's numbers on the economy are even worse, with 37 percent approving and 58 percent disapproving, the poll shows. Americans are split on whether Biden is to blame for rises in consumer prices, with 7 in 10 saying disruptions from the pandemic are the cause, and 2 in 3 blaming profit-hungry corporations.

For many people with weakened immune systems, houses of worship no longer offer refuge from the coronavirus. Many virtual services are no more, parishioners often aren't masking up, and some church leaders aren't taking steps to protect their most vulnerable members, my colleague Sarah Pulliam Baily reports. Some churchgoers are staying away from in-person services while others have left their churches entirely. “It feels a little like losing a side of your family," said one worshiper whose son is an immunocompromised cancer survivor.

The coronavirus tore through the nation's nursing homes in the early days of the pandemic, and sickened and killed residents at high rates in every surge. To better protect this vulnerable population, the White House on Monday announced a plan to boost nursing home staffing and oversight, noting that nursing home patients represent almost a quarter of all U.S. covid-19 deaths. It's part of a package of measures Biden plans to unveil in his State of the Union address Tuesday.

Long covid is still a mysterious condition, but scientists are slowly learning more about what it is, how it arises and how to treat it. The Post spoke with experts who are researching and treating long covid, and compiled answers to some of the most commonly asked questions about it. Here's the latest on what we know.

"

 

[missy]

"
Risk of contracting COVID-19 during the Omicron surge was higher when the index case was unvaccinated, though this risk was still high among vaccinated cases, researchers found.

Among index cases who were unvaccinated, the attack rate in household contacts was 64% compared with 44% in contacts of index cases who completed their primary vaccination series within 5 months and 43% among those who were vaccinated and boosted, reported Julia Baker, PhD, of the CDC, and colleagues in the Morbidity and Mortality Weekly Report.



Not surprisingly, attack rates were lower when index cases isolated or wore a mask at home. Among household contacts of index patients who isolated, the attack rate was 41% versus 68% for those who did not isolate (P<0.01). These rates were 40% for contacts of index cases who reported "ever" wearing a mask at home "during their potentially infectious period" versus 69% for those who never wore a mask at home (P<0.01), they noted.

These findings emphasize the importance of a multi-pronged strategy to prevent COVID transmission in households, including isolation, mask-wearing, and being up-to-date on vaccination, Baker and team concluded.

Among household contacts with and without a prior COVID infection, attack rates were 41% and 60%, though this difference was non-significant (P=0.0.

Baker and colleagues examined data from telephone surveys in four U.S. jurisdictions: the states of Connecticut and Utah and the cities of Chicago and Milwaukee. Households were eligible if they had at least two people living there, and were not in a congregate setting.



Index cases were the first person within each household to either experience COVID symptoms or receive a positive test. Household contacts were anyone who "spent one or more overnights in the residence with the index patient during their potentially infectious period," the authors noted.

Overall, 183 index cases and 439 household contacts were included. Median age of index cases was 39, and 59% were white.

Transmission occurred in 68% of households, and 227 contacts were classified as having COVID, for an overall attack rate of 53%.

Examining contacts by vaccination status, attack rates were unsurprisingly lowest among vaccinated and boosted contacts (48%), followed by contacts fully vaccinated within the prior 5 months (50%).

Notably, household contact attack rates were lowest when the index case was 5 to 11 years old (48%) and highest when the index case was 4 years old or younger (72%).

"These findings further highlight young children's potential contribution to household transmission of SARS-CoV-2, as well as their ongoing susceptibility to infection when SARS-CoV-2 is introduced in the home," Baker's group wrote."

 

[missy]

"

COVID Vaccine Less Effective in Younger Kids​

— Real-world data suggest substantially lower protection against infection in preprint study​

by Molly Walker, Deputy Managing Editor, MedPage Today

Effectiveness of the Pfizer COVID-19 vaccine (Comirnaty) against infection and hospitalization dropped among kids ages 5 to 11 a little over a month after vaccination, according to real-world data from New York during the Omicron wave.
From Dec. 13, 2021 to Jan. 30, 2022, vaccine effectiveness against infection within 2 weeks of full vaccination dropped from 65% (95% CI 62-6 to 12% (95% CI 8-16) by 28 to 34 days, reported Vajeera Dorabawila, PhD, of the New York State Department of Health, and colleagues.

Moreover, vaccine effectiveness against hospitalization dropped from 100%, albeit with a wide confidence interval (95% CI -189 to 100), to 48% (95% CI -12 to 75), they noted in a study published on the preprint server medRxiv.
Notably, vaccine effectiveness against hospitalization held up much better among kids ages 12 to 17, only dropping from 85% (95% CI 63-95) to 73% (95% CI 53-87). Effectiveness against infection in this age group fell from 76% (95% CI 71-81) to 56% (95% CI 43-63).
All effectiveness estimates among children ages 5 to 11 dropped below those for kids ages 12 to 17 by January 24, the authors noted, with a vaccine effectiveness against infection of 11% (95% CI -3 to 23) for age 11, and 67% (95% CI 62-71) for age 12.
Dorabawila and team examined data from three New York databases to assess the real-world effectiveness of the vaccine among children ages 5 to 17 during the Omicron wave. COVID cases were defined as positive nucleic acid amplification tests (NAAT) or antigen results.
Overall, 365,502 children ages 5 to 11 (23.4%) and 852,384 children ages 12 to 17 (62.4%) were fully vaccinated in New York state by the week of January 24-30. Mean age was about 8 among the younger age group, and about 15 for older kids. Median time since vaccination was 51 days for the younger group and 211 days for the older group.

The authors hypothesized that the lower dose among kids ages 5 to 11 accounted for the "markedly lower" vaccine effectiveness against infection. The younger group's two-dose primary series consists of 10 μg apiece versus 30 μg apiece for the older group.
Interestingly, children who were 12 years old had the highest vaccine effectiveness of all ages, "potentially due to being small size relative to dose and more recent vaccination" by an average of 6 weeks versus adolescents ages 13 to 17.
"This gap suggests a threshold effect between the two [Pfizer] vaccine doses and need for study of numbers of doses, amount per dose, dose timing, and/or antigens targeted for children 5-11 years," Dorabawila's group wrote.
Home testing was not reported in this analysis, the authors acknowledged, though this would not affect hospitalizations. They also noted that there were "relatively few" hospital admissions for children during this period. Additionally, 12.5% of vaccinated kids ages 12 to 17 received a booster dose by the end of January, "likely adding protection to that group."
"Should such findings be replicated in other settings, review of the dosing schedule for children 5-11 years appears prudent," Dorabawila and colleagues concluded.



"

 

[dk168]

@missy thanks!

It's like a really bad cold, however, not as bad as flu, as I could not get out of bed when I had flu and lost my appetite entirely!

I still have an appetite, and my sense of taste and smell do not appear to be affected so far.

I got an e-mail asking me to participate in a antiviral trial and I ticked all the eligibility boxes, so I had signed up for it. However, my symptoms are mild and may not be selected. See how it goes from here.

DK

 

[diamondringlover]

I hope you dont feel too horrible!

 

[MamaBee]

@dk168 I hope you feel better soon!

 

[dk168]

@dk168 I hope you feel better soon!

I hope so too as I hate to be ill, and thanks!

DK

 

[missy]

"

Biden on Covid …​

With both symbols and words, Biden signaled that he hoped the country was entering a new phase of the pandemic.​

He did not wear a mask while walking to the rostrum or during his speech. House Speaker Nancy Pelosi and Vice President Kamala Harris did not wear masks while sitting behind him. Few members of Congress in the audience wore them, either.​

“For more than two years, Covid has impacted every decision in our lives and the life of this nation. And I know you’re tired, frustrated and exhausted,” Biden said. “But I also know this: Because of the progress we’ve made, because of your resilience and the tools that we have been provided by this Congress, tonight I can say we’re moving forward safely, back to more normal routines.”​

Biden said his administration would expand availability of post-infection treatments and rapid tests, efforts to prepare for new variants and distribution of vaccines to other countries. He also called for workplaces and schools to remain open.​

“We can end the shutdown of schools and businesses,” he said. “Our kids need to be in school.”"​

 

[missy]

"

Hong Kong Families Despair as COVID Rules May Separate Them From Children​

By Farah Master

HONG KONG (Reuters) - Guada, a mother of two young children and pregnant with twins, cries herself to sleep at night, worried that Hong Kong's severe COVID-19 rules will separate her from her kids or force her to give birth alone.
Anyone who tests positive for COVID-19 in Hong Kong, including infants and children, are put into isolation facilities with no family contact allowed, as authorities enforce their "dynamic zero" COVID policy.
As coronavirus cases hit record daily highs, the government plans to roll out compulsory mass testing for the city's 7.4 million people in March, exacerbating separation fears among many local and expatriate families.
"Imagine the stress I'm having right now ... scared of having to give birth alone, scared of them taking my daughters away, taking my babies away, scared that if I'm positive, they are going to take me away," said Guada, an Argentinian who has lived in Hong Kong for 3-1/2 years and has two girls aged 3 and 5. She declined to give her last name due to the sensitivity of the situation.

Parents' worries have been heightened after authorities made an infected 11-month-old isolate by herself in hospital.

In the past two weeks, authorities have reported the deaths of several children who were infected with coronavirus, the youngest another 11-month-old.
Diplomats in the global financial hub say they have repeatedly raised concerns with the government over the issue of parents being separated from children in a city with some of the world's most stringent coronavirus measures.
In response to media questions, Hong Kong's Hospital Authority said it "understands the concern of parents and carers" but noted that child isolation facilities in public hospitals are seriously overloaded.

Where parents or carers were also COVID-positive, a hospital would try to ensure they could stay in the same ward as their infected child.
VIDEO CALLS
Authorities have said they are overwhelmed and cannot accommodate parents staying with infected infants as hospitals operate at maximum or over capacity with close to 10,000 new daily infections from nearly zero at the start of the year.
Parents can arrange video calls three times a day to stay in contact with their young ones, health authorities said.

"For me, it's very inhumane. I'm very afraid. I have a daughter aged 14 months, she doesn't speak, she doesn't know how our phone works," said a university lecturer who declined to be identified.

Medical clinic Central Health said isolating infants presented a "significant risk" of child fatalities "as parents may delay taking their children to hospital during critical periods when intervention could save lives".

Some families, particularly in the expatriate community, have decided to leave ahead of the mandatory coronavirus testing in March.

While details of the testing remain vague, Hong Kong Chief Executive Carrie Lam has said people will not be able to isolate at home if they test positive and must go to government centres. Isolation and quarantine centres are currently at their maximum capacity with around 60,000 residents waiting at home to be admitted.

The government is building tens of thousands of new isolation units, with the help of the Chinese government, compounding worries families will be separated.

Hong Kong has recorded over 80,000 infections and more than 400 deaths since 2020, fewer than other major cities.

Spanish expatriate Veronica, who has lived in Hong Kong for nine years and also declined to give her last name, said she was distressed about the prospect of being separated from her three-month-old.

"I'm worried about leaving him alone, I'm not worried about the virus, I have the vaccine. I'm just worried about the situation," she said.
"

 

[missy]

South Korea Records Deadliest Pandemic
Day So Far​

Carolyn Crist

"
South Korea reported its deadliest day of the pandemic as the country faces a surge due to the Omicron variant, recording 114 deaths on Sunday after the previous high of 112 deaths just 2 days before.

In addition, 715 patients were hospitalized in severe or critical condition on Monday, up from about 400 a week earlier and 200-300 in mid-February, according to The New York Times.

Cases have also increased during the last week, reaching a record of more than 171,000 daily cases on Wednesday. Since then, case numbers have remained high, at an average of more than 150,000 per day, according to the country’s latest data.

With a population of about 50 million people, South Korea now has one of the worst surges in the world and is now reporting more cases per day than the U.S. despite about 86% of people being fully vaccinated.


The government plans to have more hospital beds in March, health officials said Friday. The Korea Disease Control and Prevention Agency is prepared to receive and treat up to 2,000 patients with severe COVID-19, the Times reported.


At the same time, the government has adopted a new approach of learning to live with the coronavirus as part of daily life. Starting in March, those who live with people who have tested positive will no longer be required to quarantine, regardless of their vaccination status, the newspaper reported.

Health officials are now focusing on detecting the coronavirus in high-risk groups, such as people ages 60 and older and those with other medical conditions. They are treating only the most critical cases and asking most people who test positive to recover at home.

On Monday, South Korea’s Health Ministry also announced that people will no longer be required to show proof of vaccination or a negative test to enter indoor spaces starting on Tuesday, according to The Associated Press. Since December, adults had been required to show their vaccination status to enter restaurants, coffee shops, gyms, and karaoke venues.


Canceling the "anti-epidemic pass" will free up health care workers to help monitor the 800,000 virus patients with mild or moderate symptoms who have been asked to isolate at home, Park Hyang, a senior health ministry official, said Monday.

"While the anti-epidemic pass has been halted, we ask for people in their 60s or older and unvaccinated people to exercise even more caution than before," he said.

Sources:

The New York Times: "South Korea records its deadliest day of the pandemic."
"

 

[missy]

"

EMA Panel Backs 3-Month Interval for Moderna Booster​

By Reuters Staff

(Reuters) - The advisory committee to the European Union's drug regulator on Friday said it has recommended reducing the interval between the second dose and booster dose of Moderna Inc's COVID-19 vaccine from six months to three months.
Several countries including Greece and France have previously shortened the interval between the first two doses and the booster dose of COVID-19 vaccines, in the face of rising cases due to the Omicron variant. Some also authorised a fourth shot for the vulnerable.
The European Medicines Agency (EMA) in December said data supported safe and effective administration of a booster as early as three months after a two-shot regimen, without changing the six month recommendation.
The EMA's human medicines committee (CHMP) on Thursday also backed the use of Moderna's vaccine, Spikevax, in children aged 6 to 11. The vaccine is already approved for use in adults and children aged 12 and over in Europe.

In the United States, Spikevax is authorised as a primary two-dose regimen and booster dose for adults 18 years and older and country's health regulator last month shortened the interval between the primary series and booster to five months from six.

The CHMP on Friday also recommended authorising the use of Spikevax as a booster dose for adults who have had another COVID-19 vaccine, according to an update on its website.



Reuters Health Information © 2022

"

 

[missy]

"

Sweden's COVID Response Was Flawed but Allowed Freedoms: Commission​

By Johan Ahlander and Niklas Pollard

STOCKHOLM (Reuters) - Sweden should have shut venues and taken other tougher measures early in the COVID-19 pandemic, though its no-lockdown strategy was broadly beneficial, a commission said on Friday.
Sweden polarised opinion at home and abroad when it chose not to follow most of the rest of the world in ordering lockdowns and adopted a largely voluntary approach of promoting social distancing and good hygiene.
The commission - set up by the government under pressure from parliament - said Sweden's broad policy was "fundamentally correct."
"It meant that citizens retained more of their personal freedom than in many other countries," the report read.

But the panel of eight experts, including professors of economics and political science, said the government should have taken clearer leadership and acted sooner.

The criticisms could become a liability for the ruling Social Democrats with elections due in September.
"In February-March 2020, Sweden should have opted for more rigorous and intrusive disease prevention and control measures," the commission said in the report.
It criticised decisions not to close venues such as restaurants and shopping centres even briefly and to reject face masks early in the pandemic.

It also said the government had delegated too much responsibility to government agencies, primarily the Health Agency, and that it was not always clear who took decisions.
"In a crisis, there must be no uncertainty about who is in charge," it said.
Sweden only gradually tightened curbs and never closed schools for younger children. Authorities eventually recommended masks, but only for situations such as rush hour commutes.
More than 17,000 people have died from or with COVID-19 in Sweden, far more per capita than among Nordic neighbours but fewer than in most European countries that opted for lockdowns.

Statistics agency Eurostat figures showed the country had 7.7% more deaths in 2020 than its average for the preceding four years, among the lowest excess mortality rates in Europe.

Previous commission reports have highlighted serious deficiencies in the elderly care going into the pandemic, such as understaffing and poor hygiene.

Sweden has not seen the large-scale protests against COVID curbs that have rocked many other countries.

"

 

[missy]

"

First Deer-to-Human COVID Case? SCOTUS Hears Pill Mill Case; Alexa, Call the Doctor​

— A daily roundup of news on COVID-19 and the rest of medicine​

by Lei Lei Wu, Staff Writer, MedPage Today March 1, 2022

Oh deer! Canadian researchers report a first case of deer-to-human COVID transmission in a preprint paper. (bioRxiv)
California, Washington, and Oregon will join other states in dropping school mask mandates. (AP)
The CDC is telling unvaccinated travelers to avoid Hong Kong, where mortuaries are struggling to keep up amid a surge in COVID-19 deaths. (Reuters)
Efforts aimed at getting Medicaid enrollees vaccinated are not panning out. (Kaiser Health News)

The latest U.N. climate change report suggests the health and economic effects of severe weather will be more dire than previously predicted, and about half the world's population could be affected. (Washington Post)
As of Tuesday at 8 a.m. EST, the unofficial COVID toll reached 79,045,719 cases and 950,521 deaths, up 106,516 cases and 2,092 deaths from this time a day ago.
Also today, the Supreme Court will hear the cases of two physicians convicted of illegally prescribing opioids through pill mill clinics. (New York Times)
Alexa can now call the doctor from Amazon Echo devices. (AP)
Psychedelic therapy? Dr. Bronner's says yes. The soap company has donated over $23 million to psychedelic therapy and advocacy. (New York Times)
In a letter to healthcare providers, the FDA is urging lifelong surveillance of patients with abdominal aortic aneurysm endovascular aortic repair (EVAR) -- including imaging within 30-days of EVAR, and then annually -- to monitor for signs of serious or life-threatening adverse events from the procedure.

Meanwhile, the agency rejected approval of Oleogel-S10, an investigational herbal ointment for dystrophic and junctional epidermolysis bullosa, a rare genetic skin disease for which there are currently no approved therapies, developer Amryt Pharma announced.
Arbutus has filed a patent infringement lawsuit against Moderna for part of its mRNA vaccine technology. (Reuters)
In other vaccine news, GlaxoSmithKline said it halted three respiratory syncytial virus (RSV) vaccine trials in pregnant women following a safety review.
Three fertility doctors in Rochester, New York, were found to have been impregnating patients with their own sperm since the 1960s. Their biological children found out from DNA testing through sites like Ancestry.com. (New York Times)
Drugs for HIV prevention are still costing people thousands despite federal rules requiring insurance companies cover the costs. (CNN)
Will states ever get universal healthcare? The future of single-payer healthcare is looking dim after California Gov. Gavin Newsom (D) backed away from his campaign promise. (Kaiser Health News)

Adolescents who smoke, have obesity, or have certain psychological disorders may age faster than their peers, researchers report in JAMA Pediatrics.
In Peru, a cancer prevention group is using 1,000-year-old erotic statues to teach men how to identify signs of prostate and testicular cancer. (Reuters)
In Somaliland and other parts of Africa, female genital mutilation rates "rose alarmingly" during the pandemic, health workers warned. (AP)
"

 

[Asscherhalo_lover]

My son's school district is officially mask optional. He is vaccinated and I told him he can wear it or not, it's up to him. We'll see how it goes.

 

[missy]

My son's school district is officially mask optional. He is vaccinated and I told him he can wear it or not, it's up to him. We'll see how it goes.

Good luck @Asscherhalo_lover, it is a scary time IMO. Especially when one has children. A bunch of firsts for us and the kids. Hope your family stays well through this uncertain time. It does feel like we are finally seeing the light at the end of that proverbial tunnel. Fingers and toes crossed.

 

[MamaBee]

I really didn’t know where to post this..but this seems like the right place. My mom has had over eighty cases of Covid in her nursing home since Christmas. I didn’t see her for over two months. It went from averaging ten a week to zero last week. It’s the same this week..zero cases. It literally dropped like a cliff…I always said it felt like her nursing home was a good indicator of what was going on with Covid during the Omicron surge. I’m very hopeful that we are seeing a move into the more manageable stage. I saw her for the first time last week. I also picked her up for a visit yesterday. I’m still wearing my mask when I have to go indoors to stores..…Everyone I see in stores are maskless except for one or two shoppers. I’ll probably continue to wear my mask for a long time..I feel shell shocked..I won’t be comfortable going without one for a while..

 

[missy]

Healthgrades celebrates 24 Leading Hospitals in Early COVID Care

Despite the early challenges of the pandemic, these hospitals excelled in their response to COVID-19. Here’s how they did it.

www.healthgrades.com

 

[missy]

"

Good morning. We look at Benjamin Franklin’s lessons about vaccine persuasion.

​ ‘The accumulated loss’​

Nearly 60 million American adults — or about one of out every four — remain unvaccinated against Covid-19. They have made an irrational choice that exposes them to severe illness. But they have also made a choice with a long historical tradition.​

In his State of the Union address on Tuesday, President Biden declared, “We will never give up on vaccinating more Americans.” And Biden is right that a continued vaccination campaign can do a lot of good, given that a large majority of Covid deaths and hospitalizations are still occurring among the unvaccinated and unboosted. The question, of course, is what arguments might win over any vaccine skeptics at this point.​

​ Based on data from 14 U.S. jurisdictions. | Source: Centers for Disease Control and Prevention​

Today, I want to use history — with some help from the filmmaker Ken Burns — to answer that question.​

​ A West African pioneer​

The original American advocate for inoculation against severe disease was arguably an enslaved man named Onesimus. Before being forcibly brought to Boston, Onesimus seems to have lived in West Africa, where inoculation was a common practice. There, he had been deliberately infected with a small amount of smallpox to make him immune from a more severe version.​

In Boston, Onesimus told his owner, Cotton Mather, about the practice. Mather was among the colonies’ most prominent religious leaders in the 1720s. He was also keenly interested in science, as Burns told me when we spoke recently. Today, science and religion are often considered antithetical, Burns noted, but past religious leaders were scientific pioneers.​

When smallpox began spreading in Boston in the 1720s, Mather campaigned for residents to be inoculated — and was met with fierce criticism and even an attempt to bomb his home. Some Bostonians argued that inoculation violated God’s will. Others, including doctors, argued that it was folklore that would do more harm than good.​

These arguments were powerful because inoculation was so counterintuitive. Mather was claiming that people could avoid getting sick … by getting sick.​

Modern vaccination is somewhat less counterintuitive, because drugs can now teach the immune system to respond to a deadly virus, without having to use small amounts of an actual virus. But vaccination is still a strange notion. It involves the injection of a mysterious cocktail of foreign substances into the human body.​

That’s why nearly every new vaccine — even the life-changing polio vaccine — has had its skeptics. The skepticism has increased in recent decades, as Americans have become less trusting of institutions and experts, as Elena Conis, a medical historian, has written.​

Historically, the two most effective responses to vaccine skepticism have been government mandates and relentless, calm persuasion. But broad Covid-vaccine mandates are probably unrealistic in the U.S. today, thanks to a combination of a Supreme Court ruling and widescale public opposition. Persuasion will probably have to do most of the work.​

Persuasion tends to require taking seriously the concerns of skeptics and creating opportunities for doctors, nurses, relatives, friends and other trusted people to explain why vaccination can be counterintuitive and yet lifesaving. “As a doctor, I was always trained you never give up on people — you show up,” Dr. Vivek Murthy, the surgeon general, told me yesterday. “You build trust by listening to people, helping them feel they’re respected and valued.”​

​ Getting a shot in Los Angeles in January.Robyn Beck/Agence France-Presse — Getty Images​

​ Franky Franklin​

In Mather’s time, one such evangelist for inoculation was Benjamin Franklin. Along with several other founders — including George Washington, John Adams and Thomas Jefferson — Franklin himself was persuaded. Yet he still had a tragic relationship with smallpox inoculation.​

As the disease was sweeping through Philadelphia in 1736, he and his wife, Deborah, initially decided not to inoculate their 4-year-old son Francis, known as Franky. The boy was sick with a cold and the Franklins worried that his body would not be able to handle the side effects of inoculation. Soon, though, Franky contracted smallpox and died.​

“This is the great tragedy of Franklin’s life,” Burns told me. “Deborah and Benjamin Franklin were just beset by this mistake they made even though it was completely understandable.” (Burns has just posted a six-minute “extra” film clip about Franky and inoculation, and it’s powerful. Next month, PBS will air Burns’s new documentary, “Benjamin Franklin.”)​

When rumors spread in Philadelphia that Franky had died from the inoculation rather than the disease itself, Franklin took the painful step of writing the true story in his newspaper, The Pennsylvania Gazette. In the years that followed, he tried to persuade others to avoid his family’s fate.​

“Surely parents will no longer refuse to accept and thankfully use a discovery God in his mercy has been pleased to bless mankind with,” Franklin wrote, in a pro-inoculation pamphlet. “For the loss of one in 10 thereby is not merely the loss of so many persons, but the accumulated loss of all the children and children’s children the deceased might have had, multiplied by successive generations.”​

In the U.S. today, the death toll from Covid has exceeded 950,000, and many of those deaths occurred after vaccines were available. It is a tragic pattern that’s consistent with history: Vaccination tends to be both counterintuitive and highly effective.​

"

 

[missy]

"

White House COVID Plan Stresses 'New Moment' in the Pandemic​

— Congressional funding necessary to step up access to treatment, enhanced surveillance​

by Molly Walker, Deputy Managing Editor, MedPage Today March 2, 2022

Normal was the watchword, as White House officials unveiled an updated National COVID Preparedness Plan on Wednesday, which included increased access to treatment, enhanced surveillance, keeping schools open, and vaccinating the world.
White House COVID Response Coordinator Jeff Zients emphasized that this was a "new moment" in the fight against the virus, with a new plan that expanded on the future COVID strategy that President Biden touched upon in his State of the Union address on Tuesday.

However, Zients prefaced his remarks by saying it requires "additional congressional support and funding." Indeed, a statement released by the White House said that, "to fully execute on this plan requires Congress doing its part to invest in tools that work."
HHS Secretary Xavier Becerra made a rare appearance at the briefing, though when asked about his role in the pandemic, he reiterated that "HHS is a part of that team" assembled by the president to combat COVID, and that their efforts are "all about getting the job done."
COVID Treatment and Prevention
Zients touted the efficacy of antiviral nirmatrelvir/ritonavir (Paxlovid) against severe COVID and said that the White House ordered 20 million courses of the drug, with 1 million available this month and "more than double" that available in April.
He also referenced the Biden administration's "test-to-treat" initiative, with access to free testing and treatment in "one-stop sites" such as community health centers, long-term care facilities, veterans health centers, and pharmacies.

Regarding vaccines, Zients said the government would be ready to make Pfizer's vaccine for kids younger than age 5 available as soon as it is authorized by the FDA. He also noted a website launching "later this month" with information on vaccines and masks in any given area.
Becerra noted that the "next phase" of HHS' role in combating the pandemic is to make the logistics and operational hub they have built for COVID into a permanent part of the agency, entitled the "HHS Coordination and Response Element" (H-CORE).
He also discussed the role that HHS will play in addressing the long-term effects of COVID -- specifically, long COVID and mental health issues associated with the virus. In particular, the plan would provide "high-quality" care for long COVID, coordinate a "whole-of-government effort" to counsel children and families who have lost loved ones to COVID, and an expanded program to prevent job burnout, particularly for healthcare workers.

"We want every front-line essential worker to know that we're with you and we've got your back," Becerra said.
Preparing for New Variants
Zients went over the planned "COVID Variant Playbook" to assess a new variant's "transmissibility and severity," as well as "tabletop readiness and response exercises" conducted jointly by HHS, CDC, NIH, FDA, and the Federal Emergency Management Association, but left more details about enhanced surveillance to CDC Director Rochelle Walensky, MD.
Walensky discussed several methods of enhanced surveillance, including a national wastewater surveillance system, a national syndromic surveillance center, and a new center for forecasting and analytics. Specifically, she noted that the number of wastewater testing sites have risen from 400 to 647 sites reporting data.
In addition, a new syndromic surveillance system can collect data on COVID-related emergency department visits across the country. Walensky also said that their enhanced genomic surveillance system can "reliably identify" low levels of variants of concern -- "even those that account for 0.1% of cases," she added.

Walensky also discussed scaling up data-monitoring efforts that connect data from local public health systems to a national system to help "forecast and model public health threats" as well as "inform prevention recommendations."
In terms of detecting new variants, Anthony Fauci, MD, the White House chief medical advisor and NIAID director, discussed a plan that would allow "updated vaccines to be developed, approved, and manufactured in approximately 100 days." These vaccines would ideally be "broader and longer-lasting," providing protection against both the ancestral strain and new variants, he added.
Other Priorities
Another priority was preventing economic and school shut-downs. Zients said that the Environmental Protection Agency is issuing a new "clean air in buildings" checklist to promote "quality ventilation practices," and reinstate tax credits to help small and medium-sized businesses pay for sick leave for those who contract the virus.
Finally, Zients touched upon "vaccinating the world," saying that the U.S. would not only be providing more vaccines to other countries, but also "vaccinators in the field," and the ability to "set up vaccination sites."

The Fate of Travel Mask Mandates?
With all this talk of normalcy, officials received several questions about ending mask mandates on domestic travel, such as airplanes.
Walensky said that when evaluating these mandates, which are set to expire on March 18, they will be looking at "not only the science of transmission ... but also the epidemiology and frequency we may encounter in variants of concern in our travel corridors."
She also noted that Omicron is a milder variant, and the country has been doing "a massive amount of vaccination and boosting" and teased "more to come" about this issue.
"We want to revisit this in a separate way," Walensky said.

• 
  
  Molly Walker is deputy managing editor and covers infectious diseases for MedPage Today. She is a 2020 J2 Achievement Award winner for her COVID-19 coverage.
  
  "
  
  

 

[missy]

"

Pandemic Only Made Inequities Between Men and Women Worse​

— Analysis shows women were more likely to lose work and drop out of school​

by Kara Grant, Enterprise & Investigative Writer, MedPage Today March 2, 2022

The COVID-19 pandemic appears to have exacerbated the inequalities that already existed between men and women across the globe, a review of data showed.
Analyses of gender-specific datasets from 193 countries found that women were more likely than men to report employment loss from March 2020 to September 2021 (26% vs 20.4%, respectively), and were 1.8 to 2.4 times more likely to give up paid employment to care for others, reported Luisa Flor, PhD, of the Institute for Health Metrics and Evaluation at the University of Washington in Seattle, and colleagues.

Women and girls were also 1.21 times more likely to report dropping out of school for reasons other than school closures compared with men and boys, and were 1.23 times more likely to see increases in gender-based violence than their male counterparts, they noted in The Lancet.
Most of the existing research on the pandemic's gender disparities has been focused on the direct effects of COVID-19, including case numbers, hospitalizations, and deaths. These data tend to show that men have higher rates of hospitalization and death, Flor's group pointed out, but given their findings, women have had to bear the brunt of COVID-19's indirect reverberations.
Obtaining data from almost 200 countries also made it clear that these gender gaps vary significantly from region to region. For example, women in all regions except North Africa and the Middle East were more likely to report an increase in domestic responsibilities and caring for family members. The largest gaps between men and women on this front were seen in high-income regions like Central Europe, Eastern Europe, and Central Asia.

"These data reinforce what gender scholars have known and stated for years: that the ways in which gender power relations manifest as inequities are context-specific," wrote Rosemary Morgan, PhD, of the Johns Hopkins Bloomberg School of Public Health in Baltimore, and colleagues in an accompanying editorial. "Any action and policy should not be replicated without local adaptations, and considerations of local contexts, resources, systems, demographics, and social-cultural dynamics and spaces should always be made."
Based on one multinational source, the largest gender gaps in schooling -- wherein girls were more likely than boys to drop out of school for reasons other than school closures -- were seen in Central Europe, Eastern Europe, Central Asia, and South Asia.
Women were also more likely to report disruptions in healthcare overall, with increased disruptions in all regions, except South Asia, Southeast Asia, East Asia, Oceania, and sub-Saharan Africa.

Breaking down violence regionally, the highest increases in perceived gender-based violence were observed among women in Latin America and the Caribbean (61.2%), in high-income countries (59.9%), and in sub-Saharan Africa (56.7%). On a global scale, women and men were equally likely to report feeling unsafe at home, but broken down by region, women had higher rates of feeling unsafe in Latin America, the Caribbean, Central Europe, Central Asia, Southeast Asia, East Asia, and Oceania.
"Even though there are multiple indications that the COVID-19 pandemic has potentially exacerbated gender-based violence and complicated service provision for those experiencing violence, it is worth emphasizing that challenges in addressing gender-based violence and inadequate service provision long predate the pandemic," Flor's group wrote. "The crucial need for better evidence and sufficient resources allocated to this important health, societal, and humanitarian problem has always been urgent, and has now become even more so."
The researchers noted that the modes of data collection presented a major limitation to their study's findings. Most available information was gathered through self-report surveys distributed via apps or online platforms, thereby favoring populations with high smartphone ownership and internet access. The self-report nature of the surveys also added another limitation, as responses may be subject to desirability bias.

• 
  
  Kara Grant joined the Enterprise & Investigative Reporting team at MedPage Today in February 2021. She covers psychiatry, mental health, and medical education. Follow

Disclosures
This study was funded by the Bill & Melinda Gates Foundation.
The study authors and the editorialists reported no conflicts of interest.
Primary Source
The Lancet
Source Reference: Flor LS, et al "Quantifying the effects of the COVID-19 pandemic on gender equality on health, social, and economic indicators" Lancet 2022; DOI: 10.1016/S0140-6736(22)00008-3.
"

 

[missy]

"

Hong Kong’s loss of control​

It’s chaos in Hong Kong. While the Asian financial hub is posting successive record-breaking numbers of Covid infections and a death rate that tops the industrialized world, leaked reports of a citywide lockdown in local media have some residents fleeing while others scramble to stock up on food and medicine. After more than a week out of the public eye, Chief Executive Carrie Lam on Wednesday afternoon sought to reassure the population about the challenges ahead. China will ensure that Hong Kong has an ample supply of food and medicine during the outbreak, she said during a television interview after welcoming the first trainload of goods from the mainland. Lam was less definitive about the potential lockdown, which has been widely reported in local news outlets as an initiative designed to bolster the effectiveness of a planned mass-testing campaign that will see all 7.4 million residents swabbed three times for the virus. The reports have had dueling details on the length and severity of the lockdown for the city, known for its tiny apartments and high density. Covid-19 testing stations outside a residential building placed under lockdown. Photographer: Lam Yik/Bloomberg Lam ruled out a wholesale lockdown, without providing detail on what any restrictions would look like. She also acknowledged that there won’t be enough beds to isolate everyone found to be infected, though the government is frantically expanding capacity with the help of China in hopes of getting enough room to return to contact tracing and isolation rules once the outbreak slows. The information vacuum has exacerbated deteriorating conditions just as the outbreak becomes one of the deadliest in the world. And yet it is unfolding exactly as so many others have in the past two years, with surging fatalities in nursing homes, overwhelmed hospitals, frazzled parents and patients in gurneys lining local alleys. In an unlikely twist, the U.S. government warned citizens not to travel to Hong Kong. The city’s zero-tolerance approach is severely impacting travel and limiting access to public services, while raising the risk that infected children may be separated from their families. The city’s loss of control is a real-world illustration of the limits of the Covid Zero strategy in the face of highly transmissible variants like omicron. The virus will eventually ebb, however, making it possible for local officials to resume the efforts. That’s a battle for another day. — Michelle Fay Cortez

​ ​ "​

 

[wildcat03]

My son's school district is officially mask optional. He is vaccinated and I told him he can wear it or not, it's up to him. We'll see how it goes.

My daughter's preschool (2-K, so presumably mostly unvaccinated) went mask optional this week. Based on the photos sent home from "Wacky Wednesday" on average there are 0-2 kids masked per classroom (typical is 8-10 kids). However, her class is 6 kids with one out sick this week (ironically the child of a board member who obviously voted mask optional because it was unanimous). 4 of 5 were wearing masks.

None of the teachers are wearing masks. Mind blown.

 

[Asscherhalo_lover]

My daughter's preschool (2-K, so presumably mostly unvaccinated) went mask optional this week. Based on the photos sent home from "Wacky Wednesday" on average there are 0-2 kids masked per classroom (typical is 8-10 kids). However, her class is 6 kids with one out sick this week (ironically the child of a board member who obviously voted mask optional because it was unanimous). 4 of 5 were wearing masks.

None of the teachers are wearing masks. Mind blown.

Oof. I would not be unmasked around an age group that was not eligible for vaccination in a school setting. We have one pre-k class in my own school but they have all had COVID already.

 

[missy]

"

Beating COVID Is Child's Play​

— Betsy Herold, MD, explains how children's innate immune response typically prevents severe cases​

by Emily Hutto, Associate Video Producer March 4, 2022
Last Updated March 04, 2022

master.m3u8

In this video, Betsy Herold, MD, chief of the Division of Pediatric Infectious Disease at the Children's Hospital at Montefiore and Albert Einstein College of Medicine in New York City, discusses new research on why children experience less severe COVID-19 infections and how it could lead to innovative therapeutics for infection moving forward.
The following is a transcript of her remarks:
We began looking at COVID-19 back in March of 2020, when it first really became apparent this was going to be a significant problem. At that time, mostly we were focused obviously in our own region -- so in the Bronx and in New York in general. One of the first observations we made was that the disease seemed to be causing more severity in adults compared to children.

So in collaboration with colleagues here at Montefiore and Albert Einstein College of Medicine, as well as colleagues at Yale University, we began to collect samples from both adults and children who were being hospitalized with COVID to answer the question: What was different in the way children were responding to COVID compared to adults, and could we then learn from that to, perhaps in the future, help patients who are developing disease?
So we've completed and published two studies and are working on some additional ones right now. In those first studies, what we found is when you looked at the blood in the patients who were adults versus those who were children -- and we divided them essentially also based on the disease presentation -- so when we look at those three groups, the kids who do well, the adults who do well, and the adults who do poorly, there are clear differences.

The children overall had lower levels of what are called inflammatory cytokines. These are proteins that are secreted typically by immune cells, but they can be secreted by other cells in your body that cause inflammation. Now that by itself was not surprising. We already knew that clinically, that adults who were doing poorly were going to have higher levels of those proteins compared to adults who did well and compared to children.
But there were two proteins that really caught our eye and they became very interesting. And those are called IL [interleukin]-17A and interferon gamma. Now, the reason they were interesting is -- it was the opposite -- they were higher in the children compared to the adults -- compared both to the adults who did well and the adults who did poorly. So that suggested that perhaps those proteins were being protective.

Now, there are many cells that can make these proteins, but to simplify the story, let's just say that typically we think of them as being made by your T cells, which is part of your adaptive immune response. But when we collected T cells from a subset of patients, the T-cell responses to COVID – which, if that was the source of these "good guy" proteins, we'll call them – would've been higher in the children. It actually was the opposite: they were higher in the adults.
So clearly that was not the source of those proteins that looked like they potentially were being protective. The other place that those proteins can come from is something called your innate immune system. Your innate immune system is really the first part of your immune system.
The first time any of us see a pathogen that we've never seen before, we all sort of have this immediate response in our body of an innate immune response -- that can be proteins and cells that respond without having any memory of it [the pathogen]. That usually helps us in the first few days of infection.

Then our body starts to make what we call the adaptive immune response, which is specific for each different pathogen that we look at. And that includes your antibodies and your T cells. So since that interferon gamma and that IL-17A was not coming from the T cells, we thought those proteins are also made by innate cells, and maybe that's where it's coming from.
What that suggested to us was a model in which if you make a good enough innate response, then you maybe don't need to make as much of that adaptive memory response, because you've gotten rid of the virus. The model that our data suggests, and has subsequently been validated by other groups as well looking at different patient populations, is that kids make a better initial innate adaptive response, which helps them, number one, recover from the virus more quickly, but number two, leads to them not needing to make quite as much of that adaptive response.

And some of that adaptive response actually is what's contributing to the disease. When you have an "over-vigorous" – is the way I like to put it – adaptive response, too many T cells activated, maybe some of the antibodies in the process of trying to kill the infected cells can actually lead to more inflammation. And that leads to that ARDS [acute respiratory distress syndrome] kind of syndrome that we see in association with COVID.
So how do we use this knowledge to prevent or to treat infections as we move forward in the future? One concept there is to actually use the proteins that we and others have identified, some of these innate molecules, and actually administer those. And there have been a few clinical trials to look at giving interferon, for example, which is one of those families of proteins, to patients who have COVID. So far, that data has not been a home run yet.

But another way to think about this, and some people call this "trained immunity," is to think why would children have a stronger innate immune response? One theory is that every time you have a viral infection, your innate response sort of gets turned on. And so maybe because children have more frequent viral infections, just your run-of-the-mill colds, their innate system is a libit more turned on and it's ready to go. There is some data in animal models that suggested that indeed is the case.
So some people have argued that vaccinations -- not even just specific COVID vaccines, but that in general sort of mucosal vaccines, or other ways of turning on your innate immune system -- might work to protect people against infections.
So I think this is a really important area of research. We don't have all the answers quite yet."

 

[missy]

"

The Covid news you might have missed​

Covid-19 has been front-page news for two years. This may ultimately be remembered as the week it fell below the fold. There are two primary reasons for that. First is that the war in Ukraine is dominating the world’s attention. Second, for many places infections are receding fast after the omicron surge. That’s most apparent in the U.S., where this week President Joe Biden in his State of the Union address signaled that his policy makers are shifting to a new phase in their response. Meanwhile, schools are letting students decide whether to wear masks, and workers are returning to the office. There’s a sense of momentum toward, if not prepandemic normal, then something that might resemble it. That doesn’t mean news about the virus has evaporated. Here are some developments you may have missed: Hong Kong is grappling with the world’s biggest current outbreak. Its heralded virus precautions protected it as other parts of the world suffered, but the city had more than 52,000 confirmed cases as of Friday, and more than 100 new deaths. Some residents are fleeing to Singapore. The effects of the pandemic are still being felt in U.S. hospitals even as the number of virus patients dwindles: Medical saline, one of the most basic components of hospital care, is in short supply because of production problems, shortages of materials linked to the vaccination drive and workers who make the solution falling ill with Covid-19 Saline solution is in short supply Photographer: Daniel Acker/Bloomberg Moderna and the World Health Organization appear to be headed for a clash over patents related to the company’s vaccine. Relief groups are calling on the drug company to abandon three patents filed years ago in South Africa. An arthritis drug made by Eli Lilly and Incyte reduced the risk of death among people hospitalized with Covid-19 in a large study. The WHO backed Merck’s molnupiravir for high-risk patients. — Tim Annet "

 

[missy]

"

Infectious Disease>COVID-19 Vaccine

6 Months of U.S. Data Support Safety of mRNA COVID Vaccines​

— CDC reports find that most AEs were minor, transient, and few patients sought medical care​

by Molly Walker, Deputy Managing Editor, MedPage Today March 7, 2022

Nearly all local and systemic adverse events (AEs) reported after Pfizer or Moderna's COVID-19 vaccines were mild and transient, and only a fraction of individuals reported seeking medical care, according to data from the Vaccine Adverse Event Reporting System (VAERS) and CDC's v-safe tracker.
Out of almost 300 million mRNA vaccine doses administered in the U.S. from Dec. 14, 2020 to June 14, 2021, 92% of self-reported AEs to VAERS were not serious, and under 1% of individuals reporting data to v-safe said they sought medical care for their AEs after dose one and dose two, reported Julianne Gee, MPH, of the CDC in Atlanta, and colleagues, writing in Lancet Infectious Diseases.

Interestingly, they found that females and individuals ages 65 and younger reported more reactogenicity following vaccination than males and older adults. The authors noted that "a greater proportion of vaccines was administered to females... males" at 53.2% versus 45.8% in the study time period. Also, the median age at vaccination was 50 for those who got the Pfizer vaccine and 56 for those who got the Moderna vaccine. They advised that on the basis of these findings, "mild-to-moderate transient reactogenicity should be anticipated, particularly among younger and female vaccine recipients."
"COVID-19 vaccine safety monitoring is the most robust in U.S. history and the two complementary surveillance systems used in this study should bolster confidence that mRNA COVID-19 vaccines are safe," said co-author Hannah Rosenblum, MD, also of the CDC, in a statement.
The authors examined self-reported data from both VAERS and v-safe on 298,792,852 individuals in the U.S. who received Pfizer or Moderna vaccines. Of the 340,522 reports to VAERS, 92% were non-serious, 6.6% were serious (non-death), and 1.3% were deaths.

However, Gee's group noted caveats to the deaths, namely that reporting on any deaths after vaccination was required since the products were under emergency use authorization, but no unusual patterns were detected in the cause of death reports. They added that 80% of deaths were among adults ages 60 and up. They also pointed out that a different surveillance systemdemonstrated no increased risk of non-COVID-19 mortality in vaccinated people.
"The rapid pace at which COVID-19 vaccines were administered under emergency use, especially among older populations, was unprecedented," said co-author David Shay, MD, also of the CDC, in a statement. "Due to their age, this group already has a higher baseline mortality rate than the general population and our results follow similar patterns of death rates for people in this age group following other adult vaccinations."
The most common systemic AE reported to VAERS for both vaccines was headache (20%), followed by fatigue (17%) and fever (16%). Among the serious AEs reported, shortness of breath was the most common (15%) for both vaccines.

The CDC v-safe system tracked AEs after both dose one and two, and found that of the almost 8 million v-safe participants, about 70% reported systemic AEs after dose two versus only 53% after dose one. Headache and fatigue were the most commonly reported systemic AEs, with 56% reporting headache and 46% reporting fatigue after dose two.
Examining local AEs, about two-thirds of participants reported injection site pain after both vaccine doses.
In an accompanying editorial, Matthew Krantz, MD, and Elizabeth Phillips, MD, both of Vanderbilt University School of Medicine in Nashville, Tennessee, characterized the report as "reassuring," noting that, "there were no unexpected signals other than myopericarditis and anaphylaxis, already known to be associated with mRNA vaccines."
"The predictable, nonserious, and transient nature of the adverse events provides an objective basis for employees to be given provision for paid time off work to increase vaccine confidence and uptake by individuals," they wrote.

Krantz and Phillips added that v-safe data may be underreported in socioeconomically disadvantaged populations who might not have access to the web-based survey system.
Other limitations noted by Gee's group included potential underreporting to VAERS; that death certificate and autopsy reports were only available for a minority of deaths; and most importantly, "VAERS data alone generally cannot establish causal relationships between vaccination and adverse events," they said.

• 
  
  Molly Walker is deputy managing editor and covers infectious diseases for MedPage Today. She is a 2020 J2 Achievement Award winner for her COVID-19 coverage.

Disclosures
The study was supported by the CDC.
Gee and co-authors disclosed no relationships with industry.
Krantz disclosed no relationships with industry. Phillips disclosed support from UpToDate, Janssen, Vertex, BioCryst, and Regeneron, as well as being co-director of IIID, which holds a patent for HLA-B*57:01 testing for abacavir hypersensitivity, and has a patent pending for Detection of Human Leukocyte Antigen-A*32:01 in connection with Diagnosing Drug Reaction with Eosinophilia and Systemic Symptoms.
Primary Source
The Lancet Infectious Diseases
Source Reference: Rosenblum HG, et al "Safety of mRNA vaccines administered during the initial 6 months of the US COVID-19 vaccination programme: an observational study of reports to the Vaccine Adverse Event Reporting System and v-safe" Lancet Infect Dis 2022; DOI: 10.1016/S1473-3099(22)00054-8.
Secondary Source
The Lancet Infectious Diseases

"

 

[missy]

"

Brain Changes Seen After Mild COVID Infection​

— Tissue damage, brain shrinkage, cognitive decline emerge in longitudinal study​

by Judy George, Senior Staff Writer, MedPage Today March 7, 2022

Tissue damage and shrinkage in brain areas related to smell were seen months after people had mild SARS-CoV-2 infection, longitudinal data from the U.K. Biobank showed.
Compared with controls, people who had mild COVID demonstrated a greater reduction in grey matter thickness and tissue contrast in the orbitofrontal cortex and parahippocampal gyrus, and greater changes in markers of tissue damage in regions functionally connected to the primary olfactory cortex, reported Gwenaëlle Douaud, PhD, of the University of Oxford in England, and co-authors in Nature.

COVID patients also had a greater reduction in global brain size. On average, infected participants showed larger cognitive decline.
"Using the U.K. Biobank resource, we were in a unique position to look at changes that took place in the brain following mild -- as opposed to more moderate or severe -- SARS-CoV-2 infection," Douaud said in a statement.
"Despite the infection being mild for 96% of our participants, we saw a greater loss of grey matter volume, and greater tissue damage in the infected participants, on average 4.5 months after infection," she noted. "They also showed greater decline in their mental abilities to perform complex tasks, and this mental worsening was partly related to these brain abnormalities. All these negative effects were more marked at older ages."
"This is an outstanding study," observed Avindra Nath, MD, of the National Institute of Neurological Disorders and Stroke in Bethesda, Maryland, who wasn't involved with the research.

"A novel aspect of this study is the access to MRI scans prior to COVID-19 and then on average 140 days after COVID-19," Nath told MedPage Today. "They show that the olfactory pathways in the brain are atrophic in these patients as a group. This also includes areas involved in cognition although, interestingly, it was an area in the cerebellum."
"These findings might have major implications since it is unlikely they will reverse on their own after so many months," he added. "The critical question is whether this can result in an acceleration of the neurodegenerative process, since the researchers also noted global atrophy."
Douaud and colleagues looked at brain changes in 785 U.K. Biobankparticipants 51 to 81 years old who had two MRI scans an average of 3.2 years apart.
A total of 401 participants tested positive for SARS-CoV-2 infection between their scans, including 15 people who were hospitalized. People developed COVID between March 2020 and April 2021; they had a mean age of 58.9 at their first MRI and 62.1 at their second. The other 384 participants were age- and sex-matched controls.

Changes associated with SARS-CoV-2 infection varied in different brain regions but on average, infected participants showed an additional 0.2% to 2% loss compared with non-infected participants, with the largest differences seen in the volume of the parahippocampal gyrus (-1.3%) and entorhinal cortex (-1.8%).
To provide context, these percentages can be compared with the loss seen in normal aging -- "for instance, the longitudinal loss per year of ~0.2% (in middle age) to 0.3% (in older age) of hippocampal volume in community-dwelling individuals" -- the researchers noted.
"Our statistics also represent an average effect; not every infected participant will display brain longitudinal abnormalities," they emphasized.
Infected participants took significantly longer to complete complex tasks than non-infected participants, a difference that was more pronounced at older ages. These findings remained significant when excluding the 15 hospitalized cases. There were no signs of memory impairment.
No other brain imaging study has compared scans before and after infection from other viruses, Douaud and co-authors pointed out. A control analysis on 11 people in the U.K. Biobank who developed pneumonia not related to COVID-19 suggested the brain changes were specific to COVID-19 and not generic effects of respiratory illness.

The study had several limitations, the researchers acknowledged. There was no information about COVID symptoms, including smell or taste loss. There also was no formal way to determine which SARS-CoV-2 strain was involved, though the cohort was infected when the original strain and Alpha variant were dominant.
The brain imaging results may be hallmarks of a degenerative spread of SARS-CoV-2 through olfactory pathways, of neuroinflammation, or of a lack of sensory input due to loss of smell, Douaud and co-authors suggested. "Whether this deleterious impact can be partially reversed, or whether these effects will persist in the long term, remains to be investigated with additional follow up," they wrote.

• Judy George covers neurology and neuroscience news for MedPage Today, writing about brain aging, Alzheimer’s, dementia, MS, rare diseases, epilepsy, autism, headache, stroke, Parkinson’s, ALS, concussion, CTE, sleep, pain, and more. Follow

Disclosures
This work was primarily supported by a Wellcome Trust Collaborative Award.
Douaud had no disclosures. Co-authors reported relationships with U.K. Biobank, Novartis, Bristol Myers Squibb, Biogen, and the U.K. Research and Innovation Medical Research Council Neurosciences and Mental Health Board.
Primary Source
Nature
Source Reference: Douaud G, et al "SARS-CoV-2 is associated with changes in brain structure in UK Biobank" Nature 2022; DOI: 10.1038/s41586-022-04569-5.
"