With input from Dr Monica Vasudev

1364: IL-1 inhibition, not IL-6 inhibition, associated with reduced risk of mortality in patients hospitalized with COVID-19, respiratory insufficiency, hyperinflammation

1. A cohort study published in The Lancet Rheumatology has revealed that interleukin (IL)-1 inhibition, but not IL-6 inhibition, appears to be tied to a significant reduction of mortality among patients hospitalized with COVID-19, respiratory insufficiency, and hyperinflammation.
2. IL-6 inhibition was found to be effective only in a subgroup of patients who had considerably raised CRP levels at baseline. Both IL-1 and IL-6 inhibition were found to be effective in patients with low baseline lactate dehydrogenase (LDH).
3. Overall, 392 patients hospitalized with COVID-19, respiratory insufficiency and hyperinflammation from February 25 through May 20, 2020 were included in the study. Among the enroled patients, 275 were not given interleukin inhibitors, 62 were administered IL-1 inhibitor (anakinra), and 55 were administered an IL-6 inhibitor (29 were given tocilizumab while 26 received sarilumab).
4. All patients were given standard of care, which included hydroxychloroquine, an antiviral drug, and empirical antibiotic. Patients received anakinra intravenously at 5 mg/kg twice daily, while tocilizumab was administered as a single dose (400 mg), and sarilumab was given as a single dose of 400 mg intravenously. (Lancet Rheumatology)

1365: Common concerns about the vaccine

1. Concern about facial palsy as I had a TIA in the past
2. Concern that we have so much yet to discover about this class of viruses. Pharmaceutical companies are being urged to develop vaccines under extreme timetables yet we find we really dont have that much experience with this type of rapidly mutating virus. This situation, combined with the EUA, is a major concern as well. The recent reports from S. Africa are also of concern. Mixing vaccines is still not clear. Mixing mRNA with adenovirus vectors is not yet well understood. Many thousands of variants are now suspected.
3. Not well tested in the urge to get the vaccine out.
4. Concern that it could exacerbate my autoimmune disease.
5. The mercury in it messes up with my system.
6. Reason pushed to get the vaccine: "vaccines are safe and effective".
7. mRNA is a brand new vaccine technology
8. Media completely silent on adverse events.
9. Only 10% of adverse events actually get reported.
10. There hasnt been enough time to determine what will happen in 3 or 5 years, or later. 
11. Concern that immunity will wear off requiring additional vaccines, or variants will require yearly vaccination.
12. Concern is not the vaccines themselves, but the fake news going around about them.
13. Concern for the younger population and individuals of child bearing age.

1366: South Africa Health Minister Zweli Mkhize said that the government would wait for advice from scientists on how to proceed further, after a study demonstrated that the AstraZeneca vaccine did not lead to significant reduction in the risk of mild or moderate COVID-19 from the 501Y.V2 variant. Before the more contagious variant started circulating, the vaccine demonstrated an efficacy of around 75%. (Reuters)

1367: The SARS-CoV-2 variant first identified in the UK is fast becoming the dominant strain in many countries and is reported to be doubling every 10 days in the United States.

The findings, not yet peer-reviewed, were posted Sunday on medRxiv.

The research suggests that the transmission rate of the B.1.1.7 variant in the United States is around 30% to 40% higher than that of more common strains. (Medscape)

1368: Over a quarter of patients on dialysis died from COVID-19, reported a recent Canadian study that included more than 12,501 patients. (CMAJ)

1369:  Indonesia starts vaccinating people above 60

The first vaccinations of people more than 60 years of age started on Monday. This age group was initially excluded by the officials, citing lack of safety data.

The drug regulator reversed course and granted emergency authorization of the Sinovac vaccine for use among older people following new clinical trial data from China and Brazil showing that the vaccine was safe.

The government was criticized for excluding people above 60 as this group accounted for half of the deaths from COVID in Indonesia. Recipients in this age group will be given the second dose four weeks after the first one, instead of two. (NY Times)

Dr KK Aggarwal

President CMAAO, HCFI