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Coronavirus Updates January 1, 2022

missy

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Trying to understand long Covid​


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In a new study, a team of 50 researchers finally offered partial answers in a quest to figure out which patients are most at risk of developing long Covid—a condition in which patients still suffer from a wide range of health problems months after recovery.

People who have circulating fragments of the coronavirus, specific antibodies directed against their own tissues or organs—known as auto-antibodies—and a resurgence of the Epstein-Barr virus appear more likely to experience lasting symptoms.

The scientists found some markers that could be identified early and appeared to correlate with lingering symptoms, regardless of whether the initial infection was severe.

They followed some 300 patients from initial diagnosis to convalescence two or three months later, and compared them with healthy control subjects. They analyzed blood samples and nasal swabs, integrating the data with patients’ health records and self-reported symptoms.

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Some patients suffer a range of symptoms months after recovery from Covid.

Photographer: David Gonzalez / EyeEm

After three months, more than half of the patients reported fatigue, and a quarter reported a lingering cough. Others suffered gastro-intestinal symptoms.

The study results were complex, with different profiles associated with different symptoms. Overall, the scientists pointed to a reactivation of the Epstein-Barr virus—which usually remains dormant in the body—and circulating fragments of SARS-CoV-2 at diagnosis as factors that could anticipate long Covid. So did a handful of auto-antibodies, including some associated with lupus. They also found that patients with respiratory symptoms had low levels of the hormone cortisol.

Interestingly, the researchers also found a correlation between type 2 diabetes and cough; that women tended to suffer neurological symptoms; and that patients with heart disease or a pre-existing cough tended to experience loss of smell or taste.

The authors said their findings pointed to potential treatment strategies that include antiviral medicines, since they have an effect on viral load, and cortisol-replacement therapy, for patients who are deficient. That’s a step forward, as long Covid has created an unexpected burden on health systems.—Marthe Fourcade "
 

missy

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"

Many Adults Who Thought They Had COVID-19 Actually Didn't​

— But of those with confirmed cases, SARS-CoV-2 antibodies still seen at a median 9 months​

by Molly Walker, Deputy Managing Editor, MedPage Today February 3, 2022


A woman wearing a bicycle helmet holds up a handmade sign which reads: I CHOOSE NATURAL IMMUNITY

About half of unvaccinated adults who thought they had COVID-19 were proven wrong by antibody tests, researchers found.
In a survey of people recruited on social media, 45% of people who thought they'd had COVID, but never confirmed it, actually had no anti-spike antibodies, reported Dorry Segev, MD, PhD, of Johns Hopkins University in Baltimore, and colleagues, in a JAMA research letter.
Overall, antibodies were detected in 99% of people who said they had a positive COVID-19 test result, in 55% who believed they had COVID-19 but who were never tested, and in 11% who thought they never had SARS-CoV-2 infection.

The study took place before the Omicron wave, in which all forms of immunity have shown to be less durable. Other limitations noted by the authors included a lack of direct neutralization assays, as "antibodies alone do not directly equate to immunity," they wrote.
Segev and co-authors recruited healthy unvaccinated adults through a Twitter post and a Facebook ad from Sept. 11, 2021 to Oct. 8, 2021. Participants answered a questionnaire about demographics, COVID status, and mask use. They were divided into three groups:
  • COVID-confirmed: people who reported a test-confirmed COVID infection
  • COVID-unconfirmed: people who believed they had COVID, but were never tested
  • No-COVID: people who did not believe they had COVID and never tested positive
All groups were invited to undergo antibody testing. Overall, 816 adults underwent screening and filled out the questionnaire. Respondents had a mean age of 48, 52% were women, and 82% were white.
The COVID-confirmed group had 295 participants; of these, antibody testing confirmed 99% actually had COVID. A median of 8.7 months (range 0-20) had passed since this group's self-reported COVID diagnosis. The median level of antibodies against the SARS-CoV-2 spike protein receptor-binding domain (RBD) among those who tested positive was 205 U/mL, and "levels did not differ by months since diagnosis," according to the researchers.

Among 275 people in the COVID-unconfirmed group, the median anti-RBD level among those who tested positive was 131 U/mL. Of 246 people in the no-COVID group, the median anti-RBD level among those who tested positive was 82 U/mL.
Segev's group acknowledged that COVID diagnoses were self-reported in this study, and there may be "an unknown degree of selection bias" due to the survey's public recruitment efforts. In addition, the study population was healthy and mostly white, which could limit its generalizability.

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missy

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"

FDA Advisors Face Difficult Decision on COVID Vaccine for Youngest Kids​

— "We wouldn't say yes on the promise that three doses [will be] of value"​

by Kristina Fiore, Director of Enterprise & Investigative Reporting, MedPage Today February 3, 2022


A photo of a metal tray containing a vial of Comirnaty COVID vaccine and several syringes.

The FDA's Vaccines and Related Biological Products Advisory Committee (VRBPAC) is facing a very difficult decision.
Members are being asked to consider whether a three-dose COVID-19 vaccine series should be authorized when there are only data available on two doses, and so far, all that's known about those data is that noninferiority was not met in a prespecified immunogenicity analysis for kids ages 2 to under 5.

Will VRBPAC see some type of vaccine efficacy data in this age group, rather than just immunobridging data? A Pfizer spokesperson confirmed to MedPage Todaythat the study did include a placebo group, and the New York Times reported, citing an anonymous source, that vaccine efficacy was 57% in this age group.
Perhaps members will get an early glimpse at data with a third dose in this age group?
"We're all reading the tea leaves," said Paul Offit, MD, of Children's Hospital of Philadelphia and a VRBPAC member who will be tasked with making a decision at the February 15 meeting. He said it's likely that committee members would only give a thumbs up "if we felt comfortable that two doses offered something significant to those children."
"I can only imagine we would say yes if there's clear evidence that two doses is of value," Offit told MedPage Today. "We wouldn't say yes on the promise that three doses [will be] of value."

Federal officials appear keen to push the application through. In a press release, Pfizer noted that they began their rolling emergency use authorization (EUA) submission "following a request from" the FDA.
Previously, Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, said during a National Press Club briefing that Pfizer "decided that they believe this is really a three-dose vaccine, and there's no doubt if you give three doses you're going to get an effective and safe vaccine. But they haven't proven it yet, so that's the delay."
"I can guarantee you it's going to be effective," he added.
There is indeed good precedent for an improved antibody response with a third dose in this population, said Joseph Schwab, MD, a professor of pediatrics at Rutgers New Jersey Medical School in Newark.
"We've seen that a third dose helps increase the immune response in adults, and vaccines in general, when you give booster doses, they do step up the immune response and boost the immunity you got from the first dose or two," he said. "So, as a general principle, it makes sense that this would be positive."

However, "whether the 3-mcg dose for all three doses is going to be good enough -- we don't know until we start using it," he cautioned.
Schwab also said that authorities are likely trying to balance the "ongoing surge of Omicron, and the potential for new variants to break out, coupled with the increased hospitalizations among children that we've seen in this surge."
Janet Englund, MD, professor of infectious disease and virology at Seattle Children's, and an investigator for the Pfizer pediatric vaccine trials there, said the dire need for a vaccine in this population is certainly driving the push for authorization.
"We need it because these kids, their whole lives are impacted by not having a vaccine," she said, adding that publicly available data from the company's dose-finding studies show that the vaccine is safe for kids under 5, and has minimal side effects.
But even if two doses are authorized -- banking on the hopes that three doses will be effective -- will parents get their kids vaccinated?

"I assume compliance will be low" in the under-5 age group, Offit said. "It gets progressively lower as you get to younger and younger people."
Vaccination rates among kids ages 12 to 15 are around 55%, and rates for those ages 5 to 11 fall to around 20%, Offit said. "I suspect it's going to be even less for under-5's, but I hope I'm wrong."
If compliance is expected to be low, is releasing a vaccine prematurely going to further erode confidence -- especially if a third dose is found to be insufficient?
"I think the biggest risk [of authorization without third-dose data is] the damage it might do to confidence in using the vaccine," Schwab said, adding it would be "unfortunate" if people get frustrated with future changes in the vaccination schedule in this age group.
Starting a trial from scratch -- perhaps investigating a two-dose series of 5 or 7 mcg -- seems valuable, but may be too resource-intensive, particularly during a surge in U.S. cases, Englund said.

There are a "couple hundred families" in Englund's trials, who make multiple visits and take on the risk that they may be getting a placebo.
"They have to have their kids' blood drawn, their noses swabbed and visits every 21 days," she said. "That's a lot of work and time for these very busy families. It's really tough."
Offit echoed that sentiment: "What human price do you want to pay for knowledge?" he asked.
Still, others are adamant that third-dose data are in hand before a vaccine is put on the market.
Jeremy Faust, MD, of Mass General Brigham in Boston, and MedPage Today's editor-in-chief, wrote in his Bulletin newsletter Inside Medicine that he won't vaccinate his 3-year-old daughter until third-dose data are available.
If she were under 2, he noted, she would be vaccinated if it were authorized because "that's simply what the data show. And in this household, we go by the data."
"I'm worried that if we rush now, there will be fewer young children vaccinated by next fall than if we wait a few more weeks," Faust wrote. "I'm less interested in vaccination rates in the next 6 weeks, and more interested in vaccination rates in the next 6-12 months."

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missy

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February 4, 2022​
Good morning. China’s zero-Covid policy has kept deaths very low. Can it continue?​
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A station in Beijing where express trains connect Olympic venues.Chang W. Lee/The New York Times​

Chinese exceptionalism​


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World leaders are increasingly deciding that their countries need to figure out how to live with Covid-19 rather than minimize the number of cases.​
Britain, France, Denmark, Turkey and other parts of Europe have loosened restrictions. Australia has dropped mask mandates and reopened its border. South Africa has lifted curfews and required schools to open fully.​
China is doing none of this.​
As the Beijing Olympics begin, China continues to pursue a “zero Covid” policy. The Olympics will have few fans. As it has for almost two years, China responds to new outbreaks by imposing strict lockdowns. In the northwestern city of Lanzhou last year, officials told roughly four million people to stay home in response to fewer than 50 known cases.​
China’s strategy has had both major successes (holding deaths to low levels) and major costs (disrupting daily life even more than in other countries). It makes for a fascinating case study at a time when Americans disagree vehemently — and often along partisan lines — about whether to maintain Covid precautions or return to normal.​
China’s strategy would obviously not be possible in a country that emphasizes individual rights as much as the U.S. does. But China’s strategy does show what a society can do when it makes the prevention of Covid its No. 1 priority, almost regardless of the side effects.​
A question that experts are asking now is whether China’s strategy is sustainable, given the contagiousness of Omicron. For now, China’s leaders are sticking with it.​

The benefits​

Data coming out of China can be suspect, and local officials apparently undercounted Covid cases early in the pandemic to hide the scale of the outbreak. But most experts believe the country’s official Covid counts have been at least close to accurate for most of the past two years.​
That’s partly because big outbreaks are hard to cover up, and partly because China’s leadership has threatened to punish officials who hide cases. As Amy Qin, a Times correspondent who covers China, told us, “Local officials have every incentive to find the infections and stop the spread before they get out of hand.”​
Even if China’s official numbers are artificially low, its true Covid death toll is almost certainly much lower than that of the U.S., Europe or many other countries. Consider how enormous the official gap is:​
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Data as of Feb. 2. | Sources: Johns Hopkins University; New York Times database; National Health Commission of the People’s Republic of China​
The zero-Covid policy has also allowed some forms of normalcy to return. Masks are required in public, but unless a city is in lockdown, people have been attending parties and eating in restaurants for most of the past two years, Amy notes.​
When Covid began spreading in Wuhan, it seemed as if it might have the potential to weaken the Communist Party’s standing. Instead, China’s success at controlling Covid has turned into a public relations triumph for the regime. President Xi Jinping uses China’s management of the virus to bolster his global campaign for influence, arguing that China’s system of government works better than Western democracies do.​

The downsides​

China’s maximalist approach has had harmful side effects.​
Even modest outbreaks can lead local officials to place millions of people under lockdown, sometimes with terrible consequences. As our colleague Li Yuan has written:​
In the northwestern city of Xi’an, hospital employees refused to admit a man suffering from chest pains because he lived in a medium-risk district. He died of a heart attack.
They informed a woman who was eight months pregnant and bleeding that her Covid test wasn’t valid. She lost her baby.
Two community security guards told a young man they didn’t care that he’d had nothing to eat after catching him out during the lockdown. They beat him up.​
Lockdowns have also hurt Chinese businesses and the global economy. One reason that inflation has risen around the world is that Chinese factories and ports have been quick to shut down when there are nearby cases, disrupting supply chains.​
Chinese officials maintain that zero Covid is still viable. If that’s correct, the approach may need to become even more aggressive, given that the Omicron variant is so contagious. China’s two major vaccines appear to provide significant protection against serious illness but little protection against infection.​
China also has little natural immunity, unlike countries where the virus has spread widely. “That immunity gap between China and the outside world is only increasing,” Yanzhong Huang, a global health expert at the Council on Foreign Relations, told us. Some other countries that previously had zero-Covid strategies, like Singapore and New Zealand, have recently moved away from them.​
China seems to face a choice “between short-term pain and long-term pain,” Huang said. Maintaining zero Covid would probably require long-lasting social and economic disruptions; giving it up would invite a rapid surge of infections. “But after that you could be in much better shape,” Huang said.​
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Near the National Indoor Stadium in Beijing.Gabriela Bhaskar/The New York Times​
It does seem possible that China will start to shift its approach after the Olympics, perhaps experimenting with fewer restrictions in some cities and regions. Already, some Chinese health officials have subtly altered their message. “They are emphasizing more now the idea of responding rapidly and nimbly to small outbreaks to get as close to zero as possible,” Amy says.​
One factor may be a growing fatigue among Chinese people. While the zero-Covid strategy seems still to have widespread support, some Chinese citizens seem to be growing more frustrated with strict lockdowns. “We are definitely seeing more grumbling from people,” Amy said. “There is a growing sense that you could get caught in a lockdown at any time.”​

 
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