Coronavirus Updates January 1, 2022

[missy]

Caring for the Critically Ill Patient
January 24, 2022

Clinical Outcomes Among Patients With 1-Year Survival Following Intensive Care Unit Treatment for COVID-19​

Hidde Heesakkers, MD1; Johannes G. van der Hoeven, MD, PhD1; Stijn Corsten, MD2; et alInge Janssen, MD3; Esther Ewalds, MD4; Koen S. Simons, MD, PhD5; Brigitte Westerhof, MD6; Thijs C. D. Rettig, MD, PhD7; Crétien Jacobs, MD8; Susanne van Santen, MD, PhD9; Arjen J. C. Slooter, MD, PhD10,11; Margaretha C. E. van der Woude, MD, PhD12; Mark van den Boogaard, RN, PhD1; Marieke Zegers, PhD1
Author Affiliations Article Information
JAMA. Published online January 24, 2022. doi:10.1001/jama.2022.0040

"
Question What are the 1-year outcomes among patients who survive intensive care unit (ICU) treatment for COVID-19?

Findings In this exploratory multicenter prospective cohort study that included 246 patients who were alive 1 year following ICU treatment for COVID-19, 74.3% reported physical symptoms, 26.2% reported mental symptoms, and 16.2% reported cognitive symptoms.

Meaning Physical, mental, and cognitive symptoms were frequent 1 year after ICU treatment for COVID-19.

Abstract
Importance One-year outcomes in patients who have had COVID-19 and who received treatment in the intensive care unit (ICU) are unknown.

Objective To assess the occurrence of physical, mental, and cognitive symptoms among patients with COVID-19 at 1 year after ICU treatment.

Design, Setting, and Participants An exploratory prospective multicenter cohort study conducted in ICUs of 11 Dutch hospitals. Patients (N = 452) with COVID-19, aged 16 years and older, and alive after hospital discharge following admission to 1 of the 11 ICUs during the first COVID-19 surge (March 1, 2020, until July 1, 2020) were eligible for inclusion. Patients were followed up for 1 year, and the date of final follow-up was June 16, 2021.

Exposures Patients with COVID-19 who received ICU treatment and survived 1 year after ICU admission.

Main Outcomes and Measures The main outcomes were self-reported occurrence of physical symptoms (frailty [Clinical Frailty Scale score ≥5], fatigue [Checklist Individual Strength—fatigue subscale score ≥27], physical problems), mental symptoms (anxiety [Hospital Anxiety and Depression {HADS} subscale score ≥8], depression [HADS subscale score ≥8], posttraumatic stress disorder [mean Impact of Event Scale score ≥1.75]), and cognitive symptoms (Cognitive Failure Questionnaire—14 score ≥43) 1 year after ICU treatment and measured with validated questionnaires.

Results Of the 452 eligible patients, 301 (66.8%) patients could be included, and 246 (81.5%) patients (mean [SD] age, 61.2 [9.3] years; 176 men [71.5%]; median ICU stay, 18 days [IQR, 11 to 32]) completed the 1-year follow-up questionnaires. At 1 year after ICU treatment for COVID-19, physical symptoms were reported by 182 of 245 patients (74.3% [95% CI, 68.3% to 79.6%]), mental symptoms were reported by 64 of 244 patients (26.2% [95% CI, 20.8% to 32.2%]), and cognitive symptoms were reported by 39 of 241 patients (16.2% [95% CI, 11.8% to 21.5%]). The most frequently reported new physical problems were weakened condition (95/244 patients [38.9%]), joint stiffness (64/243 patients [26.3%]) joint pain (62/243 patients [25.5%]), muscle weakness (60/242 patients [24.8%]) and myalgia (52/244 patients [21.3%]).

Conclusions and Relevance In this exploratory study of patients in 11 Dutch hospitals who survived 1 year following ICU treatment for COVID-19, physical, mental, or cognitive symptoms were frequently reported.


Introduction
The COVID-19 pandemic resulted in a surge of critically ill patients who required treatment in intensive care units (ICUs), with many survivors of critical illness at risk of experiencing long-term impairments.1 Post-ICU symptoms can be divided within the physical, mental, and cognitive domain and are associated with increased 1-year mortality, higher health care costs, and lower quality of life (QoL).2-4

Recent studies have demonstrated that patients who required ICU treatment for COVID-19 experience short-term symptoms in all 3 domains.5-7 Long-term consequences are yet largely unknown but are likely substantial given the presence of known risk factors for post-ICU problems, circumstances of the pandemic, and the occurrence of symptoms in hospitalized non-ICU patients with COVID-19.8-10 In view of the long duration of ICU treatment among patients with COVID-19, worse long-term outcomes would be expected compared with ICU patients without COVID-19.1 Additionally, patients who survive acute respiratory distress syndrome (ARDS) (which is clinically similar to severe COVID-19) frequently experience long-term symptoms.11,12 Insight into the long-term outcomes among patients with COVID-19 who received ICU treatment is important for providing adequate care and aftercare tailored to the clinical needs of these patients.13

The aim of the present study was to assess the occurrence of physical, mental, and cognitive symptoms in patients with COVID-19 at 1 year following receipt of ICU treatment.

Methods
Study Design, Setting, and Population
This exploratory prospective cohort study is part of the MONITOR-IC study, a multicenter study in ICU survivors.14 The study protocol has been previously described15 and approved by the local research ethics committee (CMO region Arnhem-Nijmegen, the Netherlands, No. 2016-2724).

Briefly, ICU patients treated for COVID-19 were recruited from 11 Dutch hospitals (3 university hospitals, 5 teaching hospitals, and 3 nonteaching hospitals). Eligible patients were recruited for participation after ICU discharge (either before hospital discharge or as soon as possible after). Written informed consent was obtained from all patients or their legal representatives. ICU patients (aged 16 years or older and alive after hospital discharge) admitted to the ICU during the first COVID-19 surge in the Netherlands (March 1, 2020, until July 1, 2020) with confirmed COVID-19 infection (by laboratory or clinical diagnosis [eg, computed tomography]) were eligible. Exclusion criteria were an ICU admission of less than 12 hours, having a life expectancy of less than 48 hours, or receiving palliative care.

Study Outcomes
The main outcomes were physical, mental, and cognitive symptoms 1 year after ICU admission, which were measured with self-reported, recommended and validated questionnaires, completed by patients or a proxy if the patient was unable.15,16 Nonresponders received 2 reminders. The questionnaires could be completed online or on paper, based on the patients’ preference.

Physical symptoms were measured using the Clinical Frailty Score (incremental scale objectifying frailty; score range, 1 [very fit] to 9 [terminally ill], with a score of ≥5 indicating a person as frail)17,18 and the Checklist Individual Strength—fatigue subscale (a 7-point rating subscale of the CIS-20 measuring fatigue severity and consisting of 8 statements; score range, 8-56 [cutoff value of ≥27 indicates abnormal fatigue]).19,20 Moreover, the study questionnaire included a list of 30 physical problems of which presence was rated with a 4-point Likert scale (no problems, mild problems, moderate problems, or severe problems). Physical problems were present if at least 1 problem was rated as moderate or severe.

Mental symptoms of anxiety, depression, and posttraumatic stress disorder were measured using the Hospital Anxiety and Depression Scale (HADS; the HADS-Anxiety [HADS-A] and the HADS-Depression [HADS-D] components each consist of 7 questions with a 4-point Likert scale [0-3], with a cutoff value of ≥8 indicating the presence of symptoms of anxiety or depression for both subscales)21,22 and the Impact of Event Scale—6 (IES-6; consists of 6 questions derived from the IES—Revised [IES-R], with a 5-point Likert scale ranging from 0 [not at all] to 4 [extremely], with a mean cutoff value of ≥1.75 over all questions indicating presence of posttraumatic stress disorder symptoms).23,24

Cognitive symptoms were measured using the abbreviated Cognitive Failure Questionnaire-14 (14 questions with a 5-point Likert scale measuring daily life cognitive failures ranging from 0 [never] to 4 [very often] resulting in a factored score ranging from 0-100, with a score of ≥43 indicating cognitive symptoms).25

The ability to return to work was assessed by a question with multiple options regarding the patient’s level of recovery (from full recovery “working as before admission” to incapacity “completely stopped working because of the consequences of the critical illness episode”). Additionally, after inclusion, patients were asked to report their level of education and racial and ethnic background and dichotomized by high education level (indicating higher vocational or university education) and ethnicity (having Dutch ancestry or not). Patients’ other demographics and information concerning ICU admission were retrieved from medical records and the NICE (Dutch National Intensive Care Evaluation) registry.26

Statistical Analysis
Continuous variables were presented as mean (SD) or median (first and third IQR), and categorical variables were presented as proportions. Outcome scores were presented as median (IQR). Outcome scores were dichotomized using the previously mentioned thresholds and presented as proportion with 95% CIs. The occurrence of symptoms in a domain (physical, mental, cognitive) was positive if there was at least 1 symptom present in that particular domain.

Patients who completed the 1-year follow-up questionnaires were included in the analysis. Baseline characteristics were compared between responders and nonresponders (ie, included patients with available baseline information but who did not complete the 1-year follow-up questionnaires) using the independent sample I test or Mann-Whitney U test, depending on the distribution of the continuous variables, and the χ2 test was used for categorical variables.

Missing data in the CIS-8 and the HADS questionnaires were imputed using a participant’s means score if at least half of the items were answered (the half rule), and missing data in the IES-6 were replaced with the individual mean if at least 5 of 6 questions were answered.27 For the Cognitive Failure Questionnaire-14, only fully completed forms were included. All statistical tests were 2-sided and statistical significance was defined as a P < .05. Data were analyzed using SPSS version 25.

Results
Patient and ICU Characteristics
During the study period, 452 patients with COVID-19 who received ICU treatment survived to hospital discharge, of whom 302 (66.8%) were included (Figure). Of the included patients, 246 (81.5%) completed the 1-year follow-up questionnaires. ICU patients with COVID-19 had a mean (SD) age of 61.2 (9.3) years, 176 (71.5%) were men, and the mean body mass index (calculated as weight in kilograms divided by height in meters squared) was 28.0 (4.5) (Table 1). The median length of ICU stay was 18.5 days (IQR, 11 to 32).

There were no differences in patient and pre-ICU characteristics between responders and nonresponders except for ethnicity as 11.2% of the responders had other than Dutch ancestry compared with 30.0% of the nonresponders (P = .004) (eTable in the Supplement).

Physical, Mental, and Cognitive Outcomes 1 Year After ICU Treatment
At 1 year following ICU treatment, physical symptoms were reported by 74.3% (182/245) of patients, mental symptoms by 26.2% (64/244), and cognitive symptoms by 16.2% (39/241) (Table 2). Overall, 30.6% of the survivors reported symptoms in at least 2 domains, and 10.5% experienced symptoms in all 3 domains 1 year after ICU treatment (Table 3). Additionally, 57.8% of the survivors who were employed before ICU admission reported work-related problems (eg, working less hours than before or still on sick leave).

Physical Outcomes
One year after ICU treatment for COVID-19, 6.1% (15/245) of the survivors reported being frail and 56.1% (138/246) reported experiencing fatigue. Two-thirds reported new physical problems as a result of ICU treatment for COVID-19 (Table 2). Most frequently reported physical problems were weakened condition (38.9%), joint stiffness (26.3%), joint pain (25.5%), muscle weakness (24.8%), myalgia (21.3%), and dyspnea (20.8%) (Table 4).

Mental Outcomes
Symptoms of anxiety were reported by 17.9% (44/246) of the survivors and by 18.3% (45/246) for depression 1 year after ICU treatment for COVID-19 (Table 2). In addition, 9.8% of survivors (24/244) reported symptoms of posttraumatic stress disorder.

Cognitive Outcome
The median Cognitive Failure Questionnaire-14 score was 24.8 (IQR, 12.8 to 37.0) and cognitive symptoms were reported by 16.2% (39/241) of the survivors (Table 2).

The median scores and distributions of all outcome variables are presented in Table 2 and the eFigure in the Supplement.

Discussion
In this exploratory prospective cohort study including patients of 11 Dutch hospitals who survived 1 year following ICU treatment for COVID-19, physical, mental, or cognitive symptoms were reported frequently. In addition, many survivors experienced a weakened condition or musculoskeletal problems and had work-related problems as a result of the critical illness episode.

Studies in patients who survived ICU treatment for COVID-19 with outcomes up to 6 months follow-up showed comparable prevalence rates of fatigue and musculoskeletal problems, eg, ICU-acquired weakness.5,28,29 However, the reported prevalence rates for symptoms of anxiety 4 months after ICU treatment (23.4%)30 and for anxiety (33%) and depression (36%) at 6 months after ICU treatment,31 all measured with the HADS outcome measure and thresholds, are higher compared with the 1-year outcomes reported in the present study, which could possibly be attributed to the recovery of mental health over time. However, these short-term studies5,25,30,31 had smaller sample sizes, included less than half of the number of COVID-19 ICU survivors as in the present study, and only 1 study analyzed all 3 domains of post-ICU outcomes. In other viral outbreaks, for instance SARS in 2003 or MERS in 2012, approximately one-third of the ICU survivors reported mental health problems beyond 6 months after discharge, which is slightly higher than the 1-year rate of 26.2% for mental health symptoms reported in the present study.32

A recent study of ICU patients without COVID-19 and also the MONITOR-IC study, with similar questionnaires and cutoff values, reported prevalence rates among ICU survivors with a medical admission 1 year after ICU treatment (N = 649) of 77.0% for physical symptoms, 35.5% for mental symptoms, and 14% for cognitive symptoms.14,15,33 Compared with the present study, prevalence of physical (74.3%) and cognitive symptoms (16.2%) was similar. However, prevalence rates of mental symptoms (26.2%) were lower among patients who survived ICU treatment for COVID-19 compared with patients treated for another medical admission reason.33 A total of 58% of the ICU survivors with COVID-19 in the present study reported problems with return to work, compared with 43% among ICU survivors without COVID-19.33

Limitations
This study has several limitations. First, patient-reported outcome measures were assessed, which cannot be used as diagnostic tools. In addition, cognitive problems were assessed by self-report, which may differ from findings at formal neuropsychological testing.34 Second, important information about ICU treatment, such as the use sedation, prone positioning, and occurrence of delirium, was not available. Furthermore, information about post-ICU treatment, such as the use of rehabilitation programs, was also not available. This information could have been valuable to better interpret 1-year outcomes.

Third, physical symptoms are likely to be overrepresented in relation to mental and cognitive symptoms because more self-reported outcome measures were used to assess physical symptoms. Fourth, we did not study ICU patients with non–COVID-19 diagnoses, and we therefore cannot conclude that the symptoms at 1 year were specific for COVID-19.

Conclusions
In this exploratory study of patients in 11 Dutch hospitals who survived 1-year following ICU treatment for COVID-19, physical, mental, or cognitive symptoms were frequently reported.

Section Editor: Christopher Seymour, MD, Associate Editor, JAMA ([email protected]).
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Article Information
Corresponding Authors: Hidde Heesakkers, MD ([email protected]) and Marieke Zegers, PhD ([email protected]), Department of Intensive Care Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, the Netherlands.

Accepted for Publication: January 3, 2022.

Published Online: January 24, 2022. doi:10.1001/jama.2022.0040

Author Contributions: Dr Heesakkers had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Drs van den Boogaard and Zegers contributed equally as last authors.

Concept and design: Heesakkers, van der Hoeven, van den Boogaard, Zegers.

Acquisition, analysis, or interpretation of data: Heesakkers, van der Hoeven, Corsten, Janssen, Ewalds, Simons, Rettig, Westerhof, Jacobs, van Santen, Slooter, van der Woude, van den Boogaard, Zegers.

Drafting of the manuscript: Heesakkers, van den Boogaard, Zegers.

Critical revision of the manuscript for important intellectual content: van der Hoeven, Corsten, Janssen, Ewalds, Simons, Rettig, Westerhof, Jacobs, van Santen, Slooter, van der Woude, van den Boogaard, Zegers.

Statistical analysis: Heesakkers, van den Boogaard, Zegers.

Obtained funding: van den Boogaard, Zegers.

Administrative, technical, or material support: Corsten, Ewalds, Simons, van Santen, van den Boogaard.

Supervision: van der Hoeven, Janssen, Rettig, Westerhof, Jacobs, Slooter, van der Woude, van den Boogaard, Zegers.

Conflict of Interest Disclosures: None reported.
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[missy]

The omicron variant caused less severe illness in hospitalized patients than previous versions of the virus, the Centers for Disease Control and Prevention reported Tuesday. Researchers found that omicron patients had shorter hospital stays than those infected with delta and other variants, and less frequently needed intensive care. But omicron's extreme transmissibility continues to devastate the nation on a broader scale. The average daily death toll reached 2,230 on Tuesday, the highest seven-day death average since last February, before vaccines were widely available.


The World Health Organization is investigating a new version of omicron that has recently cropped up in parts of Europe or Asia. There's no evidence that the new pathogen, known as BA. 2, spreads faster, causes more severe illness or evades immunity better than the original. But it has already become the dominant form of the virus in Denmark. At least three cases have been detected in the United States at Houston Methodist Hospital in Texas. Scientists are paying close attention because so little is known about it.

Although current booster shots have been shown to prevent severe disease from omicron, Pfizer and its partner BioNTech have begun testing a new dose tailored to fight the variant. The highly anticipated trial will look at the effectiveness of the omicron-specific shot in about 1,400 people ages 18 to 55, all with varying vaccination statuses. Results are expected in the first half of the year.

Two years into the pandemic, the global response to the coronavirus is still lopsided, with wealthy countries receiving the lion's share of vaccine doses administered to date. A chorus of administration officials, public health experts and Democratic lawmakers say the explosion of omicron cases highlights the gaps in the U.S. government's approach to vaccine inequity and other problems that have left low-income nations vulnerable to the virus. Without a more aggressive global vaccination campaign, some say, another new variant could wreak havoc on us again.

Still, the WHO struck a hopeful note this week as it marked the end of the pandemic's second year. The organization's European chief said Monday that the pandemic was “entering a new phase" — far from over but perhaps stabilizing. In the United States, top federal infectious-disease expert Anthony S. Fauci said it was too early to tell whether the coronavirus was becoming endemic, saying another new variant could upend progress.

Long covid remains one of the most confounding issues in the pandemic. On Tuesday, two congressional Democrats asked the CDC to release data on the number of Americans who suffer from lasting covid-19 symptoms, with breakdowns by race, gender and age. The lawmakers cited research indicating that women are more vulnerable to long covid than men, andsaid the condition may fall disproportionately hard on minority communities. The CDC tracks data on infections and vaccinations, but detailed information on long covid is hard to come by in part because there's no definitive diagnosis.

Other important news​

The CDC warned against travel to 15 countries and territories where covid-19 risk is “very high.” Five Caribbean islands are on the list.

British police launched a criminal probe of Prime Minister Boris Johnson's parties during pandemic lockdowns. If you’re having trouble keeping up with the saga, here’s a handy guide.

A D.C. bar was repeatedly cited for unmasked employees and failing to check customers' vaccine status. Conservatives are fundraising for it.

 

[missy]

COVID-19 Vaccines Seem Safe, Generally Well Tolerated in Rheumatic, Musculoskeletal Diseases​

By Marilynn Larkin
January 25, 2022

NEW YORK (Reuters Health) - SARS-CoV-2 vaccination seems safe in rheumatic and musculoskeletal disease patients, and likely to trigger flares in less than 5% of cases, a registry study shows.
"Our findings should provide reassurance to rheumatologists, other health professionals and vaccine recipients, and promote confidence in the safety of COVID-19 vaccination in people with inflammatory rheumatic diseases," Dr. Pedro Machado of University College London told Reuters Health by email.
"While the study was not aimed at identifying predictors of flare in patients with inflammatory rheumatic diseases, we observed a low flare rate, particularly severe flares (0.6%)," he noted. "The percentage of flares was slightly higher in patients with moderate/high disease activity (5.2%) compared with patients in remission/low disease activity, raising the possibility of an association between higher disease activity and higher flare rate."
"However, it is important to note that flares can occur as part of the natural history of the disease," he said, "and the observed percentages of flare would be compatible with the natural history of the disease rather than necessarily caused by vaccines against SARS-CoV-2."

As reported in Annals of the Rheumatic Diseases, Dr. Machado and colleagues analyzed data on 5,121 patients with rheumatic and musculoskeletal diseases (RMD) from 30 countries, 90% of whom (mean age, 60.5; 68%, women) had inflammatory/autoimmune RMD (I-RMDs). The authors note that patients with I-RMDs were excluded from the vaccine clinical development programs, and previous studies in these patients were small.

Participants (10%) with noninflammatory (NI)-RMDs had a mean age of 72.4 and 77% were women.
Overall, the most frequent conditions were inflammatory joint diseases (58%), connective tissue diseases (18%) and vasculitis (12%). Fifty-four percent of patients "54% received conventional synthetic disease-modifying antirheumatic drugs (DMARDs); 42% biological DMARDs; and 35% immunosuppressants (in combination with other medications).
Most patients received the Pfizer/BioNTech vaccine (70%), followed by AstraZeneca/Oxford (17%) and Moderna (8%).

Among those who were fully vaccinated, breakthrough infections were reported in 0.7% of I-RMD patients and 1.1% of NI-RMD patients.
I-RMD flares occurred in 4.4% of patients (0.6% severe), with 1.5% resulting in medication changes.
Adverse events (AEs) were reported in 37% of I-RMD and 40% of NI-RMD cases; serious AEs occurred in 0.4% I-RMD and 1.9% NI-RMD patients.
The authors conclude, "The safety profiles of SARS-CoV-2 vaccines in patients with I-RMD was reassuring and comparable with patients with NI-RMDs. The majority of patients tolerated their vaccination well with rare reports of I-RMD flare and very rare reports of serious AEs."

Dr. Machado said, "Our data will support discussions about the safety and positive benefit/risk ratio of COVID-19 vaccination for people with inflammatory rheumatic diseases. This information will also help support the development of new and updated recommendations by competent organizations."

Dr. Wen-Hai Shao, an associate professor in the Division of Immunology, Allergy and Rheumatology at the University of Cincinnati in Ohio commented on the study in an email to Reuters Health. "DMARDs are much milder than immunosuppressants, (so) the key is those patients on immunosuppressants; however, the article didn't provide separate information on this group."

"Patients on drugs that target the adaptive immune system and the innate immune system should be analyzed separately," he said. "In addition, a lot of information is (missing)." For example, he said, How do the data compare to healthy individuals? What was the disease status when vaccination was given? What were the type and doses of drugs given? Did patients have other diseases, as well?

"A bioinformatics approach could be used to analyze the data in these different ways," Dr. Shao concluded.

SOURCE: https://bit.ly/3GZJNnS Annals of the Rheumatic Diseases


@Diamond Girl 21 just an fyi...hope you are doing well.

 

[missy]

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Watch, but Don't Worry Yet, About New Omicron Subvariant​

Damian McNamara, MA
January 25, 2022



A new, highly contagious subvariant of Omicron has emerged, which some have begun calling "son of Omicron," but public health officials say it's too soon to tell what kind of real threat, if any, this new strain will present.
In the meantime, it's worth watching BA.2, the World Health Organization says. The subvariant has been identified across at least 40 countries, including three cases reported in Houston and several in Washington state.
BA.2 accounts for only a small minority of reported cases so far, including 5% in India, 4% of those in the United Kingdom, and 2% each of cases in Sweden and Singapore.
The one exception is Denmark, a country with robust genetic sequencing abilities, where estimates range from 50% to 81% of cases.

The news throws a little more uncertainty into an already uncertain situation, including how close we might be to a less life-altering infectious disease.

For example, the world is at an ideal point for a new variant to emerge, WHO Director General Tedros Adhanom Ghebreyesus, PhD, said during a Monday meeting of the WHO executive board. He also said it's too early to call an "end game" to the pandemic.
Similarly, Anthony Fauci, MD, said on Jan. 19 that it remained "an open question" whether the Omicron variant could hasten endemic COVID-19, a situation where the virus still circulates but is much less disruptive to everyday life.

No Pi for You​

This could be the first time a coronavirus subvariant rises to the level of a household name, or — if previous variants of the moment have shown us — it could recede from the spotlight.

For example, a lot of focus on the potential of the Mu variant to wreak havoc fizzled out a few weeks after the WHO listed it as a variant of interest on Aug. 30.
Subvariants can feature mutations and other small differences but are not distinct enough from an existing strain to be called a variant on their own and be named after the next letter in the Greek alphabet. That's why BA.2 is not called the "Pi variant."
Predicting what's next for the coronavirus has puzzled many experts throughout the pandemic. That is why many public health officials wait for the WHO to officially designate a strain as a variant of interest or variant of concern before taking action.


At the moment with BA.2, it seems close monitoring is warranted.

Because it's too early to call, expert predictions about BA.2 vary widely, from worry to cautious optimism.

For example, early data indicates that BA.2 could be more worrisome than original Omicron, Eric Feigl-Ding, ScD, an epidemiologist and health economist, says on Twitter.

Information from Denmark seems to show BA.2 either has "much faster transmission or it evades immunity even more," he says.

The same day, Jan. 23, Feigl-Ding tweeted that other data shows the subvariant can spread twice as fast as Omicron, which was already much more contagious than previous versions of the virus.

At the same time, other experts appear less concerned. Robert Garry, PhD, a virologist at Tulane University in New Orleans, told The Washington Post this week that there is no reason to think BA.2 will be any worse than the original Omicron strain.


So which expert predictions will come closer to BA.2's potential? For now, it's just a watch-and-see situation.


For updated information, the website outbreak.info tracks BA.2's average daily and cumulative prevalence in the United States and in other locations.


Also, if and when WHO experts decide to elevate BA.2 to a variant of interest or a variant of concern, it will be noted on its coronavirus variant tracking website.

Damian McNamara is a staff journalist based in Miami. He covers a wide range of medical specialties, including infectious diseases, gastroenterology and critical care

"

 

[missy]

Infectious Disease>COVID-19

Tool Pinpoints Who May Benefit From COVID Convalescent Plasma​

— Allows a more individualized approach to convalescent plasma use​

by Molly Walker, Deputy Managing Editor, MedPage Today January 26, 2022

While a large meta-analysis of studies on convalescent plasma use early in the pandemic turned up no survival advantage for the typical patient hospitalized for COVID-19, researchers have mined the dataset to predict who may benefit.
Eva Petkova, PhD, of NYU Grossman School of Medicine in New York City, and colleagues devised a simple and freely available tool called the Convalescent Plasma Benefit Index Calculator that allows doctors to input certain patient criteria to determine if their patient may benefit from convalescent plasma (age, oxygen need, blood type, and history of either diabetes, heart disease, or pulmonary disease).

The meta-analysis and study on the validated treatment benefit index (TBI) toolderived from it were both published in JAMA Network Open.
Convalescent plasma was initially authorized by the FDA in August 2020, despite a lack of randomized trial data, and in February 2021, it was scaled back to only high-titer plasma for hospitalized patients early in their disease course who could not mount a sufficient immune response to COVID infection. More recently, FDA started allowing the therapy in the outpatient setting, but still limited treatment across the board to those with immunocompromised conditions.
Meta-Analysis
The COMPILE (Continuous Monitoring of Pooled International Trials of Convalescent Plasma for COVID-19 Hospitalized Patients) meta-analysis found no significant difference between patients receiving convalescent plasma or control patients based on the 11-point ordinal World Health Organization (WHO) scale, reported Andrea Troxel, ScD, also of NYU Grossman School of Medicine.
Odds ratios were 0.94 (95% credible interval [CrI] 0.74-1.19) for the median WHO score of 3 and 0.94 (95% CrI 0.69-1.30) for 7 or higher.

The meta-analysis comprised eight clinical trials that enrolled 1,138 patients to control therapy and 1,231 to convalescent plasma across Asia, Europe, North America, and South America. In six trials, controls received standard of care, and in two they received either non-convalescent plasma or saline. Patients were a mean age of 60, and about two-thirds were men.
Interestingly, while Troxel's group cited "substantial heterogeneity of treatment effect sizes," they also found that convalescent plasma was "minimally associated" with benefit in those with a baseline WHO score of 4, blood type A, and pre-existing diabetes, cardiovascular, and pulmonary disease.
TBI Tool
Using data from COMPILE, Petkova and colleagues identified the groups that had the highest likelihood of a large benefit from convalescent plasma (B1 group; 28% of the population), a modest benefit (B2 group; 42%), and those at risk for no benefit or even potential harm (B3 group; 31%):

• B1: OR 0.69 (95% CrI 0.48-1.06)
• B2: OR 0.82 (95% CrI 0.61-1.11)
• B3: OR 1.58 (95% CrI 1.14-2.17)

"Our treatment benefit index is designed to serve as a quick and effective tool for physicians to use in deciding when to administer convalescent plasma for COVID-19," Petkova said in a statement.
Those falling into group B1 were more likely to have A or AB blood type (56% for each), and a history of cardiovascular disease (52%) or pulmonary disease (52%). And the B1 and B2 groups each had twice the rates of diabetes compared with the group that derived little benefit (40% vs 20%).
When clinicians input these patient variables, the tool calculates a patient's TBI, dividing patients into three groups: substantial benefit from convalescent plasma, moderate benefit, and no expected benefit.
For example, in a 55-year-old patient who doesn't need oxygen, but with a history of heart disease and with A blood type, the calculator returns a score of 0.69, indicating a chance for substantial benefit. But a 55-year-old with B blood type needing high-flow oxygen and with no history of heart disease is likely to see no benefit from convalescent plasma or even harm.

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

 

[missy]

Presence of Autoantibodies Most Predictive of Long COVID in Study​

Diana Swift
January 26, 2022
"
A deep molecular dive into COVID-19 patients found that the presence of autoantibodies in peripheral blood at initial diagnosis was the chief of four risk factors predicting if a patient would experience long COVID.

Other significant early predictors of prolonged COVID symptoms – which the researchers called postacute sequelae – were having type 2 diabetes, SARS-CoV-2 RNAemia, and Epstein-Barr virus (EBV) viremia, Yapeng Su, PhD, of the Institute for Systems Biology (ISB) in Seattle, and colleagues wrote in Cell.

Having EBV viremia suggested that latent EBV has been reactivated, the authors noted.


"The most important postacute sequelae [that is conditions that are consequences of a disease] of COVID is the presence of autoantibodies," James R. Heath, PhD, president of ISB and a bioengineering professor at the University of Washington, Seattle, said in an interview. "It's about two times more important than the others."


Heath and coauthors said early detection of this and other variables could prompt earlier aggressive treatment in patients susceptible to long COVID and ward off lingering symptoms.

"These predictive measures of long COVID can also help to better inform patients of their possible disease course," study coauthor Daniel G. Chen, an undergraduate researcher at ISB, said in an interview. "We were also able to partially resolve the immunological underpinnings of some postacute sequelae of COVID in a way that suggested potential therapies, and the timing of those therapies."

For example, he continued, the use of antivirals very early in the infectious course may mitigate the later development of long COVID. "This will, of course, have to be explored in an appropriately designed clinical trial.


"We also identified biomarkers of certain types of long COVID, such as neurological sequelae. Those biomarkers can help define the condition, which is a first step towards developing treatments."

Study Findings​

With COVID patients monitored for 2 or 3 months, the study findings of the international "multiomic profiling" analysis include:

• Subclinical patient autoantibodies that reduce anti–SARS-CoV-2 antibodies suggest there is immune dysregulation during COVID-19 infection.
• Reactivation of latent other viruses during initial infection may be contributing to long COVID.
• Gastrointestinal postacute sequelae of COVID presents with a unique postacute expansion of cytotoxic T cells.
• SARS-CoV-2–specific and cytomegalovirus-specific CD8+ T cells displayed unique dynamics during recovery from infection.
  According to the authors, as many as 69% of COVID-19 patients suffer from long COVID – a range of new, recurrent, or ongoing problems 4 or more weeks following initial SARS-CoV-2 infection. These may include memory loss, gastrointestinal distress, fatigue, anosmia, and shortness of breath.
  
  
  Long COVID has been associated with acute disease severity, and is suspected to be related to autoimmune factors and unresolved viral fragments, according to the paper.
  
  
  

  Research Methods​

  The international study did a deep and detailed dive into multiple molecular markers of long COVID. It enrolled 209 COVID-19 patients with varying degrees of disease severity and matched them to 457 healthy controls. The researchers’ goal was to identify discrete and quantifiable long COVID factors and guide possible preemptive treatment. Patients were assessed at three time points: at initial diagnosis, during the acute disease phase about a week later, and again 2 to 3 months post onset of symptoms after recovery from the acute phase of COVID. At the third assessment, some patients had lingering symptoms such as fatigue (52% ), cough (25%), and loss of taste or sense of smell (18%).
  
  

  Author Conclusions​

  The authors found an association between T2 hyperinflammation and long COVID–anticipating autoantibodies. This association further implies that hyperinflammation-controlling therapies in the acute stage of COVID may influence whether a patient experiences long COVID. "However, the detailed timing and context of these therapies matter, and, thus, future well-controlled studies will be needed to test these and other therapeutic implications," Su and colleagues wrote.
  
  Moreover, the negative correlations between anti–SARS-CoV-2 IgG and certain autoantibodies may suggest that patients with elevated autoantibody levels are more susceptible to breakthrough infections, the authors said.
  
  "Many patients with high autoantibodies simultaneously have low protective antibodies that neutralize SARS-CoV-2, and that's going to make them more susceptible to breakthrough infections," Chen explained.
  
  "Detectability of most [long COVID-19 factors] at COVID diagnosis emphasizes the importance of early disease measurements for understanding emergent chronic conditions and suggests [long COVID] treatment strategies," they wrote.
  
  
  According to Chen, there are clear similarities in underlying immunobiology between patients with COVID autoantibodies and patients with systemic lupus erythematosus.
  
  
  "These findings are also helping us frame our thinking around other chronic autoimmune conditions, such as postacute Lyme syndrome, for example," said Heath.
  
  The bottom line, said Chen, is that measuring early long COVID indicators may result in preventive treatments. "An example is the cortisol deficiency we see in certain long COVID patients. There are known treatments such as cortisol replacement therapy that should be explored for this group."
  
  

  Outside Expert's Take on Findings​

  Commenting on the study, Sherry Hsiang-Yi Chou, MD, who was not involved in the research, called the study a very important first step in understanding the path of this complex phenomenon and perhaps other conditions with long-term side effects.
  
  "The researchers have done huge amount of innovative scientific work. They've shown the DNA signature of how our bodies respond to this disease," said Chou, who is chief of the division of neurocritical care at Northwestern Medicine in Chicago.
  
  "This type of research will help us scientifically understand and differentiate the various syndromes within long COVID. It will help identify who's at risk for different aspects of this syndrome and lead to following them for longer periods in clinical trials," she added.
  
  The authors acknowledged that lengthier studies in larger cohorts were needed to see which patients will develop long-term chronic postacute sequelae of COVID.
  
  This research was supported by the Wilke Family Foundation, the Parker Institute for Cancer Immunotherapy, Merck, and the Biomedical Advanced Research and Development Authority. Other support came from the National Institutes of Health, the Bill and Melinda Gates Foundation, Saint John's Cancer Center, Fred Hutchinson Cancer Research Center, and the European Union's Horizon 2020 research and innovation program. Heath is a cofounder of Pact Pharma. He and several coauthors disclosed various ties to multiple private-sector companies. Chen and Chou had no competing interests.
  
  "
  
  
  

 

[missy]

CDC: COVID Cases Keep Dropping, but 'Milder Does Not Mean Mild'​

Lindsay Kalter
January 26, 2022

"
Despite declining national numbers, Americans should not lose sight of the ongoing public health crisis as hospitals remain overwhelmed with COVID-19 patients, many of whom are unvaccinated, CDC Director Rochelle Walensky, MD, said at a White House briefing Wednesday.

"Although it's encouraging that Omicron appears to be causing less severe disease, it's important to remember we're still facing high overall burden of disease," she said. "Hospitalizations have rapidly increased in a short amount of time, putting a strain on local health systems. Milder does not mean mild."

Daily case rates of COVID-19 are 5 times higher with Omicron than the Delta variant. But because many Americans are vaccinated and boosted ― and Omicron seems to cause less severe disease ― hospitalizations and deaths have remained much lower, given the number of infections, Walensky said.


"When you look at the Delta period last winter, as cases increase, hospitalizations and deaths increase in a similar pattern," she said. "Strikingly, when we compare the past month, when Omicron was the dominant variant, we see a clear separation between cases, hospital admissions, and death."


This week's 7-day average of daily cases is 692,400, a decrease of 6% since last week. Hospital admissions have decreased by 8%, to 19,800.

During the briefing, White House chief medical adviser Anthony Fauci, MD, outlined a hypothetical outcome for the pandemic ― and it doesn't involve eliminating COVID-19.

"We want a level of control that does not disrupt us in society, does not dominate our lives or prevent us from doing the things we generally do under normal existence," he said. "More importantly, concentrating on severity of disease, hospitalizations, and deaths that fall in the category that what we generally accepted with other respiratory viruses."


But, he said, "We are not there right now."

Fauci also discussed research underway on a "pan-coronavirus vaccine," or a vaccine effective against all variants. The National Institute of Allergies and Infectious Diseases, which Fauci leads, has invested more than $300 billion in COVID-19 research, and $1.5 billion of that is for vaccine research.

Some pan-coronavirus vaccine candidates are already in phase I trials, he said. But he warned it will take years before these are authorized.

"Don't forget," he urged: "The current vaccine regimens already provide strong protection."
"

 

[missy]

When the Dying COVID Patient Is 23​

— Palliative care conversations have taken on a new meaning during the pandemic​

by Arian Nachat, MD January 27, 2022

I walk into a conference room with multiple family members who flew in from out of state to support the patient. There are consultants from neurology, cardiology, nephrology, intensive care, ECMO, vascular surgery, and me. I'm there as the palliative care physician.

How does an otherwise healthy 23-year-old admitted with COVID-19 diarrhea wind up so critically ill? It has to do, at least in part, with her vaccination status: unvaccinated.

We start with introductions and a summary of what has transpired to date. There is a look of terror, confusion, and questioning on every family member's face. This young lady was enjoying post-college life, loving her first job and hoping it would lead to a healthcare profession. She experienced a cardiac arrest, and wound up being resuscitated and requiring ECMO. Due to COVID-19, she has now lost both legs related to coagulopathic complications and is on dialysis due to renal failure. Her cognitive deficits are still unclear, and while she survived her COVID-19 ICU stay, her life has been shattered and altered in ways many of us will never experience or understand.

In situations like these, introducing palliative care conversations as early in the disease trajectory as possible is essential. And during the COVID-19 pandemic, this has only become increasingly important, especially with young patients.
Palliative medicine specializes in the management of patients who have serious life-limiting illnesses -- usually in the form of end organ dysfunction that will ultimately decline to the point of being terminal. These patients are generally older, with a medical history that precedes their palliative diagnosis. But as with this 23-year-old patient, this isn't always the case.

We need to evolve our conversation on health to include discussions about our inevitable mortality. Bringing in palliative medicine when someone is first diagnosed with a palliative diagnosis -- progressive heart, lung, kidney, neurologic, and liver diseases or advanced cancer, just to name a few -- is better care. We engage in conversations about values, hopes, and dreams. We establish trust and longitudinal relationships. Palliative care is for the living, regardless of the patient's diagnosis or prognosis. We help align care with their goals. It makes the dialogue around transitions when health deteriorates less frightening or ominous.



The narrative and language around death and dying have been a struggle culturally, despite being the one life experience we will all share. Many physicians were trained to avert death at all costs and were taught that discussing dying may take away patients' hope or erode trust. In some ways, we have evolved since those days, but many still don't understand how to approach this type of conversation. It requires nuance, experience, and sensitivity. Let us acknowledge the universal truth that one day we are all going to die, and plan to do it better.

Palliative care has become increasingly important during COVID-19. And now, the newest variant is resulting in a new wave of suffering. This is why anyone eligible should get vaccinated and boosted. But we also need to do a better job of messaging what the impact is on all the folks who fall in the grey zone or those who are especially vulnerable. We, as leaders in healthcare, need to be explicit about the consequences of not protecting the pregnant, the ineligible children under 5, the immunocompromised, and the healthcare workers and essential workers who face high levels of exposure. We need to be clear that many of the long COVID or post ICU COVID-19 patients will become palliative care patients moving forward. We should engage palliative care early in the disease trajectory and stop equating it with dying. Rather, introduce palliative care for what its true mission is: living well in the face of serious illness.

"

 

[missy]

Omicron Will Likely Recede More Slowly in U.S. Than in Other Countries, Expert Says​

— Continued high test positivity rate is also concerning, says Jennifer Nuzzo of Johns Hopkins​

by Joyce Frieden, Washington Editor, MedPage Today January 27, 2022

The wave of COVID-19 cases with the Omicron variant may have reached its peak in the U.S., but it likely won't decline as quickly here as it has in Europe and other places, said Jennifer Nuzzo, DrPH, senior scholar at the Johns Hopkins Center for Health Security, at a briefing on the current state of COVID, which was sponsored by the American Public Health Association (APHA).

"Not all states are seeing the declines that you may have been hearing about on the East Coast -- in fact, 19 states this week are reporting case increases, but the rate of change in most of these states is slowing. So, that is certainly welcome news and we'd like to see this trend continue," Nuzzo said at the Wednesday evening event.
And while cases with the Omicron variant have declined quickly in other countries following a surge, "I think it's going to play out differently in the United States, in part because we're such a geographically diverse country, and in part because we've seen over and over again this virus spreads in social clusters, and not all social clusters mix with each other," she added. "So, I think we're going to continue to see spread and possibly not as rapid declines as other countries have reported."

Nuzzo noted that one of her big concerns is that COVID testing is "highly constrained -- perhaps the most constrained it's been at any point in this pandemic." Looking at test positivity, which is one of the best ways to gauge the COVID situation, "I see a test positivity number that's high -- in this case, over 25% for the nation," she said. "What that tells me is that the answer to the question 'Are we testing enough?' is a resounding 'No' ... We like to see test positivity much lower than 5%, and 25% is just far too high."
The high positivity rate "means that we are missing more and more infections that are occurring," Nuzzo continued. "They're not turning up in our surveillance numbers because people aren't getting tested. Maybe they're testing themselves at home, but that's not being captured by our surveillance ... So that is a real worry and I think it really starts to occlude our vision in terms of where we're going in this pandemic, and it certainly deprives us of opportunities to interrupt transmission, to connect people to potentially life-saving care, and to otherwise just improve outcomes."

The rise of other variants is also an issue, she said, noting that although the U.S. is starting to catch up with some other countries when it comes to sequencing the virus, "we're still not a leader in terms of sequencing. So, keep that in mind when you hear about a new variant. There's probably a lot more going on out there with respect to variants that we just don't know, because we're so far behind in our surveillance in terms of looking for them."
How can we prevent the rise of new variants? "If we want to stop fretting about every other Greek letter that there is to come in the alphabet, the way that we do that is we have to bring these case numbers down ... and limit opportunities for variants to arise," said Nuzzo. And the way to do that "is by allowing more countries greater access to vaccines."

APHA Executive Director Georges Benjamin, MD, reviewed some CDC guidance that has been the subject of confusion. First, "cloth masks do provide protection, but they need to be multi-layer; they're certainly better than no mask at all," he said. However, "they're probably a little less protective than surgical masks," although the disadvantage with the latter is that they're designed to be single-use, as opposed to cloth masks, which are washable and reusable.
And although N95 and KN95 masks are the gold standard, "a high-filtration mask that is not properly worn and tight is certainly not giving you the protection that you need," said Benjamin. "So you have to wear those masks -- as well as the surgical masks and the cloth masks -- properly to get the best seal that you possibly can."
He also discussed which type of test patients who have contracted COVID should use to determine whether they're ready to return to work after isolation and quarantine. The problem with using a PCR test for that purpose "is that it is quite often positive both before and after you are contagious, so it really isn't the best tool to use. If you're negative, great, but far too many people are still positive and not just a few days afterwards -- sometimes weeks afterwards, and we still have people that are even positive months afterwards."

But if you use the antigen test, "it's much more likely for that to be reliable for return to work," he said. "And if you combine that with the loss of symptoms -- meaning that you're feeling better -- from a risk-based perspective, your risk of infecting others is greatly reduced."
That's an especially important consideration for healthcare workers, Benjamin added. "We would prefer everybody to be totally symptom-free before they go back to work."

 

[missy]

CDC: Third Dose Guarded Immunocompromised From Severe COVID​

— High VE for both immunocompromised and immunocompetent adults during Delta​

by Molly Walker, Deputy Managing Editor, MedPage Today January 27, 2022


Three doses of mRNA vaccine was effective against severe COVID-19 for both immunocompetent and immunocompromised adults during the Delta wave, researchers found.

From Aug. to Dec. 15, 2021, vaccine effectiveness (VE) against COVID-related hospitalization was 97% (95% CI 95-99) for immunocompetent adults who received a two-dose Pfizer or Moderna series followed by a booster dose and 88% (95% CI 81-93) for immunocompromised adults who received three doses of vaccine, reported Mark Tenforde, MD, PhD, of the CDC, and colleagues.



Not surprisingly, VE against hospitalization was lower with the two-dose primary series alone for both immunocompetent (82%, 95% CI 77-86) and immunocompromised adults (69%, 95% CI 57-7, the authors wrote in the Morbidity and Mortality Weekly Report.

Interestingly, a sensitivity analysis among patients with CDC-defined moderately to severely immunocompromising conditions showed a VE of 87% (95% CI 78-92) with three doses versus 65% (95% CI 49-76) with two doses.

Tenforde's team examined data from the Influenza and Other Viruses in the Acutely Ill Network (IVY Network). Case patients had COVID-like illness and tested positive for SARS-CoV-2 via nucleic acid amplification test (NAAT), while controls were hospitalized with or without COVID-like illness, but tested negative via NAAT.

Overall, they analyzed data from 2,952 hospitalized patients, 1,385 cases and 1,567 controls. Of these, 36% had an immunocompromising condition. Median patient age was 62 years, 51% were men, and 58% were non-Hispanic white.

Among the case patients, two-thirds were unvaccinated, while 29% received two doses and 3% received three doses. Among controls, 29% were unvaccinated, while 54% received two and 17% received three doses, respectively.



Not surprisingly, a higher proportion of immunocompromised patients were case patients (34%) than controls (20%, P<0.001).

Tenforde's group noted that these findings may be especially relevant during the current Omicron period, as "early evidence suggests that a third mRNA vaccine dose elicits markedly stronger neutralizing antibody responses to the Omicron variant compared with responses to two vaccine doses, and increases VE against severe disease following infection with the Omicron variant," they wrote.

They reiterated the importance of immunocompromised adults receiving a third dose of mRNA vaccine at least 28 days after their second dose. In October, CDC also recommended that certain moderately or severely immunocompromised individuals should get a booster dose at least 6 months after completing their third dose, which has since been revised to 5 months.

The agency also recommends booster doses of Pfizer or Moderna vaccine for all individuals ages 12 and up, at least 5 months after a two-dose primary series.

 

[missy]

Anticipating the next pandemic​

The U.S. isn't taking any chances on being caught off-guard by the next coronavirus variant or pandemic threat. After omicron hit faster and harder than expected, the Biden administration quietly convened a new group of federal health officials focused on developing tools to combat future outbreaks. The Pandemic Innovation Task Force, formed by the White House Office of Science and Technology Policy, will focus on developing vaccines, treatments, diagnostic tests and other tools, Bloomberg reported this month. It will help prepare the nation for new versions of the virus that might surface and future biological threats beyond Covid-19. “I’ve been waiting for the U.S. to start getting prepared for the next big variant for months,” says Robin Robinson, who served as the first director of the Biomedical Advanced Research and Development Authority, an agency that develops measures to fight disease threats, such as pandemics and bioterrorism. “We need to focus on how we come out of the pandemic and transition to the endemic phase, where this set of viruses continues to be ubiquitous in nature.” Joe Biden’s administration has quietly formed a new task force focused on developing tools to combat future coronavirus variants and other pandemic threats. Photographer: Oliver Contreras/Sipa/Getty Images Unlike the existing White House Coronavirus Task Force, the new group won’t focus on day-to-day pandemic response. Instead, it will work on preparedness projects that could be used to manage waves of new variants that could emerge within six months to two years, as well as other threats. That could mean developing diagnostic tools that help guide treatment by distinguishing between variants, updating vaccines to protect against multiple variants, identifying new drug candidates or securing additional manufacturing capacity. Led by Eric Lander, an adviser to President Joe Biden and director of the White House science and technology office, the group’s mission builds on a 10-year, $65.3 billion proposal to combat future pandemic threats. The task force will test out some of that program's long-range ideas. And White House officials aren’t the only ones looking ahead. Two influential senators—Democrat Patty Murray and Richard Burr, a Republican—have drafted a bill that would overhaul how the government monitors outbreaks, stockpiles supplies and responds to pandemic threats. The legislation also aims to refocus the mission of the Centers for Disease Control and Prevention. As pandemic preparedness becomes a hot-button issue in Washington, a lot of ideas are floating around. It remains to be seen whether they will produce real investments. Could this be the moment the U.S. repairs the cracks in its defenses? And if not now, when?—Riley Ray Griffin

​ ​ ​ ​ Track the virus​

Learning to Live With Covid​ Omicron has ushered in a new era for pandemic management. While the variant triggered the biggest global infection wave in Covid-19’s history, many countries are emerging out the other side more determined to live with the virus and reopen their economies. Outbreaks are peaking and ebbing more quickly, with omicron’s mildness and the proliferation of vaccinations keeping deaths low. That’s allowed places from the U.K. to Thailand, Ireland to Finland to remove restrictions within weeks, lifting their scores in Bloomberg’s Covid Resilience Ranking of the best and worst places to be in the pandemic. Health workers check X-ray plates from a Covid patient at the ICU ward of the Pablo Arturo Suarez Hospital, in Quito, Ecuador.

 

[mellowyellowgirl]

@Daisys and Diamonds

Hello!!!! Help!!! What the hell is going on here???? Can't they just let their citizens back and throw them into hotel quarantine????

Do you have hotel quarantine?????

Kiwi reporter trapped in Afghanistan where her pregnancy is illegal under Taliban law

OPINION:

www.news.com.au

 

[Daisys and Diamonds]

@Daisys and Diamonds

Hello!!!! Help!!! What the hell is going on here???? Can't they just let their citizens back and throw them into hotel quarantine????

Do you have hotel quarantine?????

Kiwi reporter trapped in Afghanistan where her pregnancy is illegal under Taliban law

OPINION:

www.news.com.au

Its trully a lottery
A very baddly run one
one run by miserable rule making civil servents without a hint of compassion

Thats the lottery to get a place in hotel quareteen without wbich you can't board a plane to NZ
even NZ cricket got caught out recently

 

[mellowyellowgirl]

Its trully a lottery
A very baddly run one
one run by miserable rule making civil servents without a hint of compassion

Thats the lottery to get a place in hotel quareteen without wbich you can't board a plane to NZ
even NZ cricket got caught out recently

Thanks for explaining hun!!!!

Hmm not so saintly after all huh (this is not a dig at you obviously, I think you know what I'm talking about!)

 

[Daisys and Diamonds]

Thanks for explaining hun!!!!

Hmm not so saintly after all huh (this is not a dig at you obviously, I think you know what I'm talking about!)

just great PR dept and sypathetic biased media


last week a wee girl i think in the Solimans - her mum and dad are missionaries- she fell out of a tree and had a baddly broken arm
it look ages to get her home

Stuff

i.stuff.co.nz

 

[MaisOuiMadame]

In the vaccination centre with my 5 y/o ATM. Had her vaccinated in spite of our doctors' not being exactly excited about it due to her allergies. We've had all the other children with similar allergies but minus her extremely severe asthma vaccinated first. No side effects whatsoever for them.

I went to the centre beforehand and checked out the locale. Talked to the doctor in charge. Made appointment sunday as the last patient and made sure the centre has a the intensive care pediatrician on duty.

We are asked to wait 30 minutes instead of 15 . So far everything is perfect. I'm so relieved. Keep your fingers crossed for her 2nd shot!!!

 

[missy]

@MaisOuiMadame fingers crossed it goes smoothly for your daughter.

 

[MaisOuiMadame]

@MaisOuiMadame fingers crossed it goes smoothly for your daughter.

Thank you @missy!!!

 

[lulu_ma]

Hoping your daughter is ok @MaisOuiMadame !

I am just dropping in to say that I think the numbers are now underreported in Massachusetts. Appointments at PCR test sites are still a challenge to get. The trend now is to test at home with rapid antigen tests. Even the MA Dept of Education is accepting at home rapid test results. Are these at home tests results being entered into a centralized database? I don't think so.

 

[Arcadian]

My oldest nephew has covid again. Hes not anti vaccine in general just covid vaccine. And no he's not been vaccinated, works in HV/AC. but when you're out there doing the type of work he's doing you're around all kinds of people. Maybe this will make his silly ass smarten up.

 

[MamaBee]

@MaisOuiMadame I’m happy your daughter was able to be vaccinated without causing any issues for her. I hope her second vaccine goes as smoothly as her first one.
My grandson will be five in May. I know they were worried about not having the data six months ago. I haven’t asked them if they are getting him vaccinated right away or are waiting a little bit. They are both vaccinated and boosted. They also have a twenty month old son. It will be a while for him..They are both in day care so I think they will go ahead and get the almost five year old his vaccine as soon as it’s available.

 

[mellowyellowgirl]

Anecdotally I haven't heard of any kids having side effects in my peer group and we socialise with about 20 kids who have all had a first dose. This is for 5-11 year olds.

The UK recommends a gap of 12 weeks between the two shots for 12-15 year olds.

Australia is recommending an 8 week gap but we're going with the UK 12 weeks for our son as a "middle road" approach.

About COVID-19 vaccination, safety and side effects

Find out about COVID-19 vaccination, including the different types and the side effects and safety.

www.nhs.uk

 

[MaisOuiMadame]

Anecdotally I haven't heard of any kids having side effects in my peer group and we socialise with about 20 kids who have all had a first dose. This is for 5-11 year olds.

The UK recommends a gap of 12 weeks between the two shots for 12-15 year olds.

Australia is recommending an 8 week gap but we're going with the UK 12 weeks for our son as a "middle road" approach.

About COVID-19 vaccination, safety and side effects

Find out about COVID-19 vaccination, including the different types and the side effects and safety.

www.nhs.uk

Thank you for the information. Here in France they insist on three weeks between the doses for children. They got their panties in a knot when I wanted to wait four /five.

:Rant ahead:
I wonder where they are all getting their data from . That's my main annoyance with Covid: if you (government) give me recommendations, I want to see the data /scientific study.

And Covid itself : I know so many totally symptom free people who randomly tested positive (because of sick relatives, as a precaution, pre-surgery etc etc etc). And then I know heaps of people who've had really bad flu symptoms for a week plus. And then I know one guy who has no comorbidities , is in his early fourties and went on a freaking ventilator end of December. He's fine now regarding the circumstances, but man, was that scary. All of the above people boosted. It's the randomness that boggles my mind.


:Rant over:

 

[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

Both are doing fine now. They both tested negative for flu strains. Both tested negative for pneumonia. His fever hit 104 degrees. Stayed high (101+) for several days. Home test on both negative. Rapid test on both negative. Longer result test on both negative. Still no clue what it was, just very grateful they are okay.

 

[MamaBee]

Both are doing fine now. They both tested negative for flu strains. Both tested negative for pneumonia. His fever hit 104 degrees. Stayed high (101+) for several days. Home test on both negative. Rapid test on both negative. Longer result test on both negative. Still no clue what it was, just very grateful they are okay.

@TooPatient I was going to do an unhappy face but I’m just happy they are both doing okay now. That must have been so scary.

 

[missy]

Both are doing fine now. They both tested negative for flu strains. Both tested negative for pneumonia. His fever hit 104 degrees. Stayed high (101+) for several days. Home test on both negative. Rapid test on both negative. Longer result test on both negative. Still no clue what it was, just very grateful they are okay.

Glad they are doing better and sending continued good wishes their way.

 

[wildcat03]

Pfizer Asks F.D.A. to Clear 2 Vaccine Doses for Young Children as a Start (Published 2022)

The Food and Drug Administration asked to review Pfizer’s data on two doses now, while the company continues to assess whether three doses would be more effective.

www.nytimes.com

This belongs in a February thread, but I'll put it here. WOOOOOHOOOOOOO!

 

[MamaBee]

Pfizer Asks F.D.A. to Clear 2 Vaccine Doses for Young Children as a Start (Published 2022)

The Food and Drug Administration asked to review Pfizer’s data on two doses now, while the company continues to assess whether three doses would be more effective.

www.nytimes.com

This belongs in a February thread, but I'll put it here. WOOOOOHOOOOOOO!

 

[missy]

Pfizer Asks F.D.A. to Clear 2 Vaccine Doses for Young Children as a Start (Published 2022)

The Food and Drug Administration asked to review Pfizer’s data on two doses now, while the company continues to assess whether three doses would be more effective.

www.nytimes.com

This belongs in a February thread, but I'll put it here. WOOOOOHOOOOOOO!

Ok just started the February thread. Thanks for the reminder.

 

[missy]

Challenge Trial Shows People With COVID Shed Virus After Just 2 Days​

— No safety concerns in small study of healthy young adults, supporting further trials, authors say​

by Amanda D'Ambrosio, Enterprise & Investigative Writer, MedPage Today February 2, 2022

"
Individuals exposed to SARS-CoV-2 became infectious after just 2 days, which is earlier than scientists originally estimated, according to results from the first human challenge trial investigating COVID-19.

In the study of 36 young and healthy subjects who were deliberately infected with SARS-CoV-2, viral shedding and symptoms began around 2 days post-inoculation, with viral load peaking at 5 days, reported Christopher Chiu, MD, of Imperial College London, and colleagues. The researchers published these findings, which have not yet been peer-reviewed, on the preprint server Research Square.



"Whilst the incubation period from the estimated time of natural exposure to perceived symptom onset has previously been estimated as ~5 days, this best aligns with peak symptoms and is longer than the true incubation period," the researchers wrote. They noted that because viable virus was still detectable at 10 days after exposure, the data support the idea that isolation periods should last at least 10 days after symptom onset.

Virus was first detected in the throat, but rose to significantly higher levels in the nose. The team did not observe a correlation between the level of viral load and symptoms.

Additionally, the majority of infected participants reported mild-to-moderate cold-like symptoms that were limited to the upper respiratory tract, including stuffy or runny nose, sneezing, and sore throat. Loss of smell was also common. The researchers did not report any major safety concerns or adverse events.

"Although these first-in-human data do not preclude rare adverse events that can only be detected in larger-scale studies, our results indicate that human challenge with SARS-CoV-2 is consistent with natural infection in healthy young adults, having caused no serious unexpected consequences and therefore supporting further development and expansion," Chiu and co-authors wrote.



In this trial, the team analyzed SARS-CoV-2 infections in 36 participants ages 18 to 29 (average 22 years). Two individuals were excluded due to seroconversion between screening and analysis. Participants were screened for known risk factors of severe COVID-19, including comorbidities, low or high body mass index, abnormal safety blood tests, spirometry, and chest radiography.

Of note, the researchers used the original SARS-CoV-2 strain (pre-Alpha) for their study.

"While there are differences in transmissibility due to the emergence of variants, such as Delta and Omicron, fundamentally, this is the same disease," Chiu said in a press release. "From the point of view of virus transmission related to the very high viral loads, we are likely if anything to be underestimating infectivity because we were using an older strain of the virus."

All participants -- who had no previous immunity from vaccination or infection -- were inoculated with the virus via nasal drops. The virus was taken from someone with COVID-19 illness early on in the pandemic, before any notable variants had emerged. After inoculation, individuals were quarantined for at least 14 days, or until they met discharge criteria. The researchers said they plan to follow participants for 1 year to assess long-term symptoms.



Of the subjects inoculated with SARS-CoV-2, 18 became infected, as detected by PCR test.

The mean time from initial exposure to detection and early symptoms was 42 hours. On average, virus was detected in the throat after 40 hours, and in the nose after 58 hours, but viral load was higher in the nose at its peak (median ~8.87 log10copies/ml, 95% CI 8.41-9.53).

Among the infected participants, approximately 89% experienced mild-to-moderate cold-like symptoms, and 39% developed a fever. Some also had headaches, muscle aches, and fatigue. Peak symptoms occurred at around 5 days, which was aligned with peak viral load in the nose. But despite the temporal association between nasal viral load and symptoms, there was no correlation between the amount of viral shedding and symptom score, the researchers said.

Smell disturbance was common, occurring in two-thirds of the infected participants. Nine individuals experienced complete loss of smell, but nearly all of these participants improved by day-28 post-inoculation. Up to 180 days after exposure, five participants still had some smell disturbance, and only one had prolonged smell disturbance after this time.



In an analysis of testing, the researchers found that lateral flow tests were a good predictor of contagiousness, and "can be highly effective as a trigger for interventions to interrupt transmission." Modeling showed that rapid testing twice weekly can diagnose infection before 70-80% of viable virus has been generated.

Challenge trials allow researchers to assess immunological responses, transmission dynamics, and infectious shedding after exposure, but some have called attention to complex ethical considerations.

In addition to this study, the University of Oxford is also conducting a human challenge trial that is investigating reinfection among people who have already had COVID-19.

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