Coronavirus Updates January 1, 2022

[missy]

"

The U.S. is bracing for more staff shortages in the nation’s health care system after the Supreme Court made a critical decision on vaccine mandates.​

The ruling, which upholds the Biden administration’s requirement for millions of health care workers to be vaccinated against Covid, could wedge workers between opposing state and federal policies as hospitals wrestle with resistance among some staff. Many hospitals are already under strain from the biggest surge of Covid-19 patients since spring 2020. In New York City, there are simply not enough nurses to care for them all.​

While health care providers now have a clear mandate, U.S. businesses are largely on their own. The court’s decision to block the vaccine mandate for big companies means it’s now up to chief executives to decide when and how to pursue a “new normal.”​

In other developments:​

The C.D.C. conceded that cloth masks do not offer as much protection as medical-grade masks. Our guide to finding a quality mask can help. Americans can order at-home tests through a government websitestarting Wednesday. This is how happy accidents and long-buried discoveries helped pave the path to Covid vaccines, which are now protecting hundreds of millions of people.

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[MamaBee]

I have been avoiding the grandkids since I last saw them Christmas Eve. Mom is a teacher, dad travels, 2 kids in school. This week the whole family got covid. Kids not vaccinated. (7,4) Looks mild except for mom who was ill, better, then ill again today. If we do shots every 6 mo mine expires mid Feb.

I’m sorry @AprilBaby..I hope your family gets better quickly.
We were supposed to spend Christmas with my son and family. We had to cancel it. Their 1.5 year old son in day care got exposed to Covid so they isolated with him. When he was ready to go back three more children tested positive. One was in his bis brother’s class. Then a few teachers got it. They’ve been home for 20 days. Since the boys haven’t been in day care for three weeks they were safe to visit us. We did a Christmas exchange yesterday. My son and daughter-in-law tested yesterday before coming. My husband and I tested on Friday and Saturday just before they came. We spent the day together. We didn’t see them since October. They said once the boys go back they won’t see us for a long time. It’s so hard to know what to do..I think it will be another long span of time before we see them again. My 1.5 year grandson is only warming up to me because he really only knew me on FaceTime. I hope you can work something out so you can see your family.

 

[missy]

(When) to Boost or Not to Boost, That Is the Question​

— Countless complex questions remain​

by John P. Moore, PhD January 13, 2022


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For several months, America has been in the vaccine-booster phase of the COVID-19 pandemic. Various aspects of booster policy have been controversial and/or confusing, and the public response to the need for boosters has been mixed. But what is the best way to continue to provide the sensible majority who trust in the life-saving COVID-19 vaccines with the best protection in the coming months to years? At times, it seems as if some folks believe "a dose a day keeps the doctor away." And a meme is now circulating of a "Pfizer Loyalty Card," offering a free pizza after dose nine. While droll, might that actually happen? (Dose nine, that is).



While the strong protective efficacy of the mRNA vaccines was certainly not predicted early on in the global vaccine program, a basic understanding of vaccine immunology allowed us to predict that protective antibody titers would inevitably wane over a 6-month period and could be restored with a booster dose (see Figure 3).

The Early Booster Debates

In summer 2021, data from Israel triggered discussions among policymakers, scientists, and company executives about the need for boosters in the U.S. The vaccine booster concept wasn't -- or shouldn't have been -- inherently controversial, particularly for individuals at high risk for COVID-19 complications. However, there were doubts about the arguably premature timing of, and rationale for, a broadly based boosting program. Arguments were also raised about using those doses in under-vaccinated countries instead, both on moral grounds and to prevent the emergence of even more troubling variants (e.g., Omicron...). Other debates centered on whether the goal was to protect against mild infections (which vaccines typically don't do) or severe disease and death. These discussions generally faded away once it became clear that protection against severe infections was diminishing significantly for older individuals, and that fully vaccinated people could still transmit their infections to others. In addition, anxious members of the vaccine-embracing public, including members of the media, put pressure on the Biden administration. A vaccine boost became something that Jane Public and Ronnie Reporter wanted, and, frankly, expected.



Americans can now be boosted 5 months after their initial two mRNA vaccine doses of Moderna or Pfizer. The far fewer recipients of the Johnson & Johnson (J&J) vaccine are also being boosted, most opting for an mRNA dose as that provides a stronger antibody response.

But what's next? Already, Israel is rolling out a fourth Pfizer dose and is therefore well on the way to handing over a slice of pizza. Should we do the same here, and if so, when? In the hope that any policy decisions will be science-based, I will review some of the knowns and unknowns. Whatever knowledge I possess has been significantly boosted by helpful discussions with world-class immunologist colleagues.

Determining the Right Booster Schedule

Most agree that dose three (i.e., the first boost) should not be given too early. The period between the second and third dose is critical to the maturation of the immune response and establishment of immunological memory. As the quantity of antibodies in the blood declines, their quality increases, including their ability to counter variants. While there is no "magic moment" for dose three, the original CDC recommendation for a 6-month gap for both mRNA vaccines and the recent revisions to 5 months are both about right.



But what about dose four and onwards? Is there a point when it is certainly needed? Here, we don't have hard data, although there are early indications from Israel that the antibody responses to Pfizer dose three are now dropping. That should not be a surprise, based in part on decades of experience with attempts at an HIV-1 vaccine. As but one illustrative example, an HIV-1 "spike protein" vaccine was given seven times to humans over a 30-month period. After the first two immunizations, every subsequent one triggered a rapid rise in antibody levels, followed by a gradual decline at a similar rate each time. The titer pattern over time looked like saw teeth. In the period between boosts, the antibody levels didn't disappear but the boosted peak levels weren't much higher each time -- there were ever diminishing returns to the potency of each booster dose.



Perhaps we will see something different with the SARS-CoV-2 spike protein, and maybe the mRNA delivery method will be the charm -- but I wouldn't bet the farm on a dramatically different outcome to our experiences with the HIV-1 spike protein. In other words, boosting is likely to increase protective antibody levels in the short term but probably won't be truly sustained (T-cell responses, which help to prevent severe disease, also wane but more slowly). If the pandemic persists, fairly regular boosting may therefore be needed, akin to the annual flu vaccines.

However, this scenario also invites more questions about the intervals between doses: the HIV-1 vaccine study discussed above used a 6-month interval between the later doses, probably because prior experience showed that was when the boosted titers dropped back to near baseline. The Israelis, however, are now giving the fourth Pfizer vaccine dose about 4 months after the third. Is that too soon for comfort? Well, for sure, it should be no sooner than that...and most immunologists I talked to favor a longer interval. Given the cost and logistics, some important decisions will need to be made soon.



Our political and public health leaders have much to consider, and will need to decide whether there is a need to sustain a high level of protection against SARS-CoV-2 infection and mild COVID-19.

Will We Keep Boosting...Forever?

What about the future? There is nothing inherently problematic with giving regular, sensibly spaced vaccine doses from an immunology perspective. Different COVID-19 vaccines can clearly be mixed when given sequentially. A recent HIV-1 vaccine studyin monkeys involved nine doses of mRNAs, proteins, and protein-nanoparticles over a ~14-month period in a heroic attempt to broaden the neutralizing antibody response (the major obstacle to a successful HIV-1 vaccine). Next-generation, more potent COVID-19 vaccines may eventually play an important role. We'll also need to explore alternative ways to deliver vaccines, whether based on immunology or emerging technology. What happens should be dictated by the trajectory of the pandemic, including the evolution of yet more variants. So far, despite vaccine manufacturers going ahead with their own plans, the case for variant-specific vaccines has been weak. Although, it's possible the need for them may change in the coming months as Omicron continues to spread.



Boosting J&J Vaccine Recipients

Additional complications are at play too: What's the right approach to boosting J&J vaccine recipients? They can receive a second dose 2 months after the first, but in most cases that dosing interval is many months longer (and, as noted, most opted for an mRNA boost at that point). When should they receive a third dose? For the mRNA vaccines, the critical period for immunological quality improvements is the ~6-month interval between doses two and three (see above), but when does that happen for the J&J vaccine? In the long and rather random interval between doses one and two? After dose two? Or both? Could a third dose in the near future be too soon for comfort? Having more data would help.

Factoring in Natural Immunity

We also need to consider how to -- or whether to -- factor in immune responses induced by vaccine breakthrough infections, which are becoming increasingly common. Although breakthrough Omicron infections are generally not severe, the viral antigens will surely trigger a boosting effect in vaccine-primed immune systems -- some members of the public are now embracing this idea. And we know that vaccinating previously infected people generates particularly strong immune responses ("hybrid immunity"). We can expect a lot of data on this topic in the next month or so, but for now we have to speculate.



But what happens when vaccination precedes infection? Should a two-dose vaccine recipient who is then Omicron-infected receive a further vaccine dose and, if so, when? Similarly, what happens if a triply vaccinated person becomes infected? Given how mutated the Omicron spike-protein is, an infection with this variant is likely to trigger the production of antibodies that have a lesser impact on new variants that more closely resemble the ones that circulated in 2020-2021. They would, however, be better poised to counter any variants that emerge from the Omicron lineage, as would Omicron-based vaccine boosters. In short, we need to determine how to factor in the combination of vaccination and infection history, and also how the pandemic may further evolve, to devise an optimal boosting approach. There are important scenarios that policymakers and serious immunologists must ponder soon. Otherwise, far-reaching decisions will be taken on the fly, which is never ideal.



The U.S. is blessed with an abundance of COVID-19 vaccines and world-class scientists. Our complex scenarios merit the most qualified experts to figure out the best paths forward. I, for one, look forward to reading what might emerge. I need that guidance to answer with greater confidence the questions I am frequently asked by friends, colleagues, and random members of the public. "Winging it" is becoming as tiresome as it is tiring.

John P. Moore, PhD, is a professor of Microbiology and Immunology at Weill Cornell Medicine in New York City."

 

[missy]

Europe isn’t rushing second boosters​

As people get their boosters in, many are wondering how many more will be needed for adequate protection against Covid-19. Maybe not that many. Repeat booster doses every four months could eventually weaken the immune response and tire out people, the European Medicines Agency warned last week. Instead, countries should leave more time between booster programs and tie them to the onset of the cold season in each hemisphere, following the blueprint set out by influenza vaccination strategies, the regulator said. The advice comes as some countries consider the possibility of offering people second booster shots amid surging omicron infections. Israel pushed ahead and became the first nation to start administering second boosters, or a fourth shot, to those over 60 as part of the government’s strategy to protect the most vulnerable to the virus. As of Jan. 16, about 537,419 Israelis had received a fourth dose. Healthcare workers prepare third doses of the Pfizer-BioNTech Covid-19 vaccine. Photographer: Nathan Laine/Bloomberg That contrasts with comments from the U.K., where the government’s advisory panel on inoculations said there’s no immediate need to introduce a second booster to the most vulnerable. Some three months after the third shot, protection against hospitalization among those 65 and older remains at about 90%, data from the U.K. Health Security Agency showed. With just two doses, protection against severe disease drops to about 70% after three months and to 50% after six months. The figures will be reviewed as they evolve. Boosters “can be done once, or maybe twice, but it’s not something that we can think should be repeated constantly,” Marco Cavaleri, the EMA head of biological health threats and vaccines strategy, said at a press briefing. “We need to think about how we can transition from the current pandemic setting to a more endemic setting.” In the meantime, Pfizer is developing a hybrid vaccine that combines its original shot with a formulation that shields against the highly transmissible omicron variant. Pfizer will evaluate the new hybrid formulation against an omicron-specific shot, and determine which is best suited to move forward by March, Chief Executive Officer Albert Bourla said at the JPMorgan Healthcare Conference last week. Pfizer will be ready in March to approach U.S. regulators for clearance of the modified vaccine and bring it to market, and it has already begun production, Bourla said. In Europe, regulators said that April is the soonest they could approve a new vaccine targeting a specific variant, as the process takes about three to four months.—Corinne Gretler and Irina Anghel

 

[missy]

Tragic. This pandemic is far reaching in so many ways not directly having to do with Covid.

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The Lost Girls of Covid​

The pandemic is erasing decades of progress in young women’s health, education, and independence in developing nations.
By
Jill Filipovic

​

At the girls’ rescue house down the quiet end of a dusty road in Narok County, Kenya, there are girls who are friends, and then there are Purity and Lucy. Sisters, they both say. Purity is 17; Lucy, 19. Where Purity is soft-spoken and shy, Lucy is gregarious and funny, with expressive eyebrows and a sardonic affect. When she smiles—and she smiles a lot—the corners of her mouth turn almost vertical, and her cheeks, still freckled with teenage acne, go full and flush. Purity is slender as tall grass, with glowing skin and a gap in her lower teeth that she habitually pokes her tongue through. Both grew up in traditional Masai communities, in different areas that are within striking distance of Masai Mara National Reserve, a game park that, in normal times, draws hundreds of thousands of visitors a year. Neither one’s parents went to school; Purity and Lucy were set to be among the first generation of girls in their communities to graduate from high school, maybe even from college.



Lucy wants to study the moon and become an astronaut. Purity has dreams, too, but she doesn’t talk about them much anymore. Both girls left their homes years ago, fleeing forced marriages and, for Lucy, the genital mutilation that traditionally precedes matrimony in their communities. Purity was cut when she was 10. (For privacy reasons, I’m identifying them and some others in the story only by first name or a pseudonym.)

When Covid-19 led the Kenyan government to shutter schools and ban large gatherings, the operators of the rescue house—a nonprofit shelter that offers girls a base where they can live and from which they can go to school—had little choice but to comply. The risk that a deadly disease could rip through the crowded dormitories and infect scores of girls with little access to health care was too high to do otherwise. The operators secured promises from the girls’ families that they would be treated well and sent them home. Purity and Lucy left in March 2020, returning to homes where their fathers drank heavily, often became violent, and routinely kicked them out, forcing the girls to sleep in the bush. Each felt lucky when a man from the community approached her, offering a little food, shelter, and money. Almost a year after leaving the rescue house, Purity and Lucy returned, both just weeks away from giving birth.

Lucy hoped she could leave her baby with her mother and continue going to school. Purity didn’t have a relative who could help, but she was determined to give her child resources and an education she hadn’t had. “I don’t want him or her to be like me,” she says. So she’d need to make money. Her plan was to become a tailor; she’d start by sewing tidy school uniforms for other people’s children.

Purity, Lucy, and their peers have been hit by a shadow epidemic ripping through developing countries

Kenya, like most countries in sub-Saharan Africa, has so far been spared the worst of Covid. As of Jan. 3, the country of about 55 million people had seen more than 285,000 confirmed cases and nearly 5,400 deaths. These numbers are almost certainly undercounted, but for comparison, Spain, with about 47 million people, had recorded more than 6 million Covid cases and nearly 90,000 deaths. The reasons for the discrepancy aren’t fully understood, but age seems to be a significant factor: The median Kenyan is 20 years old, while the median Spaniard is almost 44. Kenyans are also less likely to suffer from other Covid risk factors, such as cancer, diabetes, or respiratory illness. The country is among the least urbanized in the world, decreasing the potential for close-quarters transmission, and its weather allows people to spend more time outside, where the risk of infection is lower.

On the other hand, more than a third of Kenyans live in poverty, and the country has a fragile health-care system that could easily be overwhelmed by the virus. That led the government to proceed with abundant caution, closing schools from March 2020 through January 2021 and instituting a series of strict curfews, international travel bans, and county-specific lockdowns. The measures helpedkeep infection rates low, but they brought their own perils, including widespread food insecurity, rampant domestic violence, and surging unemployment. The disruptions hit women harder than men, and girls harder than boys.


“Covid was the most difficult thing we had to face and that we still face,” says Kakenya Ntaiya, an educator who grew up in a Masai community and was engaged by the time she was 5 years old. Decades ago, Ntaiya persuaded her father to let her defer her engagement and continue her schooling, eventually going to college in the U.S. When she returned to Kenya, she started a nongovernmental organization called Kakenya’s Dream, which runs a boarding school for at-risk Masai girls, similar to the school Purity and Lucy attend.

“For the first time, our students were home for nine months or more without that safe space,” Ntaiya says. “When you look at a girl going from having a place where she can jump rope and play and her only responsibility is to go to class, to back home where she’s now responsible for cooking for the others, taking care of the family, collecting firewood, getting water, and in the evening she doesn’t have her own space, there’s a bedroom with the little siblings, she’s not invited to sit in the big house, which is the father’s house, she’s in the kitchen—that was really harsh.”

The extent of the indirect damage Covid has brought is difficult to measure. What’s known so far, though, suggests that it could outweigh the disease’s direct effects in Kenya and many other African nations. The economic and social fallout of shutdowns is concentrated among the young, and almost a quarter of Kenya’s population is between 10 and 19. Purity, Lucy, and their peers have been hit by a shadow epidemic ripping through developing countries—pushing girls out of school, decreasing their earning potential, putting them at greater risk of violence, and potentially shortening their lives and those of their children.

The question now is whether there’s still time for recovery, or whether the pandemic has set girls’ progress back a generation. “Very simply, we know that adolescence is a critical moment in life for girls: It’s when many health problems either emerge or are averted, and many social ones, too,” says Lauren Rumble, a principal adviser for gender equality at Unicef. This, she says, is the time to get it right, because “if we get it wrong, we know they are going to live poorer, shorter lives.”

Before Covid, the story of girls’ progress over the past quarter-century was largely a positive one. Although only about half the world’s girls were enrolled in school in 1998, 25 years later that proportion had surged to 2 in 3, and the gender gap in education, which reflects the stubborn parental preference to invest in a son’s education but not a daughter’s, had closed in most countries. It’s no longer the case that young men are significantly more likely than young women to be literate. Rates of child marriage and female genital mutilation remain disturbingly high—about 1 girl in 5 is married before her 18th birthday, and some 200 million women and girls have undergone genital cutting—but they’ve been steadily decreasing, with drastic declines in many of the regions where these practices are most prevalent. Adolescent pregnancy, the leading killer of young women in the developing world, is down as young people gain access to modern contraceptive methods. A girl born today will live, on average, eight years longer than one born 25 years ago.

As the girls who benefited from these shifts become adults, the gains are magnified. Women with a secondary education are more likely to delay marriage and plan their family and less likely to be stuck in an abusive relationship and poverty. The children of these better-educated women are more likely to survive infancy and childhood, to go to school themselves, and to live longer, healthier lives. And as women break down long-standing barriers and assert their independence from men who disrespect or mistreat them, they become role models to girls and boys alike, expanding their idea of what’s possible for women and what’s acceptable for men. Countries with better-educated girls see so many tangible economic benefits that former World Bank economist and U.S. Treasury Secretary Lawrence Summers argued that educating girls “may well be the highest-return investment available in the developing world.”

“No mother can let her kids stay at home, not going to school”

Evaline Wanjiru has spent many of her 26 years riding the wave of improvement. Her own mother didn’t go to school, but Wanjiru did, and she was good at it. She went through Form 2 (roughly 10th grade in the U.S.), and though she dropped out when she had her daughter, Blessing, and stayed out after having her son, Miguel, she was able to get a good job, in sales and marketing for Safaricom Plc, Kenya’s largest telecommunications provider. She still lived in a family compound in Huruma, the low-income neighborhood in Nairobi where she grew up, but the 15,000 shillings (about $130) she made each month let her put both her kids in school. At 7, Blessing was “brilliant at school,” Wanjiru says, noting with pride that “she was No. 3 out of 19” in her class. Maybe she’d be a doctor one day, Wanjiru imagined. And maybe, once Wanjiru’s kids were a bit older, she could go back to school, too.

The pandemic defeated those hopes. With Kenya’s schools closed and Blessing and Miguel suddenly home all day long, Wanjiru began the struggle of working parents the world over, trying to make sure the kids were physically safe and intellectually engaged. She quizzed Blessing in English to keep her language skills sharp and tried to help her with math and reading. But at-home learning in Kenya is much different than it is in wealthier nations. While the ministry of education tried to distribute learning materials via mobile phone, radio, and television, just 1 in 5 Kenyan adolescents had access to those tools for their schoolwork, according to a report from the office of the country’s president and the international nonprofit Population Council. More than half of those studied said their home didn’t have consistent electricity.

Wanjiru’s struggles were compounded early in the pandemic, when Safaricom shuttered her office and laid her off along with the rest of her colleagues. The story was the same all over Kenya, with parents suddenly losing their livelihoods and the ability to feed their families. Kenya’s already thin safety nets were failing. With schools closed, many Kenyan children joined the 350 million kids worldwide who lost their most consistent meal of the day. By the summer of 2020 almost 75% of Kenyan adolescents were regularly missing meals.

When parents don’t have money coming in, they can’t afford the fees and uniforms that are a fixture even in primary schools in many poor countries. That’s what happened to Wanjiru: As the return date for school approached, she was already so far in arrears that the school wouldn’t give her Blessing’s last pre-Covid report card. It was unclear whether they’d let her daughter through the doors when classes recommenced. “No mother can let her kids stay at home, not going to school,” Wanjiru says. Blessing was able to return, but the family is still struggling to pay the fees.

Across town from the Wanjirus, inside a small building with gray concrete walls and dim lighting, a half-dozen girls flounce and cackle as they pick through a stack of gauzy tutus. This is Project Elimu, the premier ballet school in the neighborhood of Kibera. Community programs like this one dot the area and other dense sections of Nairobi, creating havens away from the violence and drugs that can make the streets dangerous for girls, and from the abuse and instability found in some homes. For the many children in Kibera who have loving but poor families, Project Elimu and programs like it also provide basics, from shelter to snacks to sanitary pads. And they open up possibilities—they can be one of the few places a child hears that she is in control of her life or interacts with an adult who encourages her to dream big.

Covid gutted Project Elimu: Kenya’s pandemic rules barred indoor gatherings of more than a handful of people, and donors sent their funds elsewhere. But Mike Wamaya, the 36-year-old former professional dancer who founded the program (“I’m the dance teacher, I’m the cleaner, I’m everything here,” he says), has managed to keep the doors open, at least until the nightly curfew. Wamaya works with a lot of kids, but he sees particularly striking results with girls. “I saw, getting a bit of power, how powerful they get,” he says.

One girl who hangs out at Project Elimu is Esther, a 16-year-old with neat braids and the charisma of a newscaster—something she aspires to be someday, if she makes it to someday. She attempted suicide during the pandemic, driven to desperation by an abusive mother who stabbed her with a knife. Esther was one in a sea of young people suddenly confined at home with adults who hurt them, with no school or other place to be in contact with adults who might recognize something was wrong.


Shutting down recreational community programs to prevent the spread of a deadly illness is, on its face, an obvious step. But the cost to adolescent girls can be particularly high. A studyof the 2014-16 Ebola epidemic in Sierra Leone, for example, found that girls experienced some of the most significant negative effects from the nation’s strict and broadly lifesaving policies of banning travel and closing schools. It also found those negative effects were lessened by community-based programs aimed at supporting and encouraging adolescents. Girls who’d participated in these programs prior to the epidemic were less likely to get pregnant during the lockdown period and more likely to return to school when it ended.

The Sierra Leone study provides some of the best data we have on how the response to a deadly contagion affects girls, and it helped to create a baseline for some of the first predictions about the effects of Covid shutdowns. Early on, Unesco warned that as many as 11 million girls might be pushed out of school permanently because of Covid. The United Nations Population Fund, the UN’s family-planning arm, predicted that six months of lockdowns could mean some 47 million women wouldn’t get the contraceptives they need, resulting in 7 million unintended pregnancies. Child marriages, which had been steadily decreasing, were predicted to reverse course, with 13 million more girls getting married by 2030 than would have if Covid had never happened.

Some of the consequences clearly haven’t been as dire as predicted. Contraceptive interruptions, for example, happened early in the pandemic and then dissipated. Still, the outcomes have been objectively bad: The UNFPA estimates that 12 million women were left without reliable birth control, resulting in 1.4 million unwanted pregnancies. Pre-Covid, the World Bank projected that 31 million people would escape extreme poverty in 2020. Instead, because of the pandemic, as many as 124 million people slipped below this bar that year, and the bank estimates that up to 163 million more may have followed suit in 2021. Researchers at the University of Denver forecast that it will take until 2030 for the number of women and girls living in extreme poverty to return to pre-pandemic levels.


In Kenya, according to government statistics released in June, school shutdowns disrupted the education of 18 million students. When schools reopened in January 2021, 92% of boys reenrolled, compared with 84% of girls. The consequences of girls not attending school, past research has found, include increased chances of adolescent marriage, female genital mutilation, and pregnancy. Girls who become pregnant are much likelier than adult women to die in pregnancy or childbirth and to have babies who are sicker and less likely to survive into adulthood.



According to aid groups, teen pregnancy rates in some Kenyan counties tripled in the first few months of the pandemic. And early numbers indicate that adolescent maternal deaths and stillbirths increased during that same period. When researchers asked girls in Kenya why they hadn’t returned to school, the most common reason was that their family couldn’t afford the fees. The second most common was that they were pregnant.

Other long-term effects, though, are less clear, in part because of a long-standing dearth of data, and in part because Covid has prevented in-person information-gathering, the gold standard. “You can’t have someone at a household survey level, going into a household to speak to someone directly,” says Megan O’Donnell, assistant director of the Center for Global Development’s gender program. “If you’re thinking about now only being able to rely on a mobile phone survey or an internet survey, you’ve just excluded, unintentionally, the most vulnerable.” Social isolation has also made it harder for researchers to rely on their usual adult proxies for adolescent problems: teachers, community organizers, church leaders, coaches, mentors—people like Project Elimu’s Wamaya.

That’s all left precious little information about the impact of Covid on girls like Esther. She lives in Kibera, the oldest girl in her family. With schools closed and her mother stressed and out of work, her duties were laid out: chores, cooking, tending to the younger children. Esther has a younger brother, Sam, but boys aren’t typically expected to do the same kind of household work as girls. According to Unicef, girls as young as 5 spend 30% more time on household chores than boys; by the time they’re 14, the disparity has grown to 50%. That expectation, experts and educators say, is part of what keeps girls out of school. Covid—and the sudden, expanded need for full-time caregiving that it brought—made the situation worse.

Sick of feeling like a maid, pushed to the physical and psychological brink by her mother’s abuse, and with no school to occupy her days, Esther began spending more time with her boyfriend. Within a few months, she was pregnant. He abandoned her, and she gave birth alone in the hospital; her baby, who had the umbilical cord wrapped around his neck, was delivered via emergency C-section. Esther wasn’t allowed to leave the hospital until she’d paid for the cost of her treatment and stay, a common practice in Kenya. The only person who showed up to help was Wamaya, the community dance program organizer. He paid her bill, got her home, and encouraged her to spend more time at the ballet school. It didn’t matter, he told her, if she didn’t want to dance.

Esther spends most of her time at home, caring for two babies: her son and the brother her mother gave birth to around the same time. Maybe, Esther says, something will change and she can finish her education. But she has a hard time imagining how. “Who will take care of my child when I go to school, and who will take care of her child when she goes to work?” she asks.

The best ways to get girls and women back on track, says O’Donnell of the Center for Global Development, are “cash, care, and data.” Rich countries should immediately put money into people’s pockets; they should prioritize paying for child care and encouraging men to share the burden; and they should strengthen data collection and analysis, to bring problems into clearer focus. If one thing is apparent, O’Donnell says, it’s that “the economic impact of this crisis is going to long outlast the direct health effect.”

In May, the Group of Seven publicly affirmed “a commitment to placing gender equality and the empowerment of all women and girls at the heart of our work to build back better.” It also declared: “Nowhere is our resolve stronger than in addressing the global set-back in girls’ education.” But the girls who are out of school now need more than commitment and resolve.

The Kenyan government is aware of the issues. “The Covid-19 protocols that were put in place by the Government unmasked the gaps that need to be addressed,” Julius Jwan, principal secretary for the Department of Early Learning and Basic Education, said in a written statement. The government’s strategies for girls’ education, he wrote, include “ensuring implementation of re-entry guidelines, provision of sanitary towels and other school kits, psychosocial support for the affected girls, parental empowerment on their roles and responsibilities, and review of policies and plans to ensure they are gender responsive.” Jwan said the pandemic also opened lines of communication and collaboration between the government, NGOs, educators, and religious groups, which could help address problems in the long term.

What seems to work best to keep girls in school even during a crisis is a network of dedicated adults who have the resources required to help students and their families. Dorcas Adhiambo, principal of a 240-student secondary school in Western Kenya run by the nonprofit Wiser, was able to keep almost all her girls attending class by coordinating on-campus distribution efforts and home visits to issue smartphones so girls could learn via WhatsApp. The educators also brought necessary items—sanitary pads, soap, maize, beans, sugar—to ease the pressure for girls to contribute to the family’s income at the expense of their education. This was possible because Wiser is a private program with limited scope, funded by donors who stepped up to meet specific and rapidly changing needs. It only works “if there’s heavy funding and heavy follow-up from all quarters,” Adhiambo says. “When it is a big scale, the size of Kenya, if you have a school with over 4,000 students and you don’t have access to a platform where you can meet regularly, then you leave it to chance.”

Ntaiya, the Masai educator, says that her organization did house-by-house outreach in the community to keep girls safe, and that by and large, her students are coming back. But they’re often returning wounded and traumatized. “We know that [female genital mutilation] increased,” she says. “We know teen pregnancy increased. And child marriages—it’s just on the rise. We are hoping that we can change this narrative and figure out a way of protecting girls and protecting communities and helping them thrive. But all the work we’ve done, you’re seeing it’s going backward.” She pauses and takes a breath. “It’s a tough topic to talk about.”

At the time this story was published, Kenya was dealing with a sharp rise in Covid cases attributed to the omicron variant, but the government hadn’t announced any new curfews or shutdowns. Lucy and Purity were caring for their newborn sons full time, with Lucy hoping to resume classes in May and Purity planning to return to a tailoring training program, if they could find sponsors to pay their fees.

In Kibera, Esther slips into the dance studio when things get especially rough at home. Some days she still feels helpless. But once in a while, she can imagine something better. Her own mother had no formal education, instead spending her younger years working as house help for her stepmother. Esther may not have graduated from secondary school, but she did better than her mom, and she hopes that her son will do better than her—and maybe even lift her up as he rises. “I see my son as a strong guy,” she says. “I feel like he will dream more than me. I may not get raised now. But he will raise me.”

"

 

[missy]

2:24 a.m. ET, January 17, 2021

US records 198,218 new cases and 3,286 deaths Saturday​

According to Johns Hopkins University's tally of cases in the United States, there have been at least 23,754,315 cases of coronavirus in the US, and at least 395,785 deaths.
On Saturday, Johns Hopkins reported 198,218 new cases and 3,286 new deaths.
At least 31,161,075 vaccine doses have been distributed and at least 12,279,180 doses of the vaccine have been administered, according to the US Centers for Disease Control and Prevention.
On Friday, the CDC said new more contagious variants of the coronavirus will likely accelerate the spread of the virus and that means the US must double down on efforts to protect people.
A variant first identified in Britain known as B.1.1.7 is now being found in the US too, and modeling indicates it could worsen the already terrible spread of the virus across the country, the CDC researchers said.
That means people need to try harder to wear masks, avoid gatherings and stay socially distant from one another.

"It means that it is going to be harder and harder to control it. Any of those measures we are going to have to do to a higher degree, including vaccination," said Dr. Gregory Armstrong, who directs the Office of Advanced Molecular Detection at CDC's respiratory diseases division.

12:55 a.m. ET, January 17, 2021

LA County records more than 1 million coronavirus cases​

From CNN's Paul Vercammen, Melissa Alonso and Susannah Cullinane

People wait in vehicles at a Covid-19 vaccination site in the Dodger Stadium parking lot in Los Angeles, on January 15. Bing Guan/Bloomberg/Getty Images

Los Angeles has become the first US county to report more than 1 million coronavirus cases, according to state officials.
Some 14,669 new cases were added Saturday taking the county's total to 1,003,923 cases and 13,741 confirmed virus-related deaths -- 253 reported on Saturday, Los Angeles County's Department of Public Health said in a news release.
The department also announced its first confirmed case of the UK Covid-19 B.1.1.7 variant Saturday, in a male who had traveled to L.A. County but is now isolating in Oregon.
The health department said it believed the more contagious UK variant was likely already spreading in the community and urged residents to "more diligently" follow safety measures.

"The presence of the UK variant in Los Angeles County is troubling, as our healthcare system is already severely strained with more than 7,500 people currently hospitalized," said health department director Barbara Ferrer said in a statement.
"Our community is bearing the brunt of the winter surge, experiencing huge numbers of cases, hospitalizations and deaths, five-times what we experienced over the summer."

12:03 a.m. ET, January 17, 2021

UK has vaccinated around 45% of its over 80s​

From CNN’s Sarah Dean in London

Care home resident Ian Hurley, aged 80, is seen smiling through a viewing screen as his sleeved is rolled up to receive his first dose of the Oxford/AstraZeneca COVID-19 vaccine at the Wimbledon Beaumont Care Home, in London, on January 13. Matt Dunham/AP

The United Kingdom has vaccinated around 45% of people aged 80 and over, and is urging those who have been offered a vaccine to come forward as soon as possible, the country's Department of Health said Sunday.
The announcement comes after Prime Minister Boris Johnson announced Friday that there are now more than 37,000 Covid-19 patients in hospital across the UK. He said over 3.2 million people have been vaccinated.
The UK government is calling on the public to urge their family and friends aged 80 and over to get the Covid-19 vaccine to which they are now entitled.

“We recognize that so many people want to support our NHS so health and care workers can continue to save lives, and now is your chance to get involved by helping the remaining people aged 80 and over get their jabs," Health Secretary Matt Hancock said in a statement.

Hancock also called on people to sign up volunteer in the community and in clinical trials for vaccines and Covid-19 treatments, as the National Health Service – particularly in London – struggles with a surge in hospitalizations.
The UK government aims to vaccinate the following four groups by February 15: those over the age of 70, care home residents and staff, NHS workers and clinically extremely vulnerable individuals.




12:21 a.m. ET, January 17, 2021

UK to host G7 summit in June focused on building "back better from coronavirus"​

From CNN’s Sarah Dean in London

British Prime Minister Boris Johnson speaks during a press conference at the conclusion of the G7 summit in Biarritz, France, on August 24, 2019. Jeff J. Mitchell/Getty Images

The United Kingdom will host this year’s G7 summit in Cornwall, in the country's southwest, Downing Street announced on Saturday.
The annual summit will be held in the seaside village of Carbis Bay from June 11 to 13.

Downing Street said in a statement that Prime Minister Boris Johnson will use the UK’s G7 Presidency – the first in-person summit in almost two years – to “unite leading democracies to help the world build back better from coronavirus and create a greener, more prosperous future."

As well as the other G7 countries (Canada, France, Germany, Italy, Japan and the USA), leaders from Australia, India and South Korea have been invited to attend as guest countries “to deepen the expertise and experience around the table. Between them the 10 leaders represent over 60% of the people living in democracies around the world,” Downing Street said.

“Coronavirus is doubtless the most destructive force we have seen for generations and the greatest test of the modern world order we have experienced. It is only right that we approach the challenge of building back better by uniting with a spirit of openness to create a better future,” Johnson said in the statement.
“Cornwall is the perfect location for such a crucial summit. Two hundred years ago Cornwall’s tin and copper mines were at the heart of the UK’s industrial revolution and this summer Cornwall will again be the nucleus of great global change and advancement. I’m very much looking forward to welcoming world leaders to this great region and country."

During February, the UK will assume the Presidency of the United Nations Security Council, and later this year it will host COP26 in Glasgow.




11:32 p.m. ET, January 16, 2021

Brazil's health regulator denies emergency use authorization for Russia's Sputnik V vaccine​

From CNN's Jonny Hallam in Atlanta and Rodrigo Pedroso in Sao Paulo

A health worker prepares the first dose of 'Gam-COVID-Vac', also known as Sputnik V vaccine, at Luis Lagomaggiore Hospital in Mendoza, Argentina, on December 29, 2020. Alexis Lloret/Getty Images

Brazil's health regulator has denied a request for the emergency use of Russia's Sputnik V vaccine, saying it needs to see more data.
In a statement published late Saturday, the Brazilian National Health Surveillance Agency (Anvisa), said the request for emergency use by the pharmaceutical company Uniao Química was denied because it does not yet have data from Phase lll clinical trials.
Uniao Química, in partnership with the Russian Direct Investment Fund (RDIF), filed a request for the emergency use of 10 million doses of the vaccine on Friday. As part of the partnership with União Química, RDIF said it "actively facilitated the transfer of technology to launch the production of Sputnik V in Brazil," according to a statement from RDIF on Friday. The collaboration included providing documents and biomaterials to the Brazilian company and local production of Sputnik V in Brazil began earlier this month.
Anvisa explained that it is yet to grant authorization for Phase III trials of Sputnik V to Uniao Química, which is to run the trials, because the company had not responded to its requests for the appropriate documentation.
"The documents (requesting emergency authorization) were sent back to the company after not meeting the minimum criteria, especially due to the lack of authorization for conducting Phase III clinical trials, a standard request, and issues relating to good manufacturing practices," said Anvisa.
Sputnik V has been approved under emergency use authorization procedure in a number of Latin America countries, including Argentina and Bolivia
CNN has reached out to Uniao Química and RDIF for comment.
Brazil is yet to approve any vaccine for use against Covid-19.

 

[missy]

"​

Supreme Court Says Yes to Vaccine Mandate for Healthcare Workers​

Aaron Gould Sheinin
January 13, 2022

The US Supreme Court on Thursday struck down President Joe Biden’s vaccine mandate for large businesses but said a similar one for healthcare workers may continue while challenges to the rules move through lower courts.
The vote was 6-3 against the large business mandate and 5-4 in favor of the health care worker mandate. Only health care workers at facilities that receive federal money through Medicare or Medicaid are affected, but that includes large swaths of the country’s health care industry.
Biden’s proposed vaccine mandate for businesses covered every company with more than 100 employees. It would require those businesses to make sure employees were either vaccinated or tested weekly for COVID-19.

In its ruling, the majority of the court called the plan a “blunt instrument.” The Occupational Safety and Health Administration was to enforce the rule, but the court ruled the mandate is outside the agency’s purview.

“OSHA has never before imposed such a mandate. Nor has Congress. Indeed, although Congress has enacted significant legislation addressing the COVID–19 pandemic, it has declined to enact any measure similar to what OSHA has promulgated here,” the majority wrote.
The court said the mandate is “no ‘everyday exercise of federal power.’ It is instead a significant encroachment into the lives — and health — of a vast number of employees.”
Biden, in a statement following the rulings, said when he first called for the mandates, 90 million Americans were unvaccinated. Today fewer than 35 million are unvaccinated.

“Had my administration not put vaccination requirements in place, we would be now experiencing a higher death toll from COVID-19 and even more hospitalizations,” he said.
The mandate for businesses, he said, was a “very modest burden,” as it did not require vaccination, but rather vaccination or testing.
But Karen Harned, executive director of the National Federation of Independent Businesses’ Small Business Legal Center, hailed the ruling.
“As small businesses try to recover after almost two years of significant business disruptions, the last thing they need is a mandate that would cause more business challenges,” she said in a prepared statement.

NFIB is one of the original plaintiffs to challenge the mandate.

Anthony Kreis, a constitutional law professor at Georgia State University in Atlanta, said the ruling shows “the court fails to understand the unparalleled situation the pandemic has created and unnecessarily hobbled the capacity of government to work.

“It is hard to imagine a situation in dire need of swift action than a national public health emergency, which the court's majority seems to not appreciate.”


The American Medical Association seems to agree. While applauding the decision on the health care mandate, association President Gerald Harmon, MD, said in a statement he is “deeply disappointed that the Court blocked the Occupational Safety and Health Administration’s emergency temporary standard for COVID-19 vaccination and testing for large businesses from moving forward.”


“Workplace transmission has been a major factor in the spread of COVID-19,” Harmon said. “Now more than ever, workers in all settings across the country need commonsense, evidence-based protections against COVID-19 infection, hospitalization, and death — particularly those who are immunocompromisedor cannot get vaccinated due to a medical condition.”

While the Biden administration argued that COVID-19 is an “occupational hazard” and therefore under OSHA’s power to regulate, the court said it did not agree.

“Although COVID–19 is a risk that occurs in many workplaces, it is not an occupational hazard in most. COVID–19 can and does spread at home, in schools, during sporting events, and everywhere else that people gather,” the justices wrote.

That kind of universal risk, they said, “is no different from the day-to-day dangers that all face from crime, air pollution, or any number of communicable diseases.”

But in their dissent, justices Stephen Breyer, Sonia Sotomayor, and Elena Kagan, said COVID-19 spreads “in confined indoor spaces, so causes harm in nearly all workplace environments. And in those environments, more than any others, individuals have little control, and therefore little capacity to mitigate risk.”

That means, the minority said, that COVID–19 “is a menace in work settings.”

OSHA, they said, is mandated to “protect employees” from “grave danger” from “new hazards” or exposure to harmful agents. COVID-19 certainly qualifies as that.
“The court’s order seriously misapplies the applicable legal standards,” the dissent says. “And in so doing, it stymies the federal government’s ability to counter the unparalleled threat that COVID–19 poses to our nation’s workers.”

On upholding the vaccine mandate for health care workers, the court said the requirement from the Department of Health and Human Services is within the agency’s power.

“After all, ensuring that providers take steps to avoid transmitting a dangerous virus to their patients is consistent with the fundamental principle of the medical profession: first, do no harm,” the justices wrote.

In dissenting from the majority, justices Clarence Thomas, Samuel Alito, Neil Gorsuch and Amy Cohen Barrett said Congress never intended the department to have such power.

“If Congress had wanted to grant [HHS] authority to impose a nationwide vaccine mandate, and consequently alter the state-federal balance, it would have said so clearly. It did not,” the justices wrote.

"

 

[missy]

"

Almost All Teens in ICU With COVID Were Unvaccinated, Study Shows​

Ralph Ellis
January 14, 2022

Nearly all teenagers admitted to intensive care units because of COVID-19 were unvaccinated, according to a new study published in the New England Journal of Medicine.

Two doses of the vaccine "were highly effective against COVID-19–related hospitalization and ICU admission or the receipt of life support," the authors of the study concluded.

The Pfizer vaccine prevented 94% of hospitalizations and was 98% effective in keeping the young patients out of the intensive care unit, the study said.

​

The CDC and 31 pediatric hospitals in 23 states conducted the study, in which researchers looked at data for 1,222 patients 12-18 years old hospitalized from June 1 to Oct. 25, 2021. Included were 445 teens hospitalized for COVID-19 and 777 hospitalized for other reasons.


The study said 40% of patients who tested positive were admitted to the ICU, and all but two were unvaccinated. All but one of them who needed life-supporting interventions, such as a ventilator, were unvaccinated.

"All seven deaths occurred in patients who were unvaccinated," the study said.

The results appear to confirm the effectiveness of the COVID vaccines, Kathryn M. Edwards, md< scientific director of the Vanderbilt Vaccine Research Program, wrote in an editorial accompanying the study.


"Nearly all hospitalizations and deaths in this population could have been prevented by vaccination," Edwards wrote.

Edwards said it was "distressing" that only 299 of the study participants were fully vaccinated, since the vaccine has been authorized for children 12-17 since May.

"Vigorous efforts must be expended to improve vaccination coverage among all children and especially among those at highest risk for severe covid-19," she wrote.

The vaccination rate among younger teens is not high. CDC data shows 36% of children between 12 and 17 in the U.S. have not received a single dose of vaccine, compared to 25% of the total population.


The study noted that about three-fourths of the teenagers in the study had underlying medical conditions, such as obesity, and 70% attended in-person school.

Sources​

New England Journal of Medicine: "Effectiveness of BNT162b2 Vaccine against Critical COVID-Sparing of Severe COVID-19 in Vaccinated Adolescents," "Sparing of Severe COVID-19 in Vaccinated Adolescents."

"

 

[missy]

"​

Cardiac Inflammation Can Be Present After Mild COVID Infection​

Sue Hughes
January 13, 2022



Myocardial inflammation is present in a small proportion of patients who have recovered from relatively mild cases of COVID-19 infection, a new study shows.
"Our findings suggest that even in patients who have had relatively mild cases of COVID-19, some will have inflammatory changes to the heart, and these changes can be present without any cardiac symptoms," senior author, Paaladinesh Thavendiranathan, MD, University of Toronto, told theheart.org | Medscape Cardiology.
"While our data suggest that this inflammation improves over time and the outcomes seem positive, we don't know if there will be any long-term consequences," he added.
Noting than even a short period of inflammation in the heart may be associated with symptoms or arrhythmias in the longer term, Thavendiranathan said: "I would recommend that it is best to avoid getting the infection if there is any chance of heart inflammation."

The study was published online in JAMA Cardiology on January 12.

The authors explain that among patients hospitalized with COVID, early studies suggested that approximately one in four experience cardiovascular injury, defined as an elevation in troponin levels, which was associated with a 5- to 10-fold increase in the risk for death. But there is limited information on cardiac injury in patients who do not require hospitalization.
Although a broad range of abnormal myocardial tissue has been reported in several cardiac MRI studies of patients recovered from COVID infection, there is little understanding of persistent changes in myocardial metabolism in recovered patients, which is a potential concern, given that COVID-19 is associated with systemic inflammation during the acute illness, they say.
For the current study, the researchers examined myocardial inflammation measured using two different methods — cardiac MRI and fluorodeoxyglucose–positron emission tomography (FDG-PET) — in individuals who had recovered from COVID-19 infection and looked at how this related to changes in inflammatory blood markers.

Lead author Kate Hanneman, MD, also from the University of Toronto, explained that FDG-PET imaging is more sensitive than MRI in detecting active inflammation. "Inflammatory cells have a higher uptake of glucose, and FDG-PET imaging is used to look for metabolically active inflammatory tissue that takes up glucose. It gives complementary information to MRI. Cardiac MRI shows structural or functional changes, such as scarring or edema, whereas FDG-PET imaging directly measures metabolic activity related to inflammatory cells."


The study involved 47 individuals, 51% female, with a mean age of 43 years, who had recently recovered from COVID-19 infection. Of these, the majority had had relatively mild COVID disease, with 85% not requiring hospitalization.

Cardiac imaging was performed a mean of 67 days after the diagnosis of COVID-19. At the time of imaging, 19 participants (40%) reported at least one cardiac symptom, including palpitations, chest pain, and shortness of breath.

Results showed that eight patients (17%) had focal FDG uptake on PET consistent with myocardial inflammation. Compared with those without FDG uptake, patients with focal FDG uptake had higher regional T2, T1, and extracellular volume (colocalizing with focal FDG uptake), higher prevalence of late gadolinium enhancement indicating fibrosis, lower left ventricular ejection fraction, worse global longitudinal and circumferential strain, and higher systemic inflammatory blood markers including interleukin (IL)-6, IL- 8, an high-sensitivity C-reactive protein.

Of the 47 patients in the study, 13 had received at least one dose of a COVID-19 vaccine. There was no significant difference in the proportion of patients who were PET-positive among those who had received a COVID-19 vaccine and those who had not.

There was also no difference in inflammation in patients who had been hospitalized with COVID-19 and those who had managed their infection at home.

Among patients with focal FDG uptake, PET, MRI, and inflammatory blood markers improved at follow-up imaging performed a mean of 52 days after the first imaging. The authors say this suggests that these abnormalities were not related to pre-existing cardiovascular disease.



Of the eight patients with positive FDG-PET results, two did not show any MRI abnormalities. These two patients also had elevated inflammatory biomarkers. "PET is a more sensitive method of measuring cardiac inflammation, and our results show that these changes may not always translate into functional changes seen on MRI," Thavendiranathan noted.


The only cardiac risk factor that was more common in participants with FDG uptake was hypertension. Although cardiac symptoms were nearly twice as common in participants with focal FDG uptake, this difference was not statistically significant.


"Given the growing number of survivors with similar symptoms, these interesting findings warrant further investigation," the authors say.

Noting that FDG uptake corelated with elevations in systemic inflammatory biomarkers, the researchers suggest that "a more intense systemic inflammatory process may be contributing to cardiac inflammation and the consequential alteration to regional and global myocardial function in PET-positive participants."

On repeat imaging 2 months later, all eight patients who showed FDG uptake showed improvement or resolution of inflammation without any treatment, although two patients still had some signs of inflammation. Blood biomarkers also improved on follow-up.

"This is encouraging information, but we need longer-term data to see if there are any long-term repercussions of this inflammation," Hanneman said.

"Overall, the study findings suggest an imaging phenotype that is expected to have good prognosis. However, longer-term follow-up studies are required to understand the need for ongoing cardiac surveillance, relationship to cardiac symptoms, guidance for safe return to exercise and sports participation, and long-term cardiovascular disease risk," the researchers state.

This study was funded by grants from the Joint Department of Medical Imaging Academic Incentive Fund, Peter Munk Cardiac Center Innovation Committee, and Ted Rogers Center for Heart Research. Hanneman reports personal fees from Sanofi Genzyme, Amicus, and Medscape outside the submitted work.

JAMA Cardiol.

"

 

[missy]

"​

Long COVID 'Brain Fog' Shares Features With 'Chemo Brain'​

By Reuters Staff
January 13, 2022

(Reuters) - The "brain fog" reported by some people after COVID-19 shows striking similarities to the condition known as "chemo brain" - the mental cloudiness some people experience during and after cancer treatment, according to new research.
People who had COVID-19 "frequently experience lingering neurological symptoms, including impairment in attention, concentration, speed of information processing and memory," similar to patients with cancer therapy-related cognitive impairment that is known to involve inflammation of the brain, the researchers explained in a report posted on bioRxiv ahead of peer review.
In the brains of patients who died of COVID-19, the researchers found evidence of inflammation along with high levels of inflammatory proteins, one of which, CCL11, is linked with impairments in nervous system health and cognitive function.
Among 63 patients with so-called long COVID, the researchers found high CCL11 levels in the 48 with lingering cognitive symptoms, but not in the 15 without cognitive issues. They speculate that treatments showing promise for cancer therapy-related cognitive impairment might be helpful for COVID-19 patients with similar problems. But they would need to be tested specifically for long COVID.

SOURCE: https://bit.ly/3zQVN8i bioRxiv

"

 

[dk168]

Hana Horka: Czech singer dies after catching Covid intentionally

Hana Horka's son tells the BBC his mother was unvaccinated but wanted to acquire immunity.

www.bbc.co.uk

DK

 

[missy]

Waiting for the endemic​

An increasing number of officials have uttered the word “endemic” more frequently in recent weeks, while internet searches for the term have jumped. It’s not just governments hoping that 2022 is the year Covid-19 can finally move to the back burner of public discourse. A weary public is also desperate to escape, and there’s optimism in the air that life may soon return to normal. Because omicron is proving less malevolent than previous variants, even as it spreads faster, there’s been growing talk that the worst pandemic of the past century may soon be known in another way—as endemic. Endemic would mean the disease is still circulating but at a lower, more predictable rate—and with fewer people landing in hospitals. It’s inevitable that governments will eventually need to regard Covid as one of many public health challenges that can be managed. But health experts are preaching caution, saying there’s too much uncertainty about how the virus will evolve, how much immunity society has built up, and the potential damage if people stop being careful. Plus, endemic diseases can still cause a lot of suffering. Tuberculosis, which takes second place after Covid among the world's leading infectious killers, caused about 1.5 million deaths in 2020. People drink at a pub in Sydney. Photographer: Brendon Thorne/Bloomberg At the least, there are reasons to hope that the pandemic’s grip is loosening. The world has more tools than before, from rapid tests to the ability to update and mass-produce vaccines, plus rising levels of immunity through inoculation and earlier bouts of Covid. While antibodies may dwindle, or even fail to stop infections from new variants, the other major weapon of the immune system—T cells—appears to be robust enough to prevent serious disease for most people. It’s important to remember that despite the global vaccine push—now approaching 10 billion doses administered—there are massive gaps. That includes across much of Africa due to supply constraints, but also in the Western world, where millions choose to remain unvaccinated. It’s possible that people infected with omicron aren’t building up much immunity in the face of what’s to come. The harder-hitting delta could still surge back or combine with omicron to create a new hybrid. “We still have a virus that’s evolving quite quickly,” says Catherine Smallwood, senior emergency officer at WHO Europe. “It may become endemic in due course, but pinning that down to 2022 is a little bit difficult at this stage.” Even without an official declaration downgrading the health emergency, more governments may soon start behaving as if that were the case, by relaxing societal restrictions or easing curbs on travel. While China’s Covid-zero policy is an outlier, most countries are keen to step back from intrusive measures, with many citing recent low fatalities relative to previous waves. As governments pull back, the onus will increasingly fall on individuals, through self-testing, mask-wearing and calls to voluntarily limit social interactions.—Naomi Kresge and Tim Loh

 

[missy]

The first real-world data on vaccine booster shots and the omicron variant in the United States shows that the additional doses provide robust protection against severe disease from the new pathogen. Three reports released Friday by the Centers for Disease Control and Prevention support what health authorities have said repeatedly in the weeks since omicron became dominant: that boosters are highly effective at keeping people infected with omicron alive and out of the hospital.

But the data is arriving late in the omicron surge, at a time when hospitalizations are higher than they've ever been. Booster uptake has also slowed, with just 39 percent of vaccinated people having gotten the additional shot. Experts said they hope public health officials will use the findings to encourage more Americans to get boosted. The shots “are holding up the wall against severe disease," said Eric Topol, a molecular medicine professor at Scripps Research, “and that’s phenomenal.”

Anti-vaccine activists from around the country are set to gather at the Lincoln Memorial this weekend to rally against mandates. This once-fringe movement that stirs baseless doubts about vaccine safety has never been stronger, my colleagues Peter Jamison and Ellie Silverman report. Public health experts worry that more people may refuse vaccines for themselves or their children if it continues to gain steam.

Huge numbers of American workers missed work in late December and early January because of omicron infections. New data from the Census Bureau shows that nearly 9 million people called out sick because they had covid-19 or were caring for someone who did. It's the most since the bureau started tracking coronavirus-related absences, well over last winter's peak, and marks another setback at a time of labor shortages.

Testing access is slowly expanding in the United States now that some of the Biden administration's initiatives are getting off the ground. But this country is still woefully behind others where free rapid testing has been part of daily life for months. Here’s a look at how Britain, India and Singapore do it.

In at least three countries, governments are fining or threatening financial penalties against people who refuse to get vaccinated. Early data shows that these heavy-handed policies may cause an immediate uptick in vaccinations. But some scientists and rights groups warn that it could fuel grievances and distrust in the long run.

Congress gave local governments billions of dollars in pandemic relief last spring but put few restrictions on how they could spend the money. The result has been a mix of public health initiatives and aid to local businesses, alongside some pet projects with no clear connection to the pandemic or the economic downturn it triggered. Northampton County, Pa., and Kansas City, Mo., used some of their money to set up drive-through testing and contact tracing operations. In Florida, meanwhile, Palm Beach Gardens officials steered more than $2 million into a new golf course. Alabama set aside $400 million for rebuilding a prison.

Other important news​

Vaccines don't hurt fertility. But getting covid-19 can in men, research shows.

 

[missy]

COVID at 2 Years: Preparing for a Different 'Normal'​

"
Two years into the COVID-19 pandemic, the United States is still breaking records for hospital overcrowding and new cases.

The US is logging nearly 800,000 cases a day, hospitals are starting to fray, and deaths in the US have topped 850,000. Schools oscillate from remote to in-person learning, polarizing communities.

The vaccines are lifesaving for many, yet frustration mounts as the number of unvaccinated people in this country stays relatively stagnant (63% in the US are fully vaccinated) and other parts of the world have seen hardly a single dose. Africa has the slowest vaccination rate among continents, with only 14% of the population receiving one shot, according to The New York Times tracker.



Yet there is good reason for optimism among leading US experts because of how far science and medicine have come since the World Health Organization first acknowledged person-to-person transmission of the virus in January 2020.

Effective vaccines and treatments that can keep people out of the hospital were developed at an astounding pace, and advances in tracking and testing — in both access and effectiveness — are starting to pay off.

Some experts see the possibility that the raging Omicron surge will slow, possibly by late spring, providing some relief and possibly shifting the pandemic to a slower-burning endemic.

But other experts caution to keep our guard up, saying it's time to settle into a "new normal" and upend the strategy for fighting COVID-19.

Time to Change COVID Thinking​

Three former members of the Biden-Harris Transition COVID-19 Advisory Board wrote recently in the Journal of the American Medical Association that COVID-19 has now become one of the many viral respiratory diseases providers and patients will manage each year.


The group of experts from the University of Pennsylvania, University of Minnesota, and New York University write that "many of the measures to reduce transmission of SARS-CoV-2 (eg, ventilation) will also reduce transmission of other respiratory viruses. Thus, policy makers should retire previous public health categorizations, including deaths from pneumonia and influenza or pneumonia, influenza, and COVID-19, and focus on a new category: the aggregate risk of all respiratory virus infections."

Other experts, including Amesh Adalja, MD, senior scholar at the Johns Hopkins Center for Health Security in Baltimore, Maryland, have said that it's been clear since the early days of SARS-CoV-2 that we must learn to live with the virus because it "will be ever present for the remaining history of our species."

But that doesn't mean the virus will always have the upper hand. Although the US has been reaching record numbers of hospitalizations in January, these hospitalizations differ from those of last year — marked by fewer extreme life-saving measures, fewer deaths, and shorter hospital stays — due in part to medical and therapeutic advances and in part to the nature of the Omicron variant itself.


One sign of progress, Adalja said, will be the widespread decoupling of cases from hospitalizations, something that has already happened in countries such as the United Kingdom.


"That's a reflection of how well they have vaccinated their high-risk population and how poorly we have vaccinated our high-risk population," he said.

Omicron Will Bump Up Natural Immunity​

Adalja said though the numbers of unvaccinated in the US appear stuck, Omicron's sweep will make the difference, leaving behind more natural immunity in the population.


Currently, hospitals are struggling with staffing concerns as a "direct result" of too many unvaccinated people, he said.

Andrew Badley, MD, an infectious diseases specialist at Mayo Clinic in Rochester, Minnesota, and director of the clinic's COVID-19 Task Force, said the good news with Omicron is that nearly all people it infects will recover. Over time when the body sees foreign antigens repeatedly, the quantity and quality of the antibodies the immune system produces increase and the body becomes more efficient at fighting disease.


Therefore, "a large amount of the population will have recovered and have a degree of immunity," Badley said.

His optimism is tempered by his belief that "it's going to get worse before it gets better."

But Badley still predicts a turnaround. "We'll see a downturn in COVID in late spring or early summer where well into the second quarter of 2022 "we'll see a reemergence of control."

Right now, with Omicron, one infected person is infecting three to five others, he said. The hope is that it will eventually reach one to one endemic levels.

As for the threat of new variants, Badley said, "It's not predictable whether they will be stronger or weaker."

Masks May Be Around for Years​

Many experts predict that masks will continue to be part of the national wardrobe for the foreseeable future.

"We will continue to see new cases for years and years to come. Some will respond to that with masks in public places for a very long time. I personally will do so."

Two Mindsets: Inside/Outside the Hospital​

Emily Landon, MD, an infectious disease physician and the executive medical director of Infection Prevention and Control at University of Chicago Medicine, told Medscape Medical News she views the pandemic from two different vantage points.

As a healthcare provider, she sees her hospital, like others worldwide, overwhelmed. Supplies of a major weapon to help prevent hospitalization, the monoclonal antibody sotrovimab, are running out. Landon said she has been calling other hospitals to see if they have supplies and, if so, whether Omicron patients can transfer there.


Bottom line: the things they relied on a month ago to keep people out of the hospital are no longer there, she said.


Meanwhile, "We have more COVID patients than we have ever had," Landon said.

Last year, UChicago hit a high of 170 people hospitalized with COVID. This year, so far, the peak was 270.
People are exhausted from having to do a risk-benefit analysis for every single activity they, their friends, their kids want to participate in.

Landon said she is frustrated when she leaves that overburdened world inside the hospital for the outside world with people wearing no masks or ineffective face coverings and gathering unsafely. Although some of that behavior reflects an intention to flout the advice of medical experts, some is due in part, she said, to the lack of a clear national health strategy and garbled communication from those in charge of public safety.


Americans are deciding for themselves on an a la carte basis whether to wear a mask or get tested or travel, and school districts decide individually when it's time to go virtual.


"People are exhausted from having to do a risk–benefit analysis for every single activity they, their friends, their kids want to participate in," she said.

US Behind in Several Areas​

Despite our self-image as the global leader in science and medicine, the United States stumbled badly in its response to the pandemic, with grave consequences both at home and abroad, experts say.


In a recent commentary in JAMA, Lawrence Gostin, JD, from Georgetown University in Washington, DC, and Jennifer Nuzzo, DrPH, at Johns Hopkins Bloomberg School of Public Health, point to several critical shortfalls in the nation's efforts to control the disease.


One such shortfall is public trust.

WebMD reported last summer that a poll of its readers found that 44% said their trust in the Centers for Disease Control and Prevention (CDC) had waned during the pandemic, and 33% said their trust in the Food and Drug Administration (FDA) had eroded as well.
It's one of the greatest moral failures of my lifetime.Lawrence Gostin, O'Neill Institute for National and Global Health Law, Georgetown University

Healthcare providers who responded to the WebMD poll lost trust as well. About half of the doctors and nurses who responded said they disagreed with the FDA's decision-making during the pandemic. Nearly 60% of doctors and 65% of nurses said they disagreed with the CDC's overall pandemic guidance.

Lack of trust contributes to aversion to vaccines and mitigation efforts, the authors write.

"
This will become really relevant when we have ample supply of Pfizer's antiviral medication," Gostin, who directs the O'Neill Institute for National and Global Health Law at Georgetown, told Medscape Medical News. "The next phase of the pandemic is not to link testing to contact tracing, because we're way past that, but to link testing to treatment."

Lack of regional manufacturing of products is also thwarting global progress.

"It is extraordinarily important that our pharmaceutical industry transfer technology in a pandemic," Gostin said. "The most glaring failure to do that is the mRNA vaccines. We've got this enormously effective vaccine and the two manufacturers — Pfizer and Moderna — are refusing to share the technology with producers in other countries. That keeps coming back to haunt us."

Another problem: When the vaccines are shared with other countries they are being delivered close to their expiry date or arriving at a shipyards without warning so even some of the doses that get delivered are going to waste, Gostin said.

"It's one of the greatest moral failures of my lifetime," he said.

Also a failure is the "jaw-dropping" state of testing 2 years into the pandemic, he said, as people continue to pay high prices for tests or endure long lines.

The US government last week updated its calculations and ordered 1 billion tests for the general public. The website to order the free tests is now live.

It's a step in the right direction. Gostin and Nuzzo write that there is every reason to expect future epidemics that are as serious or more serious than COVID.

"Failure to address clearly observed weaknesses in the COVID-19 response will have preventable adverse health, social, and economic consequences when the next novel outbreak occurs," they write.

Adalja, Badley, Landon, and Gostin have disclosed no relevant financial relationships.

Marcia Frellick is a freelance journalist based in Chicago. She has previously written for the Chicago Tribune, Science News, and Nurse.com, and was an editor at the Chicago Sun-Times, the Cincinnati Enquirer, and the St. Cloud (Minnesota) Times. Follow her on Twitter at @mfrellick

"

 

[missy]

"​

​

US Faces Wave of Omicron Deaths in Coming Weeks, Forecasts Say​

COVID-19 deaths from the Omicron variant are climbing and will likely increase quickly in the upcoming weeks, according to new forecasts.

Based on national forecasts, 50,000 to 300,000 more Americans could die by the time the current wave subsides in March.

"A lot of people are still going to die because of how transmissible Omicron has been," Jason Salemi, PhD, an epidemiologist at the University of South Florida, told The Associated Press.


"It, unfortunately, is going to get worse before it gets better," he said.


The 7-day average for daily new COVID-19 deaths has been increasing since mid-November, reaching nearly 1,900 on Tuesday, according to the latest datafrom Johns Hopkins University. What's more, COVID-19 deaths began rising among nursing home residents about 2 weeks ago, the AP reported.

Although the Omicron variant appears to cause milder disease, the high number of infections has led to more hospitalizations. If the higher end of the national forecast happens, the total number of U.S. COVID-19 deaths could surpass 1 million by early spring.

"Overall, you're going to see more sick people, even if you as an individual have a lower chance of being sick," Katriona Shea, PhD, an epidemiologist at Pennsylvania State University, told the AP.


Shea co-leads a team that assembles pandemic models through the COVID-19 Scenario Modeling Hub and shares the projections with the White House. The forecast includes models from 11 universities across the country.

The upcoming wave of Omicron deaths will peak in early February, she said, and weekly deaths could exceed the peak from the Delta variant and the previous peak seen in January 2021.

The combined models project 1.5 million COVID-19 hospitalizations and 191,000 COVID-19 deaths from mid-December through mid-March. But due to uncertainty in the models, the deaths from the Omicron wave could range from 58,000 to 305,000.

SOURCES:


The Associated Press: "U.S. faces wave of omicron deaths in coming weeks, models say."


Johns Hopkins University: "COVID-19 cases and deaths."


COVID-19 Scenario Modeling Hub: "Model Projection: Round 11."

"

 

[missy]

@MamaBee I don't want to wake you by texting this but for you.
We were talking about this...but not sure you saw this article.

Moderna CEO Says Data for Omicron-Specific Shot Likely Available in March​

"
(Reuters) - Moderna Inc's vaccine candidate against the Omicron coronavirus variant will enter clinical development in the next few weeks and the company expects to be able to share data with regulators around March, CEO Stephane Bancel said on Monday.
"The vaccine is being finished ... it should be in the clinic in coming weeks. We are hoping in the March timeframe to be able to have data to share with regulators to figure out next steps," Bancel said at the World Economic Forum's virtual Davos Agenda conference.
Moderna is also developing a single vaccine that combines a booster dose against COVID-19 with its experimental flu shot.
Bancel said the best case scenario was the combined COVID/flu vaccine would be available by the fall of 2023, at least in some countries.

"Our goal is to be able to have a single annual booster so that we don't have compliance issues where people don't want to get two to three shots a winter."

Many countries are already offering a third dose of a COVID-19 vaccine to their citizens, especially to older individuals and those who are immunocompromised, while Israel has started offering its citizens a fourth dose.
Earlier in January, Moderna's CEO said people may need a fourth shot in the fall of 2022 as the efficacy of boosters against COVID-19 was likely to decline over the next few months.
However, booster programs have met with skepticism from some disease experts over whether, and how widely, additional doses should become available, including the European Union's drug regulator, which has expressed doubts about the need for a fourth booster dose.

Speaking at the same event, top U.S. infectious disease expert Anthony Fauci said there was no evidence that repeat booster doses would overwhelm the immune system.
"Giving boosters at different times, there is really no evidence that's going to hinder (immune response)."
Fauci said the goal should be to have a booster that induces a response against multiple potential variants.


"

 

[MamaBee]

@MamaBee I don't want to wake you by texting this but for you.
We were talking about this...but not sure you saw this article.

Moderna CEO Says Data for Omicron-Specific Shot Likely Available in March​

"
(Reuters) - Moderna Inc's vaccine candidate against the Omicron coronavirus variant will enter clinical development in the next few weeks and the company expects to be able to share data with regulators around March, CEO Stephane Bancel said on Monday.
"The vaccine is being finished ... it should be in the clinic in coming weeks. We are hoping in the March timeframe to be able to have data to share with regulators to figure out next steps," Bancel said at the World Economic Forum's virtual Davos Agenda conference.
Moderna is also developing a single vaccine that combines a booster dose against COVID-19 with its experimental flu shot.
Bancel said the best case scenario was the combined COVID/flu vaccine would be available by the fall of 2023, at least in some countries.

"Our goal is to be able to have a single annual booster so that we don't have compliance issues where people don't want to get two to three shots a winter."

Many countries are already offering a third dose of a COVID-19 vaccine to their citizens, especially to older individuals and those who are immunocompromised, while Israel has started offering its citizens a fourth dose.
Earlier in January, Moderna's CEO said people may need a fourth shot in the fall of 2022 as the efficacy of boosters against COVID-19 was likely to decline over the next few months.
However, booster programs have met with skepticism from some disease experts over whether, and how widely, additional doses should become available, including the European Union's drug regulator, which has expressed doubts about the need for a fourth booster dose.

Speaking at the same event, top U.S. infectious disease expert Anthony Fauci said there was no evidence that repeat booster doses would overwhelm the immune system.
"Giving boosters at different times, there is really no evidence that's going to hinder (immune response)."
Fauci said the goal should be to have a booster that induces a response against multiple potential variants.


"

Missy Thank you..I read this…I don’t know what to do because now you can get the vaccine at five months. It could possibly be the end of March when the Omicron vaccine could be ready. I could get my booster February 7. It would be scary to be vulnerable while I waited. I also read Omicron may be retreating at that point so waiting for that specific vaccine could put me at risk for Delta..I know you’re also deciding what to do. Maybe a physician here will comment.
I should also note that this would be my fourth vaccine. I got an extra dose of Moderna 100mg when they were considering doing the 50mg dosage. I wanted the stronger dose so I really consider it to be a booster. It technically isn’t on my card. I could now qualify for the booster..

 

[missy]

Missy Thank you..I read this…I don’t know what to do because now you can get the vaccine at five months. It could possibly be the end of March when the vaccine could be ready. I could get my booster February 7. It would be scary to be vulnerable while I waited. I also read Omicron may be retreating at that point so waiting for that specific vaccine could put me at risk for other variants. The regular vaccine may be effective for them like it is for Delta. I know you’re also deciding what to do. Maybe a physician here will comment.

Honestly and no offense to anybody here, no one can say for sure. It isn't black and white. There is not yet definitive proof either way. It's an educated guess. Best we can do. Personally, at this time, I am waiting. But I reserve the right to change my mind with new evidence.

 

[missy]

" A jarring shift in Australia​

If we Aussies have learned anything from the past two years of fastidious compliance with the government’s strict Covid-elimination approach, it’s the meaning of sacrifice. At times, it felt cruel and unjust. Shuttered borders tore families and friends apart, and stay-at-home orders robbed us of more than a few special life-changing moments. Many simply cannot be recreated once missed. Big plans were put on hold indefinitely, and lengthy periods of isolation proved corrosive for mental health. No place in the country experienced this more acutely than Melbourne, which became the undisputed world champion of lockdowns after battling through six of them. Still, all those hardships—compounded by a vaccine debacle that limited widespread access to a variety of shots—kept us safe. That’s certainly more than what can be said for many other places in the world. The unimaginable scale of death seen in India, Indonesia and many parts of Europe and the U.S., for example, come to mind. Now, something’s changed. It doesn’t feel so secure here anymore. There’s been a jarring shift in public-health messaging recently, leaving residents in something of a tailspin as the government swiftly dismantles Covid-Zero policies that had preoccupied decision-makers for almost two years. Indeed, not two months ago, they considered Covid dangerous enough to warrant complete isolation from the rest of the world. Now, it feels like we’re being asked to leave that all in the past and move on with our lives. A customer at an outdoor table of a cafe Hardware Lane in Melbourne. Photographer: Carla Gottgens/Bloomberg Critics have referred to this new phase of the game as a “let it rip” strategy—a descriptor that Prime Minister Scott Morrison bristled against in a number of recent press conferences. But for many Australians, it feels pretty accurate. Meanwhile, we’re all watching nervously as case numbers proliferate to levels we’ve only ever read about from afar. The frightening numbers across the more populous eastern side of the country have now spooked Western Australia back into isolation. The state, which earned itself the title of being one of the world’s final Covid Zero strongholds, on Thursday delayed a planned reopening to the outside world in February over concerns about omicron, no doubt jerking around residents hoping to see an end to being shut off from the global community, as well as fellow Australians. The change in tack reveals a certain brand of imperviousness to the plight of Australians for the past two years, and also makes the prime minister seem blithely unaffected by the palpable anxiety currently surging through the community. The vast majority of us are still waiting for our booster shots, and many children have yet to receive their first and second doses. The nation is buckling under calamitous absenteeism, resulting in crumbling supply chains and food shortages. Hospitals are straining under the weight of omicron admissions, although the government reassures us that the variant is less severe than other strains. Essential rapid antigen tests are near impossible to find. And yet isolation mandates—rules designed to keep people safe—have been shortened in order to coax staff back to work. Everyone wants life to regain some semblance of normal. But that’s not quite the point. This week, Australia had its deadliest day of the pandemic—setting a grim undertone as we head into our third year of the pandemic. That's a very dispiriting sentence to write. No wonder we’re all experiencing whiplash.—Sybilla Gross

"

 

[TooPatient]

Worried badly right now. My grandfather (87 years old) had 102 degree fever yesterday. 101 degrees today. Too exhausted to even call to cancel our plans tomorrow. Did an at home test last night. Negative. I know there is some anecdotal evidence that suggests those are not very good at omicron. Hoping they take him for a better test.

He dislikes doctors on a good day. My mom and aunt are not great at managing medical stuff. Maintaining, great. New issues, awful. She and my aunt work in schools with lots of cases (including immediate coworkers who were positive last week). Plus one cousin in school. All of them out at stores and wherever too often.

ETA: Vaccinated twice (moderna, I think), but no booster. He and grandma couldn't find appointments (very minimally computer savvy) and the daughters are opposed to boosters (both girls vaccinated but no booster). Now they have my grandparents convinced the boosters are killing people

 

[ItsMainelyYou]

First, another thank you to @missy.
Your continued compilation work for our edification means the world to me.
Thank you!
I also want to extend any good vibes to everyone else struggling with the ramifications and disruptions of this disease. It's hard to weather this uncertainty and isolation. It can overwhelm. You're doing the best you can, remember to take a minute to acknowledge it.
Now, back to our scheduled programming.

 

[missy]

TY @ItsMainelyYou I appreciate that!

"
The omicron variant—a plot twist if there ever were one—showed us all that the path of the pandemic is hard to predict. We’re all starting to settle into the idea that this virus may be around for the long haul, and figuring out how to live our lives accordingly. But what does that look like? With that in mind, here are questions from reporters and editors in the Bloomberg newsroom:

We’re all wondering when the right time will be to resume certain pre-pandemic activities. For those of us desperate for some long-term planning, can we assume things will be better in the summer?

For guidance here, we turn to Katrine Wallace, an epidemiologist at University of Illinois.

“We will likely have a retreat in incidence rates soon,” Wallace says. “Hopefully the lower Covid-19 incidence rates last into the summer, but it is very difficult to predict.”

A surge of infections has previously been followed by a drop as more people became immune to whatever variant caused the outbreak in the first place. The trouble is, with so many unvaccinated people—not just in the U.S. but around the world—there is always the chance that a new variant will spread and send us back to into surge territory.

“If a variant emerges that outcompetes omicron, we could most definitely have another surge with the new variant,” Wallace says. “So global vaccine equity will be key to reducing everyone’s risk.”

Studies have suggested that omicron infections provide some immunity not just to that particular variant but also to previous versions of the virus. One reporter wondered whether people who have had a mild case of omicron are more protected than those who haven’t and can therefore take more risks like dining indoors.

“That's hard to say,” says University of Alabama epidemiologist Bertha Hidalgo. “I'm not certain that we can say that mild illness confers better immunity compared to individuals who didn't have a mild case.”

With previous variants, she noted, some 30% to 40% of people didn’t wind up with an immune protection from natural infection. Whether you’re unvaccinated, vaccinated or vaxxed and boosted can also affect how protected you are post-infection.

“It's unclear whether omicron will change that,” she says. “I would recommend that if people are infected, post-infection they should absolutely consider proceeding with caution until case rates decrease and we know more about what infection with omicron will mean for lasting immunity.”

With children under 5 still not approved for vaccination in the U.S., there has also been much anticipation of when younger kids will finally get the green light for vaccines. One reporter wondered when that might be.

It turns out that it might be a while.

The Pfizer vaccine is the U.S. shot currently authorized for the youngest kids—those 5 and up. Studies of that vaccine in kids even younger are underway, but there have been a few snags, says Monica Gandhi, an infectious disease expert at University of California, San Francisco.

In a group of trial participants ages 6 months to 4 years, says Gandhi, two shots given three weeks apart didn’t show an adequate immune response for kids ages 2, 3 and 4. However, the dose did appear effective in the younger children studied. Researchers are currently evaluating giving a third vaccine dose to kids two months after the second shot.

Gandhi also mentioned that Covaxin, an Indian vaccine with U.S. emergency authorization still pending, could potentially be authorized for children as young as 2. It is unclear whether or when that might happen, however.

Covaxin, an Indian vaccine with U.S. emergency authorization pending.

Photographer: T. Narayan/Bloomberg

A newsroom editor recently got sick and tested positive for Covid. Ten days after his symptoms began, he was still experiencing some mild complications and testing positive on a rapid antigen test. “I've heard of other people in the same situation,” he asks. “Is there something about this variant that lingers longer?”

“The best evidence that we have to answer this comes from the Japanese National Institute of Infectious Disease which, though still preliminary, suggests that omicron viral loads peak in most individuals three to six days after testing positive or after symptoms start,” says Caesar Djavaherian, a physician and co-founder of the clinic chain Carbon Health. “This peak is two to three days later than we saw with delta and alpha variants.”

If that data hold up, it might explain why people are testing positive for longer periods of time than with previous variants.

“And although antigen tests don’t necessarily mean that you are infectious to others, they remain our best surrogate,” he says. That means if you’re testing positive and still symptomatic, it’s best to at least steer clear of those who are at higher risk for severe illness.

—Kristen V. Brown

"

 

[missy]

From the NYT

Omicron is finally in retreat.​

More and more states have passed a peak in new coronavirus cases in recent days, as glimmers of progress have spread from a handful of eastern cities to much of the country. By the end of last week, the country was averaging about 720,000 new cases a day, down from about 807,000 last week. New coronavirus hospital admissions have also leveled off.​

The U.S. is not in the clear yet. It continues to identify far more infections a day than during any prior surge, creating havoc for hospitals and businesses in small towns. Deaths continue to mount, with more than 2,100 announced most days. Still, the decline in new cases offered a sense of relief to virus-weary Americans. Here’s what scientists know about Omicron.​

Did you get a breakthrough infection? Vaccinated people may now have “hybrid” immunity, but experts still encourage precautions.​

 

[missy]

COVID May Affect Spinal Fluid, Causing 'Brain Fog,' Study Says​

"A small study may help explain the cause of "brain fog," the lingering mental confusion reported in some people who've had COVID.

Researchers at the University of California, San Francisco, found abnormalities in the cerebrospinal fluid -- the clear, colorless liquid that's found in the brain and spinal cord -- of 10 of 13 people who were infected with COVID and had thinking problems. Four fluid samples from people who had COVID and didn't have thinking problems showed no abnormalities.

The study team looked at 32 adults who had recovered from COVID but didn't require hospitalization, with 22 of them having cognitive symptoms, according to the study published in the Annals of Clinical and Translational Neurology. All participants underwent a series of in-person cognitive tests and were scored using criteria for HIV-associated neurocognitive disorder, or HAND.


Participants with brain fog had problems such as "remembering recent events, coming up with names or words, staying focused, and issues with holding onto and manipulating information, as well as slowed processing speed," Joanna Hellmuth, MD, the study author and a member of the UCSF Memory and Aging Center, said in a university news release.


Seventeen participants agreed to have their cerebrospinal fluid analyzed, including 13 with brain fog symptoms. The fluid was taken an average of 10 months after COVID symptoms appeared.

Of the 13 participants with brain fog, 10 of them had abnormalities in their cerebrospinal fluid like those found in people with other infectious diseases, according to the study.

The abnormalities included elevated levels of protein that suggested inflammation and "the presence of unexpected antibodies found in an activated immune system," the news release said. These could be "turncoat" antibodies that attack the body itself, the researchers said.


"It's possible that the immune system, stimulated by the virus, may be functioning in an unintended pathological way," Hellmuth said.

Cognitive problems have also been seen in people infected with other viruses, such as HIV, SARS, MERS, hepatitis C, and Epstein-Barr, the researchers said.

Participants with thinking problems had an average of 2.5 risk factors for impaired thinking, including diabetes and high blood pressure, vascular dementia, and a history of attention deficit hyperactivity disorder (ADHD). Participants who didn't have thinking problems had an average of less than one risk factor, the study said.

Brain fog is often reported in COVID patients, according to the study. Recently, 67% of 156 post-COVID patients in New York reported having thinking problems.


Limitations in the study included the small sample size, with the researchers calling for more studies on the topic.

Sources​

Annals of Clinical and Translational Neurology: "Risk factors and abnormal cerebrospinal fluid associate with cognitive symptoms after mild COVID-19."


University of California, San Francisco: "Cerebrospinal Fluid Offers Clues to Post-COVID 'Brain Fog.'"

"

 

[missy]

COVID Fatigue Pervasive, but Men and Women React Differently​

"
Most people experience COVID fatigue a few times a week, but men and women and older and younger people have reacted differently to it, a recent WebMD poll suggests.

The poll, taken from December 23-January 4, asked readers how often they had experienced COVID-19 pandemic fatigue, defined as "being angry, exhausted, frustrated or just plain fed up with disruptions to your life or those of your family and friends," and 489 readers (120 men, 369 women) responded.

About three fourths of respondents said they are experiencing those feelings.

Women More Often Feel the Fatigue​

Just more than a third (34%) of men answered they have experienced fatigue, frustration, or feeling fed up daily compared with 40% of the women; 18% of male respondents said those feelings come a few times a week compared with 25% of women.


Some (34% of men and 23% of women) said the feelings never come and they have adjusted well to the restrictions and changes.

Poll results also highlight different experiences by age and indicate younger people have been more preoccupied with the effects.


Among those younger than 45, almost half (46%) of respondents said they experience COVID fatigue daily compared with 31% of their 45-and-older colleagues; 27% in the younger group said they experience the fatigue a few times a week as opposed to 18% in the older group. Four times as many in the older group (21% vs 5%) said they rarely experience the symptoms.

The poll asked about the long-term impacts of emotional health and found considerable concern.

Eating, Drinking Patterns Differ by Sex, Age​

More women than men responded that they have been eating more since the pandemic. While nearly a third of women said they had been eating more (32%), only 19% of men said they had. Most men (61%) reported eating the same amount compared with 42% of women.


By age, the younger group was more likely to eat less (30%) compared with 20% of their 45-and-older counterparts. The older group was much more likely to report eating the same amount (53%) compared with 39% in the younger group.


For those who drink alcohol, 16%-17% of both men and women said they have been drinking more in the pandemic. Younger respondents were more likely to report they are drinking more (20%) than those in the 45-and-older group (14%). From 11%-15% across sex and age groups reported they are drinking less these days. Nearly half of the respondents (46%) reported they don't drink alcohol.

Combating the Effects​

The poll asked about activities employed to combat pandemic fatigue and whereas men and women were just as likely to report engaging in physical activity, including walks, hikes, and exercise, women were more likely to participate in each of the other topic areas.

For example, women were more likely than men to:

• Speak with a mental health professional (22% vs 6%)
• Stay connected with family, friends, and co-workers (47% vs 27%)
• Start a new hobby (28% vs 16%)
• Use relaxation techniques (32% vs 16%)

More men than women (29% vs 24%) say they had not used any method to combat the fatigue.

Younger people were more likely than their older counterparts to report using physical activity to combat COVID stress (47% vs 33%). Younger people were almost twice as likely to start a new hobby or speak with a mental health professional (31% vs 17% and 25% vs 12%, respectively).

Women and Younger Group Report Less Patience​

The poll asked respondents to weigh in on how they would characterize any behavior changes in their interaction with others.

More women and people in the under-45 group say that they had less patience and a shorter temper than prepandemic (26% vs 18% and 31% vs 17%, respectively).
Women were also more likely to say they are more reserved and speak less during the pandemic than their male counterparts.

Whereas nearly half (49%) of men said their behavior had not changed, fewer women (34%) said the same.

Few (2%-6%), regardless of age or sex, said they have become more social or interact more with others in this period.

The poll highlighted that COVID-19 continues to weave through conversations with friends and family: 61% of all respondents said they talk about the subject as much or more than they did at the beginning of the pandemic.

Women were more likely than men to say they talk about it more these days (32% vs 18%).

Marcia Frellick is a freelance journalist based in Chicago. She has previously written for the Chicago Tribune, Science News, and Nurse.com, and was an editor at the Chicago Sun-Times, the Cincinnati Enquirer, and the St. Cloud (Minnesota) Times. Follow her on Twitter at @mfrellick

"

 

[missy]

People Who've Had COVID-19 May Still Benefit From Vaccination After Several Months​

By Megan Brooks

January 24, 2022

"
NEW YORK (Reuters Health) - Prior to the emergence of Omicron, both people previously infected with the novel coronavirus and those vaccinated against it were at much lower risk of catching COVID-19 than peers without prior COVID-19 who remained unvaccinated, a study from the Cleveland Clinic in Ohio shows.
With the emergence of Omicron, however, early findings suggest a substantial increase in risk of infection for all individuals, including those previously infected and those vaccinated, Dr. Nabin Shrestha and colleagues report in Clinical Infectious Diseases.
The researchers assessed the need for COVID-19 vaccination among people with prior COVID-19 infection. They studied more than 52,000 adults working at the Cleveland Clinic in Ohio on December 16, 2020, the day COVID-19 vaccination started.
Among these, 4,718 (9%) had prior COVID-19 and 36,922 (71%) were fully vaccinated by the end of the study (December 27, 2021).

A total of 7,851 (15%) employees acquired COVID-19 during the study, of whom 4,675 (60%) were symptomatic infections and 133 (1.7%) required hospitalization for COVID-19.

Fewer employees previously infected were vaccinated by the end of the study compared with those not previously infected (63% vs. 71%; P<0.001).
According to the researchers, the cumulative incidence of COVID-19 was "substantially higher throughout for those previously uninfected who remained unvaccinated than for all other groups, lower for the vaccinated than unvaccinated, and lower for those previously infected than those not."
After the Omicron variant emerged, cases of COVID-19 increased "dramatically" in all groups.

In multivariable analysis, both prior COVID-19 and vaccination were independently associated with significantly lower risk of COVID-19, they report.
Previously infected employees did not have a lower risk of COVID-19 overall but vaccination was associated with a significantly lower risk of symptomatic COVID-19 both before Omicron (hazard ratio, 0.60; 95% CI, 0.40 to 0.90) and after Omicron (HR, 0.36; 95% CI, 0.23 to 0.57).
The study demonstrates that both previous infection and vaccination provide "substantial protection" against COVID-19, Dr. Shrestha told Reuters Health by email.
"Individuals previously infected with COVID-19 are substantially protected against COVID-19 for several months. Beyond that time, vaccination protects against symptomatic COVID-19, possibly by boosting of waning natural immunity," he added.

"The arrival of the Omicron variant greatly changed the risk of COVID-19 for all individuals regardless of whether they were previously infected or not, and regardless of whether they were previously vaccinated or not. Protection against COVID-19 from prior infection or vaccination may be of shorter duration than before the arrival of the Omicron variant," Dr. Shrestha added.

"It's important to note that the study was conducted in an active, healthcare employee population. It included no children, very few elderly individuals and likely few immunocompromised individuals," he said.

SOURCE: https://bit.ly/32mAQ9a Clinical Infectious Diseases

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[missy]

The Advisory Committee on Immunization Practices' Interim Recommendations for Additional Primary and Booster Doses of COVID-19 Vaccines​

Sarah Mbaeyi, MD; Sara E. Oliver, MD; Jennifer P. Collins, MD; Monica Godfrey, MPH; Neela D. Goswami, MD; Stephen C. Hadler, MD; Jefferson Jones, MD; Heidi Moline, MD; Danielle Moulia, MPH; Sujan Reddy, MD; Kristine Schmit, MD; Megan Wallace, DrPH; Mary Chamberland, MD; Doug Campos-Outcalt, MD; Rebecca L. Morgan, PhD; Beth P. Bell, MD; Oliver Brooks, MD; Camille Kotton, MD; H. Keipp Talbot, MD; Grace Lee, MD; Matthew F. Daley, MD; Kathleen Dooling, MD


"

Abstract and Introduction​

Introduction​

Three COVID-19 vaccines are currently approved under a Biologics License Application (BLA) or authorized under an Emergency Use Authorization (EUA) by the Food and Drug Administration (FDA) and recommended for primary vaccination by the Advisory Committee on Immunization Practices (ACIP) in the United States: the 2-dose mRNA-based Pfizer-BioNTech/Comirnaty and Moderna COVID-19 vaccines and the single-dose adenovirus vector-based Janssen (Johnson & Johnson) COVID-19 vaccine[1,2] (Box 1). In August 2021, FDA amended the EUAs for the two mRNA COVID-19 vaccines to allow for an additional primary dose in certain immunocompromised recipients of an initial mRNA COVID-19 vaccination series.[1] During September–October 2021, FDA amended the EUAs to allow for a COVID-19 vaccine booster dose following a primary mRNA COVID-19 vaccination series in certain recipients aged ≥18 years who are at increased risk for serious complications of COVID-19 or exposure to SARS-CoV-2 (the virus that causes COVID-19), as well as in recipients aged ≥18 years of Janssen COVID-19 vaccine[1] (Table). For the purposes of these recommendations, an additional primary (hereafter additional) dose refers to a dose of vaccine administered to persons who likely did not mount a protective immune response after initial vaccination. A booster dose refers to a dose of vaccine administered to enhance or restore protection by the primary vaccination, which might have waned over time. Health care professionals play a critical role in COVID-19 vaccination efforts, including for primary, additional, and booster vaccination, particularly to protect patients who are at increased risk for severe illness and death.
After the EUA amendments, ACIP and CDC issued interim recommendations for vaccine use*,†,§.[2] Moderately to severely immunocompromised persons aged ≥12 years (Pfizer-BioNTech recipients) or ≥18 years (Moderna recipients) should receive an additional homologous dose of mRNA COVID-19 vaccine (i.e., the same vaccine product that was administered for the primary series) ≥28 days after receipt of the second dose. Regarding booster dose recommendations, recipients of a primary mRNA COVID-19 vaccination series who are 1) aged ≥65 years, 2) aged ≥18 years and reside in long-term care settings, or 3) aged 50–64 years with certain underlying medical conditions¶ should receive a COVID-19 vaccine booster dose ≥6 months after completion of the primary vaccination series. In addition, persons aged 18–49 years with certain underlying medical conditions and those aged 18–64 years who are at increased risk for occupational or institutional exposure to SARS-CoV-2 may receive a booster dose based on their individual benefits and risks. Recipients of Janssen COVID-19 vaccine aged ≥18 years should receive a COVID-19 vaccine booster dose ≥2 months after primary vaccination. Any approved or authorized COVID-19 vaccine may be used for the booster dose, regardless of vaccine received for primary vaccination (Box 2). For Pfizer-BioNTech and Janssen, the dose and volume are the same for primary and booster vaccination; for Moderna, the dose and volume of the booster dose (50 μg; 0.25 ml) are one half that used for the primary series (100 μg; 0.5 ml) (Table). As of October 28, 2021, more than 191 million persons in the United States have been fully vaccinated against COVID-19, and more than 15 million have received an additional or booster dose.**

Since June 2020, ACIP has convened 20 public meetings to review data relevant to the potential use of COVID-19 vaccines.†† To assess the certainty of evidence for benefits and harms of a booster dose, ACIP used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.§§ To further guide its deliberations around the use of an additional or booster dose, ACIP used the Evidence to Recommendations (EtR) Framework to evaluate other factors, including the importance of COVID-19 as a public health problem as well as matters of resource use, benefits and harms, patients' values and preferences, acceptability, feasibility, and equity for use of the vaccines.¶¶
ACIP recommendations for an additional dose of mRNA COVID-19 vaccine in certain immunocompromised persons were guided by data on reduced immunogenicity and effectiveness of the initial primary COVID-19 vaccination series in this population, as well as evidence of an immune response and an acceptable safety profile after an additional mRNA COVID-19 vaccine dose. During the period preceding the emergence of the highly transmissible SARS-CoV-2 B.1.617.2 (Delta) variant, vaccine effectiveness (VE) of a primary mRNA COVID-19 vaccination series against SARS-CoV-2 infection in persons aged ≥16 years was estimated to be 71% (95% confidence interval [CI] = 37%–87%) in immunocompromised persons versus 90% (95% CI = 83%–96%) in the general population and 59% (95% CI = 12%–81%) against COVID-19–associated hospitalization in immunocompromised persons aged ≥18 years versus 91% (95% CI = 86%–95%) in persons who were not immunocompromised.[3] In a series of small studies, 16% to 80% of solid organ transplant recipients and hemodialysis patients had no detectable antibody response after the second dose of an mRNA COVID-19 vaccine; among these persons, 33% to 55% developed antibodies after receiving an additional dose.[3] Local and systemic reactions reported after an additional dose of mRNA COVID-19 vaccine in certain immunocompromised persons were mostly mild to moderate and similar to those observed after previous doses; no severe adverse events were reported.[3] Data were not available to assess immunogenicity or safety of an additional dose in immunocompromised recipients of Janssen COVID-19 vaccine.

To help determine the need for a booster dose in certain populations, ACIP reviewed data on the effectiveness of COVID-19 vaccines after a primary series. In the context of waning vaccine-induced immunity and emergence of the Delta variant in the United States, declines in VE of a primary mRNA COVID-19 vaccination series against SARS-CoV-2 infection have been observed, including among groups recommended to receive early vaccine doses: VE was 75% (95% CI = 60%–85%) to 84% (95% CI = 83%–86%) among adults aged ≥65 years, 53% (95% CI = 49%–57%) among residents of long-term care facilities, and 66% (95% CI = 26%–84%) among health care personnel and other frontline workers during periods of Delta variant predominance.[4,5] VE of a primary mRNA COVID-19 vaccination series against COVID-19–associated hospitalization overall remains high (78% [95% CI = 62%–87%] to 100% [95% CI = 96%–100%]), although some studies show a slightly lower VE against hospitalization in older adults. Although data are limited, some studies suggest stable VE of Janssen vaccine over time; however, VE of the Janssen vaccine is 58% (95% CI = 12%–80%) to 83% (95% CI = 61%–93%) against SARS-CoV-2 infection and 60% (95% CI = 31%–77%) to 83% (95% CI = 61%–93%) against COVID-19–associated hospitalization among persons aged ≥18 years, which is lower than the estimates reported for mRNA vaccines in most studies.[5]
ACIP recommendations for a COVID-19 vaccine booster dose in certain persons who had completed primary vaccination were guided by data on immunogenicity, efficacy, and effectiveness of COVID-19 vaccines after booster vaccination, and a review of safety data after COVID-19 vaccine booster doses. Compared with 1 month after the last dose in the primary series, geometric mean ratios of neutralization titers were 1.8 to 3.3-fold higher 1 month after a homologous mRNA COVID-19 vaccine booster dose administered 6 months after completing the primary series, and spike binding antibody titers were 4.6 to 12-fold higher after a homologous Janssen COVID-19 booster dose administered 2–6 months after completing primary vaccination.[6,7] In a small phase I/II clinical trial, both homologous and heterologous (mix-and-match) booster dose administration, in which participants received either a Pfizer-BioNTech, Moderna, or Janssen COVID-19 vaccine primary series followed by a booster dose of the same or different vaccine, resulted in anamnestic immune responses; neutralizing antibody titers after a heterologous booster dose were similar to or higher than those observed after homologous booster vaccination.[6] Observational studies from Israel demonstrated that the short-term incremental VE of a Pfizer-BioNTech COVID-19 primary series plus booster dose (administered ≥5 months after the second dose) compared with 2 doses, ranged from 70% (95% CI = 62%–76%) in persons aged ≥40 years to 91% (95% CI = 90%–92%) in persons aged ≥60 years.[8] In placebo-controlled clinical trials, overall efficacy of the Janssen vaccine against moderate to severe COVID-19 ≥14 days after vaccination was 75% (95% CI = 55%–87%) for 2 doses administered 2 months apart versus 53% (95% CI = 47%–58%) for a single dose; in the U.S. study population, efficacy was 94% (95% CI = 59%–100%) after 2 doses and 70% (61%–77%) after 1 dose.[6]

In clinical trials for mRNA and Janssen COVID-19 vaccine booster doses, rates of local or systemic adverse events were similar or lower after a booster dose (whether homologous or heterologous) than after the last primary series dose. No serious adverse events related to the vaccine were reported for mRNA COVID-19 vaccine booster doses; for Janssen, three serious adverse events (facial paresis, pulmonary embolism, and cerebrovascular accident) were attributed by the site investigators to booster vaccination within 6 months of administration, among 5,070 booster recipients in the evaluable population.[6,7] Outside of clinical trials, more than 13 million persons in the United States had received an additional or booster dose of a COVID-19 vaccine as of October 25, 2021 (predominantly with Pfizer-BioNTech), and no unexpected patterns of adverse events have been observed in national safety surveillance systems.[6]
From the GRADE evidence assessment, the level of certainty for all benefits and harms of a Pfizer-BioNTech, Moderna, or Janssen COVID-19 vaccine booster dose was type 4 (very low certainty) for the prevention of symptomatic COVID-19, prevention of hospitalization attributable to COVID-19 (Pfizer-BioNTech and Janssen), prevention of death attributable to COVID-19 (Janssen), serious adverse events, and reactogenicity.[6,7] No data were available to assess the GRADE benefit of prevention of SARS-CoV-2 transmission. The main reasons for the low level of certainty in the evidence assessment include small study sizes, lack of a randomized primary series comparison group, short duration of follow-up, and use of immunobridging to infer vaccine efficacy (mRNA vaccines). The GRADE evidence profiles, which provide details on methods for identifying and assessing the supporting evidence, are available at https://www.cdc.gov/vaccines/acip/recs/grade/covid-19-booster-doses.html.
ACIP concluded that the evidence reviewed, including data and considerations from the EtR Frameworks, supported the use of an additional primary dose of an mRNA COVID-19 vaccine for certain immunocompromised recipients of an initial mRNA series, a COVID-19 vaccine booster dose for certain recipients of an mRNA primary series who are at increased risk for exposure to or serious complications of COVID-19, and a COVID-19 vaccine booster dose for all recipients of a Janssen COVID-19 vaccine dose. Additional supporting evidence for the EtR is available at https://www.cdc.gov/vaccines/acip/recs/grade/covid-19-immunocompromised-etr.html and https://www.cdc.gov/vaccines/acip/recs/grade/covid-19-booster-doses-etr.html.
In its deliberations, ACIP discussed the rationale for two different categories of booster dose recommendations among recipients of an mRNA primary series. Persons belonging to groups that ACIP recommends should be vaccinated with a booster dose (Box 2) are groups that are at highest risk for severe COVID-19; several studies suggest waning of VE against hospitalization in older adults. In groups that ACIP recommends may be vaccinated with a booster dose based on individual benefits and risks, evidence suggests that although VE against hospitalization remains high, waning of VE against SARS-CoV-2 infection has been observed. At the September 22–23, 2021, meeting, when booster dose deliberations were limited to Pfizer-BioNTech COVID-19 vaccine, ACIP initially recommended against booster vaccination for persons with frequent occupational or institutional exposure to SARS-CoV-2, given that protection against severe disease in the overall population remains high. However, CDC recommended that persons in this group may receive a booster dose based on their individual benefits and risks, given the implications of waning immunity against infection on health care personnel and other frontline workers, or in settings where the ability to maintain physical distancing or isolation of persons with COVID-19 is more challenging, such as correctional or detention facilities.***,††† During the October meeting when booster dose deliberations expanded to Moderna and Janssen vaccines, ACIP voted to recommend a COVID-19 vaccine booster dose to recipients of an mRNA primary series (including those who had received Pfizer-BioNTech) who were currently in the risk groups recommended by CDC to receive booster vaccination, including those at occupational or institutional risk for exposure based on individual benefits and risks. This recommendation supersedes the previous recommendations issued by ACIP and CDC in September. Additional information on individual benefit-risk assessments for mRNA booster vaccination is available at https://www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html. Regarding Janssen COVID-19 vaccine, ACIP discussed the importance of optimizing vaccine-induced protection against SARS-CoV-2 in all recipients of primary vaccination because although VE against infection and hospitalization appears stable over time, VE estimates for Janssen vaccine are overall lower than those observed for mRNA vaccines.

ACIP also emphasized that achieving high and equitable coverage with a COVID-19 primary vaccination series remains the highest priority and is fundamental to reducing COVID-19–related morbidity and mortality. ACIP also stressed the importance of ensuring global equity in access to COVID-19 vaccines for the prevention of disease in vulnerable persons and mitigation of the emergence of SARS-CoV-2 variants.

Before vaccination, providers should provide the EUA Fact Sheet for the vaccine being administered and counsel vaccine recipients about expected systemic and local reactogenicity. Additional clinical education materials are available at https://www.cdc.gov/vaccines/covid-19/index.html, including additional clinical considerations at https://www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html. The interim recommendations and clinical considerations are based on use of an additional or booster dose of COVID-19 vaccine under an EUA and might change as more evidence becomes available.

Reporting of Vaccine Adverse Events​

FDA requires that immunization providers report vaccine administration errors, serious adverse events, cases of multisystem inflammatory syndrome, and cases of COVID-19 that result in hospitalization or death after administration of COVID-19 vaccine under an EUA.[2] Adverse events that occur after receipt of any COVID-19 vaccine should be reported to the Vaccine Adverse Events Reporting System (VAERS, https://vaers.hhs.gov or 1-800-822-7967). Any person who administers or receives a COVID-19 vaccine is encouraged to report any clinically significant adverse event, whether or not it is clear that a vaccine caused the adverse event. In addition, CDC has developed a new, voluntary smartphone-based online tool (v-safe) that uses text messaging and online surveys to provide near real-time health check-ins after receipt of a COVID-19 vaccine (https://www.cdc.gov/vsafe).

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[missy]

EU Told to Prime for Fourth COVID Vaccine Dose, if Needed​

By Francesco Guarascio
January 24, 2022

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BRUSSELS (Reuters) - European Union health ministers were told on Friday to prepare to deploy a fourth dose of COVID-19 vaccines as soon as data showed it was needed, as the bloc faces a surge in cases of the Omicron variant of the coronavirus.
The EU drugs regulator said this week it would be reasonable to give a fourth dose to people with severely weakened immune systems, but more evidence was needed.
"If we see data which is conclusive on whether a fourth dose is needed, we need to be ready to act," EU Health Commissioner Stella Kyriakides told EU ministers in a video conference, her speaking points showed.
The meeting was organised at short notice by the French government, which holds the rotating presidency of the EU, and focused on whether a fourth dose is needed and on adapted vaccines against variants.

In a tweet after the conference, Kyriakides noted that the priority should be to immunise the unvaccinated, who still constitute about a quarter of the EU population.

EU members Hungary and Denmark have already decided to roll out a fourth dose of COVID vaccines. Copenhagen said it would do so for the most vulnerable, while the Hungarian government said everybody could get it after a consultation with a doctor.
The rollout of fourth doses began in Israel last month, making it the first country to administer a so-called second booster. The campaign is set to continue despite preliminary findings that the fourth dose is not enough to prevent Omicron infections.
Wealthier nations decided to speed up the rollout of third doses amid a wave of new cases caused by the more contagious Omicron variant, but remain divided over a fourth.

Many consider that more data is needed before deciding.
ADAPTED VACCINES
The meeting also discussed coordination of other policies, including possible new joint purchases, as "vaccines adapted to variants are coming soon," the French presidency said.
Vaccines adapted to Omicron could be ready as early as March, but the EU drugs regulator has said it is not yet clear whether they are needed.

Work is underway to develop multivalent vaccines that could protect against multiple variants, but it is not known when or if they could be available.

"It is clear that a new generation of vaccines that are effective against several variants, and ideally protect against infection, must be prioritised," Kyriakides told ministers.

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[missy]

Long COVID Associated With Risk of Metabolic Liver Disease​

Jim Kling

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Postacute COVID syndrome (PACS), an ongoing inflammatory state following infection with SARS-CoV-2, is associated with greater risk of metabolic-associated fatty liver disease (MAFLD), according to an analysis of patients at a single clinic in Canada published in Open Forum Infectious Diseases.
MAFLD, also known as nonalcoholic fatty liver disease (NAFLD), is considered an indicator of general health and is in turn linked to greater risk of cardiovascular complications and mortality. It may be a multisystem disorder with various underlying causes.
PACS includes symptoms that affect various organ systems, with neurocognitive, autonomic, gastrointestinal, respiratory, musculoskeletal, psychological, sensory, and dermatologic clusters. An estimated 50%-80% of COVID-19 patients experience one or more clusters of symptoms 3 months after leaving the hospital.
But liver problems also appear in the acute phase, said Paul Martin, MD, who was asked to comment on the study. "Up to about half the patients during the acute illness may have elevated liver tests, but there seems to be a subset of patients in whom the abnormality persists. And then there are some reports in the literature of patients developing injury to their bile ducts in the liver over the long term, apparently as a consequence of COVID infection. What this paper suggests is that there may be some metabolic derangements associated with COVID infection, which in turn can accentuate or possibly cause fatty liver," said Martin in an interview. He is chief of digestive health and liver diseases and a professor of medicine at the University of Miami.

"It highlights the need to get vaccinated against COVID and to take appropriate precautions because contracting the infection may lead to all sorts of consequences quite apart from having a respiratory illness," said Martin.

The researchers retrospectively identified 235 patients hospitalized with COVID-19 between July 2020 and April 2021. Overall, 69% were men, and the median age was 61 years; 19.2% underwent mechanical ventilation and the mean duration of hospitalization was 11.7 days. They were seen for PACS symptoms a median 143 days after COVID-19 symptoms began, with 77.5% having symptoms of at least one PACS cluster. Of these clusters, 34.9% were neurocognitive, 53.2% were respiratory, 26.4% were musculoskeletal, 29.4% were psychological, 25.1% were dermatologic, and 17.5% were sensory.
At the later clinical visit for PACS symptoms, all patients underwent screening for MAFLD, which was defined as the presence of liver steatosis plus overweight/obesity or type 2 diabetes. Hepatic steatosis was determined from controlled attenuation parameter using transient elastrography. The analysis excluded patients with significant alcohol intake or hepatitis B or C. All patients with liver steatosis also had MAFLD, and this included 55.3% of the study population.
The hospital was able to obtain hepatic steatosis index (HSI) scores for 103 of 235 patients. Of these, 50% had MAFLD on admission for acute COVID-19, and 48.1% had MAFLD upon discharge based on this criterion. At the PACS follow-up visit, 71.3% were diagnosed with MAFLD. There was no statistically significant difference in the use of glucocorticoids or tocilizumab during hospitalization between those with and without MAFLD, and remdesivir use was insignificant in the patient population.

Given that the prevalence of MAFLD among the study population is more than double that in the general population, the authors suggest that MAFLD may be a new PACS cluster phenotype that could lead to long-term metabolic and cardiovascular complications. A potential explanation is loss of lean body mass during COVID-19 hospitalization followed by liver fat accumulation during recovery.
Other infections have also shown an association with increased MAFLD incidence, including HIV, Heliobacter pylori, and viral hepatitis. The authors worry that COVID-19 infection could exacerbate underlying conditions to a more severe MAFLD disease state.
The study is limited by a small sample size, limited follow-up, and the lack of a control group. Its retrospective nature leaves it vulnerable to biases.
"The natural history of MAFLD in the context of PACS is unknown at this time, and careful follow-up of these patients is needed to understand the clinical implications of this syndrome in the context of long COVID," the authors wrote. "We speculate that [MAFLD] may be considered as an independent PACS-cluster phenotype, potentially affecting the metabolic and cardiovascular health of patients with PACS."

One author has relationships with several pharmaceutical companies, but the remaining authors reported no conflicts of interest. Martin has no relevant financial disclosures.

This article originally appeared on MDedge.com, part of the Medscape Professional Network.

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[missy]

Impact of COVID Vaccines on Menstrual Cycles​

Andrew M. Kaunitz, MD
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Soon after COVID-19 vaccinations became available, anecdotal reports of changes in menstrual cycles appeared and were amplified by social media.

In a report published in the January 2022 issue of ACOG's "Green Journal," which received extensive media attention, investigators used data from a widely used fertility-awareness app known as Natural Cycles.

The report utilized data collected between October 2020 and September 2021, and compared menstrual cycle changes among vaccinated individuals for three cycles prior to, and three cycles following, vaccination, with data from six cycles in unvaccinated women.

The app prompted users to report receipt or nonreceipt of COVID vaccination, including vaccine type. Based on International Federation of Gynecology and Obstetrics criteria, changes of less than 8 days in cycle length were considered normal.
Among almost 4000 women with evaluable menstrual cycle data, more than half were vaccinated during the study period.
Overall, receipt of vaccination was associated with a less than 1-day increase in cycle length, and the proportion of women experiencing changes in cycle length of 8 days or more was 4%-5%. This was similar among vaccinated and unvaccinated women.

In a subgroup analysis focusing on women who received two vaccinations within one menstrual cycle, the increase in length of their next cycle was 2 days. However, within two subsequent cycles, cycle length became similar in vaccinated and unvaccinated women.
When women who received their second shot in a subsequent cycle were analyzed, vaccination was no longer associated with significant differences in menstrual cycle length.
Vaccination brand was not associated with alterations in these findings. Likewise, vaccination was not associated with changes in duration of menstrual flow.
Limitations of this study include the fact that a high proportion of the women using this menstrual app were White and well educated, and that no information related to receipt of booster shots was collected.

Overall, this carefully conducted study validates anecdotal reports that vaccination causes changes in menstrual cycle length. However, women considering the COVID shot can be reassured that vaccination does not result in clinically significant or long-term changes in menstruation.

I am Andrew Kaunitz. Please take care of yourself and others.


Cite this: Andrew M. Kaunitz. Impact of COVID Vaccines on Menstrual Cycles - Medscape - Jan 21, 2022.